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Ahmed SH, Zakai A, Zahid M, Jawad MY, Fu R, Chaiton M. Prevalence of post-traumatic stress disorder and depressive symptoms among civilians residing in armed conflict-affected regions: a systematic review and meta-analysis. Gen Psychiatr 2024; 37:e101438. [PMID: 38881616 PMCID: PMC11177673 DOI: 10.1136/gpsych-2023-101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Background Globally, populations afflicted by armed conflict are known to have high rates of mental health disorders. Aims This meta-analysis aims to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive symptoms among civilians residing in armed conflict-affected regions. Methods This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search employing MEDLINE(R), Embase Classic+Embase, APA PsycINFO, Ovid Healthstar, Journal@Ovid Full Text, Cochrane, PTSDpubs and CINAHL was conducted from inception until 19 March 2024 to identify relevant studies. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and a Comprehensive Meta-Analysis was used to conduct the statistical analysis. Results The search yielded 38 595 articles, of which 57 were considered eligible for inclusion. The included studies comprised data from 64 596 participants. We estimated a prevalence of 23.70% (95% CI 19.50% to 28.40%) for PTSD symptoms and 25.60% (95% CI 20.70% to 31.10%) for depressive features among war-afflicted civilians. The subgroup analysis based on time since the war and the country's economic status revealed the highest prevalence for both PTSD and depressive symptoms was present during the years of war and in low/middle-income countries. Conclusions The results of this study provide conclusive evidence of the detrimental impacts of armed conflict on mental health outcomes. Hence, it is crucial to emphasise the significance of both physical and mental health in the aftermath of war and take appropriate humanistic measures to overcome challenges in the management of psychiatric illnesses. PROSPERO registration number CRD42023416096.
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Affiliation(s)
| | - Aabia Zakai
- Dow University of Health Sciences, Karachi, Pakistan
| | - Maha Zahid
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Youshay Jawad
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rui Fu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, The Center of Addiction and Mental Health, Toronto, Ontario, Canada
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Kaul A, Saboor L, Ahmad A, Mannell J, Paphitis SA, Devakumar D. What are the experiences and psychosocial needs of female survivors of domestic violence in Afghanistan? A qualitative interview study in three Afghan provinces. BMJ Open 2024; 14:e079615. [PMID: 38839389 PMCID: PMC11163623 DOI: 10.1136/bmjopen-2023-079615] [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: 09/06/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVES This study aimed to qualitatively explore (1) the experiences of female survivors of domestic abuse and mental health problems in Afghanistan; (2) how female survivors of violence and abuse, male members of the community and service providers perceive and respond to mental health and domestic violence in Afghanistan and (3) the provision of mental health services for female survivors of violence and abuse in Afghanistan, including the barriers and challenges faced around accessing mental health services. DESIGN Qualitative interviews and framework thematic analysis. SETTING Kabul, Bamyan and Nangarhar in Afghanistan. PARTICIPANTS 60 female survivors of domestic abuse, 60 male community members and 30 service providers who work with female survivors of domestic abuse. RESULTS Experiences of multiple and compounding traumatic experiences of violence, armed conflict, and complex and competing psychosocial concerns were common among the female survivor participants. All female survivor participants reported experiencing negative mental health outcomes in relation to their experiences of violence and abuse, which were further precipitated by widespread social stigma and gender norms. Support and service provision for female survivors was deemed by participants to be insufficient in comparison to the amount of people who need to access them. CONCLUSIONS There are many risks and barriers women face to disclosing their experiences of violence and mental health problems which restrict women's access to psychological support. Culturally relevant services and trauma-informed interventions are necessary to respond to these issues. Service providers should be trained to effectively recognise and respond to survivors' mental health needs.
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Affiliation(s)
- Anjuli Kaul
- Section of Women's Mental Health, King's College London, London, UK
| | - Lamba Saboor
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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Smith A, Gonzalez Smith DT, Ogunwale A, Bhugra D, Buadze A, Ventriglio A, Liebrenz M. Geopsychiatry, the United Nations' Sustainable Development Goals, and geopolitical challenges for global mental health. Int J Soc Psychiatry 2024; 70:631-635. [PMID: 38149376 DOI: 10.1177/00207640231219169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Switzerland
| | | | - Adegboyega Ogunwale
- Department of Clinical Services, Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Switzerland
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Tinsae T, Shumet S, Tadesse G, Takelle GM, Rtbey G, Melkam M, Andualem F, Nakie G, Segon T, Koye S, Fentahun S, Alemu WG. Post-traumatic stress disorder in the Ethiopian population dwelling in war-affected communities: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1399013. [PMID: 38784164 PMCID: PMC11112411 DOI: 10.3389/fpsyt.2024.1399013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Background Post-traumatic stress disorder (PTSD) is a significant mental health concern globally, particularly prevalent in populations exposed to war and conflict. This systematic review and meta-analysis aim to examine the prevalence and factors associated with PTSD among the Ethiopian population residing in war-affected communities. Methods The review was reported according to the PRISMA guidelines. Related eligible published articles were searched in electronic online databases such as PubMed, Scopus, Web of Science, MEDLINE/PubMed, Scopus, Embase, Science Direct, Web of Science, Google Scholar, and Google, which reported the prevalence and risk factors of PTSD among people dwelling in the war-affected area until January 2024. The relevant data was extracted using a Microsoft Excel spreadsheet. The meta-analysis was conducted using STATA version 11. The estimated pooled prevalence and risk factors were estimated using a random effect model. The potential risk of publication bias was checked using a funnel plot and Egger's statistical test. Results A total of nine published studies with 6107 participants were analyzed in this meta-analysis. The estimated pooled prevalence of PTSD among people living in war-affected areas was 48.4%, with a 95% CI (37.1, 59.8). This study found a higher prevalence of PTSD among women than men. Being female (OR= 2.2, 95% CI: 1.2, 4.3), witnessing a murder of a loved one (OR= 3.0, 95% CI: 1.2, 7.5), depression symptoms (OR= 2.8, 95% CI: 1.4, 5.6), and anxiety symptoms (OR= 3.4, 95% CI: 1.4, 8.0), a close family member killed or seriously injured (OR= 3.1, 95% CI: 1.2, 7.7), a moderate and high perceived threat to life (OR= 3.4, 95% CI: 1.3, 9.1), and poor social support (OR= 4.4, 95% CI: 1.1, 18.7) were associated with post-traumatic stress disorder. Conclusion The result of this study shows the high prevalence rate of PTSD in people living in war-affected areas. disparities in PTSD prevalence, with women being at higher risk, and identified risk factors were witnessing the murder of a loved one, experiencing depression and anxiety, and perceived threat to life. Addressing PTSD in war-affected communities requires comprehensive interventions that consider both individual and contextual factors. Systematic review registration www.crd.york.ac.uk/PROSPERO/, identifier CRD42024501384.
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Affiliation(s)
- Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gebresilassie Tadesse
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Segon
- Department of Psychiatry, Mattu University, Mettu, Ethiopia
| | - Selam Koye
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Wondale Getinet Alemu
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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5
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Côté-Olijnyk M, Perry JC, Paré MÈ, Kronick R. The mental health of migrants living in limbo: A mixed-methods systematic review with meta-analysis. Psychiatry Res 2024; 337:115931. [PMID: 38733932 DOI: 10.1016/j.psychres.2024.115931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024]
Abstract
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.
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Affiliation(s)
| | - J Christopher Perry
- McGill University, Department of Psychiatry, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie-Ève Paré
- University of Montreal, Department of Anthropology, Montreal, Quebec, Canada; Cegep Édouard-Montpetit, Department of Anthropology, Longueuil, Quebec, Canada
| | - Rachel Kronick
- McGill University, Department of Psychiatry, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
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Alon N, Macrynikola N, Jester DJ, Keshavan M, Reynolds CF, Saxena S, Thomas ML, Torous J, Jeste DV. Social determinants of mental health in major depressive disorder: Umbrella review of 26 meta-analyses and systematic reviews. Psychiatry Res 2024; 335:115854. [PMID: 38554496 DOI: 10.1016/j.psychres.2024.115854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/01/2024]
Abstract
There is a growing recognition of the impact of social determinants of mental health (SDoMHs) on people with, or at risk of, developing serious mental illnesses. Yet it is not known how associations of individual SDoMHs with risk for major depressive disorder (MDD) vary and roughly compare with one another. Following PRISMA guidelines, this umbrella review included 26 meta-analyses and systematic reviews that reported odds ratios, effect sizes, and/or pooled prevalence rates of MDD in samples with versus without specified SDoMHs. Childhood emotional, physical, or sexual abuse and neglect; intimate partner violence in females; and food insecurity were significantly associated with increased risk of MDD, with medium effect sizes. Natural disasters, terrorist acts, and military combat during deployment had small-size adverse effects, and homelessness, incarceration, and migration were associated with significantly elevated prevalence of MDD. Conversely, higher levels of parental care were significantly associated with reduced risk of MDD with medium effect sizes. Evidence supports the use of certain interventions at the individual and community level that can reduce the impact of these factors and promote health, although much more research is warranted in this area along with meaningful healthcare and societal policies to accomplish this goal.
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Affiliation(s)
- Noy Alon
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Natalia Macrynikola
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dylan J Jester
- Women's Operational Military Exposure Network Center of Excellence (WOMEN CoE), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Shekhar Saxena
- Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - John Torous
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Dilip V Jeste
- Global Research Network on Social Determinants of Health, La Jolla, CA, USA.
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Kirsch J, Maleku A, Kim YK, Aziz T, Dada S, Haran H, Kitchens K. The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences. Community Ment Health J 2024:10.1007/s10597-024-01283-6. [PMID: 38691243 DOI: 10.1007/s10597-024-01283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann-Whitney U and Kruskal-Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r = .53, p < .01) and between post-migration difficulties and mental health (r = .33, p < .01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal-Wallis H = 14.76, p < .05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments.
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Affiliation(s)
- Jaclyn Kirsch
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA.
| | - Arati Maleku
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Youn Kyoung Kim
- School of Social Work, Louisiana State University, Baton Rouge, LA, USA
| | | | | | - Hanna Haran
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Katherine Kitchens
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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James LE, García Mejía N, Botero-García JF, Rattner M. Feasibility, acceptability and preliminary effectiveness of a community-based group psychosocial support model for conflict survivors in Colombia: An assessment of in-person and remote intervention modalities during the COVID-19 pandemic. Glob Ment Health (Camb) 2024; 11:e61. [PMID: 38774886 PMCID: PMC11106545 DOI: 10.1017/gmh.2024.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 05/24/2024] Open
Abstract
Background Community-based psychosocial support (CB-PSS) interventions utilizing task sharing and varied (in-person, remote) modalities are essential strategies to meet mental health needs, including during the COVID-19 pandemic. However, knowledge gaps remain regarding feasibility and effectiveness. Methods This study assesses feasibility, acceptability and preliminary effectiveness of a CB-PSS intervention for conflict-affected adults in Colombia through parallel randomized controlled trials, one delivered in-person (n = 165) and the other remotely (n = 103), implemented during the COVID-19 pandemic and national protests. Interventions were facilitated by nonspecialist community members and consisted of eight problem-solving and expressive group sessions. Findings Attendance was moderate and fidelity was high in both modalities. Participants in both modalities reported high levels of satisfaction, with in-person participants reporting increased comfort expressing emotions and more positive experiences with research protocols. Symptoms of depression, anxiety and posttraumatic stress disorder improved among in-person participants, but there were no significant changes for remote participants in comparison to waitlist controls. Implications This CB-PSS intervention appears feasible and acceptable in both in-person and remote modalities and associated with reduction in some forms of distress when conducted in-person but not when conducted remotely. Methodological limitations and potential explanations and areas for future research are discussed, drawing from related studies.
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Affiliation(s)
- Leah E. James
- Heartland Alliance International, Chicago, IL, USA
- Institute of Behavioral Science, University of Colorado, Boulder, CO, USA
| | - Nicolás García Mejía
- Department of Psychology, Universidad de Los Andes, Bogota, Colombia
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Social and Behavioral Sciences, University of Groningen, Groningen, Netherlands
| | | | - Michel Rattner
- Department of Psychology, Universidad de Los Andes, Bogota, Colombia
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
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Preiss M, Fňašková M, Berezka S, Yevmenova T, Heissler R, Sanders E, Winnette P, Rektor I. War and women: An analysis of Ukrainian refugee women staying in the Czech Republic. Glob Ment Health (Camb) 2024; 11:e47. [PMID: 38690571 PMCID: PMC11058516 DOI: 10.1017/gmh.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 05/02/2024] Open
Abstract
In addition to the loss of life, Russian aggression against Ukraine, which began in February 2022, also brings interpersonal losses resulting from the need to emigrate. Parallel to the fighting men, women bear most of the burden of caring for the family. Using in-depth interviews supplemented by questions about adverse childhood experiences and administration of The Centrality of Events Scale and the PTSD Checklist - PCL-5 with 43 Ukrainian women (18-60 years old), we analyzed adaptation to the situation of emigration and the association of their war and earlier experiences with the level of traumatization. Women were interviewed shortly after emigration to the Czech Republic (3-42 week afterward). High levels of adverse childhood experiences and post-traumatic stress symptoms were found. The war was perceived as a currently negative central event associated with traumatic stress symptoms, and 79% of the sample expressed the opinion that the war had changed them. The results of this study suggest an intertwining of previous life experiences with the current need and ability to adapt.
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Affiliation(s)
- Marek Preiss
- National Institute of Mental Health, Klecany, Czech Republic
- University of New York in Prague, Prague, Czech Republic
- Central European Institute of Technology (CEITEC), Centre for Neuroscience, Masaryk University, Brno, Czech Republic
| | - Monika Fňašková
- Central European Institute of Technology (CEITEC), Centre for Neuroscience, Masaryk University, Brno, Czech Republic
| | - Sofia Berezka
- Central European Institute of Technology (CEITEC), Centre for Neuroscience, Masaryk University, Brno, Czech Republic
| | - Tetiana Yevmenova
- Central European Institute of Technology (CEITEC), Centre for Neuroscience, Masaryk University, Brno, Czech Republic
| | - Radek Heissler
- National Institute of Mental Health, Klecany, Czech Republic
| | - Edel Sanders
- University of New York in Prague, Prague, Czech Republic
| | - Petra Winnette
- Natama Institute, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivan Rektor
- Central European Institute of Technology (CEITEC), Centre for Neuroscience, Masaryk University, Brno, Czech Republic
- Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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de Leeuw AE, Ester WA, Bolhuis K, Hoek HW, Jansen PW. Maternal Migration, Prenatal Stress and Child Autistic Traits: Insights From a Population-Based Cohort Study. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00183-7. [PMID: 38599371 DOI: 10.1016/j.jaac.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 02/02/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE There is emerging evidence for an increased prevalence of autism in children of mothers with a migration background. To date, the mechanisms underlying this relationship are poorly understood. We investigated whether prenatal stress exposure mediates the association between maternal migration and child autistic traits, assessing first- and second-generation migrant mothers in the Netherlands and their children. METHOD The study was embedded in the prospective population-based Generation R cohort. Of the 4,727 participants, 1,773 mothers (38%) had a migration background. Prenatal stress was assessed using questionnaires related to stressful life events, family functioning, self-esteem, long-lasting difficulties, symptoms of psychopathology, social support, and perceived discrimination. Autistic traits were measured at age 6 years with the parent-reported Social Responsiveness Scale exclusively. Longitudinal multiple mediation analyses were performed. Analyses were stratified by migration origin (Europe and outside Europe) because of differences in migration characteristics. RESULTS Maternal migration background was associated with more experienced stress and with higher child autistic trait scores (Europe: mean = 0.42, SD = 0.25; outside Europe: mean = 0.50, SD = 0.24) compared to no migration background (Netherlands: mean = 0.38, SD = 0.23; both p < .01). Prenatal stress, especially perceived discrimination and maternal psychopathology, accounted for up to half of the total effect of maternal migration, which remained after adjusting for sociodemographic factors (Bindirect = 0.035, 95% CI = 0.027, 0.043, Btotal = 0.074). CONCLUSION Stress during pregnancy mediated the association between maternal migration status and child autistic traits. Future research should focus on early interventions to assess whether reducing prenatal stress exposure among women with a migration background can result in lower offspring autistic traits. DIVERSITY & INCLUSION STATEMENT We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
- Anne E de Leeuw
- Parnassia Psychiatric Institute, The Hague, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wietske A Ester
- Parnassia Psychiatric Institute, The Hague, the Netherlands; Leiden University Medical Center, Curium, Oegstgeest, the Netherlands; Sarr Autism Rotterdam, Youz, Parnassia Group, Rotterdam, the Netherlands
| | - Koen Bolhuis
- Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Columbia University, Mailman School of Public Health, New York
| | - Pauline W Jansen
- Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands; Erasmus University Rotterdam, the Netherlands.
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Wimer G, Larrea M, Streeter J, Hassan A, Angulo A, Armijos A, Bonz A, Tol WA, Greene MC. Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:380. [PMID: 38673293 PMCID: PMC11049989 DOI: 10.3390/ijerph21040380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.
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Affiliation(s)
- Gabrielle Wimer
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
| | | | | | - Amir Hassan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
| | | | - Andrea Armijos
- HIAS, Silver Spring, MD 62471, USA; (A.A.); (A.A.); (A.B.)
| | - Annie Bonz
- HIAS, Silver Spring, MD 62471, USA; (A.A.); (A.A.); (A.B.)
| | - Wietse A. Tol
- Department of Public Health, University of Copenhagen, 1172 Copenhagen, Denmark;
| | - M. Claire Greene
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
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Cadorin C, Purgato M, Turrini G, Prina E, Cabral Ferreira M, Cristofalo D, Bartucz MB, Witteveen AB, Sijbrandij M, Papola D, Barbui C. Mapping the evidence on psychosocial interventions for migrant populations: Descriptive analysis of a living database of randomized studies. Glob Ment Health (Camb) 2024; 11:e35. [PMID: 38572262 PMCID: PMC10988138 DOI: 10.1017/gmh.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/21/2024] [Accepted: 03/02/2024] [Indexed: 04/05/2024] Open
Abstract
Migrant mental health is a pressing public health issue with wide-ranging implications. Many randomized controlled trials (RCTs) have been conducted in this population to assess the effects of psychosocial interventions. However, the available evidence is characterized by controversy and fragmentation, with studies focusing on different migrant populations, interventions, outcomes, delivery modalities and settings. Aiming to promote systematic reviews of the effectiveness of psychosocial interventions in different migrant groups, we have developed a living database of existing RCTs. The development of the database provides an opportunity to map the existing RCT evidence in this population. A total of 135 studies involving 24,859 participants were included in the living database. The distribution of studies by year of publication aligns with the increasing global migrant population in recent years. Most studies focus primarily on adult participants, with a limited representation of children and adolescents, and a prevalence of female participants, which is consistent with epidemiological data, except for older adults, who are underrepresented in research. Studies predominantly focus on refugees and asylum seekers, likely due to their elevated risk of mental health issues, despite the substantial presence of economic migrants worldwide. While studies mainly involve migrants from the Middle East and East Asia, epidemiological data suggest a broader geographic representation, with migrants coming from Eastern Europe, Latin America and South Asia. The present descriptive analysis of RCTs on mental health and psychosocial interventions for migrant populations provides valuable insights into the existing research landscape. It should be used to inform future research efforts, ensuring that studies are more representative of the global migrant population and more responsive to the mental health needs of migrants in different contexts.
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Affiliation(s)
- Camilla Cadorin
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Madalena Cabral Ferreira
- Public Health Unit of the Primary Care Cluster of Famalicão, Northern Region Health Administration, Famalicão, Portugal
| | - Doriana Cristofalo
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Monica B. Bartucz
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute and World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Davide Papola
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Kapel Lev-Ari R, Aloni R, Ari AB. Children Fleeing War-Exploring the Mental Health of Refugee Children Arriving in Israel after the Ukraine 2022 Conflict. CHILD ABUSE & NEGLECT 2024; 149:106608. [PMID: 38141479 DOI: 10.1016/j.chiabu.2023.106608] [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: 06/14/2023] [Revised: 09/18/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND In February 2022, Ukraine suffered a devastating assault by Russia, leading to destruction, casualties, and mass displacement. Among those displaced were over 1.5 million children. Forced displacement exposes children to a heightened risk of mental health issues. OBJECTIVE This study investigated the prevalence of Post-traumatic stress disorder (PTSD) and other mental health issues among child refugees shortly after their displacement from Ukraine to Israel. It aimed to identify factors influencing PTSD development and explore their associations. METHODS The study included 59 child refugees who had arrived in Israel after fleeing the war in Ukraine. Parents completed self-report questionnaires to assess their children's mental health. RESULTS Only three children met the DSM diagnostic criteria for PTSD, with higher scores in the negative cognition and re-experiencing clusters. Over half of the children exhibited general mental health problems, with approximately 40 % showing internalizing problems, and 30 % showing externalizing problems. The study also found a significant comorbidity between PTSD symptoms and internalizing problems. Additionally, internalizing problems emerged as the sole significant predictor of PTSD levels when considering factors such as age, gender, economic status, parents' work status, internalizing problems, and externalizing problems. CONCLUSIONS Child refugees frequently experience psychological distress, even if they do not meet the formal diagnostic criteria for PTSD. They often exhibit other distress symptoms, primarily internalizing problems, which can be challenging to detect. A deeper understanding of the challenges faced by refugee children can inform the development of targeted assistance programs and the recruitment and training of personnel in host countries.
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Affiliation(s)
| | - Roy Aloni
- Department of Behavioral Sciences, Ariel University, Israel
| | - Amichai Ben Ari
- Department of Behavioral Sciences, Ariel University, Israel; Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Herold R, Lieb M, Borho A, Voss A, Unverzagt S, Morawa E, Rothermund E, Erim Y. Working conditions and mental health of migrants and refugees in Europe considering cultural origin- a systematic review. BMC Public Health 2024; 24:662. [PMID: 38429674 PMCID: PMC10908099 DOI: 10.1186/s12889-024-18096-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Migrants and refugees/asylum seekers, as a large part of the European work force, are often confronted with unfavorable working conditions in the host country. Main aim of this systematic review was to compare the association of these working conditions with mental health between migrants and refugees/asylum seekers due to their diverse migration experiences and cultural origins, and between different European host countries. METHODS Systematic search for eligible primary studies was conducted in three electronic databases (PubMed/MEDLINE, PsycINFO and CINAHL) using quantitative study designs written in English, German, French, Italian, Polish, Spanish or Turkish and published from January 1, 2016 to October 27, 2022. Primary health outcomes were diagnosed psychiatric and psychological disorders, suicide and suicide attempts, psychiatric and psychological symptoms, and perceived distress. Secondary health outcomes were more general concepts of mental health such as well-being, life satisfaction and quality of life. Two reviewers independently completed screening, data extraction and the methodological quality assessment of primary studies using the Newcastle-Ottawa-Scale. Descriptive summary of primary studies on working conditions and their relationship with mental health were conducted, comparing migrants and refugees/asylum seekers, migrants and refugees/asylum seekers of different cultural backgrounds (collectivistic and individualistic) and migrants and refugees/asylum seekers living in different host countries. RESULTS Inclusion criteria were met by 19 primary studies. Voluntary migrants are more likely to experience overqualification in the host country than refugees. In all examined host countries, migrants and refugees suffer from unfavorable working conditions, with migrants from collectivistic countries being slightly at risk compared to migrants from individualistic countries. Most unfavorable working conditions are related to poor mental health, regardless of migrant status, cultural origin or host country. CONCLUSIONS Although the results should be interpreted with caution due to the small number of studies, it is evident that to maintain both the mental health and labor force of migrants and refugees/asylum seekers, their working conditions in host countries should be controlled and improved. Special attention should be paid to specific subgroups such as migrants from collectivistic societies. ETHICS AND DISSEMINATION This systematic review is excluded from ethical approval because it used previously approved published data from primary studies. TRIAL REGISTRATION NUMBER CRD42021244840.
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Affiliation(s)
- Regina Herold
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Marietta Lieb
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Amanda Voss
- Institute and Outpatient Clinic of Occupational, Social, and Environmental Medicine, Friedrich-Alexander University Erlangen, Erlangen, Germany
| | - Susanne Unverzagt
- Center of Health Sciences, Institute of General Practice and Family Medicine, Martin-Luther University of Halle-Wittenberg, Halle, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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15
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Shamir-Stein N, Feldblum I, Rotman E, Cohen S, Brand E, Kivity S, Saban M. Exploring the Self-Reported Physical and Psychological Effects in a Population Exposed to a Regional Conflict. J Community Health 2024:10.1007/s10900-024-01337-6. [PMID: 38393653 DOI: 10.1007/s10900-024-01337-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Conflict profoundly impacts community health and well-being. While post-conflict research exists, little is known about initial effects during active hostilities. OBJECTIVE To assess self-reported changes in health behaviors, distress, and care access within one month of regional warfare onset in a conflict-affected community. METHODS An online survey was conducted in November 2023 among 501 residents (mean age 40.5 years) of a community where war began October 7th. Measures evaluated physical health, mental health, diet, substance use, sleep, weight changes, and healthcare access before and after the declaration of war. RESULTS Relative to pre-war, respondents reported significantly increased rates of tobacco (56%) and alcohol (15%) consumption, worsening sleep quality (63%), elevated distress (18% sought help; 14% needed but didn't receive it), and postponed medical care (36%). Over a third reported weight changes. Distress was higher among females and those endorsing maladaptive coping. CONCLUSION Within one month, substantial impacts on community psychosocial and behavioral health emerged. Unmet mental health needs and risk-taking behaviors were early indicators of conflict's health consequences. Continuous monitoring of conflict-affected communities is needed to inform tailored interventions promoting resilience and prevent entrenchment of harms over time.
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Affiliation(s)
| | - Ilana Feldblum
- Maccabi healthcare services, Tel Aviv-Jaffa, 6812509, Israel
| | - Eran Rotman
- Maccabi healthcare services, Tel Aviv-Jaffa, 6812509, Israel
| | - Shir Cohen
- Maccabi healthcare services, Tel Aviv-Jaffa, 6812509, Israel
| | - Einat Brand
- Maccabi healthcare services, Tel Aviv-Jaffa, 6812509, Israel
| | - Sara Kivity
- Maccabi healthcare services, Tel Aviv-Jaffa, 6812509, Israel
| | - Mor Saban
- Nursing Department, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, 69978, Israel.
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16
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Pavlova I, Rogowska AM, Zhang SX. Mental Health and well-being During the COVID-19 Pandemic and After the Russian Invasion of Ukraine. J Community Health 2024; 49:173-182. [PMID: 37620707 PMCID: PMC10881779 DOI: 10.1007/s10900-023-01273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 08/26/2023]
Abstract
The study compared the mental health of university students during the COVID-19 pandemic and the Russian invasion of Ukraine. A repeated online cross-sectional study was performed twice among university students in Ukraine: in November 2020 (Pre-war sample, n = 752) and September-October 2022 (During-war sample, n = 862). The survey measured life satisfaction (SWLS), perceived stress (PSS-10), anxiety (GAD-7), and depression (PHQ-9). Stress, anxiety, and life satisfaction levels were similar during the war and pandemic, while symptoms of depression decreased during the war, compared to the pandemic. Network analysis showed that anxiety has a crucial effect on depression and stress, and stress is most closely related to life satisfaction. The association of life satisfaction with anxiety and depression disappeared in wartime, in contrast to the pandemic. The priority of prevention and intervention programs in wartime Ukraine should focus on anxiety as the most influential factor in other mental health and well-being problems. The results showed high resistance and adaptation to war conditions among university students in Ukraine.
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Affiliation(s)
- Iuliia Pavlova
- Theory and Methods of Physical Culture Department, Lviv State University of Physical Culture, Lviv, Ukraine
| | | | - Stephen X Zhang
- Faculty of Arts, Law and Economics, Adelaide Business School, University of Adelaide, Business, Adelaide, Australia
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Bohland HK, Kimbel R, Kegel P, Dietz P, Koestner C, Letzel S, Kurmeyer C, Jesuthasan J, Schouler-Ocak M, Zier U. Depression and anxiety in female refugees from East Africa and the Middle East displaced to Germany: cross-sectional results of the female refugee study, taking sociodemographic and migration-related factors into account. Front Psychiatry 2024; 14:1303009. [PMID: 38239899 PMCID: PMC10794566 DOI: 10.3389/fpsyt.2023.1303009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024] Open
Abstract
At the end of 2022, 108.4 million people around the world were forcibly displaced, the highest number ever recorded. Of these, 50% were women. Despite this situation, little is known about the mental health of female refugees. The first aim of this study was to examine the prevalence of depression and anxiety symptoms among female refugees in Germany. The second aim was to examine which sociodemographic and migration-related variables have an impact on refugees' mental health, and the third aim was to assess the potential predictors of their mental health. A sample of 92 female refugees from East Africa and the Middle East living in Germany were interviewed. Symptoms of depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25). The experience of potentially traumatic events (PTEs) was assessed using the Posttraumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ). In our sample of female refugees, 65.2% reported symptoms of depression, and 60.9% reported symptoms of anxiety. Symptoms of depression or anxiety were associated with being from the Middle East, having a higher level of education, and reporting more PTEs. The multiple regression model for anxiety was able to explain 32.4% of the variance in anxiety symptoms. The findings highlight the high burden of mental health problems that female refugees bear. The identified predictors of depressive and anxiety symptoms should sensitize medical and refugee professionals to identify vulnerable individuals and groups, refer them to appropriate psychological treatment, and, where possible, modify the identified predictors.
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Affiliation(s)
- Helena Katharina Bohland
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Renate Kimbel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Kegel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Pavel Dietz
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Clemens Koestner
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stephan Letzel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christine Kurmeyer
- Women and equal opportunities office, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jenny Jesuthasan
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Ulrike Zier
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
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18
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Pavlova I, Rogowska AM. Exposure to war, war nightmares, insomnia, and war-related posttraumatic stress disorder: A network analysis among university students during the war in Ukraine. J Affect Disord 2023; 342:148-156. [PMID: 37690539 DOI: 10.1016/j.jad.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Little is known about the prevalence and associations between war-related variables among Ukrainians during the Russian invasion. The present study assesses the prevalence and associations between exposure to war (EW), nightmares of war (NW), insomnia, and war-related post-traumatic stress disorder (WPTSD) among university students from Ukraine. METHODS During the war, an online cross-sectional study was performed among university students (N = 1072) from western Ukraine. Newly developed questions evaluated EW and NW, while insomnia was measured using Athens Insomnia Scale (AIS), and for assessing war-related PTSD symptoms, we adopted an abbreviated six-item PTSD checklist (PCL-6). The associations between exposure to war, nightmares of war, and symptoms of insomnia and PTSD were examined using network analysis (NA). RESULTS Among university students, 98 % declared exposure to war, 86 % dreamed nightmares of war, 49 % experienced insomnia symptoms, and 27 % presented symptoms of PTSD. A network analysis found that war-related PTSD has a central and the greatest impact on the frequency of war nightmares and the severity of insomnia symptoms. LIMITATIONS Self-report measurements were applied to a gender-unbalanced sample of university students from the western regions of Ukraine, so it would be inappropriate to generalize to the population directly affected by the war. CONCLUSIONS War-related PTSD symptoms had the most significant impact on the other variables. Therefore, war-related PTSD should be a priority in treatment among university students in Ukraine. However, multidisciplinary integrative intervention programs that treat nightmares, insomnia, and PTSD, can be the most effective.
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Affiliation(s)
- Iuliia Pavlova
- Theory and Methods of Physical Culture Department, Lviv State University of Physical Culture, Lviv, Ukraine
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Caroppo E, Calabrese C, Mazza M, Rinaldi A, Coluzzi D, Napoli P, Sapienza M, Porfiri M, De Lellis P. Migrants' mental health recovery in Italian reception facilities. COMMUNICATIONS MEDICINE 2023; 3:162. [PMID: 37993495 PMCID: PMC10665420 DOI: 10.1038/s43856-023-00385-8] [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: 01/31/2023] [Accepted: 10/12/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Forced migration leaves deep marks on the psychological well-being of migrants, with post-traumatic stress disorder (PTSD) and other psychological conditions being prevalent among them. While research has clarified the extent to which pre-migration trauma is a predictor of mental health outcomes, the role of post-migration stressors in the settlement environment are yet to be fully characterized. METHODS We monitored mental health of a cohort of 100 asylum-seekers during their 14-day COVID-19-related quarantine in reception facilities in Rome, Italy, through the administration of six questionnaires (a demographic survey, the WHO-5 well-being index, the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), the Harvard Trauma Questionnaire, the Trauma and Loss Spectrum-Self Report, and the LiMEs-Italian version). Through the combination of statistical analysis and supervised learning, we studied the impact of the first contact with the reception system on asylum-seekers' mental health and sought for possible risk and shielding factors for PTSD. RESULTS We find that sheltering in refugee centers has a positive impact on migrants' mental health; asylum-seekers with PTSD reported more traumatic events and personality characteristics related to loss and trauma; life events are predictors of PTSD in asylum-seekers. CONCLUSIONS We identify past traumatic experiences as predictors of PTSD, and establish the positive role the immediate post-migration environment can play on migrants' psychological well-being. We recommend for host countries to implement reception models that provide effective protection and integration of asylum-seekers, similar to those in the Italian system.
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Affiliation(s)
- Emanuele Caroppo
- Department of Mental Health, Local Health Authority Roma 2, Rome, Italy.
| | - Carmela Calabrese
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Institut de Neurosciences des Systémes (INS), Aix Marseille Université, 13, Marseille, France
| | - Marianna Mazza
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniele Coluzzi
- Migrant Health Unit, Local Health Authority Roma 2, Rome, Italy
| | | | - Martina Sapienza
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Porfiri
- Center for Urban Science and Progress, Department of Mechanical and Aerospace Engineering, and Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA.
| | - Pietro De Lellis
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy.
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20
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Kovács J, Csukonyi C, Kovács KE, Liszka D, Walawender P. Integrative attitudes of Ukrainian war refugees in two neighboring European countries (Poland and Hungary) in connection with posttraumatic stress symptoms and social support. Front Public Health 2023; 11:1256102. [PMID: 38035297 PMCID: PMC10687397 DOI: 10.3389/fpubh.2023.1256102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Since February 24th, 2022, millions of Ukrainians have sought refuge in other, mainly European countries. Hungary, after Poland, is the second largest host of Ukrainian refugees. Only a portion of them are asylum seekers (~11.0% in Poland and ~ 1.1% in Hungary). The aim of the study is to compare the integrative acculturation attitudes between the war refugees residing in the two European countries. The comparison takes into account both the suffering of posttraumatic stress symptoms and social support. It is the first comparative study of this kind pertaining to the Ukrainian refugees in European countries. The data were obtained by a survey method using the modified CAPI (Computer Assisted Personal Interview) technique. The data analyzed were collected between November 21st and December 20th, 2022 from 728 adult Ukrainian individuals who crossed the borders of Poland and Hungary after February 24th, 2022. The research results show that refugees in Poland perceive significantly more social support and show stronger integrative attitudes than refugees in Hungary. The two samples do not differ regarding the presence of posttraumatic stress. The integrative attitudes proved not to be linked to gender and age, but linked to the host country. Besides social support and the host country, posttraumatic stress also proved to be a significant predictor of integrative attitudes.
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Affiliation(s)
- Judit Kovács
- Institute of Psychology, University of Debrecen, Debrecen, Hungary
| | - Csilla Csukonyi
- Institute of Psychology, University of Debrecen, Debrecen, Hungary
| | | | - Damian Liszka
- Institute of Sociology, University of the National Education Commission, Krakow, Poland
| | - Paweł Walawender
- Institute of Sociology, University of the National Education Commission, Krakow, Poland
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Evangelidou S, Cruz A, Osorio Y, Sequeira-Aymar E, Gonçalves AQ, Camps-Vila L, Monclús-González MM, Cuxart-Graell A, Revuelta-Muñoz EM, Busquet-Solé N, Sarriegui-Domínguez S, Casellas A, Dalmau Llorca MR, Aguilar Martín C, Requena-Mendez A. Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study. J Migr Health 2023; 8:100205. [PMID: 38047139 PMCID: PMC10692454 DOI: 10.1016/j.jmh.2023.100205] [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: 07/13/2023] [Revised: 09/26/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023] Open
Abstract
Background Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2-1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8-6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5-3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.
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Affiliation(s)
- Stella Evangelidou
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Yolanda Osorio
- Parc Sanitari Sant Joan de Deu, Programa Atenció a la Salut Mental de les persones Immigrades i Programa per Persones Sense Llar, Carrer Dr. Antoni Pujadas, 42, 08830 Barcelona, Spain
| | - Ethel Sequeira-Aymar
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Carrer Rosselló 161, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Carrer Rosselló, 149, Barcelona, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Laura Camps-Vila
- Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 13-15, 08272 Sant Fruitós de Bages, Barcelona, Spain
| | - Marta M. Monclús-González
- Centre d'Atencio Primaria Sagrada Família, Consorci Sanitari Integral (CSI), Carrer Còrsega 643, 08025 Barcelona, Spain
| | - Alba Cuxart-Graell
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Elisa M. Revuelta-Muñoz
- Centre d'Atencio Primaria Rambla Ferran, Institut Català de la Salut (ICS), Carrer Rambla Ferran 44, 25007, Lleida, Spain
| | - Núria Busquet-Solé
- Centre d'Atencio Primaria Sagrada Família, Institut Català de la Salut, Carrer St. Cristòfol, 34, 08243 Manresa, Barcelona, Spain
| | - Susana Sarriegui-Domínguez
- Centre d'Atencio Primaria 1 Maig, Institut Català de la Salut (ICS), Carrer De la Mercè, 5, 25003, Lleida, Spain
| | - Aina Casellas
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - M. Rosa Dalmau Llorca
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500, Tortosa, Tarragona, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 17177, Solna, Stockholm, Sweden
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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Asanov AM, Asanov I, Buenstorf G. Mental health and stress level of Ukrainians seeking psychological help online. Heliyon 2023; 9:e21933. [PMID: 38027618 PMCID: PMC10658344 DOI: 10.1016/j.heliyon.2023.e21933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Due to the Russian invasion of Ukraine on February 24th, 2022, more than 8 million Ukrainians have been displaced from their homes. Ukrainians exposed to armed conflict and migration are likely to have low levels of mental health status and seek help. We provide a uniform quantitative assessment of the mental health conditions of Ukrainians seeking help soon after the invasion and resettlement. We screen the mental well-being and psychological distress of 1165 refugees, migrants, internally displaced, and non-displaced individuals from Ukraine who seek psychological help online in Ukraine and across 24 countries of the European Union. We surveyed participants in the study as a part of our online program for adult Ukrainians from June 22nd to July 6th, 2022. We report descriptive results of mental-health status for the aggregate sample and the sub-groups. More than half of the respondents exhibit low levels of mental well-being and high psychological distress, with 81 % being at risk of depression; 57 % having severe psychological distress. Refugees and internally displaced participants show a particularly high risk of depression and severe psychological distress in our sample. Many Ukrainians seeking psychological help work, study, or volunteer, and those who engage in these activities have relatively alleviated mental well-being. Our results indicate a considerable psychological burden on Ukrainians. Although our analysis focuses on Ukrainians seeking help, it shows that the displaced soon after resettlement require particular attention and can be reached in a short time across borders, irrespective of their (officially documented) migration status.
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23
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Tonia T, Buitrago-Garcia D, Peter NL, Mesa-Vieira C, Li T, Furukawa TA, Cipriani A, Leucht S, Low N, Salanti G. Tool to assess risk of bias in studies estimating the prevalence of mental health disorders (RoB-PrevMH). BMJ MENTAL HEALTH 2023; 26:e300694. [PMID: 37899074 PMCID: PMC10619100 DOI: 10.1136/bmjment-2023-300694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE There is no standard tool for assessing risk of bias (RoB) in prevalence studies. For the purposes of a living systematic review during the COVID-19 pandemic, we developed a tool to evaluate RoB in studies measuring the prevalence of mental health disorders (RoB-PrevMH) and tested inter-rater reliability. METHODS We decided on items and signalling questions to include in RoB-PrevMH through iterative discussions. We tested the reliability of assessments by different users with two sets of prevalence studies. The first set included a random sample of 50 studies from our living systematic review. The second set included 33 studies from a systematic review of the prevalence of post-traumatic stress disorders, major depression and generalised anxiety disorder. We assessed the inter-rater agreement by calculating the proportion of agreement and Kappa statistic for each item. RESULTS RoB-PrevMH consists of three items that address selection bias and information bias. Introductory and signalling questions guide the application of the tool to the review question. The inter-rater agreement for the three items was 83%, 90% and 93%. The weighted kappa scores were 0.63 (95% CI 0.54 to 0.73), 0.71 (95% CI 0.67 to 0.85) and 0.32 (95% CI -0.04 to 0.63), respectively. CONCLUSIONS RoB-PrevMH is a brief, user-friendly and adaptable tool for assessing RoB in studies on prevalence of mental health disorders. Initial results for inter-rater agreement were fair to substantial. The tool's validity, reliability and applicability should be assessed in future projects.
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Affiliation(s)
- Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Natalie Luise Peter
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, München, Germany
| | - Cristina Mesa-Vieira
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Freising, Germany
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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24
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Wiederhold BK. A Legacy of Trauma: How Local Conflicts Can Have Global Implications for Mental Health. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023. [PMID: 37751187 DOI: 10.1089/cyber.2023.29296.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
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25
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Herold R, Lieb M, Borho A, Voss A, Unverzagt S, Morawa E, Erim Y. Relationship between working conditions and mental health of migrants and refugees/asylum seekers vs. natives in Europe: a systematic review. Int Arch Occup Environ Health 2023; 96:931-963. [PMID: 37439904 PMCID: PMC10361874 DOI: 10.1007/s00420-023-01981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Migrants and refugees/asylum seekers make up a significant proportion of the European workforce. They often suffer from poor working conditions, which might impact mental health. The main objective of this systematic review was to summarize and analyze existing research on working conditions of migrants and refugees/asylum seekers in European host countries and compare them to those of natives. Furthermore, the relationship between working conditions and mental health of migrants/refugees/asylum seekers and natives will be compared. METHODS Three electronic databases (PubMed/MEDLINE, PsycInfo and CINAHL) were systematically searched for eligible articles using quantitative study designs written in English, German, French, Italian, Polish, Spanish or Turkish and published from January 1, 2016 to October 27, 2022. Primary health outcomes were diagnosed psychiatric and psychological disorders, suicide (attempts), psychiatric and psychological symptoms, and perceived distress. Secondary health outcomes were more general concepts of mental health such as well-being, life satisfaction and quality of life. Screening, data extraction and the methodological quality assessment of primary studies by using the Newcastle-Ottawa Scale were done independently by two reviewers. The results of the primary studies were summarized descriptively. Migrants and refugees/asylum seekers were compared with natives in terms of the association between working conditions and mental health. RESULTS Migrants and refugees often face disadvantages at work concerning organizational (low-skilled work, overqualification, fixed-term contracts, shift work, lower reward levels) and social conditions (discrimination experiences) in contrast to natives. Most unfavorable working conditions are associated with worse mental health for migrants as well as for natives. CONCLUSIONS Even if the results are to be taken with caution, it is necessary to control and improve the working conditions of migrants and refugees/asylum seekers and adapt them to those of the native population to maintain their mental health and thus their labor force.
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Affiliation(s)
- Regina Herold
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Marietta Lieb
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Amanda Voss
- Institute and Outpatient Clinic of Occupational, Social, and Environmental Medicine, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susanne Unverzagt
- Center of Health Sciences, Institute of General Practice and Family Medicine, Martin-Luther University of Halle-Wittenberg, Halle, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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26
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Pavlova I, Krauss S, McGrath B, Cehajic-Clancy S, Bodnar I, Petrytsa P, Synytsya T, Zhara H. Individual and contextual predictors of young Ukrainian adults' subjective well-being during the Russian-Ukrainian war. Appl Psychol Health Well Being 2023. [PMID: 37652753 DOI: 10.1111/aphw.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
The Russian invasion of Ukraine is accompanied by horrific losses among civilians. This study investigates various individual (hope, optimism, resilience, post-traumatic growth, and coping strategies) and contextual predictors (experience of life under occupation, actively hostile home environment, and frequent moves) of subjective well-being among the youth living in Ukraine. A total sample of 593 students from several universities participated in the study using surveys that contained questions about sociodemographic characteristics, life satisfaction, hope, optimism, personal post-traumatic growth, resilience, and coping strategies. Data were analyzed using JAMOVI software. The level of dissatisfaction with their own lives was 34.7%; most of the respondents had a higher incidence of minimal/mild hopelessness (88.7%) and high/moderate level of optimism (60.9%). The majority of participants had moderate and high levels of post-traumatic growth (51.9% and 6.7%, respectively) and resilience (46.0% and 14.5%, respectively). Optimism, hope, resilience, post-traumatic growth, using emotional support, and life in occupation predicted life satisfaction among the study sample.
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Affiliation(s)
- Iuliia Pavlova
- Department of Theory and Methods of Physical Culture, Lviv State University of Physical Culture, Lviv, Ukraine
- Lesya Ukrainka Volyn National University, Lutsk, Ukraine
| | - Steven Krauss
- Institute for Social Science Studies, Universiti Putra Malaysia, Serdang, Malaysia
| | - Breeda McGrath
- The Chicago School of Professional Psychology, Chicago, Illinois, USA
| | | | - Ivanna Bodnar
- Department of Theory and Methods of Physical Culture, Lviv State University of Physical Culture, Lviv, Ukraine
| | - Petro Petrytsa
- Department of Physical Education and Rehabilitation, Ternopil Volodymyr Hnatiuk National Pedagogical University, Ternopil, Ukraine
| | - Tetiana Synytsya
- Faculty of Physical Culture and Sports, National University "Yuri Kondratyuk Poltava Polytechnic", Poltava, Ukraine
| | - Hanna Zhara
- Department of Biological Bases of Physical Education, Health and Sports, T.H. Shevchenko National University "Chernihiv Colehium", Chernihiv, Ukraine
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27
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Pozuelo JR, Bradenbrink R, Stierna MF, Sterck O. Depression, violence and socioeconomic outcomes among refugees in East Africa: evidence from a multicountry representative survey. BMJ MENTAL HEALTH 2023; 26:e300773. [PMID: 37597876 PMCID: PMC10577724 DOI: 10.1136/bmjment-2023-300773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Existing research on refugee mental health is heavily skewed towards refugees in high-income countries, even though most refugees (83%) are hosted in low-income and middle-income countries. This problem is further compounded by the unrepresentativeness of samples, small sample sizes and low response rates. OBJECTIVE To present representative findings on the prevalence and correlates of depression among different refugee subgroups in East Africa. METHODS We conducted a multicountry representative survey of refugee and host populations in urban and camp contexts in Kenya, Uganda and Ethiopia (n=15 915). We compared the prevalence of depression between refugee and host populations and relied on regression analysis to explore the association between violence, depression and socioeconomic outcomes. FINDINGS We found a high prevalence of elevated depressive symptoms (31%, 95% CI 28% to 35%) and functional impairment (62%, 95% CI 58% to 66%) among the refugee population, which was significantly higher than that found in the host population (10% for depressive symptoms, 95% CI 8% to 13% and 25% for functional impairment, 95% CI 22% to 28%) (p<0·001). Further, we observed a dose-response relationship between exposure to violence and mental illness. Lastly, high depressive symptoms and functional impairment were associated with worse socioeconomic outcomes. CONCLUSION Our results highlight that refugees in East-Africa-particularly those exposed to violence and extended exile periods-are disproportionately affected by depression, which may also hinder their socioeconomic integration. CLINICAL IMPLICATIONS Given the high prevalence of depression among refugees in East Africa, our results underline the need for scalable interventions that can promote refugees' well-being.
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Affiliation(s)
- Julia R Pozuelo
- Department of Global Health and Social Medicine, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Maria Flinder Stierna
- Department of International Development, University of Oxford, Oxford, UK
- ODI (Overseas Development Institute), London, UK
| | - Olivier Sterck
- Department of International Development, University of Oxford, Oxford, UK
- Institute of Development Policy, University of Antwerp, Antwerpen, Belgium
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28
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Knappe F, Filippou K, Hatzigeorgiadis A, Morres ID, Tzormpatzakis E, Havas E, Seelig H, Colledge F, Ludyga S, Meier M, de Quervain D, Theodorakis Y, von Känel R, Pühse U, Gerber M. Psychological well-being, mental distress, metabolic syndrome, and associated factors among people living in a refugee camp in Greece: a cross-sectional study. Front Public Health 2023; 11:1179756. [PMID: 37397726 PMCID: PMC10311549 DOI: 10.3389/fpubh.2023.1179756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Background Forcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO's call for evidence-based public health policies and programs for forcibly displaced people. Methods We conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake. Results The prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002). Conclusion There is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits.
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Affiliation(s)
- Florian Knappe
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Konstantinia Filippou
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Antonis Hatzigeorgiadis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Ioannis D. Morres
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece
| | - Emmanouil Tzormpatzakis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Elsa Havas
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Flora Colledge
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Marianne Meier
- Interdisciplinary Center for Gender Studies, University of Bern, Bern, Switzerland
| | | | - Yannis Theodorakis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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29
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Axinn WG, Bruffaerts R, Kessler TL, Frounfelker R, Aguilar-Gaxiola S, Alonso J, Bunting B, Caldas-de-Almeida JM, Cardoso G, Chardoul S, Chiu WT, Cía A, Gureje O, Karam EG, Kovess-Masfety V, Petukhova MV, Piazza M, Posada-Villa J, Sampson NA, Scott KM, Stagnaro JC, Stein DJ, Torres Y, Williams DR, Kessler RC. Findings From the World Mental Health Surveys of Civil Violence Exposure and Its Association With Subsequent Onset and Persistence of Mental Disorders. JAMA Netw Open 2023; 6:e2318919. [PMID: 37338903 PMCID: PMC10282884 DOI: 10.1001/jamanetworkopen.2023.18919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/23/2023] [Indexed: 06/21/2023] Open
Abstract
Importance Understanding the association of civil violence with mental disorders is important for developing effective postconflict recovery policies. Objective To estimate the association between exposure to civil violence and the subsequent onset and persistence of common mental disorders (in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) in representative surveys of civilians from countries that have experienced civil violence since World War II. Design, Setting, and Participants This study used data from cross-sectional World Health Organization World Mental Health (WMH) surveys administered to households between February 5, 2001, and January 5, 2022, in 7 countries that experienced periods of civil violence after World War II (Argentina, Colombia, Lebanon, Nigeria, Northern Ireland, Peru, and South Africa). Data from respondents in other WMH surveys who immigrated from countries with civil violence in Africa and Latin America were also included. Representative samples comprised adults (aged ≥18 years) from eligible countries. Data analysis was performed from February 10 to 13, 2023. Exposures Exposure was defined as a self-report of having been a civilian in a war zone or region of terror. Related stressors (being displaced, witnessing atrocities, or being a combatant) were also assessed. Exposures occurred a median of 21 (IQR, 12-30) years before the interview. Main Outcomes and Measures The main outcome was the retrospectively reported lifetime prevalence and 12-month persistence (estimated by calculating 12-month prevalence among lifetime cases) of DSM-IV anxiety, mood, and externalizing (alcohol use, illicit drug use, or intermittent explosive) disorders. Results This study included 18 212 respondents from 7 countries. Of these individuals, 2096 reported that they were exposed to civil violence (56.5% were men; median age, 40 [IQR, 30-52] years) and 16 116 were not exposed (45.2% were men; median age, 35 [IQR, 26-48] years). Respondents who reported being exposed to civil violence had a significantly elevated onset risk of anxiety (risk ratio [RR], 1.8 [95% CI, 1.5-2.1]), mood (RR, 1.5 [95% CI, 1.3-1.7]), and externalizing (RR, 1.6 [95% CI, 1.3-1.9]) disorders. Combatants additionally had a significantly elevated onset risk of anxiety disorders (RR, 2.0 [95% CI, 1.3-3.1]) and refugees had an increased onset risk of mood (RR, 1.5 [95% CI, 1.1-2.0]) and externalizing (RR, 1.6 [95% CI, 1.0-2.4]) disorders. Elevated disorder onset risks persisted for more than 2 decades if conflicts persisted but not after either termination of hostilities or emigration. Persistence (ie, 12-month prevalence among respondents with lifetime prevalence of the disorder), in comparison, was generally not associated with exposure. Conclusions In this survey study of exposure to civil violence, exposure was associated with an elevated risk of mental disorders among civilians for many years after initial exposure. These findings suggest that policy makers should recognize these associations when projecting future mental disorder treatment needs in countries experiencing civil violence and among affected migrants.
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Affiliation(s)
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum–Katholieke Universiteit, Campus Gasthuisberg, Leuven, Belgium
| | - Timothy L. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Rochelle Frounfelker
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, University of California, Davis Health System, Sacramento
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Biomedical Research Networking Center in Epidemiology and Public Health, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Alfredo Cía
- Anxiety Disorders Research Center, Buenos Aires, Argentina
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | | | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Marina Piazza
- Instituto Nacional de Salud, Universidad Cayetano Heredia, Lima, Peru
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Dan J. Stein
- South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Rodríguez-Muñoz MF, Chrzan-Dętkoś M, Uka A, García-López HS, Krupelnytska L, Morozova-Larina O, Vavilova A, Molotokas A, Murawska N, Le HN. The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol. Front Psychol 2023; 14:1152478. [PMID: 36993880 PMCID: PMC10042139 DOI: 10.3389/fpsyg.2023.1152478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundThe aim of the Perinatal Mental Health for Refugee Women (PMH-RW) Project is to investigate the impact of the war on perinatal mental health: anxiety, post-traumatic stress, depression, and birth trauma symptoms. It will also evaluate the factors that serve as protective elements for the development of these potential diagnoses (such as personality traits, social support, sociodemographic characteristics, and access to medical/mental health services).MethodAn international observational cohort study with baseline data is being assessed in Ukraine (for internal refugees) and several European Countries (for external refugees). The study includes as participants both pregnant women and those who have recently given birth (with babies up to 1 year old). The assessment includes measures on depression (EPDS), anxiety (GAD-7), experiences during birth (City Birth Questionnaire), post-traumatic stress symptoms [Impact of events scale—revised (PTSD-R)], Personality (10-Item Personality Inventory-TIPI), and a questionnaire for socio-demographic data which also such social support.ConclusionThis study will provide needed information for determining the impact of the Ukrainian Crisis on perinatal mental health by studying potential risk and protective factors. The data collected will be used to inform policymakers with useful information that can be used in the development of plans to protect and promote the mental health of the perinatal refugees impacted by this event. Also, it is our hope that data collected from this study will serve to plant the seeds for further research regarding the impact of the crisis in Ukraine on the offspring and to analyze how these events are affecting further generations.Clinical Trial RegistrationClinicalTrials.gov, Identifier: NCT05654987.
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Affiliation(s)
| | | | - Ana Uka
- Research Center for Sustainable Development and Innovation, Beder University College, Tirana, Albania
| | | | - Liudmyla Krupelnytska
- Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
- *Correspondence: Liudmyla Krupelnytska,
| | | | - Alona Vavilova
- Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | | | | | - Huynh-Nhu Le
- George Washington University, Washington, DC, United States
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Tham SG, Hunt IM, Turnbull P, Appleby L, Kapur N, Knipe D. Suicide among psychiatric patients who migrated to the UK: a national clinical survey. EClinicalMedicine 2023; 57:101859. [PMID: 36895802 PMCID: PMC9989630 DOI: 10.1016/j.eclinm.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Within the UK, limited research has examined migration and suicide risk. To assist with tailoring mental health care to the needs of different migrant groups, it is important to identify the clinical profile and antecedents to suicide. METHODS We focussed on two groups of migrants: those resident in the UK for less than 5 years (recent migrants) and those seeking permission to stay in the UK. Data on mental health patients who died by suicide in the UK between 2011 and 2019 were obtained as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. FINDINGS 13,948 patients died by suicide between 2011 and 2019: 593 were recent migrants with 48 seeking permission to stay in the UK. The overall suicide rate between 2011 and 2017 for patients seeking to stay was 23.8/100,000 (95% CI 17.3-32.1). There was some uncertainty around this estimate but it appeared higher than the general population suicide rate of 10.6/100,000 population (95% CI 10.5-10.7; p = .0001) for the same period. A higher proportion of migrants were from an ethnic minority group (15% recent migrants vs. 70% seeking to remain vs. 7% non-migrants) and more were viewed as at low long-term risk of suicide (63% recent migrants vs. 76% seeking to remain vs. 57% non-migrants). A higher proportion of recent migrants died within three months of discharge from psychiatric in-patient care (19% vs. 14%) compared to non-migrants. Proportionally more patients seeking to remain had a diagnosis of schizophrenia and other delusional disorders (31% vs. 15%) and more had experienced recent life events compared to non-migrants (71% vs. 51%). INTERPRETATION A higher proportion of migrants had severe or acute illness at the time of their suicide. This may be linked to a range of serious stressors and/or lack of connection with services that could have identified signs of illness early. However, clinicians often viewed these patients as low risk. Mental health services should consider the breadth of stressors migrants may face and adopt a multi-agency approach to suicide prevention. FUNDING The Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Corresponding author. National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Isabelle M. Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, University of Bristol, Bristol, UK
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Smith A, Buadze A, Liebrenz M. The United Kingdom's Rwanda asylum policy and the European Court of Human Rights' Interim Measure: Challenges for mental health and the importance of social psychiatry. Int J Soc Psychiatry 2023; 69:239-242. [PMID: 36629381 DOI: 10.1177/00207640221148091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Switzerland
| | - Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Switzerland
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Mental Health Screening for Korean Ukrainian Refugee Minors in the Republic of Korea: A Cross Sectional Pilot Study. ADOLESCENTS 2023. [DOI: 10.3390/adolescents3010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Since February 2022, the Ukrainian refugee crisis has been highlighting mental health problems associated with trauma and distress. This study aimed to evaluate the mental health status of twenty-seven refugee minors (10 to 18 years old) who fled Ukraine and temporarily settled in the Republic of Korea (ROK). This cross-sectional survey study aimed to evaluate the mental health status of ethnic Korean Ukrainian refugee minors. The Child and Adolescent Trauma Screen—Youth Report (CATS), generalized anxiety disorder seven-item scale (GAD-7), and subjective unit of distress scale (SUDs) were used for assessment. A preliminary analysis indicated that 77% Ukrainian refugee minors were exposed to and experienced war-related trauma. They are at a relatively low risk of trauma symptoms, anxiety, and distress due to stable family and visa status and a comparably better environment in the ROK. Meanwhile, refugee teenagers showed higher rates of psychological distress compared with refugee children. This finding suggests that an early psychological interventions in a host country may be beneficial to prevent mental health issues in refugee minors.
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Carpiniello B. The Mental Health Costs of Armed Conflicts-A Review of Systematic Reviews Conducted on Refugees, Asylum-Seekers and People Living in War Zones. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2840. [PMID: 36833537 PMCID: PMC9957523 DOI: 10.3390/ijerph20042840] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
AIMS Armed conflicts produce a wide series of distressing consequences, including death, all of which impact negatively on the lives of survivors. This paper focuses specifically on the mental health consequences of war on adults and child/adolescent refugees or those living in war zones through a review of all systematic reviews and/or meta-analyses published from 2005 up until the current time. RESULTS Fifteen systematic reviews and/or meta-analyses conducted in adult populations, and seven relating to children and adolescents, were selected for the purpose of this review. Prevalence rates of anxiety, depression and post-traumatic stress disorder (PTSD) were two- to three-fold higher amongst people exposed to armed conflict compared to those who had not been exposed, with women and children being the most vulnerable to the outcome of armed conflicts. A series of war-related, migratory and post-migratory stressors contribute to short- and long-term mental health issues in the internally displaced, asylum seekers and refugees. CONCLUSION It should be a required social responsibility for all psychiatrists and psychiatric associations to commit to raising awareness amongst political decision-makers as to the mental health consequences caused by armed conflicts, as part of their duty of care for people experiencing the consequences of war.
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Affiliation(s)
- Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari & Psychiatric Unit, University Hospital, 09127 Cagliari, Italy
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Tonia T, Buitrago-Garcia D, Peter N, Mesa-Vieira C, Li T, Furukawa TA, Cipriani A, Leucht S, Low N, Salanti G. A tool to assess risk of bias in studies estimating the prevalence of mental health disorders (RoB-PrevMH). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.01.23285335. [PMID: 36778304 PMCID: PMC9915820 DOI: 10.1101/2023.02.01.23285335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective Biases affect how certain we are about the available evidence, however no standard tool for assessing the risk of bias (RoB) in prevalence studies exists. For the purposes of a living systematic review on prevalence of mental health disorders during the COVID-19 pandemic, we developed a RoB tool to evaluate prevalence studies in mental health (RoB-PrevMH) and tested interrater reliability. Methods We reviewed existing RoB tools for prevalence studies until September 2020, to develop a tool for prevalence studies in mental health. We tested the reliability of assessments by different users of RoB-PrevMH in 83 studies stemming from two systematic reviews of prevalence studies in mental health. We assessed the interrater agreement by calculating the proportion of agreement and Kappa statistic for each item. Results RoB-PrevMH consists of three items that address selection bias and information bias. Introductory and signaling questions guide the application of the tool to the review question. The interrater agreement for the three items was 83%, 90% and 93%. The weighted kappa was 0.63 (95% CI 0.54 to 0.73), 0.71 (95% CI 0.67 to 0.85) and 0.32 (95% CI -0.04 to -0.63), respectively. Conclusions We developed a brief, user friendly, and adaptable tool for assessing RoB in studies on prevalence of mental health disorders. Initial results for interrater agreement were fair to substantial. The tool's validity, reliability, and applicability should be assessed in future projects.
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Purgato M, Turrini G, Tedeschi F, Serra R, Tarsitani L, Compri B, Muriago G, Cadorin C, Ostuzzi G, Nicaise P, Lorant V, Sijbrandij M, Witteveen AB, Ayuso-Mateos JL, Mediavilla R, Haro JM, Felez-Nobrega M, Figueiredo N, Pollice G, McDaid D, Park AL, Kalisch R, Petri-Romão P, Underhill J, Bryant RA, Nosè M, Barbui C. Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial. Front Public Health 2023; 11:1100546. [PMID: 36761135 PMCID: PMC9905848 DOI: 10.3389/fpubh.2023.1100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Migrant populations, including workers, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move, are exposed to a variety of stressors and potentially traumatic events before, during, and after the migration process. In recent years, the COVID-19 pandemic has represented an additional stressor, especially for migrants on the move. As a consequence, migration may increase vulnerability of individuals toward a worsening of subjective wellbeing, quality of life, and mental health, which, in turn, may increase the risk of developing mental health conditions. Against this background, we designed a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization and locally adapted for migrant populations. The effectiveness and cost-effectiveness of this stepped-care programme will be assessed in terms of mental health outcomes, resilience, wellbeing, and costs to healthcare systems. Methods and analysis We present the study protocol for a pragmatic randomized study with a parallel-group design that will enroll participants with a migrant background and elevated level of psychological distress. Participants will be randomized to care as usual only or to care a usual plus a guided self-help stress management guide (Doing What Matters in Times of Stress, DWM) and a five-session cognitive behavioral intervention (Problem Management Plus, PM+). Participants will self-report all measures at baseline before random allocation, 2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ delivery. All participants will receive a single-session of a support intervention, namely Psychological First Aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire-Anxiety and Depression Scale summary score 2 months after PM+ delivery. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, resource utilization, cost, and cost-effectiveness. Discussion This study is the first randomized controlled trial that combines two World Health Organization psychological interventions tailored for migrant populations with an elevated level of psychological distress. The present study will make available DWM/PM+ packages adapted for remote delivery following a task-shifting approach, and will generate evidence to inform policy responses based on a more efficient use of resources for improving resilience, wellbeing and mental health. Clinical trial registration ClinicalTrials.gov, identifier: NCT04993534.
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Affiliation(s)
- Marianna Purgato
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giulia Turrini
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Federico Tedeschi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Riccardo Serra
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Beatrice Compri
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giulia Muriago
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Pablo Nicaise
- Institute of Health and Society (IRSS) - UCLouvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS) - UCLouvain, Brussels, Belgium
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - Anke B. Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, VU University, Amsterdam, Netherlands
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry, La Princesa University Hospital, Instituto de Investigación Sanitaria La Princesa (IIS-Princesa), Madrid, Spain
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Mireia Felez-Nobrega
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, ERES, Paris, France
| | - Giulia Pollice
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, ERES, Paris, France
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Raffael Kalisch
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| | | | | | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Michela Nosè
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
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Rofo S, Gelyana L, Moramarco S, Alhanabadi LHH, Basa FB, Dellagiulia A, Emberti Gialloreti L. Prevalence and risk factors of posttraumatic stress symptoms among Internally Displaced Christian couples in Erbil, Iraq. Front Public Health 2023; 11:1129031. [PMID: 37033064 PMCID: PMC10076725 DOI: 10.3389/fpubh.2023.1129031] [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: 01/04/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Research about the impact of war and displacement experiences on the mental health of Internally Displaced People (IDPs) has recently grown. However, a limited number of studies focus on minorities. The objective of the present preliminary study was to estimate the prevalence of posttraumatic stress symptoms (PTSSs) among IDPs who live outside camps and belong to the Christian minority in Iraq, and to identify possible predictors. Methods Overall, 108 internally displaced Christians (54 married couples) participated in the study. Traumatic events and PTSSs were assessed using the Harvard Trauma Questionnaire. Multivariable linear regression models were used to investigate possible predictors of PTSSs. Multivariable logistic regression models have been developed to estimate the odds of presenting PTSSs. Results Results demonstrated high rates of trauma exposure, with all participants having experienced at least three traumatic events. The estimated prevalence of PTSSs was 20.3%. A low economic status, the number of traumatic events, and a second experience of displacement were associated with increased PTSSs. Five traumatic events were identified as the main predictors of PTSSs. Conclusion Findings from the current preliminary study indicated the impact of war-related traumatic events on IDPs' mental health and the negative effects of post-displacement experiences. These findings may have important implications for setting up psychosocial interventions, as well as for further promoting physical and mental health services among these populations.
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Affiliation(s)
- Sana Rofo
- Department of Psychology, Salesian University of Rome, Rome, Italy
| | - Lina Gelyana
- Department of Psychology, Salesian University of Rome, Rome, Italy
| | - Stefania Moramarco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Luma H. H. Alhanabadi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Primary Health Care, Preventive Health Affairs Directorate, Duhok, Iraq
| | - Faiq B. Basa
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Department, Rizgary Teaching Hospital, Erbil, Iraq
| | | | - Leonardo Emberti Gialloreti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- *Correspondence: Leonardo Emberti Gialloreti
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Neyazi A, Haidarzada AS, Rangelova V, Erfan A, Bashiri B, Neyazi M, Faizi N, Konşuk-Ünlü H, Griffiths MD. Prevalence and predictors of depression among women in Afghanistan: a cross-sectional study. DISCOVER PSYCHOLOGY 2023; 3:7. [PMCID: PMC9987398 DOI: 10.1007/s44202-023-00068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Depression is a very common mental health illness characterized by a cluster of signs and symptoms ranging from mood disturbances and sleep or appetite disorders to physical manifestations of the body. The purpose of the present study was to estimate the prevalence of depression and its related factors among Afghan women. A cross-sectional study was conducted among women between July 14, 2021, to August 15, 2021, in Kabul, Mazar-e-Sharif and Samangan provinces (Afghanistan). A total of 664 Afghan women participated in the study (mean age = 28.85 years; SD ± 11.57). In order to assess depression among participants, the 19-item validated Dari version of the Center for Epidemiological Studies–Depression Scale was used. Approximately four-fifths of the sample had depression symptoms (79.1%). Participants with depression symptoms were significantly more likely to (i) be aged over 30 years, (ii) live in rural areas, (iii) have a low-income level, (iv) not have an occupation, (v) have any disease/illness, and (vi) have experienced an event that had mentally affected them in the past month. Considering the high prevalence of depression symptoms among Afghan women, there is a need to integrate mental health services for women in Afghanistan. The use of interventions including regular screening for depression symptoms, and educating women and girls concerning the symptoms of depression for early self-diagnosis are essential.
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Affiliation(s)
- Ahmad Neyazi
- Afghanistan Center for Epidemiological Studies, Herat, Afghanistan
| | | | - Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University Plovdiv, Plovdiv, Bulgaria
| | - Adiba Erfan
- Faculty of Medicine, Balkh University, Mazar-e-Sharif, Afghanistan
| | - Bahara Bashiri
- Faculty of Pharmacy, Atefi Institute of Health Sciences, Herat, Afghanistan
| | - Mehrab Neyazi
- Faculty of Pharmacy, Atefi Institute of Health Sciences, Herat, Afghanistan
| | - Naweed Faizi
- Faculty of Medicine, Afghan Swiss Higher Educational Institute, Kabul, Afghanistan
| | | | - Mark D. Griffiths
- Department of Psychology, Nottingham Trent University, Nottingham, UK
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Müller F, Abdelnour AM, Rutaremara DN, Arnetz JE, Achtyes ED, Alshaarawy O, Holman HT. Mental Health Screening Differences in Non-English Speaking Patients: Results From a Retrospective Cohort Study. J Prim Care Community Health 2023; 14:21501319231200304. [PMID: 37714820 PMCID: PMC10504842 DOI: 10.1177/21501319231200304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To assess differences in mental health screening based on patient's preferred language. METHODS For this retrospective cohort study, data for 85 725 unique patients from 10 primary care clinics in West Michigan were analyzed if patients received at least 1 mental health screening with the Patient Health Questionnaire 4 (PHQ-4) within a 12-month period (10/15/2021-10/14/2022). A general linear regression model was used to assess the adjusted odds ratios (aOR) of being screened. RESULTS Patients having a preferred language other than English (n = 2755) had an 87.0% chance of receiving the recommended mental health screening, compared to 76.7% of English-speaking patients (P < .001). A multivariable model revealed decreased screening odds for Kinyarwanda (aOR 0.29, 95% CI 0.19-0.45) and Persian/Dari/Pashto (aOR 0.46, 95% CI 0.23-0.91) speaking patients and higher screening odds for Spanish (aOR 1.45, 95% CI 1.19-1.77), Bosnian (aOR 2.13, 95% CI 1.11-4.11), and Vietnamese (aOR 2.25 95% CI 1.64-3.08) speaking patients compared to English speaking patients. CONCLUSIONS Results highlight the inequities between the language groups that are probably the result of the challenges to access multilingual depression and anxiety screening instruments. Furthermore, providers may be prone to bias about who they think "needs" a mental health screening. We suggest that measures are implemented to ensure consistency in mental health screening regardless of a patients' preferred language.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Alyssa M. Abdelnour
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Diana N. Rutaremara
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Eric D. Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Harland T. Holman
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
- Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA
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Barbui C, Tedeschi F, Acarturk C, Anttila M, Au T, Baumgartner J, Carswell K, Churchill R, Cuijpers P, Karyotaki E, Klein T, Koesters M, Lantta T, Nosè M, Ostuzzi G, Pasquini M, Prina E, Sijbrandij M, Tarsitani L, Turrini G, Uygun E, Välimäki M, Walker L, Wancata J, White RG, Purgato M. Risk factors for mental disorder development in asylum seekers and refugees resettled in Western Europe and Turkey: Participant-level analysis of two large prevention studies. Int J Soc Psychiatry 2022; 69:664-674. [PMID: 36326024 DOI: 10.1177/00207640221132430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In asylum seekers and refugees, the frequency of mental disorders, such as depression, anxiety and post-traumatic stress disorder, is higher than the general population, but there is a lack of data on risk factors for the development of mental disorders in this population. AIM This study investigated the risk factors for mental disorder development in a large group of asylum seekers and refugees resettled in high- and middle-income settings. METHODS Participant-level data from two randomized prevention studies involving asylum seekers and refugees resettled in Western European countries and in Turkey were pooled. The two studies randomized participants with psychological distress, but without a diagnosis of mental disorder, to the Self-Help Plus psychological intervention or enhanced care as usual. At baseline, exposure to potentially traumatic events was measured using the Harvard Trauma Questionnaire-part I, while psychological distress and depressive symptoms were assessed with the General Health Questionnaire and the Patient Health Questionnaire. After 3 and 6 months of follow-up, the proportion of participants who developed a mental disorder was calculated using the Mini International Neuropsychiatric Interview. RESULTS A total of 1,101 participants were included in the analysis. At 3- and 6-month follow-up the observed frequency of mental disorders was 13.51% (115/851) and 24.30% (207/852), respectively, while the frequency estimates after missing data imputation were 13.95% and 23.78%, respectively. After controlling for confounders, logistic regression analysis showed that participants with a lower education level (p = .034), a shorter duration of journey (p = .057) and arriving from countries with war-related contexts (p = .017), were more at risk of developing mental disorders. Psychological distress (p = .004), depression (p = .001) and exposure to potentially traumatic events (p = .020) were predictors of mental disorder development. CONCLUSIONS This study identified several risk factors for the development of mental disorders in asylum seekers and refugees, some of which may be the target of risk reduction policies. The identification of asylum seekers and refugees at increased risk of mental disorders should guide the implementation of focused preventative psychological interventions.
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Affiliation(s)
- Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Federico Tedeschi
- 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, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Minna Anttila
- University of Turku, Department of Nursing Science, University of Turku, Finland
| | - Teresa Au
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Josef Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ken Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands.,Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Germany
| | | | - Tella Lantta
- University of Turku, Department of Nursing Science, University of Turku, Finland
| | - Michela Nosè
- 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, Italy
| | - Giovanni Ostuzzi
- 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, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Ersin Uygun
- Trauma and Disaster Mental Health, Istanbul Bilgi University, Turkey
| | - Maritta Välimäki
- University of Turku, Department of Nursing Science, University of Turku, Finland.,Xiangya Nursing School, Central South University, Xiangya Center for Evidence-Based Practice and Healthcare Innovation, Changsha, China
| | - Lauren Walker
- Department of Health Sciences, University of York, UK
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Ross G White
- School of Psychology, Queen's University Belfast, UK
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
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James PB, Renzaho AMN, Mwanri L, Miller I, Wardle J, Gatwiri K, Lauche R. The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis. Psychiatry Res 2022; 317:114899. [PMID: 36252417 DOI: 10.1016/j.psychres.2022.114899] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence exists reporting a high mental health burden among migrants globally. However, there is no global estimate of mental ill-health among African migrants despite their adverse pre-migration environments. This systematic review and meta-analysis summarise the current scholarship regarding the prevalence of anxiety, depression and Post-traumatic Stress Disorder (PTSD) in the global African migrant population. METHODS We searched six databases (Medline (EBSCOHost), PsycINFO (EBSCOHost), Web of Science, PubMed, Scopus and Cumulative Index to Nursing and Allied Health (CINAHL) from 1st January 2000 to 31st August 2021. We screened retrieved articles using strict inclusion and exclusion criteria. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools. Random-effects meta-analyses were employed using DerSimonian and Laird estimator based on inverse variance weights. The I2 statistic was used to measure heterogeneity. RESULTS Our search retrieved 1091 articles, of which 46 were included representing a total of 28,367 African migrants. The weighted mean age of African migrants was 32.98 years, and nearly half were male (n= 12852, 45.31%). Among the included studies, almost nine out of ten (n=41, 89.1%) were cross-sectional studies. The pooled prevalence of anxiety, depression and PTSD was 34.60%;95%CI (26.30-43.00), 33.20%;95%CI (27.70-38.37) and 37.9%;95%CI (23.5- 52.4) respectively. Significant heterogeneity (I2 >98%) existed in the prevalence estimates for anxiety, depression, and PTSD. Sub-group analyses indicate a significantly higher prevalence of anxiety and depression but PTSD for studies conducted in Africa than outside Africa. Similarly, higher prevalence rates for anxiety, depression, and PTSD were seen in studies that used a screening tool than in those that used a diagnostic tool, although a significant difference was observed for depression only. CONCLUSION Despite significant heterogeneity among included studies, our systematic review and meta-analysis show a high prevalence of anxiety, depression, and PTSD among African migrants. Our findings underscore the need to develop and implement serious, culturally appropriate mental health interventions that address post-migration stressors that increase their risk of mental ill-health and successful integration into host communities.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia; Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Andre M N Renzaho
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Lillian Mwanri
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, SA 5000, Australia
| | - Ian Miller
- Sport and Exercise Science, Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| | - Kathomi Gatwiri
- Centre for Children & Young People, Faculty of Health, Southern Cross University, Gold Coast, Australia
| | - Romy Lauche
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
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Renzaho AM, Hall BJ, Chen W. The mental health-migration interface among sub-Saharan African and Chinese populations. Curr Opin Psychol 2022; 47:101416. [DOI: 10.1016/j.copsyc.2022.101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
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Tay AK. The mental health needs of displaced people exposed to armed conflict. THE LANCET PUBLIC HEALTH 2022; 7:e398-e399. [DOI: 10.1016/s2468-2667(22)00088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
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Abstract
UNLABELLED Russian invasion of Ukraine has led to one of the largest refugee crises in recent history. Many internally displaced Ukrainians and refugees will need care for PTSD, anxiety, and depression. Here I will suggest practical steps to reduce long-term impact of trauma and stress on refugees' mental and physical health, and functioning. These include mental health first aid in acute phase of arrival, education of mental health and navigating healthcare system in the host countries. As well, training of manualized trauma-focused therapy and intervention methods in the host countries, focused education for physicians on psychopharmacological interventions for common mental health issues among refugees (PTSD, depression, anxiety), and utilization of videoconferencing for treatment, and consultation and supervision for providers. HIGHLIGHTS Many internally displaced Ukrainians and refugees will need care for PTSD, anxiety, and depression to prevent long-term disability and health consequences.There are challenges in receiving the needed care including stigma, lack of awareness by patients and providers, lack of resources, and lack of skills in trauma-focused treatments.In this article, suggestions are made on how to overcome these obstacles, that include mental health first aid upon arrival, education for refugees and those serving them, training providers at different layers, and remote treatment and counselling/supervision services.
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Affiliation(s)
- Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic (STARC), Wayne State University School of Medicine, Detroit, MI, USA
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