Abstract
Extant literature has documented a higher level of mental health issues among refugee populations compared with that of the general population. Mental health problems may significantly decrease refugees’ quality of life and interfere with a successful transition to their country of resettlement. Using the social determinants of mental health framework, we examined factors affecting psychological distress among Karen refugees from Burma residing in a mid-size city in a northeastern state in the United States. A total of 201 participants completed face-to-face interviews conducted in the Karen language. Results showed that trauma and religious participation were positively associated and education and health status were negatively associated with psychological distress. The findings of this study reiterate the importance of trauma and health conditions to mental health and suggest potential points of interventions among the resettled Karen refugees.
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Adelman, R. M., Cooke, A., Kim, W., & Nam, Y. (2021). Another voice: New refugee policy would bring benefits to Buffalo. The Buffalo News. Retrieved August 17, 2021 from https://buffalonews.com/opinion/another-voice-new-refugee-policy-would-bring-benefits-to-buffalo/article_0f872256-54c8-11eb-ac20-27b89ddf2f34.html
Adserà, A. C., & Pytliková, M. (2016). Language and migration. In V. Ginsburgh & S. Weber (Eds.), The palgrave handbook of economics and language (pp. 342–372). Palgrave Macmillan.
Ager, A., & Strang, A. (2008). Understanding integration: A conceptual framework. Journal of Refugee Studies, 21(2), 166–191. https://doi.org/10.1093/jrs/fen016
Ahmad, F., Othman, N., Hynie, M., Bayoumi, A. M., Oda, A., & McKenzie, K. (2020). Depression-level symptoms among Syrian refugees: Findings from a Canadian longitudinal study. Journal of Mental Health, Advance Online Publication. https://doi.org/10.1080/09638237.2020.1765998
Arcia, E., Skinner, M., Bailey, D., & Correa, V. (2001). Models of acculturation and health behaviors among Latino immigrants to the US. Social Science & Medicine, 53(1), 41–53. https://doi.org/10.1016/S0277-9536(00)00310-5
Barreto, R. M., & Segal, S. P. (2005). Use of mental health services by Asian Americans. Psychiatric Services, 56(6), 746–748. https://doi.org/10.1176/appi.ps.56.6.746
Beiser, M., & Hou, F. (2001). Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: A 10-year study. Social Science & Medicine, 53(10), 1321–1334. https://doi.org/10.1016/S0277-9536(00)00412-3
Berthold, S. M., Kong, S., Mollica, R., Kuoch, T., Scully, M., & Franke, T. (2014). Comorbid mental and physical health and health access in Cambodian refugees in the US. Journal of Community Health, 39(6), 1045–1052. https://doi.org/10.1007/s10900-014-9861-7
Bharmal, N., Hays, R. D., & McCarthy, W. J. (2014). Validity of temporal measures as proxies for measuring acculturation in Asian Indian survey respondents. Journal of Immigrant and Minority Health, 16(5), 889–897. https://doi.org/10.1007/s10903-013-9837-1
Bridekirk, J., Hynie, M., & SyRia.lth. (2021). The impact of education and employment quality on self-rated mental health among Syrian refugees in Canada. Journal of Immigrant and Minority Health, 23(2), 290–297. https://doi.org/10.1007/s10903-020-01108-0
Carlsson, J. M., Olsen, D. R., Mortensen, E. L., & Kastrup, M. (2006). Mental health and health-related quality of life: A 10-year follow-up of tortured refugees. The Journal of Nervous and Mental Disease, 194(10), 725–731. https://doi.org/10.1097/01.nmd.0000243079.52138.b7
Chang, M., & Moon, A. (2016). Correlates and predictors of psychological distress among older Asian immigrants in California. Journal of Gerontological Social Work, 59(2), 77–97. https://doi.org/10.1080/01634372.2016.1140694
Choi, G. (1997). Acculturative stress, social support, and depression in Korean American families. Journal of Family Social Work, 2(1), 81–97. https://doi.org/10.1300/J039v02n01_06
Chung, R. H., Kim, B. S. K., & Abreu, J. M. (2004). Asian American Multidimensional Acculturation Scale: Development, factor analysis, reliability, and validity. Cultural Diversity and Ethnic Minority Psychology, 10(1), 66–80. https://doi.org/10.1037/1099-9809.10.1.66
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309–1314. https://doi.org/10.1016/S0140-6736(05)61027-6
Fisher, M., & Baum, F. (2010). The social determinants of mental health: Implications for research and health promotion. Australian & New Zealand Journal of Psychiatry, 44(12), 1057–1063. https://doi.org/10.3109/00048674.2010.509311
Han, H.-R., Kang, J., Kim, K. B., Kim, M. T., & Ryu, J. P. (2007). Barriers to and strategies for recruiting Korean Americans for community-partnered health promotion research. Journal of Immigrant and Minority Health, 9(2), 137–146. https://doi.org/10.1007/s10903-006-9022-x
Hermansson, A.-C., Timpka, T., & Thyberg, M. (2002). The mental health of war-wounded refugees: An 8-year follow-up. The Journal of Nervous and Mental Disease, 190(6), 374–380.
Hollifield, M., Verbillis-Kolp, S., Farmer, B., Toolson, E. C., Woldehaimanot, T., Yamazaki, J., et al. (2013). The Refugee Health Screener-15 (RHS-15): Development and validation of an instrument for anxiety, depression, and PTSD in refugees. General Hospital Psychiatry, 35(2), 202–209. https://doi.org/10.1016/j.genhosppsych.2012.12.002
Hunkler, C., & Khourshed, M. (2020). The role of trauma for integration: The case of Syrian refugees. Soziale Welt, 71(1–2), 90–122. https://doi.org/10.5771/0038-6073-2020-1-2-90
Hynie, M. (2017). The social determinants of refugee mental health in the post-migration context: A critical review. The Canadian Journal of Psychiatry, 63(5), 297–303. https://doi.org/10.1177/0706743717746666
Jang, Y., Yoon, H., Park, N. S., & Chiriboga, D. A. (2016). Health vulnerability of immigrants with limited english proficiency: A study of older Korean Americans. Journal of the American Geriatrics Society, 64(7), 1498–1502. https://doi.org/10.1111/jgs.14199
Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28(1), 36–47. https://doi.org/10.1016/j.cpr.2007.01.017
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S.-L.T., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189. https://doi.org/10.1001/archpsyc.60.2.184
Kim, I., & Keovisai, M. (2016). Burmese Community Behavioral Health Survey final report: Overview of the study findings (Brief Report No. 2016–2). Retrieved August 17, 2021 from https://socialwork.buffalo.edu/content/dam/socialwork/social-research/IRRI/BCBHS-2016-Final-Report-Overview.pdf
Kim, J., Kim, W., Kim, I., Baltimore, K., & Lin, L. (2021a). In: The Karen Health Literacy Study: Final report. https://doi.org/10.13140/RG.2.2.27987.30244
Kim, H. S., Sherman, D. K., & Taylor, S. E. (2008). Culture and social support. American Psychologist, 63(6), 518–526. https://doi.org/10.1037/0003-066x
Kim, I. (2018). Behavioral health symptoms among refugees from Burma: Examination of sociodemographic and migration-related factors. Asian American Journal of Psychology, 9(3), 179. https://doi.org/10.1037/aap0000103
Kim, I., Kang, S.-Y., & Kim, W. (2018). The effects of religious participation and familial assistance on mental health among older Chinese and Korean immigrants: Multiple mediator analyses. Journal of Cross-Cultural Gerontology, 33(4), 411–425. https://doi.org/10.1007/s10823-018-9355-7
Kim, I., Keovisai, M., Kim, W., Richards-Desai, S., & Yalim, A. C. (2019). Trauma, discrimination, and psychological distress across Vietnamese refugees and immigrants: A life course perspective. Community Mental Health Journal, 55(3), 385–393. https://doi.org/10.1007/s10597-018-0268-2
Kim, I., & Kim, W. (2014). Post-resettlement challenges and mental health of Southeast Asian refugees in the United States. Best Practices in Mental Health, 10(2), 63–77. https://doi.org/10.1007/s10903-015-0251-8
Kim, W. (2002). Ethnic variations in mental health symptoms and functioning among Asian Americans (Publication Number 3062969) [Doctoral dissertation, University of Washington]. ProQuest Dissertations and Theses Global.
Kim, W. (2009). Drinking culture of elderly Korean immigrants in Canada: A focus group study. Journal of Cross-Cultural Gerontology, 24(4), 339–353. https://doi.org/10.1007/s10823-009-9104-z
Kim, W., Yalim, A. C., & Kim, I. (2021b). “Mental health is for crazy people”: Perceptions and barriers to mental health service use among refugees from Burma. Community Mental Health Journal, 57(5), 965–972. https://doi.org/10.1007/s10597-020-00700-w
Knol, M. J., Twisk, J. W. R., Beekman, A. T. F., Heine, R. J., Snoek, F. J., & Pouwer, F. (2006). Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia, 49(5), 837. https://doi.org/10.1007/s00125-006-0159-x
Krogstad, J. M. (2019). Key facts about refugees to the U.S. Retrieved August 17, 2021 from https://www.pewresearch.org/fact-tank/2019/10/07/key-facts-about-refugees-to-the-u-s/
Lillee, A., Thambiran, A., & Laugharne, J. (2015). Evaluating the mental health of recently arrived refugee adults in Western Australia. Journal of Public Mental Health, 14(2), 56–68. https://doi.org/10.1108/JPMH-05-2013-0033
Lubben, J. E. (1988). Assessing social networks among elderly populations. Family & Community Health, 11, 42–52.
Marshall, G. N., Schell, T. L., Elliott, M. N., Berthold, S. M., & Chun, C. A. (2005). Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA, 294(5), 571–579. https://doi.org/10.1001/jama.294.5.571
Miller, A., Hess, J. M., Bybee, D., & Goodkind, J. R. (2018). Understanding the mental health consequences of family separation for refugees: Implications for policy and practice. The American Journal of Orthopsychiatry, 88(1), 26–37. https://doi.org/10.1037/ort0000272
Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70(1), 7–16. https://doi.org/10.1016/j.socscimed.2009.09.029
Mollica, R. F., Wyshak, G., & Lavelle, J. (1987). The psychosocial impact of war trauma and torture on Southeast Asian refugees. American Journal of Psychiatry, 144(12), 1567–1987.
National Institute of Mental Health. (n.d.). Prevalence of major depressive episode among adults. Retrieved August 17, 2021 from https://www.nimh.nih.gov/health/statistics/major-depression.shtml#part_155029
Olvera, J. L. (2020). Does citizenship status, education, and medical insurance protect against psychological distress among adult Mexican immigrants? San Diego State University. Retrieved August 17, 2021 from https://www.proquest.com/dissertations-theses/does-citizenship-status-education-medical/docview/2515158119/se-2?accountid=14169
Park, J., Roh, S., & Yeo, Y. (2011). Religiosity, social support, and life satisfaction among elderly Korean immigrants. The Gerontologist, 52(5), 641–649. https://doi.org/10.1093/geront/gnr103
Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced personsa meta-analysis. JAMA, 294(5), 602–612. https://doi.org/10.1001/jama.294.5.602
Refugee Processing Center. (2019). Archived data. Retrieved August 17, 2021, from https://www.wrapsnet.org/archives/
Rubin, V., Ngo, D., Ross, A., Butler, D., & Nisha, B. (2018). Counting a diverse nation: Disaggregating data on race and ethnicity to advance a culture of health. PolicyLink. Retrieved August 17, 2021 from https://www.policylink.org/sites/default/files/Counting_a_Diverse_Nation_08_15_18.pdf
Samuelsson, G., McCamish-Svensson, C., Hagberg, B., Sundström, G., & Dehlin, O. (2005). Incidence and risk factors for depression and anxiety disorders: Results from a 34-year longitudinal Swedish cohort study. Aging & Mental Health, 9(6), 571–575. https://doi.org/10.1080/13607860500193591
Savic, M., Chur-Hansen, A., Mahmood, M. A., & Moore, V. (2013). Separation from family and its impact on the mental health of Sudanese refugees in Australia: A qualitative study. Australian and New Zealand Journal of Public Health, 37(4), 383–388. https://doi.org/10.1111/1753-6405.12088
Schweitzer, R. D., Brough, M., Vromans, L., & Asic-Kobe, M. (2011). Mental health of newly arrived Burmese refugees in Australia: Contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry, 45(4), 299–307. https://doi.org/10.3109/00048674.2010.543412
Shannon, P. J., Vinson, G. A., Wieling, E., Cook, T., & Letts, J. (2014). Torture, war trauma, and mental health symptoms of newly arrived Karen refugees. Journal of Loss and Trauma. https://doi.org/10.1080/15325024.2014.965971
Shear, M. D., & Kanno-Youngs, Z. (2019). Trump slashes refugee cap to 18,000, curtailing U.S. role as haven. The New York Times. Retrieved August 17, 2021 from https://www.nytimes.com/2019/09/26/us/politics/trump-refugees.html
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA, 302(5), 537–549. https://doi.org/10.1001/jama.2009.1132
Strijk, P. J., van Meijel, B., & Gamel, C. J. (2011). Health and social needs of traumatized refugees and asylum seekers: An exploratory study. Perspectives in Psychiatric Care, 47(1), 48–55. https://doi.org/10.1111/j.1744-6163.2010.00270.x
Taylor, E. M., Yanni, E. A., Pezzi, C., Guterbock, M., Rothney, E., Harton, E., Montour, J., Elias, C., & Burke, H. (2014). Physical and mental health status of Iraqi refugees resettled in the United States. Journal of Immigrant and Minority Health, 16(6), 1130–1137. https://doi.org/10.1007/s10903-013-9893-6
Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145–161. https://doi.org/10.1177/0022146510395592
United Nations High Commissioner for Refugees. (2019). Refugee Statistics. https://www.unrefugees.org/refugee-facts/statistics/
Wong, E. C., Marshall, G. N., Schell, T. L., Elliott, M. N., Babey, S. H., & Hambarsoomians, K. (2011). The unusually poor physical health status of Cambodian refugees two decades after resettlement. Journal of Immigrant and Minority Health, 13(5), 876–882. https://doi.org/10.1007/s10903-010-9392-y
World Health Organization. (2021). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Yalim, A. C., Kim, W., & Kim, I. (2019). Challenges in health-care service use among Burmese refugees: A grounded theory approach. Social Work in Health Care, 58(7), 665–684. https://doi.org/10.1080/00981389.2019.1616244
Zetter, R. (1991). Labelling refugees: Forming and transforming a bureaucratic identity. Journal of Refugee Studies, 4(1), 39–62. https://doi.org/10.1093/jrs/4.1.39
Acknowledgements
The authors would like to express our special thanks to the members of the research team: Aye Bay Na Sa, Lahmay Paw, Hsa Tha Blay Wah, and LaeYudra Greely for conducting interviews, Biplab Sudhin Bhattacharya, Omeed Fathi, Mary Keovisai, and Qian Zhang for their help in the interview process, Carmen Zhang for data entry, and ThinThin Conlon, Daniel Leong, and Faustina Palmatier for their role as community advisors. We also thank the Karen Society of Buffalo for their support and all the Karen community members who participated in this study.
Funding
This study was partially funded by the Buffalo Center for Social Research Les Brun Research Endowment Fund, Community for Global Health Equity Seed Grant, and HomeBASE funding from the University at Buffalo.
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Kim, W., Kim, I., Lin, L. et al. Social Determinants of Mental Health Among Karen Refugees from Burma. Community Ment Health J 58, 749–760 (2022). https://doi.org/10.1007/s10597-021-00880-z
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DOI: https://doi.org/10.1007/s10597-021-00880-z