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Running head: THE ROLE OF DISCRIMINATION, RELIGIOSITY, SOCIAL SUPPORT AND EDUCATION LEVEL ON MENTAL HEALTH OF AFGHAN REFUGEES IN RUSSIA

FEDERAL STATE AUTONOMOUS EDUCATIONAL INSTITUTION OF TERTIARY EDUCATION

«NATIONAL RESEARCH UNIVERSITY HIGHER SCHOOL OF ECONOMICS»

FACULTY OF SOCIAL SCIENCES

DEPARTMENT OF PSYCHOLOGY

Master`s program “Applied Social Psychology”

The Role of Discrimination, Religiosity, Social Support and Education Level on Mental Health of Afghan Refugees in Russia

Zaremba-Pike Svetlana

Moscow 2020

Table of contents

Introduction

1. Theoretical background of refugees' distress, discrimination, religiosity and social support

1.1 Pre-migration and Post-migration living difficulties of refugees and their vulnerability

1.2 Post-migration environment in Russia and residency issues for refugee

1.3 Socio-psychological factors affecting distress level of refugees

1.3.1 Perceived Discrimination as a factor of distress

1.3.2 Religiosity

1.3.3 Social support

1.3.4 Education level

1.4 Hypotheses

2. Empirical study of refugees' distress level and the role of socio-psychological factors

2.1 Participants

2.2 Design of the study

2.3 Data collection procedure

2.4 Data collection Materials

3. Data analyses and Results

3.1 Data analysis

3.2 Results

4. Discussion

5. Limitations

6. Future directions

Conclusions

References

Appendix

Abstract

Refugees are people who often escape adverse conditions before arriving in the host country (Convention UNHCR, 1951). Russia, like many other countries in the world, hosts large numbers of refugees, however little attention has been given to the mental health of refugees living in Russia and psychosocial factors that may affect it. This research sought to address this gap and investigated the psychosocial factors that affect refugees' distress level. The psychosocial factors studied include discrimination, social support, religiosity, and education level and those factors' role in the manifestation of distress level. The sample consisted of 96 Afghan refugees and asylum seekers living in Russia aged 18 to 60 years old. The following measures were used: Afghan Symptom Checklist (Miller et al., 2010), Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley, 1988), the Centrality of Religiosity Scale (Huber& Huber, 2012), and Discrimination and Education level scales from the MIRIPS questionnaire (Berry, 1997).

The results indicated that higher social support from significant others is negatively related to distress, whereas higher social support specifically from family members showed no significance. We also found that perceived discrimination was positively related to distress. Moreover, the study indicated that higher religiosity (faith) weakened the positive relationship between perceived discrimination and distress, acting as a protective factor in such relations. Finally, the study indicated that higher education level strengthened the positive relationship between perceived discrimination and distress. Findings from the current study suggest that more attention should be given to the psychological and sociological factors that affect the distress level of Afghan refugees in Russia.

Keywords: Refugees, distress, discrimination, religiosity, social support, education level, legal status, mental health

Introduction

People leave their inhabited homes for many different reasons. A poor socio-economic situation, war, persecution, or natural disasters in different countries make their inhabitants leave in search of a better life. According to the UNHCR report from 2017, there were 68.5 million forcibly displaced people, including 22.5 mln refugees. The global refugee population grew from 2.4 million in 1975 to 14.9 million in 1990 and to 22.5 mln people in 2017 (United Nations High Committee for Refugees, 2017).

Refugees often escape from harsh conditions, which they experienced in their countries of origin, such as natural disaster, war, genocide, persecution, imprisonment, rape, and torture (International Organization for Migration, 2011). People who go through highly traumatic events are at increased risk for developing certain mental health disorders, including post-traumatic stress, depression, anxiety, somatic responses and even sometimes psychosis ( Giacco & El-Nagib, 2016; Priebe, Giacco & El-Nagib, 2016; Pumariega, Rothe & Pumariega, 2005; Rousseau, Pottie, Thombs, Munoz & Jurcik, 2011; Silove, Ventevogel & Rees, 2017). Although not everyone develops mental illnesses due to trauma exposure, many remain prone to it, especially if they experience acute stress in an asylum country (Foster, 2001; Steel, 2001). In this manner, a post-migration environment may contribute to the mental health improvement of refugees or on the contrary may worsen their condition (Schweitzer, 2006; Foster, 2001). The positive factors that could contribute to better mental health outcomes among forced migrants are social support and religiosity (Momtaz, Hamid, Ibrahim, Yahaya & Chai, 2010; Schweitzer, Melville, Steel & Lacherez 2006). In contrast, social isolation and inability to cope relying on personal resources or spiritual practices may negatively impact refugee psychological well-being (Shoeb, Weinstein & Halpern, 2007; Schweitzer et al., 2007).

As a part of the global world, Russia is also participating in receiving forced migrants and refugees from different zones of war conflicts, people persecuted in their home countries due to various reasons. 228 392 people were given a temporary asylum (which lasts only one year ) in Russia in 2017. Mostly (226 044 temporary asylum statuses) were given to Ukraine nationals, 1317 to Syrian citizens and 417 to Afghan citizens (FSSS, 2018., Troitsky, 2017). Refugee status was given only to 2 Syrians as of end of 2018 (FSSS, 2019; CA, 2018).

People that are looking for asylum in Russia are often stuck in a deadlock due to difficulty obtaining residency status (see Troitsky, 2019). Although the law protects the legal refugee in Russia (UNHCR, 2020), it is difficult to get legal refugee status. There are only 368 people (of not Ukranian nation) who obtained refugee status as of end of 2019 (UNHCR, 2020). Russia's integration policies and legal framework also score low in international expert evaluations (Migrant Integration Policy Index, 2015). In 2016 the Russian parliament had issued a governmental decree on developing a socio-cultural policy for migrant integration (Decree 1532, 2016), however further steps have not taken place. Thus, refugees in Russia often have to live with temporary documents for many years. Unclear residence status hinder their access to (1) school education for their children (Troitsky, 2019), (2) the public healthcare system (MIPEX, 2015), and (3) legal employment. Moreover, refugees and migrants are often exposed to discrimination and xenophobia in Russia (SWM, 2014; Denisova, 2003; Mukomel, 2006; Stickley, Oh, Koyanagi, Leinsalu, Narita, Roberts & McKee, 2019).

The factors listed above often cause social isolation, which in turn leads to desperation, loneliness, and depression (Bhugra, 2003; Foster, 2001; Yakushko, 2008; El-Shaarawi, 2015). Moreover, many educated refugees experience downward migration in Russia (Karachurina, Poletaev & Florinskaya, 2015; Varshavskaya & Denisenko, 2014). They are exposed to work in low qualified jobs even if they hold a higher degree and social lifts for migrants in Russia are nearly impossible (Mukomel, 2006). Thus education level could be another contribution to higher distress exposure. In addition, new immigrants have to face acculturation difficulties, such as different cultural expectations and norms, role changes, lack of language proficiency and identity crises (Bernier, 1992; Jurcik et al., 2013; Yakobov et al., 2019). Thus, a combination of pre-migration trauma and post-migration living difficulties highly affects refugees psychological and physical health (Heeren et al., 2016; Reesp, 2003; Momartin, Steel & Coello, 2006; Li, Liddell & Nickerson, 2016, Silove et al., 2017). Yet vulnerable migrants who have experienced trauma can also be resilient and benefit from protective factors such as social support (Schweitzer et al., 2006; Rtan, Dooley & Benson, 2008; Jurcik et al., 2019) and religiosity. In this matter, the research question is to study the role of psychosocial factors that affect refugees' distress level.

Novelty and scientific significance.

Although there is some research done on Afghan refugees settling in different countries, no study has been conducted in Russia, where living realities for displaced people can be challenging (MIPEX, 2015; Troitsky, 2017).

Novelty

1) There are many studies that analyzed the mental health condition of refugees and its link to pre-migration trauma (Silove et al., 2014; Measham et al., 2014; Posselt et al., 2018).However, little research has been done studying refugees who experience post-migration living difficulties such as discrimination, downward migration, unemployment when it is unknown when they will get a permanent residense, i.e. refugees living in state of uncertainty.

2) We aim to study religiosity and its role in refugees distress level. Historically, many Afghans arrived in Russia after the fall of pro-Soviet government in Afghanistan (Dorronsoro, 2007; Zotova, 2007). They were opposed to a new political regime with more conservative views, imposing higher religiousness to its citizens (Dorronsoro, 2007). Therefore the role of religiosity as a moderating factor contributing to better or worse manifestations of distress, is particularly intriguing in terms of the current sample.

3) Social support is an important factor contributing to better resilience among refugees (Schweitzer et al., 2006; Rtan, Dooley & Benson, 2008; Jurcik et al., 2019). People may find more strength to resist stress when they have meaningful relationships with family or friends. This study, therefore, will study the impact of separate components of social support on the psychological health of refugees, which has not been conducted before.

4) Education level is another point of interest in the current research. While many studies have studied the relationships between refugees' education level and mental health (Alemi, James, Siddiq & Montgomery, 2015; Sulaiman-Hill & Thompson, 2012), only a few studies have investigated the moderation role of education level on distress (Sheikh & Anderson, 2018). Thus we will analyze its moderation role in the current study.

Scientific significance

This study complements the field of psychology related to the adaptation and integration of refugees. The study will be conducted using questionnaires especially created to measure socio-psychological factors of Afghan refugees.

Practical: The majority of studies on refugees' psychological issues have been conducted in countries with well-established refugee policies, like Canada, Australia, New Zealand, United Kingdom, and others, but no research has been done in Russia. Acknowledgement of existing problems and understanding ways to improve the lives of refugees in Russia may help in developing government policies and practices for social workers and counsellors in the future.

1. Theoretical Background of Refugees' Distress, Discrimination, Religiosity and Social Support

1.1 Pre-migration and Post-migration living difficulties of refugees and their vulnerability

Pre-migration trauma

There is a great deal of evidence that refugees experience more psychological distress than other groups of migrants (Silove et al., 2017). Unlike labour migrants, refugees enter the asylum country involuntarily, often escaping life-threatening events in their home countries, such as war, torture, political persecution or other kinds of violence (Convention UNHCR, 1951). Such adverse conditions, therefore, make refugees more vulnerable to develop psychological and mental health problems (Pumariega, Rothe & Pumariega, 2005; Silove et al., 2017). The prevailing mental health issues include posttraumatic stress disorder, depression and anxiety and to a lesser extent symptoms of psychosomatic disorder, grief-related disorders and existential crisis ( Silove, 1999; Steel, 2001). The existing research also suggests that refugees may be exposed to different interrelated traumatic events which are usually cumulative and may increase the chance of developing a mental disorder (Silove, 2009; Silove et al., 2017). These experiences can challenge their sense of empowerment, identity and meaning in life. Thus, various studies on refugee mental health report different rates of PTSD and depression, varying from 5% to 15% for PTSD and from 5% to 50% for depression (Davidson et al., 2008; Rousseau et al., 2011; Bogic et al., 2015; Silove et al.,2017). Even though more recent and more careful studies showed a lower percentage of PTSD rates, they are still at a higher rate compared to the non-refugee population which are at about 1.1%.

Post-migration living difficulties and refugees' vulnerability

Despite high exposure to traumatic events, over some period of time majority refugees' mental health improves (Lie, 2002; Steel et al., 2002). However, for some of them, it still remains a significant risk factor upon resettlement (Steel et al., 2002). For example, in a study based on Vietnamese refugees in Australia, those who were exposed to higher levels of trauma still reported worse mental health outcomes after 10 years of resettlement, compared to others who did not experience traumatic events (Steel et al., 2002). At the same time, for some people, resettlement difficulties may be so traumatic themselves, that they may lead to developing symptoms of psychological distress (Foster, 2001). Another study suggests that traumatic events refugees experience before arrival to the new country may indirectly increase their vulnerability to develop mental health problems in the future (Steel et al., 1999). For example, a refugee who went through torture, but in their new environment succeeded to pursue a normal everyday life, may still develop posttraumatic stress symptoms when faced with an acute stressor (Schweitzer, Melville, Steel & Lacherez, 2006; Foster, 2001). Silove (1999) also analyzed resettlement effects on the psychological state of refugees paying more attention to the effect of trauma in different domains of a person's life during resettlement. He argued that existing trauma manifests itself through different patterns of everyday life. In other words, it means that trauma affects every aspect of a person's life and may manifest through personal psychological difficulties or in relationships with others.

Post-migration environment

Valtonen (2004) examined refugees' relationships with trauma from different perspectives. He highlights the importance of the post-migration environment and stress caused by life conditions in the country of asylum. According to Valtonen, resettlement has been defined as “the activities and processes of becoming established after arrival in the country of settlement” (Valtonen, 2004, p.70). In fact, there is growing evidence that the post-migration part of the refugee experience, the process of resettlement, often has an even more negative impact on refugee well-being than pre-migration (Porter & Haslam, 2005). According to Brough et al. (Brough, Gorman, Ramirez, & Westoby, 2003), a key determinant of refugee well-being is the ability to be socially included into the broader community during the resettlement process. In other words, social inclusion is involvement in a broader society through interaction with its members, through the ability to be independent and function in everyday life and perceive one's goals. In this matter, psychosocial factors play a great role in refugees' psychological well-being and mental health. They may influence individual mental health by either increasing the vulnerability to trauma and stressors of life or on the contrary, be a protective factor (Schweitzer et al., 2006). Psychosocial factors could include employment, residence permit, access to the healthcare system, access to education, language proficiency, social support, personal worldviews. The importance of these factors is universal for all human beings, however, some immigrants have to live in the face of uncertainty, social isolation and in difficult psychosocial conditions for many years.

Different adverse conditions in a host country, such as prolonged detention, indefinite residence status, limited availability to work or study evidenced in increased rates of PTSD and depression symptoms (Reesp, 2003; Momartin, Steel & Coello, 2006; Li, Liddell & Nickerson, 2016, Silove et al., 2017). After studying Swiss refugees, Heeren (see Heeren et al., 2016) found that residence status positively correlates with psychopathology, showing a higher degree of psychopathology to refugees, asylum seekers and illegal immigrants compared to residents and labour migrants. Indeed, once settlement issues are resolved, post-traumatic symptoms are often also mitigated (Rousseau et al., 2011).

“Refugee” terminology used in the current study.

According to UNHCR (1951), refugees are people who have fled war, violence, conflict or persecution and have crossed an international border to find safety in another country.According to Russian legislation, refugees are people who have already been granted refugee status (FL 4528-1, 1993). However, for purposes of the current research, we will use the term refugee referring to all externally displaced people: 1) For internationally displaced non-Russian citizens, who hold refugee status; 2) For internationally displaced non-Russian citizens, who are in the process of consideration for obtaining refugee status, therefore holding asylum seeker status; 3) For internationally displaced non-Russian citizens, who applied for asylum seeker status and the documents are currently under consideration of the court; 4) For internationally displaced non-Russian citizens, who have not yet applied for asylum seeker status; 5) For internationally displaced non-Russian citizens (initially), who have been granted with Russian citizenship within the last 10 years.

1.2 Post-migration environment in Russia and residency issues for refugees

Difficulties in accessing legal status, followed further by other consequences are not rare for refugees arriving in the Russian Federation. As of January 2019, only two Syrians and 305 Afghani citizens have been granted permanent refugee status (see GKS, 2019). While temporary asylum status, which lasts only one year, have been given to 484 Afghan and 826 Syrian citizens in 2018 (GKS, 2019). In order to have legal permission to stay in a country, asylum seekers must reapply every year and the chance of getting a one-year extension of asylum status is very low. Problems with residency, in turn, raise difficulties in getting a legal job, access to health facilities, access to education and higher vulnerability of being illegally exploited (Troitsky, 2019). Thus, some families have to live in a high degree of uncertainty for years, which holds them in extremely stressful conditions for many years. Such adverse conditions on resettlement increase their chance of developing psychological problems as well, and may lead to feelings of desperation, loneliness, lack of control and low levels of well-being (Ahearn, 2001; Foster, 2001; El-Shaarawi, 2015).

The current study is focused on Afghan refugees living in Russia. Therefore, it is important to understand their lived socio-cultural realities.

The flow of Afghani refugees began in the 1990s and is partly explained by befriending relationships between the former Soviet Union and the government leadership in Afghanistan at the time (Zotova, 2007). In 1992 the post-Soviet Najibullah regime fell and Afghanistan witnessed a civil war (Dorronsoro, 2007). Fight for political leadership went far beyond just politics, but grew into war, where millions of civilians have suffered (Dorronsoro, 2007). Thus, many middle class educated Afghans began to leave the country. People went in different directions. The ones who chose Russia had either some connections with Russia (e.g., who received higher education in Russia and could speak decent Russian) or the ones who did not agree with the new political forces, which were trying to come into power (Zotova, 2007). The new asylum seekers hoped to get support from the Russian Government, however, for Russia it was not possible as the country itself was on the stage of “Perestroika” and was not able to deal with extra requests. The group of Afghan newcomers had to organise their lives on their own. Their leaders set up a non-commercial organisation and started their survival routine in Russia (BBC Russia, 2005; Kadiri, 2011).

After that, the flow of Afghan refugees continued: in the mid- 90s the rest of highly educated Afghans arrived in Russia. Apart from pro-Soviet Afghans, this group included many “mujahideen” who failed to sustain their power and had to give in to the “Taliban” regime. Devastated by the endless war, Afghan people continued to flee their country. According to the UNHCR report, as of the end 2018 (UNHCR, 2018), the number of Afghan refugees was the second in the world after Syrians, accounting for 2.7 million people . A similar situation is found in Russia where Afghans make up the largest group of refugees (FSSS, 2018). The total population of ethnic Afghans in Russia is about 100 000 people (Zotova, 2007) and they are very diverse in terms of education and in terms of their political affiliations.

Another important aspect which we wanted to emphasize in the current research is that in comparison with Afghan asylum seekers living in European or Northern American countries, Russian Afghan asylum seekers do not get governmental support and a socio-cultural integration policy does not exist. Only a few non-commercial organisations deal with refugees and forced migrants in Russia (MIPEX, 2015, Troitsky, 2017).

Thus, the issues raised above could impact refugees' mental health and mechanisms helping to cope and sustain high levels of psychological well-being are not fully studied. Hence, the next chapter is devoted to the psychological constructs of the post-migration environment that include both risk and protective factors that affect the distress level of refugees.

1.3 Psychosocial factors affecting distress level of refugees

1.3.1 Perceived Discrimination as a factor of distress

Many people who arrive in a new country to settle, especially if its values and practices represent a large cultural distance from the migrant's native country, experiences culture shock (Taft, 1977). Culture shock can be very distressing and includes a sense of frustration, and an inability to deal with everyday activities. Different social and cultural expectations, a feeling of detachment and dissociation could lead to a sense of feeling rejected or discriminated by the host population (Pantelidou & Craig, 2006). For refugees, it could be even worse, because unlike labour migrants, they do not have an option to go back. Often migrants and refugees experience a sense of fear, persecution and insecurity towards themselves (Paradies et al., 2015). Migrants in Russia face discrimination in many aspects of their life: including finding place to rent, finding work or even sending their children to school (Denisova, 2014; Mukomel, 2006; Center for information and analysis, 2020). Such a sense of discrimination has a great degree of influence on the psychological and physiological well-being of already vulnerable populations (Williams, Yu, Jackson & Anderson, 1997; Stickley et al., 2019). It could greatly affect mental health of refugees increasing the risk of such issues as depression (Silove et al.,2017), generalized anxiety disorder (Priebe et al., 2016), psychological distress (Alemi et al., 2018) or even psychosis (Hollander et al, 2016). Such findings were also confirmed by meta-analytical studies (Close et al., 2016; Dapunt, Kluge & Heinz, 2017; Pascoe & Richman, 2009).

Although the psychological effect of discrimination was studied quite thoroughly, to the extent of our knowledge, there are only a few studies concerning Afghan refugees, especially in Russia. The Afghan population has been experiencing war or war-related devastation for more than four decades now (AmnestyInternational, 2019), making its population the second biggest refugee population in the world (UNHCR, 2018). Thus, a combination of such factors as trauma, fear, high levels of distress are tightly woven in their sociological and psychological systems (Michopoulos, 2015). Repeated exposure to traumatic events throughout life increases the development of distress levels in general, including symptoms of PTSD, anxiety disorders, and depression (Schweitzer, Melville, Steel & Lacherez, 2006; Foster, 2001). People who is constantly dealing with trauma, could be also oversensitive to discrimination (Chen, Hall, Ling & Renzaho 2017; Alemi & Stempel, 2018). Pre-existing traumas may make people more vulnerable to any manifestation of discrimination, thereby increasing their levels of distress.

As we emphasized previously, post-migration social factors that refugees experience in Russia are different from Western countries, therefore, coping strategies and ways of dealing with adverse conditions could differ even for the same population depending on the country. It is greatly linked to personal resources, social support from heritage and host community as well as other resilience factors, such as belief and seek of support from a higher force (religious faith) for example (Schweitzer et al., 2006; Bonanno, 2004). Thus, further we will investigate such psychosocial factors as religiosity, social support and education level and their role in psychological distress of Afghan refugees.

1.3.2 Religiosity

An important factor that has a large impact on refugees' psychological well-being is religiosity and spirituality. Studies which analyzed the effects of various forms of religiosity showed positive relation to improving a person's psychological and physical well-being (Green & Elliot, 2010). For instance, Fernando (Fernando & Ferrari, 2011) found that buddhist spirituality helped a person to accept and recover from the trauma, find new ways of living, as well as promoted better integration in a bigger community . Schweitzer (2007) also found that believing in God helped Sudanese refugees in Australia to take control of their lives and find meaning. Another study which was performed in Malaysia revealed that among the socially isolated people over 60 years old, religiosity acted as a moderator between social isolation and psychological well-being (Momtaz et al., 2010). Religiosity also showed great importance for Iraqi refugees living in the USA (Shoeb et al., 2007). However, religiosity does not always have a positive relation to refugees' psychological health. Thus, a retrospective study of Syrian refugees did not show any significant correlation between symptoms of depression and degree of religiosity (see Naja, Aoun, El Khoury, Abdallah & Haddad, 2016). Such findings suggest that although religion in most of the cases is positively related to a better outcome of resilience and higher levels of well-being and better mental health, some other factors may moderate its effect. Thus, in terms of the current research, the role of religiosity for Afghan refugees will be studied as a factor buffering the negative effect of perceived discrimination.

1.3.3 Social support

Along with personal resources, external support is also vital for refugee well-being (Schweitzer et al., 2006; Rtan, Dooley & Benson, 2008; Jurcik et al., 2019). Social support is formed by meaningful relationships with people from one's circle of significant others. Often it includes family and friends with whom a person forms meaningful relationships (Cohen et al., 2000). For Arabs and Afghans, family (including extended family) is usually the most important source of social support (Aloud & Rathur, 2009; Awad, Martinez, & Amer, 2013; Beitin & Aprahamian, 2014).

However, when immigrating, they are forced to leave their loved ones behind, and in their adopted country, they often feel socially isolated and lonely (Llacer, Zunzunegui, del Amo, Mazarrasa, & Bolumar, 2007). Thus, upon arrival refugees may try to re-establish the new network of significant others through forming relationships with members of their own ethnic community or with members of the host population. Afghan migrants, for example, after coming to Russia in the 1990s formed a supporting community and managed to survive despite social and psychological difficulties they faced (Kirpanova, 2019; Zotova, 2007). Afghan diaspora head also highlighted the importance of their community for its members, emphasizing the significance of support they get from each other (Zotova, 2007). Having trusty relationships formed a key role in their ability to cope. Similar findings were registered in the qualitative study of Sudanese refugees resettling in Australia (see Schweitzer et al., 2007).

The study showed the importance of support from family, friends and the ethnic community. Participants of the study reported losing a big part of their social ties when fleeing to Australia (see Schweitzer et al., 2007). Unable to use social support within the family, they looked for it among broader Sudanese community members. They often referred to ingroup members for support especially in terms of questions connected to the adaptation to the new country, getting education or employment. Newcomers believed that their more experienced compatriots will suggest them well as they had to go through the same difficulties upon arrival (Schweitzer et al., 2007).

Also, ethnic concentration was related to mainstream acculturation and less distress in migrants who were trauma survivors (Jurcik et al., 2019). Thus, meaningful relationships with heritage community, family relationships as well as communication with the host community form social support which may alleviate a person's psychological and mental well-being. Although the impact of social support was illustrated in many studies, its componental analysis has not been conducted before, e.g. social support from family members, from significant others or from friends. This study, therefore, will address this gap and will study the impact of separate components of social support on the psychological health of refugees.

1.3.4 Education level

According to UNESCO (2017), Education in Afghanistan is relatively low, estimating literacy level at 43% (55.48% percent for males and 29.8 % for females). Yet people with various educational and social backgrounds may become refugees. Thus, according to a graph reported by OECD development centre “on the education level of Afghan and Syrian arrivals in Greek Islands” (OECD, 2016), 30 % of Afghans had no education, 26% had a primary education, 31% had secondary education and 13% held a higher education diploma. There is no such statistics on Afghan refugees in Russia, however, according to our literature review, we may assume that we have many educated Afghan refugees who came in the first and second waves of migration, as well as the less educated more recently. In this regard we should mention that many studies found that a lower education is associated with poorer mental health outcomes and higher education could be a protective factor when it comes to mental illness (Alemi, James, Siddiq & Montgomery, 2015; Sulaiman-Hill & Thompson, 2012).

We could presume that the ones who have a higher education, in Afghanistan, used to possess jobs that required a higher qualification. However, when they try to settle in a new country, they often engage in unskilled labour, i.e. experiencing downward migration (see Krahn, Derwing, Mulder & Wilkinson, 2000). Migrants in Russia also often engaged in lower positions than they were in their home countries (Karachurina, Poletaev & Florinskaya, 2015; Varshavskaya & Denisenko, 2014). Accumulated with other post-migration stressors, downward migration, discontent with a job may increase distress levels and lower psychological well-being of an individual (Close, Kouvonen, Bosqui, Patel, O'Reilly & Donnelly, 2016; Krahn et al, 2000). Thus, discontent with lower occupation in a host country for educated refugees could have an impact on their distress level. Thus, refugee education level could moderate the effect of other stressors, such as discrimination, unemployment or downward migration. There is a limited number of studies on the moderation effect of education (Sheikh & Anderson, 2018). Therefore, in the current research, we will analyze the role of education level on relationships between discrimination and distress.

A number of studies have analyzed the effect of perceived discrimination, social support, religiosity and education level individually on psychological well-being and distress levels of refugees. However, little research has been conducted on all four of those factors collectively on psychological well-being. Also, not much research has been done on groups of ethnic refugees living in Russia. As it was reviewed, the Russian socio-economic realities are different from the realities of refugees living in Western countries, therefore the psychological and social factors may have different effects on the levels of distress. Moreover, the current research uses culturally adapted scales measuring distress level - the Afghan symptom checklist (Miller et al., 2006), which in the extent of our research was not used much in the study of the Afghan population outside of their home country.

1.4 Hypotheses

The question of the current study, therefore, is to determine the role of psychosocial factors in refugees' distress level.

Thus, the following hypotheses will be investigated:

Hypothesis 1: Higher social support from family members will be negatively related with distress.

Hypothesis 2: Higher social support from significant others will be negatively related with distress.

Hypothesis 3: Perceived discrimination will be positively related with distress.

Hypothesis 4: The positive relation between perceived discrimination and distress will be weakened by religiosity

Hypothesis 5: The positive relation between perceived discrimination and distress will be weakened by education level

2. Empirical study of refugees' mental health and social support

2.1 Participants

The sample of the current study are Afghani refugees living in Russia (see theoretical background for more detailed information on terminology).

Such classification is important in the current research as it defines the legal status and therefore the difference in the uncertainty situation the participants live in.

Participants of the study are Afghan men and women aged from 18 to 85. For descriptive statistics please refer to Table 1.

Table 1: Sociodemographic information (N=96).

	Total	Percentage, %
Total participants	96
Age	96
18-44 years old	81	84
45-54 years old	12	12,5
Over 55	3	3,1
Gender	96
Male	54	56,3
Female	42	43,8
Marital status	94
Single	36	39,8
Married	58	60,2
Education	92
No schooling	7	7,3
Some/completed primary school	18	18,8
Some/ completed secondary school	33	34,4
Completed technical, community college	16	16,7
Tertiary education	15	15,6
Russian comprehension	91
Not at all	18	19,78
A little	33	36,26
Somewhat	22	24,17
Fairly well	14	15,38
Very well	4	4,4
Employment	96
Employed legally	12	12,5
Employed illegally	17	17,7
Unemployed	67	69,8
Arrival year	68
1996-2005	10	14,7
2006-2015	18	26,5
2016-2020	36	53
Residence status	96
Russian Passport	8	8,3
Asylum seeker status	18	18,8
Refugee status	15	15,6
Documents are under consideration of the court	27	28,1
Student visa	7	7,3
Business/working visa	4	4,2
None of the above	17	17,7

We employed 96 participants overall, the majority of whom (84.4%) fell in three age groups ranging from 18 to 44 years old. The sample consisted of 54 males (56%) and 42 females (44%). Among 96 participants 7 (7%) did not have any education, 18 respondents (19%) have received some primary education or completed it, 33 participants (34.4%) have had some, or have completed secondary education. We also had an equal number of those who received a bachelor's university degree or completed technical, community college accounting for 14 participants (15%) in each category. Only one participant claimed to have completed a Masters degree.

In terms of Russian language skills, 14 participants (14.7%) claimed not to understand Russian at all, whereas only 3 respondents (3.2%) could understand it very well and 18 (19%) fairly well. 60 participants (63%) have claimed to understand “a little” or “somewhat” Russian.

The current sample had a rather small employment rate: 29 people (30%) were enrolled in the workforce and 67 (70%) were out of jobs. Finally, 63 participants (71%) claimed that it was quite difficult or very difficult to live with their current income.

We collected the data from the respondents who came to Russia from 1996 until 2020. The Russian passport was given to 8 participants (8.3%), 15 respondents (15.6%) had refugee status. The majority, however, either did not have any legal documents (17 respondents - 17.7%) or had temporary statuses, accounting for 18 asylum seeker statuses (18.8%), 27 respondents (28.1%) reported that the cases were under consideration of the court and 17 participants (17.7%) did not choose any option. We took it as a criterion for not having any paper confirming their legality.

2.2 Design of the study

This is cross-sectional correlational quantitative research with a follow-up qualitative component.

We performed the research in three steps:

The first step consisted of questionnaire translation, adaptation and finalising. To translate the demographic questions, I invited a master's student native in Persian and a PhD student of Afghan origin who was fluent in Russian. Then this translation was verified by a medical Afghan student with fluent Russian skills. The found inaccuracies were corrected.

Adapted and validated questionnaires in the Persian language were used to measure perceived social support, psychological distress and general health among participants. Since there are some discrepancies in Persian language depending on the country, the questions were reviewed with an Afghani expert who has been educated both in Farsi and Dari. Unclear words have been replaced to be suitable for the Afghan population.

The second stage included the actual data collection and analysis, which is described further in the following subchapter.

The third stage was associated with conducting semi-structured interviews with 5 respondent and bi-cultural native Afghan experts. The interview was conducted to investigate specific items more carefully: for example, in which way the respondents perceive discrimination or what role religion plays in everyday situations etc.

2.3 Data collection procedure

During the study, three sources to employ the participants were used. About 30 questionnaires were distributed in the Afghan diaspora centre in Moscow. Another 20 participants were employed through personal contacts and snowball techniques. The rest of participants were obtained via a non-governmental organization, “Civic Assistance Committee”.

In the diaspora centre, the questionnaires were given to a person-in-charge, who took the lead to distribute questionnaires among the employees. The purpose of the study was explained to the person in charge. We reviewed all the questions. The detailed information and answers to all the enquiries were given. The full anonymity of participants was guaranteed.

In the non-governmental organization “Civic assistance committee” the participants were enrolled during the organization's reception time. The purpose of the study and anonymity was guaranteed to the participants. All participants provided informed consent. All the information was given to the participants in their native language by a bilingual interpreter of Afghan origin. The participants were rewarded with a transport card: with 200 roubles balance each. The same procedures were applied to participants when enrolled through personal contacts. However, the latter group of participants were not rewarded. We explained the study purposes and provided them with guidance on how to fill the questionnaire in Russian language.

Completed questionnaires were returned to the researcher. On average it took 15-20 minutes for the participants to complete the questionnaire. Furthermore, a few individuals, including participants and community experts were asked to participate in the interview. With the participants' consent, the interviews were recorded using voice recording equipment.

2.4 Data collection Materials

The questionnaire consists of five parts and all the questions can be found in Appendix A (in English) and Appendix B (in Persian Dari).

Multidimensional Scale of Perceived Social Support (MSPSS). To measure the level of social support in refugees in the current research I used the Multidimensional Scale of Perceived Social Support - MSPSS (Zimet, Dahlem, Zimet, & Farley, 1988). The MSPSS is a 12-item measure assessing subjective social support in the domain of family, friends and significant others on a 7-point Likert scale ranging from “Very Strongly Disagree” to “Very Strongly Agree”. It contains such questions as “There is a special person who is around when I am in need” or “I can count on my friends when things go wrong”. MSPSS is broadly used and was adapted to Farsi (Dari) language and proved its validity for the immigrant and refugee population (see Bagherian-Sararoudi et al., 2013).

Discrimination. The discrimination measure was obtained from the Mutual Intercultural Relations In Plural Societies (MIRIPS) questionnaire (Berry, 2017) and it includes 5 items with 5-point Likert scale ranging from “Strongly disagree” to “Strongly agree”. Discrimination scale has such questions as “I think that others have behaved in an unfair or negative way towards my national group” or “I feel that Russians have something against me”. The items were reversed translated and verified with bilingual interpreters.Afghan Symptom Checklist (ASCL; Miller et al.,2010) . ASCL - is a 22 items checklist with 5-point Likert scale ranging to the persistence of symptoms from “Never” to “Every day”. ASCL was developed to measure psychological distress levels for Afghan respondents. In addition to standard “Western” items such as, “During the last 2 weeks, how many times have you cried?”, it also contains culturally grounded items with such questions as “thinking too much” - a commonly recognized symptom of distress found throughout Asia (De Jong, 2002; Van de Put & Eisenbruch, 2004) or “fishar-e-bala” - emotional pressure and agitation, and “fishar-e-payin” - low energy and motivation (Miller et al., 2006).

The centrality of religiosity scale (CRS) - (Huber& Huber, 2012) is a 15 item questionnaire developed for studies with Buddhists, Hindus and Muslims. It contains such questions as “To what extent do you believe that God or something divine exists?” or “How important is a personal prayer for you?” It consists of 5-point Likert scale answers, ranging from “Not at all” to “Very much so”. Although it has 4 dimensions: ideology, public practice/ private practice, experience, intellect, for the purposes of the current research only 6 questions were chosen.

Socio-Demographic questions.

Sociodemographic variables included: age, gender, marital status, education level, self-report on the degree of fluency in Russian and in a native language (Dari, Pashto), level of religiosity, current employment, occupation in Afghanistan and Russia, current income level, the year of arrival to Russia, residence status.

Interview questions.

The interview was conducted distantly using a computer program as it could not be done in person due-to introduced quarantine Russia announced partial lockdown and quarantine measures were introduced in March, 2020 due to Covid 19 pandemic (Decree 12-UM, 2020) measures. We interviewed five refugees of Afghan origin: 2 male and 3 females who lived in Russia for four years and more. Two female and one male participant had their documents under the consideration of the court and the other two participants had a Russian passport and were represented as community leaders. The interview took 15 minutes to conduct and it was performed in Russian language. It was recorded to use in further data analysis.

The interview consisted of 16 questions and contained items like: “Do you feel that you're treated differently because of your ethnicity?” and “What do you think helps you and other refugees from your country to sustain a normal life?”. The questions were asked in a delicate form aiming not to cause harm to participants' feelings. Interview items can be found in Appendix A.

3. Data analyses and results

3.1 Data analysis

We used SPSS Statistics 22.0 to conduct descriptive statistics, correlation analysis and hierarchical regression analysis. Multiple regression analysis (Moderation), using “PROCESS” by Hayes (2017).

3.2 Results

Reliability analysis and descriptive statistics

First, we checked the dataset for missing values. Then in order to check for internal consistency and reliability we analyzed Cronbach's Alpha coefficient. The results for descriptive statistics and reliability are shown in table 2. All the measures demonstrated adequate to excellent reliability scores (б > 0.70), except for the Centrality of religiosity scale with Cronbach alpha б= 0.6.

Table 2. Reliability Scales and descriptive statistics

Variables	M	SD	min	max	б
Discrimination	1.9	.97	1	5	.84
Perceived Social Support	4.7	1.4	1	7	.89
Distress (Authentic measure)	2.0	.70	1	5	.90
Perceived social support from Significant Others	4.4	1.7	1	7	.79
Perceived social support from Family	5.3	1.5	1	7	.81
Perceived social support from Friends	4.3	1.7	1	7	.84
Psychological Well-being	2.2	.60	1	4	.76
Russian Language skills	2.5	1.04	1	5	.94
Psychological Distress level	2.0	.70	1	4	.75
Centrality of religiosity (CRS)	4.5	.80	1	5	.60

The following are the results of correlation analysis, which is depicted in Table 3.

Table 3 Correlation matrix

Variables	Edu	DISC	Distress	PSS	PSS_SO	PSS_Fam	PSS_Fr	Russ	Relig	INC	Leg	YEARS
Edu	--
DISC	-.08	--
Distress	-.01	.21*	--
PSS	-.12	-.16	-.38***	--
PSS_SO	-.13	-.20	-.45***	.91***	--
PSS_Fam	-.12	-.02	-.32**	.78***	.58***	--
PSS_Fri	-.07	-.20	-.21*	.86***	.72***	.44***	--
Russ	.29**	-.21*	.09	-.07	-.11	-.11	.03	--
Relig	-.18	.17	-.07	.29**	.21*	.31**	.21*	-.18	--
INC	-.06	.04	-.02	-.03	-.11	.16	-.10	.08	.04	--
Leg	.02	-.26*	-.11	.17	.15	.14	.16	.28**	.06	-.14	--
YEARS	.10	-.32*	-.09	.08	.16	-.04	.08	.32**	.01	-.14	.39**	--

Note. * p < .05, ** p < .01, *** p < .001

Edu = education level, DISC = discrimination, Distress = distress level (ASCL), PSS = perceived social support, PSS_SO = perceived social support from significant others, PSS_Fam = perceived social support from family, PSS_Fri = perceived social support from friends, Russ = Russian language skills, Relig = Religiosity, INC=Income; Leg = Legal status, YEARS = Number of years living in Russia.

Before performing the analysis, we recorded legal status to a variable ranging from 1 to 6. We listed them in a way that higher number showed more legal certainty than a lower number, i.e. among the respondents there were the ones who have already obtained a Russian passport, which we coded as 6 (the highest status that could be obtained) and the ones who were not registered at all, which we coded as 1.

The correlation analysis showed that Discrimination significantly correlated with Distress level (r= .208, p< .05) and had negative correlation with Russian language skills (r=- .21, p< .05), number of years living in Russia (r=- .32, p< .05) and Legal status (r=- .26, p< .05). Distress measures were negatively correlated with Perceived social support from significant others (r=- .407, p<.001), Perceived social support from family members (r= - .33, p< .01), Perceived social support (r=- .38, p< .01) and Perceived social support from friends (r=- .21, p< .05). Religiosity also showed a significant correlation with Social support measures. Legal status showed a strong positive correlation with Russian Language skills (r= .279, p< .01), Number of years living in Russia (r= .387, p< .01) and had negative correlation with Discrimination (r=- .263, p< .05).

To check the hypothesis on whether Social support variables predict the distress level we run multiple hierarchical regression analysis, excluding missing cases listwise. We performed the analysis in two steps. In the first step, we controlled the model for demographic variables, such as Age, Education level, Income and Legal status. Social support from significant others and Social support from family members and Social support from friends we included in the second step. Please refer to table 4 for results.

Table 4: Distress results testing demographic variables and Social support from significant others and Social support from family members

	Model 1	Model 2
Variables	SE	в	t	p	SE	в	t	p
Age	.07	-.15	-1.35	.18	.07	-.07	-.65	.52
Education level	.04	-.01	-.08	.93 ...

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