Understanding Adverse Social Drivers, Survival Coping and Mental Health Problems: A Qualitative Investigation with Arabic-Speaking Refugee Families in Resettlement

Background: The mental health burden resulting from war and forced displacement is significant with a substantial body of research indicating heightened risk for common mental health disorders among refugee and other forcibly displaced communities. In addition to the mental health consequences resulting from exposure to pre- and post-migration losses and traumatic events (e.g., war conditions, witnessing violence, death of loved ones), growing evidence indicates that the post-migration context and ongoing stressors common to resettlement such as English language proficiency challenges, food and housing insecurity, unemployment and social exclusion adversely impact mental health and accumulate with increased time of displacement. Minimizing the impact of adverse social drivers and strengthening families’ ability to cope with associated challenges in resettlement are important targets for promoting the mental health of refugee families.

Methods: We partnered with refugee service organizations and Syrian and Iraqi community advocates to examine factors and processes shaping the mental health and psychosocial wellbeing of Syrian and Iraqi families. We conducted qualitative interviews in Arabic with adult caregivers (n=54, 30 Syrian, 24 Iraqi) and interviews and focus groups with young people aged 12-17 (n= 48, 28 Syrian, 20 Iraqi) and drew on inductive and interpretive thematic analysis methods to examine the data.

Findings: A process model was developed depicting the interactions between 1) adverse social drivers; 2) survival coping strategies, and 3) mental health and psychosocial problems. Adverse social drivers captured synergistic and ongoing conditions of adversity and vulnerability including trauma and loss, losses of social support, daily stressors, adjustment problems and stigma. These vulnerabilities led to coping efforts including keeping to oneself, shifting family roles, revising norms and identity and worrying about the future. Mental health and psychosocial problems captured the negative impact that social conditions and survival coping had on participants leading to individual mental health struggles, tension in family relationships and feeling alone and socially disconnected.

Implications: Study findings highlight both the resilience of refugee families and the psychosocial impact of navigating a new and challenging home environment. Specifically, this study provides insight into the potential pathways through which pre- and post-migration experiences of trauma and chronic adversity impair individual mental health and family and social functioning. Coping has been under addressed in the refugee mental health literature to date and mostly focused on internal coping. Findings from this study can inform development of interventions and services that target social determinants and strengthen internal, familial and social coping to better support mental health and wellbeing. In addition, study investigators are drawing on these findings to adapt and redesign a prevention-oriented family-based mental health intervention to be delivered in community-based organizations.