Secure visa status, employment, income, good housing conditions and control over environmental circumstances are the keys to good mental health and resilience among refugees, a new study has confirmed.

The finding is the result of systematic review of factors promoting good mental health among refugees conducted by researchers at the University of NSW.

The review says there should be a focus on mental health strategies that harness refugees’ strengths.

Lead researcher and Director of the Refugee Trauma and Recovery Program at UNSW’s School of Psychology, Professor Angela Nickerson, said: “While exposure to persecution, war and displacement is associated with high rates of psychological disorders, such as PTSD and depression, remarkably the majority of refugees, despite having gone through very difficult experiences, don’t go on to develop a psychological disorder”.

She said, despite this, previous research has focused on trying to understand factors that predict psychopathology or psychological distress, rather than factors that predict wellbeing or resilience.

“More recently, however, there has been a movement towards a strengths-based approach in mental health, particularly in the refugee space, and we wanted to look at what research was out there,” Prof Nickerson said.

The paper, titled ‘A systematic review of protective and promotive factors in refugee mental health’ and published in the journal ‘Nature Mental Health’, is the first to focus on factors contributing to better mental health in refugees.

The researchers searched databases for relevant studies and screened thousands of studies.

“The lack of research looking at predictors of good mental health highlighted the deficit focus of so much research into refugee mental health,” Profs Nickerson said, adding that although 75 per cent of the world’s refugees live in lower-or-middle income countries (LMICs), most of the research took place in high income countries (HICs).

“We were interested in everything from demographic and social factors to environmental and psychological factors,” Prof Nickerson said.

“We wanted to be able to speak to a range of different implications and recommendations in the field of refugee mental health – from what psychologists or social workers might do with a client in a room, and also more broadly what kinds of conditions policy makers should be creating in countries that host refuges to help people thrive and move forward after traumatic experiences.”

The paper says the refugee experience is characterised by protracted exposure to danger and uncertainty and it highlighted factors related to stability and predictability as having some of the strongest associations with good mental health in refugees.

“It makes a lot of sense that, if people who’ve been through very difficult experiences are going to overcome those and thrive, we need to create conditions where their basic needs for safety are met,” Prof Nickerson said.

The study found a secure visa status, employment, income, good housing conditions and control over environmental circumstances were associated with good mental health outcomes in both HICs and/or LMICs.

Individuals vary in their capacity to cope with difficult circumstances, with resilience reflecting the extent to which an individual can recover or maintain good mental health in the context of adversity, the paper said.

It found that psychological factors such as cognitive strategies, self-efficacy and a sense of control were protective and promotive of wellbeing.

Building individual skills and capabilities to cope and thrive represents an important goal to promote good mental health in refugees.

“When we’re trying to understand how best to support people, we often look at the things that are going wrong, and that means our interventions are focused on those things. This study speaks to the importance of harnessing interventions that are associated with resilience, self-efficacy and psychological flexibility,” Prof Nickerson said.

But experiences such as war, persecution and displacement occur at a societal level, and so approaches to promoting good mental health in their aftermath must extend beyond the individual.

“There is a consistent link between social engagement and support and good mental health outcomes among refugees, particularly for those in high-income countries,” Prof Nickerson said.

“The ability to communicate in the host language, social support, and social engagement with both the refugees’ own community and the host community, along with religious coping strategies, were all linked with increased wellbeing.”

The paper outlined a future research agenda to progressing an understanding of refugee mental-health wellbeing.

These included studying factors associated with wellbeing and positive mental health outcomes, rather than just looking at factors that contribute to psychological distress, filling the research gap in low-and-middle-income countries and taking a cross-disciplinary research approach by bringing together researchers, psychologists, social workers and policy-makers to gain a more nuanced understanding of protective and promotive factors.

“Having refugee voices at the centre of this process is critical to help us understand priority areas for research and using these findings effectively. This will pave the way for developing policies and interventions that support refugee communities to thrive,” Prof Nickerson said.

Read the full report: https://www.nature.com/articles/s44220-024-00336-9