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Côté-Olijnyk M, Perry JC, Paré MÈ, Kronick R. The mental health of migrants living in limbo: A mixed-methods systematic review with meta-analysis. Psychiatry Res 2024; 337:115931. [PMID: 38733932 DOI: 10.1016/j.psychres.2024.115931] [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: 09/04/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024]
Abstract
The number of forcibly displaced people has more than doubled over the past decade. Many people fleeing are left in limbo without a secure pathway to citizenship or residency. This mixed-methods systematic review reports the prevalence of mental disorders in migrants living in limbo, the association between limbo and mental illness, and the experiences of these migrants in high income countries. We searched electronic databases for quantitative and qualitative studies published after January 1, 2010, on mental illness in precarious migrants living in HICs and performed a meta-analysis of prevalence rates. Fifty-eight articles met inclusion criteria. The meta-analysis yielded prevalence rates of 43.0 % for anxiety disorders (95 % CI 29.0-57.0), 49.5 % for depression (40.9-58.0) and 40.8 % for posttraumatic stress disorder (30.7-50.9). Having an insecure status was associated with higher rates of mental illness in most studies comparing migrants in limbo to those with secure status. Six themes emerged from the qualitative synthesis: the threat of deportation, uncertainty, social exclusion, stigmatization, social connection and religion. Clinicians should take an ecosocial approach to care that attends to stressors and symptoms. Furthermore, policymakers can mitigate the development of mental disorders among migrants by adopting policies that ensure rapid pathways to protected status.
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Affiliation(s)
| | - J Christopher Perry
- McGill University, Department of Psychiatry, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie-Ève Paré
- University of Montreal, Department of Anthropology, Montreal, Quebec, Canada; Cegep Édouard-Montpetit, Department of Anthropology, Longueuil, Quebec, Canada
| | - Rachel Kronick
- McGill University, Department of Psychiatry, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
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Marchetti F, Preziosi J, Zambri F, Tambascia G, Di Nolfi A, Scardetta P, Splendore F, Colaceci S, Coia M, Caredda E, Masi L, De Luca V, Perra A, Giusti A. Health needs and perception of health care quality among Asylum Seekers and Refugees in an Italian local health authority: A qualitative study. Front Public Health 2023; 11:1125125. [PMID: 37124798 PMCID: PMC10130403 DOI: 10.3389/fpubh.2023.1125125] [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: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Background Migrants, Asylum Seekers and Refugees (ASRs) represent a vulnerable diversified population with increased risks of developing health problems, and in the hosting countries several barriers often hamper their access to the health services. Gathering information about ASRs' experiences and perceptions of host country health care systems may contribute to improve the quality of health care provided. The aim of this study was to explore the health needs in their bio-psycho-social meaning, and the quality of health care as perceived from the ASRs' perspective. Methods The qualitative descriptive study was conducted as part of the Project "G-START - testing a governance model of receiving and taking care of the Asylum Seekers and Refugees." Through purposeful and snowball sampling, four Focus Groups conducted in English, Italian and French were carried out between July and August 2019, involving 50 ASRs hosted by four reception centers located on the territory pertaining to an Italian Local Health Authority covering a general population of 500.000 people. The analysis of data was categorical, and was performed using N-Vivo software. Results The macro-categories emerged were the ASRs' bio-psycho-social health needs, including mental health, sexual and reproductive health, food and nutrition, knowledge of the health care system, need for inclusion; healthcare services access, including barriers before and after the access and the ability of the local health system to respond to existing and evolving demands; strengths of the healthcare and reception systems, and suggestions for improving them in the future. Discussion and conclusions ASRs present vulnerabilities and specific health needs, and the health care system is not always able to guarantee access or to respond to these needs. Several obstacles have been highlighted, such as linguistic barriers and lack of cultural mediation, bureaucratic and administrative barriers, lack of knowledge of the Italian health care system. An effective reorganization of services driven by a more detailed output analysis of the target population needs, together with the use of cultural mediation, peer to peer education and support, and the training of health professionals are recommended to ensure a more accessible, equitable and effective health care system at local level.
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Affiliation(s)
- Francesca Marchetti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Jessica Preziosi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Francesca Zambri
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Gabriella Tambascia
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Annachiara Di Nolfi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Paola Scardetta
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Flavia Splendore
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences (UniCamillus), Rome, Italy
| | - Maura Coia
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
| | - Emanuele Caredda
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Loredana Masi
- Maternal and Child Department, Local Health Authority “Roma 5”, Rome, Italy
| | - Vittorio De Luca
- Department of Mental Health and Addiction, Local Health Authority “Roma 5”, Rome, Italy
| | - Alberto Perra
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
| | - Angela Giusti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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Hugelius K. Measurement of perceived needs in humanitarian contexts using the HESPER scale: a scoping study with reflections on the collaboration between researchers and humanitarian actors. Confl Health 2022; 16:44. [PMID: 36028872 PMCID: PMC9419316 DOI: 10.1186/s13031-022-00478-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Needs assessment is one of the fundamental humanitarian responses to sudden-onset or long-lasting emergencies. The Humanitarian Emergency Settings Perceived Needs Scale (HESPER)/ HESPER Web are valid scales for identifying perceived needs among humanitarian or disaster-affected populations, both in humanitarian practice and in science. This scoping review aimed to determine the scientific use of HESPER or HESPER Web, report on previously published perceived needs in humanitarian emergencies, and discuss how scientific and humanitarian actors can work together in a partnership in needs assessment in humanitarian settings. RESULTS In all, eight papers were found in which the HESPER or HESPER Web had been used in conflict- or post-conflict settings or natural disasters. The study samples varied from 85 to 1000 participants (mean 440). The mean number of perceived needs in all studies was 8, varying from 4.25 to 12.18. The top three needs varied in all the studies. A high number of perceived needs was associated with mental health problems. No paper has reported on how the assessment outcomes were shared between the researchers and humanitarian actors. CONCLUSION Inventorying the needs from the perspective of the affected population is important to tailor the response to each humanitarian emergency. The HESPER scale and the HESPER Web are multisectoral tools that can be used to take inventory of the perceived needs and indicate the mental health problems that arise in conflict-ridden and natural disaster contexts. It is essential that results from a scientific needs inventory are shared with adequate humanitarian stakeholders to not only facilitate a proper response, but also to foster a closer collaboration between scientists, humanitarians, and the affected population. Doing so would increase the development and use of evidence in practice when providing humanitarian aid.
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Affiliation(s)
- Karin Hugelius
- Faculty of Medicine and Health , Örebro University, Örebro, Sweden.
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