Date of Award


Document Type


Degree Name


Organizational Unit

Morgridge College of Education

First Advisor

Antonio Olmos, Ph.D.

Second Advisor

Nicholas Cutforth

Third Advisor

Gwen Mitchell


Mental health screening, Mixed methods, Newly arrived refugees, Propensity score analysis


This mixed methods dissertation explored potential differences in distress levels between newly arrived refugees from Bhutan/Nepal, Burma, Iraq, Somalia and the Democratic Republic of Congo during the first year of resettlement in Denver, Colorado. Utilizing RHS-15 quantitative outcomes and demographic data collected approximately every 3 months for 1 year, three approaches to propensity score analysis were performed with risk set matching on balancing time-varying covariates across treatment conditions at each time point. Subsequently, a three-way factorial ANOVA was conducted to examine mean differences in distress levels between treatment group, ethnocultural background, and time. In addition, clinical interview data were analyzed through a deductive coding framework to triangulate and contextualize quantitative findings.

At arrival, newly arrived refugees from Iraq reported the highest level of emotional distress followed by refugees from the DRC; whereas refugees from Bhutan/Nepal, Burma and Somalia endorsed lower levels of distress. These differences were statistically significant. In semi-structured clinical interviews, newly arrived refugees with higher distress in early resettlement reported lower monthly incomes, higher unemployment, unstable and uncomfortable housing, greater cultural and English language barriers, chronic health issues/pain and disabilities, and poor access to social support from family and friends. In contrast, newly arrived refugees with lower distress described living in comfortable and safe home environments with family and friends, stronger English skills and cultural knowledge, and greater job prospects or employment.

Findings highlight the need for screening tools to assess factors related to safety and stability in newly arrived refugees, such as access to basic needs, English skills, employment readiness, and social support, as these were found to explain differences in distress levels across the first year of resettlement. Future research should develop screening items that are grounded in culturally-specific expressions of distress, as the present study found ethnocultural background impacted newly arrived refugees' endorsement of distress symptoms. A discussion of study challenges and limitations is also provided in conclusion.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

Maria M Vukovich


Received from ProQuest

File Format




File Size

183 p.


Mental Health, Statistics, Ethnic Studies