Scandinavian Journal of Psychology, 2015, 56, 203–211
DOI: 10.1111/sjop.12194
Personality and Social Psychology The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers BRIT OPPEDAL1 and THORMOD IDSOE1,2 1 2
Department of Child Development and Mental Health, Norwegian Institute of Public Health, Oslo, Norway Norwegian Centre for Learning Environment and Behavioural Research in Education, University of Stavanger, Stavanger, Norway
Oppedal, B. & Idsoe, T. (2015). The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers. Scandinavian Journal of Psychology, 56, 203–211. There is a lack of knowledge about psychosocial resources that may sustain post-resettlement psychological adjustment among unaccompanied minor asylum-seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population-based multi-ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel. Key words: Acculturation, culture competence, depression, discrimination, mental health, post-traumatic stress symptoms, social support, unaccompanied minor asylum-seekers. Brit Oppedal, Norwegian Institute of Public Health, Department of Child Development and Mental Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway. E-mail: [email protected]
INTRODUCTION Unaccompanied minor asylum seekers have been exposed to more traumatic events and suffer from higher levels of mental health problems than other refugee and immigrant children, even years after they have been granted residence in their destination countries (Bean, Derluyn, Eurelings-Bontekoe, Broekaert & Spinhoven, 2007; Bronstein & Montgomery, 2011; Derluyn, Mels & Broekaert, 2009; Huemer, Karnik, Voelkl-Kernstock et al., 2009). Still, observers have noted strong agency and adaptive functioning among many of them (Bates, Baird, Johnson, Lee, Luster & Rehagen, 2005; Geltman, Grant-Knight, Mehta et al., 2005; Rousseau, Said, Gagne & Bibeau, 1998). In spite of the significance of social support in positive developmental outcomes, there is a lack of research on these children’s transnational social relations and success in reconstructing social supportive networks abroad and in the resettlement countries. This study aims at investigating to what extent unaccompanied minor asylum seekers perceive family networks abroad and peer networks in the resettlement country as supportive. We further explore the potential role of these networks in their post-resettlement acculturation and aspects of their mental health such as symptoms of post-traumatic stress and depression, which are the most common outcomes of war-related loss and violence among children and youth. Information about psychosocial resources that may sustain post-resettlement psychological adjustment can provide knowledge that is clinically relevant, and that may give directions to interventions to promote mental health. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
The terms “unaccompanied minor asylum seekers” or “unaccompanied minors” refer to children who migrate unaccompanied by a legal caretaker to seek asylum in a foreign country. We employ the term “unaccompanied refugees” about the participants in this study who have received residence in Norway, and in some cases have reached the age of majority. The study focuses on the proximal family and peer environments of the unaccompanied refugees, nevertheless some important macro level factors (Bronfenbrenner, 1994) should be mentioned: while some European countries grant temporary residence to unaccompanied minors until they turn 18 years, in Norway, typically, a granted residence is permanent. When the asylum application is approved, the unaccompanied refugees are resettled in municipalities nationwide, where local educational, health and child protective services oversee their developmental and psychological needs. A multiple level study did not show variation in symptoms of depression dependent on the municipality where the unaccompanied refugees resided, despite substantial demographic differences (Seglem, Oppedal & Raeder, 2011). Special group homes with full or part time staff are the typical living arrangements offered at resettlement. Culturally based discrimination is associated with poor mental health outcomes (Garcıa Coll, Lamberty, Jenkins et al., 1996; Greene, Way & Pahl, 2006; Uma~ na-Taylor & Updegraff, 2007). Norway ranks in the middle among European countries regarding openness and positive attitudes towards immigrants (Blom, 2006), and about 25% immigrants from non-Western countries
204 B. Oppedal and T. Idsoe report experiences of discrimination in different areas (Blom & Henriksen, 2008).
Social support and mental health The risk of mental health problems associated with childhood parental loss and other harsh life circumstances may be countered by children’s capacity to establish supportive relationship with extra-familial peers and adults, one of the basic resources in resilience processes (Masten, 2007; Rutter, 2005; Werner, 1995). Consequently, the reconstruction of family ties abroad and successful establishment of new supportive relationships in the country of asylum may be critical to the psychological adjustment of unaccompanied minors. The presence of social supportive relations before, during or after exposure to traumatic events has been identified as a consistent protective factor against developing and maintaining posttraumatic stress disorders PTSD (Brewin, Andrews & Valentine, 2004; Schnurr, Lunney & Sengupta, 2004). Such protective effects of social support have also been shown in relation to less pervasive stressors, such as daily hassles (Cohen & Wills, 1985; Sirin, Gupta, Ryce, Katsiaficas, Suarez-Orozco & Rogers-Sirin, 2013; Ystgaard, 1999). Social support also has beneficial effects on health in and by itself (Cohen, 1992; Oppedal & Roysamb, 2004; Rueger & Malecki, 2011; Sterrett, Jones, McKee & Kincaid, 2011). According to the main effect hypothesis supportive networks provide individuals with a sense of stability and predictability in their life situation, and a sense of being valued and esteemed (Cohen, 1992). The hypothesis also implicates mediation, as social support may either reduce the risk of negative behavior and exposure to stressful events, or increase competencies that aid people in dealing with stressful events (Cohen, 1992; Cohen and Wills, 1985; Rueger, Malecki & Demaray, 2010).
Acculturation There is considerable variation in the conceptualization of acculturation, however, it is commonly accepted that adaptation both to the heritage and the majority culture is involved (Berry, 1997; Motti-Stefanidi, Berry, Chryssochoou, Sam & Phinney, 2012; Rudmin, 2009; Schwartz, Unger, Zamboanga & Szapoocznik, 2010). One of the challenges of the conceptualization concerns the distinction between acculturation and ontogenetic development (Garcıa Coll et al., 1996; Sch€onpflug, 1997). Some researchers conceptualize acculturation simply as the development of children with immigrant backgrounds growing up in multicultural contexts (Oppedal, 2006; Sam, 2006; Sch€onpflug, 1997). From this perspective Oppedal (2006) argues that an important developmental task of acculturation is to gain necessary culture competence to succeed and have a sense of belongingness both within the heritage and the majority cultural domains; namely, heritage and host culture competence respectively. Culture competence involves knowledge and skills about verbal and non-verbal communication and interpersonal behavior patterns, and the values underlying these (Oppedal & Idsoe, 2012). The notion of culture competence is relevant when acculturation is investigated in relation to mental health, since © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
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competence is a central construct both in developmental psychopathology (Cicchetti & Schneider-Rosen, 1986) and resilience (Masten & Obradovic, 2006). During adolescence friends become increasingly important as sources of support, even if the significance of parents does not diminish (del Valle, Bravo & Lopez, 2010; Stice, Ragan & Randall, 2004). Consequently, important culture competence at this stage involves knowledge and skills that facilitate establishment and maintenance of friendship. Previous research has confirmed associations between culture competence and mental health in terms of self-esteem and internalizing symptoms, both among immigrant youth in families and unaccompanied refugees (Birman & Taylor-Ritzler, 2007; Oppedal & Idsoe, 2012; Oppedal, Roysamb & Heyerdahl, 2005).
Social support, culture competence, and discrimination A necessary condition for successful age relevant development of culture competence is that acculturating individuals entertain close relationships within the heritage and majority society cultures. Research involving youth in immigrant families has shown that support from majority culture networks was associated with host culture competence while family support was associated with heritage culture competence. Both paths had independent effects on mental health (Oppedal, Roysamb & Sam, 2004). Transnational families. With the exception of studies on the lost boys of Sudan (Luster, Qin, Bates, Johnson & Rana, 2008, 2009), there has been little focus on the role of supportive family ties in post-resettlement adaptation of unaccompanied minors. Family members abroad may represent a crucial source of emotional support in terms of perception of belonging and being valued and loved (Cohen, 1992; Luster et al., 2008, 2009). Furthermore, having contact with the family abroad implicates a cultural continuity that may provide the children with a sense of a bridge between the past and the present that sustains identity and facilitates further development of heritage culture competence (Costigan & Dokis, 2006; Tseng & Fuligni, 2000). Friends. For unaccompanied minors the establishment of close relationships with co-ethnic peers after resettlement may provide a sense of cultural continuity, of being understood, and of sharing experiences and history. Similar to the family abroad, co-ethnic friends may contribute to the maintenance and further development of the refugees’ heritage culture competence. On the other hand, contact with friends from the majority culture enables increases in knowledge and skills of necessary language and behavior patterns that can facilitate perception of being successful within and belonging to the new country’s culture (Birman, 1998; Oppedal et al., 2004). Perceived discrimination. Research has demonstrated harmful outcomes of discrimination on mental health (Green et al., 2006; Uma~ na-Taylor & Updegraff, 2007; Verkuyten & Thijs, 2006). However, resources such as strong ethnic identity, self-esteem, and social support may ameliorate the detrimental health impact, or reduce the perception of being discriminated against (Branscombe, Schmitt & Harvey, 1999; Ellis, MacDonald, Lincoln &
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Cabral, 2008). This study further the investigations of mechanisms that may explain the association between discrimination and mental health problems by proposing that individuals who perceive social support and are culturally competent are less susceptible to perceptions of discrimination. In short, knowledge about the quality of the relationships that unaccompanied refugees maintain to family and friends is important to understanding their post-migration psychological adjustment. This is so because of the close relations between social support and mental health (Brewin et al., 2000; Cohen & Wills, 1985), and because of the dynamics between social support and acculturation (Birman & Taylor-Ritzler, 2007; Oppedal et al., 2004; Sirin et al., 2013).
Aims The overall aim is to investigate the impact of support from family and friends on acculturation, discrimination, and mental health outcomes in terms of intrusive post-traumatic stress symptoms and symptoms of depression, among unaccompanied refugees. We first investigate potential differences in the level of these indices between youth who have and do not have contact with their family. Second, we test a model of hypothesized effects from social support based on research on associations between support and PTSD and notions that supportive relationships may increase competence that facilitates dealing with stressful events: (1) Social support predicts lower levels in Impact of war-related
(2)
(3) (4) (5)
traumatic events, IWRTE (intrusive post-traumatic stress symptoms) Support from family abroad and co-ethnic friends predicts heritage culture competence; support from host friends predicts host culture competence IWRTE predicts higher levels whereas culture competence predicts lower levels of perceived discrimination The effects of social support on depression is mediated by culture competence and IWRTE; Host and heritage culture competence predict lower levels of perceived discrimination and thereby lower levels of depression.
In the model we control for effects of gender, age, and length of stay in Norway.
METHOD Sample The population base for the project was unaccompanied refugees who were granted asylum between 2000 and 2010, and who were 13 years or more when their applications were approved, N = 4,051 (www.fhi.no/studier/ungkul). The Norwegian Directorate of Immigration provided information about gender, national origin, birth date, arrival date, and date and place of resettlement. Recruitment and data collection was carried out from the end of 2006 throughout 2011.The study was approved by the Regional Committee for Medical and Health Research Ethics. Based on available economic resources, all known unaccompanied refugees in 41 municipalities nationwide were targeted, n = 1,685. Letters inviting them to participate were sent to their homes and if they were less than 16 years, also to their legal guardians. Of the total invited sample 476 refugees (28.25%) were not possible to locate; 47 (3.9%) © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
declined participation, and 218 (18.0%) youth who confirmed their participation did not show up on the day of data collection. The study sample of 948 participants represented 78.4% of the final sampling frame. The few differences between participants and all non-participants (n = 3,103) reflect the variation over time in the flow of unaccompanied minors. The majority of the participants originated in Afghanistan (51%), Somalia (12%), Iraq (7%), and Sri Lanka (6%), while the remaining 24% included youth from more than 30 other countries; 82.4%, were boys. Their mean age was 18.61 years (SD 2.51), and they had a mean length of stay in Norway of 3.45 (SD 2.28) years.
Procedures The participants were gathered in small groups in familiar locations of their resettlement communities. Research assistants trained by the research team were present to assist them in filling in questionnaires in Norwegian. A protocol with standardized explanations of difficult concepts and English translations of the questions was available to them. In addition, translators who could read the questions in the mother tongue were present when necessary, which applied to about 15% of the sample. Upon completion of the questionnaire the participants received a gift certificate of 12.50 euro.
Measures Depression was measured by the Center for Epidemiological Studies Depression Scale, CES-D for adolescents (Radloff, 1991). CES-D has demonstrated adequate psychometric properties in different adolescent and ethnic groups (Roberts, 1980; Roberts, Andrews, Lewinsohn & Hobs, 1990). We used a Norwegian version of the scale which has previously been translated according to standard procedures, and compared to the Swedish version, in the context of another study (Clausen & Slagsvold, 2005). CES-D assesses how often during the last week the individual have experienced 20 symptoms along four dimensions (somatic symptoms, negative affect, positive affect, interpersonal problems) such as “I was bothered by things that usually don’t bother me.” Response categories range from 0 (rarely/never) to 3 (most of the time/ all the time). Cronbach’s alpha was 0.84. Preliminary analyses have confirmed gender and cross-cultural invariance of the four factor solution of the CES-D in samples including unaccompanied refugees, other immigrant and host youth (Oppedal & Idsoe, 2011a). A second-order factor of the current data gave good fit indices, standardized root mean squared residual (SRMR) = 0.054, root mean square error of approximation (RMSEA) = 0.037, 90% confidence interval (CI) (0.032, 0.043); comparative fit index (CFI) = 0.92; Tucker-Lewis index (TLI) = 0.92. Impact of War-Related Traumatic Events (IWRTE), involved three items. The participants informed whether they had been exposed to war first hand and if so; “do you still have troublesome memories related to the war experience,” and “do you still have nightmares concerning these experiences?” Such intrusive symptoms represent one of the three symptom dimensions included in PTSD, and were chosen based on their frequent occurrence in victims of trauma (Dyregrov & Yule, 2006). Scores ranged from 0 (no war or no symptoms); 1 (experienced war, 1 symptom); or 2 (experienced war, 2 symptoms). Cronbach’s alpha was 0.73. Social support tap emotional and tangible support in addition to reciprocity in social relationships (Ystgaard, 1997), and have in studies of culturally heterogeneous and homogenous samples of youth demonstrated acceptable reliability and validity (Oppedal, 2008; Oppedal & Roysamb, 2004; Ystgaard, 1999). Support from the three networks was assessed separately: family support included five items. Support from ethnic Norwegian friends and from co-ethnic friends included four items each. The participants checked their agreement with statements such as “I feel attached to my family;” “I can count on my friends when I need help” on a four point scale ranging from 1 (totally disagree) to 4 (totally agree). Cronbach’s alpha was 0.83, 0.80, and 0.82 respectively. The three factor SEM model had good fit to the data, after we, in accordance with the modification
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indices, let three pairs of item-residuals correlate; SRMR = 0.071; RMSEA = 0.046, 90% CI (0.038, 0.055); CFI = 0.95; TLI = 0.94. Culture Competence was measured by the by the Host and Heritage Culture Competence Scale for Adolescents, which was developed for the purpose of a large scale research program targeting a variety of immigrant and refugee populations. The gender invariance of the factor structure for a two factor model has been confirmed (Oppedal & Idsoe, 2011b). Furthermore, the construct validity in terms of external references has been demonstrated in prior studies (Dahlhaug, Oppedal & Roysamb, 2010; Oppedal & Idsoe, 2012). The scale includes nine parallel items for host and heritage culture competence. The participants checked on a four point scale from 1 (very difficult) to 4 (very easy) how easy it is for them “to speak Norwegian,” and “to know how to behave when visiting friends and families from your culture.” Cronbach’s alpha was0 .85 and 0.80 respectively. A two-factor model that was estimated gave acceptable fit to the data, after we let the item-residuals for two items correlate based on input from the modification indices; SRMR = 0.064; RMSEA = 0.051, 90% CI (0.046, 0.057); CFI = 0.91; TLI = 0.91. Perceived discrimination included 5 statements indicating varying degrees of cultural victimization (Berry, Kyunghwa, Liebkind et al., 1993). The participants responded to questions like “I have been attacked because of my ethnic background” on a four point scale ranging from fully disagree (1) to fully agree (4). Cronbach’s alpha was 0.73. We obtained a good fit for a one factor model with SRMR = 0.027; RMSEA = 0.00, 90% CI (0.000, 0.044); CFI = 1, TLI = 1, after letting the item-residuals of two item pairs correlate, as suggested by the modification indices. Length of Stay indicated years from arrival in Norway until the date of data collection. Age was self-reported. Contact with family abroad was tapped with one question with response categories of yes / no. For the purposes of the descriptive analyses, we calculated mean sum scores for depression, IWRTE, support, discrimination and culture competence. Missing values. We excluded 53 participants (5.6%) who according to preliminary exploration of the data had missing values on most of the questionnaire items. The excluded group did not differ from the participants in length of stay, gender, age, or national origin. In the remaining sample (N = 895), the number of missing values ranged from 31 to 41 on the included items. We used the full information MLR estimator in Mplus to account for missing data in the final sample (Graham, 2009).
Analyses Conventional analyses were carried out with SPSS (SPSS, 2009), and Mplus 7.1 (Muthen & Muthen, 2013) was used for SEM models. The robust maximum likelihood procedure (MLR) was used because of possible skewness. To assess goodness of fit of the models, Hu and Bentler (1999) recommend using a cut-off value of 0.08 for the standardized root mean squared residual (SRMR), supplementing it with the Tucker-Lewis Index (TLI), the Comparative Fit Index (CFI) with cut-off values close to 0.95, in addition to the Root Mean Square Error of Approximation (RMSEA) with a cut-off value 0.06 or less.
RESULTS Table 1 shows the means and standard deviations for all measures, for the total sample and by contact with the family abroad.
IWRTE and depression Of the 79% of the participants who reported first hand war experiences, 52% had current intrusive symptoms associated with those events. The CES-D has not been clinically validated in Norway; however, the mean value is close to the cut-off of 23 for clinical depression, as suggested by previous studies of adolescents (Rushton, Forcier & Schectman, 2002).
Contact with family abroad About one half of the participants, 458 (51.2%) had contact with their families abroad, either mothers (n = 284), fathers (n = 135), siblings (n = 301), and / or grandparents, uncles, aunts, and cousins (n = 54, 170, 124 respectively).
Table 1. Mean and SD of included variables for the total sample and by contact with family abroad Contact family abroad
Age Stay IWRTE Depression Social support Norwegian friends Social support co-ethnic friends Social support family Host culture competence Heritage culture competence Perceived discrimination
Total
Yes
No
18.62 (2.51) 3.45 (2.28) 0.84 (0.88) 20.89 (9.49) 3.13 (0.67) 3.15 (0.70) 3.23 (0.81) 2.69 (0.60) 3.26 (0.50) 1.80 (0.66)
19.07 (2.78) 3.99 (2.56) 0.84 (0.88) 20.00 (9.58) 3.15 (0.66) 3.21 (0.65) 3.37 (0.70) 2.71 (0.59) 3.30 (0.49) 1.79 (0.63)
18.13*** (2.15) 2.90*** (1.81) 0.82 (0.86) 21.70* (9.31) 3.11 (0.67) 3.09 (0.76) 2.95*** (0.95) 2.68 (0.60) 3.24 (0.51) 1.79 (0.68)
Note: * p < 0.05; *** p < 0.001. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
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Participants who had contact with their family reported more social support and lower levels of depression than participants without contact. The level of support from friends, host and heritage culture competence was the same in the two groups. The effect size for differences in family support based on contact or not was in the medium range (Cohen’s d = 0.51) otherwise the effect sizes were small (Cohen’s d = 0.38, 0.48, and 0.18 respectively).
The structural model The structural model was specified in accordance with the a priori assumptions of relations between the predictors of depression. The model with significant paths and effect sizes from latent constructs and IWRTE on depression is illustrated in Fig. 1. The model had adequate fit indices, SRMR = 0.046; RMSEA = 0.027, 90% CI (0.025, 0.029); CFI = 0.91; TLI = 0.90. IWRTE did not receive significant effects from any of the support networks. Social support from family, co-ethnic and host friends had as predicted, indirect effects on depression mediated by heritage and host culture competence, that was again partially mediated by discrimination (total indirect effects were small: b = –0.02, p < 0.05, b = –0.06, p < 0.01, and b = –0.07, p < 0.01, respectively). Family support had a direct effect on depression (b = –0.14, p < 0.05) in addition to the indirect effect described above. As hypothesized, the effects of social support to culture competence were culture domain specific: heritage culture competence
Support co-ethnic friends
DISCUSSION The present study examined the role of social support in postmigration acculturation and mental health. The results confirm that the young refugees parallel to experiencing high levels of mental health problems, undergo normative adaptation processes in the sense that they reconstruct supportive networks and develope culture competence. This may be a reflection of their agency and ambitions to “make it” in their new home countries, that have been observed in earlier studies (Geltman et al., 2005). Moreover, in accordance with the main effect hypothesis (Cohen, 1992) social support not only has a beneficial effect on mental health in and by itself, but also has an indirect effect by increasing competencies that aid the young refugees in dealing with discrimination.
IWRTE
0.32**
0.25**
0.11**
0.44**
Support Norwegian friends
received effects from support from family abroad and co-ethnic friends (b = 0.15, p < 0.05, b = 0.44, p < 0.05; respectively) while Norwegian culture competence received effects from support from Norwegian friends (b = 0.32, p < 0.05). Furthermore, there were indirect effects on depression from heritage and host culture competence through lower levels of perceived discrimination, however the indirect effects were again small (b = –0.03, p < 0.05; b = –0.05, p < 0.01 respectively). In addition, there were direct negative effects on depression from both competence dimensions (b = –0.12, p < 0.05; b = –0.15, p < 0.05 respectively). The effects from gender, age, and stay on the variables included in the empirical model are shown in Table 2.
Ethnic Competence
–0.13**
–0.26** 0.15**
–0.12**
DiscriminaƟon
0.20**
Depressive Symptoms
–0.14**
–0.15** Family Support
Host Competence
Fig. 1. Structural Model for Effects of Social Support, IWRTE, Culture Competence and Discrimination on Depressive Symptoms. IWRTE: Impact of War Realted Traumatic Events. * p < 0.05, ** p < 0.01. Goodness of fit: SRMR = 0.046; RMSEA = 0.027, 90%CI (0.025, 0.029); CFI = 0.91; TLI = 0.90. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
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Table 2. Effects from demographic variables on variables included in the structural equation model
Gender Age Stay
Depression
IWRTE
Discrim
CC_ethnic
CC_host
SS_familiy
SS_ethnic
SS_Norw
0.11** 0.05 –0.14**
–0.13*** 0.20*** –0.16**
–0.07 0.02 –0.02
–0.07 0.10 –0.10*
–0.14*** –0.18*** 0.27***
–0.02 –0.04 0.07
0.11* –0.06 0.05
0.01 –0.19** 0.25***
Notes: * p < 0.05; ** p < 0.01; *** p < 0.001. Numbers represent standardized regression coefficients resulting from the empirical model. Stay: time since arrival in Norway; IWRTE: Impact of war-related traumatic events; Discrim: perceived discrimination; CC_ethnic: heritage culture competence; CC_host: Norwegian culture competence; SS_family: social support from family abroad; SS_ethnic: social support from co-ethnic friends; SS_Norw: social support from ethnic Norwegian friends.
Social support Family support. The youngsters who have contact with their families abroad, perceive high levels of support from them, in spite of the barriers to physical contact and direct communication. An individual’s assessment of availability of support has been conceptualized as cognitive working models that s/he has developed based on appraisal of a stressful situation, and the need for and the availability of support (Sarason, Sarason & Pierce, 1990). Such working models may serve to promote the capacity among separated family members for intersubjectivity in terms of shared experiences, mutual understanding and empathizing (Stern, 2005), which are important dimensions underlying supportive relationships. Furthermore, from a cultural values’ perspective on child development, it is claimed that there are qualitative differences in parent-child relationships and in the child developmental outcomes that are pursued in collectivist vs. individualist cultures (Kagitcibasi, 2007; Markus & Kitayama, 1991). The interdependent family relationships and self-perceptions endorsed in collectivist cultures, from where the majority of our participants originated, may strengthen the sense of availability of support among family members (Keles & Oppedal, 2013). More specific knowledge about cognitive working models of social support and potential variations associated with cultural values of interdependence vs. independence may add to the knowledge about resilient adaptation processes among children who migrate without the company of their legal caretakers. Peer networks. The youngsters report high levels of support both from their ethnic Norwegian and co-ethnic friends, implying that they have been quite successful in establishing social networks in the local communities. The small, but significant, effect from length of stay in Norway on social support from Norwegian, but not from co-ethnic, friends (Table 2), suggests that idiosyncratic factors are at play when the youngsters establish friendships in different cultural domains. Acquisition of the host language may be one reason that relations with host peers are time dependent. Furthermore, host peers may not be readily available, for practical reasons such as the organization of special introductory classes for unaccompanied refugees who often do not have an age relevant education level. On a more subtle level, sentiments of prejudice in the host population may pose barriers to the construction of supportive peer networks for the unaccompanied refugees.
Effects of social support IWRTE. The lack of significant paths from any of the social support networks to IWRTE was unexpected as research has consis© 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
tently shown that social support protects against development and persistence of PTSD (Brewin et al., 2004; Schnurr et al., 2004). However, in contrast to those studies that were designed to investigate trajectories of PTSD, the project that provides data for the present study was designed to get information about post-resettlement adaptation. Consequently, the measurement of support was not linked to the traumatic war events, neither in time nor in context. A study of victims of abuse showed that self-esteem and appraisal support attenuated the development of PTSD, while tangible and belonging support, which are central dimensions in the present study, did not have additional effects (Hyman, Gold and Cott, 2003). The driving forces of stability and change in IWRTE and the association with depression should be further investigated in future studies. Culture competence and discrimination. The findings corroborate the notion that acculturation can provide unaccompanied refugees with individual resources such as culture competence which is directly associated with lower levels of depressive symptoms and indirectly associated through reduced levels of perceived discrimination. The study underscores the complexities of the acculturation process and its relations to social support and mental health. The findings demonstrate the crucial role that family may play in developmental processes across long distances and national borders. Family and peer networks serve different purposes in the acculturation process of the young unaccompanied refugees by either strengthening their heritage culture competence or contributing to the acquisition of the Norwegian culture competence. In this sense the acculturation of unaccompanied refugees follows the same paths as those of immigrant youth living with their families (Oppedal et al., 2004).
Limitations The study is limited by well-known inadequacies of crosssectional design regarding effects, causality, and predictions. The tested model is designed based on certain theoretical assumptions and implications from prior empirical research; hence to test alternative models was beyond the scope of this study. Most likely, the relation over time between social support and culture competence is reciprocal, with more culture competence facilitating more social support, which then contributes to enhanced culture competence. Likewise, there may be bi-directional relations between depression on the one hand and perceived discrimination or social support on the other. These dynamics should be tested in future longitudinal studies.
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The self-report also involves certain limitations associated with shared method variance that need to be taken into consideration. Unfortunately, cost considerations excluded more complex data collection and design. The study involves predictors of war-related post-traumatic intrusive symptoms (IWRTE) and depression. The impact of war and being a refugee may also affect a variety of other mental health dimensions both in terms of psychopathology and positive mental health. The level of conduct problems and life satisfaction has been addressed in other studies (Oppedal & Idsoe, 2012; Seglem, Oppedal & Roysamb, 2014). The intention of the present study was to test a theory based hypothetical model of the direct and indirect effects of social support in relation to IWRTE and depression. The measure of war-related post-traumatic stress symptoms involved only two items of intrusion. A more comprehensive index is needed for a better understanding of the dynamic over time between symptoms of depression and post-traumatic stress. The effects of culture competence may overlap with effects of other psychological constructs like IQ, cognitive and social skills, and this should be taken into consideration in interpreting the results.
CONCLUSIONS The findings demonstrate the importance of different sources of social support for a positive acculturation process and mental health among the most vulnerable group of immigrant and refugee children. Importantly, it appears that the unaccompanied refugees maintain active working models of the support that is available to them from their family abroad. Furthermore, parallel to suffering from higher levels of mental health problems than other youth (Seglem et al., 2014), they are handling the acculturation related developmental task of acquiring necessary culture competence to succeed both within their heritage and the host cultural domains. This knowledge may enhance our understanding of continuities in social and psychological developmental processes among youth exposed to war-related traumas and loss. The findings give direction to important areas of health promoting interventions, beyond dealing with the sequel of the traumas they have been exposed to, that can be implemented by caseworkers, schools and other institutions locally: first, the efforts of caseworkers and NGO’s in locating family members abroad is very important. Next, facilitating and scaffolding participation in culturally diverse, including host, peer networks, appears to be an important domain of intervention that could be focused in systematic ways. Third, organized activities to strengthen the youngsters’ culture competence may promote their coping with discrimination and mental health. Reinforcing the unaccompanied refugees’ resources by such interventions may be valuable alternatives and supplements to professional mental health services.
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Social support and acculturation 211 Stice, E., Ragan, J. & Randall, P. (2004). Prospective relations between social support and depression: Differential direction of effects for parent and peer support? Journal of Abnormal Psychology, 113, 155–159. Tseng, V. & Fuligni, A. J. (2000). Parent-adolescent language use and relationships among immigrant families with East Asian, Filipino, and Latin American backgrounds. Journal of Marriage and the Family, 62, 465–476. Uma~ na-Taylor, A. J. & Updegraff, K. A. (2007). Latino adolescents’ mental health: Exploring the interrelations among discrimination, ethnic identity, cultural orientation, self-esteem, and depressive symptoms. Journal of Adolescence, 30, 549–567. Verkuyten, M. & Thijs, J. (2006). Ethnic discrimination and global selfworth in early adolescents: The mediating role ethnic self-esteem. International Journal of Behavioral Development, 30, 107–116. Werner, E. E. (1995). Resilience in development. Current Directions in Psychological Science, 4, 81–85. Ystgaard, M. (1997). Life stress, social support and psychological distress in late adolescence. Social Psychiatry and Psychiatric Epidemiology, 32, 277–283. Ystgaard, M. (1999). Life stress, social support and psychological distress in late adolescence: a longitudinal study. Social Psychiatry and Psychiatric Epidemiology, 34, 12–19. Received 27 June 2014, accepted 11 November 2014
DOI: 10.1111/sjop.12194
Personality and Social Psychology The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers BRIT OPPEDAL1 and THORMOD IDSOE1,2 1 2
Department of Child Development and Mental Health, Norwegian Institute of Public Health, Oslo, Norway Norwegian Centre for Learning Environment and Behavioural Research in Education, University of Stavanger, Stavanger, Norway
Oppedal, B. & Idsoe, T. (2015). The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers. Scandinavian Journal of Psychology, 56, 203–211. There is a lack of knowledge about psychosocial resources that may sustain post-resettlement psychological adjustment among unaccompanied minor asylum-seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population-based multi-ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel. Key words: Acculturation, culture competence, depression, discrimination, mental health, post-traumatic stress symptoms, social support, unaccompanied minor asylum-seekers. Brit Oppedal, Norwegian Institute of Public Health, Department of Child Development and Mental Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway. E-mail: [email protected]
INTRODUCTION Unaccompanied minor asylum seekers have been exposed to more traumatic events and suffer from higher levels of mental health problems than other refugee and immigrant children, even years after they have been granted residence in their destination countries (Bean, Derluyn, Eurelings-Bontekoe, Broekaert & Spinhoven, 2007; Bronstein & Montgomery, 2011; Derluyn, Mels & Broekaert, 2009; Huemer, Karnik, Voelkl-Kernstock et al., 2009). Still, observers have noted strong agency and adaptive functioning among many of them (Bates, Baird, Johnson, Lee, Luster & Rehagen, 2005; Geltman, Grant-Knight, Mehta et al., 2005; Rousseau, Said, Gagne & Bibeau, 1998). In spite of the significance of social support in positive developmental outcomes, there is a lack of research on these children’s transnational social relations and success in reconstructing social supportive networks abroad and in the resettlement countries. This study aims at investigating to what extent unaccompanied minor asylum seekers perceive family networks abroad and peer networks in the resettlement country as supportive. We further explore the potential role of these networks in their post-resettlement acculturation and aspects of their mental health such as symptoms of post-traumatic stress and depression, which are the most common outcomes of war-related loss and violence among children and youth. Information about psychosocial resources that may sustain post-resettlement psychological adjustment can provide knowledge that is clinically relevant, and that may give directions to interventions to promote mental health. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
The terms “unaccompanied minor asylum seekers” or “unaccompanied minors” refer to children who migrate unaccompanied by a legal caretaker to seek asylum in a foreign country. We employ the term “unaccompanied refugees” about the participants in this study who have received residence in Norway, and in some cases have reached the age of majority. The study focuses on the proximal family and peer environments of the unaccompanied refugees, nevertheless some important macro level factors (Bronfenbrenner, 1994) should be mentioned: while some European countries grant temporary residence to unaccompanied minors until they turn 18 years, in Norway, typically, a granted residence is permanent. When the asylum application is approved, the unaccompanied refugees are resettled in municipalities nationwide, where local educational, health and child protective services oversee their developmental and psychological needs. A multiple level study did not show variation in symptoms of depression dependent on the municipality where the unaccompanied refugees resided, despite substantial demographic differences (Seglem, Oppedal & Raeder, 2011). Special group homes with full or part time staff are the typical living arrangements offered at resettlement. Culturally based discrimination is associated with poor mental health outcomes (Garcıa Coll, Lamberty, Jenkins et al., 1996; Greene, Way & Pahl, 2006; Uma~ na-Taylor & Updegraff, 2007). Norway ranks in the middle among European countries regarding openness and positive attitudes towards immigrants (Blom, 2006), and about 25% immigrants from non-Western countries
204 B. Oppedal and T. Idsoe report experiences of discrimination in different areas (Blom & Henriksen, 2008).
Social support and mental health The risk of mental health problems associated with childhood parental loss and other harsh life circumstances may be countered by children’s capacity to establish supportive relationship with extra-familial peers and adults, one of the basic resources in resilience processes (Masten, 2007; Rutter, 2005; Werner, 1995). Consequently, the reconstruction of family ties abroad and successful establishment of new supportive relationships in the country of asylum may be critical to the psychological adjustment of unaccompanied minors. The presence of social supportive relations before, during or after exposure to traumatic events has been identified as a consistent protective factor against developing and maintaining posttraumatic stress disorders PTSD (Brewin, Andrews & Valentine, 2004; Schnurr, Lunney & Sengupta, 2004). Such protective effects of social support have also been shown in relation to less pervasive stressors, such as daily hassles (Cohen & Wills, 1985; Sirin, Gupta, Ryce, Katsiaficas, Suarez-Orozco & Rogers-Sirin, 2013; Ystgaard, 1999). Social support also has beneficial effects on health in and by itself (Cohen, 1992; Oppedal & Roysamb, 2004; Rueger & Malecki, 2011; Sterrett, Jones, McKee & Kincaid, 2011). According to the main effect hypothesis supportive networks provide individuals with a sense of stability and predictability in their life situation, and a sense of being valued and esteemed (Cohen, 1992). The hypothesis also implicates mediation, as social support may either reduce the risk of negative behavior and exposure to stressful events, or increase competencies that aid people in dealing with stressful events (Cohen, 1992; Cohen and Wills, 1985; Rueger, Malecki & Demaray, 2010).
Acculturation There is considerable variation in the conceptualization of acculturation, however, it is commonly accepted that adaptation both to the heritage and the majority culture is involved (Berry, 1997; Motti-Stefanidi, Berry, Chryssochoou, Sam & Phinney, 2012; Rudmin, 2009; Schwartz, Unger, Zamboanga & Szapoocznik, 2010). One of the challenges of the conceptualization concerns the distinction between acculturation and ontogenetic development (Garcıa Coll et al., 1996; Sch€onpflug, 1997). Some researchers conceptualize acculturation simply as the development of children with immigrant backgrounds growing up in multicultural contexts (Oppedal, 2006; Sam, 2006; Sch€onpflug, 1997). From this perspective Oppedal (2006) argues that an important developmental task of acculturation is to gain necessary culture competence to succeed and have a sense of belongingness both within the heritage and the majority cultural domains; namely, heritage and host culture competence respectively. Culture competence involves knowledge and skills about verbal and non-verbal communication and interpersonal behavior patterns, and the values underlying these (Oppedal & Idsoe, 2012). The notion of culture competence is relevant when acculturation is investigated in relation to mental health, since © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
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competence is a central construct both in developmental psychopathology (Cicchetti & Schneider-Rosen, 1986) and resilience (Masten & Obradovic, 2006). During adolescence friends become increasingly important as sources of support, even if the significance of parents does not diminish (del Valle, Bravo & Lopez, 2010; Stice, Ragan & Randall, 2004). Consequently, important culture competence at this stage involves knowledge and skills that facilitate establishment and maintenance of friendship. Previous research has confirmed associations between culture competence and mental health in terms of self-esteem and internalizing symptoms, both among immigrant youth in families and unaccompanied refugees (Birman & Taylor-Ritzler, 2007; Oppedal & Idsoe, 2012; Oppedal, Roysamb & Heyerdahl, 2005).
Social support, culture competence, and discrimination A necessary condition for successful age relevant development of culture competence is that acculturating individuals entertain close relationships within the heritage and majority society cultures. Research involving youth in immigrant families has shown that support from majority culture networks was associated with host culture competence while family support was associated with heritage culture competence. Both paths had independent effects on mental health (Oppedal, Roysamb & Sam, 2004). Transnational families. With the exception of studies on the lost boys of Sudan (Luster, Qin, Bates, Johnson & Rana, 2008, 2009), there has been little focus on the role of supportive family ties in post-resettlement adaptation of unaccompanied minors. Family members abroad may represent a crucial source of emotional support in terms of perception of belonging and being valued and loved (Cohen, 1992; Luster et al., 2008, 2009). Furthermore, having contact with the family abroad implicates a cultural continuity that may provide the children with a sense of a bridge between the past and the present that sustains identity and facilitates further development of heritage culture competence (Costigan & Dokis, 2006; Tseng & Fuligni, 2000). Friends. For unaccompanied minors the establishment of close relationships with co-ethnic peers after resettlement may provide a sense of cultural continuity, of being understood, and of sharing experiences and history. Similar to the family abroad, co-ethnic friends may contribute to the maintenance and further development of the refugees’ heritage culture competence. On the other hand, contact with friends from the majority culture enables increases in knowledge and skills of necessary language and behavior patterns that can facilitate perception of being successful within and belonging to the new country’s culture (Birman, 1998; Oppedal et al., 2004). Perceived discrimination. Research has demonstrated harmful outcomes of discrimination on mental health (Green et al., 2006; Uma~ na-Taylor & Updegraff, 2007; Verkuyten & Thijs, 2006). However, resources such as strong ethnic identity, self-esteem, and social support may ameliorate the detrimental health impact, or reduce the perception of being discriminated against (Branscombe, Schmitt & Harvey, 1999; Ellis, MacDonald, Lincoln &
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Cabral, 2008). This study further the investigations of mechanisms that may explain the association between discrimination and mental health problems by proposing that individuals who perceive social support and are culturally competent are less susceptible to perceptions of discrimination. In short, knowledge about the quality of the relationships that unaccompanied refugees maintain to family and friends is important to understanding their post-migration psychological adjustment. This is so because of the close relations between social support and mental health (Brewin et al., 2000; Cohen & Wills, 1985), and because of the dynamics between social support and acculturation (Birman & Taylor-Ritzler, 2007; Oppedal et al., 2004; Sirin et al., 2013).
Aims The overall aim is to investigate the impact of support from family and friends on acculturation, discrimination, and mental health outcomes in terms of intrusive post-traumatic stress symptoms and symptoms of depression, among unaccompanied refugees. We first investigate potential differences in the level of these indices between youth who have and do not have contact with their family. Second, we test a model of hypothesized effects from social support based on research on associations between support and PTSD and notions that supportive relationships may increase competence that facilitates dealing with stressful events: (1) Social support predicts lower levels in Impact of war-related
(2)
(3) (4) (5)
traumatic events, IWRTE (intrusive post-traumatic stress symptoms) Support from family abroad and co-ethnic friends predicts heritage culture competence; support from host friends predicts host culture competence IWRTE predicts higher levels whereas culture competence predicts lower levels of perceived discrimination The effects of social support on depression is mediated by culture competence and IWRTE; Host and heritage culture competence predict lower levels of perceived discrimination and thereby lower levels of depression.
In the model we control for effects of gender, age, and length of stay in Norway.
METHOD Sample The population base for the project was unaccompanied refugees who were granted asylum between 2000 and 2010, and who were 13 years or more when their applications were approved, N = 4,051 (www.fhi.no/studier/ungkul). The Norwegian Directorate of Immigration provided information about gender, national origin, birth date, arrival date, and date and place of resettlement. Recruitment and data collection was carried out from the end of 2006 throughout 2011.The study was approved by the Regional Committee for Medical and Health Research Ethics. Based on available economic resources, all known unaccompanied refugees in 41 municipalities nationwide were targeted, n = 1,685. Letters inviting them to participate were sent to their homes and if they were less than 16 years, also to their legal guardians. Of the total invited sample 476 refugees (28.25%) were not possible to locate; 47 (3.9%) © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
declined participation, and 218 (18.0%) youth who confirmed their participation did not show up on the day of data collection. The study sample of 948 participants represented 78.4% of the final sampling frame. The few differences between participants and all non-participants (n = 3,103) reflect the variation over time in the flow of unaccompanied minors. The majority of the participants originated in Afghanistan (51%), Somalia (12%), Iraq (7%), and Sri Lanka (6%), while the remaining 24% included youth from more than 30 other countries; 82.4%, were boys. Their mean age was 18.61 years (SD 2.51), and they had a mean length of stay in Norway of 3.45 (SD 2.28) years.
Procedures The participants were gathered in small groups in familiar locations of their resettlement communities. Research assistants trained by the research team were present to assist them in filling in questionnaires in Norwegian. A protocol with standardized explanations of difficult concepts and English translations of the questions was available to them. In addition, translators who could read the questions in the mother tongue were present when necessary, which applied to about 15% of the sample. Upon completion of the questionnaire the participants received a gift certificate of 12.50 euro.
Measures Depression was measured by the Center for Epidemiological Studies Depression Scale, CES-D for adolescents (Radloff, 1991). CES-D has demonstrated adequate psychometric properties in different adolescent and ethnic groups (Roberts, 1980; Roberts, Andrews, Lewinsohn & Hobs, 1990). We used a Norwegian version of the scale which has previously been translated according to standard procedures, and compared to the Swedish version, in the context of another study (Clausen & Slagsvold, 2005). CES-D assesses how often during the last week the individual have experienced 20 symptoms along four dimensions (somatic symptoms, negative affect, positive affect, interpersonal problems) such as “I was bothered by things that usually don’t bother me.” Response categories range from 0 (rarely/never) to 3 (most of the time/ all the time). Cronbach’s alpha was 0.84. Preliminary analyses have confirmed gender and cross-cultural invariance of the four factor solution of the CES-D in samples including unaccompanied refugees, other immigrant and host youth (Oppedal & Idsoe, 2011a). A second-order factor of the current data gave good fit indices, standardized root mean squared residual (SRMR) = 0.054, root mean square error of approximation (RMSEA) = 0.037, 90% confidence interval (CI) (0.032, 0.043); comparative fit index (CFI) = 0.92; Tucker-Lewis index (TLI) = 0.92. Impact of War-Related Traumatic Events (IWRTE), involved three items. The participants informed whether they had been exposed to war first hand and if so; “do you still have troublesome memories related to the war experience,” and “do you still have nightmares concerning these experiences?” Such intrusive symptoms represent one of the three symptom dimensions included in PTSD, and were chosen based on their frequent occurrence in victims of trauma (Dyregrov & Yule, 2006). Scores ranged from 0 (no war or no symptoms); 1 (experienced war, 1 symptom); or 2 (experienced war, 2 symptoms). Cronbach’s alpha was 0.73. Social support tap emotional and tangible support in addition to reciprocity in social relationships (Ystgaard, 1997), and have in studies of culturally heterogeneous and homogenous samples of youth demonstrated acceptable reliability and validity (Oppedal, 2008; Oppedal & Roysamb, 2004; Ystgaard, 1999). Support from the three networks was assessed separately: family support included five items. Support from ethnic Norwegian friends and from co-ethnic friends included four items each. The participants checked their agreement with statements such as “I feel attached to my family;” “I can count on my friends when I need help” on a four point scale ranging from 1 (totally disagree) to 4 (totally agree). Cronbach’s alpha was 0.83, 0.80, and 0.82 respectively. The three factor SEM model had good fit to the data, after we, in accordance with the modification
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indices, let three pairs of item-residuals correlate; SRMR = 0.071; RMSEA = 0.046, 90% CI (0.038, 0.055); CFI = 0.95; TLI = 0.94. Culture Competence was measured by the by the Host and Heritage Culture Competence Scale for Adolescents, which was developed for the purpose of a large scale research program targeting a variety of immigrant and refugee populations. The gender invariance of the factor structure for a two factor model has been confirmed (Oppedal & Idsoe, 2011b). Furthermore, the construct validity in terms of external references has been demonstrated in prior studies (Dahlhaug, Oppedal & Roysamb, 2010; Oppedal & Idsoe, 2012). The scale includes nine parallel items for host and heritage culture competence. The participants checked on a four point scale from 1 (very difficult) to 4 (very easy) how easy it is for them “to speak Norwegian,” and “to know how to behave when visiting friends and families from your culture.” Cronbach’s alpha was0 .85 and 0.80 respectively. A two-factor model that was estimated gave acceptable fit to the data, after we let the item-residuals for two items correlate based on input from the modification indices; SRMR = 0.064; RMSEA = 0.051, 90% CI (0.046, 0.057); CFI = 0.91; TLI = 0.91. Perceived discrimination included 5 statements indicating varying degrees of cultural victimization (Berry, Kyunghwa, Liebkind et al., 1993). The participants responded to questions like “I have been attacked because of my ethnic background” on a four point scale ranging from fully disagree (1) to fully agree (4). Cronbach’s alpha was 0.73. We obtained a good fit for a one factor model with SRMR = 0.027; RMSEA = 0.00, 90% CI (0.000, 0.044); CFI = 1, TLI = 1, after letting the item-residuals of two item pairs correlate, as suggested by the modification indices. Length of Stay indicated years from arrival in Norway until the date of data collection. Age was self-reported. Contact with family abroad was tapped with one question with response categories of yes / no. For the purposes of the descriptive analyses, we calculated mean sum scores for depression, IWRTE, support, discrimination and culture competence. Missing values. We excluded 53 participants (5.6%) who according to preliminary exploration of the data had missing values on most of the questionnaire items. The excluded group did not differ from the participants in length of stay, gender, age, or national origin. In the remaining sample (N = 895), the number of missing values ranged from 31 to 41 on the included items. We used the full information MLR estimator in Mplus to account for missing data in the final sample (Graham, 2009).
Analyses Conventional analyses were carried out with SPSS (SPSS, 2009), and Mplus 7.1 (Muthen & Muthen, 2013) was used for SEM models. The robust maximum likelihood procedure (MLR) was used because of possible skewness. To assess goodness of fit of the models, Hu and Bentler (1999) recommend using a cut-off value of 0.08 for the standardized root mean squared residual (SRMR), supplementing it with the Tucker-Lewis Index (TLI), the Comparative Fit Index (CFI) with cut-off values close to 0.95, in addition to the Root Mean Square Error of Approximation (RMSEA) with a cut-off value 0.06 or less.
RESULTS Table 1 shows the means and standard deviations for all measures, for the total sample and by contact with the family abroad.
IWRTE and depression Of the 79% of the participants who reported first hand war experiences, 52% had current intrusive symptoms associated with those events. The CES-D has not been clinically validated in Norway; however, the mean value is close to the cut-off of 23 for clinical depression, as suggested by previous studies of adolescents (Rushton, Forcier & Schectman, 2002).
Contact with family abroad About one half of the participants, 458 (51.2%) had contact with their families abroad, either mothers (n = 284), fathers (n = 135), siblings (n = 301), and / or grandparents, uncles, aunts, and cousins (n = 54, 170, 124 respectively).
Table 1. Mean and SD of included variables for the total sample and by contact with family abroad Contact family abroad
Age Stay IWRTE Depression Social support Norwegian friends Social support co-ethnic friends Social support family Host culture competence Heritage culture competence Perceived discrimination
Total
Yes
No
18.62 (2.51) 3.45 (2.28) 0.84 (0.88) 20.89 (9.49) 3.13 (0.67) 3.15 (0.70) 3.23 (0.81) 2.69 (0.60) 3.26 (0.50) 1.80 (0.66)
19.07 (2.78) 3.99 (2.56) 0.84 (0.88) 20.00 (9.58) 3.15 (0.66) 3.21 (0.65) 3.37 (0.70) 2.71 (0.59) 3.30 (0.49) 1.79 (0.63)
18.13*** (2.15) 2.90*** (1.81) 0.82 (0.86) 21.70* (9.31) 3.11 (0.67) 3.09 (0.76) 2.95*** (0.95) 2.68 (0.60) 3.24 (0.51) 1.79 (0.68)
Note: * p < 0.05; *** p < 0.001. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
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Participants who had contact with their family reported more social support and lower levels of depression than participants without contact. The level of support from friends, host and heritage culture competence was the same in the two groups. The effect size for differences in family support based on contact or not was in the medium range (Cohen’s d = 0.51) otherwise the effect sizes were small (Cohen’s d = 0.38, 0.48, and 0.18 respectively).
The structural model The structural model was specified in accordance with the a priori assumptions of relations between the predictors of depression. The model with significant paths and effect sizes from latent constructs and IWRTE on depression is illustrated in Fig. 1. The model had adequate fit indices, SRMR = 0.046; RMSEA = 0.027, 90% CI (0.025, 0.029); CFI = 0.91; TLI = 0.90. IWRTE did not receive significant effects from any of the support networks. Social support from family, co-ethnic and host friends had as predicted, indirect effects on depression mediated by heritage and host culture competence, that was again partially mediated by discrimination (total indirect effects were small: b = –0.02, p < 0.05, b = –0.06, p < 0.01, and b = –0.07, p < 0.01, respectively). Family support had a direct effect on depression (b = –0.14, p < 0.05) in addition to the indirect effect described above. As hypothesized, the effects of social support to culture competence were culture domain specific: heritage culture competence
Support co-ethnic friends
DISCUSSION The present study examined the role of social support in postmigration acculturation and mental health. The results confirm that the young refugees parallel to experiencing high levels of mental health problems, undergo normative adaptation processes in the sense that they reconstruct supportive networks and develope culture competence. This may be a reflection of their agency and ambitions to “make it” in their new home countries, that have been observed in earlier studies (Geltman et al., 2005). Moreover, in accordance with the main effect hypothesis (Cohen, 1992) social support not only has a beneficial effect on mental health in and by itself, but also has an indirect effect by increasing competencies that aid the young refugees in dealing with discrimination.
IWRTE
0.32**
0.25**
0.11**
0.44**
Support Norwegian friends
received effects from support from family abroad and co-ethnic friends (b = 0.15, p < 0.05, b = 0.44, p < 0.05; respectively) while Norwegian culture competence received effects from support from Norwegian friends (b = 0.32, p < 0.05). Furthermore, there were indirect effects on depression from heritage and host culture competence through lower levels of perceived discrimination, however the indirect effects were again small (b = –0.03, p < 0.05; b = –0.05, p < 0.01 respectively). In addition, there were direct negative effects on depression from both competence dimensions (b = –0.12, p < 0.05; b = –0.15, p < 0.05 respectively). The effects from gender, age, and stay on the variables included in the empirical model are shown in Table 2.
Ethnic Competence
–0.13**
–0.26** 0.15**
–0.12**
DiscriminaƟon
0.20**
Depressive Symptoms
–0.14**
–0.15** Family Support
Host Competence
Fig. 1. Structural Model for Effects of Social Support, IWRTE, Culture Competence and Discrimination on Depressive Symptoms. IWRTE: Impact of War Realted Traumatic Events. * p < 0.05, ** p < 0.01. Goodness of fit: SRMR = 0.046; RMSEA = 0.027, 90%CI (0.025, 0.029); CFI = 0.91; TLI = 0.90. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
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Table 2. Effects from demographic variables on variables included in the structural equation model
Gender Age Stay
Depression
IWRTE
Discrim
CC_ethnic
CC_host
SS_familiy
SS_ethnic
SS_Norw
0.11** 0.05 –0.14**
–0.13*** 0.20*** –0.16**
–0.07 0.02 –0.02
–0.07 0.10 –0.10*
–0.14*** –0.18*** 0.27***
–0.02 –0.04 0.07
0.11* –0.06 0.05
0.01 –0.19** 0.25***
Notes: * p < 0.05; ** p < 0.01; *** p < 0.001. Numbers represent standardized regression coefficients resulting from the empirical model. Stay: time since arrival in Norway; IWRTE: Impact of war-related traumatic events; Discrim: perceived discrimination; CC_ethnic: heritage culture competence; CC_host: Norwegian culture competence; SS_family: social support from family abroad; SS_ethnic: social support from co-ethnic friends; SS_Norw: social support from ethnic Norwegian friends.
Social support Family support. The youngsters who have contact with their families abroad, perceive high levels of support from them, in spite of the barriers to physical contact and direct communication. An individual’s assessment of availability of support has been conceptualized as cognitive working models that s/he has developed based on appraisal of a stressful situation, and the need for and the availability of support (Sarason, Sarason & Pierce, 1990). Such working models may serve to promote the capacity among separated family members for intersubjectivity in terms of shared experiences, mutual understanding and empathizing (Stern, 2005), which are important dimensions underlying supportive relationships. Furthermore, from a cultural values’ perspective on child development, it is claimed that there are qualitative differences in parent-child relationships and in the child developmental outcomes that are pursued in collectivist vs. individualist cultures (Kagitcibasi, 2007; Markus & Kitayama, 1991). The interdependent family relationships and self-perceptions endorsed in collectivist cultures, from where the majority of our participants originated, may strengthen the sense of availability of support among family members (Keles & Oppedal, 2013). More specific knowledge about cognitive working models of social support and potential variations associated with cultural values of interdependence vs. independence may add to the knowledge about resilient adaptation processes among children who migrate without the company of their legal caretakers. Peer networks. The youngsters report high levels of support both from their ethnic Norwegian and co-ethnic friends, implying that they have been quite successful in establishing social networks in the local communities. The small, but significant, effect from length of stay in Norway on social support from Norwegian, but not from co-ethnic, friends (Table 2), suggests that idiosyncratic factors are at play when the youngsters establish friendships in different cultural domains. Acquisition of the host language may be one reason that relations with host peers are time dependent. Furthermore, host peers may not be readily available, for practical reasons such as the organization of special introductory classes for unaccompanied refugees who often do not have an age relevant education level. On a more subtle level, sentiments of prejudice in the host population may pose barriers to the construction of supportive peer networks for the unaccompanied refugees.
Effects of social support IWRTE. The lack of significant paths from any of the social support networks to IWRTE was unexpected as research has consis© 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd
tently shown that social support protects against development and persistence of PTSD (Brewin et al., 2004; Schnurr et al., 2004). However, in contrast to those studies that were designed to investigate trajectories of PTSD, the project that provides data for the present study was designed to get information about post-resettlement adaptation. Consequently, the measurement of support was not linked to the traumatic war events, neither in time nor in context. A study of victims of abuse showed that self-esteem and appraisal support attenuated the development of PTSD, while tangible and belonging support, which are central dimensions in the present study, did not have additional effects (Hyman, Gold and Cott, 2003). The driving forces of stability and change in IWRTE and the association with depression should be further investigated in future studies. Culture competence and discrimination. The findings corroborate the notion that acculturation can provide unaccompanied refugees with individual resources such as culture competence which is directly associated with lower levels of depressive symptoms and indirectly associated through reduced levels of perceived discrimination. The study underscores the complexities of the acculturation process and its relations to social support and mental health. The findings demonstrate the crucial role that family may play in developmental processes across long distances and national borders. Family and peer networks serve different purposes in the acculturation process of the young unaccompanied refugees by either strengthening their heritage culture competence or contributing to the acquisition of the Norwegian culture competence. In this sense the acculturation of unaccompanied refugees follows the same paths as those of immigrant youth living with their families (Oppedal et al., 2004).
Limitations The study is limited by well-known inadequacies of crosssectional design regarding effects, causality, and predictions. The tested model is designed based on certain theoretical assumptions and implications from prior empirical research; hence to test alternative models was beyond the scope of this study. Most likely, the relation over time between social support and culture competence is reciprocal, with more culture competence facilitating more social support, which then contributes to enhanced culture competence. Likewise, there may be bi-directional relations between depression on the one hand and perceived discrimination or social support on the other. These dynamics should be tested in future longitudinal studies.
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The self-report also involves certain limitations associated with shared method variance that need to be taken into consideration. Unfortunately, cost considerations excluded more complex data collection and design. The study involves predictors of war-related post-traumatic intrusive symptoms (IWRTE) and depression. The impact of war and being a refugee may also affect a variety of other mental health dimensions both in terms of psychopathology and positive mental health. The level of conduct problems and life satisfaction has been addressed in other studies (Oppedal & Idsoe, 2012; Seglem, Oppedal & Roysamb, 2014). The intention of the present study was to test a theory based hypothetical model of the direct and indirect effects of social support in relation to IWRTE and depression. The measure of war-related post-traumatic stress symptoms involved only two items of intrusion. A more comprehensive index is needed for a better understanding of the dynamic over time between symptoms of depression and post-traumatic stress. The effects of culture competence may overlap with effects of other psychological constructs like IQ, cognitive and social skills, and this should be taken into consideration in interpreting the results.
CONCLUSIONS The findings demonstrate the importance of different sources of social support for a positive acculturation process and mental health among the most vulnerable group of immigrant and refugee children. Importantly, it appears that the unaccompanied refugees maintain active working models of the support that is available to them from their family abroad. Furthermore, parallel to suffering from higher levels of mental health problems than other youth (Seglem et al., 2014), they are handling the acculturation related developmental task of acquiring necessary culture competence to succeed both within their heritage and the host cultural domains. This knowledge may enhance our understanding of continuities in social and psychological developmental processes among youth exposed to war-related traumas and loss. The findings give direction to important areas of health promoting interventions, beyond dealing with the sequel of the traumas they have been exposed to, that can be implemented by caseworkers, schools and other institutions locally: first, the efforts of caseworkers and NGO’s in locating family members abroad is very important. Next, facilitating and scaffolding participation in culturally diverse, including host, peer networks, appears to be an important domain of intervention that could be focused in systematic ways. Third, organized activities to strengthen the youngsters’ culture competence may promote their coping with discrimination and mental health. Reinforcing the unaccompanied refugees’ resources by such interventions may be valuable alternatives and supplements to professional mental health services.
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