Table 2 Characteristics of studies assessing long-term mental health of war refugees

Beiser & Hou (2001)

608 Southeast Asian (Vietnamese Chinese, Vietnamese and Laotians) (Canada)

>10 of residence

random and non-random (95 %; follow-up = 45 %)

Self-report developed for the study

Developed for the study. No data reported.

Depression = 2.3 %

DEPRESSION

Univariate: depressive symptoms experienced early in the process of resettlement

(decreased over 10-year period)

-Depression

Multivariate: depressive levels experienced early in the process of resettlement; unemployment or unstable employment (for men); poor English language proficiency (for women and those who did not become engaged in the labour market during the earliest years of resettlement)

Bhui et al. (2003)

180 Somali (UK)

8 of residence

random (49 %)

SCQ and HSCL

Reported as previously validated in other refugee groups (data not reported).

Anxiety and Depression = 23 %

ANXIETY AND DEPRESSION

Univariate: separated or widowed, being retired or unemployed, taking medication, not having declared asylum on entry, not having a conflict with immigration on arrival, less time in the UK (<7 yrs), shortage of food, without shelter, being lost, kidnapped, brainwashed

Multivariate (controlling for age, gender, conflict with immigration, detention on entry, declaration of seeking asylum on entry, current asylum status, income, current employment status, employment status when in Somalia, accommodation type, cigarette smoking, alcohol use, drug use and number of residence years): number of traumatic events, shortage of food and being lost, having no combat experience

Birman & Tran (2008)

212 Vietnamese (USA)

11.5 of residence

Non-random (−)

HSCL–25

Reported as previously validated in this refugee group (data not reported).

Depression = 20.8 %

DEPRESSION

-Depression

Anxiety = 20.3 %

Univariate: lower satisfaction with social support (by like-ethnic friends and one’s spouse), alienation, lower life satisfaction

-Anxiety

In this sample, Cronbach’s alpha: Anxiety = 0.93

Multivariate: lower satisfaction with social support (by like-ethnic friends and one’s spouse)

Depression = 0.94.

ANXIETY

Univariate: females, poor English language, exhibiting more Vietnamese behaviour

Multivariate: females, pre-migration trauma, exhibiting more Vietnamese behaviour

Blair (2000)

124 Cambodian (USA)

8.1 of residence

random (83 %)

NIMH DIS

NIMH DIS: Reported as previously validated in other non-refugee cultures (data not reported).

Depression = 51 %

DEPRESSION

-Depression

GAD =14 %

Univariate: Pre-migration – higher number of war traumas, loss of immediate family member (a parent, a sibling or a child), higher number of problems while trying to escape, being separated from family while in refugee camp; resettlement – higher number of resettlement stressors, financial stress (lower rates of working outside the home, lower income, receiving welfare)

-Anxiety

Social phobia = 27 %

-Social phobia

Panic disorder = 7 %

-Panic dis.

PTSD = 45 %

Comorbidity: PTSD and Depression = 71 %

DICA-R

-PTSD

DICA-R: Reported as previously validated in other non-refugee cultures (data not reported).

PTSD and Social Phobia = 32 %

PTSD

Univariate: Pre-migration – higher number of war traumas, loss of immediate family member (a sibling), being separated from family while in a refugee camp, higher number of problems while trying to escape, higher number of incidents of abuse; resettlement – higher number of resettlement stressors

Bogic et al. (2012)

854 refugees from former Yugoslavia (Germany, Italy, and the UK)

9.3 of residence

random and non–random

MINI

Reported as previously validated in other non-refugee cultures (data not reported).

Depression = 34.3 %

DEPRESSION

-Depression

PTSD = 33.1 %

Univariate: female, older age, lower education, higher number of war and post-war traumatic events, shorter time since war trauma, more migration stressors, unemployment, not feeling accepted by host country, poor host language fluency, temporary residence status, residing in Germany or the UK compared to Italy

-PTSD

GAD = 8.7 %

-GAD

-Social phobia

Social phobia = 6.4 %

-Panic disorder

Panic disorder = 10.0 %

-Agoraphobia

Agoraphobia = 18.6 %

-OCD

OCD = 4.8 %

Comorbidity:

PTSD and Depression =65.1 %

GAD and PTSD = 43.2 %

Social Phobia and PTSD = 15.9 %

GAD and depression = 50.7 %

Multivariate: older age, lower education, higher number of war-related traumatic events, shorter time since war trauma, more migration stressors, unemployment, not feeling accepted by host country, temporary residence status, residing in Germany or the UK compared to Italy

PTSD

Univariate: older age, lower education, higher number of war and post-war traumatic events, longer time since war trauma, more migration stressors, unemployment, not feeling accepted by host country, poor host language fluency, temporary residence status, residing in Germany or the UK compared to Italy

Multivariate: older age, lower education, higher number of war and post-war traumatic events, not having a combat experience, more migration stressors, temporary residence status, residing in Germany vs. Italy or the UK

ANXIETY (any anxiety disorder)

Univariate: female, older age, lower education, higher number of war and post-war traumatic events, not having a combat experience, more migration stressors, unemployment, not feeling accepted by host country, poor host language fluency, temporary residence status, residing in Germany or the UK compared to Italy

Multivariate: lower education, higher number of war and post-war traumatic events, not having a combat experience, more migration stressors, not feeling accepted by host country, temporary residence status

Buseh et al. (2000)

50 Liberian males (USA)

8.6 of residence

non–random (−)

CES–D

Reported as previously validated in other non-refugee cultures (Cronbach’s alpha =0.85).

Depressive Mood =60 %

DEPRESSION

-Depression

Univariate: more acculturative stress; CES–D subscales depressed affect, somatic/retarded activity, and interpersonal affect were positively correlated with all items on acculturative stress; CES–D subscale positive affect less perceived hate, less perceived cultural shock and lower overall acculturative stress

In this study, Cronbach’s alpha = 0.91.

Carlson & Rosser–Hogan (1994)

50 Cambodian (USA)

9.9 since leaving home country (5.4 of residence)

random (100 %)

HSCL–25

HSCL-25: Reported as previously validated in this refugee culture (test-retest reliability = 0.89; specificity = 0.73 and sensitivity = 0.88).

Depression = 80 %

DEPRESSION, ANXIETY, PTSD, Univariate: higher number of traumatic events

-Depression

PTSD = 86 %

-Anxiety

Anxiety = 88 %

PCL–C –amended

-PTSD

PCL-C: Validated in other cultures (not reported in the study).

In this study, test-retest reliability = 0.85.

Caspi et al. (1998)

161 Cambodian (USA)

7 of residence

random (78 %)

HSCL–25

HSCL-25 and HTQ validated in this culture (not reported in the study).

Not reported

DEPRESSION, ANXIETY AND PTSD

-Depression

Multivariate: no relationship observed with child loss

-Anxiety

HTQ

-PTSD

Chung & Kagawa–Singer (1993)

2180 Southeast Asian (Cambodian, Laotian, and Vietnamese) (USA)

5.9 of residence

random (−)

HOS

Reported as previously validated in other non-refugee cultures (data not reported). In this study, Cronbach’s alpha for depression = 0.85 and for anxiety = 0.89.

Not reported

DEPRESSION

-Depression

Univariate: Cambodians (followed by Lao and Vietnamese)

-Anxiety

Multivariate (controlling for ethnicity and number of years in the USA): higher number of pre-migration traumatic events and female gender; for the >5 yrs in the USA: female gender, higher number of traumatic events, longer time in refugee camp, longer time in the USA, unemployment, low family income, poor English, being Vietnamese (compared to Cambodians)

ANXIETY

Univariate: Cambodians (followed by Lao and Vietnamese)

Multivariate: Regardless of ethnicity and years in the USA – higher number of traumatic events, female gender, older age, receipt of public assistance, lower family income, poor English, being Lao; for refugees >5 yrs in the USA: female gender, older age, longer in the USA, higher number of traumatic events, longer time in refugee camp, unemployment, receiving public assistance, low family income, low English proficiency, Lao, Cambodian

Craig et al. (2008)

126 Bosnian (USA)

9 of residence

random (25.2 %)

MHI

MHI and PSDS reported as previously validated in other non-refugee cultures (MHI: Cronbach’s Alpha >0.80, test-retest reliability > 0.58;

Depression = 31.7 %

DEPRESSION

-Depression

PTSD = 66.6 %

Univariate: females, older age, lower education

-Anxiety

Anxiety = 40.5 %

PSDS

-PTSD

PTSD

Univariate: older age, lower education

ANXIETY

Univariate: older age, lower education

PSDS Cronbach’s alpha = 0.94–0.98, test-retest reliability 0.69–0.72).

In this study, MHI Cronbach’s alpha for anxiety = 0.95 and for depression = 0.96;

PSDS Cronbach’s alpha =0.97.

D'Avanzo & Barab (1998)

175 Cambodian females (USA and France)

≥5 of residence

non–random (−)

HSCL–25

Reported as previously validated in other non-refugee cultures (test-retest reliability for depression = 0.82, anxiety = 0.84, sensitivity = 0.93 and specificity = 0.76 for either).

Depression = 73.7 % (France = 85.3 %; USA = 65 %)

DEPRESSION

-Depression

Univariate: refugee women in France were more likely to be symptomatic of depression

-Anxiety

Anxiety = 81.3 % (France = 85 %; USA = 79 %)

In this study, Cronbach’s alpha for depression = 0.86 and anxiety = 0.86.

Delic-Ovcina (2010)

637 Bosnian males (USA)

6–16 (97.7 % ≥ 8 years) of residence

non–random (−)

IES

Reported as previously validated in this refugee culture (data not reported).

PTSD = 76.5 %

PTSD

-PTSD

Univariate: older age, married, lower education, perceived poor general health, recentness of dental visit, higher frequency of smoking, lack of physical activity, no health care coverage and insufficient funds for health care services

In this study, Cronbach’s alpha = 0.96.

Gerritsen et al. (2006)

178 Afghan, Iranian and Somali (Netherlands)

8.8 of residence

random (59 %)

HSCL–25

Reported as previously validated in other refugee cultures (data not reported).

Depression = 29.3 %

(sample includes 232 recently arrived refugees (M = 5.6 yrs.)

-Depression

-Anxiety

HTQ

PTSD = 10.6 %

PTSD AND DEPRESSION/ANXIETY

-PTSD

Anxiety = 27.7 %

Multivariate: asylum seeker (but not for PTSD) being from Iran or Afghanistan; female, higher number of traumatic events, higher post-migration stress, less social support

Hinton et al. (1998)

3401 Vietnamese males (USA)

8–11 of residence

random (85–96 %)

HSCL–D

Reported as previously validated in this refugee culture (sensitivity = 0.86 and specificity = 0.96).

Depression = 8.8 %

DEPRESSION

-Depression

(San Francisco = 9.8 %

Univariate: older age and veteran (in particular for those at the San Francisco and Santa Clara sites), less educated, poorer English proficiency, more recently arrived, poorer, unemployed or disabled, re-education camp survivors

Santa Clara = 8.2 %

Houston = 8.6 %)

Multivariate: unemployed or disabled, veterans, poorer English proficiency, income below poverty line, living in Houston

Hollifield et al. (2006)

252 Kurdish and Vietnamese (USA)

Kurds = 7.0 and Vietnamese 7.8 of residence

non–random (−)

HSCL–25

HSCL-25: Reported as previously validated in other refugee cultures (data not reported).PSS-SR: Reported as previously validated in other non-refugee cultures (Cronbach’s alpha = 0.91, test-retest reliability = 0.74). In this study, Cronbach’s alpha =0.95.

Depression = 38.9 %

DEPRESSION, PTSD, ANXIETY

-Depression

PTSD = 31.3 %

-Anxiety

Anxiety = 25.0 %

Univariate: higher number of war-related traumatic events

PSS-SR

-PTSD

Multivariate: higher number of war-related traumatic events

Hunt & Gakenyi (2005)

69 Bosnian (UK)

5–8 since war trauma

non–random (69 %)

IES–R

Validated in this culture (not reported in this study). In this study, Cronbach’s alpha =0.83

PTSD = 77 %

Not reported

-PTSD

(IES–R > 45)

Jaranson et al. (2004)

1134 Ethiopian (Oromo and Somali) (USA)

7.5 since leaving home country (3.4 of residence)

non–random (97 %)

PCL–C

Reported as previously validated in other non-refugee cultures (data not reported).In this study, Cronbach’s alpha =0.93.

PTSD = 13 %

PTSD

-PTSD

Univariate: being exposed to torture

Multivariate: male, being Oromo, change in religious practices since migration, higher number of traumatic events, exposure to torture

Kolassa et al. (2010)

444 Rwandans (refugee camp in Uganda)

~13 since war trauma

random (−)

PDS

Reported as previously validated in this refugee culture (test-retest reliability = 0.93). In this study, test-retest reliability = 0.87,

PTSD = 49.5 %

PTSD

-PTSD

Multivariate: higher number of traumatic events

sensitivity = 0.87 and specificity = 0.86.

Marshall et al. (2005)

490 Cambodian (USA)

20–22 of residence

random (87 %)

CIDI

Reported as previously validated in other non-refugee cultures (data not reported).

Depression = 51 %

DEPRESSION

-Depression

PTSD = 62 %

Univariate: poor English language, retired or disabled, unemployed, below federal poverty level, older age, higher number of pre–and post-migration traumatic events

-PTSD

Comorbidity of PTSD and depression = 71 %

Comorbidity of depression and PTSD = 86 %

Multivariate: (adjusted for age, gender, year of immigration, and pre- and post-migration trauma exposure): older age, higher number of pre- and post–migration traumatic events

PTSD

Univariate: older age, males, poor English language, retired or disabled, unemployed, below federal poverty level, higher number of pre–and post–migration traumatic events

Multivariate (adjusted for age, gender, year of immigration, and pre- and post-migration trauma exposure): older age, higher number of pre and post–migration traumatic events

Matheson et al. (2008)

90 Somali (Canada)

≥9 (90 % sample) of residence

non–random (−)

IES-R

IES-R: Reported as previously validated in other non-refugee cultures (data not reported).

Depression 22.5 %

DEPRESSION

-PTSD

PTSD = 22.2 %

Univariate: higher number of traumatic events, assault from a stranger or familiar other, coping strategies involving engagement with emotions and avoidant coping efforts

BDI

-Depression

In this study, Cronbach’s alpha =0.96.

BDI: Validated in other cultures (not reported in the study).

Multivariate: the relation between trauma experiences and depression was fully 9confounded by endorsement of emotion-focused coping strategies in relation to acculturation stressors

In this study, Cronbach’s alpha = 0.90.

PTSD

Univariate: higher number of traumatic events, collective trauma, threat to other, assault from a stranger or familiar other, coping strategies involving engagement with emotions and avoidant coping efforts

Multivariate: higher number of traumatic events

Mollica et al. (1998)

993 Cambodian (refugee camp on Thailand–Cambodia border)

≥5 of residence

random (98 %)

HSCL–25

HTQ and HSCL-25: Reported as validated in this culture (data not reported).

Depression 55 %

DEPRESSION, PTSD, PTSD SUB–SCALES (except avoidance, which had no dose–effect relationship), ANXIETY

-Depression

PTSD = 14.7 %

-Anxiety

HTQ

-PTSD

Multivariate (covariates: gender, age, marital status, education, trauma exposure, and one of the symptom scale or sub-scales): dose–response relationship between cumulative trauma and symptoms – recent trauma had a more potent effect except for emotional numbing (roughly equally 'potent')

Nicholson (1997)

447 Southeast Asian (Vietnamese, Cambodians, Laotians and Hmong) (USA)

9.2 of residence

non–random (−)

HTQ

HTQ: Reported as validated in this culture (data not reported).

Depression = 40 %

PTSD, ANXIETY, DEPRESSION

-PTSD

PTSD = 14 %,

HSCL–25

Anxiety = 35 %

Multivariate: degree of current stress was the strongest predictor, self–perceived poor health status, greater number of experienced traumatic events (in particular for PTSD), while greater number of witnessed events and rural background (confounded through current stress), and female gender (confounded through lower income) had indirect effects on all mental health. In addition, low income and being unmarried predicted depression; greater number of witnessed events predicted PTSD; and female gender predicted anxiety

-Depression

-Anxiety

In this study, Cronbach’s alpha =0.95.

HSCL-25: Reported as validated in this culture (data not reported).

In this study, Cronbach’s alpha for depression = 0.89 and anxiety = 0.89.

Onyut et al. (2009)

1422 Somalis and Rwandans (refugee camp in Uganda)

≥9 (80 % sample) of residence

random (<90 %)

PDS

PDS: Reported as previously validated in other non-refugee cultures (data not reported).

PTSD = 37.8 %

DEPRESSION

-PTSD

Univariate: male gender (only for Rwandese), being Somali, higher number of traumatic events, functioning deficits, physical health deficits

HSCL-25

-Depression

-Anxiety

In this study, sensitivity = 0.86 and specificity = 0.88

PTSD

Univariate: male gender (only for Rwandese), being Somali, higher number of traumatic events, functioning deficits, physical health deficits

HSCL-25: Validated in other refugee cultures (not reported in the study).

In this study, for depression subscale sensitivity = 0.67 and

ANXIETY

Univariate: female gender (only for Somali), being Somali, higher number of traumatic events, functioning deficits, physical health deficits

specificity = 0.73.

Sabin et al. (2003)

170 Guatemalan (refugee camp in Mexico)

20 of residence

random (93 %)

HSCL–25

HSCL-25 and HTQ: Reported as previously validated in other refugee cultures (data not reported).

Depression = 38.8 %

DEPRESSION

-Depression

PTSD = 11.8 %

Univariate: female, widowed, witnessing disappearance of others, torture, mutilation, higher number of traumatic events

-Anxiety

Anxiety = 54.4 %

HTQ

-PTSD

In this study, HTQ Cronbach’s alpha =0.87; HSCL-25 Cronbach’s alpha =0.95.

Multivariate: female, widowed, witnessing disappearance of others, higher number of traumatic events

PTSD

Univariate: older age, being close to death, witnessed assassination or massacre, disappearance of others, larger household size, lived in 3 or more camps, not having experienced lack of food

Multivariate: disappearance of others, being close to death, larger household size, and not having experienced lack of food

ANXIETY

Univariate: older age, higher number of traumatic events, sexual abuse or rape, witnessing massacre, witnessing disappearance of others, torture

Multivariate: witnessing a massacre, higher number of traumatic events

Schweitzer et al. (2006)

63 Sudanese (Australia)

9 since leaving home country (2 of residence)

non–random (−)

HSCL-37

HSCL-25 and HTQ: Reported as previously validated in other refugee cultures (data not reported).

Depression =16 %

DEPRESSION

-Depression

PTSD = 13 %

Univariate: female, higher number of traumas experienced by family, longer time in transit, family separation, less of ethnic community support

-Anxiety

HTQ

-PTSD

In this study, HTQ Cronbach’s alpha =0.87; HSCL-25 Cronbach’s alpha for depression = 0.89 and for anxiety = 0.82

Multivariate: female, higher number of trauma experienced by family, longer time in transit, longer residence, family separation, unemployment

PTSD

Univariate: female, higher number of trauma experienced by the individual, higher number of trauma experienced by family, less of ethnic community support, more post-migration living difficulties

Multivariate: female, higher number of trauma experienced by the individual, higher number of trauma experienced by family, less of ethnic community support

ANXIETY

Univariate: female, higher number of trauma experienced by the individual, number of trauma experienced by family, less of ethnic

community support, more post-migration living difficulties

Multivariate: female, higher number of trauma experienced by family, longer residence, less of ethnic community support, unemployment, more post-migration living difficulties

Steel et al. (2002)

1161 Vietnamese (Australia)

11.4 of residence

random (82 %)

CIDI, PVPS

PVPS: Developed in this culture (data not reported)

Depression =3 %

ANXIETY DISORDERS

PTSD = 4 %

Univariate: females

-Depression

GAD = 0.7 %

Social Phobia = 0.3 %

-PTSD

-GAD

Panic disorder = 0.6 %

-Social phobia

OCD = 0.5 %

-Panic

PVPS: similar results

disorder

-OCD

Stige & Sveaass (2010)

142 Sri Lankan Tamils & Aceh from Indonesia (Norway)

6.7 of residence

combination of random (10 %) and non-random

PTSS

Validated in other non-refugee cultures (not reported in the study).

PTSD = 75.4 %

Not reported

-PTSD

In this study, Cronbach’s alpha = 0.98

von Lersner et al. (2008)

100 refugees from former Yugoslavia (85 %), Turkey (8 %) and Iraq (5 %) (Germany)

10.8 of residence

non–random (−)

MINI

MINI: Reported as previously validated in other non-refugee cultures (data not reported).

Depression = 42.0 %

Not reported

-Depression

PTSD = 44.2 %

-Anxiety

GAD = 2 %

-Social phobia

Social phobia = 9.6 %

PDS: Validated in other refugee cultures (not reported in the study).

Panic disorder = 8 %

-Panic disorder

Agoraphobia = 9 %

-Agoraphobia

OCD = 0 %

PDS

-PTSD

Westermeyer (1988)

97 Hmong from Laos (USA)

7–9 since leaving home country (6–8 of residence)

random (95 %; 96 % at the follow–up assessment)

NIMH DIS

Validated in other non-refugee cultures (not reported in the study).

Axis 1 disorder = 44 %

Not reported

-Depression

Depression = 6.2 %

-GAD

GAD = 1 %

-OCD

OCD = 0.4 %