Protocol of the study: Multilevel community-based mental health intervention to address structural inequities and adverse disparate consequences of COVID-19 pandemic on Latinx Immigrants and African refugees.

The NIMH-funded Multilevel Community-Based Mental Health Intervention to Address Structural Inequities and Adverse Disparate Consequences of COVID-19 Pandemic on Latinx Immigrants and African Refugees study aims to advance the science of multilevel interventions to reduce the disparate, adverse mental health, behavioral, and socioeconomic consequences of the COVID-19 pandemic that are a result of complex interactions between underlying structural inequities and barriers to health care. The study tests three nested levels of intervention: 1) an efficacious 4-month advocacy and mutual learning model (Refugee and Immigrant Well-being Project, RIWP); 2) engagement with community-based organizations (CBOs); and 3) structural policy changes enacted in response to the pandemic. This community-based participatory research (CBPR) study builds on long-standing collaboration with five CBOs. By including 240 Latinx immigrants and 60 African refugees recruited from CBO partners who are randomly assigned to treatment-as-usual CBO involvement or the RIWP intervention and a comparison group comprised of a random sample of 300 Latinx immigrants, this mixed methods longitudinal waitlist control group design study with seven time points over 36 months tests the effectiveness of the RIWP intervention and engagement with CBOs to reduce psychological distress, daily stressors, and economic precarity and increase protective factors (social support, access to resources, English proficiency, cultural connectedness). The study also tests the ability of the RIWP intervention and engagement with CBOs to increase access to the direct benefits of structural interventions. This paper reports on the theoretical basis, design, qualitative and quantitative analysis plan, and power for the study.

Measuring culturally and contextually specific distress among Afghan, Iraqi, and Great Lakes African refugees.

Culturally and contextually valid measurement of psychological distress is critical, given the increasing numbers of forcibly displaced people and transnational migration. This study replicates an inductive process that elicited culturally specific expressions, understandings, and idioms of distress among Afghans to develop culturally specific measures of distress for Great Lakes Africans and Iraqis and expands this methodology to include a focus on the contexts of refugees resettled in the United States. To create the measures, we adapted Miller et al.'s (2006) model for the Afghan Symptom Checklist (ASCL) and conducted 18 semistructured qualitative interviews that attended to refugees' multiple settings; the impact of potentially traumatic events initially and postresettlement; and the experiences and impact of resettlement stressors. We tested the newly developed measures and existing ASCL with 280 recently resettled refugees (< 3 years) from Afghanistan, the Great Lakes region of Africa, and Iraq to assess factor structure, reliability, and construct validity. We successfully replicated and adapted a process for creating culturally specific measures of distress to create reliable and valid scales that consider culturally and contextually specific distress among several groups of forcibly displaced people. Our results highlight the salience of individuals' social contexts and how they are manifested as idioms of distress, bringing together two key areas of research: the social construction of mental health and social determinants of mental health. These findings have implications for improving measurement of psychological distress and for developing multilevel interventions that are culturally resonant and address factors beyond the individual level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of mental health outcomes of three refugee groups in an advocacy-based intervention: A precision medicine perspective.

OBJECTIVE: Precision medicine is an area with great potential for mental health, but has made limited gains prognostically in predicting effective treatments. For refugees exposed to violence, culture may be a crucial factor in predicting treatment outcomes. METHOD: For this study, 290 participants from three regions (Afghanistan, the Great Lakes region of Africa, and Iraq and Syria) participated in a randomized controlled trial of an advocacy-based intervention. Emotional distress symptoms were measured prior to intervention, midintervention (3 months), postintervention (6 months), and follow-up (6 months after the end of intervention). Number of traumatic events, resource access, social support, and English proficiency were tested for potential predictive effects on intervention outcome. RESULTS: Multilevel generalized linear models revealed that Afghans' (B = -0.259, SE = 0.108, p = .013), and Great Lakes Africans' (B = -0.116, SE = 0.057, p = .042) emotional distress symptoms improved as a function of the intervention, while Iraqis and Syrians showed no intervention effects. For Afghans, English proficiency (B = -0.453, SE = 0.157, p < .01) and social support (B = -0.179, SE = 0.086, p = .037) were most strongly correlated to emotional distress, while for Africans, resource access (B = -0.483, SE = 0.082, p < .001) and social support (B = -0.100, SE = 0.048, p = .040) were the strongest predictors of emotional distress. CONCLUSIONS: Response to advocacy-based interventions and active ingredients may be influenced by culture; findings have implications for refugees and precision medicine. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The impact of postresettlement stressors and access to health care on health outcomes in recently resettled refugees in the United States.

This mixed-methods study examines mechanisms connecting the deployment of economic, social, and health care resources to emotional distress and physical health outcomes. Examining such mechanisms is critical for informing strategies, policies, and other interventions for reducing health disparities and improving refugee health in the United States and other resettlement contexts. Data for this study were collected as part of a randomized control trial in a mid-sized city in the Southwestern United States. Two-hundred ninety recently resettled (< 3 years) refugee adults from 143 households were enrolled in the study (36.2% Afghan, 32.8% Iraqi/Syrian, and 31.0% Great Lakes African; 52% women). Qualitative interview data were collected via semistructured interviews. A longitudinal structural equation path model of quantitative data from three time points over 12 months tested hypotheses that emerged from qualitative findings. In semistructured interviews, refugees in the United States (a) attributed the development of worse or new physical health problems to postresettlement stressors related to financial instability and limited social support that contributed to their emotional distress and (b) reported several barriers to accessing health care in the United States, including insufficient knowledge of health care resources, inadequate patient-provider communication, and navigating complex American health insurance systems, all of which exacerbated their physical health problems. Guided by these qualitative findings, longitudinal quantitative data revealed that: (a) postmigration stressors were associated with emotional distress and poor self-reported physical health, (b) emotional distress mediated the association between postmigration stressors and global health satisfaction, and (c) emotional distress was negatively associated with global health satisfaction. Findings document stressors refugees experience in the context of the unique environment created by the American health care system and how these stressors contribute to poor physical health through increased emotional distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Persistence of the association between mental health and resource access: A longitudinal reciprocal model in a diverse refugee sample.

Stress associated with resource deprivation is an active social determinant of mental health. However, mixed findings around the strength of this association and its persistence over time obscure optimal interventions to improve mental health in forcibly displaced populations. A reciprocal model was analyzed between resource access and measures of depression, anxiety and posttraumatic stress (PTSD) symptoms at three different assessments conducted 6 months apart (Time [T] 1, T2, and T3). Participants included resettled refugees (N = 290) from three geocultural regions (i.e., Afghanistan, the Great Lakes Region of Africa, and Iraq/Syria). The results showed that although limited resource access at T1 was related to depressive and anxiety symptoms, B = 0.26, SE = 0.16, p = .023, r2 = 0.55; posttraumatic stress disorder (PTSD) symptoms, B = 0.20, SE = 0.10, p < .001, r2 = .56; and culturally specific depression and anxiety at T2, B = 0.22, SE = 0.16, p < .001, r2 = 0.65, these were not reciprocally related to resource access at T3. The results help clarify the strength and direction of effects between resource deprivation and depression, anxiety , and PTSD sympotms over time. Although resource deprivation is predictive of depression, anxiety, and PTSD symptoms among recently resettled refugees, the effect may not persist in the long term. These findings have critical implications, including the urgency of ensuring initial access to resources for resettled refugees to stave off the development of depression, anxiety and PTSD symptoms, as delaying immediate resource access may result in the development of chronic, hard-to-treat mental health disorders.

Measuring Latinx/@ immigrant experiences and mental health: Adaptation of discrimination and historical loss scales.

Migration processes encompass uncertainty, discrimination, racism, stigma, social isolation, lack of access to resources, fear of deportation, and family separation, having a critical impact on the health of Latinx/@ immigrants in the United States. It is essential to accurately measure the ways in which social, legal, economic, and political contexts impact mental health. This article discusses adaptation and use of discrimination and historical loss measures in a multilevel community-based advocacy, learning, and social support intervention (Immigrant Well-Being Project) with Latinx/@ immigrants in New Mexico, using participatory research approaches. Participants (n = 52) were recruited through community partner organizations and completed four qualitative and quantitative interviews over a 12-month period. The present analysis draws on the baseline quantitative data. Results show it is possible to adapt standardized measures of discrimination developed to assess the experiences of other racial/ethnic groups; however, the most common responses involved response options added by our research team. For the historical loss instrument, there was a high frequency of "never" answers for many items, suggesting that they were not relevant for participants or did not capture their experiences of loss. As with the discrimination measures, the items we added resonated the most with participants. The contexts of discrimination and loss for Latinx/@ immigrant populations are complex, thus the tools we use to measure these experiences and their impact on health must account for this complexity. This study contributes to these endeavors through involving community members in the conceptualization and measurement of discrimination and historical loss among Latinx/@ immigrants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Geocultural variation in correlates of psychological distress among refugees resettled in the United States.

Attention to cultural variability in mental health symptoms could inform intervention targets; however, this is currently a neglected area of study. This study examined whether the associations between common mental health disorder (CMD) symptoms and predictors of CMDs varied cross-culturally. Participants were 290 refugees from three geocultural regions (Afghanistan, Great Lakes region of Africa, and Iraq and Syria) who recently resettled in the United States and completed assessments of CMD symptoms and predictors. Multilevel generalized linear modeling was used to examine the interactions between correlates of depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms and each of the three cultural reference groups. Relative to refugees from other regions, Iraqi and Syrian participants demonstrated stronger associations between the number of reported traumatic experiences and both depressive, B = 0.01, SE = .003, p = .003, and anxiety symptoms, B = 0.01, SE = .003, p < .001; Afghan participants showed a stronger association between physical quality of life and PTSD symptoms, B = 0.02, SE = .011, p = .037; and African participants demonstrated stronger associations between gender and symptoms of all three CMDs, Bs = 0.11-.020, SEs = .04-.06, ps = .005-.008, and weaker associations between traumatic event exposure and CMD symptoms, Bs = -0.01--0.02, SEs = .003-.006, ps = .000-.002. CMD symptoms likely present differently across cultures, with various predictors more salient depending on cultural backgrounds and differential experiences that vary based on context. These findings have implications for cross-cultural assessment research and mental health.

Innovative participatory bilingual data analysis with Latinx/@ immigrants: Language, power, and transformation.

OBJECTIVE: The insights of Latinx/@ immigrants are essential to developing interventions that better address complex multilevel phenomena impacting mental health. Despite important advances in methods that genuinely embody participatory research practices, attention to collaborative data collection, analysis, and dissemination are limited. Our aim is to describe the development and implementation of research practices to address these gaps through an emphasis on and understanding of the centrality of language in collaborative research processes. METHOD: Guided from the outset by community-based participatory research principles, our community-academic research partnership recognized the importance of developing and intentionally studying our collaborative processes. As part of an ethnographic interview study with 24 Latinx/@ immigrants, a community-university research team developed innovative methods, including practices related to research team meetings, data collection, analysis, and dissemination, which we documented through ongoing discussion and reflection. RESULTS: The resulting participatory research processes were grounded in a theoretical framework of praxis and language and included six innovative and iterative stages: (a) Establishing the research team, (b) planning the interview process/data collection, (c) developing the data analysis methodology, (d) interpreting findings to adapt the intervention, (e) integrating results of the participatory process into the analysis, and (f) data analysis for dissemination. CONCLUSIONS: A focus on praxis and language revealed how the language of research structures' power, meaning, feeling, collaboration, analysis, and transformation. We also found that bilingual participatory analytic processes have important implications with respect to achieving genuine inclusion in rigorous research that moves toward equity for Latinx/@ immigrants and other populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Production and maintenance of the institutional in/visibility of sexual and gender minority students in schools.

This research investigates how school professionals, as institutional actors, influence school climates experienced by lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth. Although research links institutional characteristics to outcomes for LGBTQ youth, scholars do not yet fully understand the mechanisms. We address this gap through a mesolevel analysis of staff perspectives on schools' responsibilities to LGBTQ students. Using data from 96 semistructured interviews with high school staff during the 2016-2017 school year, we found that participants used three main cues to assess visibility of the school's LGBTQ population: (a) student self-advocacy; (b) students' enactment of LGBTQ stereotypes; and (c) same-sex relationships. Reliance on these cues led staff to underestimate the LGBTQ population and employ narrative frames to rationalize the status quo: small LGBTQ population did not merit allocating resources; all students were treated equally; LGBTQ-inclusive policies further marginalized LGBTQ students; and student issues were addressed through individualized interventions. Our research shows how staff's biases collide with institutional inertia to influence school climate, one crucial facet of the ecological contexts of LGBTQ youth. We conclude with discussion of implications and recommendations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Latinx/@ immigrant inclusion trajectories: Individual agency, structural constraints, and the role of community-based organizations in immigrant mobilities.

Immigration is at the forefront of national, state, and local policy struggles in the United States, and Latinx/@ immigrants have experienced increased deportations, detention, and individual threats. A mobilities perspective allows analysis to extend our view of migration beyond frameworks confined to pre- and postmigration, examining trajectories of social inclusion and exclusion that are influenced by multiple factors in the receiving country. The Immigrant Well-being Project, a community-based participatory research project involving university faculty, students, staff, and representatives from 4 community-based organizations (CBOs), was initiated in New Mexico in 2017 to better understand and promote Latinx/@ immigrant mental health and integration by creating change at multiple levels. We began these efforts by conducting an in-depth study of the mental health needs, stressors, current socioeconomic, legal, and political context, and local solutions as experienced by 24 Latinx/@ immigrants and their mixed status families. Five trajectories of immigrant integration emerged: continuous exclusion, simultaneous exclusion and inclusion, continuous inclusion, movement from exclusion to inclusion, and movement from inclusion to exclusion. These diverse mobilities were shaped by participants' social locations, agency, and experiences with CBOs, which played critical roles in creating, maintaining, and/or transforming immigrants' trajectories. However, CBOs could not completely buffer immigrants from the current hostile climate and related stressors that resulted in experiences of exclusion or movement from inclusion to exclusion. These findings add to understandings of immigrant mental health, complex ongoing mobility, and mechanisms of resilience and resistance within the United States and have important implications for policy and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Randomized Controlled Trial of a Multilevel Intervention to Address Social Determinants of Refugee Mental Health.

Understanding processes that support the well-being of the unprecedented numbers of forcibly displaced people throughout the world is essential. Growing evidence documents post-migration stressors related to marginalization as key social determinants of refugee mental health. The goal of this RCT was to rigorously test a social justice approach to reducing high rates of distress among refugees in the United States. The 6-month multilevel, strengths-based Refugee Well-being Project (RWP) intervention brought together university students enrolled in a 2-semester course and recently resettled refugees to engage in mutual learning and collaborative efforts to mobilize community resources and improve community and systems responsiveness to refugees. Data collected from 290 Afghan, Great Lakes African, Iraqi, and Syrian refugees at four time points over 12 months were used to test the effectiveness of RWP to reduce distress (depression and anxiety symptoms) and increase protective factors (English proficiency, social support, connection to home and American cultures). Intention-to-treat analyses using multilevel modeling revealed significant intervention effects for all hypothesized outcomes. Results provide evidence to support social justice approaches to improving refugee mental health. Findings have implications for refugees worldwide, and for other immigrant and marginalized populations who experience inequities in resources and disproportionate exposure to trauma/stress.

Family Separation and the Impact of Digital Technology on the Mental Health of Refugee Families in the United States: Qualitative Study.

BACKGROUND: Conflicts around the world have resulted in a record high number of refugees. Family separation is a critical factor that impacts refugee mental health. Thus, it is important to explore refugees' ability to maintain contact with family members across the globe and the ways in which they attempt to do so. It is increasingly common for refugees to use information and communication technologies (ICTs), which include mobile phones, the internet, and social media sites, such as Facebook, WhatsApp, Skype, and Viber, for these purposes. OBJECTIVE: The aim of this study was to explore refugees' perceptions of the impact of communication through ICTs on their mental health, the exercise of agency by refugees within the context of ICT use, especially their communication with their families, and logistical issues that affect their access to ICTs in the United States. METHODS: We used a constructivist grounded theory approach to analyze in-depth interviews of 290 adult refugee participants from different countries, who were enrolled in a randomized controlled trial of a community-based mental health intervention. RESULTS: Analyses showed that communication through ICTs had differing impacts on the mental health of refugee participants. ICTs, as channels of communication between separated families, were a major source of emotional and mental well-being for a large number of refugee participants. However, for some participants, the communication process with separated family members through digital technology was mentally and emotionally difficult. The participants also discussed ways in which they hide adversities from their families through selective use of different ICTs. Several participants noted logistical and financial barriers to communicating with their families through ICTs. CONCLUSIONS: These findings are important in elucidating aspects of refugee agency and environmental constraints that need to be further explicated in theories related to ICT use as well as in providing insight for researchers and practitioners involved in efforts related to migration and mental health.

REFUGEE MENTAL HEALTH AND HEALING: UNDERSTANDING THE IMPACT OF POLICIES OF RAPID ECONOMIC SELF-SUFFICIENCY AND THE IMPORTANCE OF MEANINGFUL WORK.

Although refugees who are accepted for resettlement in a third country are guaranteed certain rights and experience safety from war and persecution, they face many mental health challenges. Using qualitative methods and constructivist grounded theory, we explored culturally-specific perspectives on trauma and recovery among Burundian, Congolese and Iraqi refugees resettled in the United States. Eighteen semi-structured interviews provided extensive data on the meaning of productivity and work, the ways in which they index normalcy and self-sufficiency, and how they create security that facilitates the healing process. Our inductive analyses revealed that participants emphasized the relationship between productivity and healing when they described recovery from trauma. Participants also discussed individual and structural facilitators and barriers to work. Finally, prominent themes emerged around gendered roles and expectations and the ways these function in refugee resettlement contexts that are shaped by policies that demand rapid economic self-sufficiency. Taken together, these findings suggest that policies that promote underemployment and foreclose opportunities for education and professional development may contribute negatively to refugee mental health, as well as keep refugees in poverty.

Ecological Networks and Community Attachment and Support Among Recently Resettled Refugees.

Interventions aimed at enhancing mental health are increasingly centered around promoting community attachment and support. However, few have examined and tested the specific ecological factors that give rise to these key community processes. Drawing from insights from the ecological network perspective, we tested whether spatial and social overlap in routine activity settings (e.g., work, school, childcare) with fellow ethnic community members is associated with individuals' attachment to their ethnic communities and access to social resources embedded in their communities. Data on routine activity locations drawn from the Refugee Well-Being Project (based in a city in the Southwestern United States) were used to reconstruct the ecological networks of recently resettled refugee communities, which were two-mode networks that comprise individuals and their routine activity locations. Results indicated that respondents' community attachment and support increased with their ecological network extensity-which taps the extent to which respondents share routine activity locations with other community members. Our study highlights a key ecological process that potentially enhances individuals' ethnic community attachment that extends beyond residential neighborhoods.

Understanding the mental health consequences of family separation for refugees: Implications for policy and practice.

Consistent evidence documents the negative impacts of family separation on refugee mental health and concerns for the welfare of distant family members and desire to reunite with family members as priorities for refugees postmigration. Less is known about refugees' emic perspectives on their experiences of family separation. Using mixed methods data from a community-based mental health intervention study, we found that family separation was a major source of distress for refugees and that it was experienced in a range of ways: as fear for family still in harm's way, as a feeling of helplessness, as cultural disruption, as the greatest source of distress since resettlement, and contributing to mixed emotions around resettlement. In addition to these qualitative findings, we used quantitative data to test the relative contribution of family separation to refugees' depression/anxiety symptoms, posttraumatic stress disorder (PTSD) symptoms, and psychological quality of life. Separation from a family member was significantly related to all 3 measures of mental health, and it explained significant additional variance in all 3 measures even after accounting for participants' overall level of trauma exposure. Relative to 26 other types of trauma exposure, family separation was 1 of only 2 traumatic experiences that explained additional variance in all 3 measures of mental health. Given the current global refugee crisis and the need for policies to address this large and growing issue, this research highlights the importance of considering the ways in which family separation impacts refugee mental health and policies and practices that could help ameliorate this ongoing stressor. (PsycINFO Database Record

"My World is Upside Down": Transnational Iraqi Youth and Parent Perspectives on Resettlement in the United States.

The U.S. war with Iraq led to the displacement of millions of Iraqis, many of whom have resettled in the United States as refugees. We explore the challenges Iraqi families face after resettlement, with a particular focus on the agency of refugees and challenges/opportunities of familial social reproduction in a transnational context. We conducted 181 qualitative interviews with 38 Iraqis (11 youth, 27 adults) and 5 service providers. Our findings highlight the importance of exploring refugee agency and illuminate how the interplay between structure and agency in transnational contexts is a useful framework for understanding transformations around social roles.

Challenges and Innovations in a Community-Based Participatory Randomized Controlled Trial.

Randomized controlled trials (RCTs) are a long-standing and important design for conducting rigorous tests of the effectiveness of health interventions. However, many questions have been raised about the external validity of RCTs, their utility in explicating mechanisms of intervention and participants' intervention experiences, and their feasibility and acceptability. In the current mixed-methods study, academic and community partners developed and implemented an RCT to test the effectiveness of a collaboratively developed community-based advocacy, learning, and social support intervention. The goals of the intervention were to address social determinants of health and build trust and connections with other mental health services in order to reduce mental health disparities among Afghan, Great Lakes Region African, and Iraqi refugee adults and to engage and retain refugees in trauma-focused treatment, if needed. Two cohorts completed the intervention between 2013 and 2015. Ninety-three adult refugees were randomly assigned to intervention or control group and completed four research interviews (pre-, mid-, and postintervention, and follow-up). Several challenges to conducting a community-based RCT emerged, including issues related to interviewer intervention to assist participants in the control group, diffusion of intervention resources throughout the small refugee communities, and staff and community concerns about the RCT design and what evidence is meaningful to demonstrate intervention effectiveness. These findings highlight important epistemological, methodological, and ethical challenges that should be considered when conducting community-based RCTs and interpreting results from them. In addition, several innovations were developed to address these challenges, which may be useful for other community-academic partnerships engaged in RCTs.

Reconsidering culturally competent approaches to American Indian healing and well-being.

There is an urgent need to eliminate mental health disparities experienced by American Indians and Alaska Natives (AI/ANs). Service providers and researchers often address these disparities by focusing on low rates of participation in Western mental health services. In part, this reflects limited understandings of the sociopolitical and historical context of AI/AN mental health problems. Furthermore, this emphasis fails to recognize the importance of emic understandings of locally resonant coping strategies, healing, and treatment. In this article, we describe (a) a study designed to address these gaps, (b) findings related to the importance of land and place, and (c) a community-university collaboration to translate these findings into meaningful change within one Diné community. Connections to the land were an important cultural strength on which to build efforts to promote mental health. Thus, effective treatment might involve more in-depth understanding of cultural processes through which healing occurs and well-being is maintained.

Reducing mental health disparities through transformative learning: a social change model with refugees and students.

Distribution of power and resources greatly impacts the mental health of individuals and communities. Thus, to reduce mental health disparities, it is imperative to address these social determinants of mental health through social change. Engaging in social change efforts requires people to critically engage with present conditions on personal, local, national, and global levels and to develop knowledge, capacity, and experience with envisioning and creating more equitable conditions. This critical engagement can be fostered through a process of transformative learning. In this article, we examine the Refugee Well-being Project (RWP), a program that aims to improve the mental health of refugees in the United States. From 2007 to 2009, participants in the RWP in New Mexico were refugees from the Great Lakes region of Africa. The RWP paired undergraduate students with refugees to engage in mutual learning and advocacy. Data from in-depth qualitative interviews with 72 refugees and 53 undergraduate students suggest that participation in the RWP constituted a transformative learning experience through which refugees and students came to new understandings of the relationship between social inequities and well-being. For many, this provided an impetus to work toward change at multiple levels.

Reducing refugee mental health disparities: a community-based intervention to address postmigration stressors with African adults.

Refugees resettled in the United States have disproportionately high rates of psychological distress. Research has demonstrated the roles of postmigration stressors, including lack of meaningful social roles, poverty, unemployment, lack of environmental mastery, discrimination, limited English proficiency, and social isolation. We report a multimethod, within-group longitudinal pilot study involving the adaptation for African refugees of a community-based advocacy and learning intervention to address postmigration stressors. We found the intervention to be feasible, acceptable, and appropriate for African refugees. Growth trajectory analysis revealed significant decreases in participants' psychological distress and increases in quality of life, and also provided preliminary evidence of intervention mechanisms of change through the detection of mediating relationships whereby increased quality of life was mediated by increases in enculturation, English proficiency, and social support. Qualitative data helped to support and explain the quantitative data. Results demonstrate the importance of addressing the sociopolitical context of resettlement to promote the mental health of refugees and suggest a culturally appropriate, and replicable model for doing so.