A Qualitative Synthesis of the Drivers and Expressions of Mental Distress in Refugees.

Introduction

This review explored the ways in which refugees express mental distress, privileged the many voices of refugees from across the research and offered subsequent implications.



Methods

Five databases were searched; PsychInfo, SocINDEX, Scopus, Medline (EBSCO) and Web of Science between 20/09/2013 to 27/10/2023. Inclusion criteria: only qualitative research published within the last 10 years which represented the voices of refugees sufficiently enough for thematic analysis; participants aged 18 years or older who identified as being within any stage of the asylum-seeking process.



Results

A total of 10 papers were included, which accumulated the voices of 204 refugees. Samples of refugees from 6 different countries were included; Syria, Iraq, Burma, Sri Lanka, Eritrea and Bhutan. Three overarching themes were apparent: Drivers of Distress, Expressions of Distress and Coping with Distress. Expressions of Distress were inextricably linked to the Drivers of Distress and how people voiced Coping with Distress. Drivers of distress were commoly reoprted in the post migration period arising from cultural conflict, racism, issues with access to health services and most notably, experinces of hostile asylum systems.



Discussion

Limitations were noted in the reviewed studies, including: a lack of prioritization of the refugee’s voice; lack of diversity in authorship; lack of researcher reflexivity and in-depth ethical considerations; and that the use of participants’ mother tongue to convey expressions of mental distress was only observed in 1 of the studies. Implications include a need to address post migration drivers of distress, through international governmental improvements to the asylum-seeking processes and social justice work. 



Conclusions

An appreciation of the diversity of expressions of distress through humility and practitioner reflexivity is crucial, alongside taking a strengths focused and community-based approach when working with refugees.