View on the psychological wellbeing of forced migrants in Serbia through the prism of pathogenic and salutogenic mental health indicators
- Psychometric indicators of mental health variables used in this research indicate that the situation of mental health of refugees and displaced persons in Serbia is relatively favourable, i.e. if the average values, or the individual results of the majority of respondents, are viewed in the light of the reference norms. The results are not entirely unambiguous and they basically indicate that salutogenic mental health variables (resilience and positive mental capacity) are surprisingly preserved and developed, but that at the same time, the manifestation of certain pathogenic aspects of mental functioning, in a considerable number of respondents, is quite strong. In this regard, more than three quarters of the respondents demonstrate high dispositive optimism, more than two-thirds highly estimate the subjective quality of their lives, and more than half express high self-esteem, while at the same time, more than half of the respondents have visibly increased level of psychological stress (30% even highly increased) and, likewise, increased symptoms of (mild to very high) anxiety.
Socio-demographic features as correlates of pathogenic and salutogenic variables of mental health
- Gender affiliation has no unambiguous and simple connection with mental health indicators. The results show that the symptoms of psychological stress are prevalent among women in this sample of forced migrants, but that men are more exposed to the impact of stressful life events, even more so when it comes to the events that are not related to war circumstances. However, gender affiliation essentially defines and changes the character and the expression of a number of links between other socio-demographic and the health-related variables, on one hand, and variables of mental health, on the other. The contents of the research findings to be presented below will provide abundant examples.
- Origin of forced migrants has clear relation to some aspects of mental functioning: displaced persons from Kosovo have higher assessments of social support from family and were less than the refugees from the Croatia and BiH exposed to stressful life events, especially when it comes to the war circumstances; however, Kosovo IDPs also show significantly higher indicators of the generalised anxiety disorder. The influence of gender affiliation is distinct: more pronounced indicators of anxiety in displaced persons from Kosovo are in fact the result of differences that exist only among women, while on the other hand, the female subsample does not contain the mentioned differences in the assessments of social support; they are particularly significant only in men.
- Forced migrants of older age manifest a significantly higher level of loneliness and lower self-esteem level. The differences, however, regarding the level of loneliness do not exist in the female subsample, and the differences in terms of self-esteem are also much more pronounced in men than in women. In addition, older men provide significantly higher estimates of social support from friends while in women, those aged 46 to 60 have a much more developed dispositive optimism than older or younger women.
- The respondents from large families and families with children (i.e. with many children) show more pronounced indicators of structured and purposeful use of time. In addition, respondents from large families show more developed sense of coherence and higher assessments of social support from family. On the other hand, the presence of people with certain physical disabilities in families of the respondents has a different kind of relation to their mental health indicators: indicators of anxiety (GAD-7) are significantly higher in them. This is not the same, however, when it comes to family members with cognitive disabilities: correlations suggest that this is not a risk factor, in terms of increasing the probability for developing some pathogenic or degradation of salutogenic variables of mental health among other family members.
- Persons who lost someone close in war do not show higher scores of loneliness, psychological distress or anxiety. Likewise, when compared to those who have not experienced such a loss, they do not have significantly different (neither higher nor lower) scores of salutogenic mental health variables. However, these people (men and women alike) were to a greater extent exposed to stressful life events, and not just those related to war conditions, but also beyond that.
- Number of relocations after the loss of the original pre-war home is linked to adverse changes in the expression of only some pathogenic (LSC) and salutogenic (SS-A) variables. However, our analyses have revealed two particularly interesting facts. In the first place, it seems that the experience of at least one resettlement after the loss of the original home “produces” significant psychological consequences while further “accumulation” of successive relocations is not in connection with any changes of mental health indicators used in this research. Another important fact is the obvious influence of gender affiliation; i.e. in women, in relation to this factor, there are no differences with regard to the mental health indicators.
- Duration of displacement, or period from the moment of first displacement (that is, the loss of the original pre-war home) stands in distinctive connection with indicators of generalised anxiety, the number of stressful life events in the war circumstances (LSC-w) and social support from family (SS-A family). However, as people displaced from Kosovo mainly belong to one of the temporal categories of this variable, the analyses we have made perhaps reveal also the impact of cultural and social factors associated with the origin of forced migrants. In other words, when the temporal category to which the displaced from Kosovo belong is excluded from the analysis, it shows that differences with regard to LSC-w and SS-A family indicators are no longer significant. On the other hand, the differences in terms of indicators of anxiety are significant, but they (except at the level of the total sample) occur only in women. In addition, it appears that women do not manifest the mentioned differences in terms of exposure to stressful events and of social support from family. In general, however, the differences are showing that the people who had left their original pre-war home before a longer period of time manifest significantly lower indicators of anxiety, but the indicators of social support from family as well.
- Educational status of the respondents in this research is in relation to highly significant differences in several psychometric variables of mental health. In general, the respondents with higher levels of education have lower scores of pathogenic and higher scores of salutogenic variables. Gender seems to influence results: the differences related to the indicators of psychological distress are only significant in women (p < 0.01), and the differences with respect to the indicators of anxiety only in men (p < 0.01). On the other hand, the differences in subjective quality of life are significant in both gender subsamples, but the differences in assessing the sense of coherence and social support from family are (again) significant only in women (where women of higher educational status have a better assessment of the sense of coherence, but also a lower assessment of social support from family).
- Current housing status and the type of housing do not stand in connection with expressiveness of not a single indicator of pathogenic mental health variables, but significant differences occur in terms of the assessment of subjective quality of life: the highest MANSA scores are of persons who are the owners of housing units in which they live, followed by those who live in social apartments or houses owned by other members of their families, and the lowest scores are those of tenants and (a small number) of people who (still) live in some form of collective or alternative accommodation. These differences were confirmed in the male, but not in the female subsample: it seems that for women, the housing status and way of dwelling do not stand in any relation to the quality of life experience.
- When it comes to the possible impact of the pre-war housing status on the current indicators of mental health, there is an interesting (requiring further analyses and interpretations) and significant relationship with indicators of exposure to stressful life events, both in general and in the context of the war. The identified differences show that the persons who had exercised the occupancy right before the war (lived in social housing for employees in state companies and public administration) were exposed to the largest number of stressful events, and that these differences in experience are present only in men.
- When more than one person in the household achieves some income from work or property, it seems that it acts as a “protecting factor” on certain aspects of mental health: correlations are low, but show that the respondents who come from the households where more than one person earns income express lower psychological distress and provide higher assessment of subjective quality of life. If we observe different sources of income as factors of possible differences in terms of mental health indicators, several findings should be particularly emphasised:
- Earnings from a continuing and formally regulated employment appear as a factor that has to do with a number of differences in terms of mental health variables, in the form of higher indicators of salutogenic (MANSA, RSES, TSQ, SOC) and lower indicators of pathogenic (K 10, GAD-7, UCLA, LSC-g) variables. Differences also appear in both gender subsamples, although their structure and intensity are not identical for men and women.
- Social assistance, unlike earnings, relates to the differences that suggest unfavourable indicators of mental health in people who receive social assistance. Within the male subsample, differences manifest only in higher indicators of loneliness in men who receive social assistance, while women receiving social assistance have higher indicators of psychological distress and loneliness and lower indicators of subjective quality of life and dispositive optimism.
- Income from seasonal and occasional jobs is not related to the favourable indicators of mental health. On the contrary, people who generate income in this way show lower assessment of social support from friends and higher indicators of previous exposure to stressful life events. In the female subsample, however, there is no significant difference in terms of indicators of social support.
- Income from pensions is not a particularly important factor: in the context of gender subsamples there are no significant differences between pensioners and non-pensioners, while at the level of the total sample there is only one significant (p < 0.05) difference, which suggests that pensioners have somewhat higher indicators of generalised anxiety disorder.
- It should also be added that the structure of income sources among the respondents in this research is significantly different today from the one that existed in the pre-displacement period: among other things, the number of those who earn income from regular salaries has decreased by three times, the number of pensioners has increased by several times, and the number of those who earn income from some form of social assistance by over forty times.
Two socio-demographic variables that are the factor of the most numerous and most consistent differences in terms of mental health indicators, in fairly equal proportion in both men and women, are the educational status and regular earnings as a source of personal income. The respondents with higher educational status express more favourable indicators of mental health (p < 0.01) in the level of psychological distress, generalised anxiety, subjective quality of life, sense of coherence and assessment of social support from family. When it comes to the respondents who earn income from regular salaries, they have significantly (p < 0.01) lower indicators of psychological distress, anxiety, loneliness, and previous exposure to stressful life events, and higher indicators of subjective quality of life and sense of coherence.
Health and health services related data as correlates of pathogenic and salutogenic variables of mental health
- Experience of any physical injuries suffered during the war turned out to be, in the first place, a factor of significant differences in terms of most pathogenic scores: the persons who suffered any physical injury manifest higher level of psychological stress and higher number of stressful life experiences they were exposed to in the war circumstances and generally in life. The gender factor, in turn, is reflected in the form of the absence of significant differences in the level of psychological stress in the female subsample, while at the same time, women who suffered physical injury show significantly higher indicators of generalised anxiety disorder.
- Head injuries accompanied by unconsciousness, reported by almost one-fifth of the respondents in our sample, are confirmed as a factor of significant differences in terms of values of a whole range of both pathogenic and salutogenic variables of mental health. Especially pronounced and highly significant (p < 0.01) differences imply greater exposure to stressful life events not related to the war circumstances, and lower assessment of subjective quality of life and dispositive optimism. In addition, the gender factor determines the emergence of some very significant differences in male and female subsamples. More precisely, women who have experienced a head injury accompanied by unconsciousness express significantly lower estimates of social support in all areas of life, and men significantly higher indicators of psychological distress and anxiety.
- The fact (self-declared) of the use of specialist services of psychologists, psychiatrists or neuropsychiatrists is firmly linked with significantly less favourable indicators of almost all mental health variables examined in this research. Same tendency is clearly and almost identically confirmed in both men and women.
In the subsample of those who used the services of the mentioned specialists (n = 112) differences regarding some mental health indicators are additionally manifested in relation to several other variables associated with medical treatment: (non) existence of diagnosis, taking medication, discomfort when taking medication. Particularly numerous and significant differences emerge between those who still take medication and those who have stopped taking medication, naturally, in the form of unfavourable indicators with the respondents who were taking medication at the time of survey. Differences occur in both men and women, but their structure and intensity are not identical in both gender subsamples.
- There are numerous significant differences between those respondents who were involved and those who were not involved in some form of psychological counselling or therapy. However, speaking in terms of gender subsamples, there are almost no significant differences in women: the only exception are significantly lower indicators of structured and purposeful use of time among women who were involved in some form of psychotherapy or counselling. On the other hand, in men, the differences occur regarding as many as eleven mental health indicators.
- There are no significant differences in terms of mental health indicators between those respondents who were (or still are) and those who were not included in the programs of psychosocial support. However, a number of significant differences appear between those respondents who believe (n = 85) and those who do not believe (n = 138) that the program of psychosocial support would be useful for them. Generally speaking, indicators are less favourable among the respondents who think that the program of psychosocial support would be beneficial for them. The structure of these differences is also not the same in the male and the female subsamples; in women, particularly marked difference is in terms of indicators of anxiety, and in men regarding subjective quality of life, dispositive optimism and level of psychological distress.