Research Collaboration Assesses Mental Health Needs of Afghani Refugees

When the Taliban took over Afghanistan in August 2021, more than 75,000 fled the country to find a new home in the United States. Among them was Ajmal Sabawoon, a physician and public health scientist who left Kabul for Columbia, where he is now a researcher in the Columbia Mailman Department of Epidemiology.

Katherine (Kerry) Keyes, professor of epidemiology, and others across Columbia, were instrumental in securing safe passage for Sabawoon and his family. Now the two researchers are co-leading a study examining the mental health of Afghan refugees navigating the stressors of immigration after decades of exposure to political violence. They will be surveying people in Afghan migrant settlements, as well as their healthcare providers, to determine the mental health needs of displaced people.

With an eye toward preventing the mental illnesses prevalent among displaced people, such as anxiety, depression, and post-traumatic stress disorder, their goal is to establish a research program that prioritizes mental health needs and tracks long-term outcomes for resettled migrants. “The number of people who are displaced is growing—for political reasons, climate reasons, and other reasons,” Keyes says.

Their effort is one of eight Columbia Mailman Centennial Grand Challenges projects funded by Dean Linda P. Fried to support interdisciplinary research focused on addressing some of the most pressing public health problems of the 21st Century. Announced last fall, the Grand Challenges grants are designed to forge new research partnerships and serve as a new model for future research at scale.

Sabawoon, a former associate professor of Epidemiology at Kabul University of Medical Science, is the first Afghani scholar to join Columbia as part of the University’s Afghan Scholars program to assist displaced scholars and students, as well as Afghan members of the university community, who have been affected by the crisis in Afghanistan.

What is your background in public health and how did you come to flee your country?

Sabawoon: I was a physician in my home country. I did a master’s of public health program and pursued research activities with the John’s Hopkins University, Kabul University of Medical Sciences, and with national and international institutions and NGOs. When the Taliban took over my country, I knew there was no future development opportunities for my children, my wife, and my family. My family and I were in danger because of my association and work with international nonprofit and educational organizations as well as my involvement serving marginalized populations.

How did the two of you start working together?

Keyes: We have a shared collaborator based in Paris, Viviane Kovess-Masfety. She and Ajmal collaborated on a large data collection project in Afghanistan with the goal to estimate national rates of psychiatric disorders. I was brought in to help with statistical analyses. Ajmal and I connected in 2021.

Sabawoon: I was in a refugee camp in Germany after having been evacuated by the U.S army forces facilitated by the John’s Hopkins University. I along with my research team submitted a paper for a scientific journal where I was correspondent. However, there was usually no access to the Internet but fortunately, one time I got access to the Internet, and sent a message to Professor Kovess-Masfety to tell her about my situation and communication with the journal. She facilitated the introduction to Professor Keyes and also with the Scholars at Risk (SAR) program.

Keyes: I contacted my department chair [Charlie Branas] and said it would be great to create a position for Ajmal. He put me in touch with Columbia Global who facilitated getting him the research position. When Ajmal’s family applied for asylum and needed a lawyer, I reached out to Law School Professor Elora Mukherjee. She handled the entire legal process. Columbia Housing was critical to facilitating housing for Dr. Sabawoon. It all worked out incredibly well.

What is your Centennial Grand Challenges study looking at?

Sabawoon: Migration is a huge risk factor for mental health disorders. There are a lot of problems that Afghan refugees face starting with their legal status. Refugees came to the U.S. in an unplanned manner; they were not able to anticipate the difficulties of moving from one country to another. They must adjust to a new culture, including how to navigate the health care system here. There is also the constraint of being separated from family members, including those who are receiving threats from the current government. All of this is emotionally taxing. We designed this project to assess the Afghan refugee mental health situation and what their needs are here.

Keyes: There have been decades of research on migration and mental health. A lot of the top research has come from Europe, not the U.S. That’s a real missed opportunity because we have a lot of people migrating to the U.S. from many different countries and a need to evaluate psychiatric disorder risk. This project is a step toward building that research program to document that burden and develop ways to elevate suffering.

How does your project bring together your skills in different disciplines?

Keyes: I’m a quantitative epidemiologist. We knew qualitative skills were important for the work we wanted to do. I reached out to Mailman faculty I knew. Jeremey Kane in Epi and Claire Greene in Pop Fam do international work with refugees using qualitative and quantitative data collection, and I knew they would bring tremendous skills to the team. Morgan Philbin, who recently left Columbia, has extensive experience with qualitative data collection in the U.S. Monette Zard facilitated our introductions to resettlement organizations, and Goleen Samari, who also recently left Columbia, was critical to helping frame the mental health and legal needs in the Afghan community. Everyone brings something unique. Combined, we’re able to get it off the ground.