{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:49:13Z","timestamp":1793159353388,"version":"4.5.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T00:00:00Z","timestamp":1673827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The Rohingya endured intense trauma in Myanmar and continue to experience trauma related to displacement in Bangladesh. We aimed to evaluate the association of post-displacement stressors with mental health outcomes, adjusting for previously experienced trauma, in the Rohingya refugee population in Cox's Bazar, Bangladesh.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data from the Cox's Bazar Panel Survey, a cross sectional survey consisting of 5,020 household interviews and 9,386 individual interviews completed in 2019. Using logistic regression, we tested the association between post-displacement stressors such as current exposure to crime and conflict and two mental health outcomes: depression and post-traumatic stress disorder (PTSD). In adjusted analyses, we controlled for past trauma, employment status, receiving an income, food security, and access to healthcare and stratified by gender.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of depressive symptoms was 30.0% (<jats:italic>n<\/jats:italic> = 1,357) and PTSD 4.9% (<jats:italic>n<\/jats:italic> = 218). Most (87.1%, <jats:italic>n<\/jats:italic> = 3,938) reported experiencing at least one traumatic event. Multiple post-displacement stressors, such as current exposure to crime and conflict (for men: OR = 2.23, 95% CI = 1.52\u20133.28, <jats:italic>p<\/jats:italic> &amp;lt; 0.001; for women: OR = 1.92, 95% CI = 1.44\u20132.56, <jats:italic>p<\/jats:italic> &amp;lt; 0.001), were associated with higher odds of depressive symptoms in multivariable models. Trauma (OR = 4.98, 95% CI = 2.20\u201311.31, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) was associated with increased odds of PTSD. Living in a household that received income was associated with decreased odds of PTSD (OR = 0.74, 95% CI = 0.55\u20131.00, <jats:italic>p<\/jats:italic> = 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Prevalence of depressive symptoms was high among Rohingya refugees living in Cox's Bazar. Adjusting for past trauma and other risk factors, exposure to post-displacement stressors was associated with increased odds of depressive symptoms. There is a need to address social determinants of health that continue to shape mental health post-displacement and increase mental healthcare access for displaced Rohingya.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.1048649","type":"journal-article","created":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T11:34:05Z","timestamp":1673868845000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Associations among past trauma, post-displacement stressors, and mental health outcomes in Rohingya refugees in Bangladesh: A secondary cross-sectional analysis"],"prefix":"10.3389","volume":"10","author":[{"given":"Haley","family":"Ritsema","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Armstrong-Hough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,16]]},"reference":[{"key":"B1","unstructured":"UNHCR Refugee Statistics.2022"},{"key":"B2","unstructured":"UNHCR Global Trends - Forced displacement in 2020. UNHCR Flagship Reports.2020"},{"key":"B3","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s13031-020-00306-9","article-title":"Systematic human rights violations, traumatic events, daily stressors and mental health of Rohingya refugees in Bangladesh","volume":"14","author":"Riley","year":"2020","journal-title":"Confl Health."},{"key":"B4","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1177\/1363461517705571","article-title":"Daily stressors, trauma exposure, and mental health among stateless Rohingya refugees in Bangladesh","volume":"54","author":"Riley","year":"2017","journal-title":"Transcult Psychiatry."},{"key":"B5","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1007\/s00127-020-01962-1","article-title":"Trauma, mental health, and everyday functioning among Rohingya refugee people living in short- and long-term resettlements","volume":"56","author":"Khan","year":"2021","journal-title":"Soc Psychiatry Psychiatr Epidemiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1017\/S2045796019000192","article-title":"The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review","volume":"28","author":"Tay","year":"2019","journal-title":"Epidemiol Psychiatr Sci."},{"key":"B7","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1007\/s11920-016-0723-0","article-title":"The relationship between post-migration stress and psychological disorders in refugees and asylum seekers","volume":"18","author":"Li","year":"2016","journal-title":"Curr Psychiatry Rep."},{"key":"B8","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1001\/jama.294.5.602","article-title":"Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis","volume":"294","author":"Porter","year":"2005","journal-title":"JAMA."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e1003337","DOI":"10.1371\/journal.pmed.1003337","article-title":"The prevalence of mental illness in refugees and asylum seekers: a systematic review and meta-analysis","volume":"17","author":"Blackmore","year":"2020","journal-title":"PLoS Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/S0140-6736(19)30934-1","article-title":"New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis","volume":"394","author":"Charlson","year":"2019","journal-title":"Lancet."},{"key":"B11","volume-title":"Depression and Other Common Mental Disorders: Global Estimates","year":"2017"},{"key":"B12","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1002\/da.22169","article-title":"Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys","volume":"31","author":"Karam","year":"2014","journal-title":"Depress Anxiety."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e144","DOI":"10.1016\/S2542-5196(19)30037-3","article-title":"Violence and mortality in the Northern Rakhine State of Myanmar, 2017: results of a quantitative survey of surviving community leaders in Bangladesh","volume":"3","author":"Parmar","year":"2019","journal-title":"Lancet Planetary Health."},{"key":"B14","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s13031-019-0226-9","article-title":"Documentation of human rights abuses among Rohingya refugees from Myanmar","volume":"13","author":"Haar","year":"2019","journal-title":"Confl Health."},{"key":"B15","unstructured":"Sexual Violence, Trauma, and Neglect: Observations of Health Care Providers Treating Rohingya Survivors in Refugee Camps in Bangladesh2020"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1016\/S0140-6736(16)00646-2","article-title":"The Rohingya people of Myanmar: health, human rights, and identity","volume":"389","author":"Mahmood","year":"2017","journal-title":"Lancet."},{"key":"B17","unstructured":"M\u00e9decins Sans Fronti\u00e8res (MSF) International.2017"},{"key":"B18","year":"2018","journal-title":"\u201cNo one was left\u201d Death and Violence Against the Rohingya in Rakhine State, Myanmar"},{"key":"B19","unstructured":"Situation Refugee Response in Bangladesh. UNHCR Operational Data Portal (ODP).2022"},{"key":"B20","volume-title":"Country Note Bangladesh: International Protection Issues and Recommendations from International and Regional Human Rights Mechanisms and Bodies","author":"Cortinovis","year":"2021"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e211801","DOI":"10.1001\/jamanetworkopen.2021.1801","article-title":"Predisplacement abuse and postdisplacement factors associated with mental health symptoms after forced migration among Rohingya Refugees in Bangladesh","volume":"4","author":"Hossain","year":"2021","journal-title":"JAMA Netw Open."},{"key":"B22","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1080\/26410397.2019.1610275","article-title":"Mortality in Rohingya refugee camps in Bangladesh: historical, social, and political context","volume":"27","author":"Parmar","year":"2019","journal-title":"SRHM."},{"key":"B23","doi-asserted-by":"publisher","first-page":"942","DOI":"10.3390\/ijerph14080942","article-title":"Trapped in statelessness: Rohingya Refugees in Bangladesh","volume":"14","author":"Milton","year":"2017","journal-title":"Int J Environ Res Public Health."},{"key":"B24","doi-asserted-by":"publisher","first-page":"6730","DOI":"10.3390\/ijerph17186730","article-title":"Elucidating mental health disorders among Rohingya Refugees: a Malaysian perspective","volume":"17","author":"Kaur","year":"2020","journal-title":"Int J Environ Res Public Health."},{"key":"B25","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1038\/s41398-019-0537-z","article-title":"Functional impairment as a proxy measure indicating high rates of trauma exposure, post-migration living difficulties, common mental disorders, and poor health amongst Rohingya refugees in Malaysia","volume":"9","author":"Tay","year":"2019","journal-title":"Transl Psychiatry."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e212543","DOI":"10.1001\/jamanetworkopen.2021.2543","article-title":"Refugee mental health-an urgent call for research and action","volume":"4","author":"Saadi","year":"2021","journal-title":"JAMA Netw Open."},{"key":"B27","unstructured":"BairdS\n            DavisCA\n            GenoniM\n            Lopez-PenaP\n            MobarakAM\n            PalaniswamyN\n          Cox's Bazar Panel Survey. Harvard Dataverse.2021"},{"key":"B28","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/00005053-199202000-00008","article-title":"The Harvard trauma questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese Refugees","volume":"180","author":"Mollica","year":"1992","journal-title":"J Nerv Ment Dis."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1037\/pas0000115","article-title":"Posttraumatic stress disorder among refugees: Measurement invariance of Harvard Trauma Questionnaire scores across global regions and response patterns","volume":"27","author":"Rasmussen","year":"2015","journal-title":"Psychol Assess."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1321357","DOI":"10.1080\/20008198.2017.1321357","article-title":"The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups","volume":"8","author":"Wind","year":"2017","journal-title":"Eur J Psychotraumatol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1186\/s13690-020-00476-1","article-title":"The association of mental disorders with perceived social support, and the role of marital status: results from a national cross-sectional survey","volume":"78","author":"Vaingankar","year":"2020","journal-title":"Arch Public Health."},{"key":"B33","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1521\/psyc.2007.70.4.283","article-title":"Five essential elements of immediate and mid\u2013term mass trauma intervention: empirical evidence","volume":"70","author":"Hobfoll","year":"2007","journal-title":"Psychiatry."},{"key":"B34","unstructured":"Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide: Version 3: (576842013-001). American Psychological Association.2007"},{"key":"B35","article-title":"Stata Statistical Software: Release 17","year":""},{"key":"B36","unstructured":"Bangladesh: Investigate Refugee-Beatings by Police, Lift Restrictions on Movement. Fortify Rights.2022"},{"key":"B37","article-title":"\u201cAn island jail in the middle of the sea\u201d: Bangladesh's relocation of Rohingya refugees to Bhasan Char","year":"2021"},{"key":"B38","unstructured":"Human Rights Watch.2022"},{"key":"B39","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1001\/jama.2009.1132","article-title":"Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis","volume":"302","author":"Steel","year":"2009","journal-title":"JAMA."},{"key":"B40","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1177\/0706743717746666","article-title":"The social determinants of refugee mental health in the post-migration context: a critical review","volume":"63","author":"Hynie","year":"2018","journal-title":"Can J Psychiatry."},{"key":"B41","volume-title":"Gender brief on Rohingya refugee crisis in Bangladesh","year":"2017"},{"key":"B42","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1177\/1077801216689163","article-title":"Drivers of intimate partner violence against women in three Refugee Camps","volume":"24","author":"Wachter","year":"2018","journal-title":"Violence Against Women."},{"key":"B43","unstructured":"Social and cultural factors shaping health and nutrition, wellbeing and protection of the Rohingya within a Humanitarian Context\n            RipollS\n            IqbalI\n            FarzanaKF\n            MasoodA\n            GalacheCS\n            MiranteE\n          2017"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1177\/0886260521991299","article-title":"Intimate partner abuse among Rohingya women and its relationship with their abilities to reject husbands' advances to unwanted sex","author":"Islam","year":"2021","journal-title":"J Interpers Violence"},{"key":"B45","unstructured":"GaynorT\n          Rohingya Widows Worry about their Families' Futures. UNHCR.2018"},{"key":"B46","doi-asserted-by":"publisher","first-page":"5318","DOI":"10.3390\/ijerph18105318","article-title":"Displacement, violence, and mental health: evidence from Rohingya adolescents in cox's Bazar, Bangladesh","volume":"18","author":"O'Connor","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"B47","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1002\/wps.20438","article-title":"The contemporary refugee crisis: an overview of mental health challenges","volume":"16","author":"Silove","year":"2017","journal-title":"World Psychiatry."},{"key":"B48","doi-asserted-by":"publisher","first-page":"e0253013","DOI":"10.1371\/journal.pone.0253013","article-title":"The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox's Bazar, Bangladesh","volume":"16","author":"Jeffries","year":"2021","journal-title":"PLoS ONE."},{"key":"B49","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1093\/eurpub\/cky256","article-title":"The HTQ-5: revision of the Harvard Trauma Questionnaire for measuring torture, trauma and DSM-5 PTSD symptoms in refugee populations","volume":"29","author":"Berthold","year":"2019","journal-title":"Eur J Public Health."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.1048649\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T11:34:11Z","timestamp":1673868851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.1048649\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,16]]},"references-count":49,"alternative-id":["10.3389\/fpubh.2022.1048649"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.1048649","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,16]]},"article-number":"1048649"}}