From social liminality to cultural negotiation: Transformative processes in immigrant mental wellbeing

Mechanism mapping: A qualitative study of how different forms of instability mediate the relationship between legal status and immigrant mental well-being

Scholarship on undocumented immigrants has linked irregular forms of legal status to depressed mental health experiences and outcomes. The children of undocumented immigrants have also been shown to report mental health issues. More regular forms of legal status, like Deferred Action for Childhood Arrivals (DACA), have been shown to improve psychological outcomes for migrants and their children. Though the relationship between legal status and mental well-being has appeared again and again in the literature, less work has explored the mechanisms through which legal status impacts mental well-being. This paper aims to help detail this link by drawing on 50 in-depth interviews with DACA-recipient and undocumented (DACA-ineligible) immigrants conducted from 2017 to 2018 (pre- and post-DACA rescindment). Thematic analysis identified three forms of instability (nation-state, residential and household) that mediate the influence of legal status on the mental well-being of immigrants and their families. Coping with nation-state, residential and household changes depleted immigrant's mental and emotional resources, hurting their mental well-being. More regular forms of legal status (like DACA) suppressed the occurrence of instability, bolstering the mental well-being reports of DACA-recipients compared to their undocumented counterparts. Yet the program's rescission in September 2017, spiked the threat of future instability for DACA-respondents leading their negative mental well-being reports to echo those of undocumented respondents. We propose that experiencing or even expecting these forms of instability to occur mediates the influence of legal status on mental well-being. Findings shed light on how legal status influences mental well-being and contribute to the immigrant mental health literature.

Finding agency in limbo: A qualitative investigation into the impact of occupational engagement on the mental health and wellbeing of asylum seekers in the UK

The process of seeking asylum is complex and often leads to extended periods of uncertainty and liminality for people awaiting decisions on their status. Occupational engagement-defined as meaningful activities and roles that bring purpose and agency to one's life-may be a key driver for mental health recovery for marginalized populations, including asylum seekers with traumatic experiences pre- and post-migration. This study aimed to clarify how occupational engagement impacts on mental health and wellbeing and how asylum seekers maintain engagement in occupation in the context of socio-political constraints of the asylum process. We explored the occupational experiences of 12 clients of one human-rights charity, utilizing community-based participatory research methods. Participants completed group mapping sessions where they depicted routine journeys taken to perform occupations in London, which included discussion around the significance of their journeys. Four participants also completed additional "walking maps"-semi-structured interviews which occurred along a selected "occupational journey" they identified as meaningful to their wellbeing. All data were analyzed using thematic network analysis. Findings revealed that engagement in routine occupations within safe, social spaces positively affects the mental wellbeing of asylum seekers by promoting competence, agency, and feelings of belonging. The liminal space of the asylum process meant that participants' occupational engagement was limited to 'leisure' activities but was still critical to establishing forms of agency associated with their wellbeing. Implications for programs and interventions responding to the needs of asylum seekers are discussed.

Faith Maturity and Mental Well-Being: A Longitudinal Study of Indian American Followers of a Guru Tradition

This article is based on a longitudinal study of Indian Americans devoted to a guru tradition, aiming to explore how faith contributes to their mental well-being. Respondent sample size at phase 1 (2003-2004) was 1872 and at phase 2 (2013-2014) was 1764. Two scales were used to measure faith maturity and well-being. Results showed that phase 2 well-being scores of the devotees were higher, influenced by faith maturity and engagement regularity, thereby corroborating the faith-religiosity-well-being link, further reinforced by the structural equation model. Faith emerges as critical variable in working with this cohort and planning interventions towards promoting their well-being.

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.

"We would never forget who we are": resettlement, cultural negotiation, and family relationships among Somali Bantu refugees

Somali refugees are resettling in large numbers in the US, but little is known about the Somali Bantu, an ethnic minority within this population. Refugee youth mental health is linked to the functioning of the larger family unit. Understanding how the process of culturally adjusting to life after resettlement relates to family functioning can help identify what kind of interventions might strengthen families and lead to better mental health outcomes for youth. This paper seeks to address the following research questions: (1) How do different groups of Somali Bantu refugees describe their experiences of culturally adapting to life in the US?; and (2) How, if at all, do processes of cultural adaptation in a new country affect Somali Bantu family functioning? We conducted 14 focus groups with a total of 81 Somali Bantu refugees in New England. Authors analyzed focus groups using principles of thematic analysis to develop codes and an overarching theoretical model about the relationship between cultural adaptation, parent-child relationships, and family functioning. Views and expectations of parent-child relationships were compared between Somali Bantu youth and adults. Cultural negotiation was dependent upon broader sociocultural contexts in the United States that were most salient to the experience of the individual. Adult and youth participants had conflicting views around negotiating Somali Bantu culture, which often led to strained parent-child relationships. In contrast, youth sibling relationships were strengthened, as they turned to each other for support in navigating the process of cultural adaptation.

Health and legal literacy for migrants: twinned strands woven in the cloth of social justice and the human right to health care

Background

Based on an analysis of published literature, this paper provides an over-view of the challenges associated with delivering on the right to access quality health care for international migrants to industrialized countries, and asks which group of professionals is best equipped to provide services that increase health and legal literacy. Both rights and challenges are approached from a social justice perspective with the aim of identifying opportunities to promote greater health equity. That is, to go beyond the legal dictates enshrined in principles of equality, and target as an ethical imperative a situation where all migrants receive the particular assistance they need to overcome the barriers that inhibit their equitable access to health care. This assistance is especially important for migrant groups that are further disadvantaged by differing cultural constructions of gender. Viewing the topic from this perspective makes evident a gap in both research literature and policy. The review has found that while health literacy is debated and enshrined as a policy objective, and consideration is given to improving legal literacy as a means of challenging social injustice in developing nations, however, no discussion has been identified that considers assisting migrants to gain legal literacy as a step toward achieving not only health literacy and improved health outcomes, but critical participation as members of their adoptive society.

Conclusion

Increasing migrant health literacy, amalgamated with legal literacy, aids migrants to better access their human right to appropriate care, which in turn demonstrably assists in increasing social engagement, citizenship and productivity. However what is not evident in the literature, is which bureaucratic or societal group holds responsibility for assisting migrants to develop critical citizenship literacy skills. This paper proposes that a debate is required to determine both who is best placed to provide services that increase health and legal literacy, and how they should be resourced, trained and equipped.

Social support, social conflict, and immigrant women's mental health in a Canadian context: a scoping review

ACCESSIBLE SUMMARY

Social support has positive and negative dimensions, each of which has been associated with mental health outcomes. Social networks can also serve as sources of distress and conflict. This paper reviews journal articles published during the last 24 years to provide a consolidated summary of the role of social support and social conflict on immigrant women's mental health. The review reveals that social support can help immigrant women adjust to the new country, prevent depression and psychological distress, and access care and services. When social support is lacking or social networks act as a source of conflict, it can have negative effects on immigrant women's mental health. It is crucial that interventions, programmes, and services incorporate strategies to both enhance social support as well as reduce social conflict, in order to improve mental health and well-being of immigrant women.

ABSTRACT

Researchers have documented the protective role of social support and the harmful consequences of social conflict on physical and mental health. However, consolidated information about social support, social conflict, and mental health of immigrant women in Canada is not available. This scoping review examined literature from the last 24 years to understand how social support and social conflict affect the mental health of immigrant women in Canada. We searched MEDLINE, PsycINFO, CINAHL, Healthstar, and EMBASE for peer-reviewed publications focusing on mental health among immigrant women in Canada. Thirty-four articles that met our inclusion criteria were reviewed, and are summarized under the following four headings: settlement challenges and the need for social support; social support and mental health outcomes; social conflict and reciprocity; and social support, social conflict, and mental health service use. The results revealed that social support can have a positive effect on immigrant women's mental health and well-being, and facilitate social inclusion and the use of health services. When social support is lacking or social networks act as a source of conflict, it can have negative effects on immigrant women's mental health. The results also highlighted the need for health services to be linguistically-appropriate and culturally-safe, and provide appropriate types of care and support in a timely manner in order to be helpful to immigrant women.

Immigrant Mental Health, A Public Health Issue: Looking Back and Moving Forward

The Mental Health Commission of Canada's (MHCC) strategy calls for promoting the health and wellbeing of all Canadians and to improve mental health outcomes. Each year, one in every five Canadians experiences one or more mental health problems, creating a significant cost to the health system. Mental health is pivotal to holistic health and wellbeing. This paper presents the key findings of a comprehensive literature review of Canadian research on the relationship between settlement experiences and the mental health and well-being of immigrants and refugees. A scoping review was conducted following a framework provided by Arskey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005). Over two decades of relevant literature on immigrants' health in Canada was searched. These included English language peer-reviewed publications from relevant online databases Medline, Embase, PsycInfo, Healthstar, ERIC and CINAHL between 1990 and 2015. The findings revealed three important ways in which settlement affects the mental health of immigrants and refugees: through acculturation related stressors, economic uncertainty and ethnic discrimination. The recommendations for public health practice and policy are discussed.

Liminality in Cultural Transition: Applying ID-EA to Advance a Concept Into Theory-Based Practice

As global migration increases worldwide, nursing interventions are needed to address the effects of migration on health. The concept of liminality emerged as a pivotal concept in the situation-specific theory of well-being in refugee women experiencing cultural transition. As a relatively new concept in the discipline of nursing, liminality is explored using a method, calledID-EA, which we developed to advance a theoretical concept for application to nursing practice. Liminality in the context of cultural transition is further developed using the five steps of inquiry of the ID-EA method. The five steps are as follows: (1) inductive inquiry: qualitative research, (2) deductive inquiry: literature review, (3) synthesis of inductive and deductive inquiry, (4) evaluation inquiry, and (5) application-to-practice inquiry. The overall goal of this particular work was to develop situation-specific, theory-based interventions that facilitate cultural transitions for immigrants and refugees.

Somali Refugees' Perceptions of Mental Illness

Nearly 13% of the U.S. population is comprised of foreign-born individuals, with Somalis constituting one of the largest resettled groups. Research suggests that, among Somali refugees, rates of mental illness are high. Yet research shows Somalis underutilize mental health services. Understanding their perceptions of mental illness and its cures may help practitioners to design more effective treatments for this population. Thus, this pilot study investigated Somali refugees' perceptions of mental illness and its treatments. Using purposive sampling, this qualitative study interviewed 20 Somali refugees using a semi-structured interview guide. Qualitative analysis yielded participants' perceptions of mental illness through their descriptions of physical symptoms accompanying mental illness, the stigma of mental illness, causes of mental illness, medical and non-medical treatments for mental illness, spirit possession causing mental illness, and the Qur'an as treatment for mental illness. Such information may help practitioners in the United States approach Somali clients in the most culturally coherent manner.

Association between degrees of social defeat and themes of delusion in patients with schizophrenia from immigrant and ethnic minority backgrounds

Immigrants have a heightened risk of developing schizophrenia, suggesting that social factors play an important role in the pathogenesis of schizophrenia. This study aimed to examine the relationship between degrees of social defeat and themes of delusion in patients with schizophrenia from immigrant and ethnic minority backgrounds. Retrospective chart review was conducted. Patients' psychosocial history, particularly employment history, level of education, and subjective feelings of societal integration before and after immigration, were compared to determine the degree of social defeat. It was found that delusional themes of psychological persecution, such as control and reference, were more common in those with either moderate or severe degrees of social defeat.

Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups

BACKGROUND

The literature on interventions addressing the intersection of homelessness, mental illness and race is scant. The At Home/Chez Soi research demonstration project is a pragmatic field trial investigating a Housing First intervention for homeless individuals with mental illness in five cities across Canada. A unique focus at the Toronto site has been the development and implementation of a Housing First Ethno-Racial Intensive Case Management (HF ER-ICM) arm of the trial serving 100 homeless individuals with mental illness from ethno-racial groups. The HF ER-ICM program combines the Housing First approach with an anti-racism/anti-oppression framework of practice. This paper presents the findings of an early implementation and fidelity evaluation of the HF ER-ICM program, supplemented by participant narrative interviews to inform our understanding of the HF ER-ICM program theory.

METHODS

Descriptive statistics are used to describe HF ER-ICM participant characteristics. Focus group interviews, key informant interviews and fidelity assessments were conducted between November 2010 and January 2011, as part of the program implementation evaluation. In-depth qualitative interviews with HF ER-ICM participants and control group members were conducted between March 2010 and June 2011. All qualitative data were analysed using grounded theory methodology.

RESULTS

The target population had complex health and social service needs. The HF ER-ICM program enjoyed a high degree of fidelity to principles of both anti-racism/anti-oppression practice and Housing First and comprehensively addressed the housing, health and sociocultural needs of participants. Program providers reported congruence of these philosophies of practice, and program participants valued the program and its components.

CONCLUSIONS

Adapting Housing First with anti-racism/anti-oppression principles offers a promising approach to serving the diverse needs of homeless people from ethno-racial groups and strengthening the service systems developed to support them. The use of fidelity and implementation evaluations can be helpful in supporting successful adaptations of programs and services.

Culture and the social construction of gender: mapping the intersection with mental health

The social construction of gender is an important concept for better understanding the determinants of mental health in women and men. Going beyond physical and physiological differences and the traditional biomedical approach, interdisciplinary study of the complex factors related to culture and society, power and politics is necessary to be able to find solutions to situations of disparity in mental health, related to both prevalence of disorders, availability and response to treatment. Gender inequality continues to be a source of suffering for many women around the world, and this can lead to adverse mental health outcomes. This review focuses on developments in the literature on culture, gender and mental health over the past decade, focusing on themes around the social construction of gender, mental health and the media, a look at cultural competence through a gender lens, gender and the body, providing some examples of the intersection between mental health and gender in low-income countries as well as the more developed world, and the impact of migration and resettlement on mental health. At the clinical level, using a bio-psycho-social-spiritual model that can integrate and negotiate between both traditional and biomedical perspectives is necessary, combined with use of a cultural formulation that takes gender identity into account. Research involving both qualitative and quantitative perspectives, and in many cases an ethnographic framework, is essential in tackling these global issues.