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

Education level was identified as the strongest predictor of PTSD symptom severity in the pruned CART model.

• The CART analysis used a sample of 610 refugees and asylum seekers assessed at the Boston Center for Refugee Health and Human Rights.
• Individuals with some formal education reported higher PTSD symptom scores compared to those without formal education.
• Education level was retained as the primary splitting variable in the hierarchical CART model.
• PTSD symptom severity was measured using the Harvard Trauma Questionnaire.

English language proficiency was identified as the second strongest predictor of PTSD symptom severity.

• Higher English proficiency was associated with higher PTSD symptom scores.
• English proficiency was retained in the pruned CART model as a key hierarchical predictor.
• This finding suggests that linguistic integration does not straightforwardly buffer against posttraumatic stress, and may reflect increased awareness of systemic barriers.
• The CART method allowed detection of nonlinear interactions between English proficiency and other predictors.

Region of origin was identified as the third strongest predictor of PTSD symptom severity.

• Individuals originating from regions outside Uganda and Europe reported higher PTSD symptom scores.
• Region of origin was retained in the final pruned CART model alongside education and English proficiency.
• This variable likely captures differential exposure to structural barriers, discrimination, and legal insecurity based on national origin.
• The finding points to the role of geopolitical and contextual factors in shaping post-migration mental health outcomes.

Pre-migration trauma exposure variables were not retained in the final pruned CART model.

• Predictors included physical, psychological, and sexual pre-migration trauma exposure.
• Pre-migration trauma variables showed moderate importance but were excluded from the final model after pruning.
• This highlights the relatively greater influence of post-migration structural conditions over pre-migration trauma in predicting PTSD symptom severity.
• The finding challenges exclusively trauma-focused models of refugee mental health.

The study used Classification and Regression Tree (CART) analysis to identify hierarchical and nonlinear interactions among predictors of PTSD severity.

• The sample consisted of 610 refugees and asylum seekers who completed standardized assessments.
• PTSD symptom severity was assessed using the Harvard Trauma Questionnaire.
• Predictors spanned pre-migration trauma exposure, identity factors (gender, religion, sexual minority status, education level, region of origin, English proficiency), and post-migration stressors (legal status, employment, work authorization, housing, community involvement).
• CART was chosen for its ability to detect nonlinear and hierarchical interaction effects among predictors.
• The model was pruned to identify the most robust predictors.

Post-migration structural conditions including legal insecurity, social exclusion, and linguistic integration were emphasized as key shapers of refugee mental health and recovery.

• Post-migration stressors assessed included legal status, employment, work authorization, housing stability, and community involvement.
• The study was guided by Intersectionality Theory and Ecological Systems Theory.
• Findings underscore the importance of moving beyond trauma-focused models to address structural and systemic barriers.
• The authors highlight legal insecurity, discrimination, and social exclusion as critical targets for intervention to support psychological well-being of forcibly displaced populations.