Thesis (Ph.D. Psychology)--University of Waikato, 2007. / Title from PDF cover (viewed August 28, 2008) Includes bibliographical references (p. 312-331)

Through conceptualizing migration as a social process, this dissertation examines the role of social support among urban migrants. Existing research examining social support is often framed in North American or European contexts and ignores its connectivity with migration or mobility. There remains critical opportunity for research to examine how social support paradigms function in Low and Middle Income Countries (LMICs) and from the perspective of urban migrants, including refugees and economic migrants. By expanding the frame of both migration and social support research, this dissertation endeavors to enrich the empirical knowledge surrounding the role of social support among urban migrants. To accomplish this, this dissertation examines the intersection of trauma, social support, and depression among two urban migrant populations. Through its integration of data from female Syrian refuges in Jordan and male economic migrants in Kazakhstan, this dissertation aims to describe social support, potentially traumatic events (PTEs), and depressive symptomology; identify the direct association of social support and depressive symptomology, and; examine the moderating role of social support on depressive symptomology related to PTEs. This dissertation is guided by the Push-Pull Theory, the Stress-Buffering Hypothesis, and van Brenda’s conceptualization of resilience. Findings from this dissertation suggest that social support plays a critical role, both directly and indirectly, in influencing outcomes of depressive symptomology. Findings have several implications for social support measurement and direct practice of mental health clinicians, as well as informing how community-based interventions and mental-health policies within LMICs can integrate social support within their resiliency frameworks.

There is a growing acknowledgement of the importance of mental health and well-being among refugees and asylum-seekers as a result of high rates of mental distress. Most research, however, has focused on refugees and asylum-seekers who live in high-income countries, even though the vast majority (approximately 80 percent) reside in lower- and middle-income countries (LMICs). This three-paper dissertation brings attention to this research gap and examines issues surrounding the mental health of refugees and asylum-seekers living LMICs. Three different cross-sectional data sources were included in this dissertation from study participants recruited from Malaysia, Jordan, and Turkey in 2018. Additionally, three separate analyses were conducted, which include descriptive analyses and multivariable regressions. The first dissertation paper examines the scope and prevalence of mental health counseling utilization in Malaysia. Using Andersen’s Health Service Utilization as a conceptual framework, I examine how certain predisposing factors (socio-demographic characteristics), enabling factors (availability of resources), and need factors (mental health symptom severity) are associated with counseling utilization. The second dissertation paper examines suicidal behaviors among Syrian refugee women living in Jordan. Incorporating the Three-Step Theory (3ST) of suicidal behaviors, I examine how psychological pain, connectedness, and postmigration stressors are associated with suicidal behaviors. Lastly, my third dissertation paper examines the scope and prevalence of vicarious posttraumatic growth (VPTG) among service providers working with Syrian refugees in Istanbul, Turkey. Using a constructivist self- development theory, I examine how greater exposure to traumatic material, in addition to having a greater support system, and having greater years of professional experience is associated with higher levels of VPTG. Study results from Malaysia emphasize the need to understand individual and contextual determinants of mental health service use. I hypothesize that refugees and asylum seekers with certain predisposing factors (female, older age, married, higher education, lived longer in Malaysia, registered refugee), have greater enabling factors (easy access to healthcare, larger household income, do not need interpreter services, greater health literacy, and live with greater number of people in household), and have greater need factors (higher PTSD symptoms) will be more likely to attend counseling services. Almost three-quarters (71.89%) of participants surveyed had never attended mental health counseling services. The majority (71.89%) had never attended mental health counseling services, and among those who screened positive for PTSD, only a minority (16.49%) attended counseling services. My hypothesis was partially supported. Participants from Afghanistan and Myanmar were less likely to attend mental health counseling compared to Somalia and other countries (p<0.001). Not having easy access to health facility (OR:0.10, 95% CI:[0.03, 0.32]), needing interpreter services (OR:0.23, 95% CI:[0.07, 0.75]), and higher PC-PTSD scores (OR:0.69, 95% CI:[0.52, 0.91]) was associated with lower odds of counseling attendance. Other determinants of health service use such as gender, marital status, education level, years in Malaysia, registration status, household income, health literacy, and number of people in household did not show significant associations. Study results from Jordan highlight that greater research and public awareness regarding suicidal behaviors is needed among Syrian refugee women. I hypothesize that screening positive for PTSD, social isolation (have no friends or family members available to help), and greater number of postmigration stressors is associated with suicidal behaviors. Approximately one-tenth (9.86%) of participants reported suicidal behaviors (suicidal ideation and/or attempt) in the past 6-months. My hypothesis was partially supported. Screening positive for PTSD (aOR:4.02, 95% CI:[1.33, 12.15]) was associated with increased odds of suicidal behaviors, while having 1 friend or family member available to help when in need (OR:0.31, 95% CI:[0.13, 0.78]) decreased odds of suicidal behaviors. No associations between the number of postmigration stressors and suicidal behaviors were found. Lastly, results from Turkey emphasizes the importance of focusing on service providers wellbeing. I hypothesize that greater exposure to traumatic material, in addition to having a greater support system, and having greater years of professional experience is associated with higher levels of VPTG. Among service providers recruited 44.66% reported moderate-to-high levels of VPTG. My initial hypothesis was partially supported. Moderate/high/severe secondary traumatic stress (aOR:3.98, 95% CI:[1.26, 12.59]), greater social support (aOR:1.05, 95% CI:[1.00, 1.10]), and greater organizational support (OR:1.11, 95% CI:[1.02, 1.20]) was associated with moderate-to-high VPTG. Proportion of clients who disclose trauma, and years in profession did not show significant associations. Mental health utilization, suicidal behaviors, and the well-being of service providers are issues that have all been linked to the mental health and well-being of refugees and asylum-seekers. These topics have been minimally examined among forcibly displaced people living in LMICs. Clinicians and organizations must promote greater awareness of and screening for mental health conditions. Additionally, mental health and suicidal behaviors is often associated with stigma and discrimination, which means that providing basic psychoeducation surrounding mental health, its impact, as well as awareness of services available, and normalizing treatment at the individual and clinic level is essential for increasing engagement of mental health services. To further reduce global mental health disparities and provide equity in mental health care and treatment, future research and psychosocial interventions must prioritize and focus on the well-being of refugees and asylum-seekers living in LMICs.

The purpose of this study was to analyse the support systems for refugees in Southern Africa with specific reference to the Republic of Botswana. Qualitative framework as described by Lofland and Lofland (1984), Schensus and Schensus (1992) was used to conduct the investigation. Interviews were conducted with thirty refugees who currently living in Botswana as a refugee or asylum seeker. Focus group discussion was also held with twenty-six refugee workers. Interview findings were derived using Glaser and Straus' (1976) and Van Maanen, (1979) constant comparative method of qualitative analysis and were grouped into four major categories. Among the most significant findings were that the subjects agreed that on paper and by design, there are structures for providing the different services to refugees but refugees are not provided with adequate services. The second finding is that the support systems for refugees in Botswana are more focused on the provision of material support with little attention given to the psychosocial needs of the refugees. The third finding is that the Botswana government withheld some of the Articles of the 1951 UN refugee Convention, which deal with the socio-economic rights of refugees in Botswana. The fourth finding is that refugee workers need specialised training to enable them to address a wide rage of psychosocial issues affecting refugees. Last major finding is that there is no established clear system of service delivery in the participating agencies. The researcher concluded that because of trauma and stress experienced by refugees and refugee workers, there is a need to improve on the psychosocial support provided to refugees and refugee workers in Botswana by improving the knowledge and skills of refugee workers and promoting refugee participation. The researcher recommends two urgent actions that should be taken. First, the refugee management in Botswana need to improve on its service quality control mechanism, including evaluating its legal and operational framework. Second, psychosocial components need to be integrated into every aspect of the refugee programmes. This will support recovery for the many traumatised refugees and refugee workers in Botswana. / Social work / DPHIL (SOCIAL WORK)

The voices and experiences of immigrant and refugee women in Canada have been conspicuously absent from policy issues, programme planning, and mental health literature. However, more immigrant and refugee women than men, from traditional cultures, are considered to have mental health needs, because of risk factors such as stress at the time of migration, and because of Canadian policies and programmes which disadvantage them. This study explores from the consumers perspective the reasons for disparate mental health service utilization between South Asian and Latin American women in Vancouver. Using a cross-sectional, exploratory, case study approach, and a feminist perspective, ten South Asian and ten Latin American women who have used mental health services were interviewed in depth. Sixty percent of the participants were survivors of violence and torture. Five Latin American women were survivors of pre-migration catastrophic stress. Their mental health needs were characterised by traumatic experiences, grieving and depression. Except for the three who were married, they had no traditional support networks. In contrast with the South Asian group they appeared to have less shame and covert behaviour. Mental illness, considered a ‘house secret’, carries great stigma in the South Asian community, and has serious ramifications for the immediate as well as the extended family. Among South Asian participants seven had been subjected to wife battering, and four of their spouses had a substance abuse problem. Their mental health needs were also triggered by traumatic experiences, grieving and depression. The more established South Asian women had extended family living in Vancouver, yet social support was still lacking. Having ‘no one to turn to’ was a pervasive theme across both groups of women; their experiences characterised by loss. Analysis of data exploring the decision to use services illustrates stages in a process of recovery from experienced violence. Post migration domestic violence and pre-migration violence have devastating, life-shattering consequences which require culturally sensitive interventions by social workers and other health care professionals. An obligatory stage in the clinical intervention process is to explore the issue of violence. Finally, policy decisions which impact upon women from ethnocultural communities in Canada must embrace a philosophy which considers well-trained, culturally-sensitive, linguistically—competent workers a priority.

The purpose of this study was to analyse the support systems for refugees in Southern Africa with specific reference to the Republic of Botswana. Qualitative framework as described by Lofland and Lofland (1984), Schensus and Schensus (1992) was used to conduct the investigation. Interviews were conducted with thirty refugees who currently living in Botswana as a refugee or asylum seeker. Focus group discussion was also held with twenty-six refugee workers. Interview findings were derived using Glaser and Straus' (1976) and Van Maanen, (1979) constant comparative method of qualitative analysis and were grouped into four major categories. Among the most significant findings were that the subjects agreed that on paper and by design, there are structures for providing the different services to refugees but refugees are not provided with adequate services. The second finding is that the support systems for refugees in Botswana are more focused on the provision of material support with little attention given to the psychosocial needs of the refugees. The third finding is that the Botswana government withheld some of the Articles of the 1951 UN refugee Convention, which deal with the socio-economic rights of refugees in Botswana. The fourth finding is that refugee workers need specialised training to enable them to address a wide rage of psychosocial issues affecting refugees. Last major finding is that there is no established clear system of service delivery in the participating agencies. The researcher concluded that because of trauma and stress experienced by refugees and refugee workers, there is a need to improve on the psychosocial support provided to refugees and refugee workers in Botswana by improving the knowledge and skills of refugee workers and promoting refugee participation. The researcher recommends two urgent actions that should be taken. First, the refugee management in Botswana need to improve on its service quality control mechanism, including evaluating its legal and operational framework. Second, psychosocial components need to be integrated into every aspect of the refugee programmes. This will support recovery for the many traumatised refugees and refugee workers in Botswana. / Social work / DPHIL (SOCIAL WORK)

The voices and experiences of immigrant and refugee women in Canada have been conspicuously absent from policy issues, programme planning, and mental health literature. However, more immigrant and refugee women than men, from traditional cultures, are considered to have mental health needs, because of risk factors such as stress at the time of migration, and because of Canadian policies and programmes which disadvantage them. This study explores from the consumers perspective the reasons for disparate mental health service utilization between South Asian and Latin American women in Vancouver. Using a cross-sectional, exploratory, case study approach, and a feminist perspective, ten South Asian and ten Latin American women who have used mental health services were interviewed in depth. Sixty percent of the participants were survivors of violence and torture. Five Latin American women were survivors of pre-migration catastrophic stress. Their mental health needs were characterised by traumatic experiences, grieving and depression. Except for the three who were married, they had no traditional support networks. In contrast with the South Asian group they appeared to have less shame and covert behaviour. Mental illness, considered a ‘house secret’, carries great stigma in the South Asian community, and has serious ramifications for the immediate as well as the extended family. Among South Asian participants seven had been subjected to wife battering, and four of their spouses had a substance abuse problem. Their mental health needs were also triggered by traumatic experiences, grieving and depression. The more established South Asian women had extended family living in Vancouver, yet social support was still lacking. Having ‘no one to turn to’ was a pervasive theme across both groups of women; their experiences characterised by loss. Analysis of data exploring the decision to use services illustrates stages in a process of recovery from experienced violence. Post migration domestic violence and pre-migration violence have devastating, life-shattering consequences which require culturally sensitive interventions by social workers and other health care professionals. An obligatory stage in the clinical intervention process is to explore the issue of violence. Finally, policy decisions which impact upon women from ethnocultural communities in Canada must embrace a philosophy which considers well-trained, culturally-sensitive, linguistically—competent workers a priority. / Arts, Faculty of / Social Work, School of / Graduate