Refugees often experience stress and trauma in their country of origin, while leaving that country, and in their host country. These experiences increase the risk of developing mental health conditions, especially anxiety, depression, and PTSD. Studies have identified that refugees have double the rate of mental health disorders than migrant workers, though some might say their situations are relatively similar. This indicates that the refugee experience is a significant factor when discussing mental health, and female refugees suffer from mental illness more than male refugees. So why?
Why is mental illness a gendered experience? It suggests there are fundamental differences in the male and female experience as refugees, and this difference makes women more likely to suffer mental health issues than men. Some women are pregnant when they become refugees or asylum seekers, which can be another stressor, and the experience of pregnancy and raising a newborn baby in a foreign country as a refugee can lead to the development of postpartum depression, or PPD.
Women are also at greater risk of developing PTSD than men, affirming that trauma is experienced differently by men and women, and that men and women deal with trauma differently. Refugees undergo great struggle and difficult circumstances and this has a severe impact on their mental health, and it is clear that the unique experience of female refugees requires greater study and intervention to support them and help prevent the development of mental health issues. This article will be dealing exclusively with the impact of mental health on cis-women, and the differences between the experiences of cis-women and cis-men. Non-binary and transgender individuals will have different experiences and this article will not be discussing those.
Pregnancy and PPD: a case study in Canada
Refugee mothers in Canada were interviewed about their experiences and their mental health. Some of the risk factors for PPD include depression or anxiety during pregnancy; family history of depression; recent life stress; absence of social support. Many of these overlap with the experiences of pregnant refugees. This increases their risk of developing PPD, indicating that they are especially in need of support during their pregnancy to try and prevent the development of PPD, and to help those women with PPD.
An important factor in understanding how to help refugees with PPD is knowing how refugees understand PPD. Culture is defined as ‘the way of life, especially the general customs and beliefs, of a particular group of people at a particular time’ in the Cambridge Dictionary. A particular culture will dictate the way refugees view PPD.
The female refugees in Canada were interviewed and many spoke about how in their home countries PPD was not known about because it wasn’t common enough to be general knowledge. In these cultures many family members live together, or at least very near each other, and this helps support the mother. Even women who get depressed can fall back on the support of their parents and parents-in-law, and the surrounding community. Even those women who do know about PPD might not know how it feels, the full extent of how it can affect their lives.
Finally there are those cultures that stigmatise mental illness and shame women who acknowledge that they are experiencing PPD. Among these refugee mothers it is well known that the community will shun mothers experiencing depression, and they may view themselves as abnormal for experiencing symptoms of depression. To aid pregnant refugees and mothers with their mental health understanding how they understand depression culturally is important to ensure the support they need is readily available to them.
Understanding how these cultural beliefs can affect the support available to refugees and the support refugees will seek out. Refugees from cultures that have little awareness of PPD, either because PPD is less common within that culture because of the widespread family support or because PPD symptoms are seen as a natural part of birth and motherhood, are likely to not notice depression in new mothers.
A study into the effects of PPD on Asian Indian mothers uncovered that maternal depression wasn’t recognised in these communities. Refugee mothers from these cultures could be isolated from health care services and their own families, putting them at risk of worsening their depression. These women don’t know how to seek help in the host country, they are alone, struggling, and may not be able to recognise, or know, that what they’re experiencing is PPD and that they can access mental health support. In some cultures the symptoms of PPD are shamed, and mother’s can face active discrimination. Fear of stigmatisation and social pressure can isolate women from familial support and from seeking out health care. This meant that even within a family it was difficult for the mother to acknowledge that they felt depressed, and it was even more difficult to acknowledge if they needed medication and counselling.
In fact, the study looking at refugees in Canada discovered new mothers would actively hide or understate their symptoms and their depression from everyone, be it family, friends, or healthcare workers. This would bar them from accessing the support and care that these women needed. Not only had these women been through a traumatic experience leaving their country, they now faced the challenges of a completely new culture, whilst trying to raise a baby and dealing with depression on their own. Women from societies that provided ample support for new mothers also struggled accessing the support they needed. These women growing up saw and expected a level of support after birth. The host country may fail to provide adequate postpartum health care or the refugee community in the host country may not provide that support. The new mothers therefore may develop depression as they struggle without the support they thought they would get. The cultural understanding of PPD can affect the support available from the refugees family and community, and the possibility of the new mother seeking out help.
Acknowledging the possibility that transexual men and non-binary individuals can also experience pregnancy as a refugee, PPD is mostly faced by female refugees. Women’s experience of mental health as a refugee is different to men’s experience, and pregnancy is one of the aspects differentiating the experiences of cis-women and cis-men.
Trauma and acculturation
There are two differences between male and female refugees when discussing trauma that will be expanded on in this article. The types of trauma experienced, and the ways acculturation and acculturation methods influence PTSD and trauma recovery.
There are two types of traumatic load that affect PTSD. Experienced trauma, and witnessed trauma. Experienced trauma is more significant in contributing towards instances of PTSD. Women seem to experience higher rates of experienced traumatic load. This would help explain as to why the highest rates of PTSD are seen in women, when looking at the refugee population. Female refugees also scored higher in overall PTSD severity and scored higher in PTSD symptoms that increased over time. Another contributing factor to the higher rates of PTSD, and the greater severity of PTSD, experienced by women can be seen in the statistics for sexual assault. One study observed that the rate of sexual violence reported by women was 39.7%, and the rate of sexual violence reported by men was 23.6%. Additionally, sexual violence was associated with a greater risk of PTSD. Therefore, though the difference between these two rates might seem small, it can lead to a relatively large difference in instances of PTSD observed in men and women.
Acculturation is described as the process of cultural and psychological change as the result of contact between cultural groups and their individual members. Acculturation strategies largely seem to differ between men and women. Men seem to prefer to retain the values of their birth culture and reject the values of the new culture. Women tend to prefer to adopt the values of the host culture, though this doe snot necessarily also mean abandoning the values of their birth culture. However, this can cause tension within families, especially those from countries with strict gender roles. If the host country has far more liberal views towards gender roles then the woman attempting to adopt these views can cause stress in marriages. This can result in a stressful acculturation process and this stress can exacerbate depressive symptoms.
Women experience higher instances of trauma related mental illness, and the stress caused by acculturation can exacerbate mental illness. Trauma and acculturation are linked, and the acculturation process itself can be traumatic, especially when it creates a highly stressful marital situation. It is clear that trauma is relatively gendered experience, and women need more mental health support to cope. This combined with the struggles faced by pregnant women in dealing with PPD and accessing mental health support shows that gender influences the mental health of refugees, and that more work and research needs to be done to support these women.
Niamh is a second year History student at Oxford University. She researched and wrote this article as part of the Oxford University Micro Internship programme.