Impact of United States refugee ban and discrimination on the mental health of hypertensive Arabic-speaking refugees

Background

Hypertension is a global leading cause of death which disproportionately affects refugees. This chronic disease increases the risk of heart disease, stroke, brain, and other end-organ disease, if left uncontrolled. The 2017 United States travel or "Muslim" ban prevented immigrants and refugees from seven Muslim-majority countries from entering the United States, including Syria and Iraq; two major contributors to the global refugee population. As of 2020, the United States has admitted more than 133,000 and 22,000 Iraqi and Syrian refugees, respectively. Studies on the health effects of this policy on refugees are lacking. This study qualitatively explores the impact of the refugee ban on United States resettled Syrian and Iraqi refugees with hypertension.

Methods

Participants were recruited through a federally qualified health center system that is the largest healthcare provider for refugees in San Diego, CA. All participants were Arabic-speaking refugees diagnosed with hypertension from Syria and Iraq. In-depth interviews took place between April 2021 and April 2022. Inductive thematic analysis was used to analyze data from semi-structured interviews.

Results

Participants (N = 109) include 53 women and 56 men (23 Syrian, 86 Iraqi). The average age was 61.3 years (SD: 9.7) and stay in the United States was 9.5 years (SD 5.92). Four themes emerged linking the travel ban's impact on health, in line with the society to cells framework: (1) family factors: the refugee ban resulted in family separation; (2) physiological factors: the refugee ban worsened participants' mental health, exacerbating hypertension and perceived health outcomes; (3) community factors: perpetuation of Islamophobia, xenophobia, and perceived discrimination were structural barriers with links to poorer health; and (4) individual factors: trickle down consequences led to worsened participant self-image and self-perception within their host community.

Discussion

The refugee ban negatively impacted the mental and physical health of United States resettled Arabic-speaking refugees through perceived discrimination, stress, and poor social integration. It continues to have long-lasting effects years after the ban was instated. Centering family reunification within the United States Refugee Admissions Program and tailoring interventions through the healthcare and public health systems are warranted to reduce hypertension disparities in this growing and overlooked population.

Experiences of Undocumented Parents Reuniting with Children Who Entered the United States as Unaccompanied Minors

In 2021, the United States saw an exponential influx of unaccompanied migrant children crossing the U.S.-Mexico border. Upon apprehension at the border, unaccompanied children are placed in the Office of Refugee Resettlement (ORR) temporary shelter facilities. The ORR is responsible for locating, vetting, and releasing the children to their family, guardians, or a suitable sponsor. Undocumented parents seeking reunification may fear cross-examination and background checks. This study aimed to explore the experiences of undocumented families reunified with their children with the help of a community-based organization (CBO). A collective case study method was used to collect qualitative data from seven parents. Respondent parents expressed their rationale for allowing their children to cross the U.S.-Mexico border, their experience with the ORR, and the reasons they pursued community-based guidance. The results document the depth of trauma and difficulties parents of unaccompanied migrant children face with American service providers. It is recommended that immigration-related government agencies form relationships with culturally diverse organizations that are trusted by immigrant communities.

Effects of Parental Migration on Dental Caries of Six- to Eight-Year-Old Children Using Structural Equation Modeling

This cross-sectional study aimed to document the relationship between dental caries, oral health behaviors, and the duration of parental migration in rural Yunnan, China, from September to December 2020. Seven rural primary schools with high parental migration were studied. The oral health status of 500 six- to eight-year-old students was assessed using clinical examination and caregivers' interviews. A total of 51.8% of the children had at least one parent absent for at least 6 months (left-behind children). Among those children with parental migration <6 months, 40.0% consumed sugar twice or more daily and 82.8% of those with parental migration from 6 to 12 months brushed once a day or less. The percentage of daily sugar consumption twice or more and brushing once or less among those without parental migration were 36.0% and 68.6%. Prevalence of caries in permanent teeth (DMFT) in children without parental migration and those whose parental migration <6 months, 6 to <12 months, and ≤12 months were 30.9%, 20.0%, 28.7% and 19.8%, respectively. Out of several other causal pathways between parental migration and dental caries, our structural equation model delineated that sugar consumption is the important mediator variable. Special education programs may be needed to educate caregivers on sugar consumption for the left-behind children in rural areas.

Juvenile Justice, Technology and Family Separation: A Call to Prioritize Access to Family-Based Telehealth Treatment for Justice-Involved Adolescents' Mental Health and Well-Being

Separating children from families has deleterious effects on children's mental health and well-being, which is highly relevant for youth in juvenile detention and other out-of-home residential placements. Despite growth in the evidence of family-based interventions in mitigating adverse behavioral health outcomes for justice involved adolescents (JIA), gaps remain in intervention dissemination for JIA; this particularly true for those leveraging digital health technologies, a need that has intensified with the COVID-19 pandemic. Use of digital health technologies for JIAs is pressing to address structural barriers in maintaining JIA-family connections, but also to improve treatment access for detained JIAs. Court systems' capacity to support use of digital health tools, such as telehealth, appear promising. Data on the use of tele-conferencing in U.S. juvenile and family courts were collected from 456 juvenile justice professionals as part of a larger study on judicial decision making. Results suggest overwhelming adoption of video-conferencing for court hearings with only 40% of respondents reporting family court use prior to the onset of COVID-19, but majority (91%) now reporting its routine use. Youth participate from a range of settings, including detention, other residential placement, community-based behavioral health and in-home settings. The COVID-19 pandemic has created a shift in the uptake of video-conferencing platforms that could hold promise for future larger scale use across the juvenile justice system. Findings underscore feasibility and acceptability of technology requirements in key settings that should be leveraged for broad scale implementation of empirically supported family-based interventions to advance behavioral health equity for JIA.

Understanding the effects of being separated from family on refugees in Australia: a qualitative study

OBJECTIVE

To understand the impact of family separation on refugees living in Australia.

METHOD

Thirteen participants with a refugee background and experiencing separation from family participated in a semi-structured qualitative interview. Interviews were coded and a thematic analysis was conducted using NVivo software.

RESULTS

Identified themes were organised under four domains. Domain 1 focused on the personal impact of family separation. Themes were the effects on mental health and functioning, driven by incessant worrying about the safety of family and the absence of key attachment figures, the specific effects of having missing family, alterations to self-identity and family dynamics. Domain 2 focused on themes relating to actions taken to find missing family, connect or reunite with separated family. Domain 3 highlighted the coping strategies, support mechanisms and protective factors used by participants. Domain 4 identified core beliefs about the importance of family unity, focusing on security, settlement and a happy future.

CONCLUSIONS

Family separation has an enduring effect on the wellbeing of refugees, with key pathways being ongoing fear and insecurity, disrupted social attachments and identity shifts in relation to the future self.

IMPLICATIONS FOR PUBLIC HEALTH

Refugees separated from or missing family struggle with ongoing stress and adjustment issues.

Economic, Health and Physical Impacts of COVID-19 Pandemic in Sub-Saharan African Regions: A Cross Sectional Survey

Purpose

The key preventive measures adopted to minimise the spread of the coronavirus disease (COVID-19) had significant health, economic and physical impacts mostly in developing countries. This study evaluated the health, economic and physical impacts of COVID-19 lockdown measures among sub-Saharan African (SSA) population and associated demographic variations.

Methods

A total of 1970 respondents took part in this web-based cross-sectional survey during the mandatory lockdown period in most SSA. The dependent variables were health (COVID-19 infection, hospitalisation), socioeconomic (lost job, closed down business) and physical impacts (separated from family) of COVID-19. Univariate and bivariate logistic regression analyses were used to explore the factors associated with each of the dependent variables by the four sub-regions (Southern, Western, Central and East Africa).

Results

The respondents were aged 34.1 ± 11.5 years (range: 18–75 years) and mostly men (1099, 55%). 25.9% (n = 511) reported an impact of COVID-19 pandemic with significant regional variations (p < 0.0005, higher proportion were East 36.2% and Southern Africans 30.3%) but no gender (p = 0.334) and age group variations (p > 0.05). Among Central African respondents, more men than women lost their businesses (45.7% versus 14.3%, p = 0.002) and contracted COVID-19 infections (40.0% versus 18.2%, p = 0.024) during the study period. Multivariable analysis revealed that respondents from East (adjusted odds ratio [AOR] 1.95, 95% confidence interval [CI]: 1.42–2.69), Southern (AOR 1.46, 95% CI: 1.09–1.96) and Central Africa (AOR 1.47, 95% CI: 1.06–2.03) reported significantly higher impact of COVID-19. Those who reported family separation during the lockdown were more likely to be older participants (39–48 years, AOR 2.48, 95% CI: 1.11–5.57).

Conclusion

One in four SSA respondents, mostly East and Southern Africans, were adversely affected by the COVID-19 pandemic during the lockdown. Interventions in high-risk populations are needed to reduce the health, socioeconomic and gender disparities in the impacts of COVID-19.

Impact of Family Separation on Subjective Time Pressure and Mental Health in Refugees from the Middle East and Africa Resettled in North Rhine-Westphalia, Germany: A Cross-Sectional Study

Little is known about social determinants among refugees resettled in Germany. This study aims to examine the impact of family separation on refugees' subjective time pressure and mental health. Data come from the FlueGe Health Study (n = 208), a cross-sectional study administered by Bielefeld University. We used logistic regression analysis to investigate the effect of family separation on (i) being time-stressed and (ii) having a high risk for adverse mental health, considering sociodemographic and postmigration factors. As a result, more than 30% of participants with a spouse or partner and about 18% with a child or children reported separation. Multiple logistic regression showed that family separation was not associated with being time-stressed, but separation from at least one child was associated with adverse mental health (OR = 3.53, 95% CI = [1.23, 10.11]). In conclusion, family separation primarily contributes to adverse mental health among refugees from the Middle East and Africa resettled in North Rhine-Westphalia, Germany. Therefore, policies and practices that facilitate family reunification can contribute significantly to the promotion of refugees' mental health and well-being.

Mechanisms underlying the mental health impact of family separation on resettled refugees

OBJECTIVE

Many refugees experience prolonged separation from family members, which research suggests has adverse effects on mental health and post-displacement outcomes in refugee populations. We examine mental health differences in refugees separated and not separated from their families, and key post-migration factors and cultural mechanisms that may underlie this impact.

METHODS

A sample of 1085 refugees resettled in Australia, of which 23.3% were separated from all of their immediate family, took part in an online battery of survey measures indexing pre- and post-migration refugee experiences, mental health symptoms, disability and individualistic/collectivistic self-identity. Family separation was used as a predictor of mental health outcomes in a series of linear regressions, and the separated and non-separated groups were compared in multigroup path analysis models to examine group-specific indirect effects.

RESULTS

The separated group reported greater exposure to pre-migration potentially traumatic events and higher levels of post-migration living difficulties compared to the non-separated group. Family separation predicted higher post-traumatic stress and depression symptoms, but not disability, after controlling for potentially traumatic event exposure, age and sex. Path analyses revealed distinct indirect effects for separated and non-separated groups. Principally, higher collectivistic self-identity was associated with elevated post-traumatic stress, depression and disability symptoms via social-related post-migration living difficulties such as isolation and loneliness in the separated group; whereas collectivism was linked with increased depression symptoms via economic-related post-migration living difficulties in the non-separated group.

CONCLUSION

These findings indicate that family separation powerfully influences mental health outcomes, but that its effect may be mediated by the type of post-migration stress experienced in the settlement environment and culturally bound differences in how the sense of self is interconnected with family.

"Se extraña todo:" Family separation and reunification experiences among unaccompanied adolescent migrants from Central America

There has been a record surge of unaccompanied immigrant minors (UAMs) entering the United States, with 86% of those apprehended at the US-Mexico border originating from the Central American countries of El Salvador, Guatemala, and Honduras. A majority of immigrant children are separated from either one or both parents at various points during the migration process. Although average separations last 4 or more years, and may be deeply distressing, there is little research on family separations among Central American UAMs. Further, little is known about the developmental impact of separations from extended family networks, or about reunification. To address these empirical gaps, this study used community-participatory qualitative methods to deeply explore the lived experiences and emotional repercussions of family separation and reunification. The sample included 42 adolescents who had all recently migrated to the Western United States from Central America. Thematic analyses revealed that separation experiences are distressing, multifaceted, and have important developmental implications for Central American UAMs. Results illustrate the socioemotional toll that family separation and reunification can have on this vulnerable population, and highlight the need for culturally responsive, developmentally informed, and contextually appropriate care focused on family reunification in order to foster healthy psychosocial adjustment among UAMs.

Ritualistic Institution and Livelihood Fragility of Female Migrant Workers in Urban China

China’s rapid urbanization can be attributed, in part, to the contribution of female migrant workers. However, they are a socially vulnerable group. In order to explore the vulnerability of female migrant workers and its reasons, questionnaires and in-depth interviews were conducted with female migrant workers in Guangdong and Hubei provinces, China, and 992 questionnaires and 147 interview data were finally collected as the research object. The descriptive statistical analysis was conducted with the quantitative data to reveal the livelihood vulnerability of female migrant workers and its reasons, and qualitative data were used to corroborate and consolidate the argument. “Ritualistic institution” is the key to understanding the livelihood fragility of female migrant workers. The policy on migrant workers has weakened the concept of family, making it difficult for families, which are on the fringes of the national policy vision, to benefit from the system. Therefore, the livelihood costs of female migrant workers have increased. Traditional gender norms also make it difficult for migrant women to enjoy the limited benefits and resources of the policy. This weakens the authoritative role of the policy in solving the problem of livelihood vulnerability for migrant workers, particularly women. This shows that China’s policy on migrant workers is somewhat symbolic. Through “family separation” and “ritualistic institution”, it can be seen that China’s urbanization is a modern development activity that carries urban bias and lacks humanistic care value. This is bound to result in the neglect of human development, gender differences, and family, making it difficult for rural migrant women to survive. This in-depth study seeks to find solutions to the problems prevalent under the cover of contemporary Chinese modernity.

Left-Behind Women in the Context of International Migration: A Scoping Review

Introduction: Despite the research on left-behind children, less is known about left-behind women across transnational spaces. The purpose of this scoping review was to assess the extent, range, and nature of the existing body of literature on left-behind women whose partners have migrated across borders. Method: This scoping review was guided by the five-step approach of Arksey and O'Malley. Fifty-four articles that focused on left-behind women across transnational spaces were included. Data were synthesized using descriptive statistics and conventional content analysis. Results: Left-behind women were primarily from Mexico (n = 13) and the migrants' place of destination was primarily the United States (n = 14). We identified two major themes: (a) women's social, economic and cultural conditions and (b) women's well-being. Discussion: We identified significant knowledge gaps regarding left-behind women in the context of transnational migration. Implications for future research and practice are discussed.

Ritualized Law and Livelihood Fragility of Left-Behind Women in Rural China

Family separation in rural China has led to a considerably large number of left-behind women who have to deal with livelihood fragility. The Department for International Development (DFID) framework focusing on households provides a base to understand the livelihood fragility of these women. Based on this framework and the existing field research, this study identifies that the national macro-strategy of unsynchronized development of industrialization, informatization, urbanization, and agricultural modernization leads to a separated migration model for rural families. Furthermore, the process of social modernization increases the fragility risk of how the left-behind family functions. The traditional gender culture expectations also directly affect rural families to make the livelihood strategy choice of, “male working outside, female taking care of home”. Based on the above theoretical research, this study extracts the concept of “ritualized law” to shed light on gender differentiation and family separation. A number of formal social security institutions have been established to promote the development of farmers, however, the ingrained culture gender differentiation encourages men to work in the profitable urban industry while women work in the field of unpaid agriculture and shoulder the responsibility of housework. This makes the formal institution a symbolic ornament for left-behind women, while they are forced to stay in rural areas and suffer from the fragility of livelihood.

Deported Men's and Father's Perspective: The Impacts of Family Separation on Children and Families in the U.S

Background: Family separation due to the deportation of a migrant is pervasive, yet less is known about its potential impacts on the social, economic and mental well-being of families remaining in the United States. Methods: We conducted a mixed-methods study. In 2013, 303 Mexican male nationals completed an interviewer-administered questionnaire at a free clinic in Tijuana, Mexico. For this analysis, participants were: (1) ≥18 years; (2) seeking services; (3) Spanish or English speakers and (4) reported a U.S. deportation. Participants answered migration history items and open-ended questions regarding the impact of their deportation on U.S.-based family members. We present descriptive statistics and illustrative quotes for themes identified in the qualitative text data. Using a grounded-theory approach, we considered all data to develop a conceptual framework that others may use to study the consequences of family separation due to deportation. Results: Nearly two-thirds of participants reported living in the U.S. for 11+ years, a similar proportion reported 2+ deportations, and 31% reported being banned from re-entering the U.S. for 11+ years. More than one-half of participants were separated from their nuclear families (spouse/partner and/or children). Deportees who were separated from any family members reported that their families lost income for basic needs (rent/utilities: 50%, food: 44%, clothing: 39%, daycare: 16%, health insurance: 15%); school participation was also negatively impacted (31%). Qualitative data revealed that children ≤18 years remaining in the U.S. experienced mental health symptoms post-parental deportation (i.e., persistent crying, depression, sadness, anger, resentment). Deported fathers consistently expressed frustration at being unable to provide love, care, support, mentorship for their children. Based on our mixed-methods approach, we propose a framework to systematically study the consequences of family separation due to the deportation of fathers. Conclusion: Findings are consistent with the extant research. Binational interventions to support families that experience forced-separation are needed to mitigate short and long-term adverse mental health outcomes, especially among youth in the U.S., and other unfavorable family and household-level outcomes. Funding to understand the implications of maternal deportation and for longitudinal qualitative and quantitative research on migrant-focused interventions and related outcomes is needed.

Family Separation and the Impact of Digital Technology on the Mental Health of Refugee Families in the United States: Qualitative Study

Background

Conflicts around the world have resulted in a record high number of refugees. Family separation is a critical factor that impacts refugee mental health. Thus, it is important to explore refugees’ ability to maintain contact with family members across the globe and the ways in which they attempt to do so. It is increasingly common for refugees to use information and communication technologies (ICTs), which include mobile phones, the internet, and social media sites, such as Facebook, WhatsApp, Skype, and Viber, for these purposes.

Objective

The aim of this study was to explore refugees’ perceptions of the impact of communication through ICTs on their mental health, the exercise of agency by refugees within the context of ICT use, especially their communication with their families, and logistical issues that affect their access to ICTs in the United States.

Methods

We used a constructivist grounded theory approach to analyze in-depth interviews of 290 adult refugee participants from different countries, who were enrolled in a randomized controlled trial of a community-based mental health intervention.

Results

Analyses showed that communication through ICTs had differing impacts on the mental health of refugee participants. ICTs, as channels of communication between separated families, were a major source of emotional and mental well-being for a large number of refugee participants. However, for some participants, the communication process with separated family members through digital technology was mentally and emotionally difficult. The participants also discussed ways in which they hide adversities from their families through selective use of different ICTs. Several participants noted logistical and financial barriers to communicating with their families through ICTs.

Conclusions

These findings are important in elucidating aspects of refugee agency and environmental constraints that need to be further explicated in theories related to ICT use as well as in providing insight for researchers and practitioners involved in efforts related to migration and mental health.

Behind bars but connected to family: Evidence for the benefits of family contact during incarceration

Incarceration separates individuals from their families and communities, strictly limiting and controlling contact with the outside world. Despite these barriers, those who maintain contact with their families during incarceration tend to function more adaptively postrelease. Within a longitudinal framework, the current study examines mechanisms (i.e., family connectedness, postrelease planning) by which contact with family during incarceration may impact postrelease functioning (i.e., recidivism, substance misuse, mental illness, community functioning), considering differences between type of contact (visits, phone calls, letters) and whether it occurred in a jail or prison setting. Participants included 507 adults incarcerated in a local jail (M_age = 32 years, SD = 10 years; 70% male; 44.3% Black, 36.4% White; 59.5% parents). Structural equation modeling results demonstrated having more frequent contact with family during incarceration predicts increases in family connectedness, which in turn predicts better mental health during the first-year postrelease. Although not related to frequency of contact, making plans for postrelease predicted adaptive community functioning during the first-year postrelease. There were no differences in the overall model based on type of contact or incarceration in a jail versus prison setting. These findings suggest maintaining contact with family during incarceration can facilitate more psychologically healthy adjustment during the stressful process of reentering society. Furthermore, incarcerated individuals should be encouraged to make plans for postrelease while still incarcerated either independently or in collaboration with family. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Family Matters: Claiming Rights across the US-Mexico Migratory System

Immigration and Nationality Act of 1952 (INA) created an immigration system favoring the immigration of spouses, children, and parents of US citizens, thereby establishing family unity as the cornerstone of US immigration policy. Despite this historical emphasis on family unity, backlogs and limited visas for non-immediate relatives of US citizens and legal permanent residents, the militarization of the US-Mexico border, punitive measures for those who enter without inspection, such as the forced separation of children from their parents at the US border, and an aggressive policy of deportation have made it more difficult for members of Mexican binational families to unify. How do members of Mexican binational families manage the hardships that result from US immigration policies that prolong and force family separation? Immigrants and return migrants alike may not be aware of their rights and the legal remedies that exist to enforce them. Structural barriers such as poverty, legal status, fear of deportation, lack of proficiency in English, and lack of familiarity with government bureaucracies no doubt prevent many migrants in the United States and return migrants in Mexico from coming forward to request legal assistance and relief in the courts. Despite these barriers, when it comes to family matters, members of some Mexican binational families can and do assert their rights. In this article, we analyze an administrative database of the Department of Legal Protection of the Mexican consular network that documents migrant legal claims resulting from family separation, along with findings from 21 interviews with consular staff and community organizations in three consular jurisdictions - El Paso, Raleigh, and San Francisco - to investigate the sociolegal processes of claims. Our investigation centers on the mediating role the Mexican state - via its consular network - has developed to assist binational families as they attempt to assert their rights and resolve child support and child custody problems resulting from prolonged and forced family separation. We find that the resolution of binational family claims in part depends on the institutional infrastructure that has developed at local, state, and federal levels, along with the commitment and capacity of the receiving and sending states and the binational structures they establish. These binational structures transcend the limitations of national legal systems to achieve and implement family rights and obligations across borders.

Deporting social capital: Implications for immigrant communities in the United States

The United States currently removes approximately 400,000 individual migrants each year, which represents close to an eightfold increase since the mid-1990s. While scholars have studied the consequences of such policies for children and families, this article posits broader effects on communities through the reduction of immigrant social and human capital. Using findings from three studies of immigrant communities and Salvadoran deportees, we show that current deportation practices remove individuals with a wide range of socio-economic resources and ties to local communities. When they are removed from economic, family, social, and civic networks, the individuals and communities left behind are impoverished in important ways. This is particularly consequential for low-resource immigrant communities, which under the best of circumstances encounter obstacles to economic advancement, social integration, and political engagement. In addition, we consider the potential harm to the institutions in which immigrants participate, such as businesses and churches, which has implications for the economy and society more generally.