Yale School of Medicine, USA; Williams College, USA.
Veterans Affairs Boston Healthcare System, USA.
Soc Sci Med. 2024 Jun;350:116761. doi: 10.1016/j.socscimed.2024.116761. Epub 2024 Mar 29.
Existing literature documents high rates of experienced violence in asylum seekers. Despite this high prevalence, experiences of traumatic stress are neither necessary nor sufficient grounds for claiming asylum, without documented experiences of persecution. The aim of the current study is to better understand the role of co-occurring pre-migratory social determinants, stigma, and trauma on the experiences of persecution among asylum seekers in the United States.
We conducted a retrospective file review of legal declarations submitted by 25 asylum seekers who participated in forensic mental health evaluations at a pro-bono asylum clinic. We coded de-identified data for co-occurring events of trauma, social determinants of health, and components of "discrimination" from the legal definition of persecution - conceptualizing persecution as stigma-driven infliction of violence. Data was analyzed using a tiered deductive and inductive reflexive thematic analysis.
Findings suggest pre-migratory social determinants included demographics, neighborhood, economic, environmental, and social and cultural level disparities across various grounds for seeking asylum, and experiences of stigma were associated with the specific acts of violence and harm.
Our findings - specific to asylum seekers who have obtained legal representation and completed applications for asylum in the United States - describe the co-occurrence of social determinants, stigma and traumatic experiences among asylum seekers. To our knowledge, this study is the first of its kind to bridge the existing legal framework of asylum to a psychological construct incorporating trauma, stigma, and social determinants of health, lending support for the conceptualization of persecution as stigma-driven trauma.
现有文献记录了寻求庇护者经历暴力的高比率。尽管这种高流行率存在，但创伤性应激的经历既不是寻求庇护的必要条件，也不是充分条件，如果没有记录到遭受迫害的经历。本研究的目的是更好地了解在美寻求庇护者中，同时存在的前迁移社会决定因素、耻辱感和创伤对遭受迫害经历的作用。
我们对在一个公益庇护诊所接受法医心理健康评估的 25 名寻求庇护者提交的法律声明进行了回顾性档案审查。我们对身份不明的数据进行了编码，以记录同时发生的创伤、健康社会决定因素，以及从迫害的法律定义中推断出的“歧视”成分——将迫害概念化为耻辱感驱动的暴力行为。使用分层演绎和归纳反思性主题分析对数据进行了分析。
研究结果表明，前迁移社会决定因素包括人口统计学、社区、经济、环境以及在各种寻求庇护理由方面的社会和文化层面的差异，耻辱感的经历与特定的暴力和伤害行为有关。
我们的研究结果——具体针对已获得法律代表并在美国完成庇护申请的寻求庇护者——描述了寻求庇护者中社会决定因素、耻辱感和创伤经历的同时发生。据我们所知，这项研究首次将现有的庇护法律框架与一个包含创伤、耻辱感和健康社会决定因素的心理结构联系起来，为将迫害概念化为耻辱感驱动的创伤提供了支持。
