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Individual difference predictors of well-being among displaced persons who live under stressful conditions Thesis submitted for the degree of Doctor of Philosophy At the University of Leicester By Izaddin Ahmad Aziz School of Neuroscience, Psychology, and Behavior University of Leicester 2017 The Abstract Individual difference predictors of well-being among displaced persons who live under stressful conditions Izaddin A. Aziz Background The common concern surrounding the poor level of displaced life is that it might cause harmful psychological conditions. Another concern of displacement is the impact of conflict and the ability to survive in adverse situations. The reasons for conducting this thesis were developed through the literature review, and noticing a lack of studies that assess psychological issues such as well-being, resilience, prejudice and forgiveness among Syrian refugees and Iraqi displaced persons comprehensively. Research aims In particular, the studies address three issues that are fundamental to understanding how the thesis is structured. The first issue is essential in examining how war has affected individuals’ well-being in short and long term of life engagement of the refugees. The second issue investigates the impact of the displacement situation on prejudices and the possibility of forgiveness after conflict and violence between groups of people. The final issue involves identifying the factors that might help individuals to survive and face any potentially harmful situation. Methods The overall research sample includes 1,256 individuals of both genders. For collecting the data, self-report questionnaires and objective measures were used. Results The results show that the research samples indicated poor levels of quality of life, well-being, forgiveness and resilience. Importantly, these findings reveal the significant role played by positive relation domains of psychological well-being in improving resilience and forgiveness. The research has also has shown that the psychological health domain of quality of life recorded the highest significant associations with resilience and psychological well-being. To Sum up, this thesis illustrates the importance of positive social relations, lower prejudice and greater resilience in predicting mental health states. 1 Declaration For the scientific credibility, I am declaring that this thesis has been composed and organized by myself, under standard terms of supervision has been carried out. I submitted as an original piece of work. Moreover, I am declaring that this thesis has not been submitted to any other institution or for any other degree. 2017 Izaddin A. Aziz Study 1 is reported in: Aziz IA, Hutchinson CV, Maltby J. (2014) Quality of life of Syrian refugees living in camps in the Kurdistan Region of Iraq. PeerJ 2:e670 https://doi.org/10.7717/peerj.670 2 Acknowledgement First, thanks to God that make me able to finish my thesis. I owe lots of appreciation to my both extraordinary supervisors Prof. John Maltby and Dr Claire Hutchinson for the incredible support all the time with presenting invaluable help and constructive advice throughout this process. With their encouragement they made a daunting task appear attainable. I am proud and very grateful to have had them as supervisors. Moreover, I want to express my thankfulness and gratefulness to my Wife Sumaya for her support during my study. I would like to thank the Ministry of Higher Education and Scientific Research of Kurdistan region of Iraq for supporting me and making this Ph.D. initially possible. Additionally, I would like to present my thankfulness and appreciation to the Neuroscience, Psychology, and behavioural school. I am also grateful to all the Ph.D. students, lecturers, and support staff within the School of Psychology who made my academic life so enjoyable. Special thanks to Mr. Zaito Siyani from UNAMI, Mr. Hemin Hassan from Democratic, and Human Right Institutes (DHRI), Mr. Hoger Shekha, Miss. Ramzya Ameen, and Mr. Nzar Abdul-Aziz from Public Aid Organization (PAO), Miss. Skala Lotfi from REACH organization, Mr. Adnan Fadhil Khaleel from Lebanese French University Dr, Salah S. Sarteep from Salahaddin University, Mr. Zuber Sharif, Mr. Shwan Sherzad, Mr. Eadin Yosif and Mr. Ian Kilpatrick for supporting me and being helpful to make my work easier. Last but not the least, I would like to express sincere thanks to all the research samples who participated in my studies and shared their profound experiences so willingly for their cooperation, without that this research would never have been a reality. 3 Contents The Abstract ............................................................................................................................ 1 Declaration .............................................................................................................................. 2 Acknowledgement .................................................................................................................. 3 List of Tables .......................................................................................................................... 9 List of figures ........................................................................................................................ 11 Chapter One .......................................................................................................................... 13 The thesis structure ............................................................................................................... 13 1.1. Thesis Overview .......................................................................................................... 13 1.2. Part A: Global armed conflict and displacement life conditions ................................. 13 1.3. Part B: The effect of conflict on prejudice and forgiveness ........................................ 15 1.4. Part C: Surviving from adverse situation and well-being ........................................... 19 1.5. Summary ..................................................................................................................... 21 Part A .................................................................................................................................... 23 Presenting an overview of the effect of armed conflict on well-being ................................. 23 Chapter Two ......................................................................................................................... 24 Overview of global armed conflict and the psychological well-being of refugees .............. 24 2.1. Introduction ................................................................................................................. 24 2.2. Definition of refugees .................................................................................................. 25 2.3. Forced migration and the global refugee crisis ........................................................... 25 2.4. Syrian refugees ............................................................................................................ 27 2.5. The needs and physical and psychological support of refugees .................................. 29 2.6. Displacement and quality of life ................................................................................. 30 2.7. The research aims of Part A (Chapters Three and Four) ............................................. 32 Chapter Three ....................................................................................................................... 34 Quality of life of Syrian refugees living in camps in the Kurdistan Region of Iraq ............. 34 3.1. Abstract. ................................................................................................................. 34 3.2. Introduction ............................................................................................................ 35 3.3. The Research Method ............................................................................................ 37 3.3.1. The research sample ........................................................................................ 37 3.3.2. The measures .................................................................................................. 37 3.3.3. Data Analysis .................................................................................................. 38 4 3.4. Ethics ...................................................................................................................... 38 3.5. The results .............................................................................................................. 39 3.6. Discussion .............................................................................................................. 42 Chapter Four ......................................................................................................................... 44 The association between psychological quality of life scores and psychological well-being among Syrian refugees .......................................................................................................... 44 4.1. Abstract .................................................................................................................. 44 4.2. Introduction ............................................................................................................ 45 4.3. Method ................................................................................................................... 52 4.3.1. The research sample ........................................................................................... 52 4.3.2. Measures ............................................................................................................. 53 4.3.2.1. Psychological quality of life ........................................................................... 53 4.3.2.2. Psychological well-being ................................................................................ 53 4.3 Ethics ...................................................................................................................... 54 4.4 Results .................................................................................................................... 54 4.4.1 Descriptive statistics ........................................................................................... 54 4.4.2 Bivariate correlation ........................................................................................... 55 4.4.3 Multiple regression ............................................................................................. 56 4.5 Discussion .............................................................................................................. 58 4.6 Conclusion.............................................................................................................. 60 Part B .................................................................................................................................... 62 An overview of the psychological perspectives of the conflict effect on prejudice and forgiveness. ........................................................................................................................... 62 Chapter Five .......................................................................................................................... 63 The psychological perspectives of the conflict effects on prejudice and forgiveness .......... 63 5.1. Introduction ................................................................................................................. 63 5.2. Overview of Internally Displaced Persons .................................................................. 64 5.4.1. Realistic Conflict Theory ................................................................................ 67 5.4.2. Relative Deprivation Theory .......................................................................... 68 5.4.3. Social Identity Theory .................................................................................... 69 5.4.4. Integrated Threat Theory ................................................................................ 69 Chapter Six ........................................................................................................................... 78 5 Exploring the association between Explicit and Implicit Prejudice with Psychological Well- Being among two different nationalities ............................................................................... 78 6.1. Abstract .................................................................................................................. 78 6.2. Introduction ............................................................................................................ 79 6.3. Method ................................................................................................................... 81 6.3.1. The research sample ........................................................................................... 81 6.3.2. Measures ............................................................................................................. 81 6.3.2.1. Prejudice measure ........................................................................................... 81 a. Explicit measure ........................................................................................................ 82 b. Implicit measure ........................................................................................................ 82 c. The Implicit-association Test design ......................................................................... 84 a. The procedure ............................................................................................................ 86 6.3.2.2. Psychological Well-being ............................................................................... 88 6.4. Ethics ...................................................................................................................... 88 6.5. Results .................................................................................................................... 89 6.5.1. Descriptive statistic ............................................................................................ 89 6.5.2. One sample T.test ............................................................................................... 90 6.5.3. Independent sample T.test .................................................................................. 91 6.5.4. Bivariate correlations .......................................................................................... 94 6.5.5. Multiple regressions ........................................................................................... 98 6.6. Discussion ............................................................................................................ 101 6.7. Conclusion............................................................................................................ 105 Chapter Seven ..................................................................................................................... 107 Exploring the association between intrapersonal forgiveness and psychological well-being among internally displaced people in the Kurdistan region of Iraq .................................... 107 7.1. Abstract ................................................................................................................ 107 7.2. Introduction .......................................................................................................... 108 7.3. Method ................................................................................................................. 110 7.3.1. The research sample ......................................................................................... 110 7.3.2. Measures ........................................................................................................... 111 7.3.2.1. Forgiveness ................................................................................................... 111 7.3.2.2. Psychological well-being .............................................................................. 112 7.4. Ethics .................................................................................................................... 112 6 7.5. Results .................................................................................................................. 113 7.5.1. Hurt experience ................................................................................................ 113 7.5.2. Descriptive statistic .......................................................................................... 114 7.5.3. One sample T.test ............................................................................................. 114 7.5.4. Bivariate correlation ......................................................................................... 115 7.5.4.1. Correlation of hurt experience with forgiveness and psychological well-being domains 115 7.5.4.2. Correlation between forgiveness and psychological well-being domains .... 116 7.5.5. Multiple regression analysis ............................................................................. 119 7.6. Discussion ............................................................................................................ 121 7.7. Conclusion............................................................................................................ 123 Part C .................................................................................................................................. 124 Investigating resilience and people’s ability to survive from harmful situations and how it is associated with well-being .................................................................................................. 124 Chapter Eight ...................................................................................................................... 125 A general review of resilience, surviving adverse situations and well-being. .................... 125 8.1. Introduction ............................................................................................................... 125 8.2. Definitions of Resilience ........................................................................................... 126 8.3. The Theoretical Background of Resilience ............................................................... 127 8.4. Resilience as a trait the EEA Resilience Holling Model ........................................... 129 8.5. Resilience and life stress ........................................................................................... 130 8.6. Displacements conditions and resilience ................................................................... 132 8.7. Resilience and Well-Being ........................................................................................ 133 8.8. The Aim of Part C ..................................................................................................... 136 Chapter Nine ....................................................................................................................... 138 Exploring the association between quality of life and EEA resilience among Syrian refugees ............................................................................................................................... 138 9.1. Abstract ..................................................................................................................... 138 9.2. Introduction .......................................................................................................... 139 9.3. Method ................................................................................................................. 141 9.3.1. The Research Sample .................................................................................... 141 9.3.2. Measures ....................................................................................................... 142 9.4. Ethics .................................................................................................................... 142 7 9.5. Results .................................................................................................................. 143 9.5.1. Descriptive Statistics ..................................................................................... 143 9.5.2. One sample T.test ......................................................................................... 143 9.5.3. Bivariate Correlation ..................................................................................... 144 9.5.4. Multiple Regressions .................................................................................... 147 9.6. Discussion ............................................................................................................ 150 9.7. Conclusion............................................................................................................ 152 Chapter Ten ......................................................................................................................... 153 An investigation of the association between the EEA Resilience model and Psychological well-being among Iraqi internationally displaced persons in the Kurdistan region of Iraq 153 10.1. Abstract ..................................................................................................................... 153 10.2. Introduction ............................................................................................................... 154 10.3. Method ....................................................................................................................... 156 10.3.1. The research sample ...................................................................................... 156 10.3.2. Measures ....................................................................................................... 156 10.3.2.1. EEA Resilience ......................................................................................... 156 10.3.2.2. Psychological Well-being ......................................................................... 157 10.4. Ethics ......................................................................................................................... 157 10.5. Results ....................................................................................................................... 157 10.5.1. Descriptive statistic ....................................................................................... 157 10.5.2. One sample T.test ......................................................................................... 158 10.5.3. Bivariate correlations .................................................................................... 158 10.5.4. Multiple regression ....................................................................................... 162 10.6. Discussion ................................................................................................................. 164 10.7. Conclusion ................................................................................................................. 167 Chapter Eleven .................................................................................................................... 168 Overview, Research Summary and Discussion of Findings, Implications and Future Research, Research Limitations and Challenges, and Conclusion ..................................... 168 11.1. Overview .......................................................................................................... 168 11.2. Summary and discussion of findings ................................................................ 169 11.3. Implications and future research ...................................................................... 182 11.4. Research limitations and challenges ................................................................. 184 11.5. Conclusions ...................................................................................................... 185 8 List of Tables Table 1 Mean (SD) score comparisons for WHOQOL-BREF domain scores (range 4–20) between Kurdistan refugees and adults across 23 countries (n = 11,830) from Skevington et al. (2004). ....................................................................................... 39 Table 2 Mean (SD) score comparisons for WHOQOL-BREF raw scores between Syrian refugees residing in Kurdistan and refugees residing in West Africa .................... 40 Table 3 Mean (SD) score comparisons for WHOQOL-BREF transformed scores (0–100) between Syrian refugees residing in Kurdistan and refugees residing in the Gaza strip. ........................................................................................................................ 41 Table 4: Psychological well-being domains, considering high and low scores for feelings 46 Table 2: Cronbach’s alpha score obtained in the domains of psychological quality of life and psychological well-being ................................................................................. 54 Table 6: Pearson’s correlation coefficient between psychological well-being and psychological quality of life ................................................................................... 55 Table 7 Male and female correlation and Z-Score of significance of the difference between the Correlations of psychological quality of life and psychological well-being components according to gender. ........................................................................... 56 Table 8 Regression analysis with psychological quality of life as a dependent variable, and gender, age, education, marital status, health, and illness status, and psychological well-being as predictor variables ............................................................................ 57 Table 9 Cronbach's alpha, Score obtained in Self-report and Implicit tests of Prejudice and psychological well-being domains ......................................................................... 89 Table 10 One sample T-Test of explicit prejudice and psychological well-being ............... 90 Table 11 Independent sample t-test of explicit prejudice between Arab and Kurdish nationality ............................................................................................................... 91 Table 12 Independent sample t-test of implicit prejudice between Arab and Kurdish nationality, the first task is related to concept recognition ..................................... 91 Table 13 independent sample t-test of implicit prejudice between Arab and Kurdish nationality, the third task combined with pleasant and unpleasant attributes. ....... 92 9

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