Dynamics of resilience in forced migration: a 1-year follow-up study of longitudinal associations with mental health in a conflict-affected, ethnic Muslim population.

Article English OPEN
Siriwardhana, C ; Abas, M ; Siribaddana, S ; Sumathipala, A ; Stewart, R (2015)
  • Publisher: BMJ
  • Journal: BMJ Open (vol: 5)
  • Related identifiers: doi: 10.1136/bmjopen-2014-006000, pmc: PMC4336461
  • Subject: 1712 | 1699 | MENTAL HEALTH | 1692 | 1506 | 1704 | STATISTICS & RESEARCH METHODS | Research | PUBLIC HEALTH | 1724 | R1 | RA

OBJECTIVE: The concept of 'resilience' is of increasing interest in studies of mental health in populations facing adversity. However, lack of longitudinal data on the dynamics of resilience and non-usage of resilience-specific measurements have prevented a better understanding of resilience-mental health interactions. Hence, the present study was conducted to investigate the stability of levels of resilience and its associations with sociodemographic and mental health exposures in a conflict-affected internal-migrant population in Sri Lanka. DESIGN: A prospective follow-up study of 1 year. SETTING: Puttalam district of North Western province in postconflict Sri Lanka (baseline in 2011, follow-up in 2012). PARTICIPANTS: An ethnic Muslim population internally displaced 20 years ago (in 1990) from Northern Sri Lanka, aged 18 or above and currently in the process of return migration. MEASURES: It was hypothesised that levels of resilience would be associated with mental health outcomes. Resilience was measured on both occasions using the 14-item Resilience Scale (RS-14), social support by the Multidimensional Social Support Scale and Lubben Social Network Scale and common mental disorders by the Patient Health Questionnaire (PHQ). RESULTS: Of 450 participants interviewed at baseline in 2011, 338 (75.1%) were re-interviewed in 2012 after a 1-year follow-up. The mean resilience scores measured by RS-14 were 80.2 (95% CI 78.6 to 81.9) at baseline and 84.9 (83.5 to 86.3) at follow-up. At both time points, lower resilience was independently associated with food insecurity, lower social support availability and social isolation. At both time points, there were significant associations with common mental disorders (CMDs) in unadjusted analyses, but they only showed independence at baseline. The CMD prevalence, maintenance and incidence at follow-up was 8.3%, 28.2% and 2.2%, respectively. CONCLUSIONS: In this displaced population facing a potential reduction in adversity, resilience was more strongly and robustly associated with economic and social factors than with the presence of mental disorder.
  • References (46)
    46 references, page 1 of 5

    1. Connor K, Davison J. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depress Anxiety 2007;18:76-82.

    2. Rutten BP, Hammels C, Geschwind N, et al. Resilience in mental health: linking psychological and neurobiological perspectives. Acta Psychiatr Scand 2013;128:3-20.

    3. Davydov DM, Stewart R, Ritichie K, et al. Resilience and mental health. Clin Psychol Rev 2010;30:479-95.

    4. Doty B. The construct of resilience and its application to the context of political violence. Pursuit 2010;1:11.

    5. Bonanno G. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol 2004;59:20-8.

    6. Bonanno G. Uses and abuses of the resilience construct: loss, trauma, and health-related adversities. Soc Sci Med 2012;74:753-6.

    7. Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analaysis. JAMA 2005;294:602-12.

    8. Siriwardhana C, Stewart R. Forced migration and mental health: prolonged internal displacement, return migration and resilience. Int Health 2013;5:19-23.

    9. Stewart D. Research brief: resilience and mental health outcomes. London, ON: PreVAiL: Preventing Violence Across the Lifespan Research Network, 2010.

    10. Tol W, Song S, Jordans M. Annual research review: resilience and mental health in children and adolescents living in areas of armed conflict-a systematic review of findings in low and middle-income countries. J Child Psychol Psychiatry 2013;54:445-60.

  • Metrics
    No metrics available
Share - Bookmark