1
|
Osman W, Ncube F, Shaaban K, Dafallah A. Prevalence, predictors, and economic burden of mental health disorders among asylum seekers, refugees and migrants from African countries: A scoping review. PLoS One 2024; 19:e0305495. [PMID: 38913631 PMCID: PMC11195976 DOI: 10.1371/journal.pone.0305495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/30/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Asylum seekers, migrants, and refugees from African countries may have significant health needs, resulting in economic implications for receiving countries around the world. The risk of mental illness is higher in these communities because of factors like violence, deprivation, and post-immigration challenges. OBJECTIVE The purpose of this study was to examine the literature to determine the prevalence, predictors, and economic impacts of mental health (MH) disorders among asylum seekers, migrants, and refugees from African countries. DESIGN AND METHODS In this scoping review, we followed the guidelines from PRISMA and CoCoPop. A modified version of the Appraisal Tool for Cross-Sectional Studies (AXIS) was used to assess study quality for cross-sectional studies, while an appraisal list was used for qualitative studies based on the Critical Appraisal Skills Programme (CASP). Inclusion criteria included peer-reviewed articles published in English, and articles based on official reports from credible institutions and organizations. Among the exclusion criteria were publications that were not peer reviewed or had not been sourced by credible sources, publications that did not meet the study topic or language criteria, mixed populations (including Africans and non-Africans), and research abstracts, reviews, news articles, commentary on study protocols, case reports, letters, and guidelines. DATA SOURCES A systematic search was carried out in Medline (via PubMed), EMBASE, APA PsycINFO, Web of Science and EBSCO, to identify relevant articles that were published between 1 January 2000 and 31 January 2024. RESULTS A total of 38 studies met the inclusion criteria, including 22 from African countries and three qualitative studies. In terms of number of countries contributing, Uganda was the largest (n = 7), followed by Italy (n = 4). The most studied conditions, using multiple diagnostic tools, were Post-Traumatic Stress Disorder (PTSD, n = 19) and depression (n = 17). These studies all revealed elevated rates of mental health disorders among these groups, and these were related to migration, refugee-related factors, and traumatic events. Most of these groups are dominated by young males. There is, however, a prominent presence of minors and women who have suffered a variety of forms of violence, in particular sexual violence. Furthermore, mental illnesses, such as PTSD and depression, are not only persistent, but can also be transmitted to children. In accordance with our inclusion criteria, our review found only one study that examined the economic impact of MH disorders in these groups, leaving a significant knowledge gap. According to this randomized controlled trial, intervention to reduce psychological impairment can help young people stay in school, improve their quality-adjusted life year (QALY), and earn an incremental cost-effectiveness ratio (ICER) of $7260 for each QALY gained. CONCLUSION Asylum seekers, migrants, and refugees from African countries are likely to experience MH needs, according to this scoping review. As well as posing persistent challenges, these disorders can also be transmissible to offspring. In addition to longitudinal studies of these groups, economic impact studies of mental illnesses are necessary.
Collapse
Affiliation(s)
- Wael Osman
- Department of Biological Sciences, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Centre of Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
- Liverpool John Moores University in Partnership with UNICAF University, Liverpool, United Kingdom
| | - France Ncube
- Liverpool John Moores University in Partnership with UNICAF University, Liverpool, United Kingdom
- Lupane State University, Bulawayo, Zimbabwe
| | - Kamil Shaaban
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Suba University Hospital, Khartoum, Sudan
- Ibn Sina University, Khartoum, Sudan
| | - Alaa Dafallah
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Anbesaw T, Kassa MA, Yimam W, Kassaw AB, Belete M, Abera A, Abebe G, Yimer N, Melkam M, Ayano G. Factors associated with depression among war-affected population in Northeast, Ethiopia. BMC Psychiatry 2024; 24:376. [PMID: 38773453 PMCID: PMC11106904 DOI: 10.1186/s12888-024-05812-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia. METHOD A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. RESULT The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76-4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47-17.49), low social support (AOR = 1.90, 95% CI 1.23-2.96) were variables significantly associated with depression. CONCLUSION This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.
Collapse
Affiliation(s)
- Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, P.O. Box 1145, Dessie, Ethiopia.
| | - Mulat Awoke Kassa
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Wondossen Yimam
- Department of Comprehensive Nursing, College of Medicine and Health Sciences (CMHS), Wollo University (WU), P.O. Box 1145, Dessie, Ethiopia
| | - Altaseb Beyene Kassaw
- College of Medicine and Health Science, Department of Biomedical Science, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Mekonnen Belete
- College of Medicine and Health Science, School of Medicine, Department of Physiology, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Amare Abera
- College of Medicine and Health Science, School of Medicine, Department of Physiology, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Gashaw Abebe
- College of Medicine and Health Science, School of Medicine, Department of Biochemistry, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Nega Yimer
- Department of Adult Health Nursing, College of Medicine and Health Sciences (CMHS), Wollo University (WU), P.O. Box 1145, Dessie, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, University of Gondar College of Medicine and Health Sciences, PO. Box 196, Gondar, Ethiopia
| | - Getinet Ayano
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, Australia
| |
Collapse
|
3
|
Salami OO, Yaskina M, Georgiades K, Diaz E, Hegadoren K, Meherali S, Yohani S, Senthilselvan A. Mental Health of Immigrant Children and Adolescents (6-17 Years) in Canada: Evidence from the Canadian Health Measures Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6997. [PMID: 37947555 PMCID: PMC10650002 DOI: 10.3390/ijerph20216997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Studies indicate a higher prevalence of mental health problems among immigrants, but findings on immigrant children and adolescents are mixed. We sought to understand the magnitude of differences in mental health indicators between immigrant and non-immigrant children and adolescents in Canada and the influence of age, sex, household income, and household education. METHODS We completed a secondary analysis of data from the Canadian Health Measures Survey, using a pooled estimate method to combine data from four survey cycles. A weighted logistic regression was used to estimate the unadjusted and adjusted odds ratios with 95% confidence intervals. RESULTS We found an association between the mental health of immigrant versus non-immigrant children and adolescents (6-17 years) as it relates to emotional problems and hyperactivity. Immigrant children and adolescents had better outcomes with respect to emotional problems and hyperactivity/inattention compared to non-immigrant children and adolescents. Lower household socioeconomic status was associated with poorer mental health in children and adolescents. CONCLUSION No significant differences in overall mental health status were evident between immigrant and non-immigrant children and adolescents in Canada but differences exist in emotional problems and hyperactivity. Sex has an influence on immigrant child mental health that varies depending on the specific mental health indicator.
Collapse
Affiliation(s)
| | - Maryna Yaskina
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada;
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, 5009 Bergen, Norway
| | - Kathleen Hegadoren
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada; (K.H.); (S.M.)
| | - Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada; (K.H.); (S.M.)
| | - Sophie Yohani
- Department of Educational Psychology, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | | |
Collapse
|
4
|
Herati H, Meyer SB. Mental health interventions for immigrant-refugee children and youth living in Canada: a scoping review and way forward. J Ment Health 2023; 32:276-289. [PMID: 32915669 DOI: 10.1080/09638237.2020.1818710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Traumatic life events experienced by immigrant-refugee children and youth may deteriorate their mental health and well-being. It is a public health priority to develop appropriate mental health interventions for this population. AIMS To understand the psychosocial needs of immigrant-refugee children and youth resettled in Canada in the context of their school and community and to identify the characteristics of school-/community-based mental health programs for this group. METHOD Arksey and O'Malley's methodology for scoping reviews was used to select the studies based on criteria, extract data in a table, and synthesize main findings. RESULTS Fifteen peer-reviewed articles and five grey literature were identified. Key findings show that collaboration between schools, communities, and families play a crucial role in developing and implementing comprehensive mental health interventions for immigrant-refugee children/youth. Involving cultural brokers/interpreters and racially diverse school teachers/staff, is important to establish a trustful relationship between school authorities and marginalized population. CONCLUSIONS Further research is needed to examine the impact of collaborative mental healthcare among multiracial and newcomer families in Canada. Furthermore, there is a need to study the impact of adopting creative expression programs at schools/communities to improve emotional/behavioural problems and enhance school performance of these groups.
Collapse
Affiliation(s)
- Hoda Herati
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
5
|
Nkimbeng M, Nmezi NA, Baker ZG, Taylor JL, Commodore-Mensah Y, Shippee TP, Szanton SL, Gaugler JE. Depressive Symptoms in Older African Immigrants with Mobility Limitations: A Descriptive Study. Clin Gerontol 2023; 46:14-26. [PMID: 34528489 PMCID: PMC9283084 DOI: 10.1080/07317115.2021.1976893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Before, during, and after their immigration to the United States, immigrants face stressful life circumstances that may render them at risk for depressive symptoms. However, there is a dearth of research on the mental health of African immigrants. We performed secondary data analyses of two studies in the Baltimore-Washington area to describe and identify correlates of depressive symptoms in older African immigrants. METHODS Chi square tests, one-way ANOVAs, and linear regressions were used to describe and examine associations between depressive symptoms and immigrant-related risk factors. RESULTS This sample included 148 participants who had a mean age of 62 (SD ± 8.2). Clinical depressive symptoms were present in 8.1% of participants, and trouble falling asleep for more than half of the days was the most prevalent symptom (20%). Levels of education, income, and migration reasons differed significantly from clinical depressive symptoms, but these were not significantly associated with more depressive symptoms after controlling for covariates. CONCLUSIONS Longitudinal designs may further elucidate incidence, correlates, and long-term effects of depressive symptoms within this population. CLINICAL IMPLICATIONS Knowledge of depressive symptom burden and risk factors can inform timely assessment, referral, and treatment of depressive symptoms and other mental health outcomes in older African immigrants.
Collapse
Affiliation(s)
- Manka Nkimbeng
- Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
- Physical Medicine and Rehabilitation Division of Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nwakaego A Nmezi
- Physical Medicine and Rehabilitation Division of Rehabilitation Psychology and Neuropsychology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Zachary G Baker
- Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | | | | | - Tetyana P Shippee
- Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | | | - Joseph E Gaugler
- Division of Health Policy and Management, University of Minnesota School of Public Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| |
Collapse
|
6
|
Nakajima M, Sero A, Jama S, Habte S, Taha S, Habte H, Mekonnen G, Geleto I, Bongard S, al'Absi M. Acculturation Style Is Associated with Stress and Tobacco Use among East African Immigrants. J Psychoactive Drugs 2023; 55:112-121. [PMID: 35196959 DOI: 10.1080/02791072.2022.2040659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
While tobacco use rates are relatively high among East African immigrants in the U.S., factors contributing to this high rate are largely unknown. Acculturation is associated with stress and substance use. Whether acculturation styles are related to stress and current tobacco use has not been tested among this population. We conducted a cross-sectional study that included 376 East African adults who provided information on demographic background, acculturation style, acculturative stress, depressive symptoms, and tobacco use. Multivariate analysis indicated that individuals who were distant to both the culture of the host country and the culture of origin (marginalization style) had greater levels of acculturative stress than those who adopted both cultures (integration style; p < .001). Marginalized people were four to eight times and assimilated people were three to four times more likely than integration people to be a current tobacco user (p < .04). This relationship did not change after controlling for demographic information and stress. In this study, acculturation style was associated with perceived stress and current tobacco use among East African immigrants. Research focused on characterizing integrated individuals may guide efforts to develop culturally-relevant strategies to reduce tobacco-related disparities among East African individuals.
Collapse
Affiliation(s)
- Motohiro Nakajima
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Abdul Sero
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Shamso Jama
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Sara Habte
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Sartu Taha
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Hileena Habte
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Gemechu Mekonnen
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Iman Geleto
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Stephan Bongard
- Department of Psychology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| |
Collapse
|
7
|
James PB, Renzaho AMN, Mwanri L, Miller I, Wardle J, Gatwiri K, Lauche R. The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis. Psychiatry Res 2022; 317:114899. [PMID: 36252417 DOI: 10.1016/j.psychres.2022.114899] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 01/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia; Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Andre M N Renzaho
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Lillian Mwanri
- Research Centre for Public Health Policy, Torrens University Australia, Adelaide, SA 5000, Australia
| | - Ian Miller
- Sport and Exercise Science, Faculty of Health, Southern Cross University, Gold Coast, QLD, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| | - Kathomi Gatwiri
- Centre for Children & Young People, Faculty of Health, Southern Cross University, Gold Coast, Australia
| | - Romy Lauche
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| |
Collapse
|
8
|
Mesa-Vieira C, Haas AD, Buitrago-Garcia D, Roa-Diaz ZM, Minder B, Gamba M, Salvador D, Gomez D, Lewis M, Gonzalez-Jaramillo WC, Pahud de Mortanges A, Buttia C, Muka T, Trujillo N, Franco OH. Mental health of migrants with pre-migration exposure to armed conflict: a systematic review and meta-analysis. THE LANCET PUBLIC HEALTH 2022; 7:e469-e481. [DOI: 10.1016/s2468-2667(22)00061-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 01/08/2023] Open
|
9
|
Epidemiology of depression among displaced people: A systematic review and meta-analysis. Psychiatry Res 2022; 311:114493. [PMID: 35316692 DOI: 10.1016/j.psychres.2022.114493] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Displaced people are prone to develop mental health problems due to resettlement in new environments, traumatic events and forced migration. Depression is a mental health problem repeatedly observed among displaced people such as refugees, migrants, asylum seekers and internally displaced persons (IDPs). Therefore, estimating the global pooled prevalence of depression as well as pinpointing its determinants may support policymakers and health care workers to mitigate the disease burden and improve the psychological well-being of displaced people. METHODS PubMed, EMBASE, CINAHIL, Psych-INFO, and SCOPUS databases were searched for English written relevant observational studies conducted between 1984 and 2020. The methodological quality of studies was assessed using the Newcastle Ottawa Scale (NOS). Heterogeneity across studies was checked using the Q- and I2 test. Publication bias was checked by observing Funnel plot symmetry and using Egger's regression test. STATA 16 was used to combine studies using a random effect model. RESULTS Of the 4102 studies identified, 81 studies with an overall sample size of 53,458 were included in the current systematic review and meta-analysis. The pooled prevalence estimate of depression among displaced people was 26.4% (95% CI; 22.2-31.1). Also, three in five IDPs, one in three refugees and asylum seekers and one in four migrants suffer from depression globally. Being female migrant [AOR: 2.46 95% CI: 1.79-3.13, I2=34.5%), non-partnered marital status [AOR: 2.29, 95% CI: 1.29-3.30, I2= 0.00%], and perceived low social support [AOR: 1.76, 95% CI: 1.00-2.52, I2=34.6%] were significant determinants of depression among displaced people. CONCLUSION Overall, around 1 in 4 displaced people suffer from depression and exceed the prevalence of depression reported by community samples in different nations and demonstrate a need for culturally fitting and targeted responses from migrant/refugee host nations and their serving clinicians.
Collapse
|
10
|
Dubus N. Resiliency with Forced Migrants: A Qualitative Study of Providers and Forced Migrants through a ResiliencePerspective. Behav Sci (Basel) 2022; 12:bs12020027. [PMID: 35200279 PMCID: PMC8869212 DOI: 10.3390/bs12020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/31/2021] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
In the last ten years, the world has experienced unprecedented, forced migration due to civil unrest, political persecution, and the ever-growing climate crisis. This is a qualitative study of the professional experiences of social workers (n = 73) working with forced migrants (n = 34) and the lived experiences of forced migrants in several countries: Germany, Greece, Iceland, Mexico, Switzerland, and the United States. Social workers reported that most of their interventions involved short-term case management that focused on securing initial housing and healthcare. Cognitive Behavioral Therapy (CBT) was the primary intervention for behavioral health issues. The recipients of these services were appreciative of the pragmatic approach of case management as it helped them meet concrete needs. When resiliency enhancing interventions were used, recipients reported a greater sense of self-control, greater optimism for the future, and less anxious symptoms. The resiliency model used is discussed. This is a possible universal approach to working with forced migrants.
Collapse
Affiliation(s)
- Nicole Dubus
- School of Social Work, College of Health and Human Science, San Jose State University, San Jose, CA 95192, USA
| |
Collapse
|
11
|
Nkimbeng M, Akumbom A, Granbom M, Szanton SL, Shippee TP, Thorpe RJ, Gaugler JE. Where to Retire? Experiences of Older African Immigrants in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1040. [PMID: 35162063 PMCID: PMC8834587 DOI: 10.3390/ijerph19031040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 12/28/2022]
Abstract
Doubling in size since the 1970s, the aging needs of the African immigrant population are not fully understood. This qualitative study examined experiences of aging and retirement planning for African immigrant older adults in the United States (U.S.). Specifically, it explored the factors, processes, and ultimate decision of where these older adults planned to retire. Secondary analysis of semi-structured interviews with 15 older African immigrants in the Baltimore-Washington Metropolitan area was conducted. Data was analyzed using thematic analyses in NVivo. The majority of participants were women, with a mean age of 64. Three overarching themes with ten sub-themes were identified. The themes included: (1) cultural identity, which indicated the participant's comfort with the U.S. society and culture; (2) decision making, meaning factors that impact participants' choice of retirement location; and (3) decision made, meaning the final choice of where participants would like to retire. Age-friendliness for immigrant older adults in the U.S. is complex and it includes traditional domains such as physical and sociocultural environment (e.g., housing, transportation, and income). However, immigrant age-friendliness also needs to include wider contextual aspects such as political climate of their country of origin, immigrant status, family responsibilities, and acculturation in the U.S. More research is needed to better understand and facilitate age-friendly environments and transnational aging of immigrant older adults.
Collapse
Affiliation(s)
- Manka Nkimbeng
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE., Minneapolis, MN 55455, USA; (T.P.S.); (J.E.G.)
| | - Alvine Akumbom
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA; (A.A.); (S.L.S.)
| | - Marianne Granbom
- Department of Health Sciences, Lund University, 22100 Lund, Sweden;
| | - Sarah L. Szanton
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA; (A.A.); (S.L.S.)
| | - Tetyana P. Shippee
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE., Minneapolis, MN 55455, USA; (T.P.S.); (J.E.G.)
| | - Roland J. Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, 624 Broadway, Baltimore, MD 21205, USA;
| | - Joseph E. Gaugler
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE., Minneapolis, MN 55455, USA; (T.P.S.); (J.E.G.)
| |
Collapse
|
12
|
Prevalence of mental disorders in refugees and asylum seekers: a systematic review and meta-analysis. Glob Ment Health (Camb) 2022; 9:250-263. [PMID: 36618716 PMCID: PMC9806970 DOI: 10.1017/gmh.2022.29] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Studies have identified high rates of mental disorders in refugees, but most used self-report measures of psychiatric symptoms. In this study, we examined the percentages of adult refugees and asylum seekers meeting diagnostic criteria for major depressive disorder (MDD), post-traumatic stress disorder, bipolar disorder (BPD), and psychosis. METHODS A systematic literature search in three databases was conducted. We included studies examining the prevalence of MDD, post-traumatic stress disorder, BPD, and psychosis in adult refugees according to a clinical diagnosis. To estimate the pooled prevalence rates, we performed a meta-analysis using the Meta-prop package in Stata (PROSPERO: CRD42018111778). RESULTS We identified 7048 records and 40 studies (11 053 participants) were included. The estimated pooled prevalence rates were 32% (95% CI 26-39%; I 2 = 99%) for MDD, 31% (95% CI 25-38%; I 2 = 99.5%) for post-traumatic stress disorder, 5% (95% CI 2-9%; I 2 = 97.7%) for BPD, and 1% (95% CI 1-2%; I 2 = 0.00%) for psychosis. Subgroup analyses showed significantly higher prevalence rates of MDD in studies conducted in low-middle income countries (47%; 95% CI 38-57%, p = 0.001) than high-income countries studies (28%; 95% CI 22-33%), and in studies which used the Mini-International Neuropsychiatric Interview (37%; 95% CI 28-46% p = 0.05) compared to other diagnostic interviews (26%; 95% CI 20-33%). Studies among convenience samples reported significant (p = 0.001) higher prevalence rates of MDD (35%; 95% CI 23-46%) and PTSD (34%; 95% CI 22-47%) than studies among probability-based samples (MDD: 30%; 95% CI 21-39%; PTSD: 28%; 95% 19-37%). CONCLUSIONS This meta-analysis has shown a markedly high prevalence of mental disorders among refugees. Our results underline the devastating effects of war and violence, and the necessity to provide mental health intervention to address mental disorders among refugees. The results should be cautiously interpreted due to the high heterogeneity.
Collapse
|
13
|
Berhe SM, Azale T, Fanta T, Demeke W, Minyihun A. Prevalence and Predictors of Depression Among Eritrean Refugees in Ethiopia: A Cross-Sectional Survey. Psychol Res Behav Manag 2021; 14:1971-1980. [PMID: 34916858 PMCID: PMC8668244 DOI: 10.2147/prbm.s337255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Depressive disorders place an enormous burden on society and ranked fourth in the global disease burden accounting for 4.4% of the total disability-adjusted life years and 11.9% of total years lived with disability. Depression is associated with high level of morbidity and it is the most common contributor to suicide. Refugees have higher rates of mental disorders, in particular depression than those usually found in the non-war affected general population. There is a dearth of evidence in Ethiopia regarding the mental health of refugees. Objective This study aimed to assess the prevalence of depression and associated factors among Eritrean refugees in Tigray North Ethiopia. Methods A cross-sectional study was conducted at Maiayni refugee camp. A total of 800 participants were interviewed using systematic random sampling method. Pretested, structured and interviewer administered questionnaire that included socio demographic, clinical, behavioral, Harvard trauma questionnaire, and the patient health questionnaire (PHQ-9) was used. Descriptive statistics and binary logistic regression analyses were carried out. Results With 786 (98.3%) of response rate, the prevalence of depression was found to be 37.8%, 95% confidence interval (34.2, 41.2). The odds of depression was higher in females [(AOR=8.92 95% CI (5.21, 15.25)], older age [(AOR=2.72 95% CI (1.03-7.16)], those who never attended school [(AOR=3.09 95% CI (1.16-8.24)], among the unemployed [(AOR=2.36 95% CI (1.16-4.83)], those with poor social support [(AOR=8.67 95% CI (4.24-17.77)], past psychiatric history [(AOR=4.76 95% CI (1.94-11.67)], family history of a psychiatric disorder [(AOR=3.96 95% CI (1.93-8.13)], those who were using substances [(AOR=4.08 95% CI (2.51-6.65)], and among those who stayed for longer than a year at the camp [(AOR=4.18 95% CI (2.47-7.08))]. Conclusion The study revealed that depression is a major mental health and public health problem among Eritrean refugees in Ethiopia. Several socio-demographic, psychosocial, behavioral and clinical factors were significant predictors of depression among the study participants. Mental health service provision for the refugees needs to be part of the support.
Collapse
Affiliation(s)
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, University of Gondar, Gondar, Ethiopia
| | - Tolesa Fanta
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Wubit Demeke
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Amare Minyihun
- Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
14
|
Sick and Tired-Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211850. [PMID: 34831606 PMCID: PMC8619663 DOI: 10.3390/ijerph182211850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022]
Abstract
Background: An EU directive holds the EU member states responsible for implementing the provision of health care for asylum seekers. However, current literature indicates insufficient care for asylum seekers in the German health system. This article aims to characterize the situation of the client population on the waiting list of a psychosocial center (PSZ). Methods: We conducted a retrospective observational study based on client files in Halle (Saale), Germany. We included 437 adults who were on the PSZ waiting list between 2016 and 2019. Questionnaires that collected information on the clientele at two different times were analyzed. Results: The average waiting time for psychotherapy was 50 weeks. In total, 85.6% of the 188 respondents reported sleep disorders (n = 161), 65.4% of clients reported pain (n = 123) and 54.8% suicide attempts/suicidal thoughts (n = 54). In the 16-week waiting period in which the clients waited for an initial appointment with a psychologist, the residence status deteriorated in 21.3% (n = 40). Conclusion: Improving asylum seekers’ access to the German health system is urgently needed in order to prevent unnecessary suffering in the future and to comply with EU law.
Collapse
|
15
|
Tong H, Lung Y, Lin SL, Kobayashi KM, Davison KM, Agbeyaka S, Fuller-Thomson E. Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging. Int J Soc Psychiatry 2021; 67:747-760. [PMID: 33176526 DOI: 10.1177/0020764020971003] [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] [Indexed: 11/17/2022]
Abstract
Psychological distress is associated with a range of negative outcomes including lower quality of life and an increased risk of premature all-cause mortality. The prevalence of, and factors associated with, psychological distress among middle-aged and older Canadians are understudied. Using the Canadian Longitudinal Study on Aging (CLSA) baseline data, this study examined factors associated with psychological distress among adults between 45 and 85 years, including refugee status and a wide range of sociodemographic, health-related and social support characteristics. Psychological distress was measured by Kessler's Psychological Distress Scale-K10 scores. Bivariate and multivariable binary logistic regression analyses were conducted. The prevalence of psychological distress was significantly higher among the 244 refugees (23.8%), compared to 23,149 Canadian-born Canadians (12.8%) and 4,765 non-refugee immigrants (12.6%), despite the fact that the average time the refugees had lived in Canada was more than four decades. The results of the binary logistic regression analysis indicated refugees had twice the age-sex adjusted odds of psychological distress (OR = 2.31, 95% CI: 1.74, 3.07). Even after further adjustment for 16 potential risk factors, a significant relationship remained between refugee status and psychological distress (OR = 1.56; 95% CI = 1.12, 2.17). Other significant factors associated with psychological distress included younger age, female gender, visible minority status, lower household income, not having an undergraduate degree, multimorbidities, chronic pain, and lack of social support. Policies and interventions addressing psychological distress among Canadians in mid- to later life should target refugees and other vulnerable groups.
Collapse
Affiliation(s)
| | - Yu Lung
- University of Toronto, Toronto, ON, Canada
| | | | | | - Karen M Davison
- Kwantlen Polytechnic University and University of Hawai'I, Surrey, BC, Canada
| | | | | |
Collapse
|
16
|
Lin SL, Kobayashi K, Tong H, Davison KM, Arora SRA, Fuller-Thomson E. Close Relations Matter: The Association Between Depression and Refugee Status in the Canadian Longitudinal Study on Aging (CLSA). J Immigr Minor Health 2021; 22:946-956. [PMID: 31974926 DOI: 10.1007/s10903-020-00980-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined the prevalence and social determinants of depression among refugee and non-refugee adults aged 45-85 in the Canadian Longitudinal Study on Aging. Bivariate analyses and multivariable binary logistic regression analyses were conducted. The prevalence of depression was higher in a sample of 272 refugees (22.1%) and 5059 non-refugee immigrants (16.6%), compared to 24,339 native-born Canadians (15.2%). The adjusted odds ratio (aOR) of depression for refugees were not attenuated when controlling factors such as, (1) socioeconomic status, (2) health conditions and behaviours, (3) social isolation and online social networking (aORs range from 1.61 to 1.70, p's < 0.05). However, when social support representing close personal relationships was included, the odds of depression for refugees were reduced to non-significance (aOR = 1.30, 95% CI 0.97-1.74, p = 0.08). Refugees' excess vulnerability to depression is mainly attributable to lower levels of affectionate social support. Targeted interventions in nurturing supportive interpersonal relationships for refugees are warranted.
Collapse
Affiliation(s)
- Shen Lamson Lin
- Factor-Inwentash Faculty of Social Work, Institute for Life Course & Aging, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | - Karen Kobayashi
- Faculty of Social Science, University of Victoria, Victoria, Canada
| | - Hongmei Tong
- Faculty of Health and Community Studies, MacEwan University, Edmonton, Canada
| | - Karen M Davison
- Faculty of Science and Horticulture (Health Science), Kwantlen Polytechnic University, Surrey, Canada.,Faculty of Social Science, University of Hawaii, Honolulu, USA
| | - Simran R A Arora
- Factor-Inwentash Faculty of Social Work, Institute for Life Course & Aging, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, Institute for Life Course & Aging, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.,Department of Family and Community Medicine, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Factors Associated with Mental Health Service Utilization Among Ethiopian Immigrants and Refugees. J Immigr Minor Health 2021; 22:965-972. [PMID: 32130570 DOI: 10.1007/s10903-020-00984-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assesses factors associated with mental health service utilization by Ethiopian immigrants and refugees in the U.S. A cross-sectional survey, based on Anderson and Newman's Framework of Health Services, which examines facilitators and barriers of service utilization, was implemented to gather data from 297 Ethiopian immigrants and refugees in the U.S. from February to March 2018. Descriptive statistics, chi-squared tests, and logistic regression were calculated. Approximately 13.3% of participants sought mental health services from healthcare professionals; while 17.3% utilized non-healthcare professionals for mental health problems. A mental health need (depressive symptoms) was identified. A model containing predictors of mental health service use was statistically significant, with gender, marital status, and employment (full-time or part-time) as the strongest predictors. The findings suggest a need for the development of culturally appropriate interventions and implementation of policies to minimize barriers to mental health services among this under-researched population.
Collapse
|
18
|
Um MY, Lee JO, Kim HJ, Rice E, Palinkas LA. Testing the pathway from pre-migration sexual violence to suicide-related risk among North Korean refugee women living in South Korea: do social networks matter? Soc Psychiatry Psychiatr Epidemiol 2021; 56:485-495. [PMID: 33211123 DOI: 10.1007/s00127-020-01977-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine the pathways from pre-migration sexual violence to suicide-related risk via the lack of important social networks among North Korean refugee women living in South Korea. METHODS As part of a larger study, cross-sectional social network data from 273 North Korean refugee women aged 19 or older (M = 41 years; range = 19-69) were collected by self-reported surveys from April to May 2014 in South Korea. Snowball sampling was used for participant recruitment. We analyzed whether lack of network diversity and lack of kin ties mediated the association between pre-migration sexual violence and suicide-related risk in two multivariable mediation analyses. RESULTS The prevalence of past-year suicide-related risk was 34.4% in our study sample, and 31.1% of the participants reported at least one type of pre-migration sexual violence. Pre-migration sexual violence was associated with increased suicide-related risk. Lack of network diversity (b = 0.03, 95% CI 0.01-0.07) and lack of kin ties (b = 0.03, 95% CI 0.01-0.08) partially mediated this association. CONCLUSION Assessment of pre-migration sexual violence victimization needs to begin at an early stage of resettlement. Study findings highlight the urgent need to create suicide prevention programs that incorporate social network interventions, especially for North Korean refugee women who have experienced sexual violence during migration.
Collapse
Affiliation(s)
- Mee Young Um
- Arizona State University, Watts College of Public Service and Community Solutions, School of Social Work, Phoenix, AZ, USA
| | - Jungeun Olivia Lee
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Hee Jin Kim
- Myongji University, Bangmok College of General Education, 116 Myongji-ro, Cheoin-gu, Yongin-si, Gyeonggi-do, 449-728, South Korea.
| | - Eric Rice
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Lawrence A Palinkas
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| |
Collapse
|
19
|
Hollifield M, Toolson EC, Verbillis-Kolp S, Farmer B, Yamazaki J, Woldehaimanot T, Holland A. Distress and Resilience in Resettled Refugees of War: Implications for Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031238. [PMID: 33573131 PMCID: PMC7908567 DOI: 10.3390/ijerph18031238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about distress (Refugee Health Screener—15 (RHS-15)) and possible predictors of distress were collected at the domestic medical examination (T1) within 90 days of arrival and the civil surgeon examination (T2) 11–16 months after T1 for refugee groups from three countries (COU). Descriptive, correlative, analyses of variance, and regression techniques were used to determine trajectory type and their predictors. A higher percentage (7.3%) were distressed at T2 than at T1. By group, the Bhutanese became more distressed, the Burmese became less distressed, and Iraqi’s continued to have high distress. A regression model showed gender, loss, post-migration stress, and self-efficacy to be significant predictors of trajectory type (R2 = 0.46). When the T1 RHS-15 score was added to the model, observed variance increased (R2 = 0.53) and T1 RHS score accounted for the majority of variance (r = 0.64, p < 0.001), with post-migration stress accounting for markedly less (β = 0.19, p = 0.03). Loss and self-efficacy became less significant. Loss was, however, a strong predictor of delayed and chronic distress trajectory type. These data suggest that screening for distress should occur at least twice during resettlement to detect those with initial distress and those with delayed distress. Screening should be coupled with identifying other social determinants of health and a comprehensive assessment to determine the need for intervention for secondary prevention (i.e., reducing delayed distress) and treatment (reducing chronic distress).
Collapse
Affiliation(s)
- Michael Hollifield
- VA Long Beach Healthcare System, Long Beach, CA 90822, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine, Washington, DC 20052, USA
- War Survivors Institute, 5318 2nd Street, #703, Long Beach, CA, 90803, USA
- Correspondence:
| | - Eric C. Toolson
- Department of Biology, The University of New Mexico, Albuquerque, NM 87131, USA;
| | - Sasha Verbillis-Kolp
- Consultant, 3630 N. Winchell St., Portland, OR 97217, USA;
- Portland State University School of Social Work, Academic Student Recreation Center, Ste. 600, 1800 SW 6th Ave., Portland, OR 97201, USA
| | - Beth Farmer
- International Rescue Committee, 1200 S. 192nd St., SeaTac, WA 98148, USA;
| | - Junko Yamazaki
- Asian Counseling and Referral Service, Seattle, WA 98144, USA; (J.Y.); (T.W.)
| | | | - Annette Holland
- Public Health Seattle & King County, Seattle, WA 98121, USA;
| |
Collapse
|
20
|
Bilal PI, Chan CKY, Somerset SM. Depression Mediates Association Between Perceived Ethnic Discrimination and Elevated Blood Glucose Levels Among Sub-Saharan African Migrants in Australia. J Immigr Minor Health 2021; 23:199-206. [PMID: 33385270 DOI: 10.1007/s10903-020-01131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
Depression and perceived ethnic discrimination (PED) are both implicated in type 2 diabetes mellitus (T2DM) risk in some migrant populations. The role of these factors remains understudied in sub-Saharan African migrants, who comprise a significant at-risk group for T2DM in Australia. To assess interactions between PED, depression scores and elevated blood glucose levels among sub-Sahara African immigrants in North-Eastern Australia. Face to face surveys were used to assess PED and depressive tendencies in a purposive sample of 170 adults (aged ≥18 year). Fasting blood glucose levels (FBGL) were measured at the time of interviews. Prevalence of elevated FBGL (≥6.1 mmol/L), PED and severe depression (SD) were: 17.6% (n = 30), 14.7% (n = 25) and 18.8% (n = 32), respectively. Prevalence of elevated FBGL, PED and SD were all higher in males than females. The highest prevalence of elevated BGL, PED and SD each occurred in the 40-50 year age group. Strong positive correlations of both high level PED and SD with elevated FBGL were observed. There was also a strong positive association between PED and SD. Depression score was found to mediate partially the strong association between PED and elevated FBGL (β-value for PED dropped from β = 0.452 to β = 0.246, p < 0.01 and the associated between FBGL and SD remained strong β = 0.554, p < 0.01). The strong association between elevated FBGL and PED seems to be moderated by SD, indicating that interventions to attenuate depression and PED may be a useful adjunct to diabetes prevention programs in this population. Interventions targeted to specific age groups may also be warranted.
Collapse
Affiliation(s)
- P I Bilal
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - C K Y Chan
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - S M Somerset
- Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| |
Collapse
|
21
|
Um MY, Rice E, Palinkas LA, Kim HJ. Migration-Related Stressors and Suicidal Ideation in North Korean Refugee Women: The Moderating Effects of Network Composition. J Trauma Stress 2020; 33:939-949. [PMID: 32529676 DOI: 10.1002/jts.22549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/10/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022]
Abstract
Alarmingly high rates of suicidal ideation have been reported in North Korean (NK) refugee women living in South Korea. This population often endures traumatic experiences and violence in North Korea as well as human trafficking and sexual exploitation in intermediary countries. Following resettlement in South Korea, NK refugee women continue facing multiple hardships, such as discrimination, that can negatively affect their mental health and contribute to suicidality. Support from social networks can buffer the harmful impacts of pre- and postmigration stressors on mental health in NK refugee women. Using the stress-buffering hypothesis, the present study examined the moderating effects of network composition (i.e., network diversity and church-based ties) on the associations among premigration trauma, postmigration discrimination, and suicidal ideation in NK refugee women living in South Korea. Participants (N = 273) were NK refugee women living in South Korea who were 19 years of age or older; 34.4% of the participants reported past-year suicidal ideation. The study results indicated that network diversity significantly moderated the association between postmigration discrimination and suicidal ideation, p = .031, whereas networks with church-based ties significantly moderated the association between premigration trauma and suicidal ideation, p = .026. The present findings support the hypothesis that social ties can buffer the appraisal of migration-related stressors on suicidality. These findings have implications for practitioners serving vulnerable populations that experience multiple traumatic events.
Collapse
Affiliation(s)
- Mee Young Um
- School of Social Work Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Hee Jin Kim
- Bangmok College of General Education, Myongji University, Seoul, South Korea
| |
Collapse
|
22
|
Nutsch N, Bozorgmehr K. [The effect of postmigration stressors on the prevalence of depressive symptoms among refugees in Germany. Analysis of the IAB-BAMF-SOEP Survey 2016]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1470-1482. [PMID: 33103207 PMCID: PMC7686213 DOI: 10.1007/s00103-020-03238-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND International studies prove the high burden of mental illnesses among refugees. Postmigration stressors in the country of refuge may affect the mental health and result in depression. OBJECTIVES The study examines whether postmigration stressors are associated with the prevalence of depressive symptoms among adult refugees in Germany. METHODS Secondary data analysis based on cross-sectional data of the IAB-BAMF-SOEP Survey of Refugees 2016 (N = 4465) that is representative for Germany. Depressive symptoms were measured using the Patient Health Questionnaire‑2 (PHQ-2). Unadjusted and adjusted odds ratios (ORs) and confidence intervals (CIs) were calculated with binary logistic regression models to examine associations between depression and sociodemographic, postmigration, and psychosocial factors. RESULTS Depressive symptoms show 19.4% of the surveyed refugees. Almost all selected postmigration stressors are significantly associated with depression after adjustment for sociodemographic and psychosocial factors. Unemployment (aOR = 1.48 [1.04-2.12]), loneliness (aOR = 1.14 [1.10-1.18]), and a rejected or undecided asylum application (aOR = 1.34 [1.06-1.70]) increase the odds of depressive symptoms, whereas asylum interviews (aOR = 0.71 [0.56-0.91]) and higher housing satisfaction (aOR = 0.94 [0.91-0.98]) lower the odds of depression. CONCLUSIONS Postmigration stress is associated with the occurrence of depressive symptoms. Sociopolitical interventions considering stressful and protective factors of the postmigration phase can reduce the burden of mental disorders in refugee populations.
Collapse
Affiliation(s)
- Niklas Nutsch
- AG2 - Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Postfach 10 01 31, 33501, Bielefeld, Deutschland
| | - Kayvan Bozorgmehr
- AG2 - Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Postfach 10 01 31, 33501, Bielefeld, Deutschland. .,Abteilung Allgemeinmedizin und Versorgungsforschung, Sektion Health Equity Studies & Migration, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
| |
Collapse
|
23
|
Kareff S, Diaz C, Zeigler A, Faulkenberry JG, Utter BF, Barber CM, Symes S. Characterization of the Demographics and Psychiatric Co-Morbidites Among Clients of a Human Rights Clinic in Miami-Dade County, Florida, United States. Cureus 2020; 12:e8944. [PMID: 32765989 PMCID: PMC7398692 DOI: 10.7759/cureus.8944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Miami-Dade County (MDC) represents a major port of entry for people seeking asylum in the United States, and few studies have systematically evaluated the demographic characteristics of this vulnerable population. Moreover, while the burden of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are thought to be higher in this population, the prevalence of these psychiatric conditions in our community is unknown. An analysis of demographics and psychiatric co-morbidities of the Human Rights Clinic (HRC) of Miami’s 93 clients between 2010 and 2015 was conducted. The HRC cohort had the following characteristics: median age of 30 years, 52% female, 46% male, 2% transgender or intersex, and 88% originating from Latin America and the Caribbean. The prevalence of PTSD was 67% and MDD was 53% in the HRC population. We conclude that the mental health burden in asylum-seekers in MDC is alarmingly high and that healthcare providers should remain keenly attentive to the unique needs of this population.
Collapse
Affiliation(s)
- Samuel Kareff
- Internal Medicine, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Chanelle Diaz
- Internal Medicine, Montefiore Medical Center, New York, USA
| | - Amy Zeigler
- Emergency Medicine, University of Pittsburgh, Pittsburgh, USA
| | - J Grey Faulkenberry
- Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - Cecily M Barber
- Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, USA
| | - Stephen Symes
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA
| |
Collapse
|
24
|
Ahmad F, Othman N, Hynie M, Bayoumi AM, Oda A, McKenzie K. Depression-level symptoms among Syrian refugees: findings from a Canadian longitudinal study. J Ment Health 2020; 30:246-254. [PMID: 32438842 DOI: 10.1080/09638237.2020.1765998] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Canada launched the Syrian Refugee Resettlement Initiative in 2015 and resettled over 40,000 refugees. AIM To evaluate the prevalence of depression-level symptoms at baseline and one year post-resettlement and analyze its predictors. METHODS Data come from the Syrian Refugee Integration and Long-term Health Outcomes in Canada study (SyRIA.lth) involving 1924 Syrian refugees recruited through a variety of community-based strategies. Data were collected using structured interviews in 2017 and 2018. Depression symptoms were measured using Patient Health Questionnaire 9 (PHQ-9). Analysis for associated factors was executed using multinomial logistic regression. RESULTS Mean age was 38.5 years (SD 13.8). Sample included 49% males and 51% females settled in Ontario (48%), Quebec (36%) and British Columbia (16%). Over 74% always needed an interpreter, and only 23% were in employment. Prevalence of depression-level symptoms was 15% at baseline and 18% in year-2 (p < 0.001). Significant predictors of depression-level symptoms at year-2 were baseline depression, sponsorship program, province, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada. CONCLUSION Increase in depression-level symptoms deserves attention through focusing on identified predictors particularly baseline depression scores, social support, perceived control and language ability.
Collapse
Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Canada
| | - Nasih Othman
- School of Health Policy and Management, York University, Toronto, Canada
| | - Michaela Hynie
- Department of Psychology/Centre for Refugee Studies, York University, Toronto, Canada
| | - Ahmed M Bayoumi
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Anna Oda
- Centre for Refugee Studies, Refugee Integration and Long-term Health Outcomes in Canada, York University, Toronto, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, Canada
| |
Collapse
|
25
|
Ejigu AK, Seraj ZR, Gebrelibanos MW, Jilcha TF, Bezabih YH. Depression, anxiety and associated factors among housemaids working in Addis Ababa Ethiopia. BMC Psychiatry 2020; 20:231. [PMID: 32404071 PMCID: PMC7222301 DOI: 10.1186/s12888-020-02638-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Housemaids are part of women with low socioeconomic status and most of them are migrant from rural to central part of Ethiopia, less educated, either with poor, separated, single or divorced family and/or dead parents. Housemaid may experience problems like depression and anxiety more than other groups of women. Therefore, the aim of this study was to assess the magnitude and determinants of those problems among housemaids. OBJECTIVE To assess the magnitude and determinants of depression & anxiety among housemaids in Addis Ababa; Ethiopia; 2018. METHODS Community based cross-sectional study was conducted from May 1 to August 30, 2018 among housemaids working in Addis Ababa, Ethiopia. Multistage sampling technique was applied with a total of 826 samples. Quantitative data was employed by using structured questionnaires. The collected data was coded, entered in to Epi-Info version 7 and analyzed by using SPSS version 20. Descriptive, analytical statistical procedures; bivariate and multivariate binary logistic regressions with odds ratios and 95% confidence interval was employed. The statistical significance was declared at p value < 0.05. RESULTS This study enrolled 862 participants with response rate 99.5%, 99.5% refers to the number of people who actually completed the interview. The result showed prevalence of depression and anxiety among housemaids 27.5% and 32.3% respectively. Among all participants 44.6% (95% CI= 41.0 - 47.9) have mild, 18.5% (95% CI= 15.7 - 21.2) have moderate and 6.1% (95% CI= 4.5 - 7.8) have severe form of comorbid anxiety with depression. Depression (44.9%) and anxiety (41.9%) found more prevalent among the age group 16 to 20. In this study history of parental divorce, participant's divorce, physical violence and sexual violence are positively associated. Other factors; being less educated and living with relatives; were associated negatively. CONCLUSION The prevalence of Depression and Anxiety is found high among housemaid; its prevalence is more among age group 16 to 20 than other age groups. Violence, participant's divorce, history of parental divorce and contraceptive use has positively associated with depression and anxiety.
Collapse
|
26
|
Jo Y. The significance of resilience in mental health promotion of marriage immigrant women: a qualitative study of factors and processes. BMC Womens Health 2020; 20:84. [PMID: 32345269 PMCID: PMC7189560 DOI: 10.1186/s12905-020-00945-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study explores a series of processes in which marriage immigrant women achieve positive mental health status after experiencing various marriage- and migrant-related difficulties through the framework of resilience theory. As marriage immigrant women face greater barriers to public health services than non-immigrant women, it is necessary to understand the related factors, process, and context to address these barriers and strengthen available assets. METHODS A qualitative case study design was used with the phenomenological approach. Eleven mental health promotion program managers and 12 marriage immigrant women from who experienced resilience were recruited from four public-funded multicultural community centers in Seoul and Gyeonggi-do, South Korea, between December 2015 and March 2016. Using data from in-depth semi-structured face-to-face interviews, the author applied theme analysis informed by the resilience theory in order to identify factors that affect resilience and its development process. RESULTS Findings indicated that the process of resilience follows enduring difficulties, collapse of stability, access to professional help, professional and social support, and experience of growth. A combination of the staged process of growth, absence of partner support, children as a driving force for change, the need for economic activity, factors affecting difference in growth: satisfaction levels of women's need for recognition, respect, and reward, and level of spousal support were identified as factors affecting marriage immigrant women's resilience. CONCLUSIONS Spouses, children, and economic activity play key roles in resilience in positive and negative ways. The existing information barrier should be addressed at a structural level to improve the mental health of marriage immigrant women, and the optimum time for intervention is suggested within 2 years post-migration. Efforts to build supportive relationships with Korean spouses and meet the women's needs for recognition, respect, and reward may also help promote these women's resilience.
Collapse
Affiliation(s)
- Yeonjae Jo
- Dong-A University, College of Nursing, G05-510, Daeshingongwon-ro 32, Seogu, Busan, 49201, South Korea.
| |
Collapse
|
27
|
Bapolisi AM, Song SJ, Kesande C, Rukundo GZ, Ashaba S. Post-traumatic stress disorder, psychiatric comorbidities and associated factors among refugees in Nakivale camp in southwestern Uganda. BMC Psychiatry 2020; 20:53. [PMID: 32033558 PMCID: PMC7006164 DOI: 10.1186/s12888-020-2480-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 02/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Armed conflict in Africa has led to displacement of over 24.2 million people, more than 1.4 million of whom are living in Uganda. Studies show that refugees living in Ugandan refugee settlements are at increased risk for post-traumatic stress disorder. However data on the prevalence of other mental health problems among refugees including depression, anxiety and substance use disorder among refugees in Uganda is lacking. Our aim was to determine the prevalence of post-traumatic stress disorder, its main psychiatric comorbidities and perceived psychosocial needs among refugees in Nakivale refugee camp. METHODS We conducted a cross-sectional survey of refugee camp residents (n = 387) from nine different countries of origin. Psychiatric disorders were assessed using the MINI International Neuropsychiatric Interview (MINI) and perceived needs by the Humanitarian Emerging Settings Perceived Needs Scale (HESPER). RESULTS The prevalence of psychiatric disorders was high among refugees as was the level of perceived needs. The most prevalent psychiatric disorders were generalized anxiety disorders (73%), post-traumatic stress disorder (PTSD) (67%), major depressive disorder (58%) and substance use disorders (30%). There was a higher level of comorbidity between PTSD and substance use disorder (OR = 5.13), major depressive disorder (OR = 4.04) and generalized anxiety disorder (OR = 3.27). In multivariate analysis, PTSD was positively associated with the perception of stress as a serious problem (OR = 6.52; P-value = 0.003), safety and protection for women in the community (OR = 2.35; P-value = 0.011), care for family (OR = 2.00; P-value = 0.035) and Place to live in (OR = 1.83; P-value = 0.04). After applying the Bonferroni correction, the perception of stress remained significantly associated with PTSD. CONCLUSION Our findings suggest a strong association between PTSD, its main comorbidities and basic needs in Nakivale refugee camps. Mental health support should include psychological interventions as well as social assistance to improve the health of refugees.
Collapse
Affiliation(s)
- Achille Mwira Bapolisi
- Department of Psychiatry, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, DR, Congo. .,Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Suzan J. Song
- grid.253615.60000 0004 1936 9510Department of Psychiatry and Behavioural Sciences, George Washington University, Washington, DC USA
| | - Claire Kesande
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Scholastic Ashaba
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| |
Collapse
|
28
|
Haydu M, Viodres Inoue S, Silveira C, Martin D. Therapeutic itineraries of Congolese refugees in the city of São Paulo. Glob Public Health 2020; 15:840-851. [PMID: 31971086 DOI: 10.1080/17441692.2020.1714071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
São Paulo, the most populous Brazilian city, has been the main destination for refugees and it is home to the majority of Congolese, who are the second largest nationality to request refuge in Brazil. In the context of these migrations, previous experiences in displacement and in places of welcome can trigger illness and suffering. The purpose of this article was to analyse the therapeutic itineraries of refugees from the Democratic Republic of Congo who reside in the city of São Paulo. The research followed an ethnographic approach and included focus group, ethnographic observation and in-depth interviews with 15 Congolese men in refuge in São Paulo between 2015 and 2016. The difficulties faced in the dignified reconstruction of lives include housing, precarious work and racism. Different systems are actuated in healthcare, treatment in health centres and hospitals regarding acute and chronic physical problems, in addition to self-care, identified in the preparation of teas for gastrointestinal ailments. When confronted by suffering, religious social networks, and those of friends and family are activated, in addition to alcohol consumption. The family is sought when facing financial and, principally, emotional problems. The itineraries include multiple therapeutic systems and a dialectic relationship with free, universal services perceived as inequitable.
Collapse
Affiliation(s)
- Marcelo Haydu
- Instituto Adus de Reintegração do Refugiado, São Paulo, Brazil
| | - Silvia Viodres Inoue
- Postgraduate Program in Public Health, Catholic University of Santos, Santos, Brazil
| | - Cássio Silveira
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Denise Martin
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
29
|
Sengoelge M, Johnson-Singh CM, Mittendorfer-Rutz E, Vaez M, Saboonchi F. Identifying subgroups of refugees from Syria resettled in Sweden based on multiple trauma exposures: A latent class analysis of trauma history and mental health outcomes. J Psychosom Res 2019; 125:109814. [PMID: 31470254 DOI: 10.1016/j.jpsychores.2019.109814] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many refugees have been subjected to pre-migratory trauma. Evidence is needed to address the heterogeneity within refugee populations in regard to patterns of multiple trauma exposures. This study identified subgroups within a refugee population displaying different profiles of multiple trauma exposures and assessed sociodemographic predictors and differences in mental health symptom severity across these classes. METHODS Study population consisted of 1215 refugees from Syria resettled in Sweden. Latent class analysis 3-step method for modelling predictors and outcomes and a class-specific weighted multigroup approach were used to identify classes of refugees using self-reported data on violent and non-violent trauma exposures, sociodemographic variables and symptom severity scores for depression, anxiety and PTSD. RESULTS Three classes were identified: class 1 'multiple violent and non-violent trauma' (39.3%, n = 546); class 2 'witnessing violence and multiple non-violent trauma' (40.8%, n = 569); and class 3 'low multiple non-violent trauma' (20.1%, n = 281). Trauma exposure and gender significantly predicted class membership. Male gender and highest severity of mental ill health defined class 1. Female gender predicted higher mental ill health within classes 1 and 2. Across all three classes living with a partner was associated with lower severity of mental ill health regardless of trauma exposure classes. CONCLUSIONS There are distinct patterns within refugee populations concerning exposure to multiple trauma. Violence is a primary marker for higher likelihood of multiple trauma exposures and severity of mental health. Gender predisposes individuals to trauma exposure and its outcomes differentially.
Collapse
Affiliation(s)
- Mathilde Sengoelge
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden.
| | - Charisse M Johnson-Singh
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
30
|
Dowling A, Enticott J, Kunin M, Russell G. An investigation into the association of pre- and post-migration experiences on the self-rated health status among new resettled adult humanitarian refugees to Australia: a protocol for a mixed methods study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2019; 19:15. [PMID: 31039770 PMCID: PMC6492333 DOI: 10.1186/s12914-019-0198-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Refugees are one of the most vulnerable groups in our society. They are at risk of poor physical and mental health outcomes, much of this attributed to traumatic events prior to migration and the additional risk factors refugees face in the host nations. However, how migration factors shape the health of resettling refugees is not well understood. This study uses a mixed methods approach to examine how pre- and post-migration factors shape the self-rated health of resettling adult refugees in an effort to address the current knowledge gap. METHODS This study will use a sequential explanatory mixed method study design. We begin by analyzing resettlement and health data from the 'Building a New Life In Australia' longitudinal study of humanitarian refugees resettled in Australia to identify significant associations between migration factors and refugee health. Then, a series of semi-structured interviews with resettled refugees will further explore the lived experiences of refugees with respect to the relationship between migration and refugee health. Finally, we will integrate both sets of findings to develop a detailed understanding of how and why migratory factors contribute to refugee health during resettlement. DISCUSSION There is a paucity of studies that examine the multidimensional nature of refugee health during resettlement and as a result, little is understood about their resettlement health needs. This information is required to inform existing or new resettlement interventions to help promote or improve refugee health. To overcome these limitations in the research knowledge, this study will use a mixture of study methods to illustrate the complex and multifaceted determinants of refugee health during resettlement in Australia.
Collapse
Affiliation(s)
- Alison Dowling
- Department of General Practice, School of Primary Health Care, Monash University, Melbourne, Australia
| | - Joanne Enticott
- Department of General Practice, School of Primary Health Care, Monash University, Melbourne, Australia
- Southern Synergy, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Marina Kunin
- Department of General Practice, School of Primary Health Care, Monash University, Melbourne, Australia
| | - Grant Russell
- Department of General Practice, School of Primary Health Care, Monash University, Melbourne, Australia
| |
Collapse
|
31
|
Felsman IC, Humphreys JC, Kronk R. Measuring Distress Levels of Refugee Women to Enhance Community-Based Psycho-social Interventions. Issues Ment Health Nurs 2019; 40:310-316. [PMID: 30633707 DOI: 10.1080/01612840.2018.1543744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this investigation was to gain an understanding of the levels of distress in resettled refugee women as a basis for the development of improved community based interventions to enhance the resettlement experience. A convenience sample of female refugees (n = 23) in a southern US city were interviewed using a socio-demographic questionnaire; the Refugee Health Screener-15 (RHS-15); and semi-structured, exploratory questions. Results showed consistently high levels of distress, indicated by responses to the RHS-15. Women ages 19-25 and over 50 displayed the highest risk. Categories of stressors included a lack of access to health and psycho-social support services, difficulty with communicating in the English language, and social isolation. In addition, women reported that a lack of trained interpreters contributes to reduced access to health and social service, causing further distress.
Collapse
Affiliation(s)
- Irene C Felsman
- a Duke University School of Nursing , Durham , North Carolina , USA
| | | | - Rebecca Kronk
- b Duquesne University School of Nursing , Pittsburgh , Pennsylvania , USA
| |
Collapse
|
32
|
Kartal D, Alkemade N, Kiropoulos L. Trauma and Mental Health in Resettled Refugees: Mediating Effect of Host Language Acquisition on Posttraumatic Stress Disorder, Depressive and Anxiety Symptoms. Transcult Psychiatry 2019; 56:3-23. [PMID: 30117781 DOI: 10.1177/1363461518789538] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the relationship between traumatic exposure, host language acquisition and mental health (posttraumatic stress, depressive and anxiety symptoms) in long-term resettled refugees. Participants included a community sample of Bosnian refugees ( N = 138, 55% male, mean age of 40 years old) that had resettled in Australia and Austria on average 18 years prior. Two mediation models were tested based on two competing theories. Model A examined whether language acquisition mediates the relationship between traumatic exposure and mental health problems experienced by refugees. Model B examined whether mental health symptoms mediate the relationship between exposure to traumatic events and the acquisition of host language. Model A fit the data well (CFI = 1.00, SRMR = .017, RMSEA < .001, χ2 p = .526), while Model B was rejected as an acceptable model for the data (CFI = .556, SRMR = .136, RMSEA = .352). In Model A, the indirect pathway from trauma to mental health via language acquisition was significant for PTSD ( β = .067, p = .028) and anxiety symptoms ( β = .063, p = .026) but not depression symptoms ( β = .048, p = .071). Intervention strategies aimed at improving host language acquisition may be important not only in successful adaptation to daily living in the host country, but also to improve the mental health of traumatized refugees.
Collapse
|
33
|
Traumatic exposure, acculturative stress and cultural orientation: the influence on PTSD, depressive and anxiety symptoms among refugees. Soc Psychiatry Psychiatr Epidemiol 2018; 53:931-941. [PMID: 29931441 DOI: 10.1007/s00127-018-1532-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Acculturation studies conducted with refugees have predominantly concentrated on investigating the impact of acculturative stress on mental health, and have neglected to investigate the impact of cultural orientations towards the host and ethnic cultures. Furthermore, exposure to traumas is highly prevalent in refugees and strongly associated with mental health outcomes, however, rarely included in investigations of acculturative process of refugees. METHOD Using structural equation modelling, this study tested an integrated model of the relationship between traumatic exposure, acculturative stress, host and ethnic cultural orientations and posttraumatic stress disorder (PTSD), depression and anxiety symptoms among 138 Bosnian refugees resettled in Australia and Austria. RESULTS The model showed an overall good fit and noteworthy amount of variance indicating that traumatic exposure is the strongest direct and indirect predictor of PTSD, depression and anxiety symptoms. Furthermore, acculturative stress was identified as a significant risk factor influencing host cultural orientation, mediating the effect of traumatic exposure on all mental health outcomes. CONCLUSION Acculturative stress and cultural and social stressors that are related to acculturation need to be addressed alongside provision of effective psychotherapy, especially since they are significant impediments to host cultural orientation and constructive engagement with mental health services in refugees.
Collapse
|
34
|
A Review of Health Survey Research for People with Refugee Background Resettled from Africa: Research Gaps and Methodological Issues. J Racial Ethn Health Disparities 2018; 6:160-181. [PMID: 30014446 DOI: 10.1007/s40615-018-0511-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/20/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
We reviewed 27 studies on adults with a refugee background resettled from Africa published between 1999 and 2017 to appraise their methodological issues for survey research. Out of 27 studies, eleven used a single sampling method (referral = 1, convenience = 10), and 16 relied on multiple sampling methods, many of which were combinations of referral and convenience. The two most salient recruitment strategies found were building trusted relationships with the community (n = 15), and using recruiters who were culturally and linguistically matched to the refugee communities of interest (n = 14). Fifteen studies used existing data collection instruments, while in 13 studies, researchers developed their own data collection instruments. In-person or phone interviews using bilingual interviewers (n = 21) were the most frequently used mode of data collection, followed by a self-administered survey (n = 7). Our review presents methodological gaps in current refugee health studies, such as limited use of probability sampling approach due to system barriers, lack of information in community engagement and recruitment processes, and insufficient considerations of unique culture and experiences of refugee communities when developing or adapting the instruments. Efforts can be made to guide and facilitate appropriate reporting and development of more scientifically robust survey methodologies for refugee health studies, as well as to improve registration system infrastructure that may help identify these hidden populations more effectively.
Collapse
|
35
|
Lumley M, Katsikitis M, Statham D. Depression, Anxiety, and Acculturative Stress Among Resettled Bhutanese Refugees in Australia. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2018. [DOI: 10.1177/0022022118786458] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite awareness of the difficulties faced by refugees in flight, little is known about their mental health following resettlement. This article investigated rates, predictors, and moderators of anxiety, depression, and acculturative stress among members of the resettled Bhutanese refugee community in northern Queensland. A total of 148 participants (51% male), 18 to 83 years of age, participated in this cross-sectional study. A questionnaire was comprised of bilingual (English–Nepali) versions of the Depression, Anxiety, and Stress Scale (DASS-21; anxiety and depression), the Multidimensional Acculturative Stress Scale (MASS; acculturative stress), Brief-COPE (coping style), Multidimensional Scale of Perceived Social Support (MSPSS; social support), and socio-demographics. Participants reported severe levels of anxiety and moderate levels of depression, and moderate to high levels of acculturative stress. Acculturative stress was a substantive contributor to both depression and anxiety scores. Additional risk factors included the use of maladaptive/avoidant coping styles, age, and education. English language proficiency was strongly protective, as was education to Year 12 and current employment. This research is the first of its kind with this refugee group in Australia, and highlights the longevity and severity of mental health issues that affect Bhutanese refugees resettled in Australia.
Collapse
Affiliation(s)
- Mia Lumley
- University of the Sunshine Coast, Queensland, Australia
| | | | - Dixie Statham
- University of the Sunshine Coast, Queensland, Australia
| |
Collapse
|
36
|
Zhong BL, Liu TB, Chan SSM, Jin D, Hu CY, Dai J, Chiu HFK. Common mental health problems in rural-to-urban migrant workers in Shenzhen, China: prevalence and risk factors. Epidemiol Psychiatr Sci 2018; 27:256-265. [PMID: 28067189 PMCID: PMC6998856 DOI: 10.1017/s2045796016001141] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/07/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS Rural-to-urban migrant workers are a large marginalised population in urban China. Prevalence estimates of common mental health problems (CMHPs) in previous studies varied widely and very few studies have investigated migration-related factors of CMHPs in migrant workers. The objective of this study was to determine the prevalence and risk factors of CMHPs among Chinese migrant workers. METHODS A random sample of 3031 migrant workers of ten manufacturing factories in Shenzhen, China, completed a standardised questionnaire containing socio-demographic and migration-related variables and the Chinese 12-item General Health Questionnaire (GHQ-12). A GHQ-12 score of three or higher was used to denote the presence of CMHPs. RESULTS The prevalence of CMHPs was 34.4% in Chinese migrant workers. In multiple logistic regression, risk factors for CMHPs included being 16-25 years old (odd ratio [OR] 1.65, 95% confidence interval [CI] 1.28, 2.12), being 26-35 years old (OR 1.36, 95% CI: 1.05, 1.75), low monthly income (OR 1.42, 95% CI 1.04, 1.92), poor living condition (OR: 1.76, 95% CI: 1.22, 2.54), physical illness in the past 2 weeks (OR 1.72, 95% CI 1.43, 2.05), having worked in many cities (OR 1.34, 95% CI 1.03, 1.74), infrequently visiting hometown (OR 1.56, 95% CI 1.22, 1.99), poor Mandarin proficiency (OR 1.51, 95%CI 1.13, 2.01), a low level of perceived benefits of migration (OR 1.33, 95% CI 1.14, 1.55) and working more than 8 h/day (OR 1.39, 95% CI 1.14, 1.70). CONCLUSIONS CMHPs are very prevalent among Chinese migrant workers. Given the large number of Chinese migrant workers, there is an urgent need to address the mental health burden of China's migrant worker population.
Collapse
Affiliation(s)
- B. L. Zhong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
- Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, People's Republic of China
| | - T. B. Liu
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, People's Republic of China
| | - S. S. M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - D. Jin
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, People's Republic of China
| | - C. Y. Hu
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, People's Republic of China
| | - J. Dai
- Shenzhen Key Laboratory for Psychological Healthcare, Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, People's Republic of China
| | - H. F. K. Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| |
Collapse
|
37
|
Lai DWL, Li L, Daoust GD. Factors Influencing Suicide Behaviours in Immigrant and Ethno-Cultural Minority Groups: A Systematic Review. J Immigr Minor Health 2018; 19:755-768. [PMID: 27640011 DOI: 10.1007/s10903-016-0490-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This paper reviews recent literature on factors influencing suicide behaviours, including thoughts, plans, and attempts, in immigrant and ethno-cultural minority groups, to inform a more comprehensive understanding of suicide behaviours in increasingly culturally diverse populations. Thirty-three studies published between 2002 and 2013 were identified through digital databases searches and included in this review. Analysis of study findings focused on impacts of ethno-cultural identity and acculturation, other cultural and immigration influences, and family and community supports on suicide behaviours. Policy, practice, and research recommendations are identified, to inform relevant suicide prevention efforts and enhance mental health supports for immigrant and ethno-cultural minority populations.
Collapse
Affiliation(s)
- Daniel W L Lai
- Department of Applied Social Sciences, Institute of Active Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada.
| | - Lun Li
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Gabrielle D Daoust
- Department of International Relations, University of Sussex, Brighton, UK
| |
Collapse
|
38
|
Hollifield M, Warner TD, Krakow B, Westermeyer J. Mental Health Effects of Stress over the Life Span of Refugees. J Clin Med 2018; 7:jcm7020025. [PMID: 29415443 PMCID: PMC5852441 DOI: 10.3390/jcm7020025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 11/26/2022] Open
Abstract
Information about the relative impact of stressful events across the lifespan on the mental health of refugees is needed. Cross-sectional data from a community sample of 135 Kurdish and 117 Vietnamese refugees were fit to a path model about the effects of non-war stress, war-related stress, and post-migration stress on mental health. Kurdish and Vietnamese data were generally consistent with the model. However, war-related stress produced no direct but a large indirect effect through post-migration stress on mental health in Kurds. Vietnamese data indicated a modest direct war-related stress effect but no indirect influence through post-migration stress. Different types of stressful events lead to adverse mental health of displaced refugees in a somewhat group-dependent manner. Implications for prevention and treatment are discussed.
Collapse
Affiliation(s)
- Michael Hollifield
- The Tibor Rubin VA Medical Center, 5901 East 7th Street, Bldg. 128, Suite 102A, Long Beach, CA 90822, USA.
- Department of Psychiatry and Human Behavior, The University of California at Irvine School of Medicine, 101 The City Drive, Orange, CA 92868, USA.
| | - Teddy D Warner
- Department of Family and Community Medicine, University of New Mexico School of Medicine, 2400 Tucker Avenue, Albuquerque, NM 87131, USA.
| | - Barry Krakow
- Sleep and Human Health Institute, 6739 Academy Road, #380, Albuquerque, NM 87109, USA.
| | - Joseph Westermeyer
- Department of Psychiatry and the Minneapolis Veterans Administration Medical Center, University of Minnesota, Minneapolis, MN 55417, USA.
| |
Collapse
|
39
|
Papadopoulos I, Shea S. European refugee crisis: psychological trauma of refugees and care givers. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2018. [DOI: 10.1108/ijmhsc-08-2016-0032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
In recent years, the number of refugees and migrants entering Europe has increased dramatically. Such trauma may affect not only refugees themselves, but also care givers and rescue workers. The purpose of this paper is to discuss the intensity and psychological impact of the refugee crisis, with a view to suggesting ways of moving forward.
Design/methodology/approach
Based on recent literature, this paper briefly looks at the importance of attention to health and social issues, before discussing the psychological trauma of refugees and potential emotional trauma of those involved in rescue operations.
Findings
The provision of psychological support which is both compassionate and culturally competent should be viewed as essential. Furthermore, the development of resources and tools to assist with the current refugee crisis could enable care givers, rescue workers, and healthcare professionals to provide psychological support to migrants and refugees. Such resources could also encourage, and support, frontline responders in caring for their own personal psychological well-being.
Originality/value
The content of this paper could help to encourage further research in this field, including research into the emotional trauma of rescue workers. Furthermore, it is intended that this paper could contribute to an on-line knowledge base when considering the development of tools and resources to assist with the current refugee crisis.
Collapse
|
40
|
Giacco D, Laxhman N, Priebe S. Prevalence of and risk factors for mental disorders in refugees. Semin Cell Dev Biol 2017; 77:144-152. [PMID: 29174456 DOI: 10.1016/j.semcdb.2017.11.030] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/03/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
Given the increasing numbers of refugees worldwide, the prevalence of their mental disorders is relevant for public health. Prevalence studies show that, in the first years of resettlement, only post-traumatic stress disorder (PTSD) rates are clearly higher in refugees than in host countries' populations. Five years after resettlement rates of depressive and anxiety disorders are also increased. Exposure to traumatic events before or during migration may explain high rates of PTSD. Evidence suggests that poor social integration and difficulties in accessing care contribute to higher rates of mental disorders in the long-term. Policy and research implications are discussed.
Collapse
Affiliation(s)
- Domenico Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom.
| | - Neelam Laxhman
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| |
Collapse
|
41
|
Whitley R, Wang J, Fleury MJ, Liu A, Caron J. Mental Health Status, Health Care Utilisation, and Service Satisfaction among Immigrants in Montreal: An Epidemiological Comparison. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:570-579. [PMID: 27836931 PMCID: PMC5546664 DOI: 10.1177/0706743716677724] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine variations between immigrants and nonimmigrants in 1) prevalence of common mental disorders and other mental health variables; 2) health service utilisation for emotional problems, mental disorders, and addictions, and 3) health service satisfaction. METHODS This article is based on a longitudinal cohort study conducted from May 2007 to the present: the Epidemiological Catchment Area Study of Montreal South-West (ZEPSOM). Participants were followed up at 4 time points (T1, n = 2433; T4, n = 1095). Core exposure variables include immigrant status (immigrant vs. nonimmigrant), duration of residence, and region of origin. Key outcome variables included mental health status, health service utilisation, and health service satisfaction. Data were analysed both cross-sectionally and longitudinally. RESULTS Immigrants had been in Canada for 20 years on average. Immigrants had significantly lower rates of high psychological distress (32.6% vs. 39.1%, P = 0.016), alcohol dependence (1.4% vs. 3.9%, P =0.010), depression (5.2% vs. 9.2%, P = 0.008), and various other mental disorders. They had significantly higher scores of mental well-being (48.9 vs. 47.1 score, P = 0.014) and satisfaction with social (34.0 vs. 33.4 score, P = 0.021) and personal relationships (16.7 vs. 15.6 score, P < 0.001). Immigrants had significantly lower rates of health service utilisation for emotional problems, mental disorders, and addictions and significantly higher rates of health service satisfaction at all time points. Asian and African immigrants had particularly low rates of utilisation and high rates of satisfaction. CONCLUSIONS Immigrants had better overall mental health than nonimmigrants.
Collapse
Affiliation(s)
- Rob Whitley
- 1 Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| | - JiaWei Wang
- 1 Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| | - Marie-Josee Fleury
- 1 Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| | - Aihua Liu
- 1 Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| | - Jean Caron
- 1 Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| |
Collapse
|
42
|
Kokou-Kpolou K, Mbassa Menick D, Moukouta CS, Baugnet L, Kpelly DE. A Cross-Cultural Approach to Complicated Grief Reactions Among Togo–Western African Immigrants in Europe. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2017. [DOI: 10.1177/0022022117721972] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many researchers have noted that bereavement is a major stress factor associated with the etiopathogeny of psychological disorders among immigrants, but until now, the grief reactions of these ethnic minorities have not been analyzed. This study aims to examine the impact of the migration trajectory (immigration status and duration) as well as the use of ritual support to cope with grief reactions in the context of migration. Fifty-four migrants and 20 refugees ( N = 74) in France and Belgium were surveyed regarding their experience of mourning a family member. The results showed that complicated grief is associated with the status and duration of immigration. A majority of refugees reported a deterioration of their social life when the duration of their immigration exceeded 10 years. Feeling guilty, dazed or stunned, loneliness, bitterness, numbness, and emptiness made up the spectrum of severe and persistent guilt reactions. Those who took part in bereavement rituals suffered less from feelings of guilt and despondency. Eldest siblings presented a very high rate of complicated grief. These findings were discussed using a psycho-cultural approach; they demonstrated that in the context of migration, grief reactions develop around the principle of debt, based on the parent–child relationship inextricably associated with a feeling of belonging to the ethnic group and collective memory.
Collapse
Affiliation(s)
| | | | | | - Lucy Baugnet
- University of Picardie Jules Verne, Amiens, France
| | | |
Collapse
|
43
|
Johnson CM, Rostila M, Svensson AC, Engström K. The role of social capital in explaining mental health inequalities between immigrants and Swedish-born: a population-based cross-sectional study. BMC Public Health 2017; 17:117. [PMID: 28122593 PMCID: PMC5264487 DOI: 10.1186/s12889-016-3955-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Social capital may theoretically explain health inequalities between social groups, but empirical evidence is lacking. Some studies indicate that social capital may be particularly important for immigrant health. Nearly 16% of Sweden's population are foreign-born immigrants and research has shown them to be susceptible to psychological distress, though significant variation has been found between groups. In this study, we investigate the following hypotheses: 1) if non-refugees have better mental health than Swedish-born, and refugees experience worse mental health than Swedish-born; 2) if mental health status converges with that of Swedish-born with longer duration of residence; and 3) if social capital mediates the effect of immigrant status on psychological distress for different immigrant groups as compared to Swedish-born. METHODS This cross-sectional study uses baseline data from the Stockholm Public Health Cohort and includes 50,498 randomly-selected individuals from Stockholm County in 2002, 2006, and 2010. Mental health was measured as psychological distress, using the 12-item General Health Questionnaire. Social capital was measured using indicators of bonding, bridging, and linking social capital. Both cognitive and structural aspects were measured for the latter two indicators. Mediation was tested using logistic regression and the Sobel test. RESULTS The results show that refugees generally had greater odds of psychological distress than non-refugees compared to their respective Swedish-born counterparts. Among immigrant men, both refugees and non-refugees had significantly greater odds of psychological distress than Swedish-born men. Only refugee women in Sweden 10 years or more had significantly greater odds of psychological distress compared to Swedish-born women. The mediation analysis demonstrated that indicators of social capital mediated the association for all immigrant men (except non-refugees in Sweden 3-9 years) and for refugee women in Sweden 10 years or more. While bonding social capital showed the greatest mediatory role among the three social capital types, adding them together had the strongest explanatory effect. CONCLUSIONS Social capital explains differences in mental health for some immigrant groups, highlighting its role as a potentially important post-migration factor. Increased investment from policy-makers regarding how social capital can be promoted among new arrivals may be important for preventing psychological distress.
Collapse
Affiliation(s)
- Charisse M. Johnson
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, Stockholm, 171 65 Sweden
| | - Mikael Rostila
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet Sveavägen 160, Stockholm, 106 91 Sweden
| | - Anna C. Svensson
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, Stockholm, 171 65 Sweden
| | - Karin Engström
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, Stockholm, 171 65 Sweden
| |
Collapse
|
44
|
Tomita A, Labys CA, Burns JK. The relationship between immigration and depression in South Africa: evidence from the first South African National Income Dynamics Study. J Immigr Minor Health 2016; 16:1062-8. [PMID: 24526432 DOI: 10.1007/s10903-014-9987-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Few studies have examined depression among immigrants in post-apartheid South Africa, and factors that strengthen the relationship between immigration and depression. The first wave of the National Income Dynamics Study was used to investigate links between immigration and depression (n = 15,205). Depression symptoms were assessed using a 10-item version of the Center for Epidemiologic Studies Depression (CES-D) Scale. Immigrants in South Africa had fewer depressive symptoms (CES-D ≥ 10) than locally-born participants (17.1 vs. 32.4%, F = 13.5, p < 0.01). Multilevel mixed-effects logistic regression analyses found that among immigrant populations, younger age (adjusted OR 1.03, 95% CI 1.01-1.05) and black African ethnicity (adjusted OR 3.72, 95% CI 1.29-10.7) were associated with higher depression. Younger age was associated with lower depression among locally-born study participants (adjusted OR 0.98, 95% CI 0.97-0.98). The varying relationship between certain demographic factors, depression and the different mental health challenges among these groups requires closer attention.
Collapse
Affiliation(s)
- Andrew Tomita
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, 4013, South Africa,
| | | | | |
Collapse
|
45
|
Kim IH, Noh S. Ethnic and gender differences in the association between discrimination and depressive symptoms among five immigrant groups. J Immigr Minor Health 2016; 16:1167-75. [PMID: 24375383 DOI: 10.1007/s10903-013-9969-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines ethnic and gender differences in exposure to discrimination and its association with depressive symptoms among five immigrant groups. Data were derived from a cross-sectional survey of 900 adult immigrants (50.8% men, 49.2% women) sampled from five ethnic immigrant communities in Toronto between April and September 2001. Men reported higher levels of discrimination than women. Ethiopians had the highest perception of discrimination followed by Korean, Iranian, Vietnamese, and Irish immigrants. With regard to discrimination-related depressive symptoms, Iranian and Korean men showed a greater risk than their Irish counterparts. Among women, Vietnamese and Irish seemed to be more vulnerable to discrimination than other ethnic groups. Despite experiencing the highest level of discrimination, Ethiopian men and women showed no association between discrimination and depressive symptoms. The exposure and psychological response to discrimination vary significantly across ethnicities and gender.
Collapse
Affiliation(s)
- Il-Ho Kim
- Social and Epidemiological Research, Centre for Addiction and Mental Health, 33 Russell Street, Suite T-306, Toronto, ON, M5S 2S1, Canada,
| | | |
Collapse
|
46
|
Feuillet P, Lert F, Tron L, Aubriere C, Spire B, Dray-Spira R. Prevalence of and factors associated with depression among people living with HIV in France. HIV Med 2016; 18:383-394. [PMID: 27625202 DOI: 10.1111/hiv.12438] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Depression is common among people living with HIV (PLWHIV) and is associated with poorer therapeutic outcomes and risky behaviours. We sought to estimate the prevalence of major depressive episode (MDE) across PLWHIV groups, to compare this with its prevalence in the general population and to assess factors associated with it. METHODS We used data from the Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS)-Vespa2 study, a national study on a representative sample of PLWHIV conducted in France in 2011. The short form of the depression module of the World Health Organization's Composite International Diagnostic Instrument (CIDI-SF) was used to characterize the occurrence of an MDE during the previous year. MDE prevalence was assessed among the various groups of PLWHIV and compared with that in the general population, accounting for the sociodemographic characteristics of the two populations, using multivariate Poisson regression models. The same method was used to assess associated factors. RESULTS MDE prevalence was 28.1% among PLWHIV, ranging from 10.9 to 55.7% across groups. Compared with the general population by sex, regardless of sexual orientation and origin, MDE prevalence was 5.1-fold higher in HIV-infected men who have sex with men [95% confidence interval (CI) 3.9-6.6], 3.1-fold higher in non-sub-Saharan African (SSA) heterosexual men (95% CI 2.2-4.4), 1.6-fold higher in SSA migrant men (95% CI 0.9-2.6), 2.6-fold higher in non-SSA heterosexual women (95% CI 2.1-3.3), and 1.9-fold higher in SSA migrant women (95% CI 1.5-2.5). In the HIV-infected population, MDE was positively related to unemployment, material deprivation, disclosure, experience of discrimination, and untreated hepatitis C, and negatively related to age. CONCLUSIONS The prevalence of depression varied across the different groups of PLWHIV, with levels much higher than in the general population. Moreover, there was a strong association with socioeconomic status and HIV experience.
Collapse
Affiliation(s)
- P Feuillet
- Department of Social Epidemiology, INSERM UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC University of Paris 06, Paris, France
| | - F Lert
- Department of Epidemiology of Occupational and Social Determinants of Health, Center for Research in Epidemiology and Public Health, U1018, INSERM, Villejuif, France
| | - L Tron
- Department of Social Epidemiology, INSERM UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC University of Paris 06, Paris, France
| | - C Aubriere
- Department of Social Epidemiology, INSERM UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC University of Paris 06, Paris, France
| | - B Spire
- Economics and Social Sciences Applied to Health and Analysis of Medical Information (SESSTIM), UMR912, INSERM, Marseille, France.,UMRS912, IRD, Aix Marseille University, Marseille, France.,Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - R Dray-Spira
- Department of Social Epidemiology, INSERM UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC University of Paris 06, Paris, France
| | | |
Collapse
|
47
|
Major depressive disorder and suicidal behavior among urban dwelling Ethiopian adult outpatients at a general hospital. J Affect Disord 2016; 197:58-65. [PMID: 26971124 PMCID: PMC4964269 DOI: 10.1016/j.jad.2016.02.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/07/2016] [Accepted: 02/25/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND We sought to evaluate the prevalence and correlates of major depressive disorder (MDD) and suicidal behavior among urban dwelling Ethiopian adults. METHODS This was a cross-sectional study of 1097 outpatient adults (≥18 years of age) in a major hospital in Addis Ababa, Ethiopia. Sociodemographic and lifestyle characteristics were collected via structured interviews. MDD and suicidal behavior were assessed using the Composite International Diagnostic Interview (CIDI) among all study participants. Multivariable logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS Prevalence estimates for lifetime and 12-month MDD were 18.0% and 6.7%, respectively. The prevalence of suicidal behavior during the previous year (i.e., suicidal ideation, plan or attempt) was 15.2% with approximately 4% having reported attempts. Overall, women were more likely to report suicidal behavior (17.8%) than men (11.3%). MDD odds were 1.53-fold higher among women as compared with men (aOR=1.53, 95% CI 1.05-2.23). Lifetime MDD was significantly associated with age, sex, marital status, and self-reported physical health. Participants reporting poor mental health had approximately 3-fold increased odds of MDD (OR=2.93; 95%CI: 1.05-2.23); those between 35 and 44 years old (aOR=1.92; 95%CI: 1.06-3.49) and those older than 55 years (aOR=2.54; 95%CI: 1.16-5.57) had higher odds of MDD. Similarly suicidal behavior was significantly associated with sex, marital status, and self-reported physical and mental health. LIMITATIONS This cross-sectional study utilized self-reported data from outpatients. Causality cannot be inferred, and results may not be fully generalizable. CONCLUSIONS Overall results show that MDD and suicidal behavior are highly prevalent among urban-dwelling Ethiopian adults. Women and middle-age adults constitute a high-risk group and may therefore benefit from targeted interventions.
Collapse
|
48
|
Hollifield M, Toolson EC, Verbillis-Kolp S, Farmer B, Yamazaki J, Woldehaimanot T, Holland A. Effective Screening for Emotional Distress in Refugees: The Refugee Health Screener. J Nerv Ment Dis 2016; 204:247-53. [PMID: 26825376 DOI: 10.1097/nmd.0000000000000469] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Screening for emotional distress is important, but not widely available. This study assesses the utility of the Refugee Health Screener 15 (RHS-15) in a public health setting. Refugee Health Screener 15 and diagnostic proxy (DP) instruments assessing anxiety, depression, and posttraumatic stress disorder were administered to refugees from 3 countries at their public health examination. Properties of the RHS-15 and its components were evaluated utilizing appropriate methods. Scale Cronbach α was 0.95, and a factor analysis identified 1 factor accounting for 66% of scale variance. Refugee Health Screener 15 scores and cases discriminated between refugee groups similar to DPs. Refugee Health Screener 15 case sensitivity and specificity to DPs were acceptable (≥0.87/0.77). A shorter, 13-item component had acceptable metric properties. The RHS-15 appears to be a valid screener for emotional distress of refugees. The 13-item scale may be more efficient and as efficacious for case identification. The critical public health need and recommendations for implementation are discussed.
Collapse
Affiliation(s)
- Michael Hollifield
- *Pacific Institute for Research and Evaluation, Albuquerque, NM; †The VA Long Beach Healthcare System, Long Beach, CA; ‡Department of Biology, University of New Mexico, Albuquerque, NM; §Lutheran Community Services Northwest, SeaTac; ‖Asian Counseling, Referral Service; and ¶Public Health Seattle & King County, Seattle, WA
| | | | | | | | | | | | | |
Collapse
|
49
|
Durbin A, Sirotich F, Durbin J. English Language Abilities and Unmet Needs in Community Mental Health Services: a Cross-Sectional Study. J Behav Health Serv Res 2016; 44:483-497. [DOI: 10.1007/s11414-016-9503-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
50
|
Grace SL, Tan Y, Cribbie RA, Nguyen H, Ritvo P, Irvine J. The mental health status of ethnocultural minorities in Ontario and their mental health care. BMC Psychiatry 2016; 16:47. [PMID: 26915910 PMCID: PMC4768406 DOI: 10.1186/s12888-016-0759-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/22/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mental disorders are a leading cause of disability and early mortality. The objective of this study was to describe and compare psychosocial indicators and mental health service use among ethnoculturally-diverse Ontarians. METHODS This is a cross-sectional analysis of the Ontario Health Study pilot investigation. Residents were mailed an invitation to one of 3 assessment centres (urban, rural and northern sites) from March 2009 to July 2010. Participants had an interview with a nurse and completed a questionnaire on a touchscreen kiosk. The questionnaire included sociodemographic items, and scales assessing symptoms of depressive symptoms (CES-D) and anxiety (GAD-7), social support (Lubben Social Network Scale), stressful life events, and mental health service use. RESULTS Eight thousand two hundred thirty-five residents participated, among whom 6652 (82.4 %) self-reported their ethnocultural background as White, 225 (2.8 %) as South Asian, 222 (2.8 %) East Asian, 214 (2.7 %) Southeast Asian, 197 (2.4 %) Black, and 28 (0.3 %) as Aboriginal. Based on their sociodemographic characteristics, participants from these ethnocultural minority groups were matched to White participants. Black participants reported significantly greater stressful life events than White participants (p = .04), particularly death (p < .05), divorce (p = .002) and financial difficulties (p < .001). East Asian participants reported significantly less social support than their White counterparts (p < .001), and this was not confounded by measurement variance. Mental health service use was significantly lower in all ethnocultural minorities except Aboriginals, when compared to White participants (p = .001). CONCLUSIONS There is a high burden of psychosocial distress in several preponderant ethnocultural minorities in Ontario; many of whom are not accessing available mental health services.
Collapse
Affiliation(s)
- Sherry L. Grace
- School of Kinesiology and Health Science, York University, Toronto, ON Canada ,Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada ,Bethune College 368 York University, 4700 Keele Street, Toronto, ON Canada
| | - Yongyao Tan
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
| | | | - Han Nguyen
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Jane Irvine
- Department of Psychology, York University, Toronto, ON, Canada.
| |
Collapse
|