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Mahmoodi Z, Bahrami G, Ghavidel N, Seddighi H. The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: a path analysis. BMC Psychiatry 2023; 23:11. [PMID: 36600233 PMCID: PMC9812534 DOI: 10.1186/s12888-022-04502-0] [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: 10/09/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has created significant challenges in 2020 in the world and Iran. To help vulnerable groups such as refugees during the response and recovery phases of the COVID-19 pandemic, identifying the quality of life (QOL) and its associated factors is helpful. Considering that research in this field is limited, this study evaluated the effect of social determinants of health on the quality of life among Afghan refugees in Iran during the COVID-19 pandemic. METHODS We conducted a cross-sectional study on 300 Afghan refugees and migrants in Alborz province, Iran, from February to May 2022 using Convenience sampling. Data were completed using the socioeconomic status scale (SES), World Health Organization's quality of life -BREF (WHOQOL), Depression, Anxiety and Stress Scale-21 Items (DASS-21), and COVID-19 Post-Traumatic Stress Disorder Checklist (COVID-PTSD). In addition, path analysis was applied to evaluate the relationships among the research variables with quality of life. RESULTS 64.3% of the study participants were male, with a mean of 29.29 ± 9.64 years. The path analysis showed that SES had the most positive relationship (B = .266), and the number of COVID-19 cases had the most negative relationship (B = -.169) with the quality of life from both paths. The self-rated health had the most positive relationship (B = .25), and the DASS score had the most negative relationship (B = -.2) with the quality of life through only one path. Access to medical services was the only variable that indirectly had a positive causal relationship with QOL (B = .044). CONCLUSION We provided an empirical model that illustrates the relationships between quality of life and social determinants of health among Afghan refugees and migrants during the Covid19 pandemic. The negative emotional states of Depression, Anxiety, and Stress (DAS) as a mediator play an essential role in the quality of life and other variables.
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Affiliation(s)
- Zohreh Mahmoodi
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Giti Bahrami
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nooshin Ghavidel
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Hamed Seddighi
- grid.4830.f0000 0004 0407 1981Department of Psychology, University of Groningen, Groningen, The Netherlands ,grid.4830.f0000 0004 0407 1981Unit of Child and Family Welfare, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
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Conzatti A, Kershaw T, Copping A, Coley D. A review of the impact of shelter design on the health of displaced populations. JOURNAL OF INTERNATIONAL HUMANITARIAN ACTION 2022; 7:18. [PMID: 37519834 PMCID: PMC9425791 DOI: 10.1186/s41018-022-00123-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/22/2022] [Indexed: 08/01/2023]
Abstract
There are currently millions of displaced people encamped in low-quality shelters that jeopardise the health of these displaced populations. These shelters, which exhibit poor thermal regulation and air quality, are often inhabited by households for several years. Recently, the internal environment of shelters has been recognised as a determinant of the health of the occupants and the indoor air quality (IAQ) and internal temperatures have been identified as critical factors affecting occupants' health. Attempts by researchers and private companies to develop healthier shelter solutions have mainly prioritised factors such as rapid deployment, transportability and sustainability. Via a systematic bibliometric analysis of the existing literature, this review examines the impact of shelters' internal environment on occupant health. Self-reports and building simulation are the most common methodologies reported in the literature, but there is a disconnect between the reported shelter issues and their impact on health. This is likely due to the multifaceted and site-specific factors analysed. Indoor air quality, thermal comfort and overcrowding are the most commonly identified shelter issues, which are strongly related to the presence of infectious and airborne diseases. An analysis of the available literature indicates that there is still a lack of clear guidance linking shelter quality to health. Moreover, evidence of the impact of shelters on health is harder to find, and there is a gap regarding the metrics and the methodology used to evaluate shelter quality. Therefore, further research is necessary to provide evidence of the impact of shelter design on health through transdisciplinary approaches.
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Affiliation(s)
- Anna Conzatti
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - Tristan Kershaw
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - Alexander Copping
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - David Coley
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
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O’Neal CR, Tan SC, Parrott JE, Martin SW. Removal of Refugee Protections: Impact on Refugee Education, Mental Health, Coping, and Advocacy. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2022. [DOI: 10.1080/10474412.2022.2086877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Eslam Parast N, Taştekin Ouyaba A. The impact of the demographic and migration process factors of refugee women on quality of life and the mediating role of mental health. Perspect Psychiatr Care 2022; 58:785-794. [PMID: 34003486 DOI: 10.1111/ppc.12849] [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: 11/28/2020] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aims to examine the effect of sociodemographic, before, during, and postmigration factors of women refugees on quality of life (QOL) and to assess the mediation effect of mental health as a mediator in the relationships. DESIGN AND METHODS This cross-sectional study was conducted on 190 refugee women between June and August 2019. The data were analyzed using the structural equation model. FINDINGS Before migration factors affect during migration. The during migration factors affect postmigration. The before, during, and postmigration factors affect the QOL directly or indirectly. Mental health mediates this effect. PRACTICE IMPLICATIONS The study can guide interventional studies to increase the welfare of refugee women.
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Affiliation(s)
- Nastaran Eslam Parast
- Department of Obstetrics and Gynecology Nursing, Afyonkarahisar Health Sciences University Graduate Education Institute, Afyonkarahisar, Turkey
| | - Ayşe Taştekin Ouyaba
- Department of Obstetrics and Gynecology Nursing, Afyonkarahisar Health Sciences University Faculty of Health Sciences, Afyonkarahisar, Turkey
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The assessment of an extended set of socio-economic determinants to explain anxiety and uncertainty, insufficient quality and food intake of Afghan refugees. Public Health Nutr 2022; 25:554-564. [PMID: 34551852 PMCID: PMC9991560 DOI: 10.1017/s1368980021004043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES In this study, socio-economic factors associated with Afghan refugee households' food insecurity, anxiety and uncertainty, insufficient quality and food intake were determined. DESIGN Household Food Insecurity Assess Scale measurement was applied to assess food insecurity, anxiety and uncertainty, insufficient quality and insufficient food intake. Descriptive analysis and multivariable regression models were used to determine the associated factors. SETTING The study was carried out in urban areas of Tehran province in Iran. PARTICIPANTS To collect data, interviews were conducted among 317 Afghan households. The questionnaire was administered via face-to-face interviews to either the breadwinner of the selected households or a member who could respond on behalf of the household. RESULTS About 11·3 % of Afghan households who resettled in Tehran province were food secure, while 11·7 % were marginally, 40·7 % moderately and 36·3 % severely food insecure. Economic and financial factors were inversely and significantly associated with food insecurity. Employment, income, distance from the central market and personal saving were inversely associated with food insecurity, while other determinants, including the length of living time in Tehran, house type and the number of male and female children, had a direct association with food insecurity. CONCLUSIONS The associations of socio-economic factors with three categories of food insecurity differed. Elimination of occupation bans that the Iranian government imposes on refugees provides simple access to financial supports like long-term loans, and opening a bank account for refugees will benefit both Iranians and refugees.
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Shum TCT. Conceptualizing religious asylum: Security, religiosity, and subjective well-being of Christian asylum-seekers in Hong Kong. ASIAN AND PACIFIC MIGRATION JOURNAL 2021. [DOI: 10.1177/01171968211067835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article proposes the concept of religious asylum to examine how Christian asylum-seekers utilize religion to cope with their emotional experiences, induced by a sense of insecurity, during prolonged displacement. Drawing from interviews and ethnographic observations of people seeking asylum in Hong Kong, this research determines that asylum-seekers use religion to redefine their positive sense of self beyond their current situation, which is central to the construct of well-being. While religion supports asylum-seekers going through psychosocial distress and suffering, this discussion on religious asylum shows how asylum-seekers utilize the religiously inflected space to make the experience of prolonged displacement meaningful.
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Posselt M, Eaton H, Ferguson M, Keegan D, Procter N. Enablers of psychological well-being for refugees and asylum seekers living in transitional countries: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:808-823. [PMID: 30417476 PMCID: PMC7380010 DOI: 10.1111/hsc.12680] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/21/2018] [Accepted: 10/12/2018] [Indexed: 05/13/2023]
Abstract
The purpose of this systematic review was to locate and synthesise existing peer-reviewed quantitative and qualitative evidence regarding enablers of psychological well-being among refugees and asylum seekers living in transitional countries and for whom migration status is not final. Systematic searches were conducted in nine databases: Academic Search Premier, CINAHL, Embase, Emcare, Medline, Psychology and Behavioral Science, PsycINFO, Scopus, and Web of Science. Search terms were related to refugees and asylum seekers, enablers, and psychological well-being. Studies were limited to those conducted in the last 20 years, with participants who were refugees and asylum seekers with no legal residency status, aged 16 years and above, and living in transit host countries without UNHCR resettlement programmes. This systematic review was conducted between March and June 2018 and followed the PRISMA guidelines. Results were screened by two reviewers at two stages: title and abstracts, and full-text. Critical appraisal and data extraction were also completed by two reviewers. Initial database searching yielded 3,133 results. Following the addition of two records from relevant reference lists and the removal of duplicates, a total of 1,624 results were included for screening. A total of 16 articles were deemed eligible for inclusion in this review, reporting on a collective sample of 1,352 participants. Twelve qualitative and four quantitative studies identified eight enablers of psychological well-being: social support; faith, religion and spirituality; cognitive strategies; education and training opportunities; employment and economic activities; behavioural strategies; political advocacy; and environmental conditions. Despite many challenges associated with forced displacement and the transit period, this review highlights multiple factors that promote well-being and suggest areas for intervention development and resource allocation.
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Affiliation(s)
- Miriam Posselt
- Mental Health and Suicide Prevention Research GroupUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Heather Eaton
- Mental Health and Suicide Prevention Research GroupUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Monika Ferguson
- Mental Health and Suicide Prevention Research GroupUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - David Keegan
- HOST InternationalSydneyNew South WalesAustralia
| | - Nicholas Procter
- Mental Health and Suicide Prevention Research GroupUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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Bjertrup PJ, Bouhenia M, Mayaud P, Perrin C, Ben Farhat J, Blanchet K. A life in waiting: Refugees' mental health and narratives of social suffering after European Union border closures in March 2016. Soc Sci Med 2018; 215:53-60. [PMID: 30205279 DOI: 10.1016/j.socscimed.2018.08.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE In 2015, an estimated 856,723 refugees, predominantly from Syria, Afghanistan, and Iraq arrived in Greece as an entry point into the European Union. The border of the Former Yugoslav Republic of Macedonia closed in March 2016, blocking a popular route for refugees through Europe, and left around 60,000 people stranded in Greece. OBJECTIVE A mixed-method study was conducted among refugees in the regions of Attica, Epirus, and Samos between November 2016 and February 2017. The epidemiological survey showed that depending on study sites between 73% and 100% of the refugees suffered from anxiety disorder. The explanatory qualitative study aimed to understand refugees' mental health and narratives of social suffering in regards to experienced violence, the effect of current border closures, and the lack of an onward journey. METHOD The explanatory qualitative study included 47 in-depth interviews and five focus group discussions with refugees purposely recruited through the concomitant epidemiological survey, representing both genders and a range of nationalities and ages. Data were thematically analysed to identify emergent patterns and categories using NVivo 11. RESULTS The refugees overwhelmingly reported experiencing uncertainty and lack of control over their current life and future, which caused psychosocial distress and suffering. The passivity of life in refugee camps aggravated feelings of meaninglessness and powerlessness. The disruption of key social networks and absence of interactions with the surrounding Greek society led to feelings of isolation and being unwelcome. CONCLUSIONS Refugees in Greece experience psychosocial distress and social suffering as a consequence of their uncertain and disrupted lives and the loss of social networks. Faster and transparent asylum procedures, the development of meaningful and empowering activities, and fostered social interactions with the surrounding society would contribute to alleviating their psychosocial suffering.
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Affiliation(s)
- Pia Juul Bjertrup
- Department of Field Epidemiology and Training, Epicentre, 8 Rue Saint-Sabin, 75011 Paris, France.
| | - Malika Bouhenia
- Department of Field Epidemiology and Training, Epicentre, 8 Rue Saint-Sabin, 75011 Paris, France.
| | - Philippe Mayaud
- Department of Clinical Research, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK London, UK.
| | - Clément Perrin
- Médecins Sans Frontières France, 8 Rue Saint-Sabin, 75011 Paris, France.
| | - Jihane Ben Farhat
- Department of Field Epidemiology and Training, Epicentre, 8 Rue Saint-Sabin, 75011 Paris, France.
| | - Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK London, UK.
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Ziersch A, Due C. A mixed methods systematic review of studies examining the relationship between housing and health for people from refugee and asylum seeking backgrounds. Soc Sci Med 2018; 213:199-219. [PMID: 30142501 DOI: 10.1016/j.socscimed.2018.07.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/28/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022]
Abstract
Housing is an important social determinant of health and a key element of refugee integration into countries of resettlement. However, the way in which housing may affect mental and physical health for refugees and asylum seekers has not been systematically examined. This systematic review aimed to explore the effects of housing on health and wellbeing for this population, in order to identify key pathways for public health interventions. The review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Social Care Institute for Excellence (SCIE) guidelines. We identified publications through a search of Medline, PsychInfo, Scopus, Web of Science, Embase, CINAHL, Cohrane Library, Google, ProQuest, OpenGrey, MedNar and WHOLIS. Eligibility criteria included: publication in English between 1997 and 2017, with findings pertaining to the relationship between housing and health for refugees and/or asylum seekers. Out of 2371 items, 25 papers were included with a further five identified through reference lists. Eleven of the papers explored housing and health for those refugees and asylum seekers living within refugee camps, with 19 focusing on countries of resettlement. All studies identified housing issues for refugees and asylum seekers, with physical housing conditions particularly poor in refugee camps, and issues of affordability, suitability, insecure tenure and mobility as well as difficulties securing housing also highlighted in countries of resettlement. Consistent relationships were found between physical aspects of housing and physical and mental health, with other aspects of housing such as safety and overcrowding linked to mental health. There were a number of methodological issues with most of the studies, making it difficult to specify precise pathways. However, improvements to housing quality particularly in refugee camps, and targeted housing interventions more generally for refugees and asylum seekers would likely have an important public health benefit.
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Affiliation(s)
- Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, SA, 5001, Australia.
| | - Clemence Due
- Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, SA, 5001, Australia; School of Psychology, University of Adelaide, SA, 5001, Australia.
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Kevers R, Rober P, De Haene L. Unraveling the Mobilization of Memory in Research With Refugees. QUALITATIVE HEALTH RESEARCH 2018; 28:659-672. [PMID: 29251552 DOI: 10.1177/1049732317746963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, we explore how narrative accounts of trauma are co-constructed through the interaction between researcher and participant. Using a narrative multiple-case study with Kurdish refugee families, we address how this process takes place, investigating how researcher and participants were engaged in relational, moral, collective, and sociopolitical dimensions of remembering, and how this led to the emergence of particular ethical questions. Case examples indicate that acknowledging the multilayered co-construction of remembering in the research relationship profoundly complicates existing deontological guidelines that predominantly emphasize the researcher's responsibility in sensitively dealing with participants' alleged autobiographical trauma narratives. Instead, our analysis invites qualitative researchers to engage in a continued, context-specific ethical reflection on the potential risks and benefits that are invoked in studies with survivors of collective violence.
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