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Extending the Ecological Model of Distress to Social Functioning among Refugees and Asylum-seekers

Kurt, G.; Specker, P.; Liddell, B.; Keegan, D.; Nandyatama, R.; Yuanita, A.; Argadianti Rachmah, R.; Hoffman, J.; Nickerson, A.

2025-12-11 public and global health
10.64898/2025.12.09.25341945 medRxiv
Show abstract

AimSocial functioning is a crucial aspect of psychosocial adaptation following forced displacement. Yet, it has received far less attention than understanding and addressing mental health problems among refugees and asylum-seekers. This study aimed to extend the ecological model of distress - one of the most widely used frameworks in refugee mental health - to social functioning, and to identify direct and indirect pathways from established conflict- and displacement-related factors to social functioning alongside mental health problems. MethodAn online study with 1,235 refugees in Indonesia was conducted over a two-year period. Conflict-related traumatic experiences before arrival in Indonesia, post-displacement stressors in the past 12 months before baseline, were measured at the onset of the study, while social functioning and mental health outcomes (symptoms of posttraumatic stress disorder, depression, and anger) were assessed one year later. ResultsLongitudinal Structural Equation Modelling analysis revealed that pre-migration trauma predicted more post-displacement stress, higher mental health problems, but increased social functioning one year later, while post-displacement stressors predicted poorer mental health and reduced social functioning. The indirect pathway from traumatic experiences via post-displacement stressors was positive for mental health and negative for social functioning. ConclusionsThis study conceptually and empirically extended the ecological model of distress to social functioning among refugees by highlighting the dual influences of conflict-related traumatic experiences. The findings provide a springboard for advancing research and practice in the mental health and psychosocial field.

Published in Epidemiology and Psychiatric Sciences (predicted rank #16) · training set

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