An exploration of the adaptation and development after persecution and trauma (ADAPT) model with resettled refugee adolescents in Australia: A qualitative study

Abstract

Refugee adolescents endure high rates of traumatic exposure, as well as subsequent resettlement and adaptational stressors. Research on the effects of trauma in refugee populations has focussed on psychopathological outcomes, in particular posttraumatic stress disorder. However this approach does not address the psychosocial and adaptive dimensions of refugee experience. The ADAPT model proposes an alternate conceptualization of the refugee experience, theorizing that refugee trauma challenges five core psychosocial adaptive systems, and that the impact on these systems leads to psychological difficulties. This study investigated the application of the ADAPT model to adolescents’ accounts of their refugee and resettlement experiences. Deductive thematic analysis was used to analyse responses of 43 adolescent refugees to a semistructured interview. The ADAPT model was found to be a useful paradigm to conceptualize the impact of adolescents’ refugee and resettlement journeys in terms of individual variation in the salience of particular adaptive systems to individuals’ experiences. Findings are discussed in light of current understandings of the psychological impact of the refugee experience on adolescents.

Keywords

adaptation adolescence refugees theory

Introduction

The refugee experience is inherently complex, imposing unique stressors on youth (Papadopoulos, 2007). Prior to resettlement, many refugee youth endure cumulative, often prolonged trauma, including exposure to warfare, displacement, and separations from family members (Almqvist & Brandell-Forsberg, 1997; Papageorgiou et al., 2000; Rousseau, Drapeau, & Platt, 1999). Significant stressors that often continue in the resettlement period include coping with loss, grief and trauma (Momartin, Silove, Manicavasagar, & Steel, 2004); discrimination (Lindencrona, Ekblad, & Hauff, 2008; Shedlin, Decena, Noboa, & Betancourt, 2014); financial insecurity (Lindencrona et al., 2008; Porter & Haslam, 2005); and educational and occupational challenges (Beiser & Hou, 2001).

Despite these experiences having significant psychological impact, the prevalence rates of psychopathological conditions among refugees, including posttraumatic stress disorder (PTSD), are lower than expected (Fazel, Wheeler, & Danesh, 2005; Silove, 1999; Steel, Silove, Phan, & Bauman, 2002). A comprehensive meta-analysis, for example, found that 9% of adult and 11% of child and adolescent resettled refugees were diagnosed with PTSD (Fazel et al., 2005). While these rates are higher than in age-matched general populations, they demonstrate that the vast majority of refugees do not develop clinical levels of psychopathology (Bronstein & Montgomery, 2011; Silove, 1999; Steel et al., 2002). This raises questions about the applicability of the PTSD diagnosis to diverse cultural groups and the cultural shaping of responses to stress and trauma (Bracken, Giller, & Summerfield, 1995; Hinton & Lewis-Fernandez, 2011), as well as the possibility that there are other risk or protective factors for posttraumatic psychological distress (Porter, 2007; Silove, 1999). Examining processes of adaptation that may be affected by trauma during refugee experiences may explicate the links between traumatic events, psychological functioning, and psychopathology (Krell, 1997).

In response to these issues, Silove (1999, 2013) proposed an alternate theoretical framework for studying the psychological impact of the refugee experience. Citing early works with Holocaust survivors (e.g., Bergmann & Jucovy, 1982; Krell, 1997), Silove (1999) noted that experiences of persecution and gross violations of human rights may impact on adaptation in ways that go well beyond the symptoms of PTSD. The adaptation and development after persecution and trauma (ADAPT) model (Silove, 1999, 2013) posits that trauma endured by refugees has impacts on five key psychosocial domains or “adaptive systems” (Silove, 1999). The five adaptive systems in the ADAPT model are described below, with links made to the broader literature on adolescent populations where indicated, in order to operationalize constructs for use in the present study.

The safety system

In discussing this component of the model, Silove (1999 , 2013)considers the impact of threat to life on the development of PTSD. There is evidence that the likelihood of developing PTSD increases with the degree of perceived personal threat, and degree of exposure to the index trauma (Dyregrov, Gupta, Gjestad, & Mukanoheli, 2000; Reed, Fazel, Jones, Panter-Brick, & Stein, 2012). Further, for many refugees, sense of safety is repeatedly challenged by ongoing threats and adversity in the resettlement environment, including an absence of social support and lack of control over their lives (Silove, 1999, 2013). This added and ongoing challenge to their sense of safety may contribute to the development and maintenance of psychopathology, particularly PTSD (Silove, 1999). For example, resettled refugees are often subjected to racism and discrimination (Gifford, Correa-Velez, & Sampson, 2009; Pedersen & Thomas, 2013), with a recent Australian longitudinal study finding over a third of participants had been discriminated against due to their ethnicity or religion (Gifford et al., 2009). The broader literature indicates that such events can have detrimental impacts on mental health (see Priest et al., 2013, for a review), and aligns with Silove’s (2013) assertion that an absence of social support and resources may be particularly relevant in impeding recovery in the posttrauma environment.

The attachment system

Separations and loss of family members and friends are part of the refugee experience (Rousseau, Rufagari, Bagilishya, & Measham, 2004; Silove, 1999), and contribute to psychopathological outcomes (McGregor, Melvin, & Newman, 2015; Nickerson, Bryant, Steel, Silove, & Brooks, 2010). Social support is an important protective factor in the mental health of refugee youth (Fazel, Reed, Panter-Brick, & Stein, 2012; Mohlen, Parzer, Resch, & Brunner, 2005). The refugee experience may involve symbolic losses, and these can also disrupt individual’s sense of belonging and connection to family, peers, and ethnic heritage (Eisenbruch, 1991; Silove, 1999).

The justice system

Many refugees endure events that could be categorized as extreme human rights violations, including torture and forced betrayal (Carswell, Blackburn, & Barker, 2011; Silove, 1999, 2013). A sense of profound injustice may result from such experiences, and may stay with the victim for many years following the events. Adolescents and children are not exempt from enduring torture and human rights violations prior to resettlement (Neugebauer et al., 2009; Slodnjak, Kos, & Yule, 2002), and evidence demonstrates that some refugee youth may present with anger and aggressiveness, perhaps as a result of their experiences (Lustig et al., 2004; Mollica, Poole, Son, Murray, & Tor, 1997).

The existential meaning system

Silove (1999) posits that exposure to traumatic events associated with the refugee experience may lead to a crisis in refugees’ sense of faith and trust in the world, and the meaning systems they hold more generally. Given the centrality of religion to many refugees’ meaning systems, and the potential for religious faith to be negatively impacted after experiencing human-inflicted trauma (Falsetti, Resick, & Davis, 2003; Seirmarco et al., 2012), religion was conceptualized for this study as being an important part of the existential meaning system, along with self-described moral values and beliefs.

The identity/role system

Well into their resettlement, refugees are faced with continually changing circumstances and associated uncertainties. Coupled with the disruptions to cultural, familial, educational, and occupational connections, refugees face numerous threats to their identity and self-concept (Silove, 1999, 2013). Silove proposes that there may be linkages between such disruptions and subsequent feelings of passivity and hopelessness, and resultant psychopathology. Adolescents face specific challenges to sense of identity. Children and adolescents are still in the process of forming identities (Erikson, 1968; Meeus, 2011), and the refugee experience may impact the development of identity, as opposed to the disruption of established identity. Indeed, life events as well as cultural and societal influences have been implicated in processes of identity development (Grotevant, 1987).

The extent to which each of the domains of the ADAPT model are affected by trauma varies greatly according to individual and collective experience (Silove, 2013). In addition to trauma exposure and the migration trajectory, Silove points to the need to consider the role the resettlement environment plays in either mitigating or accentuating the negative impact of the refugee experience on individual’s adaptational processes.

Refugee children and adolescents are frequently described in the extant literature in dichotomous terms: they are “vulnerable” or “resilient” (Bronstein & Montgomery, 2011; Carlson, Cacciatore, & Klimek, 2012). We do not yet have nuanced understanding of psychopathological outcomes among refugee youth (Betancourt & Khan, 2008; Porter, 2007; Silove, 1999). Studies with refugee populations are dominated by quantitative approaches, which focus on identifying diagnosable psychiatric symptomatology and conditions (Berman, 2001; Khawaja, White, Schweitzer, & Greenslade, 2008; Summerfield, 1999). This approach fails to consider the individualized nature and the broader psychosocial and adaptive consequences of the refugee experience (Papadopoulos, 2007; Silove, 1999). The present study aimed to contribute to a more detailed understanding of the impact of the refugee experience on adolescents by exploring the applicability of the ADAPT model to adolescents’ accounts of their refugee and resettlement experiences.

Methods

This is a qualitative interview-based study of adolescent refugees’ postmigration adaptation experience. The study was approved by Monash University and University of Tasmania Human Research Ethics Committees, and the Victorian and Tasmanian State Departments of Education and Early Childhood Development.

Participants

Study participants were young people who self-identified as being from a refugee background, and were living in Hobart (N = 20) or Melbourne (N = 23), Australia. Three participants arrived in Australia as asylum-seekers (prior to the government’s change of policy towards processing and resettling asylum seekers offshore; see Australian Human Rights Commission, n.d.), the remainder arrived with refugee status. People arriving with refugee status in Australia are granted humanitarian visas, which affords them permanent residency, government-funded health services, and social security benefits. Inclusion criteria for all participants comprised: (a) between 12 and 21 years of age; (b) residing in Australia for 6 months or more; (c) sufficient English capabilities if they did not wish to use an interpreter; and (d) consent for their interview to be audio-recorded and transcribed. Data were collected between April, 2012 and August, 2013.

Measures

Participants took part in a semistructured interview, the Youth Experience Scale for Refugees (YES-R; McGregor, Melvin & Newman, 2014), developed for use in this study. The interview schedule was developed based on the ADAPT model (Silove, 1999), as well as the authors’ knowledge of issues experienced by youth from refugee backgrounds. Prior to use with participants, the interview schedule was reviewed by three professionals who worked with youth from refugee backgrounds (two psychologists and one case worker), and a member of the Sudanese community from a community services agency. The interview was also piloted with a small subgroup of participants (n = 4) and minor changes to the interview schedule and administration were made following this process.

The YES-R consists of open-ended questions designed to explore participants’ experiences of their refugee and resettlement journeys, in line with the five major adaptive systems explicated in the ADAPT model (Silove, 1999, 2013): safety and security (safety system); maintenance of bonds and interpersonal relationships (attachment system); effective mechanisms for administering justice (justice system); capacity to perform roles and uphold identity (identity/role system); and, ability to express aspirations that confer meaning (existential-meaning system). Although the essence of the interview-schedule was followed for all interviews, questions were used flexibly, and were adapted or omitted where indicated, in order to promote individual participants’ agency over the interview process.

Procedure

Participants were recruited through the combined use of convenience and snowball techniques from consenting educational (two public secondary schools, an English language school, a technical and further education institution [TAFE] and a university) and community-based institutions (a hospital-based refugee health clinic and a local GP practice) in Melbourne and Hobart, Australia. When recruited through educational institutions, the lead author addressed groups of prospective participants to verbally explain the research project and invite participation. The same process took place at health clinics, though the introduction of the project was provided to prospective participants by treating medical practitioners. Written consent was obtained from all participants, and, where younger than 18 years of age, from their parents or guardians. Translated versions of consent forms were made available in numerous languages (including Arabic, Burmese, and Karen). Telephone interpreters were also made available in cases where no written translated consent form was available in the parents/guardians’ language and in instances where the participant reported that their parent/guardian was illiterate. A movie voucher was provided as an appreciation gift for participation in the study.

Only one participant chose to use an interpreter, despite the opportunity being offered to all. Interviews were conducted by the lead author at institutions where recruitment took place, lasted between 30 and 90 minutes, and were audio recorded, where participants gave written consent to do so. Four participants (9%) did not consent to interviews being recorded and written notes were taken. Due to the inability to carry out thematic analysis on this data, results from these participants are not included in this report.

Data analysis

Audio-taped interview transcripts were transcribed verbatim by the lead author and a research assistant. Given English was not participants’ first language, the data were edited only to enhance readability (e.g., incorrect usage of pronouns). NVivo software (Version 10) was used for the coding of the data set. Data were analysed using deductive thematic analysis (TA) based on the ADAPT model but included an inductive component based on participants’ accounts (Braun & Clarke, 2006). The ontological position underpinning this research was critical realism (Braun & Clarke, 2013): Participants’ accounts of their experiences were taken as reality, but were considered in terms of pertinent historical, political, and cultural contexts in which they operated (Opperman, Braun, Clarke, & Rogers, 2013).

The process of TA was conducted in stages. After familiarization with the dataset, initial codes were generated based on both semantic as well as latent content, as it related to the ADAPT model. The coded information was collated into themes, which were then classified into hierarchies (i.e., overarching themes, themes, and subthemes) by identifying commonalities between groups of codes and in accordance with the ADAPT model. Following a final review of the codes, themes, and their definitions, cross-coding was carried out by two independent raters who had no involvement in the research but were experienced in qualitative data analysis, to check the validity of the coding scheme. For this process, 25% of the interviews were randomly selected, and the authors’ coding schemes were checked for accuracy. There were processes in place should cross-coders disagree with the authors’ coding scheme, however these were not required as the cross-coders were in agreement.

Results

Participant demographics

The sample consisted of a total of 43 participants, 26 female and 17 male, who had been in Australia on average 4.43 years (range 6 months to 11 years) and were between the ages of 12 and 21 (M = 17.00; SD = 2.62). Eight participants were recruited through health services and 35 through educational institutions. Regions of origin were Burma (13), Nepal (6), Rwanda (5), Afghanistan (4), Ethiopia (2), Iran (2), Kenya (2), Bhutan (1), Congo (1), Guinea (1), Kosovo (1), Pakistan (1), Sudan (1), Syria (1), Tanzania (1), and Uganda (1).

Applicability of the ADAPT model

In broad terms, results of the thematic analysis revealed that the ADAPT system was a useful conceptual framework from which to view participants’ experiences as refugees and in resettling in Australia. Importantly, there was individual variation in the salience of components of the model to individuals’ refugee and resettlement experiences. The following sections detail the results of the thematic analysis pertinent to each of the five systems.

Safety

While over half of the participants discussed the topic of safety, most did not often discuss it in great detail, suggesting that it was not an issue of concern for the majority. When the topic was discussed, it was largely in terms of Australia being characterized as a “safe” place in comparison to the countries from which participants had originated, due to an absence of war and violence. For instance, Daara¹ (M; 18 years) stated, “I’m safe here, like I don’t have to wake up in the morning and think about oh how am I going to survive today, like Afghanistan it’s like that but here it’s not.” Many Burmese participants contrasted their experiences of safety in Australia to their experiences in transit in India and Malaysia, where they felt threatened because of their refugee status. Burmese participant Hla (F; 13 years), for example, spoke of feeling “scared of people” in India because of her status as a refugee, and compared this to Australia where she appeared to hold a sense of trust in Australians, who were described as “good,” “nice and kind.”

For some, like Aela (F; 16 years), a feeling of safety in Australia came with an associated sense of freedom, “Here is such a safe place and I can do what I want.” For these participants, with safety came the ability to pursue opportunities and engage in activities in Australia that were not afforded to them in their homelands.

The issue of racism and discrimination was brought up by only a minority of participants. Daud (M; 13 years) for example, reported that his main concern in Australia was “being accepted.” When asked if he had experiences of feeling unaccepted in Australia he responded, “No, but for some reason everyone seems to think that all Muslims are terrorists.” Mbali (F; 18 years) spoke about the hardship of experiencing bullying at school. Mbali alluded to the fact that the bullying she experienced in Australia compounded already difficult experiences she had as a refugee, “’Cos you’ve already been through a lot, you don’t want to go through a lot again.”

Attachment

Family attachment relationships

Family ties were spoken of in terms of their central importance in participants’ lives. For the majority of participants, their immediate family was characterized by mutually affectionate and supportive relationships. Many participants cited examples of ways in which their family members supported them throughout their refugee experience and in resettling and adapting to life in Australia. For example, Eniola (F; 19 years) spoke of how her parents protected her when she was a young child having recently moved to Australia from Rwanda:

I mean my parents tried really hard ‘cos I think after the genocide I was really traumatized and apparently when I saw people hug I burst into tears. So like they tried to shield us from that like a lot like they wouldn’t let us see the bad side and they like really babied us.

Kabira (F; 20 years) discussed how her father provided emotional support and encouragement to her and her siblings in adapting to their lives in Australia: “He told me, ‘You don’t need to learn English, English is coming to you! So … all your dreams, it’s coming to you’ Yeah so he’s say always like this, for encourage us.” These examples illustrate the important role that parents play in supporting their children emotionally throughout all phases of their refugee experiences, and corroborate research findings that children who go through such experiences unaccompanied fare worse than those who have a parent with them (Huemer et al., 2009).

For a minority of participants, the family represented a source of stress, which appeared to have significant impact upon their emotional wellbeing. Much of the stress within participants’ families had apparent links to circumstances related to their experiences as refugees. For example, Jack (M; 16 years) described feeling “scared when I sleep,” because of his concerns about his family’s future in Australia: “my father didn’t have a job and my mother they can’t speak English. They don’t know anything … I need to get a job and keep going at school.” While Daara (M; 18 years) reported feelings of guilt over the strained relationship he held with his father, possibly partly due to, as the following quote illustrates, his father coming to Australia as an asylum seeker:

My Mum tells me it’s your dad, like he risked his life getting here, ‘cos he was a boat refugee, and he risked his life to get here, just so you could have a better future, but like you’re not taking advantage of that. You’re not taking life seriously, you should listen to him.

Approximately half of the participants were separated from immediate family members (both through death as well as family members being resettled and/or moving elsewhere), whilst nearly all participants spoke of being separated from members of their broader family unit. Participants frequently spoke of the emotional difficulty both they and their family members experienced because of such separations, like Edris (M; 18 years), who described the angst his mother experienced due to his older sister remaining in Iran: “from my mum’s side, her body’s here but her brain and heart’s over there [in Iran]… things are hard for my mum … she cries all the time, talks about her [his sister].” These findings are consistent with studies with adult refugees, in which separation from family members who remained in their countries of origin was associated with increased emotional distress (Nickerson et al., 2010; Rousseau, Mekki-Berrada, & Moreau, 2001). Finally, when asked about what they missed about their homelands, almost every participant reported that they missed family members who remained behind.

Peer attachment relationships

Adolescence is a crucial period for developing peer relations (Allen, 2008). This was reflected in interview data, in which peers were frequently mentioned and spoken of in terms that indicated their centrality to participants’ daily lives and emotional wellbeing. Kabira (F; 20 years), for example, spoke about how she often thought about returning to Syria because she was missing her friends: “sometimes, when I miss my country, I miss my friends, I say I want to go back to my country. Because this is the first time for me without my friends.”

With the exception of a few participants who had been in Australia since they were young children, many participants distinguished between the sorts of relationships they had with Australian-born peers and those they had with peers from similar ethnic and refugee backgrounds. While friendships with Australian-born peers were undoubtedly seen as important and emotionally fulfilling, they were characterized by many as necessary in order to “fit in” with peers at school, and by others as something that was necessary to improve conversational English skills. Participants thus conveyed a sense that relationships with Australian-born peers were of a different quality than those with their ethnic peers, partly due to the shared cultural values they held with peers of the same ethnicity, as illustrated by Kagiso (F; 20 years) when she discussed the importance of having friends from African backgrounds:

It’s important ‘cos I enjoy their company because having that shared thing with a person, like, you can make like inside jokes about weird things that your parents do that are so weird and peculiar and I can’t tell, like, my Australian-born friends.

In accordance with Silove’s (1999) description of a sense of belonging and social cohesion being an important component of the attachment system under the ADAPT model, there were a minority of participants whose sense of belonging appeared to be compromised in Australia, partly because of a lack of peer relations. Kabira (F; 20 years), for example, spoke extensively about how she missed her friends in Syria. She found it difficult to fit in with her classmates at TAFE who were from various other ethnic backgrounds, but also difficult to find friendships with Australians:

Sometimes it’s hard because I don’t know about Australia … I don’t know how I can talk with them [Australians], if you like this question or not, or you like this or not, yeah. And or, for another refugee, like [from] Nepal or Sudan, or another [country]… I don’t know about them, I don’t know how or what I’m talking about [with] them. Yeah because it’s different culture, different everything.

Extended social circle attachment relationships

Although not discussed in comparable detail to peer or family relationships, participants did endorse holding important interpersonal relationships with people in their social networks, particularly with “family friends” from their ethnic background that they socialized with at family gatherings and at church. Interestingly, four participants in Hobart spoke of the crucial role volunteers played in assisting their families settle in Australia, while no Melbourne participants reported such experiences. These participants likened the volunteers to members of the family, and still maintained ongoing relationships with them years after their initial involvement, in a testament to their importance in their friendship networks. Ife (F; 19 years), for example, stated of her volunteers, “And I would say to you, Andrew and Catherine was not just a volunteer for us, they was family for us and still, and still.”

The justice system

Findings relating to the justice system were few. Only two participants discussed issues that could be interpreted as related to a sense of injustice, as is described in the ADAPT model. One of these participants, Aela (F; 16 years), spoke of her incomprehension as to why terror attacks are carried out in her homeland of Afghanistan:

These stupid people just come in their cars and they just shoot everything, just like that. It is very stupid what they think in their heads and then they call themselves religion. It says in the Quran that killing others is wrong, then they kill others and call themselves very religious and Muslims, you know seriously, what are you gaining out of it outside of innocent killings and lots of blood spillings, they gain nothing out of it.

For this participant, carrying out terror attacks in the name of Islam was fundamentally unjust, not only because the attacks were carried out against innocent people but also because they contradicted her notions of what it means to be a Muslim.

The other participant who discussed issues pertaining to justice, Kabira (F; 20 years), spoke about how she felt loyal to the Syrian government at the time because she was of Palestinian heritage, and the Syrian government had taken her family in as refugees. Like Aela, she too described an inability to comprehend the reasoning behind the civil war: “It’s hard because err when you fighting with Syrian people, not with another one from another country, Syrian with Syrian people … why are you fighting?” There was one participant, Daara (M; 18 years), who evidenced direct expressions of aggression, in line with Silove’s (1999) characterization of the justice system. Much of his anger, or self-described feelings of “frustration,” appeared to be a reaction to hostile familial relations, particularly stemming from times when his father had kicked him out of home, as illustrated by the following quote:

Every time, every time I’d been kicked out, it was because my dad was telling me stuff, and I wouldn’t agree with it, and then, I’d end up getting violent and I’d punch the walls and stuff, and that’s why I just get, frustrated.

The existential meaning system

In the original description of the existential meaning system, Silove (1999) describes how some refugees who have experienced torture may undergo a ‘crisis' which disrupts their faith, trust, or sense of meaning. By contrast, the majority of participants in this study appeared to hold coherent, and in many cases strong, belief and value systems.

Religious values

Religion was reported as being a significant part of the lives of many participants and their families. Perhaps due to their developmental stage, for many of the younger participants, their religious practices were spoken about in terms of them being something that they “just did,” and were not reflected upon. Nonetheless, for many of these younger participants, religion appeared to be a central and unquestioned part of their lives, and was something they planned on continuing to maintain into adulthood. Older participants were more reflective on the reasoning behind their religious practices and faith-based belief systems. For many, faith appeared to provide direction and an overarching sense of meaning, as Kagiso (F; 20 years) explained:

I think at a time when I felt lost and such things it was that lack of faith because it’s been the thing that I’ve been grounded on for most of my life, and my life does not work without faith, like, I don’t work without it.

Religious values were overtly dismissed by only a minority of participants. For one of these participants, Daara (M; 18 years), this could be attributed to his experiences as a refugee from Afghanistan, “I dunno. I don’t believe in religion I reckon it’s just the reason to kill each other.”

Meaning systems, moral values, and beliefs

Similar to the way participants spoke of religious values, it was the older participants who spoke of the belief and meaning systems they held. Many participants’ meaning and value systems appeared to have been influenced by their experiences as refugees and their resettlement in Australia. For these participants, it appeared that rather than causing a crisis in trust, faith, and meaning, their experiences as refugees had resulted in a stronger sense of meaning and direction in their lives. In the main, they did not appear to begrudge their countries for their forced migration, as a quote by Kabira (F; 20 years) illustrates: “So Syria is like my homeland, like my mum. It’s not good to say no they are not good. But it’s war, it’s war, and nobody like war, so we escape from that.” Another participant, Ela (F; 20 years), however, was a notable exception to this. Although she was born in a refugee camp in Nepal, her family had been forced to flee Bhutan. After a conversation about the human rights violations of the Bhutanese government towards its people, Ela said, “but I really really hate Bhutan. I really don’t like it.” This quote perhaps illustrates her internalization of the abuses the country directed against her family and her people, although she herself had never lived there.

There was also a strong sense that most participants felt, while acknowledging they experienced great hardship and danger as refugees, that they in fact had been lucky in their experiences, and that there were many opportunities available to them as a result. For example, Aela (F; 16 years), said:

I will never take things for granted. I have so much here. I cherish everything here, I don’t sit here and think I don’t have this but this person has that. A lot of people don’t even have what I have, I have a roof over my head and other people don’t. So I consider myself extremely lucky.

Kagiso (F; 20 years) also discussed the positive side to her experience as a refugee:

That’s the greatest thing about the whole you know going through that whole displacement, not having anywhere you belong and stuff like that is at the end when you do arrive you have or in [the] case of my family … we’re all given like kind of unlimited opportunity … and we have support and there’s possibilities and great people, good country … And that’s the best thing about it, like, that’s what it has given me and my sisters and my family.

Identity/role system

Not all participants’ interviews were detailed enough to ascertain a sense of their self-concept. While this likely related to a range of factors (including language ability, personality characteristics, and the focus and length of the interview), participants’ age was a factor, with older participants more inclined to discuss topics related to their sense of self (Byrne & Shavelson, 1996; Sebastian, Burnett, & Blakemore, 2008). Most participants who were in late adolescence did demonstrate a coherent and assured sense of self. They generally had an understanding of their own emotional worlds, as well as a sense of how their peers and family members perceived them. Many participants stressed that a coherent sense of self was something they recommended other young people from refugee backgrounds foster in themselves. Kato (M; 16 years), for example, spoke of how important it was for young people from refugee backgrounds to embrace a sense of self in order to promote their adaptation to Australia:

Embrace who you are. As well as just being yourself, ‘cos the teenage years are weird for anybody, no matter what culture. So if you can … be your own person during your teenage years, you’ll do well.

Indeed, that sentiment was echoed by other participants, who, in giving advice to other young people from refugee backgrounds said “just be yourself” (Hiwot [F; 17 years]) and “don’t change your personality” (Laura [F; 19 years]) when settling in Australia.

Discussion

Overall, the results of the current study illustrate the applicability of the ADAPT model for conceptualizing the impact of the refugee and resettlement experience on adolescents from refugee backgrounds. Participants’ interviews clearly addressed issues related to the attachment, existential meaning, and identity/role systems, with less discussion around topics pertaining to the safety and justice systems. At an individual level, the findings demonstrated the relevance of the domains to adolescents’ experience, but there was much individual variation in the salience of particular adaptive systems. This is to be expected given that refugee and resettlement processes, as well as the ways in which people cope and adapt to such experiences, are highly individualized.

Silove (1999, 2013) conceptualized the safety system as impacting on refugees through premigratory trauma experiences and resettlement “threats.” Questions regarding premigratory traumatic experiences were omitted from the interview schedule due to concerns over possible retraumatization, and were only discussed in instances where the participant brought the topic up themselves. This may account for a lack of data pertinent to the safety system in response to premigration trauma experiences. That there were relatively few findings in relation to participants’ experience of racism and discrimination in the resettlement environment is, however, unexpected and contrary to findings obtained in a study with refugee adolescents resettled in Melbourne (Gifford et al., 2009). Respondents in the present study may have been reluctant to discuss such topics with the interviewer given that she is White, ethnic Australian background, and had not had extensive dealings with the participants prior to their involvement in the study (unlike the participants in Gifford and colleagues’ study). Despite this, some participants did report experiencing racism and discrimination and it was clear from their accounts that this had a lasting negative impact on them. The lack of data pertaining to the safety system also may be an indication that the majority of participants were able to maintain or repair their safety systems following their refugee experiences. Adaptive systems, while threatened by aspects of the refugee and resettlement experience, may be protected or even enhanced and thus contribute to positive outcomes for many people from refugee backgrounds (Silove, 2013).

Much of the content of participants’ interviews was related to the ADAPT model’s attachment system, and indicated that many youth had strong and protective attachments to family and friends alike. It was clear that their experiences as refugees had shaped and influenced the nature of attachment relationships, particularly with regard to separations from family members. Consistent with findings in adult refugees (Nickerson et al., 2010) and unaccompanied minors (Huemer et al., 2009), separations from family members were reported as a significant stressor.

In line with developmental norms (Allen, 2008), most participants’ accounts demonstrated the centrality of peer relations in their lives. Notably, the characteristics of relationships with Australian peers versus those with peers of similar ethnic backgrounds were described in qualitatively different ways: relations with peers from similar ethnic backgrounds were often characterized by mutual understanding and commonalities, whereas relationships with Australian peers were, for some participants, comparatively instrumental. These differences may reflect the process of integration (Berry, 1997), in which aspects of the host society are adopted (in this case instrumental social relationships with Australian peers) that may benefit the adoptee, whilst ties to ethnic identities and cultures (in this case friendships with ethnic peers) are maintained (Berry, 1997; Jorden, Matheson, & Anisman, 2009; Schweitzer, Melville, Steel, & Lacherez, 2006).

Content of participants’ interviews that could be classified as being subsumed under the ADAPT model’s justice system was minimal. Given that the interview directed few questions towards participants’ refugee experiences, there may not have been opportunity for participants to discuss topics pertinent to this aspect of the model. Another possibility is that, like the safety system, participants’ refugee and resettlement experiences did not challenge their perception of the integrity of the justice system. Given that the majority of participants had arrived in Australia classified as refugees (rather than asylum seekers), had not spent time in detention centres, and were engaged in school or posttertiary education at the time of the study, it may have been that their sense of justice was not undermined, or had been restored by their experiences in resettling in Australia. A final possibility is that this aspect of the model was not implicated in participants’ refugee experiences, with the exception of one participant who experienced feelings of “frustration” and behavioural disruption due to intrafamilial conflict that appeared to have some relationship to the family’s experience as refugees. Silove (1999) related this component of the model to the specific experiences of torture survivors, which have been shown to engender profound effects on victims’ sense of justice. It may be that the nature of trauma experienced by participants was of a different quality than that of torture survivors. In a similar vein, and consistent with results from other research with refugee youth, it may have been that this sample of adolescents had parents that were able to protect them from potential traumatization (Almqvist & Brandell-Forsberg, 1997; Punamäki & Puhakka, 1997).

The majority of participants in this study appeared to hold strong and coherent moral and religious beliefs that were positively shaped and solidified by their refugee experience. This observation is consistent with Silove’s (2013) assertion that many refugees experience positive adaptational and existential outcomes following their experiences. Other studies have found that some youth may experience heightened appreciation for life and spiritual growth following traumatic events (Meyerson, Grant, Carter, & Kilmer, 2011). In line with these findings, many young people expressed feelings of appreciation of their life circumstances while still acknowledging the hardships they endured as refugees.

Many participants gave accounts that demonstrated that they were insightful and self-reflective about their own psychological functioning, and that they had an age-appropriate sense of identity and self-concept. This was particularly evident when many reflected that other young people of refugee backgrounds should maintain a strong sense of self in order to enhance their adaptation to life in Australia. While Silove (1999) posited that sense of identity may be compromised by the refugee experience, the accounts provided by these adolescents suggest that, at least for some, this was not the case. This may reflect the fact that recruitment was primarily from educational institutions, where many participants were engaged in important developmentally appropriate educational pursuits. A similar study with adolescents whose educational experiences have been disrupted, might produce evidence of identity issues more in line with Silove’s original conception of this system.

The findings of this study demonstrate the relevance of the ADAPT model’s (Silove, 1999, 2013) adaptive systems to the accounts of participants’ refugee and resettlement experiences. Importantly, the results largely attested to the positive and protective role these systems played in adolescents’ adaptational outcomes. Although much has been written about the potentially adverse effects the refugee experience can impart on people’s sense of safety, attachments, self-concept, and sense of meaning, participants in this study largely demonstrated that these facets of their lives were functioning well. For many, some domains, like the existential meaning system, had even been enhanced by their experiences as refugees, not unlike what has been suggested in the literature on posttraumatic growth following traumatic experiences (Powell, Rosner, Butollo, Tedeschi, & Calhoun, 2003). These results demonstrate a need to jointly consider how adaptive processes may be compromised and enhanced in the refugee and resettlement process (Silove, 1999, 2013). Individual variation in the salience of particular adaptive systems to individuals’ adaptational outcomes demonstrates the ability of the ADAPT model to discriminate within refugee populations in relation to their resettlement and refugee journeys.

To the authors’ knowledge, this is the first study that has examined the ADAPT model in an adolescent sample. Particular components of the ADAPT model, such as the attachment and identity/role systems, may be especially important to adolescents, given their stage of psychosocial development (Erikson, 1968; Meeus, 2011). What remains to be seen is how the model operates with refugees, and indeed other populations of young people, such as migrants, who have had varying degrees of trauma experiences. Such research would build on the present study in providing important information on the specificity of the ADAPT model to different population groups.

This study has several limitations. Firstly, in not explicitly questioning participants about their premigratory refugee experiences, we may have not elicited important information pertinent to aspects of the ADAPT model. This is particularly relevant to the safety and justice systems of the model, where it is likely that premigratory experiences such as parental protectiveness and trauma exposure, play a significant role in these adaptive processes. Many of the dimensions of the ADAPT model, for example, existential meaning, contain abstract concepts that may have been challenging for some of the younger participants to understand. The recruitment procedures used may have led to a sampling bias in which those who opted to take part in the study were more acculturated than those who chose not to participate. The cross-sectional design of the study further restricts conclusions as to the relationships between aspects of the refugee experience and the adaptational processes of refugee youth, and as such, follow-up and longitudinal studies would be recommended in further studies examining such concepts in these populations.

Despite these limitations, this study provides important preliminary evidence for the relevance of the ADAPT model in theorizing the impact of the refugee and resettlement experience on a sample of adolescents. We demonstrated that adaptational systems as described in the ADAPT model are impacted and affected by the refugee experience, many in a positive way. That there were commonalities across adolescents’ accounts, particularly with regard to the importance of family relations and having a strong sense of self-identity, provides grounds for the tailoring of programs and interventions to adolescents who may experience difficulties in such domains, while the findings pertaining to individual differences in the resonance of particular adaptive systems lend themselves to further research examining the impact of such individualized processes on adolescent outcomes.

Footnotes

Acknowledgements

We wish to acknowledge the young people who kindly gave up their time to participate in the study and the reviewers for their thoughtful and informative feedback on this manuscript.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Note

Lucy S. McGregor, DPsych(Clinical), is a clinical psychologist who recently completed her doctoral thesis through Monash University’s Doctor of Clinical Psychology program. Her doctoral research examined posttraumatic stress disorder symptoms and adaptation in adolescents resettled in Australia from refugee backgrounds. Dr. McGregor is currently working clinically in a public child and adolescent mental health service in Hobart, Tasmania.

Glenn A. Melvin, MPsych, PhD, is a clinical and counselling psychologist and a senior lecturer at the Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University. Dr. Melvin’s research focuses on understanding, assessing, and treating mental health problems during adolescence. In particular, Dr. Melvin is interested in trauma experiences of adolescents of a refugee background, school refusal, suicide risk, and depressive disorders. He has received research support from the NHMRC, beyondblue, and the Endeavour Foundation.

Louise K. Newman AM, MBBS(Hons) PhD FRANZCP Cert. Child Psych RANZCP, is the Director of the Centre for Women’s Mental Health at the Royal Women’s Hospital and Professor of Psychiatry at the University of Melbourne. She is a practising infant psychiatrist with expertise in the area of disorders of early parenting and attachment difficulties in infants. Professor Newman has undertaken research into the issues confronting parents with histories of early trauma and neglect as well as the impact of immigration detention on child asylum seekers. She is the Convenor of the Asylum Seeker Advocacy Group and Vice-President of Doctors for Refugees, and has been a government advisor on asylum seeker and refugee mental health and contributed to the development of policy for mental health screening and response to torture survivors.

References

Allen

(2008) The attachment system in adolescence. In: Cassidy

Shaver

(eds) Handbook of attachment: Theory, research, and clinical applications, 2nd ed. New York, NY: Guilford, pp. 1321–1374.

Almqvist

Brandell-Forsberg

(1997) Refugee children in Sweden: Post-traumatic stress disorder in Iranian preschool children exposed to organised violence. Child Abuse and Neglect 21(4): 351–366.

Australian Human Rights Commission (n.d.) Asylum seekers and refugees guide. Retrieved from https://www.humanrights.gov.au/asylum-seekers-and-refugees-guide.

Beiser

Hou

(2001) Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: A 10-year study. Social Science and Medicine 53(10): 1321–1334.

Bergmann

Jucovy

(1982) Prelude, New York, NY: Basic Books.

Berman

(2001) Children and war: Current understandings and future directions. Public Health Nursing 18(4): 243–252. .

Berry

J. W.

(1997) Immigration, acculturation, and adaptation. Applied Psychology: An International Review 46(1): 5–34. .

Betancourt

T. S.

Khan

K. T.

(2008) The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Psychiatry 20(3): 317–328. .

Bracken

P. J.

Giller

J. E.

Summerfield

(1995) Psychological responses to war and atrocity: The limitations of current concepts. Social Science and Medicine 40(8): 1073–1082. .

10.

Braun

Clarke

(2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77–101. .

11.

Braun

Clarke

(2013) Successful qualitative research: A practical guide for beginners, London, UK: SAGE.

12.

Bronstein

Montgomery

(2011) Psychological distress in refugee children: A systematic review. Clinical Child and Family Psychology Review 14: 44–56. .

13.

Byrne

Shavelson

(1996) On the structure of social self-concept for pre-, early, and late adolescents: A test of the Shavelson, Hubner, and Stanton (1976) model. Journal of Personality and Social Psychology 70(3): 599–613. .

14.

Carlson

Cacciatore

Klimek

(2012) A risk and resilience perspective on unaccompanied refugee minors. Social Work 57(3): 259–269. .

15.

Carswell

Blackburn

Barker

(2011) The relationship between trauma, post-migration problems and the psychological well-being of refugees and asylum seekers. International Journal of Social Psychiatry 57(2): 107–119.

16.

Dyregrov

Gupta

Gjestad

Mukanoheli

(2000) Trauma exposure and psychological reactions to genocide among Rwandan children. Journal of Traumatic Stress 13(1): 3–21.

17.

Eisenbruch

(1991) From post-traumatic stress disorder to cultural bereavement: Diagnosis of Southeast Asian refugees. Social Science and Medicine 33(6): 673–680.

18.

Erikson

(1968) Identity youth and crisis, New York, NY: W. W. Norton & Company.

19.

Falsetti

Resick

Davis

(2003) Changes in religious beliefs following trauma. Journal of Traumatic Stress 16(4): 391–398. .

20.

Fazel

Reed

Panter-Brick

Stein

(2012) Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors. Lancet 379: 266–282. .

21.

Fazel

Wheeler

Danesh

(2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet 365: 1309–1314.

22.

Gifford

Correa-Velez

Sampson

(2009) Good starts for recently arrived youth with refugee backgrounds: Promoting wellbeing in the first three years of settlement in Melbourne, Australia, Melbourne, Australia: La Trobe Refugee Research Centre.

23.

Grotevant

(1987) Toward a process model of identity formation. Journal of Adolescent Research 2(3): 203–222. .

24.

Hinton

D. E.

Lewis-Fernandez

(2011) The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression and Anxiety 28(9): 783–801.

25.

Huemer

Karnik

N. S.

Voelkl-Kernstock

Granditsch

Dervic

Friedrich

M. H.

Steiner

(2009) Mental health issues in unaccompanied refugee minors. Child and Adolescent Psychiatry and Mental Health 3: 13, .

26.

Jorden

Matheson

Anisman

(2009) Supportive and unsupportive social interactions in relation to cultural adaptation and psychological distress among Somali refugees exposed to collective or personal traumas. Journal of Cross Cultural Psychology 40(5): 853–874. .

27.

Khawaja

White

Schweitzer

Greenslade

(2008) Difficulties and coping strategies of Sudanese refugees: A qualitative approach. Transcultural Psychiatry 45(3): 489–512.

28.

Krell

(1997) Psychiatry and the Holocaust (Vol. 4), New Brunswick, NJ: Transaction.

29.

Lindencrona

Ekblad

Hauff

(2008) Mental health of recently resettled refugees from the Middle East in Sweden: The impact of pre-resettlement trauma, resettlement stress and capacity to handle stress. Social Psychiatry and Psychiatric Epidemiology 43(2): 121–131.

30.

Lustig

S. L.

Kia-Keating

Knight

W. G.

Geltman

Ellis

Kinzie

Saxe

G. N.

(2004) Review of child and adolescent refugee mental health. Journal of the American Academy of Child and Adolescent Psychiatry 43(1): 24–36. .

31.

McGregor

Melvin

Newman

(2014) The Youth Experience Scale for Refugees. Unpublished instrument.

32.

McGregor

Melvin

Newman

(2015) Familial separations, coping styles, and PTSD symptomatology in resettled refugee youth. Journal of Nervous and Mental Disease 203(6): 431–438. .

33.

Meeus

(2011) The study of adolescent identity formation 2000–2010: A review of longitudinal research. Journal of Research on Adolscence 21(1): 75–94. .

34.

Meyerson

D. A.

Grant

K. E.

Carter

J. S.

Kilmer

R. P.

(2011) Posttraumatic growth among children and adolescents: A systematic review. Clinical Psychology Review 31(6): 949–964.

35.

Mohlen

Parzer

Resch

Brunner

(2005) Psychosocial support for war-traumatized child and adolescent refugees: Evaluation of a short-term treatment program. Australian and New Zealand Journal of Psychiatry 39(1–2): 81–87. .

36.

Mollica

R. F.

Poole

Son

Murray

C. C.

Tor

(1997) Effects of war trauma on Cambodian refugee adolescents’ functional health and mental health status. Journal of the American Academy of Child and Adolescent Psychiatry 36(8): 1098–1106. .

37.

Momartin

Silove

Manicavasagar

Steel

(2004) Complicated grief in Bosnian refugees: Associations with posttraumatic stress disorder and depression. Comprehensive Psychiatry 45(6): 475–482. .

38.

Neugebauer

Fisher

Turner

Yamabe

Sarsfield

Stehling-Ariza

(2009) Post-traumatic stress reactions among Rwandan children and adolescents in the early aftermath of genocide. International Journal of Epidemiology 38: 1033–1045. .

39.

Nickerson

Bryant

R. A.

Steel

Silove

Brooks

(2010) The impact of fear for family on mental health in a resettled Iraqi refugee community. Journal of Psychiatric Research 44(4): 229–235. doi:10.1016/j.jpsychires.2009.08.006.

40.

NVivo (Version 10) [Computer software] Melbourne, Australia: QSR International Pty Ltd.

41.

Opperman

Braun

Clarke

Rogers

(2013) “It feels so good it almost hurts”: Young adults’ experiences of orgasm and sexual pleasure. Journal of Sex Research. Advance online publication. doi:10.1080/00224499.2012.756982.

42.

Papadopoulos

R. K.

(2007) Refugees, trauma and adversity-activated development. European Journal of Psychotherapy and Counselling 9(3): 301–312. .

43.

Papageorgiou

Frangou-Garunovic

Iordanidou

Yule

Smith

Vostanis

(2000) War trauma and psychopathology in Bosnian refugee children. European Child and Adolescent Psychiatry 9(2): 84–90. .

44.

Pedersen

Thomas

E. F.

(2013) “There but for the grace of God go we”: Prejudice toward asylum seekers. Peace and Conflict: Journal of Peace Psychology 19(3): 253–265.

45.

Porter

(2007) Global evidence for a biopsychosocial understanding of refugee adaptation. Transcultural Psychiatry 44(3): 418–439. .

46.

Porter

Haslam

(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): 602–612. .

47.

Powell

Rosner

Butollo

Tedeschi

R. G.

Calhoun

L. G.

(2003) Posttraumatic growth after war: A study with former refugees and displaced people in Sarajevo. Journal of Clinical Psychology 59(1): 71–83. .

48.

Priest

Paradies

Trenerry

Truong

Karlsen

Kelly

(2013) A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people. Social Science and Medicine 95: 115–127.

49.

Punamäki

Puhakka

(1997) Determinants and effectiveness of children’s coping with political violence. International Journal of Behavioral Development 21: 349–370. .

50.

Reed

Fazel

Jones

Panter-Brick

Stein

(2012) Mental health of displaced and refugee children resettled in low-income and middle-income countries: Risk and protective factors. Lancet 379: 250–265. .

51.

Rousseau

Drapeau

Platt

(1999) Family trauma and its association with emotional and behavioral problems and social adjustment in adolescent Cambodian refugees. Child Abuse and Neglect 23(12): 1263–1273.

52.

Rousseau

Mekki-Berrada

Moreau

(2001) Trauma and extended separation from family among Latin American and African refugees in Montreal. Psychiatry: Interpersonal and Biological Processes 64(1): 40–59.

53.

Rousseau

Rufagari

M.-C.

Bagilishya

Measham

(2004) Remaking family life: Strategies for re-establishing continuity among Congolese refugees during the family reunification process. Social Science and Medicine 59(5): 1095–1108. .

54.

Schweitzer

Melville

Steel

Lacherez

(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): 179–188.

55.

Sebastian

Burnett

Blakemore

S.-J.

(2008) Development of the self-concept during adolescence. Trends in Cognitive Sciences 12(11): 441–446.

56.

Seirmarco

Neria

Insel

Kiper

Doruk

Gross

Litz

(2012) Religiosity and mental health: Changes in religious beliefs, complicated grief, posttraumatic stress disorder, and major depression following the September 11, 2001 attacks. Psychology of Religion and Spirituality 4(1): 10–18.

57.

Shedlin

Decena

Noboa

Betancourt

(2014) Sending-country violence and receiving-country discrimination: Effects on the health of Colombian refugees in Ecuador. Journal of Immigrant and Minority Health 16: 119–124. .

58.

Silove

(1999) The psychosocial effects of torture, mass human rights violations, and refugee trauma: Toward an integrated conceptual framework. Journal of Nervous and Mental Disease 187(4): 200–207. .

59.

Silove

(2013) The ADAPT model: A conceptual framework for mental health and psychosocial programming in post conflict settings. Intervention 11(3): 237–248. .

60.

Slodnjak

Kos

Yule

(2002) Depression and parasuicide in refugee and Slovenian adolescents. Crisis: The Journal of Crisis Intervention and Suicide Prevention 23(3): 127–132. .

61.

Steel

Silove

Phan

Bauman

(2002) Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study. The Lancet 360(9339): 1056–1062. .

62.

Summerfield

(1999) A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Social Science and Medicine 48(10): 1449–1462. .