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Resettling refugees

Nursing professor Donelle Barnes wants to change how some immigrants settle in America.

By Rick Waters '95

Imagine fleeing danger in a war-torn homeland, losing loved ones along the way, arriving in a strange country and learning to live there without understanding the native language.

Some of the nearly 75,000 refugees who arrive in the United States each year face those challenges, and whether they are escaping religious or political persecution or war, the enormous stress does not end when they settle in America. While free of the horrors of home, they still confront life changes at all angles -- housing, employment, family relationships, even basic communication.

This adaptation process produces an anxiety that researchers call acculturative stress. Severe cases can lead to clinical depression, which is statistically high among refugees. In fact, refugees have been found to experience five to eight times more emotional distress than the host population.

The good news is that social support can buffer this anxiety and, among refugees, decrease depression and improve mental health. However, scholars believe assistance programs have not focused on community-level support and have failed to provide consistent practical and informational resources. Why? Because there's not much anecdotal or statistical data. No one really knows what kind of support works best for refugees.

TCU nursing professor Donelle Barnes, right, wants to change that. Just before Christmas, she received a $137,000 grant from the National Institute of Nursing Research to collect anecdotal data on community-level support, which she can use to develop a tool to measure and improve support methods.

For the study, Barnes, who joined the Harris School of Nursing faculty in 2002, is focusing on Cuban refugees. She speaks Spanish and spent eight years in Ecuador as a hospital nurse and community development director.

"The study is going to hone in on their social environment," she says. "I'll look at what type of support they might get from other Cuban refugees, what support they're getting from other groups that speak Spanish, such as Mexican-Americans, and from others, mostly Anglos, who don't speak Spanish."

Barnes hypothesizes that refugees get different kinds of support from each group.

"For example, a fellow Cuban probably can offer more emotional support than others. 'I know what you're feeling. I'm going through it too.' But a fellow Cuban is probably not the best person to help show them how a bank works in this country or how to open a checking account."

In the first year of the three-year grant, Barnes will interview 30 to 50 adult Cuban refugees -- men and women of various ages. She expects to find older refugees having more difficulty with resettlement than younger ones. She also believes that depression is more common among women, "which is not surprising because that trend is consistent with American women."

A more stressful past will likely result in more difficulties in America, Barnes believes. "A Bosnian refugee who is highly traumatized from war might have post-traumatic stress disorder, and that will make it all the more difficult to learn new things versus a Cuban who was dissatisfied with his government and got on a boat and left," she says. "Both have stress, but each has different kinds and amounts. Cubans may be a little less stressed."

Barnes' other major hypothesis is that stressful situations seem to fuel negative mental health in the form of anxiety disorders, depression and post-traumatic stress disorder, all of which lessen quality of life and result in more health problems in general.

"The theory is that if we can assist these refugees, decrease their stress and increase their coping skills, they can experience fewer health problems and adjust better to living here," she says.

In the second year of the study, Barnes will take the interviews and create a questionnaire that will examine issues such as language learning, job attainment and helpfulness of resettlement agencies.

In the third year, she will test the questionnaire among a larger group of refugees, collecting even more data and creating a workable tool to measure social support among refugees.

"And hopefully that will be useful in my next grant -- intervention. I want to know how I can build better social support in the refugee resettlement process, so that they have fewer negative health outcomes and better quality of life."

Contact Barnes at d.barnes@tcu.edu.