Negative impacts of the adaptation process linked to local cultural stress levels in immigrants and development of psychiatric disorders: a systematic review and meta-analysis

  • Mayana Rodrigues de Melo Alves
  • Jéssica Luma Marques Freitas
  • Modesto Leite Rolim Neto Universidade Federal do Cariri



Current studies underline and enable the international scientific community to reflect on migrant needs to restart, mostly without fluency in the language from the country of destination, without a way of proving his/her knowledges and abilities, with an incomplete family core, without cultural references that until that moment defined him/her as belonging to a specific group, with defined and meaningful habits, full of symbolic representations.


Conduct an analysis on the implications of migration in refugees’ mental health, and the link between these implications and Post-traumatic Stress Disorder (PTSD).


Indexed journals in MEDLINE and LILACS databases hosted in Biblioteca Virtual em Saúde (BVS), as well as papers hosted in Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Periodicals Portal. Searches were carried using the following DeCS descriptors: “Stress Disorders, Post-Traumatic”, "Refugees” e “Mental Health”.


The 10 studies included in the present review were carried in Australia, Denmark, Ethiopia, Turkey, Uganda, Israel, South Korea and Papua New Guinea, and were published in 2014 (2), 2015 (6), and 2017 (2). Regarding the subject, 50% of the articles concentrate information regarding PTSD and mental health problems, while the remaining half deals with psychosocial effects of mass conflict on refugees. Meta-analysis concludes that a considerable percentage of refugees suffer from psychiatric disorder, I-squared (variation in ES attributable to heterogeneity) = 96,46%; Estimate of between-study variance Tau^2= 0.02. Test of ES=0 : z= 17.75 p= 0.00.


Exposure to traumatic events such as public executions and other extreme acts of violence, murder of family members, family and friends’ death due to starvation, homelessness, are closely related to PTSD prevalence in refugees. Acculturation and family’s prolonged estrangement are predictors of depressive symptoms in refugees and both exposure to a new culture and adaptation to new laws and norms of welcoming countries act as stressors and aggravators of depressive symptoms.



1. CORRÊA MAS, NEPOMUCENO RB, MATTOS WHC, MIRANDA C. Migração por sobrevivência: soluções brasileiras. REMHU - Rev. Interdiscip. Mobil. Hum., 2015, 23(44):221-236.

2. ABBOTT A. The troubled minds of migrants. Nature, 2016, 538: 159-161.

3. UN HIGH COMMISSIONER FOR REFUGEES. Desperate Journeys: Refugees and migrants entering and crossing Europe via the Mediterranean and Western Balkans routes. UNHCR report, 2017. Disponível em:

4. ALMEIDA A, AHLERT M. A inclusão social das pessoas na condição de refugiado no Brasil à luz dos direitos humanos. Barbarói, Edição Especial, 2016, 47: 09-21.

5. UBEL RRG. A mudança da política externa brasileira para imigrantes e refugiados: o caso da migração haitiana no início do século XXI. Barbarói, Edição Especial, 2016, 47: 22-43.

6. UNACR/ACNUR. Refugiado ou Migrante? O ACNUR incentiva a usar o termo correto. ACNUR, 2015. Disponível em: <>.

7. GEDIEL JAP, GODOY GG. Refúgio e hospitalidade. Curitiba: Kairós, 2016.

8. MARTINS-BORGES L. Migração involuntária como fator de risco à saúde mental. Rev. Inter. Mob. Hum, 2013, 40: 151-162.

9. INDURSKY A, OLIVEIRA LEP. Sobre a melancolização do exílio. Rev. Latinoam. Psicopat. Fund., 2016, 19(2): 242-258.

10. GABRIEL P, KACZOROWSKI J, BERRY N. Recruitment of Refugees for Health Research: A Qualitative Study to Add Refugees’ Perspectives. Int. J. Environ. Res. Public Health, 2017, 14: 125-135.

11. UNTERHITZENBERGER J, EBERLE-SEJARI R, RASSENHOFER M, SUKALE T, ROSNER R, GOLDBECK L. Trauma-focused cognitive behavioral therapy with unaccompanied refugee minors: a case series. BMC Psychiatry, 2015, 15: 260.

12. HAAGEN JFG, HEIDE FJJ, MOOREN TM, KNIPSCHEER JW, KLEBER RJ. Predicting post-traumatic stress disorder treatment response in refugees: Multilevel analysis. British Journal of Clinical Psychology, 2017, 56: 69–83.

13. LLOSA MV. Niño muerto en la playa. [Opinión.] El País. 20 set. 2015. Access: 20/10/17. Available from: .

14. MCGREGOR LS, MELVIN GA, NEWMAN LK. Familial Separations, Coping Styles, and PTSD Symptomatology in Resettled Refugee Youth. The Journal of Nervous and Mental Disease, 2015, 203(6): 431-438.

15. SLEWA-YOUNAN S, GUARAJARDO GU, YASER A, MOND J, SMITH M, MILOSEVIC D, SMITH C, LUJIC S, JORM F. Causes of and risk factors for posttraumatic stress disorder: the beliefs of Iraqi and Afghan refugees resettled in Australia. Int J Ment Health Syst, 2017, 11: 4-15.

16. SLEWA-YOUNAN S, MOND J, BUSSION E, MOHAMMAD Y, GUAJARDO MGU, SMITH M, MILOSEVIC D, LUJIC S, JORM AF. Mental health literacy of resettled Iraqi refugees in Australia: knowledge about posttraumatic stress disorder and beliefs about helpfulness of interventions. BMC Psychiatry, 2014, 14: 320-328.

17. NYGAARD M, SONNE C, CARLSSON J. Secondary psychotic features in refugees diagnosed with post-traumatic stress disorder: a retrospective cohort study. BMC Psychiatry, 2017, 17: 5-16.

18. FEYERA F, MIHRETIE G, BEDASO A, GEDLE D, KUMERA G. Prevalence of depression and associated factors among Somali refugee at melkadida camp, southeast Ethiopia: a cross-sectional study. BMC Psychiatry, 2015, 15: 171-178.

19. ALPAK G, UNAL A, BULBUL F, SAGALTICI E, BEZ Y, ALTINDAG A, DALKILIC A, SAVAS AD. Post-traumatic stress disorder among Syrian refugees in Turkey: A cross-sectional study. Int J Psychiatry Clin Pract, 2014, Early Online: 1–6.

20. HECKER T, FETZ S, AINAMANI H, ELBERT T. The Cycle of Violence: Associations Between Exposure to Violence, Trauma-Related Symptoms and Aggression—Findings from Congolese Refugees in Uganda. Journal of Traumatic Stress, 2015, 28: 448–455.

21. NAKASH O, NAGAR M, SHOSHANI A, LURIE I. The Association Between Acculturation Patterns and Mental Health Symptoms Among Eritrean and Sudanese Asylum Seekers in Israel. Cultural Diversity and Ethnic Minority, 2015, 21(3): 468–476.

22. PARK J, JUN JY, LEE YL, KIMA S, LEE S, YOO SY, KIM SJ. The association between alexithymia and posttraumatic stress symptoms following multiple exposures to traumatic events in North Korean refugees. Journal of Psychosomatic Research, 2015, 78: 77–81.

23. TAY AK, REES S, CHAN J, KARETH M, SILOVE D. Examining the broader psychosocial effects of mass conflict on PTSD symptoms and functional impairment amongst West Papuan refugees resettled in Papua New Guinea (PNG). Social Science &
How to Cite
ALVES, Mayana Rodrigues de Melo; FREITAS, Jéssica Luma Marques; ROLIM NETO, Modesto Leite. Negative impacts of the adaptation process linked to local cultural stress levels in immigrants and development of psychiatric disorders: a systematic review and meta-analysis. International Archives of Medicine, [S.l.], v. 12, dec. 2019. ISSN 1755-7682. Available at: <>. Date accessed: 01 june 2023. doi:
Psychiatry & Mental Health

Most read articles by the same author(s)