Resilience of African migrants: An integrative review

The Socio-Ecological Factors Associated with Mental Health Problems and Resilience in Refugees: A Systematic Scoping Review

Despite the immense challenges to mental health faced by refugees, research consistently finds that many nevertheless demonstrate remarkable resilience. However, a systematic account of the scientific literature on resilience among refugees is currently lacking. This paper aims to fill that gap by comprehensively reviewing research on protective and risk factors affecting refugees' resilience and mental health problems across four socio-ecological levels: individual, family, community, and society. We conducted a systematic search in the databases PsycINFO, Web of Science, and SocINDEX, as well as contacted topic experts to seek out unpublished manuscripts. This yielded 223 studies (171 quantitative, 52 qualitative), which were subjected to systematic content coding. We found consistent evidence for substantive risk factors, including traumatic experiences and gender at the individual level and postmigration stress and unemployment at the societal level. We found social support to be a clear protective factor at the family and community levels. We discuss these findings in the context of policy and intervention programs and make recommendations at different socio-ecological levels for supporting refugees' resilience.

Sub-Saharan Irregular Migrant Women's Sexuality: A Qualitative Study in Humanitarian Reception Centers

Irregular female migration to Europe is a growing phenomenon, as more and more women are fleeing their countries of origin due to gender inequality and violence. During the migration process, women experience physical, psychological and social problems that affect their sex lives. The aim of our study is to describe and understand how irregular migrant women living in humanitarian reception centers experience their sexuality at different stages of the migration process. This qualitative phenomenological study collected data through sixteen in-depth interviews with irregular migrant women between January and February 2023. Data analysis was carried out using ATLAS-ti 23.0 software, from which three themes were extracted: (1) The reality of sub-Saharan women's sexuality, (2) In search of a better life: the choice between taking the risk or surrendering, and (3) The sexual revolution among migrants. Sub-Saharan women's sexuality is subject to a complex normative order. The migratory process has severe consequences on migrant women's sex life. The sexual needs of irregular migrant women admitted to humanitarian reception centers undergo a process of change that must be understood by healthcare providers in order to make improvements to care provision.

Women's experiences of trauma-informed care for forced migrants: A qualitative interview study

Introduction

Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants.

Methods

This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation.

Results

Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support.

Conclusions

Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.

'I am because you are': Community support as a bridge to mental wellbeing for resettled African refugee women living in Rhode Island

African refugee women resettled in the United States are exposed to multiple risk factors for poor mental health. Currently, no comprehensive framework exists on which to guide mental health interventions specific to this population. Through a community-based participatory research partnership, we interviewed N = 15 resettled African refugees living in Rhode Island. Here we (1) describe how meanings of mental health within the African refugee community vary from US understandings of PTSD, depression, and anxiety and (2) generate a framework revealing how mental health among participants results from interactions between social support, African sociocultural norms, and US norms and systems. Multiple barriers and facilitators of mental wellbeing lie at the intersections of these three primary concepts. We recommend that public health and medicine leverage the strength of existing community networks and organisations to address the heavy burden of poor mental health among resettled African refugee women.

“Ain’t I a Woman?”: Feminist Participatory Action-Research with African Migrant Women Living in Spain

There is a growing trend towards a feminization of migration which calls for an urgent intersectional analysis in migration and integration research. Migrant women are exposed to numerous barriers that make difficult to participate in host communities due to the intersections between their gender, ethnicity, migratory status, etc. These barriers range from structural to daily discrimination in the shape of sexism and racism, particularly for women from regions further south of Africa. Undertaken in collaboration with a local NGO in Southern Spain, this study aims to approach African migrant women’s experiences and to promote agency and participation in host communities. It was framed in Feminist Participatory Action-Research (FPAR) based on photovoice. The participants (n = 15) generated and shared photo-narratives about their daily experiences during five sessions that were participatively analyzed, classified into four themes as follows: (1) migratory projects; (2) violence and discrimination; (3) health and social care; and (4) to be and resist as an African migrant woman. Photovoice was valued as a safe, non-hierarchical, and caring environment that promoted agency in participants and reflexivity in researchers. Our results highlight the importance and necessity on undertaking FPAR in collaboration with social organizations for emancipatory research praxis and put the emphasis on photovoice as a transformational method.

[Resilience after Flight: Perspectives of Refugees and Supporting Practice Actors]

STUDY OBJECTIVES

The study aims to identify (aim 1) and relate (aim 2) refugees' and practice actors' perspectives on resilience after a flight to broaden the depth of understanding of postflight resilience and to provide insights into relationships between practice actors and refugees.

METHODS

Three guideline-based focus groups with refugees (N=9) and practice actors (N=13) to assess the perspectives of both groups on resilience after flight were conducted in German. They were analyzed iteratively according to Constructionist Grounded Theory.

RESULTS

Refugees and practitioners report the strains of uncertainty and limitation, the adaptation processes of commonality and endeavor, and the adaptation goals of stability, connectedness, and positive emotionality (goal 1). The statements of refugees and supporting practice actors on resilience after flight concur strongly regarding their content and complement each other. Refugees report more individualized and more specifically than practice actors (goal 2).

DISCUSSION

The aspects of resilience mentioned by refugees and supporting practitioners replicate the results of previous qualitative studies on post-flight resilience conducted with refugees. Both the strain of partly not knowing adequate adaptation options locally and attempts to create resilience-promoting conditions seem to be specific to the resilience of refugees. The content-related similarities between refugees and practice actors might stem from experiences of the practice actors in the context of support processes or from similar life experiences of the practice actors. The less individualized approach to post-flight resilience of the practice actors may be caused by a higher level of abstraction, role expectations, or coping with emotional distress.

CONCLUSION

The results of the study suggest that refugee resilience is characterized by universal and population-specific aspects. That practice actors who support refugees and refugees concur on the content of post-refugee resilience validates the findings of previous qualitative studies on post-refugee resilience. The study also identified different approaches to post-flight resilience among refugees and practitioners, whose causes require further research.

Adversity, emotion, and resilience among Syrian refugees in the Netherlands

Background

Syrian refugees comprise the vast majority of refugees in the Netherlands. Although some research has been carried out on factors promoting refugee resilience, there have been few empirical studies on the resilience of Syrian refugees.

Method

We used a qualitative method to understand adversity, emotion, and the factors contributing to resilience in Syrian refugees. We interviewed eighteen adult Syrian refugees residing in the Netherlands and used thematic analysis to identify the themes.

Results

We identified themes and organized them into three main parts describing the challenges (pre and post-resettlement), key emotions pertaining to those experiences, and resilience factors. We found six primary protective factors internally and externally promoting participants' resilience: future orientation, coping strategies, social support, opportunities, religiosity, and cultural identity. In addition, positive emotions constituted a key feature of refugees’ resilience.

Conclusion

The results highlight the challenges and emotions in each stage of the Syrian refugees’ journey and the multitude of factors affecting their resilience. Our findings on religiosity and maintaining cultural identity suggest that resilience can be enhanced on a cultural level. So it is worth noting these aspects when designing prevention or intervention programs for Syrian refugees.

The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis

BACKGROUND

Evidence exists reporting a high mental health burden among migrants globally. However, there is no global estimate of mental ill-health among African migrants despite their adverse pre-migration environments. This systematic review and meta-analysis summarise the current scholarship regarding the prevalence of anxiety, depression and Post-traumatic Stress Disorder (PTSD) in the global African migrant population.

METHODS

We searched six databases (Medline (EBSCOHost), PsycINFO (EBSCOHost), Web of Science, PubMed, Scopus and Cumulative Index to Nursing and Allied Health (CINAHL) from 1st January 2000 to 31st August 2021. We screened retrieved articles using strict inclusion and exclusion criteria. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools. Random-effects meta-analyses were employed using DerSimonian and Laird estimator based on inverse variance weights. The I² statistic was used to measure heterogeneity.

RESULTS

Our search retrieved 1091 articles, of which 46 were included representing a total of 28,367 African migrants. The weighted mean age of African migrants was 32.98 years, and nearly half were male (n= 12852, 45.31%). Among the included studies, almost nine out of ten (n=41, 89.1%) were cross-sectional studies. The pooled prevalence of anxiety, depression and PTSD was 34.60%;95%CI (26.30-43.00), 33.20%;95%CI (27.70-38.37) and 37.9%;95%CI (23.5- 52.4) respectively. Significant heterogeneity (I² >98%) existed in the prevalence estimates for anxiety, depression, and PTSD. Sub-group analyses indicate a significantly higher prevalence of anxiety and depression but PTSD for studies conducted in Africa than outside Africa. Similarly, higher prevalence rates for anxiety, depression, and PTSD were seen in studies that used a screening tool than in those that used a diagnostic tool, although a significant difference was observed for depression only.

CONCLUSION

Despite significant heterogeneity among included studies, our systematic review and meta-analysis show a high prevalence of anxiety, depression, and PTSD among African migrants. Our findings underscore the need to develop and implement serious, culturally appropriate mental health interventions that address post-migration stressors that increase their risk of mental ill-health and successful integration into host communities.

Peer Mentoring Programs for Culturally and Linguistically Diverse Refugee and Migrant Women: An Integrative Review

Refugee and migrant women experience personal, cultural and structural challenges as they adapt to new lives in host countries. Peer mentoring programs are used to facilitate resettlement, build empowerment and improve job-readiness for refugee and migrant women; however, the effectiveness of these programs is not well understood. A systematic search of five databases, plus grey literature from January 2005 to December 2020, was undertaken, resulting in 12 articles. A narrative synthesis using thematic analysis identified the key components and outcomes of effective programs. Most mentoring programs were co-designed with community-based service providers, using participatory approaches to ensure cultural acceptability. Communication and sharing were facilitated using workshops and individual in-person or telephone mentoring. The training and support of mentors was critical. However, differences in expectations between mentors and mentees at times resulted in attrition. Qualitative evaluation revealed enhanced social support, greater empowerment and confidence for the women. There was improved access to the social determinants of health such as education, but limited success in obtaining employment. Mentoring programs can enhance refugee and migrant women's wellbeing and social connectedness in resettlement contexts. However, it is unclear whether these benefits can be sustained over the longer term. Future programs should be rigorously evaluated through qualitative and quantitative analyses to generate conclusive evidence for best practice.

From struggle to hope: A gender-sensitive investigation on Nigerian male and female asylum seekers' experiences

The study presents a qualitative and culturally-sensitive investigation of the lived experiences of the forced migration of six Nigerian asylum seekers, three men and three women, hosted in Italy. Through a focus on gender identity issues, the study aimed to explore possible gender differences between participants and define their specific needs, requirements and characteristics. Overall, the gender-focused perspective through which we explored participants' subjective experiences has enriched our understanding of their unique life stories, shedding light on the psychic dimensions as well as on the social and cultural inscriptions of their gender identity and providing insights on the different ways in which Nigerian women and men made sense of their experiences of displacement, migration, violence and trauma.

“God Helped Us”: Resilience, Religion and Experiences of Gender-Based Violence and Trafficking among African Forced Migrant Women

In this article, I explore how faith and religion shaped the resilience of forced migrant women subjected to intersecting gender-based violence (GBV) and trafficking. Adopting a social constructivist perspective, I draw upon interviews with 11 Christian and 4 Muslim displaced survivors of 10 African nationalities temporarily residing in Tunisia. I first outline the experiences of intersecting violence to understand what displaced survivors were resilient to, and then describe faith pathways to resilience, sometimes with spiritual struggles and unmet religious needs. I delineate ways in which personal prayers and cooperating with God enabled all but one survivor to cope with exploitation and perilous journeys toward imagined refuge. I offer insights for practitioners working with forced migrants on the move and highlight the importance of spiritual support for displaced survivors who are religious. I discuss the findings and offer implications for future research and practice.

The multifaceted nature of the response to adversity in an Italian sample of refugee community leaders

The end of the last decade saw record numbers of refugee arrivals to Italy, straining the existing reception and integration systems. Although significant research attention has focused on the prevalence of posttraumatic stress disorder (PTSD), depression, and suicidal ideation in refugee populations, there are increasing calls to study the interactions between distress, resilience, and positive outcomes of adversity. To fully understand the complexity of the refugee experience, these voices must be heard in dialogue. Studies must be framed within a more nuanced view of refugees, characterizing them not exclusively as victims but also as advocates for their own well-being and the well-being of their communities. This exploratory study performed a thematic analysis of 15 interviews conducted with refugee community leaders in Italy, each a founder or leader of a community association and actively engaged in civil society. In keeping with Papadopoulos' (2007) construct of adversity-activated development, an inductive analysis identified three distinct patterns of positive adversity response: meaning, motivation, and mobilization. A deductive analysis identified the most appropriate theories of resilience to describe the sample, which included resilience as a dynamic positive adaptation and resilience as resistance to change in moral codes and personal value systems. The resulting image of refugee community leaders in Italy is that of individuals who are exposed to adversity and experiences of suffering and distress but safeguard their core values while positively adapting to a new country.

The development and validation of the 'Good Life in the Community Scale' (GLiCS): a validation study with women migrants living in high income countries

BACKGROUND

To date, few assessment instruments have been developed to quantitatively measure the mental health status of migrant populations specifically. This paper describes the development and preliminary assessment of the 'Good Life in the Community Scale' (GLiCS). GLiCS is a wellbeing measure for migrant women in high-income settings that was coproduced with experts by experience across two phases.

METHODS

The study used a mixed-methods approach and was composed of two phases.

PHASE I

88 initial items generated using qualitative data collected in a previous study were reduced to 42 through consultation with expert advisory panels, based on whether each item was considered understandable and relevant Phase II: these 42 items were piloted with a sample of migrant women (N = 109). A preliminary exploratory factor analysis was conducted using Oblique rotation. Internal consistency was measured using McDonald's ω. Convergent validity was tested by correlating the GLiCS with the Oxford Capabilities Questionnaire Mental Health (OxCAP-MH), WHO-5 wellbeing index and Objective Social Outcomes Index (SIX). Incremental validity was tested using hierarchical regression analysis to ascertain the effect on the WHO-5 wellbeing index of: age, migration status, SIX, OxCAP-MH and GLiCS. Known groups validity, the ability a measure has to discriminate between groups likely to differ on the variables of interest, was tested between the different migrant categories using a simple between subjects ANOVA.

RESULTS

Exploratory factor analysis confirmed a 17-item (three-factor: (i) access to resources, (ii) belonging and contributing, (iii) independence) scale with high internal consistency (McDonald's ω = 0.91). Convergent and incremental validity were also evidenced.

CONCLUSION

The GLiCS has demonstrable good internal consistency and construct validity, and it presents a promising wellbeing measure for better understanding the experience of migrant women.

LGBTQI + Migrants: A Systematic Review and Conceptual Framework of Health, Safety and Wellbeing during Migration

The health and safety of LGBTQI+ migrants or migrants who are of diverse sexual orientation, gender identity or expression (SOGIE) remains an under-studied area, particularly for the period during transit from their place of origin to destination. This systematic review aims to describe the literature on the health risks and consequences among SOGIE migrants during transit and examine their access and use of services. Six peer-reviewed databases and websites of nine large migration organisations were searched to identify the literature on forced migrants and sexual and gender minorities. Twenty English-language studies from 2000-2021 were included and analysed drawing on a conceptual framework. Studies emerged from six regions and the majority of research participants identified as gay men. In general, quality appraisal demonstrated studies as either medium or high quality. Findings suggested five common themes associated with SOGIE health and well-being, including: daily exposure to discrimination, harassment and violence; coping, social support and resilience; access to services; mental health; and physical and sexual health. Depression, anxiety and post-traumatic stress disorder (PTSD) were prevalent amongst SOGIE migrants, particularly when associated with detention or camp environments, and were exacerbated by social isolation. Barriers to accessing healthcare were identified and specific sexual health services were often found lacking, especially for trans persons. Unsurprisingly, during transit, SOGIE migrants are very likely to experience the double marginalisation of their migrant or minority status and their gender identity. Results indicate that services for SOGIE migrants need to tailor service access and support approaches to respond to the particular health and protection needs of SOGIE individuals in each setting.

Migration trends and dietary patterns in Sub-Saharan African adult immigrants: A comparative analysis of populations in France, the UK, and the USA

Sub-Saharan African (SSA) communities are part of a diverse and evolving African diaspora dispersed all over the world. Few studies have examined changes in eating habits of SSA communities who migrated in Western regions of the world. A critical review was conducted on the migration trends, dietary patterns, and dietary acculturation of SSA immigrants residing in the USA, the UK, and France. A comparative analysis revealed historical and contemporary influences of migration trends, the salience and significance of preserving traditional African diet post-migration, and the leading factors to and consequences of dietary acculturation. Limitations and recommendations for research and practice are described.

Migration and Resilience in Urban Canada: Why Social Resilience, Why Now?

Drawing on an extensive review of recent literature about resilience and integration, this paper evaluates a social resilience approach to the integration of international migrants in Canadian cities. We advocate a social resilience approach that acknowledges how institutions of all types play critical roles in newcomers’ efforts to establish their lives in new places, especially when faced with unanticipated events such as a global pandemic. Centering research around the concept of social resilience goes beyond the neoliberal idea that integration is primarily an individual affair achieved with support from friends, family, and a nebulous community and draws attention to the social diversity of migrants and the complexity of their migration and settlement histories. Inherently relational, a social resilience approach encourages comparative studies of integration across cities that can reveal how different institutions and their programs affect migrants’ trajectories. Detailed examinations of local institutions and their responses to shifting selection and integration policies, especially during a pandemic, also hold the potential to provide crucial information for supporting newcomers effectively.

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

The idea of violent uncertainty was first introduced in the New England Journal of Medicine (Grace et al., 2018) making claims about the deleterious impacts of insecure immigration status on the health of migrants. Policies of uncertainty are said to directly and indirectly create harm by impacting on individual's health via detention and public degradation and undermining healthcare services. We offer original empirical evidence indicating an association with uncertainty, in the form of asylum waiting times, on refugees' self-reported health. We devise four hypotheses that: long waiting time for asylum decisions increases likelihood of self-reported health problems and the effect persists overtime, that female refugees report higher levels of health problems resulting from uncertainty and religion moderates the association between health and uncertainty. We use data from the UK longitudinal Survey of New Refugees wherein all new refugees were sent a baseline survey immediately after receiving refugee status and then follow-up surveys 21 months later. The findings show longer asylum waiting time is associated with poor health. Female refugees were more likely to report poor emotional and physical health. The negative effect of asylum waiting time on emotional health persists 21 months post settlement and is worse for women. The hypothesisabout the ameliorating effect of religion is only partially supported. Our findings supports existing theory and qualitative studies about the deleterious effects of using policies of waiting-related uncertainty for managing migration. Given the wide use of such policies in the Global North, our work is suggestive of likely generalisability. Thus, countries with large refugee populations might want to consider our findings when developing asylum policy which minimises impact on refugee health.

Cross-Border Migration of Itinerant Immigrant Retailers in Ghana

A few studies in West Africa describe the state of borders, particularly their poorly governed and porous nature. This study strove to add to the scant literature by assessing the cross-border migration patterns (modes of travel and routes of entry) of seven hundred and seventy-nine (779) West African itinerant immigrant retailers in the Accra Metropolitan Area of Ghana. The study was cross-sectional and adopted the concurrent nested mixed methods research approach. Interview schedule and interview guide were used to collect the data for analysis. The Statistical Package for the Social Sciences (SPSS) version 21 was used to analyse the quantitative data. The results show that most of the immigrants travelled to their destination (Ghana) by land, using buses and mostly through unapproved routes. Immigrants without travel documents and those who regarded border officials as extortionists were amongst those who mostly travelled through unapproved routes. Statistically, significant relationships were found between routes of entry and key demographic variables such as country of origin, gender, and marital status. It emerged that immigrants who were unmarried men and those from Togo, Burkina Faso, Niger, and Nigeria have the highest odds of migrating to the destination through unapproved routes. The study recommends that government through the Ghana Immigration Service should roll out effective border surveillance to ensure the orderly and regular migration of immigrants into the country. Also, any migration management policy which aims at stemming the current migration trend should be contextualised by taking into account the background characteristics of the immigrants involved.

Telling Our Stories: Resilience during Resettlement for African Skilled Migrants in Australia

BACKGROUND

Emigration to Australia by people from Africa has grown steadily in the past two decades, with skilled migration an increasingly significant component of migration streams. Challenges to resettlement in Australia by African migrants have been identified, including difficulties securing employment, experiences of racism, discrimination and social isolation. These challenges can negatively impact resettlement outcomes, including health and wellbeing. There has been limited research that has examined protective and resilience factors that help highly skilled African migrants mitigate the aforementioned challenges in Australia. This paper discusses how individual and community resilience factors supported successful resettlement Africans in Australia. The paper is contextualised within a larger study which sought to investigate how belonging and identity inform Afrodiasporic experiences of Africans in Australia.

METHODS

A qualitative inquiry was conducted with twenty-seven (n = 27) skilled African migrants based in South Australia, using face-to-face semi-structured interviews. Participants were not directly questioned about 'resilience,' but were encouraged to reflect critically on how they navigated the transition to living in Australia, and to identify factors that facilitated a successful resettlement.

RESULTS

The study findings revealed a mixture of settlement experiences for participants. Resettlement challenges were observed as barriers to fully meeting expectations of emigration. However, there were significant protective factors reported that supported resilience, including participants' capacities for excellence and willingness to work hard; the social capital vested in community and family support networks; and African religious and cultural values and traditions. Many participants emphasised their pride in their contributions to Australian society as well as their desire to contribute to changing narratives of what it means to be African in Australia.

CONCLUSIONS

The findings demonstrate that despite challenges, skilled African migrants' resilience, ambition and determination were significant enablers to a healthy resettlement in Australia, contributing effectively to social, economic and cultural expectations, and subsequently meeting most of their own migration intentions. These findings suggest that resilience factors identified in the study are key elements of integration.

Meaning in life and impact of COVID-19 pandemic on African immigrants in the United States

This study explored the 2020 COVID-19 pandemic impact, with its unprecedented isolation norm and social distancing requirements, on African immigrants in the United States. We focused on the sources of meaning in their daily lives, how they navigated their meaning-making process, and cultural proclivities amidst the official and unofficial mandates for social distancing. Additionally, we investigated the role technologies play in the entire process. A qualitative inquiry conducted virtually generated data from a sample of 20 participants. Results show that African immigrants derive meaning from social relationships, personal life goals, religious faith, service, and good health. The COVID-19 pandemic undoubtedly threatened participants' core meaning sources, which they rely on for life satisfaction, personal growth, and healing. Various emergent technologies helped in ameliorating the situation by providing conduits for participants to engage, albeit virtually, in most activities that positively impact their lives. This study highlights clinicians' need to integrate meaning in life discussions in their African immigrant patients' care and incorporate congruent technologies as needed.

Female Nigerian asylum seekers in Italy: An exploration of gender identity dimensions through an interpretative phenomenological analysis

We present a qualitative study exploring the subjective meanings that five female Nigerian asylum seekers hosted in Italy attributed to their pre-migratory, migratory and post-migratory experiences, with an examination in-depth of the gender identity dimensions. We developed and administered semi-structured interviews, analyzed according to the Interpretative Phenomenological Analysis. On the background of the identity breakdown produced by forced migration, we highlight an inadequate integration process of the gender roles of woman and mother, generating a fracture that makes women's experiences particularly fragile. Reflections on the implication of the study and of the development of intervention programs will be outlined.

Clinical Correlates of Deliberate Self-Harm Among Migrant Trauma-Affected Subgroups

Introduction: Studies have shown that exposure to potentially traumatic events (PTEs) during the migration process has serious consequences on mental health. Migrants with a history of PTEs are more likely to inflict deliberate self-harm (DSH), a spectrum of behavior that includes non-suicidal self-injury (NSSI). With reference to a nonclinical sample of trauma-exposed migrants, this study aims to explore the prevalence of DSH and to assess the association with sociodemographic characteristics and clinical conditions, with particular attention to post-traumatic stress disorder (PTSD) symptoms, resilience capabilities, and feelings of hopelessness. Methods: A sample of migrants underwent a baseline evaluation at an outpatient department of the National Institute for Health, Migration and Poverty (INMP). Migrants with a history of torture, rape, or other severe forms of psychological, physical, or sexual violence were invited to undergo screening at the Institute's Mental Health Unit. Trauma-exposed migrants completed a series of self-report questionnaires that assessed the presence of PTSD, depression, anxiety, suicidal ideation, resilience, and feelings of hopelessness, in addition to DSH. Univariate and multivariate log-binomial regression models were used to test the association of age and clinical characteristic of migrants with DSH. Prevalence ratio (PR) with 95% confidence intervals (95% CI) and p-values were estimated. Results: A total of 169 migrants (76.9% males), aged between 18 and 68 years, M = 28.93; SD = 8.77), were selected. Of the sample, 26.6% were frequently engaging in some form of DSH, and 30.2% were diagnosed with at least one trauma-related disorder. DSH behaviors were most common in single and unemployed migrants as well as in subjects with post-traumatic stress symptoms, feelings of anxiety, hopelessness, low capability of resilience, and suicidal ideation. Taking into account age and hopelessness, we found that PTSD and low resilience capabilities were associated with a higher risk of DSH [PR adj: 2.21; 95% CI: (1.30-3.75) and PR adj: 2.32; 95% CI: (1.16-4.62), respectively]. Conclusion: Given the association between trauma exposure and DSH among migrants, exploring the presence of DSH behavior within the immigrant community is crucial for the implementation of measures to develop intervention in a clinical setting.

Discrimination Is Associated with Elevated Cardiovascular Disease Risk among African Immigrants in the African Immigrant Health Study

Background

African Americans and other persons of African descent in the United States are disproportionately affected by cardiovascular diseases (CVD). Discrimination is associated with higher CVD risk among US adults; however, this relationship is unknown among African immigrants.

Methods

The African Immigrant Health Study was a cross-sectional study of African immigrants in Baltimore-Washington, DC, with recruitment and data collection taking place between June 2017 and April 2019. The main outcome was elevated CVD risk, the presence of ≥3 CVD risk factors including hypertension, diabetes, high cholesterol, overweight/obesity, tobacco use, and poor diet. The secondary outcomes were these six individual CVD risk factors. The exposure was discrimination measured with the Everyday Discrimination Scale; summed scores ≥2 on each item indicated frequent experiences of discrimination. Resilience was assessed with the 10-item Connor-Davidson resilience scale. Logistic regression was used to examine the odds of elevated CVD risk, adjusting for relevant covariates.

Results

We included 342 participants; 61% were females. The mean (±SD) age was 47(±11) years, 61% had at least a bachelor's degree, 18% had an income <$40,000, and 49% had lived in the US ≥15 years. Persons with frequent experiences of discrimination were 1.82 times (95%CI: 1.04-3.21) more likely to have elevated CVD risk than those with fewer experiences. Resilience did not moderate the relationship between CVD risk and discrimination.

Conclusion

African immigrants with frequent experiences of discrimination were more likely to have elevated CVD risk. Targeted and culturally appropriate interventions are needed to reduce the high burden of CVD risk in this population. Health care providers should be aware of discrimination as a meaningful social determinant of CVD risk. At the societal level, policies and laws are needed to reduce the occurrence of discrimination among African immigrants and racial/ethnic minorities.

The symbiotic relationship of vulnerability and resilience in nursing

Background: Whilst the terms vulnerability and resilience are commonly used within professional nursing discourses, they are often poorly understood. Vulnerability is often framed negatively and linked to being at risk of harm, whilst resilience is often perceived as the ability to withstand challenges. Aim: The aim of this paper is to explore resilience and vulnerability; re-positioning them within the context of contemporary professional nursing practice. Design: Discussion paper. Method: Drawing upon historical and contemporary international literature, both concepts are de-constructed and then re-constructed, examining them from the position of patient care as well as from the perspective of nurses and the nursing profession. Conclusion: Resilience and vulnerability have an interdependent relationship as resilience comes into play in situations of vulnerability. Yet, contrary to the popular discourse they are multi-faceted, complex phenomena based on factors such as individual circumstances, supports, and resources.

Resilience, trauma, and hopelessness: protective or triggering factor for the development of psychopathology among migrants?

BACKGROUND

Recently, many studies have investigated the role of migration on mental health. Nonetheless, only few focused on the consequences of childhood trauma, hopelessness, and resilience on migrants' psychopathology, including psychiatric disorders and symptoms.

METHOD

119 migrants were recruited between May 2017 and April 2018, among those applying for assessment to the Mental Health Operational Unit of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy. Assessment included the following: Zung Self-Rating Depression Scale (SDS), Zung Self-Rating Anxiety Scale (SAS), Connor-Davidson Resilience Scale (CD-RISC), Childhood Trauma Questionnaire (CTQ), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Beck Hopelessness Scale (BHS), Beck's Suicide Intent Scale (SIS), Brief Aggression Questionnaire (BAQ), Deliberate Self-Harm Inventory (DSHI).

RESULTS

53.39% of migrants scored above the PCL-5 cut-off score (mean score was 39.45). SDS scores below the cutoff suggested the presence of depression in 42.37%, while According to SAS scores anxiety levels were low in 38.98% of migrants. During childhood, physical abuse and neglect were reported respectively by 56.78 and 69.49% of migrants.

CONCLUSION

We found that Post Traumatic Stress Disorders play the role of mediators for the relation between the childhood traumatic experiences and aggressiveness, anxious and depressive symptomatology, while hopelessness is a mediator between the childhood traumatic experiences and the development of depression in adulthood. Hopelessness seems to influence the strength of the relation between childhood traumatic experiences and the individual's current intensity of suicidal attitudes, plans, and behaviors. Further developments and future perspectives of the research project are to address key gaps in the field of resilience by means of a longitudinal evaluation study in migrants, including a native population control group, acceding to NIHMP.

Reconsidering interactive resilience processes in mental health: Implications for child and youth services

Research consistently demonstrates resilience as an interactive process, drawing on personal assets together with relational and contextual resources, to support improved outcomes in contexts of nonnormative adversity. What remains unclear are the dynamics of this process and what drives it. This article draws on a prior scoping review of the literature to conceptually explore the positioning of the individual within this dynamic interplay of risks, resilience, and sociocultural context as it pertains to child and youth mental health. The paper begins by summarizing findings from this scoping review, highlighting core resilience elements and processes. These are then considered in relational to the global meaning theory, situating meaning-making as a key mechanism that mediates the interaction between individuals and their ecologies. Drawing on the literature, this article considers how this interaction shapes the particular ways in which resilience then manifests itself in the lives of individuals and becomes available as a resource to assist in the promotion of mental health.

Resilience factors, race/ethnicity and sleep disturbance among diverse older females with hypertension

BACKGROUND

This study examined the relationships between resilience and sleep disturbance in a diverse sample of older women with a history of hypertension and whether this relationship is moderated by individuals' race/ethnicity.

METHODS

Sample includes 700 females from a community-based study in Brooklyn, New York with a mean age of 60.7 years (SD=6.52). Of the participants, 28.1% were born in the U.S.; 71% were African-descent, 17.4% were European and 11.6% were Hispanics descents. Data were gathered on demographics and sleep disturbance using the Comprehensive Assessment and Referral Evaluation (CARE) and the Stress Index Scale (SIS). Resilience Factors were assessed with both the Index of Self-Regulation of Emotion (ISE) and religious health beliefs. Chi-Square, Anova, Student t-tests, and multilinear regression analysis were conducted to explore associations between resilience factors and sleep disturbance. Associations between resilience factors and sleep disturbance were examined using stratified multilinear regression analysis in three models by race/ethnicity. Regression models was conducted examining the interaction between resilience factors and stress RESULTS: Resilience factor, ISE emerged as the strongest independent predictor of sleep disturbance [B(SE) = -0.368(0.008); p < .001] for African descents. ISE was not a significant predictor of sleep disturbance among Hispanic participants [B(SE) = -0.218(0.022);p = .052], however interaction effect analysis revealed that stress level moderates significantly the relationship between ISE, and their sleep disturbance [B(SE) = 0.243(0.001);p = .036].

CONCLUSIONS

Results of our study suggest that resilience factors might be a more important protective factor for sleep disturbance among diverse older females.

Health screening and preventative health care in refugee women: A qualitative analysis

Background: Regular health screening provides opportunities for early detection and effective treatment of disease. There is underutilisation of health services by migrants from culturally and linguistically diverse backgrounds, particularly refugees in Australia. Aim: To explore the beliefs, understandings, and use of health and healthcare screening services among African refugee women living in Australia. Design/Method: Qualitative secondary analysis. Method: Oral narratives derived from two primary qualitative datasets of Sub-Saharan women in New South Wales, Australia, underwent secondary thematic analysis. Findings: Twenty-two of the forty-two women had refugee status on migrating to Australia. Thematic findings reflection of misinformation, low health literacy, and health screening as not a priority. Conclusions: There is an urgent need to develop innovative strategies to engage refugee migrant women in health screening by provision of culturally meaningful health information. Relevance to clinical practice: Including refugee women's suggestions for information to be provided by health services may improve attitudes towards screening and preventative health care.

Resilience of African migrant women: Implications for mental health practice

Migrants from areas affected by war, especially refugee migrants, are susceptible to mental health issues. In addition to recognising trauma, health professionals, such as mental health nurses, need to be aware of the strength and resilience of refugees and migrants. The capacity to provide trauma-informed care that is shaped by the recognition of clients' strength and resilience is required/paramount to meet the current demand of multiculturalism emanating from an increased global migration. To facilitate increased awareness about West African women's resilience prior to migration and support trauma-informed care, we used a qualitative strength-based storytelling approach with 22 West African women residing in Sydney, Australia. Thematic analysis of the women's stories identified two major themes: When the World Falls Apart and Battered but Strong. Findings revealed that past personal experiences significantly influenced participants' strength and resilience and contributed to their mental health. Mental health professionals such as nurses can play an important role by incorporating knowledge about the resilience of migrants and refugees into providing appropriate trauma-informed care.

Refugee women's experiences negotiating motherhood and maternity care in a new country: A meta-ethnographic review

OBJECTIVES

The aim of this meta-ethnographic review was to examine refugee women's experiences negotiating motherhood and maternity services in a new country with a view to identifying the specific needs of refugee women accessing maternity care in high income countries.

DESIGN

A meta-ethnographic synthesis of qualitative research.

DATA SOURCES

Five databases were searched for papers published in English between January 2000 and January 2017.

REVIEW METHODS

The synthesis process was guided by the seven steps of meta-ethnography. The quality of included studies was assessed using the COREQ tool.

RESULTS

One overarching theme and three major themes emerged from the synthesis. The overarching theme "Living between two cultures" conveyed women's experience of feeling "in between" cultures and described refugee women's experience of striving to maintain a strong cultural identity from their country of origin while simultaneously adapting to their new context and country. This theme permeated the following three major themes: 1) "Constructing maternal identity across cultures" which discusses the cultural conflict experienced by refugees accessing maternity services in their host country; 2) "Understanding in practice" which describes reciprocal issues in communication between women and health professionals; and 3) "Negotiating care" which illustrates a mix of coping mechanisms which refugee women utilise to navigate health services in the context of high income countries.

CONCLUSION

Liminality is a ubiquitous experience for refugee women seeking maternity care in high income countries. It impacts feelings of belonging and connection to services and society. It is often a challenging experience for many women and a time in which they reformulate their identity as a citizen and a mother. This review found that the experience of liminality could be perpetuated by social factors, and inequality of healthcare provision, where communication and cultural barriers prevented women accessing care that was equal, accessible, and meaningful. Findings revealed both positive and negative experiences with maternity care. Continuity, culturally appropriate care, and healthcare relationships played an important role in the positive experiences of women. The review also revealed the damaging effects of disparities in care experienced by refugee women.