Academic journal article European Journal of Psychotraumatology

Effects of Acculturative Stress on PTSD, Depressive, and Anxiety Symptoms among Refugees Resettled in Australia and Austria

Academic journal article European Journal of Psychotraumatology

Effects of Acculturative Stress on PTSD, Depressive, and Anxiety Symptoms among Refugees Resettled in Australia and Austria

Article excerpt

Epidemiological research in the area of posttraumatic mental health indicates that prior trauma is a significant predictor of posttraumatic stress disorder (PTSD) (Ozer, Ozer, Best, Lipsey, & Weiss, 2008), and that depressive and anxiety symptoms are prevalent comorbid outcomes of traumatic experiences in general (Australian Centre for Posttraumatic Mental Health, 2013) and refugee populations (Fazel, Wheeler, & Danesh, 2005; Kirmayer et al., 2011; Steel, Silove, Phan, & Bauman, 2002; Steel et al., 2009). In addition, challenges associated with migration to a new country have been found to increase the risk of mental health problems in refugees (Porter & Haslam, 2005; Steel, Silove, Bird, McGorry, & Mohan, 1999; Steel et al., 2002). These post-migratory challenges are often related to acculturation, defined as the process of simultaneous participation with the new culture and maintenance of the origin culture and identity (Berry, 1997). Acculturation is mutually influenced and changed by attitudes of the individual as much as the attitudes and preferences of the ethnic and host groups (Berry, 2003). The consequences of the process of acculturation have been found to be substantial and to influence mental health outcomes in migratory groups and individuals (Bhugra, 2004; Sam & Berry, 2010).

Research has found inconsistent results indicating positive, negative, or no association between acculturation and mental health outcomes in refugees (Aichberger et al., 2015; Berry, Phinney, Sam, & Vedder, 2006; Bhugra, 2003; Birman & Tyler, 1994; Escobar & Vega, 2000; Li & Anderson, 2015; Molsa et al., 2014; Schwartz, Schwartz, Unger, Zamboanga, & Szapocznik, 2010; Syed et al., 2006). Furthermore, most empirical evidence has concentrated on exploring the acculturative process of the individual without exploring the impact of the host society, which has been suggested to be important in understanding the full process of acculturation and stress associated with migration (Schwartz et al., 2010). The question therefore remains whether the influence of postmigratory demands on mental health differs based on the individual's acculturation process alone, or is it also dependent on the characteristics of the local context reflecting the acculturative preferences of the host society.

This study examines the relative contribution of premigratory traumatic experiences and post-migratory acculturative stress in predicting mental health outcomes in Bosnian refugees who have resettled in two countries and explores the potential role of the local context in the acculturative process.

Traumatic exposure, acculturation, and mental health outcomes

Research evidence suggests that refugees are exposed to multiple, sometimes extreme traumas such as torture, rape, or death of family members (Steel et al., 1999, 2002), which puts them at higher risk for developing serious mental health problems (Steel et al., 2009). Compared to the general population, refugees can be about five to ten times more likely to present with depression and PTSD symptoms respectively (Fazel et al., 2005). While there is substantial evidence to indicate that trauma exposure is a risk factor for PTSD, depression, and anxiety symptoms (Ozer et al., 2008; Steel et al., 2009), empirical evidence on the relationship between acculturation and mental health is less consistent. Some research suggests that higher levels of acculturation with the host culture are associated with better mental health, while others reported that higher levels of acculturation with the host culture is associated with worse mental health outcomes-a phenomenon named the "immigrant paradox" (for discussion see: Berry et al., 2006; Bhugra, 2003, 2004; Schwartz et al., 2010). Specific acculturative factors however, present a more consistent relationship with mental health. For example, acculturative stress experienced in response to migratory challenges is regularly identified as a significant risk factor for mental health problems (Berry, 2006b; Bogic et al. …

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