Stigma of mental illness and substance misuse in sub-Saharan African migrants: A qualitative study

Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon

Mental health-related stigma is a prominent barrier to improved mental health outcomes globally and may be particularly harmful to populations with other stigmatized identities. We aimed to understand intersectional depression- and HIV-related stigma among people with HIV (PWH) entering HIV care in Cameroon. Using baseline data from a cohort of PWH entering HIV care in Cameroon between 2019 and 2020, we characterized depression- and HIV-related stigma in the population overall and by sociodemographic sub-group. We also explored substantively meaningful variation in stigma endorsement by depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) and causal attribution of depression. Among those with elevated depressive symptoms (PHQ-9 scores > 4), we estimated the association between stigma type and depressive symptom severity using binomial regression. Among 398 participants, 49% endorsed low HIV- and depression-related stigma (N = 195), 10% endorsed high HIV- and depression-related stigma (N = 38), 29% endorsed high depression-related stigma only (N = 116), and 12% endorsed high HIV-related stigma only (N = 49). Respondents with and without heightened depressive symptoms commonly believed depressive symptoms were caused by HIV (N = 140; 32.9%). Among those with elevated depressive symptoms, the prevalence of moderate to severe symptoms was higher among those endorsing high HIV-related stigma only (prevalence ratio 1.55; 95% confidence interval: 1.01, 2.37) compared to those reporting low HIV- and depression-related stigma. HIV- and depression-related stigma are both common among PWH entering HIV care in Cameroon. The consistent association between HIV-related stigma and poor psychosocial well-being among people with HIV necessitates the urgent scale-up of evidence-based HIV-related stigma interventions specifically.

Food Related Challenges and Mental Health Among U.S. African Migrants: A Narrative Review

The United States' (US) African immigrant (AI) population is growing, yet they are underrepresented in health and nutrition research. This population experiences difficulties finding culturally appropriate foods and navigating the US food environment (FE), is highly food insecure (FI), and vulnerable to mental disorders. This review examined the current evidence for AIs' food and mental health outcomes and connections; and identified gaps in the literature and future research opportunities. A literature search was conducted using Google Scholar, PubMed, CINAHL, MEDLINE, and SCOPUS. Twenty-one studies were identified, reporting high (37-85%) FI rates, poor diet quality, and increased risk of mental disorders among participants. Challenges in the FE, lack of transportation, limited access to ethnic foods, low SES, and language barriers were associated with FI and poor diet quality. Similarly, discrimination, substance use, and immigration status were associated with depression and anxiety. However, studies examining the connection between AI's food experience and mental health are lacking. AIs are at a higher risk for FI, poor diet quality, and mental disorders. Ethnic-specific research to understand the connection between their food and mental health is needed to reduce nutrition and mental health disparities.

"You have to drink with a little bit of shame": Alcohol and other drug use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia

Migrant and ethnic minority groups are underrepresented in alcohol and other drug (AOD) research. This qualitative study explored AOD use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia. We conducted one focus group and 16 interviews and thematically analyzed data drawing on the social-ecological model of health. Theme one showed AOD use was considered a "normal" part of youth identity, particularly for participants who had grown up with peer groups in Australia. Theme two highlighted participant's sense of responsibility to meet expectations and make informed decisions about AOD use to protect themselves and their friends. Theme three highlighted participant's risk of experiencing AOD-related stigma through negative stereotypes and fear of consequences within families and communities, particularly among female participants. Participants' perceptions and experiences differed by individual factors, interpersonal relationships, AOD accessibility across settings and broader gender, cultural and religious norms. Interventions developed with young people from migrant and ethnic minority backgrounds are needed to target the social-ecological factors underpinning AOD use, particularly stigma.

Stigma Associated with Alcohol and Other Drug Use Among People from Migrant and Ethnic Minority Groups: Results from a Systematic Review of Qualitative Studies

Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.

Challenges in substance use treatment as perceived by professionals and Arabic-speaking refugees in Germany

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.

A Qualitative Exploration of Sources of Help for Mental Illness in Arabic-, Mandarin-, and Swahili-Speaking Communities in Sydney, Australia

Despite being disproportionately affected by poor mental health, culturally and linguistically diverse (CaLD) individuals seek help from mental health services at lower rates than others in the Australian population. The preferred sources of help for mental illness amongst CaLD individuals remain poorly understood. The aim of this study was to explore sources of help in Arabic-, Mandarin-, and Swahili-speaking communities in Sydney, Australia. Eight focus-group discussions (n = 51) and twenty-six key informant interviews were undertaken online using Zoom. Two major themes were identified: informal sources of help and formal sources of help. Under the informal sources of help theme, three sub-themes were identified: social, religious, and self-help sources. All three communities strongly recognised the role of social sources of help, with more nuanced roles held by religion and self-help activities. Formal sources of help were described by all communities, although to a lesser extent than informal sources. Our findings suggest that interventions to support help-seeking for all three communities should involve building the capacity of informal sources of help, utilising culturally appropriate environments, and the collaboration between informal and formal sources of help. We also discuss differences between the three communities and offer service providers insights into unique issues that require attention when working with these groups.

Conceptualisations of mental illness and stigma in Congolese, Arabic-speaking and Mandarin-speaking communities: a qualitative study

BACKGROUND

Australia is an ethnically diverse nation. Research has demonstrated an elevated risk of developing a mental illness in culturally and linguistically diverse (CaLD) communities yet uptake of mental health services is low. To improve mental health treatment seeking and outcomes for CaLD individuals in Australia there is an urgent need to deeply understand barriers to treatment such as stigma. Using an exploratory qualitative approach, the aim of the study was to explore how CaLD communities' conceptualise and interpret mental illness and associated beliefs and experiences of stigma.

METHODS

The study focused on three key CaLD groups: the Congolese, Arabic-speaking and Mandarin-speaking communities residing in Sydney, Australia. A series of eight focus group discussions (n = 51) and 26 key informant interviews were undertaken online using Zoom during the period of November to December 2021. Focus group discussions and key informant interviews were digitally recorded, transcribed, and analysed using NVivo software.

RESULTS

Three major themes were identified. The first theme related to mental illness terminology used in the three communities. Despite variation in the terms used to refer to 'mental illness' all three communities generally distinguished between 'mental illness', a more severe condition and 'mental health problems', considered to arise due to stressors. The second theme centred on beliefs about mental illness; with all three communities identifying migration-related stressors as contributing to mental illness. Culturally related beliefs were noted for the Congolese participants with the perception of a link between mental illness and supernatural factors, whereas Mandarin-speaking participants highlighted lack of inter and intrapersonal harmony and failure to adhere to values such as filial piety as contributing to mental illness. The final theme related to mental illness related stigma and the various ways it manifested in the three communities including presence of collectivist public stigma felt across all three groups and affiliate (family) stigma reported by the Arabic and Mandarin-speaking groups.

CONCLUSIONS

We found rich diversity in how these communities view and respond to mental illness. Our findings provide some possible insights on both service provision and the mental health system with a view to building effective engagement and pathways to care.

The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis

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.

Expectations and experiences of family members regarding the rehabilitation of relatives with schizophrenia in South West Nigeria

Schizophrenia is a major mental illness attributed to demonic influences in sub-Saharan Africa. In Nigeria specifically, schizophrenia is seen as an illness caused by the god of the sun, and it is believed that the condition of individuals suffering this illness worsens during the summer. This and many other beliefs result in people thinking that those with schizophrenia are dangerous and that it is contagious, resulting in avoidance and leaving their care to the family alone. Most times, families seek medical help after chronicity has set in. In many instances, the family unit is the only source of support for people with schizophrenia. The responsibility of care and stigma attributed to schizophrenia can be so enormous that family members feel overburdened; however, in situations where support services are available to help individuals return to their premorbid state or that of independence, there may be a reduction in the care burden faced by families. One such strategy that helps individuals with mental illness live independent lives while reducing their family burden is rehabilitation; this, however, is misconstrued in South West Nigeria. This study assesses the expectations and experiences of family members of individuals living with schizophrenia and undergoing psychiatric rehabilitation in South West Nigerian mental health facilities using a qualitative approach through individual interviews of 21 participants (individuals closely related to someone with schizophrenia and documented as the next of kin). The principal researcher conducted the interviews and both researchers analysed the data using the content analysis approach through NVivo version 11. This study reveals that families of individuals with schizophrenia regard them as a burden, and an ideal rehabilitation of such individuals will give them-both the individual and themselves-complete independence. The findings also reveal that family members believe rehabilitation services in research settings lack material resources and human expertise. This study concludes that family members are not satisfied with the rehabilitation approach and desire home- and community-based commitment of institutions with the rehabilitation of their relatives with schizophrenia. Therefore, this study recommends capacity building/continuous development of professionals and appraisal of clients' support services in terms of finance and empowerment. As such, rehabilitation should achieve the highest priority aftercare with clients, and the family should be educated on exactly what it entails.

Anti-stigma initiatives for mental health professionals-A systematic literature review

WHAT IS KNOWN ON THE SUBJECT?: Negative attitudes towards mental illness lead to the formation of stigma. Stigma prevents the recovery of people diagnosed with mental illness. There is evidence of stigmatic attitudes towards mental ill health among mental health professionals. Anti-stigma initiatives, such as education and training, may be effective in enhancing or maintaining positive attitudes towards mental illness among mental health professionals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Education and training that is designed and delivered around a specific mental health diagnosis or condition appears an appropriate strategy that could benefit mental health professionals to develop a deeper appreciation and understanding of mental ill health and its impacts on individuals. Consumer involvement in the education and training of mental health professionals regarding the stigma of mental illness is recommended; however, this is an under-explored area of investigation. There is a weak evidence base regarding the long-term sustainability of effects from anti-stigma education and training. This should be addressed via further research in future. WHAT ARE THE IMPLICATIONS FOR PRACTICES?: Anti-stigma initiatives can support mental health professionals to develop stigma-free, recovery-oriented practices in their work. Further, such initiatives can improve the provision of evidence-based quality care for the consumers, facilitating their recovery. ABSTRACT: Introduction Despite an increasing focus on stigma, evidence shows prejudicial attitudes towards mental illness among mental health professionals still exist. It is suggested that anti-stigma initiatives can aid in enhancing the attitudes of mental health professionals. However, research on initiatives targeting stigma of mental illness among mental health professionals is limited. Aim To identify and analyse scientific literature pertaining to the effectiveness of anti-stigma initiatives regarding mental ill health among mental health professionals. Method A systematic literature review was performed using the databases MEDLINE, CINAHL, PsycINFO, PubMed, Scopus, Google Search engine and Google Scholar. The papers were limited to English language, published in peer-reviewed journals with full-text articles available and published between the years 2008 and 2020 to understand the most recent trends in the attitudes of mental health professionals including nurses. The Population, Intervention, Comparison and Outcome (PICO) strategy was used to identify papers meeting the inclusion criteria. Results A total of 439 papers were identified. However, papers not meeting the inclusion criteria were excluded from selection. Three appraisers reviewed the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. Finally, eight unanimously accepted papers were included in the systematic review. Several effective anti-stigma initiatives were identified through the review, and these had positive impacts on mental health professionals' attitudes towards mental illness, for at least a short period. It was identified that contact-based interventions are relevant and effective although the involvement of consumers and caregivers in the design and delivery of interventions was not explicitly addressed in detail in studies included in the review. Education strategies tailored for specific mental illness may be more appropriate, rather than approaches that refer to mental illness in general. Conclusions This review shows the evidence of pessimistic attitudes towards mental illness persists among mental health professionals. Anti-stigma initiatives identified in the selected papers were effective in changing these attitudes. Future research should be focused on the effectiveness of contact-based interventions and understanding the longer-term effects of the interventions among homogeneous groups. Full consideration of the varying level of clinical experience and expertise in mental health should guide the development and implementation of anti-stigma initiatives in this context. Implications for practice Anti-stigma interventions can have a positive impact on mental health professionals' knowledge, attitudes and supportive caring for people diagnosed with mental illness. Such anti-stigma interventions may meaningfully support stakeholders to address the impact of negative attitudes on the physical and mental health status of people diagnosed with mental illness. With sustained leadership, effort and reinforcement, it is possible to create workplace cultures that prioritize stigma-free and recovery-oriented behaviours and practices within mental health services.

Diabetes and acculturation in African immigrants to the United States: analysis of the 2010-2017 National Health Interview Survey (NHIS)

Objective: This study sought to assess the association between unidimensional acculturation and diabetes, and analyze mediating pathways of the association in African immigrants to the United States (U.S.).Hypothesis: Acculturation would be positively associated with diabetes and that BMI (Body mass index), physical activity, and psychological distress would mediate this association.Methods: An analysis of cross-sectional data from the 2010-2017 National Health Interview Surveys was performed. Adults aged ≥ 18 years who were born in Africa (African immigrants) and residing in the U.S. were considered. The outcome was self-reported diabetes, and acculturation was defined by percent of life spent in the U.S. and citizenship. Multivariable logistic regression analysis was used to assess the association between acculturation and diabetes, and mediation analysis was used to examine the mediating effects of BMI, physical activity, and psychological distress on this association.Results: The analytic sample included 1648 African immigrants with mean (SD) age of 41.3 ± 0.45 years; 56.4% male. Additionally, 46% had ≥ college education, and 21.4% lived below the poverty threshold. About two-thirds were overweight/obese. Less than 50% exercised at adequate levels of physical activity levels. A small percentage (1.8%) reported psychological distress. The prevalence of self-reported diabetes was 6.1%, and 76.5% reported being acculturated. In the multivariate logistic regression analysis, higher levels of acculturation were associated with higher odds of diabetes diagnosis (Odds Ratio (OR) = 2.2; 95% CI = 1.1-4.4). Although BMI mediated the association between acculturation and diabetes (ZMediation = 2.11, p = 0.036), only 18.9% of the total effect of acculturation on diabetes was explained by BMI.Conclusions: Acculturation increased the odds of diabetes diagnosis, and BMI mediated the association. Thus, tailoring culturally-appropriate interventions to control BMI may contribute to preventing diabetes within African immigrant communities to the U.S.

The association between persistent low parental income during preschool age and mental disorder in adolescence and early adulthood: a Norwegian register-based study of migrants and non-migrants

BACKGROUND

Low socioeconomic status during childhood is associated with increased risk of mental disorders later in life. Yet, there is limited research on whether this association varies by migrant background, despite an overrepresentation of migrants among the economically disadvantaged.

METHODS

Using national register data on a study population of 577,072 individuals, we investigated the association between persistent low parental income during preschool, measured at age 3-5 years and mental disorder during adolescence and early adulthood, measured between ages 16-25. Outpatient mental healthcare (OPMH) service use was a proxy for mental disorder and was measured between 2006 and 2015. We applied discrete-time logistic regression analyses with interaction terms to study differences in the relationship between persistent low parental income and OPMH service use by migrant background and gender.

RESULTS

Persistent low parental income during preschool age was associated with increased odds of OPMH service use in adolescence and early adulthood (aOR = 1.99, 95% CI 1.90-2.08), even after adjusting for gender, migrant background, parental education and persistent lower income at later ages (aOR = 1.33, 95% CI 1.27-1.40). Statistically significant interactions between migrant background and persistent low parental income were recalculated and presented as marginal yearly probabilities. These results showed that the association was in the opposite direction for migrants; those in the higher income group had higher probability of OPMH service use, although the differences were non-significant for some groups. The relationship did not vary by gender.

CONCLUSIONS

Social inequalities in mental health, as measured by OPMH service use, may have an onset already in childhood. Interventions to reduce inequalities should therefore start early in the life course. Since the association differed for migrants, future research should aim to investigate the mechanisms behind these disparities.

Perceived and misperceived norms about khat and/or cannabis use among adults in southwest Uganda

BACKGROUND

Studies from high-income contexts have found evidence that norms about substance use are misperceived. The accuracy of perceived norms about khat and cannabis use in Uganda have not previously been described.

METHODS

We conducted a population-based study targeting all resident adults across eight villages in southwestern Uganda. Personal khat and/or cannabis use frequency was based on self-report. We measured perceived norms about substance use by eliciting individuals' perceptions about how often most other adult men and most other adult women in their villages used these substances. We compared perceived norms to aggregated village rates of use to assess the extent to which norms were misperceived. We used multivariable Poisson regression to estimate correlates of misperceived norms.

RESULTS

Among 1626 participants (91% response rate), only 29 men (4%) and 9 women (1%) reported any lifetime use of khat and/or cannabis. However, 695 participants (43%) did not think lifetime abstinence was the norm among men in their villages, and 256 participants (16%) did not think lifetime abstinence was the norm among women. Moreover, 219 participants (13%) incorrectly believed most men in their village regularly used khat and/or cannabis (≥4 times per week). Misperceived norms were present across subgroups and were correlated with larger social networks, symptoms of depression, loneliness, and younger age.

CONCLUSION

In this study of all adults across 8 villages in rural Uganda, many participants misperceived norms about khat and/or cannabis use. Providing accurate information about prevailing norms in the local population may help prevent initiation of khat and/or cannabis use among adults in this context.

Psychosocial rehabilitation of individuals with schizophrenia: a scoping review protocol

BACKGROUND

The psychosocial rehabilitation of an individual with mental illness is an evidence-based approach to reducing the burden of the illness and the associated stigma globally. Specifically, in Africa, it has promising scope for African life and the African economy. Psychosocial rehabilitation is described as a set of approaches that aim to assist an individual in achieving restoration from a state of dependency caused by schizophrenia to a state of being an independent decision-maker. However, there seems to be a dearth of literature and implementation of psychosocial rehabilitation in Africa. Therefore, it is necessary to map studies on how psychosocial rehabilitation is conducted for people living in Africa with the most chronic form of mental illness, schizophrenia.

METHODS

This study will adopt the Arksey and O'Malley scoping review framework to search and compile relevant studies. This process will involve three steps: title screening, to be performed solely by the principal investigator, followed by abstract and full-text screening, to be performed independently by two reviewers (the principal investigator and co-investigator). Rayyan QCRI, a systematic reviews web app, will be used for tracking the screening records, and data charting form will be used to extract basic data of included studies. The risk of bias in the articles identified for screening will be assessed by the Mixed Method Appraisal Tool (MMAT). Finally, the content analysis of the screened studies will be performed with NVivo.

EXPECTED OUTCOME

This study has the likelihood of revealing a research gap in psychosocial rehabilitation approaches and methods. The review results will constitute part of the available evidence that the researchers aim to adopt in the broader part of the project, which aims to develop implementation strategies for the psychosocial rehabilitation of chronic mental illnesses, specifically schizophrenia, in Sub-Sahara Africa. The implementation process also encompasses disseminating the findings of this review to stakeholders, which will enhance their knowledge of the current state of Sub-Saharan Africa and may stimulate support for the implementation of rehabilitation strategies.

Exploring stigma associated with mental health conditions and alcohol and other drug use among people from migrant and ethnic minority backgrounds: a protocol for a systematic review of qualitative studies

BACKGROUND

Stigma is a social process that impedes access to support for mental health conditions and alcohol and other drug (AOD) use, particularly for people from migrant and ethnic minority backgrounds. There is limited understanding, however, of people's experiences of stigma, the underlying drivers, intersections with ethnicity, gender, and citizenship status, and how powerful discourses and social institutions create and perpetuate systems of stigma. This review aims to synthesise and critically analyse qualitative evidence to understand how stigma associated with mental health conditions and AOD use operates among people from migrant and ethnic minority groups.

METHODS

Qualitative evidence will be identified using MEDLINE, Embase, PsycINFO, CINAHL, Applied Social Sciences Index and Sociological Abstracts. Two reviewers will screen the titles, abstracts and full-text articles. Eligible studies will include original, empirical, peer-reviewed qualitative evidence, published in English since 1990. Studies must examine stigma in relation to mental health conditions, illicit drug use or alcohol consumption among participants who are from migrant and ethnic minority backgrounds. Studies will be critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the level of confidence in the findings will be assessed using Confidence in the Evidence from Reviews of Qualitative research. Data will be analysed using the 'best fit' framework synthesis approach, drawing on the Health Stigma and Discrimination Framework.

DISCUSSION

This review will provide an in-depth understanding of the stigma associated with mental health conditions and AOD use among people from migrant and ethnic minority backgrounds. The findings will inform culturally responsive interventions that aim to reduce the negative impact of stigma on individuals, families and communities.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021204057.

Overestimation of alcohol consumption norms as a driver of alcohol consumption: a whole-population network study of men across eight villages in rural, southwestern Uganda

BACKGROUND AND AIMS

Little is known about how perceived norms about alcohol consumption may influence high alcohol consumption rates in Uganda. This study estimated the accuracy of perceived norms about men's alcohol consumption and estimated the association between perceived norms and personal alcohol consumption.

DESIGN

Cross-sectional, whole-population, sociocentric social network study.

SETTING

Eight rural villages in Rwampara District, southwestern Uganda in 2016-18.

PARTICIPANTS

A total of 719 men aged 18 years and older (representing 91% of permanent resident men).

MEASUREMENTS

Self-reported frequent (≥ 4 days per week) and heavy alcohol consumption (six or more drinks on one occasion, more than three occasions of intoxication, or spending an excessive amount on alcohol). Participants also reported whether they thought most other men in their village engaged in frequent and heavy alcohol consumption (perceived norms). Using the network study design, we calculated alcohol consumption behavior within villages and social networks. Perceived norms were compared with aggregated self-reports. Multivariable Poisson regression models were used to estimate the association between perceived norms and individual behavior.

FINDINGS

Throughout villages, frequent and heavy alcohol consumption ranged from 7 to 37%. However, 527 (74%) participants perceived, contrary to fact, that most other men in their villages frequently consumed alcohol, and 576 (81%) perceived that most others heavily consumed alcohol. Overestimation of alcohol consumption by others was pervasive among socio-demographic subgroups and was present irrespective of the actual consumption behavior at the village level and within social networks. Men who misperceived these alcohol consumption behaviors as being common were more likely to engage in frequent [adjusted relative risk (aRR) = 3.98; 95% confidence interval (CI) = 1.69-9.34) and heavy (aRR = 4.75; 95% CI = 2.33-9.69) alcohol consumption themselves.

CONCLUSIONS

Most men in eight rural Ugandan villages incorrectly thought that frequent and heavy alcohol consumption were common among men in their villages. These misperceived norms had a strong positive association with individual drinking behavior.

Mental health service use among migrant and Swedish-born children and youth: a register-based cohort study of 472,129 individuals in Stockholm

PURPOSE

Migrant children underutilize mental health services (MHS), but differences according to age, reason for migration, type of problem, and time have not been thoroughly analyzed. We aimed to explore utilization of MHS among migrant children and youth and to study if the hypothesized lower utilization could be explained by fewer neurodevelopmental assessments.

METHODS

A cohort of the population aged 0-24 years in Stockholm, comprising 472,129 individuals were followed for maximum 10 years, between January 1, 2006 and December 31, 2015. We categorized individuals as accompanied refugee migrants, unaccompanied refugee migrants and non-refugee migrants, or Swedish-born. We used survival and logistic analyses to estimate rates of utilization of MHS.

RESULTS

Migrant children and youth utilized less MHS than the majority population, with hazard ratios ranging from 0.62 (95% CI: 0.57; 0.67) to 0.72 (95% CI: 0.69; 0.76). Refugee and non-refugee children utilized less mental health care than their Swedish peers, apart from the youngest refugees (0-10 years) who had similar utilization as Swedish-born. The lower rates were partly explained by all migrant youths' lower risk of being diagnosed with a neurodevelopmental condition. Time in Sweden had a major impact, such that unaccompanied refugee minors had a higher utilization in their first 2 years in Sweden (OR: 3.39, 95% CI: 2.96; 3.85).

CONCLUSION

Migrant youth use less MHS compared with native-born peers, and this is partly explained by fewer neurodevelopmental diagnoses. Strengthening the awareness about unmet needs, and the referring capacity by professionals in contact with migrant children could help reduce barriers to care.

Addressing alcohol and other drug use among young people from migrant and ethnic minority backgrounds: Perspectives of service providers in Melbourne, Australia

Young people from migrant and ethnic minority backgrounds are recognised as emerging priority populations for reducing alcohol and other drug (AOD)-related harms in Australia. Limited research has investigated how service providers address AOD challenges in migrant communities. In this qualitative study, we interviewed 15 service providers from AOD, migrant support, community and other health services in a diverse region of Melbourne. Interviews explored the challenges that service providers faced and the strategies they implemented to engage with young migrants in relation to AOD use. Thematic analysis was used to generate four themes: stigma as a barrier to service delivery, intergenerational differences between young people and parents, the need for outreach and establishing trust and understanding over time. Service providers believed that stigma prevented many young people from migrant backgrounds having open conversations about their AOD use with family members and professionals. Participants perceived that some parents had less AOD-related knowledge and lower English language proficiency than their children creating challenges for effective communication. Service providers recognised the importance of engaging with young people in settings where they felt comfortable rather than expecting them to approach their service. Participants also acknowledged the need to invest time in establishing trust and understanding with young migrants so they could facilitate conversations about AOD use as relationships evolved. Although service providers had a strong understanding of young people's needs, they found it challenging to build relationships in the context of funding and time constraints. Our results indicate the need for long-term funding and timelines that enable service providers to build strong relationships with young migrants, their families and their broader cultural communities to facilitate access to AOD support.

Perceived barriers to care for migrant children and young people with mental health problems and/or neurodevelopmental differences in high-income countries: a meta-ethnography

OBJECTIVES

To develop conceptual understanding of perceived barriers to seeking care for migrant children and young people (aged 0-25 years) with mental health problems and/or neurodevelopmental differences in high-income countries.

DESIGN

Qualitative evidence synthesis using meta-ethnography methodology. We searched four electronic databases (Medline, PsycINFO, Global Health and Web of Science) from inception to July 2019 for qualitative studies exploring barriers to care (as perceived by migrant communities and service providers) for migrant children and young people in high-income countries with neurodevelopmental differences and/or mental health problems. The quality of included studies was explored systematically using a quality assessment tool.

RESULTS

We screened 753 unique citations and 101 full texts, and 30 studies met our inclusion criteria. We developed 16 themes representing perceived barriers to care on the supply and demand side of the care-seeking process. Barriers included: stigma; fear and mistrust of services; lack of information on mental health and service providers lacking cultural responsiveness. Themes were incorporated into Levesque et al's conceptual framework of patient-centred access to healthcare, creating a version of the framework specific to migrant children and young people's mental health and neurodevelopmental differences.

CONCLUSIONS

This is the first qualitative evidence synthesis on barriers to care for mental health problems and/or neurodevelopmental differences in migrant children and young people in high-income countries. We present an adapted conceptual framework that will help professionals and policy-makers to visualise the complex nature of barriers to care, and assist in improving practice and designing interventions to overcome them. Similar barriers were identified across study participants and migrant populations. While many barriers were also similar to those for children and young people in general populations, migrant families faced further, specific barriers to care. Interventions targeting multiple barriers may be required to ensure migrant families reach care.

Mental health service utilization among African immigrants in the United States

This study utilized Andersen's model of health behavior to explore factors associated with mental health service utilization. We also examine rates for mental health service use, treatment preferences, and barriers to care. Data were collected utilizing web-based surveys. The sample consisted of first and second-generation African immigrants who had struggled with emotional or behavioral problems in the past 12 months (N = 323). Hierarchical logistic regression analyses were conducted to examine predictors of mental health service utilization. The majority of participants (79.5%) met criteria for probable major depression, and 63% sought mental health services. Findings showed that mental health service utilization was more significantly predicted by enabling and need factors. Age (odds ratio [OR] = 1.03), religiosity (OR = 1.11), acculturative stress (OR = 1.68), neighborhood risk (OR = 0.54), and work-productivity loss (OR = 2.93) were associated with increased likelihood of mental health service use (p < 0.05). Most common barriers to service use were hopes of self-healing (56.3%) followed by financial barriers (46.2%). Findings highlight the need for public health initiatives to increase mental health literacy and financial accessibility to mental health services in response to the high mental health need and identified barriers to care in this population.

Barriers to accessing preventive health care among African-born individuals in King County, Washington: A qualitative study involving key informants

Studies of African immigrant health in the U.S. have traditionally focused on infectious diseases. However, the rising burden of non-communicable diseases (NCDs) indicates the increasing importance of general preventive health care. As part of a series of community health events designed for African-born individuals in King County, Washington, we administered key informant interviews (KIIs) with 16 health event participants, medical professionals, and community leaders to identify barriers and facilitators to use of preventive health care among African-born individuals. We used descriptive thematic analysis to organize barriers according to the socio-ecological model. Within the individual domain, KII participants identified lack of knowledge and awareness of preventive health benefits as barriers to engagement in care. Within the interpersonal domain, language and cultural differences frequently complicated relationships with health care providers. Within the societal and policy domains, healthcare costs, lack of insurance, and structural racism were also reported as major barriers. Participants identified community outreach with culturally competent and respectful providers as key elements of interventions to improve uptake. In conclusion, African immigrant communities face several barriers, ranging from individual to policy levels, to accessing health services, resulting in substantial unmet need for chronic disease prevention and treatment. Community-centered and -led care may help facilitate uptake and engagement in care.

A Functional Network Perspective on Posttraumatic Stress in Refugees: Implications for Theory, Classification, Assessment, and Intervention

There is an important, long-standing debate regarding the universality vs. specificity of trauma-related mental health symptoms in socio-culturally and linguistically diverse population groups, such as refugees and asylum seekers. Network theory, an emerging development in the field of psychological science, provides a novel data analytic methodology to evaluate and empirically examine long-standing questions about the structure and function of posttraumatic stress symptoms. We sought to empirically model the functional network of posttraumatic stress symptoms among East African refugees who survived multiple potentially traumatic events. A sample of 148 Sudanese and Eritrean male asylum seekers (M(SD)_age = 32.60(7.13) were recruited from the community in Israel. The nature and function(s) of posttraumatic symptoms (Harvard Trauma Questionnaire) were modeled using regularized partial correlation models to derive a network of symptoms. Spinglass and exploratory graph analysis walktrap algorithms were then used to identify functional "circuits of symptoms" or clusters of nodes within the network. Analyses revealed a functional symptom circuitry that shares features with the predominant western model of posttraumatic stress disorder; as well as unique functional clusters of symptoms inconsistent with nosology and symptomatology observed in studies of Western populations. Findings may have important implications for theory, classification, assessment, candidate mechanisms that may drive and maintain posttraumatic stress, and in turn may inform prevention or treatment for socio-culturally diverse forcibly displaced population groups.

Mental Health Stigma Among Black Immigrant Women in An Urban Setting

BACKGROUND

Mental health stigma results in unmet mental health needs. Research describing predictors of stigma remains limited among Black immigrants. We aim to examine stigma associated with mental illness among a group of Black immigrant women.

METHODS

We examined data from 22 women from two Black immigrant community centers. We collected surveys on demographics, cultural beliefs, migration status, religiosity and mental health stigma. Simple linear regression was used to model the unadjusted association between each component variable and overall stigma scores. All analyses were conducted using R and assumed a two-sided, 5% level of significance.

RESULTS

A linear relationship was found between author-generated scale, the Stigma and Culture Survey (SCS) and the Depression Self Stigma Scale (DSSS). Among respondents, use of religious resources was associated with less stigma (p-value: 0.04). Whereas spirituality and morality was associated with greater stigma (p-value: 0.003). United States citizenship was associated with less stigma (p-value: 0.0001).

DISCUSSION/CONCLUSION

Religion and spirituality are critical to understanding mental health stigma among Black immigrants. Studies aimed at assessing and reducing stigma need to critically engage with cultural and religious factors.

Interventions to increase migrants' care-seeking behaviour for stigmatised conditions: a scoping review

BACKGROUND

Despite availability of effective treatments, migrants in high-income countries seek care for conditions associated with stigma to a lower extent than the rest of the population. We conducted a scoping review to map the literature on interventions to increase migrants' care-seeking behaviour in high-income countries for stigmatised conditions. Main body of the abstract: We searched 15 electronic databases and journals, hand-searched references and citations, to identify studies on interventions to increase migrants' care-seeking in high-income countries for stigmatised conditions. We applied language restrictions for English and Swedish, and searched the full time period up to 5 July 2019. Our primary outcome of interest was care utilisation.

RESULTS

5447 records were identified in the literature searches. We identified 16 eligible studies, all from North America, that reported interventions to increase migrants' care-seeking behaviour for hepatitis B (n = 1) and mental health (n = 15). Three approaches were identified: health communication (n = 10), support groups (n = 2), and primary care-based approaches (n = 4). There was a general trend towards community-based interventions tailored to individual migrant groups. Significant gaps were identified in the literature, including studies conducted in Europe and studies including men or children. Furthermore, the choice of study designs introduced significant bias that prevented accurate conclusions on intervention effectiveness.

CONCLUSION

The available evidence on interventions to increase migrants' in high-income countries care-seeking behaviour for stigmatised conditions is limited in scope and quality. Future research, using reliable study designs, is needed to fill the remaining gaps and to boost the scope and reliability of the evidence.

Post-migration well-being of Sub-Saharan Africans in China: a nationwide cross-sectional survey

PURPOSE

This study aims to understand the quality of life (QOL) among Sub-Saharan African (SSA) migrants and explore the factors that contribute to and shape SSA migrants' QOL and shed light on how post-migration factors affect their QOL in China.

METHODS

We conducted a nationwide cross-sectional survey on QOL of SSA migrants in China from August, 2019 to November, 2019. We recruited SSA migrants using a combination of peer-referred online and offline surveys. The WHOQOL-BREF scale assessed the QOL of participants, and depressive symptoms were measured using Center for Epidemiologic Studies-Depression scale. Correlates of well-being including depressive symptoms, migration-related factors, and socio-demographic characteristics were included in hierarchical linear regression models to explore the contributions of these factors on QOL of SSA migrants.

RESULTS

This study included 928 eligible SSA migrants. The total score of the WHOQOL-BREF scale was 66.8 ± 14.0. Attitudes of local people toward SSA migrants (β = 3.1, 95% CI 2.4, 3.0) and satisfaction with their living conditions (β = 3.6, 95% CI 2.5, 4.7) were positively associated with QOL and explained 12.2% of the variance. Contracting an infectious disease in the past year (β = - 5.3, 95% CI - 7.6, - 2.9) and depression werenegatively associated with QOL (β = - 0.7, 95% CI - 0.7, - 0.6) and explained 24.4% of the variance.

CONCLUSION

Our study underscores the importance of several key factors that may aid in the improvement of QOL among SSA migrants. Post-migration environmental factors emerged as key correlates of QOL, which builds on previous evidence that the post-migration context should be improved to safeguard the well-being of SSA migrants in China.

Measuring subjective well-being in an understudied population of young Western-African IDPs and refugees

Purpose

The purpose of this paper is to report a real-life empirical case and discuss some caveats emerged in measuring subjective well-being (SWB) in an understudied population of adolescents refugees from West Africa.

Design/methodology/approach

During the process of translation and cultural adaptation of the subjective well-being assessment scale in the target population, the model of measurement presented some weakness with regard to content validity criteria.

Findings

This leads to a partial revision of the model and the development of new locally-based domains of SWB.

Originality/value

Context-specific factors’ robustness showed the dynamic and culture-informed nature of the SWB construct. Practical and theoretical implications of using quantitative questionnaires in non-western contexts characterized by high grades of insecurity and instability will be discussed.

Prescription drug diversion among people living with HIV: a systematic scoping review

OBJECTIVES

Globally, people living with HIV (PLWH) are at greater risk for various infections and chronic pain, therefore, vulnerable to prescription drug diversion which might negatively impact HIV care. The study purpose is to gather evidence on prescription drug diversion among PLWH.

STUDY DESIGN

This is a systematic scoping review.

METHODS

Arksey and O'Malley's framework and recommendation by Levac et al. were used to guide this study. Literature was searched in PubMed, Google Scholar, EBSCOhost (Academic Search Complete, MEDLINE and Newspaper Source) and Open Access Theses and Dissertations. Studies reporting evidence of prescription drug diversion from January 1996 to July 2017 were included. Thematic content analysis was performed to summarize data on the prevalence.

RESULTS

Twenty-nine studies were eligible for data synthesis. Twenty-six studies were conducted in the United States of America (USA), one study in France and two multicountry studies; one study in Kenya and Uganda and the other study in Botswana, Kenya, Malawi, South Africa; Zimbabwe, India, Thailand, Brazil and the USA. Research evidence shows high prevalence of prescription drug diversion for analgesics and antiretroviral drugs; meanwhile, stimulants and erectile dysfunction drugs were the least diverted drugs among PLWH. There is a research gap in low- to middle-income countries (LMICs) investigating prescription drug diversion among PLWH.

CONCLUSION

Our findings reveal that diversion of various prescription drug classes among PWLH exists. There is lack of research in LMICs. We recommend research in LMICs where there is high HIV prevalence.

PROSPERO REGISTRATION NUMBER

CRD42017074076.

A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines

BACKGROUND

Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP's own experiences of being stigmatised in the Philippines.

METHODS

A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well.

RESULTS

The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP's mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual's reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God's will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma.

CONCLUSIONS

The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.