Sleep Disturbance Common Among Refugees and Asylum Seekers Attending Psychological Services

By Will Boggs MD

July 30, 2019

NEW YORK (Reuters Health) - About three of four refugees and asylum seekers attending psychological services report moderate or severe sleep disturbance, researchers from Australia report.

"This study documents just how widespread problems with sleep are," Dr. Sean P. A. Drummond from Monash University, in Clayton, told Reuters Health by email. "Over 90% of adults and about 80% of children report at least some level of sleep problems, and in both age groups, more people experience severe sleep problems than severe problems in any other area."

Limited data suggest that adult and child refugees experience significant sleep disturbances, which are associated with poorer mental health and psychological functioning.

For their study, online July 16 in Sleep Health, Dr. Drummond's team examined data from 2,703 refugees and asylum seekers included in a database from a large multicenter psychological service provider within the greater Melbourne region.

Overall, 42.1% of individuals reported severe sleep disturbance and 33.4% reported moderate sleep disturbance, and sleep disturbance was the second most prevalent problem (after anxiety) reported among refugees and asylum seekers.

Only 11.7% of refugees and asylum seekers (8.6% of adults and 19.5% of children) reported not experiencing any sleep disturbance.

The severity of sleep disturbance was positively associated with all three mental health concerns (anxiety, depression and posttraumatic stress disorder, or PTSD) and with all three psychosocial concerns (family dysfunction, interpersonal difficulty and social isolation).

There were large effects of sleep disturbance on mental health symptoms for both adults and children, and the effect sizes between sleep disturbance and psychosocial concerns were small for children and small to medium for adults.

Hierarchical cluster analysis resolved three subgroups: severe sleep and anxiety symptoms (32.8% of the sample) described individuals with moderate mental health and psychosocial symptoms who had severe sleep disturbance and anxiety symptoms; mild to moderate symptoms (37.6% of the sample) included individuals who reported moderate sleep and mental health symptoms with mild psychosocial concerns; and mild symptoms (29.6% of the sample) comprised individuals who indicated mild concerns on all variables.

Refugees were about 60% to 70% more likely to be in a more-severe category, relative to the "all mild" category, but the two more-severe subgroups could not be differentiated by demographics, suggesting to the researchers "that there may be important variables in predicting subgroups not measured here."

"These data argue (that) clinicians should always assess sleep, in addition to physical and mental health problems," Dr. Drummond said. "Sleep must be seen as its own independent problem, and not just a symptom of something else."

"There are strong, effective, evidence-based treatments for sleep, with behavioral interventions (CBT for Insomnia, CBT-I) being the unanimous front-line treatment," he said. "CBT-I works very well in individuals with psychiatric and medical comorbidities. So, we would expect it to work well in refugees and asylum seeks. However, we need research to determine if this population would benefit even more from any modifications to CBT-I, especially those that might make the treatment more culturally sensitive."

Dr. Drummond added, "This is the largest study to examine sleep in a treatment-seeking population of refugees and asylum seekers. However, many, if not most, do not seek treatment. Thus, it is important to assess sleep in community samples."

"Also, it is important to note sleep problems are not only related to mental health concerns, but also to psychosocial problems," he said. "The daytime consequences of poor sleep may contribute to interpersonal problems or make it harder to adjust to their new lives. This study does not prove that, but it does suggest this question needs to be directly addressed."


Sleep Health 2019.