Intersectional insights into refugee mental health: exploring the impact of identity and systemic barriers

The global refugee crisis has reached unprecedented levels, placing millions of forcibly displaced individuals at heightened risk for psychological distress. While the effects of pre-migration trauma on mental health are well established, less is known about how intersecting identity factors and post-migration systemic barriers jointly shape posttraumatic stress severity.

Guided by Intersectionality Theory and Ecological Systems Theory, this study examined how pre-migration trauma exposure, identity-related characteristics, and post-migration stressors interact to predict post-traumatic stress symptom severity among refugees and asylum seekers.

Participants included 610 refugees and asylum seekers who completed standardized assessments at the Boston Center for Refugee Health and Human Rights. PTSD symptom severity was assessed using the Harvard Trauma Questionnaire. Predictors included pre-migration trauma exposure, identity factors (e.g., education level, region of origin, English proficiency), and post-migration stressors (e.g., legal status, employment, housing, community involvement). Classification and Regression Tree (CART) analysis was used to identify hierarchical and nonlinear interactions among predictors.

The pruned CART model identified education level, English language proficiency, and region of origin as the strongest predictors of PTSD symptom severity. Individuals with some formal education, higher English proficiency, and origins outside Uganda and Europe reported higher symptom scores. Pre-migration trauma variables were not retained in the final model, highlighting the influence of post-migration structural conditions.

Findings underscore the importance of moving beyond trauma-focused models to address how legal insecurity, social exclusion, and linguistic integration shape refugee mental health and recovery.