Post-migration stress among refugees – development of a new scale and associations with wellbeing

Abstract

Background: Trauma-afflicted refugees often report low subjective wellbeing and mental ill health. In addition to ill health related to pre-migration traumas, post-migration stress may contribute to the poor mental health and low wellbeing of refugees. There are currently only a few instruments for assessing post-migration stress. However, none of the existing instruments fully capture the wide variety of stressful experiences specifically faced by refugees. The current study describes the systematic development of a new measure for assessment of post-migration stress among refugees and preliminary results regarding its associations with wellbeing. Methods: A mixed-methods psychometric study comprising: construct conceptualization and initial item pool generation, linguistic and cultural adaptation, pre-testing of the scale by cognitive interviewing, content validity ratings (CVR’s) of items by an expert group, and correlational analysis with WHO-5 wellbeing index (n=41). Findings: Seven domains were conceptualized; perceived discrimination, lack of host country-specific competences, economic strain, loss of home country, home country and family concerns, social strain, and family conflicts. Cognitive interviewing, inter-item correlations and CVR’s resulted in a 24-item scale. CVI for items ranged between 0.83 and 1.0, and for the entire scale (S-CVI) was 0.95. 70.7 % (n=29) reported wellbeing below 13 on WHO-5, indicating poor wellbeing. Wellbeing was negatively associated with economic strain (r = -0.50, p < 0.01), and social strain (r = -0.46, p < 0.01). Discussion: Findings indicate preliminary support for the scale’s validity. Post-migration stress stemming from social and economic strains appear as predominant adversities in regard to wellbeing for refugees.