Abstract
INTRODUCTION: People seeking asylum are at increased risk of mental health difficulties due to premigration and postmigration experiences. The objective of this review was to understand how asylum determination process in the EU+ and UK influences the mental health of asylum seekers. METHODS: Web of Science, MEDLINE, PsycINFO, PsychArticles and Scopus were searched, with no start date specified, up to 24 August 2023. Peer-reviewed studies were eligible if they provided a qualitative analysis of primary data from adult asylum seekers and refugees regarding lived experience of asylum determination procedures in the UK and EU+, and contextual factors associated with the mental health and well-being. The protocol was not preregistered. From a total of 4902 articles, duplicates were removed, 3235 abstracts were assessed and of the remaining 113 identified for full-screen articles, 39 relevant qualitative studies were retrieved. Six further studies were identified through citation searches. RESULTS: 45 studies were included in the qualitative thematic synthesis, representing the perspectives of 1158 asylum seekers and refugees. Themes demonstrate high levels of psychological distress during and after the asylum process. This was associated with the hostile environments created by policies and procedures. Participants' mental health was affected by being caught in a stalemate while awaiting the outcome of their claim. The procedures exacerbated previous mental health difficulties. External and internal protective factors were identified, such as non-governmental organisations, religion and cognitive strategies. CONCLUSIONS: The accumulation of each step of the asylum process contributes to psychological distress and exacerbates mental health difficulties, leading to longer-term consequences for asylum seekers and refugees. Preventive strategies and policy changes are recommended. To minimise the impact of asylum procedures, clinicians should consider peer-led groups, interventions that cultivate a sense of autonomy and meaning and reduce a sense of alienation and isolation.