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

What is known:

Forced migration due to armed conflict is rising and is associated with higher levels of mental health disorders.
Internally displaced persons are not protected by international law, and may be more vulnerable in their post-displacement position.

Although at higher risk for mental health disorders, some who experience conflict-driven forced migration do not develop mental health disorders, even when the process was highly traumatic.

The paper defines resilience as:

"a multidimensional construct that incorporates personal skills and qualities together with social environments and a supportive family network"
This is as opposed to the notion it is solely down to a combination of personal attributes such as innate toughness.

Poor levels of resilience may predict the development of mental disorders. To improve mental health outcomes among the forcibly displaced via epidemiological and interventional research, understanding resilience and how it is fostered is key.

What did the review look at?

Studies published that included the role of resilience in mental health, where subjects were affected by conflict and either internally or externally displaced to any country, and the subject was over 18 years of age at the time of the study.

Both qualitative and quantitative studies were included.

What did they find?

Ten qualitative studies were included.

"Resilience in these populations affected by conflict-driven forced migration was concluded to be influenced by social complexities, family and community cohesion, family and community support, individual personal qualities, collective identity supportive primary relationships and religion."

Thirteen quantitative studies were included.

Low resilience was correlated with female sex and living in IDP camps. The majority of studies found high levels of mental disorders. In some studies, social support, capital and network were used to indirectly measure resilience.

What did the authors say about their findings?

Increased resilience was linked to high quality social support and family support, and in turn this social and familial support was associated with lever levels of psychological problems in all phases of forced migration.

Prolonged displacement was found to "erode" resilience, and magnify the negative impact of the living conditions in camps. Parental separation could affect levels of resilience and well-being later in life. Collective experience of displacement as a resilient community was found to reduce the burden of mental health illnesses.

"Undermining" influences, that is, factors which are associated with lower resilience and poor mental health, included isolation of an individual  - breakdown in family, social and cultural networks -, poor living conditions (particularly for the internally displaced), prolonged/ continued displacement.

"Supportive" influence, that is, factors which are thought to promote resilience and good mental health, were in opposition to the undermining influences, so good family, social and cultural networks, community support, family and social support (externally displaced persons are protected under international law so should receive this) and religion. Positive personal traits were also identified as supportive.

Causal pathways and directionality cannot be shown with the current data.

What did the researchers suggest?

Longitudinal studies of resilience in displaced persons could help in understanding resilience dynamics in the long term, and give insight to the relationship between resilience and situation.

Resilience, as a construct, has neither a clear definition nor a "gold standard" measurement, and this is problematic in assessing it's role in mental health.

Enhancing the resilience of displaced persons should be prioritised, and efficacy of interventions tested through randomised controlled trials.

Read the review:

Siriwardhana C, Sheik Ali S, Roberts B, Steward R. A Systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants. Conflict and Health, 2014, 8:13