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Table 3 Summary of quantitative study findings

From: A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants

Study Resilience outcomes Mental health outcomes Conclusion
Almedom et al.,[29] Considering SOC-13 results, resilience is low among those who live in IDP camps, and significantly low among women (more so for women living in IDP camps). Although no specific mental health outcomes were explored, findings show critical implications for health policy covering prolonged forced displacement. Highlights the need for international health institutions including the WHO and local players to address the plight of IDP women, particularly in conflict and post-conflict zones.
Jamil et al.,[31] Resilience is discussed in the light of two case studies presented along with quantitative analyses for mental disorder symptoms. Pre-migration and post-resettlement stressors have a strong impact on resilient behaviours. Many refugees met criteria for the diagnosis of PTSD (54.5% of the men; 11.4% of the women). 34.3% of women and 4.3% of the men were diagnosed with a depressive disorder. The HSCL-25 showed more than 80% of participants had recently experienced intense symptoms of anxiety. Primary medical care service providers need more education and training to screen refugees for mental health services. Important to have culturally-sensitive screening and diagnostic instruments.
Almedom et al.,[30] Using the SOC-13 to measure resilience quantitatively, findings show that urban (non-displaced) residents and rural, traditionally mobile (pastoralist) communities had significantly higher resilience than those living in IDP camps. Findings show that displacement can compromise individual or collective resilience among women. No specific mental health outcomes were explored. However, findings points to the fact that displacement is detrimental to the mental well-being of conflict survivors of war. Especially, the prolonged duration of the internal displacement in Eritrea (5–6 years), has been damaging . Displacement may compromise individual and/or collective resilience in women. Health research should contribute to the promotion of resilience factors in post-conflict countries as part of public health policy.
Pedersen et al.,[25] Using a mixed-method approach, protective influences derived from resilient structures in societies involved in survival and conflict resolution is explored. High levels of mental disorders (anxiety, depression, PTSD) were identified. Significant associations were observed between degree of exposure to violence and the likelihood of developing mental illness. Negative association between degree of social support and mental health outcomes was also observed. Highlights the need to look beyond PTSD and focus on culture-specific trauma-related disorders and long-term effects. Discusses the need for further research to establish social bonds, strengthen support networks and increase social cohesion in societies damaged by trauma and dislocation.
Kuwert et al.,[32] Using the RS-11, study shows that displaced individuals have significantly less resilience levels than their non-displaced peers. Even sixty years after WWII, displaced individuals showed significantly more anxiety symptoms than the non-displaced population. Displaced participants also had higher levels of depressive symptoms, albeit statistically not-significant. Study highlights the long-lasting impact of forced displacement on mental health in the now elderly German population. Provides strong evidence on the need for preventive measures and effective interventions for elderly forced migrants.
Beiser et al.,[33] The study included measures of social capital as elements of community resilience. Perceived social support is shown to reduce the probability of PTSD, along with feelings of safety and perceptions of moral and social order. Persistence of PTSD was partially attributable to the loss of social capital due to conflict-induced disintegration of social fabric. The six-month period prevalence of PTSD in the violence-affected village was 60%, more than four times higher than the non-affected village. A dose–response relationship is evident between exposure to human-induced conflict/disaster and mental health. Conflict-induced social and cultural disintegration can lead to lowering of community resilience, and continuing mental health issues.
Hooberman et al.,[34] Results indicate that relevance of resilience variables can depend on individual coping style. Emotion-based coping styles showed moderating effects between PTSD and cognitive appraisal, social comparison variables. 40% of the sample showed above cut-off scores on HTQ for PTSD. Cultural variations and overlap between PTSD symptoms and coping modes limits wider interpretations. However, clinical implications point towards using coping styles and cognition in managing PTSD among refugees surviving torture.
Andersson,[26] Resilience is not directly measured. EMBU and its outcomes on parental separation and rejection is used as a proxy measure of resilience process. Indicates the need for more exploration of childhood detachment experiences among traumatized populations and the link to the process of resilience. 65 years after the end of WWII, the Finnish refugees had a 10 times higher risk for PTSD when compared to non-evacuees. A significant proportion (36.7%) refugees had experienced extreme traumatisation. Resilience process and the link to childhood parental separation and extreme trauma require further in-depth attention.
Araya et al.,[35] The process of resilience is seen to be positively influenced by the placement of displaced persons in a community setting Task-oriented coping, higher perceived social support, and a favourable marital life associated with a markedly higher quality of life promote the resilience process. Mental distress, assessed by SCL-90-R, did not significantly differ between the two groups. Findings suggest that community setting-based living and rehabilitation improves quality of life for post-conflict displaced populations. Improvement in living conditions may also improve quality of life in camp-like shelters.
Beiser et al.,[36] Family-based and non-family based social support together with perceived quality of life was used to explore resilience outcomes. Life satisfaction and non-kin support was associated with resiliency and demonstrated a reduction in PTSD prevalence. ICD-10 criteria based lifetime prevalence for PTSD was 12%; DSM-IV criteria based lifetime prevalence was 5.8%. Pre and post migration stresses increased the risk of PTSD. Study underlines the importance of understanding resilience and its sources, most notably social support, in relation to developing PTSD.
Bhui et al.,[28] Using social support networks as an indicator of resilience, study provides evidence that larger (stronger) support networks promote resilience against developing mental disorders, especially salient in situations of high forced residential mobility for refugees. Significant associations evident for any mobility with general health, trauma history and any psychiatric diagnosis. Forced residential mobility more likely to be associated with ICD-10 criteria based psychiatric disorder compared to self-choice mobility. Social support networks may promote resilience among refugees experienced forced residential mobility and associated mental disorders.
Suarez,[37] Resilience contributed to the variance of avoidance symptoms but not to the variance of PTSD symptoms, re-experiencing or arousal. The CD-RISC mean scores in the sample were lower than that of a national community sample in the US. Only 9.3% showed possible PTSD with scores above the 2.5 HTQ cut-off. LSQ score showed a moderately high level of life stress among the participants. Complexity of interactions between resilience and post-traumatic responses are shown. The resilience shown by the women in the study calls for more recognition of women's roles in post-conflict societies.
Arnetz et al.,[27] No differences were seen in resilience between Iraqi refugees and non-Iraqi immigrants. Resilience was a important inverse predictor of psychological distress when controlled for migration and exposure to violence, but not for PTSD. Refugees had shown more PTSD symptoms compared to immigrants. Resilience and its association with decreased psychological stress is important in managing victims of conflict.