The long-term financial and psychological resettlement outcomes of pre-migration trauma and post-settlement difficulties in resettled refugees

Trajectories of psychological distress and social integration in newly resettled refugees: findings from the Building a New Life in Australia longitudinal study

PURPOSE

Refugees are at greater risk of mental illness due to stressors encountered post-resettlement. However, few longitudinal studies have examined the within-person effects of these stressors, especially with respect to social integration. This study aims to examine what factors are associated with psychological distress in a longitudinal sample of refugees resettled in Australia.

METHODS

This study used data from three Waves of the Building a New Life in Australia study, collected between 2013 and 2018. The eligible sample included 1881 adult respondents, clustered in 1175 households. We conducted multilevel mixed-effects growth modelling incorporating time-variant and time-invariant covariates with psychological distress, using the Kessler Psychological Distress Scale (K6).

RESULTS

Rates of high psychological distress increased across the 5-year follow-up period. Social integration stressors (e.g. discrimination, lower sense of belonging, loneliness, lower English proficiency) were associated with higher levels of psychological distress over time. Refugees reporting loneliness not only had a greater risk of elevated psychological distress at each time point, but the difference in risk increased over each time point. Refugees who were exposed to traumatic events, older, female and of Middle Eastern background were also more likely to report higher levels of psychological distress over time.

CONCLUSIONS

These findings highlight the importance of identifying refugees who may encounter difficulties with social integration in the early years of resettlement. Newly arrived refugees may benefit from longer-term resettlement programmes that address post-migratory stressors, particularly with regards to loneliness, to reduce the prevalence of elevated psychological distress during the early years of resettlement.

When money and mental health problems pile up: The reciprocal relationship between income and psychological distress

Background

Longitudinal studies suggest that socioeconomic status (SES) and mental health have a bidirectional relationship such that SES declines lead to a deterioration of mental health (social causation), while worsening mental health leads to SES declines (social drift). However, the dynamic relationship between income and psychological distress has not been sufficiently studied.

Methods

We use cross-lagged panel models with unit fixed effects (FE-CLPM) and data from a five-wave representative panel (n = 3103) of working-age (18-64) New York City adults. Yearly measures include individual earnings, family income (income-to-needs), and psychological distress. We also examine effects by age, gender, education, and racial/ethnic identification.

Results

We find significant bidirectional effects between earnings and distress. Increases in past-year individual earnings decrease past-month psychological distress (social causation effect [SCE], standardized β= -0.07) and increases in psychological distress reduce next-year individual earnings (social drift effect [SDE], β= -0.03). Family income and distress only have a unidirectional relationship from past-year family income to distress (SCE, β= -.03). Strongest evidence of bidirectional effects between earnings and distress is for prime working-age individuals (SCE, β= -0.1; SDE, β= -0.03), those with less than bachelor's degrees (SCE, β= -0.08; SDE, β= -0.05), and Hispanics (SCE, β= -0.06; SDE, β= -0.08). We also find evidence of reciprocal effects between family income and distress for women (SCE, β= -0.03; SDE, β= -0.05), and Hispanics (SDE, β= -0.04; SDE, β= -0.08).

Conclusions

Individual earnings, which are labor market indicators, may be stronger social determinants of mental health than family income. However, important differences in social causation and social drift effects exist across groups by age, education, gender, and racial/ethnic identities. Future research should examine the types of policies that may buffer the mental health impact of negative income shocks and the declines in income associated with worsening mental health, especially among the most vulnerable.

Do refugees with better mental health better integrate? Evidence from the Building a New Life in Australia longitudinal survey

Hardly any evidence exists on the effects of mental distress on refugee labor outcomes. We offer the first study on this topic in the context of Australia, one of the host countries with the largest number of refugees per capita in the world. Analyzing the Building a New Life in Australia longitudinal survey, we exploit the variations in traumatic experiences of refugees interacted with post-resettlement time periods to causally identify the impacts of refugee mental health. We find that worse mental health, as measured by a one-standard-deviation increase in the Kessler mental health score, reduces the probability of employment by 11.9% and labor income by 22.8%. These effects appear more pronounced for refugees that newly arrive or are without social networks, but they may be ameliorated with government support. These findings have significant implications for the development of health and labor policies, particularly regarding the integration of refugees within host countries.

A Comparison of Psychosocial Services for Enhancing Cultural Adaptation and Global Functioning for Immigrant Survivors of Torture

Forced migrants suffer from significant psychological distress. However, they often prioritize urgent practical resettlement needs over mental health needs. The present study used a quasi-experimental design to compare pathways of treatment for survivors of torture (N = 369) from 42 different counties receiving care from a refugee health clinic. Random intercept ANOVAs were used to compare combined case management services and psychological treatment (CM-PT) to case management services only (CM) on changes in cultural adaptation and global functioning over time. Results showed that both groups improved on each outcome. Importantly, the CM-PT group endorsed greater improvements in cultural adaptation (b = 0.28, 95% CI 0.14, 0.41, p ≤ 0.001) and global functioning (b = 3.29, 95% CI 1.33, 5.25, p = 0.001) compared to the CM group. These findings suggest that treatment for survivors of torture should be multifaceted and include case management and psychological treatment. Case management services alone may be beneficial when socio-cultural and resource barriers exist for mental health treatment.

Past trauma, resettlement stress, and mental health of older Bhutanese with a refugee life experience

OBJECTIVES

Older displaced persons often receive limited attention from aid organizations, policy-makers and service providers in countries of resettlement. The objective of this study is to identify the relationship between experiencing traumatic events and stressors prior to resettlement, current resettlement stressors, social support, and mental health of older Bhutanese with a refugee life experience.

METHOD

Study participants were 190 older Bhutanese with a refugee life experience living in a metropolitan area in New England (US) and Ontario (Canada). We used structural equation modeling to determine the association between traumatic and stressful events in Bhutan and Nepal, current resettlement stressors, and symptoms of anxiety and depression, as measured by the GAD-7 and PHQ-9. We assessed the role of social support as an effect modifier in the relationship between these variables.

RESULTS

Surviving torture was associated with anxiety (p=.006), and experiencing threats to physical wellbeing in Nepal was associated with both anxiety (p=.003) and depression (p=.002). The relationship between physical threats in Nepal and current mental health were partially mediated by resettlement stressors. Social support moderated the relationship between trauma, stress, and mental health.

CONCLUSION

Both past traumas and current resettlement stressors contribute to the current psychosocial functioning of older Bhutanese with a refugee life experience. Based on our findings, social support is critical in promoting mental health in this population.

Understanding the relationship between social support and mental health of humanitarian migrants resettled in Australia

Background

Forced migration can lead to loss of social support and increased vulnerability to psychological distress of displaced individuals. The aims were to ascertain the associations of sociodemographic characteristics and social support received by resettled adult humanitarian migrants in Australia; determine the relationship between social support and mental health at different intervals following humanitarian migration; and examine the modification effects of gender, age and migration pathway on that relationship.

Methods

A secondary analysis was conducted of data generated in Waves One (three to six months after resettlement), Three (three years after resettlement) and Five (five years after resettlement) of the Building a New Life in Australia prospective cohort study. The association between sociodemographic characteristics and mental health were examined at each timepoint using a multivariate regression model. Exploratory factor analysis was used to develop a two-factor social support scale (emotional/instrumental and informational support) from a larger set of items collected in the BNLA. Psychological distress was measured by the Kessler-6 scale. Path analysis was used to analyse the relationships between social support and psychological distress among the three time points considering socio-demographic characteristics simultaneously.

Results

A total of 2264 participants were included in the analyses. Age, gender, birth region, migration pathway, education level and English proficiency were significantly associated with both social support types. Main source of income was only significantly associated with informational support. Remoteness area was only significantly associated with emotional/instrumental support. As emotional/instrumental support increased by one standard deviation (SD) at Wave One, psychological distress at Wave Three decreased by 0.34 score [95% CI (− 0.61; − 0.08)]. As informational support at Wave Three increased by one SD, psychological distress at Wave Five decreased by 0.35 score [95% CI (− 0.69; − 0.01)]. The relationships between social support and psychological distress varied between genders, age groups and migration pathways.

Conclusion

Findings demonstrate the importance of emotional/instrumental support and informational support for the medium and long-term mental health of humanitarian migrants. This study also highlights the important of extending current social support provisions and tailoring programs to enhance support received by humanitarian migrant subgroups years after resettlement to improve mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14082-z.

The inter-agency standing committee (IASC) guidelines on mental health and psychosocial support (MHPSS) in emergency settings: a critique

The bio-medical model of 'mental health' and 'mental illness' that relates to the relationship between wellbeing and distress informs psychopathology and dominates conceptualisation in many Western Educated Industrialised Rich Democratic (WEIRD) populations. This paper aims to critique the model, questioning the appropriateness of psychopathology as a conceptual framework when working as a Western trained clinician with populations such as in China, Japan, Asia, the Middle-East and Africa. The paper also considers the cultural appropriateness of western notions of psychopathology when working inter-culturally in relation to the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings, and the Review of the Implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.

The effectiveness of ethno-specific and mainstream health services: an evidence gap map

BACKGROUND

People of culturally and linguistically diverse (CALD) background face significant barriers in accessing effective health services in multicultural countries such as the United States, Canada, Europe and Australia. To address these barriers, government and nongovernment organisations globally have taken the approach of creating ethno-specific services, which cater to the specific needs of CALD clients. These services are often complementary to mainstream services, which cater to the general population including CALD communities.

METHODS

This systematic review uses the Evidence Gap Map (EGM) approach to map the available evidence on the effectiveness of ethno-specific and mainstream services in the Australian context. We reviewed Scopus, Web of Science and PubMed databases for articles published from 1996 to 2021 that assessed the impact of health services for Australian CALD communities. Two independent reviewers extracted and coded all the documents, and discussed discrepancies until reaching a 100% agreement. The main inclusion criteria were: 1) time (published after 1996); 2) geography (data collected in Australia); 3) document type (presents results of empirical research in a peer-reviewed outlet); 4) scope (assesses the effectiveness of a health service on CALD communities). We identified 97 articles relevant for review.

RESULTS

Ninety-six percent of ethno-specific services (i.e. specifically targeting CALD groups) were effective in achieving their aims across various outcomes. Eighteen percent of mainstream services (i.e. targeting the general population) were effective for CALD communities. When disaggregating our sample by outcomes (i.e. access, satisfaction with the service, health and literacy), we found that 50 % of studies looking at mainstream services' impact on CALD communities found that they were effective in achieving health outcomes. The use of sub-optimal methodologies that increase the risk of biased findings is widespread in the research field that we mapped.

CONCLUSIONS

Our findings provide partial support to the claims of advocacy stakeholders that mainstream services have limitations in the provision of effective health services for CALD communities. Although focusing on the Australian case study, this review highlights an under-researched policy area, proposes a viable methodology to conduct further research on this topic, and points to the need to disaggregate the data by outcome (i.e. access, satisfaction with the service, health and literacy) when assessing the comparative effectiveness of ethno-specific and mainstream services for multicultural communities.

Distinct trajectories of psychological distress among resettled refugees: Community acceptance predicts resilience while low ingroup social support predicts clinical distress

Refugees can experience elevated levels of psychological distress upon resettlement, although disparate outcomes over time are expected. The current study modeled trajectories of changes in distress over a 5-year period among resettled refugees and sought to explicate post-settlement factors that influence distress over time. A large-scale sample of refugees resettled in Australia (2,399) was tracked over a 5-year period, completing measures of psychological distress at each wave and initial risk and protective factors immediately after resettlement. A latent class growth analysis conducted on distress found four unique classes characterized by (1) resilient levels of distress, (2) consistent clinical distress, (3) recovering levels of distress, and (4) deteriorating distress. Lower perceived discrimination and greater positive context of reception predicted membership to the resilient group and differentiated the recovering and deteriorating groups. Further, lower ingroup social support predicted membership to the clinically distressed group relative to all others. We conclude by echoing calls to strengthen community support for refugees and promote ingroup ties, particularly among those who are the most vulnerable.

Immigrant Family Financial and Relationship Stress From the COVID-19 Pandemic

We tend to overlook immigrant families in policy and program discussions related to the COVID-19 pandemic, yet they are some of the most vulnerable to the effects of this continuing crisis. This study examined the impact of the COVID-19 pandemic on immigrant families in an upper Midwest state. We interviewed 19 human and social service providers from agencies serving Somali, Latinx, and Karen (refugees from Burma/Myanmar) immigrant families between June and August 2020. Results analyzed for this paper focused on responses to questions asked about COVID-19-related financial and familial stress, and coping resources and constraints that providers were observing with their immigrant clients. Guided by the Family Adjustment and Adaptation Response Model (Patterson, 1988), we identified a pile-up of financial and relationship stressors including employment, housing, and family relationship strains, and resource access constraints. We found that job loss in already financially vulnerable immigrant families was particularly impactful. Housing insecurity soon followed. Immigrant families also faced significant constraints to resource access including lack of documentation, fear of making a mistake, language barriers, and lack of technology skills. We identified family and community resources that families used to meet demands, coping strategies, and glimmers of resilience. As we near the end of the pandemic, we urge family researchers to monitor long-term effects of the crisis on immigrant families. Findings can inform the creation of programs and policies that address immigrant family needs for resources and culturally relevant services to support their financial recovery post-COVID.

Ecologies of Resilience for Australian High School Students from Refugee Backgrounds: Quantitative Study

Forced displacement of refugees, currently at record levels, leads to increased cultural diversity in many countries with benefits and challenges for individuals, communities, and societies. Refugees often face significant stressors both pre- and post-migration, and hence are at increased risk of poor mental health and wellbeing. Children and adolescents make up a significant proportion of refugees globally, and hence mental health supports for these young people are crucial. Current mental health research often uses pathologized approaches that focus on trauma, although there is growing literature highlighting the importance of a sense of belonging and the reduction in discrimination and social exclusion, emphasizing strengths and agency of individuals and communities. Resilience is often noted for its positive influence on mental health and wellbeing; however, research regarding how mechanisms of resilience function is still developing. This study investigated mental health and wellbeing of refugee-background Australian youth to better understand the role and function of resilience. Findings suggest that intersecting social ecologies, such as those within family, school, or community networks, contribute to development of identity and a sense of belonging for youth, which together form a resilient system that provides resources for wellbeing. Adaptations of school policy and practice can support positive mental health and wellbeing outcomes by contributing to and developing resilient environments, such as through building connections to family, improving positive recognition of cultural identity for individuals and across the whole school community, and actively working to minimize discrimination.

Financial Hardship, Hope, and Life Satisfaction Among Un/Underemployed Individuals With Psychiatric Diagnoses: A Mediation Analysis

BACKGROUND

Individuals with psychiatric diagnoses who are unemployed or underemployed are likely to disproportionately experience financial hardship and, in turn, lower life satisfaction (LS). Understanding the mechanisms though which financial hardship affects LS is essential to inform effective economic empowerment interventions for this population.

AIM

To examine if subjective financial hardship (SFH) mediates the relationship between objective financial hardship (OFH) and LS, and whether hope, and its agency and pathways components, further mediate the effect of SFH on LS among individuals with psychiatric diagnoses seeking employment.

METHODS

We conducted structured interviews with participants (N = 215) of two peer-run employment programs using indicators of OFH and SFH and standardized scales for hope (overall hope, hope agency, and hope pathways) and LS. Three structural equation models were employed to test measurement models for OFH and SFH, and mediational relationships. Covariates included gender, age, psychiatric diagnosis, race/ethnicity, education, income, employment status, SSI/SSDI receipt, and site.

RESULTS

Confirmatory factor analysis (CFA) for items measuring OFH and SFH supported two separate hypothesized factors. OFH had a strong and significant total effect on SFH [standardized beta (B) = 0.68] and LS (B = 0.49), and a weak-to-moderate effect on hope (B = -0.31). SFH alone mediated up to 94% of the effect of OFH on LS (indirect effect B = -0.46, p < 0.01). The effect of SFH on LS through hope was small (indirect effect B = -0.09, p < 0.05), primarily through hope agency (indirect effect B = -0.13, p < 0.01) and not hope pathways. Black and Hispanic ethno-racial identification seemed to buffer the effect of financial hardship on hope and LS. Individuals identifying as Black reported significantly higher overall hope (B = 0.41-0.47) and higher LS (B = 0.29-0.46), net of the effect of OFH and SFH.

CONCLUSION

SFH is a strong mediator of the relationship between OFH and LS in our study of unemployed and underemployed individuals with psychiatric diagnoses. Hope, and particularly its agency component, further mediate a modest but significant proportion of the association between SFH and LS. Economic empowerment interventions for this population should address objective and subjective financial stressors, foster a sense of agency, and consider the diverse effects of financial hardship across ethno-racial groups.

Asylum seekers' and refugees' experiences of accessing health care: a qualitative study

BACKGROUND

Asylum seekers and refugees (ASRs) often experience poor health in host countries. The United Nations High Commissioner for Refugees (UNHCR) requires hosts to ensure these sanctuary seekers have access to basic health care.

AIM

To identify barriers and facilitators that affect access to health care by ASRs in Wales.

DESIGN & SETTING

Participatory research approach using qualitative focus groups across Wales, which hosts 10 000 refugees.

METHOD

Eight focus groups were undertaken with ASRs, support workers, and volunteers (n = 57).

RESULTS

Specialist NHS-funded services and grant-aided non-governmental organisations (NGOs) facilitated access to health care, including primary care. Most ASRs understood the role of general practice in providing and coordinating care, but were unaware of out-of-hours services. Reported barriers included: language difficulties, health literacy, unrecognised needs, and the cost of travel to appointments. Participants recognised the importance of mental health, but were disappointed by the state of mental health care. Some feared seeking support for mental health from their GP, and few were aware they had the right to move practice if they were unhappy. Written information about health care was not as accessible to refugees as to asylum seekers (ASs). While some participants read such material before consulting, others struggled to access information when in need. Few participants were aware of health prevention services. Even when they knew about services, such as smoking cessation, these services' difficulty in accommodating ASRs was a barrier.

CONCLUSION

The main barriers identified were: availability of interpreters; knowledge about entitlements; and access to specialist services.

Decomposing the Healthy Immigrant Effect: The Role of GDP of Birth Country in Immigrant Health

Drawing on the social-ecological systems perspective of health, this study explores whether the deteriorating trend of immigrant health over time differs depending on immigrants' pre-migration macro-level factors in their birth country. Using the Household, Income, and Labor Dynamics in Australia survey (N = 1,847), we conducted an HLM analysis to examine the association among GDP per capita in the birth country, length of stay, and immigrants' health status post-migration. Support was found for both the negative association between the length of stay and health and the positive association between the GDP of the birth country and health. The negative association between length of stay and health was stronger among immigrants from low GDP countries compared to those from high GDP countries. Our findings suggest the importance of the population-level characteristics of the birth country in understanding healthy immigrant effect post-migration.

Refugees at Work: The Preventative Role of Psychosocial Safety Climate against Workplace Harassment, Discrimination and Psychological Distress

It is widely recognised that employment is vital in assisting young refugees’ integration into a new society. Drawing on psychosocial safety climate (PSC) theory, this research investigated the effect of organisational climate on young refugee workers’ mental health (psychological distress) through stressful social relational aspects of work (e.g., harassment, discrimination). Drawing on data from 635 young refugees aged between 15 and 26 in South Australia, 116 refugees with paid work were compared with 519 refugee students without work, and a sample of young workers from Australian Workplace Barometer (AWB) data (n = 290). The results indicated that refugees with paid work had significantly lower psychological distress compared with refugees with no paid work, but more distress than other young Australian workers. With respect to workplace harassment and abuse, young refugee workers reported significantly more harassment due to their ongoing interaction and engagement with mainstream Australian workers compared with unemployed refugees. Harassment played a vital role in affecting psychological health in refugees (particularly) and other young workers. While refugee youth experienced harassment at work, overall, their experiences suggest that their younger age upon arrival enabled them to seek and find positive employment outcomes. Although PSC did not differ significantly between the employed groups, we found that it likely negatively influenced psychological distress through the mediating effects of harassment and abuse. Hence, fostering pathways to successful employment and creating safe work based on high PSC and less harassment are strongly recommended to improve refugees’ mental health and adaptation.

Chronic pain and mental health problems among Syrian refugees: associations, predictors and use of medication over time: a prospective cohort study

OBJECTIVES

This study aims to examine associations, predictors and pharmacological treatment of chronic pain and mental health problems among Syrian refugees in a longitudinal perspective.

DESIGN

Prospective cohort study.

SETTING

We collected survey data among Syrian refugees in Lebanon granted resettlement to Norway (self-administered questionnaires) and at follow-up 1 year after arrival in Norway (structured telephone interviews).

PARTICIPANTS

Adult Syrian refugees attending mandatory pretravel courses in Lebanon in 2017-2018 were invited to participate. In total, 353 individuals participated at both time points.

PRIMARY AND SECONDARY OUTCOMES

We examined the cross-sectional associations between pain, mental health and migration-related exposures at baseline and follow-up and assessed whether associations changed significantly with time. Furthermore, we investigated the longitudinal association between mental health at baseline and pain at follow-up. We also evaluated temporal changes in use of analgesics and psychotropic drugs.

RESULTS

While most refugees reported improved health from the transit phase in Lebanon to the early resettlement phase in Norway, a few had persisting and intertwined health problems. Most migration-related stressors were more closely associated with chronic pain and mental health problems after resettlement as compared with the transit phase. In parallel, poor mental health was associated with chronic pain in the follow-up (adjusted risk ratio (ARR) 1.5 (1.0, 2.2)), but not at baseline (ARR 1.1 (0.8, 1.5)). Poor mental health at baseline was a statistically significant predictor of chronic pain at follow-up among those not reporting chronic pain at baseline. At both timepoints, one in four of those with chronic pain used analgesics regularly. None with mental health problems used antidepressants daily.

CONCLUSIONS

Providers of healthcare services to refugees should be attentive to the adverse effect of postmigration stressors and acknowledge the interrelations between pain and mental health. Possible gaps in pharmacological treatment of pain and mental health problems need further clarification.

Validation of the Hopkins Symptom Checklist-25/Nepali Version among Bhutanese Refugees in the United States

BACKGROUND

Bhutanese refugees' mental problems are relatively high. The Hopkins Symptom Checklist-25 (HSCL-25) has been used widely in examining refugees' mental health, but its psychometric properties in Nepali version is unknown.

PURPOSE

To examine psychometric properties of the HSCL-25/Nepali version.

METHODS

Bhutanese refugees (n = 209) responded to demographic questionnaire, the HSCL-25/Nepali, and the Refugee Health Survey-15. Exploratory factor analysis (EFA), convergent validity, and internal consistency were performed.

RESULTS

After three rounds of EFA, item 14 was deleted resulting in HSCL-24/Nepali with good construct validity and excellent internal consistency (α = .94).

CONCLUSIONS

The HSCL-24/Nepali version is reliable and valid and can be used to culturally, appropriately assess psychological distress of Bhutanese refugees as it omits item 14 that captures individual's sexual interest.

Reflections of methodological and ethical challenges in conducting research during COVID-19 involving resettled refugee youth in Canada

Research involving migrant youth involves navigating and negotiating complex challenges in order to uphold their rights and dignity, but also all while maintaining scientific rigour. COVID-19 has changed the global landscape within many domains and has increasingly highlighted inequities that exist. With restrictions focusing on maintaining physical distancing set in place to curb the spread of the virus, conducting in-person research becomes complicated. This article reflects on the ethical and methodological challenges encountered when conducting qualitative research during the pandemic with Syrian migrant youth who are resettled in Canada. The three areas discussed from the study are recruitment, informed consent and managing the interviews. Special attention to culture as being part of the study's methodology as an active reflexive process is also highlighted. The goal of this article is to contribute to the growing understanding of complexities of conducting research during COVID-19 with populations which have layered vulnerabilities, such as migrant youth. This article hopes that the reflections may help future researchers in conducting their research during this pandemic by being cognizant of both the ethical and methodological challenges discussed.

Explanatory models and help-seeking for symptoms of PTSD and depression among Syrian refugees

OBJECTIVE

This study investigates how Syrian refugees explain and prefer to seek help for symptoms of post-traumatic stress disorder (PTSD) and depression.

METHODS

We conducted five semi-structured focus group interviews based on a vignette-technique with Syrian refugees (n = 21 men, n = 10 women). The vignettes describe a fictional person suffering from symptoms of PTSD or depression in line with DSM-5 and ICD-10 criteria.

RESULTS

Despite never mentioning PTSD, participants in the PTSD-interviews recognized the symptoms. They perceived them as a common reaction to extreme situations, mainly the war, the flight, and post-migratory stressors. Depression was labeled as either depression or feelings caused by social problems, and the participants were more hesitant to identify with these symptoms. Despite some differences, both the PTSD and depression vignettes were explained in terms of situational explanatory models and externally caused stress. The main finding is how participants described changing stressors resulting from migration and resettlement leading to a difference in how they would seek help in Syria and in Norway. Specifically, we found that preferred help-seeking and coping strategies are contextual.

CONCLUSIONS

These findings point to the need to consider transformations following forced migration when studying aspects of explanatory models, preferred help-seeking, and coping strategies in refugee groups.

The Influence of Premigration Trauma Exposure and Early Postmigration Stressors on Changes in Mental Health Over Time Among Refugees in Australia

As a result of the precarious conditions in which they migrate, refugees are likely to have experiences that increase their risk of mental health problems. Refugees tend to be predisposed to relatively high levels of distress upon resettlement, and a key predictor of these issues is traumatic experiences that occur before their arrival. Despite high initial levels of ill-health, on average, refugees tend to experience mental health recovery over time. However, both levels of mental health upon settlement and recovery over time may be negatively influenced by stressors in the postsettlement period. The present study examined changes in psychological distress and posttraumatic stress symptoms over 5 years among 2,169 refugees from various backgrounds, predominately from Iraq and Afghanistan, who participated in the Building a New Life in Australia (BNLA) study. A multivariate latent growth curve model found mental ill-health decreased on average, β = -.21 for distress and β ₌ -.31 for PTSD, ps < .001, and premigration trauma exposure predicted more initial PTSD symptoms and reduced recovery over time, β_Intercept = .21, β_Slope = -.54, p < .001. Postmigration stressors, such as loneliness, financial concerns, and cultural integration, predicted higher levels of mental health problems as well as reduced recovery over time. These findings suggest that beyond trauma exposure, the mental health of refugees upon resettlement and their recovery over time is impacted by stressors in the early resettlement period, which has important implications for interventions and services to support and encourage well-being in refugee populations.

Sport participation may protect socioeconomically disadvantaged youths with refugee backgrounds from experiencing behavioral and emotional difficulties

INTRODUCTION

Youth with refugee backgrounds experience social and socioeconomic difficulties that arise following resettlement. Research has found that sport participation generally provides youth with a protective milieu that is especially beneficial for the most disadvantaged youth. Accordingly, the current study examines whether sport participation is related to positive psychosocial outcomes for resettled adolescent refugees, and if these effects are greater for those living in socioeconomically disadvantaged communities.

METHOD

Data were from a large, nationally representative cohort of refugees recently resettled in Australia (Building New Life in Australia study, BNLA). Self-reported social and emotional well-being was collected from 415 youth who entered the country as refugees (M_age = 14.04, SD = 1.99) at three years post settlement were used.

RESULTS

A moderated regression analysis indicated that refugee youth living in socioeconomically disadvantaged neighborhoods who participated in sports reported significantly better outcomes compared to those refugee youth in economically similar neighborhoods who did not participate in sport. In contrast, refugee youth residing in more socioeconomically advantaged communities had better developmental outcomes, regardless of sport participation.

CONCLUSIONS

Sport participation is a protective factor for youth with refugee backgrounds. Community socioeconomic disadvantage moderates this relationship, whereby stronger effects were observed for adolescents in more disadvantaged communities. Protecting the most disadvantaged in our society is a human rights imperative, and the current study indicates that sport participation could contribute to these efforts among resettled refugee populations.