Bouncing forward of young refugees: a perspective on resilience research directions

Impairments in psychological functioning in refugees and asylum seekers

Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version's total and six subdomains' scores ('mobility', 'life activities', 'cognition', 'participation', 'self-care', 'getting along') as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in 'mobility' and 'participation', followed by 'life activities' and 'cognition'. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in 'participation', while past events of being close to death were associated with fewer issues with 'self-care'. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.

'Now I Have Dreams in Place of the Nightmares': An Updated Systematic Review of Post-Traumatic Growth Among Refugee Populations

Trauma exposure places refugees at serious risk of developing mental health difficulties. However, research also recognizes that refugees can respond to trauma with psychological development and growth, commonly referred to as post-traumatic growth (PTG). An updated systematic review was conducted to investigate PTG across different refugee populations, including the processes that mediate this phenomenon, and the use of therapy in promoting PTG. A systematic search of CINAHL Complete, Proquest 5000, PsychINFO, Scopus, and Web of Science was performed to identify studies exploring PTG in refugee populations, published between June 2013 and November 2021. In all, 26 studies met the inclusion criteria for this review. Quantitative results reveal a positive correlation between PTG and religious commitment and coping, and the effectiveness of narrative and community-based interventions in facilitating PTG. Qualitative results facilitate insight into the complex ways refugees find meaning and strength after trauma through religion, comparison-based thinking, helping others, and storytelling. Findings highlight the need for future research and interventions to recognize the distinct PTG experiences of different refugee populations.

Conceptualizing a resilience research framework at The National Institutes of Health

The National Institutes of Health (NIH) have recently gathered internal and external input towards a shared understanding of resilience in the wide context of human health and the biomedical sciences that would help accelerate advances in human health and its maintenance. This shared view is that resilience refers in general to a system's capacity to recover, grow, adapt, or resist perturbation from a challenge or stressor. Over time, a system's response to a challenge might show varied degrees of reactions that likely fluctuate in response to the type of challenge (internal and/or external), severity of the challenge, the length of time exposed to the challenge, other external factors and/or biological factors (innate and/or external). We have embarked on this special issue as an opportunity to explore commonalities amongst viewpoints on the science of resilience covered by the various NIH Institutes, Centers, and Offices (ICOs) with respect to the characterization of various systems, stressors, outcomes measures and metrics, and interventions and/or protective factors that are shared within each domain and across multiple domains. Here, resilience is characterized broadly by four areas of scientific study: molecular/cellular, physiologic, psychosocial and spiritual, and environmental/community resilience. Each area or domain provides general frameworks for designing studies that may help advance the science of resilience within the context of health maintenance. This special issue will also acknowledge the remaining gaps that impede advancement of the science of resilience and offer considerations for potential next steps towards addressing the research gaps.

The lived experiences of resilience among Syrian refugees in the UK: interpretative phenomenological analysis

AIMS AND METHOD

Refugees' mental health has attracted great interest from researchers recently, in view of increasing numbers of refugees settling in Europe. A deficit model, focusing on mental disorder, has often dominated the discourse on the subject, but a strength-based model is becoming more recognised and adopted. Through semi-structured interviews, and using interpretative phenomenological analysis as a data analysis tool, the current study sought to explore the lived experiences of Syrian refugees in the UK in relation to resilience factors.

RESULTS

Three main themes were identified reflecting interpersonal and family factors, factors related to religion, faith and belief systems, and personal qualities.

CLINICAL IMPLICATIONS

The study calls for perceiving refugees as resilient individuals with strengths and adaptive qualities. It also demonstrates that refugees' resilience is essentially an interpersonal process, advocating therefore for engagement and therapeutic approaches that are systemic, relational, and culturally and spiritually competent.

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.

Resilience as a multi-directional movement process: A conceptual and empirical exploration

Movement is a recurrent thematic within extant resilience scholarship. Ecological theorizations of resilience emphasize systems that are in constant movement and flux. Terms such as "bouncing back" and "bouncing forward" are frequently used to describe how individuals recover and move on from adversity and trauma. However, integrated individual-systemic explanations of resilience movement dynamics are lacking. Seeking to address this gap, this interdisciplinary article expressly frames resilience as a multi-directional movement process. Individuals do not just move forward and backwards. Rather, they move in multiple and varied ways as they seek to navigate their way through adversity-and through systems and social-ecological traps that both shape how they move and require them to keep moving. Drawing on interview data with victims-/survivors of conflict-related sexual violence in Bosnia-Herzegovina (BiH), Colombia, and Uganda, the article empirically explores what "movement" looks like at the microlevel through a focus on everyday forms and expressions of movement, while also examining how wider systemic environments shape and influence these movements.

‘Our Voices Aren’t in Lockdown’—Refugee Young People, Challenges, and Innovation During COVID-19

Using data drawn from consultations and interviews with young people from young people of refugee background in Melbourne, Australia, we examine how young people negotiate their lives in the context of settlement, specifically during the current COVID-19 pandemic. We listened to stories about the challenges they faced, and the initiative and actions they took during the lockdown of nine towers in public housing estates of inner Melbourne during June and July of 2020. In this research, we have found that, despite many pre-existing disadvantages, young people of refugee background have responded to the crisis through public health promotion, volunteering, and innovation. The pandemic has highlighted the role that young people play in supporting their families and communities in the settlement/integration process and the added responsibilities young people have assumed in the context of COVID-19. In negotiating these, young people have drawn upon embodied and communal ways of coping. This paper starts with an exploration of refugee young people’s narratives about their lives and experiences during the pandemic. We adopt intersectionality as a method and analytical tool to interpret these experiences and the roles in which young people have enacted during this time—as navigators, carers, providers, and innovators. We end by evaluating the policy gaps these reflect and highlight.

Refugee Women with a History of Trauma: Gender Vulnerability in Relation to Post-Traumatic Stress Disorder

Refugees represent a population whose living conditions have a strong impact on their mental health. High rates of post-traumatic stress disorder (PTSD), more than other mental disorders, have been found in this group, with women having the highest incidence. The objective of the present systematic review was to identify and examine studies from the last fifteen years on the relationship between the impact of traumatic experiences and PTSD psychopathology in refugee women. Twelve studies were included, from which the overall results approved this relation. In addition, six of these studies show that exposure to sexual trauma in refugee women is associated with the high odds of being at risk for PTSD. These findings suggest that gender-related traumatic experiences can explain the high rate of PTSD in refugee women and highlight the unmet need for psychosocial health care in this population.

Researching the Effectiveness of Tree of Life: an Imbeleko Approach to Counseling Refugee Youth

With the growing worldwide refugee crisis, there is a need for evidence-based interventions that specifically deal with the consequences of cumulative trauma-exposure in refugee youth. Refugee children have unique service needs and differ from their non-refugee peers in terms of sociocultural trauma, language, culture, and educational barriers. This article explains the complexities associated with understanding refugee youth and presents a proposal for studying the possible benefits of Tree of Life therapy. At the present time, Tree of Life therapy has no evidence-base because the published studies of Tree of Life with refugee and/or immigrant youth have sample sizes of one, six, eight, and twenty-nine. As a culturally-grounded, strength-based group counseling approach, Tree of Life therapy addresses traumatic experiences, recognizes participants' cultural differences, highlights individual skills, and aids in instilling both confidence and hope for the future. Ncazelo Ncube, the co-founder and main developer of Tree of Life, describes this therapy as a collective narrative practice that considers cultural beliefs and values (2006, 2010, 2018, 2019). The proposed research design is to study the effectiveness of the Tree of Life in Canada, the United States, the United Kingdom, and South Africa. The research plan is to use pragmatic, group-randomized controlled trials in the "real world" settings of schools and agencies in each of the four countries. In addition, the article describes the development of the Roots and Wings Questionnaire for Children and Youth, a culturally relevant, child-friendly questionnaire. The Tree of Life is a readily available therapy with great potential for helping traumatized refugee youth as well as other trauma-impacted young people worldwide.

Prejudice and Feeling of Threat towards Syrian Refugees: The Moderating Effects of Precarious Employment and Perceived Low Outgroup Morality

Refugees frequently experience traumatic situations that result in the deterioration of their psychological well-being. In addition, perceived prejudice and discrimination against them by the host society can worsen their mental health. In this research study, using a Spanish sample, prejudice towards Syrian refugees is analyzed taking into account feeling of threat (realistic or symbolic), precarious employment, and perceived outgroup morality. Using a total of 365 participants, our results reveal that individuals feel more prejudice towards refugees when the former scored higher in realistic threat and symbolic threat, were in a highly precarious situation of employment and perceived refugees as being more immoral. Furthermore, it was found that persons who scored high in realistic threat and at the same time were in a situation of precarious employment, were those who displayed greater prejudice. The results likewise pointed to individuals who scored high in symbolic threat and in outgroup morality as being those who felt greater rejection towards the refugees. Accordingly, our results confirm the importance of feeling of threat in relation to prejudice, and highlight two important moderating factors: precarious employment and perceived outgroup morality.

Management of mental health conditions in refugee youth: An overview for the psychiatric-mental health nurse practitioner

TOPIC

In 2017, there were a total of 70 million forcibly displaced individuals or refugees, worldwide. Unfortunately, over 50% of refugees are under the age of 18 years. Refugee youth are at-risk for a variety of mental health conditions.

PURPOSE

The purpose of this report is to provide psychiatric-mental health nurse practitioners (PMHNPs) with an understanding of unique cultural implications in refugee youth, risk factors towards the development of psychiatric illness, and means to identify those at-risk for sequelae or those meeting diagnostic criteria. Also presented are foundational treatment and management implications to ensure the provision of culturally sensitive and efficacious care to this unique population.

SOURCES USED

Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications pertaining to mental health issues in refugee youth spanning from 2013 to present. Reference lists of identified articles were also searched.

CONCLUSIONS

A variety of risk and protective factors are discussed, spanning from premigration, during flight, and postsettling periods. PMHNPs must be proficient in screening and diagnosis of mental health conditions in refugee youth and implementation of pharmacological and psychotherapeutic interventions. PMHNPs must also be well versed in community-based resources that can be utilized to promote optimal outcomes.

Social Resilience and Mental Health Among Eritrean Asylum-Seekers in Switzerland

Eritreans comprise the largest group of asylum-seekers in Switzerland. Gaining recognized refugee status can take up to 36 months, during which time asylum-seekers live in a state of legal limbo, intensifying threats to their well-being. Resilience and mental health among this population is poorly understood. We interviewed 10 asylum-seekers residing in Switzerland using qualitative, in-depth interviews. Data were analyzed using the Framework Method. Results indicated that mental health was understood as a binary state rather than a continuum and that trusted friends and family were responsible for recognizing and attempting to treat mental health problems. Pathways to care were potentially interrupted for asylum-seekers. Capital building, considered through the lens of social resilience, consisted of language learning, establishing of new individual- and community-level social networks, and proactive symbolic capital building through volunteering. We contextualize the asylum-seekers' experience into a resilience framework and offer practical recommendations for improving mental health care access.

Resilience and protective factors among refugee children post-migration to high-income countries: a systematic review

Background

Increasing numbers of children have been forced to flee and seek asylum in high-income countries. Current research indicates that focussing on resilience and protective factors is an important long-term goal for positive mental health and psychological functioning of refugee children.

Methods

We performed a systematic review of quantitative literature regarding psychological and contextual factors that contribute to resilience in refugee children residing in high-income countries. Our procedure followed guidelines from the Centre for Reviews and Dissemination.

Results

We identified a number of protective factors as related to positive outcomes. They are drawn from several ecological domains and include age, self-esteem, maintenance of cultural identity, social support, belonging and safety and innovative social care services. A key overarching point reported by the studies we reviewed was that for refugee settlement specific policies and approaches to be beneficial, they were required to be embedded within a positive socially inclusive society. We also identified several limitations across the reported studies.

Conclusion

The factors we identified would assist clinicians to adopt a resilience-focussed approach. However, a continued pre-occupation with psychopathology was evident across the studies, which we argue as holding back the development of resilience-focussed approaches.

Psychiatric screening and interventions for minor refugees in Europe: an overview of approaches and tools

Currently hundreds of thousands of minor refugees entered Europe. This group has been exposed to traumatic events pre-, during, and post-migration and is at increased risk of developing psychiatric disorders. In this article, we describe the results of our literature search on screening and interventions for post-traumatic stress disorder (PTSD) in minor refugees, in order to make recommendations for clinical practice. Results show that studies on diagnostic accuracy of assessment instruments and efficacy of mental healthcare interventions in this population are lacking. Traumatic experiences pre-flight, during the flight and at resettlement, superimposed by parental PTSD, and other contextual factors, might lead to more than 25% of minor refugees developing PTSD.

CONCLUSION

To enhance the number of minor refugees recognized with PTSD, we recommend the use of a brief screening instrument. A public health approach, focusing on environmental supportive factors is the first step in treatment for this group, followed by short-term psychological group interventions focusing on psycho-education and stress reduction. Minor refugees with no improvement in PTSD symptoms by these interventions need referral to specialized mental health care services. Mental health providers should be culturally competent. What is Known: • Post-traumatic stress disorder, anxiety, sleeping problems, and depression are the most common psychiatric disorders in minor refugees. • Evidence based methods on screening and interventions in minor refugees with psychiatric disorders are lacking. What is New: • In the absence of validated screening tools a best practice reliable, quick and child-friendly tool is presented. • A layered system for mental health care and psychosocial support in minor refugees is explained.

Exploring resilience models in a sample of combat-exposed military service members and veterans: a comparison and commentary

Background: The term resilience is applied in numerous ways in the mental health field, leading to different perspectives of what constitutes a resilient response and disparate findings regarding its prevalence following trauma. Objective: illustrate the impact of various definitions on our understanding and prevalence of resilience, we compared various resilience definitions (absence of PTSD, absence of current mental health diagnosis, absence of generalized psychological distress, and an alternative trauma load-resilience discrepancy model of the difference between actual and predicted distress given lifetime trauma exposure) within a combat-exposed military personnel and veteran sample. Method: In this combat-trauma exposed sample (N = 849), of which approximately half were treatment seeking, rates of resilience were determined across all models, the kappa statistic was used to determine the concordance and strength of association across models, and t-tests examined the models in relation to a self-reported resilience measure. Results: Prevalence rates were 43.7%, 30.7%, 87.4%, and 50.1% in each of the four models. Concordance analyses identified 25.7% (n = 218) considered resilient by all four models (kappa = .40, p < .001). Correlations between models and self-reported resilience were strong, but did not fully overlap. Conclusions:The discussion highlights theoretical considerations regarding the impact of various definitions and methodologies on resilience classifications, links current findings to a systems-based perspective, and ends with suggestions for future research approaches on resilience.

The psychotherapeutic care of refugees in Europe: treatment needs, delivery reality and recommendations for action

The special issue of the European Journal of Psychotraumatology released on 7 November 2017 focused on traumatized refugees and on the mental health burden, screening instruments and interventions in different groups of refugees. This contribution takes up this discussion on the needs and challenges for mental healthcare of traumatized refugees from the point of view of the practitioners. It reports on the findings of a survey on the treatment situation and the delivery reality of healthcare for refugees in 14 European countries, identifies treatment gaps, and sets recommendations for action at the political and therapeutic levels. The survey was conducted by the Federal Chamber of Psychotherapists with the assistance of the Network for Psychotherapeutic Care in Europe. The findings underline the need for appropriate mental healthcare for this population.

Lives on hold: A qualitative study of young refugees' resilience strategies

Although the literature on positive adjustment following traumatic events is growing, only a few studies have examined this phenomenon in young refugees. Using the social-ecological framework, the aim of this study was to identify factors and processes that according to young refugees promote their resilience. A total of 16 treatment-seeking refugees aged 13-21 years, living in the Netherlands, were interviewed. Data analysis revealed four resilience strategies: (1) acting autonomously, (2) performing at school, (3) perceiving support from peers and parents, and (4) participating in the new society. These strategies interacted with one another and demonstrated the interrelatedness between individuals and their social context. Having to wait long for a residence permit and being older appeared to negatively influence participants' resilience strategies. These findings suggest that resilience refers to a dynamic process that is context and time specific.

Growing from experience: an exploratory study of posttraumatic growth in adolescent refugees

OBJECTIVE

The aim of this study was to explore perceived posttraumatic growth (PTG) and its associations with potentially traumatic events (PTEs), dispositional optimism, perceived social support, posttraumatic stress disorder (PTSD) symptoms, and satisfaction with life (SWL) among adolescent refugees and asylum seekers.

METHOD

A cross-sectional design was employed including 111 refugees, aged 12-17, that were recruited from asylum seeker centres throughout the Netherlands. Measurements included the revised Posttraumatic Growth Inventory for Children, Children's Impact of Event Scale, Multidimensional Scale of Perceived Social Support, The Life Orientation Test, and the Satisfaction with Life Scale.

RESULTS

Participants reported mean PTG scores (20.2) indicating an average response of some perceived change, while reporting high levels of PTSD symptoms (30.6). PTG and PTSD symptoms were not related with each other (r=0.07, p=0.50). PTG was positively associated with dispositional optimism (r=0.41, p<0.01) and social support (r=0.43, p<0.01). A hierarchical regression analysis demonstrated that dispositional optimism (β=0.33; p<0.05) and social support (β=0.27; p<0.05) positively predicted PTG, explaining 22% of the PTG variance above demographic variables and PTEs. PTG was also positively related with SWL (r=0.37, p<0.01).

CONCLUSIONS

Perceived PTG and PTSD symptoms appear to be independent constructs, which co-occur in adolescent refugees and asylum seekers. The relationship between PTG and mental health remains inconclusive; PTG was positively related to SWL and not associated with PTSD symptoms. Longitudinal research is required to determine causality between PTG and mental health in this refugee population confronted with many traumatic experiences and challenging migration tasks.

Between power and powerlessness: a meta-ethnography of sources of resilience in young refugees

OBJECTIVE

This article reviews available qualitative studies that report young refugees' ways of dealing with adversity to address their sources of resilience.

DESIGN

We searched five electronic databases. Twenty-six empirical studies were included in the review. A meta-ethnography approach was used to synthesize these qualitative studies.

RESULTS

Six sources of resilience emerged: (1) social support, (2) acculturation strategies, (3) education, (4) religion, (5) avoidance, and (6) hope. These sources indicated social as well as personal factors that confer resilience in young refugees, but most of them also had counterproductive aspects.

CONCLUSION

The results, from an ecological developmental perspective, stressed the interplay between protective and risk processes in the mental health of young refugees who had resettled in Western countries, and they emphasized the variability as well as the universality of resilience-promoting processes. Further research is needed to explore the cultural shape of resilience and the long-term consequences of war and migration on young refugees.

A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants

BACKGROUND

The rising global burden of forced migration due to armed conflict is increasingly recognised as an important issue in global health. Forced migrants are at a greater risk of developing mental disorders. However, resilience, defined as the ability of a person to successfully adapt to or recover from stressful and traumatic experiences, has been highlighted as a key potential protective factor. This study aimed to review systematically the global literature on the impact of resilience on the mental health of adult conflict-driven forced migrants.

METHODOLOGY

Both quantitative and qualitative studies that reported resilience and mental health outcomes among forcibly displaced persons (aged 18+) by way of exploring associations, links, pathways and causative mechanisms were included. Fourteen bibliographic databases and seven humanitarian study databases/websites were searched and a four stage screening process was followed.

RESULTS

Twenty three studies were included in the final review. Ten qualitative studies identified highlighted family and community cohesion, family and community support, individual personal qualities, collective identity, supportive primary relationships and religion. Thirteen quantitative studies were identified, but only two attempted to link resilience with mental disorders, and three used a specific resilience measure. Over-reliance on cross-sectional designs was noted. Resilience was generally shown to be associated with better mental health in displaced populations, but the evidence on this and underlying mechanisms was limited.

DISCUSSION

The review highlights the need for more epidemiological and qualitative evidence on resilience in forcibly displaced persons as a potential avenue for intervention development, particularly in resource-poor settings.

Personal values in soldiers after military deployment: associations with mental health and resilience

BACKGROUND

After military deployment, soldiers are at an increased risk of developing posttraumatic psychiatric disorders. The correlation of personal values with symptoms, however, has not yet been examined within a military context.

METHOD

Schwartz's Portrait Values Questionnaire (PVQ), the Posttraumatic Stress Diagnostic Scale (PDS), and the 11-item version of the Resilience Scale (RS-11) were completed by 117 soldiers of the German Armed Forces who had recently been deployed to Afghanistan (n=40 undergoing initial psychiatric treatment, n=77 untreated).

RESULTS

Logistic regression showed that the value types of hedonism (-), power (-), tradition (+), and universalism (+) were significantly correlated with the probability and severity of PTSD and whether the participant was in treatment or not. The effects were partially mediated by the RS-11 scale values.

CONCLUSIONS

Value types seem to be associated with psychiatric symptoms in soldiers after deployment. These results could contribute to the further development of therapeutic approaches.