Migrations, trauma and mental health: A literature update on psychological assessment

INTRODUCTION

Migrants and refugees often face potentially traumatic events and post-migratory stressors. Upon arrival in the host country, they can be referred to mental health services to assess the impact of their previous experiences. These cross-cultural clinical encounters may raise questions, particularly regarding the assessment of mental health using models based on Western conceptions of psychopathology.

OBJECTIVES AND METHOD

The objective of the present non-systematic review of the literature is to discuss the psychological evaluation of post-traumatic reactions in migrants and refugees. More specifically, we present current research on psychopathology, resilience and post-traumatic development (PTG) among the migrant and refugee population. We also examine the cross-cultural validity of concepts such as Post-Traumatic Stress Disorder, resilience and PTG. Finally, we describe the most frequently used tools in cross-cultural psychological assessment and briefly reflect on the question of cultural sensitivity of mental health professionals. A bibliographic search was carried out using the databases: PILOTS, Pubmed, APA PsycNET, and Google Scholar using the following keywords: "migrants", "refugees", "posttraumatic stress disorder", "mental health", "Psychopathology", "risk factors", "protection factors", "posttraumatic growth" and "resilience". We have also reviewed the reference lists of articles encountered from database searches.

RESULTS

Responses to a potentially traumatic situation are multiple. Regarding the migrant and refugee population, the reviewed articles studied different post-traumatic reactions such as resilience, post-traumatic development, and psychopathologies. The most studied psychopathological responses were depression, anxiety and Post-traumatic Stress Disorder. After reviewing these studies, we asked the following question: considering the complexity of the migration process, what are the factors associated with the development of these different post-traumatic responses? Indeed, several individual and social factors before, during and after migration influence the mental health of individuals in a migration situation. Among the most cited risk factors identified were: to be a victim of or witness to violence in the country of origin and, after migration, to face post-migration difficulties such as asylum denial, to be in a precarious situation with regard to housing and work, as well as the difficulties linked to adaptation to the new culture. We have also described protective factors for the mental health of this population, such as: social support, psychological support, and a good quality of life in the host country. The reviewed articles also describe an important influence of cultural aspects on mental health, such as the perception of an event as traumatic. Although the authors of the reviewed articles accept this influence of culture on post-traumatic responses, most of the tools used to assess the mental health of migrants and refugees were created in a Western context. Studies show a growing concern with these cultural aspects, and certain tools that allow a more culturally sensitive evaluation, such as the "Cultural Formulation Interview", are being developed.

DISCUSSION AND CONCLUSION

Even if the concern with the sensitivity of the tools used in cross-cultural assessment seems to be more present in the international literature, researchers seem to encounter difficulties in better understanding the effects of culture on the mental health of individuals. With increasingly diverse societies, new research should not be based on participants' geographic or ethnic origins, but rather try to "unpack" culture with, for example, the exploration of the relationships between certain values or orientations and the different expressions of psychological distress. Finally, given the still lacking development in the field of cross-cultural research, certain practices, such as the participation of interpreters, the supervision of cultural mediators or the use of culturally sensitive tools, can help the clinician to maintain good practices with patients from different cultures in the diagnostic and psychotherapeutical processes.

Lead tolerance and accumulation in initial sporophytes of Regnellidium diphyllum Lindm. (Marsileaceae)

Regnellidium diphyllum Lindm. is a heterosporous fern which grows in shallow waters and wetlands, and water pollution contributes to its vulnerability. Environmental lead contamination is mostly caused by industrial and agricultural residues as well as domestic sewage. Given its persistence in the environment, lead can cause important toxicity in living organisms. Megaspore germination and the initial growth of R. diphyllum sporophytes were assessed in Meyer's solution with lead nitrate (Pb(NO3)2) concentrations of 0 (control), 1, 5, 10 and 50 mg L(-1). The study was conducted in a growth chamber at 25 ± 1°C and a 12 hour photoperiod with a nominal irradiance of 100 μmol m(-2) s(-1), for 28 days. Lead concentration in sporophytes was assessed using atomic absorption spectrometry. In the absence of lead, 74% of spores germinated, while significantly lower germination percentages were observed in Pb(NO3)2 concentrations of 1, 10 and 50 mg L(-1). The presence of lead did not significantly influence root growth. At 28 days, primary leaf development was significantly lower in Pb(NO3)2 concentrations of 5 mg L(-1) and higher in relation to the control. The length of secondary leaves did not significantly differ between sporophytes exposed to different concentrations of lead and those of the control at 28 days. Sporophytes exposed to 10 and 50 mg L(-1) Pb(NO3)2 accumulated 1129 mg kg(-1) and 5145 mg kg(-1) of Pb, respectively. The presence of high levels of lead in R. diphyllum sporophytes did not prevent initial development. Future studies should investigate the ability of the species to accumulate and tolerate high levels of lead in advanced stages of its development and in environmental conditions.

Radiografia intraoral e convencional da hemiarcada superior direita de gatos domésticos

A proposta com este trabalho foi avaliar a hemiarcada superior direita de gatos domésticos por meio de técnicas radiográficas odontológicas do paralelismo, empregando-se filmes intraorais aos posicionadores de Han Shin. As imagens obtidas por essa metodologia foram correlacionadas com as técnicas radiográficas convencionais (extraorais), com o intuito de se estabelecerem vantagens ou desvantagens para detectar possíveis afecções dentais e periodontais. Foram utilizados 30 gatos, sem raça definida, 17 machos e 13 fêmeas, faixa etária entre um e três anos, confinados em gatis do Departamento de Zootecnia da Universidade Federal de Lavras/MG. Com os animais sob anestesia geral, foram realizadas radiografias da hemiarcada superior direita, incluindo três incisivos, um canino, três pré-molares e um molar em radiografias intraorais e extraorais. As imagens radiográficas foram analisadas e efetuaram-se comparações qualitativas entre pares intraorais e convencionais dos mesmos animais. Para se estabelecer a técnica radiográfica dental mais bem adaptada, foram realizadas análises estatísticas pelo teste de McNemar (qui-quadrado modificado). A técnica intraoral mostrou ser superior à extraoral (P<0,05), para achados referentes a espaço periodontal aumentado, canal radicular amplo e arredondamento de ápice, e também para a avaliação mais bem detalhada de dentes caninos, pré-molares e molares em gatos.

Avaliações ultrassonográfica e radiográfica dos efeitos da suplementação com dois tipos de probióticos sobre o intestino de cães filhotes

Avaliaram-se os efeitos da suplementação de dois tipos de probióticos para cães filhotes da raça Beagle, que receberam dois tipos de dieta de alta e baixa qualidade, sobre os achados em exames de diagnóstico por imagem. Foram utilizados 18 cães filhotes da raça Beagle, distribuídos em três tratamentos inteiramente ao acaso: tratamento 1, controle (ração); tratamento 2, ração com probiótico 1 (Bifidobacterium); e tratamento 3, ração com probiótico 2 (Lactobacillus). O experimento foi dividido em duas fases, cada uma caracterizada pela mudança da dieta de qualidades diferentes. Ao exame ultrassonográfico, foi avaliada a espessura da parede gastrintestinal, e ao radiográfico, a presença de gás em alças intestinais e o espessamento da parede. Observou-se aumento da espessura da parede das alças intestinais (P<0,05), nos animais dos grupos tratados com probiótico 1 e 2 (5,74mm e 6,01mm, respectivamente) em relação aos do grupo-controle (5,03mm). O uso de probióticos não influenciou a produção de gás intestinal. Não houve diferença (P>0,05) entre os tratamentos quanto ao escore de gás intestinal. A avaliação quantitativa permitiu a determinação de um escore de gás intestinal, de forma não invasiva, por meio do software Image J®. Concluiu-se que o diagnóstico por imagem sustenta a recomendação dessa metodologia como ferramenta auxiliar na avaliação nutricional de dietas para cães.

Avaliação ultrassonográfica da anomalia vascular portossistêmica em cão: relato de caso

Relata-se a avaliação ultrassonográfica, com auxílio do Doppler em cores, da anomalia vascular portossistêmica em um cão da raça Poodle Toy, que apresentou edema pulmonar e alterações gastrintestinais. Ao exame ultrassonográfico, foram observados vasos portais dilatados e tortuosos. Esses resultados associados aos achados clínicos e laboratoriais permitem identificar a anomalia vascular portossistêmica no paciente.

Doença renal medular cística em uma cadela Yorkshire Terrier: relato de caso

Uma cadela da raça Yorkshire Terrier apresentou hematêmese, distensão abdominal, poliúria e polidipsia. Após o exame clínico do paciente, estabeleceu-se a suspeita clínica de nefropatia. Os resultados dos exames laboratoriais revelaram anemia normocítica normocrômica e concentrações séricas de uréia (306mg/dl) e de creatinina (3,6mg/dl) acima dos valores de referência. Ao ultra-som bidimensional observaram-se áreas císticas hipoecóicas e anecóicas, padrão renal hipercogênico e perda da relação corticomedular. À necropsia, a região medular apresentou grande quantidade de cistos pequenos em meio a tecido conjuntivo fibroso. A lesão tubulointersticial cortical foi a responsável pela insuficiência renal resultante. Firmou-se diagnóstico de nefrite tubulointersticial.