A supportive environment can improve refugees’ mental health

Photo courtesy of Daniel Vernon / Alamy Stock Photo.

Adapting to life in Canada: Feeling of isolation can erode refugees’ natural resilience

January 19, 2016

Close to 60 million people are displaced worldwide as a result of armed conflicts and wars. According to the United Nations High Commission for Refugees, an estimated 12 million Syrians have fled their homes since the outbreak of the Syrian civil war in March 2011. Many are victims of terror attacks, violence, or have witnessed war atrocities.

Under international law, legitimate refugees are entitled to protection and the Government of Canada has offered to provide a safe haven for several thousand Syrian refugees.

The traumatic events that caused refugees to flee their homeland and seek asylum in Canada have destabilized their sense of security. In addition, some are grieving the loss of loved ones and many fear for the safety of family and friends left behind.

Any existing mental health issues can be aggravated by the stress of migrating to a new country, which often comes with its own set of challenges in the best circumstances. Add to the mix the need to learn a new language, new social rules and acclimatize to life in a new culture, and it is easy to understand why some refugees may be dealing with severe stress or mental health issues.

Refugees coming to Canada will bring different customs and cultural expectations with them. These same differences can lend themselves to misunderstandings when health care providers are trying to diagnose mental health disorders such anxiety, depression and post-traumatic stress is how symptoms are reported by their patients.

Researchers, like Ms. Daina Crafa, whose work is funded in part by the Canadian Institutes of Health Research, have been studying ways to help ensure the successful integration of refugees resettling in foreign lands. She is at the forefront of advances in clinical interventions to detect the markers of emotional distress, including new interview tools.

By asking culturally appropriate questions, clinicians are now better able to identify the signs of distress that may vary greatly depending on cultural background. As with any illness, early detection of mental health issues will lead to early intervention and potentially better outcomes.

Daina Crafa
Photo courtesy of Mark Hengge.

Audio – Interview with Ms. Daina Crafa


Mr. David Coulombe: This is David Coulombe for CIHR’s Health Research in Action news. In light of the current discussions surrounding migrant and refugee crises, we ask ourselves where do we stand in terms of research on immigration and mental health, more specifically the effects of trauma or war on immigrants’ mental health?

Our guest today is Daina Crafa, a CIHR recipient of the Vanier Canada Graduate Scholarship Program. Daina, welcome to the interview.

Ms. Daina Crafa: Hi David. Thanks a lot for having me on the podcast.

Mr. David Coulombe: So first question, is there an impact in terms of mental health for refugees coming to Canada?

Ms. Daina Crafa: Yes, there is, and it’s something that can be positive or negative. So on the negative side, you know, migrating into a new country is a very challenging process. It can take a large toll on anyone’s mental health. You have to learn a lot of new social rules. You have to learn how to find new resources. It’s very common to feel isolated. Migrating is especially challenging for refugees. They have gone through some very traumatic events. You know, they’ve been in wars zones. They’ve experienced terrorist acts. Some of them are victims of torture, and they might also have had to leave friends and loved ones behind in the country that they’re coming from. So they’re really dealing with a lot of emotions.

In the worst case, this much stress – you know, the stress and traumas of being a refugee but then also of immigrating – may actually aggravate existing mental health issues, but it also depends a lot on what kind of environment they’re migrating into. So if they feel safe and they have enough resources and their loved ones are safe, then migrating can really positively affect mental health. They can start to heal, you know, from the trauma they’ve just been through.

Mr. David Coulombe: So mental health is really the number one issue?

Ms. Daina Crafa: It’s extremely important, definitely. It’s very important to have good mental health after migration, but I actually would argue that discrimination may be the number one issue. When refugees experience discrimination in their new country, it makes them feel less safe and reduces the feelings of self-worth and desire to adapt. Refugees really need to feel safe. They, you know, have lost friends and family in war and they’ve gone through so much that they’re just looking for a safe place to live so that they can heal, and discrimination can really undermine that process and shake their resilience.

Mr. David Coulombe: You have talked a bit about this, but what is the effects of war or major trauma on immigrants’ mental health?

Ms. Daina Crafa: Well, that is the question, David. It’s going to be different for everyone. So depression, anxiety and PTSD are common for people like refugees who are coming from war zones or have witnessed, you know, war atrocities. The effects of war on individual mental health can be difficult to predict and a lot of people are very resilient, but scientists and therapists are still looking for ways to identify who’s most likely to be affected and how to help them best deal with emotions.

Mr. David Coulombe: Maybe a last question for you, Daina. So where do we stand in terms of research in that field?

Ms. Daina Crafa: Well, the major challenge with treating refugees is that they’re not all coming from the same country and this can make them very difficult to diagnose, because when you’re treating someone from a different cultural background, they may also describe their symptoms differently.

So, for example, Canadians who feels anxious may be more likely to report an upset stomach or fidgeting, but patients from other countries might be more likely to report something like feelings of itchiness or burning. So if you don’t know what you’re looking for as a clinician, you might actually miss really important signs of emotional distress.

Researchers are working on this in cultural mental health right now. They’ve actually developed a new interview tool that helps clinicians ask foreign patients better questions in order to identify signs of distress that could vary by cultural background. And this has really been a major advance in clinical intervention.

Mr. David Coulombe: Very interesting. Thank you very much, Daina Crafa.

Ms. Daina Crafa: Of course. Thank you.

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