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Trauma Care for Forced Migrants. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2040050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Ever since World War II, forced migrations have increased exponentially, shaping our world, economies, and political discussions. When the United Nations formed the United Nations High Commissioner for Refugees (UNHCR) in 1950, it could not predict the escalation of forced migration from civil unrest, personal persecution, war, and recently, climate crises. As forced migrations increase, we must understand the emotional trauma involved, and how to mitigate it. This study examined how providers of refugee services understand, assess, and treat trauma in the forced migration population. This paper is based on qualitative data collected from social work providers who work with forced migrants. Transcribed interviews were analyzed through content analysis regarding assessment and treatment approaches. The findings show that the lack of trauma-informed care was prevalent among the participants. This was reflected in the participants’ experiences. Three main themes emerged: (1) trauma was misdiagnosed; (2) few were trained in evidence-based practices to manage trauma; and (3) providers felt isolated in their work as if working in silos. These themes and their implications are discussed.
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Amiri S. Global prevalence of anxiety and PTSD in immigrants: a systematic review and meta-analysis. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:69-88. [PMID: 35147917 DOI: 10.1007/s40211-022-00411-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/09/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND A systematic and meta-analysis of the prevalence of anxiety and posttraumatic stress disorder (PTSD) in immigrants was conducted. METHODS Based on the keywords, scientific databases were systematically searched to identify articles. The search included the three databases PubMed, Google Scholar and Research Gate until June 2020. The analysis was performed to assess the prevalence of anxiety and PTSD; subgroups were examined based on anxiety disorders. RESULTS The prevalence of agoraphobia, PTSD, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), social phobia and specific phobia were 4, 25, 9, 4, 3, 5 and 8%, respectively. CONCLUSIONS Considering the findings of the present study regarding the significant prevalence of anxiety and PTSD in the immigrant population, it is necessary to pay special attention to the mental health of this population.
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Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Henkelmann JR, de Best S, Deckers C, Jensen K, Shahab M, Elzinga B, Molendijk M. Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: systematic review and meta-analysis. BJPsych Open 2020; 6:e68. [PMID: 32611475 PMCID: PMC7443922 DOI: 10.1192/bjo.2020.54] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The number of refugees is at its highest since the Second World War and on the rise. Many refugees suffer from anxiety, depression and post-traumatic stress disorder (PTSD), but exact and up-to-date prevalence estimates are not available. AIMS To report the pooled prevalence of anxiety and mood disorders and PTSD in general refugee populations residing in high-income countries and to detect sources of heterogeneity therein. METHOD Systematic review with meta-analyses and meta-regression. RESULTS Systematic searches (final search date 3 August 2019) yielded 66 eligible publications that reported 150 prevalence estimates (total sample N = 14 882). Prevalence rates were 13 and 42% (95% CI 8-52%) for diagnosed and self-reported anxiety, 30 and 40% (95% CI 23-48%) for diagnosed and self-reported depression, and 29 and 37% (95% CI 22-45%) for diagnosed and self-reported PTSD. These estimates are substantially higher relative to those reported in non-refugee populations over the globe and to populations living in conflict or war settings, both for child/adolescent and adult refugees. Estimates were similar over different home and resettlement areas and independent of length of residence. CONCLUSIONS Our data indicate a challenging and persisting disease burden in refugees due to anxiety, mood disorders and PTSD. Knowing this is relevant for the development of public health policies of host countries. Scalable interventions, tailored for refugees, should become more readily available.
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Affiliation(s)
- Jens-R Henkelmann
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University, The Netherlands
| | - Sanne de Best
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University
| | - Carla Deckers
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University
| | - Katarina Jensen
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University
| | - Mona Shahab
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University; and Clinical Epidemiological Department, Leiden University Medical Center
| | - Bernet Elzinga
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University
| | - Marc Molendijk
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University; and Leiden Institute of Brain and Cognition, Leiden University Medical Center, The Netherlands
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Park S, Kim G. Factor Structures of Reasons for Immigration Among Older Asian and Latino Immigrants in the United States. Innov Aging 2019; 3:igz039. [PMID: 31656862 PMCID: PMC6804752 DOI: 10.1093/geroni/igz039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 11/22/2022] Open
Abstract
Backgrounds and Objectives Although reasons for immigration are significant predictors of immigrants’ health, factor structures of reasons for immigration are still unclear among older immigrants. The present study examined the factor structure of reasons for immigration among older Asian and Latino immigrants in the United States. Research Design and Methods Drawn from the National Latino and Asian American Study, 396 Latino and 298 Asian immigrants over 55 years of age were selected for analysis. Exploratory factor analysis was conducted for nine items concerning reasons for immigration in each immigrant group. Results Three factors were extracted from both Asian and Latino immigrant elders: (a) “voluntary reasons” to pursue development, (b) “involuntary reasons” due to uncontrollable situations, and (c) “semivoluntary reasons” regarding family/medical duties. While immigration to join family members was located in the “semivoluntary reasons” factor among older Asian immigrants, it was located in the “voluntary reasons” factor among older Latino immigrants. Discussion and Implications These findings suggest that three underlying factors of reasons for immigration should be understood considering the different characteristics of two racial/ethnic groups of immigrants. In addition, a migratory reason to join the family should be considered differently for elderly Asian and Latino immigrants. This three-factor framework of reasons for immigration can help clinicians provide more culturally sensitive interventions for older minority immigrants.
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Affiliation(s)
- Soohyun Park
- Department of Psychology, The University of Alabama, Tuscaloosa.,Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University, Seoul, South Korea
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5
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Foo SQ, Tam WW, Ho CS, Tran BX, Nguyen LH, McIntyre RS, Ho RC. Prevalence of Depression among Migrants: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1986. [PMID: 30213071 PMCID: PMC6163821 DOI: 10.3390/ijerph15091986] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022]
Abstract
As the number of migrants worldwide increases, it is worthwhile to examine the extent to which depression has affected this group of often vulnerable individuals. The purpose of this systematic review and meta-analysis is to examine the aggregate prevalence of depression among international migrants and to explore the variations in prevalence with demographic and educational factors. A search was conducted on the online databases PubMed and ScienceDirect whole using the terms "depression", "depressive disorder", "immigration", "immigrant", "migration", and "migrant". A total of 25 studies met our inclusion criteria. A random-effects model meta-analysis calculated an aggregate prevalence of 15.6% among migrants. Heterogeneity was identified by meta-regression and subgroup analyses, and the level of educational attainment, employment status, and length of residency spent in country of migration were found to be significant moderators contributing to depression prevalence. In conclusion, newly arrived migrants appear to be susceptible to developing depression and it is imperative that more in the form of preventive strategies and increased assistance be incorporated to ensure their psychological wellbeing and improve their mental health outcomes. Further research should be conducted to better understand the risk of psychiatric disorders among members of this subpopulation.
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Affiliation(s)
- Shea Q Foo
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Wilson W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore.
| | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Long H Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON M5T 1R8, Canada.
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
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6
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Bennett H, Boshoff A, Rigby C. The Relationship between Tenure, Stress and Coping Strategies of South African Immigrants to New Zealand. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/008124639702700305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immigration has significant psychological and social consequences for a migrant family. This study explores the adaptation of two groups of South African immigrants to life in New Zealand. Sixty-three per cent of the 72 ex-South Africans contacted, using convenience sampling, had lived in New Zealand for less than five years. The perceived difficulties related to relocating as well as the coping strategies associated with self-identified problems related to the relocation and the length of tenure in New Zealand were both qualitatively and quantitatively assessed. A problem-oriented semi-structured questionnaire and the Dimensions of Stress and Cybernetic Coping scales were used to collect the data. It appears that the longer the immigrants have been in New Zealand the less control they perceive themselves to have over the problems associated with relocation and the more likely they are to use the coping strategy of avoidance rather than actively trying to change their situation.
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Affiliation(s)
- Hillary Bennett
- Psychology Department, Massey University, Albany Campus, Auckland, New Zealand
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Ho ES. Mental Health of Asian Immigrants in New Zealand: A Review of Key Issues. ASIAN AND PACIFIC MIGRATION JOURNAL 2016. [DOI: 10.1177/011719680401300103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the mental health status of Asian immigrants in New Zealand is not well studied, the limited data that is available suggests that the mental disorder prevalence rates are similar to that of the general population, and that language problems, failure to find employment, separation from family and community, and traumatic experiences prior to migration are key factors associated with increased risk of minor mental disorders such as anxiety or depression. The research has also found that stigma is a major obstacle preventing Asian immigrants from using mainstream mental health services. Cultural differences in assessment and treatment, a lack of English proficiency and inadequate knowledge and awareness of existing services are additional barriers. These issues draw attention to the need for greater responsiveness to the needs of Asian service users and their families in the mental health system.
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Giese A, Örnek A, Kilic L, Kurucay M, Şendur SN, Lainka E, Henning BF. Anxiety and depression in adult patients with familial Mediterranean fever: a study comparing patients living in Germany and Turkey. Int J Rheum Dis 2014; 20:2093-2100. [DOI: 10.1111/1756-185x.12297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Arnd Giese
- Department of Internal Medicine I; St. Josef-Hospital Bochum; Ruhr-University Bochum; Bochum Germany
- Department of Internal Medicine I; Marienhospital Herne; Ruhr-University Bochum; Herne Germany
| | - Ahmet Örnek
- Department of Internal Medicine I; Marienhospital Herne; Ruhr-University Bochum; Herne Germany
- Institute for Radiologic Diagnostics; Bergmannsheil; Ruhr-University Bochum; Bochum Germany
| | - Levent Kilic
- Unit of Rheumatology; Department of Internal Medicine; Hacettepe University; Ankara Turkey
| | - Mustafa Kurucay
- Department of Internal Medicine I; Marienhospital Herne; Ruhr-University Bochum; Herne Germany
| | | | - Elke Lainka
- Department of Paediatrics; University Medical Centre Essen; Essen Germany
- AID-NET Autoinflammatory Disorders (AID) in Children: Genetics, Disease Mechanisms, Diagnostic Markers and Therapeutic Targets; Essen Germany
| | - Bernhard F. Henning
- Department of Internal Medicine I; Marienhospital Herne; Ruhr-University Bochum; Herne Germany
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Dao TK, Poritz JMP, Moody RP, Szeto K. Development, reliability, and validity of the Posttraumatic Stress Disorder Interview for Vietnamese refugees: a diagnostic instrument for Vietnamese refugees. J Trauma Stress 2012; 25:440-5. [PMID: 22821587 DOI: 10.1002/jts.21712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Posttraumatic Stress Disorder Interview for Vietnamese Refugees (PTSD-IVR) was created specifically to assess for the presence of current and lifetime history of premigration, migration, encampment, and postmigration traumas in Vietnamese refugees. The purpose of the present study was to describe the development of and investigate the interrater and test-retest reliability of the PTSD-IVR and its validity in relation to the diagnoses obtained from the Longitudinal, Expert, and All Data (LEAD; Spitzer, 1983) standard. Clinicians conducted the diagnosis process with 127 Vietnamese refugees using the LEAD standard and the PTSD-IVR. Assessment of the reliability and validity of the PTSD-IVR yielded good to excellent AUC (area under the receiver operating characteristic curve; .86, .87) and κ values (.66, .74) indicating the reliability of the PTSD-IVR and the agreement between the LEAD procedure and the PTSD-IVR. The results of the present study suggest that the PTSD-IVR performs successfully as a diagnostic instrument specifically created for Vietnamese refugees in their native language.
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Affiliation(s)
- Tam K Dao
- Department of Educational Psychology, University of Houston, Houston, TX 77004, USA.
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Lindert J, Ehrenstein OSV, Priebe S, Mielck A, Brähler E. Depression and anxiety in labor migrants and refugees--a systematic review and meta-analysis. Soc Sci Med 2009; 69:246-57. [PMID: 19539414 DOI: 10.1016/j.socscimed.2009.04.032] [Citation(s) in RCA: 367] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Indexed: 11/28/2022]
Abstract
Prevalence rates of depression and anxiety among migrants (i.e. refugees, labor migrants) vary among studies and it's been found that prevalence rates of depression and anxiety may be linked to financial strain in the country of immigration. Our aim is to review studies on prevalence rates of depression and/or anxiety (acknowledging that Post-traumatic Stress Disorder (PTSD) is within that class of disorders), and to evaluate associations between the Gross National Product (GNP) of the immigration country as a moderating factor for depression, anxiety and PTSD among migrants. We carried out a systematic literature review in the databases MEDLINE and EMBASE for population based studies published from 1990 to 2007 reporting prevalence rates of depression and/or anxiety and or PTSD according to DSM- or ICD- criteria in adults, and a calculation of combined estimates for proportions using the DerSimonian-Laird estimation. A total of 348 records were retrieved with 37 publications on 35 populations meeting our inclusion criteria. 35 studies were included in the final evaluation. Our meta-analysis shows that the combined prevalence rates for depression were 20 percent among labor migrants vs. 44 percent among refugees; for anxiety the combined estimates were 21 percent among labor migrants vs. 40 percent among (n=24,051) refugees. Higher GNP in the country of immigration was related to lower symptom prevalence of depression and/or anxiety in labor migrants but not in refugees. We conclude that depression and/or anxiety in labor migrants and refugees require separate consideration, and that better economic conditions in the host country reflected by a higher GNP appear to be related to better mental health in labor migrants but not in refugees.
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Affiliation(s)
- Jutta Lindert
- Department of Public Health, Protestant University of Applied Sciences Ludwigsburg, Ludwigsburg, Germany.
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Pernice R, Trlin A, Henderson A, North N, Skinner M. Employment status, duration of residence and mental health among skilled migrants to New Zealand: results of a longitudinal study. Int J Soc Psychiatry 2009; 55:272-87. [PMID: 19383670 DOI: 10.1177/0020764008093685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To report findings on employment, duration of residence and mental health from a longitudinal study of 107 skilled immigrants to New Zealand from the People's Republic of China, India and South Africa. METHODS Demographic and employment data were collected by face-to-face interviews using a structured questionnaire that included (as the mental health instrument) the General Health Questionnaire 12 (GHQ-12). The initial interview took place after the immigrants had been resident in New Zealand for an average of five months. Four subsequent interviews were conducted annually (1999-2002) on or about the anniversary of the first interview. RESULTS AND CONCLUSION Rather than an initial euphoric period followed by a mental health crisis, the results indicated poor mental health status in the first two years irrespective of employment status. Thereafter, mental health slightly improved as did employment rates. A surprising result was that although the South Africans had the highest employment rate, there were neither substantial mental health differences among the three groups nor was there a significant improvement during the course of the longitudinal study.
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12
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Stillman S, McKenzie D, Gibson J. Migration and mental health: Evidence from a natural experiment. JOURNAL OF HEALTH ECONOMICS 2009; 28:677-87. [PMID: 19349087 DOI: 10.1016/j.jhealeco.2009.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 01/07/2009] [Accepted: 02/18/2009] [Indexed: 05/20/2023]
Abstract
People migrate to improve their well-being. Yet a large literature suggests that migration can be a stressful process, with potentially negative impacts on mental health. However, to truly understand the effect of migration one must compare the mental health of migrants to what their mental health would be had they stayed in their home country. The existing literature is not able to do this. New Zealand allows a quota of Tongans to immigrate each year with a random ballot used to choose amongst the excess number of applicants. Experimental estimates of the mental health effects of migration are obtained by comparing the mental health of migrants who were successful applicants in the random ballot to the mental health of those who applied to migrate under the quota, but whose names were not drawn. Migration is found to lead to improvements in mental health, particularly for women and those with poor mental health.
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Abstract
Early research on refugee mental health and adaptation has largely proceeded from a life-events/biomedical framework. That approach has helped elucidate the relationship between life events and psychiatric symptoms, but has been criticized as reductionistic or exclusionary. This article argues that the complexity of the social domain of refugee experience and the causal interactions among biological, psychological and social domains make individual effects difficult to study in isolation. A biopsychosocial approach could complement the more focal research to move the field forward. Evidence in support of this position is marshaled from new analyses conducted on a meta-analytic data set of five decades of the worldwide empirical literature on refugee mental health, reflecting data derived from 67,294 primary study participants (Porter & Haslam, 2005). Results demonstrate the importance of higher-order interactions between distal and proximal social variables, as well as associations among biological, psychological and community-level social functioning in refugees. Interdisciplinary research and novel analytic methods can complement more focal research. The presumed benefits of returning refugees to their country of origin are questioned in light of the important effects of social variables on refugee adaptation.
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Affiliation(s)
- Matthew Porter
- Mount Sinai School of Medicine, New School for Social Research, NY, USA.
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14
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Steiner KH, Johansson SE, Sundquist J, Wändell PE. Self-reported anxiety, sleeping problems and pain among Turkish-born immigrants in Sweden. ETHNICITY & HEALTH 2007; 12:363-79. [PMID: 17701762 DOI: 10.1080/13557850701300673] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To study whether symptoms of self-reported anxiety, sleeping problems and severe pain are more common among Turkish-born immigrants in Sweden than among Swedes, and whether age and socio-economic status can explain this hypothesised difference. DESIGN Two random samples were studied -- the Swedish National Board of Health and Welfare Immigrant Survey, and the Swedish Annual Level-of-Living Survey, both from 1996. A total of 526 Turkish-born immigrants in Sweden were compared with 2,854 Swedish controls, all aged between 27 and 60 years. Data were analysed by sex, in an age-adjusted model; and a full model also included age, education, marital status, employment and country of origin (logistic regression). RESULTS In the full model, odds ratios were 2.12 (1.43-3.15) for anxiety, 2.60 (1.82-3.72) for sleeping problems, and 2.14 (1.50-3.05) for severe pain among Turkish-born men, and 2.44 (1.69-3.53) for anxiety, 3.01 (2.09-4.33) for sleeping problems, and 2.59 (1.80-3.71) for severe pain among Turkish-born women, using the Swedish controls as references. CONCLUSIONS Being a Turkish-born immigrant in Sweden significantly increases the risks for self-reported anxiety, sleeping problems and severe pain, even after adjusting for age and socio-economic status (education, marital status and employment).
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Abstract
Over the past 10 years the United States has resettled an average of 106,500 refugees annually (U.S. Committee for Refugees: Refugee Rep 1999; 20(12):1-12), relocating them to various cities across the country. Upon arrival, some states offer refugees physical health screening, specifically for communicable diseases such as tuberculosis, intestinal parasites and Hepatitis B, and for general preexisting medical problems. Unfortunately, the same attention is rarely given to potential mental health needs. Research has shown that refugees are at greater risk for depression, anxiety, and posttraumatic stress syndrome than the general U.S. population, yet they are not routinely screened. The purpose of this paper is to describe the addition of an innovative program for mental health screening in a refugee population. The current study found that mental health screening was more effective when done in a home visit situation. A 23.8% rate of depression was found amongst those refugees screened.
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Affiliation(s)
- D M Barnes
- School of Nursing, University of Texas at Austin, 1700 Red River, Austin, Texas 78701, USA.
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Heptinstall E, Sethna V, Taylor E. PTSD and depression in refugee children: associations with pre-migration trauma and post-migration stress. Eur Child Adolesc Psychiatry 2004; 13:373-80. [PMID: 15619050 DOI: 10.1007/s00787-004-0422-y] [Citation(s) in RCA: 194] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2004] [Indexed: 11/25/2022]
Abstract
This paper describes the effect of pre-migration and post-migration experiences on the mental health of a sample of 40 refugee children aged 8-16 who lived in London with at least one parent or a refugee relative. Children's post-traumatic stress disorder (PTSD) and depression symptoms were assessed with standardised self-report measures (Impact of Event Scale and Depression Self-Rating Scale for Children, respectively). Information regarding past and present experiences were gathered during an interview with parents. There was a significant correlation between the number of pre-migration traumas experienced by the families and the children's PTSD scores. There was also a significant correlation between the families' number of post-migration stresses and children's depression scores. Higher PTSD scores were significantly associated with the pre-migration experience of violent death of family members and the post-migration experience of an insecure asylum status. Higher depression scores were significantly associated with insecure asylum status and severe financial difficulties. The clinical implications of these findings are discussed.
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Affiliation(s)
- Ellen Heptinstall
- Dept. of Child and Adolescent Psychiatry, Institute of Psychiatry (King's College London), Box P085, De Crespigny Park, London SE5 8AF, UK.
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Anagnostopoulos DC, Vlassopoulou M, Rotsika V, Pehlivanidou H, Legaki L, Rogakou E, Lazaratou H. Psychopathology and mental health service utilization by immigrants' children and their families. Transcult Psychiatry 2004; 41:465-86. [PMID: 15709646 DOI: 10.1177/1363461504047930] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To investigate the psychopathology of immigrants' children and psychiatric service utilization by the immigrant families, data were collected from the files of all 35 immigrant children seen over a 3-year period at the Community Mental Health Centre of the Athens University Psychiatric Department. Immigrant children were matched by age, gender and intake date with 70 Greek children. Data concerned information about the child's place of birth, current living conditions, parents' country of origin, social and economic situation, occupations and educational status, social insurance, psychiatric history, referral source, diagnostic and therapeutic services rendered, number of sessions and outcome. Utilization of services was assessed 6 months after intake. No significant differences were found regarding family's structure and parents' psychopathology. However, immigrant families had significantly worse economic situations, lower status jobs, worse housing and were usually uninsured. No significant differences were observed regarding service utilization parameters, except concerning 'cooperation with other services' No differences were found regarding frequency or type of psychiatric diagnosis. However, 91% of the immigrant group received a psychosocial diagnosis as opposed to 49% of the Greek group. Immigrant children did not present more serious or diverse psychopathology than did Greek children. Immigrant families had equal levels of service utilization as Greek families. However, it was apparent that immigrant families did not apply for help as readily as their Greek counterparts.
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Gerritsen AAM, Bramsen I, Devillé W, van Willigen LHM, Hovens JE, van der Ploeg HM. Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study. BMC Public Health 2004; 4:7. [PMID: 15070416 PMCID: PMC385239 DOI: 10.1186/1471-2458-4-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Accepted: 03/10/2004] [Indexed: 11/18/2022] Open
Abstract
Background This article discusses the design of a study on the prevalence of health problems (both physical and mental) and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of these services. Methods/Design The study will include random samples of adult asylum seekers and refugees from Afghanistan, Iran and Somali (total planned sample of 600), as these are among the largest groups within the reception centres and municipalities in the Netherlands. The questionnaire that will be used will include questions on physical health (chronic and acute diseases and somatization), mental health (Hopkins Symptoms Checklist-25 and Harvard Trauma Questionnaire), utilisation of health care services, pre- and post-migratory traumatic experiences, life-style, acculturation, social support and socio-demographic background. The questionnaire has gone through a translation process (translation and back-translation, several checks and a pilot-study) and cross-cultural adaptation. Respondents will be interviewed by bilingual and bicultural interviewers who will be specifically trained for this purpose. This article discusses the selection of the study population, the chosen outcome measures, the translation and cross-cultural adaptation of the measurement instrument, the training of the interviewers and the practical execution of the study. The information provided may be useful for other researchers in this relatively new field of epidemiological research among various groups of asylum seekers and refugees.
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Affiliation(s)
- Annette AM Gerritsen
- Department of Medical Psychology, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Institute for Research in Extramural Medicine, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Inge Bramsen
- Department of Medical Psychology, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Institute for Research in Extramural Medicine, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Walter Devillé
- Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Loes HM van Willigen
- Consultancy for Health and Human Rights, Stuurmankade 336, 1019 WE Amsterdam, The Netherlands
| | - Johannes E Hovens
- Delta Bouman Psychiatric Teaching Hospital, P.O. Box 800, 3170 DZ Poortugaal, The Netherlands
| | - Henk M van der Ploeg
- Department of Medical Psychology, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Institute for Research in Extramural Medicine, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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20
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Guerin PB, Diiriye RO, Corrigan C, Guerin B. Physical activity programs for refugee Somali women: working out in a new country. Women Health 2003; 38:83-99. [PMID: 14535608 DOI: 10.1300/j013v38n01_06] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Islamic refugee women from non-westernized countries face a number of challenges in adapting to their new country, especially when that new country is westernized and is not Islamic. Refugees are primarily women and children, so it is important that women be in their best health because they usually bear the responsibility of caring for each other and children, often in very difficult situations. Maintaining or obtaining good levels of physical activity contributes to good health: mentally, physically and socially. At the request of women in the local Somali community, a number of initiatives were taken to increase their opportunities for physical activity. Through interviews, observations and conversations we explored barriers to fitness and exercise, the social, physical, and cultural effects of physical activity, and solutions to facilitate Somali women's access to fitness and exercise opportunities. Physical activity interventions included exercise classes in a community center used by the Somali community, trial memberships at a local women-only fitness center, and walking and sports groups. We discuss the procedural issues relating to setting-up these physical activity opportunities, the results of interviews with 37 of the women about their health and perceptions and issues relating to the physical activity options, and our recommendations for setting up similar classes with other Somali or Islamic communities.
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21
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Zahid MA, Fido AA, Alowaish R, Abd El-Motaal Mohsen M, Abdul Razik M. Psychiatric morbidity among housemaids in Kuwait. III: Vulnerability factors. Int J Soc Psychiatry 2003; 49:87-96. [PMID: 12887043 DOI: 10.1177/0020764003049002002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Housemaids are a relatively homogenous immigrant subgroup in terms of their gender; ethnic origin; and socio-cultural, educational and occupational background. Psychiatric morbidity among housemaids is two to five times higher than the native female population. AIMS To determine the possible pre-immigration risk factors for prospective psychiatric breakdown among the housemaids. METHODS The sample consisted of all the housemaids (N = 197) hospitalised during the two-year study period. The controls comprised all the newly arrived housemaids (N = 502). The measures obtained included demographic characteristics and previous history of physical illness, psychiatric illness, hospitalisation and family history of psychiatric disorder. RESULTS More than a quarter of the hospitalised group broke down within one month of their arrival. The hospitalised group had a significant excess of Sri Lankan housemaids; non-Muslims; those with less than four years of education and those with a previous history of physical illness, psychiatric illness or hospitalisation. CONCLUSIONS A number of potential risk factors results in premature repatriation of housemaids on mental health grounds. Preventive measures involving recruitment procedures and pre-departure orientation courses are needed to minimise the expatriate failure among the housemaids.
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22
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Shapiro J, Douglas K, de la Rocha O, Radecki S, Vu C, Dinh T. Generational differences in psychosocial adaptation and predictors of psychological distress in a population of recent Vietnamese immigrants. J Community Health 1999; 24:95-113. [PMID: 10202690 DOI: 10.1023/a:1018702323648] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
While first-wave Vietnamese immigrants adapted well to life in the United States, subsequent immigrants have had greater adjustment difficulties, including more evidence of psychological distress. This study aimed to analyze psychosocial adaptation differences among three generations of recent Vietnamese immigrants, as well as to examine predictors of mental distress in the sample as a whole. A community sample of 184 recent Vietnamese immigrants, categorized as either elderly, middle-aged, or young adults, was assessed for levels of psychological distress, including depression, anxiety, and PTSD, as well as family conflict, dissatisfaction with life in the U.S., acculturation and biculturalism, social support, coping, and premigratory stressors. Young Vietnamese adults were most acculturated, most bicultural, and reported themselves as healthiest and least depressed. They were most often working, least often on welfare, and had the highest family income. However, they also reported most dissatisfaction with their current lives in the U.S. and most family conflict. Regression analysis explaining approximately one-quarter of the variance in mental distress implicated current dissatisfaction with and lack of adjustment of life in the United States, as well as greater acculturation and increased family conflict. Although young adults scored significantly higher than other generations on most of the risk factors for psychological distress, they appeared to be buffered against poorer mental health outcomes by factors of generation and perceived positive overall well-being. In terms of testing a predictive model of psychological distress, this study found current adjustment factors significantly more important in determining mental health outcomes than premigratory stressors such as war-related traumas.
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Affiliation(s)
- J Shapiro
- Department of Family Medicine, University of California, Irvine, USA
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23
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Dhooper SS, Tran TV. Understanding and responding to the health and mental health needs of Asian refugees. SOCIAL WORK IN HEALTH CARE 1998; 27:65-82. [PMID: 9680655 DOI: 10.1300/j010v27n04_05] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Asian refugees in the United States have health and mental health needs that are different from those of mainstream Americans and even of recent immigrants. This paper provides a close look at the past experiences and present lives of these refugees, highlights their major problems, and identifies their health and mental health needs. It discusses the reasons why their needs are not being adequately met, and proposes the "what" and "how" of the contributions that social workers can make to addressing those needs.
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Affiliation(s)
- S S Dhooper
- College of Social Work, University of Kentucky, Lexington 40506, USA
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24
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Abstract
Immigration fueled by large population shifts across international borders will be an ongoing phenomenon throughout the world for the foreseeable future. Forces raising concern for the development of healthy immigrant communities in the United States are the scapegoating of immigrants as the cause of many of the problems of society, a growing lack of tolerance for diversity, and the need for rapid acculturation. A construct of what constitutes healthy communities for immigrants is discussed. The construct is built around the concepts of convergent stereotyping, solidarity, and agency. To help build healthy communities, transcultural nurses must assist other nurses and health care providers to function from a transcultural posture to develop culture competence, reconceptualize how immigrants are viewed, avoid reductionism of the immigrant experience into a psycho-emotional phenomenon, and actualize human development as part of community development.
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Affiliation(s)
- L DeSantis
- University of Miami, School of Nursing, Coral Gables, Florida, USA
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25
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Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z. Anxiety, depression and PTSD in asylum-seekers: assocations with pre-migration trauma and post-migration stressors. Br J Psychiatry 1997; 170:351-7. [PMID: 9246254 DOI: 10.1192/bjp.170.4.351] [Citation(s) in RCA: 356] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Research into the mental health of refugees has burgeoned in recent times, but there is a dearth of studies focusing specifically on the factors associated with psychiatric distress in asylum-seekers who have not been accorded residency status. METHOD Forty consecutive asylum-seekers attending a community resource centre in Sydney, Australia, were interviewed using structured instruments and questionnaires. RESULTS Anxiety scores were associated with female gender, poverty, and conflict with immigration officials, while loneliness and boredom were linked with both anxiety and depression. Thirty subjects (79%) had experienced a traumatic event such as witnessing killings, being assaulted, or suffering torture and captivity, and 14 subjects (37%) met full criteria for PTSD. A diagnosis of PTSD was associated with greater exposure to pre-migration trauma, delays in processing refugee applications, difficulties in dealing with immigration officials, obstacles to employment, racial discrimination, and loneliness and boredom. CONCLUSIONS Although based on correlational data derived from'a convenient' sample, our findings raise the possibility that current procedures for dealing with asylum-seekers may contribute to high levels of stress and psychiatric symptoms in those who have been previously traumatised.
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Affiliation(s)
- D Silove
- School of Psychiatry, University of New South Wales, Liverpool Hospital, Australia
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26
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Rosmond R, Lapidus L, Björntorp P. A comparative review of psychosocial and occupational environment in native Swedes and immigrants. SCANDINAVIAN JOURNAL OF SOCIAL MEDICINE 1996; 24:237-42. [PMID: 8983094 DOI: 10.1177/140349489602400403] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to evaluate potential differences in psychosocial status and work environment between native Swedes and immigrants living in Gothenburg, Sweden. A number of psychiatric, occupational and socio-economic factors were analysed by questionnaire in 1040 men born in 1944 out of 1302 selected. The immigrants (n = 182) who participated in the study used psychopharmacological drugs more extensively than native Swedes. They were more dissatisfied, had traits of depression, frequent sleeping problems, dyspepsia and headaches compared with the native Swedes. The immigrants were more often out of work, and those who were gainfully employed were more dissatisfied with their current work and their colleagues, had a lower influence on the work situation, felt a lower degree of work demands, more seldom attempted to alter their work situation when having problems, and had a more frequent desire to change their type of work. Furthermore, immigrants more often than Swedes were living under poor housing standards, indicating a low socio-economic status. They felt a low degree of time pressure and had more often experienced a serious life event compared to native Swedes. It was concluded that immigrants were more affected by psychiatric, occupational and socio-economic disabilities and handicaps than native Swedes, indicating that immigrants are a vulnerable group in Swedish society.
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Affiliation(s)
- R Rosmond
- Department of Heart and Lung Diseases, Sahlgrenska University Hospital, Göteborg, Sweden
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27
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Pernice R, Brook J. Refugees' and immigrants' mental health: association of demographic and post-immigration factors. THE JOURNAL OF SOCIAL PSYCHOLOGY 1996; 136:511-9. [PMID: 8855381 DOI: 10.1080/00224545.1996.9714033] [Citation(s) in RCA: 128] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Several demographic and post-immigration factors related to self-reported symptoms of anxiety and depression of immigrants in New Zealand were examined in a study involving a sample of 129 Southeast Asian refugees, 57 Pacific Island immigrants, and 63 British immigrants to New Zealand. A questionnaire and the Hopkins Symptom Checklist-25 (HSCL-25) in English and in three Southeast Asian translations were administered, followed by an interview in English or with an interpreter. The findings suggest that demographic characteristics are not associated with symptom level. Post-immigration factors, such as experiencing discrimination in New Zealand, not having close friends, being unemployed, and spending most of one's time with one's own ethnic group affected anxiety and depression scores.
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Affiliation(s)
- R Pernice
- Department of Rehabilitation Studies Massey University, New Zealand
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28
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Pernice R, Brook J. The mental health pattern of migrants: is there a euphoric period followed by a mental health crisis? Int J Soc Psychiatry 1996; 42:18-27. [PMID: 8730533 DOI: 10.1177/002076409604200103] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Sluzki's 1986 mental health model of the migratory process was tested with migrants (both refugees and immigrants), to New Zealand. Its central feature, suggesting an initial symptom free and euphoric phase after arrival in the country of settlement, followed by a crisis stage, was examined for 129 Southeast Asian refugees, 57 Pacific Island immigrants and 63 British immigrants. A questionnaire and the Hopkins Symptom Checklist-25, in English and in three Southeast Asian language translations, were administered face-to-face. All respondents had arrived in New Zealand within the last 15 years. The findings did not support Sluzki's model. Refugees and immigrants in the group with less than six months of residence were not symptom free. Neither did the group with six months to six years residence demonstrate a deterioration in mental health. However, mean depression levels were slightly lower for those who had lived in New Zealand for over six years, suggesting that mental health may improve the longer both refugees and immigrants reside in the host country.
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Affiliation(s)
- R Pernice
- Department of Rehabilitation Studies, Massey University, Palmerston North, New Zealand
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