This paper examines the association between post-displacement stressors and mental health outcomes among Rohingya refugees in Cox’s Bazar, Bangladesh. Since 2017, more than 770,000 Rohingya refugees have fled from Myanmar to Bangladesh, with the total number of Rohingya refugees hosted in Bangladesh reaching 981,000 as of May 2024. The majority of Rohingya refugees are hosted in refugee camps in Cox’s Bazar, where they face daily stressors such as limited work and educational opportunities, inadequate humanitarian assistance, dangerous living conditions, and limited access to healthcare.
The analysis is based on data from the 2019 Cox’s Bazar Panel Survey, covering 5,020 households and 9,386 individuals. The household surveys collected information about the household roster, food security, consumption, assistance, assets, household income, and the anthropometrics of one randomly selected child under the age of five. The individual surveys collected information about labor market outcomes, migration history, crime and conflict, and health.
The authors examined the association between post-displacement stressors, such as exposure to crime and conflict, and two mental health outcomes: depression and post-traumatic stress disorder (PTSD). Presence of depressive symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9), while PTSD was assessed using the Harvard Trauma Questionnaire (HTQ). The authors controlled for past trauma, employment status, receiving an income, food security, and access to healthcare.
Main results:
- Prevalence of depressive symptoms was high among Rohingya refugees living in Cox’s Bazar. The prevalence of moderate or severe depressive symptoms was 30 percent and the prevalence of PTSD was 5 percent.
- Most respondents (87 percent) reported experiencing at least one traumatic event. The median number of traumatic events was three. The three most reported traumatic events were exposure to death (54 percent), torture (45 percent), and combat situations (45 percent).
- Post-displacement stressors were common among Rohingya households. These included direct experiences of crime and conflict in their neighborhood (39 percent of households), food insecurity (97 percent), insufficient income to meet household needs, low rates of employment (22 percent), and low rates of income from wages (27 percent).
- Post-displacement stressors were associated with a higher likelihood of depressive symptoms. Post-displacement stressors, such as crime and conflict in one’s neighborhood, reduced household access to income, and travel time to access healthcare, significantly increase the likelihood of experiencing depressive symptoms. Exposure to crime and conflict in one’s current neighborhood approximately doubled the likelihood of depressive symptoms, controlling for other risk factors including past trauma.
- Trauma was associated with an increased likelihood of PTSD, while living in a household that received income was associated with a decreased likelihood of PTSD. Post-displacement stressors were not significantly associated with PTSD when controlling for age, sex, marital status, migration history, and past exposure to trauma.
- The displacement experience affects mental health outcomes differently depending on gender. Living in Bangladesh in July 2017, i.e., not directly experiencing the 2017 genocide but spending more time in a Bangladeshi refugee camp, significantly increased women’s likelihood of experiencing depressive symptoms but not men’s likelihood of experiencing depressive symptoms. There was no effect of gender on the likelihood of PTSD.
Adjusting for past trauma and other risk factors, the authors conclude that exposure to post-displacement stressors was associated with an increased likelihood of depressive symptoms. The findings suggest that interventions to improve post-displacement conditions for Rohingya refugees could significantly improve their mental health outcomes.