1
|
Tomren JF, Opaas M. Adult refugees' perspectives on the impact of trauma and post-migration hardships on learning. Eur J Psychotraumatol 2024; 15:2403249. [PMID: 39350743 PMCID: PMC11445927 DOI: 10.1080/20008066.2024.2403249] [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: 04/29/2024] [Revised: 07/03/2024] [Accepted: 08/31/2024] [Indexed: 10/04/2024] Open
Abstract
Background: Research shows that adult refugees' well-being and future in the reception country heavily depend on successfully learning the host language. However, we know little about how adult learners from refugee backgrounds experience the impact of trauma and adversity on their learning.Objective: The current study aims to investigate the perspectives of adult refugee learners on whether and how trauma and other adversity affect their learning.Methods: We conducted in-depth interviews with 22 adult refugees (10 women) attending the Norwegian Introduction Programme (NIP). The participants came from six Middle Eastern, Central Asian, and African countries. Two questionnaires were included, one about past stressful life events (SLESQ-Revised), and one about mental health symptoms and current psychological distress following potentially traumatic experiences (PCL-5).Results: Participants held varying beliefs about trauma's impact on learning: that it had a constant impact, that it was situational, or that it had no impact. Other aspects they brought up as having an essential effect on learning and school attendance include psychological burdens from past and present school experiences, and post-migration hardships such as loneliness, depression, ongoing violence, and negative social control. Post-migration trauma and hardships exacerbated the burden of previous trauma and were frequently associated with a greater negative influence on learning.Conclusion: This study adds new insights from adult refugee learners themselves into how post-migration hardships as well as trauma can impact their learning, and the importance of recognising their struggles. A safe space is required for refugees to open up about their difficulties in life and with learning. This knowledge can be used to enhance teaching practices, foster better teacher-student relationships, and inform policy-making decisions, ultimately benefiting both individuals and society.
Collapse
Affiliation(s)
- Janita Flem Tomren
- Ålesund Adult Education Centre, Ålesund, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Marianne Opaas
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| |
Collapse
|
2
|
Acarturk C, Kurt G, İlkkurşun Z, de Graaff AM, Bryant R, Cuijpers P, Fuhr D, McDaid D, Park AL, Sijbrandij M, Ventevogel P, Uygun E. Effectiveness of group problem management plus in distressed Syrian refugees in Türkiye: a randomized controlled trial. Epidemiol Psychiatr Sci 2024; 33:e43. [PMID: 39344836 DOI: 10.1017/s2045796024000453] [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: 10/01/2024] Open
Abstract
AIMS Despite high levels of psychological distress, mental health service use among Syrian refugees in urban settings is low. To address the mental healthcare gap, the World Health Organization developed group problem management plus (gPM+), a scalable psychological intervention delivered by non-specialist peer facilitators. The study aimed to evaluate the effectiveness of gPM+ in reducing symptoms of depression and anxiety among Syrian refugees in Istanbul, Türkiye. METHODS A randomized controlled trial was conducted among 368 distressed (Kessler Psychological Distress Scale, K10 > 15) adult Syrian refugees with impaired functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16). Participants were recruited between August 2019 and September 2020 through a non-governmental organization providing services to refugees. Participants were randomly allocated to gPM+ and enhanced care as usual (gPM+/E-CAU) (184 participants) or E-CAU only (184 participants). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist (HSCL-25)) at 3-month follow-up. Secondary outcomes were post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5; PCL-5), functional impairment (WHODAS 2.0), and self-identified problems (psychological outcome profiles). RESULTS Intent-to-treat analyses showed no significant effect of gPM+ on symptoms of anxiety, depression, PTSD and self-identified problems. Yet, there was a significant reduction in functional impairment in gPM+/E-CAU compared to E-CAU at 3-month follow-up (adjusted mean difference 1.66, 95 % CI 0.04, 3.27, p = 0.045, d = 0.19). Post-hoc subgroup analyses among participants with probable baseline depression or anxiety showed that there was a small but significant reduction in depression (adjusted mean difference -0.17, 95 % CI -0.32, -0.02, p = 0.028, d = 0.27) and anxiety (adjusted mean difference -0.21, 95 % CI -0.37, -0.05, p = 0.009, d = 0.30) symptoms comparing gPM+/E-CAU to E-CAU only at 1-week post assessment, but not at 3-month follow-up. There was a significant difference between conditions on functional impairment at 3-month follow-up, favouring gPM+/E-CAU condition (adjusted mean difference -1.98, 95 % CI -3.93, -0.02, p = 0.048, d = 0.26). CONCLUSION In this study in an urban setting in Türkiye, gPM+ did not alleviate symptoms of depression and anxiety among Syrian refugees experiencing psychological distress and daily living difficulties. However, participants with higher distress at baseline seemed to benefit from gPM+, but treatment gains disappeared in the long term. Current findings highlight the potential benefit of tailored psychosocial interventions for highly distressed refugees in volatile low-resource settings.
Collapse
Affiliation(s)
- C Acarturk
- Department of Psychology, Koc University, Istanbul, Türkiye
| | - G Kurt
- School of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Z İlkkurşun
- Department of Psychology, Koc University, Istanbul, Türkiye
| | - A M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - P Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - D Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- University of Bremen, Health Sciences, Bremen, Germany
| | - D McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A L Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - M Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P Ventevogel
- United Nations High Commissioner for Refugees, Public Health Section, Geneva, Switzerland
| | - E Uygun
- Trauma and Disaster Mental Health, Istanbul Bilgi University, Istanbul, Türkiye
| |
Collapse
|
3
|
Ter Heide FJJ, Goorden P, Nijdam MJ. Dissociative Subtype of Posttraumatic Stress Disorder and its Correlates Among Treatment-Seeking Refugees. J Trauma Dissociation 2024:1-14. [PMID: 39327715 DOI: 10.1080/15299732.2024.2407765] [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: 03/13/2024] [Accepted: 08/08/2024] [Indexed: 09/28/2024]
Abstract
The dissociative subtype of posttraumatic stress disorder (PTSD-DS) denotes a severe type of PTSD associated with complex trauma exposure and psychiatric comorbidity. Refugees may be at heightened risk of developing PTSD-DS, but research is lacking. This cross-sectional study aimed to examine PTSD-DS and its demographic, trauma-related, and clinical correlates among a convenience sample of refugee patients over 18 years old who were diagnosed with PTSD according to DSM-5. PTSD-DS (Clinician-Administered PTSD Scale for DSM-5), trauma exposure (Life Events Checklist for DSM-5) and general psychopathology (Brief Symptom Inventory) were assessed at intake. T-tests, chi-square tests, and logistical regression analysis were conducted. The final sample consisted of 552 participants (177 (32.1%) women; 375 (67.9%) men; average age 40.0 years (SD = 11.2)) who originated from 63 countries. Of those, 158 (28.6%) met criteria for PTSD-DS. Participants with PTSD-DS scored significantly higher on PTSD symptom severity (t(550)=-5.270, p < .001), number of traumatic event types (t(456)=-3.499, p < .001), and exposure to sexual assault (χ(1) = 6.471, p = .01) than those without PTSD-DS. The odds of having PTSD-DS increased by 14.1% with exposure to each additional traumatic event type (OR = 1.141, CI 0.033-1.260). In conclusion, around 29% of adult treatment-seeking refugees with PTSD met the criteria for PTSD-DS. Those exposed to multiple traumatic event types including sexual assault, regardless of sex, were especially at risk. Having PTSD-DS was associated with more severe PTSD. Prioritizing trauma-focused treatment for those with PTSD-DS is recommended.
Collapse
|
4
|
Masaki CØ, Vindbjerg E, Mortensen EL, Bruhn M, Carlsson J. The impact of temporary residence permit on symptom severity and treatment outcome among refugees with PTSD. J Psychiatr Res 2024; 179:133-140. [PMID: 39293118 DOI: 10.1016/j.jpsychires.2024.09.011] [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: 03/06/2024] [Revised: 08/28/2024] [Accepted: 09/09/2024] [Indexed: 09/20/2024]
Abstract
Despite an increased focus on the impact of post-migratory factors on the health of trauma-affected refugees, research on the influence of residence permit is limited. This influence may manifest on the outcome of psychiatric treatment. Accordingly, the aim of this study was to examine the role of temporary residence permit on symptom severity and treatment outcome among trauma-affected refugees in PTSD treatment. The sample consisted of 897 patients, who were allocated into three groups based on their residence permit: temporary residence permit, permanent residence permit, and Danish citizenship. The outcome measures were symptoms of PTSD (Harvard Trauma Questionnaire), depression and anxiety (Hopkins Symptom Checklist-25 and Hamilton Depression and Anxiety Rating Scales), quality of life (WHO-5 Well-being Index), and functioning (The Sheehan Disability Scale), evaluated before and after psychiatric treatment. Temporary residents tended to have less severe symptoms prior to treatment. Overall, no significant differences were observed between the three groups on treatment outcome. However, Danish citizens had a poorer treatment outcome on Hamilton Depression Scale compared with temporary residents. This study is one of the first to investigate treatment implications of residence permit in a clinical setting. The interactions between mental health and individual post-migratory factors are complex. Further research is still needed to understand how residence status affects mental health and treatment outcomes for refugees.
Collapse
Affiliation(s)
- Chiaki Ørum Masaki
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark.
| | - Erik Vindbjerg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Maja Bruhn
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Mattelin E, Söderlind N, Korhonen L. "You cannot just stop life for just that": a qualitative study on children's experiences on refugee journey to Sweden. Eur Child Adolesc Psychiatry 2024; 33:3133-3143. [PMID: 38360923 PMCID: PMC11424661 DOI: 10.1007/s00787-024-02387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
Children with refugee backgrounds are often exposed to violence and other adverse experiences with well-known detrimental consequences on mental health. However, the current group of approximately 40 million child refugees is heterogeneous, stressing the importance of first-person perspectives in understanding children's unique experiences and needs related to the migration process. Identifying contextual factors promoting health and resilience is also essential. For instance, the roles children play as active agents in constructing their own lives and adapting to different environments are poorly described in contemporary research on child refugees and their mental health. To address these knowledge gaps, we conducted qualitative interviews with a reflexive thematic analysis with eighteen children with refugee backgrounds in Sweden. This resulted in two main themes: Longing for a good life that cannot be taken for granted and Challenged agency and changing rights. The narratives indicate that children, although exposed to different challenges in different migration phases and based on gender and asylum status, have experiences of ordinary childhood with a desire for a good life with prospects. The results also show that children execute active and adaptable agency that is impacted by various factors. Reaching the full age appears to be a confusing and ambivalent transition due to changes in rights. The results pinpoint several possibilities to address factors that pose a risk to health and restrictions of rights among child refugees.
Collapse
Affiliation(s)
- Erica Mattelin
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Save the Children, Stockholm, Sweden
| | - Natalie Söderlind
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid, Swedish National Center On Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| |
Collapse
|
6
|
Attal JH, Lurie I, Neumark Y. Psychosocial health of migrant careworkers from Southeast Asian countries in Israel: A mixed methods study. J Migr Health 2024; 10:100263. [PMID: 39220100 PMCID: PMC11365367 DOI: 10.1016/j.jmh.2024.100263] [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: 03/18/2021] [Revised: 07/28/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
Background In 2018, 66,859 migrant careworkers were in Israel, most of whom originated from Southeast Asian countries and 81 % of whom are women. Stringent regulations combined with social invisibility creates vulnerabilities that may contribute to emotional distress. This study aimed to assess psychosocial status and determine mechanisms of emotional distress and resilience in this population. Methods Mixed methods were used in this cross-section study. An online survey measured demographic variables, psychosocial wellbeing using the HSCL-25 questionnaire, general health, perceived social support, cultural identity, and perceived othering. Based on the survey's results, interviews were conducted with a subpopulation of respondents (n = 15) to further understand the mechanisms of emotional distress and resilience, and were analyzed using a postcolonial feminist framework and grounded theory. Data collection took place during 2018-2019. Results In total, 263 careworkers completed the survey and 15 careworkers were interviewed. The overall prevalence of emotional distress according to the HSCL-25 was 36.8 %, 22.6 % on the anxiety subscale, and 41.8 % on the depression subscale. Emotional distress was associated with female sex, not being parents, poorer general health, high perceived othering, and low perceived social support. Interviews revealed that Israeli policy, and relationships with family in their country of origin and with Israeli employers and their families can either contribute to or mitigate emotional stressors. Conclusions Symptoms of emotional distress among Southeast Asian migrant careworkers in Israel are frequently reported, and may indicate rates of anxiety and depression higher than in careworkers' countries of origin and host country. Increased monitoring to protect careworkers' rights and including mental health services as part of their health insurance plan are warranted.
Collapse
Affiliation(s)
- Jordan Hannink Attal
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, PO Box 12272, Jerusalem 91120, Israel
| | - Ido Lurie
- Shalvata Mental Health Center, Hod Hasharon, Israel
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Neumark
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, PO Box 12272, Jerusalem 91120, Israel
| |
Collapse
|
7
|
Piskunowicz MT, Kołodziej K, Altukhova V, Wojtasik J, Jaremko T, Borkowska A. Associations between affective temperament, perceived stress, and helping among Ukrainians and Poles in the context of the war in Ukraine. Appl Psychol Health Well Being 2024; 16:944-966. [PMID: 37675617 DOI: 10.1111/aphw.12487] [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: 03/01/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
The Russian aggression of Ukraine has put millions of civilians under immense stress and forced many of them to leave their homes for safety and help. Poland became one of the leading destinations for waves of Ukrainians fleeing this war. The level of perceived stress in people who experienced war depends on various factors, including individual psychological variables. The main aim of this study was to analyze perceived stress levels and the predictive role of affective temperaments, as defined by Akiskal, for perceived stress in Ukrainians and Poles during the first year of the Russo-Ukrainian war. Secondly, we studied the relationship between affective temperament, stress, and commitment to help Ukrainian refugees. Self-report data from 410 Ukrainians and 146 Poles were collected. The results of this study shed light on perceived stress in war-affected populations and the role of affective temperaments in predicting its levels. We also demonstrated the links between affective temperament, perceived stress, and involvement in helping Ukrainian refugees. Understanding the mental status of people affected by war and its predictors is crucial to providing appropriate support and assistance to those in need.
Collapse
Affiliation(s)
- Małgorzata Tatiana Piskunowicz
- Department of Clinical Neuropsychology, Faculty of Health Science, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Kosma Kołodziej
- Department of Preventive Nursing, Faculty of Health Science, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Valeriia Altukhova
- Department of Clinical Neuropsychology, Faculty of Health Science, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Jakub Wojtasik
- Interdisciplinary Doctoral School of Social Science, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | | | - Alina Borkowska
- Department of Clinical Neuropsychology, Faculty of Health Science, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| |
Collapse
|
8
|
McKeon G, Curtis J, Rostami R, Sroba M, Farello A, Morell R, Steel Z, Harris M, Silove D, Parmenter B, Matthews E, Jamaluddin J, Rosenbaum S. Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework. J Immigr Minor Health 2024; 26:674-688. [PMID: 38605213 PMCID: PMC11289061 DOI: 10.1007/s10903-024-01587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 04/13/2024]
Abstract
People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing.
Collapse
Affiliation(s)
- Grace McKeon
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - Jackie Curtis
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Reza Rostami
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Monika Sroba
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | | | - Rachel Morell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Zachary Steel
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- St. John of God Health Care North Richmond Hospital, North Richmond, NSW, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Derrick Silove
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Belinda Parmenter
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Evan Matthews
- Centre for Health Behaviour Research South East Technological University, Waterford, Ireland
| | | | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
9
|
Yetim O, Çakır R, Bülbül E, Alleil İS. Peer relationships, adolescent anxiety, and life satisfaction: a moderated mediation model in Turkish and syrian samples. Eur Child Adolesc Psychiatry 2024; 33:2831-2845. [PMID: 38300342 PMCID: PMC11272711 DOI: 10.1007/s00787-023-02366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
Prior studies comparing Syrian refugee adolescents to their native peers in the same region have found higher anxiety and lower life satisfaction. Therefore, identifying regulatory variables is crucial for implementing support programs. This study examined the mediating effect of peer relationships and the moderating effect of being a refugee or native adolescent on the relationship between adolescent anxiety and life satisfaction across different samples. Participants and setting: The study included 2,336 adolescents aged 11-19 (M = 14.79, SD = 1.04). Participants completed the Screen for Child Anxiety Related Disorders, Satisfaction with Life Scale, and Strengths and Difficulties Questionnaire. The mediation and moderation effects were analyzed with the path analysis codes written on Mplus 8.3. SPSS 26 was used for descriptive statistics and group comparisons. The findings showed that peer relationships mediate adolescent anxiety and life satisfaction, and this relationship is moderated according to whether the participants are native adolescents or refugee adolescents. This study highlights the significant associations between peer relationships, adolescent anxiety, and life satisfaction and the moderating role of the participant identity. The findings may inform psychological interventions to improve Syrian refugee adolescents' mental health and well-being. These findings may also have implications for policies and programs aimed at supporting the integration of Syrian refugee adolescents in host communities.
Collapse
Affiliation(s)
- Onat Yetim
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey.
| | - Resul Çakır
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey
| | - Ece Bülbül
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey
| | | |
Collapse
|
10
|
Hornfeck F, Garbade M, Kappler S, Rosner R, Pfeiffer E, Sachser C, Kindler H. Trajectories of mental health problems in unaccompanied young refugees in Germany and the impact of post-migration factors - a longitudinal study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02535-2. [PMID: 39085492 DOI: 10.1007/s00787-024-02535-2] [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: 12/29/2023] [Accepted: 07/12/2024] [Indexed: 08/02/2024]
Abstract
Unaccompanied young refugees (UYRs) are at an elevated risk of continuing psychological distress, including posttraumatic stress symptoms (PTSS), depression, and anxiety. The post-arrival situation in a host country plays an important role in increasing or reducing mental health risks for UYRs. This study aimed to examine the trajectory of psychological distress and post-migration factors experienced by UYRs in Germany with five assessments every six months over a two-year period.Standardised self-report questionnaires were used to assess PTSS (CATS-2), depression (PHQ-9), and anxiety (GAD-7) symptoms. Material and social stressors (DSSYR), sociocultural adjustment (BSAS), frequency of contact with family members, and distress regarding asylum status were included as post-migration factors. N = 131 UYRs (Mage = 17.04; SDage = 1.46; 81.1% male) living in residential care facilities in Germany were included in this study. There was a significant loss to follow up with n = 77 after 12 months at T2 (59% attrition), and n = 37 after 24 months at T4 (28% attrition).At baseline, clinically relevant symptom scores were found in 48.1% for PTSS, 42.0% for depression, and 22.9% for anxiety. Analysis of latent growth curve models revealed that the symptom severity of depression and anxiety did not change substantially over one year, but PTSS showed a significant decline. The number of traumatic events affected initial levels of mental health problems but not their trajectory over time. The impact of post-migration factors varied between measurement points and outcome measures and did not result in a homogeneous pattern.Despite limitations, this study demonstrated the persistence of high levels of psychological distress in UYRs. Effective interventions are required at an early stage to prevent chronic trajectories and support systems should adapt to constantly changing circumstances.Trial registration number/date of registration: DRKS00017453/11th December 2019.
Collapse
Affiliation(s)
| | - Maike Garbade
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany.
| | | | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | | |
Collapse
|
11
|
Santambrogio J, Cimminiello N, Wisidagamage Don P, Leon E, Miragliotta E, Capuzzi E, Colmegna F, Clerici M. Influence of post-migration living difficulties on mental health among refugees and asylum seekers: A scoping-review on clinical tools. Int J Soc Psychiatry 2024:207640241251748. [PMID: 39049583 DOI: 10.1177/00207640241251748] [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: 07/27/2024]
Abstract
BACKGROUND The literature indicates an increasing interest in the mental health of refugees (R) and asylum seekers (AS) - particularly how it could be affected by previous exposure to trauma and violence - but less has been written about the issues they are forced to face during the post-migration period and how these also can affect mental health. Research shows that the mental health of R/AS is highly influenced by their post-migration conditions and may deteriorate due to post-migration social health-related determinants; in addition, a lack of language skills, discrimination, separation from family, poverty, and other stressors can contribute to social isolation. The difficulty in asking for help in case of psychological distress and, consequently, in accessing care, contributes to the worsening of their clinical condition. AIMS The primary purpose of this study is to identify and provide a review of the clinical tools used to screen migrants (R/AS) at risk of developing psychological distress, identifying post-migration difficulties. METHODS We searched studies in PubMed, Embase, Scopus, Cochrane (Central), and Cinahl (ultimate) with the last search on 14 April 2023, using a combination of keywords and Medical Subject Headings (MeSH). RESULTS Our systematic search identified 1,878 records. After removing duplicates, we screened 1,238 records by title and abstract, retaining 97 for full text review. Of these, 68 met full eligibility criteria (1995-2023). A total of 30 social scales have been identified, as well as structured or semi-structured questionnaires and interviews. Translated into multiple languages, the tools can be self-administered or administered by trained professionals. PMLD is known for its effectiveness in evaluating the post-migration period and predicting mental health issues. CONCLUSIONS Considering the limited number of studies and, consequently, the limited number of tools found, it can be inferred that not enough attention is given to post-migration in the broader sense.
Collapse
Affiliation(s)
- Jacopo Santambrogio
- Presidio 'G. Corberi', Mental Health and Addiction Department, ASST Brianza, Limbiate, Italy
- RSD "Beato Papa Giovanni XXIII", Mental Health and Addiction Department, ASST Brianza, Limbiate, Italy
| | - Noemi Cimminiello
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | | | - Elisabetta Leon
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Elena Miragliotta
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Enrico Capuzzi
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabrizia Colmegna
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Mental Health and Addiction Department, IRCCS San Gerardo dei Tintori, Monza, Italy
| |
Collapse
|
12
|
Grochtdreis T, König HH, Dams J. Flight-related determinants of health-related quality of life of asylum seekers and refugees in Germany: a longitudinal study based on the German Socio-Economic Panel (SOEP). BMC Public Health 2024; 24:1965. [PMID: 39044148 PMCID: PMC11264381 DOI: 10.1186/s12889-024-19489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Germany played a key role as receiving country during the so-called refugee and displacement crisis with about 5 million asylum seekers arriving in the EU between 2014 and 2020. It is well known that asylum seekers and refugees (ASRs) have a high burden of disease and are particularly prone to mental disorders such as trauma, stress-related and affective disorders. Not much is known about the determinants of health-related quality of life (HrQoL) among ASRs, especially in the context of the flight. Therefore, the aim of this study was to analyze the associations between flight-related characteristics and HrQoL of ASRs in Germany. METHODS The sample of this study was based on five consecutive waves of the Survey of Refugees samples of the German Socio-Economic Panel (n = 8015; 14,314 observations). Mental and physical HrQoL was measured using the mental (MCS) and physical (PCS) component summary scores of the SF-12v2. Associations between flight-related characteristics and HrQoL were examined using multilevel mixed-effects linear regressions. RESULTS The different countries of birth were associated with varying MCS and PCS scores. The MCS and PCS scores were lower among ASRs with an economic situation below average in their countries of origin. Persecution, discrimination, and poor living conditions as reasons for leaving the county were associated with lower MCS scores. ASRs who were dissatisfied with their own living situation and who were discriminated often due to their origin had both lower MCS and PCS scores. Not feeling welcome in Germany and missing people from one's country of origin were both associated with lower MCS scores. No worries about not being able to stay in Germany or not being able to return to one's country of origin were both associated with higher MCS scores. CONCLUSIONS The economic situation in the country of origin and the presence of persecution, discrimination, and/or poor living conditions as reason for flight may be pre-flight-related determinants of HrQoL of ASRs in Germany. Possible post-flight-related determinants can be the residence status, the satisfaction with one's living situation, discrimination due to one's origin and a feeling of missing people from one's country of origin. With regard to those determinants, the clarity about the residence status, reducing racial discrimination and the mourning of flight-related circumstances must be ensured.
Collapse
Affiliation(s)
- Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| |
Collapse
|
13
|
Hagström A, Hasson H, Hollander AC, Vahtra C, Delilovic S, Augustsson H. "Sometimes it can be like an icebreaker": A mixed method evaluation of the implementation of the Refugee Health Screener-13 (RHS-13). J Migr Health 2024; 10:100243. [PMID: 39220097 PMCID: PMC11365362 DOI: 10.1016/j.jmh.2024.100243] [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: 04/14/2024] [Revised: 06/29/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background Forced migrants are at risk of developing mental illness, yet challenges remain with underutilization of mental healthcare among this population. This study examined the implementation of the Refugee Health Screener-13 (RHS-13) in the health assessment for forced migrants in eight primary health care centres in Stockholm Region, Sweden. Methods A mixed-methods convergent parallel design was used, combining nurses self-reported quantitative data on the levels and reasons for RHS-13 use in the health assessment with qualitative interview data on the barriers and facilitators for RHS-13 use. The Consolidated Framework for Implementation Research (CFIR) was used as a coding framework for the qualitative analysis. Results Levels of RHS-13 use varied between primary health care centres, resulting in two groups: three centres with high-level (65-92%) and five centres with low-level (0-36%) implementation. Factors related to the tool itself, as well as the inner and outer context, influenced the use of RHS-13. Language barriers, insufficient time, and lack of trust in the validity and utility of RHS-13 were the main barriers, while its availability in many languages and that it was perceived as an important complement to the health assessment were the main facilitators. Conclusion RHS-13 contributes to the standardization of assessing mental health in the health assessment. Identifying context-based implementation strategies and addressing language and time issues as well as nurses trust in the tool's utility are recommended to enhance the use of RHS-13.
Collapse
Affiliation(s)
- Ana Hagström
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Henna Hasson
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | | - Carl Vahtra
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Sara Delilovic
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Hanna Augustsson
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| |
Collapse
|
14
|
Yilmaz E, Tamam L, Cengisiz C. Post-traumatic stress disorder among long-term resettled Syrian refugees in Turkey: a comprehensive analysis of pre- and post-migratory factors. Front Psychiatry 2024; 15:1352288. [PMID: 39015884 PMCID: PMC11250486 DOI: 10.3389/fpsyt.2024.1352288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/13/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction After the war in Syria, many people were forcibly displaced, and many others migrated to foreign countries. Many Syrians have been exposed to traumatic negative lifeexperiences during this process. In this context, this study was carried out to investigate the effects of pre- and post-migration traumatic experiences and living difficulties on the development of post-traumatic stress disorder (PTSD) in Syrian refugees who have been residing in Turkey for more than five years. Methods The sample size of this cross-sectional study consisted of 200 Syrian refugees. Research data were collected using a self-report questionnaire. Refugees' depression and anxiety levels were assessed with The Hopkins Symptom Checklist-25 (HSCL-25), and post-traumatic stress disorder (PTSD) symptoms were assessed with the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5). Logistic regression models were created to assess the effects of pre- and post-migration traumas, adverse events, and other sociodemographic variables, including age and gender, on PTSD. Results The study unveiled a high prevalence of PTSD (55.5%), depression (33.5%), and anxiety(4.5%) among participants. Notably, male refugees and those exposed to armed conflict exhibited a significantly higher frequency of PTSD. In contrast, depression was more prevalent among female participants. Pre-migration traumatic experiences, especially near-death situations, were identified as significant predictors of PTSD. Interestingly, while pre-migration traumatic experiences were higher, post-migration living difficulties also emerged as a concern, with factorslike "inability to return home in emergencies" and "worries about losing ethnic identity" beinghighlighted. Path analysis further revealed that pre-migration traumatic experiences indirectly contributed to PTSD by exacerbating post-migration living difficulties. Discussion Syrian refugees in Turkey, even after long-term residence, exhibit high rates of PTSD, depression, and anxiety. While pre-migration traumas play a pivotal role, post-migration challenges further compound their mental health issues. These findings underscore the need for holistic, long-term mental health interventions that address both past traumas and current living difficulties.
Collapse
Affiliation(s)
- Ertan Yilmaz
- Tayfur Ata Sokmen Faculty of Medicine, Department of Psychiatry, Mustafa Kemal University, Hatay, Türkiye
| | - Lut Tamam
- Faculty of Medicine, Department of Psychiatry, Çukurova University, Adana, Türkiye
| | - Cengiz Cengisiz
- Department of Psychiatry, Ministry of Health Manisa Mental Health and Diseases Hospital, Manisa, Türkiye
| |
Collapse
|
15
|
Osman W, Ncube F, Shaaban K, Dafallah A. Prevalence, predictors, and economic burden of mental health disorders among asylum seekers, refugees and migrants from African countries: A scoping review. PLoS One 2024; 19:e0305495. [PMID: 38913631 PMCID: PMC11195976 DOI: 10.1371/journal.pone.0305495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/30/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Asylum seekers, migrants, and refugees from African countries may have significant health needs, resulting in economic implications for receiving countries around the world. The risk of mental illness is higher in these communities because of factors like violence, deprivation, and post-immigration challenges. OBJECTIVE The purpose of this study was to examine the literature to determine the prevalence, predictors, and economic impacts of mental health (MH) disorders among asylum seekers, migrants, and refugees from African countries. DESIGN AND METHODS In this scoping review, we followed the guidelines from PRISMA and CoCoPop. A modified version of the Appraisal Tool for Cross-Sectional Studies (AXIS) was used to assess study quality for cross-sectional studies, while an appraisal list was used for qualitative studies based on the Critical Appraisal Skills Programme (CASP). Inclusion criteria included peer-reviewed articles published in English, and articles based on official reports from credible institutions and organizations. Among the exclusion criteria were publications that were not peer reviewed or had not been sourced by credible sources, publications that did not meet the study topic or language criteria, mixed populations (including Africans and non-Africans), and research abstracts, reviews, news articles, commentary on study protocols, case reports, letters, and guidelines. DATA SOURCES A systematic search was carried out in Medline (via PubMed), EMBASE, APA PsycINFO, Web of Science and EBSCO, to identify relevant articles that were published between 1 January 2000 and 31 January 2024. RESULTS A total of 38 studies met the inclusion criteria, including 22 from African countries and three qualitative studies. In terms of number of countries contributing, Uganda was the largest (n = 7), followed by Italy (n = 4). The most studied conditions, using multiple diagnostic tools, were Post-Traumatic Stress Disorder (PTSD, n = 19) and depression (n = 17). These studies all revealed elevated rates of mental health disorders among these groups, and these were related to migration, refugee-related factors, and traumatic events. Most of these groups are dominated by young males. There is, however, a prominent presence of minors and women who have suffered a variety of forms of violence, in particular sexual violence. Furthermore, mental illnesses, such as PTSD and depression, are not only persistent, but can also be transmitted to children. In accordance with our inclusion criteria, our review found only one study that examined the economic impact of MH disorders in these groups, leaving a significant knowledge gap. According to this randomized controlled trial, intervention to reduce psychological impairment can help young people stay in school, improve their quality-adjusted life year (QALY), and earn an incremental cost-effectiveness ratio (ICER) of $7260 for each QALY gained. CONCLUSION Asylum seekers, migrants, and refugees from African countries are likely to experience MH needs, according to this scoping review. As well as posing persistent challenges, these disorders can also be transmissible to offspring. In addition to longitudinal studies of these groups, economic impact studies of mental illnesses are necessary.
Collapse
Affiliation(s)
- Wael Osman
- Department of Biological Sciences, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Centre of Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
- Liverpool John Moores University in Partnership with UNICAF University, Liverpool, United Kingdom
| | - France Ncube
- Liverpool John Moores University in Partnership with UNICAF University, Liverpool, United Kingdom
- Lupane State University, Bulawayo, Zimbabwe
| | - Kamil Shaaban
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Suba University Hospital, Khartoum, Sudan
- Ibn Sina University, Khartoum, Sudan
| | - Alaa Dafallah
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
16
|
El-Ghitany EM, Ashour A, Elrewany E, Farghaly AG, Shata Z. Prevalence and predictors of depression, anxiety, and stress among refugees in Egypt. J Egypt Public Health Assoc 2024; 99:14. [PMID: 38842628 PMCID: PMC11156824 DOI: 10.1186/s42506-024-00158-8] [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: 10/07/2023] [Accepted: 04/30/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Many Refugees show multiple distressing psychological and mental health problems associated with stressful and adverse conditions in host countries. Even though Egypt is one of the top five destination countries hosting refugees and asylum-seekers in the MENA region, there is a lack of studies investigating mental health problems among refugees in Egypt. This study aimed to assess the prevalence and predictors of depression, anxiety, and stress symptoms among refugees living in Egypt. METHODS A total of 398 refugees aged 18 and above were interviewed from migrants'/refugees' community centers in Giza, Alexandria, Dakahlia, and Damietta governorates. A predesigned structured interview questionnaire was used to collect socio-demographic and migration-related variables. The Arabic Version of Depression Anxiety Stress Scales (DASS-21) was used to assess the presence and severity of the three negative emotional states. RESULTS Nearly two-thirds of the participants were Syrian (66.4%). The majority resided in Alexandria and Giza governorates (75.9%), were females (73.4%), and were married (71.1%). The most reported migration difficulty was housing (41.5%). Anxiety symptoms were reported among 63.3% (95% CI: 58.59%- 68.05%) of sampled refugees, followed by depression (61.3%, 95% CI: 56.52%-66.10%), and stress symptoms (51.5%, 95% CI: 46.56%-56.36%). Results of regression analysis showed that; female gender predicted anxiety (aOR 2.419, 95% CI: 1.485-3.941, p < 0.001) and stress (aOR 2.053, 95% CI: 1.197-3.519, p = 0.009), while younger age groups (18-25 yr. and 26-50 yr.) compared to the older age group (51 yr. and older) predicted depression (aOR 4.529, 95% CI: 1.696-12.097, p = 0.003 and aOR 2.177, 95% CI: 1.270- 3.733, p = 0.005, respectively) and stress (aOR 4.334, 95% CI: 1.556-12.074, p = 0.005 and aOR 1.808, 95% CI: 1.023-3.193, p = 0.041, respectively). Residence in Alexandria, housing, and employment difficulties predicted anxiety (aOR 2.354, 95% CI: 1.420-3.902, p < 0.001, aOR 1.726, 95% CI: 1.073-2.778, p = 0.025, and aOR 3.044, 95% CI: 1.248-7.425, p = 0.014, respectively), depression (aOR 1.949, 95% CI: 1.163-3.266, p = 0.011, aOR 1.666, 95% CI: 1.036-2.681, p = 0.035, and aOR 3.216, 95% CI: 1.321-7.828, p = 0.010, respectively), and stress (aOR 2.450, 95% CI: 1.431-4.195, p < 0.001, aOR 1.911, 95% CI: 1.187-3.078, p = 0.008, and aOR 4.482, 95% CI: 1.867-10.760, p < 0.001, respectively). CONCLUSION Mental health problems are prevalent among the refugee population in Egypt that are compounded by the difficult post-migration socio-economic situation. Multisectoral attention towards refugees' mental health is urgently needed.
Collapse
Affiliation(s)
- Engy M El-Ghitany
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ayat Ashour
- Department of Family Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
| | - Ehab Elrewany
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Azza G Farghaly
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Zeinab Shata
- Department of Family Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| |
Collapse
|
17
|
McQuaid JH, Mandavia A, Cassidy G, Silva MA, Esmail K, Aragula S, Gamez G, McKenzie K. Persecution as stigma-driven trauma: Social determinants, stigma, and violence in asylum seekers in the United States. Soc Sci Med 2024; 350:116761. [PMID: 38701637 DOI: 10.1016/j.socscimed.2024.116761] [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: 06/02/2023] [Revised: 01/11/2024] [Accepted: 03/05/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Existing literature documents high rates of experienced violence in asylum seekers. Despite this high prevalence, experiences of traumatic stress are neither necessary nor sufficient grounds for claiming asylum, without documented experiences of persecution. The aim of the current study is to better understand the role of co-occurring pre-migratory social determinants, stigma, and trauma on the experiences of persecution among asylum seekers in the United States. METHOD We conducted a retrospective file review of legal declarations submitted by 25 asylum seekers who participated in forensic mental health evaluations at a pro-bono asylum clinic. We coded de-identified data for co-occurring events of trauma, social determinants of health, and components of "discrimination" from the legal definition of persecution - conceptualizing persecution as stigma-driven infliction of violence. Data was analyzed using a tiered deductive and inductive reflexive thematic analysis. RESULTS Findings suggest pre-migratory social determinants included demographics, neighborhood, economic, environmental, and social and cultural level disparities across various grounds for seeking asylum, and experiences of stigma were associated with the specific acts of violence and harm. CONCLUSIONS Our findings - specific to asylum seekers who have obtained legal representation and completed applications for asylum in the United States - describe the co-occurrence of social determinants, stigma and traumatic experiences among asylum seekers. To our knowledge, this study is the first of its kind to bridge the existing legal framework of asylum to a psychological construct incorporating trauma, stigma, and social determinants of health, lending support for the conceptualization of persecution as stigma-driven trauma.
Collapse
|
18
|
Della Rocca B, Bello R, Carbone M, Pezzella P, Toni C, Sampogna G, Tarsitani L, Luciano M, Fiorillo A. Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions. Int J Soc Psychiatry 2024; 70:653-666. [PMID: 38069651 DOI: 10.1177/00207640231214964] [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: 06/02/2024]
Abstract
BACKGROUND According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children. METHODS The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using ("immigrants" OR "migration" OR "asylum seekers" OR "refugees") AND ("promotion" OR "prevention") AND ("mental health" OR "mental disorders" OR "psych*") AND ("children" OR "adolescents" OR "young adults") as search string. Fourteen articles qualified for the detailed review. RESULTS AND CONCLUSIONS The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed.
Collapse
Affiliation(s)
- Bianca Della Rocca
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Rosaria Bello
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Marco Carbone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Claudia Toni
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | | | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| |
Collapse
|
19
|
Ziyachi M, Castellani B. A 'Cultural Models' Approach to Psychotherapy for Refugees and Asylum Seekers: A Case Study from the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:650. [PMID: 38791864 PMCID: PMC11121039 DOI: 10.3390/ijerph21050650] [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: 04/16/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Despite the existence of significant research on the mental health care challenges of migrants, particularly refugees and asylum seekers, less attention has been paid to treatment approaches. We used a case study from the UK to look at the topic from a cultural models approach (which comes from cognitive anthropology) to analyse migrants' experiences with mental health care. Twenty-five refugees and asylum seekers living in North East England and Northern Ireland were interviewed who had used at least six sessions of talking therapy during the last three years. Our results suggested that adopting a 'cultural models' approach, which offers a new conceptual and methodological framework of migrants' experiences and their underlying schemas and expectations, would significantly contribute to building therapeutic alliances and provide relevant and appropriate treatments for migrant clients, particularly for unrecognised pre- and post-migration traumatic experiences.
Collapse
Affiliation(s)
- Mohaddeseh Ziyachi
- Department of Sociology, Durham University, Stockton Road, Durham DH1 3LE, UK;
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, Durham DH1 3LE, UK
| | - Brian Castellani
- Department of Sociology, Durham University, Stockton Road, Durham DH1 3LE, UK;
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, Durham DH1 3LE, UK
- Durham Research Methods Centre, Durham University, Stockton Road, Durham DH1 3LE, UK
- Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford GU2 7XH, UK
| |
Collapse
|
20
|
Riggs E, Gartland D, Szwarc J, Stow M, Paxton G, Brown SJ. Resilience and Positive Wellbeing Experienced by 5-12-Year-Old Children with Refugee Backgrounds in Australia: The Childhood Resilience Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:627. [PMID: 38791841 PMCID: PMC11121680 DOI: 10.3390/ijerph21050627] [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: 04/04/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Refugee research tends to be deficit based and focused on the risks threatening positive adaptation and wellbeing. High rates of mental (and physical) health issues have been reported for refugee adults and children, including intergenerational trauma. This study uses the new Child Resilience Questionnaire (CRQ), co-designed with refugee background communities, to describe resilience and positive wellbeing experienced by children of refugee-background. The Childhood Resilience Study (CRS) recruited 1132 families with children aged 5-12 years in Victoria and South Australia, Australia. This included the recruitment of 109 families from 4 refugee background communities: Assyrian Chaldean (Iraq, Syria), Hazara (Afghanistan), Karen (Burma, Thailand) and Sierra Leonean families. CRQ-parent/caregiver report (CRQ-P/C) scores were categorised into 'low', 'moderate' and 'high'. The child's emotional and behavioural wellbeing was assessed with the Strengths and Difficulties Questionnaire, with positive wellbeing defined as <17 on the total difficulties score. Tobit regression models adjusted for a child's age. The CRQ-P/C scores were not different for boys and girls of refugee background. Children of refugee-background (n = 109) had higher average CRQ-P/C scores than other CRS children (n = 1023) in the personal, school and community domains, but were lower in the family domain. Most children with 'high' resilience scores had positive wellbeing for both children of refugee-background (94.6%) and other CRS children (96.5%). Contrary to common stereotypes, children of refugee-background show specific individual, family, school and cultural strengths that can help them navigate cumulative and complex risks to sustain or develop their positive wellbeing. A better understanding as to how to build strengths at personal, family, peer, school and community levels where children are vulnerable is an important next step. Working in close collaboration with refugee communities, schools, policy makers and key service providers will ensure the optimal translation of these findings into sustainable practice and impactful public policy.
Collapse
Affiliation(s)
- Elisha Riggs
- Intergenerational Health, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.R.); (S.J.B.)
- Department of General Practice, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.R.); (S.J.B.)
- Department of Pediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Melbourne, VIC 3056, Australia; (J.S.); (M.S.)
| | - Mardi Stow
- Victorian Foundation for Survivors of Torture, Melbourne, VIC 3056, Australia; (J.S.); (M.S.)
| | - Georgia Paxton
- Immigrant Health Service, Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
| | - Stephanie J. Brown
- Intergenerational Health, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.R.); (S.J.B.)
- Department of General Practice, University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| |
Collapse
|
21
|
Hilado A, Charvonia A, Martinez Araujo WR, Rami F, Sanchez E. Supporting Migrant Children in Pediatric Settings: Lessons Learned from the US Migrant Humanitarian Crisis Response. Pediatr Ann 2024; 53:e171-e177. [PMID: 38700915 DOI: 10.3928/19382359-20240306-05] [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: 05/05/2024]
Abstract
This article examines the influx of migrants to the United States and highlights current global and local immigration trends. The authors focus on migrant children-specifically the effect of migration trauma in the context of humanitarian responses to the intentional movement of migrants to Democrat-led cities across the US to humanize the compounded effects of migration trauma, restrictive immigration policies, and the current resettlement landscape for migrants. The authors are directly involved with supporting migrant arrivals who have relocated to Chicago from the southern border, and apply field knowledge to articulate current barriers to accessing health care and best practices within pediatric settings supporting migrant arrivals. Clinical and practice implications for medical providers in pediatric settings are included. The article also highlights the role of interdisciplinary collaboration in providing health care to asylum-seeking migrants and implications for transdisciplinary workforce development in this area. [Pediatr Ann. 2024;53(5):e171-e177.].
Collapse
|
22
|
Rawers C, Redican E, Alpay EH, McElroy E, Shevlin M. Multiple trauma exposure and psychopathology in Syrian refugees living in Turkey: A latent class analysis. Acta Psychol (Amst) 2024; 245:104220. [PMID: 38490133 DOI: 10.1016/j.actpsy.2024.104220] [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: 11/19/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND After the Syrian civil war, millions of Syrian refugees migrated to neighboring countries, with the majority settling in Turkey. The prevalence of mental disorders is notably higher among refugee populations. However, prior research on Syrian refugees have mostly used variable-centred approaches which have known limitations. Thus, the present study sought to examine the occurrence and co-occurrence of traumatic experiences among Syrian refugees living in Turkey using latent class analysis (LCA). Additionally, this study aimed to identify the associations between latent class membership and trauma-related psychopathology. METHODS Participants included 593 Syrian refugees living in Turkey. LCA was used to identify latent classes of trauma exposure. Demographic predictors of the latent classes were examined and associations with PTSD, CPTSD, depression and anxiety were also explored. RESULTS Three latent classes were identified based on trauma exposure; a "multiple traumas" class, "war and human suffering" class, and "low exposure, combat-exposed" class. Odds of PTSD, CPTSD, depression, or anxiety diagnosis did not differ significantly between classes, with the exception of the "multiple traumas" class who were more likely to meet the criteria for anxiety diagnosis compared to the "low exposure" class. LIMITATIONS Historic psychiatric symptoms or post-migration stressors could not be accounted for in this study, which may explain the lack of significant differences in most mental health outcomes by trauma exposure class. DISCUSSION The latent classes identified in this study correspond with previous research regarding trauma in Syrian refugees. However, this study largely failed to find significant differences in mental health diagnoses between classes. Future research should consider the effect of post-migration stressors in refugee populations, which may play a crucial role in mental health outcomes.
Collapse
Affiliation(s)
| | - Enya Redican
- Ulster University, School of Psychology, Coleraine, UK
| | | | - Eoin McElroy
- Ulster University, School of Psychology, Coleraine, UK
| | - Mark Shevlin
- Ulster University, School of Psychology, Coleraine, UK.
| |
Collapse
|
23
|
Assaf SA, Nuwayhid I, Habib RR. A conceptual framework on pre- and post-displacement stressors: the case of Syrian refugees. Front Public Health 2024; 12:1372334. [PMID: 38737863 PMCID: PMC11082271 DOI: 10.3389/fpubh.2024.1372334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Researchers have documented multiple stressors and mental health problems along the journey of refugees as they are displaced to seek refuge in nearby and remote host countries. This article examines published research on Syrian refugees to propose a framework to conceptualize Syrian refugees' pre- and post-stressors and their collective impact on their mental health. The proposed framework provides a comprehensive understanding of the interconnected pathways between pre-displacement stressors, post-displacement stressors, and mental health outcomes for Syrian refugees. Pre-displacement stressors are best captured by the concept of trauma centrality and emotional suppression. Post-displacement stressors, categorized under financial, political, and social themes, have a direct impact on the mental health of the refugees, but could also play a partial mediating role on the impact of pre-displacement stressors on mental health. The framework suggests a direct pathway between the experience of war-related traumatic events and mental health and introduces the country of residence as a potential moderator of the severity of mental health. The latter is primarily influenced by local policies and the host communities' acceptance of refugees. We believe that the proposed framework can guide the work of researchers, policymakers, and practitioners concerned with the mental health and well-being of Syrian refugees. Additionally, although based on the experience of Syrian refugees, it presents a holistic perspective that could be adapted in other refugee settings.
Collapse
Affiliation(s)
- Sara A. Assaf
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Iman Nuwayhid
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima R. Habib
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
24
|
Lechner-Meichsner F, Comtesse H, Olk M. Prevalence, comorbidities, and factors associated with prolonged grief disorder, posttraumatic stress disorder and complex posttraumatic stress disorder in refugees: a systematic review. Confl Health 2024; 18:32. [PMID: 38627778 PMCID: PMC11020800 DOI: 10.1186/s13031-024-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The number of refugees worldwide is at an all-time high with many being exposed to potentially traumatic events and the loss of loved ones. The 11th revision of the International Statistical Classification of Diseases and Related Health Problems now includes prolonged grief disorder and complex posttraumatic stress disorder and revised criteria for posttraumatic stress disorder. An overview of these stress-related disorders among people who have become refugees is therefore needed. Consequently, we conducted a systematic review to determine prevalence rates, comorbidities, and associated factors for each of the disorders. METHOD We systematically searched PubMed, Web of Science, and PsycArticles to identify studies that reported prevalence rates, predictors or associated factors, and/or comorbid mental disorders for either (1) prolonged grief disorder, (2) posttraumatic stress disorder, or (3) complex posttraumatic stress disorder among refugees. The selection process followed the PRISMA guidelines. RESULTS A total of 36 studies met the inclusion criteria. Most of the studies were of high quality. There was substantial variation in prevalence rates by disorder, with prolonged grief ranging from 6 to 54%, posttraumatic stress disorder ranging from 0.4 to 80%, and complex posttraumatic stress disorder ranging from 3 to 74.6%. Pooled prevalence for posttraumatic stress disorder was estimated at 29.8% in treatment seeking samples and 9.92% in population samples. For complex posttraumatic stress disorder, it was estimated at 57.4% in treatment seeking samples and 7.8% in population samples. Posttraumatic stress disorder was among the most frequent comorbidities for prolonged grief disorder while depressive symptoms were the most frequently occurring co-morbidity across all three disorders. Sociodemographic variables, trauma exposure, and loss characteristics were associated with higher symptom severity. Postmigration living difficulties played an important role in prolonged grief and complex posttraumatic stress disorder. CONCLUSION The review revealed substantial differences in prevalence rates between the three studied disorders but underscored a very high prevalence of ICD-11 stress-related disorders among refugees. The identified associated factors point to subgroups that may be particularly at risk and establishes a foundational basis for targeted interventions and potential policy changes. Future research should incorporate longitudinal investigations and emphasize culturally sensitive assessments.
Collapse
Affiliation(s)
- Franziska Lechner-Meichsner
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany.
- Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands.
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Ostenstraße 26, 85072, Eichstätt, Germany
| | - Marie Olk
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
| |
Collapse
|
25
|
Saadi A, Prabhu M, Snyder SA, Daboul L, Mateen F. Neurological Care of Refugees and Other Forcibly Displaced Persons. Semin Neurol 2024; 44:217-224. [PMID: 38499195 PMCID: PMC11177780 DOI: 10.1055/s-0044-1782495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
There are more than 100 million forcibly displaced persons (FDPs) in the world today, including a high number of people who experience neurologic symptoms and presentations. This review summarizes the conceptual frameworks for understanding neurological health risks and conditions across the migration journey (premigration, migration journey, and postmigration) and life span, including special attention to pediatric FDPs. The interaction with psychiatric illness is discussed, as well as the available published data on neurologic presentations in FDPs in the medical literature. A social determinant of health lens is used to provide ways in which forcible displacement can influence brain health and neurological outcomes. Priorities and future needs for the neurological care of refugees and other FDPs are suggested.
Collapse
Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Meha Prabhu
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Sara A. Snyder
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lynn Daboul
- Mass General Brigham Neurology Residency Program, Boston, MA
| | - Farrah Mateen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
26
|
Ayubi M, Satyen L. Factors Associated with Intimate Partner Violence Perpetration Among Migrant Men: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1365-1381. [PMID: 37300321 PMCID: PMC10913363 DOI: 10.1177/15248380231178758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intimate partner violence (IPV) is the most widespread form of violence against women and the most common perpetrators are male partners. Immigration can involve stressors and barriers that are linked to male IPV perpetration. The objective of this systematic review was to identify the factors associated with IPV perpetration among migrant men. Four electronic databases, MEDLINE Complete, Embase, PsycInfo, and SocINDEX with full text, were searched up to August 2021. Studies were selected that examined factors associated with IPV perpetration among first-generation migrants who identified as men/males and were aged 18 years or older. In all, 18 articles met the eligibility criteria for the review, representing a total of 12,321 male participants, including 4,389 migrant men. A wide range of factors associated with IPV perpetration were found at the individual, relationship, community, and societal levels. Unique risk factors for migrant men's IPV perpetration were exposure to political violence, deportation experiences, and minimal legal sanctions for perpetration in some countries of origin. Societal factors explored among Latino immigrants were traditional gender roles such as machismo and norms of violence. All identified factors should be considered in the cultural contexts of the relevant samples and should not be generalized to all migrant men. The findings of modifiable and culture-specific factors have important implications for strategies aimed at reducing IPV perpetration. Future research should explore factors associated with IPV perpetration within specific cultures rather than across broad cultural groupings.
Collapse
|
27
|
Al-Adhami M, Durbeej N, Daryani A, Wångdahl J, Larsson EC, Salari R. Can extended health communication improve newly settled refugees' health literacy? A quasi-experimental study from Sweden. Health Promot Int 2024; 39:daae015. [PMID: 38430509 PMCID: PMC10908352 DOI: 10.1093/heapro/daae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2024] Open
Abstract
Structural and contextual factors such as limited work and housing opportunities negatively affect the health and well-being of newly settled refugee migrants in receiving high-income countries. Health promotion initiatives aiming at strengthening health and integration have been tried out within the Swedish Introduction program for refugee migrants. However, longitudinal evaluations of these interventions are rare. The aim of the current study was to compare the effectiveness of a regular and an extended civic orientation course with added health communication and examine whether the latter would improve self-rated health and psychological well-being, health literacy and social capital among newly settled refugee migrants in Sweden. Pre- and post-assessment questionnaires were collected from the intervention group receiving the extended course (n = 143) and a control group receiving the regular course (n = 173). Linear mixed models and chi-square analyses showed a significant increase with a small effect size (0.21) in health literacy in the intervention group. However, there were no significant changes in emotional and practical support, general self-rated health or psychological well-being. The findings indicate that added health communication provided embedded in the civic orientation course can increase health literacy. However, further longitudinal studies are needed to confirm the sustainability of the observed effect and examine whether these short-term improvements in health literacy translate to long-term advances in health and integration.
Collapse
Affiliation(s)
- Maissa Al-Adhami
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
- Research and Learning for Sustainable Development and Global Health (SWEDESD), Department of Women’s and Children’s Health, Uppsala University, Hammarskjölds väg 14B, 752 37 Uppsala, Sweden
| | - Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Achraf Daryani
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| | - Josefin Wångdahl
- Aging Research Center, Karolinska Institutet and Stockholm University, Tomtebodavägen 18 A, 171 65 Stockholm, Sweden
| | - Elin C Larsson
- Research and Learning for Sustainable Development and Global Health (SWEDESD), Department of Women’s and Children’s Health, Uppsala University, Hammarskjölds väg 14B, 752 37 Uppsala, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 65 Stockholm, Sweden
| | - Raziye Salari
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, 752 37 Uppsala, Sweden
| |
Collapse
|
28
|
Madsen J, Jobson L, Slewa-Younan S, Li H, King K. Mental health literacy among Arab men living in high-income Western countries: A systematic review and narrative synthesis. Soc Sci Med 2024; 346:116718. [PMID: 38489937 DOI: 10.1016/j.socscimed.2024.116718] [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: 07/01/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
While interest in mental health literacy (MHL) is growing rapidly, cross-cultural research focusing on MHL is developing more slowly. This inaugural systematic review explored the recognition and beliefs about the causes of mental health disorders amongst Arab men living in high income Western countries (HIWC), their help-seeking beliefs, behaviors, and sources of help, as well as barriers and facilitators to help-seeking. Six electronic database searches were conducted using Medline, Embase, ProQuest Dissertations & Theses Global, PsycINFO, Scopus, and Web of Science. These searches yielded a total of 9,460 citations. After applying inclusion criteria through both database and manual hand searches, 46 studies were identified. The findings corresponded with four of the socioecological model's five factors: intrapersonal, interpersonal, societal, and institutional. Intrapersonal factors included attributing mental health illness to life and migration stressors, and religious reasons. Interpersonal and societal factors included men favoring informal help-seeking sources as stigma was a barrier to formal help-seeking. Institutional factors around the perceived cultural competence of healthcare professionals and access difficulties were obstacles to seeking formal help. The growth in Arab migration to HIWC highlights the need for culturally tailored care. Research is needed to understand the perspectives of healthcare providers working with Arab men in addition to how men's stigmatizing attitudes are an obstacle to formal help-seeking. Interventions should be designed to address the unique mental health needs of Arab men, recognizing that some explanatory beliefs may not align with current Western models of mental health. Moreover, efforts should be made to integrate men's informal sources of support into treatment planning.
Collapse
Affiliation(s)
- Julian Madsen
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Shameran Slewa-Younan
- Macarthur Clinical School, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 275, Australia.
| | - Haoxiang Li
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Kylie King
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| |
Collapse
|
29
|
Weitzman A, Huss K, Blanton M, Swindle J, Camacho GB, Robles A. International Displacement and Family Stress in Latin America. JOURNAL OF FAMILY ISSUES 2024; 45:531-554. [PMID: 38390475 PMCID: PMC10881208 DOI: 10.1177/0192513x231151291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Family stress theories posit that individual family members are positioned to adapt to external stressors differently and that these differences can strain family systems. Analyzing in-depth interviews with a diverse sample of migrant mothers in Costa Rica, we investigate how families adjust to the stressors of international displacement. Three stages of family stress adjustment emerged from our analysis: (1) parents' prioritization of safety, (2) parents' and children's grappling with new legal, economic, and social circumstances, and (3) parents' protracted uncertainty in one or more of these realms concomitant with children's feeling resettled. A fourth stage of (4) convergent parent and child resettling also emerged, but only among select families who enjoyed stable financial or emotional support from extended kin or local institutions in Costa Rica. Parents' perceptions of their security, and social, economic, and legal circumstances contributed to the progression between stages of stress adjustment.
Collapse
Affiliation(s)
| | | | | | | | | | - Arodys Robles
- (Universidad de Costa Rica, Centro Centroamericano de Población)
| |
Collapse
|
30
|
Verhaak L, ter Heide JJ. Group Schema Therapy for Refugees with Treatment-Resistant PTSD and Personality Pathology. Case Rep Psychiatry 2024; 2024:8552659. [PMID: 38434423 PMCID: PMC10904674 DOI: 10.1155/2024/8552659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Patients with complex forms of posttraumatic stress disorder (PTSD) may benefit from schema therapy. While a small number of studies point to the effectiveness of individual schema therapy in refugees with PTSD, no evidence on group schema therapy (GST) in refugees exists. To illustrate and advocate for the use of GST in refugee patients with treatment-resistant PTSD and comorbid personality pathology, a case report is presented. Presentation. The case concerned the treatment of an East African female refugee who survived sexual and physical violence and loss as a child, as the hostage of a rebel army, and as a victim of human trafficking. She was diagnosed with PTSD, major depressive disorder, and borderline personality disorder. Trauma-focused therapy was hampered by insufficient treatment attendance due to current stress factors and early destructive coping strategies. One year of GST enabled the patient to overcome treatment-undermining patterns and benefit from subsequent trauma-focused therapy. Conclusion This case suggests that GST may have the potential to improve treatment adherence and the effectiveness of trauma-focused treatment in complex refugee patients. Clinical impressions need to be confirmed in a study that examines the feasibility, acceptability, and preliminary efficacy of GST in refugees with treatment-resistant PTSD and personality pathology.
Collapse
|
31
|
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.
Collapse
Affiliation(s)
- Ben C H Kuo
- Department of Psychology, University of Windsor, Ontario, Canada
| | | |
Collapse
|
32
|
Dadras O, Diaz E. Perceived discrimination and its association with self-rated health, chronic pain, mental health, and utilization of health services among Syrian refugees in Norway: a cross-sectional study. Front Public Health 2024; 12:1264230. [PMID: 38406500 PMCID: PMC10884245 DOI: 10.3389/fpubh.2024.1264230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background There is a scarcity of research on discriminatory experiences and their association with health outcomes among Syrian Refugees in Norway. Thus, this study aims to examine the relationship between perceived discrimination, self-rated health (SRH), chronic pain, poor mental health, and healthcare utilization among Syrian refugees resettled in Norway. Methods Cross-sectional data from the Integration for Health project were analyzed, including 154 Syrian refugees who resettled in Norway in 2018-19. Perceived discrimination, SRH, chronic pain, psychological distress, post-traumatic stress symptoms, and healthcare visits were assessed. Statistical analyses, including Poisson regression and multinomial logistic regression, were conducted. The significant statistical level was set at 0.05. Results Approximately 30% of participants reported experiencing discrimination, with no significant associations between sociodemographic factors and perceived discrimination. Perceived discrimination was significantly associated with psychological distress (adjusted PR: 2.07, 95%CI: 1.21-3.55), post-traumatic stress symptoms (adjusted PR: 11.54, 95%CI: 1.25-106.16), and 4 or more psychologist visits (adjusted OR: 12.60, 95%CI: 1.72-92.16). However, no significant associations were found between perceived discrimination and SRH; pain symptoms, or general healthcare utilization. Conclusion Experienced discrimination is highly prevalent and seems to be associated with mental health outcomes, but not clearly with SRH, pain, or general healthcare visits among Syrian refugees living in Norway. Efforts should focus on reducing discrimination, promoting social inclusion, and improving access to mental health services for refugees. Public awareness campaigns, anti-discrimination policies, and cultural training for healthcare professionals are recommended to address these issues and improve the well-being of Syrian refugees in Norway.
Collapse
Affiliation(s)
- Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Esperanza Diaz
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
33
|
de Graaff AM, Cuijpers P, Boschloo L, Elsawy M, Hunaidy S, Seedat S, Witteveen AB, Huizink AC, Sijbrandij M. The associations of hair cortisol and DHEA with posttraumatic stress disorder symptoms in refugees. Compr Psychiatry 2024; 129:152438. [PMID: 38104462 DOI: 10.1016/j.comppsych.2023.152438] [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: 06/14/2023] [Revised: 10/09/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Exposure to traumatic events, ongoing adversity, and posttraumatic stress disorder (PTSD) are associated with altered activity of the hypothalamic-pituitary-adrenal (HPA) axis, but findings are mixed. This may be explained in part by heterogeneity in PTSD symptom profiles. AIM The aim of this study was to investigate the complex relationships between the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and dehydroepiandrosterone (DHEA) in refugees. METHODS Adult (18+ years) Syrian refugees with increased levels of distress participating in a randomized controlled trial completed baseline measures to assess traumatic events (trauma checklist), post-displacement stressors (Post-Migration Living Difficulties checklist), symptoms of PTSD (PTSD Checklist for DSM-5; PCL-5), and provided a hair sample for additional stress hormone analyses. We used R-packages qgraph and bootnet to perform network analysis on the number of traumatic events and post-displacement stressors, individual symptoms of PTSD, and HPA-axis hormones cortisol and DHEA. The final network model was corrected for depression severity. RESULTS 115 (53% male, M age = 36.9, SD = 12.7) of 206 participants provided a hair sample. A higher number of traumatic events was directly associated with three symptoms of the PTSD cluster arousal and reactivity, i.e., sleep disturbance, hypervigilance and physiological reactivity, and with three other PTSD symptoms, namely flashbacks, avoidance of reminders, and self-destructive behavior. A higher number of post-displacement stressors was associated with four symptoms of the PTSD cluster cognition and mood, i.e., trauma-related amnesia, negative beliefs, blaming of self/others, and detachment, as well as with intrusive thoughts, sleep disturbance, hypervigilance, and exaggerated startle response. The number of traumatic events and post-displacement stressors were not associated with cortisol or DHEA. Cortisol was positively associated with two symptoms of the PTSD cluster cognition and mood, i.e., negative beliefs and negative trauma-related emotions, and negatively associated with avoidance of reminders. DHEA was positively associated with restricted affect and with three symptoms of the PTSD symptom cluster arousal and reactivity, i.e., irritability/anger, sleep disturbance, and self-destructive behavior, and negatively associated with avoidance of thoughts. CONCLUSIONS This study demonstrated that exposure to traumatic events and post-displacement stressors is not related to cortisol and DHEA, but that cortisol and DHEA are differentially related to individual symptoms of PTSD. While lower levels of both cortisol and DHEA were associated with increased avoidance, higher levels of cortisol were mostly associated with symptoms of the PTSD cluster cognition and mood and higher levels of DHEA were mostly associated with symptoms of the PTSD cluster arousal and reactivity. These findings contribute to explaining the variability of findings in the literature on HPA-axis activity in PTSD. ETHICS The study was approved by the Research Ethics Review Committee at VU Medical Center, the Netherlands (Protocol ID: NL61361.029.17, 7 September 2017) and prospectively registered online (https://www.trialregister.nl/trial/6665).
Collapse
Affiliation(s)
- Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands.
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Strada Mihail Kogălniceanu 1, Cluj-Napoca 400347, Romania
| | - Lynn Boschloo
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht 3584 CS, the Netherlands
| | - Mariam Elsawy
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Sam Hunaidy
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Soraya Seedat
- SAMRC Genomics of Brain Disorders Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Clinical Building, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Anja C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| |
Collapse
|
34
|
Herroudi L, Knuppel I, Blavier A. Post-migration journey: Asylum, trauma and resilience, different trajectories - A comparison of the mental health and post-migration living difficulties of documented and undocumented migrants in Belgium. Int J Soc Psychiatry 2024; 70:201-208. [PMID: 37815206 DOI: 10.1177/00207640231204212] [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: 10/11/2023]
Abstract
BACKGROUND Research on the impact of post-migration experiences on the mental health of migrant populations has shown a predictive link between post-migration living difficulties and psychological distress. While many studies have focussed on refugees and asylum seekers, there is a considerable gap in the literature concerning undocumented migrants. AIMS The aim of this study was to assess the differences in mental health between documented and undocumented migrants in Belgium. It identified the post-migration difficulties encountered by these two groups and measured their impact on their levels of trauma, resilience, anxiety, depression and their assumptive world. METHOD This study involved 69 participants, aged 18 to 68 years, who were either documented or undocumented resident in Belgium. Our data collection included the Post-Migration Living Difficulties Checklist for the measurement of post-migration difficulties, the Posttraumatic Stress Disorder Checklist - DSM-V version for the measurement of trauma, the World Assumptions Questionnaire for the measurement of the assumptive world, the Hopkins Symptom Checklist-25 for the measurement of depressive and anxiety disorders and the Adult Resilience Measure - Revised for the measurement of resilience. RESULTS Our analyses showed that the mental health of undocumented migrants was poorer than that of documented migrants, with higher levels of trauma, anxiety and depression, a more negative assumptive world, a lower sense of control and lower total and personal resilience. Our results also revealed that post-migration living difficulties were more severe and more numerous for undocumented migrants, and that they were associated to different themes in both groups. CONCLUSIONS The fact that post-migration experience plays such an important role in the mental health of migrant populations raises significant clinical, political and societal considerations. Furthermore, it would appear that undocumented migrants represent a distinct migratory group with their own specificities in terms of migration journey and mental health.
Collapse
|
35
|
Studer S, Kleinstäuber M, von Lersner U, Weise C. Increasing transcultural competence in clinical psychologists through a web-based training: study protocol for a randomized controlled trial. Trials 2024; 25:71. [PMID: 38243285 PMCID: PMC10799352 DOI: 10.1186/s13063-023-07878-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In mental health care, the number of patients with diverse cultural backgrounds is growing. Nevertheless, evaluated training programs for transcultural competence are missing. Barriers for engaging in transcultural therapy can be identified in patients as well as in therapists. Besides language barriers, clinical psychologists report insecurities, for example, fear of additional expenses when involving a language mediator, ethical concerns such as power imbalances, or fear of lack of knowledge or incorrect handling when working with patients from other cultures. Divergent values and concepts of disease, prejudices, and stereotyping are also among the issues discussed as barriers to optimal psychotherapy care. The planned study aims to empower clinical psychologists to handle both their own as well as patients' barriers through a web-based training on transcultural competence. METHODS The training includes 6 modules, which are unlocked weekly. A total of N = 174 clinical psychologists are randomly assigned to two groups: the training group (TG) works through the complete training over 6 weeks, which includes a variety of practical exercises and self-reflections. In addition, participants receive weekly written feedback from a trained psychologist. The waitlist control group (WL) completes the training after the end of the waiting period (2 months after the end of the TG's training). The primary outcome is transcultural competence. Secondary outcomes consist of experiences in treating people from other cultures (number of patients, satisfaction and experience of competence in treatment, etc.). Data will be collected before and after the training as well as 2 and 6 months after the end of the training. DISCUSSION This randomized controlled trial tests the efficacy of and satisfaction with a web-based training on transcultural competence for German-speaking clinical psychologists. If validated successfully, the training can represent a time- and place-flexible training opportunity that could be integrated into the continuing education of clinical psychologists in the long term. TRIAL REGISTRATION DRKS00031105. Registered on 21 February 2023.
Collapse
Affiliation(s)
- Selina Studer
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, 6405 Old Main Hill, Logan, UT, 84321, USA
| | | | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| |
Collapse
|
36
|
Baumgartner JS, Renner A, Wochele-Thoma T, Wehle P, Barbui C, Purgato M, Tedeschi F, Tarsitani L, Roselli V, Acartürk C, Uygun E, Anttila M, Lantta T, Välimäki M, Churchill R, Walker L, Sijbrandij M, Cuijpers P, Koesters M, Klein T, White RG, Aichberger MC, Wancata J. Impairments in psychological functioning in refugees and asylum seekers. Front Psychol 2024; 14:1295031. [PMID: 38259575 PMCID: PMC10801113 DOI: 10.3389/fpsyg.2023.1295031] [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: 09/15/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version's total and six subdomains' scores ('mobility', 'life activities', 'cognition', 'participation', 'self-care', 'getting along') as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in 'mobility' and 'participation', followed by 'life activities' and 'cognition'. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in 'participation', while past events of being close to death were associated with fewer issues with 'self-care'. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.
Collapse
Affiliation(s)
- Josef S. Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Antonia Renner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Peter Wehle
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Psychosocial Services in Vienna, Vienna, Austria
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Roselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Ceren Acartürk
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Türkiye
| | - Ersin Uygun
- Emergency and Disaster Management, Vocational School of Health Services, Bilgi University, Istanbul, Türkiye
| | - Minna Anttila
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tella Lantta
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, Faculty of Social Sciences, University of York, York, United Kingdom
| | - Lauren Walker
- Centre for Reviews and Dissemination, Faculty of Social Sciences, University of York, York, United Kingdom
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Markus Koesters
- Department of Psychiatry and Psychotherapy ll, District Hospital Guenzburg, Ulm University, Ulm, Germany
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Thomas Klein
- Department of Psychiatry and Psychotherapy ll, District Hospital Guenzburg, Ulm University, Ulm, Germany
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Ross G. White
- Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Marion C. Aichberger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
37
|
Mohsenpour A, Biddle L, Bozorgmehr K. Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: A cross-sectional, population-based, multi-level analysis in a German federal state. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001755. [PMID: 38150435 PMCID: PMC10752521 DOI: 10.1371/journal.pgph.0001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/21/2023] [Indexed: 12/29/2023]
Abstract
Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.
Collapse
Affiliation(s)
- Amir Mohsenpour
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
- Department for Psychiatry, Psychotherapy and Psychosomatic Medicine, Vitos Kurhessen, Kassel, Germany
| | - Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section for Health Equity Studies and Migration, Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
38
|
Panagiotopoulos A, Pavlopoulos V. Group Belonging and Social Identities in the Transition of Asylum-Seekers in Greece: Longitudinal Pathways to Adjustment. Healthcare (Basel) 2023; 12:55. [PMID: 38200964 PMCID: PMC10779270 DOI: 10.3390/healthcare12010055] [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: 11/05/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Millions of forced migrants settling in host countries often struggle to adjust to their new life. As their inclusion and adjustment within receiving societies has become a global social challenge, studying the factors that support their successful transition is an important topic of research inquiry. The present three-wave longitudinal study examined the role of group belonging and social identification in facilitating the transition of 60 sub-Saharan African asylum-seekers to Greece. Drawing upon the Social Identity Model of Identity Change (SIMIC), we investigated how multiple group memberships before migration, social identity continuity, and social identity gain related to their adjustment over 8 months. On the between-person level, multiple group belonging before migration indirectly contributed to better person-average levels of sociocultural adjustment, physical health functioning and satisfaction, psychological distress, and life satisfaction, by way of higher person-average levels of social identity continuity and/or social identity gain. However, multiple groups before migration also had a direct negative effect on the overall levels of psychological distress. On the within-person level, positive changes in social identity continuity and gain were related to positive changes in different adjustment-related outcomes over time. Our findings are consistent with SIMIC and highlight the importance of group belonging and associated social identities in forced migrants' transition, in ways that may pave the way for the development of social identity interventions to promote their health, well-being, and successful integration. Future longitudinal and experimental evidence with larger and more diverse samples of forced migrants is needed to establish the generalizability and causality of the observed associations.
Collapse
Affiliation(s)
- Angelos Panagiotopoulos
- Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | | |
Collapse
|
39
|
Mehjabeen D, Blignault I, Taha PH, Reavley N, Slewa-Younan S. A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants. BMC Public Health 2023; 23:2544. [PMID: 38124024 PMCID: PMC10731719 DOI: 10.1186/s12889-023-17395-9] [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: 09/14/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations. METHODS English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456). RESULTS Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions. CONCLUSION Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.
Collapse
Affiliation(s)
- Deena Mehjabeen
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.
| | - Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Perjan Hashim Taha
- College of Medicine, University of Duhok, Duhok, Iraq
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shameran Slewa-Younan
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
40
|
Mohammadi M, Jafari H, Etemadi M, Dalugoda Y, Mohtady Ali H, Phung H, Ahmadvand A, Dwirahmadi F, Barnes P, Chu C. Health Problems of Increasing Man-Made and Climate-Related Disasters on Forcibly Displaced populations: A Scoping Review on Global Evidence. Disaster Med Public Health Prep 2023; 17:e537. [PMID: 37994107 DOI: 10.1017/dmp.2023.159] [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] [Indexed: 11/24/2023]
Abstract
Forcibly displaced populations are among the most vulnerable groups in disasters. They experience poorer health conditions compared with nondisplaced individuals. However, a clear picture is lacking regarding the overall health problems encountered by disaster-induced mid- to long-term displaced people. This study investigated these disorders prevalence and identified their correlates among long-settled displaced populations worldwide. The current scoping review follows the PRISMA-ScR guidelines; a systematic search was conducted on PubMed, Web of Science, and CINAHL and included original peer-reviewed studies, commentary, reviews, and grey literature published in English between January 1990 to June 2022. In the thematic and content analysis, the authors applied the narrative review approach to identify themes and sub-themes. Forty-eight documents were identified as fully relevant to this study. The largest number of published papers were from Asia, followed by the Middle East, the United States, and Europe. IDPs in developed countries were the most researched populations. Human-made disasters were addressed by 89% of the included studies. The four main thematic categories included were "physical health," "mental health," "inadequate facilities," and "lack of healthy behaviour." The worsening of noncommunicable diseases had the highest prevalence, followed by communicable diseases. Due to their condition, forcibly displaced migrants face a triple burden of communicable diseases and noncommunicable diseases such as mental health issues. Health-related research and policy need to consider the links among disasters, health problems, and forced migration as a determinant of health in the new era of climate change-driven displacements.
Collapse
Affiliation(s)
- Mahan Mohammadi
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Hamid Jafari
- Department of Medical Emergencies, School of Medical Sciences, Sirjan, Iran
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Yohani Dalugoda
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Heba Mohtady Ali
- Cities Research Institute & School of Engineering and Built Environment, Griffith University, Gold Coast, Australia
| | - Hai Phung
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Alireza Ahmadvand
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Febi Dwirahmadi
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Paul Barnes
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| | - Cordia Chu
- School of Medicine and Dentistry, Griffith University, Brisbane, QLD 4222, Australia
| |
Collapse
|
41
|
Caroppo E, Calabrese C, Mazza M, Rinaldi A, Coluzzi D, Napoli P, Sapienza M, Porfiri M, De Lellis P. Migrants' mental health recovery in Italian reception facilities. COMMUNICATIONS MEDICINE 2023; 3:162. [PMID: 37993495 PMCID: PMC10665420 DOI: 10.1038/s43856-023-00385-8] [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: 01/31/2023] [Accepted: 10/12/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Forced migration leaves deep marks on the psychological well-being of migrants, with post-traumatic stress disorder (PTSD) and other psychological conditions being prevalent among them. While research has clarified the extent to which pre-migration trauma is a predictor of mental health outcomes, the role of post-migration stressors in the settlement environment are yet to be fully characterized. METHODS We monitored mental health of a cohort of 100 asylum-seekers during their 14-day COVID-19-related quarantine in reception facilities in Rome, Italy, through the administration of six questionnaires (a demographic survey, the WHO-5 well-being index, the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), the Harvard Trauma Questionnaire, the Trauma and Loss Spectrum-Self Report, and the LiMEs-Italian version). Through the combination of statistical analysis and supervised learning, we studied the impact of the first contact with the reception system on asylum-seekers' mental health and sought for possible risk and shielding factors for PTSD. RESULTS We find that sheltering in refugee centers has a positive impact on migrants' mental health; asylum-seekers with PTSD reported more traumatic events and personality characteristics related to loss and trauma; life events are predictors of PTSD in asylum-seekers. CONCLUSIONS We identify past traumatic experiences as predictors of PTSD, and establish the positive role the immediate post-migration environment can play on migrants' psychological well-being. We recommend for host countries to implement reception models that provide effective protection and integration of asylum-seekers, similar to those in the Italian system.
Collapse
Affiliation(s)
- Emanuele Caroppo
- Department of Mental Health, Local Health Authority Roma 2, Rome, Italy.
| | - Carmela Calabrese
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Institut de Neurosciences des Systémes (INS), Aix Marseille Université, 13, Marseille, France
| | - Marianna Mazza
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniele Coluzzi
- Migrant Health Unit, Local Health Authority Roma 2, Rome, Italy
| | | | - Martina Sapienza
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Porfiri
- Center for Urban Science and Progress, Department of Mechanical and Aerospace Engineering, and Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA.
| | - Pietro De Lellis
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy.
| |
Collapse
|
42
|
Kantor V, Weindl D, Schiess-Jokanovic J, Verginer L, Lueger-Schuster B, Knefel M. Self-perceived problems of Afghan asylum seekers and refugees and their experiences with a short psychological intervention. BMC Public Health 2023; 23:2157. [PMID: 37924097 PMCID: PMC10625214 DOI: 10.1186/s12889-023-17076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The present study examined Afghan asylum seekers' and refugees' self-perceived problems, and their experiences of treatment with an adapted version of the brief transdiagnostic psychological intervention "Problem Management Plus" (aPM+). Specifically, the study explored which problems trouble them most and how these problems influence their daily functioning. Further, it examined how various standardized outcome measures correlate with these subjectively perceived problems. METHOD This study is part of a larger RCT study (PIAAS study) in which 88 Afghan asylum seekers and refugees were randomly allocated either to aPM + in addition to treatment as usual (aPM+/TAU) or TAU alone. The presented study uses a multi-method approach consisting of two parts: First, we investigated participants' self-identified problems and subjective functional impairment using quantitative and qualitative assessment in both the aPM+/TAU and TAU group (n = 88). Second, we conducted in-depth qualitative interviews with a subsample of the aPM+/TAU group (n = 24) to gain a deeper understanding of participants' personal experiences with aPM + and to obtain suggestions for improvement. Spearman correlations were applied for quantitative data, and deductive and inductive approaches of thematic analysis were used for qualitative data. RESULTS We identified six main themes of self-perceived problems (primary post-migration living difficulties, general mental health problems, interpersonal stressors, secondary post-migration living difficulties, mental health problems specifically associated with stress, and somatic problems) and their consequences, as well as subjective functional impairment. Standardized measures of general mental health, posttraumatic psychopathology, and quality of life did not correlate with the intensity of self-perceived problems. aPM + was mostly perceived positively, and few participants had recommendations for its improvement. CONCLUSION The study aimed at giving a voice to Afghan trauma survivors to inform service providers and policy makers about their needs. Based on their expertise, future interventions can be tailored to their actual needs and optimized in terms of practical use. aPM + proved to be a positively perceived intervention that reduces subjective symptom burden and facilitates daily functioning. Culture-sensitive treatments within (mental) health services should increase service utilization and improve (mental) health in the long term.
Collapse
Affiliation(s)
- Viktoria Kantor
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| | - Dina Weindl
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria.
| | - Jennifer Schiess-Jokanovic
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| | - Lucia Verginer
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| | - Brigitte Lueger-Schuster
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| | - Matthias Knefel
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, Vienna, 1010, Austria
| |
Collapse
|
43
|
Spaaij J, de Graaff AM, Akhtar A, Kiselev N, McDaid D, Moergeli H, Pfaltz MC, Schick M, Schnyder U, Bryant RA, Cuijpers P, Sijbrandij M, Morina N. The effect of a low-level psychological intervention (PM+) on post-migration living difficulties - Results from two studies in Switzerland and in the Netherlands. Compr Psychiatry 2023; 127:152421. [PMID: 37708580 DOI: 10.1016/j.comppsych.2023.152421] [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: 03/14/2023] [Revised: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS OF THE STUDY After arriving in host countries, most refugees are confronted with numerous post-migration stressors (e.g., separation from family, discrimination, and employment difficulties). Post-migration living difficulties (PMLDs) significantly contribute to the development and persistence of mental disorders. Effective treatment approaches focusing on reducing post-migration stress are urgently needed. The aim of the present study was to examine the effect of a brief psychological intervention, Problem Management Plus (PM+), on PMLDs among Syrian refugees in two European countries. METHODS We merged data from two single-blind feasibility trials with Syrian refugees experiencing elevated levels of psychological distress and impaired functioning in Switzerland (N = 59) and the Netherlands (N = 60). Participants were randomised to receive either five sessions of PM+ or an enhanced care-as-usual control condition. PMLDs were assessed at baseline and 3 months after the intervention. To estimate treatment effect on PMLD, linear mixed model analysis was performed. RESULTS Three months after the intervention, participants in the PM+ condition reported significantly fewer PMLDs compared to the control condition. Further analyses at item-level showed that interpersonal and family related PMLDs, such as "worries about family back home" significantly improved over time in the PM+ condition. CONCLUSIONS This exploratory study suggests that brief psychological interventions have the potential to reduce PMLDs in refugees and asylum seekers. The reduction of post-migration stress in turn may subsequently lead to an overall reduction in psychological distress. CLINICAL TRIAL NUMBERS BASEC Nr. 2017-0117 (Swiss trial) and NL61361.029.17, 7 September 2017 (Dutch trial).
Collapse
Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; PluSport, Umbrella Organization of Swiss Disabled Sports, Volketswil, Switzerland; Swiss Research Institute of Public Health and Addiction (ISGF), University of Zürich, Zurich, Switzerland
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Mid Sweden University, Department of Psychology and Social Work, Östersund, Sweden
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
44
|
Churbaji D, Morina N. Cognitive factors underlying the impact of postmigration stressors on subjective well-being: Well-being comparisons and self-efficacy. Clin Psychol Psychother 2023. [PMID: 37897096 DOI: 10.1002/cpp.2928] [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: 07/04/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Migration and the resulting challenges in the host country can have a profound impact on the mental health of refugees and intensify preoccupation with one's own well-being. Yet, cognitive factors underlying the adverse impact of postmigration stressors are poorly understood. OBJECTIVE We aimed at exploring the frequency and nature of well-being comparisons in the context of flight and migration using the Comparison Standards Scale for Well-being (CSS-W), which assesses well-being related social, temporal, counterfactual, criteria-based and dimensional aversive and appetitive comparisons. We further aimed at examining the mediating role of well-being comparisons and general self-efficacy in the relationship between postmigration stressors and psychological well-being. METHODS We conducted a survey with 1070 Arabic speaking forcibly displaced people in Germany assessing well-being comparisons, general self-efficacy, postmigration stressors, subjective well-being and social media engagement. RESULTS Factor analysis of the CSS-W yielded a theoretically grounded two-factor structure proposing an aversive (mostly upward) and an appetitive (mostly downward) comparison factor. Aversive and appetitive comparisons were reported by more than 99% of participants, with temporal comparisons being reported by 98.7% of participants. Postmigration stressors were significantly related to subjective well-being and aversive well-being comparisons and general self-efficacy partially mediated this relationship. Appetitive well-being comparisons, however, were not significantly related to neither postmigration stressors nor general self-efficacy. CONCLUSION Aversive well-being comparisons and general self-efficacy seem to play a significant role in the adverse effects of postmigration stressors on subjective well-being. Longitudinal research is needed to examine the directional dynamics between general self-efficacy, well-being comparisons and postmigration stressors.
Collapse
Affiliation(s)
- Dana Churbaji
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| |
Collapse
|
45
|
Zhang D, Wang W, Wei F, Lu Y, Ji Y. Effects of medical and nursing group rounds combined with emotional nursing on quality of life and emotion in patients with malignant lymphoma. Medicine (Baltimore) 2023; 102:e35463. [PMID: 37800771 PMCID: PMC10553090 DOI: 10.1097/md.0000000000035463] [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: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
To investigate the effects of medical and nursing visits in the same group combined with emotional care on the quality of life and emotions of patients with malignant lymphoma. One hundred sixty cases of malignant lymphoma patients admitted to our hospital from March 2020 to July 2022 were selected as retrospective study subjects and divided into 80 cases each in the control group and the observation group according to the different nursing methods. Among them, the control group implemented conventional emotional care, and the observation group implemented medical and nursing visits in the same group on the basis of the control group. The differences in quality of life, anxiety-related scores and sleep quality between the 2 groups of patients with malignant lymphoma before and after nursing were compared. After nursing, the mental vitality (P = .015), social interaction (P < .001), emotional restriction (P = .007), and mental status (P = .028) scores of patients in the observation group were higher than those in the control group. After nursing, the Self-Rating Anxiety Scale (P < .001) and Hamilton Anxiety Scale (P < .001) of malignant lymphoma patients in the observation group were significantly lower than those in the control group, and the sleep quality (P < .001), increased awakening (P < .001), sleep disturbance (P < .001), night terrors (P < .001) scores in the observation group were significantly lower than those in the control group. The combination of medical and nursing group checkups and emotional care can effectively improve the quality of life and sleep of patients with malignant lymphoma and reduce adverse emotions, which is beneficial to patient prognosis and clinical treatment. It has certain reference value for the care of patients with malignant lymphoma.
Collapse
Affiliation(s)
- Dan Zhang
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weijuan Wang
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Wei
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yin Lu
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Ji
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
46
|
Führer A. [Determinants of asylum seekers' health and medical care in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1083-1091. [PMID: 37707509 PMCID: PMC10539189 DOI: 10.1007/s00103-023-03762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023]
Abstract
Asylum seekers in Germany are exposed to a variety of health-related stressors, while their access to medical care is impaired. This review explains some of the determinants that structure this situation, for example by elaborating on how the Asylum Seekers' Benefits Act (ASBA), billing via treatment vouchers, and accommodation in refugee shelters affect asylum seekers' health and healthcare utilization. Hereby, it becomes clear that the exclusion of asylum seekers from the welfare system is detrimental to their health, is expensive, and raises ethical and legal questions. In particular, the huge discretionary scope of the social welfare offices in the assumption of costs as well as the different models for billing medical services for asylum seekers are potentially unjust and lead to a plurality of care, which lacks legal and ethical justification.The second part of the article shows that asylum seekers generally suffer from the same health problems as people with statutory health insurance-with the exception of mental illnesses, which are substantially more common among asylum seekers, but are often undiagnosed and frequently inadequately treated.This leads to three practical conclusions: (1) asylum seekers should be integrated into statutory health insurance, (2) from a public health point of view, accommodation in refugee shelters should be avoided in favor of decentralized accommodation, and (3) to ensure diversity-sensitive care for all patients, the healthcare system must make adjustments to its structures and practices.
Collapse
Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Deutschland.
| |
Collapse
|
47
|
Smith ML, Seegulam V, Szentkúti P, Horváth-Puhó E, Galea S, Lash TL, Rosellini AJ, Schnurr PP, Sørensen HT, Gradus JL. Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1305-1316. [PMID: 36449069 DOI: 10.1007/s00127-022-02391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement. METHODS We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5 years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10 years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10 years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults). RESULTS Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth. CONCLUSION Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.
Collapse
Affiliation(s)
- Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya Seegulam
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St., Boston, MA, 02118, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| |
Collapse
|
48
|
Thøgersen MH, Bager L, Bangsgaard SG, Palic S, Auning-Hansen M, Møller SB, Larsen KB, Tækker L, Jensen BS, Bothe S, Nordin L. The Danish Trauma Database for Refugees (DTD): A Multicenter Database Collaboration-Overcoming the Challenges and Enhancing Mental Health Treatment and Research for Refugees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6611. [PMID: 37623194 PMCID: PMC10454926 DOI: 10.3390/ijerph20166611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Mental health of trauma-affected refugees is an understudied area, resulting in inadequate and poorer treatment outcomes. To address this, more high-quality treatment studies that include predictive analyses, long-term evaluations, cultural adaptations, and take account for comorbidities, are needed. Moreover, given the complex intertwining of refugees' health with post-migration stressors and other social factors, it is crucial to examine the social determinants of refugee mental health. The Danish Trauma Database for Refugees (DTD) is a multicenter research database uniting six national centers that provide outpatient treatment for trauma-affected refugees. Through the database, we collect clinical and sociodemographic data from approximately 1200 refugees annually and will merge the database with Danish population register data. The purpose of the DTD is two-fold; clinical and research. The DTD offers data-driven guidance for routine clinical treatment planning of the individual patient, as well as exceptional research opportunities for testing treatment interventions in clinical settings, with larger sample sizes, and more representative heterogeneity of the population. Complex analyses of risk and protective factors, barriers, access to treatment, and societal and transgenerational aspects of trauma are possible with the DTD. This conceptual paper introduces the DTD, the historical background, the development process and implementation strategy, and the associated challenges with developing and running a multicenter database. Most importantly, it highlights the clinical and research potential of the DTD for advancing the understanding and treatment of trauma-affected refugees.
Collapse
Affiliation(s)
- Marie Høgh Thøgersen
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
| | - Line Bager
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
- National Center for Register-Based Research, Aarhus University, 8210 Aarhus, Denmark
| | - Sofie Grimshave Bangsgaard
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
| | - Sabina Palic
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
| | | | - Stine Bjerrum Møller
- The Clinics for Trauma and Torture Survivors (ATT), 7100 Vejle, Denmark;
- Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark
| | | | - Louise Tækker
- Privat Treatment Center for Traumatized Refugees and Their Families, (OASIS), 1164 Copenhagen, Denmark;
| | | | - Søren Bothe
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
| | - Linda Nordin
- The Danish Institute Against Torture (DIGNITY), 2100 Copenhagen, Denmark; (L.B.); (S.G.B.); (S.P.); (S.B.); (L.N.)
- Department of Psychology, Lund University, 22100 Lund, Sweden
| |
Collapse
|
49
|
Kurt G, Ekhtiari M, Ventevogel P, Ersahin M, Ilkkursun Z, Akbiyik N, Acarturk C. Socio-cultural integration of Afghan refugees in Türkiye: the role of traumatic events, post-displacement stressors and mental health. Epidemiol Psychiatr Sci 2023; 32:e51. [PMID: 37539679 PMCID: PMC10465316 DOI: 10.1017/s204579602300063x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS Socio-cultural integration of refugees has received scant attention in the academic literature. Türkiye hosts the largest number of refugees, including Afghans, as the second largest asylum-seeking group in Türkiye. There is a dearth of research into the mental health and integration of Afghan refugees in Türkiye. The aim of the present study was to investigate socio-cultural integration outcomes among Afghan refugees in Türkiye by considering the role of traumatic events and post-displacement stressors. The role of mental health in integration outcomes was further examined. METHODS A cross-sectional, web-based survey study with 785 Afghan refugees in Türkiye was conducted between April and June 2021. Data were collected on socio-demographic characteristics, potentially traumatic events (PTEs) (Harvard Trauma Questionnaire), post-displacement stressors (Post-Migration Living Difficulties Checklist), mental health symptoms (Hopkins Symptoms Checklist-25), social integration- social bonds (contact with co-ethnic group members) and social bridges (contact with the host community)- and cultural integration (Vancouver Index of Acculturation). Structural equation modelling was conducted to test the hypothesized relationship between conflict and displacement-related stressors, mental health and socio-cultural integration. RESULTS Findings showed that conflict-related traumatic events and post-displacement stressors significantly predicted higher mental health symptoms. Experiencing traumatic events significantly predicted higher levels of social bridges, adopting destination culture and lower level of maintaining heritage culture. Mental health problems predicted the relationship between stressors related to forced displacement and integration outcomes-social bridges and adopting destination culture. These findings highlight the role of mental health as an indispensable resource for socio-cultural integration. Further, conflict and displacement-related stressors are important determinants of socio-cultural integration among Afghan refugees in Türkiye. CONCLUSION Exposure to PTEs and post-displacement stressors were significant risk factors for the mental health and socio-cultural integration of Afghan refugees in Türkiye. These stressful experiences deteriorate refugees' mental health, which hinders their integration into the host society.
Collapse
Affiliation(s)
- Gülşah Kurt
- Discipline of Psychiatry and Mental Health, UNSW, Sydney, Australia
| | | | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Merve Ersahin
- Department of Clinical Psychology, Erasmus University, Rotterdam, The Netherlands
| | | | - Nuriye Akbiyik
- Faculty of Humanities and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| |
Collapse
|
50
|
Bruno W, Dehnel R, Al-Delaimy W. The impact of family income and parental factors on children's resilience and mental well-being. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2052-2064. [PMID: 36623257 DOI: 10.1002/jcop.22995] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 06/14/2023]
Abstract
Although there is robust evidence on the intergenerational transmission of trauma-related distress, much less is known about the relation of family income and parental resilience on the resilience and mental well-being of traumatized children. We aimed to determine the association between parental resilience and perceived financial stability, and the resilience and depression of their children among Syrian refugees in Jordan. We carried out a survey of 363 parent-child dyads from a refugee clinic in Northern Jordan. Measures of resilience, trauma, symptoms of mental illnesses, and demographics were reported by the mother and child. We evaluated the associations between parental resilience and their children's mental health. Resilience was highest among parents who reported that their income met their financial needs, (65.77 [standard deviation (SD) 15.96]), and lower for those who reported less income or who stated that their income met their needs only fairly well (62.77 [SD 17.56]). Resilience was lowest for those who reported that that income met their needs poorly (48.02 [SD 23.24]). Parent resilience was positively correlated with child resilience (β = 0.076 [95% confidence interval 0.035-0.12], p < 0.001). Depression and resilience of parents were most closely correlated with the depression and resilience scores of their children, among parents who reported the highest financial stability. Income plays a modifying role in the parent-child resilience and depression associations, with this association being least pronounced within those families who were financially less secure. These findings can help develop interventions to target parental transgenerational impacts according to income status.
Collapse
Affiliation(s)
- William Bruno
- Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Rebecca Dehnel
- Long Beach Memorial Medical Center, Long Beach, California, USA
| | - Wael Al-Delaimy
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| |
Collapse
|