Long-term mental health of war-refugees: a systematic literature review

Marija Bogic, Anthony Njoku, Stefan Priebe, Marija Bogic, Anthony Njoku, Stefan Priebe

Abstract

Background: There are several million war-refugees worldwide, majority of whom stay in the recipient countries for years. However, little is known about their long-term mental health. This review aimed to assess prevalence of mental disorders and to identify their correlates among long-settled war-refugees.

Methods: We conducted a systematic review of studies that assessed current prevalence and/or factors associated with depression and anxiety disorders in adult war-refugees 5 years or longer after displacement. We searched Medline, Embase, CINAHL, PsycINFO, and PILOTS from their inception to October 2014, searched reference lists, and contacted experts. Because of a high heterogeneity between studies, overall estimates of mental disorders were not discussed. Instead, prevalence rates were reviewed narratively and possible sources of heterogeneity between studies were investigated both by subgroup analysis and narratively. A descriptive analysis examined pre-migration and post-migration factors associated with mental disorders in this population.

Results: The review identified 29 studies on long-term mental health with a total of 16,010 war-affected refugees. There was significant between-study heterogeneity in prevalence rates of depression (range 2.3-80%), PTSD (4.4-86%), and unspecified anxiety disorder (20.3-88%), although prevalence estimates were typically in the range of 20% and above. Both clinical and methodological factors contributed substantially to the observed heterogeneity. Studies of higher methodological quality generally reported lower prevalence rates. Prevalence rates were also related to both which country the refugees came from and in which country they resettled. Refugees from former Yugoslavia and Cambodia tended to report the highest rates of mental disorders, as well as refugees residing in the USA. Descriptive synthesis suggested that greater exposure to pre-migration traumatic experiences and post-migration stress were the most consistent factors associated with all three disorders, whilst a poor post-migration socio-economic status was particularly associated with depression.

Conclusions: There is a need for more methodologically consistent and rigorous research on the mental health of long-settled war refugees. Existing evidence suggests that mental disorders tend to be highly prevalent in war refugees many years after resettlement. This increased risk may not only be a consequence of exposure to wartime trauma but may also be influenced by post-migration socio-economic factors.

Figures

Fig. 1
Fig. 1
Flowchart of study selection
Fig. 2
Fig. 2
Forest plot of prevalence rates (%, with 95 % CI) of depression in long-settled war refugees in individual studies. For each study, only the name of the first author is shown
Fig. 3
Fig. 3
Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic method
Fig. 4
Fig. 4
Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by study and refugee characteristics: interview language, publication decade, origin regiona, and gender. a ‘Europe’ includes former Yugoslavia. ‘Middle East & Africa’ includes Liberia, Somalia, and Sudan. ‘Southeast Asia’ includes Cambodia, Laos, and Vietnam. ‘Other’ includes Guatemala and mixed country of origin samples
Fig. 5
Fig. 5
Prevalence rates (%, with 95 % CI) of depression in long-settled war refugees stratified by refugee characteristics: host regiona, displacement and resettlement duration. a‘Europe’ includes France, Germany, Italy, Netherlands, and United Kingdom. ‘Other Western’ includes Canada and Australia. ‘Other’ includes refugee camps in Mexico and on Thailand-Cambodia border
Fig. 6
Fig. 6
Forest plot of prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees in individual studies
Fig. 7
Fig. 7
Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling method, and interview language
Fig. 8
Fig. 8
Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by study and refugee characteristics: publication decade, origin regiona and gender. a ‘Southeast Asia’ includes Cambodia, Laos, Sri Lanka, and Vietnam. ‘Middle East & Africa’ includes Afghanistan, Iran, Somalia, and Sudan. ‘Other’ includes Guatemala, Bosnia, and mixed country of origin samples
Fig. 9
Fig. 9
Prevalence rates (%, with 95 % CI) of unspecified anxiety in long-settled war refugees stratified by refugee characteristics: host regiona, displacement and resettlement duration. a ‘Europe’ includes France, The Netherlands, and United Kingdom. ‘Other’ includes Mexico
Fig. 10
Fig. 10
Forest plot of prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees in individual studies. For each study, only the name of the first author is shown
Fig. 11
Fig. 11
Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by study characteristics: study quality, sample size, sampling and diagnostic method
Fig. 12
Fig. 12
Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by study and refugee characteristics: interview language, publication decade, region of origin, and gender. a ‘Europe’ includes former Yugoslavia. ‘Middle East & Africa’ includes Afghanistan, Ethiopia, Iran, Rwanda, and Somalia. ‘Southeast Asia’ includes Cambodia, Indonesia, Laos, Sri Lanka, and Vietnam. ‘Other’ includes Guatemala and mixed country of origin samples
Fig. 13
Fig. 13
Prevalence rates (%, with 95 % CI) of PTSD in long-settled war refugees stratified by refugee characteristics: host region, displacement and resettlement duration,. a ‘Europe’ includes Germany, The Netherlands, Norway, and United Kingdom. ‘Other Western’ includes Australia and Canada. ‘Other’ includes refugee camps in Mexico, Uganda and on Thailand-Cambodia border

References

    1. UNHCR . 2014 Global Trends: World at War. Geneva: United Nations High Commissioner for Refugees; 2015.
    1. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in Western countries: A systematic review. Lancet. 2005;365:1309–1314. doi: 10.1016/S0140-6736(05)61027-6.
    1. Tempany M. What research tells us about the mental health and psychosocial wellbeing of Sudanese refugees: a literature review. Transcult. Psychiatry. 2009;46:300–315. doi: 10.1177/1363461509105820.
    1. Mollica RF, Sarajlic N, Chernoff M, Lavelle J, Sarajlic IV, Massagli MP. Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. JAMA. 2001;286:546–554. doi: 10.1001/jama.286.5.546.
    1. Lie B. A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatr Scand. 2002;106:415–425. doi: 10.1034/j.1600-0447.2002.01436.x.
    1. Roth G, Ekblad S, Agren H. A longitudinal study of PTSD in a sample of adult mass-evacuated Kosovars, some of whom returned to their home country. Eur. Psychiat. 2006;21:152–159. doi: 10.1016/j.eurpsy.2005.11.004.
    1. Johnson H, Thompson A. The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clin Psychol Rev. 2008;2:36–47. doi: 10.1016/j.cpr.2007.01.017.
    1. Steel Z, Chey T, Silove D, Marnane C, Bryant R, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA. 2009;302:537–549. doi: 10.1001/jama.2009.1132.
    1. Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. JAMA. 2005;294:602–612. doi: 10.1001/jama.294.5.602.
    1. Robjant K, Hassan R, Katona C. Mental health implications of detaining asylum seekers: systematic review. Br J Psychiatry. 2009;194:306–312. doi: 10.1192/bjp.bp.108.053223.
    1. Beiser M, Hou F. Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study. Soc Sci Med. 2001;53:1321–1334. doi: 10.1016/S0277-9536(00)00412-3.
    1. Silove D, Steel Z, Bauman A, Chey T, McFarlane A. Trauma, PTSD and the longer-term mental health burden amongst Vietnamese refugees: A comparison with the Australian-born population. Soc Psych Psych Epid. 2007;42:467–476. doi: 10.1007/s00127-007-0194-z.
    1. Carlson EB, Rosser-Hogan R. Cross-cultural response to trauma: A study of traumatic experiences and posttraumatic symptoms in Cambodian refugees. J Trauma Stress. 1994;7:43–58. doi: 10.1002/jts.2490070106.
    1. D’Avanzo CE, Barab SA. Depression and anxiety among Cambodian refugee women in France and the United States. Issues Ment. Health Nurs. 1998;19:541–556. doi: 10.1080/016128498248836.
    1. Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. J Am Med Assoc. 2005;294:571–579. doi: 10.1001/jama.294.5.571.
    1. Lindert J, Ehrenstein O, Priebe S, Mielck A, Elmar B. Depression and anxiety in labor migrants and refugees: A systematic review and meta-analysis. Soc Sci Med. 2009;69:246–257. doi: 10.1016/j.socscimed.2009.04.032.
    1. Porter M. Global evidence for a biopsychosocial understanding of refugee adaptation. Transcult. Psychiatry. 2007;44:418–439. doi: 10.1177/1363461507081639.
    1. Thoms ONT, Ron J. Public health, conflict and human rights: Toward a collaborative research agenda. Confl. Heal. 2007;1:11. doi: 10.1186/1752-1505-1-11.
    1. Murthy RS, Lakshminarayana R. Mental health consequences of war: a brief review of research findings. World Psychiatry. 2006;5:25–30.
    1. Bowling A. Research Methods in Health: Investigating health and health services. Philadelphia: Open University Press; 2002.
    1. de Jong JT, Komproe IH, Van Ommeren M, El Masri M, Araya M, Khaled N, et al. Lifetime events and posttraumatic stress disorder in 4 postconflict settings. JAMA. 2001;286:555–562. doi: 10.1001/jama.286.5.555.
    1. Maercker A, Michael T, Fehm L, Becker ES, Margraf J. Age of traumatisation as a predictor of PTSD or major depression in young women. Br J Psychiatry. 2004;184:482–487. doi: 10.1192/bjp.184.6.482.
    1. Perkonigg A, Kessler RC, Storz S, Wittchen HU. Traumatic events and posttraumatic stress disorder in the community: Prevalence, risk factors and comorbidity. Acta Psychiatr. Scand. 2000;101:46–59. doi: 10.1034/j.1600-0447.2000.101001046.x.
    1. Sanderson S, Tatt I, Higgins J. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: A systematic review and annotated bibliography. Int J Epidemiol. 2007;36:666–676. doi: 10.1093/ije/dym018.
    1. Shamliyan T, Kane R, Dickinson S. A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol. 2010;63:1061–1070. doi: 10.1016/j.jclinepi.2010.04.014.
    1. Boyle MH. Guidelines for evaluating prevalence studies. Evid. Based Ment. Health. 1998;1:37–39. doi: 10.1136/ebmh.1.2.37.
    1. The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), Version 2.1. Geneva: World Health Organization; 1997.
    1. Westermeyer J. DSM-III psychiatric disorders among Hmong refugees in the United States: A point prevalence study. Amn J Psychiatry. 1988;145:197–202. doi: 10.1176/ajp.145.2.197.
    1. Perera S, Gavian M, Frazier P, Johnson D, Spring M, Westermeyer J, et al. A Longitudinal Study of Demographic Factors Associated With Stressors and Symptoms in African Refugees. Am J Orthopsychiatry. 2013;83:472–482. doi: 10.1111/ajop.12047.
    1. Jaranson JM, Butcher J, Halcon L, Johnson DR, Robertson C, Savik K, et al. Somali and Oromo refugees: correlates of torture and trauma history. Am J Public Health. 2004;94:591–598. doi: 10.2105/AJPH.94.4.591.
    1. Lhewa D, Banu S, Rosenfeld B, Keller A. Validation of a Tibetan translation of the Hopkins Symptom Checklist 25 and the Harvard Trauma Questionnaire. Assessment. 2007;14:223–230. doi: 10.1177/1073191106298876.
    1. Thapa S, Hauff E. Psychological distress among displaced persons during an armed conflict in Nepal. Soc. Psychiatry Psychiatr. Epidemiol. 2005;40:672–679. doi: 10.1007/s00127-005-0943-9.
    1. Sandanger IM. Concordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I. Soc. Psychiatry Psychiatr. Epidemiol. 1998;33:345–354. doi: 10.1007/s001270050064.
    1. Ventevogel P, De Vries G, Scholte W, Shinwari N, Faiz H, Nassery R, et al. Properties of the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan. Soc. Psychiatry Psychiatr. Epidemiol. 2007;42:328–335. doi: 10.1007/s00127-007-0161-8.
    1. Berlin JA. Invited commentary: benefits of heterogeneity in meta-analysis of data from epidemiologic studies. Am J Epidemiol. 1995;142:383–387.
    1. Thompson SG. Systematic review: why sources of heterogeneity in meta-analysis should be investigated. BMJ. 1994;309:1351–1355. doi: 10.1136/bmj.309.6965.1351.
    1. Blettner M, Sauerbrei W, Schlehofer B, Scheuchenpflug T, Friedenreich C. Traditional reviews, meta-analyses and pooled analyses in epidemiology. Int J Epidemiol. 1999;28:1–9. doi: 10.1093/ije/28.1.1.
    1. Ioannidis JP, Patsopoulos NA, Rothstein HR. Reasons or excuses for avoiding meta-analysis in forest plots. BMJ. 2008;336:1413–1415. doi: 10.1136/bmj.a117.
    1. Petitti DB. Approaches to heterogeneity in meta-analysis. Stat Med. 2001;20:3625–3633. doi: 10.1002/sim.1091.
    1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: A proposal for reporting. JAMA. 2000;283:2008–2012. doi: 10.1001/jama.283.15.2008.
    1. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta-Analysis. Wiley: Chichester; 2009.
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–1558. doi: 10.1002/sim.1186.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560. doi: 10.1136/bmj.327.7414.557.
    1. Bennett DA, Emberson JR. Editorial: Stratification for exploring heterogeneity in systematic reviews. Evid. Based Med. 2009;14:162–164. doi: 10.1136/ebm.14.6.162-a.
    1. Ramo D, Liu H, Prochaska J. Tobacco and marijuana use among adolescents and young adults: A systematic review of their co-use. Clin Psychol Rev. 2012;32:105–121. doi: 10.1016/j.cpr.2011.12.002.
    1. Sallis J, Prochaska J, Taylor W. A review of correlates of physical activity of children and adolescents. Med Sci Sports Exerc. 2000;32:963–975. doi: 10.1097/00005768-200005000-00014.
    1. Gerritsen A, Bramsen I, Deville W, Loes HM, Van Willigen LH, Hovens JE, et al. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2006;41:18–26.
    1. Bhui K, Abdi A, Abdi M, Pereira S, Dualeh M, Robertson D, et al. Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees - preliminary communication. Soc Psychiatry Psychiatr Epidemiol. 2003;38:35–43. doi: 10.1007/s00127-003-0596-5.
    1. Buseh AG, McElmurry BJ, Fox PG. Acculturative stress and depressed mood among Liberian men residing in a large U.S. Midwestern city. Int J Psychiatr Nurs Res. 2000;6:695–713.
    1. Delic-Ovcina L. The case of adult Bosnian Muslim male refugees in Chicago: Current health behavior outcomes and PTSD symptomatology. Dissertation Abstracts International: Section B. Sci. Eng. 2011;71:B7354.
    1. Hinton L, Jenkins C, McPhee S, Wong C, Lai K, Le A, et al. Survey of depressive symptoms among Vietnamese-American men in three locales: prevalence and correlates. J Nerv Ment Dis. 1998;186:677–683. doi: 10.1097/00005053-199811000-00003.
    1. Bogic M, Ajdukovic D, Bremner S, Franciskovic T, Galeazzi G, Kucukalic A, et al. Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK. Br J Psychiatry. 2012;200:216–223. doi: 10.1192/bjp.bp.110.084764.
    1. Caspi Y, Poole C, Mollica R, Frankel M. Relationship of child loss to psychiatric and functional impairment in resettled Cambodian refugees. J Nerv Ment Dis. 1998;186:484–491. doi: 10.1097/00005053-199808000-00006.
    1. Chung RC, Kagawa S. Predictors of psychological distress among Southeast Asian refugees. Soc Sci Med. 1993;36:631–639. doi: 10.1016/0277-9536(93)90060-H.
    1. Mollica RF, McInnes K, Poole C, Tor S. Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. Br J Psychiatry. 1998;173:482–488. doi: 10.1192/bjp.173.6.482.
    1. Onyut L, Neuner F, Ert V, Schauer E, Odenwald M, Elbert T. Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement - an epidemiological study. Confl. Heal. 2009;3:6. doi: 10.1186/1752-1505-3-6.
    1. Sabin MP, Cardozo BLMM, Nackerud LP, Kaiser RM, Varese L. Factors Associated With Poor Mental Health Among Guatemalan Refugees Living in Mexico 20 Years After Civil Conflict. JAMA. 2003;290:635–642. doi: 10.1001/jama.290.5.635.
    1. Steel Z, Silove D, Phan T, Bauman A. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study. Lancet. 2002;360:1056–1062. doi: 10.1016/S0140-6736(02)11142-1.
    1. Kolassa I, Ertl V, Eckart C, Onyut L, Kolassa S, Elbert T. Spontaneous remission from PTSD depends on the number of traumatic event types experienced. Psychol Trauma. 2010;2:169–174. doi: 10.1037/a0019362.
    1. Blair RG. Risk factors associated with PTSD and major depression among Cambodian refugees in Utah. Health Soc Work. 2000;25:23–30. doi: 10.1093/hsw/25.1.23.
    1. Craig C, Sossou M, Schnak M, Essex H. Complicated grief and its relationship to mental health and well-being among Bosnian refugees after resettlement in the United States: Implications for practice, policy, and research. Traumatology. 2008;14:103–115. doi: 10.1177/1534765608322129.
    1. von Lersner U, Wiens U, Elbert T, Neuner F. Mental health of returnees: Refugees in Germany prior to their state-sponsored repatriation. BMC Int Health Hum Rights. 2008;8:8. doi: 10.1186/1472-698X-8-8.
    1. Birman D, Tran N. Psychological distress and adjustment of Vietnamese refugees in the United States: Association with pre- and postmigration factors. Am. J. Orthop. 2008;78:109–120. doi: 10.1037/0002-9432.78.1.109.
    1. Hollifield M, Warner T, Jenkins J, Sinclair-Lian N, Krakow B, Eckert V, et al. Assessing war trauma in refugees: Properties of the Comprehensive Trauma Inventory-104. J Trauma Stress. 2006;19:527–540. doi: 10.1002/jts.20137.
    1. Nicholson BL. The influence of pre-emigration and post-migration stressors on mental health: A study of Southeast Asian refugees. Soc Work Res. 1997;21:19–31. doi: 10.1093/swr/21.1.19.
    1. Hunt N, Gakenyi M. Comparing refugees and nonrefugees: The Bosnian experience. J. Anxiety Disord. 2005;19:717–723. doi: 10.1016/j.janxdis.2004.08.004.
    1. Stige S, Sveaasstorture N. Living in exile when disaster strikes at home. Torture. 2010;20:76–91.
    1. Schweitzer R, Melville F, Steel Z, Lacherez P. Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Aust. N. Z. J. Psychiatry. 2006;40:179–187. doi: 10.1080/j.1440-1614.2006.01766.x.
    1. Matheson K, Jorden S, Anisman H. Relations between trauma experiences and psychological, physical and neuroendocrine functioning among Somali refugees: Mediating role of coping with acculturation stressors. J Immigr Minor Health. 2008;10:291–304. doi: 10.1007/s10903-007-9086-2.
    1. Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144:497–500. doi: 10.1176/ajp.144.4.497.
    1. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180:111–116. doi: 10.1097/00005053-199202000-00008.
    1. Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, et al. The NIMH Epidemiologic Catchment Area program. Historical context, major objectives, and study population characteristics. Arch Gen Psychiatry. 1984;41:934–941. doi: 10.1001/archpsyc.1984.01790210016003.
    1. Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E, et al. Mini International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33.
    1. The ESEMeD ⁄MHEDEA 2000 Investigators Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand. 2004;109(suppl 420):21–27. doi: 10.1111/j.1600-0047.2004.00327.x.
    1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–627. doi: 10.1001/archpsyc.62.6.617.
    1. Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe: A critical review and appraisal of 27 studies. Eur Neuropsychopharmacol. 2005;15:357–376. doi: 10.1016/j.euroneuro.2005.04.012.
    1. Flores G. The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review. Med Care Res Rev. 2005;62:255–299. doi: 10.1177/1077558705275416.
    1. Bhopal R, Vettini A, Hunt S, Wiebe S, Hanna L, Amos A. Review of prevalence data and evaluation of methods for cross-cultural adaptation of UK surveys on tobacco and alcohol in ethnic minority groups: A challenge for epidemiology. BMJ. 2004;328:76–80. doi: 10.1136/bmj.37963.426308.9A.
    1. Farooq S, Fear C, Oyebode F. An investigation of the adequacy of psychiatric interviews conducted through an interpreter. Psychiatr Bull. 1997;21:209–213. doi: 10.1192/pb.21.4.209.
    1. Department of Economic and Social Affairs (DESA) World Economic and Social Survey 2004: International Migration. New York: United Nations; 2004.
    1. Steel Z, Silove D, Bird K, McGorry P, Mohan P. Pathways from war trauma to posttraumatic stress symptoms amongst Tamil asylum seekers, refugees and immigrants. J Trauma Stress. 1999;12:421–435. doi: 10.1023/A:1024710902534.
    1. Gorst-Unsworth C, Goldenberg E. Psychological sequelae of torture and organized violence suffered by refugees from Iraq: Trauma-related factors compared with social factors in exile. Brit J Psychiat. 1998;172:90–94. doi: 10.1192/bjp.172.1.90.
    1. Rumbaut R. The agony of exile: A study of the migration and adaptation of Indochinese refugee adults and children. In: Refugee Children: Theory, Research, and Services. Edited by Ahearn FL, Athey JL. Baltimore. Johns Hopkins Univ Press. 1991;53:91.
    1. Piccinelli M, Wilkinson G. Gender differences in depression: Critical review. Brit J Psychiat. 2000;177:486–492. doi: 10.1192/bjp.177.6.486.
    1. Somers JM, Goldner EM, Waraich P, Hsu L. Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Can J Psychiatry. 2006;51:100–113.
    1. Frans O, Rimmo PA, Aberg L, Fredrikson M. Trauma exposure and posttraumatic stress disorder in the general population. Acta Psychiatr Scand. 2005;111:291–299. doi: 10.1111/j.1600-0447.2004.00463.x.
    1. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048–1060. doi: 10.1001/archpsyc.1995.03950240066012.
    1. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P: Trauma and posttraumatic stress disorder in the community: The Detroit Area Survey of Trauma. Arch Gen Psychiatry. 1996;1998(55):626–632.
    1. Streiner DL, Norman GR. Biases in randomized controlled trials. Commun Oncol. 2009;6:527–529. doi: 10.1016/S1548-5315(11)70365-5.
    1. Lau J, Ioannidis JPA, Terrin N, Schmid CH, Olkin I. The case of the misleading funnel plot. BMJ. 2006;333:597–600. doi: 10.1136/bmj.333.7568.597.
    1. Sterne JAC, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53:1119–1129. doi: 10.1016/S0895-4356(00)00242-0.
    1. Terrin N, Schmid CH, Lau J, Olkin I. Adjusting for publication bias in the presence of heterogeneity. Statist Med. 2003;22:2113–2126. doi: 10.1002/sim.1461.
    1. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L, Moreno SG. Assessing publication bias in meta-analyses in the presence of between-study heterogeneity. J. R. Stat. Soc. Ser. A. 2010;173:1–17. doi: 10.1111/j.1467-985X.2009.00629.x.
    1. Egger M, Schneider M, Smith GD. Spurious precision? Meta-analysis of observational studies. BMJ. 1998;316:140–144. doi: 10.1136/bmj.316.7125.140.
    1. American Psychiatric Association (APA) Diagnostic And Statistical Manual of Mental Disorders: DSM-IV. 4. Washington, DC: American Psychiatric Association; 1994.
    1. Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, et al. Measuring trauma and health status in refugees: A critical review. JAMA. 2002;288:611–621. doi: 10.1001/jama.288.5.611.
    1. Turner SW, Bowie C, Dunn G, Shapo L, Yule W. Mental health of Kosovan Albanian refugees in the UK. Br J Psychiatry. 2003;182:444–448. doi: 10.1192/bjp.182.5.444.
    1. Mezzich JE, Kirmayer LJ, Kleinman A, Fabrega H, Jr, Parron DL, Good BJ, et al. The place of culture in DSM-IV. J Nerv Ment Dis. 1999;187:457–464. doi: 10.1097/00005053-199908000-00001.
    1. Bhugra D. Depression across cultures. Prim Care Psychiatry. 1996;2:155–165.
    1. Coyne JC, Kagee A. Mental health among Bosnian refugees. JAMA. 2000;283:55–56. doi: 10.1001/jama.283.1.55.
    1. Hinton DE, Lewis-Fernández R. Idioms of distress among trauma survivors: subtypes and clinical utility. Cult Med Psychiatry. 2010;34:209–218. doi: 10.1007/s11013-010-9175-x.
    1. Bonney C. Is resettlement in a Western country the most viable solution for Protracted Refugee Situations? Journal of Politics & International Studies. 2013;9:88–125.
    1. Bulletin of the World Health Organization Galvanizing mental health research in low- and middle-income countries: role of scientific journals (joint statement) Bull World Health Organ. 2004;82:226–228.
    1. Kühne P, Rüßler H. Die Lebensverhältnisse der Flüchtlinge in Deutschland [The living conditions of refugees in Germany] Campus-Verlag: Frankfurt; 2000.

Source: PubMed

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