Self-harm and suicide among asylum seekers and refugees: A call to researchers

By Katerina Kavalidou and Alessio Albanese.

The United Nations’s refugee agency (UNHCR) has recently published an annual Global Trends Report showing that currently, nearly 79.5 million people are forcibly displaced worldwide. Whilst the majority are internally displaced (around 46 million), 26 million are refugees and 4.2 million are asylum seekers [1]. Though often discussed together, asylum seekers and refugees are highly heterogeneous groups, and their social, cultural and health needs differ significantly, also in relation to their current legal status and their migration experiences.

This is particularly noteworthy in relation to asylum seekers’ and refugees’ experiences of mental health. As risk factors for the development of mental health issues are rooted within social circumstances [2], it is pivotal to discuss the life difficulties and potentially traumatic life experiences that asylum seekers and refugees endure, and how these can impact on their wellbeing. For example, it is increasingly evident that asylum seeking and refugee populations are disproportionately more impacted by social determinants of mental health; including substandard housing, poor access to food, unemployment, discrimination, poverty and destitution [3]. Furthermore, asylum seekers are more likely to endure migration detention and hostility at border checkpoints. These are often compounded by negative pre-migration experiences, such as political, sexual and religious persecution, rape, torture, famine and war [4].

Whilst different prevalence studies report variation in terms of mental health issues in these populations [5], mood and anxiety disorders are indicated to be higher amongst asylum seekers and refugees in comparison to the general population in the host country; and post-traumatic stress disorder (PTSD) is reported to occur more often in refugee groups compared to the general population in the host country [2]. However, due to ethnic differences and culturally rooted expressions of distress in these populations, available prevalence rates of mental distress could be over or under-estimated by standard diagnostic tools developed in the Global North [2].

Beside common mental health issues, studies from Australia highlight that prolonged uncertainty and feelings of being trapped among asylum seekers may lead to suicidal behaviours [6]. However, there is scarce evidence of suicide and self-harm among refugees and asylum seekers from other hosting countries [7]. To that end, a recent systematic review presented the lack of studies investigating self-harm among asylum seekers and refugees in Europe and suggested whether this is related to academia having the tendency to relate self-harm with syndromes and not seeing it as a clinical entity on its own [8]. The authors of this latter review further indicated that unaccompanied minors have an evident risk of self-harm in the few studies conducted on them, mainly from the UK, Sweden and Belgium [8].

Approximately 856,723 refugees and asylum seekers reached Europe alive in 2015, mainly through the Greek islands, and have put their “lives in waiting” [9]. The media has given a lot of attention to the living conditions of those refugees, with details on the number of people who have self-harmed within these centres. However, no research attention has been given from experts in suicide prevention in this regard. Indeed, psychological models of suicidal behaviour place entrapment issues – often experienced by those within refugee camps – as predominant suicide risk factors and can further explain the high prevalence of self-harm in refugee camps [10].

Given the difficulties in understanding the meaning of self-harm among refugees and asylum seekers through the already established medical and psychological theories of self-harm, we need more experts in suicide prevention leading studies for these vulnerable populations in order to intervene and alleviate their pain.

References

1. 1. 2020. Figures At A Glance – UNHCR Philippines. [online] Available at: <https://www.unhcr.org/ph/figures-at-a-glance&gt; [Accessed 18 August 2020].
   2. Hirani, K., Payne, D., Mutch, R., & Cherian, S. (2016). Health of adolescent refugees resettling in high-income countries. Archives of disease in childhood, 101(7), 670-676.
   3. Porter, M., Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta analysis. Jama, 294(5), 602-612.
   4. 2020. Regional Office for Europe. Mental health promotion and mental health care in refugees and migrants. Copenhagen.
   5. Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365(9467), 1309-1314.
   6. Procter, N.G., Kenny, M.A., Eaton, H. and Grech, C. (2018), Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration. Int J Mental Health Nurs, doi:10.1111/inm.12325
   7. Vijayakumar L (2016). Suicide Among Refugees–A Mockery of Humanity. Crisis. doi:10.1027/0227-5910/a000385
   8. Gargiulo, A., Tessitore, F., Le Grottaglie, F. and Margherita, G. (2020), Self‐harming behaviours of asylum seekers and refugees in Europe: A systematic review. Int J Psychol. doi:10.1002/ijop.12697
   9. Bjertrup PJ, Bouhenia M, Mayaud P, Perrin C, Ben Farhat J, Blanchet K. (2018). A life in waiting: Refugees’ mental health and narratives of social suffering after European Union border closures in March 2016. Soc Sci Med. doi:10.1016/j.socscimed.2018.08.040
   10. Kavalidou K (2019). Brief mental-health training as a suicide intervention in Greek refugee camps. Scandinavian Journal of Public Health. https://doi.org/10.1177/1403494819828873

Alessio Albanese (@alessio_alba) is a PhD student in the department of General Practice and Primary Care, University of Glasgow (a.albanese.1@research.gla.ac.uk) and a CBT therapist attached to a GP surgery in Possil, Glasgow.

Katerina Kavalidou (@KKavalidou) is a Postdoctoral researcher at the National Suicide Research Foundation in Ireland.

*Featuring Photo by pixpoetry on Unsplash.