7ROSES, a transdiagnostic intervention for promoting self-efficacy in traumatized refugees: a first quantitative evaluation

General self-efficacy as a mediator of the association between adverse childhood experiences and psychological distress in gender-minority individuals

PURPOSE

To investigate the mediating role of general self-efficacy (i.e., belief in one's competence to cope with a broad range of stressful or challenging demands) in the relationship between adverse childhood experiences (ACEs) and psychological distress (i.e., symptoms of stress, anxiety and depression) in gender minority individuals, which include people with a gender identity that is not aligned with their sex assigned at birth.

DESIGN AND METHODS

The study sample included gender minority participants who participated in Waves 4 and 5 of Project AFFIRM, a multi-site longitudinal study of gender minority health. ACEs, general self-efficacy, and psychological distress were measured using the Behavior Risk Factor Surveillance System ACE Module at Wave 4, the PROMIS General self-efficacy measure at Wave 4, and the Brief Symptoms Inventory Global Severity Index (GSI) at Wave 5, respectively. After adjustment for covariates, including age, race, sex assigned at birth, and income, multivariable linear regression analyses were conducted to assess each component of the proposed mediation model. Next, mediation analyses were used to determine whether general self-efficacy mediated the association between ACEs and psychological distress.

FINDINGS

The sample for this study consisted of 166 gender minority adults with a mean age of 38.6 ± 12.2 years. Most were non-Hispanic White (46.4%) and female assigned at birth (59.6%). Mean ACEs score was 3.2 ± 2.1 (range 0-8), mean general self-efficacy score was 13.9 ± 3.6 (range 4-20), and mean raw-score GSI was 17.3 ± 13.7 (range 0-64). Participants who reported experiencing more ACEs had greater psychological distress (B 1.60; 95% CI = 0.66, 2.54) and lower general self-efficacy (B -0.41; 95% CI = -0.67, -0.15). In addition, lower general self-efficacy was associated with higher psychological distress (B -1.06; 95% CI = -1.61, -0.51). Bootstrap estimation of the indirect effect was significant (95% CI = 0.14, 0.90) and explained 27.1% (95% CI = 7.76, 69.76) of the total effect of ACEs on psychological distress in gender minority adults.

CONCLUSIONS

Our findings suggest that general self-efficacy partially mediated the positive association between ACEs and psychological distress in gender minority adults. Interventions that aim to improve general self-efficacy may be beneficial in alleviating psychological distress in gender minority adults.

CLINICAL RELEVANCE

Nurses can play an important role in reducing the health risks associated with ACEs by screening gender minority individuals using a trauma-informed approach to care and offering resources and referrals, as appropriate.

Self-efficacy and locus of control as transdiagnostic factors in Middle Eastern refugees

Background: Many refugees report high levels of psychopathology. As a countermeasure, some psychological interventions aim at targeting mental health difficulties in refugees transdiagnostically. However, there is a lack of knowledge about relevant transdiagnostic factors in refugee populations.Objective: To inform intervention efforts empirically, we investigated whether self-efficacy and locus of control are transdiagnostically associated with symptoms of depression, anxiety, somatisation, psychological distress, and a higher-order psychopathology factor ('p') in Middle Eastern refugees residing in Germany.Method: In total, 200 Middle Eastern refugees took part in this cross-sectional study, comprising 160 male and 40 female refugees. Participants were, on average, 25.56 years old (SD = 9.19), and 182 (91%) originally came from Syria, while remaining refugees were from Iraq or Afghanistan. They completed measures of depression, anxiety, somatisation, self-efficacy, and locus of control.Results: In multiple regression models adjusting for demographic factors (gender and age), self-efficacy and external locus of control were transdiagnostically related to depression, anxiety, somatic symptoms, psychological distress, and a higher-order psychopathology factor. Internal locus of control had no detectable effect in these models.Conclusions: Self-efficacy and external locus of control appear critical in the mental health of refugees and may be important mechanisms in overcoming posttraumatic stress and resettlement stressors. Our findings support the need to target self-efficacy and external locus of control as transdiagnostic factors of general psychopathology in Middle Eastern refugees.

Cognitive mechanisms underlying the association between trauma exposure, mental health and social engagement in refugees: A longitudinal investigation

BACKGROUNDS

Refugees and asylum-seekers are at heightened risk for developing psychological symptoms following exposure to trauma and displacement. Despite this, relatively little is known about the cognitive mechanisms that underlie common mental disorders in refugees.

METHODS

In this study, we investigated the associations between self-efficacy, beliefs about others (relating to benevolence and trust) and psychological and social outcomes in 1079 refugees from Arabic, Farsi, Tamil or English-speaking backgrounds who were residing in Australia. Participants completed an online survey assessing exposure to potentially traumatic events (PTEs), at baseline (T1), and self-efficacy, beliefs about others, PTSD symptoms, depression symptoms, anger and social engagement at baseline (T1) and six months later (T2).

RESULTS

A path analysis revealed that greater PTE exposure was associated with lower self-efficacy and lower positive beliefs about others at T1. Self-efficacy at T1 was negatively associated with depression and anger at T2, while positive beliefs about others at T1 were positively associated with social engagement and greater depression symptoms at T2.

LIMITATIONS

Limitations of this study included the fact that the study sample was not necessarily representative of the broader refugee population, and in particular may have overrepresented those with higher education levels.

CONCLUSIONS

Findings point to the critical role that cognitive variables play in the maintenance of psychological symptoms in forcibly displaced persons, and highlight the importance of targeting these in psychological interventions to promote positive posttraumatic mental health.

Mental health professionals' perspective on a brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees

Background

While many elaborated treatment protocols focus on post-traumatic stress symptoms, a large number of refugees suffer from a range of mental health problems. Thus, brief and transdiagnostic psychological interventions may be helpful first interventions for help-seeking refugees and asylum seekers in a stepped-care approach. Critically, there is limited research on how transdiagnostic interventions are received in general practice in non-specialized mental healthcare settings in high-income countries, where often only mental health professionals (MHPs) are legally allowed to treat people with mental disorders. MHPs may thus deliver such interventions, but their perspective towards them has not yet been investigated.

Objective

We aimed to investigate MHPs' perception of the usability of adapted Problem Management Plus (aPM+), a brief transdiagnostic psychological intervention for refugees, which we adapted to address distress caused by post-migration living difficulties (PMLDs).

Method

Employing an e-learning tool, we introduced the aPM+ intervention to 59 MHPs and assessed their perspective towards the intervention. We then used an inductive approach to analyse their perspective towards the intervention with open-ended questions.

Results

Altogether, 59 MHPs enrolled in the webinar and 29 provided feedback on the intervention. MHPs had a positive view on the intervention but emphasized the importance of situation-specific adaptations to the structure of the manual. The most favoured specific strategies were 'managing stress/slow-breathing', the 'tree of capabilities', and the 'riding the anger' exercise. The last two were additionally developed to reduce distress caused by PMLDs by either enhancing self-efficacy or reducing anger regulation difficulties.

Conclusions

An adaptation to aPM+ regarding more flexibility of the manual may enhance the likelihood of MHPs implementing the intervention in their daily practice. Strategies addressing coping with PMLDs could be particularly helpful.Trial registration: German Clinical Trials Register identifier: DRKS00016538.

HIGHLIGHTS

Mental health professionals had a positive view on a brief transdiagnostic psychological intervention for refugees but emphasized the importance of situation-specific adaptations to the structure of the manual.Low -intensity interventions may be useful not only in low- and middle-income countries but also in high-income countries as part of a stepped-care approach, even if distributed by MHPs instead of trained laypersons.

A brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees in Austria: a randomized controlled trial

Background

Afghan refugees often face hardship and traumatic experiences before, during, and after migration and frequently suffer from mental health burdens. Evidence based psychological treatments for refugees mostly focus on symptoms of posttraumatic stress disorder (PTSD), however, refugees often suffer from a variety of general health problems as well as depression and anxiety. We thus aimed to evaluate the effectiveness of a transdiagnostic psychological intervention.

Objective

To investigate the effectiveness of an adapted version of Problem Management Plus (aPM+) delivered by mental health professionals to adult Afghan refugees and asylum seekers.

Methods

We randomly allocated 88 Afghan refugees either to aPM+ in addition to treatment as usual (aPM+/TAU) or TAU alone. APM+ comprises of six weekly 90-minute individual sessions including strategies of stress management, problem solving, behavioural activation, strengthening social support and either anger regulation or increasing self-efficacy. The primary outcome was general health (GHQ-28) post intervention. Secondary outcome measures included distress by PMLD, Complex PTSD symptoms, quality of life, self-identified problems, and integration.

Results

Attrition was high: 42% of the randomized participants did not participate in the post-treatment assessment. A repeated measures per-protocol (completers only) ANCOVA evidenced a significant group × timepoint interaction for GHQ total scores [F(1, 47) =  14.80, p < .001, partial η2 = 0.24]. Post-hoc analyses showed significantly lower symptoms in the aPM+/TAU arm (n = 26) as compared to the TAU arm (n = 25) for the GHQ total scores (dz  = 1.04). Most secondary outcomes significantly improved in the aPM+/TAU arm, but not in the TAU arm.

Conclusion

APM+ was effective in reducing general health problems in Afghan refugees and might be considered as a first-line intervention. High drop-out rate limit the interpretations of our results, where future investigations should focus on possibilities to reduce these rates.Trial registration: Uniform Trial Number identifier: U1111-1226-3285.

HIGHLIGHTS

Refugees' mental health can be strengthened with a brief psychological intervention that also focuses on skills in the context of post-migration stressors.High drop-out rates are a major challenge for future research and delivery of psychological interventions as part of health care systems to refugees and asylum seekers.

Sexualización de niñas en redes sociales: la necesidad de inteligencia semántica en Instagram

Instagram es la red social favorita de los millennials. Sus normas comunitarias prohíben los desnudos, salvo en casos de mastectomías, lactancia materna, cuadros y esculturas. Su inteligencia artificial solo detecta porcentajes de piel en fotografías. Al no poseer inteligencia semántica, sus algoritmos no descubren otras formas de hipersexualización. En este subterfugio, niñas y chicas muestran sus cuerpos vestidos y cosificados, con uniformes escolares, rodeadas de elementos infantiles. Recrean el mito de Lolita y consiguen millones de seguidores. Este trabajo describe este oscuro fenómeno para investigar: los hashtags que emplean esa nueva forma de pornografía no censurable por los algoritmos; las percepciones objetivas y subjetivas de esas fotografías; y una propuesta de intervención en materia de género. El trabajo contiene dos fases: una exploración bibliográfica longitudinal, que ahonda en Instagram y sus condiciones de uso, la identidad personal y narratividad, y la inteligencia semántica para leer fotografías; y una indagación que correlaciona la reciprocidad de los hashtags, su denotación normal y su connotación hipersexualizada. Los resultados se ordenan en torno a dos modalidades: niñas que no tienen edad legal para tener una cuenta y chicas que sí tienen edad legal para tener una cuenta. La parte cuantitativa recoge: etiqueta, nombre de la cuenta, país y seguidores. La parte cualitativa explora: descripción de los elementos de las fotografías, significados normales y significados pornográficos implícitos. Se concluye que es necesario: detectar otros hashtags que describan otras pornografías; ampliar esta prospectiva internacionalmente; extrapolar esta investigación a otras redes sociales, como YouTube y TikTok; compartir los resultados con las redes sociales y las Fuerzas y Cuerpos de Seguridad; monitorizar el uso de las redes sociales por parte de los progenitores; formación en los entornos educativos; adquisición de inteligencia semántica por parte de las redes sociales y de los menores.

Mental Health and Illness

Circumstances forcing individuals and families to flee set the stage for disruptions in mental health and forge resilience. Individual characteristics and conditions premigration, perimigration, and postmigration influence health, mental health, care-seeking behavior, and stages of well-being and successful resettlement. Primary care providers have strategies to promote mental well-being, including focusing on resilience and social determinants of health. Integrated or collaborative care models are ideal for delivering optimum care for refugee and immigrant communities. Connecting primary and behavioral care promotes a team approach; provides comprehensive, whole-person care; and relies on participation of patients and families.