Trauma, Post-migration Factors, and Ulysses Syndrome in Refugees in Host Countries
Resumo
Post-migratory factors related to post-traumatic stress disorder (PTSD) and Ulysses syndrome were analyzed. Fifty-six adult refugees (31.57% women) with protection measures were evaluated using the Post Migration Living Difficulties and the Harvard Trauma Questionnaire. Refugees had been exposed to a mean of 15.1 traumatic situations in conflict contexts. All of them had been in mortal danger. 32.1% had suffered episodes of torture, and 30.4% suffered from PTSD with a mean of 4.18 post-traumatic symptoms. No differences were found based on gender, nationality, or host country. Traumatic and torture episodes, living in institutionalized centers, working conditions, physical health, and social and family relationships influenced the presence of PTSD. Suffering associated with family separation, social status, and risks of physical integrity was detected, without these constituting a DSM-5 diagnosis of mental disorder but rather a case of migratory mourning in its extreme version or Ulysses syndrome.
Palavras-chave
Refugees, Post-migration factors, PTSD, Ulysses syndromeReferências
Achotegui, Joseba. (2002). La depresión en los inmigrantes. Una perspectiva transcultural. Ed Mayo.
Achotegui, Joseba. (2005). El Síndrome del Inmigrante con estrés crónico y múltiple- Síndrome de Ulises. Voces de la Psiquiatría en España. Revista Vértex, 16(60), 105–114. https://raco.cat/index.php/RdM/article/view/339995
Achotegui, Joseba. (2009). Estrés límite y salud mental: el síndrome del inmigrante con estrés crónico y múltiple (Síndrome de Ulises). Gaceta Médica de Bilbao, 106(4), 122–133. https://www.gacetamedicabilbao.eus/index.php/gacetamedicabilbao/article/viewFile/278/284
Achotegui, Joseba. (2019). Migrants living in very hard situations: Extreme migratory mourning (the Ulysses syndrome). Psychoanalytic Dialogues, 29(3), 252–268. https://doi.org/10.1080/10481885.2019.1614826
Aitcheson, Rozanna J.; Abu-Bader, Soleman H.; Howell, Mary K.; Khalil, Deena, & Elbedour, Salman. (2017). Resilience in Palestinian adolescents living in Gaza. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 36–43. https://doi.org/10.1037/tra0000153
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Aragona, Massimiliano; Pucci, Daniela; Mazzetti, Marco, & Geraci, Salvatore. (2012). Post-migration living difficulties as a significant risk factor for PTSD in immigrants: a primary care study. Italian Journal of Public Health, 9(3), e7525. https://doi.org/10.2427/7525
Aragona, Massimiliano; Pucci, Daniela; Mazzetti, Marco; Maisano, Bianca, & Geraci, Salvatore. (2013). Traumatic events, post-migration living difficulties and post-traumatic symptoms in first generation immigrants: a primary care study. Annali dell’ Istituto Superiore di Sanita, 49, 169–175. https://doi.org/10.4415/ANN_13_02_08
Arnetz, Judith; Rofa, Yoasif; Arnetz, Bengt; Ventimiglia, Matthew, & Jamil, Hikmet. (2013). Resilience as a protective factor against the development of psychopathology among refugees. Journal of Nervous and Mental Disease, 201(3), 167–172. https://doi.org/10.1097%2FNMD.0b013e3182848afe
Basoglu, Metin; Jaranson, James M.; Mollica, Richard, & Kastrup, Marianne. (2001). Torture and Mental Health. In Ellen Gerrity, Farris Tuma, & Terence M. Keane (Eds.), The mental health consequences of torture (pp. 35–62). Kluwer Academic.
Beiser, Morton, & Hyman, Ilene. (1997). Refugees’ time perspective and mental health. American Journal of Psychiatry, 154(7), 996–1002. https://doi.org/10.1176/ajp.154.7.996
Beiser, Morton, & Wickrama, Kandauda. (2004). Trauma, time and mental health: A study of temporal reintegration and depressive disorder among Southeast Asian refugees. Psychological Medicine, 34(5), 899–910. https://doi.org/10.1017/S0033291703001703
Bianucci, Raffaella; Charlier, Philippe; Perciaccante, Antonio; Lippi, Donatella, & Appenzeller, Otto. (2017). The “Ulysses syndrome”: An eponym identifies a psychosomatic disorder in modern migrants. European Journal of Internal Medicine, 41, 30–32. https://doi.org/10.1016/j.ejim.2017.03.020
Bogic, Marija; Ajdukovic, Dean; Bremner, Stephen; Franciskovic, Tanja; Galeazzi, Gian M.; Kucukalic, Abdulah; Lecic-Tosevski, Dusica; Morina, Nexhmedin; Popovski, Mihajlo; Schützwohl, Matthias; Wang, Duolao, & Priebe, Stefan. (2012). Factors associated with mental disorders in long-settled war refugees: Refugees from the former Yugoslavia in Germany, Italy and the UK. The British Journal of Psychiatry, 200(3), 216–223. https://doi.org/10.1192/bjp.bp.110.084764
Bogic, Marija; Njoku, Anthony, & Priebe, Stefan. (2015). Long-term mental health of war-refugees: a systematic literature review. BMC International Health and Human Rights, 15, 29, 1–41. https://doi.org/10.1186/s12914-015-0064-9
Bonanno, George A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events?. American Psychologist, 59(1), 20–28. https://doi.org/10.1037/0003-066X.59.1.20
Bradley, Lloyd, & Tawfiq, Nouran. (2006). The physical and psychological effects of torture in Kurds seeking asylum in the United Kingdom. Torture, 16(1), 41–47. https://drive.reindex.net/RCT/101/TORT2006.1.5.pdf
Bustamante, Lineth H.; Cerqueira, Raphael O.; Leclerc, Emilie, & Brietzke, Elisa. (2018). Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review. Brazilian Journal of Psychiatry, 40(2), 220–225. https://doi.org/10.1590/1516-4446-2017-2290
Chan, K. Jacky; Young, Marta Y., & Sharif, Noor. (2016). Well-being after trauma: A review of posttraumatic growth among refugees. Canadian Psychology/Psychologie Canadienne, 57(4), 291–299. https://doi.org/10.1037/cap0000065
Craig, Tom; Mac Jajua, Peter, & Warfa, Nasir. (2009). Mental health care needs of refugees. Psychiatry, 8(9), 351–354. https://doi.org/10.1016/j.mppsy.2009.06.007
De Jong, Joop T.; Komproe, Ivan H., & Van Ommeren, Mark. (2003). Common mental disorders in postconflict settings. The Lancet, 361(9375), 2128–2130. https://doi.org/10.1016/S0140-6736(03)13692-6
European Commission. (2022). First instance decisions on applications by citizenship, age and sex - annual aggregated data (rounded). https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Annual_asylum_statistics#Decisions_on_asylum_applications
Fazel, Mina; Wheeler, Jeremy, & Danesh, John. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365(9467), 1309–1314. https://doi.org/10.1016/S0140-6736(05)61027-6
Giacco, Domenico, & Priebe, Stefan. (2018). Mental health care for adult refugees in high-income countries. Epidemiology and Psychiatric Sciences, 27(2), 109–116. https://doi.org/10.1017/S2045796017000609
Gootzeit, Joshua, & Markon, Kristian. (2011). Factors of PTSD: Differential specificity and external correlates. Clinical Psychology Review, 31(6), 993–1003. https://doi.org/10.1016/j.cpr.2011.06.005
Guarch-Rubio, Marta. (2023). Psicología de Fronteras. Prensas de la Universidad de Zaragoza.
Guarch-Rubio, Marta; Byrne, Steven, & Manzanero, Antonio L. (2020). Violence and torture against migrants and refugees attempting to reach the European Union through Western Balkans. Torture, 30(3), 67–83. https://doi.org/10.7146/torture.v30i3.120232
Guarch-Rubio, Marta, & Manzanero, Antonio L. (2017). Psychological disorders in women in long-term forced displacement in the Sahrawi refugee camps. Revista de Victimología/Journal of Victimology, 5, 151–170. https://doi.org/10.12827/RVJV.5.06
Guarch-Rubio, Marta, & Manzanero, Antonio L. (2020). Credibility and testimony in asylum procedures with unaccompanied refugee minors. European Journal of Migration and Law, 22(2), 257–271. https://doi.org/10.1163/15718166-12340076
Guarch-Rubio, Marta; Manzanero, Antonio L.; Delgado, F. Roy; Minescu, Anca, & Mohamed, Doumaha. (2025). Torture, trauma, and posttraumatic symptoms in Syrian women asylum seekers in the Greek border camp of Idomeni. Torture, 35(1), 12–25. https://doi.org/10.7146/torture.v35i1.140862
Hollander, Anna-Clara; Bruce, Daniel; Burström, Bo, & Ekblad, Solvig. (2011). Gender-related mental health differences between refugees and non-refugee immigrants-a cross-sectional register-based study. BMC Public Health, 11, 180. https://doi.org/10.1186/1471-2458-11-180
Ibrahim, Hawkar, & Hassan, Chiya Q. (2017). Post-traumatic stress disorder symptoms resulting from torture and other traumatic events among Syrian Kurdish refugees in Kurdistan Region, Iraq. Frontiers in Psychology, 8, 241-249. https://doi.org/10.3389/fpsyg.2017.00241
Keller, Allen S.; Rosenfeld, Barry; Trinh-Shevrin, Chau; Meserve, Chris; Sachs, Emily; Leviss, Jonathan A.; Singer, Elizabeth; Smith, Hawthorne; Wilkinson, John; Kim, Glen; Allden, Kathleen, & Ford, Douglas. (2003). Mental health of detained asylum seekers. The Lancet, 362(9397), 1721–1723. https://doi.org/10.1016/S0140-6736(03)14846-5
Levine, Stephen Z.; Laufer, Avital; Stein, Einat; Hamama-Raz, Yaira, & Solomon, Zahava. (2009). Examining the relationship between resilience and posttraumatic growth. Journal of Traumatic Stress, 22(4), 282–286. https://doi.org/10.1002/jts.20409
Lund, Crick; Brooke-Sumner, Carrie; Baingana, Florence; Baron, Emily C.; Breuer, Erica; Chandra, Prabha; Haushofer, Johannes; Herrman, Helen; Jordans, Mark; Kieling, Christian; Medina-Mora, M. Elena; Philm, Ellen M.; Omigbodun, Olayinka; Tol, Wietse; Patel, Vikram, & Saxena, Shekhar. (2018). Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. The Lancet Psychiatry, 5(4), 357–369. https://doi.org/10.1016/S2215-0366(18)30060-9
Manzanero, Antonio L.; Aroztegui, Javier; Fernández, Javier; Guarch-Rubio, Marta; Álvarez, Miguel A.; El-Astal, Sofian, & Hemaid, Fairouz. (2024). War, torture and trauma in preadolescents from Gaza Strip. Two different modalities of PTSD. Anuario de Psicología Jurídica, 34, 1–12. https://doi.org/10.5093/apj2024a6
Manzanero, Antonio L.; Crespo, María; Barón, Susana; Scott, M. Teresa; El-Astal, Sofian, & Hemaid, Fairouz. (2021). Traumatic events exposure and psychological trauma in children victims of war in the Gaza Strip. Journal of Interpersonal Violence, 36(3-4), 1568–1587. https://doi.org/10.1177/0886260517742911
Manzanero, Antonio L.; Fernández, Juan; Gómez-Gutiérrez, M. Mar; Álvarez, Miguel A.; El-Astal, Sofian; Hemaid, Fairouz, & Veronese, Guido. (2020). Between happiness and sorrow: Phenomenal characteristics of autobiographical memories concerning war episodes and positive events in the Gaza Strip. Memory Studies, 13(6), 917–931. https://doi.org/10.1177/1750698018818221
Manzanero, Antonio L.; Guarch-Rubio, Marta; Vallet, Rocío, & Vara, Alba. (2025). On post-traumatic stress disorder and the accessibility of memories: Traumatic memories in refugees and asylum seekers. Psychiatry, Psychology and Law, 1–14. https://doi.org/10.1080/13218719.2025.2510227
Mollica, Richard F.; Caspi-Yavin, Yael; Bollini, Paola; Truong, Toan; Tor, Svang, & Lavelle, James. (1992). The Harvard Trauma Questionnaire: Validating a crosscultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental Disease, 180(2), 111–116. https://doi.org/10.1097/00005053-199202000-00008
Najjarkakhaki, Ardalan, & Ghane, Samrad. (2021). The role of migration processes and cultural factors in the classification of personality disorders. Transcultural Psychiatry, 60(1), 99–113. https://doi.org/10.1177/13634615211036408
Priebe, Stefan; Gavrilovic, Jelena J.; Bremner, Stephen; Ajdukovic, Dean; Franciskovic, Tanja; Galeazzi, Gian M.; Kucukalic, Abdulah; Lecic-Tosevski, Dusica; Morina, Nexhmedin; Popovski, Mihajlo; Schützwohl, Matthias, & Bogic, Marija. (2013). Psychological symptoms as long-term consequences of war experiences. Psychopathology, 46(1), 45–54. https://doi.org/10.1159/000338640
Rasmussen, Andrew; Verkuilen, Jay; Ho, Emily, & Fan, Yuyu. (2015). Posttraumatic stress disorder among refugees: Measurement invariance of Harvard Trauma Questionnaire scores across global regions and response patterns. Psychological Assessment, 27(4), 1160–1170. https://doi.org/10.1037/pas0000115
Robjant, Katy; Hassan, Rita, & Katona, Cornelius. (2009). Mental health implications of detaining asylum seekers: systematic review. The British Journal of Psychiatry, 194, 306–312. https://doi.org/10.1192/bjp.bp.108.053223
Rodolico, Alessandro; Vaccino, Noemi; Riso, Maria C.; Concerto, Carmen; Aguglia, Eugenio, & Signorelli, Maria S. (2019). Prevalence of Post-Traumatic Stress Disorder among asylum seekers in Italy: A Population-Based Survey in Sicily. Journal of Immigrant and Minority Health, 22(3), 634–638. https://doi.org/10.1007/s10903-019-00948-9
Schick, Matthis; Morina, Naser; Mistridis, Panagiota; Schnyder, Ulrich; Bryant, Richard A., & Nickerson, Angela. (2018). Changes in post-migration living difficulties predict treatment outcome in traumatized refugees. Frontiers in Psychiatry, 9, 476. https://doi.org/10.3389/fpsyt.2018.00476
Schick, Matthis; Zumwald, Andre; Knöpfli, Bina; Nickerson, Angela; Bryant, Richard A.; Schnyder, Ulrich; Müller, Julia, & Morina, Naser. (2016). Challenging future, challenging past: The relationship of social integration and psychological impairment in traumatized refugees. European Journal of Psychotraumatology, 7, 28057. https://doi.org/10.3402/ejpt.v7.28057
Schmidt, Martina; Kravic, Nera, & Ehlert, Ulrike. (2008). Adjustment to trauma exposure in refugee, displaced, and non-displaced Bosnian women. Archives of Women’s Mental Health, 11(4), 269–276. https://doi.org/10.1007/s00737-008-0018-5
Shoeb, Marwa; Weinstein, Harvey, & Mollica, Richard. (2007). The Harvard trauma questionnaire: adapting a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Iraqi refugees. International Journal of Social Psychiatry, 53, 447–463. https://doi.org/10.1177%2F0020764007078362
Silove, Derrick; Sinnerbrink, Ingrid; Field, Annette; Manicavasagar, Vijaya, & Steel, Zachary. (1997). Anxiety, depression and PTSD in asylum-seekers: assocations with pre-migration trauma and post-migration stressors. The British Journal of Psychiatry, 170(4), 351–357. https://doi.org/10.1192/bjp.170.4.351
Steel, Zachary; Chey, Tien; Silove, Derrick; Marnane, Claire; Bryant, Richard, & Van Ommeren, Mark. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA, 302(5), 537–549. https://doi.org/10.1001/jama.2009.1132
Steel, Zachary; Silove, Derrick; Bird, Kevin; McGorry, Patrick, & Mohan, P. (1999). Pathways from war trauma to posttraumatic stress symptoms among Tamil asylum seekers, refugees, and immigrants. Journal of Traumatic Stress, 12(3), 421–435. https://doi.org/10.1023/A:1024710902534
Steel, Zachary; Silove, Derrick; Brooks, Robert; Momartin, Shakeh; Alzuhairi, Bushra, & Susljik, Ina. (2006). Impact of immigration detention and temporaly protection on the mental health of refugees. British Journal of Psychiatry, 188(1), 58–64. https://doi.org/10.1192/bjp.bp.104.007864
Uy, K. Kara, & Okubo, Yuki. (2018). Re-storying the trauma narrative: Fostering posttraumatic growth in Cambodian refugee women. Women & Therapy, 41(3-4), 219–236. https://doi.org/10.1080/02703149.2018.1425025
WHO. (2018). Mental health promotion and mental health care in refugees and migrants. https://www.euro.who.int/en/health-topics/health-determinants/migration-and-health/publications/2018/mental-health-promotion-and-mental-health-care-in-refugees-and-migrants-2018
Zimmerman, Cathy; Kiss, Ligia, & Hossain, Mazeda. (2011). Migration and health: A framework for 21st century policy-making. PLoS Medicine, 8(5), e1001034. https://doi.org/10.1371/journal.pmed.1001034
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