Depression, violence, and socioeconomic outcomes among refugees in East Africa: evidence from a multi-country representative survey

Background: Existing research on refugee mental health is heavily skewed towards refugees in highincome countries, even though most refugees (83%) are hosted in low- and middle-income countries. This problem is further compounded by the unrepresentativeness of samples, small sample sizes, and low response rates. Objective: To present representative findings on the prevalence and correlates of depression among different refugee sub-groups in East Africa. Methods: We conducted a multi-country representative survey of refugee and host populations in urban and camp contexts in Kenya, Uganda, and Ethiopia (n=15,915). We compared the prevalence of depression between refugee and host populations and relied on regression analysis to explore the association between violence, depression, and socioeconomic outcomes. Findings: We found a high prevalence of elevated depressive symptoms (31%, 95% CI 28% to 35%) and functional impairment (62%, 95% CI 58% to 66%) among the refugee population, which was significantly higher than that found in the host population (10% for depressive symptoms, 95% CI 8% to 13%; and 25% for functional impairment, 95% CI 22% to 28%) (p-values < 0·001). Further, we observed a dose-response relationship between exposure to violence and mental illness. Lastly, high depressive symptoms and functional impairment were associated with worse socioeconomic outcomes. Conclusion: Our results highlight that refugees in East-Africa – particularly those exposed to violence and extended exile periods – are disproportionately affected by depression, which may also hinder their socioeconomic integration. Clinical implications: Given the high prevalence of depression among refugees in East Africa, our results underline the need for scalable interventions that can promote refugees’ well-being.