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Pettrich A, Nesterko Y, Rimek E, Glaesmer H. [Psychodiagnostics in Psychosocial Centers for Refugees]. Psychother Psychosom Med Psychol 2024. [PMID: 39102845 DOI: 10.1055/a-2352-2984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
OBJECTIVE Accurate psychodiagnostics is crucial for diagnosing and ensuring quality treatment for individuals with mental health disorders. However, there is limited understanding of psychodiagnostic practices within Psychosocial Centers (PSZ) when dealing with refugees, particularly in the presence of language and cultural barriers and resource constraints. This study aims to evaluate the current status and potential pathways for enhancing culturally sensitive diagnostics in this context. METHODS We conducted an online survey using a self-developed questionnaire with representatives from 32 PSZ to examine psychodiagnostic practices, barriers, and perceived development potentials, and analyzed the data descriptively. RESULTS Most centers prefer individual case assessments over standardized diagnostics. Key barriers to using standardized questionnaires and interviews include communication difficulties (unfamiliarity with question formats, reading and writing difficulties) and resource limitations (time, translation). When conducting diagnostics, time constraints and prioritizing complex cases are the primary challenges. Additional assessments are needed for several disorders and languages. Employees are interested in receiving training in the field of culturally sensitive diagnostics. DISCUSSION Diagnostic practice in the PSZs is characterized by numerous challenges that differ from the challenges in standard care. In order to ensure appropriate standardized diagnostics and care for mentally distressed people with a refugee or migrant background, further expansion of the linguistic and cultural adaptation of established diagnostic instruments is essential. CONCLUSION In the care of psychologically distressed refugees, culturally sensitive standardized diagnostics offer critical benefits for both practitioners and affected individuals. Existing resources are being referred to.
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Affiliation(s)
- Amelie Pettrich
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Universität Leipzig
| | - Yuriy Nesterko
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Universität Leipzig
- Wissenschaftliche Abteilung, Zentrum ÜBERLEBEN, Berlin
- Klinisch-Psychologische Intervention, Freie Universität Berlin
| | - Elisa Rimek
- Klinische Psychologie und Psychotherapie, Universität Leipzig
| | - Heide Glaesmer
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Universität Leipzig
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McDermott L, Hameed I, Lau-Zhu A. Cultural Adaptations, Efficacy, and Acceptability of Psychological Interventions for Mental Health in Adults? with Refugees and Asylum-Seeker Status: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241262262. [PMID: 39096106 DOI: 10.1177/15248380241262262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
People with refugees and asylum seeker status (R/AS) have been forced to leave their home and resettle in new countries due to political unrest, conflict, and violence. This review aimed to describe the nature and extent of cultural adaptations to psychological interventions for adults with R/AS experiencing clinically significant psychological distress, and the acceptability and efficacy of these interventions. A search was conducted in October 2023 and February 2024 across five electronic databases: PsycINFO, Medline, Embase, PubMed, and Cochrane. Eligible studies were randomized controlled trials of psychological interventions conducted in any geographic context. Studies reporting on interventions with minimal adaptations only to facilitate treatment access, with no clear evidence for cultural adaptation, were excluded. Eighteen studies were identified, and cultural adaptations were described in line with the Ecological Validity Model. Studies investigating transdiagnostic interventions, cognitive behavioral therapy (CBT) interventions, and other psychotherapies were synthesized. Analysis and reporting of acceptability were limited across intervention groups, highlighting a need for more robust research in this area. CBT interventions and other psychological therapies were found to be most efficacious with moderate to large effects across validated psychological measures. Small to moderate effect sizes were observed across transdiagnostic interventions. The evidence quality was generally of some concerns. While the evidence requires further developments, the current review provides a timely synthesis of culturally adapted interventions for adults with R/AS to inform intervention development and clinical practice. Strengths, limitations, and recommendations for future research are discussed.
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Affiliation(s)
| | - Ikra Hameed
- University of Oxford, UK
- Oxford Health NHS Foundation Trust, UK
| | - Alex Lau-Zhu
- University of Oxford, UK
- Oxford Health NHS Foundation Trust, UK
- Imperial College London, UK
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3
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Mabil-Atem JM, Gumuskaya O, Wilson RL. Digital mental health interventions for the mental health care of refugees and asylum seekers: Integrative literature review. Int J Ment Health Nurs 2024; 33:760-780. [PMID: 38291740 DOI: 10.1111/inm.13283] [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: 03/09/2023] [Revised: 11/18/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
This study aimed to provide a critical analysis of the current literature on the use of digital mental health interventions (DMHIs) for the management and treatment of mental health disorders among refugees and asylum seekers. These groups are among the most disadvantaged compared to the general population in terms of health and socio-economic status, due to conflicts and wars. The number of refugees fleeing their home countries is growing exponentially, and refugees experience trauma, torture, persecution and human right abuses, which have a profound effect on their mental health and overall well-being. The researchers conducted an integrative literature review from electronic databases Medline, CINAHL and Google Scholar, selecting articles published in English from 2010 to 2023. The thematic analysis of the 10 articles identified in the review revealed four main themes and two sub-themes: (1) types of digital health intervention/apps used; (2) barriers encountered in digital health intervention; (3) user experience of the digital health intervention and (4) mapping gaps. Two sub-themes were identified located in Theme 2: (2.1) Language and demographic barriers and (2.2) Structural barriers. The study showed that the use of DMHIs was associated with positive experiences among refugees and asylum seekers. Limited mental health care is offered to refugees and asylum seekers due to a range of logistical, political, economic, geographical, language, cultural and social barriers. DMHIs have the potential to overcome and/or moderate these barriers. The study concludes that the scaled implementation of effective DMHIs holds the possibility to improve the wider distribution of mental health care among refugees and asylum seekers. However, further research is needed to confirm the effectiveness of DMHIs and to scale up studies for their utilisation among this group. In summary, this study highlights the potential of DMHIs in improving the mental health care of refugees and asylum seekers. The results of this study have important implications for mental health service providers, policymakers and researchers to address the mental health needs of this vulnerable/priority group.
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Affiliation(s)
| | - Oya Gumuskaya
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rhonda L Wilson
- University of Newcastle, Callaghan, New South Wales, Australia
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Sijbrandij M, Bass JK, Carswell K, Hamdani SU, Karyotaki E. Tipping the scales for global mental health: A summary of the Presidential Panel at the 39th Annual Meeting of the International Society for Traumatic Stress Studies. J Trauma Stress 2024. [PMID: 39018333 DOI: 10.1002/jts.23085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/06/2024] [Accepted: 06/09/2024] [Indexed: 07/19/2024]
Abstract
In the past decade, there has been an increasing focus within scientific research on how to assist people affected by the negative consequences of trauma and crises around the globe. As many countries struggle with a lack of resources to deliver mental health interventions, scalable strategies have been developed to help more people in need. These scalable strategies were the theme of the 39th annual meeting of the International Society for Traumatic Stress Studies (ISTSS). The presidential panel, chaired by Marit Sijbrandij during her ISTSS presidency, brought together a group of experts in the field of scalable interventions: Kenneth Carswell, Syed Usman Hamdani, Judy Bass, and Eirini Karyotaki. The panel highlighted the current state of the evidence on scalable interventions for adults and children and outlined important next steps for research and implementation. These recommendations include further improving the availability of, and evidence for, scalable interventions through increased training and sustained funding; conducting more studies in underrepresented samples, such as children and adolescents; and promoting open access availability of research findings worldwide. In this paper, we provide an overview of the topics discussed in the panel as well as the key takeaways.
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Affiliation(s)
- Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenneth Carswell
- Department of Mental Health, Brain Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Syed Usman Hamdani
- Global Institute of Human Development (GIHD), Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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5
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Serra R, Purgato M, Tedeschi F, Acartürk C, Karyotaki E, Uygun E, Turrini G, Winkler H, Pinucci I, Wancata J, Walker L, Popa M, Sijbrandij M, Välimäki M, Kösters M, Nosè M, Anttila M, Churchill R, White RG, Lantta T, Klein T, Wochele-Thoma T, Tarsitani L, Barbui C. Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model. Eur J Psychotraumatol 2024; 15:2355828. [PMID: 38828909 PMCID: PMC11149571 DOI: 10.1080/20008066.2024.2355828] [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: 01/23/2024] [Accepted: 04/13/2024] [Indexed: 06/05/2024] Open
Abstract
Background: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs.
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Affiliation(s)
- Riccardo Serra
- World Health Organization 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 Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marianna Purgato
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- World Health Organization 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
| | - Ceren Acartürk
- Department of Psychology, Koc University, Istanbul, Türkiye
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ersin Uygun
- Department of Psychology, Koc University, Istanbul, Türkiye
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Giulia Turrini
- World Health Organization 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
| | | | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Johannes Wancata
- Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lauren Walker
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Mariana Popa
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maritta Välimäki
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
- School of Public Health, University of Helsinki, Helsinki, Finland
| | - Markus Kösters
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, T U Dresden, Chemnitz, Germany
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Michela Nosè
- World Health Organization 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
| | - Minna Anttila
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ross G. White
- School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Tella Lantta
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia
| | - Thomas Klein
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, T U Dresden, Chemnitz, Germany
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | | | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Corrado Barbui
- World Health Organization 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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Woodward A, Fuhr DC, Barry AS, Balabanova D, Sondorp E, Dieleman MA, Pratley P, Schoenberger SF, McKee M, Ilkkursun Z, Acarturk C, Burchert S, Knaevelsrud C, Brown FL, Steen F, Spaaij J, Morina N, de Graaff AM, Sijbrandij M, Cuijpers P, Bryant R, Akhtar A, Roberts B. Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East. OPEN RESEARCH EUROPE 2024; 3:14. [PMID: 39086733 PMCID: PMC11289593 DOI: 10.12688/openreseurope.15293.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 08/02/2024]
Abstract
Background Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS systems. Methods A mixed-methods rapid appraisal methodology guided by an adapted WHO Health System Framework was used to assess HSR in eight countries (Egypt, Germany, Jordan, Lebanon, Netherlands, Sweden, Switzerland, and Türkiye). Quantitative and qualitative analysis of primary and secondary data was used. Data collection and analysis were performed iteratively by multiple researchers. Country reports were used for comparative analysis and synthesis. Results We found numerous constraints in HSR: i) Too few appropriate mental health providers and services; ii) Travel-related barriers impeding access to services, widening rural-urban inequalities in the distribution of mental health workers; iii) Cultural, language, and knowledge-related barriers to timely care likely caused by insufficient numbers of culturally sensitive providers, costs of professional interpreters, somatic presentations of distress by Syrian refugees, limited mental health awareness, and stigma associated to mental illness; iv) High out-of-pocket costs for psychological treatment and transportation to services reducing affordability, particularly in middle-income countries; v) Long waiting times for specialist mental health services; vi) Information gaps on the mental health needs of refugees and responsiveness of MHPSS systems in all countries. Six recommendations are provided to address these issues. Conclusions All eight host countries struggle to provide responsive MHPSS to Syrian refugees. Strengthening the mental health workforce (in terms of quantity, quality, diversity, and distribution) is urgently needed to enable Syrian refugees to receive culturally appropriate and timely care and improve mental health outcomes. Increased financial investment in mental health and improved health information systems are crucial.
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Affiliation(s)
- Aniek Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Daniela C. Fuhr
- Health Sciences, University of Bremen, Bremen, 28359, Germany
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, 28359, Germany
| | - Alexandra S. Barry
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
- NHS England, London, SE1 8UG, UK
| | - Dina Balabanova
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Egbert Sondorp
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
| | | | - Pierre Pratley
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
| | - Samantha F. Schoenberger
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Martin McKee
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Zeynep Ilkkursun
- Department of Psychology, Koc University, Sarıyer/İstanbul, Turkey
| | - Ceren Acarturk
- Department of Psychology, Koc University, Sarıyer/İstanbul, Turkey
| | - Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, 14195, Germany
| | - Christine Knaevelsrud
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, 14195, Germany
| | - Felicity L. Brown
- Research and Development Department, War Child Holland, Amsterdam, 1098 LE, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, 1018 WV, The Netherlands
| | - Frederik Steen
- Research and Development Department, War Child Holland, Amsterdam, 1098 LE, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, 1018 WV, The Netherlands
| | - Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, 8091, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, 8091, Switzerland
| | - Anne M. de Graaff
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bayard Roberts
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - STRENGTHS consortium
- KIT Health, KIT Royal Tropical Institute, Amsterdam, 1092 AD, The Netherlands
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Health Sciences, University of Bremen, Bremen, 28359, Germany
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, 28359, Germany
- NHS England, London, SE1 8UG, UK
- Department of Psychology, Koc University, Sarıyer/İstanbul, Turkey
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, 14195, Germany
- Research and Development Department, War Child Holland, Amsterdam, 1098 LE, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, 1018 WV, The Netherlands
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, 8091, Switzerland
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
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Ziyachi M, Castellani B. A 'Cultural Models' Approach to Psychotherapy for Refugees and Asylum Seekers: A Case Study from the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:650. [PMID: 38791864 PMCID: PMC11121039 DOI: 10.3390/ijerph21050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Despite the existence of significant research on the mental health care challenges of migrants, particularly refugees and asylum seekers, less attention has been paid to treatment approaches. We used a case study from the UK to look at the topic from a cultural models approach (which comes from cognitive anthropology) to analyse migrants' experiences with mental health care. Twenty-five refugees and asylum seekers living in North East England and Northern Ireland were interviewed who had used at least six sessions of talking therapy during the last three years. Our results suggested that adopting a 'cultural models' approach, which offers a new conceptual and methodological framework of migrants' experiences and their underlying schemas and expectations, would significantly contribute to building therapeutic alliances and provide relevant and appropriate treatments for migrant clients, particularly for unrecognised pre- and post-migration traumatic experiences.
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Affiliation(s)
- Mohaddeseh Ziyachi
- Department of Sociology, Durham University, Stockton Road, Durham DH1 3LE, UK;
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, Durham DH1 3LE, UK
| | - Brian Castellani
- Department of Sociology, Durham University, Stockton Road, Durham DH1 3LE, UK;
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton Road, Durham DH1 3LE, UK
- Durham Research Methods Centre, Durham University, Stockton Road, Durham DH1 3LE, UK
- Centre for the Evaluation of Complexity Across the Nexus, University of Surrey, Guildford GU2 7XH, UK
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8
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Dickson K, Ko SY(J, Nguyen C, Minchenko D, Bangpan M. Mental health and psychosocial support programmes for displaced populations in low- and middle-income countries (LMICs): A systematic review of process, perspectives and experiences. Glob Ment Health (Camb) 2024; 11:e62. [PMID: 38774885 PMCID: PMC11106547 DOI: 10.1017/gmh.2024.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/12/2024] [Accepted: 04/20/2024] [Indexed: 05/24/2024] Open
Abstract
Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low- and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility.
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Affiliation(s)
- Kelly Dickson
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
| | - Sum Yue (Jessica) Ko
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
| | - Celine Nguyen
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
- Southwestern Medical School, University of Texas, Dallas, TX75390, USA
| | - Dayana Minchenko
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
| | - Mukdarut Bangpan
- The Evidence for Policy and Practice information and Co-ordinating Centre (EPPI-Centre), Social Research Institute, University College London, London, UK
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9
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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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10
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Rawers C, Redican E, Alpay EH, McElroy E, Shevlin M. Multiple trauma exposure and psychopathology in Syrian refugees living in Turkey: A latent class analysis. Acta Psychol (Amst) 2024; 245:104220. [PMID: 38490133 DOI: 10.1016/j.actpsy.2024.104220] [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: 11/19/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND After the Syrian civil war, millions of Syrian refugees migrated to neighboring countries, with the majority settling in Turkey. The prevalence of mental disorders is notably higher among refugee populations. However, prior research on Syrian refugees have mostly used variable-centred approaches which have known limitations. Thus, the present study sought to examine the occurrence and co-occurrence of traumatic experiences among Syrian refugees living in Turkey using latent class analysis (LCA). Additionally, this study aimed to identify the associations between latent class membership and trauma-related psychopathology. METHODS Participants included 593 Syrian refugees living in Turkey. LCA was used to identify latent classes of trauma exposure. Demographic predictors of the latent classes were examined and associations with PTSD, CPTSD, depression and anxiety were also explored. RESULTS Three latent classes were identified based on trauma exposure; a "multiple traumas" class, "war and human suffering" class, and "low exposure, combat-exposed" class. Odds of PTSD, CPTSD, depression, or anxiety diagnosis did not differ significantly between classes, with the exception of the "multiple traumas" class who were more likely to meet the criteria for anxiety diagnosis compared to the "low exposure" class. LIMITATIONS Historic psychiatric symptoms or post-migration stressors could not be accounted for in this study, which may explain the lack of significant differences in most mental health outcomes by trauma exposure class. DISCUSSION The latent classes identified in this study correspond with previous research regarding trauma in Syrian refugees. However, this study largely failed to find significant differences in mental health diagnoses between classes. Future research should consider the effect of post-migration stressors in refugee populations, which may play a crucial role in mental health outcomes.
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Affiliation(s)
| | - Enya Redican
- Ulster University, School of Psychology, Coleraine, UK
| | | | - Eoin McElroy
- Ulster University, School of Psychology, Coleraine, UK
| | - Mark Shevlin
- Ulster University, School of Psychology, Coleraine, UK.
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11
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Jolof L, Rocca P, Carlsson T. Women's experiences of trauma-informed care for forced migrants: A qualitative interview study. Heliyon 2024; 10:e28866. [PMID: 38596047 PMCID: PMC11002685 DOI: 10.1016/j.heliyon.2024.e28866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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12
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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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13
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Mastafa S, de Montgomery CJ, Pettersson E, Norredam M, Krasnik A, Taipale H, Mittendorfer-Rutz E, Cullen AE. Risk of unemployment and work disability among refugee and non-refugee migrants with incident psychotic disorders in Sweden and Denmark. Eur J Public Health 2024; 34:129-135. [PMID: 38115235 PMCID: PMC10843956 DOI: 10.1093/eurpub/ckad207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Unemployment and work disability are common among individuals with non-affective psychotic disorders (NAPDs) but it is unknown whether rates differ among migrants and native-born individuals. The present study aimed to compare the risk of these outcomes during the first 5 years of illness in non-refugee migrants, refugees and native-born individuals with NAPDs in Sweden and Denmark-two countries with different immigration policies and models of early psychosis care. METHODS Using national registers, we identified all individuals aged 18-35 years in Sweden and Denmark who received an incident NAPD diagnosis between 2006 and 2013 (N = 6750 and 8320, respectively). Cohorts were followed for 5 years to determine the days of unemployment and sickness absence (analyzed using zero-inflated negative binomial models) and the time to receipt of disability pension (analyzed using complementary log-log models). RESULTS Relative to their native-born peers, refugees and non-refugee migrants in Sweden and non-refugee migrants in Denmark were significantly less likely to have zero unemployment days (OR range: 0.54-0.72) and all migrant groups experienced more unemployment days (IRR range: 1.26-1.37). Results were largely unchanged after adjustment for sociodemographic and clinical factors. In the adjusted model, both Swedish migrant groups and refugees in Denmark were more likely to experience zero sickness absence days than native-born individuals (OR range: 1.48-1.56). Only refugees in Denmark were at greater risk of disability pension. CONCLUSIONS Non-refugee migrants and refugees with NAPDs in both Sweden and Denmark are particularly vulnerable to experiencing unemployment. Targeted interventions may help to reduce these disparities and promote long-term work ability among migrant groups.
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Affiliation(s)
- Suborna Mastafa
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christopher J de Montgomery
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen, Denmark
| | - Emma Pettersson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marie Norredam
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen, Denmark
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Allan Krasnik
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen, Denmark
| | - Heidi Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alexis E Cullen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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14
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Kurath J, Akhtar A, Karyotaki E, Sijbrandij M, Cuijpers P, Bryant R, Morina N. What works for whom and why? Treatment effects and their moderators among forcibly displaced people receiving psychological and psychosocial interventions: study protocol for an individual patient data meta-analysis. BMJ Open 2024; 14:e078473. [PMID: 38309750 PMCID: PMC10840047 DOI: 10.1136/bmjopen-2023-078473] [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: 08/02/2023] [Accepted: 01/03/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Forcibly displaced people (FDP) have a high risk of developing mental disorders such as post-traumatic stress (PTS) disorder. Providing adequate mental healthcare for FDP is crucial but despite overall efficacy of many existing interventions, a large proportion of FDP does not benefit from treatment, highlighting the necessity of further investigating factors contributing to individual differences in treatment outcome. Yet, the few studies that have explored moderators of treatment effects are often insufficiently powered. Therefore, the present Individual Patient Data meta-analysis (IPD-MA) will investigate treatment effects and their moderators-variables related to beneficiaries, providers, intervention and study characteristics in relation to PTS outcomes. METHODS AND ANALYSIS A systematic literature search will be conducted from database inception in the databases PsycINFO, Cochrane, Embase, PTSDpubs and Web of Science. Only studies published in English, German, French, Spanish, Portuguese, and Dutch will be considered. Retrieved records will be screened for eligibility. Randomised controlled trials on adult FDP receiving psychological and psychosocial interventions aimed at alleviating symptoms such as PTS compared with a control condition without intervention will be included in this IPD-MA. Subsequently, authors of eligible studies will be contacted to request individual patient data (IPD). All datasets obtained will be synthesised into one large dataset which will be analysed using a one-stage approach by conducting mixed-effects linear regression models (ie, primary analysis). Additionally, aggregate data meta-analyes will be run using a two-stage approach by conducting multivariate regression models including all IPD (transformed) and available meta-data from study reports (ie, secondary analysis). PTS will serve as primary outcome measure, while mental health outcomes other than PTS, attendance, attrition, treatment non-response and adverse outcomes will be examined as secondary outcomes. ETHICS AND DISSEMINATION This IPD-MA does not require ethical approval. The results will be published in international peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42022299510.
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Affiliation(s)
- Jennifer Kurath
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Aemal Akhtar
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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15
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Greene MC, Muro M, Kane JC, Young E, Paniagua-Avila A, Miller-Suchet L, Nouel M, Bonz AG, Cristobal M, Schojan M, Ventevogel P, Cheng B, Martins SS, Ponce de Leon JC, Verdeli H. Task Sharing and Remote Delivery of Brief Interpersonal Counseling for Venezuelan Migrants and Refugees Living in Peru during the COVID-19 Pandemic: A Mixed-Methods Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:166. [PMID: 38397657 PMCID: PMC10888378 DOI: 10.3390/ijerph21020166] [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: 11/30/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Refugees and migrants experience an elevated risk for mental health problems and face significant barriers to receiving services. Interpersonal counseling (IPC-3) is a three-session intervention that can be delivered by non-specialists to provide psychological support and facilitate referrals for individuals in need of specialized care. We piloted IPC-3 delivered remotely by eight Venezuelan refugee and migrant women living in Peru. These counselors provided IPC-3 to Venezuelan refugee and migrant clients in Peru (n = 32) who reported psychological distress. Clients completed assessments of mental health symptoms at baseline and one-month post-intervention. A subset of clients (n = 15) and providers (n = 8) completed post-implementation qualitative interviews. Results showed that IPC-3 filled a gap in the system of mental health care for refugees and migrants in Peru. Some adaptations were made to IPC-3 to promote its relevance to the population and context. Non-specialist providers developed the skills and confidence to provide IPC-3 competently. Clients displayed large reductions in symptoms of depression (d = 1.1), anxiety (d = 1.4), post-traumatic stress (d = 1.0), and functional impairment (d = 0.8). Remote delivery of IPC-3 by non-specialists appears to be a feasible, acceptable, and appropriate strategy to address gaps and improve efficiency within the mental health system and warrants testing in a fully powered effectiveness study.
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Affiliation(s)
- M. Claire Greene
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | | | - Jeremy C. Kane
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Erin Young
- Teachers College, Columbia University, New York, NY 10026, USA
| | | | - Lucy Miller-Suchet
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | | | | | | | | | - Peter Ventevogel
- United Nations High Commissioner for Refugees, 1201 Geneva, Switzerland
| | - Bryan Cheng
- Teachers College, Columbia University, New York, NY 10026, USA
| | - Silvia S. Martins
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | | | - Helen Verdeli
- Teachers College, Columbia University, New York, NY 10026, USA
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16
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Abi Ramia J, Abi Hana R, Noun P, Cuijpers P, Carswell K, van't Hof E, Heim E, Zoghbi E, Sijbrandij M, El Chammay R. Feasibility and uptake of a digital mental health intervention for depression among Lebanese and Syrian displaced people in Lebanon: a qualitative study. Front Public Health 2024; 11:1293187. [PMID: 38317685 PMCID: PMC10840138 DOI: 10.3389/fpubh.2023.1293187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/22/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Digital interventions are increasingly regarded as a potential solution for the inaccessibility of mental health treatment across low-and-middle-income settings, especially for common mental disorders. Step-by-Step (SbS) is a digital, guided self-help intervention for depression found effective in two Randomized Controlled Trials (RCTs) in Lebanon. For research implementation and further scale-up, this paper reports the results of a qualitative evaluation of SbS among the Lebanese and others and displaced Syrians in Lebanon. Methods Thirty-four Key Informant Interviews (KIIs) were executed with participants of the RCTs, SbS staff members, and external stakeholders. Questions garnered feedback about the feasibility, acceptability, enabling factors, and barriers to adhering to the research, implementation, and the SbS intervention. A thematic analysis was conducted using NVivo, and key themes, topics, and recommendations, on research methods and the intervention itself, were generated and reported. Results Results showed a high level of acceptability of SbS among Lebanese and Syrians and identified sub-groups for whom acceptance or use might be lower, such as older adults and people with limited access to the internet or smartphones. Furthermore, interviews identified the main enabling factors and barriers to adherence related to the research design, content, and delivery approach. Barriers related to feasibility included lengthy assessments as part of the RCTs, and mistrust related to delays in study compensations. Other common challenges were forgetting login credentials, poor internet connection, being busy and competing needs. Enabling factors and best practices included motivating participants to use the intervention through the weekly support provided by helpers, setting an oral contract for commitment, and dividing the compensations into several installments as part of the RCTs. Recommendations regarding sustainability were given. Discussion The findings show that overall, SbS is feasible, acceptable, and much needed in Lebanon among the Lebanese and Syrians. This assessment identifies reasons for low adherence to the research and the intervention and presents improvement solutions. Recommendations generated in this paper inform the upscale of SbS and the planning, design, and implementation of future digital interventions in research and service provision settings in the mental health field.
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Affiliation(s)
- Jinane Abi Ramia
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization (WHO) Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Racha Abi Hana
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization (WHO) Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Philip Noun
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization (WHO) Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- International Institute for Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Edith van't Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Edwina Zoghbi
- Country Office for Lebanon, World Health Organization, Beirut, Lebanon
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, World Health Organization (WHO) Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Rabih El Chammay
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
- Psychiatry Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Dumke L, Schmidt T, Wittmann J, Neldner S, Weitkämper A, Catani C, Neuner F, Wilker S. Low access and inadequate treatment in mental health care for asylum seekers and refugees in Germany-A prospective follow-up study over 12 months and a nationwide cross-sectional study. Appl Psychol Health Well Being 2024. [PMID: 38193582 DOI: 10.1111/aphw.12523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
Refugees experience elevated rates of mental health problems, but little is known about mental health service utilization and quality among asylum seekers and refugees in Europe. In a 12-month follow-up study of newly arrived refugees (N = 166, Mage = 32.38 years, 30.7% female) and a nationwide cross-sectional study (N = 579, Mage = 33.89 years, 36.2% female) of refugees who had been living in Germany for an average of 6 years, we examined objective need for mental health treatment, perceived need, access to treatment services, and adequacy of treatment. We defined minimally adequate mental health treatment according to the WHO World Mental Health Survey as ≥8 sessions of psychotherapy (minimally adequate psychotherapy) or pharmacotherapy plus ≥4 medical visits (minimally adequate pharmacotherapy). In both studies, two in three individuals screened for mental health symptoms and additionally perceived a need for professional treatment. Of those, less than half had contact to any service provider, with only 1 in 14 receiving minimally adequate psychotherapy. Overall, no more than one in seven of refugees in need received minimally adequate treatment. Despite a comprehensive mental health-care system, refugees' access to mental health care and the treatment provided are inadequate. Health policies are urgently needed to provide equitable mental health care for all.
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Affiliation(s)
- Lars Dumke
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Telja Schmidt
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Jasmin Wittmann
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sina Neldner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Claudia Catani
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sarah Wilker
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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18
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Lovric S, Klaric M, Lovric I, Camber R, Kresic Coric M, Kvesic J, Kajic-Selak A. Clinical characteristics of psychotic disorders in patients with childhood trauma. Medicine (Baltimore) 2023; 102:e36733. [PMID: 38134067 PMCID: PMC10735130 DOI: 10.1097/md.0000000000036733] [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: 01/26/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Childhood trauma is an important predictor of psychotic disorders, with special emphasis on physical and sexual abuse. It influences the clinical picture and course of psychotic disorders. This study was conducted in the Department of Psychiatry of the University Clinical Hospital Mostar. The sample consisted of 135 participants, aged 18 to 65 years. The screening instrument to examine cognitive status was the short version of MMSE-2. Patients' background information was collected using a sociodemographic questionnaire constructed for this study. To determine childhood trauma, the Child Abuse Experience Inventory was used to examine physical, sexual, and emotional abuse, neglect and domestic violence. The positive and negative syndrome scale scale was used to evaluate the clinical profile of psychoticism, the SSI questionnaire was used to evaluate the severity of suicidality, and the functionality of the participants was evaluated using the WHODAS 2.0. Results indicate that a significant number of participants with psychotic disorders experienced childhood trauma, an important determinant of their illness. Participants who had witnessed abuse had more severe clinical presentations (earlier onset and longer duration of illness) and more pronounced psychotic symptomatology and a lower degree of functionality. Decreased functionality is associated with witnessing abuse and physical abuse. During the civil war, a significant percentage of the participants were in childhood and adolescent development (26.7%) and exposed to frequent emotional abuse and domestic violence. As 1 traumatic event in childhood makes a person more susceptible to more traumatic experiences during life. Childhood trauma is a serious and pervasive problem that has a significant impact on the development, course, and severity of the clinical presentation of psychotic disorders. Accordingly, it is necessary to provide continuous education to mental health workers, primarily psychiatrists, regarding childhood trauma so that treatment may be approached more systematically and a plan of therapeutic interventions may be more adequately designed, which would necessarily include psychosocial support in addition to pharmacotherapy.
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Affiliation(s)
- Sanjin Lovric
- Department of Psychiatry of the University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Miro Klaric
- Department of Psychiatry of the University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ivona Lovric
- Department of Dermatology of the University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Renata Camber
- Department of Psychiatry of the University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Martina Kresic Coric
- Department of Psychiatry of the University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Josip Kvesic
- Department of Psychiatry of the University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Anita Kajic-Selak
- Department of Psychiatry of the University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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Hjern A. Psychosocial support for refugee parents in well-baby clinics. Acta Paediatr 2023; 112:2460-2461. [PMID: 37784233 DOI: 10.1111/apa.16987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet, Stockholm University, Stockholm, Sweden
- Department of Medicine, Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
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Khairat M, Hodge S, Duxbury A. Refugees' and asylum seekers' experiences of individual psychological therapy: A qualitative meta-synthesis. Psychol Psychother 2023; 96:811-832. [PMID: 37166267 DOI: 10.1111/papt.12470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE The current review aimed to synthesise qualitative literature exploring adult refugees' and asylum seekers' experiences of individual psychological therapy. METHODS A comprehensive systematic search of the following databases led to the identification of eight studies for inclusion in this review: PsycINFO, PsycARTICLES, MEDLINE, EMBASE, CINAHL and Academic Search Ultimate. All selected studies used qualitative methodology to explore refugees' and asylum seekers' experiences of individual psychological therapy. Studies were appraised using an adapted version of the Critical Appraisal Skills Programme (CASP) Tool. The data from these selected studies were then synthesised using a meta-ethnographic approach. RESULTS The synthesis of selected studies resulted in the development of five themes; (i) the importance of recognition and validation within therapy, (ii) building a human connection within the therapeutic relationship and the importance of cultural competency, (iii) revisiting trauma, managing difficult emotions from therapy and regaining hope, (iv) the value of practical interventions, (v) 'one should not wake up the djinns (demons)'-cultural stigma and accessing therapy. These themes illustrated the complexities of working therapeutically with asylum seekers and refugees and the vital role of building trust and safety within the therapeutic relationship prior to engagement in therapeutic work. The results also highlighted varied responses to engaging in trauma work ranging from participants finding the experience transformative to others finding it unhelpful, some participants preferred more practical interventions. Participants' cultural backgrounds and pre-conceptions around therapy impacted on engagement and the therapist's cultural competency was a significant factor in therapeutic engagement. CONCLUSIONS Working therapeutically with asylum seekers and refugees involves a number of factors for consideration. Forced migrants' socio-political context was seen as central to their experiences of distress and recognition of these factors was imperative for positive therapeutic engagement. This review highlights a number of clinical implications to guide practitioners working therapeutically with this community.
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Affiliation(s)
- Mariam Khairat
- The Division of Health Research, Lancaster University, Lancaster, UK
| | - Suzanne Hodge
- The Division of Health Research, Lancaster University, Lancaster, UK
| | - Anna Duxbury
- Lancashire Emotional Health in Schools Service, Lancaster University, Lancaster, UK
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21
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Wells R, Acarturk C, Mozumder MK, Kurt G, Klein L, Lekkeh SA, Beetar A, Jahan S, Almeamari F, Faruk MO, McGrath M, Alam SF, Alokoud M, Dewan R, Vecih AE, El-Dardery H, Hadzi-Pavlovic D, Hammadi H, Hamoud MAS, Hasan MT, Joshi R, Kothaa S, Lamia FKC, Mastrogiovanni C, Najjar H, Nemorin S, Nicholson-Perry K, Prokrity TS, Said Yousef R, Tawakol M, Uygun E, Yasaki W, Wong S, Zarate A, Steel Z, Rosenbaum S. Testing the effectiveness and acceptability of online supportive supervision for mental health practitioners in humanitarian settings: a study protocol for the caring for carers project. BMC Psychiatry 2023; 23:884. [PMID: 38017407 PMCID: PMC10683137 DOI: 10.1186/s12888-023-05246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/01/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Local humanitarian workers in low and middle-income countries must often contend with potentially morally injurious situations, often with limited resources. This creates barriers to providing sustainable mental health and psychosocial support (MHPSS) to displaced individuals. Clinical supervision is an often neglected part of ensuring high-quality, sustainable care. The Caring for Carers (C4C) project aims to test the effectiveness and acceptability of online group-based supportive supervision on the well-being of MHPSS practitioners, as well as service-user-reported service satisfaction and quality when working with displaced communities in Türkiye, Syria, and Bangladesh. This protocol paper describes the aim, design, and methodology of the C4C project. METHOD A quasi-experimental, mixed-method, community-based participatory research study will be conducted to test the effectiveness of online group-based supportive clinical supervision provided to 50 Syrian and 50 Bangladeshi MHPSS practitioners working with Syrian and Rohingya displaced communities. Monthly data will be collected from the practitioners and their beneficiaries during the active control (six months) and supervision period (16 months over two terms). Outcomes are psychological distress (Kessler-6), burnout (the Copenhagen Burnout Inventory), compassion fatigue, compassion satisfaction, and secondary traumatic stress (Professional Quality of Life Scale), perceived injustice, clinical self-efficacy (Counseling Activity Self-Efficacy Scale), service satisfaction, and quality (Client Satisfaction Questionnaire and an 18-item measure developed in this project). A realist evaluation framework will be used to elucidate the contextual factors, mechanisms, and outcomes of the supervision intervention. DISCUSSION There is a scarcity of evidence on the role of clinical supervision in improving the well-being of MHPSS practitioners and the quality of service they provide to displaced people. By combining qualitative and quantitative data collection, the C4C project will address the long-standing question of the effectiveness and acceptability of clinical supervision in humanitarian settings.
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Affiliation(s)
- Ruth Wells
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia.
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Türkiye
| | | | - Gülşah Kurt
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Louis Klein
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | | | | | - Sabiha Jahan
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | - Md Omar Faruk
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | - Michael McGrath
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Syeda Fatema Alam
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | - Ranak Dewan
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | | | - Dusan Hadzi-Pavlovic
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | | | | | - M Tasdik Hasan
- Action Lab, Department of Human Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Australia
| | - Rohina Joshi
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Sowmic Kothaa
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | - Chiara Mastrogiovanni
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | | | - Shaun Nemorin
- New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), Sydney, Australia
| | - Kathryn Nicholson-Perry
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, Australia
| | | | | | - Mamoun Tawakol
- Department of Psychology, Koc University, Istanbul, Türkiye
| | - Ersin Uygun
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Wael Yasaki
- Hope Revival Organization, Gaziantep, Türkiye
| | - Scarlett Wong
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Ariel Zarate
- Suicide Prevention Subgroup, Cox's Bazar, Bangladesh
| | - Zachary Steel
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Simon Rosenbaum
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
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22
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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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23
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Spaaij J, de Graaff AM, Akhtar A, Kiselev N, McDaid D, Moergeli H, Pfaltz MC, Schick M, Schnyder U, Bryant RA, Cuijpers P, Sijbrandij M, Morina N. The effect of a low-level psychological intervention (PM+) on post-migration living difficulties - Results from two studies in Switzerland and in the Netherlands. Compr Psychiatry 2023; 127:152421. [PMID: 37708580 DOI: 10.1016/j.comppsych.2023.152421] [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: 03/14/2023] [Revised: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS OF THE STUDY After arriving in host countries, most refugees are confronted with numerous post-migration stressors (e.g., separation from family, discrimination, and employment difficulties). Post-migration living difficulties (PMLDs) significantly contribute to the development and persistence of mental disorders. Effective treatment approaches focusing on reducing post-migration stress are urgently needed. The aim of the present study was to examine the effect of a brief psychological intervention, Problem Management Plus (PM+), on PMLDs among Syrian refugees in two European countries. METHODS We merged data from two single-blind feasibility trials with Syrian refugees experiencing elevated levels of psychological distress and impaired functioning in Switzerland (N = 59) and the Netherlands (N = 60). Participants were randomised to receive either five sessions of PM+ or an enhanced care-as-usual control condition. PMLDs were assessed at baseline and 3 months after the intervention. To estimate treatment effect on PMLD, linear mixed model analysis was performed. RESULTS Three months after the intervention, participants in the PM+ condition reported significantly fewer PMLDs compared to the control condition. Further analyses at item-level showed that interpersonal and family related PMLDs, such as "worries about family back home" significantly improved over time in the PM+ condition. CONCLUSIONS This exploratory study suggests that brief psychological interventions have the potential to reduce PMLDs in refugees and asylum seekers. The reduction of post-migration stress in turn may subsequently lead to an overall reduction in psychological distress. CLINICAL TRIAL NUMBERS BASEC Nr. 2017-0117 (Swiss trial) and NL61361.029.17, 7 September 2017 (Dutch trial).
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Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; PluSport, Umbrella Organization of Swiss Disabled Sports, Volketswil, Switzerland; Swiss Research Institute of Public Health and Addiction (ISGF), University of Zürich, Zurich, Switzerland
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Mid Sweden University, Department of Psychology and Social Work, Östersund, Sweden
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre 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 Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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24
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Kurt G, Ekhtiari M, Ventevogel P, Ersahin M, Ilkkursun Z, Akbiyik N, Acarturk C. Socio-cultural integration of Afghan refugees in Türkiye: the role of traumatic events, post-displacement stressors and mental health. Epidemiol Psychiatr Sci 2023; 32:e51. [PMID: 37539679 PMCID: PMC10465316 DOI: 10.1017/s204579602300063x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS Socio-cultural integration of refugees has received scant attention in the academic literature. Türkiye hosts the largest number of refugees, including Afghans, as the second largest asylum-seeking group in Türkiye. There is a dearth of research into the mental health and integration of Afghan refugees in Türkiye. The aim of the present study was to investigate socio-cultural integration outcomes among Afghan refugees in Türkiye by considering the role of traumatic events and post-displacement stressors. The role of mental health in integration outcomes was further examined. METHODS A cross-sectional, web-based survey study with 785 Afghan refugees in Türkiye was conducted between April and June 2021. Data were collected on socio-demographic characteristics, potentially traumatic events (PTEs) (Harvard Trauma Questionnaire), post-displacement stressors (Post-Migration Living Difficulties Checklist), mental health symptoms (Hopkins Symptoms Checklist-25), social integration- social bonds (contact with co-ethnic group members) and social bridges (contact with the host community)- and cultural integration (Vancouver Index of Acculturation). Structural equation modelling was conducted to test the hypothesized relationship between conflict and displacement-related stressors, mental health and socio-cultural integration. RESULTS Findings showed that conflict-related traumatic events and post-displacement stressors significantly predicted higher mental health symptoms. Experiencing traumatic events significantly predicted higher levels of social bridges, adopting destination culture and lower level of maintaining heritage culture. Mental health problems predicted the relationship between stressors related to forced displacement and integration outcomes-social bridges and adopting destination culture. These findings highlight the role of mental health as an indispensable resource for socio-cultural integration. Further, conflict and displacement-related stressors are important determinants of socio-cultural integration among Afghan refugees in Türkiye. CONCLUSION Exposure to PTEs and post-displacement stressors were significant risk factors for the mental health and socio-cultural integration of Afghan refugees in Türkiye. These stressful experiences deteriorate refugees' mental health, which hinders their integration into the host society.
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Affiliation(s)
- Gülşah Kurt
- Discipline of Psychiatry and Mental Health, UNSW, Sydney, Australia
| | | | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Merve Ersahin
- Department of Clinical Psychology, Erasmus University, Rotterdam, The Netherlands
| | | | - Nuriye Akbiyik
- Faculty of Humanities and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
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25
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Blackwell MA, Lardier D, Choe R, Goodkind JR. Persistence of the association between mental health and resource access: A longitudinal reciprocal model in a diverse refugee sample. J Trauma Stress 2023; 36:796-807. [PMID: 37339147 PMCID: PMC11214801 DOI: 10.1002/jts.22948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 06/22/2023]
Abstract
Stress associated with resource deprivation is an active social determinant of mental health. However, mixed findings around the strength of this association and its persistence over time obscure optimal interventions to improve mental health in forcibly displaced populations. A reciprocal model was analyzed between resource access and measures of depression, anxiety and posttraumatic stress (PTSD) symptoms at three different assessments conducted 6 months apart (Time [T] 1, T2, and T3). Participants included resettled refugees (N = 290) from three geocultural regions (i.e., Afghanistan, the Great Lakes Region of Africa, and Iraq/Syria). The results showed that although limited resource access at T1 was related to depressive and anxiety symptoms, B = 0.26, SE = 0.16, p = .023, r2 = 0.55; posttraumatic stress disorder (PTSD) symptoms, B = 0.20, SE = 0.10, p < .001, r2 = .56; and culturally specific depression and anxiety at T2, B = 0.22, SE = 0.16, p < .001, r2 = 0.65, these were not reciprocally related to resource access at T3. The results help clarify the strength and direction of effects between resource deprivation and depression, anxiety , and PTSD sympotms over time. Although resource deprivation is predictive of depression, anxiety, and PTSD symptoms among recently resettled refugees, the effect may not persist in the long term. These findings have critical implications, including the urgency of ensuring initial access to resources for resettled refugees to stave off the development of depression, anxiety and PTSD symptoms, as delaying immediate resource access may result in the development of chronic, hard-to-treat mental health disorders.
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Affiliation(s)
- Meredith A Blackwell
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - David Lardier
- Department of Psychiatry and Behavioral Sciences, Division of Community Behavioral Health, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Ryeora Choe
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jessica R Goodkind
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
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Frankova I, Klymchuck V, Nickerson A, Sijbrandij M, Amstadter AB. A summary of the 38th Annual International Society for Traumatic Stress Studies Presidential Panel: How the traumatic stress community can assist individuals affected by the war in Ukraine. J Trauma Stress 2023; 36:682-690. [PMID: 37339112 DOI: 10.1002/jts.22945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 06/22/2023]
Abstract
As the premier global traumatic stress society, the International Society for Traumatic Stress Studies (ISTSS) has an important role to play in educating and raising awareness about the consequences of traumatic events, such as the war in Ukraine. On November 12, 2022, during its 38th annual meeting, the ISTSS hosted an invited Presidential Panel, chaired by Ananda Amstadter during her term as ISTSS President, that brought together trauma experts Peter Ventevogel, Marit Sijbrandij, Vitalii Klymchuck, Iryna Frankova, and Angela Nickerson to highlight how traumatic stress professionals can assist individuals affected by the war in Ukraine. The present paper summarizes the key points from the panel and discusses future challenges anticipated for people affected by the war.
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Affiliation(s)
- Iryna Frankova
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy, Bogomolets National Medical University, Kyiv, Ukraine
| | - Vitalii Klymchuck
- Mental Health for Ukraine Project, Lviv, Ukraine
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
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27
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Bridi L, Kaki DA, Albahsahli B, Abu Baker D, Khan X, Aljenabi R, Bencheikh N, Schiaffino MK, Moore AA, Al-Rousan T. The influences of faith on illness representations and coping procedures of mental and cognitive health among aging Arab refugees: a qualitative study. Front Psychiatry 2023; 14:1083367. [PMID: 37223492 PMCID: PMC10200919 DOI: 10.3389/fpsyt.2023.1083367] [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: 10/28/2022] [Accepted: 03/27/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Refugees experience higher rates of mental illness such as depression and post-traumatic stress disorder (PTSD) which are documented risk factors for dementia. Faith and spiritual practices have been shown to play a significant role in patients' understanding and coping with illness, however, this field of study among refugee populations remains lacking. This study aims to address this literature gap by examining the role of faith on mental health and cognitive health among Arab refugees resettled in Arab and Western countries. Materials and methods A total of 61 Arab refugees were recruited through ethnic community-based organizations in San Diego, California, United States (N = 29) and Amman, Jordan (N = 32). Participants were interviewed through in-depth, semi-structured interviews or focus groups. Interviews and focus groups were transcribed, translated, and coded using inductive thematic analysis and organized based on Leventhal's Self-Regulation Model. Results Faith and spiritual practices significantly impact participants' illness perceptions and coping procedures regardless of resettlement country or gender. Several themes emerged: (1) participants believe in the interdependent relationship between mental and cognitive health. (2) There is a self-awareness of the impact of the refugee experience and trauma on participants' mental health problems, leading to a belief of increased personal risk for developing dementia. (3) Spiritual fatalism (belief that events are predetermined by God, fate, or destiny) greatly informs these perceptions of mental and cognitive health. (4) Participants acknowledge that practicing faith improves their mental and cognitive health, and many read scripture to prevent dementia. (5) Finally, spiritual gratitude and trust are important coping procedures that build resilience among participants. Conclusions Faith and spirituality play an important role in shaping Arab refugees' illness representations and coping procedures of mental and cognitive health. Holistic public health and clinical interventions tailored to the spiritual needs of aging refugees and incorporating religion in prevention strategies are increasingly needed to improve the brain health and wellbeing of refugees.
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Affiliation(s)
- Lana Bridi
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Dahlia A. Kaki
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Dania Abu Baker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Social Work, San Diego State University, San Diego, CA, United States
| | - Xara Khan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Social Sciences, University of California, San Diego, San Diego, CA, United States
| | - Raghad Aljenabi
- School of Social Sciences, University of California, San Diego, San Diego, CA, United States
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Melody K. Schiaffino
- School of Public Health, San Diego State University, San Diego, CA, United States
- Center for Health Equity, Education, and Research, UCSD Moores Cancer Center, San Diego, CA, United States
| | - Alison A. Moore
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
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28
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McDaid D, Park AL. Making an economic argument for investment in global mental health: The case of conflict-affected refugees and displaced people. Glob Ment Health (Camb) 2023; 10:e10. [PMID: 37854391 PMCID: PMC10579650 DOI: 10.1017/gmh.2023.1] [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: 08/14/2022] [Revised: 12/04/2022] [Accepted: 01/24/2023] [Indexed: 03/06/2023] Open
Abstract
Mental health expenditure accounts for just 2.1% of total domestic governmental health expenditure per capita. There is an economic, as well as moral, imperative to invest more in mental health given the long-term adverse impacts of mental disorders. This paper focuses on how economic evidence can be used to support the case for action on global mental health, focusing on refugees and people displaced due to conflict. Refugees present almost unique challenges as some policy makers may be reluctant to divert scarce resources away from the domestic population to these population groups. A rapid systematic scoping review was also undertaken to identify economic evaluations of mental health-related interventions for refugees and displaced people and to look at how this evidence base can be strengthened. Only 11 economic evaluations focused on the mental health of refugees, asylum seekers and other displaced people were identified. All but two of these intervention studies potentially could be cost-effective, but only five studies reported cost per quality-adjusted life year gained, a metric allowing the economic case for investment in refugee mental health to be compared with any other health-focused intervention. There is a need for more consistent collection of data on quality of life and the longer-term impacts of intervention. The perspective adopted in economic evaluations may also need broadening to include intersectoral benefits beyond health, as well as identifying complementary benefits to host communities. More use can be also made of modelling, drawing on existing evidence on the effectiveness and resource requirements of interventions delivered in comparable settings to expand the current evidence base. The budgetary impact of any proposed strategy should be considered; modelling could also be used to look at how implementation might be adapted to contain costs and take account of local contextual factors.
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Affiliation(s)
- David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
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Scalable interventions for refugees. Glob Ment Health (Camb) 2023; 10:e8. [PMID: 36843882 PMCID: PMC9947626 DOI: 10.1017/gmh.2022.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 02/10/2023] Open
Abstract
Refugees experience a greater rate of common mental disorders relative to most other populations, and there remains a need to address these needs. However, most refugees are hosted in low-and-middle-income countries, where there is a lack of resources and mental health providers who can deliver mainstream mental health services. This situation has led to the emergence of scalable mental health interventions that can deliver evidence-based programs to refugees in need. Many countries hosting refugees have implemented programs that train local lay providers in interventions that can be delivered at scale. This review provides a narrative overview of these scalable interventions and critiques the evidence for their efficacy. It is noted that there are limitations to currently available scalable interventions, and there is a need for greater attention to determining the longer-term benefits of interventions, addressing the mental health needs of refugees who do not respond to these interventions, assisting refugees with more severe psychological disorders, and understanding the specific mechanisms that underpin observed benefits of these interventions.
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van Sint Fiet A, de la Rie S, van der Aa N, Bloemen E, Wind T. The relevance of social capital and sense of coherence for mental health of refugees. SSM Popul Health 2022; 20:101267. [PMID: 36281249 PMCID: PMC9587331 DOI: 10.1016/j.ssmph.2022.101267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Migration puts refugees in a completely new social context when simultaneously some have to deal with previously experienced traumatic events and post-migration stressors. Social capital and sense of coherence could be key resources to improve mental health of refugees. This study aims to examine the interplay between social capital (structural and cognitive), sense of coherence and mental health of refugees in the Netherlands. Objective The present study was conducted to i) examine if social capital (structural and cognitive) and mental health are related in a population of Dutch refugees, and ii) test if sense of coherence has a moderating and/or a mediating effect on this relation. Method Data were collected through questionnaires (n = 154) in a cross-sectional survey at different locations throughout the Netherlands. The data were analysed with multiple regression analyses and nonparametric bootstrapping using SPSS. Results Social capital (structural and cognitive) was positively related to mental health. In addition a positive relation between sense of coherence and mental health of refugees was found. The relationship between cognitive social capital and mental health was completely mediated by sense of coherence. No moderation effect of sense of coherence on the relation between social capital and mental health was found. Conclusions The current study contributed to understanding the social mechanism that determines refugee mental health: participating in social groups (structural social capital) and having supportive and trusting relationships (cognitive social capital), whilst experiencing life as comprehensible, manageable, and meaningful (sense of coherence) are positively related to better mental health of refugees. Findings indicate that preventive interventions aiming to enhance refugees' mental health may be more effective when targeting and promoting both social capital and sense of coherence, from a relatively early stage after arrival in the Netherlands. Structural and cognitive social capital are positively related to mental health of refugees. A positive relation is found between sense of coherence and mental health of refugees. Sense of coherence mediates this relation between cognitive social capital and mental health. Including resiliency factors and strengthening social mechanisms may create more effective mental health interventions.
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Affiliation(s)
- Antoine van Sint Fiet
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
- Corresponding author. Arq Centrum ’45, Nienoord 5, 1112 XE Diemen, the Netherlands.
| | - Simone de la Rie
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
| | - Niels van der Aa
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
| | - Evert Bloemen
- Pharos, Dutch Centre of Expertise on Health Disparities, Arthur van Schendelstraat 600, 3511 MJ, Utrecht, the Netherlands
| | - Tim Wind
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
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Rosner R, Hagl M, Bücheler L, Comtesse H. Homesickness in asylum seekers: The role of mental health and migration-related factors. Front Psychiatry 2022; 13:1034370. [PMID: 36386971 PMCID: PMC9659899 DOI: 10.3389/fpsyt.2022.1034370] [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: 09/01/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND While homesickness in refugees is a recurring theme in clinical practice, respective research in this population is scarce. The Utrecht Homesickness Scale (UHS) allows distinguishing between certain aspects of homesickness, namely genuine separation distress like missing family and friends or yearning for home on the one side and problems regarding adjustment to the new situation on the other; so far, the instrument was applied mainly in samples of university students, and never in refugees. OBJECTIVE We aimed to explore homesickness in a refugee population and its association with mental health symptoms and migration-related factors. In addition, we wanted to evaluate the UHS's factor structure in a sample other than students. METHODS Individuals from different countries (N = 99) seeking asylum in Germany were assessed for homesickness, migration-related variables (e.g., number of losses and stage of the asylum proceedings), and mental health symptoms (symptoms of depression, posttraumatic stress and prolonged grief). After exploratory factor analysis, standardized mean factors scores were fed into subsequent correlational and regression analyses to identify the most prominent predictors of homesickness scores. RESULTS The participants showed substantial levels of homesickness. We found a three-factor solution that implied distinct factors regarding (1) adjustment difficulties and loneliness, (2) ruminations about home, and (3) missing family and/or friends. The total homesickness score was associated with mental health but regression analyses with the three mean factor scores showed differential associations with mental health and migration-related variables. While adjustment difficulties and loneliness were-besides time since arrival in Germany-associated with mental health problems (depressive and posttraumatic stress symptoms), ruminating about home was predicted by migration-related variables (number of losses and asylum status). For the factor scores regarding missing family and/or friends, the regression model was not significant. CONCLUSION The assessment of homesickness in refugee populations is feasible and of clinical importance, especially when distinguishing between separation distress and difficulties with adjusting to the new situation.
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Affiliation(s)
- Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | | | - Leonie Bücheler
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Hannah Comtesse
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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