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Kirsch J, Maleku A, Kim YK, Aziz T, Dada S, Haran H, Kitchens K. The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences. Community Ment Health J 2024; 60:1255-1270. [PMID: 38691243 DOI: 10.1007/s10597-024-01283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann-Whitney U and Kruskal-Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r = .53, p < .01) and between post-migration difficulties and mental health (r = .33, p < .01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal-Wallis H = 14.76, p < .05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments.
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Affiliation(s)
- Jaclyn Kirsch
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA.
| | - Arati Maleku
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Youn Kyoung Kim
- School of Social Work, Louisiana State University, Baton Rouge, LA, USA
| | | | | | - Hanna Haran
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Katherine Kitchens
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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Khailenko O, Bacon AM. Resilience, avoidant coping and post-traumatic stress symptoms among female Ukrainian refugees and internally displaced people. Int J Soc Psychiatry 2024; 70:1164-1174. [PMID: 39049605 PMCID: PMC11408952 DOI: 10.1177/00207640241264662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Since the Russian full-scale invasion of Ukraine, over 10 million Ukrainians have been displaced from their homes. This has contributed to an increase in post-traumatic stress (PTS) symptoms in both refugees and internally displaced persons (IDPs). Previous research has suggested that refugees may experience higher levels of PTS due to additional stressors inherent in migration to a new country, language barriers and separation from family and social support. PTS symptoms may also be exacerbated by avoidant coping which we proposed would be more prevalent amongst refugees because of the isolating effects of migration-related stressors. AIMS The present study aimed to investigate the relationship between PTS symptoms, resilience and avoidant coping in refugees and IDPs. We predicted that refugees would report higher levels of PTS symptoms and use of avoidant coping strategies, and that avoidant coping would mediate the effect of resilience on PTS symptoms. We tested a moderated mediation model to examine whether this effect differed between IDPs and refugees. METHODS A total of 229 women (108 IDPs and 121 refugees), who were displaced after the full-scale invasion, were recruited using online platforms and volunteering centres. They completed an online questionnaire comprising measures of PTS, resilience and coping. RESULTS We found no significant differences in resilience, PTS symptoms or reported use of avoidance coping strategies between refugees and IDPs. As expected, avoidance coping mediated the negative association between resilience and PTS symptoms, but no group differences in this effect were observed. CONCLUSIONS Contrary to previous research, our findings indicate that PTS symptoms may be similarly problematic for refugees and IDPs. This may be due to increased time since the invasion as many refugees may have had time to adjust. Use of avoidant coping strategies may exacerbate PTS symptoms and our study highlights the need for mental health interventions aimed at reducing PTS symptoms in Ukrainian IDPs and refugees through fostering resilience and adaptive coping strategies.
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Boateng GO, Wachter K, Schuster RC, Burgess TL, Bunn M. A Scoping Review of Instruments Used in Measuring Social Support among Refugees in Resettlement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:805. [PMID: 38929051 PMCID: PMC11203988 DOI: 10.3390/ijerph21060805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
This study aimed to systematically review current research on the application of existing social support scales in research with refugees in resettlement, assess their quality, and identify gaps in measurement to enhance research and practice. A scoping review was conducted on the extant literature published until March 2023. A team of researchers conducted search, sorting, and data extraction processes following best practices for scale development and validation. Of the 1185 studies collected from the search process, 41 articles were retained in the final analysis, from which 17 distinct social support instruments used in research with resettled refugees were identified. An assessment of all 17 instruments showed the presence of one or more limitations associated with construct, criterion, convergent, and/or discriminant validity. Test of reliability was assessed in all studies, with a range of 0.80 to 0.90. Our findings show that most of the research evaluating social support among resettled refugees is conducted without measurement instruments adequately validated in the resettlement context. This analysis highlights the need for rigorously developed social support scales that reflect the lived experiences, needs, and priorities of resettled refugees.
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Affiliation(s)
- Godfred O. Boateng
- School of Global Health, York University, Toronto, ON M3J 1P3, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON M3J 1P3, Canada
| | - Karin Wachter
- School of Social Work, Arizona State University, Phoenix, AZ 85004, USA; (K.W.); (T.L.B.)
| | - Roseanne C. Schuster
- School of Human Evolution and Social Change, Arizona State University, Phoenix, AZ 85069, USA;
| | - Tanya L. Burgess
- School of Social Work, Arizona State University, Phoenix, AZ 85004, USA; (K.W.); (T.L.B.)
| | - Mary Bunn
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL 60612, USA;
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Alduraidi H, Al Karmi F, Mustafa A, Alzu'bi M, Odeh N, Alrawabdeh J, Alzyoud M. The Impact of War Trauma and Housing Environment on Mental Wellbeing of Syrian Refugees in Jordan: A Comparison between In-Camp and Urban Populations. Issues Ment Health Nurs 2024; 45:186-195. [PMID: 38301172 DOI: 10.1080/01612840.2023.2297306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The aim of this study is to compare mental wellbeing and levels of post-trauma distress between Syrian refugees who live inside camps and those who live outside camps in Jordan through a survey-based cross-sectional design, where data were collected from 240 adult Syrian refugees in Jordan. The Arabic versions of the Mental Health Continuum Short Form (MHC-SF), and the Impact of Event Scale-Revised (IES-R) were used to quantitatively measure variables through descriptive statistics and multiple comparative analysis tests. Despite having no significant correlation with residence, findings of the MHC-SF showed significance for mental wellbeing with employment status and income. Whereas IES-R showed that camp refugees fared significantly better in terms of trauma effect than urban refugees. It can be concluded that Syrian refugees living inside camps were disadvantaged in terms of mental wellbeing but slightly less affected by war in comparison to those living in urban areas. Improved programs and policies are needed to uplift the mental wellbeing of Syrian refugees in Jordan and to minimize the destructive traumatic effects of the Syrian war on their wellness.
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Affiliation(s)
| | - Feras Al Karmi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Anas Mustafa
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Marah Alzu'bi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Nada Odeh
- School of Medicine, The University of Jordan, Amman, Jordan
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Aydın Avci İ, Korkmaz M, Öz Yıldırım Ö, Çal A, Gülerce H, Atayoğlu AT, Kökrek Z, Ok G, Acarkan İ. Analysis of post-migration traumatic events influence on immigrants and their personality traits. Cent Eur J Public Health 2023; 31:204-209. [PMID: 37934484 DOI: 10.21101/cejph.a7651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES This study aims to analyse the way immigrants and their personality traits get affected by traumatic events in the post-migration process. METHODS This descriptive study was conducted through Google Forms with the involvement of 2,509 immigrants. A descriptive questionnaire, the "IFOMA Post-Migration Post-Traumatic Effect Scale" and the "GADOT Personality Types Determination Scale" were used to collect the research data. Independent samples t-test, one-way ANOVA, and related sample Friedman's two-way analysis tests were used in data analysis. RESULTS Immigrants were exposed to significant effects in all sub-dimensions of the Post-Migration Post-Traumatic Effect Scale. Experiencing post-traumatic stress was found to be significantly related to the research parameters, which, respectively, are gender, age, marital status, educational background, legal status, years of living in the current country, employment status, ethnicity, Turkish language proficiency, and post-migration psychological problems (p < 0.05); 42.8% of the immigrants had the Type 9 personality, and all personality types were affected by the Psychological Affection, Physical Affection, Anxiety, and Social Adaptation sub-dimensions, respectively (p < 0.05). CONCLUSION By analysing the impact of migration-induced trauma on immigrants within their society, it can be recommended to implement initiatives specific to immigrants' personality traits and to carry out protective/preventive projects that will minimize immigrants' exposure to trauma and encourage their participation in social adaptation processes.
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Affiliation(s)
- İlknur Aydın Avci
- Department of Public Health Nursing, Health Science Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Mehmet Korkmaz
- Akdagmadeni Health College, Yozgat Bozok University, Yozgat, Turkey
| | - Özge Öz Yıldırım
- Department of Public Health Nursing, Health Science Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Ayşe Çal
- Health Science Faculty, Ankara Medipol University, Ankara, Turkey
| | - Hakan Gülerce
- Department of Sociology, Harran University, Sanliurfa, Turkey
| | - Ali Timuçin Atayoğlu
- Department of Family Medicine, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Zekeriya Kökrek
- Humanities and Social Sciences Faculty, Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | - Gökçe Ok
- Ministry of Interior Presidency of Migration Management, Ankara, Turkey
| | - İsmail Acarkan
- Enneagram Education and Consultancy Centre, Istanbul, Turkey
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Alemi Q, Panter-Brick C, Oriya S, Ahmady M, Alimi AQ, Faiz H, Hakim N, Sami Hashemi SA, Manaly MA, Naseri R, Parwiz K, Sadat SJ, Sharifi MZ, Shinwari Z, Ahmadi SJ, Amin R, Azimi S, Hewad A, Musavi Z, Siddiqi AM, Bragin M, Kashino W, Lavdas M, Miller KE, Missmahl I, Omidian PA, Trani JF, van der Walt SK, Silove D, Ventevogel P. Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions. BJPsych Open 2023; 9:e125. [PMID: 37424447 PMCID: PMC10375890 DOI: 10.1192/bjo.2023.502] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/23/2022] [Accepted: 01/20/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations. AIMS We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions. METHOD In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support. RESULTS Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body-mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture. CONCLUSIONS We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.
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Affiliation(s)
- Qais Alemi
- School of Behavioral Health, Loma Linda University, California, USA
| | - Catherine Panter-Brick
- Jackson Institute for Global Affairs and Department of Anthropology, Yale University, Connecticut, USA
| | | | - Mariam Ahmady
- Department of Counselling, Faculty of Psychology and Educational Sciences, Kabul University, Afghanistan
| | | | - Hafizullah Faiz
- Jalalabad Regional Management Office, Swedish Committee for Afghanistan, Jalalabad, Afghanistan
| | - Nadia Hakim
- Migration Health Unit, International Organization for Migration, Kabul, Afghanistan
| | | | | | - Roman Naseri
- Mental Health and Psychosocial Support Unit, International Medical Corps, Kabul, Afghanistan
| | | | - Sayed Javid Sadat
- Mental Health and Peacebuilding Program, International Assistance Mission, Herat, Afghanistan
| | | | - Zalmai Shinwari
- Mental Health and Psychosocial Support Unit, HealthNet TPO, Kabul, Afghanistan
| | | | - Rohullah Amin
- Faculty of Humanities and Social Sciences, Helmut-Schmidt University, Germany
| | - Sayed Azimi
- Independent Mental Health Specialist, Geneva, Switzerland
| | - Atal Hewad
- Department of Ipso Academy and Quality Management, International Psychosocial Organisation, Konstanz, Germany
| | - Zeinab Musavi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | | | - Martha Bragin
- Silberman School of Social Work, The City University of New York, New York, USA
| | - Wataru Kashino
- Prevention Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Michalis Lavdas
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | | | - Inge Missmahl
- International Psychosocial Organisation, Konstanz, Germany
| | | | | | - Sarah Kate van der Walt
- Mental Health and Psychosocial Support Unit, Première Urgence – Aide Médicale Internationale, Kabul, Afghanistan
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Yashadhana A, Alloun E, Serova N, de Leeuw E, Mengesha Z. Place-making and its impact on health and wellbeing among recently resettled refugees in high income contexts: A scoping review. Health Place 2023; 81:103003. [PMID: 36966669 DOI: 10.1016/j.healthplace.2023.103003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/28/2023]
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Baluku MM, Nansubuga F, Kibanja GM, Ouma S, Balikoowa R, Nansamba J, Ruto G, Kawooya K, Musanje K. Associations of psychological inflexibility with posttraumatic stress disorder and adherence to COVID-19 control measures among refugees in Uganda: The moderating role of coping strategies. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 28:278-288. [PMID: 37197224 PMCID: PMC10163792 DOI: 10.1016/j.jcbs.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
Refugees are vulnerable to developing mental health problems. The unprecedented appearance and rapid spread of COVID-19 exacerbated this vulnerability, especially in low-income countries where refugees survive on humanitarian aid and live in congested settlements. These appalling living conditions are a stressor, making adherence to COVID-19 control measures impractical and an additional psychological strain for refugees. The present study examined how psychological inflexibility is associated with adherence to COVID-19 control measures. A sample of 352 refugees from Kampala City and Bidibidi settlements were recruited. Refugees with high levels of psychological inflexibility reported higher PTSD symptom severity and low adherence to COVID-19 control measures. Moreover, PTSD severity mediated the association between psychological inflexibility and adherence, while avoidance coping moderated both direct and indirect effects. Interventions for reducing psychological inflexibility and avoidance coping may be essential in boosting adherence to measures relevant to the current and future status of the pandemic, along with other crises that refugees face.
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Affiliation(s)
| | | | | | - Samuel Ouma
- Makerere University, School of Psychology, Uganda
| | | | | | - Grace Ruto
- Makerere University, Research and Innovations Fund (Mak-RIF) Secretariat, Uganda
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Paoletti P, Perasso GF, Lillo C, Serantoni G, Maculan A, Vianello F, Di Giuseppe T. Envisioning the future for families running away from war: Challenges and resources of Ukrainian parents in Italy. Front Psychol 2023; 14:1122264. [PMID: 37008874 PMCID: PMC10050883 DOI: 10.3389/fpsyg.2023.1122264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/17/2023] Open
Abstract
Since February 2022, 7.8 million people have left Ukraine. In total, 80% are women and children. The present quali-quantitative study is the first in Italy to (i) describe the adaptation challenges and the resources of refugee parents and, indirectly, of their children and (ii) investigate the impact of neuropsychopedagogical training on their wellbeing. The sample includes N = 15 Ukrainian parents (80% mothers, mean age = 34 years) who arrived in Italy in March and April 2022. The parents participated in neuropsychopedagogical training within the program Envisioning the Future (EF): the 10 Keys to Resilience. Before the training, participants completed an ad hoc checklist to detect adjustment difficulties. After the training, they responded to a three-item post-training questionnaire on the course and to a semi-structured interview deepening adaptation problems, personal resources, and the neuropsychopedagogical training effects. Participants report that since they departed from Ukraine, they have experienced sleep, mood, and concentration problems, and specific fears, which they also observed in their children. They report self-efficacy, self-esteem, social support, spirituality, and common humanity as their principal resources. As effects of the training, they report an increased sense of security, quality of sleep, and more frequent positive thoughts. The interviews also reveal a 3-fold positive effect of the training (e.g., behavioral, emotional-relational, and cognitive-narrative).
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Affiliation(s)
| | - Giulia Federica Perasso
- Research Institute for Neuroscience Education and Didactics, Fondazione Patrizio Paoletti, Assisi, Italy
- *Correspondence: Giulia Federica Perasso
| | - Carmela Lillo
- Research Institute for Neuroscience Education and Didactics, Fondazione Patrizio Paoletti, Assisi, Italy
| | - Grazia Serantoni
- Research Institute for Neuroscience Education and Didactics, Fondazione Patrizio Paoletti, Assisi, Italy
| | - Alessandro Maculan
- Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padua, Padua, Italy
| | - Francesca Vianello
- Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padua, Padua, Italy
| | - Tania Di Giuseppe
- Research Institute for Neuroscience Education and Didactics, Fondazione Patrizio Paoletti, Assisi, Italy
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Ramos AA. Considerations in designing trauma-focused interventions for displaced Afghan women. Front Glob Womens Health 2023; 3:893957. [PMID: 36909736 PMCID: PMC9996057 DOI: 10.3389/fgwh.2022.893957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/21/2022] [Indexed: 02/25/2023] Open
Abstract
In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.
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Ekoh PC, Iwuagwu AO, George EO, Walsh CA. Forced migration-induced diminished social networks and support, and its impact on the emotional wellbeing of older refugees in Western countries: A scoping review. Arch Gerontol Geriatr 2023; 105:104839. [PMID: 36343437 DOI: 10.1016/j.archger.2022.104839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 12/13/2022]
Abstract
As the number of refugees continues to increase globally, so does the number of older adults forced to migrate from their home region to Western countries. Many of these older refugees lose their social networks and support to the events leading to forced migration and may be unable to recreate them once resettled. We used Arksey and O'Malley's (2005) framework to explore how forced migration has diminished the social networks and support of older refugees in Western countries and its impact on their emotional well-being. Eight databases were searched for the review; abstracts were reviewed using Rayyan QCRi(c) before the full-text review. A total of 25 studies were included in the final analysis, and findings revealed that forced migration reduced the quantity of social networks and the quality of social support older refugees received. The reduced social network and support led to social isolation, increased migration-related grief, and mental health challenges. Advances in digital technology are not yet capable of filling the support gap. With this, we hope to inform future research on the social support needs of older refugees and raise awareness of the need for humanitarian support intervention to cushion the impact of the migration-induced loss of social networks and support.
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Affiliation(s)
- Prince Chiagozie Ekoh
- Faculty of Social Work, University of Calgary, Canada; Department of Social Work, University of Nigeria, Nsukka.
| | | | - Elizabeth Onyedikachi George
- Department of Social Work, University of Nigeria, Nsukka; Centre of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway
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Jafree SR, Nadir SMH, Mahmood QK, Burhan SK. The migrant Hazara Shias of Pakistan and their social determinants for PTSD, mental disorders and life satisfaction. J Migr Health 2023; 7:100166. [PMID: 36794096 PMCID: PMC9922968 DOI: 10.1016/j.jmh.2023.100166] [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: 02/01/2022] [Revised: 12/13/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
Background Ensuring safety and wellbeing of all the minority populations of Pakistan is essential for collective national growth. The Pakistani Hazara Shias are a marginalized non-combative migrant population who face targeted violence in Pakistan, and suffer from great challenges which compromise their life satisfaction and mental health. In this study, we aim to identify the determinants of life satisfaction and mental health disorders in Hazara Shias and ascertain which socio-demographic characteristics are associated with post-traumatic stress disorder (PTSD). Methods We used a cross-sectional quantitative survey, utilizing internationally standardized instruments; with an additional qualitative item. Seven constructs were measured, including household stability; job satisfaction; financial security; community support; life satisfaction; PTSD; and mental health. Factor analysis was performed showing satisfactory Cronbach alpha results. A total of 251 Hazara Shias from Quetta were sampled at community centers through convenience method based on their willingness to participate. Results Comparison of mean scores shows significantly higher PTSD in women and unemployed participants. Regression results reveal that people who have low community support, especially from national and ethnic community, religious community, and other community groups, had higher risk of mental health disorders. Structural equation modeling identified that four study variables contribute to greater life satisfaction, including: household satisfaction (β = 0.25, p < 0.001); community satisfaction (β = 0.26, p < 0.001); financial security (β = 0.11, p < 0.05); and job satisfaction (β = 0.13, p < 0.05). Qualitative findings revealed three broad areas which create barriers to life satisfaction, including: fears of assault and discrimination; employment and education problems; and financial and food security issues. Conclusions The Hazara Shias need immediate assistance from state and society to improve safety, life opportunities, and mental health. Interventions for poverty alleviation, mental health, and fair education and employment opportunities need to be planned in partnership with the primary security issue.
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Affiliation(s)
- Sara Rizvi Jafree
- Associate Professor & Chair, Department of Sociology, Forman Christian College University, Pakistan,Corresponding author.
| | - Syed Mujtaba Hasnain Nadir
- Gastroenterology and Clinical Informatics Speciality Trainee Registrar, Health Education England, North West Deanery, UK
| | - Qaisar Khalid Mahmood
- Assistant Professor, Department of Sociology, International Islamic University, Pakistan
| | - Syeda Khadija Burhan
- Assistant Professor, Department of Education, Forman Christian College University, Pakistan
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Brea Larios D, Sam DL, Sandal GM. Psychological distress among Afghan refugees in Norway as a function of their integration. Front Psychol 2023; 14:1143681. [PMID: 37143593 PMCID: PMC10151542 DOI: 10.3389/fpsyg.2023.1143681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
Background Often, refugees are susceptible to mental health problems due to adversities experienced before, during, and after the flight. Through a cross-sectional study, the present study examines the relationship between different aspects of integration and psychological distress among Afghans living in Norway. Methods The participants were recruited through e-mail invitations, refugee-related organizations, and social media platforms. The participants (N = 114) answered questions about integration across multiple dimensions (psychological, social, navigational, economic, and linguistic) in line with the Immigration Policy Lab index (IPL -12/24). Hopkins symptoms checklist (HSCL-25) was used to assess psychological distress. Results Based on hierarchical multiple regression analysis, both the psychological dimension (0.269 p < 0.01) and the navigational dimension (0.358 p < 0.05) of integration predicted psychological distress. Discussion/Conclusion The results suggest that the psychological aspects of integration, such as being part of a community, having feelings of security, and a sense of belonging, are beneficial for the mental health and well-being of the Afghans in Norway and contribute further to other aspects of integration.
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Affiliation(s)
- Dixie Brea Larios
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- *Correspondence: Dixie Brea Larios,
| | - David L. Sam
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Center for International Health, University of Bergen, Bergen, Norway
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Im H, Swan LET. Trauma exposure, social functioning, and common mental health disorders in Somali refugee male and female youth: An SEM analysis. Int J Soc Psychiatry 2022; 68:1539-1551. [DOI: https:/doi.org/10.1177/00207640211037726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Background: Refugee youth often face numerous adversities before and during forced migration. Although experiences vary across settings and subpopulations, common mental disorders are prevalent among refugee youth who are displaced in low- and middle-income countries. It is important to examine how risk factors are intricately linked and contribute to common mental health issues to inform clinical practice and social policy. Aims: This study aims to test the pathways from risk factors previously identified as determinants of Somali refugee youth mental health (i.e. trauma exposure, substance use, social functioning, aggression) to symptoms of PTSD, depression, anxiety, and somatic pains. Method: We collected survey data in 2013, using snowball sampling to recruit Somali refugee youth (15–35 years old) living in Eastleigh, Kenya. We ran three structural equation models to assess paths from trauma exposure to mental health symptoms, through psychosocial factors including substance use, aggression, and functional impairment. We first conducted this analysis with a mixed-gender sample ( N = 305) and then assessed gender differences by running one model for male participants ( n = 124) and another for female participants ( n = 181). Results: In the mixed-gender sample, trauma exposure directly predicted substance use and both directly and indirectly predicted aggression, functional impairment, and mental health symptoms. Substance use directly predicted aggression and functional impairment, and substance use both directly and indirectly predicted mental health symptoms. The split-gender models revealed gender differences, with only functional impairment directly predicting mental health symptoms in the male sample and with many significant direct and indirect pathways in the female sample. Conclusions: This study shows the role of trauma exposure, substance use, aggression, and social functioning in determining mental health outcomes among refugee youth and how CMD symptoms are differently manifested across genders in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, Richmond, USA
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Lai H, Due C, Ziersch A. The relationship between employment and health for people from refugee and asylum-seeking backgrounds: A systematic review of quantitative studies. SSM Popul Health 2022; 18:101075. [PMID: 35601219 PMCID: PMC9118911 DOI: 10.1016/j.ssmph.2022.101075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/05/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background For the general population, the positive effects of paid employment on health and wellbeing are well established. However, less is known for people from refugee and asylum-seeking backgrounds. This review aims to systematically summarise the quantitative literature on the relationship between employment and health and wellbeing for refugees and asylum seekers. Method A search strategy was conducted in online databases, including MEDLINE, PsychINFO, EMCARE, SCOPUS, CINHAL, ProQuest and Web of Science. Articles were screened against inclusion and exclusion criteria. Studies published in English between 2000 to October 2021 were included if they used quantitative methods to consider the relationship between employment and health for refugees and asylum seekers in resettlement countries. Study quality was assessed using The Joanna Briggs Institute's Critical Appraisal Tools. Findings were synthesised using a narrative approach. Results Seventy-two papers were identified. The majority of papers (N = 58, 81%) examined the association between employment and mental health outcomes. Overall, while there were inconsistencies in the findings, employment had a positive effect on mental health particularly in reducing levels of psychological distress and depression. Though more limited in number, the papers examining physical health suggest that people who are employed tend to have better physical health than unemployed persons. There was some evidence to support the bi-directional relationship between employment and health. Poor mental and physical health negatively impacted the odds of employment and occupational status of refugees. Conclusion Good quality employment is an essential component of refugee resettlement and this review found that in general employment is also beneficial for refugee health, particularly aspects of mental health. More research regarding the effects of employment on physical health is required. The effects of refugee-specific factors such as gender roles, torture, and trauma on the relationship between employment and health also require further investigation.
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Affiliation(s)
- Huyen Lai
- College of Medicine and Public Health, Flinders University, Australia
| | - Clemence Due
- College of Medicine and Public Health, Flinders University, Australia
- School of Psychology, Adelaide University, Australia
| | - Anna Ziersch
- College of Medicine and Public Health, Flinders University, Australia
- Flinders Health and Medical Research Institute, Flinders University, Australia
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16
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Jankovic-Rankovic J, Oka RC, Meyer JS, Snodgrass JJ, Eick GN, Gettler LT. Transient refugees' social support, mental health, and physiological markers: Evidence from Serbian asylum centers. Am J Hum Biol 2022; 34:e23747. [PMID: 35349201 DOI: 10.1002/ajhb.23747] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Refugees seeking safety across international borders are often exposed to a wide breadth of psychosocially stressful experiences that may fracture existing sources of social support and impair the generation of new social relationships, with implications for their long-term health and resilience. Using data from recently settled refugees in two asylum centers in Serbia, we examined the associations between social support, mental health, and physiological markers. METHODS In this mixed-method study of refugees (age 18-50 years, n = 76), we collected key socio-demographic information and conducted semi-structured interviews about refugees' journey and stay in Serbia, trauma/loss, and their sources of social support. We also collected self-reported measures of mental well-being as well as physiological markers relevant to repeated exposure to chronic psychosocial stress (fingernail cortisol and dried blood spots for analysis of Epstein-Barr virus [EBV] antibody titers). RESULTS We found that refugees with longer journeys reported lower social support than those with shorter journeys. Refugees with lower social support reported poorer mental well-being, greater PTSD-related symptoms, and higher recent perceived stress than those with higher social support. We also observed that refugees with lower social support and higher recent stress, respectively, tended to exhibit higher fingernail cortisol levels. However, we did not observe comparable patterns linking EBV antibodies with psychosocial functioning. CONCLUSION Our cross-sectional findings are consistent with the notion that social support is likely to be a critical component in effective interventions aimed at mitigating the adverse health effects of relocation-related illnesses and poor social functioning as they await resettlement.
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Affiliation(s)
| | - Rahul C Oka
- Department of Anthropology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Jerrold S Meyer
- Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Lee T Gettler
- Department of Anthropology, University of Notre Dame, Notre Dame, Indiana, USA.,Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, USA
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Brea Larios D, Sandal GM, Guribye E, Markova V, Sam DL. Explanatory models of post-traumatic stress disorder (PTSD) and depression among Afghan refugees in Norway. BMC Psychol 2022; 10:5. [PMID: 34983663 PMCID: PMC8728976 DOI: 10.1186/s40359-021-00709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background The current situation in Afghanistan makes it likely that we are facing a new wave of Afghan refugees, warranting more knowledge about how to deal with mental health problems among them. This study aims to gain more knowledge on Explanatory Models (EM) of depression and post-traumatic stress disorders (PTSD) among Afghan refugees resettled in Norway.
Methods We conducted six gender-separated, semi-structured focusgroup interviews based on vignettes with Afghan refugees (total N = 27). The vignettes described a fictional character with symptoms of either depression or PTSD symptoms in line with DSM-5 and ICD-10 criteria.
Results The findings showed that EM varied with gender, age, generation, and migration stories. Participants suggested different potential causes, risk factors, and ways of managing symptoms of depression and PTSD depending on the context (e.g., in Norway vs. Afghanistan). In describing the causes of the depression/PTSD in the vignettes, females tended to emphasize domestic problems and gender issues while males focused more on acculturation challenges. The younger males discussed mostly traumatic experiences before and during flight as possible causes. Conclusion The practice of condensing a single set of EMs within a group may not only be analytically challenging in a time-pressed clinical setting but also misleading. Rather, we advocate asking empathic questions and roughly mapping individual refugee patients’ perceptions on causes and treatment as a better starting point for building trusting relationships and inviting patients to share and put into practice their expertise about their own lives. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00709-0.
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Affiliation(s)
- Dixie Brea Larios
- Department of Psychosocial Science, University of Bergen, Christies Gate 12, Postboks 7807, 5015, Bergen, Norway.
| | - Gro Mjeldheim Sandal
- Department of Psychosocial Science, University of Bergen, Christies Gate 12, Postboks 7807, 5015, Bergen, Norway
| | | | - Valeria Markova
- Department of Pulmonology, Haukeland University Hospital, Bergen, Norway
| | - David Lackland Sam
- Department of Psychosocial Science, University of Bergen, Christies Gate 12, Postboks 7807, 5015, Bergen, Norway
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