Mental Health Symptoms in Iraqi Refugees: Posttraumatic Stress Disorder, Anxiety, and Depression
Jamil, Hikmet, Farrag, Mohamed, Hakim-Larson, Julie, Kafaji, Talib, Abdulkhaleq, Husam, Hammad, Adnan, Journal of Cultural Diversity
Abstract: Refugees suffer from a higher rate of mental health symptoms than the general population since they have experienced extreme suffering and the accumulated effects of trauma. Because of the diversity of regions from which refugees originate, there is a need to understand some of the unique experiences that are specific to each sub-groups of immigrants. The purpose of the present study was to explore mental health symptoms in Iraqi refugee clients who immigrated to the United States after the Gulf War of the early 1990's. As part of a larger study, 116 adult Iraqi immigrants to the United States (46 male, 70 females) who were seeking mental health services completed measures of anxiety, depression, and posttraumatic stress disorder. As expected, the majority of refugees reported intense anxiety and depression, and many met the DSM IV criteria for posttraumatic stress disorder. Like refugees from other countries-of-origin, Iraqi refugees are in need of culturally sensitive assessment and mental health treatment. The results are discussed in light of the treatment needs of Iraqi refugee clients, their resilience and motivation for a better life, and the ways that health professionals can assist in optimizing their adjustment.
Key Words: Posttraumatic Stress Disorder, Iraqi,Rrefugees, Arab American, Trauma
Between the Persian Gulf War of 1991 and the year 2000 approximately 40,700 Iraqi immigrants settled in the United States (Cainkar, 2000), and of these 29,076 qualified as refugees (U.S. Committee for Refugees, 2000). Given that the plight of refugees continues to be a worldwide problem into the 21st century (U.S. Committee for Refugees, 2004), health professionals are increasingly likely to be faced with the task of treating refugees who have been victims of torture and displacement due to political upheaval (Maratta, 2003). Thus, it is important for health professionals to enhance their understanding of the factors affecting refugees that may impact upon routine clinical assessments, diagnoses, and treatment protocols.
Recent studies on refugees from Europe, Africa, the Middle East, South America, and Asia, have demonstrated that refugees often suffer from more symptoms of depression, anxiety, and posttraumatic stress disorder, and more health problems than people who immigrate for other reasons (e.g., Ai, Peterson, & Ubelhor, 2002; Bhui et al., 2003; Hondius, van Willigen, Kleijn, & van der Ploeg, 2000; Jamil, HakimLarson, Farrag, Kafaji, Duqum, & Jamil, 2002; Keyes, 2000; Steel, Silove, Phan, & Bauman, 2002). It has been argued that past and ongoing social, political, and economic factors play a key role in the life experiences and adaptation of refugees; thus, psychiatric classification and treatment of their difficulties is likely insufficient in addressing all of the refugees' underlying needs, including those involving safety and preservation of basic human rights (e.g., Gorman, 2001; Waiters, 2001). However, community health agencies are nonetheless faced with the task of providing help to individuals with traumatic histories, and of assessing their state of mental health for the purpose of optimizing their treatment services and outcomes. On the basis of her review of empirical studies conducted on refugees from many different cultural backgrounds in the 1980's and 1990's, Keyes (2000) suggested that clinicians incorporate refugee-specific assessment and treatment practices into their repertoire of clinical skills. While many responses to the refugee experience may be universal, others vary by culture.
In the early 1990's, mental health therapists in Europe and the United States who work with immigrants from the Middle East noticed an influx of refugees from Iraq who were seeking services for symptoms related to their traumatic histories (e.g., Gorst-Unsworth & Goldenberg, 1998; Takeda, 2000). The refugees from Iraq suffered "cumulative trauma" before their immigration since they experienced the effects of the 1980s war with Iran as well as the Persian Gulf War of the early 1990s (Kira, 1999). …