Stress, Mental Health, and Self-Care Among Refugee Teachers in Malaysia

The mental health of postconflict refugees stuck in limbo in neighboring countries, often hostile to refugees, is critically important, given the current refugee crisis. Currently, more than 70 million people have been displaced, with nearly 1 million forcibly displaced from Myanmar. This pair of studies sought to highlight the importance of a culturally sensitive assessment prior to the implementation of an intervention; they rely on an Ecological Developmental approach and mixed-method model to both examine and explore stress, mental health (i.e., depression and anxiety), and self-care among refugee teachers from Myanmar who are living in Kuala Lumpur, Malaysia. For Study 1, participants included 97 primarily Burmese refugee teachers and 26 nonrefugee teachers living in Malaysia. Study 1 used quantitative measures, was cross sectional, and data were collected in 2013, including Depression, Anxiety, and Stress Scales and a self-care questionnaire. Study 1 results suggested that refugee teachers reported significantly higher rates of mental health and stress, but lower rates of self-care, compared with nonrefugee teachers. In addition, higher rates of self-care were associated with lower rates of stress and mental health symptoms, and the association was moderated by age. For Study 2, in 2018, qualitative interviews explored conceptualizations of stress, mental health, and coping among refugee teachers who were from Myanmar (n = 11). Study 2's qualitative results shed light on the unique definitions and experiences of stress, mental health, and self-care among refugee teachers in the context of macrolevel factors related to being a refugee in a country hostile to refugees. The discussion connects results to previous literature and addresses implications of this culturally sensitive assessment for future intervention development. What is the public significance of this article? This mixed-method, cross-sectional paper suggests that teachers who are refugees experience more stress, depression, and anxiety than teachers who are not refugees in Malaysia, and age plays a moderating, protective role in mitigating the relation between self-care and mental health. A predominant theme voiced by Myanmar refugees, who were refugee teachers, was that macrolevel factors associated with their refugee status (e.g., discrimination) impact microlevel, individual lived experiences (i.e., stress and mental health) of Asian teachers who are refugees; at the same time, refugee