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The Range and Impact of Postmigration Stressors During Treatment of Trauma-Affected Refugees

Bruhn, Maja, MD*; Rees, Susan, PhD, MSocPol (Hons 1); Mohsin, Mohammed, MSc, PhD‡§; Silove, Derrick, MB, ChB (Hons 1), FRANZCP, MD; Carlsson, Jessica, MD, PhD*

The Journal of Nervous and Mental Disease: January 2018 - Volume 206 - Issue 1 - p 61–68
doi: 10.1097/NMD.0000000000000774
Original Articles

Trauma-affected refugees commonly experience postmigration stressors, which can compound conflict-related emotional distress. Our study aimed to assess clinician-rated frequency and types of postmigration stressors deemed to be interfering with the treatment of refugees attending a service for trauma-related mental distress. A total of 116 patients completed 6 months of multidisciplinary treatment. Clinician-rated postmigration stressors were registered at each session. Outcome measures were Harvard Trauma Questionnaire and Global Assessment of Functioning, function (GAF-F) and symptom. Postmigration stressors were deemed to impact on 39.1% of treatment sessions with medical personnel. Issues related to work, finances, and family were the most frequently identified stressors. Postmigration stressors interfering with treatment were more common among male refugees, those living alone, those from Middle Eastern origin, and persons with low baseline GAF-F. Explicitly identifying and, where possible, dealing with postmigration stressors may assist in averting their interference with the treatment of distress in refugees.

*Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, the Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark; †Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, South West Sydney Local Health District, Sydney, Australia; ‡Psychiatry Research and Teaching Unit, Southwest Sydney Local Health District, Sydney, Australia; and §School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia.

Send reprint requests to Maja Bruhn, MD, Competence Centre for Transcultural Psychiatry, Maglevaenget 2, Building 14, 2750 Ballerup, Denmark. E-mail:

The clinical trial mentioned in this article received support from TrygFonden.

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