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Scharpf F, Masath FB, Mkinga G, Kyaruzi E, Nkuba M, Machumu M, Hecker T. Prevalence of suicidality and associated factors of suicide risk in a representative community sample of families in three East African refugee camps. Soc Psychiatry Psychiatr Epidemiol 2024; 59:245-259. [PMID: 37277656 PMCID: PMC10838827 DOI: 10.1007/s00127-023-02506-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE To assess the prevalence of suicidality and associated factors of suicide risk in a sample of Burundian refugee families living in three refugee camps in Tanzania. METHODS Children (n = 230) and their parents (n = 460) were randomly selected and interviewed about suicidality (suicidal ideation, plans, and attempts) and a range of sociodemographic, psychological, and environmental factors. Multinomial logistic regression analyses were conducted to examine factors associated with children and parents' lower and moderate or high current suicide risk. RESULTS Past-month prevalence of suicidal ideation, plans, and attempts were 11.3%, 0.9% and 0.9%, respectively, among children; 37.4%, 7.4% and 5.2%, respectively, among mothers; and 29.6%, 4.8% and 1.7%, respectively, among fathers. Older age in years (aORlower = 2.20, 95% CI 1.38-3.51; aORmoderate/high = 3.03, 95% CI 1.15-7.99) and higher levels of posttraumatic stress disorder symptoms (aORlower = 1.64, 95% CI 1.05-2.57; aORmoderate/high = 2.30, 95% CI: 1.02-5.16), internalizing (aORmoderate/high = 2.88, 95% CI 1.33-6.26) and externalizing problems (aORlower = 1.56, 95% CI: 1.06-2.31; aORmoderate/high = 3.03, 95% CI 1.42-6.49) were significantly positively associated with children's current suicide risk. For mothers, higher perceived instrumental social support (aORmoderate/high = 0.05, 95% CI < 0.01-0.58) was significantly negatively related to suicide risk, whereas exposure to community violence (aORlower = 1.97, 95% CI 1.30-2.99; aORmoderate/high = 1.59, 95% CI 1.00-2.52), living in larger households (aORlower = 1.74, 95% CI 1.17-2.57), and higher psychological distress (aORmoderate/high = 1.67, 95% CI 1.05-2.67) were significantly positively associated with suicide risk. For fathers, higher perceived instrumental social support (aORmoderate/high = 0.04, 95% CI < 0.01-0.44) and having more years of formal education (aORmoderate/high = 0.58, 95% CI 0.34-0.98) were significantly negatively and exposure to war-related trauma (aORmoderate/high = 1.81, 95% CI 1.03-3.19) was significantly positively associated with suicide risk. CONCLUSION Prevention programs should target psychopathology, community violence and social support to mitigate children and parents' current suicide risk.
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Affiliation(s)
- Florian Scharpf
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany.
- Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany.
| | - Faustine Bwire Masath
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
- Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
- Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, P. O. Box 2329, Dar es Salaam, Tanzania
| | - Getrude Mkinga
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
| | - Edna Kyaruzi
- Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, P. O. Box 2329, Dar es Salaam, Tanzania
| | - Mabula Nkuba
- Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, P. O. Box 2329, Dar es Salaam, Tanzania
| | - Maregesi Machumu
- Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, P. O. Box 2329, Dar es Salaam, Tanzania
| | - Tobias Hecker
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
- Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany
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The effects of traumatic experiences during transit and pushback on the mental health of refugees, asylum seekers, and migrants. Eur J Psychotraumatol 2023; 14:2163064. [PMID: 37052104 PMCID: PMC9873274 DOI: 10.1080/20008066.2022.2163064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: There are 26 million people recognised as refugees worldwide. Many of them spent a prolonged period of time in transit - time after they leave their country of origin and before they reach the receiving country. Transit brings numerous protection and mental health risks refugees are exposed to.Objective: The aim of this study was to assess the stressful and traumatic experiences refugees are exposed to during transit, with a special focus on the experience of pushback - the denial of access to the territory to foreign nationals and forcible return to countries of origin or neighbouring countries without an assessment of their rights to international protection, as well as the impact of these experiences on refugees' mental health and well-being.Method: 201 refugees currently residing in Serbia completed the Stressful and Traumatic Experiences in Transit questionnaire - short version (SET-SF), questionnaire for assessing stressful and traumatic experiences during pushback (SET-SF PB), Refugee Health Screener (RHS-15), and Well-being index (WHO-5).Results: The results showed that refugees experience a large number of stressful and traumatic events (M = 10.27, SD = 4.85). In addition, half of the participants experience severe symptoms of depression (50.7%), while about a third of the participants experience severe symptoms of anxiety (37.8%) and post-traumatic stress disorder (PTSD) (32.3%). Refugees who experienced pushback showed overall higher levels of depression, anxiety, and PTSD. Traumatic experiences during transit and pushback were positively related to the severity of depression, anxiety, and PTSD. In addition, traumatic experiences during pushback showed an incremental contribution in predicting refugees' mental health difficulties over and above traumatic experiences in transit.Conclusions: This study provides valuable insights into the multiple risks refugees are exposed to and emphasise the need for the provision of adequate protection and support.
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Rizzi D, Ciuffo G, Landoni M, Mangiagalli M, Ionio C. Psychological and environmental factors influencing resilience among Ukrainian refugees and internally displaced persons: a systematic review of coping strategies and risk and protective factors. Front Psychol 2023; 14:1266125. [PMID: 37876848 PMCID: PMC10590896 DOI: 10.3389/fpsyg.2023.1266125] [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: 07/24/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023] Open
Abstract
Background There is much discussion in the literature about the link between traumatic events related to war and mental illness. However, in comparison, mental health has been more researched than protective factors such as coping methods, which are the primary factors to build resilience in these circumstances. This review examines the psychological and environmental elements that influence the resilience of Ukrainian refugees and IDPs by analyzing coping strategies and risk and protective factors. Methods A literature search was conducted on PsycINFO, Pubmed, Scopus, and Science Direct, with 259 articles screened and 13 determined as eligible for inclusion. Inclusion criteria were: (1) studies on adult Ukrainian refugees and/or IDPs; (2) original, peer-reviewed studies; and (3) studies written in English or Italian language. Single-case reports and qualitative studies were excluded, as well as those studies written in any other language, and any studies for which the full-text version could not be obtained (i.e., conference abstracts). Two reviewers independently reviewed titles and abstracts, reviewed relevant articles' full text, and extracted the data. Results A diverse range of individual and socio-environmental risk and protective factors were identified, influencing the resilience of Ukrainian refugees and IDPs, as well as five main categories of coping strategies: emotion-focused strategies, problem-focused strategies, avoidance, faith-based strategies, and the ones based on sense of belonging. Discussion War trauma and associated stressors can lead to distressing physical and psychological reactions, which persist even after leaving the war zone. Many individual and socio-environmental risk factors, such as mental disorders, financial security, having relatives wounded or displaced, and an unfamiliar environment could influence the risk and severity of psychological difficulties, emphasizing the importance of coping strategies, social connections, faith, and cultural resilience. Conclusion This systematic review underscores the complex range of coping strategies and factors influencing the resilience of Ukrainian refugees and IDPs. Social connections and inclusive community interventions play vital roles in improving their psychological well-being, while longitudinal studies and culturally sensitive support are needed to address their unique challenges and strengths. Implementing collaborative care models can provide comprehensive support by integrating mental health services with primary healthcare and community-based organizations.
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Affiliation(s)
- Damiano Rizzi
- Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy
- Unità di Medicina d’Urgenza, Dipartimento di Medicina Interna, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - Giulia Ciuffo
- Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
- CRIdee, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - Marta Landoni
- CRIdee, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - Matteo Mangiagalli
- Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia, Pavia, Italy
| | - Chiara Ionio
- Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
- CRIdee, Dipartimento di Psicologia, Università Cattolica, Milan, Italy
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Abdelhamid S, Lindert J, Fischer J, Steinisch M. Negative and protective experiences influencing the well-being of refugee children resettling in Germany: a qualitative study. BMJ Open 2023; 13:e067332. [PMID: 37076150 PMCID: PMC10124287 DOI: 10.1136/bmjopen-2022-067332] [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: 04/21/2023] Open
Abstract
OBJECTIVE Conflict, forced migration and searching for safety in a foreign land are all experiences common to refugee children. They experience potentially traumatic events that are distinct from the general population, yet current adverse childhood experience (ACE) studies do not cover these events. Studies that do examine refugee children's experiences typically focus on a single stage of migration or adversities from the community, offering insight into only a fraction of their realities. This study aimed to identify potentially traumatising and protective experiences subjectively perceived as influencing refugee children's well-being from all stages of migration and all socio-ecological levels. DESIGN Qualitative study with thematic analysis of semi-structured individual and group interviews. Themes were organised within a socio-ecological model. SETTING Non-profit organisations, youth welfare facilities and societies that organise civic engagement for refugee families in the Rhine-Neckar region in Germany provided rooms where interviews could be conducted. PARTICIPANTS Refugee parents and children who spoke one of the four most common languages of those seeking asylum in Germany in 2018 were included. This study excluded refugees who were not fleeing a conflict area. Forty-seven refugee parents and 11 children (aged 8-17 years) from Syria, Iraq, Palestine, Afghanistan and Eritrea participated. RESULTS Eight major themes emerged from interviews including six reflecting potentially negative experiences and two potentially protective themes. These themes evolved from experiences such as family dispersion, displacement, rigorous immigration and national policies, as well as constructive parenting and community support. CONCLUSION It is increasingly important to identify these diverse experiences as the refugee population continues to grow, and the increased prevalence of poor health outcomes in refugee children continues to be widely documented. Identifying ACEs specifically relevant to refugee children could contribute to understanding potential pathways and could further serve as a starting point for tailored interventions.
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Affiliation(s)
- Shaymaa Abdelhamid
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Heidelberg University, Heidelberg, Germany
| | - Jutta Lindert
- Department of Social Work and Health, University of Applied Sciences Emden/Leer, Emden, Germany
| | - Joachim Fischer
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Heidelberg University, Heidelberg, Germany
| | - Maria Steinisch
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of Public Health, Social and Preventive Medicine, Heidelberg University, Heidelberg, Germany
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Ng I, Chung JW, Choi SF, Yan VC. Self-perceived mental health and factors associated with the mental health of Hong Kong's asylum-seekers and refugees - A mixed methods study. Heliyon 2023; 9:e13481. [PMID: 36814635 PMCID: PMC9939599 DOI: 10.1016/j.heliyon.2023.e13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Rationale The 21st century has seen vast flows of displaced people. In the year 2020 alone, an estimated 11.2 million were forcibly displaced as a result of persecution, conflict or generalized violence. The torment and fear of war, persecution and threat to life, whether in the home country, during the process of fleeing, or in the post-migration host country, can be extremely traumatic to these marginalized populations. Hong Kong is not a signatory to the 1951 UN Refugee Convention, but the territory has signed the 1967 UN(CAT) which requires the former colony to allow people who flee for their lives to have their cases processed in Hong Kong. Currently there are around 14,000 cases in Hong Kong, some of whom have been in Hong Kong for more than a decade, waiting for their claims to be processed, living on meagre government subsidies and with no right to work. Objectives The paper examines the mental health of asylum-seekers and refugees in Hong Kong and the factors associating with their mental health. Method A sequential mixed methods approach was conducted among asylum-seekers and refugees in Hong Kong between October 2019 and mid-2020. It comprised a pilot quantitative survey conducted with 47 participants, and follow-up qualitative interviews with 16 of the 47 participants. Survey results were analyzed using statistical measures while the qualitative in-depth interviews were thematically analyzed to identify emergent patterns and categories. Results Results from the quantitative data identify 52.2% of the asylum-seekers taking part as having symptomatic anxiety, 55.3% as having symptomatic depression and 54.3% as having overall problems. Qualitative results show that asylum-seekers and refugees cited lack of work and poverty as key factors affecting their mental health and well-being. Fear of being sent home was expressed by respondents who were married or having children for the fear of being separated from each other.
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Affiliation(s)
- Isabella Ng
- Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong,Corresponding author. The Education University of Hong Kong, B2-2/F-34, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong.
| | - Joanne W.Y. Chung
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
| | - Sharice F.Y. Choi
- Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong
| | - Vincent C.M. Yan
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
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Anjum G, Aziz M, Hamid HK. Life and mental health in limbo of the Ukraine war: How can helpers assist civilians, asylum seekers and refugees affected by the war? Front Psychol 2023; 14:1129299. [PMID: 36874809 PMCID: PMC9983366 DOI: 10.3389/fpsyg.2023.1129299] [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: 12/21/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
The terror spread by the war disrupts lives and severs families, leaving individuals and communities devastated. People are left to fend for themselves on multiple levels, especially psychologically. It is well documented that war adversely affects non-combatant civilians, both physically and psychologically. However, how the war puts civilians' lives in a limbo is an under-researched area. This paper focuses on three aspects: (1) how the mental health and well-being of Ukrainian civilians, asylum seekers, and refugees are affected by the war caused limbo; (2) what factors affect this process of being stuck in the limbo of war; and (3) how psychologists and helpers in the war-ridden and host countries can provide meaningful support. Based on the authors' own practical work with Ukrainian civilians, refugees, and professional helpers during the war, this paper provides an overview of multi-level factors that impact human psyches in a war, and possible ways to help those who are living in the war limbo. In this research and experiential learning-based review, we offer some helpful strategies, action plans, and resources for the helpers including psychologists, counselors, volunteers, and relief workers. We emphasize that the effects of war are neither linear nor equal for all civilians and refugees. Some will recover and return to a routine life while others will experience panic attacks, trauma, depression, and even PTSD, which can also surface much later and can prolong over the years. Hence, we provide experience-based ways of dealing with short-term and prolonged trauma of living with war and post-traumatic stress disorder (PTSD). Mental health professionals and other helpers in Ukraine and in host countries can use these helping strategies and resources to provide effective support for Ukrainians and for war refugees in general.
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Affiliation(s)
- Gulnaz Anjum
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Mudassar Aziz
- Department of Psychology, Kwantlen Polytechnic University, Surrey, BC, Canada
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Julianto V. Happiness of ex-refugees in the Indonesia border after two decades of Timor Leste referendum. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:17-30. [PMID: 35546045 DOI: 10.1002/jcop.22875] [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: 01/27/2022] [Revised: 04/04/2022] [Accepted: 04/16/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to find out how happy the ex-East Timor refugees who chose to become Indonesians after more than 20 years of the Timor Leste referendum were. Descriptive statistics and thematic content analysis were employed for investigating the responsible factors for their happiness level. An open survey method and the Oxford Happiness Questionnaire (OHQ) scale distribution were used in this study with 173 Indonesians who participated in the 1999 Timor Leste referendum. The results show that on a scale of 1 to 6 participants are in the second or third lowest levels of happiness. Five main factors determine the happiness of the refugees, including economic condition, recognition and appreciation from the Indonesian government, security, family, and education access. These research findings offer a deeper understanding of the ex-refugee studies to obtain psychological well-being rights in their country of choice.
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Affiliation(s)
- Very Julianto
- Department of Psychology, Faculty of Social Sciences and Humanities, UIN Sunan Kalijaga, Yogyakarta, Indonesia
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Hart PL, Zahos H, Salt N, Schofield R, Mahroof-Shaffi S, Simonek T, Harkensee C. Lessons to learn from the analysis of routine health data from Moria Refugee Camp on Lesvos, Greece. J Public Health (Oxf) 2022:6840101. [DOI: 10.1093/pubmed/fdac127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/04/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Refugees in humanitarian settings commonly experience many health needs and barriers to access healthcare; health data from these settings are infrequently reported, preventing effective healthcare provision. This report describes health needs of refugees in Moria Camp on Lesvos, Greece—Europe’s largest refugee camp.
Methods
A set of routinely collected service data of 18 131 consultations of 11 938 patients, attending a primary care clinic in the camp over 6 months in 2019–20, was analysed retrospectively, focusing on chronic health conditions.
Results
The most frequent chronic conditions were musculoskeletal pain (25.1%), mental health (15.9%), cardiac (12.7%) and endocrine conditions (8.9%). In all, 70.4% of consultations were for acute health problems, with high rates of injuries and wounds (20.8%), respiratory infections (12.5%), gastroenteritis (10.7%) and skin problems (9.7%), particularly scabies.
Conclusions
The prevalence of acute and chronic health problems is high in this setting, with some likely attributable to the deplorable living conditions in the camp. Despite its magnitude, the interpretability of routine health data is limited. A research agenda is identified, and a framework for chronic disease management in refugee camps is proposed.
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Affiliation(s)
- Paul L Hart
- 22603 Esplanada Circle W, Boca Raton , FL 33433 , USA
| | - Helen Zahos
- Griffith University School of Nursing and Midwifery, , Gold Coast, 1 Hospital Boulevard, Southport, QLD 4215 , Australia
| | - Nicola Salt
- Wandsworth Care Commissioning Group Balham Park Surgery, , 236 Balham High Road, London, SW17 7AW , UK
| | - Roger Schofield
- Shalom House Palliative Care Centre , St David’s, Pembrokeshire, SA62 6BP , UK
| | | | | | - Christian Harkensee
- Gateshead Health NHS Foundation Trust , Queen Elizabeth Avenue, Gateshead, NE9 6SX , UK
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van Eggermont Arwidson C, Holmgren J, Gottberg K, Tinghög P, Eriksson H. Living a frozen life: a qualitative study on asylum seekers' experiences and care practices at accommodation centers in Sweden. Confl Health 2022; 16:47. [PMID: 36071462 PMCID: PMC9450398 DOI: 10.1186/s13031-022-00480-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background Forced migrants fleeing conflict and violence face a high risk of mental health problems due to experiences before displacement, perilous journeys, and conditions in the new host societies. Asylum seekers seem to be in particularly vulnerable situations, indicated by higher prevalence rates of mental health problems compared to resettled refugees. Asylum seekers’ mental health is highly influenced by the conditions they face in host countries while awaiting a decision on their case. In Sweden, 40% of asylum seekers reside in state-provided accommodation centers during the asylum process. Collective accommodation centers for asylum seekers have been said to impose restrictive social conditions and to be associated with poorer mental health outcomes than other housing forms (e.g., self-organized housing). However, there seems to be a scarcity of qualitative studies exploring the experiences of asylum seekers in different contexts. The aim of this study was therefore to explore the experiences of asylum seekers and how they manage their mental wellbeing while living at accommodation centers in Sweden. Methods Fourteen semi-structured interviews with asylum seekers were conducted at two accommodation centers in Sweden. Participants were recruited using purposeful sampling and represented a diverse group of asylum seekers regarding age, background, and gender. The data was analyzed using content analysis. Results Three overarching categories were identified; 1) Frozen life, 2) Constant worrying and “overthinking”, and 3) Distractions and peer support. Participants experienced a state of being that could be characterized as a frozen life, which was associated with intense feelings of psychological distress, mostly described as manifesting itself in consuming patterns of ruminative thoughts, for instance overthinking and constant worrying. However, despite high levels of distress, participants demonstrated agency in managing negative mental health outcomes through self-care practices, peer support, and the development of care practices in caring for others in need. Conclusion This study offers new insights into the everyday challenges that asylum seekers at accommodation centers face. Furthermore, it offers valuable observations of how asylum seekers at accommodation centers cope through self-care practices, peer support, and care practices in caring for peers in need. In order to enable sustainable and empowering support, mental health and psychosocial support services must identify and address both challenges and strengths, be grounded in the lived reality of asylum seekers, and build on existing resources. Moreover, further policy work needs to be done to enable faster asylum processes.
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Affiliation(s)
- Charlotta van Eggermont Arwidson
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. .,Department of Health Sciences, Swedish Red Cross University, Huddinge, Sweden.
| | - Jessica Holmgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Kristina Gottberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Petter Tinghög
- Department of Health Sciences, Swedish Red Cross University, Huddinge, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Henrik Eriksson
- Department of Health Sciences, University West, Trollhättan, Sweden
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Bojorquez I, Sepúlveda J, Lee D, Strathdee S. Interrupted transit and common mental disorders among migrants in Tijuana, Mexico. Int J Soc Psychiatry 2022; 68:1018-1025. [PMID: 35652311 PMCID: PMC10712937 DOI: 10.1177/00207640221099419] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Policies of migration contention can interrupt the transit of people on the move, forcing them to remain in wait in non-destination countries. This liminal condition might impact negatively on migrants' mental health. AIMS To assess the relationship between interrupted transit and common mental disorders (CMD; symptoms of depression or anxiety), among migrants in shelters in Tijuana, Mexico. METHODS Cross-sectional survey conducted in November to December 2020 and February to April 2021. We assessed depressive symptoms with the Centers for Epidemiological Studies Depression scale (CES-D-7), and symptoms of anxiety with the Generalized Anxiety Disorder scale (GAD-2). We evaluated the association of being in interrupted transit (sent back from the United States to Mexico), as compared to having not crossed to the United States yet or planning to stay in Mexico, with having a CMD (either depressive or anxiety symptoms), as well as the association of other migration-related variables with CMD. RESULTS Being in interrupted transit (OR = 1.74, 95% CI [1.12, 2.71]), and having experienced violence during transit (OR = 2.50, 95% CI [1.63, 3.82]) were associated with CMD. CONCLUSIONS Interrupted transit is a potential risk factor for mental health problems among migrants. Migration and public health policies should consider the mental health consequences of interrupted transit, and promote initiatives to address the mental health needs of migrants on the move.
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Affiliation(s)
- Ietza Bojorquez
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Mexico
| | - Jaime Sepúlveda
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Deandra Lee
- Institute for Global Health Sciences, University of California, San Francisco, USA
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Sagbakken M, Bregaard IM, Varvin S. "Imagine, 7 Years Without a Future": A Qualitative Study of Rejected Asylum Seekers' Life Conditions in Norway. FRONTIERS IN SOCIOLOGY 2022; 7:813994. [PMID: 35928458 PMCID: PMC9343684 DOI: 10.3389/fsoc.2022.813994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
Asylum seekers are in an extraordinary situation as their future life depend on decisions made by authorities in a bewildering, bureaucratic system, with excessive waiting and unpredictable timeframes. Those that are not granted asylum, and not able to return to their country of origin, can neither spatially nor temporally visualize if, when or how a potential change is going to occur. This paper is part of a larger study based on narrative interviews with asylum seekers and refugees in asylum centers in Norway, exploring their experiences before, during, and after flight. As we found that the life circumstances for those being refused asylum, were highly different from other participants in the project, we chose to address this particular group in a separate paper. The participants in this part of the study consisted of 21 individuals (of a total of 78 participants) in the age range 18-44, of whom eight were female and 13 males. Trough qualitative interviews and participant observation the aim of this study was to explore and describe the life condition and mental health situation of rejected asylum seekers in Norway. We found that the gradual loss of rights, opportunities and finances are experienced as a form of violence that leads to extreme mental and social suffering. This policy clearly conflicts with Human Rights incorporated in the Norwegian constitution, and we argue that it legitimizes treating asylum seekers as a group of undesirable and underserving political bodies, with serious consequences for their mental health and wellbeing.
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Kamenshchikova A, Margineau I, Munir S, Knights F, Carter J, Requena-Mendez A, Ciftci Y, James RA, Orcutt M, Blanchet K, Veizis A, Kumar B, Noori T, Hargreaves S. Health-care provision for displaced populations arriving from Ukraine. THE LANCET INFECTIOUS DISEASES 2022; 22:757-759. [PMID: 35405089 PMCID: PMC8993168 DOI: 10.1016/s1473-3099(22)00225-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 10/24/2022]
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13
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Miller A, Burns R, Hargreaves S, Stevenson K. How should the UK respond to the Ukrainian migrant crisis? BMJ 2022; 377:o1191. [PMID: 35577381 DOI: 10.1136/bmj.o1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Rachel Burns
- Institute of Health Informatics, University College London, London, UK
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14
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Hipólito I, van Es T. Enactive-Dynamic Social Cognition and Active Inference. Front Psychol 2022; 13:855074. [PMID: 35572328 PMCID: PMC9102990 DOI: 10.3389/fpsyg.2022.855074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
This aim of this paper is two-fold: it critically analyses and rejects accounts blending active inference as theory of mind and enactivism; and it advances an enactivist-dynamic understanding of social cognition that is compatible with active inference. While some social cognition theories seemingly take an enactive perspective on social cognition, they explain it as the attribution of mental states to other people, by assuming representational structures, in line with the classic Theory of Mind (ToM). Holding both enactivism and ToM, we argue, entails contradiction and confusion due to two ToM assumptions widely known to be rejected by enactivism: that (1) social cognition reduces to mental representation and (2) social cognition is a hardwired contentful 'toolkit' or 'starter pack' that fuels the model-like theorising supposed in (1). The paper offers a positive alternative, one that avoids contradictions or confusion. After rejecting ToM-inspired theories of social cognition and clarifying the profile of social cognition under enactivism, that is without assumptions (1) and (2), the last section advances an enactivist-dynamic model of cognition as dynamic, real-time, fluid, contextual social action, where we use the formalisms of dynamical systems theory to explain the origins of socio-cognitive novelty in developmental change and active inference as a tool to demonstrate social understanding as generalised synchronisation.
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Affiliation(s)
- Inês Hipólito
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychology, Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - Thomas van Es
- Centre for Philosophical Psychology, Universiteit Antwerpen, Antwerp, Belgium
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Varvin S, Vladisavljević I, Jović V, Sagbakken M. "I Have No Capacities That Can Help Me": Young Asylum Seekers in Norway and Serbia - Flight as Disturbance of Developmental Processes. Front Psychol 2022; 12:786210. [PMID: 35069370 PMCID: PMC8769376 DOI: 10.3389/fpsyg.2021.786210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Most studies on refugee populations are organized around trauma-related issues and focus on explaining pathological factors. Few studies are anchored in general developmental psychology with the aim of exploring normal age-specific developmental tasks and how the special circumstances associated with forced migration can influence how developmental tasks are negotiated. This study is part of a larger mixed method study seeking to identify resilience-promoting and resilience-inhibiting factors, on individual and contextual levels, among asylum seekers and refugees on the move (passing through Serbia) and settled in reception centers in Norway. A strategic sample of 20 adolescent and young adult refugees/asylum seekers during flight in Serbia (10) and after arrival in Norway (10) was chosen from a sample of 178 refugees interviewed in depth in Serbia and at receptions centers in Norway. The sample reflects the focus of this paper, which is to explore adolescent and young adult refugees/asylum seekers' psychological and social needs and resources during flight to and after arrival in the host country, including how developmental tasks are negotiated. Through qualitative analysis, experiences associated with the developmental changes the participants experienced before, during, and after flight are contextualized. Their sense of self, their relationships with their families and their perceptions of their situation as adolescents or young adults in a highly unpredictable situation are presented in the light of relevant theory and findings from similar refugee studies. All the participants have fled from dangerous and intolerable situations in their home countries. They describe extreme dangers during flight in contexts that are unpredictable and where they feel lonely and unsupported. Most have unmet psychosocial needs and have received little support or help for their mental health issues during flight or after arrival in Norway. Suggestions for interventions and resilience-promoting actions are given based on the findings of the study.
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Affiliation(s)
- Sverre Varvin
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ivana Vladisavljević
- Faculty of Philosophy, University of Priština (Kosovska Mitrovica), Pristina, Serbia
| | - Vladimir Jović
- Center for Rehabilitation of Torture Victims, IAN, Belgrade, Serbia
| | - Mette Sagbakken
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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16
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Khan BM, Waserman J, Patel M. Perspectives of Refugee Youth Experiencing Homelessness: A Qualitative Study of Factors Impacting Mental Health and Resilience. Front Psychiatry 2022; 13:917200. [PMID: 35747095 PMCID: PMC9211750 DOI: 10.3389/fpsyt.2022.917200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Homeless refugee youth experience high rates of traumatic and adverse experiences, a significant burden of mental health needs, and compounded barriers in accessing support services. Despite this, there is a paucity of literature exploring the unique intersections and vulnerabilities faced by this subgroup. This study of Youth Without Shelter (YWS), an emergency residence and referral agency serving homeless youth in Toronto, Canada was a qualitative study of homeless refugee youth. Research goals were to describe the mental health needs and identify the factors contributing to the resiliency of refugee youth experiencing homelessness. Data was collected through individual semi-structured interviews with YWS youth (n = 6) and analyzed using inductive thematic analysis with a realist lens. Results highlighted that the mental health of refugee youth experiencing homelessness was subject to system-level factors such as the immigration process (n = 6), housing insecurity (n = 5), finances (n = 5), education (n = 6), employment (n = 6) and sense of safety (n = 4), with acculturative stress, including culture shock (n = 3) and language (n = 4), also have negative effects. Goal directedness (n = 5), independence or responsibility (n = 4), and nurturing social connectedness with family (n = 5), peers (n = 6), and community (n = 4) contributed to participants' resilience. A model for planning future interventions was proposed and was informed by the lived experience of participants. This model focuses on initially on immediate and basic needs and reflected evidence gathered through this work to attend to long-term needs once individuals have integrated into society. Future efforts will be directed toward translating the lived experience of this population and developing practice guidelines to optimize care.
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Affiliation(s)
- Bushra M Khan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jordana Waserman
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Mitesh Patel
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Inner City Health Associates, Unity Health Toronto, Toronto, ON, Canada
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17
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Shum TCT. Conceptualizing religious asylum: Security, religiosity, and subjective well-being of Christian asylum-seekers in Hong Kong. ASIAN AND PACIFIC MIGRATION JOURNAL 2021. [DOI: 10.1177/01171968211067835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article proposes the concept of religious asylum to examine how Christian asylum-seekers utilize religion to cope with their emotional experiences, induced by a sense of insecurity, during prolonged displacement. Drawing from interviews and ethnographic observations of people seeking asylum in Hong Kong, this research determines that asylum-seekers use religion to redefine their positive sense of self beyond their current situation, which is central to the construct of well-being. While religion supports asylum-seekers going through psychosocial distress and suffering, this discussion on religious asylum shows how asylum-seekers utilize the religiously inflected space to make the experience of prolonged displacement meaningful.
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Walther L, Rayes D, Amann J, Flick U, Ta TMT, Hahn E, Bajbouj M. Mental Health and Integration: A Qualitative Study on the Struggles of Recently Arrived Refugees in Germany. Front Public Health 2021; 9:576481. [PMID: 34805055 PMCID: PMC8599120 DOI: 10.3389/fpubh.2021.576481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Forcibly displaced people are at particular risk of mental health problems and also face specific integration challenges upon resettlement. Existing literature suggests that there may be a bidirectional relationship between mental health and integration. The present study seeks to understand the relationship between integration processes and mental health problems or significant negative emotional experiences among adult refugees in Germany. Method: Applying a qualitative approach, we conducted 54 semi-structured interviews with refugees and asylum seekers who arrived in Germany between 2013 and 2018 currently residing in Berlin, Leipzig, or the Duisburg area in North Rhine-Westphalia. Data was collected between December 2018 and September 2019. We analyzed transcripts inductively using thematic analysis. Results: Five themes covering the various links between integration and mental health problems or significant negative emotional experiences were identified. First, we found that the mental health consequences of past adverse experiences, as well as ongoing worries about those left behind in the homeland, can seriously impede refugees' ability to pursue activities key to integration. Second, the process of applying for and securing asylum can result in uncertainty and fear, which, in turn, burden the individual and may impact motivation for integration. Third, many of our participants described mental health ramifications related to feeling stuck and thwarted in the pursuit of building a life, especially in securing employment. Fourth, some participants described feeling so overwhelmed by fundamental tasks throughout the integration process, namely, language learning and bureaucratic processes, that these take a psychological toll. Fifth, we identified several forms of social disconnection between refugees and members of the host community due to xenophobia, social and cultural differences, physical and emotional isolation in refugee camps, as well as with co-nationals and fellow refugees. Negative emotions, mistrust, and socio-cultural differences that emerge throughout the integration processes seem to erode social cohesion among refugee communities, potentially further threatening mental health. Conclusion: Mental health problems and integration processes appear to be closely related across different areas of integration. Innovative solutions to challenges identified by members of the refugee community in Germany stand to benefit mental health and integration outcomes simultaneously.
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Affiliation(s)
- Lena Walther
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Diana Rayes
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Julia Amann
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Uwe Flick
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
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Pestre E. Geopolitical Borders and Psychic Borders: Is a Dialogue Possible? Toward a Geoclinical Practice Centered on the Subject of Migrants. THE PSYCHOANALYTIC QUARTERLY 2021; 90:337-372. [DOI: 10.1080/00332828.2021.1935174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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A cross-sectional survey of sociodemographic characteristics, primary care health needs and living conditions of asylum-seekers living in a Greek reception centre. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background
In 2019, a migrant camp on the Greek island of Samos designed for 650 people was home to a growing population of over 5500. We aimed to quantitatively describe living conditions and health needs in the camp.
Methods
A questionnaire was designed with reference to international humanitarian standards, following a consultative process with the asylum-seeker population. Domains assessed included demographics, living conditions, safety/vulnerability, and health. The questionnaire was piloted and then conducted in June 2019 on a sample of asylum seekers.
Results
Five hundred participants, predominantly from Afghanistan and the Democratic Republic of Congo (DRC). Of these, 79.4% lived in tents. Respondents cared for a total of 570 children; 20.6% of women were pregnant, 35.4% had experienced violence, 83% psychological distress, 71% skin disease, 66% diarrhoea and vomiting, and 64% respiratory disease. Accommodation, sanitation, and nutrition fell below internationally recognised standards, and poor access to water was significantly associated (p < 0.001) with respiratory disease, diarrhoea and vomiting, skin disease ,and psychological distress.
Conclusions
Living conditions in the Samos camp fall below basic humanitarian standards and are associated with poor health status. Further research is imperative to analyse and monitor the diverse, varying needs of asylum-seekers and inform policies to improve conditions.
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21
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Phillimore J, Cheung SY. The violence of uncertainty: Empirical evidence on how asylum waiting time undermines refugee health. Soc Sci Med 2021; 282:114154. [PMID: 34192621 DOI: 10.1016/j.socscimed.2021.114154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
The idea of violent uncertainty was first introduced in the New England Journal of Medicine (Grace et al., 2018) making claims about the deleterious impacts of insecure immigration status on the health of migrants. Policies of uncertainty are said to directly and indirectly create harm by impacting on individual's health via detention and public degradation and undermining healthcare services. We offer original empirical evidence indicating an association with uncertainty, in the form of asylum waiting times, on refugees' self-reported health. We devise four hypotheses that: long waiting time for asylum decisions increases likelihood of self-reported health problems and the effect persists overtime, that female refugees report higher levels of health problems resulting from uncertainty and religion moderates the association between health and uncertainty. We use data from the UK longitudinal Survey of New Refugees wherein all new refugees were sent a baseline survey immediately after receiving refugee status and then follow-up surveys 21 months later. The findings show longer asylum waiting time is associated with poor health. Female refugees were more likely to report poor emotional and physical health. The negative effect of asylum waiting time on emotional health persists 21 months post settlement and is worse for women. The hypothesisabout the ameliorating effect of religion is only partially supported. Our findings supports existing theory and qualitative studies about the deleterious effects of using policies of waiting-related uncertainty for managing migration. Given the wide use of such policies in the Global North, our work is suggestive of likely generalisability. Thus, countries with large refugee populations might want to consider our findings when developing asylum policy which minimises impact on refugee health.
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Affiliation(s)
- Jenny Phillimore
- School of Social Policy, Sociology and Criminology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Sin Yi Cheung
- School of Social Sciences, Cardiff University, King Edward VII Ave, Cardiff, CF10 3WT, UK.
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22
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Turrini G, Tedeschi F, Cuijpers P, Del Giovane C, Kip A, Morina N, Nosè M, Ostuzzi G, Purgato M, Ricciardi C, Sijbrandij M, Tol W, Barbui C. A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD. BMJ Glob Health 2021; 6:e005029. [PMID: 34088735 PMCID: PMC8183228 DOI: 10.1136/bmjgh-2021-005029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Refugees and asylum seekers are vulnerable to common mental disorders, including post-traumatic stress disorder (PTSD). Using a network meta-analysis (NMA) approach, the present systematic review compared and ranked psychosocial interventions for the treatment of PTSD in adult refugees and asylum seekers. METHODS Randomised studies of psychosocial interventions for adult refugees and asylum seekers with PTSD were systematically identified. PTSD symptoms at postintervention was the primary outcome. Standardised mean differences (SMDs) and ORs were pooled using pairwise and NMA. Study quality was assessed with the Cochrane Risk of Bias (RoB) tool, and certainty of evidence was assessed through the Confidence in Network Meta-Analysis application. RESULTS A total of 23 studies with 2308 participants were included. Sixteen studies were conducted in high-income countries, and seven in low-income or middle-income countries. Most studies were at low risk of bias according to the Cochrane RoB tool. NMA on PTSD symptoms showed that cognitive behavioural therapy (CBT) (SMD=-1.41; 95% CI -2.43 to -0.38) and eye movement desensitisation and reprocessing (EMDR) (SMD=-1.30; 95% CI -2.40 to -0.20) were significantly more effective than waitlist (WL). CBT was also associated with a higher decrease in PTSD symptoms than treatment as usual (TAU) (SMD -1.51; 95% CI -2.67 to -0.36). For all other interventions, the difference with WL and TAU was not significant. CBT and EMDR ranked best according to the mean surface under the cumulative ranking. Regarding acceptability, no intervention had less dropouts than inactive interventions. CONCLUSION CBT and EMDR appeared to have the greatest effects in reducing PTSD symptoms in asylum seekers and refugees. This evidence should be considered in guidelines and implementation packages to facilitate dissemination and uptake in refugee settings.
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Affiliation(s)
- Giulia Turrini
- Cochrane Global Mental Health and 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
| | - Federico Tedeschi
- Cochrane Global Mental Health and 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
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Ahlke Kip
- Institute of Psychology, University of Münster, Munster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Munster, Germany
| | - Michela Nosè
- Cochrane Global Mental Health and 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
| | - Giovanni Ostuzzi
- Cochrane Global Mental Health and 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
- Cochrane Global Mental Health and 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
| | - Chiara Ricciardi
- Cochrane Global Mental Health and 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
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wietse Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, New York, USA
| | - Corrado Barbui
- Cochrane Global Mental Health and 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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Topalovic T, Episkopou M, Schillberg E, Brcanski J, Jocic M. Migrant children in transit: health profile and social needs of unaccompanied and accompanied children visiting the MSF clinic in Belgrade, Serbia. Confl Health 2021; 15:32. [PMID: 33926486 PMCID: PMC8082862 DOI: 10.1186/s13031-021-00366-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background Thousands of children migrate to Europe each year in search of safety and the promise of a better life. Many of them transited through Serbia in 2018. Children journey alone or along with their family members or caregivers. Accompanied migrant children (AMC) and particularly unaccompanied migrant children (UMC) have specific needs and experience difficulties in accessing services. Uncertainty about the journey and daily stressors affect their physical and mental health, making them one of the most vulnerable migrant sub-populations. The aim of the study is to describe the demographic, health profile of UMC and AMC and the social services they accessed to better understand the health and social needs of this vulnerable population. Methods We conducted a retrospective, descriptive study using routinely collected program data of UMC and AMC receiving medical, mental and social care at the Médecins sans Frontières clinic, in Belgrade, Serbia from January 2018 through January 2019. Results There were 3869 children who received medical care (1718 UMC, 2151 AMC). UMC were slightly older, mostly males (99%) from Afghanistan (82%). Skin conditions were the most prevalent among UMC (62%) and AMC (51%). Among the 66 mental health consultations (45 UMC, 21 AMC), most patients were from Afghanistan, with 98% of UMC and 67% of AMC being male. UMC as well as AMC were most likely to present with symptoms of anxiety (22 and 24%). There were 24 UMC (96% males and 88% from Afghanistan) that received social services. They had complex and differing case types. 83% of UMC required assistance with accommodation and 75% with accessing essential needs, food and non-food items. Several required administrative assistance (12.5%) and nearly a third (29%) legal assistance. 38% of beneficiaries needed medical care. Most frequently provided service was referral to a state Centre for social welfare. Conclusion Our study shows that unaccompanied and accompanied migrant children have a lot of physical, mental health and social needs. These needs are complex and meeting them in the context of migration is difficult. Services need to better adapt by improving access, flexibility, increasing accommodation capacity and training a qualified workforce.
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Affiliation(s)
- Tijana Topalovic
- International Committee of the Red Cross, Tresnjinog cveta 1, Belgrade, 11000, Serbia.
| | - Maria Episkopou
- Médecins Sans Frontières Operational Centre Brussels, Athens, Greece
| | | | - Jelena Brcanski
- National Institute of Public health of Serbia, Belgrade, Serbia
| | - Milica Jocic
- Adventist Development and Relief Agency, Belgrade, Serbia
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24
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Lindert J, Neuendorf U, Natan M, Schäfer I. Escaping the past and living in the present: a qualitative exploration of substance use among Syrian male refugees in Germany. Confl Health 2021; 15:26. [PMID: 33845859 PMCID: PMC8042941 DOI: 10.1186/s13031-021-00352-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
Background Syrians have been the largest group of refugees in Germany since 2014. Little is known about Syrian refugees` perspectives on substance use. The aim of this study is to investigate the perspective of male refugees from Syria and to foster specific knowledge and understanding of substance use. Methods We applied a qualitative study design. Five semi-structured focus group discussions with a total of 19 refugees were conducted in 2019 among the difficult to reach population of Syrian refugees. Audio recordings were translated and transcribed. We used a hybrid approach by integrating inductive and deductive thematic frameworks. Results We identified common themes. Firstly, refugees perceived that substances are widely available and accepted in Germany. Secondly, refugees perceived that rules and norms in Germany differ from rules and norms in the home country and favor availability of substances. Thirdly, substance use is related to the intention to escape the past. Fourthly, substance use is related to living in the present through connecting with others and being part of the community. Finally, mental health professional treatment for substance use is associated with shame. Conclusions Findings support Syrian refugees` perspectives of substance use as a way of both escaping the past and coping with psychosocial difficulties in the present in a socio-ecological understanding. Understanding the explanatory model of Syrian refugees can inform future interventions to prevent substance abuse and design tailored interventions. Further studies with Syrian refugees in more countries are needed to better understand resettled refugees` perspectives on substance use. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00352-x.
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Affiliation(s)
- Jutta Lindert
- Center for Interdisciplinary Addiction Research (ZIS), University of Hamburg, Hamburg, Germany. .,Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ulrike Neuendorf
- Center for Interdisciplinary Addiction Research (ZIS), University of Hamburg, Hamburg, Germany
| | - Marta Natan
- Center for Interdisciplinary Addiction Research (ZIS), University of Hamburg, Hamburg, Germany
| | - Ingo Schäfer
- University Hospital Hamburg / Eppendorf, Hamburg, Germany
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Reis AC, Lokpo K, Bojanic M, Sperandei S. In search of a "vocabulary for recreation": Leisure-time physical activity among humanitarian migrants in regional Australia. PLoS One 2020; 15:e0239747. [PMID: 33052914 PMCID: PMC7556461 DOI: 10.1371/journal.pone.0239747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/13/2020] [Indexed: 11/18/2022] Open
Abstract
This study provides an exploration of the meanings of leisure for humanitarian migrants in regional Australia and these meanings' implications for health. It uses mixed-methods to explore leisure-time physical activity participation and day-to-day experiences of leisure and health. A sample representing approximately one third of the Coffs Coast adult humanitarian migrant population completed the survey, as well as 32 individuals who participated in interviews and focus groups. Findings were organised into three themes and explored issues around mental health and time for leisure, cultural differences in experiencing leisure, and the connections with experiences of other disadvantaged groups. We conclude by arguing that leisure needs to be brought to the fore of discussions around service provision and policy making concerned with the wellbeing of the refugee migrant population, particularly focusing on support for the (re)development of a vocabulary for recreation, as a step forward in the journey to healing and belonging.
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Affiliation(s)
- Arianne C. Reis
- School of Health Sciences, Western Sydney University, Sydney, Australia
- * E-mail:
| | - Komla Lokpo
- Sanctuary Australia Foundation, Coffs Harbour, Australia
| | - Matthew Bojanic
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Sandro Sperandei
- Institute of Scientific and Technological Communication & Information in Health, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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Rometsch C, Denkinger JK, Engelhardt M, Windthorst P, Graf J, Nikendei C, Zipfel S, Junne F. Care providers' views on burden of psychosomatic symptoms of IS-traumatized female refugees participating in a Humanitarian Admission Program in Germany: A qualitative analysis. PLoS One 2020; 15:e0239969. [PMID: 33017408 PMCID: PMC7535032 DOI: 10.1371/journal.pone.0239969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 09/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Traumatized refugees often suffer from diverse psychosomatic symptoms. Female Yazidi refugees from Northern Iraq who survived attacks of the so-called "Islamic State" were brought to Germany to receive special medical and psychotherapeutic treatment in a unique worldwide humanitarian admission program (HAP). Here, we report on their psychosomatic symptoms and helpful strategies from the perspective of care providers. METHODS Care providers (N = 84) in this HAP were interviewed in an individual setting as well as in focus groups to gather information about the HAP beneficiaries' psychosomatic symptoms. Data analysis followed Qualitative Content Analysis by Mayring. RESULTS The care providers reported five main psychological burdens of the Yazidis: 1) insecurity regarding loss, 2) worries about family members, 3) ambivalence about staying in Germany or returning to Iraq, 4) life between two worlds and 5) re-actualization of the traumatic experiences. The predominant psychological symptoms the care providers noticed were fear, depressive symptoms, feelings of guilt, and sleep and eating disorders. Regarding somatic symptoms, the care providers mainly received complaints about pain in the head, back, chest and stomach. Helpful strategies for providing adequate health care were care providers' cooperating with physicians, precise documentation of beneficiaries' symptoms, and additional support in directing the beneficiaries through the health care system. Regarding psychotherapy, interpreters help to overcome language barriers, onsite psychotherapy, flexible therapy appointments, psychoeducational methods, time for stabilization, and support in coping with daily life aspects. In the care providers' experience, psychotherapists have to build a relationship of trust. After grief therapy, a trauma-specific therapy in a culturally adapted way is possible. CONCLUSION The HAP is a unique model health care program to offer highly traumatized refugees medical and psychological help. Care providers reported on several (psycho-)somatic symptoms of the traumatized women. The strategies the HAP care providers perceived as helpful can be recommended for similar projects in the future.
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Affiliation(s)
- Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Zehetmair C, Nagy E, Leetz C, Cranz A, Kindermann D, Reddemann L, Nikendei C. Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study. J Med Internet Res 2020; 22:e17906. [PMID: 32965229 PMCID: PMC7542415 DOI: 10.2196/17906] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023] Open
Abstract
Background Refugees have an increased risk of developing mental health problems. There are insufficient psychosocial care structures to meet the resulting need for support. Stabilizing and guided imagery techniques have shown promising results in increasing traumatized refugees’ emotional stabilization. If delivered via audio files, the techniques can be practiced autonomously and independent of time, space, and human resources or stable treatment settings. Objective This study aimed to evaluate the self-practice of stabilizing and guided imagery techniques via digital audio files for traumatized refugees living in a reception and registration center in Germany. Methods From May 2018 to February 2019, 42 traumatized refugees participated in our study. At T1, patients received digital audio files in English, French, Arabic, Farsi, Turkish, or Serbian for self-practice. Nine days later, at T2, a face-to-face interview was conducted. Two months after T2, a follow-up interview took place via telephone. Results At T2, about half of the patients reported the daily practice of stabilizing and guided imagery techniques. At follow-up, the average frequency of practice was once weekly or more for those experiencing worse symptoms. No technical difficulties were reported. According to T2 and follow-up statements, the techniques helped the patients dealing with arousal, concentration, sleep, mood, thoughts, empowerment, and tension. The guided imagery technique “The Inner Safe Place” was the most popular. Self-practice was impeded by postmigratory distress factors, like overcrowded accommodations. Conclusions The results show that self-practice of stabilizing and guided imagery techniques via digital audio files was helpful to and well accepted by the assessed refugees. Even though postmigratory distress factors hampered self-practice, “The Inner Safe Place” technique was particularly well received. Overall, the self-practiced audio-based stabilizing and guided imagery techniques showed promising results among the highly vulnerable group of newly arrived traumatized refugees.
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Affiliation(s)
- Catharina Zehetmair
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ede Nagy
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Carla Leetz
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Anna Cranz
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - David Kindermann
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Luise Reddemann
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, University of Klagenfurt, Klagenfurt, Austria
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital of Heidelberg, Heidelberg, Germany
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Sagbakken M, Bregård IM, Varvin S. The Past, the Present, and the Future: A Qualitative Study Exploring How Refugees' Experience of Time Influences Their Mental Health and Well-Being. FRONTIERS IN SOCIOLOGY 2020; 5:46. [PMID: 33869453 PMCID: PMC8022670 DOI: 10.3389/fsoc.2020.00046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/29/2020] [Indexed: 05/31/2023]
Abstract
The experience of time has a decisive influence on refugees' well-being and suffering in all phases of their flight experiences. Basic safety is connected both developmentally and in present life with a feeling of continuity and predictability. Refugees often experience disruption of this basic sense of time in their home country due to war, persecution, and often severe traumatization, during flight, due to unpredictable and dangerous circumstances in the hands of smugglers, and after flight, due to unpredictable circumstances in asylum centers, e.g., extended waiting time and idleness. These context-dependent disruptions of normal experiences of time may lead to disturbances in mental life and extreme difficulties in organizing one's daily life. This article is based on narrative interviews with 78 asylum seekers and refugees in asylum centers in Norway, exploring their experiences before, during, and after flight. The distinction between abstract, chronological time, and concrete time connecting situational experiences (daily activities, such as daily rhythm of sleep and wakefulness) proved important for understanding how the experiences became mentally disturbing and how people tried to cope with this experience more or often less successfully. Prominent findings were loss of future directedness, a feeling of being imprisoned or trapped, disempowerment, passivity and development of a negative view of self, memory disturbances with difficulty of placing oneself in time and space, disruptions of relations, and a feeling of loss of developmental possibilities. Some had developed resilient strategies, such as imagining the flight as a holiday trip, to cope with the challenges, but most participants felt deeply disempowered and often disorientated. The analysis pointed clearly to a profound context dependent time-disrupting aspect of the refugee experience. An insecure and undefined present made participants unable to visualize their future and integrate the future in their experience of the present. This was connected with the inherent passivity and undefined waiting in the centers and camps, and with previous near encounters with annihilation and death. A response was often withdrawal into passivity.
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Affiliation(s)
- Mette Sagbakken
- Faculty of Health Sciences, OsloMet–Oslo Metropolitan University, Oslo, Norway
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Jankovic-Rankovic J, Oka RC, Meyer JS, Gettler LT. Forced migration experiences, mental well-being, and nail cortisol among recently settled refugees in Serbia. Soc Sci Med 2020; 258:113070. [DOI: 10.1016/j.socscimed.2020.113070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/01/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
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Shahin W, Kennedy GA, Cockshaw W, Stupans I. The role of refugee and migrant migration status on medication adherence: Mediation through illness perceptions. PLoS One 2020; 15:e0227326. [PMID: 31923264 PMCID: PMC6953853 DOI: 10.1371/journal.pone.0227326] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023] Open
Abstract
Background Illness perceptions may vary between different populations. This raises the question as to whether refugees and migrants of the same ethnic background have different perceptions. Understanding differences may have a significant impact on enhancing medication adherence in these groups. Objective The study examined the associations and differences between illness perceptions, and medication adherence in hypertensive Middle Eastern migrants and refugees. Methods Middle Eastern refugees and migrants (≥30 years old), with hypertension were recruited from Arabic community groups in Australia and asked to complete a cross-sectional survey. The survey consisted of basic socio-demographic and clinical profile, self-reported illness perceptions, and self-reported medication adherence. The outcome measure was the Medication Adherence Questionnaire. Simple mediation modelling was applied to examine the role of illness perceptions as a mediator between different migration statuses, and medication adherence. Results A total of 320 participants were recruited; 168 refugees, and 152 migrants. Educational level was found to be positively significantly associated with medication adherence in refugees, p = 0.003, while employed migrants were more likely to report higher adherence to hypertensive medication, p = 0.005. In both groups, there was a significant association between illness perceptions and medication adherence p = 0.0001. Significant differences were found between both groups regarding adherence and illness perceptions variables. Refugees had more negative illness perceptions and were less adherent than migrants. Illness perception was a mediator in the relationship between migration status and medication adherence; the unstandardized indirect effect was 0.24, and the 95% confidence interval ranged from (0.21–0.36). Conclusions To achieve better adherence to medications in vulnerable populations such as refugees, illness perceptions need to be understood, and differentiated from other populations, such as migrants from similar backgrounds. Patients’ education about illnesses and medications should be specific and targeted to each population. Interventional studies are recommended to modify refugees’ and migrants’ illness perceptions, to enhance medication adherence and wellbeing.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- * E-mail:
| | - Gerard A. Kennedy
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Wendell Cockshaw
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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Schottland-Cox J, Hartman J. Physical Therapists Needed: The Refugee Crisis in Greece and Our Ethical Responsibility to Respond. Phys Ther 2019; 99:1583-1586. [PMID: 31504927 DOI: 10.1093/ptj/pzz128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 05/03/2019] [Accepted: 06/04/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Julie Schottland-Cox
- PTs for Refugees, 311 Second Street, Sausalito, CA 94965 (USA); Ious 21, Glyfada, Attika 16675, Greece. Address all correspondence to Ms Schottland-Cox at:
| | - Jeff Hartman
- University of Wisconsin School of Medicine and Public Health, Doctor of Physical Therapy Program, Madison, Wisconsin
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Kleinert E, Müller F, Furaijat G, Hillermann N, Jablonka A, Happle C, Simmenroth A. Does refugee status matter? Medical needs of newly arrived asylum seekers and resettlement refugees - a retrospective observational study of diagnoses in a primary care setting. Confl Health 2019; 13:39. [PMID: 31452677 PMCID: PMC6700982 DOI: 10.1186/s13031-019-0223-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/12/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Providing adequate healthcare to newly arrived refugees is considered one of the significant challenges for the German healthcare system. These refugees can be classified mainly into two groups: asylum seekers (who have applied for asylum after arrival in Germany and are waiting for the refugee-status decision) and resettlement refugees (who have already been granted asylum status before arriving in Germany). Whereas earlier studies have explored the health status of asylum seekers especially in terms of mental and behavioural disorders and infectious diseases without distinguishing between these two groups, our study aims to evaluate possible relationships of asylum status and medical needs of these two groups with a special focus on mental and behavioural disorders and infectious diseases. METHODS In this retrospective observational study, collected data on all asylum-seeker and resettlement-refugee patients (N = 2252) of a German reception centre (August 2017 to August 2018) is analysed by absolute and relative frequencies and medians. Patient data, collected by chart review, include age, gender, country of origin, asylum status, and diagnoses (ICD-10). To describe the relationship between sociodemographic factors (including asylum status) and diagnoses, we used tests of significance and bivariate correlations with Spearman correlation coefficients. All collected data are pseudonymised. RESULTS Of all 2252 patients, 43% were resettlement refugees. In almost all ICD-10 categories, asylum seekers received significantly more diagnoses than resettlement refugees. According to our data, asylum seekers presented with mental and behavioural disorders nine times more often (9%) than resettlement refugees (1%). In the case of infectious diseases, the results are mixed: asylum seekers were twice as frequently (11%) diagnosed with certain infectious and parasitic diseases than resettlement refugees (5%), but resettlement refugees were treated twice as often (22% of the asylum seekers and 41% of the resettlement refugees) for diseases of the respiratory system, of which 84% were acute respiratory infections (in both groups). CONCLUSION This study indicates that patients with unregulated migration more frequently present symptoms of psychiatric diseases and somatoform symptoms than resettlement refugees. A health policy approach within migration policy should aim to enable persecuted persons to migrate under regulated and safe conditions. TRIAL REGISTRATION German Clinical Trials Register: DRKS00013076, retrospectively registered on 29.09.2017.
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Affiliation(s)
- Evelyn Kleinert
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
| | - Ghefar Furaijat
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
| | - Nele Hillermann
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
| | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- German Center for Infection Research, Partner site Hanover-Brunswick, Hannover, Germany
| | - Christine Happle
- Department of Pediatrics, Neonatology, and Allergology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Anne Simmenroth
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
- Department of General Practice, University Medical Centre Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
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A Descriptive Study of the Schooling and Higher Education Reforms in Response to the Refugees’ Influx into Greece. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8030072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Since 2015, a large number of migrants (refugees and asylum seekers) from the Middle East, Asia, and Africa have arrived in Greece and continued their onward journey to western European countries where they settled. As various European Union (EU) countries have later blocked the flow of migrants from Greece to their final destination, thousands of them have been trapped in Greece, confined in overcrowded, temporary camps (known as “hot spots”) and awaiting the processing of their asylum application. The current article examines the response of the Greek educational institutes (primary, secondary and tertiary levels) to the recent migrant influx, with ultimate goals to integrate, educate, and assist them. The number of refugees and asylum seekers living in Greece is estimated to be 58,000 (2018 data) with 22,500 children among them. Their schooling inclusion follows the plan 111, “Refugee Education Host Structures (REHSs)”, as initiated by the Greek Ministry of Education in 2017. Students’ leakage range is still high (10–40% at elementary school and 45–56% at high School). The disruption in their life results in the lack of regular attendance. Greek universities responded to the challenge of the refugee influx, especially the University of the Aegean (UAeg), which is located on the eastern Mediterranean migration route. The UAeg’s response plan focuses on four areas: (a) to provide education to refugees; (b) to conduct research on the refugee phenomenon and migration processes; (c) to increase local citizens’ awareness and improve social inclusion toward the migrants; and (d) to develop technologies to improve daily life in the refugee camps. These actions are significant toward the social inclusion and cohesion of refugees and the further improvement of their daily life.
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