Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
Institute of Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA.
Soc Psychiatry Psychiatr Epidemiol. 2021 Jun;56(6):1015-1023. doi: 10.1007/s00127-020-02010-8. Epub 2021 Jan 4.
A large body of research highlights the lasting impact of pre-resettlement violence on the mental health of refugees after resettlement. However, there is limited research on violence exposure after resettlement and its association with mental health. We examine the association of pre- and post-resettlement violence with post-resettlement mental health symptoms in a survey of Somali refugees in the US and Canada.
We collected survey data from 383 Somalis across five cities in the US and Canada (Boston, MA; Minneapolis, MN; Lewiston, NC; Portland, ME; Toronto, Canada). Wave 1 data were collected between May 2013 and January 2014, while Wave 2 was collected between June 2014 and August 2015. Data from both waves were used to examine whether the association of past violence exposures persists across time and with more recent violence exposures. The War Trauma Screening Scale assessed exposure to any pre- and post-resettlement violence at Wave 1, while the My Exposure to Violence scale assessed any past-year violence exposure at Wave 2. Mental health outcomes included symptoms of depression and anxiety (Hopkins Symptom Checklist) and post-traumatic stress symptoms (Harvard Trauma Questionnaire). Separate linear regression models at Waves 1 and 2 examined the relationship of past violence exposure to standardized scores of mental health symptoms. Participants were 22 years of age, on average. Fifty-six percent of our sample had been exposed to violence after resettlement by Wave 2. At Wave 1, the associations of pre- and post-resettlement violence with mental health were comparable in magnitude across depression [β = 0.39, 95% CI (0.21 0.57) vs. β = 0.36, 95% CI (0.10 0.62)], anxiety [β = 0.33, 95% CI (0.12 0.55) vs. β = 0.38, 95% CI (0.01 0.75)], and PTSD [β = 0.55, 95% CI (0.37 0.72) vs. β = 0.47, 95% CI (0.21 0.74)]. At Wave 2, pre-resettlement violence was associated with depressive symptoms only [β = 0.23, 95% CI (0.06 0.40)], while past-year exposure to violence had the largest association with all mental health outcomes [depression: β = 0.39, 95% CI (0.17 0.62); anxiety: β = 0.46, 95% CI (0.01 0.75); PTSD: β = 0.67, 95% CI 0.46 0.88)].
Our study is the first to examine refugees' exposure to post-resettlement violence across time, finding that Somali refugees' exposure is both persistent and prevalent after resettlement. Post-resettlement violence had a larger association with mental health than pre-resettlement exposure by Wave 2. Our study highlights the urgent need to understand the role of post-resettlement violence exposure for refugees in the US and Canada.
大量研究强调了在重新安置后，前重新安置暴力对难民心理健康的持久影响。然而，关于重新安置后暴力的暴露及其与心理健康的关联的研究有限。我们在美国和加拿大的索马里难民调查中研究了前重新安置和重新安置后暴力与重新安置后心理健康症状之间的关联。
我们从美国和加拿大五个城市（马萨诸塞州波士顿；明尼苏达州明尼阿波利斯；北卡罗来纳州刘易斯顿；缅因州波特兰；加拿大多伦多）的 383 名索马里人中收集了调查数据。第一波数据收集于 2013 年 5 月至 2014 年 1 月之间，而第二波数据收集于 2014 年 6 月至 2015 年 8 月之间。我们使用两波数据来检查过去暴力暴露的关联是否随着时间的推移而持续存在，并与最近的暴力暴露有关。战争创伤筛查量表在第一波评估了任何前重新安置和重新安置后暴力的暴露情况，而我的暴力暴露量表在第二波评估了任何过去一年的暴力暴露情况。心理健康结果包括抑郁和焦虑症状（霍普金斯症状清单）和创伤后应激症状（哈佛创伤问卷）。第一波和第二波的单独线性回归模型检查了过去暴力暴露与心理健康症状的标准化得分之间的关系。参与者的平均年龄为 22 岁。我们的样本中有 56%的人在第二波时经历过重新安置后的暴力。在第一波时，前重新安置和重新安置后暴力与抑郁[β=0.39，95%置信区间（0.21 0.57）与β=0.36，95%置信区间（0.10 0.62）]、焦虑[β=0.33，95%置信区间（0.12 0.55）与β=0.38，95%置信区间（0.01 0.75）]和 PTSD[β=0.55，95%置信区间（0.37 0.72）与β=0.47，95%置信区间（0.21 0.74）]的关联在幅度上相当。在第二波时，前重新安置暴力仅与抑郁症状相关[β=0.23，95%置信区间（0.06 0.40）]，而过去一年的暴力暴露与所有心理健康结果的关联最大[抑郁：β=0.39，95%置信区间（0.17 0.62）；焦虑：β=0.46，95%置信区间（0.01 0.75）；PTSD：β=0.67，95%置信区间 0.46 0.88]。
我们的研究首次检查了难民在时间上重新安置后的暴力暴露情况，发现索马里难民在重新安置后既持续又普遍地暴露于暴力之下。与第二波时的前重新安置暴露相比，重新安置后的暴力与心理健康的关联更大。我们的研究强调了迫切需要了解重新安置后暴力暴露对美国和加拿大难民的作用。
