Newcomers to Canada, in general, face countless challenges which may entail stress. Some newcomers, however, such as refugees, may have had very stressful experiences and mental health conditions prior to arrival in Canada. Research evidence indicates that mental stress among newly arrived refugees is mitigated by a socially supportive environment such as might exist in a housing cooperative (Allodi and Rojas, 1988); by social support derived from the ethnic community; by social support derived from a strong marriage; and by avoiding references to stressful and depressive past experiences (Beiser, 1987; Beiser, Turner and Ganesan, 1991). Length of residence in Canada is found to be positively related to refugees’ mental health (Beiser, 1988).
With reference to children and adolescents, a recent study of Yugoslav refugees in Sweden shows that the psychosocial adaptation of children is positively associated with their mothers' well-being. Thus, risk factors for mental ill health among children were neutralized in those situations where the mother was optimistic and perceived by her children to offer social support (Ekblad, 1993). In a similar vein, it has been shown that social support ameliorates the effects of chronic stress among Namibian adolescent refugees living in exile in Africa (Shisana and Celentano, 1985).
Length of residence in Canada surfaces again as an important factor in the psychological adjustment of refugees. For example, a study of Somali refugee women
between 18 and 50 years of age, living in the Ottawa-Hull region, shows that an average of four years of residence in Canada is associated with preference for integration in Canadian society, while longer residence and stronger self-identification as Canadian tended to be associated with more anti-Somali sentiments (Young, 1996). In the same study, "younger Somali women showed higher levels of depression. Dissatisfied with their expatriate life, refugees in Canada with political asylum indicated a desire to return to Somalia."
Available evidence indicates that the psychological well-being of refugees is related to their resettlement experiences. For example, a study of Ethiopian refugees resettled in the Western United States shows that stress levels are higher among refugees resettled by agencies than among refugees resettled by volunteers (McSpadden, 1987). It is interesting to note that the stress levels among these Ethiopian refugees is negatively associated with the ability of either settlement approach to provide employment or access to education, even when proficiency in English is held constant.
Turning now to the delivery of health services, several studies have identified major health issues facing immigrant and refugee women in Canada and have argued that the existing health system should plan for the needs of an increasingly multicultural society (see, for example, Equal Opportunity Consultants, 1991; Stevens, 1991). It has also been argued that delivery of health care services should involve, among other things, the use of interpreters, education of health care professionals, and adaptation to clients’ cultural needs (Mattson, 1989; Nudelman, 1994).
In an interesting study of displaced families housed in a refugee centre in Zagreb, Croatia, it is noted that that sources of family stress during exile include: "(1) concern over family members and family completeness; (2) dependence on others; (3) marginalization, stigmatization, and diminished social position; (4) perceptions of social injustice; (5) acculturation; (6) perception and interpretation of current events; (7) helplessness; (8) uncertainty; and (9) problems with the organization of everyday life." Sensitivity to these same issues in the Canadian context would probably help to ameliorate the effects of stress factors on refugees in Canada.