Research conducted by Jesus College DPhil candidate Raphael Bradenbrink, a researcher in the Department of International Development at Oxford, and international colleagues working across the fields of global health, psychiatry and international development, shows that refugees in East-Africa—particularly those exposed to violence and extended exile periods—are disproportionately affected by depression, which may also hinder their socioeconomic integration.

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The study – Depression, violence and socioeconomic outcomes among refugees in East Africa: evidence from a multicountry representative survey – is published in BMJ Mental Health (Vol 26, Issue 1).

Existing research on refugee mental health is heavily skewed towards refugees in high-income countries, even though most refugees (83%) are hosted in low-income and middle-income countries, such as Uganda, Turkey, and Bangladesh. The problem is further compounded by the unrepresentativeness of samples, small sample sizes and low response rates.

This study set out to present representative findings on the prevalence and correlates of depression among different refugee subgroups in East Africa. The multidisciplinary research group* conducted a representative survey of approximately 16,000 refugees and host populations in Kenya, Uganda and Ethiopia, and made three key findings.

Firstly, refugees in East Africa are disproportionately affected by mental health issues compared to the host population. For example, 31% have (moderate to severe) depressive symptoms versus 10% in the host population. Secondly, more than half of the refugee sample was exposed to violence before fleeing, which significantly predicted mental illness, and adverse socioeconomic outcomes, during exile. Thirdly, the group found that depressive symptoms, and exposure to violence, are associated with worse socioeconomic outcomes in exile, and these issues tend to persist and accumulate with longer exile duration, further hindering integration and imposing significant societal costs.

The results highlight that refugees in East Africa – particularly those exposed to violence and extended exile periods – are disproportionately affected by depression, which may also hinder their socioeconomic integration.

Raphael said: “These findings underscore the importance of early mental health screening of refugees upon arrival in a host country, and the need for expanding treatment interventions that promote wellbeing, to prevent a negative spiral of worsening outcomes over time.”

He added: “We hope our findings remind donors, host countries, and providers of refugee assistance to take mental health interventions seriously.”

Raphael joined Jesus College in 2020. After completing his undergraduate and Master’s degrees in Political Science at Heidelberg University, Germany in 2018, he became a research assistant at the Refugee Studies Centre, University of Oxford, working primarily on projects in Ethiopia and Kenya. In his doctoral research, Raphael explores the history and politics of humanitarian aid, in particular the role of public-private-partnerships in refugee assistance.

*The research group involved in the Depression, violence and socioeconomic outcomes among refugees in East Africa: evidence from a multicountry representative survey study are:

• Dr Julia R Pozuelo –  Department of Global Health and Social Medicine, Harvard University; Department of Psychiatry, University of Oxford; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
• Raphael Bradenbrink – Department of International Development, University of Oxford,
• Maria Flider Stierna – Department of International Development, University of Oxford; Overseas Development Institute, London
• Olivier Sterck – Department of International Development, University of Oxford; Institute of Development Policy, University of Antwerp, Belgium