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Metersky K, Jordan A, Al-Hamad A, El-Masri M. Psycho-social Stressors Experienced by Young war Refugees in Developed Countries: A Scoping Review. Can J Nurs Res 2024; 56:350-362. [PMID: 39033428 DOI: 10.1177/08445621241263459] [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] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Refugees escaping political unrest and war are an especially vulnerable group. Arrival in high-income countries (HICs) is associated with a 'new type of war', as war refugees experience elevated rates of psycho-social and daily stressors. PURPOSE The purpose of this scoping review is to examine literature on psycho-social stressors amongst young war refugees in HICs and impact of stressors on intergenerational transmission of trauma within parent-child dyads. The secondary objectives are to identify the pre-migration versus post-migration stressors and provide a basis to inform future research projects that aim to lessen the burden of stress and inform evidence-based improvements in this population. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Extension (PRISMA-ScR) guided the reporting of this review that was performed using a prescribed scoping review method. Extracted from five databases, 23 manuscripts published in 2010 or later met the inclusion criteria. RESULTS Three themes emerged: pre-migration stressors, migration journey stressors and uncertainty, and post-migration stressors. While post-migration environments can mitigate the health and well-being of war refugees, socio-cultural barriers that refugees often experience at the host country prevent or worsen their psycho-social recovery. CONCLUSION To assist the success of war refugees in HICs, therapeutic interventions must follow an intersectional approach and there needs to be a wider application of trauma informed models of care. Findings of this review may help inform future intervention studies aiming to improve the psycho-social health of this population.
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Affiliation(s)
- Kateryna Metersky
- Faculty of Community Services, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Adam Jordan
- Spec. Hons. Kinesiology & Health Science, BASc Nutrition and Food, Minor in Psychology, School of Nutrition, Toronto Metropolitan University, Toronto, Canada
| | - Areej Al-Hamad
- Faculty of Community Services, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Maher El-Masri
- Faculty of Community Services, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
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Huynh I, Li CKW. Protective and Promotive Factors in Migrant and Refugee Children Facing Violence: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241287157. [PMID: 39396185 DOI: 10.1177/15248380241287157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2024]
Abstract
Migrant and refugee children are at risk of experiencing various forms of violence before, during, or after migration. This study systematically identifies, reviews, and synthesizes evidence on protective and promotive factors that contribute to the resilience of migrant and refugee children facing violence. Of the 3,663 articles identified through search in five electronic databases and snowball technique, 31 quantitative or qualitative research studies met the inclusion criteria. To be included in the review, studies had to (1) have been published after 2013; (2) have been published in English; (3) include migrant or refugee children and/or adolescents aged 18 or below at the time of interview or migration; (4) mention some types of maltreatment, peer violence, or community violence faced by the children or adolescents; (5) examine the association between the hypothesized protective or promotive factors and indicators of adaptive functioning; and (6) include outcome measures that assessed adaptive functioning such as well-being or absence or low-levels of internalizing and externalizing problems. Quality assessment did not lead to the exclusion of any studies. Five levels of protective and promotive factors were identified: individual, family, school and peers, community, and spatial dimension, which converged to highlight the importance of regulatory, interpersonal, and meaning-making strengths for these children. Understanding and addressing these protective and promotive factors is crucial for promoting well-being and improving mental health outcomes in migrant and refugee children facing violence. The findings of this review have significant implications for designing intervention programs and public policies that support these children effectively.
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Affiliation(s)
- Inès Huynh
- Social Work and Social Administration, University of Hong Kong, Pokfulam, Hong Kong
| | - Carrie K W Li
- Social Work and Social Administration, University of Hong Kong, Pokfulam, Hong Kong
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Suleiman K, Lightfoot E, Moone R. Strategies and sacrifices of family caregiving in the Somali-American community: a qualitative study. BMC Health Serv Res 2024; 24:1186. [PMID: 39367423 PMCID: PMC11453006 DOI: 10.1186/s12913-024-11543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/04/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Among the many pressing concerns of the Somali-American community, and other similar immigrant and refugee communities as they grow in the United States, is the provision of care for older adults and adults with disabilities. The implications of effective caregiving range from the facilitation of community building and place-making to the delivery and management of healthcare on a systemic level. However, little is currently known about Somali-American family caregivers, including their duties and responsibilities, primary concerns, and the impacts of surrounding influences on their ability to fulfill their role. METHODS Semi-structured interviews were conducted with 10 Somali-American family caregivers in Somali language. The resulting transcripts were translated into English by a professional interpreter and analyzed using an inductive thematic analysis approach. A key informant from the community was additionally consulted for insights regarding cultural nuances and interpretations of idiomatic expressions and concepts. RESULTS Thematic analysis of the reports revealed the principal themes of visitation, patient accompaniment, and self-sacrifice through acceptance and God-consciousness as pervasive and salient concerns across participants. Furthermore, the heightened stresses of the COVID-19 pandemic revealed just how severe the consequences can be when access to culturally habituated navigational tools and coping mechanisms are restricted. CONCLUSIONS In light of our findings, the growing concern for discrimination and sociocultural discord in the Somali-American community presents a particularly prescient threat to the well-being and sustainability of family caregivers. Their experiences must be understood and used to promote education and partnership between the healthcare system and the community in order to build trust and ensure a healthy future for this indispensable population.
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Affiliation(s)
- Kamal Suleiman
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Rajean Moone
- Center for Health Aging and Innovation, University of Minnesota, Minneapolis, MN, USA
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Terrana A, Bruno W, Ibrahim N, Kaiser BN, Wei J, Al-Delaimy W. The Somali Distress and Resilience Scale: Development of a novel measure for Somali adults. Transcult Psychiatry 2024:13634615241272982. [PMID: 39215519 DOI: 10.1177/13634615241272982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Although resilience has been identified as an important mediator of negative mental health outcomes among refugee populations, there are few culturally specific measures of resilience among such communities and no such measure among Somalis. In this study we aimed to develop a culturally appropriate measure of resilience specific to Somali adults in San Diego, as an example of a vulnerable refugee community. A community-based, exploratory sequential mixed method investigation was conducted via focus group discussions (n = 4), cognitive interviews (n = 4), and iterative survey adaptation. Somali refugee adults in San Diego (N = 183) were surveyed with this novel scale, a standardized measure of resilience, and assessments of depression, anxiety, and PTSD. Results were analyzed via correlation coefficients and multivariate linear regression modeling. Qualitative findings supported the inclusion of items addressing both barriers and facilitators of good mental health, which resulted in the development of the Somali Distress and Resilience Survey (SDRS). Linear regression analysis revealed that the SDRS demonstrated significant associations with symptoms of depression and PTSD, while the standardized measure of resilience did not demonstrate associations with any of the mental health outcomes assessed. The SDRS identified obstacles to resilience among Somali individuals, placing them at risk of developing negative mental health outcomes. Our novel measure also demonstrated more robust relationships with these outcomes than a standardized measure of resilience, suggesting greater utility of the adapted scale. However, the SDRS's development raises larger questions about the limitations of developing and comprehensively evaluating novel resilience measures in a community-based setting.
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Affiliation(s)
- Alec Terrana
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - William Bruno
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA
| | - Najla Ibrahim
- Somali Family Service of San Diego, San Diego, CA, USA
| | - Bonnie N Kaiser
- Department of Anthropology and Global Health Program, University of California San Diego, San Diego, CA, USA
| | - Jenny Wei
- Herbert Wertheim School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Wael Al-Delaimy
- School of Medicine, University of California San Diego, San Diego, CA, USA
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Segev D, Schiff M, Shelef L. Occupational rehabilitation of Israel Defense Forces veterans with PTSD: A 5-year follow-up. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2024. [PMID: 39155791 DOI: 10.1002/ijop.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 07/21/2024] [Indexed: 08/20/2024]
Abstract
The MOD Rehabilitation Department (RD) offers three types of rehabilitation tracks (RTs): (a) education, (b) work placement, (c) economic independence. This study aimed to examine which of the offered RTs predicted a better integration into the workforce. This is an observational, prospective, case-controlled study. Data were collected from administrative files. The data pertained to soldiers injured in military service, under RD care and recognised as posttraumatic stress disorder (PTSD) patients between 2001 and 2006. As rehabilitation takes 5-6 years, we examined two points in time: 2015 and 5 years later, in 2020. The studied population comprised 462 male military veterans injured during military service and diagnosed with PTSD (mean age at the time of injury was 24.60 [SD 5.70]; median = 22). Of the participants, 87.9% (n = 406) also sustained physical injury, and 12.1% were not injured physically (n = 56; 12.1%). A regression analysis indicated that the educational RT (OR = 19.509; p = .001) predicted integration into the workforce. The whole model explained 49.0% of the variance. Of the three RT types examined, education is the most important. The more years of study, the better the ability to integrate into the workforce.
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Affiliation(s)
- Dan Segev
- Disabled IDF Veterans Rehabilitation Department, Ministry of Defense, Petah Tikva, Israel
- School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
| | - Miriam Schiff
- School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
| | - Leah Shelef
- School of Social Work, Sapir Academic College, D. N. Hof Ashkelon, Israel
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Yetim O, Çakır R, Bülbül E, Alleil İS. Peer relationships, adolescent anxiety, and life satisfaction: a moderated mediation model in Turkish and syrian samples. Eur Child Adolesc Psychiatry 2024; 33:2831-2845. [PMID: 38300342 PMCID: PMC11272711 DOI: 10.1007/s00787-023-02366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
Prior studies comparing Syrian refugee adolescents to their native peers in the same region have found higher anxiety and lower life satisfaction. Therefore, identifying regulatory variables is crucial for implementing support programs. This study examined the mediating effect of peer relationships and the moderating effect of being a refugee or native adolescent on the relationship between adolescent anxiety and life satisfaction across different samples. Participants and setting: The study included 2,336 adolescents aged 11-19 (M = 14.79, SD = 1.04). Participants completed the Screen for Child Anxiety Related Disorders, Satisfaction with Life Scale, and Strengths and Difficulties Questionnaire. The mediation and moderation effects were analyzed with the path analysis codes written on Mplus 8.3. SPSS 26 was used for descriptive statistics and group comparisons. The findings showed that peer relationships mediate adolescent anxiety and life satisfaction, and this relationship is moderated according to whether the participants are native adolescents or refugee adolescents. This study highlights the significant associations between peer relationships, adolescent anxiety, and life satisfaction and the moderating role of the participant identity. The findings may inform psychological interventions to improve Syrian refugee adolescents' mental health and well-being. These findings may also have implications for policies and programs aimed at supporting the integration of Syrian refugee adolescents in host communities.
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Affiliation(s)
- Onat Yetim
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey.
| | - Resul Çakır
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey
| | - Ece Bülbül
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey
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Jiang W, Yang Y, He Y, Liu Q, Deng X, Hua Y, Hayixibayi A, Ni Y, Guo L. Contribution of diversity of social participation on the mental health of humanitarian migrants during resettlement. Epidemiol Psychiatr Sci 2024; 33:e29. [PMID: 38779823 PMCID: PMC11362679 DOI: 10.1017/s2045796024000313] [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: 10/19/2023] [Revised: 03/20/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
AIMS By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences. METHODS Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed. RESULTS Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = -0.62 [95% confidence interval (CI), -1.07 to -0.17] for one type of social participation; β = -0.57 [95% CI, -1.04 to -0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65-0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61-0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress. CONCLUSIONS The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.
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Affiliation(s)
- Weiqing Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yuwei Yang
- Institute of Infectious Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People’s Republic of China
| | - Yitong He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Qianyu Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xueqing Deng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yilin Hua
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Alimila Hayixibayi
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Yanyan Ni
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
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Kristen A, Moretti MM, Osman F. "It opened a new door for me": A qualitative study of forcibly displaced parents' experiences of an attachment-based parenting program. Clin Child Psychol Psychiatry 2024; 29:700-712. [PMID: 37728567 PMCID: PMC10945979 DOI: 10.1177/13591045231202875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
The aim of the study was to explore forcibly displaced parents' experiences of how an online attachment-based parenting program (eConnect) impacted their relationships with their teens. Data was collected from four focus group discussions with 28 parents who participated in the eConnect program. Data was analyzed using network thematic analysis. A global theme emerged from the analysis: Strengthened Parent-Teen Relationships. Four underpinning organizing themes described the process through which the parent-teen relationship was strengthened: Knowledge Served as the Foundation for Change, Increased Parental Self-Efficacy, Improved Emotional Attunement Facilitates Dyadic Affect Regulation, and Shifted Power Dynamics and Emerging Mutual Parent-Teen Partnership. Findings suggest that eConnect is promising intervention for strengthening parent-teen relationships and supporting forcibly displaced families.
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Affiliation(s)
- Anna Kristen
- Department of Psychology, Simon Fraser University, Canada
| | | | - Fatumo Osman
- School of Health and Welfare, Dalarna University, Sweden
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Weitzman A, Huss K, Blanton M, Swindle J, Camacho GB, Robles A. International Displacement and Family Stress in Latin America. JOURNAL OF FAMILY ISSUES 2024; 45:531-554. [PMID: 38390475 PMCID: PMC10881208 DOI: 10.1177/0192513x231151291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Family stress theories posit that individual family members are positioned to adapt to external stressors differently and that these differences can strain family systems. Analyzing in-depth interviews with a diverse sample of migrant mothers in Costa Rica, we investigate how families adjust to the stressors of international displacement. Three stages of family stress adjustment emerged from our analysis: (1) parents' prioritization of safety, (2) parents' and children's grappling with new legal, economic, and social circumstances, and (3) parents' protracted uncertainty in one or more of these realms concomitant with children's feeling resettled. A fourth stage of (4) convergent parent and child resettling also emerged, but only among select families who enjoyed stable financial or emotional support from extended kin or local institutions in Costa Rica. Parents' perceptions of their security, and social, economic, and legal circumstances contributed to the progression between stages of stress adjustment.
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Affiliation(s)
| | | | | | | | | | - Arodys Robles
- (Universidad de Costa Rica, Centro Centroamericano de Población)
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Mendez L, Kerig PK. Newcomers to Unwelcoming Lands: A Conceptual Review of the Dimensions of Discrimination Experienced by Refugee Youth and the Processes Imparting Risk and Resilience. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:903-915. [PMID: 38045850 PMCID: PMC10689638 DOI: 10.1007/s40653-023-00534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 12/05/2023]
Abstract
In 2018, half of refugees worldwide were under the age of 18. Although often resilient, refugee youth experience chronic and pervasive traumatic events prior to and during migration, and are at risk for continued victimization and stressors while in their host country. In particular, refugee youth encounter ongoing discrimination during resettlement, a primary stressor that reduces their wellbeing and adaptation. Given the relevance of discrimination for refugee youth, the goal of the current review is to increase our understanding of the dimensions of discrimination faced by refugee youth and the risk and resilience processes that may be involved in these negative experiences. Thus, this review presents the existing theoretical and empirical research on this topic and creates a model that organizes these findings. The present review concludes with recommendations for prevention and intervention efforts and considerations for future research.
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Affiliation(s)
- Lucybel Mendez
- University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT 84112 USA
- Department of Psychology, University of Utah, 380 S 1530 E BEH S 502, Salt Lake City, UT 84112 USA
| | - Patricia K. Kerig
- University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT 84112 USA
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Abdi S, Akinsulure-Smith AM, Sarkadi A, Fazel M, Ellis BH, Gillespie S, Juang LP, Betancourt TS. Promoting positive development among refugee adolescents. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:1064-1084. [PMID: 37807940 DOI: 10.1111/jora.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023]
Abstract
Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suárez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suárez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.
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Affiliation(s)
- Saida Abdi
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | | | | | | | | | - Sarah Gillespie
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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Sharma M, Backman A, Vesga-Lopez O, Zayas L, Harris B, Henderson DC, Koenen KC, Williams DR, Borba CPC. Trauma, risk, and resilience: A qualitative study of mental health in post-conflict Liberia. Transcult Psychiatry 2023:13634615231191992. [PMID: 37731360 DOI: 10.1177/13634615231191992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
The Liberian civil wars led to widespread destruction and devastation for its individuals, communities, and economy. However, individuals' subjective trauma experiences and long-term psychological impact remain relatively understudied. This study aims to explore context-specific traumatic events and examine how risk and protective factors combine with traumas to influence trajectories of suffering and recovery over time. We conducted 43 semi-structured interviews with Liberian adults who were present during the Liberian civil wars, and we used line-by-line open coding, thematic analysis, and axial coding to analyze and contextualize the data. Eight key trauma themes emerged: Abuse (emotional, physical, and sexual), Captivity, Combat, Killings, Physical Illness, Resource Loss, Family Separation, and War Environment. The risk and protective factors that were reported as salient were: Age, Biological Sex, Socioeconomic Status, and Community Support. Further, key patterns emerged across interviews that indicated greater risk for long-term suffering: 1) exposure to multiple traumatic events, 2) certain types of traumatic events (like killing of a close family member), and 3) the combination of specific traumatic events and risk and protective factors (like older women witnessing the killing of their children). This study provides culturally relevant information on trauma, suffering, and resilience in post-conflict Liberia, with the aim of guiding the development of screening tools and targeted psychological interventions that improve well-being over time.
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Affiliation(s)
- Manasi Sharma
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Lazaro Zayas
- Massachusettes General Hospital, Boston, MA, USA
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Efe YS, Söyünmez S, Zülkar Y, Başdaş Ö. Determining family relations through drawing: Family relations in images drawn by immigrant children. J Pediatr Nurs 2023; 72:e105-e113. [PMID: 37331835 DOI: 10.1016/j.pedn.2023.06.016] [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: 06/28/2022] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE The aim of the study was to evaluate family relations of immigrant children with the drawing method. DESIGN AND METHODS The sample, which was carried out using the visual phenomenology method, consisted of 60 immigrant children between the ages of 4-14. The data were collected by face-to-face interviews with the children and family, using the Family Information Form and the Family Drawing Test. The data obtained from the drawings were analyzed with the MAXQDA 2022 program. RESULTS The pictures drawn by the children were examined and 3 themes (Chaos, Necessity, Development) and 9 sub-themes (Interpersonal Relations, Thoughts about Future, Violence, Authority, Emotional State, Communication, Needs and Desires, Role Modeling, Personality) were formed. CONCLUSIONS It was determined that the family relations of immigrant children were adversely affected, children had conflicts with family members, were exposed to violence, felt many emotions, such as fear, anxiety, loneliness, anger, longing, exclusion, and needed communication, attention, and support. IMPLICATION TO PRACTICE It is thought that nurses could use the picture analysis method to understand the feelings and thoughts of children.
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Affiliation(s)
- Yağmur Sezer Efe
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Selin Söyünmez
- Department of Child Health and Diseases Nursing, Institute of Health Sciences, Erciyes University, Kayseri.
| | - Yeşim Zülkar
- Department of Nursing, Faculty of Health Sciences, Avrasya University, Trabzon, Turkey
| | - Öznur Başdaş
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
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Kristen A, Salari R, Moretti M, Osman F. Attachment and trauma-informed programme to support forcibly displaced parents of youth in Sweden: feasibility and preliminary outcomes of the eConnect Online programme. BMJ Open 2023; 13:e072368. [PMID: 37550024 PMCID: PMC10407377 DOI: 10.1136/bmjopen-2023-072368] [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: 01/31/2023] [Accepted: 06/29/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES To assess the feasibility, acceptability and the impact of an online parenting programme for forcibly displaced parents of adolescents. DESIGN The study was a single-arm feasibility study using pre-intervention post-intervention and follow-up assessments. SETTING Participants were recruited from municipality-based activities for refugee parents in a small city in the south of Sweden. PARTICIPANTS Participants were forcibly displaced parents (n=23; 47.8% maternal figures) of youth (n=23; 8-17 years old; 26.1% female) from Syria, Afghanistan and Somalia participating in an online parenting programme (eConnect). INTERVENTION eConnect is an attachment-based and trauma-informed parenting intervention and was delivered over the course of 10 weekly sessions. PRIMARY AND SECONDARY OUTCOME MEASURES Feasibility was assessed by programme enrolment, attendance, completion and acceptability of the online platform and cultural fit of the programme. Primary outcome measures were programme impact on youth mental health problems. Secondary outcome measures were programme impact on family functioning and parent-child attachment insecurity. RESULTS The eConnect programme was highly feasible in terms of overall enrolment (100%), attendance (89.6%) and retention rates (100%). The online platform was acceptable, with mixed feedback primarily related to the access and usage of technology. Cultural fit of the programme was acceptable. Youth mental health problems (η 2=0.29) and family functioning significantly improved (η 2=0.18) over the course of the programme. Unexpectedly, parent reports of youth attachment insecurity significantly worsened (η 2=0.16). CONCLUSIONS The findings suggest that the online delivery of Connect was a promising way to reduce barriers to service access and improve mental health problems and family functioning among forcibly displaced parents and their children during COVID-19. Future research is needed to explore the acceptability and impact of this programme post-COVID-19, and to develop culturally tailored and psychometrically sound measures for parent and youth reports of attachment.
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Affiliation(s)
- Anna Kristen
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Raziye Salari
- Child Health and Parenting, Department of Public Health and Caring Sciences, Uppsala Universitet Institutionen for folkhalso- och vardvetenskap, Uppsala, Sweden
| | - Marlene Moretti
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Fatumo Osman
- School of Health and Welfare, Hogskolan Dalarna, Falun, Sweden
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15
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Edwards NM, Isik-Ercan Z, Lu HT, Fall M, Sebti L. "Do the Best You Can with Resources You Have to Offer": Community stakeholder views on supporting immigrant families. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:837-859. [PMID: 36413594 DOI: 10.1002/jcop.22970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
First and second-generation immigrant families of young children in the United States face potential challenges that may be mitigated with stakeholder support in their communities. We examined self-reported views and behaviors among professionals (n = 76) working with families in a mid-Atlantic urban community, and whether these views correlated with demographic factors. Over half of respondents were not able/willing to report the number of immigrant families served and over half believed immigrant parents are less likely to advocate for themselves or their child. Participants were fairly split in seeking advice from others and comfort in talking with immigrant families about their culture/needs. It is essential to assess stakeholders' views on perceived roles, roadblocks, and desired supports. This analysis informs efforts to work more collaboratively with community partners to improve outreach to immigrant families during those formative years in a child's development. Implications for research, practice, and policy are discussed.
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Affiliation(s)
- Nicole Megan Edwards
- Department of Interdisciplinary and Inclusive Education, College of Education, Rowan University, Glassboro, New Jersey, USA
| | - Zeynep Isik-Ercan
- Department of Interdisciplinary and Inclusive Education, College of Education, Rowan University, Glassboro, New Jersey, USA
| | - Huan-Tang Lu
- Department of Educational Services and Leadership, College of Education, Rowan University, Glassboro, New Jersey, USA
| | - Madjiguene Fall
- School of Curriculum & Teaching, College of Education, Kean University, Union, New Jersey, USA
| | - Latifa Sebti
- Doctoral Candidate, PhD in Education: Special Education Concentration, College of Education, Rowan University, Glassboro, New Jersey, USA
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16
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Weitzman A, Camacho GB, Robles A, Blanton M, Swindle J, Huss K. Costa Rica as a Destination for Migrants in Need of International Protection: IMR Country Report. INTERNATIONAL MIGRATION REVIEW 2023; 57:436-448. [PMID: 37009048 PMCID: PMC10063213 DOI: 10.1177/01979183221104473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this IMR Country Report, we draw attention to Costa Rica as a strategic location for expanding research and theory on migrants in need of protection (MNP), who have migrated abroad primarily to evade an imminent threat to their survival. MNP constitute an increasing share of all international migrants in Costa Rica and worldwide, yet research on these migrants and their migration dynamics remains comparatively underdeveloped relative to research on migrants who relocate abroad primarily in pursuit of material gains, social status, or family reunification. As we highlight, Costa Rica is an instrumental site to deepen understandings of MNP populations and migration dynamics because its large and rapidly growing MNP population is incredibly diverse with respect to national origins, demographic characteristics, and underlying motivations for migration. This diversity presents ample opportunities to better understand heterogeneity in the different types of threats MNP seek to evade; how and why MNP incorporation is shaped by individuals' demographic attributes and pre-migration threats; and how the social networks of various MNP subpopulations develop and overlap with time. Moreover, the geographic concentration of MNP in two regions in Costa Rica lends itself to primary data collection among this population and generates opportunities for estimating local MNPs' demographic characterization, even in the absence of a reliable sampling frame.
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Affiliation(s)
- Abigail Weitzman
- Department of Sociology & Population Research Center, University of Texas
| | | | - Arodys Robles
- Centro Centroamericano de Población, Universidad de Costa Rica
| | - Matthew Blanton
- Department of Sociology & Population Research Center, University of Texas
| | | | - Katarina Huss
- Department of Sociology & Population Research Center, University of Texas
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Sim A, Puffer E, Ahmad A, Hammad L, Georgiades K. Resettlement, mental health, and coping: a mixed methods survey with recently resettled refugee parents in Canada. BMC Public Health 2023; 23:386. [PMID: 36823525 PMCID: PMC9948768 DOI: 10.1186/s12889-023-15300-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Resettlement experiences of refugee parents are under-researched despite evidence indicating higher risk of poor mental health. The current study integrates family systems and social determinants of refugee mental health frameworks to examine: (1) Refugee parents' experiences of resettlement stressors and mental health; (2) Perceived impacts of resettlement stressors on individual and family indicators of well-being; and (3) Refugee parents' coping strategies and resources. METHODS The study draws on data from a mixed methods survey conducted with 40 Government-Assisted Refugee parents who had resettled to Hamilton, Canada within the past 4 years. Quantitative and qualitative data were analyzed separately and then integrated at the results stage using a weaving approach. RESULTS Results indicate significant exposure to economic and social stressors across multiple domains of daily life, as well as high levels of parental psychological distress. Parents drew linkages between resettlement stressors and negative mental health impacts that were compounded by intersecting risk factors of ill health, caregiving burden, single parenthood, and low levels of education and literacy. Most parents rated themselves as coping well or very well and described various coping strategies such as positive reframing, problem solving, planning, and turning to religion. Quantitative and qualitative findings indicate high frequency of positive parent-child interaction and low frequency of family conflict, and highlight the importance of family as a protective resource for coping with adversity. Exploratory regression analyses suggest that longer stay in Canada, poorer self-rated health, higher levels of resettlement stressors, and more conflict between adults in the household may be associated with greater psychological distress. CONCLUSION Study findings highlight both the resilience of refugee parents and the psychological toll of navigating their families through a new and challenging environment. Policies and programs to provide comprehensive social and economic supports to refugees beyond the first one to two years after arrival are necessary to mitigate the mental health impacts of displacement over time and strengthen individual and family resilience. Such programs should include culturally responsive and family-based models of mental health care that acknowledge collective experiences and impacts of adversity, as well as harness family resources to overcome past and present challenges.
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Affiliation(s)
- Amanda Sim
- Department of Psychiatry and Behavioural Neurosciences, The Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.
| | - Eve Puffer
- grid.26009.3d0000 0004 1936 7961Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, Durham, NC USA
| | - Afreen Ahmad
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, The Offord Centre for Child Studies, McMaster University, Hamilton, ON Canada
| | - Lina Hammad
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, The Offord Centre for Child Studies, McMaster University, Hamilton, ON Canada
| | - Katholiki Georgiades
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, The Offord Centre for Child Studies, McMaster University, Hamilton, ON Canada
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DiClemente-Bosco K, Neville SE, Berent JM, Farrar J, Mishra T, Abdi A, Beardslee WR, Creswell JW, Betancourt TS. Understanding mechanisms of change in a family-based preventive mental health intervention for refugees by refugees in New England. Transcult Psychiatry 2023; 60:142-155. [PMID: 35989681 PMCID: PMC9943782 DOI: 10.1177/13634615221111627] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transnational migration of refugees is associated with poor mental health, particularly among children. We conducted a pilot trial of the Family Strengthening Intervention for Refugees (FSI-R), using a community-based participatory research (CBPR) approach to deliver a home-based intervention "for refugees by refugees" to improve family functioning and child mental health. N = 80 refugee families in the Greater Boston area participated in the study (n = 40 Somali Bantu families; n = 40 Bhutanese families) with n = 41 families randomized to care-as-usual. Of the 39 families who received FSI-R, n = 36 caregivers and children completed qualitative exit interviews. We present findings from these interviews to identify the mechanisms through which a family-strengthening intervention for refugees can be acceptable, feasible, and effective at improving family functioning and children's mental health outcomes. Authors applied Grounded Theory to code interview transcripts and detailed field notes and used an iterative process to arrive at final codes, themes, and a theoretical framework. The greatest contributors to acceptability and feasibility included flexibility in scheduling intervention sessions, the interventionist being a community member, and improvements to family communication and time spent together. All of these factors were made possible by the CBPR approach. Our findings suggest that given the socio-political context within the U.S. and the economic challenges faced by refugee families, the successful implementation of such interventions hinges on culturally-grounding the intervention design process, drawing heavily on community input, and prioritizing community members as interventionists.
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Affiliation(s)
- Kira DiClemente-Bosco
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Sarah Elizabeth Neville
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Jenna M. Berent
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Jordan Farrar
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Tej Mishra
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | - Abdirahman Abdi
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
| | | | - John W. Creswell
- Department of Family Medicine, University of Michigan Medical School, Dexter, MI, USA
| | - Theresa S. Betancourt
- Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, MA, USA
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19
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Saunders NR, Gandhi S, Wanigaratne S, Lu H, Stukel TA, Glazier RH, Rayner J, Guttmann A. Health Care Use and System Costs Among Pediatric Refugees in Canada. Pediatrics 2023; 151:190230. [PMID: 36458412 DOI: 10.1542/peds.2022-057441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Resettled refugees land in Canada through 3 sponsorship models with similar health insurance and financial supports but differences in how resettlement is facilitated. We examined whether health system utilization, costs, and aggregate 1-year morbidity differed by resettlement model. METHODS Population-based matched cohort study in Ontario, 2008 to 2018, including pediatric (0-17 years) resettled refugees and matched Ontario-born peers and categorized refugees by resettlement model: (1) private sponsorship (PSRs), (2) Blended Visa Office-Referred program (BVORs), and (3) government-assisted refugee (GAR). Primary outcomes were health system utilization and costs in year 1 in Canada. Multivariable logistic regression was used to test the associations between sponsorship model and major illnesses. RESULTS We included 23 287 resettled refugees (13 360 GARs, 1544 BVORs, 8383 PSRs) and 93 148 matched Ontario-born. Primary care visits were highest among GARs and lowest in PSRs (median visits [interquartile range], GARs 4[2-6]; BVORs 3[2-5]; PSRs 3[2-5]; P <.001). Emergency department visits and hospitalizations were more common among GARs and BVORs versus PSRs (emergency department: GARs 19.2%; BVORs 23.4%; PSRs 13.8%; hospitalizations: GARs 2.5%; BVORs 3.2%; PSRs 1.1%, P <.001). Mean 1-year health system costs were highest among GARs (mean [standard deviation] $1278 [$7475]) and lowest among PSRs ($555 [$2799]; Ontario-born $851 [9226]). Compared with PSRs, GARs (adjusted odds ratio 1.63, 95% confidence interval 1.47-1.81) and BVORs (adjusted odds ratio 1.52, 95% confidence interval 1.26-1.84) were more likely to have major illnesses. CONCLUSIONS Health care use and morbidity of PSRs suggests they are healthier and less costly than GARs and BVOR model refugees. Despite a greater intensity of health care utilization than Ontario-born, overall excess demand on the health system for all resettled refugee children is low.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics.,Institute of Health Policy, Management and Evaluation.,Edwin S.H. Leong Centre for Healthy Children.,ICES, Toronto, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | | | - Susitha Wanigaratne
- ICES, Toronto, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | | | - Therese A Stukel
- Institute of Health Policy, Management and Evaluation.,ICES, Toronto, Canada
| | - Richard H Glazier
- Institute of Health Policy, Management and Evaluation.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital Toronto, Canada
| | - Jennifer Rayner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Alliance for Healthier Communities, North York, Canada.,Western University, Centre for Studies in Family Medicine, London, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics.,Institute of Health Policy, Management and Evaluation.,Edwin S.H. Leong Centre for Healthy Children.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
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20
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Neville SE, DiClemente-Bosco K, Chamlagai LK, Bunn M, Freeman J, Berent JM, Gautam B, Abdi A, Betancourt TS. Investigating Outcomes of a Family Strengthening Intervention for Resettled Somali Bantu and Bhutanese Refugees: An Explanatory Sequential Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12415. [PMID: 36231735 PMCID: PMC9566609 DOI: 10.3390/ijerph191912415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Pre- and post-migration stressors can put resettled refugee children at risk of poor mental health outcomes. The Family Strengthening Intervention for Refugees (FSI-R) is a peer-delivered preventative home visiting program for resettled refugees that aims to draw upon families' strengths to foster improved family communication, positive parenting, and caregiver-child relationships, with the ultimate goal of reducing children's risk of mental health problems. Using an explanatory sequential mixed methods design, this study draws upon qualitative interviews with caregivers (n = 19) and children (n = 17) who participated in a pilot study of the FSI-R intervention in New England, as well as interventionists (n = 4), to unpack quantitative findings on mental health and family functioning from a randomized pilot study (n = 80 families). Most patterns observed in the quantitative data as published in the pilot trial were triangulated by qualitative data. Bhutanese caregivers and children noted that children were less shy or scared to speak up after participating in the FSI-R. Somali Bantu families spoke less about child mental health and underscored feasibility challenges like language barriers between caregivers and children. Interventionists suggested that families with higher levels of education were more open to implementing behavior change. In both groups, families appreciated the intervention and found it to be feasible and acceptable, but also desired additional help in addressing broader family and community needs such as jobs and literacy programs.
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Affiliation(s)
- Sarah Elizabeth Neville
- Intenational Health Institute, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Kira DiClemente-Bosco
- Center for Dissemination and Implementation Science, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Lila K. Chamlagai
- Brown Mindfulness Center, Behavioral Health and Social Science Department, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Mary Bunn
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Jordan Freeman
- Bill & Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jenna M. Berent
- Research Program on Children in Adversity, School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
| | - Bhuwan Gautam
- College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | | | - Theresa S. Betancourt
- Research Program on Children in Adversity, School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
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21
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Osman F, Schön UK, Klingberg-Allvin M, Flacking R, Tistad M. The implementation of a culturally tailored parenting support programme for Somali immigrant parents living in Sweden—A process evaluation. PLoS One 2022; 17:e0274430. [PMID: 36103499 PMCID: PMC9473391 DOI: 10.1371/journal.pone.0274430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Parental support programmes aim to strengthen family functioning and the parent–child relationship and to promote the mental health of children and parents. However, there is a lack of knowledge on how parenting support programmes can be implemented for newly arrived immigrant parents. This process evaluation describes the implementation of a successful parenting programme for immigrant parents from Somalia and identifies key components of the implementation process with a focus on Reach, Adaptation, and Fidelity of Ladnaan intervention. Method This process evaluation considered context, implementation and mechanism of impact, in accordance with the Medical Research Council’s guidance. Data were collected through focus group discussions, a questionnaire, attendance lists, field and reflection notes and observations of the sessions. The data were then analysed using content analysis and descriptive statistics. Results Of the 60 parents invited to the parenting programme, 58 participated in the sessions. The study showed that involving key individuals in the early stage of the parenting programme’s implementation facilitated reaching Somali-born parents. To retain the programme participants, parents were offered free transportation. The programme was implemented and delivered as intended. A majority of the parents were satisfied with the programme and reported increased knowledge about children’s rights and the support they could seek from social services. Conclusions This study illustrates how a parenting support programme can be implemented for Somali-born parents and provides guidance on how to attract immigrant parents to and engage them in participating in parenting support programmes.
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Affiliation(s)
- Fatumo Osman
- Department of Health and Welfare, Dalarna University, Falun, Sweden
- * E-mail:
| | - Ulla-Karin Schön
- Department of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | - Renée Flacking
- Department of Health and Welfare, Dalarna University, Falun, Sweden
| | - Malin Tistad
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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22
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Eltanamly H, Leijten P, van Rooij F, Overbeek G. Parenting in times of refuge: A qualitative investigation. FAMILY PROCESS 2022; 61:1248-1263. [PMID: 34523125 PMCID: PMC9543259 DOI: 10.1111/famp.12717] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/24/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023]
Abstract
This qualitative study sheds light on how the different phases of refuge and resettlement shape parents' perceptions of their parenting. We used in-depth interviews to examine parents' accounts of how war and refuge gave rise to different stressors, and how these in turn shaped parenting. We interviewed 27 Syrian refugee parents recently settled in the Netherlands (16 families) twice, using a grounded theory approach. We distinguished five phases of refuge, namely prewar, war, flight, displacement, and resettlement. During flight and displacement, stressors associated with financial and material losses appeared to induce parental empathy for children's suffering, which seemed to increase parental leniency. Stressors emerging from family separation during displacement, however, were reported to burden parents and to lead to uncertainty, which seemed to compromise parental warmth and sensitive discipline. While narratives suggest that families reacted in similar ways during the phases of war, flight, and displacement, differences seemed to emerge during the resettlement phase. Some parents stated that in resettlement, they experienced post-traumatic growth (e.g., increased compassion for their children) and were more autonomy supporting than before the war. Other parents seemed to struggle with accepting and supporting their children's emotions and appeared to resort more readily to parental control. Our findings suggest that emotional exhaustion plays a key role in how parents viewed their parenting changed during refuge, and that individual differences in parents' abilities to recover from emotional exhaustion played a key role in shaping parenting in resettlement.
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23
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Abi Zeid Daou KR. Refugee mothers mental health and social support needs: A systematic review of interventions for refugee mothers. EUROPES JOURNAL OF PSYCHOLOGY 2022; 18:337-349. [PMID: 36348821 PMCID: PMC9632558 DOI: 10.5964/ejop.4665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/22/2021] [Indexed: 11/20/2022]
Abstract
Refugee mothers endure and are at risk for depression, post-traumatic stress, suicidality, and anxiety. There is a gap in the literature regarding interventions for refugee mothers’ mental health and well-being. Interventions involving refugee mothers rarely provide adequate support for refugee mothers’ specific mental health needs and challenges. This paper presents empirical evidence to contextualize the risks refugee mothers face, such as gender-based violence, mental health challenges, and language barriers. Then, the paper provides a critical systematic review of interventions conducted with refugee mothers. The critical systematic review suggests that creating and providing a safe space, being a linguistic liaison, community-building, and advocating for refugee mothers’ needs are emergent protective factors for refugee mothers. Finally, based on the review, recommendations for future interventions followed.
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24
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Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [DOI: https:/doi.org/10.1007/s10597-021-00928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 06/22/2023]
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25
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Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [PMID: 35013831 DOI: 10.1007/s10597-021-00928-0] [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: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, VA, 23284, USA.
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin - Madison, 610 Walnut St., Madison, WI, 53726, USA
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26
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Sun M, Tran D, Bach A, Ngo U, Tran T, Do T, Meyer OL. Impact of War and Resettlement on Vietnamese Families Facing Dementia: A Qualitative Study. Clin Gerontol 2022; 45:798-807. [PMID: 35485807 PMCID: PMC9680835 DOI: 10.1080/07317115.2022.2071661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Most Vietnamese immigrants in the U.S. today arrived as political refugees due to the Vietnam War in the late 20th century. Refugees are disproportionally affected by health and mental health disparities as a result of experiencing distress and potentially traumatic experiences before, during, and after their migration processes. This study involved Vietnamese families facing dementia and used a qualitative approach to investigate participants' experiences before, during, and right after their resettlement in the U.S. METHODS In-person interviews were conducted with 11 Vietnamese adults who cared for their family member with dementia. A descriptive analysis approach was used. RESULTS Five major themes emerged from the interviews:1) immigrating separately from family members, 2) difficult and unsafe journeys, 3) experiences of loss, 4) lack of support systems in the U.S., and 5) feelings of unhappiness, sadness, or signs of depression. CONCLUSIONS This study provides a close examination of Vietnamese refugees' unique backgrounds and how individuals with dementia and their caregivers from this population may be disproportionally impacted by stress. CLINICAL IMPLICATIONS To reduce health disparities, we recommend that providers and policymakers allocate more resources for culturally appropriate routine assessment, treatment, and referrals of those with dementia and their caregivers.
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Affiliation(s)
- Mengxue Sun
- University of California, Davis, Davis, CA 95616, USA
| | - Duyen Tran
- University of California, Davis, Davis, CA 95616, USA
- University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Anna Bach
- University of California, Davis, Davis, CA 95616, USA
- University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Uyen Ngo
- University of California, Davis, Davis, CA 95616, USA
| | - Tiffany Tran
- University of California, Davis, Davis, CA 95616, USA
| | - Thuy Do
- Asian Resources Inc., Sacramento, CA 95824, USA
| | - Oanh L. Meyer
- University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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27
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Kelstrup L, Carlsson J. Trauma-affected refugees and their non-exposed children: A review of risk and protective factors for trauma transmission. Psychiatry Res 2022; 313:114604. [PMID: 35580432 DOI: 10.1016/j.psychres.2022.114604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 01/12/2023]
Abstract
The rates of posttraumatic stress syndrome (PTSD) are high among refugee populations. At the same time, evidence is emerging of intergenerational transmission of psychopathology. The objective of this study was to examine the current knowledge on risk and protective factors for adverse mental health outcomes in the non-exposed offspring of trauma-affected refugees. A systematic search was undertaken from 1 January 1981 to 5 February 2021 (PubMed, Embase, PSYCInfo). Studies were included if they reported on families of trauma-exposed refugee parents and mental health outcomes in their non-exposed children. The search yielded 1415 results and twelve articles met inclusion criteria. The majority of studies emphasized the negative effects of parental mental health symptoms. There was substantial evidence of an association between parental PTSD and increased risk of psychological problems in offspring. Parenting style was identified as both a potential risk and protective factor. Risk/protective factors at the individual and family level were identified, but findings were inconclusive due to sample sizes and study designs. There is a need for evidence-based interventions aimed at improving child outcomes, especially by improving parental mental health and reinforcing parenting skills. Future research should aim to incorporate broader aspects of child development.
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Affiliation(s)
- Laura Kelstrup
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Wilhelm AK, Allen ML, Pratt RJ. Belonging to Three Worlds: Somali Adolescent-Parent Relationships in the United States and Implications for Tobacco Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3653. [PMID: 35329340 PMCID: PMC8953780 DOI: 10.3390/ijerph19063653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
Immigrant family relationships help to buffer the adolescent adoption of health risk behaviors but can be strained by post-immigration structural and cultural barriers. This study qualitatively examines how Somali adolescent-parent relationship factors influence Somali adolescent tobacco use and identifies areas for further family support to prevent Somali adolescent tobacco use. We conducted fifteen key informant interviews with professionals serving the Somali community in clinical, educational, religious, or other community organization roles in one Minnesota metropolitan region. Data were collected and analyzed using approaches rooted in Grounded Theory. Key informants contrasted parenting experiences in Somalia with those in the United States and described how four key factors-structural and cultural barriers, multicultural identity formation, evolving parental expectations and responsibilities, and shifting family resources and support-have influenced Somali parent-child relationship quality and function following immigration. Informants shared the implications of these factors on parental ability to address adolescent tobacco use and discussed potential strategies to support parents that fell into two categories: assisting parents in adapting their parenting approaches to a new context and supporting knowledge and skill development in addressing tobacco use prevention specifically. Incorporating strategies that support Somali parents in their evolving parental roles and attend to structural and cultural barriers to tobacco prevention are essential to consider when developing family-centered tobacco prevention interventions in this population.
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Affiliation(s)
- April K. Wilhelm
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55414, USA; (M.L.A.); (R.J.P.)
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55414, USA
| | - Michele L. Allen
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55414, USA; (M.L.A.); (R.J.P.)
| | - Rebekah J. Pratt
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55414, USA; (M.L.A.); (R.J.P.)
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Varvin S, Vladisavljević I, Jović V, Sagbakken M. "I Have No Capacities That Can Help Me": Young Asylum Seekers in Norway and Serbia - Flight as Disturbance of Developmental Processes. Front Psychol 2022; 12:786210. [PMID: 35069370 PMCID: PMC8769376 DOI: 10.3389/fpsyg.2021.786210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Most studies on refugee populations are organized around trauma-related issues and focus on explaining pathological factors. Few studies are anchored in general developmental psychology with the aim of exploring normal age-specific developmental tasks and how the special circumstances associated with forced migration can influence how developmental tasks are negotiated. This study is part of a larger mixed method study seeking to identify resilience-promoting and resilience-inhibiting factors, on individual and contextual levels, among asylum seekers and refugees on the move (passing through Serbia) and settled in reception centers in Norway. A strategic sample of 20 adolescent and young adult refugees/asylum seekers during flight in Serbia (10) and after arrival in Norway (10) was chosen from a sample of 178 refugees interviewed in depth in Serbia and at receptions centers in Norway. The sample reflects the focus of this paper, which is to explore adolescent and young adult refugees/asylum seekers' psychological and social needs and resources during flight to and after arrival in the host country, including how developmental tasks are negotiated. Through qualitative analysis, experiences associated with the developmental changes the participants experienced before, during, and after flight are contextualized. Their sense of self, their relationships with their families and their perceptions of their situation as adolescents or young adults in a highly unpredictable situation are presented in the light of relevant theory and findings from similar refugee studies. All the participants have fled from dangerous and intolerable situations in their home countries. They describe extreme dangers during flight in contexts that are unpredictable and where they feel lonely and unsupported. Most have unmet psychosocial needs and have received little support or help for their mental health issues during flight or after arrival in Norway. Suggestions for interventions and resilience-promoting actions are given based on the findings of the study.
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Affiliation(s)
- Sverre Varvin
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ivana Vladisavljević
- Faculty of Philosophy, University of Priština (Kosovska Mitrovica), Pristina, Serbia
| | - Vladimir Jović
- Center for Rehabilitation of Torture Victims, IAN, Belgrade, Serbia
| | - Mette Sagbakken
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Interiano-Shiverdecker CG, Kondili E, Bazzi R. Refugees in Context: A Systemic, Intersectional Exploration of Discrimination in the United States. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2022. [DOI: 10.1007/s10447-021-09457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mangrio E, Grahn M, Zdravkovic S, Cuadra C. Social relations and mental ill-health among newly arrived refugees in Sweden: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000362. [PMID: 36962385 PMCID: PMC10021175 DOI: 10.1371/journal.pgph.0000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous research indicates that social relations have an impact on the well-being of refugees and that well-being is important for effective integration into the host country. Few studies in Sweden have, to the best of our knowledge, looked at the association between social relations and mental ill-health among newly arrived refugees. The aim is to investigate what effect social relations have on the mental health of newly arrived refugees in the south of Sweden. METHODS A cross-sectional study was conducted in Scania, the southernmost county of Sweden, between February 2015 and February 2016. The study population consisted of newly arrived adult refugees speaking Dari or Arabic, who received the civic and health information that is part of an introduction course for all newly arrived refugees. RESULTS Individuals who rarely met with friends had higher odds of experiencing mental ill-health [OR = 1.70, 95% CI, 1.03-2.82] than individuals who frequently spent time with friends. Furthermore, individuals who seldom attended social/community meetings or activities in an organisation or group, such as a sports association or another kind of association, a church, a mosque, or women's or men's meetings, had higher odds of mental ill-health (OR = 1.58, 1.1-2.28), compared to those who frequently did so. CONCLUSIONS The study suggests a link between spending time with friends, as well as engaging in social/community activities, and the mental health of newly arrived refugees in the southernmost county of Sweden, which is one of the counties in Sweden that received the highest number of refugees. The results are in line with a previous study on the same subject in Sweden.
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Affiliation(s)
- Elisabeth Mangrio
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
- Malmö Institute for Studies of Migration, Diversity and Welfare [MIM], Malmö University, Malmö, Sweden
| | - Mathias Grahn
- Unit for Safety and Security, Municipality of Malmö, Malmö, Sweden
| | - Slobodan Zdravkovic
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
- Malmö Institute for Studies of Migration, Diversity and Welfare [MIM], Malmö University, Malmö, Sweden
| | - Carin Cuadra
- Department of Social Work, Malmö University, Malmö Sweden
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Salinas M, Salinas JL. "We Are from Nowhere": A Qualitative Assessment of the Impact of Collective Trauma from the Perspective of Resettled Bhutanese Refugees. Health Equity 2021; 5:762-769. [PMID: 34909546 PMCID: PMC8665813 DOI: 10.1089/heq.2020.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Limited research has explored mental health concerns and collective trauma experienced by Bhutanese refugees due to their displacement from Bhutan, refugee camp life in Nepal, and resettlement to U.S. society. Purpose: To understand how collective trauma experienced by Bhutanese refugees influences the process of resettlement and integration into U.S. society to better address mental health concerns from the community. Methods: Qualitative data were collected through four focus groups (N=40) with Bhutanese refugee women in central Massachusetts from June to November of 2016 to discuss refugee resettlement experiences and mental health concerns. Findings: Bhutanese refugees shared insights on their resettlement experiences where several broader themes emerged, including historical collective trauma, closed-door culture, and processing mental health stigma. The displacement from Bhutan, hardships in Nepal refugee camps, and isolation in U.S. society led to a collective trauma among the community. Participants described America as having a closed-door culture that limits their integration into society, causing unique challenges based on their context of integration. The collective trauma also poses challenges toward processing mental health stigma, yet community building offers insights on how Bhutanese refugees can address these issues in collective spaces. Conclusions: The historical collective trauma must be considered when working with Bhutanese refugees to understand the context of their resettlement to address mental health concerns.
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Affiliation(s)
- Manisha Salinas
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Juan L Salinas
- Department of Sociology, Anthropology, and Social Work, University of North Florida, Jacksonville, Florida, USA
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Scoglio AAJ, Salhi C. Violence Exposure and Mental Health Among Resettled Refugees: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2021; 22:1192-1208. [PMID: 32238052 DOI: 10.1177/1524838020915584] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Refugee populations are often characterized by their high exposure to violence, which are tied to various challenges upon resettlement. This systematic review synthesizes the empirical literature related to violence exposure for refugees resettled in high-income countries and the impact of that exposure on mental health symptoms. The authors reviewed quantitative studies published from 2000 to 2018 and found 12 studies met criteria for inclusion. Studies were excluded if the study did not include a measured mental health outcome, if violence exposure was not measured and reported on distinctly from nonviolent exposures, if the sample did not include a refugee population, or if the relationship between violence exposure and mental health of refugees was not empirically examined. Overall, studies found that resettled refugee populations were more likely to have higher rates of violence exposure than comparison groups. This violence exposure was significantly related to higher mental health symptoms, including symptoms of depression, anxiety, and, most commonly reported, posttraumatic stress disorder. However, there is substantial heterogeneity in measurement of violence exposure, particularly in the use of author-created scales. The vast majority of included studies examined only exposure to violence prior to resettlement. The review shows significant evidence for the effect of violence prior to resettlement on mental health after resettlement and reveals a need for improved measurement and definitions of violence exposure at different time points for resettled refugee populations. Assessing current exposure to violence is an important step for effective intervention related to mental health dilemmas for refugee populations.
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Affiliation(s)
- Arielle A J Scoglio
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Carmel Salhi
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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Motti-Stefanidi F, Pavlopoulos V, He J. Immigrant Youth Resilience: Theoretical Considerations, Empirical Developments, and Future Directions. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2021; 31:966-988. [PMID: 34820947 DOI: 10.1111/jora.12656] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Resilient adaptation among immigrant youth provides the foundation for healthy and productive adult lives. Great diversity is observed in their adaptation. This diversity has been studied during the past decade from different angles and intellectual traditions. However, the results are disconnected. In this paper, first, we present a resilience conceptual model for understanding immigrant youth adaptation. We argue that its concepts and principles allow us to best pull together what is known and discover what is still unknown. Together with narrower topic-specific conceptual models, it can guide the formulation of hypotheses regarding immigrant youth resilience. Second, we examine comparatively, through the lens of this conceptual model, results of a content analysis on the abstracts of studies on individual differences in immigrant youth adaptation, conducted during the past decade in North American and European countries. Finally, we discuss the meaning of acculturation-related terms which are often used in an inconsistent way.
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Affiliation(s)
| | | | - Jia He
- DIPF Leibniz Institute for Research and Information in Education
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35
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Michlig GJ, Johnson-Agbakwu C, Surkan PJ. "Whatever you hide, also hides you": A discourse analysis on mental health and service use in an American community of Somalis. Soc Sci Med 2021; 292:114563. [PMID: 34776285 DOI: 10.1016/j.socscimed.2021.114563] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022]
Abstract
After decades of refugee displacement, Somalis are at increased risk for poor mental health. However, uptake of treatment referrals in primary care is low among Somalis compared to other refugee groups. The objective of this analysis was to understand specific resistances to US mental health care contributing to this gap in coverage. One hundred and sixty-eight Somali men and women over the age of 14, participated in 28 focus group from October 2017 to November 2018 discussing wellbeing and healthcare in the US. Transcripts were analyzed based on critical discourse theory, informed by the theoretical work of Michel Foucault. This study identified two primary discourses, one biomedical and the other driven by Somali community mental health knowledge and social practice. Mental health as an object of Muslim faith, nosological fusion of psychiatric illness terms, and stigmatization and internal social control to limit disclosure were discussed. US mental health services were described as giving off a bad vibe, and represented external institutions of power, exacerbated by perceived discrimination. Somali youth occupied social bridging positions between cultural vs. US knowledge and practice. Three negotiating discourses emerged wherein participants created discursive solutions to these sites of resistance, including 1) how the social acceptability of seeking psychological care might be increased while maintaining Somali emotional resilience, 2) stressing the need to seek medical care as a practical supplement to spiritual care, and 3) highlighting the need for Somali youth to enter health fields. Findings suggest that intervention strategies not only ensure that services are culturally appropriate and sensitive to religion, but also consider that services are potentially seen as both an extension of US institutional power and an affront to Somali identity making. Overcoming these challenges may involve nurturing the negotiating discourses taken up by communities.
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Affiliation(s)
- Georgia J Michlig
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, USA.
| | | | - Pamela J Surkan
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, USA
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36
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Kurt G, Ilkkursun Z, Javanbakht A, Uygun E, Karaoglan-Kahilogullari A, Acarturk C. The psychological impacts of COVID-19 related stressors on Syrian refugees in Turkey: The role of resource loss, discrimination, and social support. INTERNATIONAL JOURNAL OF INTERCULTURAL RELATIONS : IJIR 2021; 85:130-140. [PMID: 34565947 PMCID: PMC8455287 DOI: 10.1016/j.ijintrel.2021.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 05/11/2023]
Abstract
COVID-19 does not leave behind refugees. They are disproportionately affected during the current pandemic. The present study aimed to investigate the psychological impacts of COVID-19 related stressors -resource loss and perceived discrimination during the COVID-19 pandemic- on Syrian refugees in Turkey. Further, the buffering role of perceived social support against the detrimental impacts of such stressors was examined. An online cross-sectional study was conducted between September-October 2020. A sample of 345 Syrian refugees in Turkey completed the questions about demographic characteristics, resource loss and perceived discrimination during the pandemic, perceived social support, and depressive and anxiety symptoms. A high level of depressive and anxiety symptoms was reported in our sample. Resource loss and perceived discrimination during the pandemic significantly and positively predicted depressive and anxiety symptoms. Perceived social support acted as a buffer against the detrimental effect of resource loss on mental health. For those with higher perceived social support, resource loss during the pandemic did not significantly predict depressive and anxiety symptoms. The results indicate the detrimental role of COVID-19 related stressors on refugee mental health. Social support is an important protective factor for mental health amidst the pandemic. Our findings highlight the importance of considering the precarious conditions of refugees in all COVID-19 responses and communications.
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Affiliation(s)
- G Kurt
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Z Ilkkursun
- Department of Psychology, Koc University, Istanbul, Turkey
| | - A Javanbakht
- Stress, Trauma, and Anxiety Research Clinic (STARC), Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - E Uygun
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Turkey
| | | | - C Acarturk
- Department of Psychology, Koc University, Istanbul, Turkey
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37
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Gillespie S, Winer JP, Issa O, Ellis BH. The role of discrimination, assimilation, and gender in the mental health of resettled Somali young adults: A longitudinal, moderated mediation analysis. Transcult Psychiatry 2021; 60:74-85. [PMID: 34665077 DOI: 10.1177/13634615211048053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acculturation styles have important associations with future adjustment among immigrants and refugees, yet less is known about the individual and interpersonal factors that influence the strategy an individual adopts. High rates of discrimination may signal the receiving community's rejection of one's ethnic group, increasing pressure to assimilate and suppress one's heritage identity. Within a sample of Somali young adults (18-30, N = 185) resettled in North America, this study tested whether two acculturation styles (assimilation and integration) longitudinally mediate the relation between discrimination and three mental health outcomes (i.e., anxiety, depression, and posttraumatic stress disorder), and whether gender moderated these relations. Discrimination had a direct, positive relation with future mental health symptoms for females, which was not mediated by acculturation strategy. By contrast, the association between discrimination and mental health outcomes for males was fully mediated by increased endorsement of assimilation, but not integration. Experiences of marginalization may erode connections to both the Somali community and to the nation of resettlement, which have been identified as particularly strong protective forces within this community. Interventions targeted at the receiving community to reduce the rates of discrimination toward immigrants and refugees and interventions to strengthen youth's sense of belonging in both the predominant culture and their culture of origin may improve transdiagnostic mental health outcomes.
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Affiliation(s)
- Sarah Gillespie
- Institute of Child Development, 5635University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey P Winer
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Osob Issa
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - B Heidi Ellis
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Davison CM, Watt H, Michael S, Bartels SA. "I don't know if we'll ever live in harmony": a mixed-methods exploration of the unmet needs of Syrian adolescent girls in protracted displacement in Lebanon. ACTA ACUST UNITED AC 2021; 79:173. [PMID: 34627364 PMCID: PMC8501367 DOI: 10.1186/s13690-021-00696-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 09/20/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The current crisis in Syria has led to unprecedented displacement, with neighbouring Lebanon now hosting more than 1.5 million conflict-affected migrants from Syria. In many situations of displacement, adolescent girls are a vulnerable sub-group. This study explores and describes the self-reported unmet needs of Syrian adolescent girls who migrated to Lebanon between 2011 and 2016. METHODS This mixed-methods study focusing on the unmet needs of adolescent girls was part of a larger research project on child marriage among Syrian migrants in Lebanon. Participants were recruited using purposive sampling in three field locations in Lebanon by locally trained research assistants. One hundred eighty-eight Syrian adolescent girls chose to tell qualitative stories about their own experiences. Using handheld tablets and an application called "Sensemaker" stories were audio-recorded and later transcribed. Participants were asked to then self-interpret their stories by answering specific quantitative survey-type questions. Demographic information was also collected. NVivo was used to undertake deductive coding of the qualitative data using Maslow's Hierarchy of Needs as an analytic frame. RESULTS Among the 188 self-reported stories from adolescent girls, more than half mentioned some form of unmet need. These needs ranged across the five levels of Maslow's Hierarchy from physiological, safety, belonging, esteem and self-actualization. Nearly two thirds of girls mentioned more than one unmet need and the girls' expressed needs varied by marital status and time since migration. Unmet esteem needs were expressed in 22% of married, and 72% of unmarried girls. Belongingness needs were expressed by 13% of girls who migrated in the last 1-3 years and 31% of those who migrated in the previous 4-5 years. CONCLUSION Many needs of displaced Syrian adolescent girls remain unmet in this situation of now protracted displacement. Girls most commonly expressed needs for love and belonging followed closely by needs for safety and basic resources. The level and type of unmet need differed by marital status and time since displacement. Unmet needs have been associated elsewhere with physical illness, life dissatisfaction, post-traumatic stress, depression, anxiety and even death. These results can inform integrated interventions and services specifically targeting adolescent girls and their families in the protracted migration situation now facing Lebanon.
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Affiliation(s)
- Colleen M Davison
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Carruthers Hall #203, Kingston, Ontario, Canada. .,Department of Global Development Studies, Queen's University, Kingston, ON, Canada.
| | - Hayley Watt
- Bachelor of Health Sciences Program, Queen's University, Kingston, ON, Canada
| | - Saja Michael
- ABAAD Resource Centre for Gender Equality, Beirut, Lebanon
| | - Susan A Bartels
- Department of Global Development Studies, Queen's University, Kingston, ON, Canada.,Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
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Cohodes EM, Kribakaran S, Odriozola P, Bakirci S, McCauley S, Hodges HR, Sisk LM, Zacharek SJ, Gee DG. Migration-related trauma and mental health among migrant children emigrating from Mexico and Central America to the United States: Effects on developmental neurobiology and implications for policy. Dev Psychobiol 2021; 63:e22158. [PMID: 34292596 PMCID: PMC8410670 DOI: 10.1002/dev.22158] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022]
Abstract
Children make up over half of the world's migrants and refugees and face a multitude of traumatic experiences prior to, during, and following migration. Here, we focus on migrant children emigrating from Mexico and Central America to the United States and review trauma related to migration, as well as its implications for the mental health of migrant and refugee children. We then draw upon the early adversity literature to highlight potential behavioral and neurobiological sequalae of migration-related trauma exposure, focusing on attachment, emotion regulation, and fear learning and extinction as transdiagnostic mechanisms underlying the development of internalizing and externalizing symptomatology following early-life adversity. This review underscores the need for interdisciplinary efforts to both mitigate the effects of trauma faced by migrant and refugee youth emigrating from Mexico and Central America and, of primary importance, to prevent child exposure to trauma in the context of migration. Thus, we conclude by outlining policy recommendations aimed at improving the mental health of migrant and refugee youth.
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Affiliation(s)
- Emily M Cohodes
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sahana Kribakaran
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Paola Odriozola
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sarah Bakirci
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sarah McCauley
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - H R Hodges
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Lucinda M Sisk
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sadie J Zacharek
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Dylan G Gee
- Department of Psychology, Yale University, New Haven, Connecticut, USA
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Swan LET, Im H. Risk and Protective Factors for Common Mental Disorders among Urban Somali Refugee Youth. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:321-333. [PMID: 34471451 PMCID: PMC8357879 DOI: 10.1007/s40653-020-00325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to explore exposure to trauma as well as demographic and psychosocial factors as predictors of mental health symptoms among Somali refugees in Kenya. Participants were recruited via snowball sampling to complete a survey and included 86 Somali refugee youth, aged 15 to 34 years, who were living in Eastleigh. We measured trauma using a total traumas experienced variable as well as four trauma types categories (pre-migration/migration trauma, post-migration trauma, family trauma, and individual trauma). We measured anxiety and depression symptoms using the Hopkins Symptom Checklist-25 (HSCL-25) and PTSD using the PTSD Check List - Civilian Version (PCL-C). We ran descriptive statistics followed by multiple linear regression models with trauma exposure, education, gender, and willingness to share problems as predictors of mental health symptoms. Out of 12 possible traumatic events, most participants (83.7%) reported experiencing at least one trauma, and participants reported experiencing an average of 3.76 total traumas. The regression models predicted between 11.5% and 35.5% of the variance of the mental health symptoms. Willingness to share problems was a significant predictor of decreased mental health symptoms in most models. These findings highlight the role of trauma exposure and psychosocial factors in predicting Somali refugee mental health and indicate that implementing programs to encourage problem sharing may help address Somali refugee mental health needs. Further research is needed to explore the differential impact of trauma exposure and various psychosocial factors on Somali refugee mental health.
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Affiliation(s)
- Laura E. T. Swan
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave, Richmond, VA 23284 USA
| | - Hyojin Im
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave, Richmond, VA 23284 USA
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Swan LET, Im H. Risk and Protective Factors for Common Mental Disorders among Urban Somali Refugee Youth. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:321-333. [DOI: https:/doi.org/10.1007/s40653-020-00325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 06/22/2023]
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42
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Yun S, Ahmed SR, Hauson AO, Al-Delaimy WK. The Relationship Between Acculturative Stress and Postmigration Mental Health in Iraqi Refugee Women Resettled in San Diego, California. Community Ment Health J 2021; 57:1111-1120. [PMID: 33385267 DOI: 10.1007/s10597-020-00739-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/29/2020] [Indexed: 01/09/2023]
Abstract
Due to the lack of research on the adverse impact of acculturative stress on the mental health, the current study examined the associations between acculturative stress and post-migration mental health outcomes among 219 Iraqi refugee women resettled in San Diego, California. Mental illness, trauma history, and acculturative stress were measured and descriptive statistical analyses, and multivariate logistic regression analyses were conducted to determine the association between acculturative stress, depression, and anxiety among the refugee women.About half of the participants were categorized as having anxiety (45.6%) and depression (55.3%). The multivariate regression analysis found that the odds of a mental health outcome of depression and anxiety in relation to acculturative stress, increases by a factor of 1.056 and 1.076 respectively, for every point increase on the acculturative stress scale.The study's findings reflect a linear association of acculturative stress with depression and anxiety among Iraqi refugee mothers resettled in San Diego. The mental well-being of refugees does not always improve nor does their trauma disappear by resettling in a new country. Policy makers should consider extending the evaluation, follow-up, and support of Iraqi refugee mental health long beyond the current 90 post arrival policy.
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Affiliation(s)
- Sandra Yun
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Sawssan R Ahmed
- Department of Psychology, California State University, Fullerton, CA, USA
| | - Alexander O Hauson
- California School of Professional Psychology, San Diego, CA, USA.,Department of Psychiatry, School of Medicine, University of California, San Diego, CA, USA
| | - Wael K Al-Delaimy
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
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Davis SH, Winer JP, Gillespie SC, Mulder LA. The Refugee and Immigrant Core Stressors Toolkit (RICST): Understanding the Multifaceted Needs of Refugee and Immigrant Youth and Families Through a Four Core Stressors Framework. ACTA ACUST UNITED AC 2021; 6:620-630. [PMID: 34258385 PMCID: PMC8267510 DOI: 10.1007/s41347-021-00218-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022]
Abstract
Research indicates that refugee and immigrant youth commonly face four core stressors during resettlement in a new country and culture: trauma, acculturative stress, resettlement stress, and isolation. This Four Core Stressors framework can be used to educate providers about these populations’ unique needs and support assessment of relevant socioecological factors influencing health. To facilitate education, training, and dissemination of this framework and complement existing provider resources, we developed the Refugee & Immigrant Core Stressors Toolkit (RICST), a free, web-based toolkit that provides an overview of the Four Core Stressors framework, assessment questions across the four domains, scaffolding to identify needs and points of triage, and recommended interventions. Public hosting of the RICST via REDCap began in March 2018. In addition to the toolkit, users are prompted to provide location of service delivery, intended purpose of use, and interface feedback. Between March 2018 and October 2020, the RICST was used over 2300 times across 6 continents. Most providers used the toolkit to learn more about the needs of refugee and immigrant youth in general, and several noted that it is a valuable educational tool for staff unfamiliar with these populations. Open-ended qualitative feedback indicated high usability. Amidst historically high levels of forced displacement, tools to support provider effectiveness in working with these populations are increasingly needed. The RICST shows promise as an educational, assessment, and treatment-planning tool for providers working with refugee and immigrant families globally. Future directions include location-specific resource mapping and culture-specific intervention strategies.
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Affiliation(s)
- Seetha H. Davis
- Trauma and Community Resilience Center, Boston Children’s Hospital, Boston, MA USA
| | - Jeffrey P. Winer
- Trauma and Community Resilience Center, Boston Children’s Hospital, Boston, MA USA
| | - Sarah C. Gillespie
- Institute of Child Development, University of Minnesota, Minneapolis, MN USA
| | - Luna A. Mulder
- Trauma and Community Resilience Center, Boston Children’s Hospital, Boston, MA USA
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Samuels EA, Orr L, White EB, Saadi A, Padela AI, Westerhaus M, Bhatt AD, Agrawal P, Wang D, Gonsalves G. Health Care Utilization Before and After the "Muslim Ban" Executive Order Among People Born in Muslim-Majority Countries and Living in the US. JAMA Netw Open 2021; 4:e2118216. [PMID: 34328502 PMCID: PMC8325073 DOI: 10.1001/jamanetworkopen.2021.18216] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE The health effects of restrictive immigration and refugee policies targeting individuals from Muslim-majority countries are largely unknown. OBJECTIVE To analyze whether President Trump's 2017 executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States" (known as the "Muslim ban" executive order) was associated with changes in health care utilization by people born in targeted nations living in the US. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included adult patients treated at Minneapolis-St. Paul HealthPartners primary care clinics or emergency departments (EDs) between January 1, 2016, and December 31, 2017. Patients were categorized as (1) born in Muslim ban-targeted nations, (2) born in Muslim-majority nations not listed in the executive order, or (3) non-Latinx and born in the US. Data were analyzed from October 1, 2019, to May 12, 2021. EXPOSURES Executive order 13769, "Protecting the Nation from Foreign Terrorist Entry into the United States." MAIN OUTCOMES AND MEASURES Primary outcomes included the number of (1) primary care clinic visits, (2) missed primary care appointments, (3) primary care stress-responsive diagnoses, (4) ED visits, and (5) ED stress-responsive diagnoses. Visit trends were evaluated before and after the Muslim ban issuance using linear regression, and differences between the study groups after the executive order issuance were evaluated using difference-in-difference analyses. RESULTS A total of 252 594 patients were included in the analysis: 5667 in group 1 (3367 women [59.4%]; 5233 Black individuals [92.3%]), 1254 in group 2 (627 women [50%]; 391 White individuals [31.2%]), and 245 673 in group 3 (133 882 women [54.5%]; 203 342 White individuals [82.8%]). Group 1 was predominantly born in Somalia (5231 of 5667 [92.3%]) and insured by Medicare or Medicaid (4428 [78.1%]). Before the Muslim ban, primary care visits and stress-responsive diagnoses were increasing for individuals from Muslim-majority nations (groups 1 and 2). In the year after the ban, there were approximately 101 additional missed primary care appointments among people from Muslim-majority countries not named in the ban (point estimate [SE], 6.73 [2.90]; P = .02) and approximately 232 additional ED visits by individuals from Muslim ban-targeted nations (point estimate [SE], 3.41 [1.53]; P = .03). CONCLUSIONS AND RELEVANCE Results of this cohort study suggest that after issuance of the Muslim ban executive order, missed primary care appointments and ED visits increased among people from Muslim-majority countries living in Minneapolis-St. Paul.
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Affiliation(s)
- Elizabeth A. Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lilla Orr
- Department of Political Science, Yale University, New Haven, Connecticut
| | - Elizabeth B. White
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston
| | - Aasim I. Padela
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | | | - Aarti D. Bhatt
- Division of General Internal Medicine, University of Minnesota, Minneapolis
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dennis Wang
- Yale School of Medicine, New Haven, Connecticut
| | - Gregg Gonsalves
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Salhi C, Scoglio AAJ, Ellis H, Issa O, Lincoln A. The relationship of pre- and post-resettlement violence exposure to mental health among refugees: a multi-site panel survey of somalis in the US and Canada. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1015-1023. [PMID: 33398495 DOI: 10.1007/s00127-020-02010-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND A large body of research highlights the lasting impact of pre-resettlement violence on the mental health of refugees after resettlement. However, there is limited research on violence exposure after resettlement and its association with mental health. We examine the association of pre- and post-resettlement violence with post-resettlement mental health symptoms in a survey of Somali refugees in the US and Canada. METHODS AND FINDINGS We collected survey data from 383 Somalis across five cities in the US and Canada (Boston, MA; Minneapolis, MN; Lewiston, NC; Portland, ME; Toronto, Canada). Wave 1 data were collected between May 2013 and January 2014, while Wave 2 was collected between June 2014 and August 2015. Data from both waves were used to examine whether the association of past violence exposures persists across time and with more recent violence exposures. The War Trauma Screening Scale assessed exposure to any pre- and post-resettlement violence at Wave 1, while the My Exposure to Violence scale assessed any past-year violence exposure at Wave 2. Mental health outcomes included symptoms of depression and anxiety (Hopkins Symptom Checklist) and post-traumatic stress symptoms (Harvard Trauma Questionnaire). Separate linear regression models at Waves 1 and 2 examined the relationship of past violence exposure to standardized scores of mental health symptoms. Participants were 22 years of age, on average. Fifty-six percent of our sample had been exposed to violence after resettlement by Wave 2. At Wave 1, the associations of pre- and post-resettlement violence with mental health were comparable in magnitude across depression [β = 0.39, 95% CI (0.21 0.57) vs. β = 0.36, 95% CI (0.10 0.62)], anxiety [β = 0.33, 95% CI (0.12 0.55) vs. β = 0.38, 95% CI (0.01 0.75)], and PTSD [β = 0.55, 95% CI (0.37 0.72) vs. β = 0.47, 95% CI (0.21 0.74)]. At Wave 2, pre-resettlement violence was associated with depressive symptoms only [β = 0.23, 95% CI (0.06 0.40)], while past-year exposure to violence had the largest association with all mental health outcomes [depression: β = 0.39, 95% CI (0.17 0.62); anxiety: β = 0.46, 95% CI (0.01 0.75); PTSD: β = 0.67, 95% CI 0.46 0.88)]. CONCLUSIONS Our study is the first to examine refugees' exposure to post-resettlement violence across time, finding that Somali refugees' exposure is both persistent and prevalent after resettlement. Post-resettlement violence had a larger association with mental health than pre-resettlement exposure by Wave 2. Our study highlights the urgent need to understand the role of post-resettlement violence exposure for refugees in the US and Canada.
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Affiliation(s)
- Carmel Salhi
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA. .,Institute of Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA.
| | | | - Heidi Ellis
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Osob Issa
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Alisa Lincoln
- Institute of Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
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Wilhelm AK, McRee AL, Bonilla ZE, Eisenberg ME. Mental health in Somali youth in the United States: the role of protective factors in preventing depressive symptoms, suicidality, and self-injury. ETHNICITY & HEALTH 2021; 26:530-553. [PMID: 30141350 DOI: 10.1080/13557858.2018.1514451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Community, school, family, and individual factors protect against mental illness in general samples of adolescents. How these assets apply to Somali youth resettled to the United States (U.S.), a group with significant trauma exposure, remains unclear. We aimed to quantify which protective factors are associated with lower prevalence of depressive symptoms, suicidality, and self-injury among Somali youth in the U.S. compared with their non-Hispanic white peers.Design: Participants consisted of 8th, 9th, and 11th grade respondents to the 2016 Minnesota Student Survey, an anonymous school-administered statewide survey with 85.5% school district participation, who identified as Somali ethnicity (n = 1552) or as non-Hispanic white (n = 80,583). Multivariable logistic regression assessed odds of depressive symptoms, suicidal ideation and attempts, and self-harm, using eight protective factors (i.e. internal developmental assets, school engagement, empowerment, and family and teacher connectedness, caring adults and after-school activity frequency and quality) as independent variables. Models were run separately for Somali and white youth.Results: Somali youth reported similar rates of depressive symptoms, but lower levels of suicidal ideation or attempts and self-harm behaviors than their white peers (p < 0.001). All eight protective factors were associated with outcomes in the expected direction for white youth. For Somali youth, internal developmental assets (aOR 0.79, 95% CI: 0.65-0.97), empowerment (aOR 0.58, 95% CI: 0.45-0.73), family connectedness (aOR 0.60, 95% CI: 0.51-0.71), perception of caring adults in the community (aOR: 0.84, 95% CI: 0.76-0.92), and quality of after-school activities (aOR: 0.72, 95% CI: 0.61-0.86) were protective against depressive symptoms, with similar patterns for other outcomes. Other school factors protected Somali youth less consistently.Conclusions: Previously established protective factors against mental illness, particularly school factors, do not universally apply to Somali youth. Interventions that strengthen individual, family, or community factors, or that increase the relevance of school factors, should be explored for these youth.
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Affiliation(s)
- April K Wilhelm
- Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN, USA
| | - Zobeida E Bonilla
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Schwartz D, Ryjova Y, Kelleghan AR, Fritz H. The refugee crisis and peer relationships during childhood and adolescence. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2021. [DOI: 10.1016/j.appdev.2021.101263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Pérez IE, Wu R, Murray CB, Bravo D. An interdisciplinary framework examining culture and adaptation in migrant children and adolescents. New Dir Child Adolesc Dev 2021; 2021:13-39. [DOI: 10.1002/cad.20405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Isabela E. Pérez
- Department of Psychology University of California Riverside Riverside California USA
| | - Rachel Wu
- Department of Psychology University of California Riverside Riverside California USA
| | - Carolyn B. Murray
- Department of Psychology University of California Riverside Riverside California USA
| | - Diamond Bravo
- Department of Psychology University of California Riverside Riverside California USA
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Enge KEA, Stige B. Musical pathways to the peer community: A collective case study of refugee children’s use of music therapy. NORDIC JOURNAL OF MUSIC THERAPY 2021. [DOI: 10.1080/08098131.2021.1891130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kaja Elise Aaslid Enge
- Faculty of Arts and Physical Education, Volda University College, Volda, Norway
- The Grieg Academy Music Therapy Research Centre, University of Bergen, Bergen, Norway
| | - Brynjulf Stige
- The Grieg Academy Music Therapy Research Centre, University of Bergen, Bergen, Norway
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African Refugee Youth's Experiences of Navigating Different Cultures in Canada: A "Push and Pull" Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042063. [PMID: 33672518 PMCID: PMC7923778 DOI: 10.3390/ijerph18042063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
Refugee youth face challenges in navigating different cultures in destination countries and require better support. However, we know little about the adaptation experiences of African refugee youth in Canada. Accordingly, this paper presents the adaptation experiences of African refugee youth and makes recommendations for ways to support youth. Twenty-eight youth took part in semi-structured interviews. Using a thematic analysis approach, qualitative data revealed four themes of: (1) ‘disruption in the family,’ where youth talked about being separated from their parent(s) and the effect on their adaptation; (2) ‘our cultures are different,’ where youth shared differences between African and mainstream Canadian culture; (3) ‘searching for identity: a cultural struggle,’ where youth narrated their struggles in finding identity; and (4) ‘learning the new culture,’ where youth narrated how they navigate African and Canadian culture. Overall, the youth presented with challenges in adapting to cultures in Canada and highlighted how these struggles were influenced by their migration journey. To promote better settlement and adaptation, youth could benefit from supports and activities that promote cultural awareness with attention to their migration experiences. Service providers could benefit from newcomer-friendly and culturally sensitive training on salient ways of how experiences of multiple cultures affect integration outcomes.
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