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April 12, 2018

The Dire Consequences of Family Separation for Refugee Mental Health

Cover of American Journal of Orthopsychiatry (small)Historically, family reunification has been a cornerstone of U.S. immigration and refugee policy. However, recent changes in governmental policies and practices have increased refugees' and immigrants' risks for being separated from their families.

In their recent paper in the American Journal of Orthopsychiatry, Miller, Hess, Bybee, and Goodkind describe findings from a study with recently resettled refugees in the U.S. that reveal the significant impact of family separation on multiple dimensions of refugees' mental health and the ways in which this impedes newcomer integration in U.S. society.

These findings highlight the importance of local, state, federal and international immigration and refugee policies returning to a prioritization of family reunification.

Using qualitative and quantitative data from 165 adult refugees from Afghanistan, the Great Lakes Region of Africa (Burundi, Democratic Republic of Congo, Rwanda), Iraq, and Syria who were participating in an NIH-funded, community-based mental health intervention study (visit Refugee Well-being Project for a description of the intervention), the authors found that family separation was a major source of distress for refugees and that it was experienced in a range of ways.

Analyses of in-depth qualitative interviews revealed that many refugee participants experienced family separation as their greatest source of distress since resettlement. Refugees described their fears for family members still in conflict situations and their feelings of powerlessness to help them.

Furthermore, the interviews highlighted ways in which family separation hindered refugees' ability to adjust to their lives in the U.S. through its contribution to mixed emotions around resettlement, intensification of refugees' cultural dislocation, and constraint of refugees' ability to obtain social support because of not wanting to burden distant family members living in danger.

To further validate their findings that family separation was one of the most salient and distressing aspects of refugees' resettlement experiences, Miller and colleagues decided to take advantage of the quantitative data collected in their mixed methods study to test the relative contribution of family separation to refugees' depression and anxiety symptoms, PTSD symptoms, and psychological well-being.

Importantly, separation from family members was significantly related to all three measures of mental health, and it explained significant additional variance in all three measures even after accounting for participants' overall level of trauma exposure. This is particularly striking because, relative to 26 other types of trauma exposure, family separation was one of only two traumatic experiences that explained additional variance in all three measures of mental health.

Given the current global refugee crisis and the need for policies to address this large and growing issue, the authors' research highlights the importance of considering the ways in which family separation impacts refugee mental health and the policies and practices that could help ameliorate this ongoing stressor. Their findings also emphasize the importance of conducting mixed methods research with refugee populations to more comprehensively understand refugee experiences.

The authors build on Rousseau and colleagues' (2001) research that suggests that the extended separations from family that refugees experience — often as their family members' refugee or immigration cases pend according to an unknown timeline — are examples of "Western administrative violence" that continue to cause harm to refugees and should be acknowledged and addressed when considering how to improve the well-being of refugees and immigrants.

The severe curtailment of the U.S. refugee resettlement program, increased deportations of unauthorized immigrants, and the altered priorities of U.S. immigration policy are among the many recent policy changes that the authors' research shows are likely to have serious mental health impacts for individuals as well as negative effects on newcomer integration in U.S. society in the long-term.

Thus, a return to policies and practices that facilitate family reunification is important for promoting refugee and immigrant well-being.


  • Rousseau, C., Mekki-Berrada, A., & Moreau, S. (2001). Trauma and extended separation from family among Latin American and African refugees in Montreal. Psychiatry, 64, 40–59. http://dx.doi.org/10.1521/psyc.


  • Miller, A., Hess, J. M., Bybee, D., & Goodkind, J. R. (2018). Understanding the mental health consequences of family separation for refugees: Implications for policy and practice. American Journal of Orthopsychiatry, 88(1), 26–37. http://dx.doi.org/10.1037/ort0000272

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Note: This article is in the Clinical Psychology topic area. View more articles in the Clinical Psychology topic area.

About the Authors

Jessica Goodkind is a community psychologist and associate professor of sociology at the University of New Mexico. She works collaboratively with communities to understand and address the mental health consequences of exposure to highly stressful social environments and to develop and assess processes that promote healing, well-being, and social justice. Specifically, her research focuses on partnering with refugee, immigrant, and Native American communities to implement and test community-based approaches to reducing social inequities and health disparities. Dr. Goodkind can be reached via email.

Alexander S. Miller is an emergency medicine resident at Oregon Health and Science University. He attended medical school at the University of New Mexico, where he worked with the Refugee Well-Being Project and met Drs. Goodkind, Bybee, and Hess.

Julia Meredith Hess is a cultural anthropologist and research assistant professor in the department of pediatrics at the University of New Mexico. She is a migration scholar who studies migrant — including refugee and immigrant — health and well-being. Much of her work concerns addressing social determinants of health and reducing social inequities using community-engaged research approaches. She is the author of Immigrant Ambassadors: Citizenship and Belonging in the Tibetan Diaspora.

Deborah Bybee is a professor of ecological/community psychology at Michigan State University who specializes in research design and statistical methodology. Her work focuses on the application of multivariate techniques to understand complex, real-world phenomena, especially those that involve change over time. Her substantive interests include violence against women, trauma, and mental health.