Mental health literacy of resettled Afghan refugees in Australia : an exploration of how resettled refugees understand post-traumatic stress disorder and its treatment

xiii CHAPTER ONE INTRODUCTION . 16 1.1 Definition of Refugees, Asylum Seekers and Displaced Persons . 16 1.2 Background History of Afghanistan‘s Ethnic Hazara Population . 19 1.2.1 Hazara (Shiite) . 20 CHAPTER TWO: THE MENTAL HEALTH OF REFUGEES . 26 2.5 Pre-displacement Factors . 32 2.6 Post-displacement Factors . 33 2.6.1 Language . 34 2.6.3 Housing . 36 2.6. 4 Social isolation . 38 2.6. 5 Social connection . 41 2.6. 6 Discrimination and racism . 43 CHAPTER FOUR: STUDY AIMS, OBJECTIVES AND METHODS . 64 4.1 Aims . 64 4.3 Methods . 65 4.3.1 Recruitment process . 65 4.3.2 Procedures . 66 4.3.3 Quantitative study: Mental Health Literacy Survey. 67 4.3.3.1 Psychological scales . 68 4.3.3.2 Sample size and statistical power . 70 4.3.3. 3 Statistical analysis` . 70 4.3. 4 Qualitative interview procedure and participants . 71 4.3. 4.1 Grounded theory and thematic analysis . 73 v 4.3. 4.3 Epistemology . 78 CHAPTER FIVE: RESULTS . 81 5.1 Study One: Quantitative Survey and Psychological Scales.81 5.1.1 Demographic and clinical characteristics. 81 5.1.2 Mental health of respondents . 83 5.1.3 Mental health literacy, attitudes and beliefs . 83 5.1.4 Beliefs about treatment and treatment providers . 85 5.1.5 Beliefs about causes and risk factors . 91 5.1.6 Beliefs about mental health problem, severity, prevalence and likely outcomes . 95 5.1.7 Attitudes to a person experiencing mental health problem . 97 5.1.8 Treatment preferences, causes and risk factors selected by participants who correctly identified PTSD . 97 5.1.9 Personal experiences related to vignette . 97 5.1.10 Help-seeking behaviours . 99 5.1.11 Examination of associations between MHL and individuals‘ demographic and clinical characteristics . 100 5.2 Study Two: Qualitative Interviews:. 101 5.2.1 Barriers to treatment . 101 5.2.2 Shame . 102 5.2.3 Gossip . 104 5.2.4 Help-seeking . 106 5.2.5 Stigma . 110 5.2.6 Specific aspects of mental health literacy/beliefs . 115 5.2.6.1 Wider political unrest/conflict (global level) . 116 5.2.6.2 New context: New challenges. 120 5.2.6.3 Individual perceptions and actions (local level) . 127 What is mental health? 127 vi Mental health, physical health and sleep. 128 Strategies for coping with sleep problems . 132 5.2. 7 Religion and spirituality . 134 CHAPTER SIX: DISCUSSION . 141 6.1 Discussion of Study One.141 6.1.1 Mental health literacy survey: Problem recognition, beliefs about the severity of problem, treatment and prevalence, causes and risk factors, perceived stigma and help-seeking behaviours . 141 6.1.1.1 Problem recognition . 141 6.1.1.2 Beliefs about the mental health problem‘s severity, prevalence and treatment 143 6.1.1.3 Beliefs about causes and risk factors of mental illness . 147 6.1.1.4 Perceived Sympathy and Discrimination . 148 6.1.1.5 Help-seeking behaviours. 150 6.1.1.6 Professional treatment providers . 150 6.1.1.7 Beliefs about the role of medication and religion as treatment . 152 6.1.1.8 Beliefs about usefulness of self-help activities . 153 6.1.1.9 The role of religion in beliefs about vulnerability to development of PTSD 154 6.1.2 Clinical characteristics of the surveyed population . 156 6.1.2.1 Post-traumatic stress disorders. 156 6.1.2.2 Exposure to traumatic events . 157 1.1.2.3 Functional impairment . 158 6.1.2.4 Depression . 159 6.1.2.5 Anxiety disorders . 159 6.1.2.6 Resilience . 160 6.1.3 Conclusion . 162 6.2 Discussion of Study Two.164 vii 6.2.1 Belonging . 164 6.2.2 Sense of otherness . 165 6.2.3 Employment . 166 6.2.4 Language . 168 6.2.5 Fear of safety of family . 171 6.2.6 Loss and grief . 171 6.2. 7 Conclusion . 173 6.2. 7.1 Stigma as a barrier to help-seeking . 175 6.2. 7.2 Conceptualisation of mental illnesses: The role of religion and the use of the Western medical model . 176 6.2. 7.3 Shame. 178 6.2. 7.4 Gossip . 180 6.2. 7.5 Informal and formal help-seeking. 181 CHAPTER SEVEN: INTEGRATED DISCUSSION . 186 7.1 Lasting Effects of Trauma and War . 187 7.2 Post-migration Factors . 188 7.3 Disability Associated with Mental Illness and Resilience . 188 7.4 Recognition of Mental Health Issues and Help-seeking Behaviours . 189 7.5 Perception of Their own Mental Health . 190 7.6 Helpfulness of Treatment and Treatment Providers . 191 7.7 Stigma Associated with Mental Illness . 192 7.8 Discrepancies Between the Findings of the Quantitative and Qualitative Studies . 193 7.9 Implications for Clinical Pra