Gendered resettlement and social capital processes shaping Afghan refugee health and mental health

Analyzing data from the Afghan Community Health Survey (N=258), this study explores the influence of resettlement factors (acculturation, perceived discrimination, and social capital) on the prevalence of PTSD, mental distress, somatization, and poor self-reported health among Afghan refugees living in the San Francisco Bay Area. Acculturation measures include gender ideology, strength and relative weight of Afghan and American identities, attitudes on the “Americanization” of their children, civic and political engagement, English competency, literacy, religiosity, and consumption of Afghan expressive culture. Social capital measures include number of reliable strong ties with Afghans and non-Afghans, regular contact with extended family, and membership in voluntary associations. OLS regression models explaining health and mental health outcomes were conducted with and without controls for trauma exposure in Afghanistan and during flight from Afghanistan. A key finding is that gender ideology shapes outcomes differently for men and women. Net of controls, more egalitarian women and more “traditional” men experience greater distress. Relatedly, for men, but not women, levels of distress are associated with fears about the Americanization of their children and grandchildren, particularly around issues of dating and marriage. Women experience more distress than men related to low English competency and social isolation, and conversely women experience greater resilience than men from regular contact with a large extended family. Perceived discrimination negatively affects outcomes for men and women equally. Religiosity is not related to outcomes. The range of findings is interpreted holistically and their significance for health and mental health service providers is discussed.