Forced Migration and Triple Trauma across Migration Stages: Mental Health Outcomes

Background and Purpose:

Refugees are forced to leave their homelands because of war, conflict, violence, and religious or political persecution. Their journey is often marked by traumatic experiences at each stage of migration. Even though there is significant research on refugees’ mental health, there is a scarcity of studies on the cumulative impact of trauma across the migration journey. Each stage of migration presents unique challenges that can have long-term effects on mental health. Greater exposure to traumatic experiences at each stage increases the risk of poor mental health outcomes among refugees.

Africa has experienced large-scale migration due to ongoing humanitarian crises, including in East African countries such as Ethiopia and Eritrea, where war and political instability persist. This exploratory qualitative study focuses on the stages of migration (pre-migration, in-transit, and post-migration) and their impact on mental health outcomes among Ethiopian and Eritrean refugees (EER) resettled in North Carolina.

Methods: A qualitative design with a phenomenological approach was conducted to explore EER mental health, focusing on the three main timelines in the refugees’ lives: pre-migration (context of home country, causes of departure), journey in transit countries (routes, experiences, challenges, etc.), and settlement in the host country (adjustment, needs, expectations, etc.). Based on in-depth life histories of EER (N = 17) aged 18 and older (M = 37.2) who have resettled in the U.S. in the last decades, this study explores the relationship between the traumas of refugee life and mental health outcomes in the country of resettlement.

Findings: Findings showed that EER experience traumatic events in the pre-migration, in-transit, and post-migration stages, which impact their mental health. Each stage of migration exposes EERs to various mental health challenges, such as depression, PTSD, and anxiety, due to their traumatic experiences. Deep-rooted stigma and discrimination prevent EER communities from openly discussing mental health challenges. The results showed that EERs are not inclined to seek mental health interventions unless they encounter severe issues, primarily due to cultural stigma, language barriers, and a lack of culturally appropriate options. Rather, they frequently rely on informal support from friends, family, and the community, as well as spiritual or religious explanations for their mental health challenges. This research, the first known study on the migration experiences of EERs, underscores the importance of understanding each stage of migration and its impact on the mental health of refugees.

Conclusions: The findings of this study provide insights regarding each stage of migration and the impact of those experiences on their mental health. The research will advance our understanding of the pre-migration, in-transit, and post-migration experiences of EERs. Trauma was found to significantly affect the mental health of EERs. However, the aim of this study is not to pathologize refugees, but rather to foster a deeper understanding of their experiences.