The violence of uncertainty: Empirical evidence on how asylum waiting time undermines refugee health

"The chaos of not knowing": Embodied experiences of waiting for public housing redevelopment and relocation

The US Department of Housing and Urban Development has instituted several successive programs to redevelop aging and distressed US public housing. The current program, the Choice Neighborhoods Initiative, aims not only to redevelop housing but also to improve the health of public housing residents through a whole neighborhood transformation, at the cost of privatizing components of housing. In the present case study, we examine relationships and perceptions about public housing redevelopment and health among residents affected by the Sun Valley Choice Neighborhood Initiative in Denver, Colorado. We address how public housing residents experience redevelopment, with particular emphasis on the temporal, physical and embodied mental experience of "waiting" for housing in a community undergoing radical transformation. We understand and conceptualize waiting as the process that generates stressors, and embodiment as the process of internalizing stressors through the mechanism of weathering (Geronimus, 1992; Krieger, 2021). Through repeated interviews with 21 residents, we highlight several themes that tie together experiences of waiting for displacement as well as experiences of stress and uncertainty related to the bureaucracy of public housing redevelopment. We document how participants struggled with the emotional impact of imposed change, found waiting to be destabilizing for their mental health, and how they embodied experiences of displacement anxiety. These findings show how redevelopment projects impose a forced waiting on the state that extends precarity and further destabilizes the lives and mental health of public housing residents.

The mental health of migrants living in limbo: A mixed-methods systematic review with meta-analysis

The number of forcibly displaced people has more than doubled over the past decade. Many people fleeing are left in limbo without a secure pathway to citizenship or residency. This mixed-methods systematic review reports the prevalence of mental disorders in migrants living in limbo, the association between limbo and mental illness, and the experiences of these migrants in high income countries. We searched electronic databases for quantitative and qualitative studies published after January 1, 2010, on mental illness in precarious migrants living in HICs and performed a meta-analysis of prevalence rates. Fifty-eight articles met inclusion criteria. The meta-analysis yielded prevalence rates of 43.0 % for anxiety disorders (95 % CI 29.0-57.0), 49.5 % for depression (40.9-58.0) and 40.8 % for posttraumatic stress disorder (30.7-50.9). Having an insecure status was associated with higher rates of mental illness in most studies comparing migrants in limbo to those with secure status. Six themes emerged from the qualitative synthesis: the threat of deportation, uncertainty, social exclusion, stigmatization, social connection and religion. Clinicians should take an ecosocial approach to care that attends to stressors and symptoms. Furthermore, policymakers can mitigate the development of mental disorders among migrants by adopting policies that ensure rapid pathways to protected status.

Impact of Environmental Uncertainty on Depression and Anxiety Among Chinese Workers: A Moderated Mediation Model

Purpose

Environmental uncertainty has reached unprecedented levels in recent years. While there is substantial knowledge about the connection between environmental uncertainty and organizational outcomes, limited attention has been devoted to investigating its impact on employees' depression and anxiety symptoms. Grounded in job demands-resources theory, this study aims to explore the relationship between environmental uncertainty and employees' depression and anxiety symptoms, and it further investigates the mediating role of work pressure and the moderating role of union practices.

Methods

In September 2022, we undertook a cross-sectional survey study, gathering data from 1081 employees across various enterprises situated in Liaoning, China. Throughout this timeframe, notable global occurrences heightened the awareness of environmental uncertainty. Following the exclusion of participants who did not provide information on the main variables, the final valid sample comprised 940 employees. To test all hypotheses, a series of confirmatory factor analyses and path-analytic procedures were conducted using Mplus 7.0.

Results

Our results confirm that environmental uncertainty, as a high job demand, increases employees' work pressure, thereby elevating rates of anxiety and depression; the indirect relationship between environmental uncertainty and employees' anxiety and depression through work pressure is stronger when union practices are lower.

Conclusion

Our findings indicate the detrimental impact of environmental uncertainty on employees' mental health, and highlight the roles of work pressure and union practices. In light of this, organizations should take steps to mitigate employees' perceptions of environmental uncertainty and establish mental health programs, in cooperation with union practices, to protect employees' mental well-being.

Human biology and the study of precarity: How the intersection of uncertainty and inequality is taking us to new extremes

Inequality represents an extreme environment to which humans must respond. One phenomenon that contributes to this growing extreme is precarity or the intersection of uncertainty and some form of inequality. While precarity has an important intellectual history in the fields of sociology and sociocultural anthropology, it has not been well studied in the field of human biology. Rather human biologists have engaged with the study of closely related concepts such as uncertainty and resource insecurity. In this article, we propose that human biology take on the study of precarity as a novel way of investigating inequality. We first provide a brief intellectual history of precarity which is followed by a review of research on uncertainty and resource security in human biology which, while not exhaustive, illustrates some key gaps that precarity may aid us in addressing. We then review some of the pathways through which precarity comes to affect human biology and health and some of the evidence for why the unpredictable nature of precarity may make it a unique physiological stress. A case study based on research in Nuñoa, Peru provides an important example of how precarity can elucidate the influences of health in an extreme setting, albeit with insights that apply more broadly. We conclude that precarity holds important potential for the study of human biology, including helping us more effectively operationalize and study uncertainty, encouraging us to explore the predictability of resources and stressors, and reminding us to think about the intersectional nature of stressors.

Taking Action towards an Inclusive Career Counselling for Asylum Seekers and Refugees-A Literature Review Based on the PRISMA Model

Over the past decade, scholarly attention has increasingly focused on what is known as the 'refugee gap', which refers to the great difficulty asylum seekers and refugees face in entering the labour market in the host country. This poses a grave threat of social and occupational marginalisation for this group and highlights the role of systemic factors in facilitating resilience outcomes. By adopting a systemic perspective, this research aims to provide a critical reflection on the key features that should be considered when designing and implementing effective career counselling interventions for asylum seekers and refugees. To this end, a systematic review of the international applied research published by October 2022 has been carried out, using the PRISMA model. The 20 selected publications are grouped according to three main career research strands that reflect the core aspects to be addressed within career interventions in order to assist asylum seekers and refugees in their life and career transition in the host country, namely (i) psychosocial resources, (ii) identity transformation processes, and (iii) lived experiences and meaning-making processes. The main findings of the studies are discussed by looking into common themes that emerge from the literature, namely challenges related to migration contexts, self-regulating personal resources and skills, and sense of self and identity in career transitions, as well as considerations on the design aspects of career counselling and research targeting As&R. Finally, some guidelines and directions for action are provided for the purpose of developing inclusive career counselling interventions for As&R.

Facing the COVID-19 Pandemic: A Mixed-Method Analysis of Asylum Seekers' Experiences and Worries in the Canton of Vaud, Switzerland

Objectives: The clinical and social burden of the COVID-19 pandemic were high among asylum seekers (ASs). We aimed to understand better ASs' experiences of the pandemic and their sources of worries. Methods: Participants (n = 203) completed a survey about their worries, sleep disorders, and fear of dying. We also conducted semi-structured interviews with ASs living in a community center (n = 15), focusing on how social and living conditions affected their experiences and worries. Results: ASs in community centers experienced more sleep disorders related to the COVID-19 pandemic than those living in private apartments (aOR 2.01, p = 0.045). Similarly, those with lower education had greater fear for their life due to the COVID-19 pandemic (aOR 2.31, p = 0.015). Qualitative findings showed that sharing living spaces was an important source of worries for ASs and that protective measures were perceived to increase social isolation. Conclusion: Our study highlighted the impact of the COVID-19 pandemic for ASs and the importance of tailoring public health measures to their needs and living conditions.

Investigating the aftermath of the Türkiye 2023 earthquake: exploring post-disaster uncertainty among Syrian migrants using social network analysis with public health approach

Objectives

On February 6th, 2023, a doublet earthquake struck Türkiye, impacting more than 15 million people including migrants, and resulting in over 50,000 deaths. The Syrian migrants experience multiple uncertainties in their daily lives which are further compounded by multifaceted challenges of the post-disaster environment. Social media was used intensively and with impunity in this environment and thereby provides a window into the explicit and implicit dynamics of daily life after a disaster. We aimed to explore how a post-disaster environment potentially generates new uncertainties or exacerbating pre-existing ones for migrants through social media analysis with an indirect perspective, in the context of 2023-Earthquake in Türkiye and Syrian migrants.

Methods

Social network analysis was used to analyze Twitter-data with the hashtags 'Syrian' and 'earthquake' during a 10-day period beginning on March 22nd, 2023. We calculated network metrics, including degree-values and betweenness-centrality and clustered the network to understand groups. We analyzed a combination of 27 tweets with summative content analysis using a text analysis tool, to identify the most frequently used words. We identified the main points of each tweet and assessed these as possible contributors to post-disaster uncertainty among migrants by using inductive reasoning.

Results

There were 1918 Twitter users, 274 tweets, 124 replies and 1726 mentions. Discussions about Syrian migrants and earthquakes were established across various groups (ngroups(edges > 15) = 16). Certain users had a greater influence on the overall network. The nine most frequently used words were included under uncertainty-related category (nmost_frequently_used_words = 20); 'aid, vote, house, citizen, Afghan, illegal, children, border, and leave'. Nine main points were identified as possible post-disaster uncertainties among migrants.

Conclusion

The post-disaster environment has the potential to exacerbate existing uncertainties, such as being an undocumented migrant, concerns about deportation and housing, being or having a child, inequality of rights between being a citizen and non-citizen, being in minority within minority, political climate of the host nation and access to education or to generate new ones such equitable distribution of aid, which can lead to poor health outcomes. Recognizing the possible post-disaster uncertainties among migrants and addressing probable underlying factors might help to build more resilient and healthy communities.

Caregiver stress and social determinants of health in key populations: immigrant parents, parents of children with medical complexity, and adolescent parents

PURPOSE OF REVIEW

To examine the five domains of social determinants of health - economic stability, education access, healthcare access and quality, neighborhood and built environment, and social and community context - and how these relate to caregiver stress in under-resourced populations.

RECENT FINDINGS

Socioeconomic and family factors are increasingly understood as drivers of child health. Caregiver stress can impact family stability and child wellbeing. Immigrant parents, caregivers of children with medical complexity, and adolescent parents experience stressors due to the unique needs of their families. These groups of parents and caregivers also face various challenges identified as social determinants of health. Interventions to mitigate these challenges can promote resilience, care coordination, and community-based supports.

SUMMARY

Current research describes caregiver stress in key populations, how caregiver stress affects children, and approaches to minimize and mitigate these effects. Pediatric providers can implement best practices to support families who are navigating stress due to caregiving and social determinants of health.

Living a frozen life: a qualitative study on asylum seekers' experiences and care practices at accommodation centers in Sweden

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.

Impact of and Coping with Post-Traumatic Symptoms of Refugees in Temporary Accommodations in Germany: A Qualitative Analysis

Due to pre-, peri- and post-migratory stress factors, refugees often experience higher levels of psychological stress than the general population. Post-traumatic stress disorder, in particular, has an increased prevalence in the refugee population. However, living conditions in the early post-migratory phase are characterized by many challenges. In the present qualitative study, 14 refugees with symptoms of PTSD from temporary accommodations in Germany were interviewed in semi-structured interviews about their individual experiences of the impact of their trauma sequelae symptoms on their current living conditions and interactions. Participants reported dealing with post-traumatic symptoms primarily through distraction strategies, such as working or learning the language or social interaction. Many reported a sense of mistrust as a result of traumatic experiences. Current stress factors cited included uncertain asylum status, worry about family members and lack of ability to influence living situations. The interactions between the post-traumatic symptoms and the living conditions of the refugees were highlighted. The effects of the symptomatology of trauma sequelae and the framework conditions under which refugees live can lead to aggravated psychological distress. Therefore, special attention must be paid to refugee mental health care.

The association between uncertainty and mental health: a scoping review of the quantitative literature

BACKGROUND

The current moment is characterised by deep-rooted uncertainties, such as climate change and COVID-19. Uncertainty has been reported to be associated with negative mental health outcomes, such as stress and anxiety. However, no comprehensive review on the association between uncertainty and mental health exists.

AIM

The aim of the current scoping review was to systematically explore and describe the literature on the link between uncertainty and mental health.

METHODS

A scoping review was undertaken following guidelines by Arksey and O'Malley (2005).

RESULTS

One hundred and one papers addressing the association between uncertainty and mental health were identified. Most were cross-sectional studies (67%) conducted in the fields of medicine or nursing (59%), in high-income countries, among adult populations (74%), and in medical settings. Substantial heterogeneity was identified in the measurements of uncertainty and mental health. Most studies (79%) reported a positive association between uncertainty and mental health problems.

CONCLUSIONS

Research is needed in more diverse contexts and populations. More robust designs are required to provide insight into the directionality and strength of the association between uncertainty and mental health. Few studies reported how individuals coped with uncertainty. Future studies should address the identified gaps and investigate interventions to address uncertainty and its determinants.

Structural and Symbolic Violence Exacerbates the Risks and Consequences of Sexual and Gender-Based Violence for Forced Migrant Women

While much attention is focused on rape as a weapon of war, evidence shows that forced migrant women and girls face increased risks of Sexual and Gender-Based Violence (SGBV) both during and following forced displacement. In this paper, we argue that gendered forms of structural and symbolic violence enable and compound the harms caused by interpersonal SGBV against forced migrant women and girls. These forms of violence are encountered in multiple contexts, including conflict and post-conflict settings, countries of refuge, and following resettlement. This paper illustrates the consequences of resultant cumulative harms for individuals and communities, and highlights the importance of considering these multiple, intersecting harms for policy and practice.