Post-traumatic stress disorder and life events among recently resettled refuges

Background: In refugee health, one topic is how important posttraumatic stress disorder (PTSD) is from a public health point of view. The present study was initiated in order to study the prevalence of PTSD through structured assessment in a group of recently resettled refugees, to study important classes of present life events and their interaction with health by means of qualitative and quantitative methods as well as hormonal markers. Further, associations between traumatisation, PTSD and alexithymia were of interest.

Subjects and methods: Participants eligible for the study were 18-48 years old recently resettled refugees from Iraq with at least five years of school. Eighty-six out of 321 eligible subjects participated. The study was prospective in design and used questionnaires in order to collect information about life events and self-reported health at baseline and three follow-up assessments every three months. At the same time, blood samples were collected and stored. At the end of data collection, samples were analysed for cortisol, thyroxine, prolactin, and dehydroepiandrosterone sulphate (DHEA-s). Participants were screened with a specific health interview, and subjects exceeding a low cut-off score - 75/86 - were examined with structured clinical assessment for posttraumatic stress disorder. Questionnaires were translated into Arabic and South Kurdic and back-translated.

Results: The prevalence of PTSD among the participants was 37,2 % and was higher among males than females, consistent with lower self-reported trauma exposure among females. The significant life events of importance for present health were distress in significant others, concerns related to issues of family reunion, and inordinate demands in the introduction programme. Housing problems were associated with deteriorated health in PTSD subjects. The pattern of cortisol changes was the same in PTSD and non-PTSD subjects, whereas there was an interaction with PTSD for DHEA-s. PTSD was associated with higher alexithymia score, but this was related to increased dysphoric affect. The health screening interview was without complications. Subjects with difficulties concentrating were 23 times more likely to have a PTSD diagnosis.

Conclusions: PTSD is prevalent in refugees. During the observation period, factors such as housing problems and self-perceived inordinate demands were associated with deteriorated health markers. Vulnerable subjects are easy to identify, and self-reported distress predicts deteriorated health. Distress in significant others abroad is a very prevalent stressor, and concern for significant others in the home country is thus a factor of importance for mental health in refugee populations. According to the longitudinal analysis, DHEA-s and related steroid molecules could be associated with patophysiology in PTSD. Recent life events are important for present health status of refugees and interact with previous traumatic experiences.

List of scientific papers

I. Sondergaard HP, Ekblad S, Theorell T (2001). Self-reported life event patterns and their relation to health among recently resettled Iraqi and Kurdish refugees in Sweden. J Nerv Ment Dis. 189(12): 838-45.
https://pubmed.ncbi.nlm.nih.gov/11794577

II. Sondergaard HP, Hansson LO, Theorell T (2002). Elevated blood levels of dehydroepiandrosterone sulphate vary with symptom load in posttraumatic stress disorder: findings from a longitudinal study of refugees in Sweden. Psychother Psychosom. 71(5): 298-303.
https://pubmed.ncbi.nlm.nih.gov/12207110

III. Sondergaard HP, Theorell T (2002). A longitudal study of hormonal reactions accompanying life events in recently resttled refugees. Psychotherapy and Psychosomatics. [Accepted]

IV. Sondergaard HP, Ekblad S, Theorell T (2002). Screening for post-traumatic stress disorder among refugees. Nordic J Psychiatry. [Accepted]

V. Sondergaard HP, Theorell T (2002). Alexithymia, emotions and PTSD; findings from a prospective study of refugees. [Submitted]