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Lor M, Yu Z, Chen W, Xiong Y, Yonker JA, Brown R, Krahn DD. Refugee-related trauma patterns and mental health symptoms across three generations of Hmong Americans. J Trauma Stress 2022; 35:1087-1098. [PMID: 35201638 PMCID: PMC9355917 DOI: 10.1002/jts.22813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/01/2022] [Accepted: 01/13/2022] [Indexed: 11/11/2022]
Abstract
Hmong adults who are Vietnam War refugees have been exposed to refugee-related trauma, but little is known about associations between patterns of trauma exposure and mental health outcomes in Hmong adults. We examined patterns of trauma exposure and mental health symptoms (i.e., somatization, depression, anxiety, and probable posttraumatic stress disorder [PTSD]) in three generations of Hmong adults (N = 219). Trauma exposure and probable PTSD were measured using the Harvard Trauma Questionnaire-Hmong Version. Somatization, depression, and anxiety symptoms were measured using the Brief Symptom Inventory. Latent class analysis (LCA) and auxiliary analysis of sociodemographic characteristics and mental health symptoms were performed. The best-fitting LCA model described three distinct classes: complex and pervasive trauma (60.3%), combat situation and deprivation trauma (26.0%), and low exposure to refugee-related trauma (13.7%). Participants in the complex and pervasive trauma class were the oldest, had the shortest U.S. residency, were the least proficient in English, and reported the most severe mental health symptoms; those in the combat situation and deprivation trauma class were the youngest, moderately proficient in English, and reported moderate mental health symptoms; and those in the low exposure to refugee-related trauma class were the most proficient in English, had the longest U.S. residency, and reported the least severe mental health symptoms. Our findings call for surveillance and a trauma-informed approach for Hmong elders with limited English proficiency, who have a high risk of experiencing accumulative effects of refugee-related trauma and are susceptible to poor mental health outcomes.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin–Madison, Wisconsin, USA
| | - Zhiyuan Yu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Wenyi Chen
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Yee Xiong
- University of Wisconsin–Madison, Wisconsin, USA
| | | | - Roger Brown
- University of Wisconsin–Madison, Wisconsin, USA
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Salama E, Castaneda AE, Suvisaari J, Rask S, Laatikainen T, Niemelä S. Substance use, affective symptoms, and suicidal ideation among Russian, Somali, and Kurdish migrants in Finland. Transcult Psychiatry 2022; 59:37-51. [PMID: 32164497 PMCID: PMC8859688 DOI: 10.1177/1363461520906028] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Comorbidity of substance use with affective symptoms and suicidality has been well documented in the general population. However, population-based migrant studies about this association are scarce. We examined the association of affective symptoms and suicidal ideation with binge drinking, daily smoking, and lifetime cannabis use among Russian, Somali, and Kurdish migrants in comparison with the Finnish general population. Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu, n = 1307) and comparison group data of the general Finnish population (n = 860) from the Health 2011 Survey were used. Substance use included self-reported current binge drinking, daily smoking, and lifetime cannabis use. Affective symptoms and suicidal ideation were measured using the Hopkins Symptom Checklist-25 (HSCL-25). We performed multivariate logistic regression analyses, including age, gender, and additional socio-demographic and migration-related factors. Suicidal ideation (OR 2.4 95% CI 1.3-4.3) was associated with binge drinking among Kurds and lifetime cannabis use among Russians (OR 5.6, 95% CI 1.9-17.0) and Kurds (OR 5.5, 95% CI 1.9-15.6). Affective symptoms were associated with daily smoking (OR 1.6, 95% CI 1.02-2.6) and lifetime cannabis use (OR 6.1, 95% CI 2.6-14.5) among Kurdish migrants. Our results draw attention to the co-occurrence of suicidal ideation, affective symptoms, and substance use, especially among Kurdish migrants. These results highlight the variation of comorbidity of substance use and affective symptoms between the different populations. This implies that screening for substance use in mental healthcare cannot be neglected based on presumed habits of substance use.
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Affiliation(s)
- Essi Salama
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Turku, Finland.,Child Psychiatry, Turku University Hospital, Finland
| | - Anu E Castaneda
- National Institute for Health and Welfare (THL), Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | | | - Shadia Rask
- National Institute for Health and Welfare (THL), Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL), Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.,Joint municipal authority for North Karelia social and health services (Siun sote), Finland
| | - Solja Niemelä
- Department of Psychiatry, University of Turku, Finland.,Addiction Psychiatry Unit, Turku University Hospital, Finland
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Straiton ML, Powell K, Reneflot A, Diaz E. Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services. Health Care Women Int 2015; 37:118-39. [PMID: 26251953 DOI: 10.1080/07399332.2015.1077844] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term "immigrants" masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success.
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Affiliation(s)
- Melanie L Straiton
- a Division of Mental Health , Norwegian Institute of Public Health , Oslo , Norway.,b School of Psychology , University of Adelaide , Adelaide , South Australia , Australia
| | - Kathryn Powell
- c School of Population Health , University of Adelaide , Adelaide , South Australia , Australia
| | - Anne Reneflot
- a Division of Mental Health , Norwegian Institute of Public Health , Oslo , Norway
| | - Esperanza Diaz
- d Department of Global Public Health and Primary Health Care , University of Bergen , Bergen , Norway
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Bolton P, Bass JK, Zangana GAS, Kamal T, Murray SM, Kaysen D, Lejuez CW, Lindgren K, Pagoto S, Murray LK, Van Wyk SS, Ahmed AMA, Mohammad Amin NM, Rosenblum M. A randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraq. BMC Psychiatry 2014; 14:360. [PMID: 25551436 PMCID: PMC4301059 DOI: 10.1186/s12888-014-0360-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Experiencing systematic violence and trauma increases the risk of poor mental health outcomes; few interventions for these types of exposures have been evaluated in low resource contexts. The objective of this randomized controlled trial was to assess the effectiveness of two psychotherapeutic interventions, Behavioral Activation Treatment for Depression (BATD) and Cognitive Processing Therapy (CPT), in reducing depression symptoms using a locally adapted and validated version of the Hopkins Symptom Checklist and dysfunction measured with a locally developed scale. Secondary outcomes included posttraumatic stress, anxiety, and traumatic grief symptoms. METHODS Twenty community mental health workers, working in rural health clinics, were randomly assigned to training in one of the two interventions. The community mental health workers conducted baseline assessments, enrolled survivors of systematic violence based on severity of depression symptoms, and randomly assigned them to treatment or waitlist-control. Blinded community mental health workers conducted post-intervention assessments on average five months later. RESULTS Adult survivors of systematic violence were screened (N = 732) with 281 enrolled in the trial; 215 randomized to an intervention (114 to BATD; 101 to CPT) and 66 to waitlist-control (33 to BATD; 33 to CPT). Nearly 70% (n = 149) of the intervention participants completed treatment and post-intervention assessments; 53 (80%) waitlist-controls completed post-intervention assessments. Estimated effect sizes for depression and dysfunction were 0.60 and 0.55 respectively, comparing BATD participants to all controls and 0.84 and 0.79 respectively, compared to BATD controls only. Estimated effect sizes for depression and dysfunction were 0.70 and 0.90 respectively comparing CPT participants to all controls and 0.44 and 0.63 respectively compared to CPT controls only. Using a permutation-based hypothesis test that is robust to the model assumptions implicit in regression models, BATD had significant effects on depression (p = .003) and dysfunction (p = .007), while CPT had a significant effect on dysfunction only (p = .004). CONCLUSIONS Both interventions showed moderate to strong effects on most outcomes. This study demonstrates effectiveness of these interventions in low resource environments by mental health workers with limited prior experience. TRIAL REGISTRATION ClinicalTrials.Gov NCT00925262 . Registered June 3, 2009.
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Affiliation(s)
- Paul Bolton
- Center for Refugee and Disaster Response and Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E8646, Baltimore, MD, 21205, USA. .,Applied Mental Health Research Group, Center for Refugee and Disaster Response, Johns Hopkins University Bloomberg School of Public Health, c/o 159 Tilden Road, Scituate, MA, 02066, USA.
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD, 21205, USA.
| | | | - Talar Kamal
- Fine Arts Institute, University of Sulaimani, Kurdistan Region, Iraq.
| | - Sarah McIvor Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD, 21205, USA.
| | - Debra Kaysen
- Department of Psychiatry & Behavioral Sciences, University of Washington, 1100 NE 45th Street, Suite 300, Seattle, WA, 98105, USA.
| | - Carl W Lejuez
- Department of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, College Park, MD, 20742-5141, USA.
| | - Kristen Lindgren
- Center for the Study of Health and Risk Behaviors, University of Washington, 1100 NE 45th, Suite 300, Seattle, WA, 98105, USA.
| | - Sherry Pagoto
- Division of Preventive and Behavior Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD, 21205, USA.
| | - Stephanie Skavenski Van Wyk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD, 21205, USA.
| | - Ahmed Mohammed Amin Ahmed
- Trauma Rehabilitation and Training Center, and Department of Community Health, Sulaimania Polytechnic University, Sulaimania, Kurdistan Region, Iraq.
| | | | - Michael Rosenblum
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Room E3616, Baltimore, MD, 21205, USA.
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Straiton M, Reneflot A, Diaz E. Immigrants' use of primary health care services for mental health problems. BMC Health Serv Res 2014; 14:341. [PMID: 25127890 PMCID: PMC4137098 DOI: 10.1186/1472-6963-14-341] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 08/08/2014] [Indexed: 12/22/2022] Open
Abstract
Background Equity in health care across all social groups is a major goal in health care policy. Immigrants may experience more mental health problems than natives, but we do not know the extent to which they seek help from primary health care services. This study aimed to determine a) the rate immigrants use primary health care services for mental health problems compared with Norwegians and b) the association between length of stay, reason for immigration and service use among immigrants. Methods National register data covering all residents in Norway and all consultations with primary health care services were used. We conducted logistic regression analyses to compare Norwegians’ with Polish, Swedish, German, Pakistani and Iraqi immigrants’ odds of having had a consultation for a mental health problem (P-consultation). Results After accounting for background variables, all immigrants groups, except Iraqi men had lower odds of a P-consultation than their Norwegian counterparts. A shorter length of stay was associated with lower odds of a P-consultation. Conclusions Service use varies by country of origin and patterns are different for men and women. There was some evidence of a possible ‘healthy migrant worker’ effect among the European groups. Together with previous research, our findings however, suggest that Iraqi women and Pakistanis in particular, may experience barriers in accessing care for mental health problems.
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Affiliation(s)
- Melanie Straiton
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
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Erdal K, Singh N, Tardif A. Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway. J Affect Disord 2011; 133:481-8. [PMID: 21620476 DOI: 10.1016/j.jad.2011.04.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Internationally, depression is a common psychological disorder whose treatment depends upon its identification by treating professionals as well as patient utilization of mental health care systems; the latter often being hampered by cultural differences between patients and health professionals. METHOD The current study used vignettes of depressed patients which varied the culture and/or social circumstances of the patient to assess whether these variables influenced the conceptualization of depression and its treatment. Participants (N=722) included mental health professionals, lay people, immigrants, and refugees in Norway. RESULTS We found that immigrants and refugees, particularly those of non-western origin, endorsed different types of depression treatments from native Norwegians and mental health professionals, and judged who deserved treatment and who was overreacting based on the patient's culture and social circumstances, while native Norwegians did not. LIMITATIONS While widely used cross-culturally, vignette methodology is limited in its generalizability to real clinical situations. Acculturation was not evaluated, which may have influenced the results. CONCLUSIONS Findings support the integration of cultural competency ideals not only into treatment, but also into public health promotions of mental health services for lay people.
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Affiliation(s)
- Kristi Erdal
- Department of Psychology, The Colorado College, 14 East Cache La Poudre Street, Colorado Springs, CO 80903, USA.
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