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Kuo BCH, Rappaport LM. A prospective longitudinal study of depression, perceived stress, and perceived control in resettled Syrian refugees' mental health and psychosocial adaptation. Transcult Psychiatry 2024:13634615241227696. [PMID: 38356312 DOI: 10.1177/13634615241227696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
This prospective study examined the psychosocial adaptation of a community sample of newly resettled Syrian refugees in Canada (N = 235). Specifically, depressive symptoms, perceived stress, and perceived control were collected in Arabic at baseline and 1-year follow-up. Two theory-informed, cross-lagged panel models demonstrated that higher baseline depressive symptoms predicted lower perceived self-efficacy and lower perceived control at 1-year follow-up. Similarly, baseline depressive symptoms were concurrently correlated with higher perceived helplessness, lower perceived self-efficacy, and lower perceived control. Secondary regression analyses further demonstrated that baseline depressive symptoms predicted lower perceived social support and higher anxiety symptoms, though neither were assessed at baseline. Empirical results identify a potentially broad, precipitating, and persistent effect of depressive symptoms on Syrian refugees' psychosocial resources and adaptation post-migration, which is consistent with both the transactional model of stress and coping and the self-efficacy theory of depression, respectively. Clinically, the study results highlight the importance of early screening for depressive symptoms among refugee newcomers within a culturally and trauma-informed, integrated health setting. Furthermore, this study underscores the value and need for theoretically guided longitudinal studies to advance future research on refugee mental health and psychosocial adaptation.
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Affiliation(s)
- Ben C H Kuo
- Department of Psychology, University of Windsor, Ontario, Canada
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2
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Milewski A, Weinstein E, Lurie J, Lee A, Taki F, Pilato T, Jedlicka C, Kaur G. Reported Methods, Distributions, and Frequencies of Torture Globally: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2336629. [PMID: 37787994 PMCID: PMC10548313 DOI: 10.1001/jamanetworkopen.2023.36629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
Importance Despite its prohibition by the United Nations Convention against Torture and other international treaties, torture has been perpetrated against countless individuals worldwide, and health care practitioners globally are increasingly encountering refugee torture survivors in their clinical practices. The methods, geographic distribution, and frequency of torture globally are not well described, which limits health care practitioners' ability to adequately diagnose and treat the sequelae of torture. Objective To rank the commonness of torture methods and identify the regions of the world with which they are associated. Data Sources For this systematic review and meta-analysis, Ovid MEDLINE, Ovid Embase, Web of Science, and The Cochrane Library were searched from inception to July 2021. Study Selection Included studies were peer-reviewed articles in English, contained an independent sample population of individuals who experienced torture, and outlined the type(s) of torture experienced. Excluded studies were not peer reviewed, lacked an independent sample population, or did not specify torture methods. Articles were chosen for inclusion by 2 independent and blinded reviewers, and a third, independent reviewer resolved discrepancies. Overall, 266 articles-15.3% of the 1739 studies initially identified for full review-met the inclusion criteria. Data Extraction and Synthesis Data abstraction and quality assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 2 independent and blinded reviewers into predefined templates, and a third, independent reviewer resolved discrepancies. The risk of bias was evaluated using the Downs and Black Checklist. Main Outcomes and Measures Torture methods were ranked by their average frequencies, numbers of reporting studies, and numbers of countries wherein the methods occurred. Results A total of 9937 titles and abstracts were screened, and 266 studies encompassing 103 604 individuals (13 350 men, 5610 women, and 84 644 unspecified) were analyzed. Torture was reported for 105 countries; 21 methods accounted for 84% of all reported methods and 10 methods accounted for 78% of all physical tortures. The top 3 methods were beating or blunt-force trauma (reported in 208 studies and 59 countries; average frequency, 62.4%; 95% CI, 57.7%-67.1%), electrical torture (reported in 114 studies and 28 countries; average frequency, 17.2%; 95% CI, 15.0%-19.4%), and starvation or dehydration (reported in 65 studies in 26 countries; average frequency, 12.7%; 95% CI, 10.2%-15.2%). According to the Downs and Black appraisal tool, 50 studies were rated as good or excellent and 216 as fair or poor. Conclusions and Relevance The findings of this study suggest that torture remains widespread. Although innumerable torture methods exist, a limited number account for the vast majority of reported tortures. So that targeted therapies may be developed, additional investigation is needed to better elucidate the sequelae associated with the most common torture methods, described here.
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Affiliation(s)
- Andrew Milewski
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Eliana Weinstein
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Jacob Lurie
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Annabel Lee
- Weill Cornell Medicine Medical College, New York, New York
| | - Faten Taki
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Tara Pilato
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York
| | - Caroline Jedlicka
- Kingsborough Community College, City University of New York, Brooklyn
| | - Gunisha Kaur
- Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York
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Mohammadifirouzeh M, Oh KM, Basnyat I, Gimm G. Factors Associated with Professional Mental Help-Seeking Among U.S. Immigrants: A Systematic Review. J Immigr Minor Health 2023; 25:1118-1136. [PMID: 37000385 PMCID: PMC10063938 DOI: 10.1007/s10903-023-01475-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/01/2023]
Abstract
Structural and cultural barriers have led to limited access to and use of mental health services among immigrants in the United States (U.S.). This study provided a systematic review of factors associated with help-seeking attitudes, intentions, and behaviors among immigrants who are living in the U.S. This systematic review was performed using Medline, CINAHL, APA PsycInfo, Global Health, and Web of Science. Qualitative and quantitative studies examining mental help-seeking among immigrants in the U.S. were included. 954 records were identified through a search of databases. After removing duplicates and screening by title and abstract, a total of 104 articles were eligible for full-text review and a total of 19 studies were included. Immigrants are more reluctant to seek help from professional mental health services due to barriers such as stigma, cultural beliefs, lack of English language proficiency, and lack of trust in health care providers.
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Affiliation(s)
- Mona Mohammadifirouzeh
- College of Public Health, School of Nursing, George Mason University, 4400 University Dr, Fairfax, VA 22030 USA
| | - Kyeung Mi Oh
- College of Public Health, School of Nursing, George Mason University, 3C4, Peterson Hall 3041, 4400 University Dr, Fairfax, VA 22030 USA
| | - Iccha Basnyat
- College of Humanities and Social Sciences, Global Affairs Program and Department of Communication, George Mason University, Horizon Hall 5200, Fairfax, VA 22030 USA
| | - Gilbert Gimm
- College of Public Health, Department of Health Administration and Policy, George Mason University, MS-1-J3, Peterson Hall 4410, 4400 University Dr, Fairfax, VA 22030 USA
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Dehghan R, Osella C. The psychological impact of sexual torture: A gender-critical study of the perspective of UK-based clinicians and survivors. Transcult Psychiatry 2022; 59:380-392. [PMID: 35382629 PMCID: PMC9149530 DOI: 10.1177/13634615221089491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the high prevalence of sexual torture and its close link with gender, little work has been published on refugee torture survivors from Muslim-majority countries. The aim of this project was to introduce a gender-critical framework, that draws on post-modern and post-colonial feminism, to the study of sexual torture in terms of its operationalization and psychological impact in Iranian, Afghan, and Kurdish refugees in the United Kingdom (UK). This exploratory qualitative research was conducted in collaboration with two voluntary organizations in the UK. Mental healthcare providers (HCPs) were invited to participate through convenience sampling from amongst their staff as well as from community mental health services. Torture survivors were recruited through snowball sampling. The study consists of two parts: 1) semi-structured face-to-face interviews with a total of eight experts (doctors and therapists) and three torture survivors; followed by 2) a focus group with four experts to discuss the emerging results from the interviews and together reflect on the politics of gender and sexuality in the context of torture ('assisted sense-making'). A thematic gender-critical analysis was performed for the qualitative data. Our findings from interviews with (only Kurdish) torture survivors and HCPs suggest that gender mediates the impact of sexual torture at the intersection of gender, cultural norms, forms of social inequality, and body politics. The conclusions of the study will have implications for health services by deepening our understanding of variables that intersect in an entangled and unpredictable network.
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Affiliation(s)
- Roghieh Dehghan
- Centre for Gender and Global Health, 4919University College London
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Profiles of post-migration stressors and mental health in refugees: A latent class analysis. Psychiatry Res 2022; 311:114494. [PMID: 35287045 DOI: 10.1016/j.psychres.2022.114494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/27/2022] [Accepted: 03/05/2022] [Indexed: 11/23/2022]
Abstract
Studies have documented the mental health effects of pre-migration trauma on resettled refugees and identified distinct psychological symptom profiles using person centred statistical techniques (e.g., latent class analysis; LCA). These techniques have advanced our understanding of the complex presentation of trauma and psychopathology in refugees. The current study employs LCA to examine patterns of exposure to stressors including post-migration stressors, allowing us to identify patterns of post-migration stress exposure and their association with mental health outcomes. Participants were 1085 Arabic, Farsi, Tamil, or English speaking adult refugees. Pre-migration trauma, post-migration stressors, PTSD, depression, anger, and functional impairment was measured. LCA was conducted to identify distinct classes of post-migration stressors and associations with mental health and adjustment in the resettlement environment. Latent class analysis revealed 5 classes of participants: high difficulties class (7.2%), immigration fear class (14.4%), social disconnection class (17.3%), moderate difficulties class (28.9%) and a low difficulties class (32.3%). Each of the five classes shared commonalities in addition to key differences associated with specific demographic characteristics and psychopathology. Post-migration stressors appear to map onto distinct profiles, which uniquely contribute to functional impairment and mental health outcomes in refugees. These findings have substantial implications for public health and social services working with resettled refugee communities.
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Sheth N, Patel S, O’Connor S, Dutton MA. Working Towards Collaborative, Migrant-Centered, and Trauma-Informed Care: a Mental Health Needs Assessment for Forced Migrant Communities in the DC Metropolitan Area of the United States. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2021. [DOI: 10.1007/s12134-021-00884-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grasser LR, Haddad L, Manji S, Assari S, Arfken C, Javanbakht A. Trauma-Related Psychopathology in Iraqi Refugee Youth Resettled in the United States, and Comparison With an Ethnically Similar Refugee Sample: A Cross-Sectional Study. Front Psychol 2021; 12:574368. [PMID: 33828500 PMCID: PMC8019895 DOI: 10.3389/fpsyg.2021.574368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Conflict in Iraq has displaced millions of refugee youth. Warzone exposure and forced migration have unique acute and chronic impacts on youth, yet effects of exposure may not be universal across diverse refugee groups. Understanding how youth from various refugee groups are differentially affected by stress and trauma is critical to allocate resources and implement screening measures with the goal of providing early intervention. Method To identify the effects of warzone exposure and forced migration, a convenience sample of 48 Iraqi refugee youth ages 6-17 was assessed within the first month of arrival to the United States. Youth provided self-reported severity of posttraumatic stress and anxiety symptoms; symptom severity was then compared with an existing sample of 135 Syrian refugee youth to explore whether refugee youth of different nationalities experience the same effects of warzone exposure and forced migration. These data are the baseline for a longitudinal developmental study of refugee health, which also includes parental data. Results Severity of separation anxiety and negative alterations in cognition and mood were the greatest symptomatic concerns in Iraqi refugee youth. Thirty-eight percent of responding Iraqi youth showed possible indication of an anxiety disorder. Severity of posttraumatic stress symptoms was lower in Iraqi youth compared to Syrian youth. For both Iraqi and Syrian refugee youth, separation anxiety was the most significant concern, with more than 80% of both samples showing a possible indication of clinically significant separation anxiety. Conclusion The present observational study indicated that Iraqi refugee youth experience a range of anxiety and posttraumatic stress symptoms following warzone exposure and forced migration; posttraumatic stress symptoms were less severe in Iraqi versus Syrian youth. Comparing refugee youth of different nationalities is of particular importance, as our results demonstrate that findings from one refugee population cannot easily be generalized to another. Clinical and research efforts should prioritize interventions to address separation anxiety in refugee youth, which was of concern in both samples.
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Affiliation(s)
- Lana Ruvolo Grasser
- Stress, Trauma, and Anxiety Research Clinic (STARC Lab), Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Luay Haddad
- Stress, Trauma, and Anxiety Research Clinic (STARC Lab), Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Suzanne Manji
- Stress, Trauma, and Anxiety Research Clinic (STARC Lab), Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States.,Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
| | - Cynthia Arfken
- Stress, Trauma, and Anxiety Research Clinic (STARC Lab), Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic (STARC Lab), Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
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Bentley JA, Feeny NC, Dolezal ML, Klein A, Marks LH, Graham B, Zoellner LA. Islamic Trauma Healing: Integrating Faith and Empirically Supported Principles in a Community-Based Program. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:167-192. [PMID: 34025104 PMCID: PMC8136181 DOI: 10.1016/j.cbpra.2020.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Access to adequate, much less state-of-the-art, mental health care is a global problem. Natural disasters, civil war, and terrorist conflict have forcibly displaced millions of Muslims and have resulted in a remarkable level of individual and communitywide trauma exposure. As a result, many are at risk for posttraumatic stress and other trauma-related disorders. Many religiously oriented Muslims traditionally rely on Islamic principles and teachings, as well as their community, to cope with and address trauma-related distress. Islamic Trauma Healing is a six-session, lay-led group intervention developed within a Somali Muslim community that integrates evidence-based trauma-focused cognitive-behavioral therapy principles with cultural and religious practices aimed to enhance uptake and create an easily up-scalable intervention for a wide range of trauma. In sessions, narratives of prophets who have undergone trauma (e.g., Prophet Ayyub, faith during hard times) present Islamic principles and facilitate cognitive shifts. Group members spend individual time turning to Allah in dua (i.e., informal prayer), focused on exposure to trauma memories. Program themes arc across suffering to healing to growth following trauma. This paper describes the core theoretical principles and methods in the Islamic Trauma Healing program. We also describe leader perspectives and the program's train-the-trainer model, in which lay leaders are trained to further disseminate the program and allow Islamic Trauma Healing to be owned and sustained by the Muslim community.
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Keshk M, Harrison R, Kizito W, Psarra C, Owiti P, Timire C, Camacho MM, De Maio G, Safwat H, Matboly A, Van den Bergh R. Offering care for victims of torture among a migrant population in a transit country: a descriptive study in a dedicated clinic from January 2017 to June 2019. Int Health 2021; 13:89-97. [PMID: 33021313 PMCID: PMC7902272 DOI: 10.1093/inthealth/ihaa068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/17/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background Medecins Sans Frontieres set up a clinic to provide multidisciplinary care to a vulnerable migrant population experiencing torture. We describe the population accessing care, the characteristics of care provided and patient outcomes. Methods A descriptive retrospective cohort study of patients enrolled in care during January 2017–June 2019 was conducted. Results Of 2512 victims of torture cases accessing the clinic, the male: female ratio was 1:1. About 67% of patients received medical care, mostly for chronic pain treatment. About 73% of patients received mental healthcare, 37% received physiotherapy and 33% received social support care; 49% came to the clinic upon the recommendation of a friend or family member. The discharge with improvement rate ranged from 23% in the mental health service to 9% in the sociolegal service. Patients retained in care had a median IQR of 3 (2–4) follow-up visits for medical care, 4 (2–7) for mental health, 6 (3–10) for physiotherapy and 2 (1–4) for sociolegal. Conclusion Care for victims of torture cases among vulnerable migrants is complex. For those who did receive care that led to an improvement in their condition, their care models have been described, to allow its implementation in other non-specialised settings.
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Affiliation(s)
| | | | | | | | - Phillip Owiti
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Collins Timire
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
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Schippert ACSP, Grov EK, Bjørnnes AK. Uncovering re-traumatization experiences of torture survivors in somatic health care: A qualitative systematic review. PLoS One 2021; 16:e0246074. [PMID: 33539415 PMCID: PMC7861410 DOI: 10.1371/journal.pone.0246074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
Little research has focused on torture survivors' re-traumatization experiences in health and hospital units that treat somatic diseases, though any medical procedure can re-traumatize survivors. This study's purpose was to summarize qualitative research evidence on torture survivors' somatic healthcare experiences and to identify "triggers" or "reminders" that can lead to re-traumatization. The study's search strategies identified 6,326 citations and eight studies, comprising data from 290 participants, exploring encounters with healthcare providers from torture survivors' perspectives, which were included in the present research. Dallam's Healthcare Retraumatization Model was used as a framework for data extraction and analysis. Five main themes were elicited from the findings: (1) invisibility, silence, and mistrust; (2) healthcare providers' attitudes and a lack of perceived quality in healthcare; (3) disempowerment; (4) avoidance; and (5) satisfaction and gratitude. An analysis of the study's findings revealed that torture survivors do not receive adequate healthcare and may experience challenges during treatment that can result in re-traumatization. The findings of this literature review provide a basis for understanding the difficulties that survivors experience in receiving somatic healthcare, as well as an explanation of the re-traumatization process.
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Affiliation(s)
- Ana Carla S. P. Schippert
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Akershus University Hospital, Oslo, Norway
| | - Ellen Karine Grov
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Ann Kristin Bjørnnes
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Hollifield M, Toolson EC, Verbillis-Kolp S, Farmer B, Yamazaki J, Woldehaimanot T, Holland A. Distress and Resilience in Resettled Refugees of War: Implications for Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031238. [PMID: 33573131 PMCID: PMC7908567 DOI: 10.3390/ijerph18031238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about distress (Refugee Health Screener—15 (RHS-15)) and possible predictors of distress were collected at the domestic medical examination (T1) within 90 days of arrival and the civil surgeon examination (T2) 11–16 months after T1 for refugee groups from three countries (COU). Descriptive, correlative, analyses of variance, and regression techniques were used to determine trajectory type and their predictors. A higher percentage (7.3%) were distressed at T2 than at T1. By group, the Bhutanese became more distressed, the Burmese became less distressed, and Iraqi’s continued to have high distress. A regression model showed gender, loss, post-migration stress, and self-efficacy to be significant predictors of trajectory type (R2 = 0.46). When the T1 RHS-15 score was added to the model, observed variance increased (R2 = 0.53) and T1 RHS score accounted for the majority of variance (r = 0.64, p < 0.001), with post-migration stress accounting for markedly less (β = 0.19, p = 0.03). Loss and self-efficacy became less significant. Loss was, however, a strong predictor of delayed and chronic distress trajectory type. These data suggest that screening for distress should occur at least twice during resettlement to detect those with initial distress and those with delayed distress. Screening should be coupled with identifying other social determinants of health and a comprehensive assessment to determine the need for intervention for secondary prevention (i.e., reducing delayed distress) and treatment (reducing chronic distress).
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Affiliation(s)
- Michael Hollifield
- VA Long Beach Healthcare System, Long Beach, CA 90822, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine, Washington, DC 20052, USA
- War Survivors Institute, 5318 2nd Street, #703, Long Beach, CA, 90803, USA
- Correspondence:
| | - Eric C. Toolson
- Department of Biology, The University of New Mexico, Albuquerque, NM 87131, USA;
| | - Sasha Verbillis-Kolp
- Consultant, 3630 N. Winchell St., Portland, OR 97217, USA;
- Portland State University School of Social Work, Academic Student Recreation Center, Ste. 600, 1800 SW 6th Ave., Portland, OR 97201, USA
| | - Beth Farmer
- International Rescue Committee, 1200 S. 192nd St., SeaTac, WA 98148, USA;
| | - Junko Yamazaki
- Asian Counseling and Referral Service, Seattle, WA 98144, USA; (J.Y.); (T.W.)
| | | | - Annette Holland
- Public Health Seattle & King County, Seattle, WA 98121, USA;
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Zoellner LA, Bentley JA, Feeny NC, Klein AB, Dolezal ML, Angula DA, Egeh MH. Reaching the Unreached: Bridging Islam and Science to Treat the Mental Wounds of War. Front Psychiatry 2021; 12:599293. [PMID: 34149468 PMCID: PMC8208506 DOI: 10.3389/fpsyt.2021.599293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Radical new paradigms are needed to equip non-professionals and leverage community faith-based infrastructure to address the individual and communal wounds of war- and conflict-related trauma. Muslims in war-torn regions like Somalia experience high rates of trauma and posttraumatic stress; yet, lack of providers, potential stigma, and lack of integration with one's faith are substantial barriers to care. In this pre-post feasibility clinical trial (NCT03761732), mosque leaders implemented a brief, group- and mosque-based intervention, Islamic Trauma Healing, targeting trauma-related psychopathology and community reconciliation for trauma survivors (N = 26) in Somaliland, Somalia. Leaders were trained in a brief 2-day training, with supervision provided remotely via WhatsApp. This six-session intervention combines empirically-supported trauma-focused psychotherapy and Islamic principles, focusing on wisdom from the lives of the Prophets and turning to Allah in dua about trauma. There were large, clinically meaningful effects for PTSD (g = 1.91), depression (g = 2.00), somatic symptoms (g = 2.73), and well-being (g = 1.77). Qualitative data from group members highlighted how well the program was aligned with their Islamic faith, built community, and need to expand the program. These results highlight the feasibility of this non-expert, easily up-scalable mental health approach in war-torn Muslim regions and refugee communities. This program has the potential to provide a low-cost, self-sustaining, Islam-based intervention addressing the psychological wounds of war consistent with the IOM's call to develop novel approaches to address unmet clinical needs. ClinicalTrials.gov Identifier: NCT03761732.
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Affiliation(s)
- Lori A Zoellner
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Jacob A Bentley
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Norah C Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Alexandra B Klein
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Michael L Dolezal
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Dega A Angula
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Momin H Egeh
- Ma'alin Haruon Masjid, Hargeisa, Somalia.,Abu-Bakar Al-Siddique Islamic Center, Borama, Somalia
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Jannesari S, Hatch S, Prina M, Oram S. Post-migration Social-Environmental Factors Associated with Mental Health Problems Among Asylum Seekers: A Systematic Review. J Immigr Minor Health 2020; 22:1055-1064. [PMID: 32430778 PMCID: PMC7441054 DOI: 10.1007/s10903-020-01025-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People seeking asylum are at an increased risk of mental disorder compared to refugees and other migrants. This paper aims to understand the impact of postmigration social-environmental factors to help inform efforts to reduce rates of mental disorder. We conducted a systematic review searching 11 databases, as well as 6 government and nongovernment websites. We asked 5 experts for recommendations, and carried out forwards and backwards citation tracking. From 7004 papers 21 were eligible and had the appropriate data. Narrative synthesis was conducted. 24 Social-environmental factors were identified and categorised into 7 themes: working conditions, social networks, economic class, living conditions, healthcare, community and identity, and the immigration system. Evidence suggests that discrimination and post-migration stress are associated with increased rates of mental disorder. The post-migration environment influences the mental health of people seeking asylum. Discrimination and post-migration stress are key factors, warranting further research and public attention.
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Affiliation(s)
- Sohail Jannesari
- Health Service and Population Research, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Stephani Hatch
- Psychological Medicine, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Prina
- Health Service and Population Research, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sian Oram
- Health Service and Population Research, The Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, 16 De Crespigny Park, London, SE5 8AF, UK
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Gillespie S, Cardeli E, Sideridis G, Issa O, Ellis BH. Residential mobility, mental health, and community violence exposure among Somali refugees and immigrants in North America. Health Place 2020; 65:102419. [PMID: 32877868 DOI: 10.1016/j.healthplace.2020.102419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Refugees and immigrants resettled in high income countries often later experience a new phase of residential uncertainty in search of safe and secure housing. This study investigated the effect of past year housing stability on symptoms of posttraumatic stress disorder (PTSD) and exposure to neighborhood violence among a sample of 1st and 2nd generation Somali young adults (N = 198) living in urban areas in North America. In one year, 8.1% of the sample experienced a forced move and 20.7% of the sample moved voluntarily. Discrimination, neighborhood violence, economic insecurity, and interpersonal conflict precipitated forced moves. Forced moves were associated with worsening PTSD symptomology over one year, while voluntary moves were associated with improvements in symptoms. The current study provides evidence of the importance of safe, stable housing for the mental health of young adult immigrants.
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Affiliation(s)
- Sarah Gillespie
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA.
| | - Emma Cardeli
- Boston Children's Hospital, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Georgios Sideridis
- Boston Children's Hospital, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Osob Issa
- Boston Children's Hospital, Department of Psychiatry, Boston, MA, USA
| | - B Heidi Ellis
- Boston Children's Hospital, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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Nesterko Y, Jäckle D, Friedrich M, Holzapfel L, Glaesmer H. Factors predicting symptoms of somatization, depression, anxiety, post-traumatic stress disorder, self-rated mental and physical health among recently arrived refugees in Germany. Confl Health 2020; 14:44. [PMID: 32670398 PMCID: PMC7346670 DOI: 10.1186/s13031-020-00291-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/30/2020] [Indexed: 01/28/2023] Open
Abstract
Background There is a large body of research indicating increased prevalence rates of mental disorders among refugees. However, the vast majority of the evidence available on risk factors for mental disorders among refugees focuses on post-migration stressors and was collected in surveys that were conducted months and sometimes years after the participants had resettled. Objective In the present study, we analyze socio-demographic and flight-related characteristics as predictors for symptoms of somatization, depression, anxiety, and post-traumatic stress disorder as well as self-rated mental and physical health in recently arrived refugees (up to 4 weeks after arrival) in Germany. Methods The study was conducted in a reception facility for asylum-seekers in Leipzig, Germany. A total of 1316 adult individuals arrived at the facility during the survey period; 502 took part in the study. The questionnaire (self-administrated) included socio-demographic and flight-related questions as well as standardized instruments for assessing PTSD (PCL-5), depression (PHQ-9), anxiety (HSCL-10) and somatization (SSS-8). Linear regression models were conducted to predict symptoms of different mental disorders as well as self-rated mental and physical health. Results Lack of information about family members and subjective need for health care were found to be significantly associated with symptoms of depression, somatization, anxiety, and PTSD. Better self-rated mental health was significantly associated with partnership, childlessness, lower number of traumatic events, and having information about family left behind. No associations were found between flight-related factors and symptom burden. Conclusions The results provide initial methodologically robust insights for research and health care services, which should aid in better identifying newly arrived refugees in need of psychosocial care. Furthermore, the results might help answering the question of how to provide health care for highly vulnerable groups within refugee populations regardless their residential status.
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Affiliation(s)
- Yuriy Nesterko
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - David Jäckle
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Laura Holzapfel
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
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Brunnet AE, Dos Santos Lobo N, Silveira T, Kristensen CH, Derivois D. Migrations, trauma and mental health: A literature update on psychological assessment. Encephale 2020; 46:364-371. [PMID: 32576365 DOI: 10.1016/j.encep.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Migrants and refugees often face potentially traumatic events and post-migratory stressors. Upon arrival in the host country, they can be referred to mental health services to assess the impact of their previous experiences. These cross-cultural clinical encounters may raise questions, particularly regarding the assessment of mental health using models based on Western conceptions of psychopathology. OBJECTIVES AND METHOD The objective of the present non-systematic review of the literature is to discuss the psychological evaluation of post-traumatic reactions in migrants and refugees. More specifically, we present current research on psychopathology, resilience and post-traumatic development (PTG) among the migrant and refugee population. We also examine the cross-cultural validity of concepts such as Post-Traumatic Stress Disorder, resilience and PTG. Finally, we describe the most frequently used tools in cross-cultural psychological assessment and briefly reflect on the question of cultural sensitivity of mental health professionals. A bibliographic search was carried out using the databases: PILOTS, Pubmed, APA PsycNET, and Google Scholar using the following keywords: "migrants", "refugees", "posttraumatic stress disorder", "mental health", "Psychopathology", "risk factors", "protection factors", "posttraumatic growth" and "resilience". We have also reviewed the reference lists of articles encountered from database searches. RESULTS Responses to a potentially traumatic situation are multiple. Regarding the migrant and refugee population, the reviewed articles studied different post-traumatic reactions such as resilience, post-traumatic development, and psychopathologies. The most studied psychopathological responses were depression, anxiety and Post-traumatic Stress Disorder. After reviewing these studies, we asked the following question: considering the complexity of the migration process, what are the factors associated with the development of these different post-traumatic responses? Indeed, several individual and social factors before, during and after migration influence the mental health of individuals in a migration situation. Among the most cited risk factors identified were: to be a victim of or witness to violence in the country of origin and, after migration, to face post-migration difficulties such as asylum denial, to be in a precarious situation with regard to housing and work, as well as the difficulties linked to adaptation to the new culture. We have also described protective factors for the mental health of this population, such as: social support, psychological support, and a good quality of life in the host country. The reviewed articles also describe an important influence of cultural aspects on mental health, such as the perception of an event as traumatic. Although the authors of the reviewed articles accept this influence of culture on post-traumatic responses, most of the tools used to assess the mental health of migrants and refugees were created in a Western context. Studies show a growing concern with these cultural aspects, and certain tools that allow a more culturally sensitive evaluation, such as the "Cultural Formulation Interview", are being developed. DISCUSSION AND CONCLUSION Even if the concern with the sensitivity of the tools used in cross-cultural assessment seems to be more present in the international literature, researchers seem to encounter difficulties in better understanding the effects of culture on the mental health of individuals. With increasingly diverse societies, new research should not be based on participants' geographic or ethnic origins, but rather try to "unpack" culture with, for example, the exploration of the relationships between certain values or orientations and the different expressions of psychological distress. Finally, given the still lacking development in the field of cross-cultural research, certain practices, such as the participation of interpreters, the supervision of cultural mediators or the use of culturally sensitive tools, can help the clinician to maintain good practices with patients from different cultures in the diagnostic and psychotherapeutical processes.
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Affiliation(s)
- A E Brunnet
- Pontifical Catholic University of Rio Grande do Sul, Graduate Program in Psychology, School of Health Sciences, Porto Alegre, Rio Grande do Sul, Brazil; University of Burgundy - Franche-Comté, Laboratory Psy-DREPI EA 7458, Dijon, France.
| | - N Dos Santos Lobo
- Pontifical Catholic University of Rio Grande do Sul, Graduate Program in Psychology, School of Health Sciences, Porto Alegre, Rio Grande do Sul, Brazil
| | - T Silveira
- Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - C H Kristensen
- Pontifical Catholic University of Rio Grande do Sul, Graduate Program in Psychology, School of Health Sciences, Porto Alegre, Rio Grande do Sul, Brazil
| | - D Derivois
- University of Burgundy - Franche-Comté, Laboratory Psy-DREPI EA 7458, Dijon, France
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Sidhu SS, Vasireddy R. The Detention of Migrant Families. J Am Acad Child Adolesc Psychiatry 2020; 59:681-683. [PMID: 32061927 DOI: 10.1016/j.jaac.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/17/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
In this letter to the editor, we attempt to summarize some existing literature on the detention of migrant youths and families while providing readers with a context for this issue. We discuss phases of trauma for migrant children prior to addressing current conditions, discuss existing research regarding the impact of detention on migrant families, and conclude with recommendations on how to improve safety and mental health conditions for migrant families in detention.
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Tsur N, Defrin R, Shahar G, Solomon Z. Dysfunctional pain perception and modulation among torture survivors: The role of pain personification. J Affect Disord 2020; 265:10-17. [PMID: 31957687 DOI: 10.1016/j.jad.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/05/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Individuals exposed to trauma, especially those who develop posttraumatic stress disorder (PTSD), are at a higher risk of suffering from chronic pain as well as altered pain perception and modulation. However, the underlying mechanisms of these processes are yet to be established. Recent findings have indicated that trauma survivors tend to personify chronic pain that is developed after the exposure, in a way that resonates with the traumatic experience. The aim of this study was to test whether pain personification plays a significant role in explaining the long-term links between trauma, PTSD and pain. METHODS This study is part of a large-scale longitudinal study on ex-prisoners of war (ex-POWs) from the 1973 Yom-Kippur war, who were followed over 35 years after the war. Fifty-nine ex-POWs who were exposed to torture and 44 matched combatants were assessed for PTSD at 18, 30, and 35 post-war. Quantitative somatosensory testing of heat-pain threshold, pain tolerance, conditioned pain modulation (CPM), and temporal summation of pain (TSP), as well as torturing personification, were assessed at 35 years after the war. RESULTS Sequential mediation analyses revealed that the associations between torture and heat pain threshold, as well as pain tolerance were mediated by PTSD at several time-points (-1.43<indirect effect < 1.47). Torturing personification significantly mediated the associations between torture, PTSD, CPM and TSP (-0.16 < indirect effect). CONCLUSIONS These findings point to the effect of trauma on the subjective orientation towards bodily signals as a key factor in dysfunctional pain modulation.
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Affiliation(s)
- Noga Tsur
- The Bob Shapell School of Social Work, Tel Aviv University, Israel.
| | - Ruth Defrin
- Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Golan Shahar
- Stress, Self & Health (STREALTH) Lab, Department of Psychology, Ben-Gurion University of the Negev, Israel
| | - Zahava Solomon
- The Bob Shapell School of Social Work, Tel Aviv University, Israel; I-CORE Research Center for Mass Trauma, Tel Aviv University, Israel
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Hou WK, Liu H, Liang L, Ho J, Kim H, Seong E, Bonanno GA, Hobfoll SE, Hall BJ. Everyday life experiences and mental health among conflict-affected forced migrants: A meta-analysis. J Affect Disord 2020; 264:50-68. [PMID: 31846902 PMCID: PMC7064367 DOI: 10.1016/j.jad.2019.11.165] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/29/2019] [Accepted: 11/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are a growing number of forced migrants worldwide. Early detection of poor adjustment and interventions to facilitate positive adaptation within these communities is a critical global public health priority. A growing literature points to challenges within the post-migration context as key determents of poor mental health. AIMS The current meta-analysis evaluated the association between daily stressors and poor mental health among these populations. METHOD A systematic search in PsycINFO, PubMed, and Web of Science identified relevant studies from inception until the end of 2018. Effect sizes (correlation coefficients) were pooled using Fisher's Z transformation and reported with 95% confidence intervals. Moderator and mediator analyses were conducted. The protocol is available in PROSPERO [CRD42018081207]. RESULTS Analysis of 59 eligible studies (n = 17,763) revealed that daily stressors were associated with higher psychiatric symptoms (Zr=0.126-0.199, 95% CI=0.084-0.168, 0.151-0.247, p<0.001) and general distress (Zr=0.542, 95% CI=0.332-0.752, p<0.001). Stronger effect sizes were observed for mixed daily stressors relative to subjective, interpersonal, and material daily stressors, and for general distress relative to posttraumatic stress symptoms and general well-being. Effect sizes were also stronger for children and adolescents relative to adults. Daily stressors fully mediated the associations of prior trauma with post-migration anxiety, depressive, and post-traumatic stress disorder symptoms. CONCLUSIONS This meta-analysis provides a synthesis of existing research on the role of unfavorable everyday life experiences and their associations with poor mental health among conflict-affected forced migrants. Routine assessment and intervention to reduce daily stressors can prevent and reduce psychiatric morbidity in these populations.
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Affiliation(s)
- Wai Kai Hou
- Laboratory of Psychology and Ecology of Stress (LoPES), Department of Psychology, Centre for Psychosocial Health, The Education University of Hong Kong, Tai Po, NT, Hong Kong, China.
| | - Huinan Liu
- Laboratory of Psychology and Ecology of Stress (LoPES), Department of Psychology, Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Li Liang
- Laboratory of Psychology and Ecology of Stress (LoPES), Department of Psychology, Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Jeffery Ho
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hyojin Kim
- Teachers College, Columbia University, New York NY, USA
| | - Eunice Seong
- Teachers College, Columbia University, New York NY, USA
| | | | | | - Brian J. Hall
- Department of Psychology, University of Macau, Macau SAR, China
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20
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Exploring the effectiveness of the Tree of Life in promoting the therapeutic growth or refugee women living with HIV. ARTS IN PSYCHOTHERAPY 2019. [DOI: 10.1016/j.aip.2019.101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Mental Health of Refugees and Torture Survivors: A Critical Review of Prevalence, Predictors, and Integrated Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132309. [PMID: 31261840 PMCID: PMC6651013 DOI: 10.3390/ijerph16132309] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/27/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
Civilian war trauma and torture rank among the most traumatic life experiences; exposure to such experiences is pervasive in nations experiencing both internal and external conflict. This has led to a high volume of refugees resettling throughout the world with mental health needs that primary care physicians may not be screening for and prepared to effectively address. In this article, we review the literature on demographics, predictors, mental health outcomes of torture, and integrated care for the mental health needs of refugees. We searched PubMed and PSYCINFO databases for original research articles on refugees and mental health published in the English language between 2010 and present. Nine percent of 720 adults in conflict areas in Nepal, with predominance of literate married males, met the threshold for Post-Traumatic Stress Disorder (PTSD), 27.5% for depression, and 22.9% for anxiety. While, PTSD rate has been documented as high as 88.3% among torture survivors from Middle East (ME), Central Africa (CA), South Asia (SA), Southeast Europe (SE). Depression was recorded as high as 94.7% among 131 African torture survivors and anxiety as high as 91% among 55 South African torture survivors. Torture severity, post-migration difficulties, and wait time to receive clinical services were significantly associated with higher rate of mental health symptoms. Mental health screening is not a standard component of initial physical exams for refugees, yet these individuals have had high trauma exposure that should inform clinical care. Integrated care models are lacking but would greatly benefit this community to prevent progression to greater severity of mental health symptoms.
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Steil R, Gutermann J, Harrison O, Starck A, Schwartzkopff L, Schouler-Ocak M, Stangier U. Prevalence of prolonged grief disorder in a sample of female refugees. BMC Psychiatry 2019; 19:148. [PMID: 31088419 PMCID: PMC6518607 DOI: 10.1186/s12888-019-2136-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/30/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) is a distinct syndrome that follows bereavement. It is different from other mental disorders and is characterized by symptoms such as yearning for the bereaved, or intense emotional pain or distress. Violent loss is one major risk factor for the development of PGD. OBJECTIVES PGD has been studied in different populations, mostly in small samples, with only a few of them being representative. Although research highlighted that traumatic experiences paired with challenges related to migration make refugees particularly vulnerable to PGD, PGD has only rarely been studied in refugees. Thus, this article a) examines the prevalence of PGD in female refugees in Germany according to the criteria proposed by Prigerson and colleagues in 2009, and b) associates PGD with other common psychopathology (e.g. anxiety, depression, somatization and trauma). METHOD A total of 106 female refugees were assessed for bereavement and PGD. Of these 106 individuals, 85 were interviewed using the Prolonged Grief Disorder Scale (PG-13). Symptoms of anxiety and depression were assessed by the Hopkins Symptom Checklist-25 (HSCL-25), somatization was assessed by the Somatization Subscale of the Symptom-Checklist-90 (SCL-90), and the number of witnessed and experienced trauma was assessed by the Posttraumatic Diagnostic Scale (PDS/HTQ). RESULTS Ninety of the 106 participants had experienced bereavement, and among those, 9.41% met criteria for PGD. The most frequent PGD symptoms were bitterness, longing or yearning for the bereaved, and lack of acceptance of the loss. Furthermore, grief symptoms were significantly associated with symptoms of depression, anxiety, somatization, and the number of experienced traumatic events. CONCLUSION The PGD prevalence rate found corresponds with previous studies, demonstrating that prevalence rates for PGD are especially high in refugees. High prevalence rates of bereavement as well as PGD highlight the need for assessment and specifically tailored treatment of PGD in refugees. PGD goes along with significant psychopathology, which further emphasizes the need for treatment.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany.
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Octavia Harrison
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Annabelle Starck
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Laura Schwartzkopff
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
| | - Meryam Schouler-Ocak
- Department of Psychiatry, Institute of Medicine, University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt on Main, Hesse, Germany
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Post-migration treatment targets associated with reductions in depression and PTSD among survivors of torture seeking asylum in the USA. Psychiatry Res 2019; 271:565-572. [PMID: 30554104 DOI: 10.1016/j.psychres.2018.12.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 12/20/2022]
Abstract
Mental health research among asylum seekers and refugees has largely focused on effects of pre-migration trauma on post-migration wellbeing. While emerging literature highlights the importance of post-migration factors, we do not yet understand how addressing these factors may influence change in psychological distress. This study uses archival clinical data to identify post-migration correlates of reductions in distress among torture survivors, after accounting for pre-migration trauma. Depression (Patient Health Questionnaire-9) and Post Traumatic Stress Disorder (PTSD; Harvard Trauma Questionnaire) were measured among torture survivors following 6 months of interdisciplinary treatment (N = 323). Relationships between pre-, post-migration factors, and changes in symptom levels from intake to six months follow-up, were evaluated using regression analyses. Average levels of depression and PTSD significantly reduced after six months of treatment. Higher exposure to pre-migration trauma, female gender, and change to a more secure visa status were associated with reduced distress. Accessing more social services and not reporting chronic pain were associated with reduced PTSD. Stable housing and employment significantly moderated the relationship between lower chronic pain and reduced PTSD. Although effect sizes were small, results emphasize the importance of post-migration factors on wellbeing among torture survivors and are a first step towards identifying key treatment targets.
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von Werthern M, Robjant K, Chui Z, Schon R, Ottisova L, Mason C, Katona C. The impact of immigration detention on mental health: a systematic review. BMC Psychiatry 2018; 18:382. [PMID: 30522460 PMCID: PMC6282296 DOI: 10.1186/s12888-018-1945-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of asylum seekers, refugees and internally displaced people worldwide has increased dramatically over the past 5 years. Many countries are continuing to resort to detaining asylum seekers and other migrants, despite concerns that this may be harmful. In light of the considerable body of recent research, this review aims to update and expand on a 2009 systematic review on the mental health consequences of detention on adult, adolescent and child immigration detainees, which found (on the basis on 9 studies) that there was consistent evidence that immigration detention had adverse effects on mental health. METHODS Three databases were searched using key terms relating to immigration detention and mental health. Electronic searches were supplemented by reference screening. Studies were included if they were quantitative, included individuals detained for immigration purposes, reported on mental health problems and were published in peer-reviewed journals. Two reviewers independently screened papers for eligibility, and a further two reviewers completed quality appraisals for included studies. RESULTS Twenty- six studies (21 of which were not included in the 2009 review) reporting on a total of 2099 participants were included in the review. Overall, these studies indicated that adults, adolescents and children experienced high levels of mental health problems. Anxiety, depression and post-traumatic stress disorder were most commonly reported both during and following detention. Higher symptom scores were found in detained compared to non-detained refugees. In addition (and more clearly than was evident in 2009), detention duration was positively associated with severity of mental symptoms. Greater trauma exposure prior to detention was also associated with symptom severity. CONCLUSIONS The literature base reviewed in this paper consistently demonstrated severe mental health consequences amongst detainees across a wide range of settings and jurisdictions. There is a pressing need for the proper consideration of mental health and consequent risk of detention-related harm in decisions surrounding detention as well as for improved care for individuals within detention facilities. Recommendations based on these findings are presented, including increased focus on the identification of vulnerability and on minimising the duration of detention.
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Affiliation(s)
- M. von Werthern
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - K. Robjant
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - Z. Chui
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - R. Schon
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - L. Ottisova
- Health Services and Population Research Department, Kings College London, London, UK
| | - C. Mason
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - C. Katona
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
- Division of Psychiatry, University College London, London, UK
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Ziersch A, Due C. A mixed methods systematic review of studies examining the relationship between housing and health for people from refugee and asylum seeking backgrounds. Soc Sci Med 2018; 213:199-219. [PMID: 30142501 DOI: 10.1016/j.socscimed.2018.07.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/28/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022]
Abstract
Housing is an important social determinant of health and a key element of refugee integration into countries of resettlement. However, the way in which housing may affect mental and physical health for refugees and asylum seekers has not been systematically examined. This systematic review aimed to explore the effects of housing on health and wellbeing for this population, in order to identify key pathways for public health interventions. The review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Social Care Institute for Excellence (SCIE) guidelines. We identified publications through a search of Medline, PsychInfo, Scopus, Web of Science, Embase, CINAHL, Cohrane Library, Google, ProQuest, OpenGrey, MedNar and WHOLIS. Eligibility criteria included: publication in English between 1997 and 2017, with findings pertaining to the relationship between housing and health for refugees and/or asylum seekers. Out of 2371 items, 25 papers were included with a further five identified through reference lists. Eleven of the papers explored housing and health for those refugees and asylum seekers living within refugee camps, with 19 focusing on countries of resettlement. All studies identified housing issues for refugees and asylum seekers, with physical housing conditions particularly poor in refugee camps, and issues of affordability, suitability, insecure tenure and mobility as well as difficulties securing housing also highlighted in countries of resettlement. Consistent relationships were found between physical aspects of housing and physical and mental health, with other aspects of housing such as safety and overcrowding linked to mental health. There were a number of methodological issues with most of the studies, making it difficult to specify precise pathways. However, improvements to housing quality particularly in refugee camps, and targeted housing interventions more generally for refugees and asylum seekers would likely have an important public health benefit.
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Affiliation(s)
- Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, SA, 5001, Australia.
| | - Clemence Due
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, SA, 5001, Australia; School of Psychology, University of Adelaide, SA, 5001, Australia.
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Le L, Morina N, Schnyder U, Schick M, Bryant RA, Nickerson A. The effects of perceived torture controllability on symptom severity of posttraumatic stress, depression and anger in refugees and asylum seekers: A path analysis. Psychiatry Res 2018; 264:143-150. [PMID: 29631246 DOI: 10.1016/j.psychres.2018.03.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
Torture is associated with greater psychopathology, however, the specific mechanisms underlying the effects of torture remain unclear. Research suggests that the perceived uncontrollable nature of, rather than the exposure to, torture, influences the development of psychological disorders. Perceived distress during torture has also been shown to influence psychological outcomes. This cross-sectional study explored the relationship between perceived torture controllability, emotions (i.e., anger and fear) during torture, and current posttraumatic stress (PTS), depression and anger symptoms, controlling for the effects of post-migration living difficulties. Data were collected from 108 refugees and asylum seekers in treatment at two psychiatric clinics in Zurich, Switzerland. Path analyses revealed negative correlations between PTS, depression and anger symptoms, and perceived torture controllability, and positive correlations with anger and fear during torture. Furthermore, the effects of perceived torture controllability on PTS and depression symptoms were mediated by fear during torture, and on anger symptoms via anger during torture. This was over and above the effects of post-migration living difficulties on psychological symptoms. The study provides preliminary evidence that perceived uncontrollability and distress during torture might be significant risk factors for current mental health of torture survivors. These findings may have implications for informing interventions for torture survivors.
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Affiliation(s)
- Lillian Le
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Naser Morina
- Department of Psychiatry and Psychotherapy, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia.
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Posttraumatic Stress Disorder, Orientation to Pain, and Pain Perception in Ex-Prisoners of War Who Underwent Torture. Psychosom Med 2018; 79:655-663. [PMID: 28658194 DOI: 10.1097/psy.0000000000000461] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Studies suggest that torture survivors often experience long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture or rather the subsequent posttraumatic stress disorder (PTSD) explains these pain problems. Furthermore, although catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations. METHODS Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain threshold and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain. RESULTS Although chronic pain was associated with PTSD (0.44 < β < 0.49, p < .002), increased pain perception was correlated with torture (0.33 < β < 0.65, p < .05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (β = 0.18 and 0.19, respectively; p < .05). Fear of pain moderated the association between torture and pain perception (β = 0.41 and 0.42, respectively; p < .017). CONCLUSIONS The findings suggest that chronic pain is contingent upon the psychological toll of torture, that is, PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to previous experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences after trauma.
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Abstract
The psychological effects of war represent a growing public health concern as more refugees and asylum seekers migrate across borders. This study investigates whether sociodemographic, premigration and postmigration, and psychosocial factors predict adverse psychiatric symptoms in refugees and asylum seekers exposed to torture (N = 278). Hierarchical linear regressions revealed that female sex, older age, and unstable housing predicted greater severity of anxiety, posttraumatic stress disorder (PTSD), and depression. Cumulative exposure to multiple torture types predicted anxiety and PTSD, while mental health, basic resources (access to food, shelter, medical care), and external risks (risk of being victimized at home, community, work, school) were the strongest psychosocial predictors of anxiety, PTSD, and depression. Also, time spent in the United States before presenting for services significantly predicted anxiety, PTSD, and depression. Consequently, public-sector services should seek to engage this high-risk population immediately upon resettlement into the host country using a mental health stepped care approach.
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Slobodin O, Ghane S, De Jong J. Developing a culturally sensitive mental health intervention for asylum seekers in the Netherlands: A pilot study. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2018. [DOI: 10.4103/intv.intv_2_18] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Whitsett D, Sherman MF. Do resettlement variables predict psychiatric treatment outcomes in a sample of asylum-seeking survivors of torture? Int J Soc Psychiatry 2017; 63:674-685. [PMID: 28838279 DOI: 10.1177/0020764017727022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Mental health clinicians who work with asylum seekers provide services to patients who face stressful everyday living conditions. However, little is known about how these problems potentially impact psychiatric treatment within these populations. The purpose of this study was thus to examine whether resettlement factors predict outcomes of a mental health intervention for a sample of asylum-seeking survivors of torture. METHODS The study included data from a US outpatient clinic that specialized in treating asylum-seeking survivors of torture. Patients (primarily from Iraq, Afghanistan and African Countries) were evaluated on demographic factors at intake and psychiatric symptoms throughout the course of treatment. RESULTS Patients experienced significant reductions in depression, anxiety and trauma symptoms, although symptoms still remained near or above clinical thresholds. Stable, uncrowded housing conditions significantly predicted lower depression, anxiety and trauma symptoms at follow-up. CONCLUSION These findings support the hypotheses that individuals seeking asylum within the United States who have survived torture can benefit from psychiatric treatment and emphasize the importance of stable living conditions in improving treatment effectiveness. This suggests the need for further research on social predictors of treatment outcomes, as well as the need for clinicians and policymakers to target improved housing as a potentially important tool to reduce psychiatric problems related to torture and forced migration.
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Affiliation(s)
- David Whitsett
- Department of Psychology, Loyola University Maryland, Baltimore, MD, USA
| | - Martin F Sherman
- Department of Psychology, Loyola University Maryland, Baltimore, MD, USA
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Bustamante LHU, Cerqueira RO, Leclerc E, Brietzke E. Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review. ACTA ACUST UNITED AC 2017; 40:220-225. [PMID: 29069252 PMCID: PMC6900760 DOI: 10.1590/1516-4446-2017-2290] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/13/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services. METHODS The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017. The following keywords were used: migration, mental health, mental health services, stress, posttraumatic stress disorder, and trauma. RESULTS Migration is associated with specific stressors, mainly related to the migratory experience and to the necessary process of acculturation occurring in adaptation to the host country. These major stressors have potential consequences in many areas, including mental health. The prevalence of PTSD among migrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers. CONCLUSIONS Mental health professionals must be trained to recognize and provide appropriate care for posttraumatic and/or stress-related disorders among migrants.
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Affiliation(s)
- Lineth H U Bustamante
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Raphael O Cerqueira
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Emilie Leclerc
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elisa Brietzke
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Jayawickreme N, Verkuilen J, Jayawickreme E, Acosta K, Foa EB. Measuring Depression in a Non-Western War-Affected Displaced Population: Measurement Equivalence of the Beck Depression Inventory. Front Psychol 2017; 8:1670. [PMID: 29018389 PMCID: PMC5622946 DOI: 10.3389/fpsyg.2017.01670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022] Open
Abstract
Depression is commonly seen in survivors of conflict and disaster across the world. There is a dearth of research on the validity of commonly used measures of depression in these populations. Measurements of depression that are used in multiple contexts need to meet measurement equivalence, i.e., the instrument measures the same construct in the same manner across different groups. The Beck Depression Inventory (BDI) was administered to female trauma survivors in the United States (n = 268) and female survivors of war in Sri Lanka (n = 149). Three metrics of measurement equivalence—structural, metric, and scalar—were examined. Two- and three-factor structures of the BDI that have been identified in other populations did not provide a good fit for our data. However, a bifactor model revealed a similar general distress dimension across populations, but dissimilar secondary dimensions or subfactors. The Sri Lankan subfactor comprised of predominantly somatic symptoms and the United States subfactor comprised of cognitive and somatic symptoms. While intercepts of individual BDI items differed, their differences seem to be offsetting. Total BDI scores across these two populations are roughly comparable, although caution is recommended when interpreting them. Making comparisons on subscales is not recommended.
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Affiliation(s)
- Nuwan Jayawickreme
- Department of Psychology, Manhattan College, New York City, NY, United States
| | - Jay Verkuilen
- Department of Educational Psychology, City University of New York, New York City, NY, United States
| | - Eranda Jayawickreme
- Department of Psychology, Wake Forest University, Winston-Salem, NC, United States
| | - Kaylaliz Acosta
- Department of Psychology, Manhattan College, New York City, NY, United States
| | - Edna B Foa
- Department of Psychiatry, Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA, United States
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Exploring the Relationship between Housing and Health for Refugees and Asylum Seekers in South Australia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091036. [PMID: 28885594 PMCID: PMC5615573 DOI: 10.3390/ijerph14091036] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 02/08/2023]
Abstract
Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.
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Tsur N, Shahar G, Defrin R, Lahav Y, Ginzburg K. Torturing personification of chronic pain among torture survivors. J Psychosom Res 2017; 99:155-161. [PMID: 28712422 DOI: 10.1016/j.jpsychores.2017.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Consistent with the human tendency to anthropomorphize objects, events, and situations, individuals might ascribe human characteristics to physical symptoms and illnesses. This manuscript presents an examination of chronic pain personification in torture survivors. Specifically, it was hypothesized that torture survivors personify chronic pain as a torturing sensation. It was further hypothesized that PTSD mediates the effect of past torture on torturing pain personification. METHODS Fifty-nine Israeli ex-prisoners of war (ex-POWs), who experienced severe torture in captivity, and 44 matched controls completed self-administered questionnaires at 18, 30, and 35years post captivity. RESULTS Whereas ex-POWs exhibit higher torturing personification than controls, no differences were found in concrete description of chronic pain. PTSD trajectories were implicated in different levels of torturing personification. Finally, sequential mediation analysis revealed that PTSD at T2 and T3 mediated the association between torture and torturing personification. CONCLUSIONS The findings suggest that trauma shapes the way individuals relate to and experience their bodily sensations.
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Affiliation(s)
- Noga Tsur
- The Bob Shapell School of Social Work, Tel Aviv University, Israel.
| | - Golan Shahar
- Stress, Self & Health (STREALTH) Lab, Department of Psychology, Ben-Gurion University of the Negev, Israel
| | - Ruth Defrin
- Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yael Lahav
- The Bob Shapell School of Social Work, Tel Aviv University, Israel; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Karni Ginzburg
- The Bob Shapell School of Social Work, Tel Aviv University, Israel
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LeMaster JW, Broadbridge CL, Lumley MA, Arnetz JE, Arfken C, Fetters MD, Jamil H, Pole N, Arnetz BB. Acculturation and post-migration psychological symptoms among Iraqi refugees: A path analysis. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2017; 88:38-47. [PMID: 28253013 DOI: 10.1037/ort0000240] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Refugees frequently experience symptoms of posttraumatic stress and depression, which impede their acculturation in the new host country where they are resettling. There are few longitudinal studies investigating predictors of mental health and acculturation during the early postmigration period. We conducted a longitudinal study of 298 Iraqi refugees, assessing them upon arrival to the U.S. and 1 year after migration. Premigration trauma was associated with increased PTSD and depressive symptoms at baseline, and with decreased acculturation 1 year later. Resilience was associated with depressive symptoms at 1-year follow-up, but not with other resettlement outcomes (PTSD symptoms, English-language skills, or acculturation). PTSD and depressive symptoms at baseline predicted the same symptoms at 1-year follow-up, but not any other resettlement outcomes. The number of chronic diseases at baseline predicted worse PTSD and depressive symptoms, acculturation, and English language skills at 1-year follow up. Postmigratory exposure to daily stressors and less social support predicted worse 1-year outcomes. Results suggest that interventions that aim to improve mental health and promote acculturation among refugees should assess their history of trauma, chronic disorders, and psychological symptoms soon after migration, and promptly provide opportunities for social support. (PsycINFO Database Record
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Affiliation(s)
- Joseph W LeMaster
- Department of Family Medicine, Family Medicine Research Division, University of Kansas
| | | | | | - Judith E Arnetz
- Department of Family Medicine and Public Health Sciences, Wayne State University
| | - Cynthia Arfken
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University
| | | | - Hikmet Jamil
- Department of Family Medicine and Public Health Sciences, Wayne State University
| | | | - Bengt B Arnetz
- Department of Family Medicine and Public Health Sciences, Wayne State University
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Kaltenbach E, Härdtner E, Hermenau K, Schauer M, Elbert T. Efficient identification of mental health problems in refugees in Germany: the Refugee Health Screener. Eur J Psychotraumatol 2017; 8:1389205. [PMID: 29163869 PMCID: PMC5687797 DOI: 10.1080/20008198.2017.1389205] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/29/2017] [Indexed: 11/06/2022] Open
Abstract
Background: A substantial number of refugees present with mental disorders. This appears particularly acute in the currently increasing refugee populations in Europe. Although EU guidelines demand the identification and support of vulnerable individuals such as survivors of trauma, no adequately validated and comprehensive mental health screening instruments for refugees residing in Europe currently exist. Objective: We studied the feasibility, validity, and reliability of the Refugee Health Screener-15 (RHS-15) - a time-efficient and easy-to-implement screening developed by Hollifield et al. (2013) - as a self-rating and interview instrument. Methods: A sample of refugees from different countries (N = 86), representative of those who had arrived around the turn of the year 2015/2016 in Germany, filled in the RHS-15 on their own. A semi-structured clinical interview was later conducted with a random subsample (n = 56). Results: Fifty-two percent of the refugees examined screened positive in the RHS-15, thus indicating current mental health problems. The RHS-15 showed a good feasibility, reliability, and validity in both the self-rating and the interview version. It detected clinically relevant mental health problems when PTSD, depression, anxiety, or somatization problems were present. A shorter 13-item version proved to be equally valid. Conclusions: Together with previous research on the RHS in refugees living in the US, this suggests that the RHS is a time-efficient and accurate instrument that is able to detect common mental health problems in a wide range of refugees. Prospectively, the RHS could be used as an instrument for identifying vulnerable refugees, for example, by integrating it in the initial medical examination in the host community, thereby initiating support.
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Affiliation(s)
- Elisa Kaltenbach
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Eva Härdtner
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | - Maggie Schauer
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
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Abstract
Refugees demonstrate high rates of post-traumatic stress disorder (PTSD) and other psychological disorders. The recent increase in forcible displacement internationally necessitates the understanding of factors associated with refugee mental health. While pre-migration trauma is recognized as a key predictor of mental health outcomes in refugees and asylum seekers, research has increasingly focused on the psychological effects of post-migration stressors in the settlement environment. This article reviews the research evidence linking post-migration factors and mental health outcomes in refugees and asylum seekers. Findings indicate that socioeconomic, social, and interpersonal factors, as well as factors relating to the asylum process and immigration policy affect the psychological functioning of refugees. Limitations of the existing literature and future directions for research are discussed, along with implications for treatment and policy.
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Hoffman SJ, Robertson CL, Shannon PJ, Cook TL, Letts J, Mathiason MA. Physical Correlates of Torture Exposure in Karen Refugees. JOURNAL OF LOSS & TRAUMA 2016. [DOI: 10.1080/15325024.2016.1212609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sequenzielle Traumatisierungen, Traumafolgestörungen und psychotherapeutische Behandlungsansätze bei kriegstraumatisierten erwachsenen Flüchtlingen in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:621-6. [DOI: 10.1007/s00103-016-2337-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nordbrandt MS, Carlsson J, Lindberg LG, Sandahl H, Mortensen EL. Treatment of traumatised refugees with basic body awareness therapy versus mixed physical activity as add-on treatment: Study protocol of a randomised controlled trial. Trials 2015; 16:477. [PMID: 26492879 PMCID: PMC4619210 DOI: 10.1186/s13063-015-0974-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 09/23/2015] [Indexed: 11/23/2022] Open
Abstract
Background Treatment of traumatised refugees is one of the fields within psychiatry, which has received little scientific attention. Evidence based treatment and knowledge on the efficiency of the treatment for this complex patient group is therefore scarce. This leads to uncertainty as to which treatment should be offered and potentially lowers the quality of life for the patients. Chronic pain is very common among traumatised refugees and it is believed to maintain the mental symptoms of trauma. Hence, treating chronic pain is believed to be of high clinical value for this patient group. In clinical studies, physical activity has shown a positive effect on psychiatric illnesses such as depression and anxiety and for patients with chronic pain. However, scientific knowledge about physical activity as part of the treatment for traumatised refugees is very limited and no guidelines exist on this topic. Methods/design This study will include approximately 310 patients, randomised into three groups. All three groups receive psychiatric treatment as usual for the duration of 6–7 months, consisting of consultations with a medical doctor including pharmacological treatment and manual-based Cognitive Behavioural Therapy. The first group only receives treatment as usual while the second and the third groups receive either Basic-Body Awareness Therapy or mixed physical activity as add-on treatments. Each physical activity is provided for an individual 1-hour consultation per week, for the duration of 20 weeks. The study is being conducted at the Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup in the Capital Region of Denmark. The primary endpoint of the study is symptoms of Post Traumatic Stress Disorder; the secondary endpoints are depression and anxiety as well as quality of life, functional capacity, coping with pain, body awareness and physical fitness. Discussion This study will examine the effect of physical activity for traumatised refugees. This has not yet been done in a randomised controlled setting on such a large scale before. Hereby the study will contribute to important knowledge that is expected to be used in future clinical guidelines and reference programs. Trial registration ClinicalTrials.gov NCT01955538. Date of registration: 18 September 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0974-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maja Sticker Nordbrandt
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevænget 2, 2750, Ballerup, Denmark.
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevænget 2, 2750, Ballerup, Denmark.
| | - Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevænget 2, 2750, Ballerup, Denmark.
| | - Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevænget 2, 2750, Ballerup, Denmark.
| | - Erik Lykke Mortensen
- Section of Occupational and Environmental Health, Øster Farimagsgade 5, building 5, 1., 1353, København K, Denmark.
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