Mental Health Post-Resettlement Among Afghan Refugees in St. Louis, Missouri

Background and Purpose: St. Louis has recently been identified as the US metropolitan area with the third highest rate of foreign-born population growth, with Afghan refugees making a significant contribution. Nevertheless, Afghan refugees’ experiences, particularly concerning mental health, remain understudied. The psychological well-being of refugees is a multifaceted issue influenced by various contextual factors and individual experiences pre-, during, and post-resettlement. While evidence on the mental health impact of individual experiences before and during migration continues to grow, considerably less attention has been given to how post-resettlement experiences shape refugees’ mental health, especially in the US. This study aims to explore the mental health of Afghan refugees in St. Louis in relation to post-resettlement factors such as social connectedness and their perceptions of their environment, with the goal of identifying key contributors to mental health that could inform future interventions.

Methods: Data from 162 Afghan adults (Mage = 38.64, SD = 10.85; 15.43% female) was collected in 2024 through interviewer-administered surveys in English, Pashto, and Dari as part of a cross-sectional study. Surveys gathered data on demographics, social connectedness using the Social Connectedness Scale – Revised, quality of life using the WHO Abbreviated Quality of Life scale – which includes questions on mental health –, and integration using the Multidimensional Measure of Immigrant Integration. Descriptive analysis was used to measure mental health challenges, followed by bivariate analyses to test the associations between identified challenges and the study variables and regression analysis to explore predictors. To contextualize the findings, results were compared to data from the adult sample of the 2022 wave of the Annual Survey of Refugees (ASR; N = 1,503), a nationally representative dataset, to compare rates of mental health challenges identified among Afghans in St. Louis with the rates in the general refugee population in the US.

Results: Results indicated that Afghan refugees in St. Louis were experiencing mental health challenges at higher rates than the general population of refugees in the U.S. In particular, 10.72% of the ASR sample were experiencing negative feelings most or all of the time compared to 30.87% of Afghans in St. Louis. Among our sample, the frequency of experiencing negative feelings was associated with age, household size, English language proficiency, psychological integration, navigational integration, physical quality of life, and environmental quality of life. When entered into a regression model, only social connectedness, physical quality of life, and English language proficiency were significant negative predictors of mental health challenges.

Conclusions and Implications: This study reveals elevated mental health challenges among Afghan refugees in St. Louis compared to the broader US refugee population. Results suggest that social workers, as key service providers for refugees, should consider programs and services aimed at enhancing social support, physical quality of life, and language proficiency among refugees to foster their mental health. Future research could explore how mental health and its contributing factors evolve over time post-resettlement, the potential bidirectionality of these relationships, and the impact of policy climate and economic integration.