A systematic review of protective and promotive factors in refugee mental health

There are currently over 117 million forcibly displaced people worldwide, and approximately 45 million of these are refugees and asylum-seekers. Despite exposure to substantial adversity, many refugees do not develop clinically significant psychopathology. There is a need to understand factors that are associated with good mental health in refugees to inform policy-makers and practitioners working with refugees. Here we aim to synthesize research on factors that are protective (associated with lower negative mental health outcomes) or promotive (associated with higher positive mental health outcomes) among adult refugees living in high-income countries (HICs) and lower-and-middle-income countries (LMICs). We searched four databases (PubMed, Embase, ProQuest and PsycINFO) for relevant studies conducted up until December 2022. A total of 174 articles were included in this review, of which 81% were undertaken in HICs and 19% in LMICs. Key protective and promotive factors were identified across the following domains: sociodemographic characteristics (for example, male gender/sex), environmental factors (for example, financial security, permanent visa status), sociocultural factors (for example, social support, support engagement) and psychological factors (for example, self-efficacy). Based on the outcomes of this review, we provide recommendations for governments, organizations and policymakers working to support good mental health in refugees and propose a research agenda to advance knowledge in the field. Cross-domain investigation and cross-disciplinary collaboration represents a critical next step to understanding and enhancing factors that promote good mental health in refugees.