Transitioning to a Salutogenic Framework for War-Traumatized Refugees through the Lens of the Sense of Coherence Theory

Background and Purpose: Under the current political administration, refugee resettlement services have been subjected to substantial decreases. Presently, voluntary agencies are restricted to providing basic living support for 30 to 90 days. Cash and medical assistance are now only offered for four months. Given that the first few months of refugee resettlement entail a search for new residence, acquirement of employment, learning English, securing employment, obtaining medical care, navigating public transportation, and seeking legal support, there is a dearth of time to meet the behavioral health needs of refugees fleeing war-torn countries, who are often suffering from PTSD, depression, adjustment disorder, and anxiety. Given such time constraints, if refugees receive any services for behavioral health, these services often focus on Western therapeutic approaches, emphasizing individual psychotherapy, which are likely to be more time-consuming. Refugees are also often ambivalent about Western therapeutic approaches because they lack familiarity with them. Such approaches are antithetical to the community-based lifestyles that many refugees hail from. Therefore, it is necessary to explore alternative approaches that may better align with the needs of war-impacted refugees to help facilitate well-being within a limited timeframe.

Methods: Six mental health professionals, including three psychologists, two social workers, and one psychiatrist, were interviewed to gather phenomenological insights into their experiences working with newly arrived Ukrainian refugees in the Philadelphia region. The purposive sample consisted of Ukrainian-speaking females aged 30 to 59. Four participants had experienced displacement and had been living in the Philadelphia region for less than two years, while the remaining two had resided in Philadelphia for over a decade. Five participants held master’s degrees, and one had a Ph.D. All participants received their education in Ukraine. Three participants were employed by NGOs, while the other three maintained private practices.

Recruitment was conducted through flyers posted on Telegram and at the Ukrainian Education and Cultural Center. The 90-minute interviews were conducted in Ukrainian by a bilingual researcher fluent in both Ukrainian and English. The conversations were transcribed verbatim, translated into English using DeepL software, and analyzed thematically with Dedoose qualitative software.

Findings: Based on the results of this qualitative study, Ukrainian refugees experience loneliness, trauma, language barriers, economic and financial problems, lack of employment, family separation, and homesickness during resettlement in the complex metropolis of Philadelphia. In the thematic analysis of Ukrainian mental health professionals’ perspectives, results revealed the necessity to address behavioral health problems and resettlement challenges by focusing on culturally-sensitive, community, and group-based approaches, as opposed to Western-influenced individual psychotherapy.

Conclusion and Implications: It is necessary to consider behavioral health approaches that align with the needs of war-impacted refugees and not impose Western-style therapeutic modalities. Such modalities may deter refugees from seeking behavioral health services and therefore not enhance their well-being. In order to achieve well-being, staying aligned with the lens of the Sense of Coherence theory (Antonovsky, 1979) and its salutogenic focus, is integral for achievement of refugees’ well-being. Moreover, behavioral health practitioners can adopt culturally-sensitive, community, and group-based approaches vis-à-vis proper training and education.