Migration is associated with specific stressors, mainly related to the experience of leaving the country of origin and moving to a new, unfamiliar country. This process is usually associated with multiple stressors (e.g., language, financial pressure, challenging immigration processes, family separation, etc.). These stressors usually contribute to different mental health problems, especially Post Traumatic Stress Disorder (PTSD). The prevalence of PTSD among immigrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers.
In the USA, the foreign-born population is about 45 million representing close to 15% of the total population and growing!
The magnitude of the problem is much bigger than imagined. For example, approximately 244 million people have left their country of origin for different reasons. Usually, immigrants are searching for employment, reuniting with family members, or seeking refuge for humanitarian reasons.
One of the characteristics of stress related to the process of immigration is its chronicity. Multiple stressors involved include feelings of “not belonging”, issues with documentation, work, and housing conditions, language, cultural gaps, loneliness, etc. The process of immigration involves the concept of “loss” related to grieving what has been left behind or lost.
The challenges related to immigration can lead to what is called “immigrant syndrome with chronic or multiple stress” or “Ulysses syndrome” (immigration syndrome associated with chronic, multiple stressors). This is named after the myth of Ulysses and the odyssey when returning at the end of the Trojan War. Ulysses syndrome includes four sets of manifestations: 1) in the depressive set: sadness, crying, guilt (paranoid type), and ideas of death (although infrequent); 2) in the anxious set: tension and nervousness, excessive and recurrent worries, irritability, and insomnia; 3) in the somatization set: headache, fatigue, and musculoskeletal, abdominal, and thoracic somatizations; and 4) in the cognitive set: memory deficit, attention deficit, and physical and temporal disorientation.
The immigration process is further complicated by the impact of exposure to traumatic events. The process of immigration, the process of acculturation, and the multiple obstacles faced by immigrants provide ample opportunity to experience traumatic events. The overall prevalence of PTSD among immigrants has been about 47%. The prevalence among refugees was almost twice as high as in labor migrants, due to exposure to more risk factors, such as violence, war, and political persecution which are often stimuli for migration.
Several risk factors for PTSD include being a victim of violence (e.g., torture, rape/sexual assault, armed conflicts), and economic hardship. Other post-migration difficulties can be traumatic such as poor social network (e.g., loneliness, difficulty integrating), poor access to counseling services, sense of instability (e.g., not having legal immigrant status, unemployment), detention, communication difficulties, acculturative stress associated with post-migration experiences, and others.
Recognizing the high risk of PTSD related to immigration is a first step in addressing this severe issue. This needs to be identified not just by the immigrants themselves but by those who interact or provide services to immigrants. For example, teachers become an important contact point and are usually excellent in spotting issues with immigrant children. Together with school counselors, this can help create an effective team in identifying and providing support. The medical field is another critical point of contact with immigrants when providing health services to immigrants. Coworkers and employers can also help in the process of signaling any potential crisis and providing support. These “points of contact” can help initiate a process of proper mental health treatment follow-up.
In the end, being able to prevent or provide early treatment becomes a necessity as the foreign-based USA population continues to grow. By “intercepting” these issues early, not only will those affected improve their sense of well-being but will also save the huge cost and negative implications of PTSD.
Fortunately, there is an effective treatment for PTSD. It is important, though, to find the right mental health specialist that is trained in diagnosing and treating PTSD. There are several proven approaches to PTSD that include Cognitive Behavioral Therapy, prolonged exposure, EMDR.
Importantly, when treating PTSD having sensitivity to the individual and the specific situation is as important as utilizing the right technique.
In my practice, I have been able to work with multiple cases and individuals from different backgrounds, cultures, and situations. The results are significant as the treatment facilitates the process of regaining a sense of control over your lives and recovering the happy person that is ready to thrive and contribute.