Table 1. Characteristics of included studies using general samples, grouped by population type.
| Author, Pub. Year | Population Summary | Setting | Ethnicity (Region of Origin) | Age* (y) | Gender | Religion | Trauma Exposure | Duration of Resettlement* (y) | Data Collection |
|---|---|---|---|---|---|---|---|---|---|
| Source or Measurement | |||||||||
| Refugees granted permanent asylum status: | |||||||||
| Alley 1982 [18] | Indochinese refugees who had entered Utah (USA) beginning in 1978 | Community | All Indochinese | NR | NR | NR | NR | NR | Survey |
| Amin 2021 [20] | 9-year cohort aged 16–64 years on Dec 31, 2004 | Community | Eritrean, Ethiopian, Somali, Afghani, Iranian, Iraqi, Syrian, Chilean, former Yugoslavian | range: 16–64 | M- 58% | NR | NR | NR | National Cause of Death and inpatient records registers |
| Ao 2016 [21] | Adults in 7 cities in Georgia, New York, Arizona, and Texas | Community | All Bhutanese | median 34 (range: 18–83) | Mixed | 72% Hindu, 10% Buddhist, 16% Christian | 36% had experienced 4–7 traumatic events pre-migration, and 34% had experienced ≥8 | median: 1.8 | Beck Scale for Suicidal Ideation |
| (Range: 0.2–5) | |||||||||
| Bhui 2003 [25] | Somali refugees in the London Borough of Greenwich (UK) | Community | All Somali | mean: 40.4; range: 20–88 | M- 51% | NR | Shortage of food and water, no shelter, poor health, torture, imprisonment, murder, separated from family and enforced isolation | Men: 7.9; Women: 8.2 | BDI Suicide items |
| Choi 2020 [30] | Youth in 7th-12th grade with either father/ mother born in North Korea | Classrooms in middle and high schools | All North Korean | NR | F- 41% | NR | NR | NR | Korean Youth’s Risk Behavior Survey |
| Hollander 2020 [42] | Cohort aged 16 and up who were born between 1975 and 1984 | Community | 19% former Yugoslavian, 18% Iraqi, 13% Central Asian, 11% Somali or Eritrean or Ethiopian or Djibouti, 11% Southeast Asian, 10% Iranian, 7% Baltics or Russian, 7% North Asian, 4% North African | 24.8 (7.0) | M- 59% | NR | NR | 1–6 | Causes of Death Register |
| (at cohort entry) | |||||||||
| Jankovic 2013 [47] | Refugees from former Yugoslavia who experienced war trauma residing in UK, Italy, Germany | NR | All from former Yugoslavia | 41.6 | M- 49% | NR | Mean war events: 6.8 | NR | MINI International Neuropsychiatric Interview |
| (10.8) | |||||||||
| Meyerhoff 2020 [55] | Adults living in the greater Burlington, Vermont region | a local community center and a community mental health clinic serving refugees | All Bhutanese | mean: 41 | M- 52% | 65% Hindu, 17% Buddhist, 13% Christian, 5% Kirat | NR | NR | Beck Scale for Suicidal Ideation |
| Nickerson 2019 [60] | Adults literate in Arabic, Farsi, Tamil or English | Community | 67% Iraqi, 20% Syrian, 6% Iranian, 3% Afghani | 39.0 (12.5) | M- 53% | NR | potentially traumatic events: mean 3.30 (SD 3.30) | 1.44 (1.37) | PHQ-9 (item 9) questionnaire and additional suicidal intent questions |
| Noh 2017 [61] | North Korean refugees living in Seoul (South Korea) | Hana Center (a representative welfare center supported by the Korean government to assist NKRs in South Korea) | All North Korean | ≥30 years | M- 23% | NR | NR | 68% been in South Korea for <5 | Health questionnaire |
| Norredam 2013 [62] | Refugees in Denmark from January 1993 to December 1999 and native Danes | Community | 57% former Yugoslavian, 16% North African, 11% Iraqi, 10% other Middle Eastern | >18 years | Males: Refugees 56%; Danish-born 56% | NR | NR | NR | Danish Register on Causes of Death |
| Park 2018 [64] | North Korean refugee youth living in South Korea | Schools | Born in North Korea or China | mean 19; range: 13 to 17 | M- 33% | NR | NR | NR | Questionnaire |
| Salama 2020† [71] | Migrants living in 6 big cities | Community | 59% Kurdish, 41% Somali | range: 18–64 | F- 52% | Somalis and the majority of Kurds (75%) were Muslim | NR | >1 | Hopkins Symptoms Checklist-25 (suicidal ideation item of HSCL-25) |
| Saunders 2017 [72] | Youth living in Ontario | Community | Mixed | range: 10–24 | M-~50% | NR | NR | Range: 0–10 | Ontario Registrar General Vital Statistics-Deaths registry |
| Saunders 2019 [73] | Adults living in Ontario for <10 years | Community | Mixed | NR | Mixed | NR | NR | <10 | National Ambulatory Care Reporting System and Ontario Registrar General Vital Statistics-Deaths registries |
| Sobhanian 2006 [76] | Former refugee detainees from the Woomera Detention Centre living Australia | Community | Iranian and Afghani | 31.8 (9.2); range: 18 to 70 | M- 69% | NR | NR | Time in the detention centre ranged from 2 to 21 months; 11.30 months (3.80); Time living in the community ranged from 1 to 20; mean 6.97 months | The Truncated Assessment of Self-Destructive |
| Thoughts (TASDT) | |||||||||
| Tousignant1999 [85] | Adolescents from refugee families living in Canada | Schools | 35 countries of origin were represented: El Salvador, Cambodia, Laos, Iran, Vietnam and the regions of Southeast Asia and Central America | mean: 15.7; range: 13 to 19 | M- 48% | NR | NR | NR | Diagnostic Interview Schedule for Children Version 2.25 (DISC-2.25) for DSM-III-R diagnoses |
| Um 2020 [86] | Adults living in Seoul, Gyeonggi Province, and Incheon | Household | All North Korean | mean: 40.6 | F- 67% | 68% Christian | NR | mean: 6.3 | 5-item suicidal ideation scale |
| Vigod 2019 [87] | Mothers within 1 year postpartum in Ontario | Community | Mixed | mean: 30 | F- 100% | NR | NR | NR | National Ambulatory Care Reporting System database |
| Westman 2006 [89] | National cohort aged 25–64 years | Community | Eastern European, Middle Eastern, other non-European countries‡ | range: 25–64 | Mixed (disaggregated below) | NR | NR | NR | National Cause of Death Register |
| Refugees in refugee camps or with temporary protection: | |||||||||
| Akinyemi 2012 [16] | Adults residing >1 year in Oru Refugee Camp | Refugee camp | 66% Liberian, 33% Sierra-Leonean, 1% Togolese | 34.8 (12.8) | M- 59% | 70% Christian, 30% Muslim | NR | 8.6 (4.8) | Mini-International Neuropsychiatric Interview (MINI) |
| Al-Modallal 2012 [17] | Refugee women attending healthcare centers in the cities of Amman, Zarqa, and Irbid (Jordan) | Health care centers in refugee camps | NR | Range: 16 to 62 | F- 100% | NR | NR | NR | Survey |
| Falb 2013 [32] | Refugee women living in 3 camps along the Thai-Burma Border | Refugee camps | Mostly Burmese (79% Karen, 21% other) | 32.1 (8.4) | F- 100% | Christian: 54%; other 46% | 80/848 reported conflict victimization | NR | Questionnaire |
| Fellmeth 2016 [33] | Migrant and refugee pregnant women in a refugee camp along the Thailand-Myanmar border | Refugee camp | Mostly Burmese | Women who died by suicide: 18 to 36 | F- 100% | NR | NR | NR | Clinic review of maternal deaths (MMR among live births) |
| Hermans 2017 [39] | Refugees in long-stay refugee camps at Lesbos (Greece) | Refugee camps | 36% Syrian, 28% Afghani, 20% Pakistani | Median: 23 (IQR 28–38); 23% children | NR | NR | NR | NR | Clinical assessment |
| Itani 2017a [45] | Middle school students in Gaza and West Bank | Occupied Palestinian Territory and UNRWA refugee camps’ schools | All Palestinian | most 13–15 | F- 53% | NR | NR | NR | Global School-based Student Health Survey |
| Itani 2017b [45] | Middle school students in Jordan | UNRWA refugee camp schools | All Palestinian | most 13–15 | M- 52% | NR | NR | NR | Global School-based Student Health Survey |
| Itani 2017c [45] | Middle school students in Lebanon | UNRWA refugee camp schools | All Palestinian | most 13–15 | F- 54% | NR | NR | NR | Global School-based Student Health Survey |
| Itani 2017d [45] | Middle school students in Syria | UNRWA refugee camp schools | All Palestinian | most 13–15 | M- 51% | NR | NR | NR | Global School-based Student Health Survey |
| Rahman 2003 [66] | Afghan mothers in refugee camps in Pakistan | Refugee camps | All Afghani | 28.2 (7.3) | F- 100% | NR | NR | 13 (3.4) months | Pushto version of the Self-Reporting Questionnaire (SRQ- 20) |
| Slodnjak 2002 [75] | Refugee students from Bosnia and Herzegovina and Slovenian students from same age and school grade | School | All Bosnian and Herzegovina | 14 to 15 | M—refugees: 47%; Slovenian-born: 49% | NR | 80% of the student refugees and 90% of their relatives had experienced war events | NR | Interviews |
| Ssenyonga 2012 [78] | Adults resident at Nakivale camp | Refugee camp | All Congolese (DRC) | ≥18 | Mixed | NR | Domestic violence exposure: mean 11.3 (SD 6.3) lifetime events, and 2.1 (SD 3.6) ongoing events | NR | Survey |
| Vijayakumar 2017 [88] | Residents of refugee camps in Tamil Nadu, South India | 2 refugee camps | All Sri Lankan | mean: 40 | F- 58% | 71% Hindu, 29% Christian, 1% Muslim | Trauma during war: a) 31% lost/got separated from significant family member/friend; b) 27% confirmed/presumed death of family member/friend; c) 16% lost/got separated from 1st-degree relative | mean: 18.3 | Beck’s Scale for Suicidal Ideation, and additional questions |
| Yu 2008 [91] | Refugees in protective facilities under the South Korean government protection in 2 Chinese cities | Protective facilities | All North Korean | range: 15–59 | F- 71% | NR | NR | range: from under 1 to over 5 | Personality Assessment Index (Suicide Ideation subscale of PAI; Morey 1991) |
| Mixed refugees populations: | |||||||||
| Stein 2010 [81] | Refugees sub-group among general populations surveyed in 21 low-, middle-, and high-income countries | NR | Nigeria, South Africa, Brazil, Colombia, Mexico, United States, India, Japan, New Zealand, China, Belgium, Bulgaria, France, Germany, Italy, the Netherlands, Romania, Spain, Ukraine, Israel, Lebanon | >18 | Mixed | NR | NR | NR | World Mental Health (WMH) version of the WHO Composite International Diagnostic Interview (CIDI) and Suicidality Module of the WMH-CIDI |
| Asylum seekers: | |||||||||
| Cheney 2017 [29] | Male-to-female transgender asylum seekers in California | An advocacy and immigration legal services organization | All Mexican | mean: 32 (range: 20–58) | 100% male-to-female transgender | NR | All had experienced physical and/or sexual assaults | NR | Review of declaration documents that were part of asylum application, including professional psychological evaluation |
| Cohen 2008 [31] | Asylum seekers in immigration removal centres and prisons | Immigration removal centres and prisons | Mixed | NR | Mixed | NR | NR | NR | Specific monitoring data (from medical records) |
| Fuhrer 2016 [35] | Asylum seekers in Halle (Germany) | NR | Mixed | >15 years | M- 85% | NR | NR | NR | Hopkins-Symptom-Checklist 25 (HSCL 25) and the Harvard Trauma Questionnaire |
| (Had to speak Arab, Farsi/Dari, French, Hindi or English) | |||||||||
| Goosen 2011 [37] | Asylum seekers living in reception centres | Residential asylum seeker reception centres | Afghani, Iraqi, Angolan, Congolese (DRC), Azerbaijani, former Yugoslavian, Somali, Sudanese | ≥15 | Mixed (disaggregated below) | NR | NR | NR | A national standard suicidal behaviour notification form |
| Grupp 2020 [38] | Adults fluent in English, German, French, Farsi, Arabic, Kurdish, or Tigrinya | in their accommodation, at meeting points for asylum seekers, or through language courses | 28% Iranian, 19% Eritrean, 17% Somali, 10% Afghani, 8% Cameroonian, 7% Syrian | 30.5 (8.1) | M- 66% | NR | NR | 15.1 months | PHQ-9 |
| (23.2) | |||||||||
| Huemer 2011 [44] | Unaccompanied minors aged 15–18 years | 8 residential accommodations for unaccompanied refugee minors | 34% Gambian, 27% Somali, 20% Nigerian, 5% Guinea-Bissau, 14% other African | 17.0 (0.8) | M- 85% | 66% Muslim, 22% Christian | NR | NR | Mini-International Neuropsychiatric Interview for children and adolescents (MINI Kid) |
| Keller 2003 [48] | Detained asylum seekers in New York, New Jersey, and Pennsylvania | Detention centers | 77% African, 10% Eastern European, 6% Asian, 4% South American, 3% Middle Eastern | 28 (7.3) | M- 80% | NR | 74% had been tortured before immigration, 59% reported murder of family member or friend, 26% reported sexual assault | NR | Self-report in physician interview |
| Koppenaal 2003 [50] | Asylum seekers accommodated in housing facilities of the Central Organ Asylum Seekers | Housing facilities for asylum seekers | Mixed | All ages included | Mixed | NR | NR | NR | Statistics Netherlands causes of death list |
| Mittendorfer-Rutz 2020 [57] | Unaccompanied minors/ youth | 4 state agencies and 2 NGOs | Mixed | range: 10–21 | Mixed | NR | NR | NR | NGOs data and reports to the Health and Social Care Inspectorate. Validated using the national forensic autopsies register database |
| Nickerson 2019 [60] | Adults literate in Arabic, Farsi, Tamil or English | Community | 48% Iranian, 22% Sri Lankan, 12% Iraqi, 4% Afghani | 35.4 (8.6) | M- 69% | NR | PTE: mean 7.21 (SD 4.83) | 3.65 (1.32) | PHQ-9 (item 9) questionnaire, and additional suicidal intent question |
| Staehr 2006 [79] | Asylum seekers aged 15 and up | Hospitals and Red Cross asylum centres | 20% Iraqi, 15% Bosnian-Hercegovina, 14% Afghani, 6% Kosovon, 4% Iranian, 41% Other | ≥15 | Mixed | NR | ~1/3 of those with suicidal behaviour experienced imprisonment and torture/war, 4 reported rape, and 4 forced marriage | mean: 12.3 months | Asylum centre reports and hospital records |
| Steel 2004 [80] | 10 families from one ethnic group held for a protracted period | A remote detention facility | NR (all same ethnic group; 14 parents + their 20 children) | Ranges: parents 28–44; children 3–19 | F-64% (parents) | 71% Muslim | All adults reported traumatic experiences in their country of origin, with it being common for one parent to have been imprisoned and tortured for political reasons. All families reported fleeing their country of origin out of fear for the life of one or all of the family members. All families described traumatic experiences in detention. | mean: 2.3 (range: 2.0–2.7) | Structured Clinical Interview for DSM-IV Axis I Disorders; and Schedule for Affective Disorders and Schizophrenia for School-Age Children |
| Sultan 2001 [82] | Detained refugees in Sydney | Detention centre | Afghani, Iraqi, Iranian, former Yugoslavian, etc. | NR | M- 85% | NR | 58% had been physically tortured, 27% experienced the murder or disappearance of immediate family member | mean: 2.1 (minimum 9 months) | Semi-structured interview |
| Winkler 2019 [90] | Asylum seekers in Berlin | 9 refugee shelters | 37% Syrian, 15% Afghani, 9% Iraqi, 8% Albanian, 6% Iranian, 5% Moldovan | 30.6 (10.0) | M- 75% | NR | NR | 128 days (177) | Questionnaire |
| Mixed samples of refugees & asylum seekers: | |||||||||
| Bhui 2006 [26] | Somali refugees in the London Boroughs of Tower Hamlets and Lambeth (UK) | Primary care and community | All Somali | ≥18 years | M- 49% | NR | NR | NR | MINI Neuropsychiatric Interview |
| Leiler 2019 [52] | Adults in asylum accommodations in Jämtland-Härjedalen county | 13 asylum accommodations | 38% Afghani, 27% Syrian, etc. | 71% were <35 years | M- 72% | NR | NR | NR | PHQ-9 (item 9) |
| Sohn 2019 [77] | Refugees in various stages of the refugee approval process residing in Seoul and Gyeonggi province | Community | 51% Sub-Saharan African (Nigerian, Ethiopian, Liberian), 34% Middle Eastern (Yemeni, Egyptian), 8% Asian, etc. | 34% <30; 39% 31–40; 21% 41–50; 6% >51 | M- 72% | NR | NR | 38% <1; 41% 1–5; 21% >5 | Korean National Health and Nutrition Examination Survey |
| Tay 2019 [84] | Rohingya from Myanmar or the offspring of at least one Rohingya parent | 49 villages | All Rohingya | 28.3 (9.0) | M- 78% | NR | 81% tortured, 80% witnessed rape or sexual violence, 69% no food or water, 64% witnessed murder of friends or family, 62% no shelter, 61% witnessed mass killings or atrocities, 56% forced to flee home | 47 months (44) | Suicidal ideation was assessed using an item on the depression screen: “how often have you thought about taking your own life in the last two weeks?” |
| Internally displaced people: | |||||||||
| Kim 2007 [49] | Internally displaced persons in Nyala, South Darfur | 6 IDP camps | Sudanese | 34 | Mixed | 99% Muslim Sunni, 1% Christian | NR | mean 6.1 months (SE 0.1) | PHQ-9; and yes/no interview questions |
| Marroquín Rivera 2020 [54] | Adolescents displaced by armed conflict | Community | Colombian | range: 12–17 | F- 64% | NR | NR | NR | National Mental Health Survey |
| Salah 2013 [70] | Internally displaced persons in Khartoum and Gezira IDP areas in Central Sudan | Settlements for IDP | Sudanese | median: 35; range: 18 to 85 | M- 44% | NR | Moved due to war/ problem Khartoum: 8.1%; Gezira: 17.5% | Khartoum 18.6 (10.1); Gezira: 18.9 (10.3) | MINI International Neuropsychiatric Interview |
| Tamayo Martinez 2016 [83] | Adults internally displaced due to conflict | Community | Colombian | mean: 41.2 (95% CI: 39.7, 42.7) | F- 51% | NR | 61% exposed to traumatic events themselves or a close person | NR | National Mental Health Survey |
*Presented as Mean (SD) unless otherwise noted.
†Data were extracted and pooled for the Somali and Kurdish groups as these were reported to be majority refugees in the publication.
‡Westman 2006 study’s main countries of birth were, by region, Eastern European: Czechoslovakia, Estonia, Hungary, Romania, Soviet Union; Middle Eastern: Lebanon, Iran, Iraq, Syria, Turkey; Other non-European: Chile, Ethiopia, India, Somalia, Thailand. These regions were extracted since they were reported as mainly refugee countries in the publication.
Abbreviations: BDI = Beck Depression Inventory; F = female; M = male; NR = not reported; PHQ = Patient Health Questionnaire; pub = publication; y = years.