Forced residential mobility and social support: impacts on psychiatric disorders among Somali migrants

Somali refugees in urban neighborhoods: an eco-social study of mental health and wellbeing

Background

Impact of pre-migration trauma and post-migration settlement on refugee mental health and wellbeing is well-documented. However, little research has focused on the specific places where refugees settle and spend their daily lives within the post-migration context. This study adopts an eco-social perspective to explore the relationship between urban neighborhoods and refugee mental health and wellbeing.

Methods

We conducted twenty-six qualitative interviews with Somali refugees in London and Bristol in the UK. The transcripts were coded using an inductive approach and analyzed through thematic analysis.

Results

Somali refugees navigate a complex urban environment comprising various neighborhood features which include important places near home, interactions with neighbors, and community spaces. While these features afford them resources to improve mental health and wellbeing, they also present challenges such as high urban density, exposure to violence or discrimination, and neighborhood disorder.

Conclusion

The societal and physical features of urban neighborhoods intersect with refugee experiences of adversity, trauma and stress over time. As eco-social niches, urban neighborhoods are both accommodating, safe and familiar, as well as alien, threatening and unwelcoming. To support mental health and wellbeing and ensure successful settlement, it is essential to recognize the agency of refugees and provide continuous support throughout the entire asylum process and after, ensuring stable and safe living conditions.

Mental healthcare access among resettled Syrian refugees in Leipzig, Germany

Our aim was to examine mental health needs and access to mental healthcare services among Syrian refugees in the city of Leipzig, Germany. We conducted a cross-sectional survey with Syrian refugee adults in Leipzig, Germany in 2021/2022. Outcomes included PTSD (PCL-5), depression (PHQ-9), anxiety (GAD-7) and somatic symptom (SSS-8). Descriptive, regression and effect modification analyses assessed associations between selected predictor variables and mental health service access. The sampling strategy means findings are applicable only to Syrian refugees in Leipzig. Of the 513 respondents, 18.3% had moderate/severe anxiety symptoms, 28.7% had moderate/severe depression symptoms, and 25.3% had PTSD symptoms. A total of 52.8% reported past year mental health problems, and 48.9% of those participants sought care for these problems. The most common reasons for not accessing mental healthcare services were wanting to handle the problem themselves and uncertainty about where to access services. Adjusted Poisson regression models (n = 259) found significant associations between current mental health symptoms and mental healthcare service access (RR: 1.47, 95% CI: 1.02-2.15, p = 0.041) but significance levels were not reached between somatization and trust in physicians with mental healthcare service access. Syrian refugees in Leipzig likely experience high unmet mental health needs. Community-based interventions for refugee mental health and de-stigmatization activities are needed to address these unmet needs in Leipzig.

Psychosocial Attributes of Housing and Their Relationship With Health Among Refugee and Asylum-Seeking Populations in High-Income Countries: Systematic Review

Objectives: Housing as a social determinant of health should provide not only shelter, but also a feeling of home. We explored psychosocial pathways creating a sense of home and influencing the relationship between housing and health among asylum seekers and refugees (ASR) in high-income countries. Methods: We performed a systematic review. To be included, studies had to be peer-reviewed, published between 1995 and 2022, and focus on housing and health of ASR in high-income countries. We conducted a narrative synthesis. Results: 32 studies met the inclusion criteria. The psychosocial attributes influencing health most often identified were control, followed by expressing status, satisfaction, and demand. Most attributes overlap with material/physical attributes and have an impact on ASR's mental health. They are closely interconnected with each other. Conclusion: Psychosocial attributes of housing play an essential role in the health of ASR; they are closely associated with material/physical attributes. Therefore, future research on housing and health of ASR should routinely study psychosocial attributes, but always in association with physical ones. The connections between these attributes are complex and need to be further explored. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021239495.

Refugee mental health and the role of place in the Global North countries: A scoping review

Post-migration factors significantly influence refugee mental health. This scoping review looks at the role of place in refugee mental health. We included 34 studies in Global North high-income countries that elaborated on the place characteristics of facilities, neighbourhoods, urban and rural areas, and countries. While the role of place remains under-theorised, all studies reveal common characteristics that support a strong relationship between place of residence, refugee mental health and wellbeing outcomes in post-migration context. Given that refugees often have little or no choice of where they ultimately live, we suggest future research should focus on how characteristics of place co-constitute post-migration refugee mental health risks, protections, and outcomes.

Language Ability Accounts for Ethnic Difference in Mathematics Achievement

The mathematics achievement of minority students has always been a focal point of educators in China. This study investigated the differences in mathematics achievement between Han and minority pupils to determine if there is any cognitive mechanism that can account for the discrepancy. We recruited 236 Han students and 272 minority students (including Uygur and Kazak) from the same primary schools. They were tested on mathematics achievement, language abilities, and general cognitive abilities. The results showed that Han pupils had better mathematics achievement scores and better Chinese language ability than minority students. After controlling for age, gender, and general cognitive abilities, there were still significant differences in mathematics achievement between Han and minority students. However, these differences disappeared after controlling for language ability. These results suggest that the relatively poor levels of mathematics achievement observed in minority students is related to poor Chinese language skills.

Residential mobility, mental health, and community violence exposure among Somali refugees and immigrants in North America

Refugees and immigrants resettled in high income countries often later experience a new phase of residential uncertainty in search of safe and secure housing. This study investigated the effect of past year housing stability on symptoms of posttraumatic stress disorder (PTSD) and exposure to neighborhood violence among a sample of 1^st and 2nd generation Somali young adults (N = 198) living in urban areas in North America. In one year, 8.1% of the sample experienced a forced move and 20.7% of the sample moved voluntarily. Discrimination, neighborhood violence, economic insecurity, and interpersonal conflict precipitated forced moves. Forced moves were associated with worsening PTSD symptomology over one year, while voluntary moves were associated with improvements in symptoms. The current study provides evidence of the importance of safe, stable housing for the mental health of young adult immigrants.

Seeking sanctuary: rethinking asylum and mental health

Forced migrants are at an increased risk of mental disorder compared to host country populations. To effectively address this, programmatic and policy responses need to be underpinned by rigorous evidence. Drawing on our experience conducting a systematic review of post-migration risk factors for mental disorder among asylum seekers and our appraisal of related systematic reviews, this paper discusses four challenges facing the field: (1)The reliance on Western conceptions of mental health.(2)The investigation, to date, of a relatively narrow range of potential risk factors.(3)The lack of consistency in the measurement and reporting of risk factor variables.(4)The use of the legal term 'asylum seeker' to define study populations.We suggest potential ways forward, including using mental health measures developed in collaboration with communities affected by forced migration, the examination of key risk factors around homelessness and workers' rights, the development of a core set of risk factors to be investigated in each study, and defining study populations using the conceptual category of 'sanctuary seekers' - people who have fled their country and are asking another country for safety and residence.

Health Realization Community Coping Intervention for Somali Refugee Women

Health Realization (HR) is a strengths-based stress and coping intervention used to promote the use of internal and external coping resources. Our three-arm comparison group trial examined the effects of a culturally adapted Somali HR intervention on coping and mental health outcomes in 65 Somali refugee women post-resettlement. Subjects participated one of three conditions: HR intervention, nutrition attention-control, and evaluation-control. The HR intervention significantly affected multiple dimensions of coping: WAYS-distancing (p = 0.038), seeking social support (p = 0.042), positive reappraisal (p = 0.001); and Refugee Appraisal and Coping Experience Scale-Internal subscale (p = 0.045). The HR intervention also demonstrated improvement in depression symptom ratings (p = 0.079). We discuss findings from the pilot, challenges encountered conducting a three-arm comparison group trial, and implications for further research involving the HR intervention with culturally diverse refugee communities.

Exploring the Relationship between Housing and Health for Refugees and Asylum Seekers in South Australia: A Qualitative Study

Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.

Changes in mental disorder prevalence among conflict-affected populations: a prospective study in Sri Lanka (COMRAID-R)

BACKGROUND

Longitudinal data are lacking on mental health trajectories following conflict resolution and return migration. COMRAID-R is a follow-up study of Muslims displaced by conflict from Northern Sri Lanka 20 years ago who are now beginning to return.

METHODS

Of 450 participants in displacement interviewed in 2011, 338 (75.1%) were re-interviewed a year later, and a supplementary random sample (n = 228) was drawn from return migrants with a comparable displacement history. Common mental disorder (CMD; Patient Health Questionnaire) and post-traumatic stress disorder (CIDI-subscale) were measured.

RESULTS

A CMD prevalence of 18.8% (95%CI 15.2-22.5) at baseline had reduced to 8.6% (5.6-11.7) at follow-up in those remaining in displacement, and was 10.3% (6.5-14.1) in return migrants. PTSD prevalences were 2.4%, 0.3% and 1.6% respectively.

CONCLUSIONS

We observed a substantial decrease in CMD prevalence in this population over a short period, which may reflect the prospect of return migration and associated optimism following conflict resolution.

Dynamics of resilience in forced migration: a 1-year follow-up study of longitudinal associations with mental health in a conflict-affected, ethnic Muslim population

OBJECTIVE

The concept of 'resilience' is of increasing interest in studies of mental health in populations facing adversity. However, lack of longitudinal data on the dynamics of resilience and non-usage of resilience-specific measurements have prevented a better understanding of resilience-mental health interactions. Hence, the present study was conducted to investigate the stability of levels of resilience and its associations with sociodemographic and mental health exposures in a conflict-affected internal-migrant population in Sri Lanka.

DESIGN

A prospective follow-up study of 1 year.

SETTING

Puttalam district of North Western province in postconflict Sri Lanka (baseline in 2011, follow-up in 2012).

PARTICIPANTS

An ethnic Muslim population internally displaced 20 years ago (in 1990) from Northern Sri Lanka, aged 18 or above and currently in the process of return migration.

MEASURES

It was hypothesised that levels of resilience would be associated with mental health outcomes. Resilience was measured on both occasions using the 14-item Resilience Scale (RS-14), social support by the Multidimensional Social Support Scale and Lubben Social Network Scale and common mental disorders by the Patient Health Questionnaire (PHQ).

RESULTS

Of 450 participants interviewed at baseline in 2011, 338 (75.1%) were re-interviewed in 2012 after a 1-year follow-up. The mean resilience scores measured by RS-14 were 80.2 (95% CI 78.6 to 81.9) at baseline and 84.9 (83.5 to 86.3) at follow-up. At both time points, lower resilience was independently associated with food insecurity, lower social support availability and social isolation. At both time points, there were significant associations with common mental disorders (CMDs) in unadjusted analyses, but they only showed independence at baseline. The CMD prevalence, maintenance and incidence at follow-up was 8.3%, 28.2% and 2.2%, respectively.

CONCLUSIONS

In this displaced population facing a potential reduction in adversity, resilience was more strongly and robustly associated with economic and social factors than with the presence of mental disorder.

A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants

BACKGROUND

The rising global burden of forced migration due to armed conflict is increasingly recognised as an important issue in global health. Forced migrants are at a greater risk of developing mental disorders. However, resilience, defined as the ability of a person to successfully adapt to or recover from stressful and traumatic experiences, has been highlighted as a key potential protective factor. This study aimed to review systematically the global literature on the impact of resilience on the mental health of adult conflict-driven forced migrants.

METHODOLOGY

Both quantitative and qualitative studies that reported resilience and mental health outcomes among forcibly displaced persons (aged 18+) by way of exploring associations, links, pathways and causative mechanisms were included. Fourteen bibliographic databases and seven humanitarian study databases/websites were searched and a four stage screening process was followed.

RESULTS

Twenty three studies were included in the final review. Ten qualitative studies identified highlighted family and community cohesion, family and community support, individual personal qualities, collective identity, supportive primary relationships and religion. Thirteen quantitative studies were identified, but only two attempted to link resilience with mental disorders, and three used a specific resilience measure. Over-reliance on cross-sectional designs was noted. Resilience was generally shown to be associated with better mental health in displaced populations, but the evidence on this and underlying mechanisms was limited.

DISCUSSION

The review highlights the need for more epidemiological and qualitative evidence on resilience in forcibly displaced persons as a potential avenue for intervention development, particularly in resource-poor settings.

Migration experiences, employment status and psychological distress among Somali immigrants: a mixed-method international study

Background

The discourse about mental health problems among migrants and refugees tends to focus on adverse pre-migration experiences; there is less investigation of the environmental conditions in which refugee migrants live, and the contrasts between these situations in different countries. This cross-national study of two samples of Somali refugees living in London (UK) and Minneapolis, Minnesota, (USA) helps to fill a gap in the literature, and is unusual in being able to compare information collected in the same way in two cities in different countries.

Methods

There were two parts to the study, focus groups to gather in-depth qualitative data and a survey of health status and quantifiable demographic and material factors. Three of the focus groups involved nineteen Somali professionals and five groups included twenty-eight lay Somalis who were living in London and Minneapolis. The quantitative survey was done with 189 Somali respondents, also living in London and Minneapolis. We used the MINI International Neuropsychiatric Interview (MINI) to assess ICD-10 and DSM-IV mental disorders.

Results

The overall qualitative and quantitative results suggested that challenges to masculinity, thwarted aspirations, devalued refugee identity, unemployment, legal uncertainties and longer duration of stay in the host country account for poor psychological well-being and psychiatric disorders among this group.

Conclusion

The use of a mixed-methods approach in this international study was essential since the quantitative and qualitative data provide different layers and depth of meaning and complement each other to provide a fuller picture of complex and multi-faceted life situations of refugees and asylum seekers. The comparison between the UK and US suggests that greater flexibility of access to labour markets for this refugee group might help to promote opportunities for better integration and mental well-being.