Changing health along the Syrian refugees trajectories to Norway. Somatic and mental health relationships and implication for treatment.

When the massive flight of forced migrants from Syria to Europe started a few years ago, health related challenges facing Syrian refugees under flight and after arrival to Norway have only scarcely been studied, and knowledge of whether health care needs are met is sparse. There were only few targeted therapeutic interventions described, and the treatment effect had rarely been investigated systematically through research. The lacking evidence base for health care services to newly arrived refugees created the backdrop for this study. Starting in 2016, the CHART project has studied the relationship between somatic and mental health disorders among this new migrant group in Norwegian society: asylum seekers and refugees from Syria. The project has focused on the health and the perception of health care services following their migration trajectory both from the perspective of ill health and unmet health needs but also and from a salutogenic perspective exploring how to maintain good health. The clinical implications of the association between somatic and mental health have been tested by measuring the effect of two different group-based treatments, physiotherapy and self-help psychological therapy, on both somatic and mental health.

The CHART project is completed in accordance to the initial protocol. Seven main papers are already published and two are on their way, under peer-review. The project has been presented at several conferences, both physical and digital ones. The project is working with the last dissemination phase in collaboration with IOM creating a video that will be made available through the website and at meetings with the municipalities, researchers and users. We have also obtained a new grant form NFR to continue the CHART cohort in a way that will continue to improve the evidence based on this field.

Norway received over 30.000 asylum seekers in 2015 and the number of refugees in the country will soon reach a total of 200.000. Refugees living in Norway have higher burden of disease than other migrants and are underrepresented in the labour market. The associations between somatic and mental health for this population is barely explored, but several studies show the challenge of adequately diagnosing immigrants from non-Western countries with specific diseases, which hinders correct treatment and rehabilitation processes, and decreases the satisfaction of patients with the health care system. Although the healthy immigrant effect is described also for refugees and there is evidence of rapid deterioration of their health once in the host country, little is known about the interactive development of somatic and mental disease through the migration path, this is to say, pre-departure, at interception and at destination, for these patients. For asylum seekers and refugees from Syria on their way to or already living in Norway, this project will determine the risk factors for negative development of somatic and mental health and for increase of unmet health care needs, through the different stages of the migration process. Also, the clinical implications of the associations between mental and somatic health will be tested by measuring the effect of two different treatments, individual physiotherapy and group-based psychological treatment, on both somatic and mental health. Therefore, our results will provide valuable information about the high health risk stages of the migration path, enabling preventive strategies at these points, and about the implications of the interactions between somatic and mental health for the design of health care for asylum seekers and refugees. Although our study will only include refugees from Syria through to enable a trajectory approach, we believe our results will universally apply to any asylum seeker/refugee group.