Syrian Refugee Youth Resettled in Norway: Mechanisms of Resilience Influencing Health-Related Quality of Life and Mental Distress

Abstract

Background: The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms to inform future interventions and policy. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect. Methods: This was a cross-sectional study of Syrian youth recently resettled in Norway, aged 13-24 years. Regression and moderation analyses were used to explore different interactions, including moderated mediation using the PROCESS macro for SPSS. Result: A direct main effect of promotive resilience was found for health-related quality of life (HRQoL) and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of protective resilience were found. Post-migration stressors mediated the effects of potentially traumatic events (PTE) from war and flight, and this indirect effect was present at all levels of resilience. Conclusion: Despite high risk exposure and mental distress, resilience was also high. Broad resilience interventions targeting multiple factors would likely benefit the group, but these should include both individual assets and building supportive environments. Additionally, reducing current stress and providing treatment for those in need could enable recovery and increase the efficacy of resilience factors already present.

Keywords: Syria; health-related quality of life; mental distress; post-migration stressors; post-traumatic stress disorder; refugee; resilience; youth.

Figure 1

Conceptual model of moderated mediation analyses, SPSS PROCESS model 8. Paths a represent the relationship between the predictor and the mediator, and path b between mediator and outcome whilst the predictor value is controlled. The c′ path is the direct effect between the predictor and the outcome excluding the mediator variables. The indirect effect is indicated by a statistically significant difference between c and c′. The indirect effect would be significant if CIs do not include zero. “Resilience” indicates the direct main effect (promotive resilience), and “PTE × Resilience” indicates the interaction term (protective resilience).

Figure 2

Potentially traumatic events' effect on Global HRQoL mediated by post-migration stressors and moderated by resilience. (A) Mediation (PROCESS model 4), (B) Moderated mediation (PROCESS model 8). Independent variable: PTE [potentially traumatic events (RTHC)]. Mediator: post-migration stressors (RPMSS). Outcome: global HRQoL [health-related quality of life (KIDSCREEN-10)]. Moderator: resilience (CYRM-12). Covariate: age. All coefficients are unstandardized. *p < 0.05, **p < 0.01, ***p < 0.001.

Figure 3

Potentially traumatic events' effect on PTSD mediated by post-migration stressors and moderated by resilience. (A) Mediation (PROCESS model 4), (B) Moderated mediation (PROCESS model 8). Independent variable: PTE [potentially traumatic events (RTHC)]. Mediator: post-migration stressors (RPMSS). Outcome: PTSD [post-traumatic stress disorder (CRIES-8)]. Moderator: resilience (CYRM-12). All coefficients are unstandardized. *p < 0.05, **p < 0.01, ***p < 0.001.

Figure 4

Potentially traumatic events' effect on general mental distress mediated by post-migration stressors and moderated by resilience. (A) Mediation (PROCESS model 4), (B) Moderated mediation (PROCESS model 8). Independent variable: PTE [potentially traumatic events (RTHC)]. Mediator: post-migration stressors (RPMSS). Outcome: general mental distress (HSCL-10). Moderator: resilience (CYRM-12). Covariate: gender. All coefficients are unstandardized. *p < 0.05, **p < 0.01, ***p < 0.001.