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Perich T, Andriessen K. The impact of family history of mental illness on mental health help seeking in university students. J Ment Health 2024:1-7. [PMID: 38832569 DOI: 10.1080/09638237.2024.2361235] [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: 07/18/2023] [Accepted: 03/22/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND University students with a family history of mental illness may have an increased risk of developing mental health problems. AIMS The aim of the study was to assess differences in mental health help seeking among students with a family history of mental illness compared to those without a family history. METHODS A total of 1127 university students, aged 18 to 30 years, completed an online survey with questions about mental illness, family history of mental illness, help seeking, and psychological symptoms. RESULTS Students with a family history of mental illness were more likely to report clinically significant symptoms and more likely to use social media and online support programs. They reported similar rates of in-person help seeking. Those with more than one family member with a mental illness reported greater symptom severity, more use of online programs, and increased likelihood of prescription drug use than those with only one family member. CONCLUSIONS More research is needed to understand how to increase access to mental health care and to address barriers to help-seeking considering family history of mental illness. University students may not be accessing appropriate treatment and care as required, with the rates of in-person help-seeking being low overall.
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Affiliation(s)
- Tania Perich
- School of Psychology, Western Sydney University, Penrith, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Billian J, Imfeld L, Roth CB, Moeller J, Lang UE, Huber CG. Treatment-seeking threshold and accessibility of psychiatric outpatient services in Switzerland: the relationship with stigma and self-esteem. Front Psychiatry 2024; 15:1377971. [PMID: 38680786 PMCID: PMC11045997 DOI: 10.3389/fpsyt.2024.1377971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Perceived stigmatization and low self-esteem are linked to poorer mental health outcomes, but their impact on treatment-seeking thresholds and the importance of outpatient service location remain unclear. The study included 525 outpatients of the University Psychiatric Clinic (UPK) Basel, Switzerland, of whom 346 were treated at inner city services and 179 at services located on the main site of the UPK at the outer city limits. Perceived discrimination and devaluation (PDD), self-esteem (SE), treatment-seeking threshold (TST), and accessibility were measured via a self-reported questionnaire. The PDD consisted of 12 items evaluating beliefs about the level of stigma towards individuals with mental illness in the general population on a 5-point Likert scale. SE, TST and accessibility were assessed through single-item 7-point Likert scales. PDD and SE were positively correlated (p < 0.001), suggesting that lower perceived stigma was linked to higher self-esteem, and were not associated with TST. The relationship between PDD and SE remained consistent after controlling for age, gender, and nationality. Age was negatively correlated with TST (p = 0.022), while gender did not significantly influence any of the variables. There was little variation regarding PDD, with emergencies at the site of the psychiatric clinic and substance use disorder (SUD) patients reporting higher levels of stigmatization. Emergency patients and those with SUD and personality disorder reported the lowest SE ratings. TST showed a broad range and was highest for emergency services and transcultural psychiatry patients. Differences in accessibility were mainly linked to the location, with outpatient service users in the inner city reporting better accessibility (p < 0.001) and higher SE (p = 0.009). In comparison to patients using services with planned contacts only, patients in emergency settings differed by higher TST (p = 0.018) and better ratings of accessibility (p = 0.004). In conclusion, there was a relevant amount of stigmatization, impaired self-esteem, and, for some outpatient services, high thresholds to seek treatment. Future research should explore other factors influencing TST. The findings highlight the need to address stigmatization and accessibility when planning mental health services.
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Affiliation(s)
- Janina Billian
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Lukas Imfeld
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Institute for Evaluation Research, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Basel, Switzerland
| | - Carl B. Roth
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Julian Moeller
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Undine E. Lang
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Christian G. Huber
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
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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.
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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
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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.
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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
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Madsen J, Jobson L, Slewa-Younan S, Li H, King K. Mental health literacy among Arab men living in high-income Western countries: A systematic review and narrative synthesis. Soc Sci Med 2024; 346:116718. [PMID: 38489937 DOI: 10.1016/j.socscimed.2024.116718] [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: 07/01/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
While interest in mental health literacy (MHL) is growing rapidly, cross-cultural research focusing on MHL is developing more slowly. This inaugural systematic review explored the recognition and beliefs about the causes of mental health disorders amongst Arab men living in high income Western countries (HIWC), their help-seeking beliefs, behaviors, and sources of help, as well as barriers and facilitators to help-seeking. Six electronic database searches were conducted using Medline, Embase, ProQuest Dissertations & Theses Global, PsycINFO, Scopus, and Web of Science. These searches yielded a total of 9,460 citations. After applying inclusion criteria through both database and manual hand searches, 46 studies were identified. The findings corresponded with four of the socioecological model's five factors: intrapersonal, interpersonal, societal, and institutional. Intrapersonal factors included attributing mental health illness to life and migration stressors, and religious reasons. Interpersonal and societal factors included men favoring informal help-seeking sources as stigma was a barrier to formal help-seeking. Institutional factors around the perceived cultural competence of healthcare professionals and access difficulties were obstacles to seeking formal help. The growth in Arab migration to HIWC highlights the need for culturally tailored care. Research is needed to understand the perspectives of healthcare providers working with Arab men in addition to how men's stigmatizing attitudes are an obstacle to formal help-seeking. Interventions should be designed to address the unique mental health needs of Arab men, recognizing that some explanatory beliefs may not align with current Western models of mental health. Moreover, efforts should be made to integrate men's informal sources of support into treatment planning.
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Affiliation(s)
- Julian Madsen
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Shameran Slewa-Younan
- Macarthur Clinical School, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 275, Australia.
| | - Haoxiang Li
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Kylie King
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
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Mastrogiovanni N, Byrow Y, Nickerson A. The Development and Validation of a Measure of Mental Health, Help-Seeking Beliefs in Arabic-Speaking Refugees. Assessment 2023:10731911231220482. [PMID: 38159035 DOI: 10.1177/10731911231220482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Despite reporting elevated rates of posttraumatic stress disorder (PTSD), refugees are less likely than other groups to seek psychological treatment. Relatively little attention has been paid to the role of negative help-seeking beliefs in influencing treatment uptake. The current study sought to develop and psychometrically validate a novel measure indexing negative help-seeking beliefs for refugees (Help-Seeking Beliefs Scale [HSBS]). In this study, 262 Arabic-speaking refugee participants completed an online survey consisting of the HSBS along with measures indexing similar constructs (self-stigma of PTSD and help-seeking, perceived stigma, negative help-seeking attitudes, and help-seeking intentions). Factor analysis revealed a three-factor structure aligning with key themes identified in the literature: (a) Fear of Negative Consequences, (b) Inappropriateness, and (c) Perceived Necessity. The scale demonstrated excellent internal consistency, convergent validity, and predicted reduced help-seeking intentions. Results support the utility of a novel measure capturing a prominent help-seeking barrier in a population with high psychopathology and low treatment uptake.
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Mehjabeen D, Blignault I, Taha PH, Reavley N, Slewa-Younan S. A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants. BMC Public Health 2023; 23:2544. [PMID: 38124024 PMCID: PMC10731719 DOI: 10.1186/s12889-023-17395-9] [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: 09/14/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations. METHODS English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456). RESULTS Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions. CONCLUSION Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.
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Affiliation(s)
- Deena Mehjabeen
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.
| | - Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Perjan Hashim Taha
- College of Medicine, University of Duhok, Duhok, Iraq
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shameran Slewa-Younan
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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8
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Findlater L, Robin C, Hopgood K, Waite T. Help-seeking following a flooding event: a cross-sectional analysis of adults affected by flooding in England in winter 2013/14. Eur J Public Health 2023; 33:834-840. [PMID: 37328436 PMCID: PMC10567239 DOI: 10.1093/eurpub/ckad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Flooding can cause long-term, significant impacts on mental health in affected populations. We explored help-seeking behaviour of households affected by flooding. METHODS A cross-sectional analysis was conducted on National Study of Flooding and Health data on households flooded in England in winter 2013/14. Participants (Year 1: n = 2006; Year 2: n = 988; Year 3: n = 819) were asked if they sought help from health services and other sources. Logistic regression was conducted to calculate odds ratios (ORs) of help-seeking in flooded and disrupted participants compared to unaffected, adjusted for a priori confounders. RESULTS The odds of seeking help from any source 1 year after flooding were greater for flooded participants [adjusted OR (aOR): 1.71, 95% confidence interval (CI): 1.19-1.45] and those disrupted by flooding (aOR: 1.92, 95% CI: 1.37-2.68) compared to unaffected participants. This continued in the second year (flooded: aOR 6.24, 95% CI: 3.18-13.34; disrupted: aOR: 2.22, 95% CI: 1.14-4.68), and help-seeking remained greater in flooded than unaffected participants in the third year. Flooded and disrupted participants were particularly likely to seek help from informal sources. Help-seeking was more prevalent amongst participants with mental health outcomes, but a notable proportion of individuals with any mental health outcome did not seek help (Year 1: 15.0%; Year 2: 33.3%; Year 3: 40.3%). CONCLUSIONS Flooding is associated with increased demand for formal and informal support, persisting for at least 3 years, and an unmet need for help amongst affected individuals. Our findings should be considered in flood response planning to reduce the long-term adverse health impacts of flooding.
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Affiliation(s)
- L Findlater
- UK Health Security Agency, Bristol, UK
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) on Behavioural Science and Evaluation at the University of Bristol, Bristol, UK
| | - C Robin
- UK Health Security Agency, Bristol, UK
- National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) on Behavioural Science and Evaluation at the University of Bristol, Bristol, UK
| | - K Hopgood
- UK Health Security Agency, Bristol, UK
| | - T Waite
- Department of Health and Social Care, UK
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van der Schyff EL, Ridout B, Amon KL, Forsyth R, Campbell AJ. Providing Self-Led Mental Health Support Through an Artificial Intelligence-Powered Chat Bot (Leora) to Meet the Demand of Mental Health Care. J Med Internet Res 2023; 25:e46448. [PMID: 37335608 DOI: 10.2196/46448] [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: 02/12/2023] [Revised: 04/21/2023] [Accepted: 05/17/2023] [Indexed: 06/21/2023] Open
Abstract
Digital mental health services are becoming increasingly valuable for addressing the global public health burden of mental ill-health. There is significant demand for scalable and effective web-based mental health services. Artificial intelligence (AI) has the potential to improve mental health through the deployment of chatbots. These chatbots can provide round-the-clock support and triage individuals who are reluctant to access traditional health care due to stigma. The aim of this viewpoint paper is to consider the feasibility of AI-powered platforms to support mental well-being. The Leora model is considered a model with the potential to provide mental health support. Leora is a conversational agent that uses AI to engage in conversations with users about their mental health and provide support for minimal-to-mild symptoms of anxiety and depression. The tool is designed to be accessible, personalized, and discreet, offering strategies for promoting well-being and acting as a web-based self-care coach. Across all AI-powered mental health services, there are several challenges in the ethical development and deployment of AI in mental health treatment, including trust and transparency, bias and health inequity, and the potential for negative consequences. To ensure the effective and ethical use of AI in mental health care, researchers must carefully consider these challenges and engage with key stakeholders to provide high-quality mental health support. Validation of the Leora platform through rigorous user testing will be the next step in ensuring the model is effective.
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Affiliation(s)
- Emma L van der Schyff
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Brad Ridout
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Krestina L Amon
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Rowena Forsyth
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Andrew J Campbell
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, The University of Sydney, Sydney, Australia
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Hanft-Robert S, Lindberg LG, Mösko M, Carlsson J. A balancing act: how interpreters affect the therapeutic alliance in psychotherapy with trauma-affected refugees-a qualitative study with therapists. Front Psychol 2023; 14:1175597. [PMID: 37260954 PMCID: PMC10228651 DOI: 10.3389/fpsyg.2023.1175597] [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: 02/27/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Objective The therapeutic alliance (TA) has the highest predictive value concerning the success of psychotherapy. The presented study aimed to explore how the presence of an interpreter affects the TA when working with trauma-affected refugees. Method Semi-structured interviews were conducted with seven psychologists working in an outpatient clinic specialized in mental health care for migrant and refugee patients with trauma-related mental health problems in Denmark. Interviews were transcribed verbatim and analyzed using a structuring content analysis approach. Results TA has been described as a dynamic therapist-interpreter-patient alliance triangle consisting of three distinct but highly intertwined and mutually influential dyadic alliances. Specific factors affecting the quality of the TA were identified, e.g., interpreter being emotionally attuned yet not overly involved; interpreter being barely visible yet present as a human being. Characteristics of trauma-affected refugee patients affecting the TA formation were also identified, e.g., a high level of personal distrust, different understandings of mental disorders and psychotherapy, stigmatization, perceptions of authorities. Conclusion The presence of interpreters was perceived ambivalently and the formation of a good TA seems to be a balancing act. Based on the findings, recommendations for forming and maintaining a good TA in interpreter-mediated psychotherapy are provided.
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Affiliation(s)
- Saskia Hanft-Robert
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Glahder Lindberg
- Mental Health Center Ballerup, Copenhagen University Hospital – Mental Health Services Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mike Mösko
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany
| | - Jessica Carlsson
- Mental Health Center Ballerup, Copenhagen University Hospital – Mental Health Services Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Carew JW, Hamze M, Atassi B, Abbara A, Khoshnood K. Investment in Cancer Prevention and Care for Forcibly Displaced Syrians Is an Urgent Priority. JCO Glob Oncol 2023; 9:e2200382. [PMID: 36595718 PMCID: PMC10166440 DOI: 10.1200/go.22.00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- John W Carew
- Science Health Education Center, Dana Farber Cancer Institute, Boston, MA
| | | | - Bassel Atassi
- OSF Little Company of Mary Medical Center, Evergreen Park, IL
| | - Aula Abbara
- Department of Infectious Diseases, Imperial College, London, United Kingdom
| | - Kaveh Khoshnood
- Yale School of Public Health, Yale University, New Haven, CT
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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: 0] [Impact Index Per Article: 0] [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.
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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
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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
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14
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Zheng M, Chen F, Pan Y, Kong D, Renzaho AMN, Sahle BW, Mahumud RA, Ling L, Chen W. Trends and Impact Factors of Mental Health Service Utilization among Resettled Humanitarian Migrants in Australia: Findings from the BNLA Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10119. [PMID: 36011758 PMCID: PMC9408151 DOI: 10.3390/ijerph191610119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Resettled humanitarian migrants (HMs) have high levels of mental disorders, but factors associated with the utilization of mental health services (MHS) are poorly understood. We aimed to explore trends and impact factors of MHS utilization among HMs in the process of resettlement in Australia. A total of 2311 HMs from the 1st (2013), 3rd, and 5th (2018) waves of a national cohort study were included. MHS utilization in the past year was assessed by two indicators: having MHS contacts and the frequency of MHS contacts. Trends were identified by Cochran-Armitage tests, and generalized linear mixed models and ordered logistic models were fitted to explore impact factors of MHS utilization. The proportion of having MHS contacts significantly rose from 13.0% to 29.4% over the five years. MHS utilization was mainly driven by perceived needs, such as post-traumatic stress disorders and the degree of post-migration stress. Unemployment and strong belongingness to the local community were also associated with having MHS contacts. No significant gender difference was found in having MHS contacts but females tended to contact MHS more frequently. Resettled HMs have a persistent dilemma of high mental illness prevalence and MHS underutilization. Sustainable mental health education and long-term resettlement services targeted at social integration that consider gender difference are urgently needed in host countries.
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Affiliation(s)
- Meng Zheng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Feng Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Yan Pan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Di Kong
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Andre M. N. Renzaho
- School of Medicine, Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2751, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Berhe W. Sahle
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, VIC 3125, Australia
- Centre for Quality and Patient Safety Research, Alfred Health Partnership, Institute for Health Transformation, Melbourne, VIC 3125, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3125, Australia
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
- Center for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou 510080, China
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15
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Shawcroft J, Coyne SM. Does Thor ask Iron Man for Help? Examining Help-Seeking Behaviors in Marvel Superheroes. SEX ROLES 2022. [DOI: 10.1007/s11199-022-01301-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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16
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Lechner-Meichsner F, Comtesse H. Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees. Front Psychiatry 2022; 13:852714. [PMID: 35479495 PMCID: PMC9037322 DOI: 10.3389/fpsyt.2022.852714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees. Method We focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis. Results In both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help. Conclusion Results suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size.
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Affiliation(s)
- Franziska Lechner-Meichsner
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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17
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Ahmadinia H, Eriksson-Backa K, Nikou S. Health information seeking behaviour during exceptional times: A case study of Persian-speaking minorities in Finland. LIBRARY & INFORMATION SCIENCE RESEARCH 2022. [DOI: 10.1016/j.lisr.2022.101156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Denkinger JK, Rometsch C, Murray K, Schneck U, Brißlinger LK, Rahmani Azad Z, Windthorst P, Graf J, Hautzinger M, Zipfel S, Junne F. Addressing barriers to mental health services: evaluation of a psychoeducational short film for forcibly displaced people. Eur J Psychotraumatol 2022; 13:2066458. [PMID: 35646296 PMCID: PMC9132417 DOI: 10.1080/20008198.2022.2066458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the high prevalence of mental illness in forcibly displaced people, their utilization of mental health services is low. Major barriers to seeking mental health services include mental health self-stigma. To address this issue, the psychoeducational short film 'Coping with Flight and Trauma' was developed as a brief online intervention. OBJECTIVE The present study aims to evaluate the feasibility and acceptance of the newly developed 10 min film, and to assess changes in self-stigma and help seeking. METHOD The evaluation of the film was conducted using a mixed-methods design with an online survey including the Self-Stigma of Mental Illness Scale, help seeking, and mental health variables at baseline, postintervention, and 3 month follow-up, in addition to telephone interviews postintervention with a randomly selected volunteer subsample. RESULTS A total of 134 participants with a forced displacement history within the past 8 years took part in the study, of whom 66% scored as having probable post-traumatic stress disorder (PTSD), depression, and/or anxiety. The results revealed emotional, cognitive, and behavioural changes postintervention. Directly after watching the film, participants reported reduced self-stigma and increased openness towards accessing mental health services. At follow-up, precisely 3.8 months later, these changes were no longer significant, yet 11% of participants reported having started psychotherapy since watching the film. Probable PTSD was associated with higher self-stigma at all three time-points. The majority (90%) would recommend watching the film to other forcibly displaced people. CONCLUSIONS Self-stigma was shown to be a robust and persistent issue, which tends to be underestimated by individuals not affected by mental illness. Low-threshold psychoeducational online interventions may be a promising tool to reduce barriers to accessing mental health services for forcibly displaced people, e.g. by being implemented in stepped-care models. HIGHLIGHTS Mental health self-stigma was shown to be a persistent and underestimated burden in forcibly displaced people.Psychoeducational online interventions are promising for addressing the burden of self-stigma and reducing barriers to seeking mental health services.
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Affiliation(s)
- J K Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - C Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - K Murray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - U Schneck
- refugio stuttgart e.v., Stuttgart, Germany
| | - L K Brißlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Z Rahmani Azad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - P Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Hospital Havelhöhe, Berlin, Germany
| | - J Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - M Hautzinger
- Department of Clinical Psychology and Psychotherapy, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - S Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - F Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
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19
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Albanian Migrants in Cyclades: Contact with Mental Health Services and Implications for Practice. PSYCH 2021. [DOI: 10.3390/psych3040057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to examine the potential differences between Albanian migrants and Greeks in the islands of Paros and Antiparos with regard to seeking help from the local public mental health service, namely the Mobile Mental Health Unit of NE Cyclades Islands (EPAPSY-NGO). The study’s instruments include the Global Assessment of Functioning (GAF) and a questionnaire for recording psychosocial profile data and information concerning contact with the services. The results showed that significantly less Albanian migrants contacted the mental health services in the past in comparison to Greeks. When using the service, the Albanians were more likely to see a psychiatrist in the Unit, rather than a psychologist-psychotherapist, and they more often received prescriptions for medication. There was a significantly higher dropout rate among Albanian migrants. This study highlights the different aspects of access and use of mental health services among Albanian migrants compared with native residents. Further research should focus on the factors related to early dropouts and difficulties accessing mental health services in rural areas, in order to develop more focused and effective interventions and improve the quality of care provided.
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20
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Hack-Polay D, Mahmoud AB, Kordowicz M, Madziva R, Kivunja C. "Let us define ourselves": forced migrants' use of multiple identities as a tactic for social navigation. BMC Psychol 2021; 9:125. [PMID: 34433484 PMCID: PMC8386008 DOI: 10.1186/s40359-021-00630-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The article examines how and why multiple identities are altered, used and discarded by forced migrants. Methods The research is located in the constructivist paradigm. We used thematic analysis to analyse data gathered through interviews with nineteen forced migrants. Results We found that, though individual migrants can make deliberate choices about which identities to be associated with, they are constrained in the process by external socio-economic factors that lead them to adopt identities that are perceived to be advantageous to navigate the new social system. Moreover, the construction of forced migrants’ identity includes significant contextuality, transactionality and situatedness. Conclusions Our research contributes to the literature on migrant identity practice concerning the stigma associated with forced migrant status and the extent to which migrants appraise their reception in exile as undignified. Additionally, examining migrant identities allows the researchers to apprehend the diverse facets of identity as far as migrants are concerned. Future research may draw a larger sample to examine other impactful dimensions of identity fluctuation, e.g. gender, education, social media, the extent of prior trauma, etc.
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Affiliation(s)
- Dieu Hack-Polay
- Crandall University, Moncton, Canada. .,University of Lincoln, Lincoln, UK.
| | - Ali B Mahmoud
- St. John's University, New York City, USA.,University of Wales Trinity St David, Lampeter, UK
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21
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Migrants and Service Providers' Perspectives of Barriers to Accessing Mental Health Services in South Australia: A Case of African Migrants with a Refugee Background in South Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178906. [PMID: 34501496 PMCID: PMC8430647 DOI: 10.3390/ijerph18178906] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022]
Abstract
International mobility has increased steadily in recent times, bringing along a myriad of health, social and health system challenges to migrants themselves and the host nations. Mental health issues have been identified as a significant problem among migrants, with poor accessibility and underutilisation of the available mental health services (MHSs) repeatedly reported, including in Australia. Using a qualitative inquiry and one-on-one in-depth interviews, this study explored perspectives of African migrants and service providers on barriers to accessing MHSs among African migrants in South Australia. The data collection took place during the COVID-19 pandemic with lockdown and other measures to combat the pandemic restricting face to face meetings with potential participants. Online platforms including Zoom and/or WhatsApp video calls were used to interview 20 African migrants and 10 service providers. Participants were recruited from community groups and/or associations, and organisations providing services for migrants and/or refugees in South Australia using the snowball sampling technique. Thematic framework analysis was used to guide the data analysis. Key themes centred on personal factors (health literacy including knowledge and the understanding of the health system, and poor financial condition), structural factors related to difficulties in navigating the complexity of the health system and a lack of culturally aware service provision, sociocultural and religious factors, mental health stigma and discrimination. The findings provide an insight into the experiences of African migrants of service provision to them and offer suggestions on how to improve these migrants’ mental health outcomes in Australia. Overcoming barriers to accessing mental health services would need a wide range of strategies including education on mental health, recognising variations in cultures for effective service provision, and addressing mental health stigma and discrimination which strongly deter service access by these migrants. These strategies will facilitate help-seeking behaviours as well as effective provision of culturally safe MHSs and improvement in access to MHSs among African migrants.
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22
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Mental Illness Stigma and Associated Factors among Arabic-Speaking Religious and Community Leaders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157991. [PMID: 34360281 PMCID: PMC8345608 DOI: 10.3390/ijerph18157991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
Evidence suggests that Arabic-speaking refugees in Australia seek help from informal sources, including religious and community leaders, when experiencing mental health issues. Despite their significant influence, there is scarce research exploring attitudes of Arabic-speaking leaders toward mental illness. The current exploratory study explored mental illness stigma and various factors among Arabic-speaking religious and community leaders. This study uses a subset of data from an evaluation trial of mental health literacy training for Arabic-speaking religious and community leaders. Our dataset contains the pre-intervention survey responses for 52 Arabic-speaking leaders (69.2% female; mean age = 47.1, SD = 15.3) on the ability to recognise a mental disorder, beliefs about causes for developing mental illness, and two stigma measures, personal stigma, and social distance. Being female was associated with a decrease in personal stigma. An increase in age was associated with an increase in personal stigma. Correct recognition of a mental disorder was associated with decreased personal stigma, and after adjusting for age and gender, significance was retained for the I-would-not-tell-anyone subscale. Endorsing the cause “being a person of weak character” was associated with an increase in personal stigma. There is an urgent need for future research to elucidate stigma to develop effective educational initiatives for stigma reduction among Arabic-speaking leaders.
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23
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Hendaus M, Mourad N, Younes S, Hammoudi D, Rahal M, Basheti I. The psychological impact of the Syrian crisis on refugees living in Lebanon. Perspect Psychiatr Care 2021; 57:1376-1381. [PMID: 33258132 DOI: 10.1111/ppc.12700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aims to evaluate the impact of war on Syrian refugees' life in Bekaa/Lebanon, focusing on psychological and physical symptoms, and to assess the prevalence of the most common symptoms of posttraumatic stress disorder (PTSD) in affected patients recruited in the study. DESIGN AND METHODS This observational study was conducted over a period of 1 month-June 2019-in three main camps in the Bekaa region. After taking approval, a total number of 108 Syrian refugees were interviewed and asked about their quality of life and health conditions in camps, after leaving their country. A validated questionnaire was filled by field researchers to gather information on refugees' psychological distresses, physical symptoms, and future perspective. FINDINGS During the 4 weeks of study, 108 refugees completed the questionnaire; psychological assessment showed 73.8% of refugees who were exposed to the fighting atmosphere, suffered from one or more psychological symptoms related to PTSD. In addition, 50.5% of the refugees were <30 years old, and among those, 83.5% believed that they have no future for themselves and their families, while 15.4% lost hope in a better life. Seventy-four percent reported at least one physical symptom in the past 4 weeks that is related to PTSD. Furthermore, 64.3% strongly agreed that there is lack of awareness and medical care including psychological and mental health, while 56.1% strongly agreed on the important role of pharmacists and other healthcare professionals in providing advice to patients on their overall health and mental health. CONCLUSION Syrian refugees at the assessed camps suffered from psychological distress that requires urgent attention. Current medical and psychological support is absent, and further assessment is needed.
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Affiliation(s)
- Mohamed Hendaus
- Department of Pharmacy Practice, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Nisreen Mourad
- Department of Pharmacy Practice, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Samar Younes
- Department of Biomedical Sciences, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Dalal Hammoudi
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Mohamad Rahal
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Iman Basheti
- Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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24
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Orzechowski M, Wigand ME, Nowak M, Becker T, Steger F. Post-traumatic stress disorder, human rights and access to healthcare: an analysis of judgments of the European Court of Human Rights from an ethical perspective. Eur J Psychotraumatol 2021; 12:1930704. [PMID: 34211639 PMCID: PMC8221123 DOI: 10.1080/20008198.2021.1930704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: Human rights violations such as torture are associated with a high risk of post-traumatic stress disorder (PTSD). The judgements of the European Court of Human Rights (ECtHR) include a normative perspective on PTSD and address central ethical questions. Objective: To help bridge the gap between the psycho-medical and the legal discourse on human rights violations and to illustrate their medico-ethical implications by systematically assessing and categorizing all judgements by the ECtHR dealing with PTSD. Method: The ECtHR database was searched for 'post-traumatic stress disorder'. A descriptive statistic was performed on the Articles of the European Convention on Human Rights involved and violations to these articles. In a qualitative analysis, the judgements were thematically grouped. Results: The search yielded n = 103 judgements, of which n = 90 were included. There were mostly violations of Article 3 (prohibition of torture), Article 8 (Right to respect for private and family life) and Article 6 (Right to a fair trial). PTSD in these judgements is normatively discussed with regards to ethical, social and political themes such as inadequate access to healthcare, especially in prison, matters of asylum, expulsion and extradition, protection of minorities and minors, as well as rights and duties of traumatized witnesses. Conclusion: PTSD plays a central role in a large number of ECtHR judgements. Our results show that PTSD as a medical diagnosis also encompasses legal, ethical, social, and political dimensions. This knowledge is essential for healthcare professionals working with traumatized persons, but can also be relevant for political decision-makers.
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Affiliation(s)
- Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Moritz E Wigand
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany.,Department of Psychiatry II, Ulm University and BKH Günzburg, Günzburg, Germany
| | - Marianne Nowak
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University and BKH Günzburg, Günzburg, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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25
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Lindegaard T, Kashoush F, Holm S, Halaj A, Berg M, Andersson G. Experiences of internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a qualitative study. BMC Psychiatry 2021; 21:288. [PMID: 34082745 PMCID: PMC8173836 DOI: 10.1186/s12888-021-03297-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioural therapy (ICBT) is a promising treatment for refugee and immigrant populations suffering from common mental disorders. The aim of the present study was to investigate experiences of participating in a guided ICBT program among resettled Arabic-speaking individuals suffering from symptoms of anxiety and depression. METHODS Ten individuals who had previously received ICBT consented to participate and were interviewed using semi-structured telephone interviews. The interviews were conducted 10 months after treatment termination. Data were transcribed and analysed using a Thematic Analysis framework. RESULTS The Thematic Analysis resulted in five overarching themes 1) The importance of being seen, 2) New ways of knowing and doing, 3) Treatment format not for everyone, 4) Changing attitudes towards mental health and help-seeking and 5) The healthcare system as a complex puzzle. Participants described varying levels of success in applying the new information learned from the treatment in their everyday lives. The results also indicate that participation in the ICBT program to some extent mitigated mental health stigma and acted as a precursor to other forms of treatment seeking. CONCLUSIONS The findings in the present study are largely in line with previous qualitative research studies on ICBT participants. Future research should investigate whether a more explicit focus on refugee-specific stressors and barriers to treatment engagement and implementation can increase adherence to ICBT programs in this population.
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Affiliation(s)
- Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden.
| | - Fatima Kashoush
- grid.5640.70000 0001 2162 9922Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden
| | - Sara Holm
- grid.5640.70000 0001 2162 9922Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden
| | - Asala Halaj
- grid.9619.70000 0004 1937 0538Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Matilda Berg
- grid.5640.70000 0001 2162 9922Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden
| | - Gerhard Andersson
- grid.5640.70000 0001 2162 9922Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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26
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Kieseppä V, Jokela M, Holm M, Suvisaari J, Gissler M, Lehti V. Post-traumatic stress disorder among immigrants living in Finland: Comorbidity and mental health service use. Psychiatry Res 2021; 300:113940. [PMID: 33906030 DOI: 10.1016/j.psychres.2021.113940] [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] [Received: 01/17/2020] [Accepted: 04/10/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare differences in comorbidity between immigrants and Finnish-born controls, and to examine the treatment received by immigrants with PTSD. Our original data included all the immigrants living in Finland by the end of 2010 and matched controls. For this study, we selected individuals who had received a diagnosis of PTSD during 2010-2015 (immigrants: n = 754, Finnish-born controls: n = 311). We compared the frequency of different comorbid conditions between immigrants and natives. Multinomial logistic regression was used to predict categorized treatment intensity with the region of origin and length of residence among the immigrants. Psychiatric comorbidity was much more extensive among the Finnish-born controls than among immigrants. Immigrants from Africa and the Middle East more often received treatment of low intensity compared with immigrants from Western countries. The length of residence was associated with more frequent treatment. The important differences in comorbidity and background characteristics between immigrants and natives should be taken into account in planning treatment guidelines for PTSD. The disparities in treatment intensity across different immigrant groups indicate a need to improve the services for immigrants with PTSD.
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Affiliation(s)
- Valentina Kieseppä
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Markus Jokela
- Department of Psychology and Logopedics, Medicum, University of Helsinki, Helsinki, Finland
| | - Minna Holm
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Venla Lehti
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Nugent C, Rosato M, Hughes L, Leavey G. Risk factors associated with experienced stigma among people diagnosed with mental ill-health: a cross-sectional study. Psychiatr Q 2021; 92:633-643. [PMID: 32857285 PMCID: PMC8110482 DOI: 10.1007/s11126-020-09827-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE to examine the relationship between religiosity, social support, trauma, quality of life and experienced stigma of mental illness amongst a population diagnosed with mental ill-health. METHODS A cross-sectional survey of day service users in Northern Ireland (n = 295) covering a range of issues including religiosity, social support, quality of life and prior experience of trauma. Stigma was measured using a recognised stigma scale. We used multinomial logistic regression to examine risk factors associated with experienced stigma. RESULTS Univariate analysis showed significant associations between stigma and age, number of friends, social support, quality of life and prior experience of trauma. Age, quality of life, and trauma remained independently associated with stigma in a multivariate logistic regression model (x2(12) = 98.40, p < 0.001). CONCLUSION Younger people, those with less social support, prior experience of trauma and with poorer quality of life are at increased risk of experiencing stigma related to their diagnosis of mental illness. The findings provide further understanding of stigma and are useful for those overseeing programmes to improve access to mental health treatment.
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Affiliation(s)
- C. Nugent
- Bamford Centre for Mental Health and Wellbeing; School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
| | - M. Rosato
- Bamford Centre for Mental Health and Wellbeing; School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
| | - L. Hughes
- Bamford Centre for Mental Health and Wellbeing; School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
| | - G. Leavey
- Bamford Centre for Mental Health and Wellbeing; School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA Northern Ireland
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Walther L, Amann J, Flick U, Ta TMT, Bajbouj M, Hahn E. A qualitative study on resilience in adult refugees in Germany. BMC Public Health 2021; 21:828. [PMID: 33931077 PMCID: PMC8086291 DOI: 10.1186/s12889-021-10817-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Because refugees face significant adversities before, during, and after resettlement, resilience is of central importance to this population. However, strengths-based research on post-migration refugee experiences is sparse. Methods We conducted semi-structured interviews with 54 adult refugee participants who arrived in Germany between 2013 and 2018 in their preferred language. We analyzed different aspects of resilience in these interviews using thematic analysis. Results Nine themes were identified. Four themes manifest resilience in different ways and encompass cognitive as well as behavioral strategies for facing adversity, self-ascriptions of resilience as a personal trait or lasting characteristic, and the role of volunteering, work, and activism for refugee causes. Five themes capture factors that facilitate resilience: social support, experiencing migration as an opportunity generally and for women in particular, being a parent, and being young. Conclusions This study adds to a growing body of knowledge about resilience among adult refugees. It may support clinicians working with refugees by making them aware of specific manifestations of resilience and factors promoting positive adaptation specific to this client group. It also contributes to a more strengths-based view on refugee mental health and processes of integration. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10817-6.
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Affiliation(s)
- Lena Walther
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany.
| | - Julia Amann
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Uwe Flick
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
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29
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Community-centred interventions for improving public mental health among adults from ethnic minority populations in the UK: a scoping review. BMJ Open 2021. [PMCID: PMC8039264 DOI: 10.1136/bmjopen-2020-041102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objectives Undertake a scoping review to determine the effectiveness of community-centred interventions designed to improve the mental health and well-being of adults from ethnic minority groups in the UK. Methods We searched six electronic academic databases for studies published between January 1990 and September 2019: Medline, Embase, PsychINFO, Scopus, CINAHL and Cochrane. For intervention description and data extraction we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and Template for Intervention Description and Replication guide. Quality was assessed using Cochrane risk of bias tools. Grey literature results were deemed beyond the scope of this review due to the large number of interventions and lack of available outcomes data. Results Of 4501 studies, 7 met the eligibility criteria of UK-based community interventions targeting mental health in adults from ethnic minority populations: four randomised controlled trials, one pre/post-pilot study, one cross-sectional study and one ethnographic study. Interventions included therapy-style sessions, peer-support groups, educational materials, gym access and a family services programme. Common components included a focus on tackling social isolation, using lay health workers from within the community, signposting and overcoming structural barriers to access. Four studies reported a statistically significant positive effect on mental health outcomes and six were appraised as having a high risk of bias. Study populations were ethnically heterogeneous and targeted people mainly from South Asia. No studies examined interventions targeting men. Conclusions There is a paucity of high-quality evidence regarding community-centred interventions focused on improving public mental health among ethnic minority groups. Decision makers need scientific evidence to inform effective approaches to mitigating health disparities. Our next steps are to map promising community activities and interventions that are currently being provided to help identify emerging evidence.
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Muhorakeye O, Biracyaza E. Exploring Barriers to Mental Health Services Utilization at Kabutare District Hospital of Rwanda: Perspectives From Patients. Front Psychol 2021; 12:638377. [PMID: 33828506 PMCID: PMC8019821 DOI: 10.3389/fpsyg.2021.638377] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Barriers to mental health interventions globally remain a health concern; however, these are more prominent in low- and middle-income countries (LMICs). The barriers to accessibility include stigmatization, financial strain, acceptability, poor awareness, and sociocultural and religious influences. Exploring the barriers to the utilization of mental health services might contribute to mitigating them. Hence, this research aims to investigate these barriers to mental health service utilization in depth at the Kabutare District Hospital of the Southern Province of Rwanda. The qualitative approach was adopted with a cross-sectional study design. The participants were patients with mental illnesses seeking mental health services at the hospital. Ten interviews were conducted in the local language, recorded, and transcribed verbatim and translated by the researchers. Thematic analysis was applied to analyze the data collected. The results revealed that the most common barriers are fear of stigmatization, lack of awareness of mental health services, sociocultural scarcity, scarcity of financial support, and lack of geographical accessibility, which limit the patients to utilize mental health services. Furthermore, it was revealed that rural gossip networks and social visibility within the communities compounded the stigma and social exclusion for patients with mental health conditions. Stigmatization should be reduced among the community members for increasing their empathy. Then, the awareness of mental disorders needs to be improved. Further research in Rwanda on the factors associated with low compliance to mental health services with greater focus on the community level is recommended.
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Affiliation(s)
- Oliviette Muhorakeye
- Department of Clinical Psychology, School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Emmanuel Biracyaza
- Department of Community Health, School of Public Health, University of Rwanda, Butare, Rwanda.,Sociotherapy Programme, Prison Fellowship Rwanda (PFR), Member of Prison Fellowship International, Kigali, Rwanda
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Wittmann L, Dimitrijevic A, Ehlers A, Foa EB, Kessler H, Schellong J, Burgmer M. Psychometric properties and validity of the German version of the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5). Eur J Psychotraumatol 2021; 12:1965339. [PMID: 34589176 PMCID: PMC8475123 DOI: 10.1080/20008198.2021.1965339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The availability of psychometrically sound instruments for the assessment of Post-Traumatic Stress Disorder (PTSD) is indispensable for clinical and scientific work with individuals suffering from trauma-related distress. OBJECTIVE The aim of the present study was to translate the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5) into German and to evaluate its psychometric properties as well as convergent, discriminant, and factorial validity. METHOD The authorized German translation of the PDS-5 was completed by 270 patients admitted to specialized outpatient trauma clinics. Of these, 57.8% completed the PDS for a second time (mean time between assessments was 12.0 days). In order to examine convergent and discriminant validity of the PDS-5, the Post-traumatic Stress Disorder Checklist for DSM-5 as well as Patient Health Questionnaire subscales assessing depression (PHQ-9), somatization (PHQ-15), and Generalized Anxiety Disorder (GAD-7) were applied. RESULTS The PDS-5 total score showed excellent internal consistency (α = .91) and re-test reliability (rho = .84). Convergent validity was supported by a strong correlation with the total score of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5; rho = .91). Correlations with Patient Health Questionnaire subscales of depression (rho = .81), anxiety (rho = .72), and somatization (rho = .65) were significantly lower (all p < .001) indicating discriminant validity of the PDS-5. Confirmative Factor Analysis did not result in a clear preference for one of the tested models. Defining a diagnostic cut-off value of ≥36 based on ROC analysis resulted in high sensitivity (.92) and specificity (.96) compared to a probable PTSD diagnosis according to the PCL-5. CONCLUSIONS In summary, our results indicate that the German PDS-5 translation provides valid and reliable information concerning both PTSD severity and diagnosis.
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Affiliation(s)
- Lutz Wittmann
- Department of Psychology, International Psychoanalytic University, Berlin, Germany
| | | | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Edna B Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadephia, PA, USA
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL-Hospital Münster, Münster, Germany.,University Hospital Münster, Münster, Germany
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Support and Emotional Well-Being of Asylum Seekers and Refugees in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228365. [PMID: 33198150 PMCID: PMC7697546 DOI: 10.3390/ijerph17228365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022]
Abstract
Although the world’s forcibly displaced population reached 79.5 million in 2019, their difficult situations and the issues they struggle with remain practically invisible in Spanish society. Therefore, it seems necessary to provide greater insight into an invisible reality to improve the refugees’ situation. The present cross-sectional study aims to draw a general profile of refugees’ and asylum seekers’ main characteristics in Spain and their well-being. A total of 186 refugees living in Spain participated. An ad-hoc questionnaire was administered to obtain data regarding sociodemographic profile, language skills, and social and institutional support. A standardized instrument, SPANE, was used to measure well-being. It can be seen that healthcare, followed by legal aid, are the easiest to access. On the other hand, finding a job, having money, and finding housing are the most difficult. In general, it seems possible to say that the refugees present more positive feelings than negative ones, which implies a positive emotional balance, although the average score obtained for emotional balance is quite far from the highest possible score. We consider this to be a pivotal first step which can provide useful information for the further design of aid strategies to improve this vulnerable group’s situation.
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Therapeutic Nature Activities: A Step Toward the Labor Market for Traumatized Refugees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207542. [PMID: 33081308 PMCID: PMC7590045 DOI: 10.3390/ijerph17207542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Globally, the number of refugees is growing. For many refugees, entering the labor market in their new country of residence is challenging. Some remain forever dependent on welfare services, and this not only weakens their chances of integration, but also harms their health and well-being. METHODS This qualitative single case study focused on a group of war-stricken refugees in Denmark. The study investigated the impact of an eight-month horticultural vocational program aimed at improving their ability to complete an education program or to work. A total of 29 interviews were conducted and analyzed using the interpretative phenomenological analysis (IPA) method. RESULTS The natural environment in the eco-village evoked a feeling of safety as well as positive memories in the participants, in contrast to the traumatic memories they had of their flight. Horticultural activities and the positive and respectful attitude from staff initiated a recovery process. New skills were achieved at an individual pace, and feelings of isolation decreased. These findings can be implicated in future interventions.
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Castaneda AE, Çilenti K, Rask S, Lilja E, Skogberg N, Kuusio H, Salama E, Lahti J, Elovainio M, Suvisaari J, Koskinen S, Koponen P. Migrants Are Underrepresented in Mental Health and Rehabilitation Services-Survey and Register-Based Findings of Russian, Somali, and Kurdish Origin Adults in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176223. [PMID: 32867157 PMCID: PMC7504052 DOI: 10.3390/ijerph17176223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022]
Abstract
Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants.
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Affiliation(s)
- Anu E. Castaneda
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
- Correspondence: ; Tel.: +358-29-524-7848
| | - Katja Çilenti
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Shadia Rask
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Eero Lilja
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Natalia Skogberg
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Hannamaria Kuusio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Essi Salama
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Turku, FI-20014 Turku, Finland & Child Psychiatry, Turku University Hospital, 20521 Turku, Finland;
| | - Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
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Chynoweth SK, Buscher D, Martin S, Zwi AB. A social ecological approach to understanding service utilization barriers among male survivors of sexual violence in three refugee settings: a qualitative exploratory study. Confl Health 2020; 14:43. [PMID: 32670397 PMCID: PMC7346522 DOI: 10.1186/s13031-020-00288-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/15/2020] [Indexed: 11/11/2022] Open
Abstract
Background Post-sexual violence service utilization is often poor in humanitarian settings. Little is known about the service uptake barriers facing male survivors specifically. Methods To gain insights into this knowledge gap, we undertook a qualitative exploratory study to better understand the barriers to service utilization among male survivors in three refugee-hosting countries. The study sites and populations included refugees who had travelled the central Mediterranean migration route through Libya living in Rome and Sicily, Italy; Rohingya refugees in Cox’s Bazar, Bangladesh; and refugees from eastern Democratic Republic of the Congo, Somalia, and South Sudan residing in urban areas of Kenya. Methods included document review, 55 semi-structured focus group discussions with 310 refugees, semi-structured key informant interviews with 148 aid workers and human rights experts, and observation of service delivery points. Data were thematically analyzed using NVivo 12. Results We identified eleven key barriers and situated them within a social ecological framework to describe impediments at the policy, community (inter-organizational), organizational, interpersonal, and individual levels. Barriers entailed: 1) restrictions to accessing legal protection, 2) legislative barriers such as the criminalization of same-sex sexual relations, 3) few designated entry points, 4) poor or nonexistent referral systems, 5) lack of community awareness-raising and engagement, 6) limited staff capacity, 7) negative provider attitudes and practices, 8) social stigma, 9) limited knowledge (at the individual level), 10) self-stigma, and 11) low formal help-seeking behaviors. Conclusion The social ecological framework allowed us to better understand the multifaceted ways that the barriers facing male survivors operate and reinforce one another, and may be useful to inform efforts promoting service uptake. Additional research is warranted in other refugee settings.
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Affiliation(s)
- Sarah K Chynoweth
- Women's Refugee Commission, 15 West 37th St, New York, NY 10018 USA.,Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales, Sydney, NSW 2052 Australia
| | - Dale Buscher
- Women's Refugee Commission, 15 West 37th St, New York, NY 10018 USA
| | - Sarah Martin
- Gender Associations, c/o Ufer Berlin, Paul-Lincke-Ufer 41, 10999 Berlin, Germany
| | - Anthony B Zwi
- Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, The University of New South Wales, Sydney, NSW 2052 Australia
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