Afghan Evacuees in Chicago and Nashville Strengthening Knowledge of Mental Health Promoting Factors

Background: Approximately 75,000 Afghan evacuees resettled in the U.S. immediately after US troop withdrawal from their country in 2021. Families fled suddenly, leaving behind most of what they own and know, with numerous families being separated in the process. Two key resettlement cities in the U.S., Chicago and Nashville, received individuals and families with limited notice, as service providers were ill-equipped to identify or meet needs beyond those required for basic survival. In response, the current study was designed to gain insight into factors associated with mental health and emotional well-being, in response to provider requests for these data.

Methods: A cross-sectional, exploratory survey study was designed to gain insight into experiences of stress, social support and integration, mental health, and overall well-being of Afghan adults (n=177) who arrived in August 2021 or later. Using purposive sampling strategies, recruitment occurred via listservs, flyers, and word of mouth. Data were collected in native languages, Dari and Pashto, by certified Afghan interpreters. Both male and female interpreters were hired to facilitate higher comfort level with data collection, as recommended by our community partners. Descriptive data, t-tests, and linear regression analyses were employed to examine mental health and well-being data by location (Chicago or Nashville) and to explore correlates of overall refugee mental health (Refugee Health Screener).

Results: About half (50.3%) of participants were women, with 29.6% having some college or higher educational attainment. The majority of participants (70.2%) were working in the U.S., slightly higher than rates before evacuating Afghanistan (65.9%). Reliability scores were good for all study measurement tools. T-test results suggest that refugee overall mental health was lower in Nashville than Chicago (t=-4.05, p<.001), as were post-migration stress scores (Refugee Post-Migration Stress Scale; t=-4.27, p<.001). Social support scores (Multidimensional Scale of Perceived Social Support) were lower in Nashville (t=-2.43, p=.014). The overall regression model was significant (F=4.78; p<.001) and explained 60.6% of variance. Three independent variables correlated with poorer mental health: refugee post-migration stress (B=.311; p=.001); feeling like an outsider (B=3.48; p=.018); and lower English speaking proficiency (B=-5.731; p=.035).

Conclusion: Findings yield novel and meaningful data related to location of resettlement and factors that correlate with mental health. Chicago, as a more diverse and robust resettlement location, has a larger network of both formal and informal support that may contribute to reduced stress, mental health concerns, and larger social networks. Further, stress and lower integration (feeling like an outsider and lacking English proficiency) emerged as risk factors for mental health. Social workers can apply this data to assess stress levels and implement programming for improved integration that includes English classes. Advocacy for increased services for non-refugee evacuees is also essential. Future research should include longitudinal data collection to evaluate well-being over time and investigate interventions toward improved mental health and well-being.