MENTAL HEALTH SERVICE DELIVERY FOR AFGHAN REFUGEES IN THE U.S.
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2024
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Refugees are exposed to many stress factors that negatively impact their well-being prior to, during, and after resettlement that contribute to depression, anxiety, and somatization disorders (Abou-Saleh & Christodoulou, 2016). Refugees from war-torn countries, including Afghanistan, experience war trauma, as well as marginalization and discrimination in a new country, increasing the risk of depression and anxiety in refugees. As of September 15, 2022, the total Afghan population in the U.S. was 189,493, with Afghan refugees arriving in four major waves--during the Soviet-Afghan War (1979–1989), during the Afghan Civil War (1990 to 1995), during the U.S./NATO intervention and fall of the Taliban (1996-2001), and during U.S./NATO withdrawal and resumption of power by Taliban forces in 2021 (Alemi, n.d.). Although research on 4th-wave refugees is limited, research on earlier waves found that the prevalence of mental health disorders among Afghan refugees was high (Alemi et al., 2016). Despite high prevalence, many refugees in the United States do not receive mental health care due to limited English-language skills, lack of awareness of services, reluctance to seek help due to cultural stigma around mental disorders, and negative attitudes towards and by providers (Satinsky et al., 2019). Research also suggests that education, income, and other factors influenced access to and utilization of mental health resources (Steele et al., 2007). Research suggests that mental health help-seeking among early-wave refugees is low (Abou-Saleh & Christodoulou, 2016). What is not known are the main barriers that prevent access to and utilization of mental health care in the most recent wave of Afghan refugees (Byrow et al., 2020).
The objective of this dissertation is to better understand the need for, access to, and use of mental health services among Afghan refugees in the U.S. Through three studies, I: 1) conducted individual interviews with service providers to understand mental health needs of Afghan refugees in the U.S.; 2) conducted one-on-one interviews with Afghan refugees to determine the needs for mental health care and the barriers to accessing mental health services; and 3) administered a survey with Afghan refugees in two cities of Sacramento and Fremont in California to assess the influence of socioeconomic status (SES), sex, and years in the U.S. on mental health service use and knowledge.
Due to my recent refugee status from Afghanistan, I was uniquely qualified to conduct this research. The lawyer helping me with my personal asylum application established my connection with her friend who is lawyer in San Francesco. She connected me with the service providers and as well as with members of the U.S. Afghan community that assisted me in recruiting my samples.
The aim of my first study was to identify service providers’ perspectives on the mental health needs and service use of Afghan refugees in the U.S. by conducting interviews with service providers. I completed interviews with nine service providers in January 2024. These service providers highlighted a number of barriers Afghan refugees face in accessing mental health services, including language barriers, cultural stigma, and a lack of knowledge about available resources. Furthermore, they emphasized the importance of providing culturally sensitive care and developing community-based support networks.
The aim of my second study was to identify refugee perceptions of supports and barriers to mental health in a sample of 20 adult Afghan refugees in two cities of California--Fremont and Sacramento. I found that language barriers, cultural stigmas surrounding mental health, financial constraints, and limited access to services all contributed to Afghan refugees’ mental health issues. Those arriving since 2021 had better access to supportive services than those who came to the U.S. in earlier waves. Participants who received services were very grateful for the assistance. They also recognized the importance of family, community, and faith-based coping mechanisms in addressing mental health issues.
The aim of my third study was to identify how socioeconomic status, sex, and years living in the U.S. influence mental health service utilization for Afghan refugees through quantitative surveys. Surveys were completed by 189 adults. I found that socioeconomic factors, such as household income in the U.S., significantly affected Afghan refugee mental health service utilization. Additionally, prior knowledge of mental health services and feelings of safety within the community were significant predictors of service use. Unexpectedly, neither sex nor years living in the U.S. were significantly associated with service utilization.
Taken together, the findings suggest that addressing the complex interplay of socioeconomic, cultural, and structural factors is essential in promoting mental health service utilization among Afghan refugees in the U.S. Based on these findings, recommendations for practice are outlined, including providing targeted support for refugees with limited financial resources, improving language-appropriate and culturally competent mental health services, and increasing awareness and outreach efforts within refugee communities. These findings also can be useful in shaping policy in the area of mental health services for refugees and helping design interventions that promote access to and utilization of mental health services for Afghan refugees in the U.S. Future researchers in this area should consider longitudinal studies, which would allow for follow-up of Afghan refugees who need mental health services, comparing outcomes among those that do and do not receive mental health services
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125 pages
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