magazine issue 1 2019 / Issue 39

Refugees wel(l)come: The impact of social support on refugees’ well-being

• written by Ina-Maria Döring
• edited by Rosine Rutten

To date, the refugee crisis has been a central issue for society and associated with several challenges. This article focuses on the well-being of refugees as a basis for successful integration. In particular, it addresses the question of how social support can positively affect refugees’ well-being and the consequences related to missing social support. In this context, a differentiation is made between formal and informal social support for refugees.

Ensuring well-being for refugees means their journey continues long after crossing the border. Image from Nicolas Vigier on Flickr under CC0 license.

Statistics from the office of the United Nations High Commissioner for Refugees (UNHCR) reveal the depth of the refugee issue: In 2015, 65.3 million people worldwide had to leave their homes and flee to a new country. It was the highest number of forcibly displaced people worldwide ever recorded. Expressed in terms of nation-state size, refugees across the globe would make up the 21^st biggest nation in the world. Taking a closer look at the statistics, 86 % of refugees come from developing countries, 50 % of them are children (6). This large number of refugees poses some challenges for host countries, particularly the psychological condition in which the refugees find themselves upon arrival (7). This is accompanied by the high prevalence of mental disorders among refugees, which can be explained by the causes of flight, such as war, torture, and poverty or political, cultural, or religious oppression. As their lives have been threatened, refugees often suffer from these traumatic situations, which can lead to mental disorders and impair their well-being.

In order to have a better understanding and improvement of the health situation, and the well-being of refugees in particular, psychologists are investigating factors that can influence well-being positively. A group of researchers in Australia determined predictive values for several variables, e.g., educational background, self-esteem, or a supportive social environment, which seem to be associated with subjective health and happiness of refugees (8). Support of others turns out to be a critical factor for refugees to cope with the demands of resettlement (9). In this context, social support is discussed as a key factor for the psychological well-being of refugees. Against this background, this article aims to illustrate the positive effects of social support provided by two different sources on refugees’ well-being. It also considers how the lack of social support can affect well-being. At first, two questions need to be answered: What does social support and well-being generally mean? Secondly, who provides social support to refugees and how does that influence well-being?

What is well-being?

Although well-being is essential to psychological practice and research and a central aspect for understanding human health, there is still no generally accepted definition of this construct (4, 10). The reasons for this can be found in the multidimensionality of well-being on the one hand and the determination of well-being across many individual variables such as culture, social contacts, and others, on the other hand. Well-being can be affected by external factors and should therefore always be understood in terms of an individual’s socio-cultural context (4). However, there is agreement in science that well-being is more than the absence of illnesses. The World Health Organization (WHO) describes well-being as the knowledge of one’s own abilities, along with productivity and self-realization in society (5). A widely tested model in this context, the six-factor model of psychological well-being, postulates six key dimensions of well-being: self-acceptance, personal growth, purpose in life, environmental mastery, autonomy, and positive relations with others (11). If these factors are considered, it becomes evident that they are variables that can be influenced so that well-being can be improved. As already mentioned, the socio-cultural background of an individual plays a pivotal part in this. Transferring this knowledge to the situation of refugees, the question arises, how can the host society best support refugees in their well-being in order to promote successful integration? Previous research in other contexts has shown that formal and informal support can have beneficial effects on well-being (3). This article therefore discusses the possible aspects of formal and informal support on refugee well-being, while first determining what is meant by support at all.

What is social support?

Social support is defined as a positive resource provided by one’s environment, which helps with coping with stressful situations, critical life events, and daily problems (2, 3). In order to improve differentiation, a distinction is made between two types of sources of social support: On the one hand, formal social support systems include professional entities - such as governments of host societies, politics, and services (12), while, on the other hand, informal social support systems include help provided by ethnic communities, family members, friends, and peers (9). This differentiation allows a deeper understanding of ways refugees find access to social support and provides the basis for the following considerations.

The influence of formal social support on well-being

Focusing on formal social support, research has revealed that one way to formally support refugees is to provide a sense of affiliation and opportunities to utilize their abilities in the new society (8). Examples of how governments can offer different kinds of services to support the settlement process include housing security, language courses, education, and employment. These services can contribute to refugees’ well-being, because they foster a sense of being socially supported (13). Through housing security, e.g., refugees can enter the workforce or build a social network on their own (8). Another key factor for successful formal social support is broader access to language schools. Through language learning offerings, the governments of immigration countries can support social integration by counteracting the habit of staying within one’s own ethnic group (12). Underlining the importance of language acquisition, it seems that achieving an acceptable competence in the host country’s language will lower the likelihood of depressive symptoms in young refugees (14). This is easy to imagine if people remember how difficult it can be to communicate during a holiday in a foreign country if they cannot speak the local language, which also, consequently, makes them feel unfamiliar and insecure about their own abilities.

By providing formal support, however, governments can facilitate refugees’ connections to social and economic resources, which is crucial as social and environmental well-being has been shown to depend on the subjective social status (15). According to Montgomery (16), community interventions should aim for a “secure, predictable, coherent and stable life context” for refugees (p. 32). Furthermore, through professional treatment strategies, preventive mental health measures (17), and culturally competent supportive services (12), it can be ensured that refugees feel secure and well cared for. This can reinforce a sense of welcome and thus a sense of belonging to the new society. In this way, formal social support can contribute to refugees’ well-being through the fact that they can become citizens of the new country over time (15). In the context of the six-factor model of well-being, it becomes clear that formal social support can improve the dimensions of personal growth, purpose in life, autonomy, and positive relations with others.

The influence of informal social support on well-being

Similar effects can be observed for informal social support system: research indicates that social reinforcement provided by refugees’ own ethnic community has significant positive effects on well-being. In particular, people of the same origin represent an important source of support for refugees. For example, as Sundanese cultural life is largely based on ethnic community and extended family (18), researchers have shown that when Sudanese refugees interact it with people from their own ethnic background, such interactions have a positive effect on their well-being as this promotes a sense of togetherness and solidarity for each other. The exchange of experience and mutual support in dealing with the new challenges play an especially central role here (15). Even family contacts like parent-children-interactions can be of vital importance for mental health and well-being of refugee children and adolescents (18). Against this background, the inclusion of socio-cultural background as a component of well-being becomes clear.

Particularly for refugee children and adolescents, connectedness with their peers, like close friends and classmates, is an essential factor in this context because it provides additional informal social support through interpersonal relationships, friendship, and belonging (17). In this context it is interesting that adolescents, who reported having close friends and being supported by them, had higher global self-worth scores and recognized themselves as being more socially acceptable (17), key factors of well-being defined by the six-factor model. Researchers also emphasize the importance of positive relationships for a higher self-esteem and social adjustment (15). Moreover, school belonging will have a positive impact on the refugee child’s self-esteem (14). All these examples of informal social support have a direct impact on the well-being of refugees but also have an indirect positive influence through their stress-buffering function. (17).

Missing formal social support

What happens if missing social support affects refugee’s well-being negatively? Starting with the negative consequences of the lack of formal social support, it seems clear that ensuring the best possible formal social support for refugees is a major challenge for host countries, and this often results in the inadequate provision of formal social support services (12). In particular, structural problems in the organization of political responsibility and government services surrounding host countries can lead to a feeling of isolation and negligence. Researchers who have analyzed the Canadian government’s refugee policies emphasize coordination barriers between the government and service agencies as a central problem for inadequate formal social support (12). Among others, like the common challenges regarding communication barriers and a lack of economic integration, financial insecurity—especially in the early post-arrival period—or the legal requirements for achieving regular immigration status, family separation, or gender role changes can often be challenging (12). Drawing on the six-factor model again, it becomes clear why lack of formal social support can lead to reduced well-being: Central variables of well-being, such as autonomy, purpose in life, and environmental mastery are limited by inadequate formal social support. In addition, aid programs that fail to address refugees’ needs can reduce their well-being. If, for example, a severely traumatized refugee is offered a language course before being provided psychological help, the offer will not be suited to the needs of this person.

This difference between the aid offers and refugees’ needs can also be illustrated by other examples. Often, refugees coming from different countries with different cultural backgrounds would need individual treatment and ethno-cultural specific formal social support for promoting well-being. To treat refugees as individuals, e.g., by offering language courses, and financial or health-related services, there is need for more personal and financial resources, which are often lacking. Due to the lack of personal resources, refugees are hardly ever treated in an individual, holistic way.  They are often served through standard programs and mainstream services. According to Stewart and colleagues (19), reform initiatives concerning refugees’ needs, e.g., employment, social and health-related services, are not consistent with the culturally-embedded support demands of refugees. This is why the negative consequences of missing formal social support can appear: as they are distrusting of the agencies, refugees can remain socially isolated and forced to stay within their own social or ethnic group (12). It also limits their autonomy and personal growth, which can make it increasingly difficult for them to successfully integrate.

Missing informal social support

Negative consequences for refugees’ well-being may also occur if informal social support is inadequate: Research suggests that there are fewer refugees in places with poor ethnic diversity and low ethnic representation. Such an initial situation reinforces feelings of loneliness and isolation among refugees in host countries (9). The central problem with this is a lack of occasions for the refugees to communicate in their own language or to receive support from those who share the own cultural background (9). The importance of informal social support provided by their own family can be better understood by evaluating the situation of refugee adolescents. Bean and colleagues (20) compared two groups of refugee adolescents distinguished by only one condition: one group lived with parental caregivers, the other group comprised unaccompanied refugee adolescents. They observed that refugee adolescents who were unattended presented more symptoms of internalizing complaints and traumatic stress than refugee adolescents who lived together with their parents (21). Another negative aspect becomes apparent when looking at the lack of informal social support at schools: refugee adolescents with poor peer attachment have a lower well-being in psychological and social relationships. Furthermore, refugee adolescents who were bullied and socially isolated showed lower scores in happiness and self-esteem (15), again key elements in the definition of well-being.

Perceived discrimination plays a major role in the consideration of informal social support. Perceived discrimination has been identified as a key factor in predicting depression and post-traumatic stress among Somali adolescents in the US (22). The importance of successful school enrollment for the well-being of young refugees has already been highlighted. If this does not succeed, the possibilities for these young people to become part of their new environment are reduced, which can lead to psychological complaints and impaired well-being (14). Even with existing integration efforts by the host country, the feeling of a non-existent or even destroyed social network can lead to increased levels of stress, anxiety, and depression symptoms among refugees (23). This again underlines the importance of informal social support for well-being and thus successful integration of refugees.

Perceived discrimination is a barrier to successful integration and well-being of refugees. Image from Garry Knight on Flickr under CC0 license.

Limitations of social support

There is wide consensus that different recipients need different forms of social support. Knoll and Schwarzer (24) established three forms: emotional, informational, and instrumental social support. Emotional support requires offering the recipient solace and expressing compassion and warmth. Informational social support involves providing the recipient with information and good advice, while instrumental social support contains practical support in everyday life. In order for social support to be beneficial, it is essential that there is a match between sources and forms of social support (25, 26). This aspect of social support is not easy for many refugees to differentiate and understand. Moreover, to date there has been little research on this aspect of social support for refugees. Social support is important for well-being and integration, and emotional social support is primarily provided by persons within the same social or cultural background, e.g., from family members or within ethnic communities. Simultaneously, informational and instrumental social support is shared within the ethnic-community, but also needs to be provided by service programs. It seems that informal social support is still culturally limited. By reaching out, connecting, and helping, host societies could also offer informal social support. It is important to emphasize that the use of social support seems to be culture-specific. For example, Somali refugees make more use of family members as the providers of main support, while Chinese immigrants use help from service institutions (19). Therefore, social support appears to be limited in the sense that it is not tailored to an individual and special needs, but rather serves the broad masses. This is, however, also a product of the high number of refugees and the low level of resources available.

So far, little effort has been expended on the question of how formal and informal social support in the case of refugees operate and interact. A deeper understanding of the underlying mechanisms of impact and the individualities of different cultures could help to make refugee aid programs more efficient, better address their needs, and thus increase their well-being. This in turn could provide a better basis for successful integration.

Conclusion

In summary, providing social support to refugees is of vital importance for their well-being, according to the understanding of the six-factor model. Since most refugees come to host societies with a desire to belong, it is of utmost importance to offer them the opportunity to make contacts and to get involved (15). The aim of this article was to illustrate the influence of formal and informal social support on refugees’ well-being. Despite several limitations, it seems reasonable to suggest that formal as well as informal social support have a pivotal impact on refugees’ well-being. Further research is needed to identify specific underlying social-support mechanisms to understand the interaction between the two mentioned constructs. For example, Kovacev and Shute (17) suggests that social support can be a possible mediator between cultural adaption and psychosocial adjustment in general. In the future, it will be particularly important to implement these findings in practice in order to achieve a better well-being of refugees in which all—both the refugees and the host society—can benefit. For refugees and countries of resettlement, effective supporting strategies are essential, as it is only when refugees are supported through appropriate social support services that host countries can use human capital adequately (12). It will be an issue of future research to use this knowledge to determine social support specific measures to optimize the integration process and refugees’ well-being. And it is also a question everyone can ask themselves: Have we already given enough attention and care to the social support of refugees?

Feel inspired and want to help? Find more information on these websites on what you can do to make refugees feel welcome:

http://www.unhcr.org/

https://www.migrationpolicy.org/

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