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Da'as R, Slobodin O. "God Did Not Create Us This Way": An Investigation into the Experiences of School Counselors Working with Arab-Muslim LGBTQ Youth. JOURNAL OF HOMOSEXUALITY 2024:1-25. [PMID: 38421282 DOI: 10.1080/00918369.2024.2321239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Schools play a key role in supporting, protecting, and advocating for LGBTQ students. However, educational programs worldwide tend to exclude and marginalize LGBTQ issues, especially when it comes to ethnic and racial minorities. In the current study, we examined Arab school counselors' experiences of working with Arab-Muslim LGBTQ youth. After 100 counselors declined to participate, the study included semi-structured interviews with 60 female counselors in Arab-Muslim schools in Israel. Data were analyzed using interpretive phenomenological analysis. Four main themes emerged: religious considerations, causal explanations of LGBTQ orientation, working practices, and supportive resources. Our findings point to the unique challenges facing Arab school counselors who are torn between their professional values and traditional norms. Among the strategies counselors used for managing this tension were separating LGBTQ orientation from LGBTQ adolescents, passive listening while avoiding proactive inquiry, and referring to LBGTQ orientation as a transient phase. Our findings emphasize the need to develop culturally relevant programs that address LGBTQ orientation for students, teachers, and families.
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Affiliation(s)
- Raneen Da'as
- School of Education, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ortal Slobodin
- School of Education, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Martinez AB, Lau JYF, Morillo HM, Brown JSL. 'C'mon, let's talk: a pilot study of mental health literacy program for Filipino migrant domestic workers in the United Kingdom. Soc Psychiatry Psychiatr Epidemiol 2024; 59:385-401. [PMID: 36575338 PMCID: PMC9794465 DOI: 10.1007/s00127-022-02405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This pilot study of a culturally adapted online mental health literacy (MHL) program called 'Tara, Usap Tayo!' (C'mon, Let's Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK). METHODS Using mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt's (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants' attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants' feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions. RESULTS The online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group. CONCLUSION By improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.
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Affiliation(s)
- Andrea B Martinez
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of Behavioral Science, College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines.
| | - Jennifer Y F Lau
- Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hannah Misha Morillo
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - June S L Brown
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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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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Mental Health Screening for Korean Ukrainian Refugee Minors in the Republic of Korea: A Cross Sectional Pilot Study. ADOLESCENTS 2023. [DOI: 10.3390/adolescents3010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Since February 2022, the Ukrainian refugee crisis has been highlighting mental health problems associated with trauma and distress. This study aimed to evaluate the mental health status of twenty-seven refugee minors (10 to 18 years old) who fled Ukraine and temporarily settled in the Republic of Korea (ROK). This cross-sectional survey study aimed to evaluate the mental health status of ethnic Korean Ukrainian refugee minors. The Child and Adolescent Trauma Screen—Youth Report (CATS), generalized anxiety disorder seven-item scale (GAD-7), and subjective unit of distress scale (SUDs) were used for assessment. A preliminary analysis indicated that 77% Ukrainian refugee minors were exposed to and experienced war-related trauma. They are at a relatively low risk of trauma symptoms, anxiety, and distress due to stable family and visa status and a comparably better environment in the ROK. Meanwhile, refugee teenagers showed higher rates of psychological distress compared with refugee children. This finding suggests that an early psychological interventions in a host country may be beneficial to prevent mental health issues in refugee minors.
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Allwood M, Ghafoori B, Salgado C, Slobodin O, Kreither J, Waelde LC, Larrondo P, Ramos N. Identity-based hate and violence as trauma: Current research, clinical implications, and advocacy in a globally connected world. J Trauma Stress 2022; 35:349-361. [PMID: 34708457 DOI: 10.1002/jts.22748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022]
Abstract
Hate-based violence is increasingly recognized as an urgent social justice and human rights issue that is pervasive across geographical and socioeconomic boundaries. There is a growing body of research that demonstrates the traumatic impact of hate-based violence on the victim's mental and physical health. This review focuses on examining scientific knowledge and prevalence data on identity-based hate and violence exposure. A framework for conceptualizing hate-based violence as a traumatic event or series of traumatic events is offered as a means to understand research findings and intervention approaches. The importance of research, advocacy, and human rights training is highlighted in the efforts to address the traumatic impact of identity-based hate and violence.
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Affiliation(s)
- Maureen Allwood
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, New York, USA
| | - Bita Ghafoori
- Long Beach Trauma Recovery Center, Department of Advanced Studies in Education and Counseling, California State University, Long Beach, Long Beach, California, USA
| | - Carolina Salgado
- Department of Psychiatry, Universidad Catolica del Maule, Talca, Chile
| | - Ortal Slobodin
- Department of Education, Ben-Gurion University of the Negev, Beersheba, Israel
| | | | - Lynn C Waelde
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Paulina Larrondo
- Centre for Reproductive Medicine and Adolescent Integral Development, School of Medicine, University of Chile, Santiago, Chile
| | - Nadia Ramos
- Department of Psychiatry, Universidad de Talca, Talca, Chile
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Heidinger E. Overcoming Barriers to Service Access: Refugees’ Professional Support Service Utilization and the Impact of Human and Social Capital. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2022. [DOI: 10.1007/s12134-022-00939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractAfter arriving in a new country, refugees are typically dependent on professional support to re-establish their livelihood. However, it is well documented that refugees face barriers when seeking access to services aimed at facilitating their settlement. This study examines refugees’ support service needs, their actual utilization, and investigates the impact of social and human capital on service utilization. Using data from the IAB-BAMF-SOEP Survey of Refugees (2016–2019; N=7662), this paper, employing nested logistic regression models, highlights the diversity of refugees’ support service needs as well as large differences in utilization across eight different domains during the first couple of years after arriving in Germany. It provides evidence for an overall positive association between human and social capital and service utilization in general while also revealing differences in service domains. While language proficiency is positively associated with service utilization across all service domains, previous work experience in the country of origin particularly increases utilization of employment-related services. The analyses also find a positive association of inter-ethnic networks, whereas intra-ethnic connections are negatively associated with service utilization across many domains. The findings are especially relevant since they support the hypothesis of exclusive host community knowledge that benefits those refugees who engage with individuals outside their own ethnic network. The findings of this study accentuate the need to acknowledge the diversity of refugees’ service needs as well as the barriers to service utilization that only well-equipped refugees seem to be able to overcome.
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Pluck F, Ettema R, Vermetten E. Threats and Interventions on Wellbeing in Asylum Seekers in the Netherlands: A Scoping Review. Front Psychiatry 2022; 13:829522. [PMID: 35432018 PMCID: PMC9010677 DOI: 10.3389/fpsyt.2022.829522] [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] [Received: 12/05/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most asylum seekers experience stress, not only due to the reason for fleeing and their travel but also due to their compulsory stay in the asylum seeker center in the Netherlands and the asylum procedure. This often leads to self-medication and addiction which causes lower self-esteem and lower quality of life. Adverse life events, forced migration, and prolonged asylum procedures, in addition to the complexity of the acculturation process, can all contribute to higher levels of psychopathology. OBJECTIVE What are the threats to wellbeing in terms of mental health, psychosocial, and addiction problems, and what are the effective interventions for wellbeing for asylum seekers in asylum seeker centers in the Netherlands, reported in the literature? METHOD Following the descriptive nature of the research question and the need for identifying knowledge gaps, an overview of existing knowledge was created by executing a scoping review on influencing factors on the mental health of asylum seekers. The Neuman system model was used as a guiding framework to understand the complexity of the issues this population experience and to identify the stressors and the factors which cause the imbalance and also the disease. RESULTS The literature review resulted in 26 articles that met the criteria for inclusion. The threats included the influence of staying in the environment of an asylum seekers center, drug abuse among asylum seekers, health-care professionals and employees who do not detect or underestimate the underlying suffering of asylum seekers, and frequent relocations of asylum seekers. The two assessment instruments used were the Rapid-Assessment-Response method (RAR method) and the Health Information Assessment Tool Asylum Seeker tool (HIATUS tool). Finally, the five interventions were identified: therapy for asylum seekers diagnosed with post-traumatic stress disorder (PSTD), art therapy, education focused on prevention as intervention, cultural interview, and mindspring. CONCLUSION The knowledge on identifying and reducing threats, assessment, and treatment interventions for asylum seekers living in an asylum seekers center found in the literature provided perspectives on improving their wellbeing. The great diversity of cultural aspects and continuous changes in the number and origin of refugees in the Dutch asylum seekers centers disrupted the continuity of care.
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Affiliation(s)
- Ferdy Pluck
- Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands.,Research Group Personalized Integrated Care, University of Applied Science Utrecht, Utrecht, Netherlands.,Amethist Addiction Care, Almere, Netherlands
| | - Roelof Ettema
- Research Group Personalized Integrated Care, University of Applied Science Utrecht, Utrecht, Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands.,Arq Psychotrauma Expert Group, Diemen, Netherlands.,Department of Military Mental Health Care (MGGZ), Ministry of Defense, Utrecht, Netherlands
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Hawkes C, Norris K, Joyce J, Paton D. Professional mental health support seeking in Women of Refugee Background resettled in Australia: An exploratory study of facilitators and barriers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e440-e456. [PMID: 33797138 DOI: 10.1111/hsc.13370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/30/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
The present study is the first to investigate factors influencing professional mental health support seeking in Women of Refugee Background (WoRB) in Australia. WoRB are a vulnerable population with a range of complex mental health needs. Despite this, research has indicated that WoRB are an underrepresented population in the utilisation of mental health support services. This is a particular concern in Australia, due to an increasing number of WoRB being resettled. A multivariate logistical regression was conducted on a sample of 450 WoRB resettled in Australia from the Building a New Life in Australia (BNLA) data set to investigate factors associated with seeking professional mental health support. Several factors were identified as being significantly associated with professional mental health support seeking in WoRB resettled in Australia, including age, resettlement location, marital status, prearrival trauma involving violence against women, language barriers and health-related variables, including mental distress and long-term disability. The current study provides a unique insight into professional mental health support seeking from a gendered perspective in WoRB resettled in Australia. Insights into factors that influence seeking professional mental health support in this highly vulnerable population must inform mental health practice, service delivery and policies.
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Affiliation(s)
- Clare Hawkes
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kimberley Norris
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Janine Joyce
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Douglas Paton
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
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Kula Y, Cohen O, Clempert N, Grinstein-Cohen O, Slobodin O. Educating nursing students for cultural competence in emergencies: a randomized controlled trial. BMC Nurs 2021; 20:184. [PMID: 34587960 PMCID: PMC8479710 DOI: 10.1186/s12912-021-00704-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Racial and ethnic minorities suffer significantly more than others in the wake of disasters. Despite the growing recognition of the importance of culturally competent health services, systematic cultural competence training in the medical education system is still scarce, especially in the field of emergency. The current study aimed to examine the effectiveness of an online culturally informed intervention for increasing cultural competence in emergencies among nursing students. METHODS A randomized controlled trial was used to test the intervention effectiveness in increasing nursing students' cultural competence in four domains: attitudes, knowledge, skills, and encounters. The study included 72 undergraduate nursing students recruited from two academic institutes. Participants were randomized (1:1 ratio) to an intervention (n = 34) and control group (n = 38). The study adheres to the Consolidated Standards of Reporting Trials (CONSORT). Data analysis was based on multivariate analysis of variance with repeated measures, followed by post hoc analyses with Bonferroni correction for multiple comparisons. RESULTS Results showed that the intervention was effective in increasing the participants' culturally competent knowledge. The effect of the intervention on the skills domain approached significance. No group differences were identified in the attitudes and the encounters domains. CONCLUSIONS An online culturally informed intervention, incorporated in the curriculum, was effective in enhancing the cognitive aspect of cultural competence (especially at the basic knowledge and understanding levels), but not other domains. Our results encourage the development of future intervention programs that are based on a deep understanding of local values, needs, and preferences.
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Affiliation(s)
- Yosef Kula
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Odeya Cohen
- Department of Nursing, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Clempert
- Department of Middle East Studies, Ben-Gurion Universityof the Negev, Beer-Sheva, Israel
| | - Orli Grinstein-Cohen
- Department of Nursing, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ortal Slobodin
- Department of Education, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel.
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Murphy R, Keogh B, Higgins A. An embodied distress: African asylum seekers' experiences of mental health difficulties while awaiting an asylum outcome in Ireland. Transcult Psychiatry 2021; 58:239-253. [PMID: 33103605 DOI: 10.1177/1363461520966108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The mental health of asylum seekers has attracted significant interest and examination. Quantitative studies have consistently indicated that asylum seekers experience mental distress at a higher rate than both host populations and their refugee counterparts. Qualitative insight into asylum seekers' embodied experience of mental distress is limited. This qualitative narrative study aimed to explore African asylum seekers' everyday embodied experiences of mental distress. Sixteen semi-structured one-to-one interviews were conducted with African asylum seekers who had experienced mental distress and were receiving mental health care services in Ireland. Narrative data were analysed using a holistic analysis framework of narrative form and content. Participants described their everyday endurance of relentless rumination, shame, self-loathing, anger, and mistrust, and of becoming demoralised and hopeless. Study findings indicate that asylum seekers' mental distress interweaves the physical, psychological, emotional, and social realms, thus impacting on the whole of their being. Consequences for asylum seekers include feeling anaesthetised, having a severely diminished capacity to connect and interact with their external surroundings and other people, and, for some, efforts to end their life.Examinations of, and responses to, asylum seekers' mental distress must delve beyond the confines of diagnostic categorisations and codifications of symptomology. To achieve heightened understanding and efficacious interventions, we must empathetically listen and engage with asylum seekers' narratives of distress and the socio-cultural and socio-political context they inhabit.
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Lau LS, Rodgers G. Cultural Competence in Refugee Service Settings: A Scoping Review. Health Equity 2021; 5:124-134. [PMID: 33778315 PMCID: PMC7990563 DOI: 10.1089/heq.2020.0094] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: Refugees and asylum seekers have unique and complex needs related to their experiences of forced displacement and resettlement. Cultural competence is widely recognized as important for the provision of effective and equitable services for refugee populations. However, the delivery of culturally appropriate services-including health care and social services-is often complicated by unclear definitions and operationalization of cultural competence. Further, the unique needs and priorities of people from refugee backgrounds are under-addressed in the cultural competence literature. This scoping review seeks to synthesize the peer-reviewed literature examining cultural competence in refugee service settings. Methods: A systematic search of four databases (EBSCO, Proquest, Scopus and Google Scholar) identified 26 relevant peer-reviewed studies for analysis. Results: A range of approaches to cultural competence were identified at the level of individual providers and organizations. Conclusion: We identified a need for greater refugee participation and perspectives in the practice of cultural competence, increased conceptual clarity and greater recognition of structural barriers. We call for further rigorous research that critically examines the concept of cultural competence and its meaning and relevance to refugee populations.
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Affiliation(s)
- Ling San Lau
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
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Zehetmair C, Zeyher V, Cranz A, Ditzen B, Herpertz SC, Kohl RM, Nikendei C. A Walk-In Clinic for Newly Arrived Mentally Burdened Refugees: The Patient Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052275. [PMID: 33668936 PMCID: PMC7956492 DOI: 10.3390/ijerph18052275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 11/16/2022]
Abstract
Providing refugees with psychosocial support is particularly important considering the high level of mental health problems prevalent in this population. A psychosocial walk-in clinic operating within a state reception and registration center in Germany has been supporting mentally burdened refugees since 2016. This study focused on patients' perspectives on their mental health burden, the psychosocial walk-in clinic, and future help seeking. We conducted interviews with n = 22 refugees attending the walk-in clinic from March to May 2019. Qualitative analysis focused on the following four topics: (1) mental burden from the patients' perspective, (2) access to the psychosocial walk-in clinic, (3) perception of counseling sessions, and (4) perception of follow-up treatment. The results show that the majority of interviewees were burdened by psychological and somatic complaints, mostly attributed to past experiences and post-migratory stress. Therapeutic counseling and psychiatric medication were found to be particularly helpful. Most of the participants felt motivated to seek further psychosocial support. Key barriers to seeking psychosocial help included shame, fear of stigma, and lack of information. Overall, the psychosocial walk-in clinic is a highly valued support service for newly arrived refugees with mental health issues.
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Affiliation(s)
- Catharina Zehetmair
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
- Correspondence: ; Tel.: +49-6221-56-3873
| | - Valentina Zeyher
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
| | - Anna Cranz
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
| | - Beate Ditzen
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, 69115 Heidelberg, Germany; (B.D.); (R.M.K.)
| | - Sabine C. Herpertz
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University Hospital, 69115 Heidelberg, Germany;
| | - Rupert Maria Kohl
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, 69115 Heidelberg, Germany; (B.D.); (R.M.K.)
| | - Christoph Nikendei
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
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Giordano F, Ungar M. Principle-driven program design versus manualized programming in humanitarian settings. CHILD ABUSE & NEGLECT 2021; 111:104862. [PMID: 33278731 DOI: 10.1016/j.chiabu.2020.104862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/21/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Affiliation(s)
- F Giordano
- Department of Psychology - Resilience Research Unit, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20121, Milan, Italy.
| | - M Ungar
- Canada Research Chair in Child, Family and Community Resilience, Resilience Research Centre, Dalhousie University, PO Box 15000, Halifax, NS, B3H4R2, Canada.
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Shala M, Morina N, Burchert S, Cerga-Pashoja A, Knaevelsrud C, Maercker A, Heim E. Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. Internet Interv 2020; 21:100339. [PMID: 32983906 PMCID: PMC7495109 DOI: 10.1016/j.invent.2020.100339] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Internet- and mobile-based mental health interventions have the potential to narrow the treatment gap in ethnic groups. Little evidence exists on the cultural adaptation of such interventions. Cultural adaptation of evidence-based interventions distinguishes between surface and deep structure adaptation. Surface refers to matching materials (e.g., illustrations, language) or methods of treatment delivery to the target population, whereas deep structure adaptation considers cultural concepts of distress (CCD). So far, CCD have only been considered to a limited extent in cultural adaptation of psychological interventions, and there is a lack of well documented adaptation procedures. AIMS With a cross-disciplinary and mixed-method approach, following a new conceptual framework for cultural adaptation of scalable psychological interventions, this study aimed to develop both surface and deep structure adaptations of an internet- and mobile-based intervention called Hap-pas-Hapi for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. METHODS A qualitative ethnopsychological study was conducted to examine the target group's CCD. Focus group discussions, an online survey, and individual key informant interviews were utilised to evaluate the original intervention, adaptation drafts and the final adapted intervention. A reporting system was developed to support the decision-making process and to report all adaptations in a transparent and replicable way. RESULTS The ongoing involvement of target population key informants provided valuable feedback for the development of a more person-centred intervention, which might enhance treatment acceptance, motivation and adherence. DISCUSSION This study provides empirical and theory-based considerations and suggestions for future implementation that may foster acceptability and effectiveness of culturally adapted evidence-based interventions.
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Affiliation(s)
- Mirëlinda Shala
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Switzerland
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Arlinda Cerga-Pashoja
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Eva Heim
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
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Byrow Y, Pajak R, Specker P, Nickerson A. Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review. Clin Psychol Rev 2019; 75:101812. [PMID: 31901882 DOI: 10.1016/j.cpr.2019.101812] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 01/04/2023]
Abstract
Despite elevated rates of psychological disorders amongst individuals from a refugee background, levels of mental health help-seeking in these populations are low. There is an urgent need to understand the key barriers that prevent refugees and asylum-seekers from accessing help for psychological symptoms. This review synthesises literature examining perceptions of mental health and barriers to mental health help-seeking in individuals from a refugee background. Our analysis, which complies with PRISMA reporting guidelines, identified 62 relevant studies. Data extraction and thematic analytic techniques were used to synthesise findings from quantitative (n = 26) and qualitative (n = 40) studies. We found that the salient barriers to help-seeking were: (a) cultural barriers, including mental health stigma and knowledge of dominant models of mental health; (b) structural barriers, including financial strain, language proficiency, unstable accommodation, and a lack of understanding of how to access services, and (c) barriers specific to the refugee experience, including immigration status, a lack of trust in authority figures and concerns about confidentiality. We discuss and contextualise these key themes and consider how these findings can inform the development of policies and programs to increase treatment uptake and ultimately reduce the mental health burden amongst refugees and asylum-seekers.
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Affiliation(s)
- Yulisha Byrow
- School of Psychology, University of New South Wales, Sydney, Australia.
| | - Rosanna Pajak
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Philippa Specker
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
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Spanhel K, Schweizer JS, Wirsching D, Lehr D, Baumeister H, Bengel J, Sander L. Cultural adaptation of internet interventions for refugees: Results from a user experience study in Germany. Internet Interv 2019; 18:100252. [PMID: 31890608 PMCID: PMC6926246 DOI: 10.1016/j.invent.2019.100252] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The estimated number of refugees worldwide resulting from persecution, conflict, violence, or human rights violations reached 25.4 million in 2017. An increased prevalence of mental disorders combined with language and socio-cultural barriers pose a challenge for healthcare systems. Internet-based interventions can help to meet this challenge. For the effective use of such interventions in refugees, cultural adaptations are necessary. The variety of their cultural backgrounds thereby is particularly challenging. METHODS We conducted this explorative qualitative study in order to identify elements of Internet-based interventions that need cultural adaptation to be suitable for refugees. Six refugees from Syria, Iran, Eritrea, Algeria, and Iraq, and six healthcare providers (two social workers, two psychologists, one physiotherapist, one physician) working with refugees went through an intervention for individuals with sleeping problems (eSano Sleep-e). Possible threats to user experience were identified using the Think Aloud method and semi-structured interviews. Statements were analysed based on the grounded theory method. RESULTS Results indicate the necessity to adapt the intervention to the specifics of refugees including aspects related to the flight (i.e., past and current stressors) and non-western characteristics (i.e., habits, disease and treatment concepts). Elements of adaptation should include pictures, role models, language, psychoeducational elements, structure of modules, and format of presentation. CONCLUSIONS Cultural adaptation can be used to facilitate the identification with an intervention, which seems crucial to increase the acceptance among refugees. In spite of their diverse cultural backgrounds, it appears feasible to create interventions that allow identification by refugees from different home countries.
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Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany
| | - Johannes Samuel Schweizer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany
| | - Dorothea Wirsching
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany
| | - Dirk Lehr
- Department of Health Psychology, Institute of Psychology, Leuphana University Lüneburg, Universitätsallee 1, D-21335 Lüneburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, D-89081 Ulm, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany
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Slobodin O, Clempert N, Kula Y, Cohen O. Educating health professionals for cultural competence in emergency situations: A study protocol for a randomized controlled trial. J Adv Nurs 2019; 76:380-386. [DOI: 10.1111/jan.14245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/02/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ortal Slobodin
- Department of Education Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Neta Clempert
- Department of Middle East Studies Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Yosef Kula
- Masters' program in Emergency Medicine School of Public Health Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
| | - Odeya Cohen
- Masters' program in Emergency Medicine School of Public Health Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheva Israel
- Nursing Department Recanati School for Community Health Professions Ben‐Gurion University of the Negev Beer‐Sheva Israel
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Newnham EA, Pearman A, Olinga-Shannon S, Nickerson A. The mental health effects of visa insecurity for refugees and people seeking asylum: a latent class analysis. Int J Public Health 2019; 64:763-772. [PMID: 31139848 DOI: 10.1007/s00038-019-01249-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/09/2019] [Accepted: 05/07/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Current regional conflicts are creating a surge in forced migration, and heightened visa restrictions are increasingly being applied. The current study aimed to examine the relationship between visa insecurity and psychological outcomes within a large clinical sample of refugees and people seeking asylum in Australia. METHODS The sample comprised 781 clients (53.9% male, 16-93 years) attending a clinic for trauma survivors. Country of birth was most frequently identified as Afghanistan (18.1%), Iraq (15.3%) and Iran (15.1%). The Hopkins Symptom Checklist was administered at admission. RESULTS Latent class analyses identified four groups varying in severity of symptoms, namely very high (16.1%), high (38.1%), moderate (31.5%), and low (14.3%). People with insecure visa status were at least five times more likely to report high (OR = 5.86, p < 0.001) or very high (OR = 5.27, p < 0.01) depression and anxiety symptoms than those with permanent residency. Women were almost twice as likely to report high (OR = 1.96 p < 0.01) or very high (OR = 1.96, p < 0.05) symptoms. CONCLUSIONS The findings suggest that temporary visas play a significant role in psychological distress and that timely immigration processing has important implications for health outcomes.
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Affiliation(s)
- Elizabeth A Newnham
- School of Psychology, Curtin University, GPO Box U1987, Perth, 6845, Australia. .,FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, USA. .,School of Psychological Science, The University of Western Australia, Perth, Australia.
| | - April Pearman
- Association for Services to Torture and Trauma Survivors (ASeTTS), Perth, Australia
| | | | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
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