Post-migration journey: Asylum,trauma and resilience,different trajectories – A comparison of the mental health and post-migration living difficulties of documented and undocumented migrants in Belgium

Introduction

According to the United Nations High Commissioner for Refugees (2022), there are more than 89.3 million people displaced worldwide by conflict, human rights abuses, climate change, food insecurity, etc. In 2021, 43.5% of asylum applications submitted to the Belgian authorities resulted in asylum being granted to 10,093 people, with a refusal rate of 56.5% (Asylum Information Database, 2022). In 2017, the Belgian authorities found that only 20% of dismissed migrants left the country (Migrants-Refugees, 2020). People in an irregular situation, also known as undocumented migrants, refer to people who do not have or no longer have a valid residence permit authorising them to stay in Belgium legally. Undocumented migrants have few legal rights (Ligue des droits de l’Homme, 2016).

The scientific literature has long established that migrant populations are likely to develop mental health disorders (Cleary et al., 2018; Knefel et al., 2020). The most frequently diagnosed would be post-traumatic stress disorder (PTSD), depressive disorders and finally anxiety disorders (Aragona et al., 2011; Brunnet et al., 2018; Silove et al., 1997).

Research on the predictors of mental health in migrant populations has mainly focussed on pre-migration and perimigration factors (Sinnerbrink et al., 1997; Steel et al., 2017). Recent literature has shown a predictive link between post-migration living difficulties and psychological distress in migrant populations (Alemi et al., 2016; Aragona et al., 2020; Gleeson et al., 2020). In the face of these advances, it has been observed that the post-migration journey is still insufficiently investigated in current research, and in treatment protocols, psychotherapies (Knefel et al., 2020). However, some authors have argued that post-migration difficulties have a more severe impact on mental health than adversities experienced before migration (Carswell et al., 2011; Laban et al., 2008). Undocumented migrants appear to be more heavily impacted by uncertain employment, limited social and family networks, restricted access to information, lack of legal protection, exploitation and access to housing (Croix-Rouge de Belgique, 2014; Garcini et al., 2017; Momartin et al., 2006; Nickerson et al., 2019). They are also more likely to be exposed to physical, verbal, psychological and gender-based violence (Keygnaert et al., 2012; Steel et al., 2006).

In view of these findings, the aim of this study was to assess the differences between documented and undocumented migrants in terms of mental health. Secondly, we identified the post-migration living difficulties experienced by these two groups, and measured their impact on their levels of trauma, resilience, anxiety, depression and their assumptive world.

Methods

Data analysis

All analyses were conducted using the SAS statistical program Version 9.4. There was less than 5% missing data on any of the variables included in the analyses.

Results

Discussion

This study investigated the impact of post-migration living difficulties on mental health in a sample of documented and undocumented people living in Belgium. Our analyses confirmed that the mental health of undocumented migrants was poorer than that of documented migrants. However, we were unable to find any difference between the two groups in feelings of safety and relational resilience. Our results also revealed differences in the post-migration difficulties experienced by both groups. Finally, we found that post-migration difficulties had a significant impact on the mental health of the migrant populations. The majority of the results obtained in this study confirmed our initial hypotheses and were in line with previous international research.

First, we observed higher levels of PTSD in our sample for undocumented migrants. This difference could be explained in different ways: either undocumented migrants are more exposed to traumatic events during their pre-migration journey, or during their peri-migration journey, or after their resettlement in the host country, in the post-migration phase. These three hypotheses remain widely discussed in current scientific research and are not mutually exclusive (Knefel et al., 2020; Steel et al., 2017). Furthermore, authors have recently highlighted that the difficulties encountered in the host country have a greater impact on trauma than previous experiences in the country of origin (Carswell et al., 2011; Li et al., 2016; Zimbrean et al., 2014) and the development of PTSD is thought to be largely dependent on the conditions of resettlement in the host society (Schweitzer et al., 2011; Silove et al., 2000). Thus, studies have shed light on a disturbing effect of ‘re-traumatisation’ in Western countries (Posselt et al., 2020).

Then, we found higher levels of anxiety and depression in our sample for undocumented migrants. These results are in line with previous research (Newnham et al., 2019). This difference could be explained by a combination of many obstacles encountered in the host country. Studies have identified a risk of major depressive disorder that is twice as high for unemployed migrants (Croix-Rouge de Belgique, 2014; Heeren et al., 2014; Hocking et al., 2015a).

It is possible that the high levels of PTSD, anxiety and depression measured in the undocumented migrant group are due to their vulnerability to the development of mental health disorders. Given their low representativeness in prevalence studies of migrant populations, we might therefore expect an underestimation of the general mental health statistics for this particular group. Additionally, the levels of mental health disorders experienced by the documented migrants in our sample were particularly high compared to the prevalence observed in the general population, as demonstrated in previous studies (Schweitzer et al., 2011). This allows us to deduce that the restorative effect of the positive asylum decision would not erase the trauma experienced despite the granting of a protection status.

Moreover, our findings showed a more negative assumptive world and a lower sense of control for the undocumented migrants. In contrast, we could not find any difference between the two groups for the feeling of security. These results are new. On the other hand, the absence of difference between documented and undocumented migrants about the feeling of security is more surprising. Different explanations may be suggested. These results could indicate that documented migrants have a lower sense of security than expected. Thus, we could assume that recognised refugees continue to live in a context of insecurity. This could also indicate that undocumented migrants have a higher sense of security than expected. Thirdly, these results could be the consequence of an external factor or methodological biases.

In addition, we found lower total resilience and personal resilience in our sample for undocumented migrants. In contrast, we could not find any difference between the two groups for relational resilience. These results are new. In our view, the differences between documented and undocumented migrants could be explained by the Drive to Thrive theory developed by Hou et al. (2018). This theory postulates that resilience is determined by the maintenance of regularity and structure in the everyday environment, following the experience of traumatic events. This theory posits that in precarious conditions a reduction in the regularity of daily routines would be associated with poorer mental health and resilience capacities (Hou et al., 2018).

Furthermore, this study showed that the number and severity of post-migration living difficulties differed. Those experienced by undocumented migrants are both more severe and more numerous. These results are consistent with the current literature comparing migrants with temporary and permanent status (Garcini et al., 2017; Momartin et al., 2006; Nickerson et al., 2019).

Our results also show that the post-migration difficulties experienced vary in their content. On the one hand, the most reported difficulties for documented migrants are: separation from their families, followed by difficulties in obtaining appropriate housing, and finally the inability to return to their country of origin in case of an emergency. On the other hand, the difficulties most often mentioned by undocumented migrants concern issues related to employment and fear of being repatriated to their country of origin, followed by problems related to the asylum application and concerns about the family left behind. These data lead us to make several observations. First of all, despite the protection status they hold, documented migrants still seem to regularly face major post-migration difficulties related to housing or employment. Secondly, it is surprising to note that employment-related difficulties are equivalent to the fear of expulsion for undocumented migrants and outweigh all other post-migration difficulties. This underlines the fact that employment integration is the starting point for resettlement in the host country, providing opportunities for socialisation, financial resources, access to basic needs and a way of finding a role in society. Finally, we can also identify in these results the importance of the social and family network for both groups which is recognised as a protective factor in the literature (Fossion et al., 2006; Schweitzer et al., 2007).

Additionally, findings showed a significant impact of post-migration difficulties on measures of trauma, depression, anxiety, the assumptive world, sense of control and security and total, personal and relational resilience for the whole sample. These findings are consistent with recent studies (Li et al., 2016).

Finally, our research has highlighted important clinical, social and political implications for mental health professionals, policy makers and the general public.

Limitations

The current study had several limitations.

First, our sample differed in terms of the residence status obtained, age, gender, nationality or length of stay in Belgium. For example, the group of documented migrants included people from different backgrounds, who had been granted international protection status, subsidiary protection status, naturalisation or family reunification. Likewise, migration conditions differed. It is therefore not possible to account for the role of the different migration conditions or the different status obtained. Several differences that could have limited generalisability of findings (Li et al., 2016). However, this diversity was intended to gather a representative sampling of the highly diverse migrant population in Belgium.

Second, a bias often identified within the literature concerns the exaggeration of symptoms of precarious populations in order to be viewed favourably and attract public sympathy (Hocking et al., 2015a, 2015b, Steel et al, 2006). Within our study, this could have led to an amplification of difficulties and needs. Conversely, some participants might have concealed certain aspects of their experience so that disclosure would not undermine their status or procedure (e.g. in the case of undeclared work or false claims). We tried to avoid these reporting biases by making it clear to each participant that all data collected was anonymous and confidential, so that what was shared could not in any way promote or affect their immigration status.

Finally, the data collection undertaken using self-report measures rather than clinician administered diagnostic interviews. Our analyses relied exclusively on self-reporting by participants, as it is frequently done in migration research. This way of collecting data could have biased our results, due to its lack of objectivity, compared to diagnostic interviews administered by a clinician. Indeed, self-reporting of clinical symptoms may have led to an underestimation or overestimation of these symptoms and limit the accuracy of the diagnosis