1
|
Ojha S, Thapa S, Thapa SB. Mental health problems among Syrian refugees in Nordic countries: a systematic review. Nord J Psychiatry 2024; 78:561-569. [PMID: 39282824 DOI: 10.1080/08039488.2024.2403600] [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: 05/03/2024] [Revised: 08/20/2024] [Accepted: 09/09/2024] [Indexed: 10/02/2024]
Abstract
INTRODUCTION The Syrian refugee crisis has led to significant population displacement, with many seeking refuge and asylum in Nordic countries. While these countries offer safety and stability, the resettlement process combined with the refugees' own traumatic experiences can exacerbate existing or precipitate new mental health issues. AIM This systematic review aims to comprehensively analyse the literature on mental health problems among Syrian refugees resettled in Nordic countries, exploring their prevalence and associated factors. METHODS A comprehensive literature search was conducted following PRISMA guidelines, utilizing databases including Web of Science, PubMed, MEDLINE, and Cochrane. The included studies focused on adult Syrian refugees or asylum seekers aged 18 and above, residing within Nordic countries, and investigated various mental health problems between March 2011 and January 2024, conducted in various Nordic countries. RESULTS Studies revealed high prevalence rates of PTSD (26%-45%), depression (40%-45%), and anxiety (30%-32%). Factors contributing to mental health problems included pre- and post-migration trauma, perceived discrimination, and socio-demographic variables. Pre-migration trauma exposure, such as witnessing violent events, was linked to trauma centrality and emotional suppression. Post-migration stressors like discrimination and financial strain, along with socio-demographic factors like gender and age, were associated with mental health issues. Specifically, female and older refugees reported higher levels of anxiety, depression, and low future expectations. CONCLUSION The findings underscore the urgent need for comprehensive mental health assessment and services for Syrian refugees in Nordic countries. Addressing trauma, discrimination, and socio-economic challenges is crucial for improving their well-being and facilitating successful integration into host countries.
Collapse
Affiliation(s)
- Sneha Ojha
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sahara Thapa
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Suraj Bahadur Thapa
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
2
|
Shchaslyvyi AY, Antonenko SV, Telegeev GD. Comprehensive Review of Chronic Stress Pathways and the Efficacy of Behavioral Stress Reduction Programs (BSRPs) in Managing Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1077. [PMID: 39200687 PMCID: PMC11353953 DOI: 10.3390/ijerph21081077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 09/02/2024]
Abstract
The connection between chronic psychological stress and the onset of various diseases, including diabetes, HIV, cancer, and cardiovascular conditions, is well documented. This review synthesizes current research on the neurological, immune, hormonal, and genetic pathways through which stress influences disease progression, affecting multiple body systems: nervous, immune, cardiovascular, respiratory, reproductive, musculoskeletal, and integumentary. Central to this review is an evaluation of 16 Behavioral Stress Reduction Programs (BSRPs) across over 200 studies, assessing their effectiveness in mitigating stress-related health outcomes. While our findings suggest that BSRPs have the potential to enhance the effectiveness of medical therapies and reverse disease progression, the variability in study designs, sample sizes, and methodologies raises questions about the generalizability and robustness of these results. Future research should focus on long-term, large-scale studies with rigorous methodologies to validate the effectiveness of BSRPs.
Collapse
Affiliation(s)
- Aladdin Y. Shchaslyvyi
- Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, 150, Zabolotnogo Str., 03143 Kyiv, Ukraine; (S.V.A.); (G.D.T.)
| | | | | |
Collapse
|
3
|
Assaf SA, Nuwayhid I, Habib RR. A conceptual framework on pre- and post-displacement stressors: the case of Syrian refugees. Front Public Health 2024; 12:1372334. [PMID: 38737863 PMCID: PMC11082271 DOI: 10.3389/fpubh.2024.1372334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Researchers have documented multiple stressors and mental health problems along the journey of refugees as they are displaced to seek refuge in nearby and remote host countries. This article examines published research on Syrian refugees to propose a framework to conceptualize Syrian refugees' pre- and post-stressors and their collective impact on their mental health. The proposed framework provides a comprehensive understanding of the interconnected pathways between pre-displacement stressors, post-displacement stressors, and mental health outcomes for Syrian refugees. Pre-displacement stressors are best captured by the concept of trauma centrality and emotional suppression. Post-displacement stressors, categorized under financial, political, and social themes, have a direct impact on the mental health of the refugees, but could also play a partial mediating role on the impact of pre-displacement stressors on mental health. The framework suggests a direct pathway between the experience of war-related traumatic events and mental health and introduces the country of residence as a potential moderator of the severity of mental health. The latter is primarily influenced by local policies and the host communities' acceptance of refugees. We believe that the proposed framework can guide the work of researchers, policymakers, and practitioners concerned with the mental health and well-being of Syrian refugees. Additionally, although based on the experience of Syrian refugees, it presents a holistic perspective that could be adapted in other refugee settings.
Collapse
Affiliation(s)
- Sara A. Assaf
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Iman Nuwayhid
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima R. Habib
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
4
|
Stevens SK, Timmer-Murillo SC, Tomas CW, Boals A, Larson CL, deRoon-Cassini T, Larsen SE. Event centrality and posttraumatic stress symptoms after traumatic injury: A longitudinal investigation. J Trauma Stress 2022; 35:1734-1743. [PMID: 36104984 DOI: 10.1002/jts.22877] [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] [Received: 04/07/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
The development of posttraumatic stress symptoms (PTSS) can occur following a traumatic injury, which may include an increase in negative cognitions. One cognitive construct shown to be associated with the development of PTSS is event centrality, or the degree to which an individual views a traumatic experience as central to their life story. Although cross-sectional work has demonstrated a robust connection between event centrality and PTSS, the directionality of this association remains unclear. Most previous work has investigated centrality as a predictor of PTSS, although one recent study suggests that PTSS may, in fact, predict event centrality. The current longitudinal study enrolled adult civilian participants (N = 191) from a Level 1 trauma center following a traumatic injury and assessed both event centrality and PTSS at three points posttrauma (3, 12, and 18 months). A time-constrained random intercept cross-lagged panel analysis showed that PTSS predicted event centrality over the 18-month follow-up period, B = 0.16, p = .021, but event centrality did not predict PTSS, B = -0.27, p = .340. These findings suggest that the development of PTSS following trauma exposure may lead to the perception of the traumatic event as central to an individual's story over time. Further longitudinal research is necessary to determine what variables may influence the connection between PTSS and event centrality.
Collapse
Affiliation(s)
- Sarah K Stevens
- Department of Psychological Science, University of California-Irvine, Irvine, California, USA
| | - Sydney C Timmer-Murillo
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Carissa W Tomas
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adriel Boals
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Terri deRoon-Cassini
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sadie E Larsen
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Milwaukee VA Medical Center, Milwaukee, Wisconsin, USA
| |
Collapse
|
5
|
Sá FHDL, Waikamp V, Freitas LHM, Baeza FLC. Mental health outcomes in Syrian refugees: A systematic review. Int J Soc Psychiatry 2022; 68:933-953. [PMID: 35657322 DOI: 10.1177/00207640221099404] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Syria is the main country of origin for refugees in the world. The prevalence of mental disorders in this population is high, but there is a lack of more comprehensive data on mental health issues in this population. AIM This study aims to review the literature for mental health outcomes in Syrian refugees. METHODS We performed a systematic quantitative literature review of original observational studies indexed on the MEDLINE via PubMed, Embase, Web of Science, PsycINFO, LILACS, and SciELO databases with quantitative data reporting mental health outcomes in Syrian refugees. A descriptive analysis was conducted, and the quality of the included studies was assessed using an adaptation from The National Institutes of Health (NIH) quality assessment tool for observational studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS A total of 64 studies were included. The majority were published between 2019 and 2020, and focused on the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety, with a wide range of variations. Other outcomes were difficulties in the post-migration period and promotive factors for mental health, such as resilience, positive coping strategies, and psychosocial well-being. CONCLUSIONS High prevalence rates of mental disorders were observed, as well as risk factors for their occurrence. Studies showed a very high variability of prevalence rates and heterogeneity in methodologies. There is a need for research focusing on other determinants and specific necessities for mental health, especially in the post-resettlement period.
Collapse
Affiliation(s)
- Fernando Henrique de Lima Sá
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil
| | - Vitória Waikamp
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil
| | - Lúcia Helena Machado Freitas
- Post-Graduate Program in Psychiatry and Behavioral Sciences, Federal University at Rio Grande do Sul, Porto Alegre, Brazil.,Clinical Hospital of Porto Alegre, Rio Grande do Sul, Brazil
| | | |
Collapse
|
6
|
Gewirtz A, Muldrew L, Sigmarsdóttir M. Mental health, risk and resilience among refugee families in Europe. Curr Opin Psychol 2022; 47:101428. [DOI: 10.1016/j.copsyc.2022.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
|
7
|
Eiset AH, Aoun MP, Stougaard M, Gottlieb AG, Haddad RS, Frydenberg M, Naja WJ. The association between long-distance migration and PTSD prevalence in Syrian refugees. BMC Psychiatry 2022; 22:363. [PMID: 35624508 PMCID: PMC9137139 DOI: 10.1186/s12888-022-03982-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/06/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Refugees are forced migrants but there is a large variation in the distance that refugees cover and there is a paucity in the evidence of how this may affect refugees' health and health care needs. OBJECTIVE We investigated the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health. METHODS Included from 2016-2019 were adult Syrian refugees in Lebanon and Denmark that arrived up to 12 months prior to inclusion. PTSD was assessed using the Harvard Trauma Questionnaire and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience and general mental well-being, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analyses were performed. RESULTS Included were 599 participants in Lebanon (mean age 35 years old, 73% being female) and 133 participants in Denmark (mean age 30 years old, 47% being female). After multiply imputing missing data and propensity score-weighted adjustment for confounding, migration to Denmark instead of Lebanon was associated with an increase in PTSD prevalence of 9 percentage point (95% CI [-1; 19] percentage point). CONCLUSIONS Long-distance migration may be associated with an increase in PTSD prevalence in refugees. The migration could be an important factor to consider when assessing refugees' and asylum seekers' health. Practitioners should consider "long-distance migration" in refugee health screenings and in particular when assessing the risk of post-traumatic stress disorder. Future research should be designed to ultimately lead to studies of relevant interventions to lower the risk of post-traumatic stress disorder in refugees.
Collapse
Affiliation(s)
- Andreas Halgreen Eiset
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Palle Juul Jensens Boulevard 175, 8200 Aarhus N, Aarhus, Denmark.
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark.
| | - Michaelangelo P Aoun
- Faculty of Medical Sciences, Lebanese University, P.O. Box 6573/14, Badaro, Museum, Beirut, Lebanon
| | - Monica Stougaard
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Palle Juul Jensens Boulevard 175, 8200 Aarhus N, Aarhus, Denmark
| | - Annemarie Graa Gottlieb
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Palle Juul Jensens Boulevard 175, 8200 Aarhus N, Aarhus, Denmark
| | - Ramzi S Haddad
- Faculty of Medical Sciences, Lebanese University, P.O. Box 6573/14, Badaro, Museum, Beirut, Lebanon
| | - Morten Frydenberg
- Consultant Biostatistician, Høgemosevej 19A, Olsted, 8380, Trige, Denmark
| | - Wadih J Naja
- Faculty of Medical Sciences, Lebanese University, P.O. Box 6573/14, Badaro, Museum, Beirut, Lebanon
- King Hussein Cancer Center, Queen Rania St 202, Amman, Jordan
| |
Collapse
|
8
|
Wang N, Chung MC, Liu F, Wang Y. Posttraumatic stress on Chinese adolescents’ posttraumatic growth: The role of trauma centrality and emotion regulation. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03131-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
9
|
Liddell BJ, Batch N, Hellyer S, Bulnes-Diez M, Kamte A, Klassen C, Wong J, Byrow Y, Nickerson A. Understanding the effects of being separated from family on refugees in Australia: a qualitative study. Aust N Z J Public Health 2022; 46:647-653. [PMID: 35357742 DOI: 10.1111/1753-6405.13232] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To understand the impact of family separation on refugees living in Australia. METHOD Thirteen participants with a refugee background and experiencing separation from family participated in a semi-structured qualitative interview. Interviews were coded and a thematic analysis was conducted using NVivo software. RESULTS Identified themes were organised under four domains. Domain 1 focused on the personal impact of family separation. Themes were the effects on mental health and functioning, driven by incessant worrying about the safety of family and the absence of key attachment figures, the specific effects of having missing family, alterations to self-identity and family dynamics. Domain 2 focused on themes relating to actions taken to find missing family, connect or reunite with separated family. Domain 3 highlighted the coping strategies, support mechanisms and protective factors used by participants. Domain 4 identified core beliefs about the importance of family unity, focusing on security, settlement and a happy future. CONCLUSIONS Family separation has an enduring effect on the wellbeing of refugees, with key pathways being ongoing fear and insecurity, disrupted social attachments and identity shifts in relation to the future self. IMPLICATIONS FOR PUBLIC HEALTH Refugees separated from or missing family struggle with ongoing stress and adjustment issues.
Collapse
Affiliation(s)
| | | | | | | | | | - Christina Klassen
- School of Psychology, UNSW Sydney, New South Wales.,Transcultural Psychiatry, McGill University, Canada
| | - Joshua Wong
- School of Psychology, UNSW Sydney, New South Wales
| | | | | |
Collapse
|
10
|
Chung MC, Shakra M. The Association Between Trauma Centrality and Posttraumatic Stress Among Syrian Refugees: The Impact of Cognitive Distortions and Trauma-Coping Self-Efficacy. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:1852-1877. [PMID: 32515293 DOI: 10.1177/0886260520926311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While research suggests that the war in Syria has led to a drastic re-evaluation of oneself and elevated psychiatric symptoms among Syrian refugees, little is known whether these psychological reactions might be influenced by maladaptive beliefs about oneself and the world and their ability to cope with the effect of the trauma. This study aimed to provide further evidence on the association between trauma centrality, posttraumatic stress, and psychiatric comorbidity, and examine whether cognitive distortions and trauma-coping self-efficacy would mediate the impact of trauma centrality on distress among Syrian refugees residing in Sweden. Four-hundred seventy-five Syrian refugees completed a demographic page, the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Cognitive Distortion Scales, and trauma-coping self-efficacy. Results showed that trauma centrality was significantly correlated with posttraumatic stress disorder (PTSD) and psychiatric comorbidity after adjusting the effects of trauma exposure characteristics. Cognitive distortions mediated the impact of trauma centrality on the two distress outcomes; trauma-coping self-efficacy did not but was negatively correlated with outcomes. To conclude, the war in Syria changed self-perception, outlook on life, and identity among Syrian refugees. These changes were related to increased psychological symptoms especially for those who had distorted beliefs about themselves and the world. Refugees' belief in the lack of ability to cope with the effect of the trauma impacted psychological distress independently of changes in self-perception.
Collapse
|
11
|
Kim K, Kim SH, Kim S. Psychometric Properties of the Korean version of the Emotion Regulation Questionnaire (K-ERQ) in a Clinical Sample. Psychiatry Investig 2022; 19:125-134. [PMID: 35124946 PMCID: PMC8898603 DOI: 10.30773/pi.2021.0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/12/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The Emotion Regulation Questionnaire (ERQ) is one of the widely used instruments to assess emotion regulation skills in many countries, including Korea. However, its psychometric properties have not been validated within this population. Also, the ERQ has increasingly been used in studies with psychiatric patients despite a general lack of validation in clinical settings. Therefore, the present study aimed to investigate the psychometric properties of the Korean version of the ERQ (K-ERQ) using a clinical sample in Korea. METHODS One hundred and ninety-three psychiatric patients completed a packet of self-report measures, including K-ERQ, K-BDI-II, K-ASI-3, PCL-5-K, AUDIT-K. Confirmatory factor analysis (CFA) was administered to investigate the factor structure of the K-ERQ, and internal reliability and validity were examined. RESULTS Results of the CFA supported the two-factor structure, but only after the removal of one item. The K-ERQ showed good internal consistency reliability, and its concurrent validity was also confirmed. Cognitive reappraisal was negatively correlated with depression and alcohol use disorder-related symptoms, and expressive suppression was positively correlated with depression, anxiety sensitivity, posttraumatic stress disorder (PTSD)-related symptoms and alcohol use disorder-related symptoms. Significant group differences were found in the use of emotion regulation strategies; patients with PTSD reported the higher level of cognitive reappraisal than patients with depressive disorders, bipolar disorders, and attention-deficit hyperactivity disorder. CONCLUSION The 9-itemed K-ERQ is a reliable and valid tool to assess the emotion regulation strategies in a Korean clinical sample. Our study also adds preliminary evidence on the usefulness of the ERQ in clinical settings.
Collapse
Affiliation(s)
- Kawon Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, College of Medicine and Mental Health Institute, Hanyang University, Seoul, Republic of Korea
| | - Sojung Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| |
Collapse
|
12
|
Nguyen TP, Guajardo MGU, Sahle BW, Renzaho AMN, Slewa-Younan S. Prevalence of common mental disorders in adult Syrian refugees resettled in high income Western countries: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:15. [PMID: 34986827 PMCID: PMC8729124 DOI: 10.1186/s12888-021-03664-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. METHODS Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. RESULTS Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. CONCLUSIONS Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population.
Collapse
Affiliation(s)
- Thomas P Nguyen
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Berhe W Sahle
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, Victoria, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andre M N Renzaho
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Shameran Slewa-Younan
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia.
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
13
|
Bernardi L, Gotlib IH, Zihnioğlu Ö. Effects of COVID-19-related life changes on mental health in Syrian refugees in Turkey. BJPsych Open 2021; 7:e182. [PMID: 34659792 PMCID: PMC8503067 DOI: 10.1192/bjo.2021.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mental disorders are currently the greatest global health burden. The coronavirus diseases 2019 (COVID-19) pandemic is having an adverse impact on people's mental health, particularly in vulnerable populations, such as refugees. AIMS The present study was designed to examine the association between COVID-19 and changes in mental health in Syrian refugees in Turkey. METHOD We conducted a two-wave panel survey of a representative sample of 302 of the estimated 500 000 Syrian refugees (ages 18 and older) living under humanitarian support in Istanbul (first wave between 9 and 15 July 2020 and the follow-up between 11 and 14 September 2020). We administered seven items from the CoRonavIruS Health Impact Survey in addition to one-context specific item about life changes because of COVID-19, and measures of depression (10-item Center for Epidemiologic Study Depression Scale, CESD-10), anxiety (6-item State-Trait Anxiety Inventory, STAI-6) and perceived stress (Perceived Stress Scale, PSS-4). RESULTS A factor analysis yielded three COVID-19 factors, labelled 'social relationships', 'stress' and 'hope.' We conducted a series of cross-lag panel analyses to test associations between the COVID-19 factors and mental health. We found associations between all COVID-19 factors and CESD-10, between COVID-19 'stress' and STAI-6, and between COVID-19 'stress' and COVID-19 'hope' and PSS-4. CONCLUSIONS Our measures of life changes because of the COVID-19 pandemic are associated with changes in the mental health of Syrian refugees living in Istanbul. It is therefore important that they are provided with services to reduce what may be particularly debilitating consequences of COVID-19.
Collapse
|
14
|
Stein J, Niemeyer H, Meyer C, Wirz C, Eiling A, Gruzman R, Heeke C, Stammel N, Knaevelsrud C. Posttraumatic stress in adult civilians exposed to violent conflict, war and associated human rights abuses in the Eastern Mediterranean Region: A systematic review and meta-analysis. J Affect Disord 2021; 294:605-627. [PMID: 34332362 DOI: 10.1016/j.jad.2021.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Eastern Mediterranean Region (EMR) is the stage of the world's most violent conflicts and the origin of the largest refugee population worldwide. These conflicts can result in symptoms of posttraumatic stress (PTS). To date, no comprehensive meta-analysis on proportions of PTS in civilians from the EMR has been conducted. Sample characteristics, methodological, conflict-related and displacement-related factors might affect rates of PTS. METHODS A systematic literature search for studies investigating PTS in adult civilians from the EMR was conducted until March 2020 and resulted in 118 individual study samples that were suitable for inclusion. A quality assessment was conducted. A random effects meta-analysis on proportions and sensitivity analyses were performed, and a 95% prediction interval was calculated. Subgroup analyses to identify moderators (e.g. diagnostic instruments, displacement) were conducted. RESULTS The quality of the included study samples varied. The pooled estimate of proportions from all 118 study samples was 0.31 (95% CI: 0.27 - 0.35). Heterogeneity was considerable (Q = 10151.58, p < .0001; I2 = 98.64%). The prediction interval was 0.01 to 0.76. The results remained unchanged after excluding nine outlier study samples. Heterogeneity remained high in all subgroups (range of I2: 87.91 to 99.62). LIMITATIONS Due to heterogeneity the pooled estimate cannot be interpreted. Moderators contributing to heterogeneity could not be detected. CONCLUSIONS The proportion of symptoms of PTS in civilians from the EMR varies considerably. The prediction interval indicates that the true rate falls between 1% and 76%. Future studies need to identify variables that affect heterogeneity.
Collapse
Affiliation(s)
- Jana Stein
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany.
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Caroline Meyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christina Wirz
- Division of Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Rebecca Gruzman
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nadine Stammel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
15
|
Grassi M, Pellizzoni S, Vuch M, Apuzzo GM, Agostini T, Murgia M. Psychometric Properties of the Syrian Arabic Version of the Impact of Event Scale-Revised in the Context of the Syrian Refugee Crisis. J Trauma Stress 2021; 34:880-888. [PMID: 33772886 DOI: 10.1002/jts.22667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 11/11/2022]
Abstract
The Impact of Event Scale-Revised (IES-R) is a widely used self-report questionnaire used to assess symptoms of posttraumatic stress disorder (PTSD). Although the IES-R has been translated and validated in multiple languages, no previous version has employed the Arabic dialect commonly spoken in Syria. The present work aimed to assess the psychometric properties of a Syrian Arabic version of the IES-R. Syrian citizens (N = 288) living in refugee camps in Turkey were administered the Syrian Arabic IES-R as part of a humanitarian aid project focused on providing psychological assistance. The data were analyzed with respect to 10 previously published factor solutions. We found that the best-fitting model was a four-factor structure that included factors involving Avoidance-Numbing, Intrusion, Hyperarousal, and Sleep Disturbance. The model showed strong measurement invariance between male and female subsamples, allowing for meaningful comparisons of the factor means. Overall, the present findings support the validity of a new version of the IES-R, which can be used by both researchers and clinicians responding to the urgent need for psychological care for Syrian refugees fleeing war-related violence.
Collapse
Affiliation(s)
- Michele Grassi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Marta Vuch
- United World College of the Adriatic, Duino Aurisina, Italy
| | | | - Tiziano Agostini
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Mauro Murgia
- Department of Life Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
16
|
Liddell BJ, Byrow Y, O'Donnell M, Mau V, Batch N, McMahon T, Bryant R, Nickerson A. Mechanisms underlying the mental health impact of family separation on resettled refugees. Aust N Z J Psychiatry 2021; 55:699-710. [PMID: 33111540 DOI: 10.1177/0004867420967427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Many refugees experience prolonged separation from family members, which research suggests has adverse effects on mental health and post-displacement outcomes in refugee populations. We examine mental health differences in refugees separated and not separated from their families, and key post-migration factors and cultural mechanisms that may underlie this impact. METHODS A sample of 1085 refugees resettled in Australia, of which 23.3% were separated from all of their immediate family, took part in an online battery of survey measures indexing pre- and post-migration refugee experiences, mental health symptoms, disability and individualistic/collectivistic self-identity. Family separation was used as a predictor of mental health outcomes in a series of linear regressions, and the separated and non-separated groups were compared in multigroup path analysis models to examine group-specific indirect effects. RESULTS The separated group reported greater exposure to pre-migration potentially traumatic events and higher levels of post-migration living difficulties compared to the non-separated group. Family separation predicted higher post-traumatic stress and depression symptoms, but not disability, after controlling for potentially traumatic event exposure, age and sex. Path analyses revealed distinct indirect effects for separated and non-separated groups. Principally, higher collectivistic self-identity was associated with elevated post-traumatic stress, depression and disability symptoms via social-related post-migration living difficulties such as isolation and loneliness in the separated group; whereas collectivism was linked with increased depression symptoms via economic-related post-migration living difficulties in the non-separated group. CONCLUSION These findings indicate that family separation powerfully influences mental health outcomes, but that its effect may be mediated by the type of post-migration stress experienced in the settlement environment and culturally bound differences in how the sense of self is interconnected with family.
Collapse
Affiliation(s)
| | - Yulisha Byrow
- School of Psychology, UNSW Sydney, Sydney, NSW, Australia
| | | | - Vicki Mau
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Nicole Batch
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Tadgh McMahon
- Settlement Services International, Ashfield, NSW, Australia
| | - Richard Bryant
- School of Psychology, UNSW Sydney, Sydney, NSW, Australia
| | | |
Collapse
|
17
|
Borho A, Morawa E, Schmitt GM, Erim Y. Somatic distress among Syrian refugees with residence permission in Germany: analysis of a cross-sectional register-based study. BMC Public Health 2021; 21:896. [PMID: 33975567 PMCID: PMC8114491 DOI: 10.1186/s12889-021-10731-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have already proven high rates of common mental disorders in Syrian refugees. Nevertheless, little is known about the patterns of somatic distress among this refugee population. For this reason, we aimed to examine the prevalence, co-occurrence, and risk factors of somatic distress among Syrian refugees in Germany. METHODS This study analyzes the second measurement point (N = 116) of a prospective register-based survey among 200 adult Syrian refugees with residence permission in Germany. The survey consisted of information on sociodemographic and migration-specific characteristics, health care utilization, traumatic life events, acculturative stress (Barcelona Immigration Stress Scale (BISS); subscales: perceived discrimination, intercultural contact stress, homesickness, and general psychosocial stress), and self-reported outcomes of somatic distress (Patient Health Questionnaire (PHQ-15)), depression (PHQ-9), generalized anxiety disorder (GAD-7), and post-traumatic symptoms (Essen Trauma Inventory (ETI)). RESULTS Almost half of the respondents (49.1%) were identified as being at risk of somatic distress (PHQ-15 score ≥ 6), and even 24.1% being bothered by moderate-to-severe levels of somatic distress (PHQ-15 score ≥ 10). The most robust associations with somatic distress were found for female gender, the amount of health care utilization, multiple trauma exposures, general psychosocial stress, and self-reported depression and anxiety symptoms. High comorbidities with somatic distress were shown for all of the common mental disorders studied. CONCLUSIONS The presented study reveals a significant risk of somatic distress among this displaced population and highlights implications for policy and health care providers.
Collapse
Affiliation(s)
- Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| |
Collapse
|
18
|
Abstract
AIMS Refugees and asylum-seekers are typically exposed to multiple potentially traumatic events (PTEs) in the context of war, persecution and displacement, which confer elevated risk for psychopathology. There are significant limitations, however, in extant approaches to measuring these experiences in refugees. The current study aimed to identify profiles of PTE exposure, and the associations between these profiles and key demographics, contextual factors (including ongoing stressors, method of travel to Australia and separation from family), mental health and social outcomes, in a large sample of refugees resettled in Australia. METHODS Participants were 1085 from Arabic, Farsi, Tamil and English-speaking refugee backgrounds who completed an online or pen-and-paper survey in their own language. Constructs measured included PTE exposure, demographics, pre-displacement factors, ongoing stressors, post-traumatic stress disorder symptoms, depression symptoms, anger reactions, plans of suicide and social engagement. RESULTS Latent class analysis identified four profiles of PTE exposure, including the torture and pervasive trauma class, the violence exposure class, the deprivation exposure class and the low exposure class. Compared to the low exposure class, participants in the trauma-exposed classes were more likely to be male, highly educated, from Farsi and Tamil-speaking backgrounds, have travelled to Australia by boat, experience more ongoing stressors and report both greater psychological symptoms and social engagement. CONCLUSIONS This study found evidence for four distinct profiles of PTE exposure in a large sample of resettled refugees, and that these were associated with different demographic, psychological and social characteristics. These findings suggest that person-centred approaches represent an important potential avenue for investigation of PTE exposure in refugees, particularly with respect to identifying subgroups of refugees who may benefit from different types or levels of intervention according to their pre-migration PTE experiences.
Collapse
|
19
|
Nissen A, Cauley P, Saboonchi F, J Andersen A, Solberg Ø. Mental health in adult refugees from Syria resettled in Norway between 2015 and 2017: a nationwide, questionnaire-based, cross-sectional prevalence study. Eur J Psychotraumatol 2021; 12:1994218. [PMID: 34900120 PMCID: PMC8654398 DOI: 10.1080/20008198.2021.1994218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The number of forcibly displaced people globally has never been higher, with refugees from Syria constituting the largest displaced population worldwide. Many studies have documented elevated levels of mental health problems in refugee populations, though prevalence estimates of common mental disorders vary considerably between studies, explained both by methodological and contextual factors. OBJECTIVE Using questionnaire-based screening checklists to approximate the prevalence of and investigate risk factors for post-traumatic stress disorder (PTSD), anxiety and depression among adult refugees from Syria resettled in Norway and to compare estimates with a sister-study in Sweden. METHOD Cross-sectional survey of a randomly selected sample from the National Population Register in Norway of adult refugees from Syria who were granted residency rights in Norway between 2015 and 2017 (Nsample = 9,990; nrespondents = 902). Above-threshold scores on the Harvard Trauma Questionnaire (HTQ) and Hopkins Symptoms Checklist (HSCL-25) defined caseness for PTSD (HTQ>2.06); anxiety (HSCLanxitey>1.75); and depression (HSCLdepression>1.80). RESULTS Weighted, checklist-positive prevalence estimates for PTSD, anxiety and depression were 29.7% (25.4%-34.4%), 30.1% (25.7%-34.9%), and 45.2% (40.6%-49.8%), respectively. Cumulative exposure to potentially traumatic experiences before or during flight was a clear risk factor for all outcomes, and female gender was a risk factor for anxiety and depression, though only in adjusted analyses. The choice of HTQ cut-off to define PTSD caseness (2.5 vs. 2.06) had a notable effect on prevalence estimates. CONCLUSION In line with prior evidence, the present study suggests adult refugees from Syria resettled in Norway have higher rates of anxiety and depression and markedly higher rates of PTSD compared to general, non-refugee populations, and that this is clearly linked to past traumatic experiences. Prevalence estimates were highly consistent with estimates from the sister-study in Sweden, which used almost identical methodology. Findings underline the importance of screening for and intervening on mental health problems in newly arrived refugees.
Collapse
Affiliation(s)
- Alexander Nissen
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Health Sciences, Swedish Red Cross University College, Huddinge, Sweden
| | - Prue Cauley
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Fredrik Saboonchi
- Department of Health Sciences, Swedish Red Cross University College, Huddinge, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Arnfinn J Andersen
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Øivind Solberg
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Health Sciences, Swedish Red Cross University College, Huddinge, Sweden
| |
Collapse
|
20
|
Chung MC, Slanbekova GK, Kabakova MP, Kalymbetova EK, Kudaibergenova AZ. The relationship between posttraumatic stress disorder, trauma centrality, interpersonal sensitivity and psychiatric co-morbidity among students in Kazakhstan: a Latent Class Analysis. J Ment Health 2020; 30:698-705. [PMID: 32938238 DOI: 10.1080/09638237.2020.1818704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Trauma can lead to trauma centrality and affect levels of interpersonal sensitivity and psychiatric co-morbidity. Whether a coexisting relationship between posttraumatic stress disorder (PTSD) and trauma centrality can influence levels of interpersonal sensitivity and psychiatric co-morbidity among university students from Kazakhstan is unknown. AIM To investigate the impact of the aforementioned co-existing relationship on interpersonal sensitivity and psychiatric co-morbidity among Kazakh university students. METHODS 597 students (F = 428, M = 169) completed questionnaires measuring PTSD, psychiatric co-morbidity, interpersonal sensitivity, and trauma centrality. RESULTS 28%, 32% and 40% met the criteria for full, partial and no-PTSD, respectively. Latent Class Analysis revealed a three-class solution: Class 1 (the altered-self group) with a low level of PTSD but a high level of trauma centrality, Class 2 (the traumatized-self group) with high levels of PTSD and trauma centrality and Class 3 (the low symptom group) with low levels of PTSD and trauma centrality. There were significant differences in the levels of interpersonal sensitivity and psychiatric co-morbidity across three classes. CONCLUSION There are individual differences in the display of posttraumatic stress disorder symptoms, and trauma centrality. These differences can influence interaction with others and psychological distress.
Collapse
Affiliation(s)
- Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Ho Tim Building, Shatin, Hong Kong
| | | | - Maira Pobedovna Kabakova
- Department of General and Applied Psychology, Kazakh National University Named After Al-Farabi, Almaty, Kazakhstan
| | - Elmira Kenesovna Kalymbetova
- Department of General and Applied Psychology, Kazakh National University Named After Al-Farabi, Almaty, Kazakhstan
| | | |
Collapse
|
21
|
Kheirallah KA, Cobb CO, Alsulaiman JW, Alzoubi A, Hoetger C, Kliewer W, Mzayek F. Trauma exposure, mental health and tobacco use among vulnerable Syrian refugee youth in Jordan. J Public Health (Oxf) 2020; 42:e343-e351. [PMID: 31742341 DOI: 10.1093/pubmed/fdz128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about tobacco use among youth exposed to armed conflicts, or the influence of trauma on tobacco use in this context. This study examined patterns of smoking by tobacco product and gender among Syrian refugee youth living in host communities in Jordan and assessed the associations of post-traumatic stress disorder (PTSD) and depression symptoms, trauma exposure and social support with current smoking status in boys and girls. METHODS Syrian refugee students (mean [standard deviation] age = 14.9 [1.33] years) were identified through the public school system. Data were collected using an online Arabic questionnaire that included questions about demographics, trauma exposure, current smoking (cigarette and waterpipe), PTSD, depression and perceived social support. Logistic regression was used to assess the adjusted effects of independent variables on current smoking status. RESULTS One in 7 boys and one in 14 girls were current smokers, with boys reporting greater tobacco use than girls. Among boys, current smokers reported significantly higher family member loss and lower perceived family social support than nonsmokers; among girls, current smokers also reported significantly higher family member loss as well as greater PTSD symptoms and lower perceived significant other/special person social support. CONCLUSIONS Tobacco use is established among this vulnerable group. The findings highlight the potential role of psychosocial support for tobacco prevention and cessation strategies.
Collapse
Affiliation(s)
- Khalid A Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 21110, Jordan
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Jomana W Alsulaiman
- Department of Pediatrics, Faculty of Medicine, Yarmouk University, Irbid 21110, Jordan
| | - Abdallah Alzoubi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 21110, Jordan
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Wendy Kliewer
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA
| | - Fawaz Mzayek
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, TN 38152, USA
| |
Collapse
|
22
|
Kiselev N, Morina N, Schick M, Watzke B, Schnyder U, Pfaltz MC. Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist's view. BMC Psychiatry 2020; 20:378. [PMID: 32680485 PMCID: PMC7366894 DOI: 10.1186/s12888-020-02783-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. METHODS An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data. RESULTS Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. CONCLUSIONS Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.
Collapse
Affiliation(s)
- Nikolai Kiselev
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Naser Morina
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Matthis Schick
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Birgit Watzke
- grid.7400.30000 0004 1937 0650Department of Clinical Psychology and Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
| |
Collapse
|
23
|
Borho A, Viazminsky A, Morawa E, Schmitt GM, Georgiadou E, Erim Y. The prevalence and risk factors for mental distress among Syrian refugees in Germany: a register-based follow-up study. BMC Psychiatry 2020; 20:362. [PMID: 32641014 PMCID: PMC7346482 DOI: 10.1186/s12888-020-02746-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders among refugees as well as their risk factors are already well documented in cross-sectional reports. However, longitudinal follow-up designs are widely lacking. Therefore, the aim of this study was to examine the change of the prevalence of mental disorders among Syrian refugees with German residence permission, taking into account their increasing length of stay in Germany, and to uncover the change in their relationship to pre- and post-migration risk factors. METHODS This study formed part of a register-based follow-up study with two measurement points in Erlangen (Germany). At the first time of recruitment in 2017, 200 of the 518 Syrian refugees with residence permission living in Erlangen took part. During the second survey timeframe 1.5 years later, in 2019, 108 of the former 200 Syrian refugees participated again and formed the total sample for this follow-up study. The survey instruments included demographics, migration-related variables and symptoms of post-traumatic stress (Essen Trauma Inventory, ETI), depression (Patient Health Questionnaire - PHQ-9) and generalized anxiety disorder (GAD-7). RESULTS At the time of the first survey, 26.9% of the participants exceeded the cut-off for a clinically relevant depression diagnosis, 16.7% for an anxiety disorder and 13.9% for a PTSD diagnosis. At the second measurement point, it was 30.6% for depression, 15.7% for an anxiety disorder and 13.0% for PTSD. No significant changes between the measurement points were found for any of the disorders. In multiple linear regression analyses, higher perceived discrimination, a higher number of traumatic experiences and a shorter duration of residence permission were shown to be the most important pre- and post-migration predictors of psychological stress independent of the time of measurement. CONCLUSIONS There is strong empirical evidence that the prevalence rates of mental distress among refugees are significantly higher compared to the overall population. However, it has not yet become clear how these prevalence rates change with an increasing length of stay in the host countries. The results of our study indicate that the psychological burden on this refugee population remains consistently high over time, despite partly improved living conditions, and confirm the importance of therapeutic interventions.
Collapse
Affiliation(s)
- Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Andre Viazminsky
- grid.5330.50000 0001 2107 3311Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- grid.5330.50000 0001 2107 3311Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Ekaterini Georgiadou
- grid.5330.50000 0001 2107 3311Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany ,Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Yesim Erim
- grid.5330.50000 0001 2107 3311Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| |
Collapse
|
24
|
Wang N, Chung MC, Wang Y. The relationship between posttraumatic stress disorder, trauma centrality, posttraumatic growth and psychiatric co-morbidity among Chinese adolescents. Asian J Psychiatr 2020; 49:101940. [PMID: 32065961 DOI: 10.1016/j.ajp.2020.101940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/09/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
This study examined the inter-relationship between posttraumatic stress disorder (PTSD) from past trauma, psychiatric co-morbidity, trauma centrality and posttraumatic growth (PTG) among Chinese adolescents. Nine hundred and forty-eight Chinese adolescents (M = 462, F = 486) were recruited from two secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Centrality of Events Scale, the Posttraumatic Growth Inventory, the General Health Questionnaire-28, and the Educational Stress Scale for Adolescents. After controlling for demographic variables and levels of academic stress, structural equation modeling showed that PTSD was positively associated with trauma centrality and psychiatric co-morbidity but negatively associated with posttraumatic growth. Trauma centrality mediated the impacts of PTSD on posttraumatic growth and psychiatric co-morbidity. To conclude, PTSD from past trauma could impact adolescents' ways of perceiving positive aspects of their trauma and psychological well-being. Such impact, however, was influenced by the changes in their self-concept.
Collapse
Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Man Cheung Chung
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Yabing Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| |
Collapse
|
25
|
Kiselev N, Pfaltz M, Haas F, Schick M, Kappen M, Sijbrandij M, De Graaff AM, Bird M, Hansen P, Ventevogel P, Fuhr DC, Schnyder U, Morina N. Structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland. Eur J Psychotraumatol 2020; 11:1717825. [PMID: 32128044 PMCID: PMC7034440 DOI: 10.1080/20008198.2020.1717825] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/26/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background: Due to their experiences of major stressful life events, including post-displacement stressors, refugees and asylum seekers are vulnerable to developing mental health problems. Yet, despite the availability of specialized mental health services in Western European host countries, refugees and asylum seekers display low mental healthcare utilization. Objective: The aim of this study was to explore structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland. Method: In this qualitative study, key-informant (KI) interviews with Syrian refugees and asylum seekers, Swiss healthcare providers and other stakeholders (e.g. refugee coordinators or leaders) were conducted in the German-speaking part of Switzerland. Participants were recruited using snowball sampling. Interviews were audiotaped and transcribed, and then analysed using thematic analysis, combining deductive and inductive coding. Results: Findings show that Syrian refugees and asylum seekers face multiple structural and socio-cultural barriers, with socio-cultural barriers being perceived as more pronounced. Syrian key informants, healthcare providers, and other stakeholders identified language, gatekeeper-associated problems, lack of resources, lack of awareness, fear of stigma and a mismatch between the local health system and perceived needs of Syrian refugees and asylum seekers as key barriers to accessing care. Conclusions: The results show that for Syrian refugees and asylum seekers in Switzerland several barriers exist. This is in line with previous findings. A possible solution for the current situation might be to increase the agility of the service system in general and to improve the willingness to embrace innovative paths, rather than adapting mental healthcare services regarding single barriers and needs of a new target population.
Collapse
Affiliation(s)
- Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Monique Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Florence Haas
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marie Kappen
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Anne M De Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam and Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Martha Bird
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Pernille Hansen
- Reference Centre for Psychosocial Support, International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Daniela C Fuhr
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
26
|
Peconga EK, Høgh Thøgersen M. Post-traumatic stress disorder, depression, and anxiety in adult Syrian refugees: What do we know? Scand J Public Health 2019; 48:677-687. [PMID: 31814514 DOI: 10.1177/1403494819882137] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria's neighboring countries and Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and post-traumatic stress disorder. Since the war, no systematic review has been conducted regarding the prevalence of these in the Syrian refugee group. Research is needed to develop strategies to improve the integration of Syrian refugees. OBJECTIVE This study provides a systematic review of peer-reviewed articles that feature originally collected data regarding the prevalence of post-traumatic stress, depression, and anxiety in adult Syrian refugees. METHODS The authors searched online databases (PsychInfo, PubMed, PILOTS) for peer-reviewed articles that used validated screening tools to provide mental health prevalence rate estimates in adult Syrian refugees. This article explores potential sources of heterogeneity, including individual risk factors such as demographic and environmental variables. RESULTS In total, 15 eligible studies provided cross-sectional data for 8176 adult Syrian refugees resettled in 10 countries, with significant variation in assessment and sampling methods. Combined, these studies indicate prevalence rates of 43.0% (range: 23.4-83.4%) for post-traumatic stress, 40.9% (range: 20-44.1%) for depression, and 26.6% (range: 19.30-31.8%) for anxiety morbidity in adult Syrian refugees. Larger and more rigorous surveys reported similar prevalence rates to studies with less rigorous designs, but vast heterogeneity in prevalence of morbidity persisted among all. Conclusions: Syrian refugees could be over 10 times more likely to develop post-traumatic stress and other disorders than the general population. Although there are limitations when comparing studies with different research methodologies, the results of this study suggest increased focus on adequate mental health support is necessary.
Collapse
Affiliation(s)
- Emma K Peconga
- Department of Psychology, University of Washington, USA.,Department of Rehabilitation, The Danish Institute Against Torture (Dignity), Denmark
| | - Marie Høgh Thøgersen
- Department of Rehabilitation, The Danish Institute Against Torture (Dignity), Denmark
| |
Collapse
|
27
|
Valentine SE, Marques L, Wang Y, Ahles EM, Dixon De Silva L, Alegría M. Gender differences in exposure to potentially traumatic events and diagnosis of posttraumatic stress disorder (PTSD) by racial and ethnic group. Gen Hosp Psychiatry 2019; 61:60-68. [PMID: 31715388 PMCID: PMC6870874 DOI: 10.1016/j.genhosppsych.2019.10.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a robust literature base documenting gender differences and racial/ethnic differences in exposure to potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) diagnosis. Yet, to the best of our knowledge, this is the first study to evaluate the risk of PTEs and PTSD between genders, stratified by race/ethnicity. We aimed to better understand whether factors associated with poor psychological adjustment following PTEs (e.g., PTE type, sociodemographic factors, social support) varied by gender and race/ethnicity. METHOD Data were collected from three U.S.-based national studies comprising the Collaborative Psychiatric Epidemiologic Surveys (CPES; N = 13,649). Trained lay interviewers administered questionnaires and collected data on PTE exposure, PTSD, and psychosocial covariates. Regression analyses were conducted to investigate relations between PTEs, PTSD, and gender, stratified by race/ethnicity. RESULTS Adjusting for sociodemographic variables, mental health comorbidity, social support, and PTE frequency, White, African-American, and Afro-Caribbean women had higher odds of PTSD than men in their respective racial/ethnic groups, whereas gender differences were not observed for Latinos or Asians. CONCLUSION Findings suggest that risk of exposure to PTEs and PTSD may differ by gender and race/ethnicity. Future studies should consider the contributions of social, cultural, and contextual factors in estimating PTSD risk.
Collapse
Affiliation(s)
- Sarah E Valentine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America; Department of Psychiatry, Boston Medical Center, Boston, MA, United States of America.
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ye Wang
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Emily M Ahles
- College of Applied Behavioral Sciences, University of Indianapolis, Indianapolis, IN, United States of America
| | - Louise Dixon De Silva
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Margarita Alegría
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| |
Collapse
|