1
|
Yim SH, Said G, King D. Practical recommendations for addressing the psychological needs of unaccompanied asylum-seeking children in England: A literature and service review. Clin Child Psychol Psychiatry 2024:13591045241252858. [PMID: 38869026 DOI: 10.1177/13591045241252858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Globally, there is an increasing trend of forcibly displaced people, of which over 40% are children. Unaccompanied asylum-seeking children (UASC) are at risk of experiencing psychological distress and developing mental health difficulties. However, in the UK, the approach from statutory mental health services is inconsistent across different geographical areas. AIM This report outlines recommendations for statutory mental health services in the UK in relation to working with UASC. METHOD A rapid evaluation method was adopted including interviewing fifteen key informants as well as reviewing existing clinical guidelines. Key informants included clinicians, service managers, social workers and commissioners from Local Authorities, National Health Services, and third sector partners. Recommendations were synthesised using narrative synthesis. RESULTS AND CONCLUSION Existing service provision and barriers to the implementation of interventions were summarised and compared against existing guidelines. The report presents recommendations on assessments, screening tools, and psychological interventions for developing a pathway for UASC within statutory services.
Collapse
Affiliation(s)
- See Heng Yim
- King's College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | | | | |
Collapse
|
2
|
Öztürk G, Timarcioğlu K, Dikeç G, Karali E, Nacaroğlu H, Çakir H, Harmanci Seren AK. Syrian refugees' experiences while receiving mental health services and psychiatric nursing care: A qualitative study. J Adv Nurs 2024; 80:1511-1522. [PMID: 37849232 DOI: 10.1111/jan.15894] [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: 03/13/2023] [Revised: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
AIM This study examined the experiences of Syrian refugees in a community centre in Turkiye as they access mental health services and receive psychiatric nursing care. DESIGN A qualitative design was adopted in the study. METHODS Data were collected from southern Turkiye between November and December 2021. The researchers conducted three semi-structured focus group interviews. Colaizzi's phenomenological method was followed to analyse the qualitative data. A total of 19 Syrian refugees participated in the focus group interviews. RESULTS Three key themes related to immigrants' experiences of receiving mental health services and nursing care were identified: barriers to receiving mental health services, coping with negative experiences in Turkiye and satisfaction with mental health services. The participants identified the barriers they experienced while receiving health services as those pertaining to language, discrimination and stigmatization. They also mentioned the methods of coping with these negative experiences in Turkiye. Despite their negative experiences, they expressed satisfaction with the mental health services they received, especially psychiatric nursing care. CONCLUSIONS This study determined that Syrian refugees face barriers in accessing and receiving mental health services. They stated that mental health professionals in Turkiye approach them with empathy, particularly those in psychiatric nursing. Healthcare professionals may be trained in culturally sensitive care to increase awareness. IMPACT Studies have frequently examined the experiences of nurses providing care to refugees, but few have focused on evaluating nursing care from the perspective of refugees. Syrian refugees have reported various obstacles in accessing and receiving mental healthcare services. Health professionals, especially psychiatric nurses in mental health psychosocial support centres, must facilitate the processes to eliminate these obstacles. REPORTING METHOD The consolidated criteria for reporting qualitative research (COREQ) were used. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
Collapse
Affiliation(s)
- Gizem Öztürk
- Department of Nursing, Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey
| | | | - Gül Dikeç
- Department of Nursing, Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey
| | - Ece Karali
- The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
| | | | - Hanife Çakir
- University of Health Sciences Istanbul Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | | |
Collapse
|
3
|
Özaslan A, Yildirim M, Guney E, İlhan MN, Vostanis P. Mental health problems and help-seeking behaviours of Syrian refugee adolescents: mediating role of self-stigma. Psychol Med 2024; 54:732-741. [PMID: 37642171 DOI: 10.1017/s0033291723002416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Although common mental health problems have been widely studied with self-stigma, few studies have focused on the mediating effect of self-stigma in the relationship between mental health problems and help-seeking behaviours of refugee adolescents. Therefore, the purpose of the present study was to examine whether self-stigma mitigates the adverse effects of stress, anxiety, and depression symptoms on the help-seeking behaviours of Syrian adolescents living in Turkey. METHODS The participants of this study included 488 Syrian refugee adolescents (boys, 63.73%; girls, 3627%) living in Turkey. Participants completed the Depression Anxiety Stress Scale and General Help-Seeking Scale and Self-Stigma of Seeking Psychology Help Scale. RESULTS The findings revealed that stress (β = 0.19, p < 0.01), anxiety (β = 0.12, p < 0.05), and depression (β = 0.17, p < 0.01) had significant and positive predictive effects on self-stigma, but not on help-seeking behaviours. Also, self-stigma (β = -0.12, p < 0.01) had a significant negative predictive effect on help-seeking behaviours. With regard to the indirect effects, the findings showed that self-stigma fully mediated the associations between stress - help-seeking [effect = -0.05, 95% confidence interval (CI) -0.11 to -0.01], anxiety - help-seeking (effect = -0.04, 95% CI -0.09 to -0.01)], and depression - help-seeking (effect = -0.05, 95% CI -0.12 to -0.01). CONCLUSIONS Our findings highlight the potential negative effects of self-stigma on the help-seeking behaviours of Syrian refugee adolescents, both directly and indirectly. These results can be used to develop and implement effective and efficient interventions to address the unmet mental health needs of refugee adolescents.
Collapse
Affiliation(s)
- Ahmet Özaslan
- Child and Adolescent Psychiatry Department, Gazi University Medical Faculty, Ankara, Turkey
| | - Murat Yildirim
- Department of Psychology, Faculty of Science and Letters, Ağrı İbrahim Çeçen University, Agri, Turkey
| | - Esra Guney
- Child and Adolescent Psychiatry Department, Gazi University Medical Faculty, Ankara, Turkey
| | - Mustafa Necmi İlhan
- Department of Public Health, Gazi University Medical Faculty, Ankara, Turkey
| | | |
Collapse
|
4
|
Ayejoto DA, Agbasi JC, Nwazelibe VE, Egbueri JC, Alao JO. Understanding the connections between climate change, air pollution, and human health in Africa: Insights from a literature review. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, TOXICOLOGY AND CARCINOGENESIS 2023; 41:77-120. [PMID: 37880976 DOI: 10.1080/26896583.2023.2267332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Climate change and air pollution are two interconnected global challenges that have profound impacts on human health. In Africa, a continent known for its rich biodiversity and diverse ecosystems, the adverse effects of climate change and air pollution are particularly concerning. This review study examines the implications of air pollution and climate change for human health and well-being in Africa. It explores the intersection of these two factors and their impact on various health outcomes, including cardiovascular disease, respiratory disorders, mental health, and vulnerable populations such as children and the elderly. The study highlights the disproportionate effects of air pollution on vulnerable groups and emphasizes the need for targeted interventions and policies to protect their health. Furthermore, it discusses the role of climate change in exacerbating air pollution and the potential long-term consequences for public health in Africa. The review also addresses the importance of considering temperature and precipitation changes as modifiers of the health effects of air pollution. By synthesizing existing research, this study aims to shed light on complex relationships and highlight the key findings, knowledge gaps, and potential solutions for mitigating the impacts of climate change and air pollution on human health in the region. The insights gained from this review can inform evidence-based policies and interventions to mitigate the adverse effects on human health and promote sustainable development in Africa.
Collapse
Affiliation(s)
- Daniel A Ayejoto
- Department of Environmental and Sustainability Sciences, Texas Christian University, Fort Worth, Texas, USA
| | - Johnson C Agbasi
- Department of Geology, Chukwuemeka Odumegwu Ojukwu University, Uli, Anambra State, Nigeria
| | - Vincent E Nwazelibe
- Department of Earth Sciences, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Johnbosco C Egbueri
- Department of Geology, Chukwuemeka Odumegwu Ojukwu University, Uli, Anambra State, Nigeria
| | - Joseph O Alao
- Department of Physics, Air Force Institute of Technology, Kaduna, Nigeria
| |
Collapse
|
5
|
Yang L, Mittendorfer-Rutz E, Amin R, Helgesson M. Risk factors for common mental disorders in young refugees from Iran, Somalia and Syria to Sweden. J Public Health (Oxf) 2023; 45:593-603. [PMID: 37061995 PMCID: PMC10470362 DOI: 10.1093/pubmed/fdad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 01/16/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Our primary aim was to determine sociodemographic and health-related risk factors for diagnosed common mental disorders (CMDs) among young refugees in Sweden. METHODS All young adult refugees from Iran, Somalia and Syria (n = 7192), who were residents in Sweden in 2009, were followed from 2010 to 2013 regarding diagnosed CMDs. Cox regression models were used to compute hazard ratios (HRs) of CMDs with 95% confidence intervals (CIs). RESULTS Those arriving as unaccompanied refugee minors had a lower risk of being diagnosed with CMDs (HR: 0.7; 95%CI: 0.6-0.9) than those arriving as accompanied refugee minors. A higher risk of being diagnosed with CMDs was also found in female refugees (HR: 1.3; 95%CI: 1.1-1.5) compared with male refugees. In addition, individuals with a low (HR: 1.7; 95%CI: 1.3-2.3) or a medium (HR: 1.4; 95%CI: 1.1-1.8) educational level were found to have a higher risk of being diagnosed with CMDs compared with individuals with a high educational level. Refugees from Iran (HR: 2.3; 95%CI: 1.8-2.9) had a higher risk of a diagnosis of a CMD than refugees from Somalia. Moreover, refugees with a diagnosis of a mental disorder other than a CMD (HR: 4.2; 95%CI: 2.8-6.1), digestive (HR: 1.5; 95%CI: 1.0-2.2) or musculoskeletal diseases (HR: 1.5; 95%CI: 1.0-2.2) had a higher risk of being diagnosed with subsequent CMDs, compared with those with no such disorders. CONCLUSIONS Pre-existing diagnoses of mental disorders other than CMDs, and digestive and musculoskeletal disorders should be carefully considered in clinical assessments to initiate early interventions to prevent CMDs.
Collapse
Affiliation(s)
- Lijun Yang
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Ridwanul Amin
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm SE-171 77, Sweden
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm SE-171 77, Sweden
| |
Collapse
|
6
|
Moutsou I, Georgaca E, Varaklis T. Psychotherapeutic and Psychosocial Interventions with Unaccompanied Minors: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11060918. [PMID: 36981575 PMCID: PMC10048295 DOI: 10.3390/healthcare11060918] [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: 02/08/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Unaccompanied minors (UAMs) are considered a particularly vulnerable population, facing severe threats regarding their physical and mental health. As their number has increased in recent years worldwide, research on mental health interventions has become necessary. The implementation of psychotherapeutic interventions has been documented, but psychosocial interventions seem to not have been consistently studied. In this review, we summarize the psychotherapeutic and psychosocial interventions with UAMs that have been studied up to now. Following the PRISMA guidelines for scoping reviews, we searched four databases and included studies and practice papers; there were no restrictions on publication date, geographical region, language, or method. We identified 46 studies on psychotherapeutic interventions and 16 studies on psychosocial interventions that met the inclusion criteria. Psychotherapeutic interventions were mainly based on cognitive behavioural, psychodynamic, narrative, art and transcultural approaches and aimed at improving UAMs' trauma, mental health and wellbeing, as well as professionals' skills and therapeutic protocols. Several studies showed promising results, with the cognitive behavioural approaches being the most researched. However, more research is needed in order to draw conclusions in terms of effectiveness. Psychosocial interventions followed various approaches and aimed at UAMs' empowerment, wellbeing, support and integration, as well as at improving caregivers' skills. Nonetheless, they seem not only very heterogeneous but also understudied, and we believe that a focus on them would be very useful. Methodological limitations and their implications for future research are discussed.
Collapse
Affiliation(s)
- Irene Moutsou
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Theofilos Varaklis
- School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| |
Collapse
|
7
|
Bansal N, Karlsen S, Sashidharan SP, Cohen R, Chew-Graham CA, Malpass A. Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography. PLoS Med 2022; 19:e1004139. [PMID: 36512523 PMCID: PMC9746991 DOI: 10.1371/journal.pmed.1004139] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention. METHODS AND FINDINGS Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to "ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view)." We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as "medical" and "Eurocentric") and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections. CONCLUSIONS In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services.
Collapse
Affiliation(s)
- Narinder Bansal
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Saffron Karlsen
- Centre for the Study of Ethnicity and Citizenship, School of Sociology, Politics and International Studies, University of Bristol, Bristol, United Kingdom
| | - Sashi P. Sashidharan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rachel Cohen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Alice Malpass
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
8
|
Karamehic-Muratovic A, Sichling F, Doherty C. Perceptions of Parents' Mental Health and Perceived Stigma by Refugee Youth in the U.S. Context. Community Ment Health J 2022; 58:1457-1467. [PMID: 35396648 DOI: 10.1007/s10597-022-00958-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/04/2022] [Indexed: 01/27/2023]
Abstract
Refugees are at an increased risk of mental health problems due to the multiple traumas experienced. Mental health help-seeking and utilization remains low among resettled refugees in the US, however, with stigma as a major barrier. The goal of this paper was to explore second-generation youth's perceptions of parents' mental health and perceived stigma. Data includes in-depth interviews with 62 Bosnian youth resettled in St. Louis. Results indicate that from the perspective of their children, first-generation refugee parents continue to face mental health challenges. The findings show that parents' and youth's understanding of mental health is tied to cultural stigma surrounding mental health. Additionally, intergenerational trauma might be affecting the child-parent relationship. As mass violence around the world continues and people are at continued risk of becoming refugees, this study contributes by advancing research on the long-term mental health and well-being of refugees and their children.
Collapse
Affiliation(s)
- Ajlina Karamehic-Muratovic
- Department of Sociology and Anthropology, Saint Louis University, 3700 Lindell Blvd, St. Louis, MO, 63108, USA.
| | - Florian Sichling
- Department of Social Work, University of Missouri St. Louis, One University Blvd., St. Louis, MO, 63121, USA
| | - Caroline Doherty
- Department of Sociology and Anthropology, Saint Louis University, 3700 Lindell Blvd, St. Louis, MO, 63108, USA
| |
Collapse
|
9
|
Eruyar S, Hunt S, O’Reilly M, Alowaybil R, Vostanis P. Responsiveness of support systems to address refugee young people’s mental health needs: Stakeholder perspectives from Turkey and the UK. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2123697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Affiliation(s)
- Seyda Eruyar
- Department of Psychology, Necmettin Erbakan University, Konya, Turkey
| | - Sarah Hunt
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
| | - Michelle O’Reilly
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
| | - Reem Alowaybil
- Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Panos Vostanis
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
| |
Collapse
|
10
|
Pfeiffer S. Kinder- und Jugendlichenpsychotherapie Verhaltenstherapie (KJPVT). KINDHEIT UND ENTWICKLUNG 2022. [DOI: 10.1026/0942-5403/a000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Symbolic Interaction, Power, and War: Narratives of Unaccompanied Young Refugees with War Experiences in Institutional Care in Sweden. SOCIETIES 2022. [DOI: 10.3390/soc12030090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study concerns young people who have experienced war, taken shelter in Sweden, and been placed in institutions. The purpose of the study is to identify and analyze power relations that contribute to the shaping of young people’s identities and repertoires of action via stigmatizations and social comparisons with different reference groups. The study’s empirical material includes qualitatively oriented interviews with six young people from Iraq, Syria, and Afghanistan who have experienced war, followed by placement in institutional care in Sweden. Analytical findings with the following themes are presented: (1) concrete—physical exercise of power, (2) blackmail as an exercise of power, and (3) anonymous—bureaucratized exercise of power. The study demonstrates that narratives about war, escaping war, and postwar life in Sweden, constructing and reconstructing an image of a series of interactive rituals that are both influenced by and influence the power dynamic between the actors. This relationship, in turn, creates and recreates an interplay among the stigmatizing experiences of the youths, their social comparisons, and definitions of inequality.
Collapse
|
12
|
Rodriguez IM, Dobler V. Survivors of Hell: Resilience Amongst Unaccompanied Minor Refugees and Implications for Treatment- a Narrative Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:559-569. [PMID: 34820043 PMCID: PMC8586295 DOI: 10.1007/s40653-021-00385-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Approximately half of the world's displaced population are children and a significant proportion of these are unaccompanied asylum-seeking children (UASC). UASC are the most vulnerable of all refugee populations. Up to 90% of UASC have been subjected to exploitation, including trafficking or being drafted into military groups. Having survived the perils of flight, UASC are confronted with continued challenges, including the uncertainties regarding their residential rights in host counties. Unsurprisingly, the prevalence of mental health problems is higher amongst UASC than in any other refugee group. Yet, Mental Health and Psychosocial Support (MHPSS) appears to neither reach nor engage UASC. This begs for re-examination of what and how MHPSS is offered. Despite high levels of adversity, UASC often have considerable resilience, and make remarkable recoveries. However, literature exploring their resources or their own views of what helps or hinders recovery is scarce. In this narrative review, we explore individual and systemic factors promoting recovery in UASC. We consider theoretical understanding of resilience, emerging data and user perspectives. From these we deduct four areas of resilience in UASC: Individual factors - prosocial behaviour, problem-solving skills; Lifetime relationships - positive early family relationships, connection with family and country of origin, positive peer and adult relationships in host country; Acculturation - integration of own and new culture, positive relationships with prosocial institutions; Care arrangements - supported but less restrictive living arrangements. We suggest, MHPSS may need to focus on enhancing social networks, including connectedness with positive relationships in the home-country, life-history work with a focus on resource-building experiences in addition to trauma, and promoting integration of old and new cultural values. We also conclude that despite growing data, there is a gap in both eliciting user perspectives and understanding adaptive resources, especially those emerging during early development and within their cultural setting. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00385-7.
Collapse
Affiliation(s)
| | - Veronika Dobler
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
13
|
Mental healthcare for asylum-seekers and refugees residing in the United Kingdom: a scoping review of policies, barriers, and enablers. Int J Ment Health Syst 2021; 15:60. [PMID: 34127043 PMCID: PMC8201739 DOI: 10.1186/s13033-021-00473-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Since 2011, a large influx of asylum-seekers and refugees has put pressure on the UK’s under-resourced national health services and mental health services. Asylum-seekers and refugees (ASR) may experience traumatic events pre-departure, life-threating circumstances on their journeys, and difficulties integrating into host countries related to immigration policies, social isolation, poor living conditions, and unemployment, all of which can significantly affect their mental health. This topic is increasingly important due to the numbers of people seeking asylum and growing concern for their mental health on resettlement. This study examined UK-wide policies and guidance, healthcare practices, barriers, and enablers of mental healthcare for ASR residing in the UK. Methods We conducted a scoping review using Arksey and O’Malley’s 2005 framework, which included semi-structured interviews with stakeholders from non-governmental organisations, academia, UK National Health Service, and community groups. We synthesised and analysed literature and interview data thematically to examine current barriers and potential enablers of ASR mental health support in the UK. Results We included 39 literature sources, of 1,638 identified, and 10 stakeholder interviews. Sources, most published in 2019 (n = 13), included data from England (n = 13), Scotland (n = 3), Wales (n = 3), and Northern Ireland (n = 2) and covered access to care (n = 16), mental health disorders (n = 7), impacts on health (n = 7), barriers to care (n = 13), policies and plans (n = 4), and clinical recommendations (n = 3). Synthesised themes from literature and interviews included existing barriers (i.e. communication difficulties and lack of funding, resources, and political will) and potential enablers (i.e. proposed provision practices, social needs of ASR, and policy changes). Conclusions There is a gap in the literature regarding UK-wide assessment of access and delivery of mental healthcare for ASR in the UK. Time sensitive and culturally appropriate approaches are needed, with greater funding and resource support from the UK Government. This study provides justification for a call to relax hostile environment policies, and for ASR-specific mental health services and support to be considered within the UK. Further research is needed to assess implementation of guidelines across the UK. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-021-00473-z.
Collapse
|
14
|
Unaccompanied minors’ experiences of narrative exposure therapy. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Despite the understanding that unaccompanied minors’ (UAM) experience high rates of post-traumatic stress, the provision of evidence-based trauma-focused therapies is low for this population. Narrative exposure therapy (NET) is an effective short-term intervention for treating post-traumatic stress disorder (PTSD) after multiple traumatic experiences, such as those experienced by UAM. Within the existing literature, there is a lack of research investigating unaccompanied minors’ experiences of NET or any trauma-focused therapy. Participants were four UAM experiencing PTSD who formed part of a pilot delivery of NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted and transcripts were analysed using interpretative phenomenological analysis (IPA). This project identified five themes that encapsulated unaccompanied minors’ experiences of receiving NET, including the process of preparing for this therapy, what it was like to receive it, and the differences they identified at the end of treatment. The significance of this taking place within a safe therapeutic relationship was explored within the context of the attachment losses experienced by UAM, and the impact this has on emotion regulation was considered. The potential of a reduction in PTSD symptoms facilitating a positive spiral in adolescence was reflected on within this paper.
Key learning aims
(1)
To understand the experience of unaccompanied asylum-seeking minors (UAM) receiving narrative exposure therapy (NET) for post-traumatic stress disorder.
(2)
To understand the key concerns and motivators for UAM when considering engaging in NET.
(3)
To understand how these experiences relate to theoretical frameworks and the existing literature relating to emotional difficulties in adolescence.
Collapse
|
15
|
Osooli M, Ohlsson H, Sundquist J, Sundquist K. Attention deficit hyperactivity disorder in first- and second-generation immigrant children and adolescents: A nationwide cohort study in Sweden. J Psychosom Res 2021; 141:110330. [PMID: 33326861 DOI: 10.1016/j.jpsychores.2020.110330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/30/2020] [Accepted: 12/06/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Studies on the incidence of Attention Deficit Hyperactivity Disorder (ADHD) among immigrant children and adolescents is limited and results are mixed. The aim of this study was to compare the ADHD risk between first- and second-generation immigrants aged 4-16 years and their native peers in Sweden. METHODS This was an open nationwide retrospective cohort study. We included 1,902,526 native and 805,450 children and adolescents with an immigrant background, born 1987-2010, and aged 4-16 years at baseline. We identified participants using national population data and participants were observed until they received an ADHD diagnosis in the National Patient Register, turned 18 years, migrated, died, or until the end of the study, whichever came first. ADHD risks were adjusted for birth year and age and maternal income at baseline. RESULTS For both males and females, the ADHD risk was lower among most immigrant groups. However, the combination of a Swedish-born mother and foreign-born father was associated with an increased risk of ADHD. The ADHD risk varied substantially between immigrants from different regions of the world. For example, immigrants from other Scandinavian countries, North America, and Latin America and the Caribbean had higher rates of ADHD compared with natives. CONCLUSIONS Future research should examine the underlying factors behind the differences in ADHD risks between certain immigrant subgroups and natives, such as family structure, cultural and language barriers and potential differences in health care utilization among immigrant families.
Collapse
Affiliation(s)
- Mehdi Osooli
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Functional Pathology, Center for Community-based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Shimane, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Functional Pathology, Center for Community-based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Shimane, Japan
| |
Collapse
|
16
|
Bamford J, Fletcher M, Leavey G. Mental Health Outcomes of Unaccompanied Refugee Minors: a Rapid Review of Recent Research. Curr Psychiatry Rep 2021; 23:46. [PMID: 34196826 PMCID: PMC8249279 DOI: 10.1007/s11920-021-01262-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE To examine mental health outcomes of unaccompanied refugee minors during global policy shift. Additionally, to consider mental health service delivery and placement type for this group. METHODS A rapid systematic search of research published since 2018 which related to mental health outcomes of unaccompanied refugee minors. Data extracted, risk of bias assessed and outcomes reviewed qualitatively. RESEARCH FINDINGS We found 181 papers, of which 14 met inclusion criteria. This review found consistently high levels of PTSD and PTSS among URMs in various contexts. Exposure to trauma, being unaccompanied (compared to accompanied), being female and being older are associated with poor outcomes. Depression and anxiety were consistently high among URMs and associated with discrimination, limited language attainment and daily hassles. High rates of mental illness and symptoms among unaccompanied refugee minors were consistent across national and settlement contexts but the quality of the evidence is variable with significant heterogeneity of assessment. We relate persistence of poor mental health outcomes with problems accessing mental health services and discuss the role of key post-migration factors influencing outcomes-in particular placement type and the use of detention centres.
Collapse
Affiliation(s)
- Jordan Bamford
- grid.4777.30000 0004 0374 7521Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Mark Fletcher
- grid.4777.30000 0004 0374 7521Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland, UK.
| |
Collapse
|