Risk for mental illness following exposure to violence and threats among newly arrived refugees

BMC Research Notes (2022) 15:361 Mangrio et al. BMC Research Notes https://doi.org/10.1186/s13104-022-06239-1 Open Access RESEARCH NOTE Risk for mental illness following exposure to violence and threats among newly arrived refugees Elisabeth Mangrio1,2*, Slobodan Zdravkovic1,2 and Anna‑Karin Ivert3 Abstract Objective: There is an association between pre-migration exposure to threats and violence, and the risk for mental illness among newly arrived refugees (NAR). The aim of this study is therefore to investigate the effect of pre-migra‑ tion violent and threatening experiences on the mental health of NAR in Sweden. The participants were recruited between February 2015 and February 2016, undergoing the naturalisation process in Sweden. In total, 681 question‑ naires were returned (response rate of 39.5%). Results: The results showed that almost 50% of the sample were at risk for mental illness. Analysis of pre-migration exposure to violence or threats, and risk for mental illness, showed a significant odds ratio for violence as well as for threats. Analysing men and women separately resulted in a significant odds ratio for women for pre-migration threats. For men, pre-migration violence and threats were significantly associated with the risk for mental illness. The host society receiving NAR must screen for mental illness and be prepared to provide support and care for refugees who were exposed to violence or threats, and who are subsequently at risk for mental illness. This must be considered in order to improve health and subsequently the social integration of refugees. Keywords: Mental illness, Newly arrived refugees, Threats, Violence, Quantitative research Introduction In 2015, the number of refugees entering Europe increased significantly [1] and that year, more than 160,000 persons applied for asylum in Sweden [2]. The migration process often entails being separated from family members, and thus lacking a support network [3, 4], while the process also increases the odds for exposure to violence [5]. After the arrival in the host country, the refugees face challenges finding safe housing, which in turn could increase the risk for exposure to violence [6, 7]. We are also aware that women are exposed to an *Correspondence: 1 Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden Full list of author information is available at the end of the article increased risk of violence, including forced sexual relations, sexual violence from partners, or through trafficking [8]. Prevalence of depression and anxiety among Newly arrived refugees (NAR) tends to be higher than in host populations [9] and poor socioeconomic conditions, including unemployment and isolation, are associated with increased rates of depression among refugees [10]. Health, both physical and mental, is important for NAR, in order to be able to participate in the establishment process [11]. Therefore, there is a need to examine risk factors among NAR that are associated with mental health problems. The objective of the present study is to investigate the effect of pre-migration experiences of violence and threats on mental health among a sample of NAR in Sweden. Gender differences will also be investigated in © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Mangrio et al. BMC Research Notes (2022) 15:361 order to determine whether experiences of violence and/ or threats affect females and males differently. Main text Materials and methods Approximately 1,700 questionnaires were distributed to NAR who spoke Dari and Arabic (from Syria, Iraq and Afghanistan), and who participated in the mandatory 2 year naturalisation process in Scania, Sweden. At the time of the survey, the NAR had been granted refugee status and received either temporary or permanent residency permits. The participants were recruited by inviting all eligible adult NAR between February 2015 and February 2016 [12]. In total, 681 questionnaires were returned, resulting in a response rate of 39.5%. Sixteen individuals with missing gender data were excluded, resulting in a final sample of 665 respondents. Data collection was assessed by a self-administered questionnaire that included questions about health, sleep, level of education, well-being, accommodation type, and social relations. The questions were translated by authorised translators, and validated by civic and health communicators. A pilot study among civic and health communicators that themselves were newly arrived in Sweden as refugees, was conducted prior to the study in order to validate comprehension of the questionnaire. After the pilot study, minor adjustments were made. Prior to the data collection, the NAR got oral and written information about the study and the questionnaires were distributed along with the civic and society information and the NAR received the questionary and were able to ask the civic and society communicators with help if questions were difficult to understand. Then the informants posted the questionnaires in a pre-packed envelope. There was no way to measure what level of health literacy the informants had at the time of the survey. Variables Dependent variable In this study, the General Health Questionnaire (GHQ-12) [13] was used to examine the risk of mental illness. The instrument is a 12-item questionnaire with a four-point Likert scale measuring a person’s well-being, including mainly depressive symptoms, worry, sleep and cognitive functioning. A score sum of ≥ 3 according to Goldberg’s [13] original recommendation was used. Independent variables Pre-migration exposure to violence was derived from the following question: Have you been exposed to physical violence during the last 12 months before you came to Sweden that were so serious that you got afraid? Answers: yes, no. Page 2 of 5 Post-migration exposure to violence was derived from the following question: Have you been exposed (...truncated)