2015/09-2016/02 Mental health in Iraqi refugees: Importance of post-displacement social stressors - BB Arnetz, JE Arnetz, H Jamil
Aims: This revised R01 application, which is in response to PA-07-312, “Mental Health Consequences of Violence and Trauma,” proposes a unique collaboration between university researchers and state and community Arab-American and Chaldean organizations to accomplish our aims of understanding the long-term mental health status and post-displacement social and institutional influences in newly arrived Iraqi refugees to metro Detroit. Along with our extensive preliminary research with this population and prior collaborations with these organizations, there are several unique advances of the proposed project. First, we will document the entire pool of refugees and randomly sample 300 participants, thereby obviating the limitations of the usual, convenience sampling. Second, we will follow these refugees prospectively, assessing mental disorders and risk factors using Arab-speaking interviewers and translated measures, at baseline as well as at 1- and 2-year follow-ups. Third, in addition to assessing the role of stressors encountered in this new environment, we will examine the influence of educational and vocational training on mental health outcomes, beyond the role played by pre-displacement risk factors and post-displacement stressors. Finally, to determine whether our findings regarding mental disorders and post-displacement risk factors are unique to Iraqi refugees, we will recruit and prospectively assess in parallel fashion a comparison sample of 300 non-refugee immigrants from the Mideast. Overall, these novel research questions and innovative methods will contribute to our long-term-objective of furthering our understanding of post-displacement institutional risk and resiliency factors for refugee mental health.
This project, therefore, has three primary aims: Primary Aim # 1: Cross-sectional evaluation of mental disorders and pre-displacement risk factors. To document the prevalence of mental disorders (major depressive disorder, PTSD, and generalized anxiety disorder) and symptoms (depression, anxiety, PTSD, somatic symptoms) in a random sample of new Iraqi refugees, and to evaluate the association of pre-displacement risk factors (e.g., trauma exposure, torture, childhood victimization) to mental disorders and symptoms. The prevalence and risk factor relationships among Iraqi refugees will be compared to those in a sample of non-refugee immigrants. We expect that rates and symptom levels of the specific disorders mentioned above will be higher among Iraqi refugees than immigrants, and that this will be accounted for by the greater prior trauma experience of the refugees. Primary Aim # 2: Prospective evaluation of mental health outcomes and the role of post-displacement stressors as risk factors. To document long-term rates and changes in mental disorders and symptoms over two years among Iraqi refugees, and to evaluate the association of post-displacement stressors (e.g., victimization, discrimination, and violence) on long-term mental health. Mental disorder rates and the role of post-displacement stressors among refugees will be compared to those found among non-refugee immigrants. We expect that refugees will have higher long-term rates of mental disorders than immigrants, and that post-displacement stress will predict long-term mental health status even after controlling for pre-displacement risk factors and baseline mental health. Primary Aim # 3: Prospective evaluation of mental health outcomes and the role of educational and vocational resources as protective factors.To evaluate the hypothesized protective role of institutional resources—including utilization of, for example, educational and vocational training—on the long-term mental health of Iraqi refugees, and determine whether these resources predict mental health outcomes differently for refugees and immigrants.
We expect that increased use of these resources will predict better long-term mental health, even after controlling for the influence of pre-displacement risk factors, post-displacement stressors, and baseline mental health. This research is highly innovative, in that it uses a randomly selected sample of newly arrived Iraqi refugees, an appropriate comparison group of non-refugee immigrants, a prospective design to determine long-term mental health outcomes, and the evaluation of the role played by post-displacement stressors and institutional resources. Our multi-disciplinary research team will take advantage of our excellent relationship to the Arab American and Chaldean community by applying a community-based participatory approach to address these important questions. This research will lead to improved scientific understanding of the relationship between social and institutional factors, service utilization, and mental health outcomes among refugees.