This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (40)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Psychiatry  • World Health  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

A Meta-analysis

Matthew Porter, PhD; Nick Haslam, PhD

JAMA. 2005;294:602-612.

Context  The global refugee crisis requires that researchers, policymakers, and clinicians comprehend the magnitude of the psychological consequences of forced displacement and the factors that moderate them. To date, no empirical synthesis of research on these issues has been undertaken.

Objective  To meta-analytically establish the extent of compromised mental health among refugees (including internally displaced persons, asylum seekers, and stateless persons) using a worldwide study sample. Potential moderators of mental health outcomes were examined, including enduring contextual variables (eg, postdisplacement accommodation and economic opportunity) and refugee characteristics.

Data Sources  Published studies (1959-2002) were obtained using broad searches of computerized databases (PsycINFO and PILOTS), manual searches of reference lists, and interviews with prominent authors.

Study Selection  Studies were selected if they investigated a refugee group and at least 1 nonrefugee comparison group and reported 1 or more quantitative group comparison on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4% of identified reports), yielding 59 independent comparisons and including 67 294 participants (22 221 refugees and 45 073 nonrefugees).

Data Extraction  Data on study and report characteristics, study participant characteristics, and statistical outcomes were extracted using a coding manual and subjected to blind recoding, which indicated high reliability. Methodological quality information was coded to assess potential sources of bias.

Data Synthesis  Effect size estimates for the refugee-nonrefugee comparisons were averaged across psychopathology measures within studies and weighted by sample size. The weighted mean effect size was 0.41 (SD, 0.02; range, –1.36 to 2.91 [SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement conditions moderated mental health outcomes. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes. Methodological differences between studies affected effect sizes.

Conclusions  The sociopolitical context of the refugee experience is associated with refugee mental health. Humanitarian efforts that improve these conditions are likely to have positive impacts.

Author Affiliations: Columbia Presbyterian Medical Center, New York, NY (Dr Porter); University of Melbourne, Melbourne, Australia (Dr Haslam).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Screening for Traumatic Exposure and Posttraumatic Stress Symptoms in Adolescents in the War-Affected Eastern Democratic Republic of Congo
Mels et al.
Arch Pediatr Adolesc Med 2009;163:525-530.
ABSTRACT | FULL TEXT  

Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence
Hobfoll et al.
Focus 2009;7:221-242.
ABSTRACT | FULL TEXT  

Mental health implications of detaining asylum seekers: systematic review
Robjant et al.
Br. J. Psychiatry 2009;194:306-312.
ABSTRACT | FULL TEXT  

Post-Traumatic Stress in Asylum Seekers and Refugees From Chechnya, Afghanistan, and West Africa: Gender Differences in Symptomatology and Coping
Renner and Salem
Int J Soc Psychiatry 2009;55:99-108.
ABSTRACT  

Factors associated with the health status of internally displaced persons in northern Uganda
Roberts et al.
J. Epidemiol. Community Health 2009;63:227-232.
ABSTRACT | FULL TEXT  

A glossary of culture in epidemiology
Hruschka and Hadley
J. Epidemiol. Community Health 2008;62:947-951.
ABSTRACT | FULL TEXT  

Food insecurity, stressful life events and symptoms of anxiety and depression in east Africa: evidence from the Gilgel Gibe growth and development study
Hadley et al.
J. Epidemiol. Community Health 2008;62:980-986.
ABSTRACT | FULL TEXT  

Mental healthcare of asylum-seekers and refugees
McColl et al.
Adv. Psychiatr. Treat. 2008;14:452-459.
ABSTRACT | FULL TEXT  

Acculturation, Partner Violence, and Psychological Distress in Refugee Women From Somalia
Nilsson et al.
J Interpers Violence 2008;23:1654-1663.
ABSTRACT  

Difficulties and Coping Strategies of Sudanese Refugees: A Qualitative Approach
Khawaja et al.
Transcultural Psychiatry 2008;45:489-512.
ABSTRACT  

Access To Care Among Displaced Mississippi Residents In FEMA Travel Trailer Parks Two Years After Katrina
Shehab et al.
Health Aff (Millwood) 2008;27:w416-w429.
ABSTRACT | FULL TEXT  

How scientifically valid is the knowledge base of global mental health?
Summerfield
BMJ 2008;336:992-994.
FULL TEXT  

2008 Theme Issue on Violence and Human Rights: Call for Papers
Cole and Flanagin
JAMA 2007;298:2792-2793.
FULL TEXT  

Meaning or Measurement? Researching the Social Contexts of Health and Settlement among Newly-Arrived Refugee Youth in Melbourne, Australia
Gifford et al.
Journal of Refugee Studies 2007;0:fem004v1-fem004.
ABSTRACT | FULL TEXT  

Global Evidence for a Biopsychosocial Understanding of Refugee Adaptation
Porter
Transcultural Psychiatry 2007;44:418-439.
ABSTRACT  

Ethical Research in Refugee Communities and the Use of Community Participatory Methods
Ellis et al.
Transcultural Psychiatry 2007;44:459-481.
ABSTRACT  

Trauma and Stress Response Among Hurricane Katrina Evacuees
Mills et al.
Am. J. Public Health 2007;97:S116-S123.
ABSTRACT | FULL TEXT  

Violence and Human Rights: A Call for Papers.
Cole and Flanagin
JAMA 2006;296:2261-2262.
FULL TEXT  

Detention of refugees
Fazel and Silove
BMJ 2006;332:251-252.
FULL TEXT