Taking refuge in resilience

Geranium: (geranium platypetalum) a symbol of determination

Each year, approximately 13,750 refugees arrive in Australia, with children and adolescents comprising at least half this number. The story is much the same throughout the world: between June 2018 and 2019, the UK accepted 18,519 people, while 22,900 people resettled in the US.

It wouldn’t be a stretch to assume that some of these young people may be at elevated risk of mental health problems associated with a range of possible traumatic experiences before, during, and after their migration. Yet despite this, the majority do not appear to experience mental health problems, and researchers in Australia believe this could be due to their resilience.

Reported rates in Australia show between 18 and 35 percent of refugee children experienced a psychiatric disorder, with studies showing a wide range of incidence. In Sweden, 18 percent of Iranian refugee children were found to suffer from PTSD, while 25 percent of Bosnian children and 57 percent of Cuban children in the US reported symptoms. In the US, 12.9 percent of Cambodian children exiled, and 17 percent of Bosnian adolescents exhibited depression, while 11.5 percent of Tibetan refugee children in India were diagnosed as suffering from both PTSD and major depression. The numbers vary but they’re lower than would be expected for children who have experienced the stress of displacement and migration.

“There has been little research exploring the role of resilience as a distinct psychological construct,” explained Prof Tahereh Ziaian, Associate Professor of Psychology, Social Work and Social Policy at the University of South Australia. “Although most young refugees exposed to trauma do not develop mental health problems, resilience and coping are largely neglected in refugee research, theory, and practice.”

Resilience is broadly defined as the ability of a person to successfully adapt to or recover from stressful or traumatic experiences. It is currently recognized as a multidimensional construct including personal characteristics and skills, as well as external protective factors such as a supportive family and social environment. It is also understood to be a dynamic process that fluctuates according to age, gender, individual circumstance and developmental, historical, and cultural context. It’s more than just self-esteem or hardiness.

“For example, it is a school-aged child’s ability to make friends, engage in academic pursuits, be guided by primary caregivers, and engaged in other behaviours acceptable in his or her society, as well as, be resistant to psychological illness, despite experiencing significant adversity such as war, political oppression, poverty, and abuse,” explained Prof Ziaian.

There’s a Kurdish saying: “I have crossed so many rivers, I no longer get wet.”

Although increasing exposure to traumatic experiences has been related to higher levels of psychiatric symptoms in both young and adult refugees, a number of protective and risk factors have been found to impact on their psychological wellbeing. For example, if a mother was found to have increased wellbeing and reduced psychological problems, their children were more likely to have better wellbeing and social adaptation. Conversely, physiological, psychological or developmental vulnerabilities prior to the trauma of migration predicted slower recovery from mental health problems.

Sadly, long-time exposure to moderate stressors in refugee camps subsequent to the traumatizing events and relative young age at the time of the atrocities were both related to relatively low levels of post-traumatic symptoms, suggesting the children simply got used to it.

“Other protective factors included religious beliefs and practices, which were relatively accessible and afforded a sense of continuity, comfort, and meaning in life,” added Prof Ziaian.

There are many factors here deemed to be protective of mental health, but prior to this research, there had been no systematic attempt to explore the nature and predictors of resilience as a distinct psychological construct in young refugees.

“This may be critical,” said Prof Ziaian. “Research has found that poor resilience predicts the development of psychological symptoms such as depression and anxiety and moderates the relationship between childhood adversity and subsequent psychiatric distress.”

The researchers realized that the psychological construct of resilience may be a critical element of any intervention to alleviate mental health problems among incumbent refugees, but the nature of resilience had yet to be explored. They developed a questionnaire using the Connor-Davidson Resilience Scale (CD-RISC) which they disseminated among 170 refugees aged 13-17 from Bosnia, Serbia, Iran, Iraq, Afghanistan, Sudan and Liberia. These countries were selected because at the time of the study in 2011, they represented the top refugee source countries.

The CD-RISC survey was combined with assessments of the participants’ depressive symptomatology, which scored components of negative mood, self-esteem and anhedonia using the Children’s Depression Inventory (CDI). Then, the participants completed the Strengths and Difficulties Questionnaire, a widely used tool to identify the presence of emotional and behavioural difficulties in children and adolescents, and the Migration and Settlement Questionnaire which covered various sociodemographic and settlement information including satisfaction with the Australian sociocultural environment and English language proficiency.

Interestingly, the results showed females tended to have higher resilience, as did those adolescents who had been living in Australia longer. Those suffering from depressive symptoms or other emotional problems had lower resilience, and there was little evidence of an association between resilience scores and exposure to trauma.

Adolescents who had been living in Australia longer showed greater resilience.

The fact that adolescents with higher levels of resilience had fewer depressive symptoms may indicate that resilience protects young refugees against the future onset of mental health, or that mental health problems have an adverse effect on resilience and coping. Research with non-refugee adolescents has previously found that higher resilience—including external protective factors such as family cohesion and support from the wider community—predicts lower levels of depression and anxiety, adding to the evidence backing resilience.

“It appears that resilient people are also motivated to engage in prosocial behaviours or that helping others facilitates resilience,” said Prof Ziaian. “Future research could investigate this, which could in turn aid in the design of effective interventions to enhance resilience and thereby, mental wellbeing.”

Female participants showed higher total resilience across all scales, although the researchers did not offer any explanation for this. It could be determined that female refugees are more likely to migrate with families which would lend them a protective element against future mental health problems.

The length of time in Australia was also shown to have an impact on a participant’s resilience score, which may suggest that resilience increases as people adapt and acclimatize to Australian society and culture, and as time passes from the pre-migration traumatic event. The data suggested that a substantial proportion of the children were not exposed to—or could not remember experiencing—traumatic events, but rather were exposed to lower intensity stress during prolonged displacement which aided in developing resilience.

The results of this study can now be used to help better support migrants of all ages and backgrounds with their mental health upon their arrival in their new country, and demonstrate the multi-faceted nature of resilience. ■