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      The Social Determinants of Refugee Mental Health in the Post-Migration Context: A Critical Review

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      The Canadian Journal of Psychiatry
      SAGE Publications

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          Abstract

          With the global increase in the number of refugees and asylum seekers, mental health professionals have become more aware of the need to understand and respond to the mental health needs of forced migrants. This critical review summarizes the findings of recent systematic reviews and primary research on the impact of post-migration conditions on mental disorders and PTSD among refugees and asylum seekers. Historically, the focus of mental health research and interventions with these populations has been on the impact of pre-migration trauma. Pre-migration trauma does predict mental disorders and PTSD, but the post-migration context can be an equally powerful determinant of mental health. Moreover, post-migration factors may moderate the ability of refugees to recover from pre-migration trauma. The importance of post-migration stressors to refugee mental health suggests the need for therapeutic interventions with psychosocial elements that address the broader conditions of refugee and asylum seekers' lives. However, there are few studies of multimodal interventions with refugees, and even fewer with control conditions that allow for conclusions about their effectiveness. These findings are interpreted using a social determinants of health framework that connects the risk and protective factors in the material and social conditions of refugees' post-migration lives to broader social, economic and political factors.

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          Most cited references29

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          The mental health of civilians displaced by armed conflict: an ecological model of refugee distress.

          Early research on the mental health of civilians displaced by armed conflict focused primarily on the direct effects of exposure to war-related violence and loss. Largely overlooked in this war exposure model were the powerful effects of ongoing stressors related to the experience of displacement itself. An ecological model of refugee distress is proposed, drawing on research demonstrating that mental health among refugees and asylum seekers stems not only from prior war exposure, but also from a host of ongoing stressors in their social ecology, or displacement-related stressors. Implications of this model for addressing the mental health and psychosocial needs of refugees and other displaced populations are considered.
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            How economic, humanitarian, and religious concerns shape European attitudes toward asylum seekers

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              Health psychology: developing biologically plausible models linking the social world and physical health.

              Research over the past several decades has documented psychosocial influences on the development and progression of several major medical illnesses. The field is now increasingly focused on identifying the biological and behavioral mechanisms underlying these effects. This review takes stock of the knowledge accumulated in the biological arena to date and highlights conceptual and methodological approaches that have proven especially productive. It emphasizes the value of a disease-centered approach that "reverse engineers" adverse health outcomes into their specific biological determinants and then identifies psychologically modulated neuroendocrine and immunologic dynamics that modulate those pathological processes at the cellular and molecular levels.
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                Author and article information

                Journal
                The Canadian Journal of Psychiatry
                Can J Psychiatry
                SAGE Publications
                0706-7437
                1497-0015
                December 04 2017
                December 04 2017
                May 2018
                : 63
                : 5
                : 297-303
                Affiliations
                [1 ]Department of Psychology, York University, Toronto, Canada
                Article
                10.1177/0706743717746666
                5912301
                29202665
                c7d10507-f09d-4933-8993-ad885edff5f4
                © 2018

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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