Refugee Mental Health in the United States: An Intersectional Approach

Updated: Apr 28

Concerns over refugee mental health have risen over the years, yet inequities in mental health outcomes persist. In the U.S., there is an excess mental health burden among refugees. The lifetime prevalence of PTSD among refugees is 31.46% [1], which is approximately 4.5 times the lifetime prevalence of PTSD in the U.S. general population, 6.8%. [2]Similarly, the lifetime prevalence of any depressive disorder among refugees is 31.5% [3], about 4.4 times the lifetime prevalence in the U.S. general population.[4] The mental health burden does not fall on all refugees equally, with female identifying refugees being reported to face a higher prevalence of mental health issues than male refugees.[5] While refugees often face trauma in their home country and it is logical that trauma leads to mental health challenges, the prevalence and persistence of these mental health issues among refugees in the U.S. raise concerns: what factors may be working to produce and sustain excess the mental health burden among refugees in the U.S. and how can we intervene to address this inequity in mental health status? This essay aims to examine historical approaches of ameliorating the mental health burden experienced by refugees, apply the lenses of intersectionality and colonialism/imperialism in public health to understand how refugee mental health is shaped, and offer practical changes to how we approach developing interventions targeting refugee mental health.


Background

The United Nations High Commissioner on Refugees (UNHCR) defines a refugee as “someone who has been forced to flee his or her country because of persecution, war, or violence [and]. . . has a well-founded fear of persecution”.[6] The U.S. has consistently accepted large numbers of refugees since 1980[7] and as a participating member of the UN, the U.S. is supposed to follow the 1951 Refugee Convention and 1967 Protocol. Outlined in the 1951 Refugee Convention are the rights accorded to refugees and the responsibilities of the countries providing refugee resettlement. According to Article 23 of the 1951 Convention, “The Contracting States shall accord to refugees lawfully staying in their territory the same treatment with respect to public relief and assistance as is accorded to their nationals”.[8] While there is parity on paper, the persistent excess mental health burden experienced by refugees begs the question, “What factors are producing these inequitable mental health outcomes?”

To begin to understand why refugees are experiencing an excess mental health burden in the U.S., one may benefit