Health disparities among Burmese diaspora: an integrative review

Tens of thousands of displaced Burmese ethnic minorities have endured various adversities for over six decades but are largely underserved. This study aimed to illuminate the health impacts of their misfortunes and unmet areas of concern. Using a holistic lens, we conducted an integrative review of 47 papers spanning the years 2004 to 2022 from diverse data sources. The results revealed widespread multimorbidity, triggered mainly by displacement. The diaspora's problematic health conditions were worse than their host country's general population. There was a strong indication that the diaspora's unfortunate health trajectory is determined early in life. Ongoing human rights violations and grossly inadequate health care interventions deepened pre-existing health conditions. Noteworthy emerging treatment initiatives, including integrative health care, were underutilized. The persisting health and intervention needs among the diaspora warrant advanced studies to facilitate much-needed resource mobilization and collaboration among stakeholders to promote health equity.

Funding

There was no financial support for this manuscript.

Acculturative stress, stigma, and mental health challenges: emic perspectives from Somali young adults in San Diego county's 'Little Mogadishu'

OBJECTIVES

The purpose of this study was to explore the social factors that contribute to the mental health challenges that Somali young adults endure.

DESIGN

In a two-phase qualitative approach carried-out in the San Diego area, in phase-I, we conducted exploratory interviews with key-informants including clinicians and local Somali leaders (n = 7) who are familiar with the challenges of young Somalis. This information was then augmented through a focus group discussion with Somali young adults (n = 4) to gain further contextual knowledge and for access to the larger community of young people for phase-II. In this second phase, we carried-out individual interviews with 21 Somali young adults. Interviews covered topics including the social factors influencing their mental health, typical strategies for coping with psychological distress, barriers to seeking professional mental health services, and suggestions for combating mental health problems affecting young Somalis.

RESULTS

Participant narratives indicate that psychological distress (depression and posttraumatic stress disorder) are highly pervasive, and that shame, acculturative stress and ethnic discrimination as well as parents' dismissive reactions to their children's emotional problems perpetuate mental health problems. Coping strategies included support from friends, religious activities, and playing soccer. Suggestions for addressing their challenges centered on engagement from their own community to advocate for mental health.

CONCLUSIONS

Implications of this study are discussed in the context of bridging intergenerational and acculturation divides to deliver culturally competent interventions that improve the mental health and well-being of Somali young adults and aid them in their adjustment to the U.S.

Prevalence and Social-Ecological Correlates of Intimate Partner Violence in a Conflict Zone-Evidence From the 2015 Afghanistan Demographic and Health Survey

This study examined the prevalence and social-ecological correlates of male-to-female intimate partner violence (IPV) in Afghanistan. Using data from the 2015 Afghanistan Demographic and Health Survey, which included 20,793 currently married women, we found that the past-year prevalence of physical IPV was highest (46%), followed by emotional (34%) and sexual forms (6%). Results also showed that the risk of IPV in general was associated with an array of community and societal-, family and relationship-, and person-level factors. Our findings point to potential intervention targets for women in this conflict zone where IPV is a highly pervasive and complex societal challenge.

Prevalence and social determinants of tobacco use in Afghanistan

Background

Limited evidence exists on the prevalence and social determinants of tobacco use in Afghanistan—a fragile post-war context where the tobacco epidemic is on the rise. This study aimed to estimate the prevalence and social determinants of tobacco use in Afghan men and women.

Methods

Data from the 2015 Afghanistan Demographic and Health Survey of 10 760 men and 29 461 women were used to generate weighted prevalence estimates for smoking, smokeless tobacco (SLT) products including chew and snuff tobacco, ‘any tobacco use’ and ‘dual tobacco use’. We also modelled associations with tobacco outcomes using binary logistic regressions.

Results

We found that for men, smoking cigarettes was the most prevalent form of tobacco use (21.9% [95% confidence interval {CI} 21.2–22.7]). Prevalence rates were far lower for women, with cigarette/pipe smoking at 3.4% (95% CI 3.2–3.7). For both sexes, tobacco use was inversely associated with education and positively associated with agricultural and skilled and unskilled manual labour occupations. Wealth increased the odds of smoking for men but decreased the odds for women. Media exposure had little influence on tobacco use among women; however, the effects were more varied for men.

Conclusions

Our results demonstrate social inequalities in tobacco use among Afghan men and women, which calls for stronger tobacco control measures and continued monitoring of this growing epidemic.

Association between HIV knowledge and stigmatizing attitudes towards people living with HIV in Afghanistan: findings from the 2015 Afghanistan Demographic and Health Survey

BACKGROUND

Afghanistan has witnessed a dramatic increase in HIV infections. Public health officials have responded with campaigns to educate the public about HIV prevention and transmission. We examine the association between HIV prevention and transmission knowledge and stigma towards people living with HIV (PLHIV) in Afghanistan.

METHODS

We conducted a secondary analysis of cross-sectional data (n=11 930) from the 2015 Afghanistan Demographic and Health Survey. Hierarchical linear regression analysis was used to examine the effects of accurate HIV knowledge related to safer sex and local misconceptions about the virus's transmission (e.g. mosquitos and witchcraft) on two stigma outcomes, namely, stigma towards public others with HIV (teachers and food vendors) and stigma towards close family members with HIV.

RESULTS

Stigmatizing attitudes were highly prevalent and HIV knowledge varied widely. Multivariate analyses show that correct knowledge related to local misconceptions about HIV prevention and transmission is significantly associated with lower stigma towards public others (ΔR2adjusted=0.07); however, knowledge had little and contradictory influence in the model predicting stigma towards close family members with HIV (ΔR2adjusted=0.005).

CONCLUSIONS

These findings suggest that it would be worthwhile designing interventions that dispel local misconceptions about HIV. This may be helpful in reducing stigma towards PLHIV in public positions but not towards family members, which calls for alternative strategies for reducing HIV-related stigma.

ETHNIC DIFFERENCES IN THE RELATIONSHIP BETWEEN SOCIAL CAPITAL AND PSYCHOLOGICAL DISTRESS IN OLDER CALIFORNIANS

Seniors aged 65 and older are at great risk of psychological distress given their functional decline, which is known to limit participation and engagement in community life. The purpose of this study is to examine whether higher indices of social capital have a positive impact on the mental health of older, ethnic Californians. We conducted a secondary analysis of data for 7,485 Californians 65 and older from the 2016 California Health Interview Survey (CHIS). A principal components analysis generated two social capital measures; one measuring safety and social cohesion, the other civic engagement. Hierarchical linear regression analyses were conducted to assess the independent effects of social capital subscales on the severity of psychological distress as measured by the Kessler-6 (K6).Respondents were on average moderately distressed, with small yet significantly higher K6 scores observed among African Americans, Asians, and Native Americans. The addition of our social capital variables in subsequent steps resulted in little yet significant change in explaining psychological distress (ΔR2 = .02, p < .001) with only neighborhood safety and social cohesion being inversely associated with K6 (β = -.15, p < .001). The interaction between ethnicity and neighborhood safety and social cohesion resulted in non-significant associations with K6 scores for all ethnic minority subgroups; however, for African Americans the relationship with psychological distress actually increased significantly (β = .24, p < .001). Our findings suggest that specific types of social capital may be helpful in remediating psychological distress for certain ethnic minority groups.

Effect of Perceived Discrimination on Depressive Symptoms in 1st- and 2nd-Generation Afghan-Americans

While it is well established that Afghan refugees are disproportionately affected by mental health problems, limited evidence exists concerning the psychosocial needs of their children who are transitioning to adulthood in the United States; that is, of 1st- and 2nd-generation Afghan-Americans. The purpose of this study was to examine the effect of perceived discrimination on depressive symptoms in this population, and to determine whether discrimination is buffered by ethnic identity and social support. A convenience sample of 133 1st- and 2nd-generation Afghan-Americans participated in this study by completing a brief survey. We used OLS regression methods to control for covariates, and to sequentially test study hypotheses. The results show that perceived discrimination was significantly associated with high levels of depression. Furthermore, the effect of discrimination on depression was not buffered by ethnic identity or social support. We found that perceived discrimination was a significant source of stress and a risk-factor for negative mental health outcomes among 1st- and 2nd-generation Afghan-Americans. Future research should examine additional pre-dispositional and protective factors for discriminatory experiences and associated health outcomes.

Discrimination and distress among Afghan refugees in northern California: The moderating role of pre- and post-migration factors

This study investigates the effect of perceived discrimination on the mental health of Afghan refugees, and secondly, tests the distress moderating effects of pre-migration traumatic experiences and post-resettlement adjustment factors. In a cross-sectional design, 259 Afghans completed surveys assessing perceived discrimination and a number of other factors using scales developed through inductive techniques. Multivariable analyses consisted of a series of hierarchical regressions testing the effect of perceived discrimination on distress, followed by a sequential analysis of moderator variables. Perceived discrimination was significantly associated with higher distress, and this relationship was stronger among those with a strong intra-ethnic identity and high pre-resettlement traumatic experiences. The expected buffering effects of civic engagement, ethnic orientation (e.g. integration), and social support were not significant. Discrimination is a significant source of stress for Afghan refugees, which may exacerbate stresses associated with other pre- and post-migration stressors. Future research is needed to tailor interventions that can help mitigate the stress associated with discrimination among this highly vulnerable group.

Risk and protective factors associated with the mental health of young adults in Kabul, Afghanistan

BACKGROUND

We examined the mental health status and severity of psychological distress symptoms among young adults residing in Kabul, Afghanistan and determined how such outcomes might be influenced by an array of risk and protective factors.

METHODS

A cross-sectional study design was adopted using convenience, snowball, and street-intercept recruitment techniques. Surveys were completed by 232 young adults between 18 and 35 years of age in September 2015. We used both etic (mental health component of the SF-8) and emic (Afghan Symptom Checklist) measures of mental health and psychological distress, respectively, and regressed these outcome measures against socio-demographic, physical health, and psychological variables (resilience, hope-optimism) using ordinary least squares (OLS) regression methods.

RESULTS

We found that poor mental health is common in this sample, affecting 75% of participants; and, that distress symptoms (depressive, anxiety, and somatoform symptoms) occur often. Regression models were consistent in showing higher education as a risk-factor for both outcomes, whereas, age, ethnicity, and income significantly contributed only to the ASCL model as risk-factors. However, both outcomes were strongly influenced by protective factors such as good physical health status and higher perceived hope-optimism.

CONCLUSIONS

Our study provides further evidence of how current economic conditions in Kabul contribute to poor mental health and symptom severity, but also show how positive physical health and perceived hope-optimism can be protective. This study provides support for developing culturally-competent policies and interventions that build on protective factors.

Determinants of Health Care Services Utilization among First Generation Afghan Migrants in Istanbul

There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live.

Use of intrarenal needle manometry in acute renal dysfunction following renal transplantation

Intrarenal manometry (IRM) using the Salaman fine-needle technique was routinely performed in 28 renal transplant patients in order to make the differential diagnosis of acute tubular necrosis, cyclosporin nephrotoxocity, and acute rejection. A total of 246 IRM determinations with simultaneous percutaneous renal biopsies were obtained in cases of acute renal failure following a renal transplant. Normal IRM values were 21.4 +/- 1.3 mm Hg. After collecting the clinical data, cyclosporin levels, ultrasound information, response to therapy, and renal biopsy results, we retrospectively obtained 49 IRM measurements in acute rejection, 9 in cyclosporin nephrotoxicity, and 26 in acute tubular necrosis. The values in acute rejection (41.3 +/- 9.5 mm Hg) were significantly different from the normally functioning kidneys, cyclosporin nephrotoxicity, or acute tubular necrosis. The values in cyclosporin nephrotoxicity were slightly elevated when compared to the normal or acute tubular necrosis determinations (p < 0.04) but were still significantly lower than the acute rejection. Our results suggest that IRM represents a useful technique in the approach to the acute renal dysfunction in renal transplant recipients.