Research on Refugees in AJO
Pejic, V.; Hess, R.; Miller, G.; & Wille, A. (2016). Family first: Community-based supports for refugees. American Journal of Orthopsychiatry 86(4):409-414.
This article presents a community-based approach that targets family interventions and services through a preventive, family systems ecological framework. A public health approach is used to emphasize the need for a tiered model of family support that builds on the strengths of refugee families while recognizing their specific needs and challenges. The rationale for a family systems ecological perspective is presented to highlight the critical features of effective family support programs for refugee families, followed by a discussion regarding the transitions and adaptation faced by refugee families when entering the United States. Finally, a public-health problem solving model is employed to promote a comprehensive vision for how more effective support can be developed to best serve the mental health needs of refugee families. An integrated case example highlighting the Somali Parent Program, a family-focused intervention, is also provided.
Ellis, B.; Abdi, S.; Lazarevich, V.; White, M.; Lincoln, A.; Stern, J.; & Horgan, J. (2016). Relation of psychosocial factors to diverse behaviors and attitudes among Somali refugees. American Journal of Orthopsychiatry 86(4):393-408.
Refugee studies have examined both resilience and adverse outcomes, but no research has examined how different outcomes co-occur or are distinct, and the social-contextual factors that give rise to these diverse outcomes. The current study begins to address this gap by using latent profile analysis to examine the ways in which delinquency, gang involvement, civic engagement, political engagement, and openness to violent extremism cluster among Somalirefugees. We then use multivariable regression analyses to examine how adversity (e.g., discrimination, trauma, and marginalization) is associated with the identified latent classes. Data were collected from 374 Somali refugee young adults (Mage = 21.30 years, SD = 2.90, range 18–30, 38% female) from 4 different North American communities. Participants completed a structured survey assessing their experiences of adversity, delinquent and/or violent attitudes and behaviors (e.g., attitudes toward violent extremism, participation in delinquent behaviors, involvement in gangs), and positive outcomes (e.g., civic and political engagement). Our findings indicate that participants fall into 5 distinct groups, and that social-contextual and individual factors are uniquely related to those groups. Specifically, strong social bonds seem to be associated with positive outcomes. These findings point to the need to further examine both positive and negative outcomes, paying special attention to social–contextual factors.
Tay, A.; Rees, S.; Kareth, M.; & Silove, D. (2016). Associations of adult separation anxiety disorder with conflict-related trauma, ongoing adversity, and the psychosocial disruptions of mass conflict among West Papuan refugees. American Journal of Orthopsychiatry 86(2):224-235.
Refugees commonly experience traumatic events that threaten the self and close others, suggesting the possibility that they may experience overlapping symptoms of posttraumatic stress disorder (PTSD) and separation anxietydisorder (SAD). We examine this possibility among West Papua refugees (n = 230) displaced to Port Moresby, Papua New Guinea. We also examine associations between the combined PTSD−SAD construct and indices of past trauma exposure, ongoing adversity, and the psychosocial disruptions caused by mass conflict and displacement. We applied culturally adapted interview modules to assess symptoms of PTSD, SAD, traumatic events (TEs), ongoing adversity, and 5 psychosocial dimensions. Latent class analysis identified a PTSD class (23%), a posttraumatic (PT) SAD class (22%), and a low-symptom class (55%). Compared with the low-symptom class, both the PTSD and PT−SAD classes endorsed higher levels of exposure to all domains of TEs (conflict -related trauma, witnessing murder, childhood related adversities, traumatic losses, and health stress) and ongoing adversity (access to health care, displacement/separation, safety in the community, and access to basic needs), but the 2 comorbid groups did not differ on these indices. The PT−SAD class alone scored higher than the low-symptom reference class in relation to disruptions to the psychosocial domains (safety/security, bonds/network, access to justice, roles/identities, existential meaning) and higher than the PTSD class on safety/security, justice and roles/identities. Our findings suggest that the PT−SAD pattern may represent a response to the most severe forms of psychosocialdisruptions of mass conflict among refugees. A focus on separation anxiety may enhance psychotherapies designed to treat PTSD in refugees.
McGregor, L.; Melvin, G.; & Louise, K. (2015). Differential accounts of refugee and resettlement experiences in youth with high and low levels of post traumatic stress disorder (PTSD) symptomatology: A mixed-methods investigation. American Journal of Orthopsychiatry 85(4):371-381.
In recent years there has been increased debate and critique of the focus on psychopathology in general, and posttraumatic stress disorder (PTSD) in particular, as a predominant consequence of the refugee experience. This study was conducted to broaden the conceptualization and examination of the outcomes of the refugee experience by jointly examining how adaptive processes, psychosocial factors, and psychopathology are implicated. A mixed-methods approach was used to specifically examine whether adolescents’ (N = 10) accounts of their refugee and resettlement experiences differed according to their level, “high” or “low,” of PTSD symptomatology. The superordinate themes of cultural belongingness and identification, psychological functioning, family unit functioning and relationships, and friendships and interpersonal processes, were identified as having particular relevance for the study’s participants and in distinguishing between participants with high and low levels of PTSD symptomatology. Findings were characterized by marked differences between adolescents’ accounts according to their symptomatology levels, and may thereby inform important avenues for future research as well as clinical prevention and intervention programs with refugee youth.
Ellis, B.; Lankau, E.; Ao, T.; Benson, M.; Miller, A.; Shetty, S.; Lopes Cardozo, B.; Geldmann, P.; & Cochran, J. (2015). Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior. American Journal of Orthopsychiatry 85(1):43-55.
Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutaneserefugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressors such as illiteracy, family conflict, and being separated from family members were more associated. IPTS holds promise in understandingsuicide in the resettled Bhutanese community.
Afifi, W.; Afifi, T.; Robbins, S.; & Nimah, N. (2013). The relative impacts of uncertainty and mothers' communication on hopelessness among Palestinian refugee youth. American Journal of Orthopsychiatry 83(4):495-504.
The life of adolescent refugees has been described as uncertainty laden. Yet no quantitative data exist to elucidate that experience of uncertainty, investigate its implications in that population, or explore potential moderators. This study applies the Entropy Model of Uncertainty (Hirsh, Mar, & Peterson, 2012) and the stress‐buffering hypothesis (for review, see Hegelson, 2003) to examine the experience of uncertainty among adolescent Palestinians living in refugee camps in Lebanon. It then tests the role of mothers' uncertainty‐related communication for adolescent hopelessness. One hundred and sixty‐two adolescents across 2 refugee camps in Lebanon participated in the study. Results support the existence of elevated levels of uncertainty about both personal and macrosecurity, show an association between uncertainty regarding personal security and levels of hopelessness, and suggest that uncertainty's negative impact may overwhelm the role of mothers' supportive communication as a buffer against hopelessness. Interestingly, the data also suggest surprisingly little hopelessness in this population.
Field, N.; Muong, S.; & Sochanvimean, V. (2013). Parental styles in the intergenerational transmission of trauma stemming from the Khmer Rouge regime in Cambodia. American Journal of Orthopsychiatry 83(4):483-494.
The impact of parental styles in intergenerational transmission of trauma among mothers who survived the KhmerRouge regime in Cambodia, in power from 1975 to 1979, and their teenaged children was examined in 2 studies. In Study 1, 46 Cambodian female high school students and their mothers were recruited. Each daughter completed anxiety and depression measures as well as assessment of her mother's role‐reversing, overprotective, and rejecting parental styles, whereas the mothers completed measures of their trauma exposure during the Khmer Rouge regimeand PTSD symptoms. In support of trauma transmission, the mother's PTSD symptoms were predictive of her daughter's anxiety. Moreover, the mother's role‐reversing parental style was shown to mediate the relationship between her own and her daughter's symptoms. In support of their generalizability, the results were replicated in Study 2 in a Cambodian‐American refugee sample comparing 15 mental health treatment‐seeking mothers and their teenaged children with 17 nontreatment‐seeking mother–child pairs. The implications of the findings within the larger literature on intergenerational trauma transmission stemming from genocide are discussed.
Perera, S.; Gavian, M.; Frazier, P.; Johnson, D.; Spring, M.; Westermeyer, J.; Butcher, J.; Halcon, L.; Robertson, C.; Savik, K.; & Jaranson, J. (2013). A longitudinal study of demographic factors associated with stressors and symptoms in African refugees. American Journal of Orthopsychiatry 83(4):472-482.
The objectives of this study were to assess differences in premigration, transit, and resettlement stressor exposure and post traumatic stress disorder (PTSD) symptoms as a function of demographic characteristics (i.e., gender, ethnicity, age, time in United States) and to examine the concurrent and longitudinal relations between stressor exposure and PTSD symptoms. The sample consisted of adult (18–78 years) Somali and Oromo refugee men and women (N = 437). Qualitative data regarding participants’ self‐nominated worst stressors collected at Time 2 (T2) informed the development of quantitative scales assessing premigration, transit, and resettlement stress created using items collected at Time 1 (T1). PTSD symptoms were measured at both T1 and T2. Quantitative analyses showed that levels of stressor exposure and PTSD symptoms differed as a function of refugee demographic characteristics. For example, Oromo, more recent, women, and older refugees reported more premigration and resettlement stressors. Oromo refugees and refugee men reported more PTSD symptoms in regression analyses with other factors controlled. Premigration, transit, and resettlement stressor exposure generally was associated with higher PTSD symptom levels. Results underscore the importance of assessing stress exposure comprehensively throughout the refugee experience and caution against overgeneralizing between and within refugee groups.
Ellis, B.; MacDonald, H.; Klunk-Gillis, J.; Lincoln, A.; Strunin, L.; & Cabral, H. (2010). Discrimination and mental health among Somali refugee adolescents: The role of acculturation and gender. American Journal of Orthopsychiatry 80(4):564-575.
This study examines the role of social identity (acculturation and gender) in moderating the association between discrimination and Somali adolescent refugees’ mental health. Participants were English‐speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135). Perceived discrimination, trauma history, posttraumatic stress disorder (PTSD), depressive symptoms, and behavioral acculturation were assessed in structured interviews. Fourteen in‐depth qualitative interviews and 3 focus groups were also conducted. Results indicated that discrimination was common and associated with worse mental health. For girls, greater Somali acculturation was associated with better mental health. Also, the association between discrimination and PTSD was less strong for girls who showed higher levels of Somali acculturation. For boys, greater American acculturation was associated with better mental health, and the association between discrimination and depression was less strong for boys with higher levels of American acculturation.
Murray, K.; Davidson, G.; & Schweitzer, R. (2010) Review of refugee mental health interventions following resettlement: best practices and recommendations. American Journal of Orthopsychiatry 80(4):576-85.
There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community‐based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.