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On an ice-cold day in January, clinical psychologist Emily Holmes picked up a stack of empty diaries and went down to Stockholm’s central train station in search of refugees. She didn’t have to look hard. Crowds of lost-looking young people were milling around the concourse, in clothes too flimsy for the freezing air. “It struck me hard to see how thin some of the young men were,” she says.
Holmes, who works at Stockholm’s Karolinska Institute, was seeking help with her research — a pilot project on post-traumatic stress disorder (PTSD), which is all too common in refugees. She wanted to see whether they would be willing to spend a week noting down any flashbacks — fragmented memories of a trauma that rush unbidden into the mind and torment those with PTSD. She easily found volunteers. And when they returned the diaries, Holmes was shocked to see that they reported an average of two a day — many more than the PTSD sufferers she routinely dealt with. “My heart went out to them,” she says. “They managed to travel thousands of kilometres to find their way to safety with this level of symptoms.”
German researchers pledge help in refugee crisis
Europe is experiencing the largest movement of people since the Second World War. Last year, more than 1.2 million people applied for asylum in the European Union — and those numbers underestimate the scale of the problem. Germany, which has taken in the lion’s share of people, reckons that it received more than a million refugees in 2015, tens of thousands of whom have yet to officially apply for asylum. Most came from Syria, Afghanistan and Iraq. Many have experienced war, shock, upheaval and terrible journeys, and they often have poor physical health. The crisis has attracted global attention and sparked political tension as countries struggle to accommodate and integrate the influx.
What hasn’t been widely discussed is the enormous burden of mental-health disorders in migrants and refugees. Clinical psychologist Thomas Elbert from the University of Konstanz in Germany is conducting a local survey of refugees that suggests “more than half of those who arrived in Germany in the last few years show signs of mental disorder, and a quarter of them have a PTSD, anxiety or depression that won’t get better without help”. Previous research shows that refugees and migrants are also at a slightly increased risk of developing schizophrenia.
“It is a public-health tragedy — and it’s a scandal that it is not recognized as such, as a physical epidemic would be,” says epidemiologist James Kirkbride of University College London.
Doctors and researchers are starting to take action. Holmes and other psychologists and psychiatrists are working with refugees to develop practical, cheap and effective therapies for trauma-related disorders — therapies that could be quickly deployed on this group. Other scientists want to work with local refugees to understand more about how the different types of stresses they suffer play out in their brains, and to learn more about the basic biology of psychiatric disorders.
Lost generation looms as refugees miss university
Scientists hope that their studies will help them to deal with other displaced populations, and help policymakers to accommodate the current influx. Politicians have been too slow to consider mental health when they call for refugees to integrate quickly, Elbert says. “It is illusory to think that people can learn a new language and find work when they can’t function properly mentally. If we want quick integration, we need an immediate plan for mental health.”
Making a new life
Amira is a clinical psychologist and a refugee from Syria. When the war there started, she worked in camps for Syrian refugees in Jordan. She saw people who had been physically attacked, women who had been raped and children who had been neglected. The symptoms of PTSD were clear, and she knows that many refugees have depression and anxiety, too. She asked that her real name not be used.
She arrived in Sweden at the end of December 2015, and wanted to help other refugees but was not allowed to work at first. She tried to make contacts in Stockholm and joined a language course for refugees; she felt very alone but carried on. Now, she has a 6-month position. “I met many children who have experienced war,” she says. “We feel sad, [about] how our children think and how they feel. I have a child and I try to protect him.”
Researchers already have a wealth of evidence about the mental health of migrant and refugee populations around the world. (The United Nations defines refugees as people fleeing armed conflict or persecution and migrants as people who choose to move to improve their lives. Asylum seekers are those seeking official refugee status; but sometimes different definitions are used.) A 2005 meta-analysis of studies performed mostly in northern Europe showed that first- and second-generation migrants were at much greater risk of schizophrenia than non-migrants — and that those from developing countries were more at risk than those from developed ones1 .
A large cohort study published in March looked at 1.3 million people who had arrived in Sweden before 2011 (see ‘Migrant crisis’). Refugees had a threefold higher incidence of schizophrenia and other psychotic disorders than native-born Swedes, and a 66% higher incidence than migrants who were not refugees2. (The overall risk for refugees and migrants still remains comparatively low, at perhaps 2–3%.) Kirkbride, an author on the study, says that his team’s more recent analysis of UK migration data suggests that the level of increased risk of psychotic disorders may depend on how old people were when they migrated — with children potentially at greater risk.
http://www.nature.com/news/the-mental-health-crisis-among-migrants-1.20767
