Determinants of mental disorders of Afghan migrants during the COVID-19 pandemic

Abstract

Purpose
Afghan migrants are at an increased risk of mental disorders due to various political, economic and security-associated stressors. COVID-19 has brought extra concerns for this group of migrants around the world. Few studies have examined how the perception of the host society and perceived stress are associated with the mental health of migrants during the COVD-19 pandemic. This study aims to examine the role of perceived justice, freedom and the burden of COVID-19 on experienced stress and depression among Afghan migrants in Iran.

Design/methodology/approach
N = 497 participants representing the Afghan migrant community between 15 and 80 years old participated in the study. The target population was recruited from Afghan migrants residing in Kerman city in Iran, the capital of one of the provinces with the highest number of Afghan migrants in Iran. The participants answered questions on depression, positive mental health and a series of stressors such as perceived justice, freedom and the burden of COVID-19. Data was collected in November and December 2021 during the third wave of the COVID-19 pandemic in Iran.

Findings
The authors found a significant effect of the burden of the COVID-19 pandemic on migrants’ perceived stress and depression. On the other hand, perceptions of justice and freedom in the host country can significantly reduce stress and depression. The results show that stress mediates the effect of justice, freedom and the burden of COVID-19 on depression. In addition, positive mental health moderates the impact of stress on depression.

Originality/value
The current study is one of the pioneering studies that examines the determinants of Afghan migrants’ mental disorders during the COVID-19 pandemic in Iran.

Full text

Determinants of mental disorders of
Afghan migrants during the
COVID-19 pandemic
Fatemeh Khozaei, Claus-Christian Carbon and Nordin Abd Razak
Abstract
Purpose –Afghan migrants are at an increased risk of mental disorders due to various political,
economic and security-associated stressors. COVID-19 has brought extra concerns for this group of
migrants around the world. Few studies have examined how the perception of the host society and
perceived stress are associated with the mental health of migrants during the COVD-19 pandemic. This
study aims to examine the role of perceived justice, freedom and the burden of COVID-19 on
experienced stress and depression among Afghan migrants in Iran.
Design/methodology/approach –N = 497 participants representing the Afghan migrant community
between 15 and 80 years old participated in the study. The target population was recruited from Afghan
migrants residing in Kerman city in Iran, the capital of one of the provinces with the highest number of
Afghan migrants in Iran. The participants answered questions on depression, positive mental health and
a series of stressors such as perceived justice, freedom and the burden of COVID-19. Data was collected
in November and December 2021 during the third wave of the COVID-19 pandemic in Iran.
Findings –The authors found a significant effect of the burden of the COVID-19 pandemic on migrants’
perceived stress and depression. On the other hand, perceptions of justice and freedom in the host
country can significantly reduce stress and depression. The results show that stress mediates the effect
of justice, freedom and the burden of COVID-19 on depression. In addition, positive mental health
moderates the impact of stress on depression.
Originality/value –The current study is one of the pioneering studies that examines the determinants of
Afghan migrants’ mental disorders during the COVID-19 pandemic in Iran.
Keywords Mental disorder, Migration, Stress, Depression, Burden of COVID-19, Mediator
Paper type Research paper
1. Introduction
Over the past decades, the world has witnessed a significant increase in global migration.
In 2019 alone, there have been 272 million migrants worldwide, including refugees and
asylum seekers (United Nations High Commissioner for Refugees, 2020). Various pushing
factors have caused forced migrations, such as war or safety issues (e.g. persecution and
violence) and a flagging economy in the home country (Mandi
c, 2021;Ghatak, 2021).
Refugees, a population living away from their homeland, are unwilling to return to their home
countries due to undesirable situations.
With a growing migration rate, the mental health of immigrants has been a great concern (Yi
and Liang, 2020;Yang et al., 2021). Multiple factors affect their mental health negatively.
Before relocation, immigrants, including refugees, might have been exposed to stressful
incidents such as conflicts and challenging or even life-threatening migration journeys
(Silove et al., 2017). Many migrants and refugees have been subject to stressful
experiences in their home countries (Giacco et al.,2018) and during their migration routes.
Fatemeh Khozaei is based
at the Department of
Architectural Engineering,
Dhofar University, Salalah,
Sultanate of Oman.
Claus-Christian Carbon is
based at the Department of
General Psychology and
Methodology, University of
Bamberg, Bamberg,
Germany and Research
Group EPÆG (Ergonomics,
Psychological Aesthetics,
Gestalt), Bamberg,
Germany.
Nordin Abd Razak is based
at the School of Educational
Studies, Universiti Sains
Malaysia, Penang,
Malaysia.
Received 26 April 2021
Revised 19 July 2022
Accepted 2 September 2022
DOI 10.1108/IJMHSC-04-2021-0040 VOL. 18 NO. 4 2022, pp. 301-314, ©Emerald Publishing Limited, ISSN 1747-9894 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 301

Migration seems to risk the health of migrants even after having been resettled. They are
more likely to be socio-economically disadvantaged and often face ethnic discrimination in
destination countries, they are at risk of mental health issues (Sternthal et al.,2011). They
might also suffer from mental disorders such as anxiety, post-traumatic stress and
depression (Tingho
¨get al.,2017;Awuah et al., 2020) and experience acculturation
problems in the host countries (Connor, 2010). Compared with first-rate citizens, migrants
are generally more likely to deal with mental health issues (Blukacz et al., 2020). The degree
and the starting point of migrants’ declining health or mental health status seem to be
affected by a variety of factors such as the length of residence in the country of destination,
their age, gender, place of birth, language proficiency, as well as marital status (Mangrio
et al.,2021
;Fuller-Thomson et al.,2011).
Afghan migrants have long been one of the most marginalized groups of migrants and
refugees. Specifically, since the so-called Arab Spring in the early 2010s and more
generally in the past 40years, many Afghan migrants have been displaced. Iran, Pakistan
and Germany are among the countries that have been the top destinations for Afghan
migrants and refugees in the past few years (Alemi et al.,2014). As the majority of Afghan
are illegal migrants, they have to work in bad conditions for minimal pay, exacerbating their
challenging living circumstances (Lebni et al., 2022). Long years of civil war with the Taliban
and the lack of stability in Afghanistan have been the primary culprits for the rapid increase
of migrants in recent years. Afghan migrants have long gone through trauma. Long-term
hardship and the loss of loved ones have been drivers for escaping from Afghanistan. The
prevalence of mental disorders among Afghan migrants in Iran has been reported to be
twice as many as the local population (Badrfam & Zandifar, 2021).
The COVID-19 pandemic, which began in the USA around January 2020, added new
challenges for migrants and refugees. Recent studies suggest that migrants and, more
specifically, those who are working in low-paid jobs are experiencing psychological
stressors due to poverty (Espinel et al.,2020), discrimination and inequity (Li and Rose,
2020), social exclusion (Li and Jiang, 2020), as well as unfavorable daily experiences of all
kinds (Hou et al., 2020) under the COVID-19 situation. Very little is known about the mental
disorders of migrant and refugee populations affected by COVID-19 (Acharya et al., 2021).
A recent qualitative study in Iran shows that the COVID-19 pandemic has had a tremendous
negative impact on the family life of Afghans in Iran, e.g. the men’s unemployment has
exacerbated domestic violence (Lebni et al.,2022).
Given the large population of Afghan migrants, we selected Iran as a case study to shed
light on the determinants of mental disorders among Afghan migrants in Iran. We examined
whether the perceived justice, freedom and burden of COVID-19 are associated with
depression directly and indirectly via stress as a mediator. We further examined the
possible moderating effect of good mental health on the relationship between stress and
depression.
2. Theoretical framework
The current study attempts to shed light on the determinants of mental disorders of Afghan
migrants. This study draws upon Miller and Rasmussen’s (2017) social-ecological model,
which argues that daily stressors (e.g. poverty) that migrants and refugees encounter
during the migration and post-resettlement life negatively influence mental health. This
theory highlights that daily stress could be caused by harmful and uncontrollable social and
material issues associated with post-resettlement life. This model shows how interactions
between internal psychological processes and ecological variables affect mental health.
In the present study, we use the label “migrants” for all Afghans who have left their
country and have settled in Iran, including refugees. Post-displacement stressors may
affect the mental health of migrants more than premigration stressors (Li et al., 2016;
PAGE 302 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jVOL. 18 NO. 4 2022

Morgan et al., 2017). Previous studies suggest that Afghan migrants in various countries
experience significant stressors such as poverty, housing, employment precariousness
and inadequate income (Kavian et al., 2020;Alemi et al., 2014). Based on these ideas,
we stated the following hypotheses:
H1. The burden of COVID-19 increases the migrants’ stress.
Earlier studies suggest that perceived justice and freedom have a negative effect on mental
health (Scholten et al.,2017). Accordingly, the more the people of society believe in being
treated fairly and having freedom in their community, the better their mental health will be.
Justice is often perceived to be associated with social and macroeconomic factors (Fischer,
2016), and is linked to health benefits (Sert et al.,2014). In addition, a growing literature has
shown that mental health is positively correlated with belief in executing justice in societies,
while mental distress is negatively associated with it (Otto et al., 2006). Hence, we might
assume that those with low perceived justice feel more stressed because such a perception
influences the individual’s sense of control, security and predictability.
In political psychology, freedom as an aspect of political value has been considered a
complementary part of justice (Rokeach, 1973). In a longitudinal study of 52 countries,
Inglehart et al. (2008) found an association between a sense of freedom and happiness.
Reviewing the results shows that freedom seems to be associated with perceived stress.
However, the exact association requires more investigation (Scholten et al.,2018).
Therefore, we will assume a link between freedom and stress. Accordingly, the current
study proposes the following hypotheses:
H2. Perceived justice has a negative effect on stress.
H3. Perceived freedom has a negative effect on stress.
Mental health problems, including depression, are related to poverty, rural–urban migration,
stigmatization, domestic violence, workload and stress in many communities. Studies
suggest that women are particularly at a higher risk of mental health (Hanandita and
Tampubolon, 2014). Poor people are more likely to suffer from mental health problems, and
the relationship between poverty and mental health is strong in the areas where there is
inequality in income (Chiavegatto Filho et al.,2013). A considerable body of studies using
interviews focusing on life experiences has documented severe stressors before
depressive episodes. According to Mazure (1998), 80% of depressed cases were triggered
by crucial negative life events.
Based on the above ideas, the research hypothesizes are listed below:
H4. Stress has a positive effect on depression.
H5. The burden of COVID-19 has a positive effect on depression.
H6. Perceived justice has a negative effect on depression.
H7. Perceived freedom has a negative effect on depression.
H8. Stress mediates the relationship between the burden of COVID-19 and depression.
H9. Stress mediates the relationship between perceived freedom and depression.
H10. Stress mediatesthe relationship between perceived justice and depression.
Mental health can be examined from two perspectives. Positive mental health (PMH) is
described as having optimized mental functioning and well-being feelings. On the contrary,
negative mental health covers harmful health conditions, psychopathology or psychiatric
illnesses. Though these variables are inter-related, they may work independently (Keyes,
2007). Therefore, neglecting positive characteristics will minimize the predictive power of
stress. Daily stressors can result in depression and anxiety (Parrish et al.,2011). Previous
VOL. 18 NO. 4 2022 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 303

studies suggest that stress can predict depression (Sun et al., 2020). Besides, the more
people are exposed to stressful situations, the more likely they will be depressed. However, so
far, the direct effects of stress on depression have not been investigated, and the possible
moderating factors have not been examined. Accordingly, the current study hypothesizes that:
H11. Positive mental health moderates the relationship between stress and depression.
Figure 1 presents the conceptual model of research.
3. Research methodology
In this study, we examined the determinants of mental disorders among Afghan migrants in
Iran. We aimed to examine the relationship between stress, depression, the burden of
COVID-19, perceived justice and freedom subsumed with positive mental health.
3.1 Participants
Based on the report of the statistical center of Iran in 2015, the largest population of Afghan
migrants lives in the provinces of Kerman, Tehran, Khorasan and Isfahan. In the current
study, participants were recruited among Afghan migrants residing in the Kerman city. The
target population was defined as individuals 15 years old and older who left their country
and settled in Iran.
3.2 Measurement scale
The distributed questionnaire consists of several items and constructs. The first part of
the questionnaire measured the socio-economic characteristics of respondents,
including gender, age, marital status, duration of stay and work permission. Several
scales were used further to measure respondents’ stress, depression, PMH, perceived
freedom, justice and the burden of COVID-19. For measuring depression and stress, we
used the Depression, Anxiety and Stress Scale (DASS-21). This scale has been
frequently used for measuring mental disorders. Respondents were asked to answer 14
questions declaring their stress and depression in the past seven days. To measure
PMH, we used the PMH scale proposed by Lukat et al. (2016), which has nine questions.
For measuring justice and freedom, we adapted questions from Scholten et al. (2017).
The participants were asked to express how they felt treated fairly and how much
freedom they felt in the host country. For measuring the burden of COVID-19, the
questions were adapted from Brailovskaia and Margraf (2021).Table 1 presents
measurement constructs and items.
Figure 1 The conceptual model of research
Burden of
Corona
Justice
Freedom
Stress
Depression
Positive
mental
health
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3.3 Procedure
The questionnaire was translated into Deri by an authorized translator and then translated
back into English by another bilingual Afghan-English translator who was blinded to the
original questionnaire. Then English-Deri language versions were then compared. For the
respondents with no educational background, our Afghan research assistant conducted
interviews and recorded the respondents’ answers on the answer sheet separately. The
questionnaire was piloted with ten educated and non-educated Afghan migrants. Data was
Table 1 Measurement constructs and items
Construct Items Questions Measurement Source
Burden of COVID-19 BUC1 The current social situation burdens me 1 = I do not agree
7 = I totally agree
BUC2 I feel restricted in my everyday life
BUC3 I am afraid of the current situation
BUC4 I feel socially isolated
BUC5 I am making the best of the situation
BUC6 I look forward to what will happen
BUC7 I now know better what is important to me
BUC8 My relationships with family and friends have become
stronger and better
BUC9 My current situation has some advantages
BUC10 I am worried about my future life
Positive mental health PMH1 I am often carefree and in good spirits 0 = I disagree
3=I agree
PMH2 I enjoy my life
PMH3 All in all, I am satisfied with my life
PMH4 In general, I am confident
PMH5 I manage well to fulfill my needs
PMH6 I am in good physical and emotional condition
PMH7 I feel that I am well equipped to deal with life and its
difficulties
PMH8 Much of what I do brings me joy
PMH9 I am a calm, balanced human being
Depression DEP1 I found it hard to wind down 0 = did not apply to me at all
3=applied to me very
much, or most of the time
DEP2 I was aware of the dryness of my mouth
DEP3 I could not seem to experience any positive feeling at all
DEP4 I experienced breathing difficulty (e.g. excessively rapid
breathing, breathlessness in the absence of physical
exertion)
DEP5 I found it difficult to work up the initiative to do things
DEP6 I tended to over-react to situations
DEP7 I experienced trembling (e.g. in the hands)
Stress I felt I was close to panic 0 = did not apply to me at all
3=applied to me very
much, or most of the time
I was unable to become enthusiastic about anything
I felt I was not worth much as a person
I felt that I was rather touchy
I was aware of the action of my heart in the absence of
physical exertion (e.g. sense of heart rate increase,
heart missing a beat)
I felt scared without any good reason
I felt that life was meaningless
Justice When you compare yourself with other people in <your
home country>, how fairly treated do you feel?
0= not fair at all
100 = very fair
Freedom When you compare yourself with other people in <your
home country>, how free do you feel?
0= not free at all
100 = very free
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collected between November and December 2021 from Afghan participants using
convenience sampling. The research site of the study included five districts of Kerman with
the highest population of Afghan migrants. Data was collected by one Iranian and one
Afghan-trained research assistant.
All participants filled out a consent form about the research objectives and were assured of
the confidentiality of their responses. Respondents answered questions on their
demographic background, perceived stress and depression in the past seven days, PMH
and the burden of COVID-19. Respondents received a token of appreciation upon
completion of the survey. The participant spent between 10 and 20 min filling out the
questionnaires.
The research model and hypotheses were tested using partial least squares (PLS) analysis
with the SmartPLS 3.3 software (Ringle et al.,2015). Due to the study’s exploratory nature
and the use of hierarchal variables, PLS was considered appropriate for the study. In
addition, for examining the significance of the path coefficient among latent variables, a
series of non-parametric bootstrapping with 5,000 iterations were applied. Besides, the
reliability and validity of constructs (measurement model) and structural model were
examined for finalizing the outcome. For assessment of reliability and validity of constructs
rho_A, composite reliability (CR), CA, average variance extracted (AVE) were tested and for
examining the structural model coefficient of determination (R2), effect size (f2), variance
inflation factor (VIF) and predictive relevance (Q2) were tested and reported.
3.4 Data sharing statement
The current article includes the complete raw data set collected in the study, including the
participants’ data set, syntax file and log files for analysis. All data files will be automatically
uploaded to the Figshare repository as soon as the article is accepted.
4. Results
4.1 Demographic backgrounds
From the 497 questionnaires administered and collected, 28 questionnaires were omitted
as the respondents left most of the questions blank. This leads to a total number of 469
processable questionnaires. Table 2 presents the demographic information of respondents
taking part in the study. The mean age for participants was 30.6 years (SD = 14.30). The
study included 191 male and 278 female participants. Then, 362 participants were between
Table 2 Respondents’demographic characteristics
Demographic factors Categories N(%)
Gender Male 191 40.7
Female 278 59.3
Age 15–35 years 362 77.1
36–55 years 62 13.2
Above 56 years 45 9.6
Marriage status Single 169 36.0
Married 300 64.0
Duration of living in Iran >10 years 62 13.7
11–20 years 190 19.8
21–30 years 127 50.0
31–40 years 60 13.2
Above 40 years 15 3.3
Education level Non educated 355 75.7
Full or some parts of primary school 114 24.3
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the ages of 15 and 35, 62 were between the ages of 36 and 55 and 45 were over the age of
45. While 169 of the participants were single, 300 were married.
4.2 Measurement model assessment
The proposed measurement model was assessed and used a two-stage approach as
suggested by Anderson and Gerbing (1988). First, we assessed the measurement model
for each latent variable undertaken in the study. For the study, we conceptualized the
measurement model as a reflective measurement model, which allows us to assess
reliability, convergent and discriminant validity. The reliability of the measurement model is
assessed by referring to Cronbach’s
a
coefficient, and the CR, a cut-off value of 0.70 is
acceptable. Initially, the overall model was assessed, and constructs with AVE lower than
0.50 were identified.
Items with the lowest loadings were discarded. Table 3 indicates that the values of CR and
Cronbach’s
a
exceeded the cut-off value of 0.70, suggesting internal consistency reliability.
As evaluated by the value of AVE for all of the constructs, the convergent validity exceeded
the cut-off value of 0.50. In addition, the outer loading value of all items of each construct,
namely, Burden of COVID-19 (BUC), Depression (Dep), Justice (JUS), Freedom (FREE),
PMH and stress (STR), is higher than .70. Table 3 presents the established reliability and
convergent validity of research constructs.
In the next step, we examined the discriminant validity of the constructs. We used the
Fornell–Larcker criterion and heterotrait-monotrait (HTMT) ratio (Voorhees et al., 2016). The
accepted HTMH value must be lower than 0.85 or 0.90 (Henseler et al.,2015). Table 3
Table 3 Reliability and convergent validity for research constructs
Construct Items Loadings rho_A CR CA AVE
Burden of COVID-19 BUC1 0.862 0.856 0.890 0.837 0.670
BUC2 0.752
BUC4 0.811
BUC9 0.845
Depression Depr1 0.946 0.971 0.975 0.970 0.850
Depr2 0.870
Depr3 0.931
Depr4 0.909
Depr5 0.905
Depr6 0.931
Depr7 0.960 1.000
Justice Jus 1.000 1.000 1.000 1.000 1.000
Freedom Free 1.000 1.000 1.000 1.000 1.000
Positive mental health PMH1 0.897 1.069 0.963 0.956 0.763
PMH2 0.852
PMH3 0.911
PMH4 0.867
PMH5 0.921
PMH6 0.917
PMH7 0.880
PMH8 0.728
Stress Stress1 0.972 0.987 0.988 0.986 0.923
Stress2 0.986
Stress3 0.980
Stress4 0.916
Stress5 0.977
Stress6 0.948
Stress7 0.946
Notes: CR = composite reliability; AVE = average variance extracted; VIF = variance inflation factor
VOL. 18 NO. 4 2022 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 307

reveals that discriminant validity was acceptable in the study data. In addition, the criterion
of Fornell and Larcker (1981) suggests that the square root of the AVEs of each construct
must be ensured to be greater than the correlation estimate between constructs. Table 3
supports this criterion and demonstrates the discriminant validity.
4.3 Structural model assessment and multigroup analysis
4.3.1 Direct effects. Table 4 presents the results of the path analysis used to test the
hypothesis of direct effects among latent variables. The results highlight the effect of the
Burden of COVID-19 on Stress (
b
= 0.430, p<0.001); hence, H1 was supported. H2 and
H3 were also supported as perceived justice (
b
=0.066, p<0.008) and freedom (
b
=
0.592, p<0.001) reduced stress significantly. Stress (
b
=0.797,p<0.001) and burden
of COVID-19 (
b
= 0.072, p<0.001) were found to have positive effects on depression (H4
and H5). Justice was also found to have a negative effect on depression (
b
=0.067, p<
0.001); hence, the result of the study also supported H6.H7 was rejected because the
direct effect of freedom on depression was not significant (
b
=0.027, p= 0.124).
Based on the R
2
values, justice, freedom and the burden of COVID-19 approximately
explained 96% of the variance of depression and 83% of the variance of stress. The effect
size (f
2
) estimates the extent to which an IV affects DV. As suggested by Chin (1998),the
values of 0.02, 0.15 and 0.35 represent the level of effect size as small, moderate and
substantial, respectively. As it is depicted in Table 4,thef
2
for the effects of justice on stress
(0.020), justice on depression (0.007) and freedom on depression (0.006) is considered
small. The f
2
for the impacts of the burden of COVID-19 on depression (0.054) is moderate,
and for the impact of the burden of COVID-19 on stress (0.797), freedom on stress (1.550),
stress on depression (2.801) is considered substantial. Multicollinearity among the variables
was evaluated, taking into account the variance inflation factor (VIF) value. It is suggested
that VIF that exceeds 10 indicates a potential issue with multicollinearity (Hair et al.,2010).
As shown in Table 4, VIF for all of the variables was below the threshold of 10. The
predictive relevance of the model (Q
2
) was examined with the help of the blindfolding
procedure. The Q
2
values for depression (0.813) and stress (0.767) suggest that the model
has sufficient predictive relevance.
4.3.2 Indirect effect. In this study, we examined the mediating effect of stress on the
relationship between the burden of COVID-19, perceived justice and freedom and
depression. In addition, the study examines the moderating effect of PMH on the
relationship between stress and depression. To examine the possible mediating effect of
stress, we applied its approach (indirect effect). The indirect effect was assessed with the
help of a bootstrapping procedure for examining the possible significance of the path
coefficients (Chin et al.,2008). Table 5 shows the results of the path analysis used to test
the hypothesis of indirect effects. The t-values were computed using a bootstrapping
procedure (Hayes, 2009) with 5,000 samples. H8 examined the indirect effect of stress
between the burden of COVID-19 and depression. This mediating effect was confirmed by
Table 4 Direct effects, H1 to H7
Hypothesis Direct/indirect effect Path coefficient
b
t-value p-value 2.5% 97.5% VIF f
2
Supported
H1 Burden of COVID-19 !Stress 0.430 13.464 <0.001 0.370 0.494 1.414 0.797 Yes
H2 Justice !Stress 0.066 2.644 0.008 0.117 0.018 1.324 0.020 Yes
H3 Freedom !Stress 0.592 17.925 0.001 0.654 0.526 1.378 1.550 Yes
H4 Stress !Depression 0.797 31.057 0.001 0.747 0.849 6.559 2.801 Yes
H5 Burden of COVID-19 !Depression 0.072 3.971 0.001 0.035 0.107 2.771 0.054 Yes
H6 Justice!Depression 0.067 5.375 0.001 0.090 0.043 1.660 0.007 Yes
H7 Freedom !Depression 0.027 0.124 0.124 0.063 0.007 3.614 0.006 No
PAGE 308 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jVOL. 18 NO. 4 2022

the findings (
b
=0.343,t= 11.432, p<0.001). Despite the insignificant direct effect of
freedom on depression, the indirect effect through stress was positive. Accordingly, the
study confirms the mediating effect of stress on the relationship between freedom and
depression (
b
=0.472, t= 17.514, p<0.001), and H9 was supported. H10 was also
supported as stress mediated the relationship between justice and depression (
b
=0.053,
t= 2.693, p<0.007). As shown in Table 5, the moderating effect of PMH on the effect of
stress on depression was significant (
b
= - 0.124, t= 10.971, p<0.001). Accordingly, H11
was accepted as PMH decreased the impact of stress on depression.
5. Discussion
Most of the studies on the mental health of migrants have focused on internal and
ecological factors independently rather than proposing a model showing how such factors
act in concert to affect the mental health of this overlooked and vulnerable population,
especially during the COVID-19 pandemic. For this purpose, we examined the relationship
between stress, depression, burden of COVID-19, perceived justice and freedom and PMH.
The conceptual model of the research consisted of 11 hypotheses.
Some researchers have earlier concentrated on perceived stress during the COVID-19
pandemic (Boyraz et al.,2020). Studies suggest that during outbreaks and
pandemics, stress can be caused by the unpredictability of the disease, feeling
worried for one’s or family member’s health, the absence of control over the situation,
individual freedom, contradictory messages from officials and unexpected shifts in
plans for the near future (Khoo et al.,2021). Brooks et al.(2020) found that factors such
as long-term quarantine, fears of infection, insufficient information, stigmatization and
financial loss were associated with negative psychological effects. Such stressors can
be assumed to result in a more considerable risk of psychopathology (Pfefferbaum
and North, 2020).
Recently, several studies have examined the effect of the burden of COVID-19 on migrants.
This includes increased stress and depression (Hajjar and Abu-Sittah, 2021;Zhang et al.,
2021). Our study suggests that the burden of COVID-19 is indeed a substantial stressor for
Afghan migrants. This finding is consistent with various studies on the migrants increased
level of stress during the COVID-19 pandemic (Choudhari, 2020;Solheim et al., 2022;Turna
et al., 2021). These findings can be explained from various perspectives. First of all, many
of Afghan migrants have no jobs with secure monthly income. Second, the majority of
Afghan women are housewives and do not contribute to the economy of the family. Third,
some of these migrants do not have any medical insurance; accordingly, getting infected
by a dangerous virus such as SARS-CoV-2 in this situation would be very costly, potentially
even more dangerous and stressful for them.
Our assessment of determinants of stress included perceived justice as well. We expected
a higher perceived level of justice predict less stress. Our findings supported this research
hypothesis and were aligned with previous studies that suggest perceived justice improves
mental health (McLeod, 2015;Subramanian and Kawachi, 2004). Besides, in various
settings such as working environments, studies suggest that perceived justice can predict
Table 5 Structural (inner) model assessment
Hypothesis Indirect effect Path coefficient
Confidence interval
(95%) bias corrected t-value p-value Supported
H8 BUC !Stress !Depression 0.343 0.288_0.405 11.432 0.001 Yes
H9 Freedom !Stress !Depression 0.472 0.530_0.422 17.514 0.001 Yes
H10 Justice !Stress !Depression 0.053 0.092_0.015 2.693 0.007 Yes
H11 Moderating effect Positive mental health 0.124 0.109_0.143 10.971 0.001 No
VOL. 18 NO. 4 2022 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 309

the experienced stress (Dbaibo et al, 2010). Very little is known about the role of perceived
justice on mental health of migrants during pandemic, and our study adds to the body of
literature.
In addition, we found that perceived freedom predicted stress with a negative coefficient.
This finding is in accord with the human development model (Welzel et al.,2003), proposing
that an increased level of freedom reduces poor mental health. In addition, previous studies
suggest that freedom is a significant negative predictor of poor mental health (Scholten
et al.,2017
). The confirmed positive effect of freedom in this study aligns with earlier studies
that suggest having autonomy improves mental health even without consideration of wealth
(Fischer and Boer, 2011). Compared to the frustrating personal experiences in their
homeland, it seems that Afghan migrants can enjoy more freedom, even though they are
generally financially deprived. We also revealed that a higher level of stress predicted more
depression. Our finding was in line with previous studies suggesting stress increases the
chance of depression (Mazure, 1998). Besides, the findings of the study revealed that
burden of COVID-19 significantly increase depression, while perceived justice and freedom
significantly reduce the migrants’ depression.
The impact of freedom on depression was not significant. Justice and the burden of COVID-
19 were found to be significant. The study further found that stress mediated the
relationship between the burden of COVID-19, freedom, justice and depression (H8, H9,
H10). The moderating effect of PMH on the relationship between stress and depression was
found to be significant.
In the present study, we focused on the determinants of Afghan migrants’ mental disorders.
The unstable situation in Afghanistan in the past decades has brought various difficulties for
the people of this country. Continuous acts of war accompanied by a steadily rising death
toll of civilians have lowered the chance of a promising future. One outcome is the
continuous and massive migration and displacement of Afghan citizens to foreign countries.
However, while migration may save lives, it does not guarantee a comfortable, trouble-free
life for the people of this country. If the destination country does not deport them, they may
be able to build their castle of dreams without a strong financial background or support. The
burdens on Afghan migrants, on the other hand, have been exacerbated by the COVID-19
pandemic. The repeated lockdowns and job insecurities, besides the lack of access to
sufficient food due to their economic crisis, could have worsened the situation of these
migrants compared to the pre-COVID-19 era. The empirical evidence from the current study
suggests that reducing the burden of COVID-19 can improve the mental health of these
migrants by reducing stress and depression.
6. Conclusion and implication
Based on the suggested model of this study, it can be concluded that perceived stress and
depression among Afghan migrants are as likely to be exacerbated by the burden of
COVID-19. However, perceived justice and freedom in Iran can significantly decrease
stress and depression. Stress mediates the effect of perceived justice, freedom and the
burden of COVID-19 on depression. PMH moderated the impact of stress on depression.
This result shows that to fully understand and respond to the mental health needs of Afghan
migrants, it is crucial to evaluate the present environmental stressors in the host country
carefully. Inadequate knowledge of post-migration stressor evaluation runs the danger of
attributing the mental disorders of Afghans to earlier war exposure. The suggested model
shows pathways through which psychological and ecological variables interact and affect the
mental health of migrants.
Health authorities can use the results of the study and develop psychosocial interventions
for the mental health of Afghan migrants.
PAGE 310 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jVOL. 18 NO. 4 2022

7. Limitations and future direction
First, this study is cross-sectional, and an in-depth understanding of the relationships
among the variables requires qualitative data. Second, the data was gathered from Afghan
migrants who were residing in one of the cities of Iran. This group was recruited through
convenience sampling. This limit the generalizability of data to migrants from other
countries. Further studies might compare the migrants’ perceived stress in the host country
based on their length of stay and economic or demographic background or examine the
effect of psychological interventions on the mental health of Afghan migrants. Further
studies might also examine how migrants’ mental disorders can be influenced by the effects
of friendly relationships between the host society and migrants, a sense of community,
financial support of migrants or possible support of non-governmental organizations
(NGOs) for vulnerable groups.
References
Acharya, S.R., Moon, D.H., Chun, J.H. and Shin, Y.C. (2021), “COVID-19 and mental health: anxiety
disorders among immigrants due to COVID-19 outbreak in South Korea”, The International Journal of
Psychiatry in Medicine, Vol. 57 No. 4, pp. 323-337, doi: 10.1177/00912174211042695.
Alemi, Q., James, S., Cruz, R., Zepeda, V. and Racadio, M. (2014), “Psychological distress in Afghan
refugees: a mixed-method systematic review”, Journal of Immigrant and Minority Health,Vol.16No.6,
pp. 1247-1261, doi: 10.1007/s10903-013-9861-1.
Anderson, J.C. and Gerbing, D.W. (1988), “Structural equation modeling in practice: a review and
recommended two-step approach”, Psychological Bulletin, Vol. 103 No. 3, pp. 411-423, doi: 10.1037/
0033-2909.103.3.411.
Awuah, R.B., de-Graft Aikins, A., Dodoo, F.N.A., Meeks, K.A., Beune, E.J.,Klipstein-Grobusch, K.,Addo,
J., Smeeth, L., Bahendeka, S.K. and Agyemang, C. (2020), “Psychosocial stressors among Ghanaians in
rural and urban Ghana and Ghanaian migrants in Europe”, Journal of Health Psychology,Vol.27No.3,
doi: 10.1177/1359105320963549.
Badrfam, R. and Zandifar, A. (2021), “Mental health status of Afghan immigrants in Iran during the COVID-19
pandemic: an exacerbation of a long-standing concern”, Asian Journal of Psychiatry, Vol. 55, p. 102489.
Bido, D., da Silva, D. and Ringle, C. (2014), “Structural equation modeling with the SmartPLS”, Brazilian
Journal of Marketing,Vol.13No.2.
Blukacz, A., Cabieses, B. and Markkula, N. (2020), “Inequities in mental health and mental healthcare
between international immigrants and locals in Chile: a narrative review”, International Journal for Equity
in Health, Vol. 19 No. 1,p. 197.
Boyraz, G., Legros, D.N. and Tigershtrom, A. (2020), “COVID-19 and traumatic stress: the role of
perceived vulnerability, COVID-19-related worries, and social isolation”, Journal of Anxiety Disorders,
Vol. 76, p. 76, doi: 10.1016/j.janxdis.2020.102307.
Brailovskaia, J. and Margraf, J. (2021), “The relationship between burden caused by a coronavirus
(covid-19), addictive social media use, sense of control, and anxiety”, Computers in Human Behavior,
Vol. 119, doi: 10.1016/j.chb.2021.106720.
Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N. and Rubin, G.J.
(2020), “The psychological impact of quarantine and how to reduce it: rapid review of the evidence”, The
Lancet, Vol. 395 No. 10227, pp. 912-920, doi: 10.1016/S0140-6736(20)30460-8.
Chiavegatto Filho, A.D.P., Kawachi, I., Wang, Y.P., Viana, M.C. and Andrade, L.H.S.G. (2013), “Does
income inequalityget under the skin? A multilevel analysis of depression, anxiety, and mental disorders in
Sao Paulo, Brazil”. Journal of Epidemiology and Community Health, Vol. 67 No. 11, pp. 966-972,
doi: 10.1136/jech-2013-202626.
Chin, W.W. (1998), “The partial least squares approach for structural equation modeling”, Modern
Methods for Business Research, Lawrence Erlbaum Associates Publishers, Mahwah, NJ, pp. 295-336.
Chin, W.W., Peterson, R.A. and Brown, S.P. (2008), “Structural equation modeling in marketing: some
practical reminders”, Journal of Marketing Theory and Practice, Vol. 16 No. 4, pp. 287-298, doi: 10.2753/
mtp1069-6679160402.
VOL. 18 NO. 4 2022 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 311

Choudhari, R. (2020), “COVID 19 pandemic: mental health challenges of internal migrant workers of
India”, Asian Journal of Psychiatry, Vol. 54, p. 102254.
Connor, P. (2010), “Explaining the refugee gap: economic outcomes of refugees versus other
immigrants”, Journal of Refugee Studies, Vol. 23 No. 3, pp. 377-397,doi: 10.1093/jrs/feq025.
Dbaibo, D., Harb, C. and Van Meurs, N. (2010), “Values and justice as predictors of perceived stress in
Lebanese organisational settings”, Applied Psychology, Vol. 59 No. 4, pp. 701-720.
Espinel, Z., Chaskel, R., Berg, R.C., Florez, H.J., Gaviria, S.L., Bernal, O., Berg, K., Mun
˜oz, C., Larkin, M.G.
and Shultz, J.M. (2020), “Venezuelan migrants in Colombia: COVID-19 and mental health”, The Lancet
Psychiatry, Vol. 7 No. 8, pp. 653-655, doi: 10.1016/S2215-0366(20)30242-X.
Fischer, R. (2016), “Justice and culture”, in Sabbagh, C. and Schmitt, M. (Eds), Handbook of Social
Justice Theory and Research, Springer-Verlag, New York, NY.
Fischer, R. and Boer, D. (2011), “What is more important for national well-being: money or autonomy? A
meta-analysis of well-being, burnout, and anxiety across 63 societies”, Journal of Personality and Social
Psychology, Vol. 101 No. 1, pp. 164-184, doi: 10.1037/a0023663.
Fornell, C. and Larcker, D.F. (1981), “Structural equation models with unobservable variables and
measurement error: algebra and statistics”.
Fuller-Thomson, E., Noack, A.M. and George, U. (2011), “Health decline among recent immigrants to
Canada: findings from a nationally-representative longitudinal survey”, Canadian Journal of Public
Health, Vol. 102 No. 4, pp. 273-280, doi: 10.1007/BF03404048.
Ghatak, S. (2021), “An analysis of climate change related vulnerability among the forced migrants in
India”, in Kateja, A. and Jain, R. (Eds), Urban Growth and Environmental Issues in India, Springer,
Singapore, pp. 189-206, doi: 10.1007/978-981-16-4273-9_12.
Giacco, D., Laxhman, N. and Priebe, S. (2018), “Prevalence of and risk factors for mental disorders in
refugees”, Seminars in Cell & Developmental Biology, Vol. 77, pp. 144-152, doi: 10.1016/j.
semcdb.2017.11.030.
Hair, J.F., Black, B., Babin, B.J. andAnderson, R.E. (2010),Multivariate Data Analysis: Global Edition,7th
ed., Pearson Education International, Upper Saddle River, NJ.
Hajjar, M.S. and Abu-Sittah, G.S. (2021), “The multidimensional burden of COVID-19 on Syrian refugees
in Lebanon”, Journal of Global Health, Vol. 11, p. 5003, doi: 10.7189/jogh.11.05003.
Hanandita, W. and Tampubolon, G. (2014), “Does poverty reduce mental health? An instrumental variable
analysis”,Social Science & Medicine, Vol. 113, pp. 59-67, doi: 10.1016/j.socscimed.2014.05.005.
Hayes, A.F. (2009), “Beyond baron and Kenny: statistical mediation analysis in the new millennium”,
Communication Monographs, Vol. 76 No. 4, pp. 408-420, doi: 10.1080/03637750903310360.
Henseler, J., Ringle, C.M. and Sarstedt, M. (2015), “A new criterion for assessing discriminant validity in
variance-based structural equation modeling”, Journal of the Academy of Marketing Science,Vol.43
No. 1, pp. 115-135, doi: 10.1108/imds-09-2015-0382.
Hou, W.K., Liu, H., Liang, L., Ho, J., Kim, H., Seong, E., Bonanno, G.A., Hobfoll, S.E. and Hall, B.J.(2020),
“Everyday life experiences and mental health among conflict-affected forced migrants: a meta-analysis”,
Journal of Affective Disorders, Vol. 264, pp. 50-68, doi: 10.1016/j.jad.2019.11.165.
Inglehart, R., Foa, R., Peterson, C. and Welzel, C. (2008), “Development, freedom, and rising happiness:
a global perspective (1981-2007)”, Perspectives on Psychological Science, Vol. 3 No. 4, pp. 264-285,
doi: 10.1111/j.1745-6924.2008.00078.x.
Kavian, F., Mehta, K., Willis, E., Mwanri, L., Ward, P. and Booth, S. (2020), “Migration, stress and the
challenges of accessing food: an exploratory study of the experience of recent Afghan women refugees
in Adelaide, Australia”, International Journal of Environmental Research and Public Health,Vol.17No.4,
doi: 10.3390/ijerph17041379.
Keyes, C.L.M. (2007), “Promoting and protecting mental health as flourishing: a complementary strategy
for improving national mental health”, American Psychologist, Vol. 62 No. 2, pp. 95-108, doi: 10.1037/
0003-066x.62.2.95.
Khoo, S.S., Toh, W.X. and Yang, H. (2021), “Seeking control during uncontrollable times: control abilities
and religiosity predict stress during COVID-19”, Personality and Individual Differences,Vol.175,
p. 110675, doi: 10.1016/j.paid.2021.110675.
PAGE 312 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jVOL. 18 NO. 4 2022

Lebni, J.Y., Enayat, H., Irandoost, S.F. and Dehghan, A.A. (2022), “Exploring the challenges of afghan
refugee women facing COVID-19: a qualitative study in Iran”, Frontiers in Public Health,Vol.10.
Li, C. and Jiang, S. (2020), “Social exclusion, sense of school belonging and mental health of migrant
children in China: a structural equation modeling analysis”, Children and Youth Services Review,Vol.89,
pp. 6-12, doi: 10.1016/j.childyouth.2018.04.017.
Li, J. and Rose, N. (2020), “Urban social exclusion and mental health of China’s rural-urban migrants “a
review and call for research”, Health & Place, Vol. 48, pp. 20-30, doi: 10.1016/j.healthplace.2017.08.009.
Li, S.S., Liddell, B.J. and Nickerson, A. (2016), “The relationship between post-migration stress and
psychological disorders in refugees and asylum seekers”, Current Psychiatry Reports, Vol. 18 No. 9, pp. 1-9.
Lukat, J., Margraf, J. R., Lutz, R., van der Veld, W.M. and Becker, E.S. (2016), “Psychometric properties
of the positive mental health scale (PMH-scale)”, BMC Psychology, Vol. 4 No. 1, pp. 1-14, doi: 10.1080/
08870440701456020.
McLeod, J.D. (2015), “Why and how inequality matters”, Journal of Health and Social Behavior,Vol.56
No. 2, pp. 149-165, doi: 10.1177/0022146515581619.
Mandi
c, D. (2021), “What is the force of forced migration? Diagnosis and critique of a conceptual
relativization”, Theory and Society, Vol. 51 No. 1, pp. 61-90,doi: 10.1007/s11186-021-09446-0.
Mangrio, E., Sjo
¨stro
¨m, K., Grahn, M. and Zdravkovic, S. (2021), “Risk for mental illness and family
composition after migration to Sweden”, Plos One, Vol. 16 No. 5, p. e0251254.
Mazure, C.M. (1998), “Life stressors as risk factors in depression”, Clinical Psychology: Science and
Practice, Vol. 5 No. 3, pp. 291-313, doi: 10.1111/j.1468-2850.1998.tb00151.x.
Miller, K.E. and Rasmussen, A. (2017), “The mental health of civilians displaced by armed conflict: an
ecological model of refugee distress”, Epidemiology and Psychiatric Sciences,Vol.26No.2,
pp. 129-138.
Morgan, G., Melluish, S. and Welham, A. (2017), “Exploring the relationship between postmigratory
stressors and mental health for asylum seekers and refused asylum seekers in the UK”, Transcultural
Psychiatry, Vol. 54 Nos 5/6, pp. 653-674.
Otto, K., Boos, A., Dalbert, C., Scho
¨ps, D. and Hoyer, J. (2006), “Posttraumatic symptoms, depression,
and anxiety of flood victims: the impact of the belief in a just world”, Personality and Individual
Differences, Vol. 40 No. 5, pp. 1075-1084.
Parrish, B.P., Cohen, L.H. and Laurenceau, J.-P. (2011), “The prospective relationship between negative
affective reactivity to daily stress and depressive symptoms”, Journal of Social and Clinical Psychology,
Vol. 30 No. 3, pp. 270-296, doi: 10.1521/jscp.2011.30.3.270.
Pfefferbaum, B. and North, C.S. (2020), “Mental health and the COVID-19 pandemic”, New England
Journal of Medicine, Vol. 383 No. 6, pp. 510-512, doi: 10.1056/NEJMp2008017.
Ringle, C., Da Silva, D. and Bido, D. (2015), “Structural equation modeling with the SmartPLS”.
Rokeach, M. (1973), The Nature of Human Values, Free Press, New York, NY.
Scholten, S., Velten, J. and Margraf, J. (2018), “Mental distress and perceived wealth, justice and
freedom across eight countries: the invisible power of the macrosystem”, Plos One, Vol. 13 No. 5,
doi: 10.1371/journal.pone.0194642.
Scholten, S., Velten, J., Neher, T. and Margraf, J. (2017), “Wealth, justice and freedom: objective and
subjective measures predicting poor mental health in a study across eight countries”, SSM - Population
Health, Vol. 3, pp. 639-648, doi: 10.1016/j.ssmph.2017.07.010.
Sert, A., Elc¸ i, M., Uslu, T. and Sener,
_
I. (2014), “The effects of organizational justice and ethical climate on
perceived work related stress”, Procedia –Socialand Behavioral Sciences, Vol. 150, pp. 1187-1198.
Silove, D., Ventevogel, P. and Rees, S. (2017), “The contemporary refugee crisis: an overview of mental
health challenges”, World Psychiatry,Vol. 16No. 2, pp. 130-139, doi: 10.1002/wps.20438.
Solheim, C.A., Ballard, J., Fatiha, N., Dini, Z., Buchanan, G. and Song, S. (2022), “Immigrant family
financial and relationship stress from the COVID-19 pandemic”, Journal of Family and Economic Issues,
pp. 1-14.
Sternthal, M., Slopen, N. and Williams, D.R. (2011), “Racial disparities in health: how much does stress
really matter?”, Du Bois Review: Social Science Research on Race, Vol. 8 No. 1, pp. 95-113, doi: 10.1017/
S1742058X11000087.
VOL. 18 NO. 4 2022 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 313

Subramanian, S.V. and Kawachi, I. (2004), “Income inequality and health: what have we learned so far?”,
Epidemiologic Reviews, Vol. 26 No. 1,pp. 78-91, doi: 10.1093/epirev/mxh003.
Sun, J., Buys, N., Stewart, D. and Shum, D. (2020), “Mediating effects of coping, personal belief, and
social support on the relationship among stress, depression, and smoking behavior in university
students”, Health Education, Vol. 111 No. 2, pp. 133-146, doi: 10.1108/09654281111108544.
Tingho
¨g, P., Malm, A., Arwidson, C., Sigvardsdotter, E., Lundin, A. and Saboonchi, F. (2017),
“Prevalence of mental ill-health, traumas and postmigration stressamong refugees from Syriaresettled in
Sweden after 2011: a population-based survey”, BMJ Open, Vol. 7 No. 12, pp. 1-12, doi: 10.1136/
bmjopen-2017-018899.
Turna, J., Zhang, J., Lamberti, N.,Patterson, B., Simpson,W., Francisco, A. P., … andVan Ameringen, M.
(2021), “Anxiety, depression and stress during the COVID-19 pandemic: results from a cross-sectional
survey”, Journal of Psychiatric Research, Vol. 137, pp. 96-103.
United Nations High Commissioner for Refugees (2020), “World migration report 2020”.
Voorhees, C.M., Brady, M.K., Calantone, R. and Ramirez, E. (2016), “Discriminant validity testing in
marketing: an analysis, causes for concern, and proposed remedies”, Journal of the Academy of
Marketing Science, Vol. 44 No. 1, pp. 119-134, doi: 10.1007/s11747-015-0455-4.
Welzel, C., Inglehart, R. and Kligemann, H.-D. (2003), “The theory of human development: a cross-
cultural analysis”, European Journal of Political Research, Vol. 42 No. 3, pp. 341-379, doi: 10.1111/1475-
6765.00086.
Yang, F., Zou, X., Xiong, M., Hall, B.J., Sakyi, K., Ong, J.J., Bodomo, A., Cao, H., Yang, B. and Wang, C.
(2021), “Mental health on the move: an observational study to characterize post-migration depression
symptoms among migrants from Sub-Saharan Africa in China”, Journal of Psychosomatic Research,
Vol. 149, p. 110602.
Yi, Y. and Liang, Y. (2020), “The effect of socio-economic status and social inclusion on the mental health
of Chinese migrants: a comparison between interprovincial and intra-provincial migrants”, Journal of
Health Psychology, Vol. 25 No. 3, pp. 387-399, doi: 10.1177/1359105317718058.
Zhang, M., Gurung, A., Anglewicz, P., Baniya, K. and Yun, K. (2021), “Discrimination and stress among
Asian refugee populations during the COVID-19 pandemic: evidence from Bhutanese and Burmese
refugees in the USA”, Journal of Racial and Ethnic Health Disparities, Vol. 9 No. 2, pp. 589-597.
Further reading
Hair, y J., Hult, G.T.M., Ringle, C.M. and Sarstedt, M. (2017), A Primer on Partial Least Squares Structural
Equation Modeling (PLS-SEM), 1st Ed., SAGE publication, CA.
Corresponding author
Fatemeh Khozaei can be contacted at: fatemehkhozaei@du.edu.om
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