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Sabado P, Kuoch K, Sngiem S, Peong V, Chan L, Hopson C, Veng T, Colfax G, Tham L, Sen-Matthews A, Ung V, Tieng P, Siphan C, Dance J, Chang K, Doxey J, Wood J, D'Anna L. A Community-Defined Approach to Address Trauma Among Cambodian Immigrants and Refugees. Health Promot Pract 2023:15248399231184450. [PMID: 37482758 DOI: 10.1177/15248399231184450] [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: 07/25/2023]
Abstract
Asian American and Pacific Islanders are one of the fastest growing and most diverse groups in the United States. Yet, they are often aggregated as a single group, masking within-group differences in rates of disease and demographic characteristics commonly associated with elevated health risk. While more than four decades have passed since the Khmer Rouge genocide, Cambodians continue to experience trauma-related psychiatric disorders, including post-traumatic stress disorder and major depression. Funded by the California Department of Public Health Office of Health Equity, the Community Wellness Program (CWP) aimed to reduce mental health disparities among Cambodians in Long Beach and Santa Ana, California, using community-defined approaches. The 6-month program comprised community outreach, educational workshops, strengths-based case management, and social and spiritual activities. Our study aimed to examine the effects of the CWP on trauma symptoms. Program evaluation followed an incomplete stepped wedge waitlist design with two study arms. A linear mixed models analysis revealed that participants reported fewer trauma symptoms as a result of participation in the CWP and that participants experienced fewer symptoms over time. This is an especially important finding, as trauma can lead to long-term individual health effects and to social and health repercussions on an entire cultural group by way of intergenerational trauma. As the number of refugees and displaced individuals continues to grow, there is an urgent need for programs such as the CWP to prevent the lasting effects of trauma.
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Affiliation(s)
| | - Kimthai Kuoch
- Cambodian Association of American, Long Beach, CA, USA
| | | | | | - Ladine Chan
- Families in Good Health, Long Beach, CA, USA
| | - Chan Hopson
- Khmer Parent Association, Long Beach, CA, USA
| | | | - Gary Colfax
- Cambodian Association of American, Long Beach, CA, USA
| | - Lavyn Tham
- United Cambodian Community, Long Beach, CA, USA
| | | | - Virak Ung
- Cambodian Association of American, Long Beach, CA, USA
| | | | | | | | - Kyle Chang
- California State University, Long Beach, CA, USA
| | | | | | - Laura D'Anna
- California State University, Long Beach, CA, USA
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Lavdas M, Guribye E, Sandal GM. "Of course, you get depression in this situation": Explanatory Models (EMs) among Afghan refugees in camps in Northern Greece. BMC Psychiatry 2023; 23:125. [PMID: 36843000 PMCID: PMC9968643 DOI: 10.1186/s12888-023-04613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/16/2023] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND Afghan refugees and asylum seekers constitute one of the largest groups that live in camp settings in Greece. While they experience psychological distress, they are facing significant barriers in accessing appropriate mental health care. Explanatory Models (EMs) provide a context-sensitive framework for understanding the differences between health professionals, refugees and NGOs that operate on the field. This study aims at further understanding how Afghan refugees perceive and explain depression and largely psychological distress, and how this influences their choices for coping strategies and help-seeking. METHODS This qualitative study included six vignette-based semi-structured focus-group discussions with Afghan refugees and asylum-seekers (total N = 19, 12 female and 7 male) residing largely in camp settings in Northern Greece. The vignette describes a fictional person with symptoms of depression in line with DSM-5 and ICD-10 criteria. The interviews were recorded, transcribed, and analysed through template analysis. RESULTS EMs for depression are explained through Pre-migration Traumatic Experiences (PMTE) and Post-migration Living Difficulties (PMLD) relating to camp settings. Female participants identified gender-based and domestic violence as contributing to psychological distress while males highlighted conflict and persecution. Life in the camp with associated inactivity, and uncertainty for the future, was perceived as a significant risk factor for psychological distress among females and males. In terms of coping strategies, females tended to focus on mobilizing collective resources within the camp (e.g. safe space for women facilitating emotional support), while males advocated for self-empowerment and solution-oriented coping. The value of engagement in peer helper-roles was highlighted. CONCLUSIONS The results highlight the potential value of community-based psychosocial approaches to support and promote mental health within camp settings. Additionally, they may inform policies and practices regarding access to appropriate mental health care for Afghan refugees. Further research is needed to establish the efficiency of such interventions in this context.
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Affiliation(s)
- Michalis Lavdas
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.
| | - Eugene Guribye
- grid.509009.5NORCE Norwegian Research Centre, Kristiansand, Norway
| | - Gro Mjeldheim Sandal
- grid.7914.b0000 0004 1936 7443Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
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Fine SL, Kane JC, Spiegel PB, Tol WA, Ventevogel P. Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR's Health Information System (2009-2018). BMC Med 2022; 20:183. [PMID: 35570266 PMCID: PMC9109385 DOI: 10.1186/s12916-022-02371-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study examines mental, neurological, and substance use (MNS) service usage within refugee camp primary health care facilities in low- and middle-income countries (LMICs) by analyzing surveillance data from the United Nations High Commissioner for Refugees Health Information System (HIS). Such information is crucial for efforts to strengthen MNS services in primary health care settings for refugees in LMICs. METHODS Data on 744,036 MNS visits were collected from 175 refugee camps across 24 countries between 2009 and 2018. The HIS documented primary health care visits for seven MNS categories: epilepsy/seizures, alcohol/substance use disorders, mental retardation/intellectual disability, psychotic disorders, severe emotional disorders, medically unexplained somatic complaints, and other psychological complaints. Combined data were stratified by 2-year period, country, sex, and age group. These data were then integrated with camp population data to generate MNS service utilization rates, calculated as MNS visits per 1000 persons per month. RESULTS MNS service utilization rates remained broadly consistent throughout the 10-year period, with rates across all camps hovering around 2-3 visits per 1000 persons per month. The largest proportion of MNS visits were attributable to epilepsy/seizures (44.4%) and psychotic disorders (21.8%). There were wide variations in MNS service utilization rates and few consistent patterns over time at the country level. Across the 10 years, females had higher MNS service utilization rates than males, and rates were lower among children under five compared to those five and older. CONCLUSIONS Despite increased efforts to integrate MNS services into refugee primary health care settings over the past 10 years, there does not appear to be an increase in overall service utilization rates for MNS disorders within these settings. Healthcare service utilization rates are particularly low for common mental disorders such as depression, anxiety, post-traumatic stress disorder, and substance use. This may be related to different health-seeking behaviors for these disorders and because psychological services are often offered outside of formal health settings and consequently do not report to the HIS. Sustained and equitable investment to improve identification and holistic management of MNS disorders in refugee settings should remain a priority.
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Affiliation(s)
- Shoshanna L Fine
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jeremy C Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
| | - Paul B Spiegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Arq International, Diemen, the Netherlands
| | - Peter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Psychosocial Impact of the COVID-19 Pandemic on Healthcare Workers and Initial Areas of Action for Intervention and Prevention-The egePan/VOICE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910531. [PMID: 34639831 PMCID: PMC8508196 DOI: 10.3390/ijerph181910531] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/15/2022]
Abstract
Introduction: Epidemics lead to an increase in occupational stress and psychological strain among healthcare workers. However, the impact of a pandemic outbreak on healthcare systems is yet to be clearly defined. Therefore, this work aims to describe and analyze specific areas of workload among different groups of healthcare workers during the first wave of the COVID-19 pandemic. Methods: A sample of N = 8088 persons working in the German-speaking healthcare sector participated in the VOICE/egePan online survey, which addressed the impact of the COVID-19 pandemic during the second quarter of 2020. We used 15 self-constructed items, based on the work of Matsuishi et al. (2012), to identify potential COVID-19-specific topics. Results: N = 7542 records of healthcare workers were analyzed. Of these, 60.80% reported, retrospectively, an increase in stress since the outbreak of the pandemic. Problem areas tended to be indicated more frequently by the women surveyed than by the men. Nurses, paramedics and medical technicians reported the highest fear of infecting others while physicians reported the highest fear of physical or mental exhaustion. With respect to age, older respondents indicated less fear and felt more protected. Men and people living alone were more likely to use dysfunctional coping strategies. Migrants reported a higher fear of becoming infected or infecting others as well as they reported about increased levels of smoking. Discussion: Retrospectively, the COVID-19 pandemic led to an increase in stress among healthcare workers. Problem areas have different focuses with regard to different living situations, environmental conditions and professions. In order to lay the best basis for healthy and efficient work, it seems necessary to take measures especially tailored to the needs of different groups of healthcare workers.
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Yun S, Ahmed SR, Hauson AO, Al-Delaimy WK. The Relationship Between Acculturative Stress and Postmigration Mental Health in Iraqi Refugee Women Resettled in San Diego, California. Community Ment Health J 2021; 57:1111-1120. [PMID: 33385267 DOI: 10.1007/s10597-020-00739-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/29/2020] [Indexed: 01/09/2023]
Abstract
Due to the lack of research on the adverse impact of acculturative stress on the mental health, the current study examined the associations between acculturative stress and post-migration mental health outcomes among 219 Iraqi refugee women resettled in San Diego, California. Mental illness, trauma history, and acculturative stress were measured and descriptive statistical analyses, and multivariate logistic regression analyses were conducted to determine the association between acculturative stress, depression, and anxiety among the refugee women.About half of the participants were categorized as having anxiety (45.6%) and depression (55.3%). The multivariate regression analysis found that the odds of a mental health outcome of depression and anxiety in relation to acculturative stress, increases by a factor of 1.056 and 1.076 respectively, for every point increase on the acculturative stress scale.The study's findings reflect a linear association of acculturative stress with depression and anxiety among Iraqi refugee mothers resettled in San Diego. The mental well-being of refugees does not always improve nor does their trauma disappear by resettling in a new country. Policy makers should consider extending the evaluation, follow-up, and support of Iraqi refugee mental health long beyond the current 90 post arrival policy.
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Affiliation(s)
- Sandra Yun
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Sawssan R Ahmed
- Department of Psychology, California State University, Fullerton, CA, USA
| | - Alexander O Hauson
- California School of Professional Psychology, San Diego, CA, USA.,Department of Psychiatry, School of Medicine, University of California, San Diego, CA, USA
| | - Wael K Al-Delaimy
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
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Fogden G, Berle D, Steel Z. The Impact of Family Separation and Worry About Family on Psychological Adjustment in Refugees Resettled in Australia. J Trauma Stress 2020; 33:894-907. [PMID: 32667086 DOI: 10.1002/jts.22568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 11/11/2022]
Abstract
Few reliable predictors of postarrival psychological adjustment have been identified with regard to refugees once they arrive in their host country. We investigated the association between family separation and psychological symptoms in refugees resettled in Australia from 2013 to 2016. Participants were 1,495 adult refugees (M = 38.9 years, SD = 12.7) who participated in the Building a New Life in Australia population-based study across 4 years. Participants were assessed for psychological distress and posttraumatic stress symptoms (PTSS) using the Kessler Psychological Distress Scale (K6) and Posttraumatic Stress Disorder-8 (PTSD-8), respectively. We used latent class growth analysis (LCGA) to identify latent longitudinal trajectories and binary logistic regression to assess the contribution of family predictor variables toward PTSD-8 and K6 symptom trajectory class membership. The LCGA supported a four-class solution for PTSS, categorized as improving PTSS (18.4%), persistently high PTSS (11.5%), resilient PTSS (57.3%), and deteriorating PTSS (12.6%). For the K6, LCGA supported a four-class solution comprising classes categorized as persistently high psychological distress (PD; 7.0%), improving PD (17.3%), resilient PD (61.1%), and deteriorating PD (14.6%). Separation from family members did not independently predict the course of psychological symptoms; however, worry about family and friends contributed to the persistence of high PTSD-8 scores, OR = 1.75, and deteriorating K6 scores, OR = 1.57. The current findings suggest persistently high or worsening psychological symptom trajectories during the postsettlement phase may be marked by worry about family and friends, in addition to older age and female gender, rather than separation alone.
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Affiliation(s)
- Georgia Fogden
- Discipline of Clinical Psychology, University of Technology Sydney, Sydney, Australia
| | - David Berle
- Discipline of Clinical Psychology, University of Technology Sydney, Sydney, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Zachary Steel
- School of Psychiatry, University of New South Wales, Sydney, Australia.,St John of God Healthcare, Richmond Hospital, Sydney, Australia.,Black Dog Institute, Randwick, Australia
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Hou T, Zhang F, Mao X, Deng G. Chronotype and psychological distress among Chinese rural population: A moderated mediation model of sleep quality and age. PLoS One 2020; 15:e0241301. [PMID: 33125424 PMCID: PMC7598484 DOI: 10.1371/journal.pone.0241301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/12/2020] [Indexed: 12/02/2022] Open
Abstract
PURPOSES Evidence suggests evening-type individuals have a higher risk of reporting psychological distress than morning-type individuals. However, less is known regarding the underlying processes that might mediate or moderate this association among Chinese rural population. This study aimed to evaluate the prevalence of psychological distress, investigate whether sleep quality would mediate the association between chronotype and psychological distress and explore whether age would moderate the direct or indirect effect of the mediation model. METHODS The cross-sectional study utilized a sample of 884 rural residents from rural regions in Anqing City, Anhui Province, China. Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and 21-item Depression Anxiety Stress Scale (DASS-21) were used to measure chronotype, sleep quality and psychological distress, respectively. MacKinnon's four-step procedure was employed to examine the mediation effect, while Hayes PROCESS macro (model 59) was used to perform the moderated mediation analysis. RESULTS The prevalence of psychological distress among Chinese rural population was 33.4%. The association between chronotype and psychological distress was partially mediated by sleep quality (indirect effect = - 0.05, 95% CI = [-0.08, -0.03]). In addition, age moderated the first stage (sleep quality-psychological distress) of the indirect effect, with the indirect effect being attenuated for older rural residents. As suggested by Johnson-Neyman technique, the association between sleep quality and psychological distress was only significant when the age of the participant was lower than 48.59. CONCLUSIONS The incidence of psychological distress among Chinese rural residents cannot be neglected. Interventions for the enhancement of sleep quality to prevent and reduce psychological distress should be prioritized to rural residents who are prone to eveningness, especially those who are younger.
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Affiliation(s)
- Tianya Hou
- Department of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Fan Zhang
- Department of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xiaofei Mao
- Department of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Guanghui Deng
- Department of Psychology, Naval Medical University (Second Military Medical University), Shanghai, China
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Posttraumatic Stress and Depression Among Syrian Refugees Living in Turkey: Findings From an Urban Sample. J Nerv Ment Dis 2019; 207:995-1000. [PMID: 31658240 DOI: 10.1097/nmd.0000000000001104] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although most of the 3.6 million Syrian refugees in Turkey live outside refugee camps, most mental health research is on camp residents and few are on those living in cities. We aimed to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and depression in Syrian refugees living in an urban area in Turkey. A total of 420 adult Syrians living in Ankara were assessed using the Harvard Trauma Questionnaire and the Beck Depression Inventory. Probable PTSD and depression rates were 36.5% and 47.7%, respectively. Female sex, physical illness, and greater number of potentially traumatic events predicted both PTSD and depression. PTSD was additionally predicted by past psychiatric illness, and depression was predicted by lower economic status. Interestingly, lower economic status predicted depression among men, but not among women. Studies on refugees should be sensitive to factors that could have a significant effect on mental health such as sex or residence.
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Uy KK, Okubo Y. Re-Storying the Trauma Narrative: Fostering Posttraumatic Growth in Cambodian Refugee Women. WOMEN & THERAPY 2018. [DOI: 10.1080/02703149.2018.1425025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K. Kara Uy
- Department of Student Health and Psychological Services, Evergreen Valley College, San Jose, California
| | - Yuki Okubo
- Department of Psychology, Salisbury University, Salisbury, Maryland
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10
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van der Ham AJ, Ujano-Batangan MT, Ignacio R, Wolffers I. The dynamics of migration-related stress and coping of female domestic workers from the Philippines: an exploratory study. Community Ment Health J 2015; 51:14-20. [PMID: 25342077 DOI: 10.1007/s10597-014-9777-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
Female domestic workers face many migration-related stressors that affect their mental health, but we know little about the dynamics of stress and coping in different migration phases. This exploratory study aims to assess stress and coping of female migrant domestic workers from the Philippines in different phases of the migration process; prior to migration, in the country of destination and upon return to the Philippines. Data were collected in 2010 using questionnaires (N = 500). Validation of findings took place in a work shop (23 participants) and two focus groups (13 and 8 participants). Stress levels of women were significantly higher abroad than in the Philippines. Stress and coping in the Philippines was primarily related to financial issues, while stress and coping abroad related more strongly loneliness, working conditions and employers. Findings from this study provide insight in the phase-specific and transnational dimensions of stress and coping.
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Affiliation(s)
- Alida Joanna van der Ham
- Athena Institute, VU University Amsterdam, De Boelelaan 1081, 1081 HV, Amsterdam, The Netherlands,
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Kane JC, Ventevogel P, Spiegel P, Bass JK, van Ommeren M, Tol WA. Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps. BMC Med 2014; 12:228. [PMID: 25420518 PMCID: PMC4269097 DOI: 10.1186/s12916-014-0228-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population-based epidemiological research has established that refugees in low- and middle-income countries (LMIC) are at increased risk for a range of mental, neurological and substance use (MNS) problems. Improved knowledge of rates for MNS problems that are treated in refugee camp primary care settings is needed to identify service gaps and inform resource allocation. This study estimates contact coverage of MNS services in refugee camps by presenting rates of visits to camp primary care centers for treatment of MNS problems utilizing surveillance data from the Health Information System (HIS) of the United Nations High Commissioner for Refugees. METHODS Data were collected between January 2009 and March 2013 from 90 refugee camps across 15 LMIC. Visits to primary care settings were recorded for seven MNS categories: epilepsy/seizure; alcohol/substance use; mental retardation/intellectual disability; psychotic disorder; emotional disorder; medically unexplained somatic complaint; and other psychological complaint. The proportion of MNS visits attributable to each of the seven categories is presented by country, sex and age group. The data were combined with camp population data to generate rates of MNS visits per 1,000 persons per month, an estimate of contact coverage. RESULTS Rates of visits for MNS problems ranged widely across countries, from 0.24 per 1,000 persons per month in Zambia to 23.69 in Liberia. Rates of visits for epilepsy were higher than any of the other MNS categories in nine of fifteen countries. The largest proportion of MNS visits overall was attributable to epilepsy/seizure (46.91% male/35.13% female) and psychotic disorders (25.88% male/19.98% female). Among children under five, epilepsy/seizure (82.74% male/82.29% female) also accounted for the largest proportion of MNS visits. CONCLUSIONS Refugee health systems must be prepared to manage severe neuropsychiatric disorders in addition to mental conditions associated with stress. Relatively low rates of emotional and substance use visits in primary care, compared to high prevalence of such conditions in epidemiological studies suggest that many MNS problems remain unattended by refugee health services. Wide disparity in rates across countries warrants additional investigation into help seeking behaviors of refugees and the capacity of health systems to correctly identify and manage diverse MNS problems.
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Affiliation(s)
- Jeremy C Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 894, Baltimore, MD, 21205, USA.
| | - Peter Ventevogel
- Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland.
| | - Paul Spiegel
- Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland.
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 894, Baltimore, MD, 21205, USA.
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 894, Baltimore, MD, 21205, USA.
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Goodkind JR, Hess JM, Isakson B, LaNoue M, Githinji A, Roche N, Vadnais K, Parker DP. Reducing refugee mental health disparities: a community-based intervention to address postmigration stressors with African adults. Psychol Serv 2014; 11:333-46. [PMID: 24364594 PMCID: PMC4107192 DOI: 10.1037/a0035081] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Refugees resettled in the United States have disproportionately high rates of psychological distress. Research has demonstrated the roles of postmigration stressors, including lack of meaningful social roles, poverty, unemployment, lack of environmental mastery, discrimination, limited English proficiency, and social isolation. We report a multimethod, within-group longitudinal pilot study involving the adaptation for African refugees of a community-based advocacy and learning intervention to address postmigration stressors. We found the intervention to be feasible, acceptable, and appropriate for African refugees. Growth trajectory analysis revealed significant decreases in participants' psychological distress and increases in quality of life, and also provided preliminary evidence of intervention mechanisms of change through the detection of mediating relationships whereby increased quality of life was mediated by increases in enculturation, English proficiency, and social support. Qualitative data helped to support and explain the quantitative data. Results demonstrate the importance of addressing the sociopolitical context of resettlement to promote the mental health of refugees and suggest a culturally appropriate, and replicable model for doing so.
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Affiliation(s)
| | - Julia M Hess
- Department of Pediatrics, University of New Mexico Health Sciences Center
| | - Brian Isakson
- Department of Psychiatry, University of New Mexico Health Sciences Center
| | - Marianna LaNoue
- Department of Family & Community Medicine, Jefferson Medical College, Thomas Jefferson University
| | - Ann Githinji
- Department of Anthropology, University of Virginia
| | - Natalie Roche
- Department of Pediatrics, University of New Mexico Health Sciences Center
| | | | - Danielle P Parker
- Department of Pediatrics, University of New Mexico Health Sciences Center
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Revisiting the California Southeast Asian Mental Health Needs Assessment Data: An Examination of Refugee Ethnic and Gender Differences. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2002.tb00173.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Abstract
Although asylum seeking has become a major political issue in the Western world, research on its psychological impact is still in its infancy. This study examined levels and predictors of distress among a community sample of persons who have sought asylum in Ireland. A key aim was to provide a longitudinal analysis of the relationship between legal status security and psychological distress. Distress was measured by the Symptom Checklist-90-Revised at Time 1 (N = 162) and its shorter version (the Brief Symptom Inventory) at Time 2 (N = 70). Levels of severe distress were high at both baseline (46%) and follow-up (36%). The only persons to show a decrease in distress were those who had obtained a secure legal status (e.g., refugee status or residency) between the study phases. Distress risk factors included female gender, an insecure legal status, separation from children, discrimination, and postmigration stress. Protective factors were social support (Time 1) and the presence of a partner. The findings suggest that asylum seekers are a high-risk group for distress. This risk can be reduced by appropriate policy changes and interventions to increase social resources.
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15
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Turnip SS, Hauff E. Household roles, poverty and psychological distress in internally displaced persons affected by violent conflicts in Indonesia. Soc Psychiatry Psychiatr Epidemiol 2007; 42:997-1004. [PMID: 17896062 DOI: 10.1007/s00127-007-0255-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 09/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Some of the possible reasons for deteriorating mental health among forced migrants have been identified as poverty, traumatic experiences before migration and postmigration negative life events. Previous studies suggest that the prevalence of psychological distress of forced migrants is higher among women than men. However, there is a lack of studies of internally displaced persons (IDP) that assess the relationship between psychological distress and selected variables in low income countries. OBJECTIVES This study aims to assess the association between poverty, household roles and psychological distress among IDP in Ambon, Indonesia, and to identify different risk factors of psychological distress across household roles. METHODS In a cross-sectional study carried out in Ambon from July to September 2005, 460 adults were recruited from 200 households in 10 camp locations on Ambon Island. The Hopkins Symptom Check List-25 was used as a dichotomous variable ("case" score >/= 1.75) to measure psychological distress, and questionnaires were used to measure socioeconomic level, trauma experiences related to conflict and current health conditions. Data were collected through face-to-face structured interviews. RESULTS The overall prevalence of psychological distress was 47%. Prevalence was highest among women, regardless of their household roles (55%), and lowest among men (37%). Different risk factors for psychological distress were identified for each household role. Poverty-related risk factors were only significant among "mothers". An important risk factor for "fathers" was long-term illness (lasting more than three months), and for "mothers" was witnessed murder. CONCLUSION Different risk factors were identified for each household role of IDP, indicating that their mental health care requirements may be different.
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Affiliation(s)
- Sherly Saragih Turnip
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, c/o Ullevål universitetssykehus, 0407, Oslo, Norway.
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Otto MW, Hinton DE. Modifying Exposure-Based CBT for Cambodian Refugees with Posttraumatic Stress Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2006; 13:261-270. [PMID: 20072706 PMCID: PMC2804994 DOI: 10.1016/j.cbpra.2006.04.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cambodian refugees represent a severely traumatized population living in the United States. In this paper, we describe the modification of a cognitive-behavior therapy program to facilitate delivery of an exposure-based treatment for posttraumatic stress disorder while addressing some of the challenges brought by differences in language and culture between providers and patients. Our treatment modifications include the use of metaphors and culturally relevant examples to aid the communication of core concepts by interpreters, an emphasis on teaching the "process" of exposure therapy rather than relying on specific exposure practice in the group setting, a focus on interoceptive exposure to allow more effective group practice and to address culturally specific symptom interpretations, attention to the way in which treatment procedures interacted with culturally specific beliefs, and efforts to integrate treatment services within the community. Although data are limited, results to date suggest that this modified treatment was acceptable to patients and offered benefits on the order of large effect sizes.
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Schulz P, Schlotz W, Wolf J, Wüst S. Geschlechtsunterschiede bei stressbezogenen Variablen. ACTA ACUST UNITED AC 2002. [DOI: 10.1024//0170-1789.23.3.305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Obwohl Frauen durchschnittlich von mehr Befindensstörungen, Stress und körperlichen Beschwerden berichten als Männer, weist ihre höhere Lebenserwartung objektiv auf eine bessere Gesundheit hin. Zur Erklärung dieses paradoxen Befundes wird die interindividuell variierende Neigung zur Besorgnis herangezogen. In der Besorgnis-Skala des Trierer Inventar zur Erfassung von chronischem Stress (TICS) zeigt sich eine altersunabhängig stärker ausgeprägte Besorgnisneigung bei Frauen (N = 1255), die Geschlechtsunterschiede in anderen Skalen zum chronischen Stress aufklärt. In einer weiteren Stichprobe (N = 360) erklärt die Variable Besorgnisneigung Geschlechtsunterschiede bei stressbezogenen Variablen, die in der Literatur berichtet werden. Nach den hier vorgestellten Ergebnissen lassen sich die durchschnittlich höheren Werte von Frauen im Stresserleben, bei den fatalistisch-externalen Kontrollüberzeugungen, bei der Stressanfälligkeit, der Depressivität und bei körperlichen Beschwerden, sowie ihre geringeren Werte im Selbstwertgefühl und im Selbstkonzept eigener Fähigkeiten auf den Geschlechtsunterschied in der Besorgnisneigung zurückführen. Messungen der Cortisol-Aufwachreaktion und des Cortisol-Tagesprofils sind von der Neigung zur Besorgnis unabhängig. Die Befunde werden zur Erklärung der geschlechtsabhängigen Diskrepanz zwischen Morbidität und Mortalität herangezogen.
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Kivling-Bodén G, Sundbom E. The relationship between post-traumatic symptoms and life in exile in a clinical group of refugees from the former Yugoslavia. Acta Psychiatr Scand 2002; 105:461-8. [PMID: 12059851 DOI: 10.1034/j.1600-0447.2002.02247.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the association between life situation factors and post-traumatic symptoms among refugees from the former Yugoslavia. METHOD Twenty-six refugees from the former Yugoslavia were examined by the Harvard Trauma Questionnaire during psychiatric treatment, and 3 years later. At follow-up they also answered a questionnaire regarding their life situations. RESULT A higher post-traumatic symptom level at follow-up was associated with a pattern of negative living conditions such as open unemployment, social isolation, and a high dependence on social welfare. Gender differences were found regarding the factors most related to symptom severity. CONCLUSION The results indicate that a main problem in this patient group may be how to break vicious circles of high symptom levels and a poor life situation which suggests a need for integrated rehabilitation efforts.
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De Vries J. Mental health issues in Tamil refugees and displaced persons. Counselling implications. PATIENT EDUCATION AND COUNSELING 2001; 42:15-24. [PMID: 11080602 DOI: 10.1016/s0738-3991(99)00120-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Fifty-one Sri Lankan Tamil refugees/displaced persons living in South India completed the Hopkins Symptom Checklist-58. In addition, in interviews they answered open-ended questions about personal loss, personal traumatic experiences, negative feelings, living in camps, and the availability of support. The health of the respondents was poor. Moreover, experiences such as watching the killing of family members and being wounded were mentioned as reasons to flee. Many respondents said they experienced negative feelings. Social support was reasonably available although family members were often not situated in the same camp.
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Affiliation(s)
- J De Vries
- Department of Psychology, Tilburg University, Research Institute Psychology & Health, LE Tilburg, The Netherlands.
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Hinton L, Jenkins CN, McPhee S, Wong C, Lai KQ, Le A, Du N, Fordham D. A survey of depressive symptoms among Vietnamese-American men in three locales: prevalence and correlates. J Nerv Ment Dis 1998; 186:677-83. [PMID: 9824169 DOI: 10.1097/00005053-199811000-00003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vietnamese are one of the fastest growing ethnic minority groups in the United States. The purpose of this study was to determine the prevalence and correlates of high depression scores among Vietnamese men in three locales. Computer assisted telephone interviews were conducted with adult Vietnamese men in San Francisco/Alameda Counties, Santa Clara County, and the city of Houston. Telephone numbers of households with Vietnamese surnames were chosen randomly from area telephone books. Depression was assessed using a previously validated Vietnamese language depression screening instrument with 86% sensitivity and 96% specificity for major depression. Between 8.2% and 9.8% of the men scored above the cut-off. Logistic regression analysis revealed that men who were the least proficient in English, poorer, unemployed or disabled, veterans, and those living in Houston were more likely to have a high depression score. Based on the characteristics of the screening instrument, rates of clinical depression among Vietnamese men may be modestly higher than rates for men in the general population. However, high-risk subgroups identified by our analyses may suffer from substantially higher rates of clinical depression. To our knowledge, ours is the first study to show that community context or locale is an independent predictor of high depressive symptoms in this population. These findings have important implications for prevention and intervention approaches to depression among Vietnamese men.
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Affiliation(s)
- L Hinton
- Department of Psychiatry, University of California Davis School of Medicine, Sacramento 95817, USA
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