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Hilado A, Bond M, Sanchez E. Predicting Mental Health Care Enrollment and Treatment Uptake among Newly Arrived Refugees in U.S. Resettlement Programs. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241276778. [PMID: 39277775 DOI: 10.1177/00221465241276778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
This article examines variables that predict mental health care enrollment and engagement among refugees. The authors explore a mental health care model designed to identify mental health needs early among refugee arrivals that may interfere with adjustment and overall health outcomes using data from a Midwest refugee resettlement program. Using ecological models of mental distress and theories on help-seeking behaviors, the authors used logistic and count regressions to predict enrollment in mental health care services and utilization rates. Gender, nationality, and presenting problems were significant predictors of enrollment and length of engagement in services. The findings provide guidance to practitioners and resettlement agencies on refugee mental health and opportunities to increasing access and engagement in mental health care.
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Affiliation(s)
| | - Melissa Bond
- University of California, San Francisco, San Francisco, CA, USA
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Saleh EA, Wazaify M, Khoshnood K. Substance Use in Humanitarian Settings: A Case from Yemen. Subst Abuse Treat Prev Policy 2024; 19:28. [PMID: 38789984 PMCID: PMC11127395 DOI: 10.1186/s13011-024-00606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/04/2024] [Indexed: 05/26/2024] Open
Affiliation(s)
- Ebtesam A Saleh
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany.
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Aden University, Aden, Yemen.
| | - Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Kaveh Khoshnood
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Logie CH, Okumu M, Admassu Z, MacKenzie F, Tailor L, Kortenaar JL, Perez-Brumer A, Ahmed R, Batte S, Hakiza R, Kibuuka Musoke D, Katisi B, Nakitende A, Juster RP, Marin MF, Kyambadde P. Exploring ecosocial contexts of alcohol use and misuse during the COVID-19 pandemic among urban refugee youth in Kampala, Uganda: Multi-method findings. J Migr Health 2024; 9:100215. [PMID: 38375158 PMCID: PMC10875238 DOI: 10.1016/j.jmh.2024.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/16/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
Urban refugees may be disproportionately affected by socio-environmental stressors that shape alcohol use, and this may have been exacerbated by additional stressors in the COVID-19 pandemic. This multi-method study aimed to understand experiences of, and contextual factors associated with, alcohol use during the pandemic among urban refugee youth in Kampala, Uganda. We conducted a cross-sectional survey (n = 335), in-depth individual interviews (IDI) (n = 24), and focus groups (n = 4) with urban refugee youth in Kampala. We also conducted key informant interviews (n = 15) with a range of stakeholders in Kampala. We conducted multivariable logistic regression analyses with survey data to examine socio-demographic and ecosocial (structural, community, interpersonal) factors associated with ever using alcohol and alcohol misuse. We applied thematic analyses across qualitative data to explore lived experiences, and perceived impacts, of alcohol use. Among survey participants (n = 335, mean age= 20.8, standard deviation: 3.01), half of men and one-fifth of women reported ever using alcohol. Among those reporting any alcohol use, half (n = 66, 51.2 %) can be classified as alcohol misuse. In multivariable analyses, older age, gender (men vs. women), higher education, and perceived increased pandemic community violence against women and children were associated with significantly higher likelihood of ever using alcohol. In multivariable analyses, very low food security, relationship status, transactional sex, and lower social support were associated with increased likelihood of alcohol misuse. Qualitative findings revealed: (1) alcohol use as a coping mechanism for stressors (e.g., financial insecurity, refugee-related stigma); and (2) perceived impacts of alcohol use on refugee youth health (e.g., physical, mental). Together findings provide insight into multi-level contexts that shape vulnerability to alcohol mis/use among urban refugee youth in Kampala and signal the need for gender-tailored strategies to reduce socio-environmental stressors.
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Affiliation(s)
- Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, IL, USA
- School of Social Sciences, Uganda Christian University, Mukono, Uganda
| | - Zerihun Admassu
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Frannie MacKenzie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lauren Tailor
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jean-Luc Kortenaar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rushdia Ahmed
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Shamilah Batte
- Organization for Gender Empowerment and Rights Advocacy- OGERA Uganda, Kampala, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | - Brenda Katisi
- Young African Refugees for Integral Development (YARID), Kampala, Uganda
| | | | - Robert-Paul Juster
- Department of Psychiatry & Addiction, University of Montreal, Montreal, Canada
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Peter Kyambadde
- Most At Risk Population Initiative Clinic, Mulago Hospital, Kampala, Uganda
- National AIDS Control Program, Ministry of Health, Kampala, Uganda
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Makoha G, Denov M. War, forced displacement, and alcohol abuse: experiences and perceptions of war-affected south Sudanese refugee youth living in Bidibidi refugee settlement in northern Uganda. Front Public Health 2024; 12:1232504. [PMID: 38375335 PMCID: PMC10875737 DOI: 10.3389/fpubh.2024.1232504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Refugees are at high risk of alcohol abuse due to their experiences of structural, physical, sexual, and psychological violence in their countries of origin, during flight, and within host communities. Given the prolonged civil war in their country, South Sudanese have continued to flee profound forms of violence and now constitute the largest population of refugees in Uganda. However, little is known about their displacement experiences, as well as the reality of alcohol use and abuse within refugee settlements. Drawing upon the direct voices of a sample of war-affected South Sudanese young people, this article explores their experiences of forced displacement and their links to alcohol abuse, as well as their perceptions regarding appropriate alcohol treatment interventions for refugees in the camp. A total of 22 semi-structured qualitative interviews were conducted with 14 refugee youth (aged 18-25) alongside eight adult key informants who work with the youth (religious leaders, sports coaches, educators, social workers, and settlement administrators). Using thematic analysis, the study revealed a series of key themes influencing and shaping the high incidence of alcohol abuse among the youth. These included traumatic wartime and migration experiences, family separation, poor prospects, and the ubiquitous availability of alcohol in the settlement. In addition, we show how alcohol operates as a strategic tool for survival for the youth, as well as highlight how these perceptions can help to inform alcohol treatment interventions in the Bidibidi refugee settlement. To our knowledge, this is the first in-depth study of alcohol abuse among war-affected South Sudanese refugee youth in Uganda, addressing a significant gap in the current literature on war-affected youth, forced displacement, and alcohol abuse. We contend that involving youth in the design of interventions can be helpful for culturally sensitive and relevant prevention, treatment, and care in refugee settings. In addition, providing employment opportunities and meaningful engagement for growth through social participation can help to address harmful alcohol use among youth in the camps.
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Affiliation(s)
- Godfrey Makoha
- School of Social Work, McGill University, Montreal, QC, Canada
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Logie CH, Loutet MG, Okumu M, Coelho M, Lukone SO, Kisubi N, Latif M, McAlpine A, Kyambadde P. Exploring a syndemic of poverty, cumulative violence, and HIV vulnerability among refugee youth: multi-method insights from a humanitarian setting in Uganda. AIDS Care 2024; 36:36-43. [PMID: 37921837 DOI: 10.1080/09540121.2023.2277151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Synergistic associations between social inequities and HIV vulnerabilities - known as a syndemic - are understudied with youth in humanitarian settings. We explored refugee youths' HIV prevention needs in Bidi Bidi Refugee Settlement, Uganda. This multi-methods study involved 6 focus groups and 12 in-depth individual interviews (IDI) with refugee youth (n = 60) aged 16-24, and IDI with refugee elders (n = 8) and healthcare providers (n = 8). We then conducted cross-sectional surveys with refugee youth (16-24 years) (n = 115) to assess: poverty, recent sexual and gender-based violence (SGBV), and condom engagement motivation (CEM) (wanting to learn about condoms for HIV prevention). Multivariable logistic regression was used to estimate adjusted odds ratios for associations between poverty and SGBV with CEM. Qualitative narratives revealed poverty and trauma elevated substance use, and these converged to exacerbate SGBV. SGBV and transactional sex increased HIV vulnerabilities. Among survey participants, poverty and recent SGBV were associated with reduced odds of CEM. The interaction between poverty and recent SGBV was significant: the predicted probability of CEM among youth who experienced both poverty and SGBV was almost half than among youth who experienced poverty alone, SGBV alone, or neither. Findings signal the confluence of poverty, violence, and substance use elevate refugee youth HIV vulnerabilities.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Miranda G Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | | | | | - Nelson Kisubi
- Uganda Refugee and Disaster Management Council, Yumbe, Uganda
| | - Maya Latif
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Alyssa McAlpine
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Peter Kyambadde
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
- Most at Risk Population Initiative (MARPI), Kampala, Uganda
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Saleh EA, Klapprott F, Heinz A, Kluge U. Challenges in substance use treatment as perceived by professionals and Arabic-speaking refugees in Germany. Subst Abuse Treat Prev Policy 2023; 18:69. [PMID: 37978534 PMCID: PMC10656940 DOI: 10.1186/s13011-023-00576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Substance use (SU) and substance use disorders (SUDs) have been recently documented among forcibly displaced populations as a coping mechanism to migration and postmigration stressors. Although the literature exploring substance use among refugees has grown recently, little is known about SU among Arabic-speaking refugees and, more specifically, on the challenges and experiences in regards to SU treatment. This study investigates this topic from the perspectives of Arabic-speaking refugees and professionals in Germany. METHODS Design and participants To expand our knowledge on this topic, a qualitative approach was employed by conducting in-depth and semi-structured interviews among 26 participants (13 refugees and 13 professionals) in Germany during 2020-2021. Purposive sampling was used to recruit Arabic-speaking refugees in two rehabilitation centers in Berlin. Data and analysis Interviews were conducted with 26 participants of which 13 were refugees and 13 professionals. Refugees were interviewed individually in the rehabilitation centers, they ranged from 21 to 52 years of age, and their average time in Germany was 6.3 years. An open-ended survey was conducted among the professionals via the SoSci-survey platform, and they ranged from 22 to 66 years of age, with an average of 5 to 9 years of work experience. Data were analyzed using thematic analysis. RESULTS Three themes resulted from the thematic analysis: (1) The treatment is facilitated by institutional and emotional support; (2) The affected refugees struggle with complex contextual barriers to access SUD treatment; and (3) Individual and community preventive strategies are needed. CONCLUSIONS This study provides insight into the support and challenges of accessing effective SU treatment and prevention among Arabic-speaking refugees in Germany. Collaborative efforts by the community, professionals, and policymakers are needed to facilitate access to effective treatment and implement culturally and linguistically sensitive approaches for the treatment and prevention of SU among refugees.
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Affiliation(s)
- Ebtesam A Saleh
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany.
- Department of Pharmacology, Faculty of Pharmacy, University of Aden, Aden, Yemen.
| | - Felix Klapprott
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute for Integration and Migration Research (BIM), Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Kluge
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Charité Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute for Integration and Migration Research (BIM), Humboldt-Universität zu Berlin, Berlin, Germany
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Lorenz MH, Ensle A, Taggert J, Uricher J, Heidenreich T, Laging M. Professionals' Perspectives on Substance Use among Refugees in Shared Accommodations: A Qualitative Study. HEALTH & SOCIAL WORK 2023:7191810. [PMID: 37286196 DOI: 10.1093/hsw/hlad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 06/09/2023]
Abstract
Refugees are at a higher risk of hazardous substance use due to their traumatic experiences in their country of origin, their flight, and the difficult situation of arriving in the host country. The professionals interviewed in this study describe both the heightened vulnerability and the circumstances refugees live in after arriving in Germany. Evidence was collected by interviewing five professionals who work for and with refugees in the context of a qualitative study. Interviews were conducted with a semistructured interview guideline and analyzed for thematic content. Based on the interview data, the authors identified risk factors for hazardous substance use and possible solutions to improve the situation in shared accommodations for refugees and asylum seekers who see substance use as a resource for coping. In addition, existing barriers impede refugees from finding prevention measures and intervention programs. There is a need for specialized addiction aid with culturally appropriate programs and preventive measures to reach refugees who live in shared accommodations in Germany. Furthermore, interdisciplinary cooperation in the areas of addiction aid, refugee support, and mental healthcare should be improved.
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Affiliation(s)
- Miriam Hedwig Lorenz
- MA, is social worker and PhD student, Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Flandernstraße 101, Esslingen am Neckar, Baden-Württemberg 73732, Germany
| | - Anja Ensle
- MA, is social worker, Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen am Neckar, Baden-Württemberg, Germany
| | - Julia Taggert
- MA, is social worker, Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen am Neckar, Baden-Württemberg, Germany
| | - Jonathan Uricher
- MA, is social worker, sociologist, and PhD student, Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen am Neckar, Baden-Württemberg, Germany
| | - Thomas Heidenreich
- PhD is psychologist, psychotherapist, and professor of psychology for social work and care, Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen am Neckar, Baden-Württemberg, Germany
| | - Marion Laging
- PhD is social worker, professor of social work, and vice president for education and advanced training, Faculty of Social Work, Education and Nursing Sciences, Esslingen University of Applied Sciences, Esslingen am Neckar, Baden-Württemberg, Germany
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Lazaridou FB, Heinz A, Schulze D, Bhugra D. Racialised identity, racism and the mental health of children and adolescents. Int Rev Psychiatry 2023; 35:277-288. [PMID: 37267023 DOI: 10.1080/09540261.2023.2181059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 06/03/2023]
Abstract
As a social justice issue, it is suggested that racialised identity may represent a critical moderator in the association between racism and adverse mental health. We performed a meta-moderation analysis of studies on racialised identity, racism and adverse mental health in children and adolescents. We searched Pubmed, Web of Science, SocINDEX, PsychInfo, Medline, CINAHL and EBSCO Academic Search Ultimate for peer-reviewed articles published between January 2013 and December 2022. Nine studies, encompassing 2146 Black, Moroccan, Turkish, Indigenous, South Korean, Latinx and Multi-heritage children and adolescents between the ages of 7 and 16, were included, covering depressive symptoms, substance use, internalising symptoms and externalising symptoms. A random effect meta-analysis reported a medium size positive correlation of 0.26 (95% CI = 0.20-0.32) between racism and adverse mental health. A comparison between internalising and externalising symptoms revealed a smaller positive correlation of 0.25 (95% CI = 0.09-0.41) for internalising symptoms and a slightly larger positive correlation of 0.30 (95% CI = 0.19-0.41) for externalising symptoms. A small negative moderation of -0.07 (95% CI = -0.17 to 0.02) was found for racialised identity in the association between racism and internalising symptoms, whilst no moderation was found between racism and externalising symptoms. Overall, a negligible moderation of -0.02 (95% CI = -0.08-0.05) was found for racialised identity in the association of racism to adverse mental health. These findings suggest that the effect of racism on internalising symptoms is slightly stronger for children and adolescents with lower racialised identities and slightly weaker for those with higher racialised identities.
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Affiliation(s)
- Felicia Boma Lazaridou
- Department of Psychiatry and Neurosciences, Campus Mitte, Charité Universitätsmedizin Berlin, Germany
- The National Discrimination and Racism Monitor, German Institute for Integration and Migration Research - DeZIM, Germany
- Department of Migration, Mental and Physical Health Promotion, Berlin Institute of Integration and Migration Research - BIM, Humboldt-Universität zu Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Campus Mitte, Charité Universitätsmedizin Berlin, Germany
- Department of Migration, Mental and Physical Health Promotion, Berlin Institute of Integration and Migration Research - BIM, Humboldt-Universität zu Berlin, Germany
- Psychiatric University Clinic of Charité Universitätsmedizin at Alexianer St Hedwig Hospital Berlin, Germany
| | - Daniel Schulze
- Institute of Biometry and Clinical Epidemiology, Campus Mitte Charité Universitätsmedizin Berlin, Germany
| | - Dinesh Bhugra
- The Institute of Psychiatry, Psychology and Neuroscience - IoPPN, King's College London, UK
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Pettersen RJ, Debesay J. Substance use and help-seeking barriers: a qualitative study of East African migrants' experiences of access to Norwegian healthcare services. BMC Health Serv Res 2023; 23:107. [PMID: 36726096 PMCID: PMC9891897 DOI: 10.1186/s12913-023-09110-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Migration to Norway has increased rapidly in recent decades. Migrants have a lower prevalence of substance use, but may have an elevated risk of developing mental health issues and substance use problems due to various migration and post-migration factors. Few studies have sought to understand substance use problems among migrants in Norway. This study aimed to explore how people of East African background experience help-seeking for substance use problems in the Norwegian healthcare system. METHODS Using an explorative approach, in-depth individual interviews were conducted with six adult participants from Somalia, Eritrea and Sudan who had been in contact with the Norwegian healthcare system. The goal of the interviews was to facilitate in-depth and nuanced descriptions of the participants' lived experience of help-seeking for substance use problems. The data were analysed using interpretive phenomenological analysis. RESULTS The analysis resulted in five themes in which participants described their help-seeking experiences for substance use problems as lack of knowledge and access to information, scepticism towards a 'white system', fear of exclusion from family and ethnic community, racism as a barrier to help-seeking, and positive experiences and ideas for future treatment practices. CONCLUSION This study provides an improved understanding of how migrants with substance use problems experience help-seeking in healthcare. The variety of barriers illustrates inequality in substance use care for East African migrants in Norway.
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Affiliation(s)
- Ruben Jervell Pettersen
- grid.412414.60000 0000 9151 4445Faculty of Health, Department of Nursing, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130 Oslo, Norway
| | - Jonas Debesay
- grid.412414.60000 0000 9151 4445Faculty of Health, Department of Nursing, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130 Oslo, Norway
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Greene MC. Commentary on Saleh et al: The triple burden of stigma experienced by forcibly displaced people with substance use disorder - considerations for research and practice. Addiction 2023; 118:254-255. [PMID: 36457268 DOI: 10.1111/add.16094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
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Hertner L, Stylianopoulos P, Heinz A, Kluge U, Schäfer I, Penka S. Substance (mis)use among refugees as a matter of social ecology: insights into a multi-site rapid assessment in Germany. Confl Health 2023; 17:1. [PMID: 36658646 PMCID: PMC9850330 DOI: 10.1186/s13031-023-00499-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Previous research concluded that substance (mis)use is increasing among forcibly displaced populations. Nevertheless, little research has been conducted within a social ecological framework aimed at identifying and understanding the factors affecting substance (mis)use embedded in the post-migration context in high-income countries. The present study aims to develop an understanding of the links and underlying mechanisms between refugees' social ecological determinants and substance (mis)using behavior. METHODS Rapid assessments (RAs), including 108 semi-structured interviews and 10 focus group discussions with key persons from various professional, and personal backgrounds, were carried out in German urban and rural areas. The RA approach of interviewing key persons and not solely refugees that (mis)use substances allowed us to gather multi-perspective knowledge on this sensitive topic. Qualitative content analysis was applied, aiming at identifying determinants of substance (mis)use embedded in the post-migration context of refugees and understanding the underlying mechanisms. RESULTS One main result of the data suggests that the link between refugees' countries of origin and their post-migration substance (mis)use is not as direct as often assumed. It is observed that refugees' prospects and opportunities in receiving countries (e.g., work permits) undermine this commonly reproduced link. Further determinants are related to living conditions in German refugee shelters and social relations with peers and families. The influence of refugees' living conditions can be summarized as potentially increasing substance availability and distress, whereas family separation produces a loss of control and responsibility, increasing the risk for substance (mis)use. Peers' influence on substance (mis)use was reported to reflect a search for a sense of belonging. CONCLUSIONS Given that refugees who (mis)use substances have limited to no control over the factors identified in our study to be associated with substance (mis)use, common treatment and prevention approaches are challenged. Furthermore, we recommend aiming for a holistic comprehension of refugees' substance (mis)use by expanding the focus beyond individuals to the social ecological context in any attempt, including prevention, treatment, research, and policy.
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Affiliation(s)
- Laura Hertner
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Panagiotis Stylianopoulos
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute for Empirical Integration and Migration Research at the Humboldt Universität zu Berlin, Berlin, Germany
| | - Ulrike Kluge
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute for Empirical Integration and Migration Research at the Humboldt Universität zu Berlin, Berlin, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Simone Penka
- Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Bahati R, Ashaba S, Sigmund CD, Rukundo GZ, Ainamani HE. Gender differences in substance use and associated factors among urban refugees in Uganda. Eur J Psychotraumatol 2023; 14:2238583. [PMID: 37534475 PMCID: PMC10402830 DOI: 10.1080/20008066.2023.2238583] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Alcohol and other substances use related problems among refugees is a global public health concern. Although there is substantial research on the use of alcohol and other substances among the refugees, little is known about gender and other factors that might be associated with the use of alcohol and other substances. Our study aimed to assess the prevalence of alcohol and substance use across gender and other specific associated factors among urban refugees living in Mbarara city, Southwestern Uganda. METHODS In a cross-sectional study, 343 refugees were interviewed on the use of alcohol and other substances using the Alcohol Use Disorder Identification Test and the Drug Abuse Screening Test. The associated factors included, age, marital status, occupation, duration (length of stay) in Uganda, educational levels, stigma and depression. Linear regression analysis was used to examine the associations between the predictor and outcome variables. RESULTS No significant gender difference in alcohol use was found, and the overall prevalence of hazardous, harmful or dependent alcohol use among our sample of refugees living in Mbarara city was 43%. There were however, statistically significant gender differences in the use of other substances, with a significantly higher percentage of men than women reporting intermediate, substantial, or severe substance use (45% among men, 37% among women). Higher levels of depression and being separated from one's spouse were associated with higher levels of alcohol and substance use. In addition, higher age and being male were associated with the use of substances other than alcohol. CONCLUSIONS Our findings indicate a high prevalence of problematic alcohol and substance use among both male and female refugees. Clinical interventions focused on the treatment and prevention of alcohol and substance use among the refugee communities may benefit from focusing on depressive symptoms as well.
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Affiliation(s)
- Ronald Bahati
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Public Health and Biomedical Sciences, Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Cathy Denise Sigmund
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Crown College, St. Bonifacius, MN, USA
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Herbert Elvis Ainamani
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Public Health and Biomedical Sciences, Faculty of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
- Department of Mental Health, School of Medicine, Kabale University, Kabale, Uganda
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