New paradigms of enquiry into posttraumatic stress disorder symptoms and adaptation in adolescents from refugee backgrounds: a mixed methods approach

Historically, research with refugee populations has generally characterised the impact of the refugee experience in psychopathological terms, that is, by examining how particular aspects of people’s experiences as refugees lead to specific psychiatric outcomes. Particular emphasis has been devoted to the examination of posttraumatic stress disorder (PTSD), with prevalence studies consistently finding that a small but significant proportion of refugees develop the disorder. Though the PTSD syndrome has been shown to be valid in ethnically diverse refugee populations, the emphasis on examining PTSD specifically, and psychopathology generally, has come under increased debate in recent years. Critics argue that research into PTSD has been reductive in focus, in its failure to examine how interrelationships between pre-migration, resettlement and psychosocial variables act in the aetiology of the disorder. Further critique has been directed toward the emphasis on examining PTSD and psychopathology as predominant outcomes of the refugee experience, when other important familial, psychosocial and adaptive processes are clearly implicated, yet understudied. The overarching aim of this thesis, therefore, was to examine the impacts of the refugee experience in general, and PTSD symptomatology in particular, from broader conceptual and empirical perspectives. Three empirical studies utilising a mixed-methods research approach were undertaken, with a total of 50 young people from refugee backgrounds participating in the research. Participants completed quantitative measures assessing for PTSD symptomatology and use of coping styles, and partook in a semi-structured interview specifically designed for use in the present research and based on a proposed theoretical model of refugee adaptation. The first study, comprised of the full sample of 50 participants, sought to jointly investigate how familial separations and the use of coping styles related to PTSD symptomatology in youth. Young people who were residing with non-intact immediate families were found to have higher levels of PTSD symptomatology than those who did not have immediate familial separations, though there were no differences between groups in their use of coping styles. Hierarchical multiple regressions revealed a significant relationship between the use of avoidance coping and increased PTSD symptoms, however this diminished to non-significance once possible confounds were controlled for. The second study aimed to explore, based on adolescents’ accounts of their resettlement and refugee experiences, psychosocial and adaptive mechanisms that may play a role in PTSD symptomatology. This study was based on a sub-sample of 10 participants, and utilised interpretative phenomenological analysis to analyse the differences in qualitative accounts between participants with high and low levels of PTSD symptoms. The themes of cultural belongingness and identification, psychological functioning, family unit functioning and relationships, and friendships and interpersonal processes, were identified as having particular relevance for distinguishing between participants with high and low levels of PTSD symptomatology. The third study was based on a sub-sample of 43 participants, all of whom completed the semi-structured interview and consented for it to be audio-recorded. This study was undertaken to examine the applicability of a theoretical model of psychosocial adaptation to adolescents’ accounts of their refugee and resettlement experiences. Utilising thematic analysis, preliminary evidence for the model’s validity was obtained. Taken together, the results from the present thesis provide strong evidence for the need to conceptualise and examine the impacts of the refugee experience from broader psychosocial and ecological perspectives. Adolescents’ familial systems were particularly implicated in the studies’ findings, emphasising the need for future theory development and research to consider this central, yet understudied, aspect of the refugee experience