Dr Susannah Tipping Supervised by Dr Ida Kaplan & Prof Di Bretherton Research completed as part of

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1 Dr Susannah Tipping Supervised by Dr Ida Kaplan & Prof Di Bretherton Research completed as part of MPsych(ClinPsych)/PhD, University of Melbourne

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3 History: Sudan & South Sudan Independence 1956 North/South Civil War: & Darfur conflict: Diverse Peace agreement: 2005 South Sudan: 2011 Ongoing violence & famine

4 Displacement In 2000s Sudan was a major source of IDPs & refugees Sudanese humanitarian entrants to Australia Around 22, 000 entrants, mainly in the mid 00s Majority aged 25 years Highly disrupted education Varying degrees of family intactness

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6 Refugee Mental Health (RMH) Burgeoning RMH and survivor of violence literature Incorporation of PTSD into the DSM-III in 1980 Health and human rights documenting impact of HRVs Regional differences in approaches Distinct from broader trauma literature Trauma PLUS displacement, forced migration etc Range of disciplines relevant to RMH

7 Post-Displacement Mental Health Risk factors (internal & external factors) Greater exposure to pre-migration trauma Ongoing conflict in country of origin Discrimination & unemployment Language struggles Personal characteristics (e.g., older, female, higher level of past education) Protective factors (internal & external factors) Participation in society (e.g., in employment or education) Social resources (e.g., community support, family presence) Personal resources (e.g., coping strategies, belief systems)

8 RMH : Observations Research mainly conducted in a developed resettlement country Psychological research dominated by quantitative methods & rates of mental health problems cf. social science research More recently, an increase in qualitative methodologies Theoretical influences not always articulated

9 Relevant Theories & Frameworks Psychosocial frameworks Social psychological theories Sociological and anthropological approaches & concepts Phenomenological & existential psychology Ecological-developmental theories

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11 Methodology & Method Constructivist lens Cultural consultation Mixed-methods WHOQoL-Bref; WHO5; Life Regard Index-Revised; Friendship Scale Semi-structured interview Non-random sampling

12 Methodology & Method Coding of interviews QSR NVivo Coding tree informed by literature & early interviews Refined over time Some participants re-interviewed two years later Reflective journal

13 Gender Years in Aust Study or work (main activity) - female 13 - average 1.9y - high school 7 - male 17 - range 0.3-4y - TAFE/bridging 5 Age Ethnic group - university 10 - average 22.7y - Dinka 16 - FT/PT/casual work 8 - range 18-30y - Nuer 7 Family intactness Birth Country - Bari 2 - at least one parent 13 - Sudan 30 - Madi 2 - siblings (no parents) 7 Time in temporary settlement (exc ID) - Other 3 - aunts/uncles/cousins - no-one - average 8.5y Religion - child plus others 1 - range Christian 30 Refugee camp Exit Country - average 6.3y - Kenya 16 - range 0-15y - Uganda 9 - Egypt

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15 Initial Observations Participants preferred qualitative to the quantitative Recurring themes across the three constructs Seemed irrelevant what I asked Spoke about things that mattered to them Valued the opportunity to have a say

16 Quantitative Findings Restricted to non-parametric correlations Sample size Non-normal distribution Amongst other significant relationships Time in exile negatively correlated with overall health Social connectedness correlated with well-being Life framework correlated with time in exile

17 Family & Friends Cairo Uganda Nairobi Trust

18 Overview of Key Themes Factors contributing to a sense of meaning: Education Systems and structures (incl. representatives of) Family, friends and community Personal and cultural beliefs Expectations about life in Australia and the future Barriers & facilitators to settlement: Tangible (e.g., services, people) Symbolic (e.g., sense of belonging, feeling equal) Challenge of juggling two plus cultures

19 Themes: Peace & Conflict Foundations: Security & sense of safety Forced displacement shaping personal belief systems Life is a struggle Human rights Harmony and conflict in relationships Peace and conflict in the society in which one lives Future peace in South Sudan

20 The Unintended Conference

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22 Synthesis

23 Implications Participatory/action research exploring concepts of peace and ways to build peace Individual, family, community, and societal levels Peace in South Sudan: The potential role of the diaspora community Role of different methods/approaches in conflict transformation Partnerships & resources for members of the diaspora engaged in peace-building initiatives

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25 Key References Tipping, S., Bretherton, D., & Kaplan, I. (2007). Meaning in life and social connectedness: The experience of Sudanese young people (re)settling in Australia. In N. Haslam & D. Lusher (Eds.) Seeking Asylum in Australia (pp ). Sydney: The Federation Press. Ager, A., & Strang, A. (2008). Understanding integration: A conceptual framework. Journal of Refugee Studies 21(2), Ager, A., & Young, M. (2001). Cultivating the psychosocial health of refugees. In M. MacLachlan (Ed) Cultivating health: Cultural perspectives on promoting health (pp ). New York, NY, US, John Wiley & Sons Ltd. Basoglu, M., S. Mineka, et al. (1997). Psychological preparedness for trauma as a protective factor in survivors of torture. Psychological Medicine 27(6), Beiser, M. & Hou, F. (2001). Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: A 10-year study. Social Science & Medicine 53(10), Beiser, M. & Hou, F. (2006). Ethnic identity, resettlement stress and depressive affect among Southeast Asian refugees in Canada. Social Science & Medicine, 63, Berry, J. W. (1991). Refugee adaptation in settlement countries: An overview with an emphasis on primary prevention. In F. L. Ahearn, Jr. and J. L. Athey (Eds.) Refugee children: Theory, research and services. Baltimore, The Johns Hopkins University Press. Bronfenbrenner, U. and P. A. Morris (2006). The bioecological model of human development. In R. M. Lerner & W. Damon (Eds.) Handbook of child psychology (6th ed.): Vol 1, Theoretical models of human development. (pp ). Hoboken NJ, US, John Wiley & Sons Inc. Colic-Peisker, V. & Walker, I. (2003). Human capital, acculturation and social identity: Bosnian refugees in Australia. Journal of Community & Applied Social Psychology 13(5),

26 Key References Department of Immigration and Citizenship (Australia). (2007). Sudanese Community Profile. Accessed at: De Vries, J. and G. L. Van Heck (1994). Quality of life and refugees. International Journal of Mental Health, 23(3), Englund, H. (1998). Death, trauma and ritual: Mozambican refugees in Malawi. Social Science & Medicine 46(9), Goodman, J. H. (2004). Coping with trauma and hardship among unaccompanied refugee youths from Sudan. Qualitative Health Research, 14(9), Lie, B. (2002). A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatrica Scandinavica 106(6), Malkki, L. H. (1995). Refugees and exile: From "Refugee Studies" to the national order of things. Annual Review of Anthropology, 24, Miller, K. E. and L. M. Rasco (Eds.) (2004). The mental health of refugees: Ecological approaches to healing and adaptation. Mahwah, NJ, US, Lawrence Erlbaum Associates, Publishers. Miller, K., Worthington, G., Muzurovic, J., Tipping, S., & Goldman, A. (2002). Bosnian refugees and the stressors of exile: A narrative study. American Journal of Orthopsychiatry, 72(3), Porter, M. & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. JAMA: Journal of the American Medical Association, 294(5), Rousseau, C. and A. Drapeau (2003). Are refugee children an at-risk group? A longitudinal study of Cambodian adolescents. Journal of Refugee Studies 16(1),

27 Key References Schweitzer, R., Greenslade, J., & Kagee, A. (2007). Coping and resilience in refugees from the Sudan: a narrative account. Australian and New Zealand Journal of Psychiatry, 41, Schweitzer, R., Melville, F., Steel, Z., & Lacherez, P. (2006). Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Australian and New Zealand Journal of Psychiatry, 40(2), Silove, D. (1999). The psychosocial effects of torture, mass human rights violations, and refugee trauma: Toward an integrated conceptual framework. Journal of Nervous & Mental Disease 187(4), Sonn, C. (2009). Immigration and identity: The ongoing struggles for liberation. In M. Montero & C. C. Sonn (Eds.) Psychology of liberation (pp ). London, Springer. Spinelli, E. (2005). The interpreted world: An introduction to phenomenological psychology. London, SAGE Publications. Staub, E. (2001). Individual and group identities in genocide and mass killing. In R. D. Ashmore, L. Jussim, & D. Wilder (Eds.). Social identity, intergroup conflict, and conflict reduction (pp ). New York, NY, US, Oxford University Press. Steel, Z., T. Chey, et al. (2009). 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. JAMA: Journal of the American Medical Association. Special Issue: Violence and human rights 302(5), van Deurzen-Smith. (1997). Everyday mysteries: Existential dimensions of psychotherapy. New York, Routledge. VFST (1998). Rebuilding shattered lives. 27