Psychosocial Health and Wellbeing in an Environment of Risk: A Mixed Methods Exploration of Urban Congolese Refugee Resilience in Kenya

Abstract

Background: The current global refugee crisis requires attention from the public health community to improve the health and wellbeing of forcibly displaced groups. Eighty-six percent of refugees are hosted in developing countries, while 58% migrate to urban centers in search of opportunities. Although there are benefits to urban migration, refugees residing in Nairobi, Kenya are vulnerable to police extortion, arrests, deportations, and social exclusion as a result of anti-refugee policies. Despite threats to psychosocial wellbeing, many refugees successfully cope with acute and cumulative stressors to exhibit positive mental health outcomes in the context of adversity. This dissertation explores the ways urban Congolese refugees in Nairobi negotiate and navigate personal, social, and environmental resources to mitigate stress and promote psychosocial wellbeing. Research Aims: The dissertation included the following three aims: (1) document stressors experienced by urban Congolese refugees in Nairobi; (2) describe the range of coping supports available to Congolese refugees; identify how individuals, families, and groups navigate and negotiate these resources; and (3) explore relationships that exist among stressors, supportive resources, and reported mental health status of urban Congolese refugees. Methods: Mixed-methods exploratory research took place over a 12-month period in Nairobi. Preliminary research was conducted between May and August 2012, and dissertation fieldwork occurred between January and August 2014. Qualitative research included ethnographic participant observation, semi-structured in-depth interviews, and small group discussions with Congolese refugees (n=70). Additional interviews were conducted in Kenya with academics (n=3), intergovernmental employees (n=4), representatives from government agencies (n=2), and refugee service providers (n=18). Quantitative research was comprised of two surveys administered to Congolese refugees (N=244) in 150 households. The Self-Reporting Questionnaire (SRQ-20) assessed mental health functioning, and a survey developed in-field inventoried perceived stressors and supports. Results: The results by aim were: (1) stressors fell within three primary domains: inadequate material resources, political and personal insecurity, and emotional distress; (2) Congolese refugees utilized three salient coping strategies, comprised of reliance on religious communities and faith in God, participation in borrowing networks, and managing memories; and (3) isolation was associated with poor mental health functioning, while perceived support from religious communities enhanced mental health outcomes. Recommendations: Organizations should bolster community-based programs and strengthen partnerships with religious communities to improve the psychosocial wellbeing of urban Congolese refugees. Conclusions: Shifting the paradigm with refugee populations from a deficits-centric to resilience-focused framework recognizes the inherent strengths of individuals, families and communities with refugee status, and has the potential to mold future research and praxis that aims to enhance the wellbeing of displaced populations.