Physical Symptoms Related to Mental Health Disorders
Poor mental health doesn’t always manifest in psychological ways. Mental health conditions can have both mental and somatic (physical) symptoms. Many cultures only acknowledge the physical symptoms of psychological conditions.
Many refugees are unable to accurately express how they’re feeling. This is especially true for those without significant language skills, or who did not grow up in cultures that talk about mental health,
Their physical symptoms may include:
- Muscle tension
- Gastrointestinal issues
When patients present with what seem to be only physical issues, their underlying psychological issues may not be addressed.
Children are especially likely to present with the above symptoms. Young people are still developing and are vulnerable, so it is especially important to care for their mental health.
Impact of Refugee Situations on Childhood Emotional Development
The data is clear: a traumatic past irrevocably shapes a child’s future. How it is dealt with will impact them through childhood, adolescence, and the rest of their lives.
Maintaining positive child and teen mental health is already a challenge for parents and guardians of well-adjusted children who haven’t experienced trauma. We must give children a sense of self and a sense of security, expose them to enough adversity to grow, and help them adapt to change in healthy ways.
When a child is displaced, all of these challenges become much harder. Leaving home puts children in a vulnerable position. They are at risk of:
- Hunger and deprivation
- Religious or ethnic persecution
- Discrimination and racism
- Sexual and physical violence
- Getting lost or separated from family
- Frequent moves and school changes
- Culture shock
Children who encounter such events are likelier to develop mental health conditions including PTSD, anxiety, depression, grief, and stress.
Symptoms of underlying mental health conditions include:
- Academic problems
- Trouble paying attention
- Behavioral difficulties
- Attachment issues
- Isolation and alienation
- Difficulty making friends
- Invasive memories and nightmares
- Sadness and irritability
- Becoming triggered by events similar to the trauma
Also, children are very likely to manifest physical symptoms of their trauma, known as “somatization.” In children, this often includes:
- Headaches and stomachaches
- Continual crying
- Unexplained pains in the body
- Constant sleepiness or lethargy
Refugee children often do not come from populations that have access to evidence-based mental health care. They may also not trust authority figures, and may underreport their symptoms in order to avoid treatment.
It’s critical that doctors, nurses, teachers, administrators, and caregivers learn to recognize symptoms so they can request an assessment, if necessary.
Mental Health Assessments for the Refugee Population
Due to the unique nature of their experiences and trauma, typical mental health screenings are generally unhelpful in assessing refugees. Luckily, a number of refugee mental health guides and screenings are currently available.
CDC’s Guidance for Mental Health Screening During the Domestic Medical Examination for Newly Arrived Refugees
CDC guidelines help health care workers determine which newly arrived refugees require mental health care and support.
Steps in the process include reviewing refugees’ overseas documentation for signs of trauma and illness, asking directly about symptoms, screening for mental health and substance use, and developing an action plan and/or referral.
The Comprehensive Trauma Inventory – 104 (CTI-104)
The Comprehensive Trauma Inventory helps clinicians assess levels of war-related trauma experienced by refugees. The inventory consists of 104 statements about war experiences (e.g., “fleeing or hiding from soldiers or enemies”). Participants fill out the form by indicating if each event happened to them, and if so, how severely they were impacted.
It is also worth noting that most refugees, even adults, present first with somatic (physical) symptoms. It is important to screen each patient in order to discover if there are mental health issues. If we fail to do so, we miss opportunities to help.
The New Mexico Refugee Symptom Checklist – 121 (NMRSCL – 121)
Clinicians use the New Mexico Refugee Symptom Checklist to assess the health of refugees on a broad range of psychological and somatic symptoms. The checklist was developed with refugee populations and includes 121 symptoms (e.g., “fear or jumpiness at loud noises,” “rashes on your skin”).
Participants rank their experiences on how much each symptom has bothered them in the past year. Clinicians organize the number of symptoms into 12 different scales of mental and physical health conditions.
Online screening is one of the quickest and easiest ways to determine whether you are experiencing symptoms of mental illness. Take the Test
Stages of the Refugee Journey
Refugees go through many changes before they find a place to settle. They typically experience trauma throughout their journey. The nature of that trauma and any resulting mental health disorders may change over time.
From the preflight period to migration itself to post-migration, refugees are typically unable to find stability until they settle permanently. Even then, life poses challenges that native-born people in any given country do not experience. The settlement period can sometimes be as difficult as the three preceding stages.
In this phase, also known as “premigration,” life in the refugee’s home country becomes increasingly difficult. They may lose jobs, family members may leave, violence could rise, children may leave school, or persecutions may increase.
For refugees who plan to relocate (as opposed to those who are forcibly displaced without warning), planning happens in this phase.
Also known as the “flight” period. This is a time of active travel for refugee individuals and families. The journey is often dangerous. Not everyone is allowed to leave their country, so some must do so in secrecy.
Risks such as exposure, unreliable or nonexistent transportation, detention, and medical emergencies are very real. Many people die during migration, especially children and older adults.
When refugees finally resettle, which sometimes takes years, they often face challenges in accessing care and social services.
Although the physical journey is over, getting what they need in their new community can pose a challenge to refugee mental health.
Also called the “integration period,” settlement is when a refugee permanently settles down in their new home. Now they must acquire work and housing, get children into school, and learn to navigate their new neighborhood, among other concerns. These steps require language skills, money, and other resources that are often hard to come by.
Each of these stages impacts refugee mental health differently. Preflight and migration are frightening, creating trauma for children and adults alike. The post-migration and settlement periods bring relief from imminent danger, but not from uncertainty. Any stage of the journey can have repercussions.