Understanding the Role of Collective Trauma on Afghan Refugee Mental Health: A Transformative Mixed Methods Study

Background: Although much work has been done to promote mental health among resettled refugees in the United States, there is still significant gaps in culturally responsive mental health interventions. Current efforts are still limited to focusing on individual trauma experiences and Western notions of individualism, often missing collective historic experiences impacting refugee mental health. For refugee groups that come from communal cultures, collective trauma experiences may have compounding impact on mental health outcomes at the individual level. One of the refugee groups facing decades of war and displacement, are Afghan refugees. The sudden withdrawal of U.S. troops from Afghanistan has additionally exacerbated experiences of collective trauma among this population. While there is evidence of high levels of mental health concerns and post-migration difficulties among this population, there is a lack of understanding of the impact of collective trauma experiences among Afghan refugees. This study examined the role of collective trauma on the mental health of resettled Afghan refugees in the United States.

Methods: Using a transformative explanatory sequential mixed methods research design through a community-based participatory research (CBPR) approach, quantitative data was first collected via community surveys (N = 173), followed by qualitative data collected via focus group discussions (FGD; N = 35) with Afghan refugees in a mid-western U.S. city. Data were collected from August 2022 through January 2023 in Dari, Pashto and English languages. Snowball sampling was used to recruit participants. Quantitative variables included demographic variables, mental health outcomes, individual trauma, collective trauma, and post-migration difficulties. Data analysis included a hierarchal multiple regression analysis. Qualitative data collection centered around collective trauma experiences and solutions to healing. Grounded theory methods of coding—open, axial, selective— were used to analyze qualitative data from FGDs.

Results: After controlling for demographic variables, quantitative data revealed that higher levels of collective trauma were significantly associated with worse mental health outcomes (β = .38, p < .001). There were significant moderating effects between individual trauma and collective trauma on mental health (β = .46, p < .001). The interaction between individual and collective trauma explained 58% of the variance in mental health outcomes, after controlling for demographic variables (R² change= .58; p < .001). Three major themes emerged from the qualitative data: (1) impacts of collective trauma in the post-resettlement context; (2) post-migration stress: too little support, not enough opportunity; and (3) collective solutions for collective trauma. Integrated results show collective trauma has a significant impact on mental health outcomes among Afghan refugees in the post-resettlement context and the need for the development of community-level interventions to collectively heal.

Conclusion: Afghan refugees are arriving in the United States after enduring years of war, violence, and collective trauma. The findings of this mixed methods study shed light on the impact of this collective trauma on Afghan refugees' mental health. Further research should continue to explore this construct to deepen understanding of collective trauma not only among Afghan refugees, but also other refugee groups.