Conceptual Model of Refugee Family Dynamics: A Study with Sri Lankan Tamils

Background and Purpose: This paper synthesizes findings from four studies (2015-2018) with Sri Lankan Tamil refugees in Gummidipoondi camp, India, who have experienced over four decades of displacement. Using Community Based Participatory Research with the Organization for Eelam Refugee Rehabilitation (OfERR) and a Community Advisory Board, we examined migration stressors, mental health, family dynamics, and resource utilization. The research aimed to: (a) develop a conceptual model of refugee family dynamics, (b) create policy frameworks addressing refugees' challenges, (c) assess repatriation readiness, (d) design mental health support systems and e) increase direct resource access for refugees.

Method: Mixed-methods explanatory convergent design. S1 (n=50), purposive sampling, examined migration stressors and psychological distress. S2 (n=15), qualitative interviews, explored intergenerational conflict and repatriation readiness. S3 (n=120), quantitative hierarchical linear regression and Extreme Gradient Boosting (XGBoost) machine learning, analyzed migration stressors, family functioning and mental health. S4 (n=18), qualitative purpose interviews culturally interpreted previous findings.

Results: Studies revealed each unit increase in daily migration stressors was associated with a 1.16-unit increase in psychological distress (p<0.001), family dynamics moderates this relationship. Higher distress levels were found among married participants (p=0.036), who had children (p=0.021), or lived with families (p<0.001). Total transmigration stressor significantly correlated health outcomes and family functioning: somatic complaints (r = 0.38, p < 0.001), depressive symptoms (r = 0.47,p < 0.001), hostility (r = 0.47, p < 0.001), and negatively with family functioning (r = − 0.24, p = 0.007). Significant reduction in overall transmigration stressors found between Phase I and Phase II (MPhaseI = 54.49, SD = 12.29; MPhaseII = 49.89, SD = 10.16; p < 0.01), reflecting improvement in family functioning over time. Hierarchical regression analysis revealed family cohesion had a statistically significant role in mitigating mental health risks (β = −0.163, p < 0.05). Authoritarian parenting styles were prevalent, leading to intergenerational conflicts, particularly with adolescents born in camps.

Conclusions and Implications: Findings directly informed policy changes: (1) The UNHCR Sri Lanka adopted repatriation framework in their policy recommendations to the governments of Sri Lanka and India; (2) Indian government established a weekly mobile clinic with psychiatric services; and (3) Trained community health workers were integrated as support systems, expanding mental health service delivery across camps. Specifically, health workers increased contact with families to support the reduction in family conflict. Studies demonstrate community-engaged scholarship can drive meaningful policy change and directly impact refugee families. Additionally, the implementation of the mobile clinic and integration of trained health workers has substantially improved access to mental health service for the Tamil refugees. Knowledge translation was further enhanced through a 2018 conference that convened elders and health workers from 123 refugee camps where findings and implementation strategies were disseminated. These outcomes highlight the impact social work research can have at both policy and practice levels, creating direct transformative change within marginalized communities. Future research should examine the longitudinal impact of these interventions on repatriation readiness and mental health outcomes.