It’s time to focus on mental health strategies that match refugees’ strengths, researchers say

A systematic review led by Professor Angela Nickerson of the University of New South Wales (UNSW) has identified several strong protective and facilitatory factors associated with better mental health outcomes among refugee adults.

“Although exposure to persecution, war and displacement is associated with high rates of mental health disorders, such as PTSD and depression, remarkably, the majority of refugees, despite going through very difficult experiences, do not develop a mental health disorder,” says Prof. Nickerson, Director of the Refugee Trauma and Recovery Program at UNSW’s School of Psychology.

Nevertheless, previous research has focused on understanding factors that predict psychopathology or psychological distress, rather than factors that predict well-being or resilience.

“More recently, however, there has been a move towards a strength-based approach in mental health, particularly in the refugee field, and we wanted to look at what research was available,” says Prof. Nickerson.

The newspaper, which appears this week Nature mental healthis the first to focus on factors that contribute to better mental health in refugees.

To conduct the review, researchers searched four databases for relevant studies. They screened thousands of studies, of which 174 met the study criteria. They found that 81% of the documents included were refugees living in high-income countries (HICs) and 19% in lower- and middle-income countries (LMICs).

“The lack of research on predictors of good mental health highlights the deficit focus of so much research into refugee mental health,” says Prof. Nickerson. She also noted that although 75% of the world’s refugees live in the least developed countries, most research took place in HICs.

“It highlights a real gap in refugee research,” says Prof. Nickerson.

What were the researchers looking for?

“Our systematic review included studies on the mental health of refugees or asylum seekers, and we looked at factors that we called protective or beneficial to mental health. Protective factors are associated with reduced poor mental health outcomes, and promoting factors are associated with increases in mental health. good mental health outcomes,” says Prof. Nickerson.

The researchers wanted to understand how to strengthen an individual or community’s strengths to alleviate or even prevent suffering.

“We were interested in everything from demographic and social factors to environmental and psychological factors,” says Prof. Nickerson.

“We wanted to be able to talk about a range of different implications and recommendations in the field of refugee mental health – from what psychologists or social workers might do with a client in a room, and also more broadly, what circumstances policymakers should create in countries hosting shelters to help people thrive and move forward after traumatic experiences.”

Findings of the study

The refugee experience is characterized by prolonged exposure to danger and uncertainty. The research found that factors related to stability and predictability were among the strongest associations with good mental health in refugees.

“It makes perfect sense that if people who have been through very difficult experiences are to overcome them and thrive, we need to create conditions in which their basic needs for safety are met,” says Prof. Nickerson.

The study found that secure visa status, employment, income, good housing conditions and control over environmental conditions were associated with good mental health outcomes in both HICs and/or LMICs.

Individuals vary in their ability to cope with difficult circumstances, with resilience reflecting the extent to which an individual can recover or maintain good mental health in the context of adversity.

The research found that psychological factors such as cognitive strategies, self-efficacy and a sense of control protect and promote well-being.

Building individual skills and capacities to cope and thrive represents an important goal for promoting good mental health in refugees.

“When we try to understand how best to support people, we often look at the things that go wrong, and that means our interventions focus on those. This study speaks to the importance of leveraging interventions linked to resilience , self-efficacy and psychological flexibility,” says Prof. Nickerson.

But experiences such as war, persecution and displacement occur at the societal level, and therefore approaches to promoting good mental health in their aftermath must extend beyond the individual.

“There is a consistent link between social engagement and support and good mental health outcomes among refugees, especially for those in high-income countries,” says Prof. Nickerson.

“The ability to communicate in the language of the host country, social support and social engagement with both the refugees’ own and host communities, along with religious coping strategies, were all associated with greater well-being.”

The way forward

This review presents a clear research agenda, with at least three key pathways to advance our understanding of refugee mental health wellbeing, says Prof. Nickerson.

“One is to purposefully study factors associated with well-being and positive mental health outcomes, rather than just looking at factors that contribute to psychological distress. Refugee communities are remarkably resilient, and we can learn a lot from people who have overcome adversity to thrive in their new country.

‘Two of these is filling the research gap in low- and middle-income countries. The majority of refugees live in transit environments outside high-income countries. If we want to provide effective support, we need to understand the factors that promote good functioning. in these contexts.

“And finally, it is important to adopt an interdisciplinary research approach. By bringing together researchers, psychologists, social workers and policymakers, we can gain a more nuanced understanding of protective and facilitatory factors. The voice of refugees is central to this. This process is critical in helping us understand priority research areas and use these findings effectively. This will pave the way for developing policies and interventions that support refugee communities to thrive.”