Onset of Posttraumatic Stress Disorder and Major Depression Among Refugees and Voluntary Migrants to the United States

Although refugees are generally thought to be at increased risk for posttraumatic stress disorder (PTSD) and major depressive episode (MDE), few studies have compared onset of PTSD and MDE between refugees and voluntary migrants. Given differences in migration histories, onset should differ pre- and postmigration. The National Latino and Asian American Survey (NLAAS) is a national representative, complex dataset measuring psychiatric morbidity, mental health service use, and migration history among Latino and Asian immigrants to the United States. Of the 3,260 foreign-born participants, 660 were refugees (a weighted proportion of 9.52%). Refugees were more likely to report a history of war-related trauma, but reports of other traumatic events were similar. Premigration onset of PTSD was statistically higher for refugees than voluntary migrants, odds ratio (OR) = 4.86, 95% confidence interval (CI) 2.01, 11.76, where postmigration onset for PTSD was not, OR = 0.61, 95% CI 0.29, 1.28; a similar pattern was found for MDE, OR = 1.98, 95% CI 1.11, 3.51; and OR = 1.02, 95% CI 0.65, 1.62, respectively. Although refugees arrive in host countries with more pressing psychiatric needs, onset is comparable over time, suggesting that postmigration refugees and voluntary migrants may be best served by similar programs.