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Mendez L, Kerig PK. Newcomers to Unwelcoming Lands: A Conceptual Review of the Dimensions of Discrimination Experienced by Refugee Youth and the Processes Imparting Risk and Resilience. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:903-915. [PMID: 38045850 PMCID: PMC10689638 DOI: 10.1007/s40653-023-00534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 12/05/2023]
Abstract
In 2018, half of refugees worldwide were under the age of 18. Although often resilient, refugee youth experience chronic and pervasive traumatic events prior to and during migration, and are at risk for continued victimization and stressors while in their host country. In particular, refugee youth encounter ongoing discrimination during resettlement, a primary stressor that reduces their wellbeing and adaptation. Given the relevance of discrimination for refugee youth, the goal of the current review is to increase our understanding of the dimensions of discrimination faced by refugee youth and the risk and resilience processes that may be involved in these negative experiences. Thus, this review presents the existing theoretical and empirical research on this topic and creates a model that organizes these findings. The present review concludes with recommendations for prevention and intervention efforts and considerations for future research.
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Affiliation(s)
- Lucybel Mendez
- University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT 84112 USA
- Department of Psychology, University of Utah, 380 S 1530 E BEH S 502, Salt Lake City, UT 84112 USA
| | - Patricia K. Kerig
- University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT 84112 USA
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Neville SE, DiClemente-Bosco K, Chamlagai LK, Bunn M, Freeman J, Berent JM, Gautam B, Abdi A, Betancourt TS. Investigating Outcomes of a Family Strengthening Intervention for Resettled Somali Bantu and Bhutanese Refugees: An Explanatory Sequential Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12415. [PMID: 36231735 PMCID: PMC9566609 DOI: 10.3390/ijerph191912415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Pre- and post-migration stressors can put resettled refugee children at risk of poor mental health outcomes. The Family Strengthening Intervention for Refugees (FSI-R) is a peer-delivered preventative home visiting program for resettled refugees that aims to draw upon families' strengths to foster improved family communication, positive parenting, and caregiver-child relationships, with the ultimate goal of reducing children's risk of mental health problems. Using an explanatory sequential mixed methods design, this study draws upon qualitative interviews with caregivers (n = 19) and children (n = 17) who participated in a pilot study of the FSI-R intervention in New England, as well as interventionists (n = 4), to unpack quantitative findings on mental health and family functioning from a randomized pilot study (n = 80 families). Most patterns observed in the quantitative data as published in the pilot trial were triangulated by qualitative data. Bhutanese caregivers and children noted that children were less shy or scared to speak up after participating in the FSI-R. Somali Bantu families spoke less about child mental health and underscored feasibility challenges like language barriers between caregivers and children. Interventionists suggested that families with higher levels of education were more open to implementing behavior change. In both groups, families appreciated the intervention and found it to be feasible and acceptable, but also desired additional help in addressing broader family and community needs such as jobs and literacy programs.
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Affiliation(s)
- Sarah Elizabeth Neville
- Intenational Health Institute, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Kira DiClemente-Bosco
- Center for Dissemination and Implementation Science, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lila K. Chamlagai
- Brown Mindfulness Center, Behavioral Health and Social Science Department, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Mary Bunn
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Jordan Freeman
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jenna M. Berent
- Research Program on Children in Adversity, School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
| | - Bhuwan Gautam
- College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | | | - Theresa S. Betancourt
- Research Program on Children in Adversity, School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
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Grieco-Page H, Black CJ, Berent JM, Gautam B, Betancourt TS. Beyond the Pandemic: Leveraging Rapid Expansions in U.S. Telemental Health and Digital Platforms to Address Disparities and Resolve the Digital Divide. Front Psychiatry 2021; 12:671502. [PMID: 34421669 PMCID: PMC8377496 DOI: 10.3389/fpsyt.2021.671502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/14/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Haley Grieco-Page
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
| | - Candace J. Black
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
| | - Jenna M. Berent
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
| | - Bhuwan Gautam
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
- Bhutanese Society of Western Massachusetts, Springfield, MA, United States
| | - Theresa S. Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, United States
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African Refugee Youth's Experiences of Navigating Different Cultures in Canada: A "Push and Pull" Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042063. [PMID: 33672518 PMCID: PMC7923778 DOI: 10.3390/ijerph18042063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
Refugee youth face challenges in navigating different cultures in destination countries and require better support. However, we know little about the adaptation experiences of African refugee youth in Canada. Accordingly, this paper presents the adaptation experiences of African refugee youth and makes recommendations for ways to support youth. Twenty-eight youth took part in semi-structured interviews. Using a thematic analysis approach, qualitative data revealed four themes of: (1) ‘disruption in the family,’ where youth talked about being separated from their parent(s) and the effect on their adaptation; (2) ‘our cultures are different,’ where youth shared differences between African and mainstream Canadian culture; (3) ‘searching for identity: a cultural struggle,’ where youth narrated their struggles in finding identity; and (4) ‘learning the new culture,’ where youth narrated how they navigate African and Canadian culture. Overall, the youth presented with challenges in adapting to cultures in Canada and highlighted how these struggles were influenced by their migration journey. To promote better settlement and adaptation, youth could benefit from supports and activities that promote cultural awareness with attention to their migration experiences. Service providers could benefit from newcomer-friendly and culturally sensitive training on salient ways of how experiences of multiple cultures affect integration outcomes.
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Family-Based Mental Health Promotion for Somali Bantu and Bhutanese Refugees: Feasibility and Acceptability Trial. J Adolesc Health 2020; 66:336-344. [PMID: 31699604 PMCID: PMC7007860 DOI: 10.1016/j.jadohealth.2019.08.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/29/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE There are disparities in mental health of refugee youth compared with the general U.S. POPULATION We conducted a pilot feasibility and acceptability trial of the home-visiting Family Strengthening Intervention for refugees (FSI-R) using a community-based participatory research approach. The FSI-R aims to promote youth mental health and family relationships. We hypothesized that FSI-R families would have better psychosocial outcomes and family functioning postintervention compared with care-as-usual (CAU) families. We hypothesized that FSI-R would be feasible to implement and accepted by communities. METHODS A total of 40 Somali Bantu (n = 103 children, 58.40% female; n = 43 caregivers, 79.00% female) and 40 Bhutanese (n = 49 children, 55.30% female; n = 62 caregivers, 54.00% female) families were randomized to receive FSI-R or CAU. Refugee research assistants conducted psychosocial assessments pre- and post-intervention, and home visitors delivered the preventive intervention. Multilevel modeling assessed the effects of FSI-R. Feasibility was measured from retention, and acceptability was measured from satisfaction surveys. RESULTS The retention rate of 82.50% indicates high feasibility, and high reports of satisfaction (81.50%) indicate community acceptance. Across communities, FSI-R children reported reduced traumatic stress reactions, and caregivers reported fewer child depression symptoms compared with CAU families (β = -.42; p = .03; β = -.34; p = .001). Bhutanese FSI-R children reported reduced family arguing (β = -1.32; p = .04) and showed fewer depression symptoms and conduct problems by parent report (β = -9.20; p = .04; β = -.92; p = .01) compared with CAU. There were no significant differences by group on other measures. CONCLUSIONS A family-based home-visiting preventive intervention can be feasible and acceptable and has promise for promoting mental health and family functioning among refugees.
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Affiliation(s)
- Bruno Falissard
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France.
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Frounfelker RL, Tahir S, Abdirahman A, Betancourt TS. Stronger together: Community resilience and Somali Bantu refugees. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2020; 26:22-31. [PMID: 30920250 PMCID: PMC6765444 DOI: 10.1037/cdp0000286] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Refugee populations are at risk of adverse mental health outcomes. It is important to identify refugee strengths at the community level that can be leveraged to overcome barriers to well-being. In pursuit of this goal, this study focuses on identifying what promotes community resilience among Somali Bantu refugees in the United States. METHOD Researchers used snowball-sampling strategies in a large New England city to recruit 81 Somali Bantu youth and adults to participate in 14 focus groups conducted between 2011 and 2013. Researchers used principles of thematic content analysis to analyze data specific to the construct of community resilience. RESULTS Authors identified 2 main components of Somali Bantu community resilience: independence and cultural preservation. There were 2 themes related to promoting community resilience among Somali Bantu: commitment to community, and religion and spirituality. CONCLUSIONS We discuss the importance of identifying culturally informed components of community resilience that can be used to develop services for refugee populations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Rochelle L. Frounfelker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Division of Social and Transcultural Psychiatry. McGill University
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Hodes M. New developments in the mental health of refugee children and adolescents. EVIDENCE-BASED MENTAL HEALTH 2019; 22:72-76. [PMID: 30944095 PMCID: PMC10270370 DOI: 10.1136/ebmental-2018-300065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 12/22/2022]
Abstract
The increase in refugees globally since 2010 and the arrival of many into Europe since 2015, around 50% of whom are under 18 years, have been the stimulus to greater investigation and publications regarding their mental health. This clinical review summarises selected themes in the field as described in the published literature since 2016. The themes include refugee statistics, premigration and postmigration experiences, psychopathology focusing on parent-child relationships, unaccompanied refugee minors and associations between resettlement, acculturation and mental health. Some important reviews and studies are discussed that address service and treatment provision. While there has been a recent increase in research in this field, more is needed into the course of psychopathology, protective factors and the promotion of integration into resettlement countries, as well as models of service delivery and treatment effectiveness.
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Affiliation(s)
- Matthew Hodes
- Department of Medicine, Centre for Psychiatry, Imperial College London, London, UK
- Westminster Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
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Poudel-Tandukar K, Jacelon CS, Chandler GE, Gautam B, Palmer PH. Sociocultural Perceptions and Enablers to Seeking Mental Health Support Among Bhutanese Refugees in Western Massachusetts. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 39:135-145. [DOI: 10.1177/0272684x18819962] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study aimed to identify cultural influences on seeking mental health support among Bhutanese refugees resettled in Western Massachusetts. Bhutanese refugees aged 18 years or older were recruited for eight focus group discussions, organized by age and gender ( N = 67, 49.3% female, mean age = 38, SD = 15.9). The PEN-3 cultural model was used as the theoretical framework to examine the roles of cultural perceptions that influence mental health-seeking behaviors. Focus group discussions were audio taped to facilitate the thematic-analysis. Younger participants (<35 years) reported experiencing stressors relating to economic hardships and difficulties in developing academic and social skills as they juggle breadwinner and care-giving responsibilities for their families. Older participants reported frustration with the difficulties in learning English and increased dependence on their children. Family members provided the initial frontline support to persons with mental health problems. If family support did not work, they consulted with their relatives and trustworthy community members for further assistance. Psychological factors such as fears of emotions, social norms, beliefs, and self-esteem associated with cultural norms and values influenced seeking mental health support. All participants expressed the need to have a culturally tailored intervention to develop acquired skills to improve their self-esteem and self-efficacy in order to integrate into their new social and cultural environment. Because family members make important decisions about seeking mental health support, involving family members in developing and delivering culturally appropriate skill development interventions could be a potential strategy to reduce their stress and increase resilience in this refugee community.
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Affiliation(s)
| | | | | | - Bhuwan Gautam
- Bhutanese Society of Western Massachusetts, Springfield, MA, USA
| | - Paula H. Palmer
- School of Community and Global Health, Claremont Graduate University, CA, USA
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Brown FL, Mishra T, Frounfelker RL, Bhargava E, Gautam B, Prasai A, Betancourt TS. 'Hiding their troubles': a qualitative exploration of suicide in Bhutanese refugees in the USA. Glob Ment Health (Camb) 2019; 6:e1. [PMID: 30854217 PMCID: PMC6401374 DOI: 10.1017/gmh.2018.34] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/25/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach. METHODS Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted. RESULTS Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness. CONCLUSIONS This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees' social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.
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Affiliation(s)
- F. L. Brown
- War Child Holland, Amsterdam, The Netherlands
- Research Program for Children and Global Adversity, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - T. Mishra
- Research Program for Children and Global Adversity, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - R. L. Frounfelker
- Research Program for Children and Global Adversity, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- SHERPA Research Centre, CIUSS Centre-Ouest de l-ile de Montreal, Montreal, Canada
- McGill University, Montreal, Canada
| | | | - B. Gautam
- Research Program for Children and Global Adversity, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Hodes M, Anagnostopoulos D, Skokauskas N. Challenges and opportunities in refugee mental health: clinical, service, and research considerations. Eur Child Adolesc Psychiatry 2018; 27:385-388. [PMID: 29442230 DOI: 10.1007/s00787-018-1115-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Hodes
- Centre for Psychiatry, Hammersmith Hospital Campus, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK.
| | - Dimitris Anagnostopoulos
- Department of Child and Adolescent Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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