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

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Farah Ahmad at York University
Farah Ahmad
Nasih Othman at Region of Peel
Nasih Othman
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Wendy Lou
Wendy Lou
Wendy Lou
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Abstract and Figures

Posttraumatic-stress-disorder (PTSD) is one of the common mental health conditions among Afghan refugees resettled in developed countries. The current study explores how social support, coping and other factors correlate with PTSD in this population. A survey was conducted with 49 adult Afghan refugees (males 41%, female 59%) who completed Harvard Trauma Questionnaire during their visit to a Community Health Centre in Toronto. Bivariate analysis and structural-equation-modeling (SEM) were used to examine associations and pathways between PTSD and other variables. Mean PTSD score was 2.53 (SD 0.92) with 53% showing symptoms of PTSD which was significantly associated with age, unemployment, social support and self-rated health. SEM showed that higher social support scores were significantly associated with lower PTSD scores, and the effect of coping and English language were mediated through social support. The high prevalence of PTSD, its association with social support and self-rated health are important issues to be considered for refugee resettlement programs.
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Vol.:(0123456789)
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Community Mental Health Journal (2020) 56:597–605
https://doi.org/10.1007/s10597-019-00518-1
ORIGINAL PAPER
Posttraumatic Stress Disorder, Social Support andCoping Among
Afghan Refugees inCanada
FarahAhmad1 · NasihOthman2 · WendyLou3
Received: 19 December 2018 / Accepted: 9 December 2019 / Published online: 12 December 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
Posttraumatic-stress-disorder (PTSD) is one of the common mental health conditions among Afghan refugees resettled in
developed countries. The current study explores how social support, coping and other factors correlate with PTSD in this
population. A survey was conducted with 49 adult Afghan refugees (males 41%, female 59%) who completed Harvard
Trauma Questionnaire during their visit to a Community Health Centre in Toronto. Bivariate analysis and structural-equation-
modeling (SEM) were used to examine associations and pathways between PTSD and other variables. Mean PTSD score was
2.53 (SD 0.92) with 53% showing symptoms of PTSD which was significantly associated with age, unemployment, social
support and self-rated health. SEM showed that higher social support scores were significantly associated with lower PTSD
scores, and the effect of coping and English language were mediated through social support. The high prevalence of PTSD, its
association with social support and self-rated health are important issues to be considered for refugee resettlement programs.
Keywords PTSD· Social support· Refugees· Afghan· Canada
Introduction
According to 2016 estimates, there are over 40 million inter-
nally displaced persons and 22.5 million refugees globally
many of whom are fleeing conflicts, wars and acts of violent
extremism (International Organization for Migration 2018).
Exposure to multiple harmful and traumatic circumstances
is common to many refugees, impacting their physical and
mental health. Being one of the most troubled countries for
several decades, Afghanistan is one of the top ten refugee-
producing countries worldwide (IOM 2018). Post-traumatic
stress disorder (PTSD) is one of the common conditions
observed among Afghan refugees. Studies report the preva-
lence of PTSD among Afghan refugees and asylum seekers
as 34% in UK (Bronstein etal. 2012), 35% in Netherlands
(Gernaat etal. 2002), 46% in Australia (Yaser etal. 2016),
50% in the United States (Malekzai etal. 1996), and 21%
in another study from Netherlands that included Iranian and
other nationalities as well (Gerritsen etal. 2006). PTSD is
similarly common among residents of Afghanistan; a nation-
wide survey showed that 42% of the adult population had
PTSD (women 48%, men 32%) and 62% reported experi-
encing at least four trauma events during the past 10years
(Cardozo etal. 2004). Among those who migrate to other
countries as refugees, many continue to face difficulties in
the host country due to the complex procedures they need to
go through, the uncertainty of their financial and living situ-
ation and the differences they face on daily bases in terms of
language, culture and access to health and social care sys-
tems (Hecker etal. 2018). Refugees need assistance in this
regard and those with mental health conditions, including
PTSD, ought to be promptly supported in order to overcome
their symptoms and, hence, regain full functionality. This
is particularly relevant for countries accepting refugees on
ongoing bases, such as Canada that settled 27,000 refugees
* Farah Ahmad
farahmad@yorku.ca
Nasih Othman
nasih@yorku.ca
Wendy Lou
wendy.lou@utoronto.ca
1 School ofHealth Policy andManagement, York University,
4700 Keele Street, HNES Building, Rm 414, Toronto,
ONM3J1P3, Canada
2 School ofHealth Policy andManagement, York University,
Toronto, Canada
3 Biostatistics Division, Dalla Lana School ofPublic Health,
University ofToronto, Toronto, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Afghan refugees have been exposed to decades of war, violence, and displacement which have led to high rates of PTSD. It has been found that PTSD among Afghan refugees is extremely heterogeneous, with rates of 34% in the UK, 46% in Australia, and 53% in Canada [24,25]. Trauma is often exacerbated by post-migration stressors such as cultural adjustment and social isolation [22,25]. ...
... The global prevalence of PTSD in refugees is estimated at 31.46%, which is significantly higher than that reported in host populations [21,22]. The prevalence is even higher among Afghan refugees, ranging from 34% in the UK to 53% in Canada, indicating the enormous psychological toll of war and displacement [24,25]. One Pakistan-based study reported a 79.20% PTSD prevalence in Afghan refugees, with symptoms that were also linked to intergenerational trauma [10]. ...
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This study examines the mental health challenges faced by Afghan refugees resettled in South Korea, focusing on post-traumatic stress disorder (PTSD). Using trauma theory and ecological system theory, this research explores the impact of pre-migration trauma and post-migration stressors, such as cultural adaptation difficulties, language barriers, and social isolation. Adopting a qualitative descriptiveanalytical methodology and utilizing trauma theory and ecological system theory, this study identifies the compounded effects of these stressors on refugees’ mental health and their integration into South Korean society. The findings reveal that South Korea’s homogeneous society exacerbates these challenges, with limited culturally competent mental health care available. The study concludes that trauma, language barriers, cultural adjustment difficulties, and social isolation are central contributors to psychological distress, and emphasizes the need for systemic and trauma-informed interventions to mitigate these challenges and support refugees’ integration.
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... 11 Another study at a community health center in Toronto used a standardized trauma screen of adult Afghan refugees and found high rates of post-traumatic stress disorder (PTSD), associated closely with unemployment and inadequate social support. 12 Most large cohort studies among Afghan refugees have been conducted in countries bordering Afghanistan or in European countries. Iran hosts the second largest Afghan refugee population globally. ...
... [26][27][28] Unlike other analyses of post-resettlement Afghan refugees, our cohort had a lower observed prevalence of diagnosed mental illnesses like PTSD relative to other organ systems. 12,29 We suspect that formal diagnoses of mental health disorder may have been limited by the short period that patients were followed in the refugee clinic, with generalists primarily reporting nonspecific symptoms until other organic diagnoses could be ruled out or a formal psychiatric diagnosis could be made. In contrast, a study conducted in Turkey among Afghan refugees reported high rates of depression (50%) and anxiety (41%), indicating a higher prevalence of mental health conditions than observed in our cohort. ...
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... When using such terms, the clinician can better assist in understanding the psychological functioning of the individual and overcome the associated stigma of talking about trauma-related experiences. Table 2 depicts the Farsi/Persian equivalent words for the most common symptoms of trauma among Afghans extracted from the available literature (Ahmad et al., 2020;Alemi et al., 2014Alemi et al., , 2016Eggerman & Panter-Brick, 2010;Gokani et al., 2023;Hamrah, 2020;Miller et al., 2006;Yaser et al., 2016). Please see Table 2 for details. ...
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... The journey from Afghanistan to the U.S. often exacerbates existing vulnerabilities due to a significant loss of social support and identity for many refugees. This loss, coupled with the challenges of resettlement, contributes to the mental and physical health issues faced by this population (Azagba et al., 2019, Ahmad et al., 2020. Culturally, many rely primarily on social and religious coping mechanisms and are less likely to seek clinical treatment, possibly due to barriers such as language, transportation, financial constraints, and unfamiliarity with the U.S. healthcare system (Alemi et al., 2016, Azagba et al., 2019, Siddiq et al., 2022, Stead et al., 2016, Kieseppä et al., 2020, De Anstiss and Ziaian, 2010. ...
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... For example, language acquisition plays a crucial role in refugees' ability to adapt to a new environment in their host country (Beiser & Hou, 2001;Długosz, 2023). Poor language skills can restrict work opportunities to jobs that do not match a refugee's skills and qualifications, and in turn led to lower psychological well-being (Bridekirk & Hynie, 2020;Mazhak et al., 2023), Furthermore, refugees who have no social support network or have been separated from their family have more PTS symptoms (Ahmad et al., 2019;Miller et al., 2018;Schweitzer et al., 2006). Indeed, 34% of Ukrainian refugees have reported that family was an important part of coping with the stresses of war (Oviedo et al., 2022). ...
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The mental health and help-seeking behaviour of resettled Afghan refugees in Australia
Article
Full-text available
  • Aug 2017
Background: Psychological trauma, in particular, posttraumatic stress disorder (PTSD) and depression, are highly prevalent among resettled refugees. However, little is known regarding the mental health status and associated help-seeking behaviour of resettled Afghan refugees in Australia. Methods: A sample of 150 resettled Afghan refugees (74 males; mean age 32.8 years, SD = 12.2) living in Adelaide, South Australia were recruited. Self-reported measures of PTSD, depression, exposure to traumatic events, functional impairment, self-recognition of PTSD symptomatology and help-seeking behaviours were completed. Multivariate analysis of variables associated with help-seeking was conducted. Results: Forty-four percent of participants met criteria for clinically significant PTSD symptoms and all but one participant reported being exposed to 1 or more traumatic and/or conflict related events, such as 'losing your property and wealth'. Moreover, 14.7% of participants had symptoms suggestive of clinically significant depression. General practitioners were the most common source of help in relation to mental health problems, with very few participants (4.6%) seeking help from specialist trauma and torture mental health services. Self-recognition of having a PTSD related mental health problem and functional impairment levels were both found to be independent predictors of help-seeking (p ≤ .05). Conclusions: The findings provide further evidence for high rates of PTSD symptomatology and low uptake of mental care among resettled refugees. Poor self-recognition of the presence and/or adverse impact of PTSD symptoms may need to be targeted in mental health promotion programs designed to improve "mental health literacy" and thereby promote early and appropriate help-seeking where this is needed.
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Differential Associations Among PTSD and Complex PTSD Symptoms and Traumatic Experiences and Postmigration Difficulties in a Culturally Diverse Refugee Sample
Article
  • Nov 2018
Forced migration is one of the major challenges currently facing the international community. Many refugees have been affected by traumatic experiences at home and during their flight, putting them at a heightened risk of developing trauma‐related disorders. The new version of the International Classification of Diseases (ICD‐11) introduced two sibling disorders, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). So far, little is known about risk and protective factors in refugees that are specifically associated with the disturbances in self‐organization (DSO) characteristic of CPTSD. In this study, we aimed to investigate the association between PTSD and DSO symptoms and traumatic experiences, postmigration difficulties, and social support in a culturally diverse sample of refugees who resettled in Switzerland. A total of 94 refugees (85.1% male; M age = 31.60 years, SD = 10.14, range: 18–61 years) participated in this study. Trained assessors performed either guided questionnaire assessments or structured interviews. In our advice‐ and help‐seeking sample, 32.9% of individuals suffered from PTSD and 21.3% from CPTSD. After controlling for potential gender differences, we found positive associations between PTSD symptoms and trauma exposure, β = .22, as well as between DSO symptoms and postmigration living difficulties, β = .42, and lack of social support, β = .22. Our findings support the notion that it is highly important to consider differential associations among PTSD and DSO symptoms and risk and protective factors to gain a deeper understanding of the trauma‐related problems refugees face.
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