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Incagli C, Sommer N, Durieux-Paillard S, Aréchaga EPR, Reyre A. The role of mind-body interventions in traumatised refugees' primary care: A qualitative exploration of professionals' experiences in a dedicated programme in Geneva. Explore (NY) 2024; 20:103072. [PMID: 39413536 DOI: 10.1016/j.explore.2024.103072] [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: 08/01/2024] [Revised: 10/08/2024] [Accepted: 10/09/2024] [Indexed: 10/18/2024]
Abstract
Post-traumatic physical and psychological symptoms are pervasive among refugees. Primary care staff face numerous challenges and often seek innovative ways of addressing their refugee patients' physical and mental health needs. A nascent body of literature suggests that mind-body interventions (MBIs1) have a positive effect on post-traumatic symptoms in this population. But the quality of evidence is still poor, and little is known about the role MBI could play in the primary care of refugees. Following the implementation of two different kinds of MBI in a dedicated primary care unit, this study aimed to explore staff members' perceptions and prescribing habits for MBI. Given the paucity of information about this topic, we used a qualitative design combining ethnography and discourse analysis providing in-depth insight into professionals' experiences of MBI. Data collected over five-months of non-participative observation and the transcription of twelve interviews were analysed following the Interpretative Phenomenological Analysis method (IPA) yielding four main results: (1) Generally poor initial understanding of MBI; (2) A variety of conditions and situations where MBIs appeared acceptable and helpful; (3) A persistent lack of experience and knowledge about the indications for MBI, hindering prescription; (4) The importance of articulating MBIs with mental health services. These results, in the light of the existing literature, suggest that stronger evidence for MBI efficacy for refugees is required, a key to improving professionals' understanding of MBI, providing them with explicit prescription criteria, and encouraging stakeholders to implement these innovative interventions.
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Affiliation(s)
- Caterina Incagli
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland.
| | - Nora Sommer
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland.
| | - Sophie Durieux-Paillard
- Primary care department, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Eva P Rocillo Aréchaga
- Primary care department, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
| | - Aymeric Reyre
- Department of psychiatry, University Hospital of Geneva, Domaine de Belle-Idée, Chemin du Petit Bel-Air 2, 1226 Thônex, Switzerland; CESP-INSERM, U1018, Developmental psychiatry team, Paris-Saclay University, UVSQ, INSERM, 16 Avenue Paul Vaillant Couturier, 94807, Villejuif Cedex, France.
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Olcese M, Madera F, Cardinali P, Serafini G, Migliorini L. The role of community resilience as a protective factor in coping with mental disorders in a sample of psychiatric migrants. Front Psychiatry 2024; 15:1430688. [PMID: 39176226 PMCID: PMC11338846 DOI: 10.3389/fpsyt.2024.1430688] [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: 05/10/2024] [Accepted: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
Background Over the past decade migration to Italy has increased significantly for various reasons including armed conflicts. Generally, the migration process is exposed to different risk factors during different periods of migration, which can compromise well-being and promote the onset or exacerbation of mental disorders. A community with resources and the perception of one's community as resilient can be important protective factor in the context of migration. Purpose This study aims to understand which variables in migration predict an increase in perceived community resilience and to understand the role of community resilience in the relationship between mental disorders and subjective well-being in a sample of 100 adult migrants at the first consultation interview in the ambulatories of Psychiatry Unit. Methods After defining the inclusion and exclusion criteria, migrants were asked to fill out self-report questionnaires to collect socio-demographic data and to assess perception of mental disorders, perceived community resilience and perception of subjective well-being. Descriptive analysis, simple regression, and moderation analyses were conducted to test the hypotheses. Results The results show that the variable meaning attributed to the community with reference to the host community, migration with someone, and longer duration of stay in Italy contribute to increased perceptions of community resilience. In addition, a direct negative effect of mental disorders on subjective well-being and the moderating role of community resilience in relationship between mental disorders and subjective well-being have been demonstrated. Conclusions This result underscores the importance of perceived community resilience in mitigating the negative effects of mental disorders on subjective well-being. Perceiving one's community as more resilient seems to protect against the impact of mental disorders on subjective well-being. Our results support an ecological model of migrants' mental health that values the community and its resources in coping with mental disorders in the context of migration.
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Affiliation(s)
- Martina Olcese
- Department of Education Sciences, University of Genoa, Genoa, Italy
| | - Francesco Madera
- Department of Education Sciences, University of Genoa, Genoa, Italy
| | | | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Laura Migliorini
- Department of Education Sciences, University of Genoa, Genoa, Italy
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Hagström A, Hasson H, Hollander AC, Vahtra C, Delilovic S, Augustsson H. "Sometimes it can be like an icebreaker": A mixed method evaluation of the implementation of the Refugee Health Screener-13 (RHS-13). J Migr Health 2024; 10:100243. [PMID: 39220097 PMCID: PMC11365362 DOI: 10.1016/j.jmh.2024.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/29/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background Forced migrants are at risk of developing mental illness, yet challenges remain with underutilization of mental healthcare among this population. This study examined the implementation of the Refugee Health Screener-13 (RHS-13) in the health assessment for forced migrants in eight primary health care centres in Stockholm Region, Sweden. Methods A mixed-methods convergent parallel design was used, combining nurses self-reported quantitative data on the levels and reasons for RHS-13 use in the health assessment with qualitative interview data on the barriers and facilitators for RHS-13 use. The Consolidated Framework for Implementation Research (CFIR) was used as a coding framework for the qualitative analysis. Results Levels of RHS-13 use varied between primary health care centres, resulting in two groups: three centres with high-level (65-92%) and five centres with low-level (0-36%) implementation. Factors related to the tool itself, as well as the inner and outer context, influenced the use of RHS-13. Language barriers, insufficient time, and lack of trust in the validity and utility of RHS-13 were the main barriers, while its availability in many languages and that it was perceived as an important complement to the health assessment were the main facilitators. Conclusion RHS-13 contributes to the standardization of assessing mental health in the health assessment. Identifying context-based implementation strategies and addressing language and time issues as well as nurses trust in the tool's utility are recommended to enhance the use of RHS-13.
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Affiliation(s)
- Ana Hagström
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Henna Hasson
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | | - Carl Vahtra
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Sara Delilovic
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Hanna Augustsson
- Region Stockholm, Centre for Epidemiology and Community Medicine (CES, with Swedish acronym), Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
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Dickson K, Ko SY(J, Nguyen C, Minchenko D, Bangpan M. Mental health and psychosocial support programmes for displaced populations in low- and middle-income countries (LMICs): A systematic review of process, perspectives and experiences. Glob Ment Health (Camb) 2024; 11:e62. [PMID: 38774885 PMCID: PMC11106547 DOI: 10.1017/gmh.2024.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/12/2024] [Accepted: 04/20/2024] [Indexed: 05/24/2024] Open
Abstract
Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low- and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility.
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Affiliation(s)
- Kelly Dickson
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
| | - Sum Yue (Jessica) Ko
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
| | - Celine Nguyen
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
- Southwestern Medical School, University of Texas, Dallas, TX75390, USA
| | - Dayana Minchenko
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
| | - Mukdarut Bangpan
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
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Cadorin C, Purgato M, Turrini G, Prina E, Cabral Ferreira M, Cristofalo D, Bartucz MB, Witteveen AB, Sijbrandij M, Papola D, Barbui C. Mapping the evidence on psychosocial interventions for migrant populations: Descriptive analysis of a living database of randomized studies. Glob Ment Health (Camb) 2024; 11:e35. [PMID: 38572262 PMCID: PMC10988138 DOI: 10.1017/gmh.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/21/2024] [Accepted: 03/02/2024] [Indexed: 04/05/2024] Open
Abstract
Migrant mental health is a pressing public health issue with wide-ranging implications. Many randomized controlled trials (RCTs) have been conducted in this population to assess the effects of psychosocial interventions. However, the available evidence is characterized by controversy and fragmentation, with studies focusing on different migrant populations, interventions, outcomes, delivery modalities and settings. Aiming to promote systematic reviews of the effectiveness of psychosocial interventions in different migrant groups, we have developed a living database of existing RCTs. The development of the database provides an opportunity to map the existing RCT evidence in this population. A total of 135 studies involving 24,859 participants were included in the living database. The distribution of studies by year of publication aligns with the increasing global migrant population in recent years. Most studies focus primarily on adult participants, with a limited representation of children and adolescents, and a prevalence of female participants, which is consistent with epidemiological data, except for older adults, who are underrepresented in research. Studies predominantly focus on refugees and asylum seekers, likely due to their elevated risk of mental health issues, despite the substantial presence of economic migrants worldwide. While studies mainly involve migrants from the Middle East and East Asia, epidemiological data suggest a broader geographic representation, with migrants coming from Eastern Europe, Latin America and South Asia. The present descriptive analysis of RCTs on mental health and psychosocial interventions for migrant populations provides valuable insights into the existing research landscape. It should be used to inform future research efforts, ensuring that studies are more representative of the global migrant population and more responsive to the mental health needs of migrants in different contexts.
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Affiliation(s)
- Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Madalena Cabral Ferreira
- Public Health Unit of the Primary Care Cluster of Famalicão, Northern Region Health Administration, Famalicão, Portugal
| | - Doriana Cristofalo
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Monica B. Bartucz
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Schouler-Ocak M, Moran JK. Anxiety and mood disorders in forcibly displaced people across the world. Curr Opin Psychiatry 2024; 37:18-22. [PMID: 37972938 DOI: 10.1097/yco.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW Displaced persons around the world have intensified in the previous decade and are predicted to rise further with greater global instability. The mental health issues involved with fleeing one's home, and attempting to make a new life in a host country need to be understood and addressed. RECENT FINDINGS Prevalence of anxiety and mood disorders, including posttraumatic stress disorder appear to be higher for displaced peoples than for the population in the host country. This is consistent across different methods. Traumatic life events in the country of origin as well as during flight contribute to symptom severity. Factors in the host country increasing severity including isolation, discrimination, low social support. There are successfully implemented intercultural interventions at the individual level of the practitioner, as well as at the institutional level. SUMMARY There are many possibilities for successful interventions in displaced people, realizing this at a scale appropriate to the size of the problem remains a challenge.
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Affiliation(s)
| | - James Kennth Moran
- Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin Berlin, Berlin, Germany
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Chen S, Wang Y, She R. Prevalence and gender disparity of those who screen positive for depression in China by the classification of the employer and industry: a cross-sectional, population-based study. BMC Psychiatry 2023; 23:62. [PMID: 36694143 PMCID: PMC9872324 DOI: 10.1186/s12888-023-04557-7] [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: 05/23/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The important role of mental health in sustainable economic development is gradually being recognized. This study aimed to evaluate the prevalence and gender disparity of those who screen positive for depression in China by the employer and industrial classification. METHODS We used data from a nationally representative survey, the China Family Panel Studies. Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Employer classifications were categorized according to the local characteristics of Mainland China. Industrial classifications were defined using level-1 of the China version of the International Standard Industrial Classification of All Economic Activities. Weighted logistic regressions were fitted to estimate the gender disparities, controlling for confounders. RESULTS Forty eight thousand six hundred twenty eight adults were included. 18.7% (95%CI 18.1-19.4) of sampled adults were screened positive for depression symptoms, with 16.6% (95%CI 15.8-17.5) in males vs 21.0% (95%CI 20.1-22.0) in females. By classification of the employer, the prevalence was lowest among those employed by Government/party organisations (11.8%, 95%CI 8.9-15.4), and highest in those self-employed (21.8%, 95%CI 20.8-22.9); the gender disparity was mainly found in those employed by Sole proprietorship (Adjusted odds ratio [AOR] = 1.95, 95%CI 1.19-3.19) and Private enterprise (AOR = 1.34, 95%CI 1.13-1.59), as well as those self-employed (AOR = 1.49, 95%CI 1.3-1.17). By industrial classification, the prevalence was lowest among those who worked in the industry of Real estate (7.2%, 95%CI 4.8-10.6), and highest among those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (22.9%, 95%CI 15.5-32.4); the gender disparity was mainly found in those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (AOR = 3.29, 95%CI 1.18-9.15), Manufacturing (AOR = 1.41, 95% CI 1.09-1.82), Wholesale and retail trade (AOR = 1.48, 95% CI 1.07-2.06), and Accommodation and food service (AOR = 1.91, 95% CI 1.15-3.18). CONCLUSION The prevalence of depression in China had a wide variation by classifications of the employer and industry. Gender disparities were identified among workers from Sole proprietorship, Private enterprise, and self-employed, or workers from the industry of Agriculture, forestry, animal husbandry and fishing, Manufacturing, Wholesale and retail trade, and Accommodation and food service.
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Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Yuqi Wang
- grid.83440.3b0000000121901201Department of Computer Science, University College London, London, WC1E 6BT UK
| | - Rui She
- grid.16890.360000 0004 1764 6123Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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