Skip to main content

Advertisement

Log in

The Relationship Between Acculturative Stress and Postmigration Mental Health in Iraqi Refugee Women Resettled in San Diego, California

  • Original Paper
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Due to the lack of research on the adverse impact of acculturative stress on the mental health, the current study examined the associations between acculturative stress and post-migration mental health outcomes among 219 Iraqi refugee women resettled in San Diego, California. Mental illness, trauma history, and acculturative stress were measured and descriptive statistical analyses, and multivariate logistic regression analyses were conducted to determine the association between acculturative stress, depression, and anxiety among the refugee women.

About half of the participants were categorized as having anxiety (45.6%) and depression (55.3%). The multivariate regression analysis found that the odds of a mental health outcome of depression and anxiety in relation to acculturative stress, increases by a factor of 1.056 and 1.076 respectively, for every point increase on the acculturative stress scale.

The study’s findings reflect a linear association of acculturative stress with depression and anxiety among Iraqi refugee mothers resettled in San Diego. The mental well-being of refugees does not always improve nor does their trauma disappear by resettling in a new country. Policy makers should consider extending the evaluation, follow-up, and support of Iraqi refugee mental health long beyond the current 90 post arrival policy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Abe, J. S., & Zane, N. W. (1990). Psychological maladjustment among Asian and White American college students: Controlling for confounds. Journal of Counseling Psychology, 37, 437–444.

    Google Scholar 

  • Abe-Kim, J. S., Okazaki, S., & Goto, S. G. (2001). Unidimensional versus dimensional approaches to the assessment of acculturation for Asian American populations. Cultural Diversity & Ethnic Minority Psychology, 7, 232–246.

    CAS  Google Scholar 

  • Ahmed, S. R., Kia-Keating, M., & Tsai, K. H. (2011). A structural model of racial discrimination, acculturative stress, and cultural resources among Arab American adolescents. American Journal of Community Psychology, 48(3–4), 181–192. https://doi.org/10.1007/s10464-011-9424-3.

    Article  PubMed  Google Scholar 

  • Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46, 5–34.

    Google Scholar 

  • Berry, J. W. (1998). Acculturation and health: Theory and research. In S. S. Kazarian & D. R. Evans (Eds.), Cultural clinical psychology: Theory, research, and practice (pp. 39–57). Washington, DC: American Psychological Association.

    Google Scholar 

  • Berry, J. W. (2006). Acculturation: A conceptual overview. In M. H. Bornstein & L. R Cote (Eds.), Acculturation and parent-child relationships: Measurement and development (pp. 13–30). Lawrence Erlbaum Associates Publishers.

  • Betancourt, T. S., Abdi, S., Ito, B. S., Lilienthal, G. M., Agalab, N., & Ellis, H. (2015). We left one war and came to another: Resource loss, acculturative stress, and caregiver-child relationships in Somali refugee families. Cultural Diversity & Ethnic Minority Psychology, 21(1), 114–125. https://doi.org/10.1037/a0037538.

    Article  Google Scholar 

  • Bith-Melander, P., Chowdhury, N., Jindal, C., & Efird, J. T. (2017). Trauma affecting Asian-Pacific islanders in the San Francisco bay area. International Journal of Environmental Research and Public Health, 14(9), 1053.

    PubMed Central  Google Scholar 

  • Bogic, M., Njoku, A., & Priebe, S. (2015). Long-term mental health of war-refugees: A systematic literature review. BMC International Health and Human Rights, 15(1), 29.

    PubMed  PubMed Central  Google Scholar 

  • Bond, L., Giddens, A., Cosentino, A., Cook, M., Hoban, P., Haynes, A., et al. (2007). Changing cultures: Enhancing mental health and wellbeing of refugee young people through education and training. Promotion & Education, 14(3), 143–149.

    Google Scholar 

  • Brown, C., Schale, C. L., & Nilsson, J. E. (2010). Vietnamese immigrant and refugee women’s mental health: An examination of age of arrival, length of stay, income, and English language proficiency. Journal of Multicultural Counseling and Development, 38(2), 66–76.

    Google Scholar 

  • Bulut, E., & Gayman, M. D. (2016). Acculturation and self-rated mental health among Latino and Asian immigrants in the United States: A Latent class analysis. Journal of Immigrant and Minority Health, 18(4), 836–849.

    PubMed  Google Scholar 

  • Burnam, M. A., Hough, R. L., Karno, M., Escobar, J. I., & Telles, C. (1987). Acculturation and lifetime prevalence of psychiatric disorders among Mexican Americans in Los Angeles. Journal of Health and Social Behaviors, 28, 89–102.

    CAS  Google Scholar 

  • Cainkar, L. (1999). The deteriorating ethnic safety net among Arab immigrants in Chicago (p. 246). Social and Cultural Sciences Faculty Research and Publications.

  • California Department of Social Services (CDSS)-Refugee Programs Bureau. Total Arrivals to California Counties by Country of Origin. (2017). October 1, 1994 through September 30, 2016. Retrieved from: https://www.cdss.ca.gov/Portals/9/Refugee/Arrivals/1995-2016_Arrivals_by_Country_of%20Origin_and_County.pdf?ver=2017-08-18-105610-630

  • Carswell, K., Blackburn, P., & Barker, C. (2011). The relationship between trauma, post-migration problems and the psychological well-being of refugees and asylum seekers. International Journal of Social Psychiatry, 57(2), 107–119. https://doi.org/10.1177/0020764008105699.

    Article  Google Scholar 

  • Chung, R. C. Y. (2001). Psychosocial adjustment of Cambodian refugee women: Implications for mental health counseling. Journal of Mental Health Counseling, 23(2), 115.

    Google Scholar 

  • Chung, R. C. Y., Bemak, F., & Kagawa-Singer, M. (1998). Gender differences in psychological distress among Southeast Asian refugees. The Journal of Nervous and Mental Disease, 186(2), 112–119.

    CAS  PubMed  Google Scholar 

  • Connor, K., & Davidson, J. (2003). Development of a new resilience scale: The Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety, 18, 76–82. https://doi.org/10.1002/da.10113.

    Article  PubMed  Google Scholar 

  • Dekel, R., & Goldblatt, H. (2008). Is there intergenerational transmission of trauma? The case of combat veterans’ children. American Journal of Orthopsychiatry, 78(3), 281–289.

    Google Scholar 

  • East, P. L., Gahagan, S., & Al-Delaimy, W. K. (2018). The impact of refugee mothers’ trauma, posttraumatic stress, and depression on their children’s adjustment. Journal of Immigrant and Minority Health, 20, 271–282.

    PubMed  Google Scholar 

  • Escobar, J. I. (1998). Immigration and mental health: Why are immigrants better off? Archives of General Psychiatry, 55, 781–782.

    CAS  PubMed  Google Scholar 

  • Fagen, P. W. (2011). Refugees and IDPs after conflict. United States Institute of Peace, Special Report, 268, 1–15.

  • Fares, S., Dirani, J., & Darwish, H. (2019). Arabic validation of the hopkins symptom checklist-25 (HSCL) in a Lebanese sample of adults and older adults. Current Psychology, 1–8.

  • Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309–1314.

    Google Scholar 

  • Field, N. P., Muong, S., & Sochanvimean, V. (2013). Parental styles in the intergenerational transmission of trauma stemming from the Khmer Rouge regime in Cambodia. American Journal of Orthopsychiatry, 83(4), 483–494.

    Google Scholar 

  • Ghaffarian, S. (1998). The acculturation of Iranian immigrants in the United States and the implications for mental health. The Journal of Social Psychology, 138(5), 645–654.

    CAS  PubMed  Google Scholar 

  • Glymour, M. M. (2006). Using causal diagrams to understand common problems in social epidemiology. Methods in Social Epidemiology, 393–428.

  • González, H. M., Vega, W. A., & Tarraf, W. (2010). Health care quality perceptions among foreign-born Latinos and the importance of speaking the same language. The Journal of the American Board of Family Medicine, 23(6), 745–752.

    PubMed  Google Scholar 

  • Hadley, C., Zodhiates, A., & Sellen, D. W. (2007). Acculturation, economics and food insecurity among refugees resettled in the USA: A case study of West African refugees. Public Health Nutrition, 10(4), 405–412.

    PubMed  Google Scholar 

  • Hernán, M. A., Hernández-Díaz, S., Werler, M. M., & Mitchell, A. A. (2002). Causal knowledge as a prerequisite for confounding evaluation: An application to birth defects epidemiology. American Journal of Epidemiology, 155(2), 176–184.

    PubMed  Google Scholar 

  • Hofstra, J., van Oudenhoven, J. P., & Buunk, B. P. (2005). Attachment styles and majority members’ attitudes towards adaptation strategies of immigrants. International Journal of Intercultural Relations, 29(5), 601–619.

    Google Scholar 

  • Hollander, A. C. (2013). Social inequalities in mental health and mortality among refugees and other immigrants to Sweden–epidemiological studies of register data. Global Health Action, 6(1), 21059.

    PubMed  Google Scholar 

  • Hovey, J. D., & Magaña, C. G. (2002). Psychosocial predictors of anxiety among immigrant Mexican migrant farmworkers: Implications for prevention and treatment. Cultural Diversity and Ethnic Minority Psychology, 8(3), 274–289.

    PubMed  Google Scholar 

  • Hsu, E., Davies, C. A., & Hansen, D. J. (2004). Understanding mental health needs of Southeast Asian refugees: Historical, cultural, and contextual challenges. Clinical Psychology Review, 24(2), 193–213.

    PubMed  Google Scholar 

  • Jamil, H., Hakim-Larson, J., Farrag, M., Kafaji, T., Duqum, I., & Jamil, L. H. (2002). A retrospective study of Arab American mental health clients: Trauma and the Iraqi refugees. American Journal of Orthopsychiatry, 72(3), 355–361.

    Google Scholar 

  • Jamil, H., Farrag, M., Hakim-Larson, J., Kafaji, T., Abdulkhaleq, H., & Hammad, A. (2007). Mental health symptoms in Iraqi refugees: Posttraumatic stress disorder, anxiety, and depression. Journal of Cultural Diversity, 14(1), 19.

    PubMed  Google Scholar 

  • Kartal, D., & Kiropoulos, L. (2016). Effects of acculturative stress on PTSD, depressive, and anxiety symptoms among refugees resettled in Australia and Austria. European Journal of Psychotraumatology, 7(1), 28711.

    PubMed  Google Scholar 

  • Kira, I. A., Lewandowski, L., Templin, T., Ramaswamy, V., Ozkan, B., & Mohanesh, J. (2010). The effects of perceived discrimination and backlash on Iraqi refugees’ mental and physical health. Journal of Muslim Mental Health, 5(1), 59–81.

    Google Scholar 

  • Kira, I. A., Lewandowski, L., Chiodo, L., & Ibrahim, A. (2014). Advances in systemic trauma theory: Traumatogenic dynamics and consequences of backlash as a multi-systemic trauma on Iraqi refugee Muslim adolescents. Psychology, 5(05), 389.

    Google Scholar 

  • Kleijn, W. C., Hovens, J. E., & Rodenburg, J. J. (2001). Posttraumatic stress symptoms in refugees: Assessments with the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist–25 in different languages. Psychological Reports, 88(2), 527–532. https://doi.org/10.2466/pr0.2001.88.2.527.

    Article  CAS  PubMed  Google Scholar 

  • Kuo, W. (1984). Prevalence of depression among Asian-Americans. Journal of Nervous and Mental Disease, 172, 449–457.

    CAS  Google Scholar 

  • LeMaster, J. W., Broadbridge, C. L., Lumley, M. A., Arnetz, J. E., Arfken, C., Fetters, M. D., et al. (2018). Acculturation and post-migration psychological symptoms among Iraqi refugees: A path analysis. American Journal of Orthopsychiatry, 88(1), 38.

    Google Scholar 

  • Lischer, S. K. (2008). Security and displacement in Iraq: Responding to the forced migration crisis. International Security, 33(2), 95–119. https://doi.org/10.1162/isec.2008.33.2.9.

    Article  Google Scholar 

  • Matheson, K., Jorden, S., & Anisman, H. (2008). Relations between trauma experiences and psychological, physical and neuroendocrine functioning among Somali refugees: Mediating role of coping with acculturation stressors. Journal of Immigrant Minority Health, 10(4), 291–304. https://doi.org/10.1007/s10903-007-9086-2.

    Article  PubMed  Google Scholar 

  • Mikal, J. P., & Woodfield, B. (2015). Refugees, post-migration stress, and internet use: A qualitative analysis of intercultural adjustment and internet use among Iraqi and Sudanese refugees to the United States. Qualitative Health Research, 25(10), 1319–1333.

    PubMed  Google Scholar 

  • Miller, A. M., & Chandler, P. J. (2002). Acculturation, resilience, and depression in midlife women from the former Soviet Union. Nursing Research, 51(1), 26–32.

    PubMed  Google Scholar 

  • Nickerson, A., Bryant, R. A., Schnyder, U., Schick, M., Mueller, J., & Morina, N. (2015). Emotion dysregulation mediates the relationship between trauma exposure, post-migration living difficulties and psychological outcomes in traumatized refugees. Journal of Affective Disorders, 173, 185–192. https://doi.org/10.1016/j.jad.2014.10.043.

    Article  PubMed  Google Scholar 

  • Padilla, A. M., Wagatsuma, Y., & Lindholm, K. J. (1985). Acculturation and personality as predictors of stress in Japanese and Japanese Americans. Journal of Social Psychology, 125, 295–305.

    CAS  Google Scholar 

  • Peña-Sullivan, L. (2020). The “wrong kind” of immigrants: Pre-migration trauma and acculturative stress among the undocumented latinx community. Clinical Social Work Journal, 48(4), 351–359.

    Google Scholar 

  • Phillimore, J. (2011). Refugees, acculturation strategies, stress and integration. Journal of Social Policy, 40(3), 575–593.

    Google Scholar 

  • Phinney, J. S., Horenczyk, G., Liebkind, K., & Vedder, P. (2001). Ethnic identity, immigration, and well-being: An interactional perspective. Journal of Social Issues, 57(3), 493–510.

    Google Scholar 

  • Ponce, N. A., Lavarreda, S. A., Yen, W., Brown, E. R., DiSogra, C., & Satter, D. E. (2004). The California Health Interview Survey 2001: Translation of a major survey for California’s multiethnic population. Public Health Reports, 119(4), 388–395.

    PubMed  PubMed Central  Google Scholar 

  • Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Jama, 294(5), 602–612.

    CAS  PubMed  Google Scholar 

  • Roche, K. M., Vaquera, E., White, R. M., & Rivera, M. I. (2018). Impacts of immigration actions and news and the psychological distress of U.S. Latino parents raising adolescents. Journal of Adolescent Health, 62(5), 525–531.

    Google Scholar 

  • Schweitzer, R. D., Vromans, L., Brough, M., Asic-Kobe, M., Correa-Velez, I., Murray, K., & Lenette, C. (2018). Recently resettled refugee women-at-risk in Australia evidence high levels of psychiatric symptoms: Individual, trauma and post-migration factors predict outcomes. BMC Medicine, 16(1), 149.

    PubMed  PubMed Central  Google Scholar 

  • Shekunov, J. (2016). Immigration and risk of psychiatric disorders: A review of existing literature. American Journal of Psychiatry Residents Journal, 11(2), 3–5.

    Google Scholar 

  • Shrier, I., & Platt, R. W. (2008). BMC Medical Research Methodology, 8, 70. https://doi.org/10.1186/1471-2288-8-70.

    Article  PubMed  PubMed Central  Google Scholar 

  • Simich, L., Beiser, M., & Mawani, F. N. (2003). Social support and the significance of shared experience in refugee migration and resettlement. Western Journal of Nursing Research, 25(7), 872–891.

    PubMed  Google Scholar 

  • Siriwardhana, C., Ali, S. S., Roberts, B., & Stewart, R. (2014). A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants. Conflict and Health, 8(1), 13.

    PubMed  PubMed Central  Google Scholar 

  • Söndergaard, H. P., & Theorell, T. (2004). Language acquisition in relation to cumulative posttraumatic stress disorder symptom load over time in a sample of resettled refugees. Psychotherapy and Psychosomatics, 73(5), 320–323.

    PubMed  Google Scholar 

  • Suttorp, M. M., Siegerink, B., Jager, K. J., Zoccali, C., & Dekker, F. W. (2015). Graphical presentation of confounding in directed acyclic graphs. Nephrology Dialysis Transplantation, 30(9), 1418–1423. https://doi.org/10.1093/ndt/gfu325.

    Article  Google Scholar 

  • Szaflarski, M., Cubbins, L. A., & Meganathan, K. (2017). Anxiety disorders among US immigrants: The role of immigrant background and social-psychological factors. Issues in Mental Health Nursing, 38(4), 317–326.

    PubMed  PubMed Central  Google Scholar 

  • Taylor, E. M., Yanni, E. A., Pezzi, C., Guterbock, M., Rothney, E., Harton, E., et al. (2014). Physical and mental health status of Iraqi refugees resettled in 2the United States. Journal of Immigrant and Minority Health, 16(6), 1130–1137.

    PubMed  PubMed Central  Google Scholar 

  • Thibeault, M. A., Mendez, J. L., Nelson‐Gray, R. O., & Stein, G. L. (2017). Impact of trauma exposure and acculturative stress on internalizing symptoms for recently arrived migrant‐origin youth: Results from a community‐based partnership. Journal of Community Psychology, 45(8), 984–998.

    Google Scholar 

  • Thomas, M., & Choi, J. B. (2006). Acculturative stress and social support among Korean and Indian immigrant adolescents in the United States. Journal of Sociology and Social Welfare, 33(2), 123–143.

    Google Scholar 

  • United Nations High Commission for Refugees. (2018). Statistics on displaced Iraqis around the world. UNHCR-Iraq emergency. Retrieved December 4, 2020, from https://www.unhcr.org/iraq-emergency.html.

  • Van Oudenhoven, J. P., Ward, C., & Masgoret, A. (2006). Patterns of relations between immigrants and host societies. International Journal of Intercultural Relations, 30(6), 637–651.

    Google Scholar 

  • Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime prevalence of DSM–III–R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55, 771–778.

    CAS  PubMed  Google Scholar 

  • Wang, C. D., & Mallinchrodt, B. (2006). Acculturation, attachment, and psychosocial adjustment of Chinese/Taiwanese international students. Journal of Counseling Psychology, 53, 422–433.

    Google Scholar 

  • Wei, M., Heppner, P., Mallen, M., Ku, T., Liao, K., & Wu, T. (2007). Acculturative stress, perfectionism, years in the United States, and depression among Chinese international students. Journal of Counseling Psychology, 54, 385–394.

    Google Scholar 

  • Williams, C. L., & Berry, J. W. (1991). Primary prevention of acculturative stress among refugees: Application of psychological theory and practice. American Psychologist, 46(6), 632.

    CAS  Google Scholar 

  • Wood, R. M., & Gibney, M. (2010). The Political Terror Scale (PTS): A re-introduction and a comparison to CIRI. Human Rights Quarterly, 32, 367.

    Google Scholar 

  • Xu, L., & Chi, I. (2013). Acculturative stress and depressive symptoms among Asian immigrants in the United States. Asian American Journal of Psychology, 4(3), 217–226. https://doi.org/10.1037/a0030167.

    Article  Google Scholar 

  • Yako, R. M., & Biswas, B. (2014). “We came to this country for the future of our children. We have no future”: Acculturative stress among Iraqi refugees in the United States. International Journal of Intercultural Relations, 38, 133–141.

    Google Scholar 

  • Yeh, C. J. (2003). Age, acculturation, cultural adjustment, and mental health symptoms of Chinese, Korean, and Japanese immigrant youths. Cultural Diversity and Ethnic Minority Psychology, 9(1), 34–48.

    PubMed  Google Scholar 

  • Ziaian, T., de Anstiss, H., Antoniou, G., Baghurst, P., & Sawyer, M. (2012). Resilience and its association with depression, emotional and behavioural problems, and mental health service utilisation among refugee adolescents living in South Australia. International Journal of Population Research, 2012.

Download references

Acknowledgements

Data collection for this work was supported by a grant from the UC San Diego Community Pediatrics pilot funding.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wael K. Al-Delaimy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yun, S., Ahmed, S.R., Hauson, A.O. et al. The Relationship Between Acculturative Stress and Postmigration Mental Health in Iraqi Refugee Women Resettled in San Diego, California. Community Ment Health J 57, 1111–1120 (2021). https://doi.org/10.1007/s10597-020-00739-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-020-00739-9

Keywords

Navigation