Author Affiliations: Columbia Presbyterian
Medical Center, New York, NY (Dr Porter); University of Melbourne, Melbourne,
Australia (Dr Haslam).
Context The global refugee crisis requires that researchers, policymakers, and
clinicians comprehend the magnitude of the psychological consequences of forced
displacement and the factors that moderate them. To date, no empirical synthesis
of research on these issues has been undertaken.
Objective To meta-analytically establish the extent of compromised mental health
among refugees (including internally displaced persons, asylum seekers, and
stateless persons) using a worldwide study sample. Potential moderators of
mental health outcomes were examined, including enduring contextual variables
(eg, postdisplacement accommodation and economic opportunity) and refugee
Data Sources Published studies (1959-2002) were obtained using broad searches of
computerized databases (PsycINFO and PILOTS), manual searches of reference
lists, and interviews with prominent authors.
Study Selection Studies were selected if they investigated a refugee group and at least
1 nonrefugee comparison group and reported 1 or more quantitative group comparison
on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4%
of identified reports), yielding 59 independent comparisons and including
67 294 participants (22 221 refugees and 45 073 nonrefugees).
Data Extraction Data on study and report characteristics, study participant characteristics,
and statistical outcomes were extracted using a coding manual and subjected
to blind recoding, which indicated high reliability. Methodological quality
information was coded to assess potential sources of bias.
Data Synthesis Effect size estimates for the refugee-nonrefugee comparisons were averaged
across psychopathology measures within studies and weighted by sample size.
The weighted mean effect size was 0.41 (SD, 0.02; range, −1.36 to 2.91
[SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement
conditions moderated mental health outcomes. Worse outcomes were observed
for refugees living in institutional accommodation, experiencing restricted
economic opportunity, displaced internally within their own country, repatriated
to a country they had previously fled, or whose initiating conflict was unresolved.
Refugees who were older, more educated, and female and who had higher predisplacement
socioeconomic status and rural residence also had worse outcomes. Methodological
differences between studies affected effect sizes.
Conclusions The sociopolitical context of the refugee experience is associated with
refugee mental health. Humanitarian efforts that improve these conditions
are likely to have positive impacts.
Porter M, Haslam N. Predisplacement and Postdisplacement Factors Associated With Mental
Health of Refugees and Internally Displaced PersonsA Meta-analysis. JAMA. 2005;294(5):602-612. doi:10.1001/jama.294.5.602