Post-migration and stigma-based factors influencing mental health among refugees and sexual minority migrants

This thesis investigated how experiences in the new country of residence influence mental health among two subgroups among migrants that have been shown to be at heightened risk of developing poor mental health: refugees and sexual minorities (i.e., individuals identifying as lesbian, gay, bisexual, or other non-heterosexual orientation).

The first study showed that refugees from Syria recently resettled in Sweden had high levels of poor mental health, including depression, anxiety, posttraumatic stress disorder (PTSD), and low subjective wellbeing. More than half of the participants in the study met criteria for at least one of the studied types of poor mental health. A majority of the participants further had experienced several traumas in Syria and across the migration route, including war, loss of loved ones, and physical and sexual violence, including torture. Stressful experiences in Sweden, like feeling isolated or excluded, having financial difficulties, feeling disrespected because of oneŐs origin, and being sad because of not being reunited with family members, were also common. Those who had often had these types of stressful experiences were more likely to suffer from poor mental health compared to those who had not had these experiences often.

The second study described the development of an instrument for assessing post-migration stress among refugees, the Refugee Post-Migration Stress Scale (RPMS). The RPMS was used in the first study, and data from that study was used to test whether the instrument assessed post-migration stress in the way that we intended. The second study showed that the RPMS is an instrument wellsuited for assessing post-migration stress among refugees.

The third study showed that sexual minorities who had migrated to Sweden were at greater risk of poor mental health compared to heterosexuals born in Sweden. This risk was similar to that found among sexual minorities born in Sweden. Sexual minority migrants born outside of Europe were, however, no more likely than heterosexuals born in Sweden to have received psychiatric treatment, despite the greater risk of mental health symptoms in this group. Interestingly, sexual minority migrants born outside of Europe were less likely to have experienced discrimination compared to Swedish-born sexual minorities, which impacted the risk of poor mental health.

The fourth and final study showed that sexual minorities in Europe who had a migration background or identified as being ethnic minorities were at greater risk of depressive symptoms compared to sexual minorities with no migration background or ethnic minority status. They were also more likely to have been exposed to discrimination because of their sexual orientation, and to threats or violence, and they were more likely to conceal their sexual orientation. The study further showed that sexual minority individuals Đ both those with migration background or ethnic minority status and those without Đ residing in countries characterized by laws and policies that fail to protect or even discriminate against sexual minorities, and with negative population attitudes towards sexual minorities, were at greater risk of depressive symptoms and sexual orientation concealment compared to those living in countries with more favorable structural climate for sexual minorities.

Taken together, the findings in this thesis show that factors in the new country of residence, including stressful experiences of discrimination, social isolation, financial difficulties and family separation, and stigma towards sexual minorities, including unfavorable laws and policies, negative social attitudes, and experiences of discrimination, have adverse effects on the mental health of refugees and sexual minority migrants. These findings point to the importance of reducing post-migration stress and stigma towards sexual minorities.

List of scientific papers

I. Tinghšg P, Malm A, Arwidsson C, Sigvardsdotter E, Lundin A & Saboonchi F. Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey. BMJ open. 2017;7.
https://doi.org/10.1136/bmjopen-2017-018899

II. Malm A, Tinghšg P, Narusyte J & Saboonchi, F. The Refugee Post-Migration Stress Scale (RPMS) Đ development and validation among refugees from Syria recently resettled in Sweden. Conflict and Health. 2020.
https://doi.org/10.1186/s13031-019-0246-5

III. Malm A, Tinghšg, P & BrŠnstršm, R. Differences in mental health symptoms and treatment for common mental disorders by sexual orientation and migration background in a population-based sample. [Submitted]

IV. Malm A, Tinghšg, P & BrŠnstršm, R. Depressive symptoms and stigma among sexual minority individuals with migration background or ethnic minority status: an investigation of sexual orientation structural stigma and migrant structural stigma across 30 European countries. [Manuscript]