Integration and its relationship to mental health trajectories over time for Syrian refugees in Canada: A latent class growth analysis

Resettled refugees arrive in Canada through three different programs - the Government-Assisted Refugees (GAR) program, where services and financial support are provided through Service Providing Organizations, the Private Sponsorship of Refugees (PSR) program, where support is provided by private citizens or not for profit groups, and the Blended Visa Office-Referred program (BVOR) where settlement support comes from private citizens but financial support is divided between government and private sponsors. Between November 2015 and July 2017, more than 31,000 Syrian refugees arrived to Canada through these different pathways, creating an opportunity to explore the longitudinal impact of integration support and pathways within a single cohort of refugee newcomers Before and during the migration journey many refugees experience severe hardships and traumatic life events including conflict-related violence, family loss, injuries and poor nutrition that put them at risk for both physical and mental health problems (Hansson et al., 2010; Pottie et al., 2011). The experience of resettlement is typically associated with little preparation or control over the destination or timing of migration, the need to leave material resources and documentation behind, and often following years of displacement and disrupted education and employment. Moreover, many resettled refugees have no family members or friends in the site of resettlement to assist in the settlement process. As a result, refugees can experience a range of resettlement challenges that are more pressing than those of other newcomers. Refugees’ health and integration experiences are tightly interwoven. Unmet physical and mental health needs create barriers to successful integration, including challenges finding and maintaining adequate employment, housing and education (Hynie, 2014). Simultaneously, growing evidence shows that existing physical and health problems may be exacerbated by social determinants of health including housing, employment, access to health and social services and experiences of social inclusion or exclusion (Hansson et al., 2010; Hynie, 2018). The need for societies to recognize and accommodate newcomers in order to support integration emphasizes the bilateral nature of integration; it is not merely a case of newcomers adapting to their new environments but environments adapting to meet the needs of all current members of the community (Hynie, 2024). The goal of this project was to document the impact of post-migration support and explore the ways in which social determinants influenced the long-term health and well-being of Syrians resettled to Canada during the major resettlement wave between 2015 and 2017. We conducted a mixed-methods longitudinal Canadian study (SyRIA.lth) that compared how GAR and PSR resettlement programs in three different provinces (Ontario, British Columbia and Quebec) support long-term social integration pathways for refugees and the impact of these pathways on physical and mental health. These participants were followed for four years, (Waves 1 through 4). Our goal was to recruit 10% of adult refugees who resettled in our six target cities. Ultimately, we successfully recruited 24.0% of adult GARs, 9.8% of adult PSRs and 13.8% of adult BVORs settled across the 6 cities, based on settlement statistics provided by Immigration, Refugees, and Citizenship Canada (IRCC). In the first annual wave of the study, 1932 base-line surveys with newly resettled Syrian refugees across Canada (922 from Ontario, 697 from Quebec and 313 from British Columbia) were completed of which 45% were GARs, 51% PSRs and 4% BVORs. In the Wave 2 follow-up survey, 1805 participants participated; 1716 in Wave 3, and 1665 in Wave 4. In addition, 153 participants participated in 20 focus groups nationally across Canada between year 1 and 2. These data have been analyzed and some of the early findings indicated that type of sponsorship and sociodemographic factors influenced integration outcomes of this population (Hynie et al., 2019), that mental health outcomes seemed to be getting worse over time (Ahmad et al., 2021), and that declining mental health may be particularly likely among moderately and highly educated newcomers who struggled to find employment commensurate with their education and experience (Bridekirk et al., 2021). The last year of planned data collection fell during 2020, 3 to 6 months into the first wave of pandemic, and demonstrated the early impact of COVID-19 restrictions on the health and well-being of the participants. During the pandemic, refugees also faced elevated risks of isolation due to limited digital literacy and lack of access to technology (Hynie et al., 2022; ISSofBC, 2021). The pandemic also exacerbated economic stress, and resulted in a rapid loss or reduction of employment, especially for those with lower levels of education, which can include refugees (Beland et al., 2020; IRCC, 2019). However, given that many of the sample were still transitioning to full-time employment and thus households were still relying on social assistance, or those working were working in "essential" sectors, the economic impact of the pandemic was less severe than it might have been for those who had been in the country longer. There are concerns that the data collected at that time did not adequately capture the long-term health and well-being of the sample, since it was collected in the midst of a crisis. It was also not clear if the impacts of, and factors that predict resilience to, the COVID pandemic could be determined so early into the pandemic. Therefore, in this present study we aim to conduct a final wave of data collection on a subset of participants to examine longer term integration outcomes and also explore the impact of the COVID-19 pandemic on the study sample. The project will produce knowledge that will inform promising practices for refugee integration and deepen our understanding of the influence of the social determinants of health (SDOH).

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