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12.02.2014
Studies have shown that the more active we are with our hobbies, the more we can get rid of stress. No matter how much time you take for yourself, your body is always going to be strained if it isn’t getting enough rest.
When stress seems to be all around you and closing in – releasing that stress by verbalizing yourself can be a big help.
If you’re struggling with how to deal with stress and anxiety and would like someone to talk to who can really help, contact me for your 20 minute free consultation.
Get your free “Coaching Tip of the Week” along with the “You Deserve a Break” guide featuring 15 different ways to relax. Of all the things we hear from health experts, that whole "stress is killing you" thing is probably the most annoying — and repetitive.
Sorry, we can't stop your boss from piling on the busywork — or keep your roommate from eating all your peanut butter. Jodie Gale is a leading specialist in women’s emotional, psychological and spiritual health and well-being. This article outlines the main findings of an exploratory, mixed methods study examining the health and resettlement experiences of predominantly Muslim Afghan and Kurdish refugees in New Zealand and Australia. In recent years, a growing body of international literature has examined factors impacting refugee mental health. Some critics have expressed concern about the “medicalization of distress” as a pathologic disorder (Summerfield, 1997, p. At the refugee group level, the collective experience of human rights violations may be reflected in attitudes toward contact between host and refugee culture, with groups from some cultural backgrounds settling better into a new society than others. In recent years, Australia and New Zealand (NZ) have both accepted refugees from Afghanistan and the Middle East, the two regions currently generating nearly half of all refugees under United Nations protection (UNHCR, 2010).
Our mixed methods study aimed to explore resettlement experiences and mental health outcomes, and to identify ongoing sources of stress for former refugees from Afghanistan and the Kurdish regions of the Middle East resettled in new host countries.
The exploratory study utilized a mixed-methods approach to qualitatively identify major sources of stress, health-seeking, and coping strategies through open ended questions in one-to-one interviews and also to provide a quantitative assessment of psychological well-being in a sample of Kurdish and Afghan former refugees now living in NZ and Australia (KARNZA). Study participants were of Afghan or Kurdish ethnicity, 18 years or older at the time of the study in 2008, who arrived in New Zealand or Australia as refugees or asylum-seekers between 1988 and 2008, and were residents of Perth or Christchurch at the time of data collection. Comparison with 2006 census data from Western Australia for similar ethnic groups, and construction of a ‘tentative map’ of demographics compiled with assistance from community leaders (Faugier & Sargeant, 1997), suggests that a reasonably representative sample was recruited. The majority of people participated in individual face-to-face interviews lasting 1-2 hours, and fewer than 10 from the total group of 193 preferred to self-complete the questions and return their responses by mail.
A full description of the reasons for selection and characteristics of all the study instruments, as well as language considerations, is available elsewhere (Sulaiman-Hill & Thompson, 2010), but a brief summary is presented here.
The main challenge was to select a generalized screening test to measure psychological well-being, which was available in suitably validated and translated versions, in particular Farsi and Arabic, for use with the study communities.
The Kessler-10 consists of ten questions with five response categories designed to measure psychological distress over the previous four weeks.
Descriptive statistics were calculated for K-10 results, as well as sociodemographic variables. A summary of K-10 scores, for which there were significant differences between demographic groups, is shown in Table 1.
Kessler-10 results were further analyzed using a split-file function to assess possible differences by gender or refugee community.
The number of days that participants were totally unable to manage and days when they needed to cut back on activities was evenly spread across K-10 scores. Participants were asked whether any symptom or their distress was due to a physical health reason. K-10 scores for psychological distress were compared with findings from both New Zealand (2006-07) and Australian (2007-08) health surveys. Participants were asked to discuss causes of ill health, particularly their mental health, to determine major ongoing sources of stress during the qualitative part of the interview. Interview data from participants identified as having a very high risk of psychological distress were further analyzed to identify any trends in the main stressors reported (Table 4).
In comparison with the themes recognized by the general group of participants in Table 3, those in the high risk distress group identified problems more specifically related to resettlement issues. Although other cultural and religious tensions with host societies were noted, many of these are not specific to refugees.
The majority of participants were aware that many of their physical symptoms related to psychological problems and used the range of coping strategies described in Table 5. The present study is exploratory, aiming to assess ongoing sources of stress for resettled refugees and the impact on their mental health status.
The description “thinking too much” was used, or understood, by almost all participants when discussing ongoing sources of stress during interview. News from home also often highlights family separation and lack of support, and the impact of this extends over many years. Several study participants highlighted the problem of status dissonance, conceptualized as a conflict between professional and social expectations and reality.
An unexpected finding was that status dissonance and disempowerment were more commonly mentioned by women than by men. In general, the majority of participants identified the factors that impact negatively on their mental health. This study was exploratory, as a comparative assessment of similar groups in Australia and New Zealand has not previously been attempted. In addition, cut-off points for each instrument should ideally be determined for each cultural group surveyed, so some care needs to be taken with interpretation of Kessler-10 scores (Fischer, 2004; Smith, 2004). Our study findings suggest that former refugee participants may suffer from significantly higher levels of psychological distress than the general population, and this was particularly related in our study to poorer English language ability, unemployment status, lower educational level, and female gender. Special thanks to all former refugee participants, key informants and interpreters from the Afghan and Kurdish communities in Christchurch and Perth, without whose assistance this study would not have been possible. On of the best coping mechanisms to deal with stressis sleep.   Sleep is vital to our health, and this includes stress.
Whether you are looking to just unload a burden and get the stress off your chest or you are looking to express yourself and get feedback on how to make a change, talking can be a big help. Start by taking an hour to yourself each evening before bed, or cutting one coffee out of your daily routine. I would love to talk with you about how I can help you overcome stress and anxiety in your life and in your business. May starts off on a fantasy-fueled note, and nobody can tell you not to rock your rose-colored glasses. She is a therapeutic counsellor, life-coach and psychotherapist practising in Manly and Allambie Heights on the Northern Beaches of Sydney, Australia. As post-migration experiences can impact the psychological well-being of already traumatized individuals, this study aimed to identify major sources of stress and describe the coping strategies they use to deal with it. Much of the early literature was influenced by trauma psychiatry, with its emphasis on posttraumatic stress disorder (PTSD) and disability.
Majority group attitudes towards migrants, social exclusion, and perceptions of discrimination are especially relevant for visibly different groups like Muslims or Africans, and pose particular challenges to resettlement (Casimiro, Hancock, & Northcote, 2007).
Since 2000, Australia alone has accepted over 58,000 Afghan refugees and New Zealand more than 5000 (UNHCR, 2009), so their long-term settlement outcomes are of ongoing relevance. The presence of established communities of former refugees in Perth, Western Australia, and Christchurch, New Zealand, guided the choice of ethnic groups. This mixed approach helped to contextualize the quantitative findings, explore the impact of psychological distress on functioning, and highlight participants expressed needs and concerns.
Inclusion of participants settled for up to 20 years meant that the Kurdish group in Perth, who mostly arrived during the 1990s, could be included, and also allowed a longer-term focus.
Short chains of contacts and the application of an informal quote to ensure a range of different Afghan ethnic groups (Hazara, Tajik, Uzbek, etc.) and religious affiliations were included, and helped to reduce selection bias and improve representativeness. The first part of the interview involved completion of the psychometric instruments outlined below, provided in English, Farsi, or Arabic for self-completion or with an interpreter’s help if required.
The Kessler-10 scale which was developed as a population screening tool for psychological distress, has been used in New Zealand and Australian National Health and in state surveys, and is readily available in a selection of suitable languages. Each item is scored between 1 (None of the time) and 5 (All of the time), with higher scores indicating more distress. Cronbach’s alpha was calculated to assess reliability of the instrument, scoring 0.86 for our sample. Only one participant in Perth had spent twenty years or more in a refugee situation prior to resettlement, compared to 36 (29 Kurdish, 7 Afghans) in Christchurch. Those participants who were unemployed or unable to speak English also had a higher risk of psychological distress. Almost 79% of the sample with symptoms reported being totally unable to manage at some time during the previous month (median: females 4 days, males 2 days), although some reported being unable to cope with the activities of daily life for anything up to an entire month.
Only 3 people out of 26 (two males, one female) who believed their symptoms were due to a mental health problem consulted a health professional about them.
Responses were classified into nine themes (Table 3); themes reported by the majority of participants responding to this question, reflected ongoing psychological difficulties related to past experiences, retraumatization by current affairs reporting and news from home, too much time to introspect, and generally poor mental health.
For males, a majority described “thinking too much” as the main stressor, with separation having a negative impact on many in the group. Twenty-four participants had K-10 scores of 30 or more; 83% were living in Christchurch, 67% were Kurdish, 63% were female, and 21% were working.
These people are grappling with daily hassles, many of which could be resolved by improved settlement policies and better cross-cultural education of the public. Overall, exercise was the most commonly mentioned way of dealing with psychological distress. A comparison with data from New Zealand and Australian health surveys indicates that the levels of psychological distress experienced by participants is considerably higher than the general population in these countries, with over 66% of former refugees scoring in the moderate, high, or very high risk categories, compared with 21% and 32% in the general population in New Zealand and Australia, respectively.
It encompassed many depressive emotions and anxiety symptoms, as reflected in the K-10 criteria, and was the most common source of concern for both men and women.
Separation was the second most commonly described stressor, and was more important for females than males.
In common with the circumstances of many refugees and other migrants, former professionals and academics are often forced to work in low-paid and dangerous jobs, which may contribute to a continuing sense of despondency. We had anticipated that men would be more concerned about obtaining employment appropriate to their previous experience and qualifications, and humiliated by dependence on welfare and social services, but this was only important to few participants.
They were well aware of ongoing sources of stress, and have adopted a range of strategies to enable them to cope.
Many reported considerable associated morbidity, being unable to manage or having to cut back on daily activities at some time during the previous month. Thanks to Nasr (Nicholas) Sulaiman-Hill and Sawsan Kamal Ahmad for their help with data collection, also the people and agencies that provided advice around recruitment. Things like reading a book or playing a musical instrument require us to engage in the activity, which works well to help us leave the stresses of the day behind.


Try to make an effort to get into a routine of going to bed at the same time every night, and giving yourself enough time to get a full eight hours sleep.  If stress itself is having a negative impact on your sleeping patterns, then it may be a good idea to talk to a doctor and try self-help techniques such as deep breathing before you go to bed each night. By talking to someone about your problems, maybe going through all the possible outcomes, you’ll gain some clarity over the situation. Try to gradually cut down the amount you drink, as caffeine is well known to contribute to stress.
If you feel like you can’t talk to your family or a friend, talk to someone outside the situation. If you find that nothing is helping, make sure to speak to a doctor about your stress levels. Stress is giving us high blood pressure, sabotaging our fitness goals, and affecting our fertility.
Lucky for us, the stress-fighting ninjas at Happify created this handy series of graphics that tell you everything you need to know about our least favorite s-word. The sun blazes through the relationship zones of your chart all month, accompanied by amorous Venus, helping you attract people who want to stick around for the long haul. Spending too much time reflecting on past experiences and current international events, separation from family, and feeling overwhelmed by resettlement challenges and concerns were important sources of ongoing stress. They argue that this could distort perceptions about the vast majority of survivors, reducing discussion of refugee issues to psychopathology and objectification of refugee groups (Muecke, 1992). The inclusion of the Kurdish groups from Iran and Iraq, who share certain similarities with people from Afghanistan, allows opportunities for comparison.
The study was approved by the Human Research Ethics Committee, Curtin University in Perth, Western Australia. With the exception of the Christchurch Kurdish community, a small cohesive group which allowed all eligible members to be approached, at least six discrete snowball initiation points were used with each remaining group. A more detailed discussion of the methodological challenges relating to sampling and recruitment in this study is reported elsewhere (Sulaiman-Hill & Thompson, 2011). In the second part of the interview, open-ended questions were used to direct in-depth discussion of points of interest. Kruskal-Wallis and Mann-Whitney U-tests were performed to assess differences between groups of variables. Ninety participants identified as Afghan and 103 were Kurdish, and 93% of the sample was Muslim.
There was a significant difference between the level of education and Kessler-10 scores on the Kruskal-Wallis test, with those having more education reporting lower K-10 scores (lower risk of psychological distress). For the number of days of cutting back on normal activities, nearly 70% reported some limitation, mostly less than 7 days in total (median: females 2 days, males 0 days). When compared across psychological distress level categories, there was no significant difference between groups. The major disparity in results between Australian and New Zealand refugee participants is likely to reflect differences in resettlement time, as all people in the 11-20 year group were living in Perth. This theme was termed “Thinking too much”, a common descriptor used by study participants for introspection and depressive and anxiety symptoms. They were evenly spread by settlement time (range 1-13 years), time spent as a refugee before resettlement (less than 1 year-27 years), and education level. For example, in New Zealand, most refugees are provided with subsidized social housing on arrival if available, but tensions with neighbors, especially in some low socioeconomic areas, has been an ongoing concern and cause of distress for many.
Although used by both men and women, three quarters of the people discussing exercise were men. This is consistent with previous studies which have reported a high prevalence of mental health concerns among former refugee groups. In nearly all cases, this theme reflected participants having too much time worrying about events overseas or dwelling on past experiences. Women are more likely to be at home with young children, less likely to speak English well (85% of those not speaking English were female), and have greater potential for social isolation. Many are now driving taxis to make ends meet and maintain some sense of self respect, despite the inherent dangers and exposure to less-desirable elements in society.
Women, on the other hand, seemed to experience a reversal effect, possibly due to differing expectations in the host country and a change in their traditional roles. The first relates to methodological challenges, particularly around sampling, which occur with many small-scale refugee research projects.
Most people with symptoms did not seek professional help, but instead relied on their own coping strategies. Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study. Disability and Health Service Utilization Associated with Psychological Distress: The Influence of Ethnicity.
Isolation and Insecurity: Resettlement Issues Among Muslim Refugee Women in Perth, Western Australia. Integration into the Australian Labour Market: The Experience of Three "Visibly Different" Groups of Recently Arrived Refugees International Migration, 45(1), 59-85. Standardization to Account for Cross-Cultural Response Bias: A Classification of Score Adjustment Procedures and Review of Research in JCCP. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. The Relationship Between Psychological Well-Being and Adjustment of Both Parents and Children of Exiled and Traumatized Iraqi Refugees. The Dual Imperative in Refugee Research: Some Methodological and Ethical Considerations in Social Science Research on Forced Migration.
General Mental Health, Quality of Life and Suicide-Related Attitudes Among Kurdish People in Iran. Ethiopian refugees in the UK: Migration, adaptation and settlement experiences and their relevance to health. Predisplacement and Postdisplacement Factors Associated With Mental Health of Refugees and Internally Displaced Persons: A Meta-analysis.
An Application of 'Snowball' Sampling Among a Small Dispersed Migrant Population for Health Research.
Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Trauma, PTSD and the longer-term mental health burden amongst Vietnamese refugees: A comparison with the Australian-born population.
Torture, Mental Health Status and the Outcomes of Refugee Applications among Recently Arrived Asylum Seekers in Australia. Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement - A Systematic Review and Meta-analysis. Pathways from War Trauma to Posttraumatic Stress Symptoms Among Tamil Asylum Seekers, Refugees, and Immigrants.
What Research tells us about the Mental Health and Psychosocial Wellbeing of Sudanese Refugees: A Literature Review. 2009 Global Trends: Refugees, Asylum Seekers, Returnees, Internally Displaced and Stateless Persons.
Properties of the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-Reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan.
Getting out more and socializing with other people can also work as a distraction from stress. It’s also important to avoid sugary foods (that create a high and then a crash), and to eat a balanced diet. It's pretty overwhelming to even think about trying to cut down on all the inevitable pressures and strains in our daily lives.
Consider the next few pages your secret tension-busting weapon — stress-ninja nunchuks, if you will. High levels of psychological distress and morbidity continued to be observed for some participants, several years after arrival.
Instead of portraying refugees as passive victims, they could instead be seen as “prototypes of resilience”(Muecke, 1992, p.
A major point of difference between countries, however, is in the number of annual asylum applications, with four times the number per capita received in Australia.
These explored resettlement difficulties, perceptions of their personal experience of health and sickness, and their strategies for dealing with stress and ill health. In addition, Kessler-10 data was aggregated into a categorical variable (psych level) based on levels of distress, which were then used to calculate X2 statistics for subjective morbidity, reasons for distress, and help-seeking.
Further analysis using Mann-Whitney tests for each paired combination of categories indicated that people with only minimal education had significantly higher levels of psychological risk than those who have had secondary or tertiary-level education. However, when the number of days they were unable to cope was compared by distress level, no significant differences were observed. However, levels of psychological distress remained well above those of national population distribution in both New Zealand and Australia. Separation from family, especially those still in conflict settings, was another major source of stress, often closely related to news from home, as described in the first theme. In addition, limited social housing stock can result in the need for expensive private rentals; contribute to fragmentation of communities and social isolation.
Exercise frequently involved getting outside in the fresh air and usually included going for a brisk walk. A previous study with Iraqi and Kurdish participants found they were greatly influenced by political events and the situation of significant others in their home country (Sondergaard et al., 2001).
This is compounded if husbands are working long hours to support their immediate family (and frequently also extended family back home). For example, the high-profile stabbing of an Afghan former refugee taxi driver in Christchurch at the end of 2008 sent shockwaves through the small, close-knit community, highlighting concerns of vulnerability and prompting many to question their long-term settlement realities amid reports that he often felt intimidated by drunken and aggressive customers and faced constant abuse and threats of violence (Anon, 7 December 2008). Some women, particularly pre-literate learners, found attending classes to be quite stressful especially when it involved trying to juggle housework and child-rearing responsibilities without extended family involvement. We noted a discrepancy between this and a patronizing attitude among some support workers who seem to be oblivious to the underlying reasons for refugees’ distress and to consider refugees as ignorant. The snowball method used means our results are not generalizable to a wider population, although the personal endorsements inherent in this method (which helped break down barriers and provided reassurance to potentially suspicious participants) ensured a large enough sample for a valid study.
Effect of Gender and Marital Status on Somatization Symptoms of Immigrants from Various Ethnic Groups Attending a Primary Care Service. The effect of acculturation and social support on change in mental health among young immigrants. Cultural and Spiritual Constructions of Mental Distress and Associated Coping Mechanisms of Tibetans in Exile: Implications for Western Interventions. Social support and the significance of shared experience in refugee migration and resettlement. Self-reported life event patterns and their relation to health among recently resettled Iraqi and Kurdish refugees in Sweden.


Especially when everything from apartment decor to fried foods to Pinterest could be turning us into raw balls of frayed nerves.
More recently, much of the research focus has shifted to the post-migration period, exploring links between the early settlement phase and psychological wellbeing.
515), and the broader social, economic, and political challenges taken into account when assessing their experiences and expressed needs (Watters, 2001). In particular, those referred to as ‘boat people’ in Australia have become the subject of intense public scrutiny and debate over the past decade, with government attempts to curb rising numbers of so-called ‘illegal’ arrivals resulting in the introduction of policies of mandatory detention and off-shore processing in the early 2000s. The main study findings including psychological distress scores and associated morbidity, and major sources of stress and the type of coping strategies used by participants are reported in this article.
All study materials including information sheets and consent forms were professionally translated into Farsi and Sorani (Kurdish dialect) using standard back-translation methods. All 193 participants completed standardized questionnaires and 124 provided qualitative responses to open-ended questions discussed during interview. Dependence on welfare payments and the necessity to deal with government agencies is considered humiliating and disempowering. For some people walking up in the NZ mountains, where they could experience a sense of freedom was particularly helpful. This was also reported in a meta-analysis of 59 comparison studies of refugee mental health, where worse outcomes were observed for those whose initiating conflict was unresolved (Porter & Haslam, 2005).
An examination of the coping strategies employed by females suggests the importance of social contact, especially with other women. The whole social structure of the new host society, lack of family support, changing roles and expectations, social dispersal of ethnic groups around the city and different expectations of neighbors, contribute to a sense of social dislocation for many former refugee women. In our study, most participants were fully aware of the impact of both pre- and post-migration influences on their mental health, but felt many of their problems were insoluble.
This method was particularly successful for recruiting many female refugees, who may decline to participate if approached directly; our strategy of using multiple entry points into each community resulted in a sample with reasonable representativeness based on census data and community-supplied demographic information. Cultural and religious worries for our predominantly Muslim sample were also of concern, although we were unable to draw any specific religiously based inferences from this study.
Others have questioned the validity of applying Western concepts of trauma to non-Western groups, describing links between cultural, religious, and political factors in construction of mental distress (Ruwanpura, Mercer, Ager, & Duveen, 2006) and a lack of culturally specific considerations have been noted in some studies (Keyes, 2000). While many hard-line policies have been reviewed under subsequent governments, asylum seekers continue to arrive, with public opinion polarized regarding how the problem should be managed. Provision of translated materials and access to interpreters allowed people with limited literacy or English language skills to participate. An additional four questions that do not contribute to the final score are included to assess the impact or degree of disability associated with the identified level of psychological distress. Qualitative responses to open-ended questions were managed using NVivo 8 (QSR International). Stressors identified by women more than males included disempowerment, status dissonance, and social isolation.
Although efforts to improve cultural competence among government and agency employees are to be applauded, it is often superficial and limited.
Socializing was the second most common method of handling stress, and it was mainly favored by women (of those who mentioned the importance of social interaction 70% were female, 30% male).
Many of these variables are interrelated: learning English could be more difficult for people with limited literacy skills and those with minimal education may have less English at the time of migration, which in turn will impact on employability.
Similarly, Kira and colleagues (2008) identified an association between war media reporting and physical and mental health problems in Iraqi refugees.
However, for many people it is not culturally acceptable to discuss private family matters with outsiders, so the lack of contact with close female relatives was a concern for many. Some of these effects can be seen in the findings from the highest risk group, which highlight the impact of ongoing resettlement concerns on their mental health. This is clearly reflected in attitudes towards health-seeking, with many people not obtaining professional help despite considerable morbidity.
Using only Muslim interviewers also helped our credibility, but potentially introduced some social desirability bias as no one mentioned drinking alcohol or taking drugs to alleviate stress, despite anecdotal reports that some people (mostly men) do this. However, these findings raise important questions about the impact that being a visibly different religious minority may have on an individual’s psychological well-being, in two countries with predominantly Christian influences. Selecting instruments for assessing psychological wellbeing in Afghan and Kurdish refugee groups.
In particular, mixed-method studies are recommended to examine the relative influence of current stressors compared with past trauma and the impact on functioning (Tempany, 2009). They were initially coded using open coding in which the data from each question was broken down into distinct units of meaning.
In some cases, this was related to unfulfilled expectations, as described by one woman who had always wanted to be a teacher in Afghanistan. During data collection, a very experienced agency worker was overheard joking with colleagues that Muslim clients had tried to obtain a prayer rug on their resettlement grant. Over half of the women in the total group interviewed reported discussing their problems with friends or family. In particular, many of the Christchurch Kurdish participants were long-term refugees, spending more than twenty-five years in refugee camps prior to resettlement, and had not had the educational opportunities of some other participants, which may account for some disparities between Kurds in each location. They report negative impacts from media exposure that was comparable to the death or serious injury of a family member or friend during the war.
This was seen as a particular issue for women wearing hijab and resulted in many preferring to socialize with other Muslims rather than the general population. Many of the stressors identified by that group, in particular housing problems, economic challenges, employment difficulties, lack of cultural awareness by agency staff and inadequate long-term support, could be addressed by targeted policies and improved support programs.
These findings add support to those reported by Boufous and colleagues (2005) in an Australian study using the same instrument (Kessler-10). Participants may also be more likely to discuss religious coping mechanisms than they would if interviewed by non-Muslims. Further comparative studies examining the impact of visible difference on public attitudes and acceptance of different refugee groups would be of additional value. Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands.
Changing images of refugees: A comparative analysis of Australian and New Zealand print media 1998-2008. The axial coding stage involved comparisons of the codes with one another to discover links between the categories, with related categories aggregated to produce the thematic categories reported (Grbich, 1999). Although the educational opportunities are now available in New Zealand, without family support for childcare she is still unable to fulfill her dream. Since it was often not considered appropriate to discuss some concerns with men or people outside the direct family group, phoning mothers and sisters overseas on a regular basis was almost universally reported, despite the cost.
The challenges, especially for older, pre-literate learners from traditional backgrounds, to adapt and succeed in modern, literate societies are immense and observed in our results, although age as a variable was not significant. Participants in our study also described retraumatization, feelings of helplessness, and anxiety for the safety of family members back home, often in response to news reports and media images. In some cases, existing relationships may also fall apart due to the stress of the whole resettlement experience. The arrival of asylum seekers in Australia has, since 2001, been associated with a hardening of public and political attitudes toward refugees, and this may also contribute to the perception of some participants that they will never really fit in.
Consensus on the themes was achieved by discussion between the researchers and Afghan and Kurdish interpreters.
When fundamental concerns are dismissed or trivialized, participants described feeling upset and stressed. These family members were able to provide a level of emotional support that was otherwise lacking in their post-resettlement environment. A meta-analysis of compromised mental health among refugees found those who were older and more educated had worse outcomes (Porter & Haslam, 2005), findings which differ from the current study which found those with minimal education had higher psychological distress scores. This has been a particular concern for people from Afghanistan and Iraq in recent years and may be exacerbated by public ignorance and insensitivity in host countries. In these situations, women may become more socially isolated, or even shunned by other community members for the perception that they have failed in their family ‘duties’ or to uphold cultural norms.
An examination of the portrayal of Muslims or refugees in the Australian media reveals the extent of this (Sulaiman-Hill, Thompson, Afsar, & Hodliffe, 2011). Of note in the current study was that only male participant spontaneously mentioned considering professional help as an option, and only 21% of men (compared to 48% of women) in the high risk group actually reported visiting a doctor for any reason.
Psychometric properties of an interviewer-administered version of the Kessler Psychological Distress scale (K10) among Dutch, Moroccan and Turkish respondents. Avoidance strategies and relaxation techniques were used equally by both men and women, however, religious practices such as reading the Qur’an and praying proved particularly important for females (90% of people who mentioned this were women). The psychological consequences of this are evidenced by the inability of many people to cope with daily life tasks and difficulties with concentration described.
The stresses for women in these situations are significant; trying to raise their children alone, socially isolated from their own ethnic community, often unable to speak English well enough to mix comfortably with locals, aware of cultural and religious distance, and reliant on government support for necessities, all impact on their levels of psychological distress. Many of these women attributed their symptoms to a physical problem which may reflect gender differences in somatization (Aragona, Monteduro, Colosimo, Maisano, & Geraci, 2008). The Afghan Symptom Checklist: A Culturally Grounded Approach to Mental Health Assessment in a Conflict Zone. These women derived significant inner strength from their religious conviction, which proved helpful when dealing with the public reactions around asylum arrivals and international terrorism.
Greater understanding of the issues confronting refugees could enable better educational outcomes. Although it is possible that attitudes to health services may be informed by social mobility or education, no differences in attributing symptoms to a physical as opposed to mental health problem (or whether a doctor was consulted) were noted based on the length of time settled or education level of the women concerned. They reported a sense of solidarity and unity with their Muslim sisters, irrespective of their various backgrounds and ethnicities. This might be achieved by extending education programs over a longer timeframe to allow people time to adjust and overcome some of their initial resettlement difficulties, or greater flexibility with timetabling of English-language classes so they could study when most receptive.
Skepticism regarding professional support was also noted, with a few participants confessing that they gave mental health professionals the answers they wanted to hear, because they believed their problems could not be resolved and preferred to rely on their own coping mechanisms.
Similar findings have been reported by Ruwanpura and colleagues (2006), who detected ambivalence among Tibetan refugees towards the use of Western therapies. Although some participants in their study group adopted a pragmatic, integrative approach to treatment options, their primary coping strategies were linked to culturally relevant family and religious support mechanisms.



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