Many refugees have experienced severe trauma, such as war, torture, human trafficking and extreme poverty, all of which place them at much greater risk for mental illness, even years later.
Now a new German study finds that, even after arriving in Germany, refugees are often forced to live in conditions which further worsen their mental stress.
A research team from the Max Planck Institute for Experimental Medicine show that each additional risk factor puts further strain on the mental health of young refugees. This can lead to functional deficits and behavioral problems, which may be expressed as aggressive and criminal behavior later in life.
It is therefore even more imperative to provide care and support for refugees, and to offer them the opportunity to break out of the spiral of negative experiences.
Previous studies have shown that traumatic experiences, physical and sexual abuse, drug and alcohol use and living in a city are all factors linked to an increase in the risk of mental illness. If a person is subjected to several of these risk factors before the age of 20, he or she is more likely to exhibit aggressive and criminal behavior later in life.
This led a group of Göttingen researchers to take a closer look at a specific risk group: young refugees, as they often experience traumatic events not only in their home country and during their flight, but also face mentally stressful conditions after their arrival in Germany.
Further, the effect of these risk factors is more pronounced among young people, because their brains are still developing, and they react more sensitively to adverse experiences.
To better understand the effects of harmful environmental stress on young refugees, and the consequences for their mental health, the team conducted detailed interviews with 133 relatively healthy refugees (average age 22). Many had traveled to Germany as unaccompanied minors.
In addition to the history-taking, the researchers also looked at the participants’ physical health and used structured interviews to assess any emerging signs of behavioral problems.
“Many refugees are exposed to a shocking number of risk factors,” said Martin Begemann, first author on the publication. In addition to the actual migration experience, more than 95 percent of the refugees are affected by other stressful life events, habits or living conditions that make them more susceptible to mental illness.
In the vast majority of cases, the researchers identified two, three or even more than four additional risk factors. Around half the participants had experienced traumatic experiences before and during their journey; a quarter had suffered physical and sexual abuse.
Around 40 percent of participants had scars or wounds from stabbing or shooting injuries, explosions or the resultant burns. Four young men displayed clear psychotic symptoms, two of these also had suicidal thoughts.
Overall, the more risk factors that were present in a person, the greater the reduction in their ability to function, and the more likely they were to show indications of mental health problems. Precisely which risk factors were present was less significant.
Surprisingly, close and stable personal relationships offered the refugees no protection from these negative effects: Having fled with family or friends, or having a good social network at the time of the study, had no influence on a person’s current mental state. The authors suspect that social support has only a weak protective effect.
It would be several years before the researchers could determine which refugees will go on to exhibit psychological problems or even criminal behavior. However, they expect they will only be able to contact about half of the participants again due to numerous transfers between refugee centers and deportations to the country of origin.
So what can be done right now to improve the poor prognosis for refugees under extreme stress?
“Given that each additional risk factor increases the probability of subsequent aggressive behaviour, criminal activity and mental disorders, we have to prevent the accumulation of further stress factors,” said study leader Hannelore Ehrenreich.
For example, providing refugees with close medical and psychological care and giving them their first simple work activities and language courses even before a final decision on their residence status could help significantly. This could help them to escape from cramped housing conditions where they are confronted with boredom, violence and drugs.