Health-related quality of life in refugee youth and the mediating role of mental distress and post-migration stressors

Abstract

Purpose: The aim of this study is to explore how potentially traumatic events (PTEs) from war and flight influence health-related quality of life (HRQoL) in young refugees after recent resettlement. In a model based on earlier theory, we tested if post-migration stressors and mental distress mediated the effect of PTEs on HRQoL, individually and in serial. We also explored how different types of post-migration stressors influenced different dimensions of HRQoL.

Methods: This study used a cross-sectional design where 160 Syrian youth recently resettled in Norway completed questionnaires at school between May and December 2018. Correlations between types of post-migration stressors and dimensions of HRQoL were explored and a serial multiple mediator model was tested. Models were adjusted for age and gender, using two types of mental distress; post-traumatic stress disorder (PTSD) and general mental distress.

Results: Higher levels of PTEs reduced experienced HRQoL, but this direct effect was mediated by post-migration stressors alone and in serial with mental distress. Despite high levels of mental distress, this did not affect HRQoL independently, only in serial mediation with increased post-migration stressors. Economic concerns and discrimination were types of post-migration stressors affecting several dimensions of HRQoL.

Conclusion: Quality of life in refugee is affected by past events from war, stressors in current resettlement and elevated mental distress through complex interrelations. The study reiterates the importance of considering structural and everyday post-migration stressors in policy and intervention to improve the health and wellbeing of refugee youth.

Keywords: Health-related quality of life; Mental distress; Post-migration stressors; Post-traumatic stress disorder; Refugee; Youth.

Fig. 1

Conceptual serial mediation model. Path c is the total effect of the predictor (Potentially Traumatic Events) and outcome variable (Health-Related Quality of Life) both directly and indirectly through the mediators. Paths a₁ and a₂ represent the relationship between the predictors and the mediators (Post-migration stressors and general mental distress/PTSD). Path d₂₁ is the relationship between the two mediators. Paths b₁ and b₂ indicate the association between the mediators and outcome whilst the predictor value is controlled. The c’ path is the direct effect between the predictor and the outcome excluding the mediator variables. The indirect effect (c–c’ = a₁b₁ + a₂b₂ + a₁₂₁b₂) is indicated by a statistically significant difference between c and c’. The indirect effect would be significant with CIs not including zero ([30])

Fig. 2

Serial multiple mediation of PTEs’ (Refugee trauma history checklist) relationship to Global HRQoL (KIDSCREEN-10), including post-migration stressors (Refugee post-migration stress scale) as the first mediator and general mental distress (HSCL-10) as a second mediator (n = 117). *p < 0.05. **p < 0.01. ***p < 0.001. Values shown are unstandardised coefficients

Fig. 3

Serial multiple mediation of PTEs’ (refugee trauma history checklist) relationship to Global HRQoL (KIDSCREEN-10), including post-migration stressors (Refugee post-migration stress scale) as the first mediator and PTSD (CRIES-8) as a second mediator (n = 114), *p < 0.05. **p < 0.01. ***p < 0.001. Values shown are unstandardised coefficients

Fig. 4

Reversed serial multiple mediation of PTEs’ (refugee trauma history checklist) relationship to Global HRQoL (KIDSCREEN-10), including PTSD (CRIES-8) as the first mediator and post-migration stressors (Refugee post-migration stress scale) as a second mediator (n = 114), *p < 0.05. **p < 0.01. ***p < 0.001. Values shown are unstandardised coefficients