Sudanese Adolescent Refugees: Acculturation and Acculturative Stress

Acculturative Stress, Mental Health, and Well-Being among Deaf Adults

Acculturative stress is associated with negative mental health among culturally diverse individuals. Deaf and Hard-of-Hearing (DHH) individuals experience acculturative stress as they navigate within and between the Hearing and Deaf communities, yet, research has not examined the relationship between deaf acculturative stress and psychological functioning. This study examined the relationships between deaf acculturative stress, well-being, and symptoms of depression and anxiety. One hundred and ten DHH adults (71.6% female, 82.7% White, median age = 30-39) completed an online survey including the Multidimensional Inventory of Deaf Acculturative Stress (MIDAS), demographic questions, and measures of psychological functioning. After controlling for relevant sociodemographic factors, the MIDAS Stress from the Deaf and Hearing Community scales emerged as significant predictors of well-being and symptoms of anxiety and depression. Findings are discussed within the context of DHH sociocultural experiences, and suggestions for future research are offered to inform clinical work with DHH individuals.

The Experiences and Perspectives of African-Australian Community Service Providers Who Work with At-Risk and Justice-Involved Youth

African-Australian young people are over-represented in custody in the state of Victoria. It has been recognized in recent government and stakeholder strategic plans that African-Australian community service providers are well placed to help address the increasing complex needs of at-risk African-Australian youth. However little is known about the capacities of such providers to effectively contend with this growing social concern. In response, this study aimed to explore the perspectives and operational (service delivery and governance) experiences of African-Australian community organizations which provide services to at-risk young people in Victoria. Through a series of in-depth interviews with the leadership of eight key African-Australian service providers, we aimed to identify their perceived strengths, obstacles faced and proposed strategies to realize key objectives. Perspectives on key risk factors for young African-Australian justice system contact were also gathered. Several themes were extracted from the interviews, specifically (i) Risk factors for African-Australian youth justice-involvement (school disengagement, peer delinquency, family breakdown, intergenerational discord, perceived social rejection), (ii) The limitations of mainstream institutions to reduce African-Australian youth justice-involvement (too compliance focused, inflexible, business rather than human-centered, disconnected from communities and families), (iii) The advantages of African-Australian community service providers when working with African-Australian youth (community credibility, client trust, flexibility, culturally responsive), (iv) The challenges faced by African-Australian service providers (lack of funding/resources, professional staff shortages, infrastructural/governance limitations), and (v) "What works" in service provision for at-risk African-Australians (client involvement in program design, African staff representation, extensive structured programming matched with client aspirations, prioritizing relationship building, persistent outreach, mental health and legal literacy for clients and families). Implications for service delivery and social policy are discussed within.

Development of the Multidimensional Inventory of Deaf Acculturative Stress

Deaf adults may experience acculturative stress as they navigate within and between the Hearing and Deaf communities. However, no measure has been developed to assess levels of deaf acculturative stress. This study aimed to develop the Multidimensional Inventory of Deaf Acculturative Stress (MIDAS). The MIDAS was developed through a sequential and iterative scale development procedure and then tested on a sample of 104 deaf adults across the United States (age range = 18-79; 74% female). Principal component analyses were run for item refinement and selection. The final analyses yielded four factors for Stress from the Hearing Community, three factors for Stress from the Deaf Community, and two factors for Intersectionality. Construct validity was demonstrated through correlations in the expected directions with measures of Hearing and Deaf acculturation identity and ethnic/racial identity. The utility of the MIDAS is discussed with regard to future research.

Risk and Protective Factors Experienced by Fathers of Refugee Background during the Early Years of Parenting: A Qualitative Study

Fathers of refugee background with young children can experience significant mental health difficulties, with the potential for intergenerational impacts. This study aimed to explore how fathers of refugee background experience risk and protective factors for their own health and wellbeing during the early years of parenting. Semi-structured interviews and one semi-structured focus group were conducted with fathers of refugee background, with young children (0–5 years), who had settled in Australia. Transcribed interviews were analysed using thematic analysis, informed by the socioecological model of health. A total of 21 fathers participated in the study. Risk factors experienced included: prior experiences of trauma, reduced access to family support in Australia, adjustments in parenting roles, and the challenges of learning a new language and securing employment. Fathers drew on a number of sources of strength, including a sense of joy from fatherhood and support from partners, families, and communities. While most fathers regularly accompanied their partners and children to healthcare appointments, they were rarely asked by healthcare professionals about their own needs. Our findings support the idea that there is a need for greater assistance for fathers, particularly for navigating issues arising from the settlement process. Healthcare services working with families of refugee background must adopt a father-inclusive, trauma-informed approach that is responsive to fathers’ needs.

Navigating Deaf and Hearing Cultures: An Exploration of Deaf Acculturative Stress

While there are many benefits of bilingualism and biculturalism, it is increasingly recognized that individuals may also experience acculturative stress as they navigate between different cultural environments. Acculturative stress results from struggles to acculturate, including pressures from the dominant culture and one's heritage culture to maintain specific languages, values, and customs. This study sought to explore experiences of acculturative stress among Deaf and Hard of Hearing (DHH) adults. Thirteen ethnically and racially diverse DHH adults, aged 21-52, participated in semi-structured focus groups. Krueger's (1994) framework analysis was used to analyze the data. Participants reported pressures from the Hearing community as Hearing, Speaking, and English Pressures; Hearing Cultural Expectations; and Family Marginalization. Pressures from the Deaf community included ASL Pressures; Deaf Cultural Expectations; and Small Community Dynamics. Participants also discussed unique stressors related to their intersecting cultural identities (Intersectionality). The psychosocial impacts of acculturative stress included anger, anxiety, depression, exhaustion, resentment, and trauma. Coping resources were also discussed. Results highlight the saliency of acculturative stress among DHH adults and the need for continued investigations of the construct, particularly as it relates to mental health.

Prioritising Family Needs: A Grounded Theory of Acculturation for Sub-Saharan African Migrant Families in Australia

Pre-existing acculturation models have focused on individual orientation and may not be fully applicable to African migrants due to their strong connection to family. In this study, we utilised qualitative semi-structured interviews to explore how 22 migrant families from eight sub-Saharan African representative countries: Congo, Eritrea, Kenya, Nigeria, Rwanda, Sierra Leone, Uganda and Zimbabwe, who now reside in Townsville, Australia experienced the acculturation process. Data were analysed at the family unit level using the three steps of grounded theory method: open, axial and selective coding. The theory derived illustrates that the acculturation process involves two major phases (maintaining core moral values and attaining a sense of belonging) within which six categories were identified. Three of the categories were related to deeply held heritage values and beliefs (family relationships, societal expectations and cultural norms), while the other three (religious beliefs, socio-economic gains and educational values) indicated integration with the host culture. These categories constitute central concerns for the participants and demonstrate what matters to them as a family unit and not as individuals. We conclude that a selective process of “prioritising family needs” determines the acculturation strategy of sub-Saharan African migrant families, aiding the fulfilment of their migration goals, ensuring effective functioning of the family unit, and enabling them to be productive members of their local community.

Understanding the role of acculturative stress on refugee youth mental health: A systematic review and ecological approach to assessment and intervention

In this article, we conduct a systematic review of the extant literature on the risk and protective factors that impact the healthy resettlement of refugee children around the world. We identify acculturative stress as a main risk factor to consider for assessment and intervention given that is often overlooked in the literature for refugee children, but has been found to strongly impact their socio-emotional development. In addition, we discuss ecologically framed/culturally responsive interventions and assessment practices that could aid in the successful resettlement of refugee children. We also discuss the limitations of the extant research on refugee children and make recommendations for future research directions.

Depression, Anxiety, and Acculturative Stress Among Resettled Bhutanese Refugees in Australia

Despite awareness of the difficulties faced by refugees in flight, little is known about their mental health following resettlement. This article investigated rates, predictors, and moderators of anxiety, depression, and acculturative stress among members of the resettled Bhutanese refugee community in northern Queensland. A total of 148 participants (51% male), 18 to 83 years of age, participated in this cross-sectional study. A questionnaire was comprised of bilingual (English–Nepali) versions of the Depression, Anxiety, and Stress Scale (DASS-21; anxiety and depression), the Multidimensional Acculturative Stress Scale (MASS; acculturative stress), Brief-COPE (coping style), Multidimensional Scale of Perceived Social Support (MSPSS; social support), and socio-demographics. Participants reported severe levels of anxiety and moderate levels of depression, and moderate to high levels of acculturative stress. Acculturative stress was a substantive contributor to both depression and anxiety scores. Additional risk factors included the use of maladaptive/avoidant coping styles, age, and education. English language proficiency was strongly protective, as was education to Year 12 and current employment. This research is the first of its kind with this refugee group in Australia, and highlights the longevity and severity of mental health issues that affect Bhutanese refugees resettled in Australia.

The impact of perceived childhood victimization and patriarchal gender ideology on intimate partner violence (IPV) victimization among Korean immigrant women in the USA

Childhood victimization experiences are common among intimate partner violence (IPV) victims. This study examines the link between childhood physical and sexual victimization experiences and adulthood IPV among Korean immigrant women in the USA. As Korean immigrants often use physical punishment to discipline their children, and reporting sexual abuse is discouraged due to stigmatization in this community, cultural factors (e.g. patriarchal values) related to childhood victimization and IPV were also examined. Survey data from Korean immigrant women in the USA were collected. Using a case-control design, we compared 64 Korean immigrant women who have experienced IPV in the past year with 63 Korean immigrant women who have never experienced IPV in their lifetime. The findings of this study reveal that IPV victims, compared with non-victims, experienced higher childhood victimization rates. Logistic regression analysis demonstrated that childhood victimization and patriarchal gender ideology strongly predict IPV victimization among Korean immigrants. However, patriarchal values did not moderate the relationship between childhood victimization and IPV. To prevent IPV among Korean immigrant population, we need to make special efforts to prevent childhood abuse and change ingrained cultural attitudes about child physical and sexual abuse among immigrant communities through culturally sensitive programs.

Intergenerational variation in sexual health attitudes and beliefs among Sudanese refugee communities in Australia

The aim of this study was to develop intergenerational understanding of the factors perceived to be influencing the sexual health and wellbeing of young Sudanese refugees in Queensland, Australia. Data from 11 semi-structured, face-to-face interviews exploring sexual health knowledge, attitudes and behaviours with young people aged 16 to 24 years, and five focus groups with adults from the broader Queensland Sudanese community, were compared and contrasted. Findings indicate that sexual health-related knowledge, attitudes and beliefs, along with patterns of sexual behaviour, are changing post-resettlement and this creates considerable intergenerational discord and family conflict. Study findings provide an understanding of how the interplay between traditional cultural gender, parenting and relationship norms and perceived normative Australian beliefs and patterns of behaviour influence the construction of both young people's and their parents' attitudes to sexual health post-arrival. We suggest that sexuality education programmes adapted to the specific cultural- and age-related contexts need to be introduced early within the resettlement process for both young people and their families.

Epidemiology of Substance Use among Forced Migrants: A Global Systematic Review

INTRODUCTION

Forced migration is occurring at unprecedented levels. Forced migrants may be at risk for substance use for reasons including coping with traumatic experiences, co-morbid mental health disorders, acculturation challenges and social and economic inequality. This paper aimed to systematically review the literature examining substance use among forced migrants, and identify priority areas for intervention and future research.

METHODS

Seven medical, allied health and social science databases were searched from inception to September 2015 in accordance with PRISMA guidelines to identify original peer-reviewed articles describing any findings relating to alcohol and/or illicit drug use among refugees, internally displaced people (IDPs), asylum seekers, people displaced by disasters and deportees. A descriptive synthesis of evidence from quantitative studies was conducted, focusing primarily on studies which used validated measures of substance use. Synthesis of evidence from qualitative studies focused on identifying prominent themes relating to the contexts and consequences of substance use. Critical Appraisal Skills Programme (CASP) checklists were used to assess methodological quality of included studies.

RESULTS

Forty-four quantitative (82% cross-sectional), 16 qualitative and three mixed-methods studies were included. Ten studies were rated as high methodological quality (16%), 39 as moderate quality (62%) and 14 as low quality (22%). The majority of research was conducted among refugees, IDPs and asylum seekers (n = 55, 87%), predominantly in high-income settings. The highest-quality prevalence estimates of hazardous/harmful alcohol use ranged from 17%-36% in camp settings and 4%-7% in community settings. Few studies collected validated measures of illicit drug use. Seven studies compared substance use among forced migrants to other migrant or native-born samples. Among eight studies which conducted multivariable analysis, male sex, trauma exposure and symptoms of mental illness were commonly identified correlates of substance use.

CONCLUSION

Our understanding of substance use among forced migrants remains limited, particularly regarding persons displaced due to disasters, development and deportation. Despite a growing body of work among refugee-background populations, few studies include refugees in low and middle-income countries, where over 80% of the global refugee population resides. Findings suggest a need to integrate substance use prevention and treatment into services offered to forced migrants, particularly in camp settings. Efforts to develop and evaluate interventions to reduce substance use and related harms are needed.

A Comparison of Goal Setting and Reputational Orientations of African Adolescents From Refugee Backgrounds in Intensive English Centers and Mainstream Secondary School Classrooms

We compared the goals, reputations and behaviours of three groups: African adolescents from refugee backgrounds in Australian Intensive English Centres (IEC), African adolescents who have transitioned from an IEC into mainstream schooling, and Australian mainstream adolescents. We posit the need for African adolescents from refugee backgrounds to identify with the dominant social group within the IEC and mainstream settings is important for the goals they set, the reputations they choose, and the manner in which they pursue them. To this end, we conducted a cross sectional comparison through Reputation Enhancing Goals Theory, an approach congruent with sociocultural adaptation. We found African adolescents in IEC contexts set academic goals associated with a conforming reputation, whereas African adolescents in mainstream schooling set social goals associated with a non-conforming reputation. Australian mainstream students had an equal split between academic and social goals and conforming/non-conforming reputations. Each of the three groups indulged in behaviours congruent with the goals set and reputation sought. A series of multiple-mediation models revealed significant indirect effects on a number of variables via School Connectedness, Control over most important goal, and to a lesser extent Goals. African adolescents in mainstream schooling attempt to adapt to another dominant culture (i.e., mainstream peers) on transitioning from IEC, but face confusion about who they are and who they wish to be. The implications for adolescents from African refuge backgrounds is, that while placing them in IECs for up to two years is laudable, further support is needed when they transition to mainstream schooling.

Between power and powerlessness: a meta-ethnography of sources of resilience in young refugees

OBJECTIVE

This article reviews available qualitative studies that report young refugees' ways of dealing with adversity to address their sources of resilience.

DESIGN

We searched five electronic databases. Twenty-six empirical studies were included in the review. A meta-ethnography approach was used to synthesize these qualitative studies.

RESULTS

Six sources of resilience emerged: (1) social support, (2) acculturation strategies, (3) education, (4) religion, (5) avoidance, and (6) hope. These sources indicated social as well as personal factors that confer resilience in young refugees, but most of them also had counterproductive aspects.

CONCLUSION

The results, from an ecological developmental perspective, stressed the interplay between protective and risk processes in the mental health of young refugees who had resettled in Western countries, and they emphasized the variability as well as the universality of resilience-promoting processes. Further research is needed to explore the cultural shape of resilience and the long-term consequences of war and migration on young refugees.

Experiences of and attitudes toward injecting drug use among marginalized African migrant and refugee youth in Melbourne, Australia

Little is known about injecting drug use (IDU) among people from culturally and linguistically diverse backgrounds in Australia. We interviewed 18 young people of African ethnicity (6 current/former injectors, 12 never injectors) about exposure and attitudes to IDU. Exposure to IDU was common, with IDU characterized as unnatural, risky and immoral. IDU was highly stigmatized and hidden from family and friends. There is a need for culturally appropriate programs to promote open dialogue about substance use to reduce stigma and prevent African youth who may use illicit drugs from becoming further marginalized.

Heavy alcohol consumption among marginalised African refugee young people in Melbourne, Australia: motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking

OBJECTIVE

Little is known about substance use among resettled refugee populations. This study aimed to describe motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking among marginalised African refugee young people in Melbourne, Australia.

DESIGN

Face-to-face interviews were conducted with 16 self-identified African refugees recruited from street-based settings in 2012-2013. Interview transcripts were analysed inductively to identify key themes.

RESULTS

Participants gathered in public spaces to consume alcohol on a daily or near-daily basis. Three key motivations for heavy alcohol consumption were identified: drinking to cope with trauma, drinking to cope with boredom and frustration and drinking as a social experience. Participants reported experiencing a range of health and social consequences of their alcohol consumption, including breakdown of family relationships, homelessness, interpersonal violence, contact with the justice system and poor health. Strategies for managing drinking included attending counselling or residential detoxification programmes, self-imposed physical isolation and intentionally committing crime in order to be incarcerated.

CONCLUSION

These findings highlight the urgent need for targeted harm reduction education for African young people who consume alcohol. Given the importance of social relationships within this community, use of peer-based strategies are likely to be particularly effective. Development and implementation of programmes that address the underlying health and psychosocial causes and consequences of heavy alcohol use are also needed.

Household food insecurity shows associations with food intake, social support utilization and dietary change among refugee adult caregivers resettled in the United States

Forced migration puts families at risk of household food insecurity and economic hardship. We administered a questionnaire to examine household food insecurity in a sample of 49 recently legally resettled Sudanese refugees with at least one child under age 3 years. Of households polled, 37% had experienced household food insecurity and 12% reported child hunger within the previous month. Increasing severity of household food insecurity was associated with decreased consumption of high-cost, high-nutrient-density food items and increased consumption of some low-cost traditional Sudanese foods by adult caregivers of young children. Furthermore, household food insecurity was associated with decreased household and per capita food expenditure, indicators of more limited dietary change with migration, and indicators of increased social support.

Hidden yet visible: methodological challenges researching sexual health in Sudanese refugee communities

Research addressing sensitive topics with people from small, minority, ethnic communities can present challenges that are difficult to address using conventional methods. This paper reports on the methodological approach used to explore sexual health knowledge, attitudes and beliefs among the Sudanese community in Queensland, Australia. The multiphase, mixed-method study involved young people 16 to 24 years of age participating in a written survey and semi-structured interview and focus-group discussions with the broader Queensland Sudanese community members. Community collaboration, the key factor to the success of this research, optimised the development of a research environment that built trust and facilitated access and subsequent understanding. Research conducted in partnership with the target community can address methodological challenges and produce meaningful information when researching sensitive topics with small but 'highly-visible' populations.

Sudanese Refugees in Australia: The Impact of Acculturation Stress

Refugees from Sudan are the fastest growing community in Australia. Australian mental health professionals have to be prepared to offer services to this ethnic group along with the other mainstream and diverse consumers. In order to offer culturally competent services, these mental health professionals are required to be familiar with this emerging community. As such, a review was undertaken with two main goals. Firstly, the review aimed to educate Australian mental health professionals about the demographics and culture of Sudan, the traumas encountered as a result of the civil war, factors leading to massive exodus and the difficulties of the transit and postmigration phase. Secondly, the review intended to inform Australian mental health professionals about the possible acculturation stress that is manifested in the form of intergeneration and role conflict and marital difficulties. The review highlights limitations on the number of studies addressing acculturation stress of Sudanese refugees and even fewer on the impact it has on relationships. Future research directions are discussed.