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A systematic review of protective and promotive factors in refugee mental health

Nature Mental Health volume 2, pages 1415–1428 (2024)Cite this article

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Abstract

There are currently over 117 million forcibly displaced people worldwide, and approximately 45 million of these are refugees and asylum-seekers. Despite exposure to substantial adversity, many refugees do not develop clinically significant psychopathology. There is a need to understand factors that are associated with good mental health in refugees to inform policy-makers and practitioners working with refugees. Here we aim to synthesize research on factors that are protective (associated with lower negative mental health outcomes) or promotive (associated with higher positive mental health outcomes) among adult refugees living in high-income countries (HICs) and lower-and-middle-income countries (LMICs). We searched four databases (PubMed, Embase, ProQuest and PsycINFO) for relevant studies conducted up until December 2022. A total of 174 articles were included in this review, of which 81% were undertaken in HICs and 19% in LMICs. Key protective and promotive factors were identified across the following domains: sociodemographic characteristics (for example, male gender/sex), environmental factors (for example, financial security, permanent visa status), sociocultural factors (for example, social support, support engagement) and psychological factors (for example, self-efficacy). Based on the outcomes of this review, we provide recommendations for governments, organizations and policymakers working to support good mental health in refugees and propose a research agenda to advance knowledge in the field. Cross-domain investigation and cross-disciplinary collaboration represents a critical next step to understanding and enhancing factors that promote good mental health in refugees.

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Data availability

The data used in this review are available in the Supplementary Information.

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Acknowledgements

This work was supported by the Social Policy Group. A.N. is supported by an Australian National Health and Medical Research Council (NHMRC) Leadership Investigator Grant (APP2018204). Z.E.S. was supported by an Australian National Health and Medical Research Council Emerging Leader Grant (2008170). The funders had no role in study design, collection, analysis or interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication. We thank M. O’Brien, the Academic Engagement Librarian at UNSW, for her contribution to the search strategy.

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Authors and Affiliations

  1. School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia

    Angela Nickerson, Vivian Mai, Casey Willoughby, Kiarne Humphreys, Jenny J. Y. Im & Belinda J. Liddell

  2. HOST International, Parramatta, New South Wales, Australia

    David Keegan

  3. Excelsia College, Macquarie Park, New South Wales, Australia

    David Keegan

  4. Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia

    Suresh Sundram

  5. Mental Health Program, Monash Health, Clayton, Victoria, Australia

    Suresh Sundram

  6. Cabrini Outreach, Malvern, Victoria, Australia

    Suresh Sundram

  7. Mental Health and Suicide Prevention Research and Education Group, University of South Australia, Mawson Lakes, South Australia, Australia

    Nicholas Procter

  8. Orygen, Melbourne, Victoria, Australia

    Zac E. Seidler

  9. Center for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia

    Zac E. Seidler

  10. Movember Institute of Men’s Health, Richmond, Victoria, Australia

    Zac E. Seidler

  11. Department of Psychology, Bielefeld University, Bielefeld, Germany

    Florian Scharpf

  12. School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, Australia

    Belinda J. Liddell

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Contributions

A.N., D.K. and B.J.L. contributed to the concept and design of this study. Data screening and extraction were undertaken by V.M., C.W., K.H. and J.J.Y.I. The paper was drafted by A.N., V.M. and J.J.Y.I. Critical revision of the paper was carried out by A.N., V.M., D.K., C.W., K.H., J.J.Y.I., S.S., N.P., Z.E.S., F.S. and B.J.L. Funding was obtained by A.N. and D.K.

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Supplementary Tables 1 and 2, Text 1, Methods, Fig. 1, Results and References.

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Nickerson, A., Mai, V., Keegan, D. et al. A systematic review of protective and promotive factors in refugee mental health. Nat. Mental Health 2, 1415–1428 (2024). https://doi.org/10.1038/s44220-024-00336-9

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