By Ibrahima Sarr and Peter Ventevogel

The male Rohingya refugee is among 80 Rohingya trained by UNHCR and partners to provide individualized counselling as part of the Mental Health and Psychosocial Support Programme (MHPSS) in Cox’s Bazar, Bangladesh. Refugees who fled violence in Myanmar since 2017 continue to face ongoing mental health challenges exacerbated by difficult living conditions in the camps. © UNHCR

As we mark World Mental Health Day on October 10, it is important to recognize the disproportionate impact of mental health on refugees.

Refugees often endure multiple stressors that affect their mental health and well-being. These stressors can occur before, during, and after their journey to safety, including during their settlement and integration into new environments.

Various individual, social, and structural factors influence mental health. Psychological and biological factors, such as emotional coping skills and genetic predispositions, can heighten to the risk of mental health conditions. Additionally, refugees are often exposed to adverse social, economic, geopolitical, and environmental conditions—such as poverty, unemployment, violence, inequality, and environmental degradation—which further raises their risk of mental health issues.

Numerous studies have shown that in the general population, unemployed individuals tend to have worse mental health compared to those who are employed. There is, however, surprisingly little data examining the relationship between refugee mental health and employment or livelihoods.

In this blog, we provide preliminary comparable evidence of the mental health of refugees in five host countries— Bangladesh, the Czech Republic, Kenya, South Sudan, and Uganda. Mental health was measured using a brief self-reporting tool, the Patient Health Questionnaire 9 or the Patient Health Questionnaire 8, which are multipurpose instruments widely used for depression screening and measuring the severity of depression.

Across countries, refugees tend to experience more severe depression than hosts

In all five countries, refugees have on average worse mental health than host community members. In the Czech Republic, refugees are 1.7 times more likely to be distressed than hosts. In Uganda, the disparity is even greater, with 54.1% of refugees reporting depressing compared to just 5.2% of hosts). In contrast, in Bangladesh, depression rates are almost identical between refugees and hosts (13.6%).

Figure 1: Prevalence of mental health among refugees and hosts

Source: Bangladesh: Cox’s Bazar Panel Survey dataset (2019); Czech Republic: Voice of Ukrainians: mental health (2022), Kenya: Kenya Analytical Program on Forced Displacement (2023); South Sudan: Forced Displacement Survey, 2023 (2023); Uganda: Uganda High-Frequency Phone Survey 2020-2024 (2019)

Across different refugee-hosting countries, refugee women are more likely to be distressed than refugee men, except in Kenya

Mental health conditions can affect everyone, regardless of gender, age, or background. But evidence suggests that in the general population, women are more likely to experience depression.

Data illustrated in Figure 2 suggests that this trend is pronounced among refugees, with female refugees generally far more likely to suffer from depressive symptoms compared to their male counterparts, with the exception of Kenya. The prevalence of depression among refugee females can be up to twice as high as that of male refugees, making this an area of concern for targeted mental health interventions.

Figure 2: Prevalence of depression among refugee men and women

Employment and livelihoods are critical for mental health

Unemployment can have a significant impact on mental health, often leading to increased anxiety and depression. We compare the levels of depression among employed and unemployed refugees across the five countries, and find that in all cases, unemployed refugees are more likely to experience distress. In Uganda, for example, the mental health of unemployed refugees is 1.7 times worse than that of employed refugees. In South Sudan, unemployed refugees are 4 percentage points more likely to be distressed than employed refugees.

Of course, this statistical relationship does not necessarily infer causality. It may be that refugees with depression have more difficulties finding employment, or conversely, that employment helps protect against mental health issues.

Robust evidence confirms that employment improves overall health, while unemployment leads to a deterioration of health (Rueda et al., 2012). This is also true for mental health: Having decent work boost and protects mental health. However, poor working environments increase mental health risks.

In refugee settings, the psychosocial value of employment is evident. A recent study highlights how employment in refugee camps fosters personal income and fosters self-reliance while also leading to other valued outcomes such as respect from others and community integration (Husam et al, 2022). In that sense, employment is a critical factor in promoting the mental health of refugees and as such may lessen dependence on the mental health system over time (Drake and Wallach, 2020).

Figure 3: Prevalence of mental health among employed and unemployed refugees

A two-way relationship between mental health and employment

It is well established that having decent work improves mental health. However, the relationship between employment and mental health is likely bidirectional: good mental health contributes to a refugee’s ability to engage in employment, take advantage of livelihood opportunities, and escape poverty. Consequently, mental health interventions may yield economic benefits, and there is some evidence supporting this (see e.g. Lund et al. (2020). Therefore, combining mental health support with livelihood initiatives could have significant synergies, given the connection between poverty and mental health.

While there is limited research on the link between refugee mental health interventions and livelihoods or employment, groundbreaking work is underway. In Uganda, UNHCR and ILO’s Prospects Partnership is pioneering efforts to explore this relationship further. Watch refugees and UNHCR staff describe their experiences in this short video (also below). UNHCR and the World Bank are also doing so through a cash transfer and psychosocial training programme in Kenya.

Prioritize mental health for sustainable refugee empowerment

Mental health conditions are more prevalent among refugees than host communities, a fact that calls for action. Community programmes and mental health therapies can play a critical role in reducing the mental health burden. Facilitating refugees’ access to the labour market, as well as providing them with opportunities to acquire new skills or job placements, can significantly improve their well-being.

Employment fosters self-reliance, which in turn improves the mental health of refugees. Integrating mental health support with livelihoods programmes offers a powerful approach to promote refugees’ capacity to effectively engage in livelihoods. At the same time, prioritizing mental health during unemployment is crucial for overall refugee well-being. More operational research is urgently needed to explore how to best combine mental health interventions with employment programmes for refugees.

A data-driven look at how promoting employment fosters refugee mental health

Across countries, refugees tend to experience more severe depression than hosts

Across different refugee-hosting countries, refugee women are more likely to be distressed than refugee men, except in Kenya

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