Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
J Clin Sleep Med. 2021 Mar 1;17(3):479-489. doi: 10.5664/jcsm.8972.
Sleep disturbance is common in those who experience trauma. In a sample of nontreatment-seeking refugees, we examined the associations between trauma exposure, postmigration stress, sleep symptoms, and posttraumatic psychological symptoms.
Syrian and Iraqi refugees (n = 86; 51% female; mean age = 45 years) residing in Australia were recruited from the local community. Cross-sectional descriptive design, multinominal regression analyses, and mediation analyses were used. Participants completed measures in Arabic assessing premigration trauma exposure, postmigration stress, sleep symptoms, and mental health. They also completed 7 days of sleep diaries and actigraphy.
We identified 34.9% of the participants as normal sleepers, 32.6% as probably having insomnia, and 32.6% as likely having insomnia. Variables associated with greater sleep disturbance (McFadden's R² = 0.57) included greater trauma exposure, increased time of resettlement, greater postmigration stress, and greater presleep arousal. The association of premigration trauma exposure to current posttraumatic symptoms was mediated sequentially by postmigration stress and sleep symptoms.
Our findings highlight the extent of sleep disturbance in refugees. We found evidence for an indirect pathway between trauma exposure and posttraumatic symptoms through premigration stress and sleep (particularly presleep arousal). In the current global refugee crisis, improving the existing system of care in countries experiencing increased migration is critical. Because sleep disturbance is a modifiable condition associated with mental health, targeting sleep could be an important component of psychological interventions for refugees.
创伤后人群常出现睡眠障碍。本研究以未接受治疗的难民为研究对象，考察了创伤暴露、后迁移压力、睡眠症状与创伤后心理症状之间的关系。
从澳大利亚当地社区招募了 86 名叙利亚和伊拉克难民（51%为女性，平均年龄为 45 岁）参与本横断面描述性研究。采用多项分类回归分析和中介分析。参与者以阿拉伯语形式完成了关于前迁移期创伤暴露、后迁移期压力、睡眠症状和心理健康的评估。他们还完成了 7 天的睡眠日记和活动记录仪记录。
我们发现 34.9%的参与者为正常睡眠者，32.6%可能患有失眠症，32.6%可能患有失眠症。与睡眠障碍程度增加相关的变量（麦克法登 R²=0.57）包括更多的创伤暴露、重新安置时间的增加、更多的后迁移压力和更大的睡前觉醒。前迁移创伤暴露与当前创伤后症状之间的关联通过后迁移压力和睡眠症状呈顺序中介。
我们的研究结果突显了难民睡眠障碍的严重程度。我们发现了创伤暴露与创伤后症状之间存在通过前迁移期应激和睡眠（特别是睡前觉醒）的间接途径的证据。在当前全球难民危机中，改善经历移民增加的国家现有的医疗体系至关重要。由于睡眠障碍是一种与心理健康相关的可改变的状况，针对睡眠问题可能是对难民进行心理干预的一个重要组成部分。
