dr. M. Dekker
dr. M. Keestra
drs. S. Sitalsing
prof. dr. F. van Vree
drs. L. Wenting
The Netherlands has been a ‘multi-cultural’ society for many centuries, with refugee populations from the 17th Century onwards. In the first years of this new millennium, with the new restricting laws on the acceptance of refugees, the number of refugees decreased: there were 69,620 refugees in the Netherlands in the period between 2000 and 2010. However, with new conflicts like the ones in Syria and Iraq, this number increased again in the most recent years. In 2015, there were 88,256 settled refugees and 28,051 refugees who were still waiting for a decision on their request. The prediction is that these numbers will vary in the coming years, as they are among others dependent on the armed conflicts in the world. But it is not only the total number that we should be looking at: we should not neglect the individual.
The refugees in the Western world form a very divergent group of people, as they originate from more than hundred different countries. They therefore bring along a wide range of ideas, life styles, religions, norms, and values. Some of these are similar to those in the West; some are very different. Some refugees are very religious people, some are more urbanized persons, and sometimes these two apparent extremes are mixed in the same individual. How do all these different individuals integrate in the modern Western world? How do negative experiences from their past influence this integration? What psychological and social factors determine their ability to adjust to their new environment? This article describes different psychological problems that refugees are suffering from after they arrive in the Western world, and discusses the factors that underlie these problems.
Refugees with psychological problems
Most refugees have experienced gruesome events in wartime: bombardments, shooting, confrontations with dead and heavily wounded persons, hunger, and a lack of physical protection. Some were imprisoned and tortured or abused. Others lost their family by political murders or war, or experienced relatives gone missing, not knowing if they are dead or alive. These relatives are most likely to be dead, but their bodies have not been found yet.1 Refugees have traveled to Western Europe through countries where they were not welcome, and most of them have had difficulties getting through the closed borders of ‘fortress Europe’. Concurring this fortress has cost them lots of energy and money; a reason why mostly only refugees of the high and middle class incomes succeed in arriving in Western Europe. Every single refugee arriving in the Netherlands has gone through situations as described above.2,3,4
It is therefore no surprise that refugees suffer from mental disorders, most notably post-traumatic stress disorder (PTSD) and depression. Review studies from the United States have shown a high level of distress among refugees, but also large variations in the prevalence rates of these disorders.5 The large differences are mostly due to the different circumstances the refugees have experienced, but methodological differences between the studies cannot be neglected. Fazel and colleagues (2005) found in their review that PTSD and depression rates were about ten times higher in refugees’ populations than in the age-matched general population. To put some numbers on there: Steel and colleagues (2009) concluded that the prevalence rate for PTSD in refugees was 30.6% and that for depression 30.8%. To compare: in the general population in the United States, the PTSD prevalence over a lifetime is 6.1% 6 and that for depression is 16.6%.6,7
Studies performed in the Netherlands also showed higher numbers of disorders among refugees than in the general population. Gernaat and colleagues (2002) found in a study of Afghani refugees that 57% of them suffered from depression and 35% of them had PTSD.8 Laban and colleagues (2005) found in Iraqi refugees that 41% of the men and 61% of the women suffered from depressive disorders. Also the prevalence of PTSD was higher in the women: 57%, compared to 40% of the men.
Tekst loopt door onder de afbeelding.
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8. Gernaat, H.B.P.E., A.D.Malwand, C.J.Laban, I.Komproe en J.T.V.M. de Jong (2002). Veel psychiatrische stoornissen bij Afghaanse vluchtelingen met verblijfsstatus in Drenthe, met name depressieve stoornis en posttraumatische stressstoornis.[Many psychiatric disorders in Afghani refugees with a permit to stay in Drenthe, specially depression and PTSD]. Nederlands Tijdschrift voor Geneeskunde, (146): 1127-31
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