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Kaminer D, Booysen D, Ellis K, Kristensen CH, Patel AR, Robjant K, Sardana S. Improving access to evidence-based interventions for trauma-exposed adults in low- and middle-income countries. J Trauma Stress 2024; 37:563-573. [PMID: 38459223 DOI: 10.1002/jts.23031] [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] [Received: 02/02/2024] [Revised: 02/11/2024] [Accepted: 02/11/2024] [Indexed: 03/10/2024]
Abstract
In low- and middle-income countries (LMICs), the mental health consequences of trauma exposure pose a substantial personal, societal, and economic burden. Yet, the significant need for evidence-based mental health treatment remains largely unmet. To unlock the potential for mental health care for trauma survivors in lower-resource contexts, it is critical to map treatment barriers and identify strategies to improve access to evidence-based, culturally appropriate, and scalable interventions. This review, based on an International Society for Traumatic Stress (ISTSS) briefing paper, describes the treatment gap facing adults with traumatic stress in LMICs and identifies the barriers that contribute to this gap. We then highlight strategies for enhancing access to effective treatments for these populations, including task-sharing, the use of culturally adapted and multiproblem interventions, and digital tools to scale access to appropriate care. Finally, we offer recommendations for policymakers, researchers, and service providers to guide an agenda for action to close the treatment gap for trauma survivors in LMICs.
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Affiliation(s)
- Debra Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Duane Booysen
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Kate Ellis
- Department of Psychology, American University in Cairo, New Cairo, Egypt
| | - Christian Haag Kristensen
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Anushka R Patel
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Katy Robjant
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Srishti Sardana
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Tannerah A, Hazel O, Desson S, Farah R, Kamil‐Thomas Z, Iqbal H, Eames C, Saini P, Bifarin O. Consultations With Muslims From Minoritised Ethnic Communities Living in Deprived Areas: Identifying Inequities in Mental Health Care and Support. Health Expect 2024; 27:e14132. [PMID: 38956944 PMCID: PMC11220172 DOI: 10.1111/hex.14132] [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: 12/03/2023] [Revised: 04/27/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Limited research concerning existing inequities in mental health care and support services in the United Kingdom captures perceptions and lived experiences of the significantly underrepresented Muslim population. METHODS Underpinned by social constructivist theory, we used consultation to facilitate public and patient involvement and engagement (PPIE) to identify inequities in mental health care and support experienced by Muslims from minoritised ethnic communities living in deprived areas in Liverpool, UK. The rationale was to (a) better inform standards and policies in healthcare and (b) provide a psychologically safe space to members of the Muslim community to share perceptions and experiences of mental health care and support services. To ensure trustworthiness of the data, member checking was adopted. This paper describes the procedure to achieving this consultation, including our recruitment strategy, data collection and analysis as well as key findings. FINDINGS Twenty-seven consultees attended the women's consultation and eight consultees attended the men's consultation. Consultees were from Yemeni, Somali, Sudanese, Egyptian, Algerian, Pakistani and Moroccan communities and share the Islamic faith. Four key interlinked themes were identified from consultees' narratives: (1) broken cycle of trust; (2) an overmedicalised model of care; (3) community mental health prevention initiatives; and (4) culturally conscious training and education. CONCLUSIONS The Muslim population has identified numerous barriers to accessing mental health support and there is a need to resource activities that would aid deeper understanding of mental health support needs through continuous and meaningful community initiatives. This would afford mental health practitioners and organisations opportunities for developing realistic anti-racism strategies, effectively adopting social prescription, strengthening partnerships and collaborations aimed at supporting delivery of evidence-based mental health care provisions to tackle mental health inequities. PATIENT AND PUBLIC INVOLVEMENT This paper reports on the involvement and engagement of Muslims from minoritised ethnic communities living in the Liverpool city region.
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Affiliation(s)
- Ashraf Tannerah
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
- Alder Hey Children's NHS Foundation TrustLiverpoolUK
| | | | - Sheree Desson
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
- Mersey Care NHS Foundation TrustLiverpoolUK
| | - Rahima Farah
- Central Liverpool Primary Care NetworkLiverpoolUK
- Liverpool City CouncilLiverpoolUK
| | - Zalihe Kamil‐Thomas
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Halima Iqbal
- School of Nursing and Healthcare LeadershipUniversity of BradfordBradfordUK
| | - Catrin Eames
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Pooja Saini
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Oladayo Bifarin
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
- Mersey Care NHS Foundation TrustLiverpoolUK
- Senior Research Leader ProgrammeNational Institute for Health and Care Research (NIHR)LondonUK
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Alarcão V, Candeias P, Stefanovska-Petkovska M, Neves J, Pintassilgo S, Machado FL, Santos O, Virgolino A, Santos RR, Heitor MJ, Costa A. Insights from the EQUALS4COVID19 study on migrant mental health in Portugal: a cross-sectional mixed-methods approach. BMC Public Health 2024; 24:2023. [PMID: 39075428 PMCID: PMC11285180 DOI: 10.1186/s12889-024-19563-x] [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: 11/21/2023] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic and related disruptive consequences in the economic, health, and educational sectors have impacted people's lives, contributing to a context of increased economic and social vulnerability. The pandemic has revealed and accentuated social inequalities and discrimination based on racial or ethnic origin. This study aimed to contribute to the promotion of the mental health and well-being of migrant populations living in Portugal via the definition of an analytical framework and recommendations emerging from the EQUALS4COVID19 project. METHODS To gather information on the impact of the COVID-19 pandemic and resilience determinants among immigrants, a mixed-methods approach was implemented in 2022, combining a cross-sectional survey targeting immigrant adults in Portugal, focus groups with immigrants, focus groups with healthcare professionals, and in-depth individual interviews with stakeholders involved in the implementation of measures related to mental health and well-being during the pandemic. The analysis followed an integrated framework; quantitative data informed the script of qualitative data collection methods, and qualitative analysis informed the reinterpretation of quantitative data. RESULTS The survey with 604 Brazilian and Cape Verdean immigrants revealed that gender (being a woman) was associated with both psychological distress and depression-related symptomatology and that the perception of discrimination was a major risk factor for psychological suffering, while perceived social support and individuals' resilience characteristics were protective factors. Qualitative data provided deeper insights into these findings, revealing the ways mental health is affected by social structures, such as gender and ethnic hierarchies. Migrants tend to work in precarious jobs requiring physical presence, which, together with dense housing conditions, puts them at higher risk of infection. The deterioration of the economic conditions of the general population has also increased the perception of ethnic-racial discrimination, which was found to be related to the increase in insecurity and anxiety-related symptomatology among the migrant population. Newly arrived migrants, with reduced support networks, experienced a greater sense of insecurity as well as concern and anguish regarding relatives who live far away, in their home country. Migrant women reported greater family-related distress, including work-life balance problems. CONCLUSIONS Proposals to address mental health inequalities should be considered in the context of the necessary global changes both at the societal level and in the delivery of mental health services. Additionally, they should be considered with the active involvement of migrants, families, and communities in the design and delivery of mental health promotion and care processes.
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Affiliation(s)
- Violeta Alarcão
- Centro de Investigação e Estudos de Sociologia, Iscte - Instituto Universitário de Lisboa, Avenida das Forças Armadas, Lisboa, 1649-026, Portugal.
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal.
- Iscte - Instituto Universitário de Lisboa, Avenida das Forças Armadas, Lisboa, 1649-026, Portugal.
| | - Pedro Candeias
- Centro de Investigação e Estudos de Sociologia, Iscte - Instituto Universitário de Lisboa, Avenida das Forças Armadas, Lisboa, 1649-026, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
- Iscte - Instituto Universitário de Lisboa, Avenida das Forças Armadas, Lisboa, 1649-026, Portugal
| | - Miodraga Stefanovska-Petkovska
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Júlia Neves
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Sónia Pintassilgo
- Centro de Investigação e Estudos de Sociologia, Iscte - Instituto Universitário de Lisboa, Avenida das Forças Armadas, Lisboa, 1649-026, Portugal
- Iscte - Instituto Universitário de Lisboa, Avenida das Forças Armadas, Lisboa, 1649-026, Portugal
| | - Fernando Luís Machado
- Centro de Investigação e Estudos de Sociologia, Iscte - Instituto Universitário de Lisboa, Avenida das Forças Armadas, Lisboa, 1649-026, Portugal
- Iscte - Instituto Universitário de Lisboa, Avenida das Forças Armadas, Lisboa, 1649-026, Portugal
| | - Osvaldo Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
- Unbreakable Idea Research, Estrada Nacional 115, Sítio da Caniceira, nº 1, Casarão, Painho, 2550-426, Portugal
| | - Ana Virgolino
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Ricardo R Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
| | - Maria João Heitor
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
- Psychiatry and Mental Health Department, Hospital Beatriz Ângelo, Loures, Portugal
- Centro de Investigação Interdisciplinar em Saúde (CIIS), Faculdade de Medicina, Universidade Católica Portuguesa, Lisboa, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Lisboa, Portugal
| | - Andreia Costa
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-028, Portugal
- Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas - TERRA, Lisboa, Portugal
- Innovation and Development Centre of Lisbon (CIDNUR), Nursing Research, Nursing School of Lisbon, Lisbon, Portugal
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Straiton ML, Abebe DS, Hauge LJ. Age of migration and common mental disorders among migrants in early adulthood: a Norwegian registry study. BMC Psychiatry 2024; 24:521. [PMID: 39039492 PMCID: PMC11265079 DOI: 10.1186/s12888-024-05963-1] [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: 01/26/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Younger age of migration is associated with higher risk of psychotic disorders but the relationship between age of migration and common mental disorders is less clear. This study investigates the association between age of migration and diagnosed common mental disorders among migrants living in Norway. METHODS Using national Norwegian register data from 2008 to 2019, we compared the odds of a common mental disorder diagnosis in healthcare services during early adulthood among non-migrants, descendants and migrants with different ages of migration and lengths of stay. We also investigated differences in the relationship for different migrant groups and for men and women. RESULTS Descendants and childhood migrants with ≥ 19 years in Norway had higher odds of common mental disorders than non-migrants, while those migrating during adolescence with ≥ 19 years in Norway had similar odds. Those migrating during emerging and early adulthood had lower odds. Overall among migrants, the relationship between age of migration and common mental disorders was more pronounced for migrants < 19 years in Norway than ≥ 19 years and for non-refugees compared with refugees, especially men. CONCLUSIONS Descendants and childhood migrants with long stays may have higher odds of common mental disorders due to the associated stress of growing up in a bicultural context compared with non-migrants. Age of migration has a negative association with diagnosed common mental disorders but much of this effect may attenuate over time. The effect appears weaker for refugees, and particularly refugee men, which may reflect higher levels of pre-migration trauma and stress associated with the asylum-seeking period for those arriving as adults. At the same time, migrants, especially those arriving as adults, experience barriers to care. This could also explain the particularly low odds of diagnosed common mental disorders among adult migrants, especially those with shorter stays.
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Affiliation(s)
- Melanie L Straiton
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, Oslo, 0213, Norway.
| | - Dawit Shawel Abebe
- Oslo Metropolitan University, P.O. Box 4, St Olavs plass, Oslo, 0130, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.O. Box 104, Brumunddal, NO-2381, Norway
| | - Lars Johan Hauge
- Division of Mental and Physical Health, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, Oslo, 0213, Norway
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El Masri R, Chaar S, Elias J, Meksassi B, Ali R, Roberts B, Brown FL, Asmar MK, McKee M, El Chammay R, Singh NS. Barriers, facilitators and proposed solutions to equitable mental health financing and service delivery for the Lebanese populations and displaced Syrians in Lebanon: Findings from a qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003318. [PMID: 38941293 PMCID: PMC11213328 DOI: 10.1371/journal.pgph.0003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/15/2024] [Indexed: 06/30/2024]
Abstract
Forcibly displaced populations experience an increased burden of mental illness. Scaling up mental health (MH) services places new resource demands on health systems in crises-affected settings and raises questions about how to provide equitable MH services for refugee and host populations. Our study investigates barriers, facilitators, and proposed solutions to MH financing and access for Lebanese populations and Syrian refugees in Lebanon, a protracted crisis setting. We collected qualitative data via 73 interviews and 3 focus group discussions. Participants were purposively selected from: (i) national, United Nations and NGO stakeholders; (ii) frontline MH service providers; (iii) insurance company representatives; (iv) Lebanese and Syrian adults and parents of children aged 12-17 years using MH services. Data were analysed using inductive and deductive approaches. Our results highlight challenges facing Lebanon's system of financing MH care in the face of ongoing multiple crises, including inequitable coverage, dependence on external humanitarian funds, and risks associated with short-term funding and their impact on sustainability of services. The built environment presents additional challenges to individuals trying to navigate, access and use existing MH services, and the social environment and service provider factors enable or hinder individuals accessing MH care. Registered Syrian refugees have better financial coverage to secondary MH care than Lebanese populations. However, given the economic crisis, both populations are facing similar challenges in paying for and accessing MH care at primary health care (PHC) level. Multiple crises in Lebanon have exacerbated challenges in financing MH care, dependence on external humanitarian funds, and risks and sustainability issues associated with short-term funding. Urgent reforms are needed to Lebanon's health financing system, working with government and external donors to equitably and efficiently finance and scale up MH care with a focus on PHC, and to reduce inequities in MH service coverage between Lebanese and Syrian refugee populations.
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Affiliation(s)
- Rozane El Masri
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Sandy Chaar
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Joseph Elias
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Bassel Meksassi
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Rayane Ali
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Felicity L. Brown
- Research and Development Department, War Child Holland, Beirut, Lebanon
| | | | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rabih El Chammay
- Department of Psychiatry, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon
| | - Neha S. Singh
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Chu N, Pho J, Dark L, Tan A, Alford S, Tang CY, Ellison C, Lim D. A scoping review into the service needs of people from culturally and linguistically diverse backgrounds living with disability to engage in meaningful occupations. Aust Occup Ther J 2024; 71:408-422. [PMID: 38359914 DOI: 10.1111/1440-1630.12938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Although there is a large proportion of people from culturally and linguistically diverse backgrounds within Australia, their rate of access to disability services is disproportionately low. This review aims to understand the service needs of people from culturally and linguistically diverse backgrounds with disability to facilitate engagement in meaningful occupations. METHODS Arksey and O'Malley's scoping review framework was employed. Ten databases were searched for Australian studies. A deductive content analysis framework was applied in the synthesis. RESULTS Fourteen papers were included. Themes that emerged include language and cultural needs and considerations, which highlights the need for information sharing to take account of intergenerational, intercultural and sociolinguistic differences. It also identified the need for improved training and skills of existing interpreters. Culturally competent and responsive services was another theme identified, which emphasised the need to enhance the workforces' understanding of cultural practices. There is also a strong call for a more culturally diverse workforce to reduce the use of some interpreters and to build a more culturally competent workforce. The last theme was responsive service delivery, which requires the governance to support the development of a nurturing trusting therapeutic relationship. CONCLUSIONS Service providers should be trained on the inequities and intersectionality of this population. Further research is required to explore current disability policy in Australia with an intersectionality lens to ensure recommendations can be made to address barriers and ensure this population receives services in a manner that enhances their ability to engage in occupations meaningfully.
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Affiliation(s)
- Natalie Chu
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Jacqueline Pho
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Leigha Dark
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Aidan Tan
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Clarice Y Tang
- College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
| | - Caroline Ellison
- Justice and Society, University of South Australia, Magill, South Australia, Australia
| | - David Lim
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
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Fisher AP, Patronick J, Moscato EL, Gerhardt CA, Treble-Barna A, Radonovich K, Wade SL. Barriers to Care and Perceived Need for Mental Health Services Among Adolescent and Emerging Adult Survivors of Pediatric Brain Tumors. J Adolesc Young Adult Oncol 2024; 13:469-480. [PMID: 38100322 PMCID: PMC11296316 DOI: 10.1089/jayao.2023.0119] [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: 12/17/2023] Open
Abstract
Purpose: Pediatric brain tumor survivors (PBTS) commonly experience mental health challenges, which can be exacerbated during adolescence and emerging adulthood (AEA). We examined survivors and caregivers' perceived need for mental health services and barriers to receiving mental health care. Methods: Families completed surveys to assess perceived need for mental health services, socioemotional impairment, and barriers to mental health services. Survivors were between 13 and 25 years of age and were at least 5 years from diagnosis. Results: Sixty-nine caregiver-PBTS dyads participated, as well as 18 survivors and 20 caregivers who participated individually. Approximately half of survivors were male (n = 57, 52.3%), 85% (n = 93) were White, and their average age was 19.31. Most caregivers (n = 63, 70.8%) and survivors (n = 55, 63.2%) endorsed need for services for the survivors. Adolescents endorsed more barriers related to perceived helpfulness, t(18) = 2.3, p = 0.03, d = 0.54, and effects of services, t(18) = 3.8, p < 0.001, d = 0.88, than their caregivers. Emerging adults, t(34) = 2.4, p = 0.02, d = 0.41, endorsed more content barriers than their caregivers.. Discussion: Both survivors and their caregivers reported obstacles to accessing mental health services such as perceived lack of need, concerns regarding the effectiveness and usefulness of services, and limited knowledge about the content of services. Psychoeducation and psychosocial screening can support families in understanding survivors' need for mental health services.
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Affiliation(s)
- Allison P. Fisher
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jamie Patronick
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Emily L. Moscato
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Cynthia A. Gerhardt
- Department of Pediatrics and Psychology, The Abigail Wexner Research Institute, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Amery Treble-Barna
- Neurodevelopmental Center, WVU Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Krestin Radonovich
- Physical Medicine and Rehabilitation and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shari L. Wade
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
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Ahmed SM, Saber AF, Naif AA, Hamad AH, Ahmed SK, Abdullah AY, Qurbani K, Hussein S. Exploring Young Adults' Reluctance to Engage With Psychiatric Hospitals in Erbil, Iraq: Identifying Barriers to Psychiatric Care. Cureus 2024; 16:e62164. [PMID: 38993398 PMCID: PMC11238745 DOI: 10.7759/cureus.62164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND AIM In Erbil, Iraq, the reluctance of young adults to engage with psychiatric services is influenced by a complex array of barriers, including stigma-related, attitudinal, and instrumental factors that hinder effective mental healthcare access. This study aimed to identify these specific barriers to accessing psychiatric care among young adults in Erbil. MATERIALS AND METHODS The study utilized a cross-sectional online survey conducted between April 5th and May 1st, 2024. Data collection was carried out through purposive sampling and involved a comprehensive questionnaire. Electronic informed consent was obtained from all participants before they started the survey, which collected demographic data and utilized the Barriers to Access to Care Evaluation (BACE v3) tool. Statistical analysis was conducted using SPSS version 27 (IBM Corp., Armonk, NY). Descriptive statistics (frequency and percentage) were used for categorical data, while the mean and standard deviation characterized continuous variables. Chi-square tests, including Fisher's exact test and odds ratio (OR), were used to analyze categorical data, with a significance level set at p < 0.05. RESULTS A total of 407 participants were enrolled in the study. The study highlighted several barriers to mental health care. Stigma-related barriers were significant, with participants fearing being seen as weak (mean score = 2.14, SD = 0.96) and concerns about being labeled "crazy" (mean score = 1.80, SD = 1.19). Regarding attitudinal barriers, there was a notable preference for dealing with issues independently (mean score = 2.04, SD = 0.98) and a tendency toward resolving problems without professional help (mean score = 1.88, SD = 0.98). Additionally, instrumental barriers were identified, including the rare availability of culturally diverse mental health professionals (mean score = 1.78, SD = 1.09) and practical difficulties such as arranging transportation to appointments (mean score = 0.61, SD = 0.87). CONCLUSION The study demonstrated that young adults in Erbil face significant stigma and attitudinal and instrumental barriers to accessing psychiatric care. In response to these findings, it is recommended for the government to prioritize mental health awareness, actively destigmatize mental health issues, and improve service accessibility to foster a supportive care environment. Additionally, mental health professionals and educational institutions should collaborate to provide targeted support programs and resources for young adults.
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Affiliation(s)
- Sangar M Ahmed
- Department of Public Health, College of Health Sciences, Hawler Medical University, Erbil, IRQ
- Department of Nursing, Faculty of Nursing, Tishk International University, Erbil, IRQ
| | - Abdulmalik F Saber
- Department of Psychiatric and Mental Health Nursing, College of Nursing, Hawler Medical University, Erbil, IRQ
| | - Ahmed A Naif
- Department of Psychiatric and Mental Health Nursing, College of Nursing, Hawler Medical University, Erbil, IRQ
| | - Abdulqader H Hamad
- Department of Psychiatric and Mental Health Nursing, College of Nursing, Hawler Medical University, Erbil, IRQ
| | - Sirwan K Ahmed
- College of Nursing, University of Raparin, Sulaymaniyah, IRQ
| | - Ammar Y Abdullah
- Department of Psychiatric and Mental Health Nursing, College of Nursing, Hawler Medical University, Erbil, IRQ
| | - Karzan Qurbani
- Department of Biology, University of Raparin, Sulaymaniyah, IRQ
| | - Safin Hussein
- Department of Biology, University of Raparin, Sulaymaniyah, IRQ
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Woodward A, Fuhr DC, Barry AS, Balabanova D, Sondorp E, Dieleman MA, Pratley P, Schoenberger SF, McKee M, Ilkkursun Z, Acarturk C, Burchert S, Knaevelsrud C, Brown FL, Steen F, Spaaij J, Morina N, de Graaff AM, Sijbrandij M, Cuijpers P, Bryant R, Akhtar A, Roberts B. Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East. OPEN RESEARCH EUROPE 2024; 3:14. [PMID: 39086733 PMCID: PMC11289593 DOI: 10.12688/openreseurope.15293.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 08/02/2024]
Abstract
Background Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems. Methods A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. Results We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided to address these issues. Conclusions All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.
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Affiliation(s)
- Aniek Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Daniela C. Fuhr
- Health Sciences, University of Bremen, Bremen, 28359, Germany
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, 28359, Germany
| | - Alexandra S. Barry
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
- NHS England, London, SE1 8UG, UK
| | - Dina Balabanova
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Egbert Sondorp
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
| | | | - Pierre Pratley
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
| | - Samantha F. Schoenberger
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Martin McKee
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Zeynep Ilkkursun
- Department of Psychology, Koc University, Sarıyer/İstanbul, Turkey
| | - Ceren Acarturk
- Department of Psychology, Koc University, Sarıyer/İstanbul, Turkey
| | - Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, 14195, Germany
| | - Christine Knaevelsrud
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, 14195, Germany
| | - Felicity L. Brown
- Research and Development Department, War Child Holland, Amsterdam, 1098 LE, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, 1018 WV, The Netherlands
| | - Frederik Steen
- Research and Development Department, War Child Holland, Amsterdam, 1098 LE, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, 1018 WV, The Netherlands
| | - Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, 8091, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, 8091, Switzerland
| | - Anne M. de Graaff
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bayard Roberts
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - STRENGTHS consortium
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Health Sciences, University of Bremen, Bremen, 28359, Germany
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, 28359, Germany
- NHS England, London, SE1 8UG, UK
- Department of Psychology, Koc University, Sarıyer/İstanbul, Turkey
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, 14195, Germany
- Research and Development Department, War Child Holland, Amsterdam, 1098 LE, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, 1018 WV, The Netherlands
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, 8091, Switzerland
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
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10
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Haber Y, Levkovich I, Hadar-Shoval D, Elyoseph Z. The Artificial Third: A Broad View of the Effects of Introducing Generative Artificial Intelligence on Psychotherapy. JMIR Ment Health 2024; 11:e54781. [PMID: 38787297 PMCID: PMC11137430 DOI: 10.2196/54781] [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: 11/22/2023] [Revised: 03/24/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Unlabelled This paper explores a significant shift in the field of mental health in general and psychotherapy in particular following generative artificial intelligence's new capabilities in processing and generating humanlike language. Following Freud, this lingo-technological development is conceptualized as the "fourth narcissistic blow" that science inflicts on humanity. We argue that this narcissistic blow has a potentially dramatic influence on perceptions of human society, interrelationships, and the self. We should, accordingly, expect dramatic changes in perceptions of the therapeutic act following the emergence of what we term the artificial third in the field of psychotherapy. The introduction of an artificial third marks a critical juncture, prompting us to ask the following important core questions that address two basic elements of critical thinking, namely, transparency and autonomy: (1) What is this new artificial presence in therapy relationships? (2) How does it reshape our perception of ourselves and our interpersonal dynamics? and (3) What remains of the irreplaceable human elements at the core of therapy? Given the ethical implications that arise from these questions, this paper proposes that the artificial third can be a valuable asset when applied with insight and ethical consideration, enhancing but not replacing the human touch in therapy.
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Affiliation(s)
- Yuval Haber
- The PhD Program of Hermeneutics and Cultural Studies, Interdisciplinary Studies Unit, Bar-Ilan University, Ramat Gan, Israel
| | | | - Dorit Hadar-Shoval
- Department of Psychology and Educational Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Zohar Elyoseph
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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11
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Gubi E, Hollander AC, Bäärnhielm S. "I had no idea there were psychiatric clinics for children": A qualitative study of how migrant parents reach Swedish mental health services for their children. Transcult Psychiatry 2024:13634615241250203. [PMID: 38780532 DOI: 10.1177/13634615241250203] [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: 05/25/2024]
Abstract
Migrant children have repeatedly been shown to underutilize psychiatric services and to face barriers to care, yet few studies have examined the experience of migrant parents who are successful in their help-seeking efforts for their children's mental health. The aim of this study was to gain a deeper understanding of facilitators and obstacles to reaching care among migrant parents in contact with child psychiatric services. We explored how migrant parents in Stockholm, Sweden, experienced the process of reaching child mental health services. Participants were recruited from out-patient mental health clinics. Ten in-depth interviews were conducted; qualitative analysis of transcripts was undertaken using thematic content analysis. Parents described a desire to reach services but difficulties doing so on their own. We identified a strong dependence on referring agents, such as schools and child health centers, for parents to gain contact. Informants expressed a high degree of trust toward these agents. Contrary to previous studies, stigma was not described as an obstacle to help-seeking but was recognized by informants as a potential barrier to care had they not emigrated. Although participants in our study had differing educational backgrounds and residency times in Sweden, a common experience of reliance on others for reaching services was evident in the data. Our findings highlight the role of referring agents as bridging contacts between different welfare services. Understanding the specific local resources and services that are available to migrant parents, and strengthening these across different sectors, could potentially help reduce barriers to care.
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Affiliation(s)
- Ester Gubi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sofie Bäärnhielm
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet (KI) and Transcultural Centre, Stockholm Health Care Services, Stockholm, Sweden
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12
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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.
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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
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13
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Stecher C, Cloonan S, Domino ME. The Economics of Treatment for Depression. Annu Rev Public Health 2024; 45:527-551. [PMID: 38100648 DOI: 10.1146/annurev-publhealth-061022-040533] [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: 12/17/2023]
Abstract
The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12-17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments' relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
| | - Sara Cloonan
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Marisa Elena Domino
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
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14
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Lynch L, Moorhead A, Long M, Hawthorne-Steele I. "If you don't actually care for somebody, how can you help them?": Exploring Young People's Core Needs in Mental Healthcare-Directions for Improving Service Provision. Community Ment Health J 2024; 60:796-812. [PMID: 38430285 PMCID: PMC11001725 DOI: 10.1007/s10597-024-01237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 03/03/2024]
Abstract
Youth suicide and mental health are important issues of global concern that require timely and evidence-based interventions to increase quality of life and prevent deaths. Findings report that young people have lower mental health help-seeking rates, and there is a lack of qualitative research examining why. The aim of this research study was to further understanding on young people's core needs in mental healthcare based on actual experiences (PLE) of help-seeking with providers of mental health services. Constructivist Grounded Theory methods (Charmaz, 2014) informed this study design, and in-depth interviews and a focus group were conducted with 18 young people. The findings were presented across four sub-categories, which together describe the common factors, that are regarded as essential in youth mental healthcare provision. These include: 1. The services; 2. The helper; 3. The interventions, and 4. The impact of development. Critical discussion into young people's needs in mental healthcare was provided including the key service factors, approach and rapport with helpers, types of intervention and alignment with typical developmental capacity. This article provides guidance on how to improve, design, or reform service provision, and can be a useful resource for policy makers, service providers and practitioners. This study concluded that youth participation in the co-design of service provision is important as it can reduce health disparities and ensure that services provide relevant, respectful and suitable care that reflects the way in which young people experience mental health problems as well as the ways in which they want to be helped.
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Affiliation(s)
- Louise Lynch
- School of Communication and Media, Faculty of Arts, Humanities and Social Sciences, Ulster University, York Street, Belfast, Co. Antrim, BT15 1ED, Northern Ireland.
| | - Anne Moorhead
- School of Communication and Media, Institute for Nursing and Health Research, Ulster University, York Street, Belfast, Co. Antrim, BT15 1ED, Northern Ireland
| | - Maggie Long
- School of Communication and Media, Centre for Communication and Media Research, Faculty of Arts, Humanities and Social Science, Ulster University, York Street, Belfast, Co. Antrim, BT15 1ED, Northern Ireland
| | - Isobel Hawthorne-Steele
- School of Applied Social and Policy Sciences, Faculty of Arts, Humanities and Social Sciences, Ulster University, York Street, Belfast, Co. Antrim, BT15 1ED, Northern Ireland
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15
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Tuffour I. 'They tried to evil me': An explanatory model for Black Africans' mental health challenges. Nurs Inq 2024; 31:e12602. [PMID: 37735926 DOI: 10.1111/nin.12602] [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: 04/11/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
This paper explores the explanatory models of mental challenges among Black Africans in England. It argues that understanding these models is critical for providing culturally appropriate care to this population. The study employed qualitative methodology, and interpretative phenomenological analysis (IPA). Twelve mental health service users who are living in England and self-identified as first or second-generation Black Africans were purposively selected. The data were gathered using face-to-face semistructured interviews. Data were manually analysed in accordance with IPA concepts of searching for common, unique and idiosyncratic themes across transcripts. The findings revealed three themes Black Africans associated to their explanatory model of mental health challenges: complexities of migration, African-centred worldview and negative life experiences. To help alleviate the Eurocentric nature of mental health practice in England, it is hoped that this explanatory model will become an integral part of mental health practice in England and around the world.
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Affiliation(s)
- Isaac Tuffour
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
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16
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Krzyż EZ, Lin HR. Meta-synthesis of mental healthcare-seeking behavior - Perspectives of refugees and asylum seekers. Arch Psychiatr Nurs 2024; 49:10-22. [PMID: 38734444 DOI: 10.1016/j.apnu.2024.01.010] [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: 02/26/2023] [Revised: 10/31/2023] [Accepted: 01/13/2024] [Indexed: 05/13/2024]
Abstract
The number of refugees and asylum seekers worldwide is increasing, and these populations often experience significant mental health challenges due to their difficult life experiences. This study aims to explore the perspectives of refugees and asylum seekers regarding their behavior when seeking mental healthcare. We conducted a meta-synthesis of thirteen articles published between January 2000 and January 2023. The study identified four main themes: understanding of mental health, utilization of health services, the role of society, and necessary interventions. Based on our findings, we provided recommendations for healthcare providers, governments, and researchers to improve the mental healthcare-seeking behavior of these populations in the future.
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Affiliation(s)
- Ewa Zuzanna Krzyż
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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17
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Miqdadi AI, Chong MC, Yoong TL, Koh OH, Alhadidi M. Internet-Based Cognitive-Behavioral Therapy for Individuals Experiencing Panic Attacks: A Scoping Literature Review. J Psychosoc Nurs Ment Health Serv 2024; 62:9-15. [PMID: 37751578 DOI: 10.3928/02793695-20230919-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Panic attacks (PAs) are prevalent and highly comorbid with various physical and psychological disorders. Cognitive-behavioral therapy (CBT) is a well-established psychosocial intervention. Internet-delivered CBT (ICBT) presents a promising avenue to overcome barriers and provide evidence-based support to those in need. The current scoping review aimed to systematically map the existing literature and identify knowledge gaps regarding the impact of ICBT on outcome measures for individuals experiencing PAs. The PRISMA guidelines for scoping reviews were used. A total of 3,044 records were retrieved, and 18 studies from 2013 to 2023 were ultimately included in the analysis. ICBT demonstrated effectiveness as a psychosocial intervention for improving panic symptoms and anxiety in individuals with PAs. However, the impact of ICBT on quality of life (QOL) remains inconclusive. All studies included in this review focused on assessing the severity of panic symptoms, with limited emphasis on measuring QOL. This scoping review holds significant implications for research and practice. However, further addressing the research needs identified in this review will enhance our understanding and improve treatment outcomes for PAs. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 9-15.].
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18
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Özaslan A, Yildirim M, Guney E, İlhan MN, Vostanis P. Mental health problems and help-seeking behaviours of Syrian refugee adolescents: mediating role of self-stigma. Psychol Med 2024; 54:732-741. [PMID: 37642171 DOI: 10.1017/s0033291723002416] [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: 08/31/2023]
Abstract
BACKGROUND Although common mental health problems have been widely studied with self-stigma, few studies have focused on the mediating effect of self-stigma in the relationship between mental health problems and help-seeking behaviours of refugee adolescents. Therefore, the purpose of the present study was to examine whether self-stigma mitigates the adverse effects of stress, anxiety, and depression symptoms on the help-seeking behaviours of Syrian adolescents living in Turkey. METHODS The participants of this study included 488 Syrian refugee adolescents (boys, 63.73%; girls, 3627%) living in Turkey. Participants completed the Depression Anxiety Stress Scale and General Help-Seeking Scale and Self-Stigma of Seeking Psychology Help Scale. RESULTS The findings revealed that stress (β = 0.19, p < 0.01), anxiety (β = 0.12, p < 0.05), and depression (β = 0.17, p < 0.01) had significant and positive predictive effects on self-stigma, but not on help-seeking behaviours. Also, self-stigma (β = -0.12, p < 0.01) had a significant negative predictive effect on help-seeking behaviours. With regard to the indirect effects, the findings showed that self-stigma fully mediated the associations between stress - help-seeking [effect = -0.05, 95% confidence interval (CI) -0.11 to -0.01], anxiety - help-seeking (effect = -0.04, 95% CI -0.09 to -0.01)], and depression - help-seeking (effect = -0.05, 95% CI -0.12 to -0.01). CONCLUSIONS Our findings highlight the potential negative effects of self-stigma on the help-seeking behaviours of Syrian refugee adolescents, both directly and indirectly. These results can be used to develop and implement effective and efficient interventions to address the unmet mental health needs of refugee adolescents.
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Affiliation(s)
- Ahmet Özaslan
- Child and Adolescent Psychiatry Department, Gazi University Medical Faculty, Ankara, Turkey
| | - Murat Yildirim
- Department of Psychology, Faculty of Science and Letters, Ağrı İbrahim Çeçen University, Agri, Turkey
| | - Esra Guney
- Child and Adolescent Psychiatry Department, Gazi University Medical Faculty, Ankara, Turkey
| | - Mustafa Necmi İlhan
- Department of Public Health, Gazi University Medical Faculty, Ankara, Turkey
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19
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Moggia D, Lutz W, Kazantzis N, Schwartz B, Bakker D. Symptom Reduction and Engagement in a Cognitive-Behavioral Mobile Phone App: A Study of User Profiling to Determine Prognostic Indicators. Behav Ther 2024; 55:217-232. [PMID: 38418036 DOI: 10.1016/j.beth.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE We investigated the presence of latent transition profiles in a sample of users of a cognitive-behavioral mental health app for the general population. Users' baseline characteristics were used as predictors of the profiles. The role of engagement with the app in the transition profiles was examined. METHOD A total of 541 users completed the Patient Health Questionnaire-9 and the General Anxiety Disorder-7 when started using the app and 30 days after. Random-Intercept Latent Transition Analysis was implemented to identify users' profiles and transition patterns as classes. The age of the users and the Emotional Self-Awareness Scale-Revised (ESAS-R) were used as predictors of class membership at baseline. The Homework Rating Scale-Mobile Application (HRS-MA; as a measure of engagement) was used as a predictor of class membership at 30 days of app use. RESULTS A 3-class solution was obtained according to the severity of symptoms (from mild to moderately severe). Age and ESAS-R predicted class membership initially; the higher the age and ESAS-R, the higher the probability of starting using the app with lower distress levels. The HRS-MA predicted class membership at 30 days of app use; the higher the engagement for more symptomatic and younger users, the higher the probability of improvement. However, older users tended to engage less. CONCLUSION Our findings underpin the relevance of easily accessible digital interventions for young adults with mild to moderate mental health problems. Further studies and developments are required to enhance these apps for older cohorts.
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Affiliation(s)
| | | | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit; Beck Institute for Cognitive Behavior Therapy
| | | | - David Bakker
- Monash University; University of Tasmania; Cognitive Behavior Therapy Research Unit
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20
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Schneider J, Wiechers M, Burger M, Pogarell O, Übleis A, Padberg F, Strupf M. [Video-Assisted Psychotherapy For Refugees: A Pilot Study]. Psychother Psychosom Med Psychol 2024; 74:129-133. [PMID: 38552619 DOI: 10.1055/a-2238-4076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Global conflicts and humanitarian crises led to an increase in forced migration to Germany in recent years. To improve the mental health care system for refugees and asylum seekers in Germany perspectively, we aim to examine the feasibility of implementing the culturally sensitive group psychotherapy Empowerment for refugees with affective disorders in a video-assisted setting. METHODS Empowerment is a culturally sensitive, interpreter-assisted intervention for the treatment of depressive and stress-related symptoms in refugees. Four male refugees from Afghanistan participated in a pilot study. The intervention included 16 modules delivered via video over a 12-week period. RESULTS The internet connection was frequently unstable and led to organizational challenges. The therapy was feasible in terms of linguistic and interactional aspects. DISCUSSION The stability of the internet connection represents the major criterion for a successful implementation of the therapy. Implications for future studies are discussed. CONCLUSION Regarding the potential opportunities to improve the mental health care provision to refugees and asylum seekers in the future, the video-assisted therapy concept could be investigated in a randomized controlled trial.
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Affiliation(s)
- Johanna Schneider
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Maren Wiechers
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Max Burger
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Oliver Pogarell
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Aline Übleis
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Frank Padberg
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Michael Strupf
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
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Kuhn E, Saleem M, Klein T, Köhler C, Fuhr DC, Lahutina S, Minarik A, Musesengwa R, Neubauer K, Olisaeloka L, Osei F, Reinhold AS, Singh I, Spanhel K, Thomas N, Hendl T, Kellmeyer P, Böge K. Interdisciplinary perspectives on digital technologies for global mental health. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002867. [PMID: 38315676 PMCID: PMC10843075 DOI: 10.1371/journal.pgph.0002867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Digital Mental Health Technologies (DMHTs) have the potential to close treatment gaps in settings where mental healthcare is scarce or even inaccessible. For this, DMHTs need to be affordable, evidence-based, justice-oriented, user-friendly, and embedded in a functioning digital infrastructure. This viewpoint discusses areas crucial for future developments of DMHTs. Drawing back on interdisciplinary scholarship, questions of health equity, consumer-, patient- and developer-oriented legislation, and requirements for successful implementation of technologies across the globe are discussed. Economic considerations and policy implications complement these aspects. We discuss the need for cultural adaptation specific to the context of use and point to several benefits as well as pitfalls of DMHTs for research and healthcare provision. Nonetheless, to circumvent technology-driven solutionism, the development and implementation of DMHTs require a holistic, multi-sectoral, and participatory approach.
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Affiliation(s)
- Eva Kuhn
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Maham Saleem
- Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Thomas Klein
- Department of Psychiatry and Psychotherapy II, Ulm University, Guenzburg, Germany
| | - Charlotte Köhler
- Department of Data Science & Decision Support, European University Viadrina, Große, Frankfurt (Oder), Germany
| | - Daniela C. Fuhr
- Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of Bremen, Health Sciences, Bremen, Germany
| | - Sofiia Lahutina
- TUM Department of Sport and Health Sciences (TUM SG), Chronobiology and Health, Technical University of Munich, Munich, Germany
- TUM Institute for Advanced Study (TUM-IAS), Technical University of Munich, Garching, Germany
| | - Anna Minarik
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosemary Musesengwa
- Department of Psychiatry and Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | | | - Lotenna Olisaeloka
- Institute for Global Health, University College London, London, United Kingdom
| | - Francis Osei
- Department of Health and Physical Activity, Professorship for Medical Sociology and Psychobiology, University of Potsdam, Potsdam, Germany
| | - Annika Stefanie Reinhold
- Medical Faculty Mannheim, Department of Public Mental Health, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Ilina Singh
- Department of Psychiatry and Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | - Kerstin Spanhel
- Faculty of Medicine, Institute for Medical Psychology and Medical Sociology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Tereza Hendl
- Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University in Munich, Munich, Germany
| | - Philipp Kellmeyer
- Department of Neurosurgery, University of Freiburg—Medical Center, Freiburg im Breisgau, Germany
- School of Business Informatics and Mathematics, University of Mannheim, Mannheim, Germany
| | - Kerem Böge
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
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22
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Bowling AR, Klein AB, Sheikh IS, Dolezal ML, Alsubaie MK, Rosencrans PL, Walker RS, Bentley JA, Zoellner LA, Feeny NC. Perceived Need for a Faith-Based Trauma-Focused Treatment in a Sample of Forcibly Displaced Muslims. COGENT MENTAL HEALTH 2024; 3:1-18. [PMID: 38550624 PMCID: PMC10972603 DOI: 10.1080/28324765.2024.2305417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/09/2024] [Indexed: 04/01/2024]
Abstract
Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.
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Affiliation(s)
- Alexandra R. Bowling
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Alexandra B. Klein
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Ifrah S. Sheikh
- University of Washington, Department of Psychology, Seattle, WA USA
| | - Michael L. Dolezal
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA, USA
| | | | | | | | - Jacob A. Bentley
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA, USA
| | - Lori A. Zoellner
- University of Washington, Department of Psychology, Seattle, WA USA
| | - Norah C. Feeny
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
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23
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Dumke L, Schmidt T, Wittmann J, Neldner S, Weitkämper A, Catani C, Neuner F, Wilker S. Low access and inadequate treatment in mental health care for asylum seekers and refugees in Germany-A prospective follow-up study over 12 months and a nationwide cross-sectional study. Appl Psychol Health Well Being 2024. [PMID: 38193582 DOI: 10.1111/aphw.12523] [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: 09/09/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
Refugees experience elevated rates of mental health problems, but little is known about mental health service utilization and quality among asylum seekers and refugees in Europe. In a 12-month follow-up study of newly arrived refugees (N = 166, Mage = 32.38 years, 30.7% female) and a nationwide cross-sectional study (N = 579, Mage = 33.89 years, 36.2% female) of refugees who had been living in Germany for an average of 6 years, we examined objective need for mental health treatment, perceived need, access to treatment services, and adequacy of treatment. We defined minimally adequate mental health treatment according to the WHO World Mental Health Survey as ≥8 sessions of psychotherapy (minimally adequate psychotherapy) or pharmacotherapy plus ≥4 medical visits (minimally adequate pharmacotherapy). In both studies, two in three individuals screened for mental health symptoms and additionally perceived a need for professional treatment. Of those, less than half had contact to any service provider, with only 1 in 14 receiving minimally adequate psychotherapy. Overall, no more than one in seven of refugees in need received minimally adequate treatment. Despite a comprehensive mental health-care system, refugees' access to mental health care and the treatment provided are inadequate. Health policies are urgently needed to provide equitable mental health care for all.
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Affiliation(s)
- Lars Dumke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Telja Schmidt
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Jasmin Wittmann
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sina Neldner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Claudia Catani
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sarah Wilker
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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24
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Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J, Coates R, Hogg S, Cheyne H, McMullen S, Gilbody S, Salmon D, Ayers S. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-187. [PMID: 38317290 DOI: 10.3310/kqfe0107] [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: 02/07/2024]
Abstract
Background Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Objectives Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Methods Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Data sources Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. Review methods In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Results Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. Limitations In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. Conclusions The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. Recommendations for health policy and practice These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Future work Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. Trial registration This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton & Sussex Medical School, Falmer, UK
| | | | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Alderdice
- Oxford Population Health, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Sally Hogg
- The Parent-Infant Foundation, London, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
| | - Debra Salmon
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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Mastrogiovanni N, Byrow Y, Nickerson A. The Development and Validation of a Measure of Mental Health, Help-Seeking Beliefs in Arabic-Speaking Refugees. Assessment 2023:10731911231220482. [PMID: 38159035 DOI: 10.1177/10731911231220482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Despite reporting elevated rates of posttraumatic stress disorder (PTSD), refugees are less likely than other groups to seek psychological treatment. Relatively little attention has been paid to the role of negative help-seeking beliefs in influencing treatment uptake. The current study sought to develop and psychometrically validate a novel measure indexing negative help-seeking beliefs for refugees (Help-Seeking Beliefs Scale [HSBS]). In this study, 262 Arabic-speaking refugee participants completed an online survey consisting of the HSBS along with measures indexing similar constructs (self-stigma of PTSD and help-seeking, perceived stigma, negative help-seeking attitudes, and help-seeking intentions). Factor analysis revealed a three-factor structure aligning with key themes identified in the literature: (a) Fear of Negative Consequences, (b) Inappropriateness, and (c) Perceived Necessity. The scale demonstrated excellent internal consistency, convergent validity, and predicted reduced help-seeking intentions. Results support the utility of a novel measure capturing a prominent help-seeking barrier in a population with high psychopathology and low treatment uptake.
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26
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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.
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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
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27
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Khairat M, Hodge S, Duxbury A. Refugees' and asylum seekers' experiences of individual psychological therapy: A qualitative meta-synthesis. Psychol Psychother 2023; 96:811-832. [PMID: 37166267 DOI: 10.1111/papt.12470] [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: 08/16/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE The current review aimed to synthesise qualitative literature exploring adult refugees' and asylum seekers' experiences of individual psychological therapy. METHODS A comprehensive systematic search of the following databases led to the identification of eight studies for inclusion in this review: PsycINFO, PsycARTICLES, MEDLINE, EMBASE, CINAHL and Academic Search Ultimate. All selected studies used qualitative methodology to explore refugees' and asylum seekers' experiences of individual psychological therapy. Studies were appraised using an adapted version of the Critical Appraisal Skills Programme (CASP) Tool. The data from these selected studies were then synthesised using a meta-ethnographic approach. RESULTS The synthesis of selected studies resulted in the development of five themes; (i) the importance of recognition and validation within therapy, (ii) building a human connection within the therapeutic relationship and the importance of cultural competency, (iii) revisiting trauma, managing difficult emotions from therapy and regaining hope, (iv) the value of practical interventions, (v) 'one should not wake up the djinns (demons)'-cultural stigma and accessing therapy. These themes illustrated the complexities of working therapeutically with asylum seekers and refugees and the vital role of building trust and safety within the therapeutic relationship prior to engagement in therapeutic work. The results also highlighted varied responses to engaging in trauma work ranging from participants finding the experience transformative to others finding it unhelpful, some participants preferred more practical interventions. Participants' cultural backgrounds and pre-conceptions around therapy impacted on engagement and the therapist's cultural competency was a significant factor in therapeutic engagement. CONCLUSIONS Working therapeutically with asylum seekers and refugees involves a number of factors for consideration. Forced migrants' socio-political context was seen as central to their experiences of distress and recognition of these factors was imperative for positive therapeutic engagement. This review highlights a number of clinical implications to guide practitioners working therapeutically with this community.
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Affiliation(s)
- Mariam Khairat
- The Division of Health Research, Lancaster University, Lancaster, UK
| | - Suzanne Hodge
- The Division of Health Research, Lancaster University, Lancaster, UK
| | - Anna Duxbury
- Lancashire Emotional Health in Schools Service, Lancaster University, Lancaster, UK
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28
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Guerrero Z, Melicharová H, Kavanová M, Prokop D, Škvrňák M, Kunc M, Leontiyeva Y, Vitíková J, Spurný M, Pilnáček M, Kyselá M, Zhmurko O, Tabery P, Winkler P. Mental health conditions and help-seeking among Ukrainian war refugees in Czechia: A cross-sectional study. Psychiatry Res 2023; 329:115552. [PMID: 37864995 DOI: 10.1016/j.psychres.2023.115552] [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: 05/23/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND We aimed to screen Ukrainian war refugees (UWR) in Czechia for depression and anxiety, and to assess their recognition of personal mental health problems and related help-seeking. METHODS We conducted a cross-sectional study on a sample of UWR in Czechia. We used PHQ-8 and GAD-7 to screen for depression and anxiety, SELF-I to assess the recognition of respondents' own mental health problems, and a set of questions regarding mental health-related help-seeking. FINDINGS Our sample consisted of 1,347 UWR. More than 41 % of respondents screened positively for moderate or severe depression and more than 23 % for moderate or severe anxiety. Self-recognition of mental health as well as help-seeking was very low among those who screened positively for moderate or severe depression or anxiety. INTERPRETATION Even those UWR who report severe symptoms do not identify themselves as potentially having mental health issues and are not seeking help.
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Affiliation(s)
- Zoe Guerrero
- Department of Public Mental Health, National Institute of Mental Health, Czechia; WHO Collaborating Center for Public Mental Health Research and Service Development, National Institute of Mental Health, Czechia
| | - Hana Melicharová
- Department of Public Mental Health, National Institute of Mental Health, Czechia
| | | | | | | | | | - Yana Leontiyeva
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Jana Vitíková
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Martin Spurný
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Matouš Pilnáček
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Monika Kyselá
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Olga Zhmurko
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Paulína Tabery
- Institute of Sociology of the Czech Academy of Sciences, Czechia
| | - Petr Winkler
- WHO Collaborating Center for Public Mental Health Research and Service Development, National Institute of Mental Health, Czechia; Health Service and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King's College London.
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29
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Hynie M, Oda A, Calaresu M, Kuo BCH, Ives N, Jaimes A, Bokore N, Beukeboom C, Ahmad F, Arya N, Samuel R, Farooqui S, Palmer-Dyer JL, McKenzie K. Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review. J Immigr Minor Health 2023; 25:1171-1195. [PMID: 37407884 PMCID: PMC10509103 DOI: 10.1007/s10903-023-01521-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19-32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.
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Affiliation(s)
- Michaela Hynie
- Department of Psychology, York University, Toronto, Canada.
- Centre for Refugee Studies, York University, 4700 Keele St., Toronto, ON, M3J1P3, Canada.
| | - Anna Oda
- Centre for Refugee Studies, York University, 4700 Keele St., Toronto, ON, M3J1P3, Canada
| | - Michael Calaresu
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Ben C H Kuo
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Nicole Ives
- School of Social Work, McGill University, Montreal, Canada
| | - Annie Jaimes
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
| | - Nimo Bokore
- School of Social Work, Carleton University, Ottawa, Canada
| | | | - Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Canada
| | - Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Rachel Samuel
- Counseling Psychology, Yorkville University, Fredericton, Canada
| | | | | | - Kwame McKenzie
- Wellesley Institute, Toronto, Canada
- Division of Health Equity, CAMH, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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30
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Davoren N, McEleney A, Corcoran S, Tierney P, Fortune DG. Refugees and asylum seekers who have experienced trauma: Thematic synthesis of therapeutic boundary considerations. Clin Psychol Psychother 2023. [PMID: 37658701 DOI: 10.1002/cpp.2894] [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: 04/04/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Therapeutic boundaries are limits to appropriate behaviours within a therapist-client relationship (e.g. related to accepting gifts, self-disclosures, therapist neutrality and advocacy). Therapeutic boundary considerations are fundamental in the care of refugees and asylum seekers. Research on the experiences of therapists navigating such boundaries is sparse and warrants further exploration. The aim of this qualitative systematic review was to thematically synthesise literature regarding therapists' (psychologists, psychotherapists, counsellors) experiences of implementing flexible therapeutic boundaries with refugee and asylum seeker clients and determine how such applications have been helpful for therapeutic interventions. METHOD Six databases were searched. Following full-text screening, 21 papers were included in the analysis. Boundary theory underpinned the analysis. RESULTS Three major themes were developed: (i) Changes to Therapeutic Practice & Therapeutic Intervention, (ii) Re-Conceptualisation of Therapy as 'Clinical Political' and Re-Conceptualisation of Therapist Identity and (iii) Careful Monitoring of Personal Boundaries-Not becoming 'Hardened' or 'Haunted'. Papers described how, when used in a reflective, considerate way, flexible therapeutic boundaries can strengthen the therapist-client alliance and positively impact therapeutic interventions. Many therapists acknowledged making conscious efforts to re-conceptualise therapeutic work with refugee and asylum seeker clients from advocacy standpoints. However, systemic constraints, and lack of guidance, made this difficult to navigate and contributed to therapist burn-out. CONCLUSIONS Boundary considerations manifested as interpersonal, structural and cultural changes to practice. These have implications for clinical practice and developing guidelines on boundary practices with refugees and asylum seekers. Future research should explore promoting therapist well-being and training needs for therapists supporting this population.
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Affiliation(s)
- Niamh Davoren
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Alice McEleney
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Santhi Corcoran
- Department of Psychology, Mary Immaculate College, Limerick, Ireland
| | - Phelim Tierney
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Service Executive, Mid-West Region, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Dumke L, Wilker S, Kotterba A, Neuner F. The role of psychotherapists' perceived barriers in providing psychotherapy to refugee patients. Clin Psychol Psychother 2023; 30:1071-1082. [PMID: 37114524 DOI: 10.1002/cpp.2859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/22/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
Access to psychotherapy is critical to improving mental health, but only a small proportion of refugees receive treatment in the regular psychotherapeutic care system in high-income countries. In previous research, outpatient psychotherapists reported several barriers to more frequent treatment of refugee patients. However, it is unclear to what extent these perceived barriers contribute to the poor provision of services to refugees. In a survey of N = 2002 outpatient psychotherapists in Germany, we collected data on perceived treatment barriers and on the integration of refugees into regular psychotherapeutic practice. Half of the psychotherapists reported that they do not treat refugee patients. In addition, therapies provided for refugees were, on average, 20% shorter than for other patients. Regression analyses showed direct negative associations between psychotherapists' overall perception of barriers with the number of refugees treated and the number of sessions offered to refugee patients, even when controlling for sociodemographic and workload-related characteristics. Correlation analyses on the level of specific types of barriers further revealed that particularly language-related barriers and lack of contact with the refugee population are negatively correlated with the number of refugees treated and the number of sessions for refugees. Our findings indicate that the integration of refugees into regular psychotherapeutic care could be improved by measures to connect psychotherapists with refugee patients as well as professional interpreters and to ensure coverage of costs for therapy, interpreters and related administrative tasks.
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Affiliation(s)
- Lars Dumke
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Sarah Wilker
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Anna Kotterba
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
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Blignault I, Saab H, Youssef H, Baddah H, Giourgas K, Woodland L. "It Is Definitely a Good Program for Everyone from Every Community": A Qualitative Study of Community Partner Perspectives on the Culturally and Linguistically Diverse (CALD) Mindfulness Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6608. [PMID: 37623191 PMCID: PMC10454450 DOI: 10.3390/ijerph20166608] [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: 05/24/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Meeting the health needs of migrant and refugee communities is crucial to successful settlement and integration. These communities are often under-served by mental health services. Previous research has demonstrated the effectiveness of a group mindfulness-based intervention tailored for Arabic and Bangla speakers living in Sydney, Australia. This study aimed to explore community partner perspectives on the program's impact, contributing factors and sustainability, and to elicit suggestions for future development. Data were collected via semi-structured telephone interviews with a purposively selected sample of 16 informants. Thematic analysis was conducted using the Rigorous and Accelerated Data Reduction (RADaR) technique. Community partners welcomed the emphasis on promoting wellbeing and reported that the community-based in-language intervention, in both face-to-face and online formats, overcame many of the barriers to timely mental health care for culturally and linguistically diverse (CALD) communities, with a beneficial impact on group participants, program providers, partner organisations and the broader community. Positive outcomes led to stronger community engagement and demand for more programs. For group mental health programs, both trust and safety are necessary. Relationships must be nurtured, diversity within CALD communities recognised, and projects adequately resourced to ensure partner organisations are not overburdened.
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Affiliation(s)
- Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
| | - Hend Saab
- Multicultural Health Team, South Eastern Sydney Local Health District, Darlinghurst, NSW 2010, Australia; (H.S.); (H.B.); (K.G.)
| | - Hanan Youssef
- Multicultural Health Team, South Eastern Sydney Local Health District, Darlinghurst, NSW 2010, Australia; (H.S.); (H.B.); (K.G.)
| | - Heba Baddah
- Multicultural Health Team, South Eastern Sydney Local Health District, Darlinghurst, NSW 2010, Australia; (H.S.); (H.B.); (K.G.)
| | - Klara Giourgas
- Multicultural Health Team, South Eastern Sydney Local Health District, Darlinghurst, NSW 2010, Australia; (H.S.); (H.B.); (K.G.)
| | - Lisa Woodland
- Health Equity, Promotion and Prevention Service, South Eastern Sydney Local Health District, Darlinghurst, NSW 2010, Australia;
- Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW 2052, Australia
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Farhadi A, Javadian H, Vahedparast H, Marzban M, Nemati R, Larijani B, Nabipour I. Association between depression and blood pressure in community-dwelling older adults: focus on Bushehr elderly health (BEH) program. BMC Public Health 2023; 23:1565. [PMID: 37592235 PMCID: PMC10436588 DOI: 10.1186/s12889-023-16288-1] [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: 01/31/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Depression and increased blood pressure are significant burdens in elderly care. This study was conducted to discover the association between hypertension (HTN) and depression based on data obtained from the Bushehr Elderly Health (BEH) program in a large population of Iranian elderly in Bushehr, southern Iran. METHODS This study was carried out based on data obtained from the Bushehr Elderly Health (BEH) program in a large population of Iranian elderly in Bushehr, a southern city in Iran. 2419 old adults were included in the study through multi-stage random sampling. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9), and blood pressure was measured using a standard mercury sphygmomanometer. Statistical analysis was conducted via chai-square, analysis of variance (ANOVA), and univariate and multivariate linear regression tests. RESULTS The mean age of participants was 69.95 ± 6.95 years. The prevalence of depression was 23.8%. Diastolic blood pressure (DBP) decreased with increasing PHQ score (B=-0.001; 95%CI: -0.00 to -0.00, P-value = 0.011). In the final model adjusted for confounding variables, no significant association was found between depression score and DBP (B=-0.00; 95%CI: -0.00 to 0.00, P = 0.13). Conversely, in the final model, which included the confounding variable, SBP was significantly associated with depression. It was deduced that a variable acted as a negative confounder in this association; in a way that with increased depression score, SBP significantly decreased (B=-0.00; 95% CI: -0.00 to -0.00, P = 0.04). CONCLUSION Depression and its related medications could be significantly associated with controlled SBP. Health practitioners in primary health care centers must monitor the elderly inflicted with HTN for early symptoms of depression to help maintain blood pressure levels using medicinal and non-medicinal interventions.
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Affiliation(s)
- Akram Farhadi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hamed Javadian
- Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran.
- Department of Nursing, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Hakimeh Vahedparast
- Department of Nursing, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Maryam Marzban
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran.
- Department of Human Genetics, McGill University, Montreal, QC, Canada.
| | - Reza Nemati
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
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Elgersma IH, Hart RK, Straiton ML, Hauge LJ, Reneflot A. Migrant background and the impact of the COVID-19 pandemic on mental healthcare consultations among children and adolescents in Norway: a nationwide registry study. BMC Health Serv Res 2023; 23:718. [PMID: 37391771 DOI: 10.1186/s12913-023-09666-3] [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: 10/05/2022] [Accepted: 06/07/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Despite concern about migrant children's mental health and their access to mental healthcare services during the COVID-19 pandemic, this topic has attracted little research attention. This study aimed to examine the impact of the COVID-19 pandemic on the use primary and specialist healthcare services for mental health problems among children and adolescents with migrant background. METHODS Using event study models, we investigated the impact of lockdown and subsequent COVID-19 infection control measures on children's health service use for mental health problems according to migrant background. Drawing on reimbursement data from Norwegian public healthcare providers we observe consultations in a pre-pandemic (2017-2019) and pandemic cohort (2019-2021) in primary and specialised care. RESULTS The pre-pandemic cohort included 77 324 migrants, 78 406 descendants of migrants and 746 917 non-migrants and the pandemic cohort included 76 830 migrants, 88 331 descendants and 732 609 non-migrants (age 6-19). The full cohorts were observed for mental healthcare use in primary care while a subsample (age 6-16) was observed for health care use in specialist care. Lockdown resulted in a dip in consultation volumes for mental disorders for all children, but this dip was relatively larger and more persistent for children with migrant background. After lockdown, consultation volumes rose more for non-migrant children than for children with migrant background. Consultations in primary healthcare peaked during January to April 2021 for non-migrants and descendants of migrants, but not for migrants (4%, 95% CI -4 to 11). In specialist care during the same period, consultations dropped by 11% for migrants (95% CI -21 to -1). By October 2021, all mental health consultations in specialist care were up with 8% for non-migrants (95% CI 0 to 15), and down with -18% for migrants and -2% for descendants (95% CIs -31 to -5 and -14 to 10). Migrant males experienced the largest reduction in consultations. CONCLUSIONS Changes in consultation volumes among children with migrant background after lockdown were not as pronounced as for non-migrants, and at times actually decreased. This suggests that an increase in barriers to care emerged during the pandemic for children with a migrant background.
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Affiliation(s)
- Ingeborg Hess Elgersma
- Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway.
| | - Rannveig Kaldager Hart
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Lars Johan Hauge
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Reneflot
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
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Knappe F, Filippou K, Hatzigeorgiadis A, Morres ID, Tzormpatzakis E, Havas E, Seelig H, Colledge F, Ludyga S, Meier M, de Quervain D, Theodorakis Y, von Känel R, Pühse U, Gerber M. Psychological well-being, mental distress, metabolic syndrome, and associated factors among people living in a refugee camp in Greece: a cross-sectional study. Front Public Health 2023; 11:1179756. [PMID: 37397726 PMCID: PMC10311549 DOI: 10.3389/fpubh.2023.1179756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Background Forcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO's call for evidence-based public health policies and programs for forcibly displaced people. Methods We conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake. Results The prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002). Conclusion There is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits.
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Affiliation(s)
- Florian Knappe
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Konstantinia Filippou
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Antonis Hatzigeorgiadis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Ioannis D. Morres
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece
| | - Emmanouil Tzormpatzakis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Elsa Havas
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Flora Colledge
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Marianne Meier
- Interdisciplinary Center for Gender Studies, University of Bern, Bern, Switzerland
| | | | - Yannis Theodorakis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Straiton M, Liefbroer AC, Hollander AC, Hauge LJ. Sickness absence around contact with outpatient mental health care services - differences between migrants and non-migrants: a Norwegian register study. BMC Psychiatry 2023; 23:428. [PMID: 37316795 DOI: 10.1186/s12888-023-04874-x] [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: 10/03/2022] [Accepted: 05/15/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Mental disorders are a leading cause of sickness absence. Some groups of migrants are at higher risk of both mental disorder and sickness absence. Yet, research on sickness absence in relation to mental disorders among migrants is limited. This study investigates differences in sickness absence in the twelve-month period around contact with outpatient mental health services between non-migrants and various migrant groups with different length of stays. It also considers whether these differences are similar for men and women. METHODS Using linked Norwegian register data, we followed 146,785 individuals, aged 18-66 years, who had attended outpatient mental health services and who had, or had recently had, a stable workforce attachment. The number of days of sickness absence was calculated for the 12-month period surrounding contact with outpatient mental health services. We applied logistic regression and zero-truncated negative binomial regression to assess differences in any sickness absence and number of days of absence between non-migrants and migrants, including refugees and non-refugees. We included interaction terms between migrant category and sex. RESULTS Refugee men and other migrant men from countries outside the European Economic Area (EEA) had a higher probability of any sickness absence in the period surrounding contact with outpatient mental health services than their non-migrant counterparts. Women from EEA countries with stays of less than 15 years had a lower probability than non-migrant women. Additionally, refugees, both men and women, with 6-14 years in Norway had more days of absence while EEA migrants had fewer days than their non-migrant counterparts. CONCLUSIONS Refugee men and other non-EEA migrant men appear to have higher sickness absence than non-migrant men around the time of contact with services. This finding does not apply to women. Several probable reasons for this are discussed, though further research is required to understand why. Targeted strategies to reduce sickness absence and support the return to work for refugees and other non-EEA migrant men are needed. Barriers to timely help-seeking should also be addressed.
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Affiliation(s)
- Melanie Straiton
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway.
| | - Aart C Liefbroer
- Netherlands Interdisciplinary Demographic Institute, PO Box 11650, The Hague, 2502 AR, The Netherlands
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Sociology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna-Clara Hollander
- Epidemiology of Psychiatric Conditions, Substance Use and Social Environment, Department of Global Public Health, Karolinska Institute, Stockholm, 171 77, Sweden
| | - Lars Johan Hauge
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
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Pijlman V, Eichelsheim V, Pemberton A, de Waardt M. "Sometimes It Seems Easier to Push It Away": A Study Into the Barriers to Help-Seeking for Victims of Sexual Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7530-7555. [PMID: 36710513 DOI: 10.1177/08862605221147064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Experiencing sexual violence may have serious long-term consequences for victims. Seeking help may decrease the chances of developing long-term physical and psychosocial problems. Still not every victim seeks help, and especially with victimization of sexual violence, there may be several reasons as to why. The barriers to help-seeking are diverse and may depend on several contextual factors. This study, as part of a larger research project, aimed to determine the barriers that victims of sexual violence experience in their decision to seek help in a non-college setting. This mixed-methods study included an online survey (N = 133) and open-ended survey (N = 207) amongst victims of 18 years and older. The online survey data were analyzed using chi-square tests for independence and t-tests; the open-ended survey data were analyzed using a descriptive approach. The online survey data showed that minimization of the incident was higher for non-help-seekers, whilst distrust toward support providers and issues with the accessibility of help were higher for help-seekers. No further significant associations were found between the decision to seek help and the barriers to help-seeking. From the open-ended survey data, three categories of barriers were distinguished: (a) individual barriers, such as feelings of shame, (b) interpersonal barriers, such as the fear of negative social reactions and (c) sociocultural barriers, such as societal stereotypes regarding sexual violence. The findings suggest that victims experience various, but primarily individual, barriers to help-seeking and that these barriers do not strongly differ between help-seekers and non-help-seekers. This study highlights the importance of addressing barriers to help-seeking on an organizational and societal level to encourage help-seeking.
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Affiliation(s)
- Valérie Pijlman
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, Netherlands
| | - Veroni Eichelsheim
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, Netherlands
- University of Groningen, Netherlands
| | - Antony Pemberton
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, Netherlands
- Leuven Institute of Criminology (LINC), Belgium
| | - Mijke de Waardt
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, Netherlands
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Krstanoska-Blazeska K, Renzaho A, Blignault I, Li B, Reavley N, Slewa-Younan S. A Qualitative Exploration of Sources of Help for Mental Illness in Arabic-, Mandarin-, and Swahili-Speaking Communities in Sydney, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105862. [PMID: 37239588 DOI: 10.3390/ijerph20105862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Despite being disproportionately affected by poor mental health, culturally and linguistically diverse (CaLD) individuals seek help from mental health services at lower rates than others in the Australian population. The preferred sources of help for mental illness amongst CaLD individuals remain poorly understood. The aim of this study was to explore sources of help in Arabic-, Mandarin-, and Swahili-speaking communities in Sydney, Australia. Eight focus-group discussions (n = 51) and twenty-six key informant interviews were undertaken online using Zoom. Two major themes were identified: informal sources of help and formal sources of help. Under the informal sources of help theme, three sub-themes were identified: social, religious, and self-help sources. All three communities strongly recognised the role of social sources of help, with more nuanced roles held by religion and self-help activities. Formal sources of help were described by all communities, although to a lesser extent than informal sources. Our findings suggest that interventions to support help-seeking for all three communities should involve building the capacity of informal sources of help, utilising culturally appropriate environments, and the collaboration between informal and formal sources of help. We also discuss differences between the three communities and offer service providers insights into unique issues that require attention when working with these groups.
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Affiliation(s)
| | - Andre Renzaho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown 2571, Australia
| | - Ilse Blignault
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown 2571, Australia
| | - Bingqin Li
- Social Policy Research Centre, University of New South Wales, Sydney 2052, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia
| | - Shameran Slewa-Younan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown 2571, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia
- School of Medicine, Western Sydney University, Campbelltown 2571, Australia
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van der Meer AS, Durlach F, Szota K, Christiansen H. "I can't describe how I could get better, but I would like to" - Conception of health and illness of refugee youth in Germany. Front Psychol 2023; 14:1107889. [PMID: 37251071 PMCID: PMC10213462 DOI: 10.3389/fpsyg.2023.1107889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction and objective Almost half of all the people displaced worldwide are children and adolescents. Many refugee children, adolescents, and young adults suffer from psychological stress. However, their utilization of (mental) health services is low, probably due to a lack of knowledge about (mental) health and (mental) health care. The current study aimed to explore concepts of (mental) health and illness of refugee youth as well as assess their mental health literacy (MHL) to arrive at conclusions for improving mental health care access and use. Method From April 2019 to October 2020, we conducted 24 face-to-face interviews with refugee children and adolescents in an outpatient clinic (n = 8), in youth welfare facilities (n = 10), and at a middle school (n = 6). A semi-structured interview was used to assess knowledge about mental and somatic health and illness as well as corresponding health strategies and care options. The material was evaluated using qualitative content analysis. Results Participants (N = 24) were between 11 and 21 years old (M = 17.9, SD = 2.4). The coded material was assigned to four thematic main areas: (1) conception of illness, (2) conception of health, (3) knowledge about health care structures in their country of origin, and (4) perceptions of mental health care structures in Germany. Compared to somatic health, the interviewed refugee children and adolescents knew little about mental health. Furthermore, respondents were more aware of opportunities of somatic health promotion, but almost none knew how to promote their mental health. In our group-comparative analysis we observed that younger children possess little knowledge about mental health-related topics. Conclusion Our results show that refugee youth have more knowledge about somatic health and somatic health care than about mental health (care). Accordingly, interventions to promote the MHL of refugee youth are necessary to improve their utilization of mental health services and to provide adequate mental health care.
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Khatib HE, Alyafei A, Shaikh M. Understanding experiences of mental health help-seeking in Arab populations around the world: a systematic review and narrative synthesis. BMC Psychiatry 2023; 23:324. [PMID: 37161342 PMCID: PMC10170733 DOI: 10.1186/s12888-023-04827-4] [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: 11/24/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in mental health service utilisation and access is well established. Mental illness is common among Arab populations globally, but most individuals display negative attitudes towards mental health and do not seek professional help. The aim of this systematic review was to determine 1) help-seeking behaviours 2) help-seeking attitudes and 3) help-seeking barriers and facilitators, related to mental health services among Arab adults. METHOD A pre-defined search strategy and eligibility criteria allowed for database searching using terms related to: mental health, Arabs, help-seeking, as well as experiences and behaviours. Seventy-four articles were included and analysed through narrative synthesis. Results were reported using the PRISMA guidelines. The review protocol was registered prospectively on PROSPERO (CRD42022319889). RESULTS Arabs across the world have negative attitudes towards formal help-seeking and are reluctant to seek help, despite the presence of psychological distress. There is little information on factors that influence help-seeking behaviours and rates of service use. Preference for informal help sources such as family and friends were expressed and considered more acceptable. Low mental health literacy, stigma, gender, age, education, religion, acculturation, and immigrant status were the most common factors influencing help-seeking attitudes. Barriers to help-seeking included stigma, privacy and confidentiality, trust, mental health literacy, language, logistics, and culture related barriers. Increasing societal and family awareness, external support and encouragement, shared culture between the client and therapist, quality of doctor patient relationship, and feelings of connectedness with the host country among refugees were mentioned facilitators. Mixed findings for the role of religion, and family and community, in relation to facilitating or hindering help-seeking were reported. CONCLUSIONS There is an increased likelihood and preference to seek informal sources of psychological support among Arabs. Contextual and cultural factors impeding help-seeking for Arabs are common across the world. Future research should address actual utilisation rates of services to better understand factors that influence help-seeking behaviours and facilitators to help-seeking. Increasing mental health literacy and developing anti stigma campaigns is necessary. Developing culturally informed interventions should inform future efforts to promote help-seeking among this population.
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Affiliation(s)
- Hania El Khatib
- Division of Psychiatry, University College London, London, UK
| | - Aisha Alyafei
- Division of Psychiatry, University College London, London, UK
| | - Madiha Shaikh
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
- North East London NHS Foundation Trust, London, UK.
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Claus L, Schouler-Ocak M, Braakman MH, Sabbe B, Van Beuren G, van den Ameele S. Unlocking asylum seekers' voices: protocol of a mixed-method clinical study on the use of the cultural formulation interview with asylum seekers in Belgium. Front Psychiatry 2023; 14:1156803. [PMID: 37215655 PMCID: PMC10192900 DOI: 10.3389/fpsyt.2023.1156803] [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: 02/01/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
Background Despite a high prevalence of mental disorders among asylum seekers, many barriers to mental healthcare exist. Cultural and contextual factors strongly influence the experience and expression of psychological distress, putting asylum seekers at greater risk of misdiagnosis and inappropriate treatment. The Cultural Formulation Interview (CFI) is a useful tool to map out cultural and contextual factors of mental disorders; however, to the best of our knowledge, it has not yet been investigated in asylum seekers specifically. The primary aim of this study is to evaluate the value of the CFI in the psychiatric assessment of asylum seekers. Second, we will describe the themes relevant to psychiatric distress in asylum seekers that are identified by the CFI. In addition, asylum seekers' experience of the CFI will be evaluated. Methods and analysis This cross-sectional, mixed-method clinical study aims to recruit a group of 60-80 asylum seekers (age 15-29) with mental health symptoms. Data will be collected using structured (MINI, PCL-5, HDRS-17, WHOQoL-BREF & BSI) and semi-structured (CFI & CFI-debriefing) questionnaires to assess cultural background, contextual factors, and illness severity. Multidisciplinary case discussions will be held after the completion of interviews, following a methodological stepped approach. Combining qualitative and quantitative research techniques, this study aims to generate reliable knowledge on working with the CFI in asylum seekers. Based on the findings, recommendations for clinicians will be developed. Discussion This study addresses the knowledge gap on using the CFI in asylum seekers. Compared to prior studies, it will provide new insights into the use of the CFI in the specific context of working with asylum seekers. Ethics and dissemination Prior research on the CFI in asylum seekers is limited, partly because of their high vulnerability and low access to care. The study protocol has been tailored in close collaboration with several stakeholders and validated after piloting. Ethical approval has already been obtained. Together with the stakeholders, the results will be translated into guidelines and training materials. Recommendations to policymakers will also be provided.
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Affiliation(s)
- Lukas Claus
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, Belgium
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Meryam Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Mario H. Braakman
- Department of Psychiatric Residency Training, Pro Persona Mental Health, Wolfheze, Netherlands
- Department of Criminal Law, Tilburg Law School, Tilburg University, Tilburg, Netherlands
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Godfried Van Beuren
- Management Culturally Sensitive Care, St. Alexius Psychiatric Hospital, Grimbergen, Belgium
| | - Seline van den Ameele
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Universiteit Antwerpen (UA), Antwerp, Belgium
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Chimoriya R, Mohammad Y, Thomson R, Webster C, Dunne R, Aibangbee M, Ip D, Slewa-Younan S. Mental illness stigma and associated factors among Arabic-speaking refugee and migrant populations in Australia. Int J Ment Health Syst 2023; 17:11. [PMID: 37138317 PMCID: PMC10155307 DOI: 10.1186/s13033-023-00580-z] [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: 06/10/2022] [Accepted: 04/13/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Arabic-speaking refugee and migrant populations form a significant proportion of Australia's population. Despite high levels of psychological distress among Arabic-speaking populations, low uptake of mental health services has been demonstrated. Evidence suggests poor levels of mental health literacy (MHL) and high levels of stigmatising attitudes among Arabic-speaking populations, which may act as barriers to help-seeking behaviours. This study aimed to explore the relationships between measures of mental illness stigma, socio-demographic factors and psychological distress, as well as to determine the factors associated with MHL (i.e., correct recognition of mental illness and knowledge of causes) among Arabic-speaking refugee and migrant populations in Australia. METHODS Participants were recruited from non-government organisations in Greater Western Sydney that provided support services to Arabic-speaking migrants and/or refugees. As this study is nested within an interventional pilot study evaluating a culturally tailored MHL program, only the pre-intervention survey responses for 53 participants were utilised. The survey measured key aspects of MHL (i.e., recognition of mental illness, knowledge of causes), levels of psychological distress (using K10 scale), and stigmatising attitudes towards mental illness (using Personal Stigma Subscales and Social Distance Scale). RESULTS The Personal Stigma subscale of 'Dangerous/unpredictable' was strongly positively correlated with participants' K10 psychological distress scores and strongly negatively correlated with years of education completed. There were moderate negative correlations between two Personal Stigma subscales ('Dangerous/unpredictable' and 'I-would-not-tell-anyone') and the length of stay in Australia. Being female was associated with an increase in personal stigma demonstrated by higher scores for 'I-would-not-tell-anyone' subscale than males. Similarly, increase in age was associated with a decrease on scores of the personal stigma 'Dangerous/unpredictable'. CONCLUSIONS While future research with larger sample size are needed, the study findings can be considered as adding to the evidence base on mental illness related stigma in Arabic-speaking populations. Further, this study provides a starting point in developing the rationale for why population sub-group specific interventions are required to address mental illness stigma and improve MHL among Arabic-speaking refugee and migrant populations in Australia.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Yaser Mohammad
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | - Russell Thomson
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, Australia
| | - Cheryl Webster
- Anglicare, Anglican Community Services, Baulkham Hills, Australia
| | - Rachel Dunne
- Anglicare, Anglican Community Services, Baulkham Hills, Australia
| | | | - David Ip
- Anglicare, Anglican Community Services, Baulkham Hills, Australia
| | - Shameran Slewa-Younan
- School of Medicine, Western Sydney University, Campbelltown, Australia.
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia.
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Ben Abid I, Ouali U, Ben Abdelhafidh L, Peterson CE. Knowledge, attitudes and mental health of sub-Saharan African migrants living in Tunisia during COVID-19 pandemic. CURRENT PSYCHOLOGY 2023:1-13. [PMID: 37359600 PMCID: PMC10098244 DOI: 10.1007/s12144-023-04607-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/28/2023]
Abstract
COVID-19 pandemic potentially impacted the mental health of migrants. Our objective was to measure the prevalence of psychological distress among a group of sub-Saharan African migrants living in Tunisia, and its association with knowledge about COVID-19. The Questionnaire of Knowledge towards COVID-19 (QK-COVID-19) was used to evaluate the level of Knowledge about COVID-19. The participants were asked about their attitudes for seeking information and healthcare services related to the pandemic using a multiple-choice questionnaire. The Hopkins Symptoms Checklist (HSCL-25)) was used to screen for anxiety and depression. A logistic regression was used to estimate the adjusted odds of having psychological distress across levels of QK-COVID-19 score. Among the 133 participants, 34.6% (95% CI: 26.5, 42.67) had psychological distress, 91% were unemployed and 96% uninsured. Of the respondants, 20% had low QK-COVID-19 score , and 44.36% had medium score. The adjusted odds of psychological distress for those with high and medium QK-COVID-19 scores were respectively 3.9 (95% CI: 1.08, 14.13) and 6.39 (95% CI: 1.79, 22.9) times that of those with low scores. Screening and early treatment of anxiety and depression among migrants during outbreaks is an imperative. Further investigations of the determinants of mental health of sub-Saharan African migrants are needed.
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Affiliation(s)
- Imen Ben Abid
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago (UIC), Chicago, IL USA
| | - Uta Ouali
- School of Medicine, University of Tunis El Manar, Tunis, Tunisia
- Department of Psychiatry “A”, Razi Hospital, Manouba, Tunisia
| | | | - Caryn E. Peterson
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago (UIC), Chicago, IL USA
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UÇGUN T, AKGÜN ÇITAK E. Mental Health of Migrants in the Covid-19 Pandemic: A Systematic Review. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1082835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The Covid-19 pandemic has negatively affected the mental health of individuals due to both the process and the restrictions it imposes. Migrants, especially one of the vulnerable groups, have been adversely affected by the pandemic due to both the difficulties brought by the migration itself and the living conditions unsuitable for Covid-19. All these negative situations caused the migrants to experience psychosocial problems and created a threat in terms of mental health. A limited number of studies have been found in the literature on the psychosocial problems and mental health of migrants. The aim of this study is to review the studies on the evaluation of psychosocial problems and mental health of immigrants during the Covid-19 pandemic and to systematically examine the results of these studies. Systematic searches were conducted in “PubMed”, “Web of Science”, “ScienceDirect” and “Scopus” database with using to ‘migrants, migrant workers, Covid-19 pandemic, mental health, psychosocial issues’ keywords and combinations. Seventeen studies were included in the systematic review. The sample size of the studies varies between 10 and 28.853. As a result of the data, it was determined that the most common psychosocial problems of migrants in the Covid-19 pandemic are depression, anxiety, distress, hopelessness, decrease in socioeconomic level, and social isolation. As a result of the study, it was found that many psychosocial problems that migrants experienced during the Covid-19 pandemic negatively affected their mental health. The evidence determined in this study may guide the psychosocial evaluation of migrants in Covid-19 pandemic.
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Moutsou I, Georgaca E, Varaklis T. Psychotherapeutic and Psychosocial Interventions with Unaccompanied Minors: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11060918. [PMID: 36981575 PMCID: PMC10048295 DOI: 10.3390/healthcare11060918] [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: 02/08/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Unaccompanied minors (UAMs) are considered a particularly vulnerable population, facing severe threats regarding their physical and mental health. As their number has increased in recent years worldwide, research on mental health interventions has become necessary. The implementation of psychotherapeutic interventions has been documented, but psychosocial interventions seem to not have been consistently studied. In this review, we summarize the psychotherapeutic and psychosocial interventions with UAMs that have been studied up to now. Following the PRISMA guidelines for scoping reviews, we searched four databases and included studies and practice papers; there were no restrictions on publication date, geographical region, language, or method. We identified 46 studies on psychotherapeutic interventions and 16 studies on psychosocial interventions that met the inclusion criteria. Psychotherapeutic interventions were mainly based on cognitive behavioural, psychodynamic, narrative, art and transcultural approaches and aimed at improving UAMs' trauma, mental health and wellbeing, as well as professionals' skills and therapeutic protocols. Several studies showed promising results, with the cognitive behavioural approaches being the most researched. However, more research is needed in order to draw conclusions in terms of effectiveness. Psychosocial interventions followed various approaches and aimed at UAMs' empowerment, wellbeing, support and integration, as well as at improving caregivers' skills. Nonetheless, they seem not only very heterogeneous but also understudied, and we believe that a focus on them would be very useful. Methodological limitations and their implications for future research are discussed.
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Affiliation(s)
- Irene Moutsou
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Theofilos Varaklis
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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Branam LS, Yigit I, Haji S, Clark J, Perkins JM. Kurdish Refugee Beliefs about Mental Health and Help-Seeking: A Community-Engaged Research Study in Tennessee. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1224. [PMID: 36673976 PMCID: PMC9858981 DOI: 10.3390/ijerph20021224] [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: 11/04/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Refugee populations exhibit high rates of PTSD, anxiety, depression, and psychological distress, but are less likely to receive care than the general population. Perceptions among the Kurdish refugee community about causes and consequences of mental illness symptoms and perceived barriers to help-seeking are understudied. This community-engaged research study conducted in-depth interviews with Kurdish refugees from Iraq to explore their beliefs about drivers of mental illness and seeking help for mental health. Iterative thematic analysis of transcripts from ten participants indicated four key themes: (1) social network loss due to resettlement causes poor mental health; (2) socioeconomic status loss due to unrecognized professional qualifications puts strain on mental health; (3) social stigma about mental health and fears about disclosure of mental health issues within community and subsequent negative gossip prevent help-seeking; and (4) social interaction may alleviate mental illness symptoms. Overall, Kurdish refugees perceived social factors as major drivers of mental illness symptoms and barriers to help-seeking in their community. However, while participants believed that the general community attitude was against help-seeking, most participants personally expressed support of anyone in their community needing to see a mental health professional. Future research should assess the extent to which perceived community norms differ from aggregated personal help-seeking attitudes and behaviors among Kurdish refugees from Iraq in the United States.
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Affiliation(s)
- Leah S. Branam
- Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, 230 Appleton Pl, Nashville, TN 37203, USA
- School of Nursing, Vanderbilt University, 461 21st Ave S, Nashville, TN 37240, USA
| | - Ismail Yigit
- Department of Sociology, Tennessee State University, 3500 John A Merritt Blvd, Nashville, TN 37209, USA
| | - Sipal Haji
- Catholic Charities, Diocese of Nashville, 2806 McGavock Pk, Nashville, TN 37214, USA
| | - Jennifer Clark
- Catholic Charities, Diocese of Nashville, 2806 McGavock Pk, Nashville, TN 37214, USA
| | - Jessica M. Perkins
- Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, 230 Appleton Pl, Nashville, TN 37203, USA
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Meurling J, Rondung E, Leiler A, Wasteson E, Andersson G, Richards D, Shahnavaz S, Bjärtå A. An online tiered screening procedure to identify mental health problems among refugees. BMC Psychiatry 2023; 23:7. [PMID: 36597066 PMCID: PMC9811744 DOI: 10.1186/s12888-022-04481-2] [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: 08/19/2022] [Accepted: 12/16/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Many refugees suffer from mental health problems due to stressful and traumatic events before, during, and after migration. However, refugees are facing a wide variety of barriers, limiting their access to mental health care. Internet-based tools, available in several languages, could be one way to increase the availability of mental health services for refugees. The present study aimed to develop and test a screening tool to screen for clinically relevant symptoms of psychiatric disorders common among refugees (i.e. Depression, Anxiety, Post-traumatic stress disorder, and Insomnia). We, designed, translated, and adapted an internet-based tiered screening procedure suitable for use with the largest refugee populations residing in Sweden. The tool aims to accurately identify symptoms of mental distress (Tier 1), differentiate between symptoms of specific psychiatric disorders (Tier 2), and assess symptom severity (Tier 3). We tested the overall efficiency of using a tiered screening procedure. METHODS Seven hundred fifty-seven refugees residing in Sweden, speaking any of the languages Arabic, Dari, Farsi, English, or Swedish, completed an online questionnaire following a three-tiered procedure with screening instruments for each tier. In this study, the Tier 3 scales were used as reference standards for clinically relevant symptoms, to evaluate screening efficiency in terms of accuracy and reduction of item burden in previous tiers. RESULTS The results show that the tiered procedure could reduce the item burden while maintaining high accuracy, with up to 86% correctly assessed symptoms and few false negatives with moderate symptoms and above (at most 9%), and very few with severe symptoms (at most 1.3%). DISCUSSION This study generated an accurate screening tool that efficiently identifies clinically relevant symptoms of common psychiatric disorders among refugees. Using an adapted online tiered procedure to screen for multiple mental health issues among refugees has the potential to facilitate screening and increase access to mental health services for refugees. We discuss the utility of the screening tool and the necessity of further evaluation.
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Affiliation(s)
- Jennifer Meurling
- Department of Psychology and Social work, Mid Sweden University, 831 25, Östersund, Sweden.
| | - Elisabet Rondung
- grid.29050.3e0000 0001 1530 0805Department of Psychology and Social work, Mid Sweden University, 831 25 Östersund, Sweden
| | - Anna Leiler
- grid.29050.3e0000 0001 1530 0805Department of Psychology and Social work, Mid Sweden University, 831 25 Östersund, Sweden
| | - Elisabet Wasteson
- grid.29050.3e0000 0001 1530 0805Department of Psychology and Social work, Mid Sweden University, 831 25 Östersund, Sweden
| | - Gerhard Andersson
- grid.5640.70000 0001 2162 9922Department of Behavioral Sciences and Learning, Linköping University, 581 83 Linköping, Sweden
| | - Derek Richards
- grid.8217.c0000 0004 1936 9705School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Shervin Shahnavaz
- grid.467087.a0000 0004 0442 1056Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Insititutet, & Stockholm Health Care Services, Region Stockholm, 171 77 Stockholm, Sweden
| | - Anna Bjärtå
- Department of Psychology and Social work, Mid Sweden University, 831 25, Östersund, Sweden.
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Kaptan SK, Yilmaz B, Varese F, Andriopoulou P, Husain N. What works? Lessons from a pretrial qualitative study to inform a multi-component intervention for refugees and asylum seekers: Learning Through Play and EMDR Group Traumatic Episode Protocol. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:361-381. [PMID: 35700344 PMCID: PMC10084026 DOI: 10.1002/jcop.22908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
Almost half of the trials failed to recruit their targeted sample size of which 89% could be preventable. Successful implementation of mental health trials in a context of forcibly displaced individuals can be even more challenging. Mental health difficulties have the potential to impact parenting skills, which are linked to poor development in children, while parenting interventions can improve parents' mental health and parenting behaviors. However, the evidence on parenting interventions for refugees is limited. A parenting intervention, Learning Through Play Plus Eye Movement Desensitization and Reprocessing Group Treatment Protocol, has been designed to address parental mental health. This pretrial qualitative study, conducted with refugees, asylum seekers and professionals, aimed to explore their perceptions of the intervention and to identify barriers and recommendations for better engagement, recruitment, and delivery. Three themes were generated from thematic analysis: the content of the intervention, suggestions for improvement and implementation, and understanding the role of the facilitator. These themes provided insights into the issues that might predict the barriers for delivery of the intervention and offered several changes, including destigmatization strategies to improve engagement.
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Affiliation(s)
- Safa Kemal Kaptan
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Betul Yilmaz
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Filippo Varese
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
- Complex Trauma and Resilience Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | | | - Nusrat Husain
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
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Ziaian T, Puvimanasinghe T, Miller E, Augoustinos M, Esterman A, Baddeley M, Arthur N, de Anstiss H, Tsoulis E, Stewart-Jones T, Ghassemi E, Pir T. Rebuilding life after migration: Research protocol of a mixed methods study on settlement experiences of refugee and migrant youth. PLoS One 2023; 18:e0285023. [PMID: 37115787 PMCID: PMC10146506 DOI: 10.1371/journal.pone.0285023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Internationally, there is an urgent need to understand factors promoting successful settlement and integration of people with forced or voluntary migration experiences (i.e., refugee and non-refugee migrants). This paper provides a protocol of a mixed-methods investigation of contextual factors of successful settlement and service utilization of youth and their families, as young people could be at higher risk due to stressors associated with pre-migration trauma, post-migration settlement stressors, and adolescent development. This large-scale mixed-methods study will be conducted across three countries. A questionnaire survey will seek responses from 1200 youth aged 15-24 years residing in South Australia, Ontario, Canada, and California, United States of America. The qualitative component of the study will comprise 54 focus groups (324 participants) with youth and their parents/caregivers. The study design allows a range of important phenomena (e.g., different migration pathways and settlement countries) and key questions (e.g., regarding the intersection of migration, settlement, and wellbeing) to be addressed. It also allows for generalizability of findings to be tested across different communities and countries. Findings will support recommendations for policy and practice and may be generalized to advance research with youth and their families. This study is one of the largest, most comprehensive studies of youth settlement.
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Affiliation(s)
- Tahereh Ziaian
- University of South Australia, Justice and Society, Adelaide, Australia
- Centre for Workplace Excellence, University of South Australia, Adelaide, Australia
| | - Teresa Puvimanasinghe
- University of South Australia, Justice and Society, Adelaide, Australia
- Centre for Workplace Excellence, University of South Australia, Adelaide, Australia
| | - Emily Miller
- University of South Australia, Justice and Society, Adelaide, Australia
- Centre for Workplace Excellence, University of South Australia, Adelaide, Australia
| | | | - Adrian Esterman
- University of South Australia, Allied Health & Human Performance, Adelaide, Australia
| | | | - Nancy Arthur
- University of South Australia, Business, Adelaide, Australia
| | - Helena de Anstiss
- Multicultural Youth South Australia, Adelaide, South Australia, Australia
| | - Eugenia Tsoulis
- Australian Migrant Resource Centre, Adelaide, South Australia, Australia
| | | | | | - Tara Pir
- Institute for Multicultural Counseling and Education Services, Los Angeles, California, United States of America
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Scalable interventions for refugees. Glob Ment Health (Camb) 2023; 10:e8. [PMID: 36843882 PMCID: PMC9947626 DOI: 10.1017/gmh.2022.59] [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: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 02/10/2023] Open
Abstract
Refugees experience a greater rate of common mental disorders relative to most other populations, and there remains a need to address these needs. However, most refugees are hosted in low-and-middle-income countries, where there is a lack of resources and mental health providers who can deliver mainstream mental health services. This situation has led to the emergence of scalable mental health interventions that can deliver evidence-based programs to refugees in need. Many countries hosting refugees have implemented programs that train local lay providers in interventions that can be delivered at scale. This review provides a narrative overview of these scalable interventions and critiques the evidence for their efficacy. It is noted that there are limitations to currently available scalable interventions, and there is a need for greater attention to determining the longer-term benefits of interventions, addressing the mental health needs of refugees who do not respond to these interventions, assisting refugees with more severe psychological disorders, and understanding the specific mechanisms that underpin observed benefits of these interventions.
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