Current Research - Dr. Ken Miller

Current and Recently Completed Projects

Ken Miller, Ph.D.
Associate Professor of Psychology
Pomona College

Idioms of Distress and Help-Seeking Behavior in Afghanistan
Co-Investigators: Ken Miller, Ph.D., Patricia Omidian, Ph.D.

Effective mental health interventions depend on a sound understanding of the ways in which well-being and distress are understood and expressed in specific cultural contexts. This study will use qualitative methods (ethnography, semi-structured interviews, participant-observation) to examine indigenous idioms of distress and related help-seeking behaviors among Afghans in the city of Kabul. The study will also assess the relationships between the recently developed Afghan Symptom Checklist (see below) and a measure of psychosocial functioning, and between the ASCL and several western measures of psychopathology.

Help-Seeking Pathways Among Bosnian Refugees
Principal Investigator: Ken Miller, Ph.D.
Research Team: Aisa Sadikovic, MD and Suad Sadikovic, MD

This study will use qualitative methods (ethnography, semi-structured interviews, participant-observation) to examine factors affecting the use of both formal and informal sources of psychological assistance in two refugee communities in northern California: The Bosnian community in the greater San Jose area, and the Afghan community in Fremont, Hayward, Newark, and Concord. Anticipated start date is Fall, 2005. A second aim is to identify barriers to the use of mental health services in each community.

The Afghan Symptom Checklist: A Field Study of Mental Health in Kabul, Afghanistan
Principal Investigator: Ken Miller, Ph.D. Co-Investigator: Patricia Omidian, Ph.D.
Research Team: Abdul Samad Quraishy, Naseema Quraishy, Mohammed Nader Nasiry, Seema Nasiry, Nazar Mohammed Karyar, and Abdul Aziz Yaqubi

A primary aim of this project was to field test a methodology for developing culturally grounded mental health assessment measures in conflict and post-conflict situations. The project combined ethnographic and multivariate methods to examine Afghan conceptions of psychological wellbeing and distress, and to develop a culturally grounded measure of mental health among Afghans. Narratives were gathered regarding 40 individuals: 10 women and 10 men who had suffered during and after the war and were continuing to experience mental health problems, and 10 women and 10 men who had also suffered but who were now doing well. From these narratives, indicators of positive and negative mental health were identified, and a 22 item questionnaire was develop assessing the frequency with which people had experienced the most commonly listed indicators of poor mental health during the previous two weeks. The survey was back-translated, pilot tested, and administered to 324 adults (162 women and 162 men) in eight districts of Kabul. The results, which are currently being prepared for publication, indicate high levels of depression, anxiety, and traumatic grief among Afghan women, especially widows, and moderate levels of distress among Afghan men. The study also identified several mental health constructs that have no precise equivalent in English (i.e., in Western psychiatry), but which are quite common among Afghans. These include jigar khun, asAbi, fishar bala, and fishar payin. The scale demonstrated an excellent level of internal consistency (alpha=.93). Its construct validity was established by its strong positive correlation with a measure of war-related violence and loss, the Afghan War Experiences Scale (r=.70). An exploratory factor analysis yielded 3 factors, "Sadness with Social Withdrawal and Somatic Distress", "Ruminative Sadness Without Social Withdrawal or Somatic Distress", and "Stress-Induced Reactivity".

A manuscript describing the development of the ASCL and results of the survey in Kabul has been provisionally accepted for publication in the American Journal of Orthopsychiatry. A pre-publication copy of the paper is available on request.

Funding for this project came from a grant from the College of Behavioral and Social Sciences at San Francisco University, and an Award from the Society for the Psychological Study of Social Issues (SPSSI). Additional support was provided by the American Friends Service Committee in Kabul.

The Mental Health of Refugees: Ecological Approaches to Adaptation and Healing
Kenneth E. Miller and Lisa M. Rasco, Editors. Published in 2004 by Lawrence Erlbaum Associates, Inc.

This edited volume brings together experts in ecologically-based approaches to addressing the mental health needs of refugee and internally displaced communities. The opening chapter provides and theoretical and empirical basis for advocating a shift from clinic-based to community-based, ecological refugee mental health interventions. The introduction is followed by descriptions and evaluations of nine community-based mental health projects with refugee and displaced communities in a diverse range of settings, including Sri Lanka, Angola, Palestine, Cambodia, Columbia, East Timor, Guinea, and the United States (Hmong refugees in Michigan and Bosnian & Kosovar refugees in Illinois).. The book includes a chapter on the evaluation of ecological mental health and psychosocial interventions with refugees and displaced people in or near settings of ongoing conflict, and concludes with a consideration of critical issues in the development and implementation of ecological interventions with refugee and displaced populations.

All royalties from the sales of this book are being donated to The Noor Education Center in Afghanistan, a community-based, empowerment-focused organization run by and for Afghan women.

The Mental Health of Refugees may be purchased directly from the publisher at www.erlbaum.com or at most major book retailers.

Contributors and chapters include:

Kenneth E. Miller & Lisa M. Rasco	An Ecological Framework for Addressing the Mental Health Needs of Refugee Communities
Michael Wessells & Carlinda Monteiro	Internally Displaced Angolans: A Child-focused, Community-based Intervention
Jon Hubbard & Nanacy Pearson	Sierra Leonian Refugees in Guinea: Addressing the Mental Health Effects of Massive Community Violence
Willem van de Put & Maurice Eisenbruch	Internally Displaced Cambodians: Healing Trauma in Cambodian Communities
Rachel Tribe and the Family Rehabilitation Centre Staff	Internally Displaced Sri Lankan Women: The Women's Empowerment Programme
Kathleen Kostelny & Michael Wessells	Internally Displaced East Timorese: Challenges and Lessons of Large Scale Emergency Assistance
Jorge Enrique Buitrago Cuéllar	Internally Displaced Columbians: The Recovery of Victims of Political Violence Within a Psychosocial Framework
Stevan Weine, Suzanne Feetham, Yasmina Kulauzovic, Senela Besic, Alma Lezic, Aida Mujagic, Jasmina Muzurovic, Dzemila Spahovic, Merita Zhubi, John Rolland, & Ivan Pavkovic	Bosnian and Kosovar Refugees in the United States: Family Interventions in a Services Framework
Jessica Goodkind, Panufa Hang, & Mee Yang	Hmong Refugees in the United States: A Community-based Advocacy & Learning Intervention
Jon Hubbard & Kenneth E. Miller	Evaluating Ecological Mental Health Interventions with Refugee Communities
Lisa M. Rasco & Kenneth E. Miller	Innovations, Challenges, and Critical Issues in the Development of Ecological Mental Health Interventions with Refugees

Traumatic Grief Among Bosnian Refugees
Principal Investigator: Ken Miller
Research Team: Dr. Jasmina Redzic and Madhur Kulkarni, MS

This study is examining the prevalence and correlates of traumatic grief in a sample of 50 Bosnian refugees in Santa Clara County, in northern California. Traumatic grief is a recently identified clinical syndrome that shares symptoms with, yet is distinct from, post-traumatic stress disorder and depression. It is form of complicated grief believed to develop in some individuals in the wake of a particularly traumatic loss, either because of the nature of the loss itself, or because of the individual's attachment history and their reactions to experiences of separation and loss. Surprisingly, TG has rarely been studied among refugees, despite the frequent occurrence of the violent loss of loved ones among refugee populations. The present study was designed to address this empirical gap.

The Relative Contribution of War Experiences and Exile-related Stressors to Levels of Distress Among Bosnian Refugees
Principal Investigator: Ken Miller
Research Team: Dr. Stevan Weine, Alma Ramic, Dr. Nenad Brkic, Dr. Zvezdana Djuric Bjedic, Dr. Amir Smajkic, Dr. Esad Boskailo, and Dr. Greg Worthington

This study examined the relative contribution of war-related experiences of violence and loss, and exile-related stressors including social isolation and a lack of meaningful daily activities, to levels of trauma and depression in two groups of Bosnian refugees, one a clinical sample and the other a non-clinic, community sample.

An article describing the study and its results was recently published in the Journal of Traumatic Stress (Miller, K., Weine, S., Ramic, A., Brkic, N., Djuric Bjedic, Z., Smajkic, A., Boskailo, E., & Worthington, G. (2002). Citation: The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. Journal of Traumatic Stress, 15, 377-387. Results were also presented at the 1999 annual meeting of the International Society for Traumatic Stress Studies, in Miami, FL.

ABSTRACT

The present study examined the relative contribution of two exile-related variables--social isolation and daily activity level--as well as war experiences of violence and loss, to levels of PTSD and depressive symptomatology in 2 groups of Bosnian refugees, one a clinical and the other a non-clinical community group. As hypothesized, degree of exposure to war-related violence was highly predictive of level of PTSD symptoms in both groups; in addition, social isolation was significantly related to PTSD symptomatology in the community group. Also as predicted, depressive symptomatology was accounted for primarily by the exile-related stressors. The two groups differed, however, with respect to the particular exile-related variable that was significantly associated with level of depressive symptoms. Whereas for the clinic group, level of daily activities was highly predictive of scores on the measure of depression, and social isolation was not, the reverse was true for community group. For the clinical group, which experienced a significantly greater number of interpersonal losses than the community group during the war, additional variance in depressive symptomatology was accounted for by experiences of war-related loss. Exposure to war-related violence was not associated with level of depressive symptoms in either group. Differences between groups with regard to the salience of specific stressors are considered, as are the implications of the study's findings for psychosocial interventions with refugees.

Distress and Coping Among Bosnian Refugees
Principal Investigator: Ken Miller
Research Team: Dr. Greg Worthington, Jasmina Muzurovic, JD, Susie Tipping, and Allison Goldman, BA

This study utilized semi-structured interviews to examine salient exile-related stressors as well as patterns of coping strategies and resources among a sample of 28 Bosnian refugees attending a mental health clinic in Chicago. Preliminary results from the study were presented at the 108th annual meeting of the American Psychological Association in Washington, DC, in August, 2000.

An article describing the study and the findings regarding exile-related stressors was published in the American Journal of Orthopsychiatry. Citation: Bosnian refugees and the stressors of exile: A narrative study. American Journal of Orthopsychiatry, 72, 341-354. A poster examining the fundamental importance of adopting an historical perspective in studying refugee mental health, and drawing on the findings of this study, was recently presented by Madhur Kulkarni at the Biennial Meeting of the Society for Community Research and Action in Las Vegas, NM, in June 2003. Ms. Kulkarni also presented a poster at the 2004 Western Psychological Association's annual meeting in Phoenix, in which she drew on the data from this study to examine the role of the family as a moderator of war-related trauma and exile-related stressors among Bosnian refugees. A third poster based summarizing the primary findings of this study was presented at the 108th annual meeting of the American Psychological Association. Click here to view the poster (you'll need Microsoft Word to open the poster).

ABSTRACT:

This study utilized semi-structured interviews to examine exile-related stressors affecting Bosnian refugees in Chicago. Participants were 28 adult Bosnians, current or former clients in a mental health program serving the area's Bosnian refugee community. The interviews covered three areas: life in pre-war Bosnia, the journey of exile, and most centrally, life in Chicago. The use of a narrative approach allowed participants to identify and explore those exile-related stressors most salient within their community. Primary sources of exile-related distress included social isolation and the loss of community, separation from family members, the loss of important life projects, a lack of environmental mastery, poverty and related stressors such as inadequate housing, and the loss of valued social roles. The implications of the study's findings for community-based, ecological grounded interventions with refugees are considered.

Interpreting in Refugee Mental Health Settings
Principal Investigator: Ken Miller, Ph.D.
Research Team: Zoe Martell, MS, Linda Pazdirek, MS, Melissa Caruth, MS and Diana Lopez, BA

In this study, we examined the challenges and dynamics associated with interpreting in psychotherapy with refugees. The methodology includes semi-structured interviews with interpreters and psychotherapists, and a questionnaire, designed for this study, assessing interpreters' experiences and perceptions regarding several variables related to the experience of interpreting in psychotherapy with refugees. Linda Pazdirek recently completed her Master's thesis using data from this study, and a symposium based on the results of this study was held in the summer of 2001, at the annual meeting of the American Psychological Association, in San Francisco. A paper based on this study, entitled "Interpreting in psychotherapy with refugees: An exploratory study", is currently in press with the American Journal of Orthopsychiatry

Growing up in Exile: A Narrative Study of Young Adult Children of Refugees
Principal Investigator: Ken Miller, Ph.D.
Research Team: Hallie Kushner, BA, Zoe Martell, MS, Jill McCall, MS, Derrick Laurel, BA

This study is using semi-structured interviews to examine the unique developmental and psychosocial challenges faced by young adult children of refugees living in northern California. Participants in this study represent a range of ethnic and national backgrounds, including Cambodian, Vietnamese, Salvadoran, Chilean, Iranian, and Afghan. We are currently in the phase of data analysis. A paper based on the study was presented by Dr. Miller at the Refugee Studies Programme at the University of Oxford in May, 2003, and is currently under review for publication in a forthcoming volume on adolescents in situations of armed conflict.