"…current social and structural determinants will invariably impact all refugees resettling in the United States in terms of their mental health outcomes."

War-related traumas constantly force thousands of people to leave their homes and resettle in unfamiliar countries. Resettlement is stressful for refugees and can have a huge impact on their mental state. Though war-related traumatic experiences are often viewed as the primary cause behind refugees' mental health conditions, other social/environmental factors are also relevant.

According to the observations of Dr. Isok Kim, assistant professor of social work at the University at Buffalo, there is a significant correlation between Latino and Southeast Asian refugees' mental health and post-resettlement factors. Dr. Kim's study, published in the Journal of Immigration and Minority Health, questions modern-day approaches to diagnosis/treatment of refugees, and suggests that improving communication in doctor-patient relationships is essential to bettering refugees' mental health.

Key Determinants of Mental Health Risks for Refugees in the US

Refugees exposed to war/violence are reported to be at a much greater risk of developing mental disorders. Those who resettle in Western countries, like the US, can be ten times more likely to develop PTSD than members of the general population. Dr. Kim breaks down the determinants of developing these risks into two categories:

    • Structural Determinants
      • Refugees' socioeconomic positions upon entering a new country are determined by several factors: income, education, gender, occupation, race/ethnicity, social class and nativity status. This study examines how each factor contributes to stratification as a result of social/economic policies put into place by a society that favors the majority group. This means minority groups like refugees lack power, and are exposed to different mental health vulnerabilities.
    • Social Determinants
      • Material Circumstances: Refugees are often unable to bring resources with them from their home countries, making their financial status comparable to that of the poor in the US. Because most of their time prior to resettlement was likely spent in refugee camps, it is very likely they do not have the skills necessary to find employment before their initial federal/state benefits expire. This puts refugees at a significant resource and financial disadvantage.
      • Psychosocial Circumstances: Material circumstances lead to psychosocial stratification—including job stress and lack of coping resources—negatively affecting mental health outcomes.
      • Health Factors: "Very few mental health services are available for Asian Americans, partly because funding agencies at all levels of society often ascribe to the myth of the model minority," Dr. Kim says. This myth presents an isolated image of successful Asian Americans, failing to take into account the levels of environmental/social challenges faced by refugees.
"…it is very important to secure funding to promote, recruit, and train young people from these communities in mental health, and healthcare in general, so that they can go back to their own communities and engage in culturally and linguistically appropriate mental health services …"

What Doctors Can Do to Help

The results of this study display a strong correlation between refugees' mental health and post-resettlement factors. Dr. Kim explains how to improve communication in doctor-patient relationships to better the mental health conditions of refugees.

  • Educate Yourself: Doctors must begin by learning about their patients' country/culture beforehand, on their own time. Avoid asking patients obvious information about their national/cultural backgrounds. This wastes time and makes the patient feel misunderstood.
  • Listen: Taking a genuine interest in a patient's experiences and listening without judgment is crucial. Doctors must be sincere about any lack of understanding they may have regarding patients' experiences.
  • Avoid Assumptions: Not all refugees have PTSD or a trauma-related diagnosis. "Only about 30-40% of refugees will require specialty psychiatric services related to their trauma/torture experiences," Dr. Kim says. "It is crucial to attend to their needs beyond trauma: unmet basic needs and daily challenges can and will make things worse for many of the refugees, which might push them over the clinical edge."
  • Be a Resource: Individual healthcare professionals might not have all the resources to meet a patient's needs. It can be helpful to organize a team of professionals and tackle these complex challenges together.

Ultimately, Dr. Kim says, "Existing structural and institutional power must align with these underserved communities to support from outside in. This means instituting a stronger healthcare system that provide equitable services without unreasonable financial burden and creating wider social safety net programs that not only target refugee communities, but are designed to serve all people regardless of their status."

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Seth Davin Norrholm, Ph.D.


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