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Table 4 Overview and summary of qualitative study findings

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

Study Sample and background Resilience findings Mental health findings Conclusion
Davis et al.,[38] 19 adult Southeast Asian (Vietnamese, Cambodian and Laotian) women in central Pennsylvania, US Pre and post migration experiences were explored. Cultural bereavement, post-migration adversity, despair and isolation were overcome with different survival strategies. Family cohesion and adaptation highlighted as promoters of resilience. None of the participants were seen to be suffering from PTSD related to traumatic displacement. Study argues that it is largely the lack of same ethnic communities and family support systems that may lead to the development of mental health issues. Recognition of cultural bereavement by health workers and development of interventions that involve ethnic and cultural identity is important to promote resilience and mental well-being.
Schweitzer et al.,[39] 13 resettled Sudanese refugees in Australia, aged 17-44 Several strengths and resources that allowed coping with migration stressors for refugees were identified: family and community support; religion; personal qualities, and comparison with others. These can act as promoters of resilience against the development of psychological sequelae of forced displacement. Forced displacement creates significant psychological stressors during pre-migration, transition and post-migration periods. Coping strategies form an important part of resilience in response to trauma and forced migration experience. Identifying these factors are important in formulating strategies to improve the well-being of resettled refugees. However, small sample size and heterogeneous sample limits interpretation.
Sossou et al.,[40] 7 Bosnian refugee women resettled in Southern US Narrative analysis identified several resilience factors: importance of family and values, role of spirituality as a strength through non-organized religion and community support services during resettlement. The study aimed to explore general wellbeing in the backdrop of prior trauma. Life and experiences during war, challenges during resettlement such as misconceptions on mental health services were indicated as potential reasons for poor mental health. Life experiences during and post-war and resettlement experiences may lead to poor mental health. Family, spirituality and social support can be resilience promoting factors for these female refugees. However, the small sample size limits wider interpretation.
Somasundaram & Sivayokan,[41] IDPs in Vanni, Sri Lanka An exploration of collective trauma experienced during forced displacement and conflict. Resilience and post-traumatic growth develops in spite of severe traumatic experience of displacement and resulting breakdown of family/community network and structures. Severity of the forced displacement episode leads to the development of psychosocial symptoms including PTSD. Interventions for psychosocial regeneration are required to rebuild the family and community structures in the aftermath of mass displacement including the healing of memories.
Nuwayhid et al.,[42] IDPs in Lebanon Community resilience explored by combining direct observation, key informant discussions and review of material. Community resilience is suggested as a process rather than an outcome. Resilience is built upon collective identity, previous war experience and social support networks. Links between resilience (community or individual) were not explored. However, the impact of sudden forced migration on psychosocial health of communities is noted. Implications for public health professionals to build community resilience is discussed. Capitalising on community resilience a key component of public health action.
Thomas et al.,[43] 16 Pakistani and 8 Somali urban refugees in Nepal Primary relationships along with supportive networks of friends and family members facilitated coping mechanisms, functioning as a mode of resilience for many. These provided a buffer against vulnerabilities and reduced anxiety through psychological support. Religion also played a similar role in promoting resiliency. Psychosocial distress of being a refugee was explored. Vulnerability was characterised by discrimination, daily stressors, unfulfilled expectations, and lack of control, culminating in generally poor reported mental health. Culturally relevant programmes that seek to develop esteem and build resilience should be developed alongside individualised therapy for those who are vulnerable. External support should be designed in a way that builds resilience and facilitates coping.
Fernando,[44] 43 Sri Lankans Resilience construct examined through focus groups. Some elements of resilience are common across ethnic-cultural groups while other differed across ethnicities. Two distinct non-western resilience components identified were psychosocial gratitude and strong will linked to religion or karma. Certain resilience components can be taught. Links between type of trauma and components of resilience identified. Components of resilience, and understanding of resilience can vary across ethno-cultural groups. Public health interventions and policies can make use of components of resilience that can be taught to populations experiencing trauma.
Lenette et al.,[45] 4 single African (Sudan, Burundi, Democratic Republic of Congo) refugee women in Australia Resilience ethnographically explored as a social process linked to every-day life in the context of interactions between individuals and environment. Resilience is identified as an inter-subjective process connecting refugee women with their environment through social spaces. Nature and dynamicity of resilience is described. Social complexities in resilience and stress is discussed. Mental health is not specifically explored or studied. However, pre-migration stressors and post-migration stressors such as daily living, coping, and resettlement are discussed. The findings argue for more attention to resilience pathways and outcomes linked to day-to-day lives of refugees, which can be useful in developing refugee mental health practices.
Chung et al.,[46] 9 single, low-income refugee women (Hungary, Nigeria, Iraq, Cameroon, Afghanistan, Sudan, DR Congo) in Ontario, Canada Study explored how resilience is grown, promoted or can be reinforced. Through a grounded theory approach, findings show that informal, formal support and individual characteristics of refugee women reinforce resilience. Findings support a collective resilience model. No specific mental health issues were explored. Links were made with migratory and post-migratory stresses. Organizational and social support reinforces resilience. Individual characteristics are an important factor in sustaining resilience. Collective resilience require further exploration.
Lewis,[47] 80 Tibetan exiles living in Dharamsala, India An ethnographic study exploring resilience among Tibetans in exile, a community known to be highly resilient to trauma. Tibetans consider resilience as an active and learned process, and use Buddhist thinking to exempt negative influence of trauma. Traumatic experiences instigated by torture, violence and displacement were explored. Findings challenge the idea that trauma is inevitable in conflict or political violence and that some communities dispel or transform distress.