The mental health of civilians displaced by armed conflict: an ecological model of refugee distress

Abstract

Early research on the mental health of civilians displaced by armed conflict focused primarily on the direct effects of exposure to war-related violence and loss. Largely overlooked in this war exposure model were the powerful effects of ongoing stressors related to the experience of displacement itself. An ecological model of refugee distress is proposed, drawing on research demonstrating that mental health among refugees and asylum seekers stems not only from prior war exposure, but also from a host of ongoing stressors in their social ecology, or displacement-related stressors. Implications of this model for addressing the mental health and psychosocial needs of refugees and other displaced populations are considered.

Post-conflict struggles as networks of problems: A network analysis of trauma, daily stressors and psychological distress among Sri Lankan war survivors

“…That there were clusters of multiple types of nodes that appeared to reinforce each other is consistent with the theoretical loss spirals in COR theory (Hobfoll, 2001). That social problems were so central to the network supports the psychosocial emphasis on daily stressors being mediators of the effects of trauma on mental health (Miller & Rasmussen, 2010; 2014; 2017). Whether this is because traumatic events set off chains of stressors or because those exposed to trauma are more likely to rate problems as more stressful and perhaps even generate problems (Neuner, 2010) is subject to some debate, and not likely solved here.…”

“…COR theory has substantial support in war-affected populations, including Sri Lanka (e.g., Mattock, 2005; Siriwardhana et al, 2013, Somasundaram & Sivayokan, 2013; Witting, Lambert, Wickrama, Thanigaseelan, & Merten, 2016). Other similar theories with empirical support include the daily stressors model, in which the effects of war-related trauma on psychological distress are mediated and moderated by frequent stressors and stressful conditions (Miller & Rasmussen, 2010; 2014; 2017). It is not our intention in the current study to somehow propose new theory via network science, only to present findings using alternative methods.…”

Children of War: Quebec’s Social Policy Response to Children and Their Families

“…From our review of the literature we propose Miller and Rasmussen's (2010;2016) integrative model as a benchmark for a comprehensive understanding of children's realities and needs. This model acknowledges the pre, peri and post migratory experiences of children and addresses both traumatic experiences and psychosocial realities of children as they interact.…”

“…As noted earlier, Miller and Rasmussen (2010;2016) suggest that trauma-oriented and psychosocially oriented approaches be integrated in order to offer a complex and holistic understanding of children's needs. We therefore sought to explore whether the four policies embraced this integrative approach in their conceptualisation of needs, and whether their approaches overlapped.…”

“…This prioritisation of language, culture and social integration is not inherently problematic, especially considering the mandate of schools and the literature in the field suggesting that wellbeing of refugees is highly dependent on their social integration, and their ability to communicate within their host society (Burnette & Peel, 2001;Fantino & Colak, 2008;Kirmayer, 2011;Miller & Rasmussen, 2016). However, the ability to learn and integrate within the host society is contingent upon having the psychological availability to learn.…”