Pre-migration trauma predicts mental disorders and posttraumatic stress disorder; however, the post-migration context can equally determine the mental health of immigrants and refugees. For example, post-migration social determinants help moderate the immigrants ' or refugees ' ability to recover from pre-migration trauma (Hynie, 2017).
In addition to the factors illustrated in the figure on the previous page, social determinants also include the way society is organized, which affects an individual's place within it, along with corresponding factors such as creating a sense of belonging and sense of purpose. These factors can then shape health and illness.
Humans have evolved to respond automatically to perceived and real threats, which can be detrimental to survival in the short term. However, if this response is continuously activated, well-being and health may be negatively impacted. Health problems as the result of chronic stress, such as depression, increased vulnerability to infection, diabetes, high blood pressure, and increased cholesterol, are more prevalent in poorer populations in industrialized countries (Marmot & Wilkinson, 2005). The figure below outlines three pathways that link social structure with well-being and health.
Social
structure
Early life
Genes
Culture
Social environment
Working conditions
Material factors
⥥ ⇘Health behaviours
⇋Psychological stress
⥥ ⇘ ⥥Pathophysiological changes
⥢Brain
⥥Well being, morbidity, mortality
For those that are still suffering from their exposures, you know, people are having a hard time sleeping and often having nightmares and flashbacks. I think for many of them the key issue isn't necessarily their pre-migration trauma but it's the issues they're struggling with once they arrive in Canada. So over and over and over again, we see people that we have diagnosed with a mental health issue that's related to trauma they've had pre-migration. And they'll see our consulting psychiatrists or start on medication. They'll often see counsellors, and excellent counsellors, that do a lot of this work. It's not until they get a job or it's not until, you know, they're reunited with family or they develop a sense of community, it's really then that we see the greatest impact on people's mental health functioning. So, you know, I think that's something to really recognize is that for those of us that have diagnosed PTSD or depression in refugee populations, often those social determinants of health are as important as some of the more conventional treatments we're accustomed to using. It is really important to recognize the importance of housing and the importance of having a community and the importance of a sense of self again. And often for many refugee patients, for many immigrants, that's lost post-migration.
People who suffer from adverse social and economic conditions, such as low-income, poor-quality housing, food insecurity, inadequate working conditions, insecure employment and various forms of discrimination, tend to experience high levels of stress. Chronic stress weakens resistance to disease and disrupts the functioning of the hormonal and metabolic systems. This makes people more vulnerable to various illnesses, including cardiovascular and immune system diseases, adult-onset of diabetes, as well as depression and anxiety (American Psychological Association, 2017).
People who experience high levels of stress often attempt to relieve these pressures by adopting unhealthy coping behaviours, such as the excessive use of alcohol, smoking and overeating carbohydrates (Ibid.). Mental health problems and illnesses are no different from physical health problems; there are a number of factors at play.