Common Mental Health Challenges Among Refugee Families

The challenges associated with being a refugee or asylum-seeker can take a significant toll on individual and family mental health. Refugee families may be at a higher risk of stress, relationship conflicts, mental illness, and more. These challenges often continue after arriving in a new country, where there are typically new stressors and where getting mental health support can be difficult for various reasons. Read on to learn more about the mental health challenges refugee families may face, plus common barriers to care and resources that may help.

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Common mental health challenges refugee families may experience

Some common mental health concerns that may affect refugee families include the following.

Post-traumatic stress disorder (PTSD)

PTSD can develop after a person experiences or witnesses a traumatic event. Some common causes of PTSD include war, natural disasters, car accidents, and sexual assault. Refugees may be at increased risk of PTSD as a result of what they’ve been through in their home country, during their journey to a new place, and/or when they arrive in a new place.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), some common symptoms of PTSD may include:

• Having intrusive memories or dreams of the traumatic event
• Avoiding reminders of the event
• Lasting feelings of shame, horror, anger, and/or guilt
• Loss of interest in activities once enjoyed
• Being easily startled
• Behaving dangerously or recklessly
• Physical symptoms, like muscle pain, headaches, stomachaches, and trouble sleeping

Depression

Major depressive disorder, also called MDD or simply “depression,” is a mental illness that can cause periods of intense sadness along with other mental and physical symptoms. Depression can have multiple causes, including genetics and life experiences. Stressful life events—which, for refugees, may include the stress of being displaced—may also trigger depressive episodes in some people. According to the DSM-5, some common symptoms of major depressive disorder may include:

• Lasting feelings of sadness, guilt, and/or worthlessness
• Loss of interest in activities once enjoyed
• Trouble concentrating 
• Low levels of motivation and energy
• Eating too much or too little
• Sleeping too much or too little
• Thinking about death or self-harm

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

Anxiety

There are various types of anxiety disorders, but generalized anxiety disorder (GAD) is one of the most common. GAD can make people worry excessively about future events. Stressful and traumatic events may make people more likely to develop anxiety—and because anxiety disorders often have a genetic component too, members of some families may be especially vulnerable to them. According to the DSM-5, symptoms of generalized anxiety disorder may include things like:

• Worrying excessively, to the point that it interferes with daily life
• Feeling unable to control one’s worrying
• Restlessness, irritability, and a feeling of being “on edge”
• Trouble concentrating
• Muscle tension
• Trouble sleeping

Social isolation

Although social isolation isn’t a mental illness itself, loneliness may raise the risk of mental health disorders like depression and anxiety. It may also contribute to negative physical health outcomes. Especially once they’ve moved to a new country, refugee families may be at an increased risk of social isolation and its side effects due to being far from relatives, facing language barriers, and other factors. In a 2022 study, researchers interviewed a group of migrant mothers with young children about their experiences. They noted that among the interviewees, social isolation was a common theme.

Family conflict

The stress of being a refugee can also put a strain on relationships between family members. As a result, family conflict could increase as well, which may particularly affect the mental health of children. According to a 2018 research summary, conflict between parents may negatively impact their children’s mental, emotional, and behavioral health. 

Barriers to receiving mental health care commonly faced by refugees

The World Health Organization reports that despite often having an increased need for mental health care, many refugees may struggle to get it. This can happen for a variety of reasons, including the following.

Mental health stigma

Mental health stigma can make people with a mental illness experience shame, guilt, isolation, and other negative emotions about themselves as a result of their condition. Stigma around reaching out for mental health support is also common and may be more prevalent in some cultures than others. 

Stigma of various types related to mental health commonly affects refugee families, which can decrease the likelihood of them seeking help. For example, findings from a 2019 study analyzing the experiences of 103 refugees suggest that those who felt higher levels of stigma were less likely to seek help for symptoms of PTSD. 

Visa status

People applying for asylum or refugee status may avoid seeking mental health support due to uncertainty about their status. The same 2019 study cited above found that asylum seekers with an “insecure” visa status were less likely to seek help for mental health concerns. The researchers suggest that this may be because people with an insecure visa status may be more likely to be separated from their family members. This can limit their social networks, making it harder to find care and get transportation to mental health appointments. Language barriers and cost are likely also contributing factors.

Language barriers

As the US Committee for Refugees and Immigrants explains, language services are supposed to be offered to refugees and others who get mental health care through their insurance. However, health insurance may not be available to all refugees for various reasons, and even when it is, this law regarding translation services is rarely enforced. Mental health providers may also not be aware of language support options, further limiting a refugee’s ability to communicate. This can make it harder to find and receive care. 

Limited mental health services

Limited availability of mental health services like counseling may also be a contributing factor. In a 2023 report summarizing barriers to mental healthcare for refugees in the US, researchers explain that service providers often have long waiting lists. There are also limited resources dedicated to screening refugees for mental illnesses and referring them for treatment. 

Getting mental health support as a refugee

Despite the barriers, there are mental health resources that refugees may be able to connect with to improve their mental health and well-being. If you’re looking for mental health support as a refugee, you might inquire with your local health department, as they often have programs providing physical and mental health services specifically for refugee families. In addition, many community mental health clinics provide mental health screenings, counseling, and medication management, often for little to no cost. Finally, humanitarian organizations and nonprofit groups may also provide assistance, such as mental health services, to newly arrived refugees.

Examples of some specific resources that may help refugees get connected with mental health care and other services include:

• The UN Refugee Agency
• National Network for Immigrant and Refugee Rights (NNIRR)
• USAHello
• The National Alliance on Mental Illness (NAMI)

Therapy may be a particularly useful mental health resource for refugees experiencing challenges like those covered here. By working with a therapist, clients may learn to manage stress, develop healthy coping strategies, and better maintain their long-term mental health. However, for those who may not have the ability to get insurance, finding affordable therapy can be difficult. According to 2023 statistics from Mental Health America, cost is the reason reported by the majority of American adults with an unmet mental healthcare need for why they don’t receive treatment. 

Online therapy may be a more affordable and convenient option for receiving mental health care, since online sessions typically cost less than in-person ones. Studies also suggest that, in many cases, online therapy can effectively treat the types of mental health conditions that tend to affect refugees. In 2017, researchers analyzed existing data from 373 studies on online cognitive behavioral therapy (CBT). Their findings suggest that online therapy can be an effective treatment for generalized anxiety disorder, depression, PTSD, and other mental illnesses.