Posttraumatic Stress Disorder, Social Support and Coping Among Afghan Refugees in Canada

Authors:  Farah Ahmad, Nasih Othman, Wendy Lou
Location: Toronto, Canada

Summary

Posttraumatic-stress-disorder (PTSD) is one of the common mental health conditions among Afghan refugees resettled in developed countries. This research explored how social support, coping mechanisms and other factors from the socioecological model (intra/interpersonal  community and institutional levels) interact and correlate with the intensity of PTSD symptoms in three domains: re-experiencing, avoidance and arousal.

A survey was conducted with 49 adult Afghan refugees (males 41%, female 59%) who completed the Harvard Trauma Questionnaire during their visit to a Toronto Community Health Centre known as Access Alliance Multicultural Health and Community Services.

The results showed the following:

• PTSD was more common in higher ages with those aged over 45 years having a prevalence of 80.0% compared to 36.8% in people below 30 years.
•  Employment was significantly associated with lower PTSD scores as prevalence of PTSD was zero in those employed and 59% in those unemployed.
• Self reported poor/fair health was significantly associated with high PTSD prevalence compared to better health (67% vs.32%) higher scores for social support were significantly associated with lower scores of all three PTSD domains.
• Having children was significantly associated with higher coping scores.
• English language fluency was a strong significant factor for higher social support scores.
• The severity of PTSD arousal symptom was a strong predictor of lower scores for self-rated health.
• Being a female and being in a relationship were also positive factors for social support although not statistically significant.

How does this research apply to my work?

• When planning and implementing mental health promotion programs for refugees, apply the socioecological approach rather than an individual focused medical model. The socioecological model intervenes at various levels. This includes developing community-based programs that strengthen adaptation, social-inclusion and support development of relationships within and outside family and ethnic groups along with opportunities to learn the language of the host country. Interventions like these can assist refugees in developing new skills, increase their employment chances, and improve their PTSD and other mental health symptoms.
•  Use a peer support approach since it can be an important component of social support programs and has shown effectiveness in developing social networks and empowering experiences along with enhanced wellbeing. Also, group-based activities can be effective in addressing social isolation, promoting rights of refugees and responding to their needs.
• Pertaining to coping and its effects on PTSD, deliver workshops on healthy coping strategies. A focus on coping skills and associated resources can bridge the medical and social care programs with anticipated improvements in the mental health of refugees.

What should I take away from this research?

Perceived social support was shown to be statistically significant in tempering the three domains of PTSD symptoms. This highlights the crucial role of social support in enhancing the mental health of immigrants and refugees and its place in their settlement and integration. Feeling connected and embedded in a supportive environment are essential elements of any program addressing common mental health disorders including PTSD and requires the involvement of family and community.

What is the next step?

The authors noted that additional longitudinal studies with larger sample size is needed to determine trends of PTSD symptoms among resettled refugees and how to best manage these symptoms. In addition, qualitative research with refugees and families is needed to understand their experiences with the post-traumatic stress and coping strategies.

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