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Biesiada A, Mastalerz-Migas A, Babicki M. Response to provide key health services to Ukrainian refugees: The overview and implementation studies. Soc Sci Med 2023; 334:116221. [PMID: 37689012 DOI: 10.1016/j.socscimed.2023.116221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/01/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND The outbreak of war in Ukraine has contributed to the largest migration crisis in this part of Europe since the Second World War. In a short period of time, several million refugees of different ages and with different health needs have arrived in Poland. This study aims to assess the health problems of Ukrainian refugees, evaluate the barriers faced by primary care physicians (PCPs), and analyse and evaluate the system solutions available (including the use of modern information technology) to address them. METHODOLOGY For this purpose, an original questionnaire distributed to PCPs in Poland was created and a literature review of implemented system solutions was conducted. The survey was conducted between the 3rd-10th April 2022-45 days after the outbreak of the war. The survey was repeated between 20th January and February 15, 2023. RESULTS The survey was completed by 402 physicians who provided health care to refugees at that time. There were 252 respondents in the first stage of the study while 150 PCPs took part in the repeat survey. The findings of the survey revealed that the most common health problems among refugees were infections, regardless of age. The biggest barrier to providing care to refugees was the lack of available medical records and language difficulties. During the first months of the refugee influx in Poland, many - both systemic and grassroot - solutions were implemented to improve the quality of health care for refugees. CONCLUSIONS According to PCPs, the language barrier and the lack of previous medical records are key constraints when providing medical care to refugees. The health needs of refugees and the difficulties in providing care for them require constant monitoring and implementation of appropriate systemic solutions that can reduce the limitations in the daily work of medical staff.
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Affiliation(s)
- Aleksander Biesiada
- Ad Vitam Przychodnia Zdrowia Sp. z o.o. Sp. k, Poland; Polish Society of Family Medicine, Poland.
| | - Agnieszka Mastalerz-Migas
- Polish Society of Family Medicine, Poland; Department of Family Medicine, Wroclaw Medical University, 51-141, Wroclaw, Poland
| | - Mateusz Babicki
- Polish Society of Family Medicine, Poland; Department of Family Medicine, Wroclaw Medical University, 51-141, Wroclaw, Poland
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Behrendt M, Vervliet M, Rota M, Adeyinka S, Uzureau O, Rasmussen A, Glaesmer H, Lietaert I, Derluyn I. A conceptual study on the relationship between daily stressors, stressful life events, and mental health in refugees using network analysis. Front Psychol 2023; 14:1134667. [PMID: 37599778 PMCID: PMC10438848 DOI: 10.3389/fpsyg.2023.1134667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction There is growing recognition that daily stressors, such as social and material deficiencies, can be highly detrimental to the mental health of refugees. These stressors are in addition to stressful life events, which have been widely studied in the context of migration and forced displacement. Despite increasing evidence for an ecological model, there is still no consensus regarding the conceptualization of these highly influential factors. In particular, the demarcation of daily stressors from stressful life events and the categorization of daily stressors require further examination in order to develop usable and accurate tools for researchers, design effective interventions for practitioners and assist politicians in designing meaningful policies. Methods To address these challenges, we used data from a sample of 392 unaccompanied young refugees from diverse backgrounds and employed network analysis to examine the relationships between daily stressors, stressful life events, and symptoms of depression, anxiety, and post-traumatic stress. Results Our findings highlight the significant relationship between daily stressors and mental health, particularly depression. Meaningful clusters of daily stressors include material stressors, social stressors, and social exclusion stressors. Conclusion Our results demonstrate the importance of considering daily stressors in the mental health of refugees and suggest that using a network approach offers a viable way to study these complex interrelationships. These findings have implications for researchers, practitioners, and policymakers in understanding and addressing the mental health needs of refugees.
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Affiliation(s)
- Malte Behrendt
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Marianne Vervliet
- Department of People and Well-Being, Thomas More University of Applied Sciences, Mechelen, Belgium
| | - Marina Rota
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Sarah Adeyinka
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Océane Uzureau
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Andrew Rasmussen
- Culture, Migration, and Community, Department of Psychology, Fordham University, New York, NY, United States
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Medical Faculty, The University of Leipzig Medical Center, Leipzig, Germany
| | - Ine Lietaert
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
- Institute on Comparative Regional Integration Studies, United Nations University, Bruges, Belgium
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
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Garbade M, Eglinsky J, Kindler H, Rosner R, Sachser C, Pfeiffer E. Factors affecting the acculturation strategies of unaccompanied refugee minors in Germany. Front Psychol 2023; 14:1149437. [PMID: 37404580 PMCID: PMC10315911 DOI: 10.3389/fpsyg.2023.1149437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
Background Different acculturation strategies might be related to different mental health outcomes and social participation of unaccompanied refugee minors (URMs), but little is known about which factors influence this acculturation process. Therefore, the aim of this investigation was to examine the impact of individual, stress-related, and contextual factors on the acculturation process of URMs in Germany. Methods A sample of N = 132 URMs living in child and youth welfare service facilities in Germany completed questionnaires about their acculturation orientation, traumatic experiences, daily stressors, asylum stress, and perceived social support between June 2020 and October 2021. This investigation is part of the multi-center randomized control trial BETTER CARE. Data were analyzed descriptively and via multiple hierarchical regression. Results Integration (43.5%) and Assimilation (37.1%) were the most common acculturation strategies used by URMs. Multiple hierarchical regression models showed that daily stressors (e.g., the lack of money) were associated with a stronger orientation toward the home country, whereas traumatic events were associated with a weaker orientation toward their home country. No significant predictors were found for the orientation toward the host country. Discussion Overall, URMs in Germany showed favorable acculturation strategies. Nevertheless, daily stressors and traumatic experiences might influence this process. The implications for practitioners and policymakers are discussed with a view to further improving the acculturation process of URMs in Germany.Clinical Trial Registration: German Clinical Trials Register, DRKS00017453 https://drks.de/search/de/trial/DRKS00017453. Registered on December 11, 2019.
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Affiliation(s)
- Maike Garbade
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Jenny Eglinsky
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | | | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
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Andersson ES, Øverlien C. Navigating cultural transitions during resettlement: the case of unaccompanied refugee minors. Front Psychol 2023; 14:1080072. [PMID: 37228345 PMCID: PMC10203603 DOI: 10.3389/fpsyg.2023.1080072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Refugees face the process of cross-cultural transitions upon arrival in their host country. This process is commonly referred to as acculturation and can be particularly challenging for asylum-seeking children and adolescent unaccompanied by a caregiver. To more effectively facilitate unaccompanied refugee minors (URMs) resettlement, this study sought to obtain an enhanced understanding of the acculturation processes of these youth'. Methods Thus, interviews with 48 URMs, all of whom arrived before the age of 16 years, were analyzed in two steps. First, how the youth described their host country's society and culture, followed by how they navigated within this societal and cultural landscape during resettlement. Results The youth described how they navigated the Norwegian cultural and societal landscape by gaining cultural competence, adapting and finding ways to contribute, which made it easier for the youth to gain access to the society, to succeed as well as enhance their sense of agency. However, the youths also reported having to navigate between the expectations of their original and host country cultures, struggling with finding a balance between the two cultures. Discussion The youth' acculturation processes seemed to be the result of both their own needs, wishes and behavior as well as specific features in their host country culture, which supports the notion that acculturation processes to some degree are context- and culture-dependent. Knowledge regarding the cultural and societal framework that these youth face and how they navigate within it during resettlement is critical for identifying possible cross-cultural challenges and promoting positive developmental tracks. To understand more about acculturation and integration processes, future research should include specific cultural and societal features as well as immigrants' own perspectives and experiences during resettlement.
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Affiliation(s)
- Elin Sofia Andersson
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Carolina Øverlien
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Department of Social Work, Stockholm University, Stockholm, Sweden
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Adeyinka S, Lietaert I, Derluyn I. It Happened in the Desert, in Libya and in Italy: Physical and Sexual Violence Experienced by Female Nigerian Victims of Trafficking in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4309. [PMID: 36901324 PMCID: PMC10002192 DOI: 10.3390/ijerph20054309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Nigerian girls and women constitute a large percentage of African victims of human trafficking in Italy. Extensive research has been conducted on the causes, push-and-pull factors, and the perpetrators in the phenomenon of trafficking Nigerian women and girls into Italy. However, limited data exist on the women and girls' narratives of their experiences during their migratory journey from Nigeria to Europe. Using data collected through a mixed method, longitudinal design, 31 female Nigerian victims of trafficking in Italy were interviewed for this study. This study gives voice to the experiences of sexual violence that these women and girls encounter during transit, leading to many of them arriving in Italy severely traumatized. It also discusses the health impact of these experiences and the different survival strategies that they are forced to employ. The study shows how sexual and physical violence is employed by smugglers, traffickers, and people in authority alike. It shows that the violence experienced along the way does not end after arrival in the destination country (in this case, Italy), but is, in some cases, exacerbated and similar to previous experiences of violence.
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Cowling MM, Anderson JR. The effectiveness of therapeutic interventions on psychological distress in refugee children: A systematic review. J Clin Psychol 2023. [PMID: 36634291 DOI: 10.1002/jclp.23479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To systematically review existing research exploring the effectiveness of psychological interventions in reducing symptoms of distress amongst refugee and asylum-seeker children. METHOD Six databases were searched to identify English studies presenting original empirical quantitative data (published before September 2022) testing the efficacy of psychological interventions for children from refugee and asylum-seeking backgrounds. Quality of studies were assessed through the Appraisal Tool for Cross-Sectional Studies as well as the Cochrane Risk of Bias Tool. Relevant data were extracted to facilitate a narrative synthesis. RESULTS Seventy-one eligible articles were identified (n > 10,000). A number of cognitive-behavioral, psychosocial, and trauma-focused interventions that catered specifically to children and their families were identified. A synthesis of these results suggest that interventions may assist in the reduction of various psychopathologies, although the effects were mixed across intervention types. CONCLUSIONS While the review yielded promising findings, most findings were derived from small pilot and empirical studies, leading to difficulties with drawing conclusions. There remains a need for studies using more rigorous research methodologies to expand and ratify this valuable knowledge base. CLINICAL SIGNIFICANCE Forced displacement is at an all-time high. Many children are being forced to seek asylum and refuge, and they become vulnerable to the development of poor mental health, with limited understanding surrounding how to appropriately intervene. This review aims to equip clinicians with increased knowledge and confidence in working therapeutically alongside clients from refugee or asylum-seeking background, with the goal of fostering positive mental health and wellbeing.
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Affiliation(s)
- Misha M Cowling
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Joel R Anderson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia.,Australian Research Centre in Sex, Health, & Society, La Trobe University, Melbourne, Australia
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Daniel-Calveras A, Baldaquí N, Baeza I. Mental health of unaccompanied refugee minors in Europe: A systematic review. CHILD ABUSE & NEGLECT 2022; 133:105865. [PMID: 36095862 DOI: 10.1016/j.chiabu.2022.105865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nearly half of the refugee and asylum seeking population in Europe is under the age of 18, and many of these individuals are unaccompanied children and adolescents. OBJECTIVE The aim of this systematic review is both to summarize findings regarding the prevalence of mental health disorders among unaccompanied refugee minors (URM) in European countries since the last available systematic review (October 2017), and to describe associated risk factors. METHODS Five databases were systematically searched for articles published between October 1, 2017 and May 1, 2022. RESULTS The findings from 23 studies conducted in 9 countries which examined 80,651 child and adolescent URM are explained. Afghanistan was the most common country of origin in the majority of studies and >75 % of the subjects were boys. Most of the studies (N = 13, 56.5 %) assessed posttraumatic stress disorder (PTSD) prevalence. We found a high prevalence of mental health disorders among URM children and adolescents, which varied considerably between studies, ranging from 4.6 % to 43 % for (PTSD), 2.9 % to 61.6 % for depression, 32.6 % to 38.2 % for anxiety and 4 to14.3 % for behavioral problems. Two studies looking at suicide attempts and deaths, also observed higher rates in URM compared to the host population of the same age. The studies looking at mental health risk factors suggest that levels of social support in the host country, rearing environment, and other factors are associated with psychopathology. Moreover, a meta-analysis of four studies regarding PTSD in URM and accompanied refugee minors (ARM) showed a lower prevalence among ARM: -1.14 (95%CI:-1.56-0.72). CONCLUSIONS PTSD, depression and anxiety are the most prevalent problems among the URM population in Europe. Early intervention in host countries is needed in order to improve mental health outcomes for this vulnerable population and avoid possible neglect.
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Affiliation(s)
| | - Nuria Baldaquí
- Psychiatry and Psychology Department, Hospital Clínic de Barcelona, SGR-881 Barcelona, Spain
| | - Inmaculada Baeza
- Universitat de Barcelona, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, ISCIII, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (CERCA-IDIBAPS), Barcelona, Spain.
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