Refugees’ High Burden of Chronic Pain Tied to Mental Illness Refugees’ High Burden of Chronic Pain Tied to Mental Illness

The study covered in this summary was published in and has not yet been peer reviewed.

Key Takeaways

  • The study found a high burden of chronic pain in Syrian adult refugees in Norway that has adverse consequences towards their daily functioning.

  • Anxiety, depression, and PTSD are associated with higher levels of chronic pain in the refugee population studied.

  • Being a male refugee is associated more strongly with anxiety and depression leading to functional impairment than being a woman. Being a woman is associated with higher odds of chronic pain. Gender acted as an effect modifier between mental illness and functional impairment.

  • Future research aimed toward harmonizing and standardizing pain measurement to measure its effect on health burden is needed. Pain should be understood under an ethnocultural construct to enhance transcultural validity.

Why This Matters

  • The present cross-sectional survey of adult refugees from Syria resettled in Norway is only one of a few studies investigating the burden of chronic pain and how it relates to mental ill health in a general refugee population. Elevated rates of PTSD, depression, and anxiety have been repeatedly found in refugee populations and high levels of pain have also been documented.

  • Attention to the association between chronic pain and mental health should be made by personnel working with refugees. Because of the gender-specific associations between mental illness and functional impairment, initiatives addressing mental health, chronic pain, or functional impairment in refugee populations should consider gender when tailoring their content and outreach.

Study Design

  • The study involved a cross-sectional, postal survey questionnaire of participants randomly drawn from full population registries in Norway. There was an initial low response. Invitations were sent out in November 2018 and did not close until September 2019. Several efforts were made to boost participation, including one postal or telephone reminder to all nonresponders. 

  • Participants were refugee adults from Syria aged 18 and older who arrived in Norway between 2015 and 2017. Gender was tested as an effect modifier. 

  • Chronic pain was measured with 10 items on the questionnaire and was defined as pain for 3 or more consecutive months in the last year. It included both musculoskeletal pain and pain in five other body regions (stomach, head, genital area, chest, other). 

  • Anxiety, depression, and PTSD symptoms were measured with the 25-item Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, and the Refugee Trauma History Checklist. 

  • Questionnaires on perceived general health regarding refugee perceptions of their own health, and functional impairment affecting daily activities because of illness, disability, and mental health were adapted from the European Social Survey 2010.

Key Results

  • A total of 902 participants who responded to the questionnaire were included in the study from roughly 10,000 invitations, giving a participation rate of about 10%, with no differences in gender distribution.

  • The overall prevalence of severe chronic pain was 43.1%, and overall perception of poor general health was 39.9%. 

  • A strong association of chronic pain with all mental illness measured, poor perceived general health, and functional impairment was made (P < .001).  All mental health variables were associated with increased odds of chronic pain (anxiety odds ratio [OR], 2.42; depression OR, 2.28; PTSD OR, 1.97; all OR fully adjusted).

  • Chronic pain was associated with poor perceived general health and functional impairment with no difference across gender. Mental health showed weaker association with poor perceived general health than chronic pain.

  • Syrian men with mental health had three times higher odds of functional impairment.  For women, there was no evidence of association between any of the mental ill health variables and functional impairment. Being a woman was associated with chronic pain and poor perceived general health but not functional impairment.

  • Being a woman was associated with 50% higher odds of chronic pain in both unadjusted and adjusted models


  • With a 10% response rate, selection bias in this cross-sectional study may have been present.

  • The cross-sectional design of the study limits causality.

  • The validity of the survey is questionable because of transcultural construct regarding pain and mental illness.

  • Regression models were built with data at hand. Without preregistered plans for data-handling, the findings should be viewed as exploratory with a risk for false-positive findings.


  • No external funding was received.  The study was funded by the Norwegian Center for Violence and Traumatic Stress Studies.

  • None of the authors disclosed relevant financial relationships.

This is a summary of a preprint research study, “Chronic pain, mental health and functional impairment in adult refugees from Syria resettled in Norway: a cross-sectional study,” written by researchers at the Norwegian Centre for Violence and Traumatic Stress Studies in Oslo, the Norwegian Institute of Public Health in Oslo, and the Weill Cornell Medicine in New York City on Research Square, provided to you by Medscape.  This study has not yet been peer reviewed. The full text of the study can be found on

For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, and LinkedIn