Correlates and predictors of psychological distress among Afghan refugees in San Diego County

Abstract

The psychological effects of war and resulting displacement continue to negatively impact Afghan refugees. The purpose of this study was to investigate factors that are associated with and predict psychological distress symptoms among Afghan refugees. We analyzed data from a diverse sample of 130 Afghan refugees recruited through non-random sampling in the San Diego area. Participants completed self-report questionnaires consisting of a culturally validated measure of psychological distress – the Afghan Symptom Checklist – alongside standardized measures of acculturation, social support and perceived stress. In bivariate analyses, older age, older age at migration, female gender, being widowed, having lower education, being unemployed, unable to comfortably pay monthly bills, having lower acculturation and social support, and higher levels of perceived stress were associated with psychological distress. However, only few variables – female gender, widowed, unable to comfortably pay monthly bills and perceived stress – remained significant in multivariate analysis. The findings from this study contribute to understanding the social determinants of distress that affect Afghans in exile, even after long-term resettlement in the USA. These reported outcomes support the need for continued research with Afghans, alongside the implementation of culturally relevant psychosocial interventions that emphasize prevention of post-resettlement stressors immediately upon resettlement.

Keywords:

• Afghan
• refugee
• psychological distress
• acculturation
• social support

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Qais Alemi, PhD, MPH, MBA, is a behavioral scientist and an assistant professor of research methods in the Department of Social Work & Social Ecology at Loma Linda University. Dr. Alemi completed his doctoral education in Social Policy & Social Research (PhD; 2013), along with graduate degrees in [global] public health (MPH; 2006) and health administration (MBA; 2008) at Loma Linda University. His research focuses on global mental health issues, specifically, investigating the psychosocial well-being of conflict-affected populations along with exploring methods for improving “cultural fit” within health and mental health care delivery systems.Sigrid James, PhD, MSW, is faculty on sabbatical in the Department of Social Work and Social Ecology at Loma Linda University (since 2004) and currently holds a guest professorship at the University of Kassel at the Institute for Social Work and Social Policy. She completed her graduate studies at UCLA (MSW; 1990) and the University of Southern California (PhD; 2003) and a Fellowship in Dissemination and Implementation Research at Washington University (2010–12). Her research, which has in part been funded by the National Institute of Mental Health, lies at the intersect of child welfare and mental health, and she has published numerous articles about services for youth in the child welfare system, in particular those who have experienced episodes in residential care and psychiatric settings. Within this context she is interested in the implementation of evidence-based practices, a topic that is subject of some of her recent publications.Hafifa Siddiq, RN, MSN, is currently a nursing doctoral student at the University of California, Los Angeles studying chronic illness management and vulnerable populations, with a research emphasis on breast cancer and colorectal cancer screening among older adult refugees. She earned her Master of Science in Nursing from Charles R. Drew University in South Los Angeles, with a focus in clinical nurse leadership, and a Bachelor of Science in Health Sciences with a focus on community health education from California State University, Long Beach.Susanne Montgomery, PhD, MSN, MPH, is a social/behavioral epidemiologist with a focus on hard-to-access underserved populations, on issues of health disparities from a behavioral health and prevention research perspective. A “translational” researcher Dr. Montgomery has been a principal investigator and co-investigator of NIH, CDC and State of California funded research projects since 1990. She has extensive experience in conducting community-based translational participatory research (CBPR) and evaluation —advocating for translating and applying research findings to the community level. She has published over 80 peer-reviewed articles concerning cancer prevention, teen pregnancy, HIV/AIDS, and alcohol and tobacco use, and regularly serves as a reviewer of several national peer-review journals. After many years on several study sections of National Institutes of Health (NIH) she is now a member of the “College of Reviewers” for NIH.

Additional information

Funding

This manuscript was supported in part by the Sigma Xi dissertation scholarship, Loma Linda University (recipient Q. Alemi), and by NIMH K01 MH077732-01A1 (PI: S. James).