Geocultural variation in correlates of psychological distress among refugees resettled in the United States

Abstract

Attention to cultural variability in mental health symptoms could inform intervention targets; however, this is currently a neglected area of study. This study examined whether the associations between common mental health disorder (CMD) symptoms and predictors of CMDs varied cross‐culturally. Participants were 290 refugees from three geocultural regions (Afghanistan, Great Lakes region of Africa, and Iraq and Syria) who recently resettled in the United States and completed assessments of CMD symptoms and predictors. Multilevel generalized linear modeling was used to examine the interactions between correlates of depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms and each of the three cultural reference groups. Relative to refugees from other regions, Iraqi and Syrian participants demonstrated stronger associations between the number of reported traumatic experiences and both depressive, B = 0.01, SE = .003, p = .003, and anxiety symptoms, B = 0.01, SE = .003, p < .001; Afghan participants showed a stronger association between physical quality of life and PTSD symptoms, B = 0.02, SE = .011, p = .037; and African participants demonstrated stronger associations between gender and symptoms of all three CMDs, Bs = 0.11–.020, SEs = .04–.06, ps = .005‐.008, and weaker associations between traumatic event exposure and CMD symptoms, Bs = ‐0.01–‐0.02, SEs = .003–.006, ps = .000–.002. CMD symptoms likely present differently across cultures, with various predictors more salient depending on cultural backgrounds and differential experiences that vary based on context. These findings have implications for cross‐cultural assessment research and mental health.

Predictors of mental health outcomes of three refugee groups in an advocacy-based intervention: A precision medicine perspective.

“…However, for displaced individuals from Afghanistan and the Great Lakes region of Africa, findings not only suggested that an advocacy-based intervention is effective for treating culturally specific symptoms of emotional distress, but also offered potential mechanisms of action that may inform a precision mental health approach: indicating that improved English proficiency and social support for Afghans and increased access to resources and social support for Great Lakes Africans may be the factors producing these successes. Identifying these active ingredients is critical for developing and disseminating effective interventions for some of the world’s most vulnerable groups (Blackwell, Yeater, et al, 2022; Blackwell, Lardier, et al, 2022). Should future research among refugees resettled in the United States replicate these findings, these differences may be able to provide precision medicine guidance for treatment types and targets among diverse violence- and conflict-exposed groups.…”

“…In addition to resource access as a potential active ingredient of intervention, we also selected several other variables, which have been shown to impact mental health outcomes (trauma exposure) and were expected to change as a result of the intervention (social support and perceived English proficiency) to examine potential mechanisms of change. In addition to expecting that these factors would change as a result of the intervention, previous research has shown that all predictors—resource access (Goodkind et al, 2014; Kasujja et al, 2022), trauma exposure (Steel et al, 2009), social support (Sundvall et al, 2021; Wachter et al, 2018), and, for resettled refugees, English proficiency (LeMaster et al, 2018; Sharifian et al, 2021)—are predictive of mental health symptoms for refugees from these regions and, at baseline, for the refugees in this sample (Blackwell, Lardier, et al, 2022; Blackwell, Goodkind, & Yeater, 2023; Goodkind et al, 2020).…”