WPA guidance on mental health and mental health care in migrants

Need Fulfillment During Intergroup Contact: Three Experience Sampling Studies

One challenge of modern intergroup contact research has been the question of when and why an interaction is perceived as positive and improves intergroup relations. We propose to consider the perceived fulfillment of the situationally most relevant need. We conducted three intensive longitudinal studies with recent migrants to capture their interactions with the majority out-group (Nmeasurements = 10,297; Nparticipants = 207). The situational need fulfillment mechanism is consistently a strong predictor of perceived interaction quality and positive out-group attitudes following intergroup interactions. The model is specific to out-group contact, robust to various need types, and works at least as well as Allport's contact conditions. As one of the first studies to test intergroup contact theory using intensive longitudinal data, we offer insight into the mechanisms of positive intergroup contact during real-life interactions and find situational motivations to be a key building block for understanding and addressing positive intergroup interactions.Public significance statement: In this article, we provide evidence that the fulfillment of situational needs during real-life intergroup contacts meaningfully predicts perceived interaction quality and positive outgroup attitudes. Methodologically, this offers a testament to the emerging practice of capturing real-life interactions using intensive longitudinal data. Theoretically, our results give weight to motivational fulfillment as a flexible and effective mechanism for understanding positive intergroup contact.

Challenges in the Repatriation Processes of a Foreign Citizen With Schizophrenia: A Case Report From Tanzania

Background: Schizophrenia is a chronic mental health disorder characterized by an array of symptoms, leading to impairment of functioning. Many patients with schizophrenia tend to have long-stay hospitalizations due to several factors, one of them being the repatriation process. Case Presentation: I report the case of a 29-year-old male foreign citizen who presented with auditory hallucinations, paranoid delusions, and aggressiveness. The patient had a history of multiple admissions due to poor drug adherence. After being admitted to the psychiatry ward, the patient was improved and ready for discharge after 4 weeks but struggled to remember his relatives' phone numbers. Due to financial constraints and poor support, the repatriation process was delayed for 160 days. Conclusion: The present case highlights the challenges in managing schizophrenia abroad, urging international protocols to streamline the repatriation process and address financial, logistical, and social barriers for improved outcomes.

Comparative efficacy and acceptability of psychosocial interventions for PTSD, depression, and anxiety in asylum seekers, refugees, and other migrant populations: a systematic review and network meta-analysis of randomised controlled studies

Background

Migrant populations are at increased risk of developing mental health problems. We aimed to compare the efficacy and acceptability of psychosocial interventions in this population.

Methods

We conducted a systematic review and network meta-analysis (NMA). Cochrane Central Register of randomised trials (CENTRAL), MEDLINE, PTSDpubs, PsycINFO, PubMed, CINAHL, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov were searched from database inception to October 7, 2024, to identify randomized clinical trials assessing the efficacy of psychosocial interventions for migrant populations in reducing symptoms of post-traumatic stress disorder (PTSD), depression or anxiety. Studies with second-generation migrants were excluded if they comprised over 20% of participants. Two independent researchers screened, reviewed, and extracted data. The primary outcomes were the severity of PTSD, depression, and anxiety symptoms at post-intervention. Secondary outcomes included acceptability. Standardised mean differences (SMDs) and risk ratios (RRs) were pooled using pairwise and NMA. PROSPERO: CRD42023418817.

Findings

Of the 103 studies with 19,230 participants included, 96 contributed to the meta-analyses for at least one outcome, with women representing 64% of the participants. Narrative Exposure Therapy (NET), counselling, Eye Movement Desensitization and Reprocessing (EMDR), and creative expressive interventions demonstrated greater efficacy than treatment as usual (TAU) in reducing PTSD symptoms, with SMDs [95% Confidence Intervals (CIs)] ranging from -0.69 [-1.14, -0.24] to -0.60 [-1.20, -0.01], albeit with low confidence in the evidence. For depressive symptoms, Integrative therapy emerged as the top intervention compared to TAU, with moderate confidence (SMD [95% CI] = -0.70 [-1.21, -0.20]). For anxiety symptoms, NET, Integrative therapy, and Problem Management Plus (PM+)/Step-by-Step (SbS) were more effective than TAU, with SMDs [95% CIs] ranging from -1.32 [-2.05, -0.59] to -0.35 [-0.65, -0.05]. Still, the confidence in the evidence was low. Overall, head-to-head comparisons yielded inconclusive results, and the acceptability analysis revealed variations across interventions. 16% of the studies (17 studies) were classified as "high risk" of bias, 68% (70) as having "some concerns", and 18% (19) as "low risk". We identified considerable heterogeneity (I2 of >70%).

Interpretation

The analysis revealed no clear differences in the efficacy of psychosocial interventions compared to TAU for reducing symptoms of PTSD, depression, and anxiety. While certain interventions showed potential benefits, confidence in these findings was generally low, limiting the ability to draw definitive conclusions about their comparative effectiveness.

Funding

This research received no specific grant from any funding agency.

Comparative Evaluation of Health Status of Syrian Refugee and Tur CCH_70042 kish Children, Alongside the Factors Influencing Sociocultural Adaptation of Syrian Children in Türkiye

BACKGROUND

The objective of this study encompasses two distinct facets. First, it aims to provide a comprehensive analysis of the comparative assessment of psychosocial wellbeing and oral health status among Syrian and Turkish children in Türkiye. Secondly, it aims to elucidate the factors that play a role in shaping the sociocultural adaptation of Syrian children.

METHODS

A cross-sectional survey assessing self-esteem, social anxiety and resilience and clinical examination were conducted on a convenience sample of Syrian refugee and Turkish children. The sample consisted of 396 participants (55.7% male and 44.3% female), including 173 Syrian individuals (43.7%) with a mean age of 14.12 years (SD = 2.24), and 223 Turkish individuals (56.3%) with a mean age of 12.44 years (SD = 2.47). Sociocultural adaptation and perceived discrimination scales were also taken by refugee children.

RESULTS

Overall, psychosocial wellbeing, academic success and oral health outcomes of refugee participants were lower than those of the Turkish general population. Specifically, independent samples t-test revealed that Syrian refugee children exhibited higher levels of social anxiety (t(384) = 3.138, p < 0.005), higher resilience (t(384) = 3.866, p < 0.001), lower self-esteem (t(389) = 4.614, p < 0.001) and poorer academic performance (t(370.981) = -8.441, p < 0.001) compared to Turkish children. In terms of oral health, Syrian children exhibited significantly higher levels of dental health problems, including DMFT (t(394) = 4.203, p < 0.001), DMFS (t(394) = 4.858, p < 0.001) and PPD (t(394) = 15.09, p < 0.001) than their Turkish counterparts. A one-way ANOVA showed that socio-economic status was an important factor in psychosocial and oral health outcomes, except for psychological resilience (F(2,378) = 0.029, p = 0.971). Children from low socioeconomic backgrounds showed higher levels of social anxiety (F (2,376) = 10.704, p = 0.00), lower academic performance (F(2,365) = 33.119, p = 0.00) and poorer oral health outcomes including DMFT (F(2,381) = 7.230, p = 0.001), DMFS (F(2,381) = 4.983, p = 0.007) and PPD (F(2,381) = 22.463, p = 0.00). Pearson correlation analyses indicated that sociocultural adaptation of refugees was positively associated with their resilience (r = 0.45, p < 0.01), and negatively associated with perceived discrimination (r = -0.34, p < 0.01).

CONCLUSION

The findings underscore the need for integrated healthcare interventions that address the multifaceted health needs of vulnerable populations in diverse societies.

Mental health and justice beyond borders: Global crises, sociopolitical determinants, and contemporary practices in forensic psychiatry

In an era marked by escalating international crises, environmental shifts, and sociopolitical volatilities, global mental health is facing profound challenges. With its distinctive position at the intersection between clinical and judicial domains, forensic psychiatry can be predisposed to the consequences of adverse external determinants and events. At present, geopolitical conflicts, rising insecurities, climate change, forced and voluntary migration, and regressive sociopolitical ideologies are all compounding role responsibilities, care models, and ethical expectations across forensic-psychiatric practice; in short, complex distal factors are increasingly informing domestic considerations. These far-reaching concerns indicate a need for adaptive and proactive responses, underpinned by cultural sensitivity, social justice, and respect for human rights. Through illustrative examples from different regions, this perspective paper calls for a greater recognition of the transnational dynamics that are affecting local contexts of practice. Equally, it outlines the importance of advocacy, interdisciplinary collaborations, and potential evolutions in training and ethical frameworks to address contemporary issues. By adopting these approaches, forensic psychiatrists can promote more just systems and equitable mental healthcare for patients amidst the uncertainties of an interconnected and rapidly transforming world.

Migration and mental health problems of older adults: Challenges and proposed solutions

Due to several geopolitical factors, the number of older migrants increased worldwide with an estimated of 34.3 million in 2020. Older migrants are particularly vulnerable to mental health problems because of their physical health, reduced social networks, and lack of social support. This review aims to summarize current evidence on mental health issues of older persons related to migration and propose possible actions to promote mental health and prevent psychiatric illnesses of this vulnerable group. There are two types of migration in the elderly, for those with and without secured support. Not surprisingly, they have major differences in many characteristics. Common mental health problems in older migrants are depression, loneliness, anxiety, and other symptoms that become complicated with existing or new physical conditions. The links between migration, mental health, and older adults are explored in this paper. Suggested solutions for mental health practitioners and policymakers are proposed. In order to explore these challenges, further suggestions are offered to ensure that older adults' mental health and wellbeing are looked after.

Food Related Challenges and Mental Health Among U.S. African Migrants: A Narrative Review

The United States' (US) African immigrant (AI) population is growing, yet they are underrepresented in health and nutrition research. This population experiences difficulties finding culturally appropriate foods and navigating the US food environment (FE), is highly food insecure (FI), and vulnerable to mental disorders. This review examined the current evidence for AIs' food and mental health outcomes and connections; and identified gaps in the literature and future research opportunities. A literature search was conducted using Google Scholar, PubMed, CINAHL, MEDLINE, and SCOPUS. Twenty-one studies were identified, reporting high (37-85%) FI rates, poor diet quality, and increased risk of mental disorders among participants. Challenges in the FE, lack of transportation, limited access to ethnic foods, low SES, and language barriers were associated with FI and poor diet quality. Similarly, discrimination, substance use, and immigration status were associated with depression and anxiety. However, studies examining the connection between AI's food experience and mental health are lacking. AIs are at a higher risk for FI, poor diet quality, and mental disorders. Ethnic-specific research to understand the connection between their food and mental health is needed to reduce nutrition and mental health disparities.

Mapping the evidence on psychosocial interventions for migrant populations: Descriptive analysis of a living database of randomized studies

Migrant mental health is a pressing public health issue with wide-ranging implications. Many randomized controlled trials (RCTs) have been conducted in this population to assess the effects of psychosocial interventions. However, the available evidence is characterized by controversy and fragmentation, with studies focusing on different migrant populations, interventions, outcomes, delivery modalities and settings. Aiming to promote systematic reviews of the effectiveness of psychosocial interventions in different migrant groups, we have developed a living database of existing RCTs. The development of the database provides an opportunity to map the existing RCT evidence in this population. A total of 135 studies involving 24,859 participants were included in the living database. The distribution of studies by year of publication aligns with the increasing global migrant population in recent years. Most studies focus primarily on adult participants, with a limited representation of children and adolescents, and a prevalence of female participants, which is consistent with epidemiological data, except for older adults, who are underrepresented in research. Studies predominantly focus on refugees and asylum seekers, likely due to their elevated risk of mental health issues, despite the substantial presence of economic migrants worldwide. While studies mainly involve migrants from the Middle East and East Asia, epidemiological data suggest a broader geographic representation, with migrants coming from Eastern Europe, Latin America and South Asia. The present descriptive analysis of RCTs on mental health and psychosocial interventions for migrant populations provides valuable insights into the existing research landscape. It should be used to inform future research efforts, ensuring that studies are more representative of the global migrant population and more responsive to the mental health needs of migrants in different contexts.

New in Town-An internet-based self-efficacy intervention for internal migrants: A randomized controlled trial

OBJECTIVE

Migration is a profound life transition that may threaten migrants' well-being and mental health. Results of several studies suggest that social self-efficacy beliefs may be beneficial for the psychological adjustment of migrants, buffering the effect of specific stressors related to migration, helping them reduce anxiety levels, and providing support in forming of new social bonds and better integration with a new community or culture. The primary purpose of this randomized controlled trial was to examine the effectiveness of the New in Town internet-based self-efficacy intervention for internal migrants in Poland.

METHODS

Participants were 158 internal adult migrants who had changed residence in the last 6 months. They were randomized into two groups: an experimental group (receiving an internet-based self-efficacy intervention), and a waiting list control group. We examined if the intervention was effective in enhancing participants' social self-efficacy (primary outcome), general self-efficacy, social support, satisfaction with life, and reduced reported loneliness (secondary outcomes). Outcome measures were assessed at baseline (Time 1) and 3-weeks later (Time 2). The dropout rate was 50.6%. Initially, we planned to gather follow-up data also 8-weeks after baseline (Time 3). However, due to health and safety reasons related to the COVID-19 pandemic, we decided to stop the trial. Finally, we included in our analysis only data gathered before the COVID-19 pandemic at Time 1 and Time 2.

RESULTS

A total of 159 individuals who met the study's inclusion criteria and completed the baseline assessment were randomly assigned to either the experimental group (n = 80) or the waiting list control group (n = 79). Nevertheless, one participant assigned to the control group was excluded from the analyses because they withdrew their consent to participate after being randomized. The study results suggest that compared to the waitlist control group (n = 78), participants in the experimental group (n = 80) reported a higher level of general self-efficacy beliefs at Time 2 (Cohen's d = 0.47; 95% CI: 0.15-0.79). However, there were no statistically significant effects on social self-efficacy, social support, satisfaction with life, and loneliness.

CONCLUSION

The study offers preliminary support for the effectiveness of an internet-based self-efficacy intervention designed for internal migrants on general self-efficacy beliefs.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov (identifier: NCT04088487) on 11th September 2019.

Satisfaction, engagement, and outcomes in internet-delivered cognitive behaviour therapy adapted for people of diverse ethnocultural groups: an observational trial with benchmarking

Introduction

Depression and anxiety are the most common mental health disorders worldwide. Internet-Delivered Cognitive Behaviour Therapy (ICBT) can reduce barriers to care to broad cross sections of the population. However, People of Diverse Ethnocultural Backgrounds (PDEGs) other than White/Caucasian underutilize mental health services and are under represented in clinical trials of psychological interventions.

Methods

To address this research gap we adapted an evidence-based ICBT program for PDEGs. The current pilot study explores the engagement, satisfaction, and effectiveness in the adapted ICBT program by PDEGs (N=41) when benchmarked against a sample of PDEGs (N=134) who previously completed a non-adapted version of the ICBT program.

Results

An intent-to-treat analyses showed that the adapted ICBT program is effective in reducing anxiety and depression symptoms among PDEGs. Large within-group pre-to post-treatment Cohen's effect sizes of d = 1.23, 95% CI [0.68, 1.77] and d = 1.24, 95% CI [0.69, 1.79] were found for depression and anxiety, respectively. Further, 81.8% of the PDEGs who received the adapted ICBT reported overall satisfaction, 90.9% reported increased confidence in managing symptoms, and 70.7% completed majority of the psychoeducational lessons in the ICBT program.

Conclusion

No statistically significant differences in the clinical outcomes, engagement, and satisfaction were found between the pilot study and benchmark sample. Future directions for ICBT research with PDEGs are described.

Clinical trial registration

https://beta.clinicaltrials.gov/study/NCT05523492, identifier NCT05523492.

Navigating whiteness: affective relational intensities of non-clinical psychosocial support by and for culturally and linguistically diverse people

Mental health is political, with intersecting economic, cultural, racialized, and affective dimensions making up the care assemblage, signalling how care is conceptualised and who is deserving of care. In this article, we examine emotions circulating in a non-clinical psychosocial support program for culturally and linguistically diverse people experiencing mental ill-health, foregrounding the relations between culture, race, economy, and assumptions underpinning understandings of care. The mental health program under study offers psychosocial support for culturally and linguistically diverse people to manage life challenges and mental ill-health exacerbated by navigating the complexities of Australia's health and social care systems. We draw on interviews with clients, staff, and providers of intersecting services, employing Ahmed's concept of affective economies and Savreemootoo's concept of navigating whiteness to examine the care assemblage within interview transcripts. We provide insight into affective intensities such as hate, anger, and indifference embedded in white Anglo-centric services, positioning culturally and linguistically diverse people on the margins of care. Non-clinical psychosocial support programs can counter such affective intensities by training and employing multicultural peer support workers-people with lived experience-prioritising relational and place-based approaches to care and supporting and providing clients with relevant skills to navigate an Anglo-centric care system. However, this support is filled with affective tensions: (com)passion, frustration and fatigue circulate and clash due to the scarcity of resources, further signalling what type of care (and with/for whom) is prioritised within Australian relations of care.

A retrospective analysis of the ethnicity of individuals referred to a tertiary neuropsychology service in the United Kingdom

Objective: Ethnic minorities comprise approximately 18% of the UK population and are at high risk of developing neurological conditions. Despite this, there is little information regarding their access to neuropsychology services. This study evaluated whether ethnic minorities were proportionally represented in a tertiary neuropsychology department in the UK in accordance with census data for the region. We also aimed to highlight which ethnic groups were over- and underrepresented. Method: Anonymised demographic data of 3429 outpatient and 3304 inpatient referrals to an adult UK neuropsychology department was collected. These data were compared to the 2021 UK census data for the region. Results: Ethnicities in both the outpatient referrals (χ2(15) = 24066.55, p < .001) and inpatient referrals (χ2(15) = 35940924.75, p < .001) are significantly different from the Census. All ethnic minorities were underrepresented in adult neuropsychology referral data for both outpatient settings (-0.06% to -4.66%) and inpatient settings (-0.01% to -4.99%). Pakistani individuals were the most underrepresented across all settings, followed by individuals from an African background. Conversely, individuals of White British ethnicity were overrepresented in both outpatient settings (+10.73%) and inpatient settings (+15.68%). Conclusions: The UK ethnic minorities were not referred to a neuropsychology service relative to regional population prevalence. This contradicts their increased susceptibility for risk of neurological conditions but may also indicate the inaccessibility of neuroscience services for ethnic minorities. Replicating this study across different regions and gathering data on prevalence rates for different neurological conditions across ethnicity is recommended. Additionally, improving accessibility of neuropsychology services for British ethnic minorities should be prioritised.

Psychiatric disorders in inpatient Ethiopian migrant workers in the United Arab Emirates

Migrant workers have higher rates of mental health problems than non-migrant workers, with Ethiopian migrant workers in the United Arab Emirates appearing to be overrepresented in the psychiatric inpatient population compared with their numbers in the general population. We sought to investigate the pattern of psychiatric inpatient admissions in Ethiopian migrant workers over a 10-year period (2011-2020) in order to highlight demographic and clinical characteristics, and to investigate factors predicting the length of hospital stay. We reported the mean and frequency of demographic and clinical data of Ethiopian psychiatric inpatients at one of the largest governmental hospitals in eastern Abu Dhabi between 2011 and 2020, and investigated factors predicting length of stay in hospital using linear regression. Our results show that Ethiopian expatriates made up 7.9% of all admissions over a 10-year period, had a mean length of hospital stay of almost 20 days, with 98.1% of them being female, 92.8% being domestic workers, 90.1% having a language barrier, 57.4% being single and 55.5.% having one or more recent stressors prior to admission. The most common diagnoses were acute stress reaction (31.6%), psychosis (29.3%), bipolar disorder (14.8%) and adjustment disorder (11.0%). Work-related stress, termination of employment and several clinical factors significantly predicted length of stay in hospital.

Psychopathological risk in a sample of immigrant preadolescents in Italy

BACKGROUND

Aim of the study was to collect information about emotional features in a sample of immigrant preadolescents in order to identify traits of emotional fragility or psychopathological risk factors.

METHODS

The sample consists of 1206 preadolescents (180 immigrants, 1026 Italian natives) attending the third year of the middle schools. In order to assess anxiety levels and the presence of depressive symptoms the Self-Administered Psychiatric Scale (SAFA-A) and the Children's Depression Inventory (CDI) were administered. Coping strategies and behavior problems were evaluated by the Coping Inventory for Stressful Situation (CISS) and the Youth Self Report scale (YRS). All teachers filled out the Teacher's Report Form (TRF). Parents were asked to fill out a form on social-demographic features and the Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS

Immigration resulted a risk factor for development of anxiety (OR=0.702), depression (OR=0.644), internalizing problems (OR=0.685), behavior problems (OR=0.622) and total problems (OR=0.719). Teachers observed more behavior problems and lower competences in immigrants than natives. Immigrants relied significantly more often on emotion-oriented coping strategies to resolve stressful situation than natives (P=0.045). Analyzing the immigrants' sample, second generation children reported significantly higher levels in total competence (school, activity and relationship) than first generation ones (P≤00.1); on the contrary there were no significant differences between the two groups concerning other behavioral and emotional problems or the preferred coping style. Natives' families reported significantly higher levels of perceived support than immigrant ones.

CONCLUSIONS

Our findings confirm the hypothesis that preadolescent immigrants are more at risk for psychopathological risk factors than native peers.

Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland

Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.

Perspectives of culturally and linguistically diverse (CALD) community members regarding mental health services: A qualitative analysis

WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant, refugee and asylum seeker populations worldwide are at high risk of mental health issues National mental health policies call for recognising Australian society's multicultural characteristics to ensure adequate mental health services to CALD communities Several barriers exist for people from CALD communities in Victoria to access and utilise mental health services Improving mental health professionals' knowledge of mental health service provision and cultural responsiveness can enhance CALD community access to services. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We analysed the perspectives of people from CALD communities in Victoria regarding their needs and experiences with mental health services. Participants reported diverse perceptions and understanding of mental health issues and services Various challenges were identified regarding health service utilisation for the CALD community in Victoria, including language barriers, stigma towards mental health issues, mental health illiteracy, distrust and lack of familiarity with mainstream mental health services. These challenges were acknowledged by community members even after a long residence in Australia The data generated on the beliefs about mental health issues and consequent help-seeking behaviours highlight the importance of culturally sensitive targeted prevention and early intervention strategies and ongoing commitment to building mental health literacy in the wider community WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The information from the study can be adapted for quality improvement and culturally responsive practices The strategies for effective service delivery drawn by this paper can be a comprehensive resource tool for mental health professionals, organisations and policymakers The findings imply that CALD mental health service users and their families will likely benefit from improved service assessment and quality of mental health care and equity when MHNs undertake cultural competence training and bring that into their practice.

ABSTRACT

INTRODUCTION: Victoria is one of the most multicultural states in Australia. Many CALD communities in Victoria may have encountered complicated migration journeys and complex life stressors during their initial settlement, leading to adverse mental health concerns. This diversity necessitates public policy settings to ensure equity and access in health services planning and delivery. While the MH policies and services take cultural diversity into account, there needs to be more implementation of those components of MH policies that relate to the particular needs of various CALD communities in Victoria. Even though mental health services prevent and address mental health issues, many barriers can impair CALD community access and utilisation of mental health services. Furthermore, the recent Royal Commission inquiry into the Victorian Mental Health system drives a renewed policy imperative to ensure meaningful engagement and cultural safety of all people accessing and utilising mental health services (Department of Health, 2023).

AIM

This study focused on the perspectives of people from CALD communities in Victoria regarding their mental health service needs, understandings of and experiences with mental health services to prepare an education package for mental health nurses as part of a larger multi-method research project.

METHOD

A qualitative descriptive design was used to collect and analyse the perspectives of 21 participants in Victoria, using telephone interviews, followed by thematic analysis.

RESULTS

The themes and sub-themes identified were: Settling issues; Perceptions of understanding of mental health issues (help-seeking attitudes toward mental health issues; the need for CALD community education); perceived barriers to accessing and utilising mental health services in Victoria (socio-cultural and language barriers; stigma, labelling and discrimination; knowledge and experience of accessing health facilities); experience with mental health services and professionals.

DISCUSSION

Community participation, mental health professional education and robust research regarding the mental health needs of CALD people are some of the recommended strategies to improve access and utilisation of mental health services in Victoria.

IMPLICATIONS FOR PRACTICE

The current study can contribute to the existing knowledge, understanding, practice and quality improvement as it vividly portrays the issues of various CALD communities in Victoria. The findings of this study imply that CALD MH service users and their families are likely to benefit in terms of improved service assessment and quality of MH care and equity when MHNs undertake CC training and bring that into their practice.

Effectiveness of a stepped-care programme of WHO psychological interventions in migrant populations resettled in Italy: Study protocol for the RESPOND randomized controlled trial

Introduction

Migrant populations, including workers, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move, are exposed to a variety of stressors and potentially traumatic events before, during, and after the migration process. In recent years, the COVID-19 pandemic has represented an additional stressor, especially for migrants on the move. As a consequence, migration may increase vulnerability of individuals toward a worsening of subjective wellbeing, quality of life, and mental health, which, in turn, may increase the risk of developing mental health conditions. Against this background, we designed a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization and locally adapted for migrant populations. The effectiveness and cost-effectiveness of this stepped-care programme will be assessed in terms of mental health outcomes, resilience, wellbeing, and costs to healthcare systems.

Methods and analysis

We present the study protocol for a pragmatic randomized study with a parallel-group design that will enroll participants with a migrant background and elevated level of psychological distress. Participants will be randomized to care as usual only or to care a usual plus a guided self-help stress management guide (Doing What Matters in Times of Stress, DWM) and a five-session cognitive behavioral intervention (Problem Management Plus, PM+). Participants will self-report all measures at baseline before random allocation, 2 weeks after DWM delivery, 1 week after PM+ delivery and 2 months after PM+ delivery. All participants will receive a single-session of a support intervention, namely Psychological First Aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire-Anxiety and Depression Scale summary score 2 months after PM+ delivery. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, resource utilization, cost, and cost-effectiveness.

Discussion

This study is the first randomized controlled trial that combines two World Health Organization psychological interventions tailored for migrant populations with an elevated level of psychological distress. The present study will make available DWM/PM+ packages adapted for remote delivery following a task-shifting approach, and will generate evidence to inform policy responses based on a more efficient use of resources for improving resilience, wellbeing and mental health.

Clinical trial registration

ClinicalTrials.gov, identifier: NCT04993534.

Suicidal behavior in a migrant majority population and impact on trends during the early Covid-19 period: a cross sectional study in Qatar

Background

Qatar is a high-income country with 90% of the population being economic migrants from low income countries. Due to this unique population composition, it has been suggested that Qatar may not follow suicide trends of high-income countries. Additionally, there is paucity of information on suicidal trends and rates due to social and cultural reasons. The Covid-19 pandemic has additionally impacted mental health of migrants differently form native Qataris.

Objectives

This study explores suicidal behavior trends among individuals attending the main Emergency Department in the state of Qatar for mental health emergencies. The study also compared these trends for pre-pandemic period to early post pandemic period.

Methods

A cross-sectional study of individuals attending the main emergency department of the country from 1st December 2019 to 30th June 2020 was carried out using a composite data collection form. This identified 799 individuals presenting with mental health emergencies. Suicidal behaviors, relevant sociodemographic data, along with factors known to be associated with suicidal behaviors were collected for this group.

Results

24.9% (n = 199) of the sample presented with suicidal behaviors. Younger age (31.16 ± 9.497), current hopelessness (70; 54.7%), history of suicidal thoughts (50; 47.2%), history of suicidal attempts (43; 34.7%), history of self-harm thoughts (35; 39.3%), history of self-harm attempts (41; 37.6%) were highly significantly associated with suicidal behavior (p < 0.01). Qataris formed 27% of the group presenting with suicidal behaviors although they constitute only around 10% of the population. There was no significant change in the rate of presenting with suicidal behaviors during the early stages of the Covid-19 pandemic.

Conclusions

This study reports an annual incidence of suicidal behaviors in Qatar lower than that has been previously reported. The authors surmise that this may be due to improved availability and early intervention of mental health services and decreased stigma around mental health.

Homesickness in asylum seekers: The role of mental health and migration-related factors

Background

While homesickness in refugees is a recurring theme in clinical practice, respective research in this population is scarce. The Utrecht Homesickness Scale (UHS) allows distinguishing between certain aspects of homesickness, namely genuine separation distress like missing family and friends or yearning for home on the one side and problems regarding adjustment to the new situation on the other; so far, the instrument was applied mainly in samples of university students, and never in refugees.

Objective

We aimed to explore homesickness in a refugee population and its association with mental health symptoms and migration-related factors. In addition, we wanted to evaluate the UHS's factor structure in a sample other than students.

Methods

Individuals from different countries (N = 99) seeking asylum in Germany were assessed for homesickness, migration-related variables (e.g., number of losses and stage of the asylum proceedings), and mental health symptoms (symptoms of depression, posttraumatic stress and prolonged grief). After exploratory factor analysis, standardized mean factors scores were fed into subsequent correlational and regression analyses to identify the most prominent predictors of homesickness scores.

Results

The participants showed substantial levels of homesickness. We found a three-factor solution that implied distinct factors regarding (1) adjustment difficulties and loneliness, (2) ruminations about home, and (3) missing family and/or friends. The total homesickness score was associated with mental health but regression analyses with the three mean factor scores showed differential associations with mental health and migration-related variables. While adjustment difficulties and loneliness were-besides time since arrival in Germany-associated with mental health problems (depressive and posttraumatic stress symptoms), ruminating about home was predicted by migration-related variables (number of losses and asylum status). For the factor scores regarding missing family and/or friends, the regression model was not significant.

Conclusion

The assessment of homesickness in refugee populations is feasible and of clinical importance, especially when distinguishing between separation distress and difficulties with adjusting to the new situation.

Quality of Life, Depressive Symptoms, and Personality Traits in Syrian Refugee Adolescents

Purpose

Refugee adolescents' quality of life (Qol) was not investigated during the Covid-19 pandemic which have a potential impact on refugee adolescents' Qol. In this study, it is planned to investigate refugee adolescents' Qol and its association with depression and quality of life.

Methods

301 refugee adolescents aged between 14 and 18 who immigrated from Syria was included in the study. Personality Inventory for DSM-5 Brief Form (PID-5 BF), Beck Depression Scale, and Life Quality Scale was used as assessment tools. The data were tested using structural equation modeling.

Results

Both depressive symptoms and personality traits are associated with low Qol. Also, depression mediated the relationship between personality disorder and Qol.

Conclusion

This is the first study that investigates Qol in Syrian refugee adolescents during the pandemic. This study draws attention to the importance of depressive symptoms and personality traits management for improvement of Qol in Syrian refugee adolescent population.

Highlights

• Depressive symptoms are associated with low Qol in refugee adolescents.• Personality traits are associated with low Qol in refugee adolescents.• Depressive symptoms have a mediator role between personality traits and Qol.

The Intellectual Structure of Research on Rural-to-Urban Migrants: A Bibliometric Analysis

As noted in the United Nations' Sustainable Development Goals 2030 agenda, sustainable cities "without leaving anyone behind" should take into consideration migrant groups, which may play only a marginal role but may be at the root of potential social conflicts. This study thereby promotes cross-disciplinary explorations of knowing and understanding the rural-to-urban internal migrants against the background of rapid urbanization. This study conducted a bibliometric analysis based on 2788 English language articles obtained from the Web of Science Core Collection database. As China's unique Hukou system highlights the divide between rural migrants and urban dwellers, migrant studies have extended to a diverse range of interests. We underlined the most productive sources and authors in this area and identified networks of collaboration among countries and institutions. Furthermore, we found trends in research themes and topics and research clusters through keyword-based analysis techniques. The results provide a rich source of information on the intellectual structure of the chosen domain of rural-to-urban migrants.

Interrupted transit and common mental disorders among migrants in Tijuana, Mexico

BACKGROUND

Policies of migration contention can interrupt the transit of people on the move, forcing them to remain in wait in non-destination countries. This liminal condition might impact negatively on migrants' mental health.

AIMS

To assess the relationship between interrupted transit and common mental disorders (CMD; symptoms of depression or anxiety), among migrants in shelters in Tijuana, Mexico.

METHODS

Cross-sectional survey conducted in November to December 2020 and February to April 2021. We assessed depressive symptoms with the Centers for Epidemiological Studies Depression scale (CES-D-7), and symptoms of anxiety with the Generalized Anxiety Disorder scale (GAD-2). We evaluated the association of being in interrupted transit (sent back from the United States to Mexico), as compared to having not crossed to the United States yet or planning to stay in Mexico, with having a CMD (either depressive or anxiety symptoms), as well as the association of other migration-related variables with CMD.

RESULTS

Being in interrupted transit (OR = 1.74, 95% CI [1.12, 2.71]), and having experienced violence during transit (OR = 2.50, 95% CI [1.63, 3.82]) were associated with CMD.

CONCLUSIONS

Interrupted transit is a potential risk factor for mental health problems among migrants. Migration and public health policies should consider the mental health consequences of interrupted transit, and promote initiatives to address the mental health needs of migrants on the move.

Effectiveness and cost-effectiveness for the treatment of depressive symptoms in refugees and asylum seekers: A multi-centred randomized controlled trial

Background

Current evidence points towards a high prevalence of psychological distress in refugee populations, contrasting with a scarcity of resources and amplified by linguistic, institutional, financial, and cultural barriers. The objective of the study is to investigate the overall effectiveness and cost-effectiveness of a Stepped Care and Collaborative Model (SCCM) at reducing depressive symptoms in refugees, compared with the overall routine care practices within Germany's mental healthcare system (treatment-as-usual, TAU).

Methods

A multicentre, clinician-blinded, randomised, controlled trial was conducted across seven university sites in Germany. Asylum seekers and refugees with relevant depressive symptoms with a Patient Health Questionnaires score of ≥ 5 and a Refugee Health Screener score of ≥ 12. Participants were randomly allocated to one of two treatment arms (SCCM or TAU) for an intervention period of three months between April 2018 and March 2020. In the SCCM, participants were allocated to interventions tailored to their symptom severity, including watchful waiting, peer-to-peer- or smartphone intervention, psychological group therapies or mental health expert treatment. The primary endpoint was defined as the change in depressive symptoms (Patient Health Questionnaire-9, PHQ-9) after 12 weeks. The secondary outcome was the change in Montgomery Åsberg Depression Rating Scale (MADRS) from baseline to post-intervention.

Findings

The intention-to-treat sample included 584 participants who were randomized to the SCCM (n= 294) or TAU (n=290). Using a mixed-effects general linear model with time, and the interaction of time by randomisation group as fixed effects and study site as random effect, we found significant effects for time (p < .001) and time by group interaction (p < .05) for intention-to-treat and per-protocol analysis. Estimated marginal means of the PHQ-9 scores after 12 weeks were significantly lower in SCCM than in TAU (for intention-to-treat: PHQ-9 mean difference at T₁ 1.30, 95% CI 1.12 to 1.48, p < .001; Cohen's d=.23; baseline-adjusted PHQ-9 mean difference at T₁ 0.57, 95% CI 0.40 to 0.74, p < .001). Cost-effectiveness and net monetary benefit analyses provided evidence of cost-effectiveness for the primary outcome and quality-adjusted life years. Robustness of results were confirmed by sensitivity analyses.

Interpretation

The SSCM resulted in a more effective and cost-effective reduction of depressive symptoms compared with TAU. Findings suggest a suitable model to provide mental health services in circumstances where resources are limited, particularly in the context of forced migration and pandemics.

Funding

This project is funded by the Innovationsfond and German Ministry of Health [grant number 01VSF16061]. The present trial is registered under Clinical-Trials.gov under the registration number: NCT03109028. https://clinicaltrials.gov/ct2/show/NCT03109028

Factors influencing the attitudes of young Sri Lankan-Australians towards seeking mental healthcare: a national online survey

Background

Sri Lankans, as part of the South Asian diaspora, comprise one of the largest migrant groups in Australia. Although few data are available, South Asian migrants appear to experience higher rates of mental health problems, but seek help at lower rates than other migrant groups. Understanding factors that underpin mental health care seeking is necessary to inform mental health promotion strategies, including access to care. The aim was to investigate factors influencing attitudes to seeking care for mental health problems among young Sri Lankan-Australians born in Sri Lanka or in Australia.

Methods

An anonymous cross- sectional online survey which included the Multiethnic Identity Measure, Perceived Stigma Questionnaire, General Help-Seeking Questionnaire, Attitudes Towards Seeking Professional Psychological Help questionnaire and study specific questions to ascertain sociodemographic characteristics. The survey was advertised on social media and specifically included young adults aged between 18–30, who self-identified as being of Sri Lankan heritage and were living in Australia. Participation was not possible for those that did not have access to the internet. Data were analyzed using bivariable and multivariable statistics.

Results

Of the 396 people who attempted the survey, 323 provided fully completed data, 2 provided > 50% completed data which were included in the analyses. 71 were excluded because < 50% of the survey was completed. From all participants, 39.70% were born in Australia (SLaus), 54.46% born in Sri Lanka (SLsl) and 5.8% born in other countries. SLsl had more stigmatizing attitudes towards mental illness (p = 0.027) and seeking professional psychological help (p = 0.03). Women, those who had spent more years living in Australia and whose fathers were more highly educated had less stigmatized attitudes toward mental illness and help-seeking.

Conclusion

Country of birth, family characteristics and gender influence stigma towards mental illness and help-seeking. Public health strategies to promote understanding of mental health problems and seeking mental healthcare are more likely to be effective if they address these factors directly.

Competence in Daily Activities and Mental Well-Being among Technical Intern Trainees in Japan: A Cross-Sectional Study

Migrant workers are at a greater risk of having low mental well-being compared to their local counterparts. The Japanese government accepts migrants through its Technical Intern Training programs, but the factors associated with their mental well-being remain unclear. This study aimed to (1) assess trainees' competence and importance in daily activities and (2) examine the association between their competence and mental well-being. We conducted a cross-sectional study using self-administered questionnaires. We recruited trainees through their supervising organizations and social media. We used the Occupational Self-Assessment tool to measure competence and importance in daily activities and the World Health Organization-5 Well-being Index to measure mental well-being. Hierarchical regression analysis was used to examine the association between competence and mental well-being. Among 383 trainees, 30.6% felt difficulty expressing themselves, and 27.4% felt difficulty accomplishing goals. Almost 50% valued self-care, working towards their goals, and managing their finances. Higher competence scores were associated with higher mental well-being scores (B = 0.76; 95% CI = 0.52, 1.00). Competence may be a key to having higher mental well-being among migrant trainees in Japan. A supportive and enabling environment, as well as mental health promotion at the community level, may improve trainees' competence in daily activities.

Impact of language proficiency on mental health service use, treatment and outcomes: "Lost in Translation"

BACKGROUND

Mastery of a language is bound to place of origin; low language proficiency is thus related to migration and cultural differences, all of which influence access to mental health care, treatment and outcomes. Switzerland, being multilingual, allows the disentangling of language proficiency from migration and, to some extent, culture. This study uses propensity score matching to explore how language proficiency relates to help-seeking behaviour, service use, treatment and outcomes in patients with mental health disorders.

METHODS

We used the first admission of patients admitted to and discharged from an academic psychiatric hospital in Switzerland between January 1st, 2013 and December 31st, 2019, with an observation period of one-year post-discharge (until December 31st, 2020). We paired 2101 patients with low language proficiency to 2101 language proficient patients, balancing baseline sociodemographic and clinical characteristics using propensity score matching.

RESULTS

Patients with low language proficiency had a higher probability of compulsory admission (OR: 1.79, 99%CI: 1.60-2.02); which remained after adjustment for confounders (OR: 1.51; 99%CI: 1.21-1.89). Whilst in treatment, they had higher rates of compulsory medication (OR: 1.73, 99%CI: 1.16-2.59) and seclusion/restraint (OR: 1.87, 99%CI: 1.25-2.79). Furthermore, patients initially admitted voluntarily had a higher probability of being compulsorily retained (OR: 1.74, 99%CI: 1.24-2.46). Both groups showed similar clinical improvement rates and service use parameters.

CONCLUSIONS

Our results demonstrate that low language proficiency constitutes a risk factor for coercive measures throughout hospitalisation. The results demonstrate the need for an increase in language sensitivity in psychiatric care.

Cultural Bereavement and Mental Distress: Examination of the Cultural Bereavement Framework through the Case of Ethiopian Refugees Living in South Korea

In South Korea, a mono-ethnic nation, refugees and asylum seekers from culturally distant countries are exposed to cultural bereavement, cultural identity shock, and cultural inconsistency for themselves and their children. Along with biological, psychological, and social factors, this phenomenon is hypothesized as playing a major role in an increased rate of distress among refugees. This study explored the experiences of 11 Ethiopian refugees living in South Korea, and their relevance to cultural bereavement while affirming and suggesting an update for the cultural bereavement framework. The analysis showed the refugees experiencing a slight continuation of dwelling in the past; a sense of guilt due to the fading of one’s culture; different types of anger; and anxiety with relation to the cultural identity of themselves and of their young children. Strong religious beliefs, a continuation of religious practice, informal gatherings within the Ethiopian diaspora, and organized community activities provided an antidote for cultural bereavement. The implication of the result hopes to assist and direct practitioners to identify complex manifestations of mental distress that often get wrongfully labeled as to their causation as well as methods and sources of diagnosis. Any update on the cultural bereavement framework also needs to consult the setting and peculiar circumstances of the displaced people in question.

LGBTQI + Migrants: A Systematic Review and Conceptual Framework of Health, Safety and Wellbeing during Migration

The health and safety of LGBTQI+ migrants or migrants who are of diverse sexual orientation, gender identity or expression (SOGIE) remains an under-studied area, particularly for the period during transit from their place of origin to destination. This systematic review aims to describe the literature on the health risks and consequences among SOGIE migrants during transit and examine their access and use of services. Six peer-reviewed databases and websites of nine large migration organisations were searched to identify the literature on forced migrants and sexual and gender minorities. Twenty English-language studies from 2000-2021 were included and analysed drawing on a conceptual framework. Studies emerged from six regions and the majority of research participants identified as gay men. In general, quality appraisal demonstrated studies as either medium or high quality. Findings suggested five common themes associated with SOGIE health and well-being, including: daily exposure to discrimination, harassment and violence; coping, social support and resilience; access to services; mental health; and physical and sexual health. Depression, anxiety and post-traumatic stress disorder (PTSD) were prevalent amongst SOGIE migrants, particularly when associated with detention or camp environments, and were exacerbated by social isolation. Barriers to accessing healthcare were identified and specific sexual health services were often found lacking, especially for trans persons. Unsurprisingly, during transit, SOGIE migrants are very likely to experience the double marginalisation of their migrant or minority status and their gender identity. Results indicate that services for SOGIE migrants need to tailor service access and support approaches to respond to the particular health and protection needs of SOGIE individuals in each setting.

Albanian Migrants in Cyclades: Contact with Mental Health Services and Implications for Practice

The purpose of this study was to examine the potential differences between Albanian migrants and Greeks in the islands of Paros and Antiparos with regard to seeking help from the local public mental health service, namely the Mobile Mental Health Unit of NE Cyclades Islands (EPAPSY-NGO). The study’s instruments include the Global Assessment of Functioning (GAF) and a questionnaire for recording psychosocial profile data and information concerning contact with the services. The results showed that significantly less Albanian migrants contacted the mental health services in the past in comparison to Greeks. When using the service, the Albanians were more likely to see a psychiatrist in the Unit, rather than a psychologist-psychotherapist, and they more often received prescriptions for medication. There was a significantly higher dropout rate among Albanian migrants. This study highlights the different aspects of access and use of mental health services among Albanian migrants compared with native residents. Further research should focus on the factors related to early dropouts and difficulties accessing mental health services in rural areas, in order to develop more focused and effective interventions and improve the quality of care provided.

Refugee Mental Health, Global Health Policy, and the Syrian Crisis

The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced and 26.4 million registered refugees. The ongoing conflict in Syria is a major contributor. After a decade of violence and destabilization, over 13.4 million Syrians have been displaced, including 6.7 million internally displaced persons and 6.7 million refugees registered in other countries. Beyond the immediate political and economic challenges, an essential component of any response to this humanitarian crisis must be health-related, including policies and interventions specific to mental health. This policy and practice review addresses refugee mental health in the context of the Syrian crisis, providing an update and overview of the current situation while exploring new initiatives in mental health research and global health policy that can help strengthen and expand services. Relevant global health policy frameworks are first briefly introduced, followed by a short summary of recent research on refugee mental health. We then provide an update on the current status of research, service provision, and health policy in the leading destinations for Syrians who have been forcibly displaced. This starts within Syria and then turns to Turkey, Lebanon, Jordan, and Germany. Finally, several general recommendations are discussed, including the pressing need for more data at each phase of migration, the expansion of integrated mental health services, and the explicit inclusion and prioritization of refugee mental health in national and global health policy.

Suicide rates and risk factors for suicide among Israeli immigrants from Ethiopia (1985-2017)

BACKGROUND

Suicide rates among Ethiopian immigrants to Israel (EI) are relatively high. This study sought to identify suicide-risk factors in this population in order to suggest some potentially preventive measures to mental health policymakers who are struggling to prevent suicide among EI.

METHOD

Nationwide age-adjusted suicide rates were calculated for EI, Former Soviet Union immigrants (FSUI) and Israeli-born (IB) Jews by age, gender, and year of death and, for EI, by marital status and immigration period in the years 1985-2017 (1990-2017 for FSUI).

RESULTS

Age-adjusted suicide rates for the period 1990-2017 confirmed the significantly higher rate among EI--3.1 times higher than for FSUI and 4.1 times higher than for IB. Similar rates were obtained for both genders, within each age group, and in all study years. Comparable male/female rate ratios were found among EI and IB (3.3, 3.6, respectively). Over the years of the study, only among the Ethiopian immigrants were there large fluctuations in suicide rates: a decrease (1992-2001), followed by an increase (2001-2006), and then a progressive decrease (from 2006). The secular changes differed greatly according to age. Among females, these fluctuations were smaller, the decrease began earlier and was greater, and the subsequent increase was much smaller. Marriage was found to be less protective for Ethiopian immigrants than for the other surveyed populations.

CONCLUSIONS

The considerable gap between the EI's and FSUI's suicide rates highlights the critical role of immigrants' integration difficulties. These difficulties among EI lead to ongoing conflict within the family, which may explain why marriage is less protective for EI. Nevertheless, progressive integration is occurring as indicated by the decline in suicide rates since 2006. The fluctuations in EI suicide rates over time seem to be associated with modifications in social welfare allowances, which are crucial for EI of low socioeconomic status. Groups at risk, particularly EI men facing socioeconomic challenges and EI with considerable family conflict, typically identified by HMOs and welfare services, should be screened for suicide risk, and those identified as at risk referred to tailored workshops sensitive to Ethiopian culture.

Meta-analysis of probability estimates of worldwide variation of CYP2D6 and CYP2C19

Extensive migration has led to the necessity of knowledge regarding the treatment of migrants with different ethnical backgrounds. This is especially relevant for pharmacological treatment, because of the significant variation between migrant groups in their capacity to metabolize drugs. For psychiatric medications, CYP2D6 and CYP2C19 enzymes are clinically relevant. The aim of this meta-analysis was to analyze studies reporting clinically useful information regarding CYP2D6 and CYP2C19 genotype frequencies, across populations and ethnic groups worldwide. To that end, we conducted a comprehensive meta-analysis using Embase, PubMed, Web of Science, and PsycINFO (>336,000 subjects, 318 reports). A non-normal metabolizer (non-NM) probability estimate was introduced as the equivalent of the sum-prevalence of predicted poor, intermediate, and ultrarapid metabolizer CYP2D6 and CYP2C19 phenotypes. The probability of having a CYP2D6 non-NM predicted phenotype was highest in Algeria (61%) and lowest in Gambia (2.7%) while the probability for CYP2C19 was highest in India (80%) and lowest in countries in the Americas, particularly Mexico (32%). The mean total probability estimates of having a non-NM predicted phenotype worldwide were 36.4% and 61.9% for CYP2D6 and CYP2C19, respectively. We provide detailed tables and world maps summarizing clinically relevant data regarding the prevalence of CYP2D6 and CYP2C19 predicted phenotypes and demonstrating large inter-ethnic differences. Based on the documented probability estimates, pre-emptive pharmacogenetic testing is encouraged for every patient who will undergo therapy with a drug(s) that is metabolized by CYP2D6 and/or CYP2C19 pathways and should be considered in case of treatment resistance or serious side effects.

Alcohol, Other Drugs Use and Mental Health among African Migrant Youths in South Australia

This paper was part of a large study that explored suicide among African youths in South Australia. The paper reports perspectives about alcohol and other drugs (AOD) use and mental health among African migrant and refugee youths in South Australia. The study employed a qualitative inquiry, conducting 23 individual interviews and one focus group discussion with eight participants. An acculturative stress model informed data analysis, interpretation and the discussion of the findings that form the current paper. African migrant and refugee youths revealed challenging stressors, including related to cultural, socioeconomic, living conditions, and pre- and post-migration factors that contributed to mental health problems and the use of AOD in their new country. The traumatic loss of family members and social disruption experienced in their countries of origin were expressed as part of factors leading to migration to Australia. While in Australia, African migrant and refugee youths experienced substantial stressors related to inadequate socioeconomic and cultural support, discrimination, poverty, and unemployment. Participants believed that differences in cultural perspectives about AOD use that existed in Africa and Australia also shaped the experiences of social stressors. Additionally, participants believed that these cultural differences and the identified stressors determined AOD use and mental health problems. The findings highlight the need to understand these social and cultural contexts to improve mental health services and help reduce the use of AOD, which, when problematic, can influence the health and integration experiences of these populations.

Mental Health and Service Use of Migrants in Contact with the Public Psychiatry System in Paris

BACKGROUND

Migrants, and particularly asylum seekers, are at increased risk of psychiatric disorders in comparison with natives. At the same time, inequalities in access to mental health care are observed.

METHODS

In order to evaluate whether the Parisian public psychiatric system is optimally structured to meet the needs of this population, we examined data on mental health and service use considering three different levels: the global system treatment level, a psychiatric reception center, and mobile teams specializing in access to psychiatric care for asylum seekers.

RESULTS

We found higher treatment rates among migrants than among natives (p < 0.001) but inequalities in pathways to care: more mandatory admissions (OR = 1.36, 95% CI: 1.02-1.80) and fewer specialized consultations (OR = 0.56, 95% CI: 0.38-0.81). We observed a mismatch between increased need and provision of care among migrants without stable housing or seeking asylum.

CONCLUSIONS

Inequalities in the provision of care for migrants are observed in the Parisian public psychiatric system, particularly for those experiencing poor social and economic conditions. There is a need to facilitate access to mental health care and develop more tailored interventions to reduce discontinuity of care.

Country of birth, time period of resettlement and subsequent treated common mental disorders in young refugees in Sweden

BACKGROUND

Little is known regarding treatment for common mental disorders (CMDs) in young refugees. We aimed to identify (i) if the risk of treatment for CMDs in young refugees varies by their country of birth, compared with the Swedish-born population and (ii) if time period of resettlement influences these possible associations.

METHODS

All Swedish-born individuals and people who were granted refugee status, aged 16-25 years, living in Sweden on 31 December 1999, 2004 or 2009 (around 1 million people with 3-4% refugees in each cohort), were followed for 4 years for treated CMDs by linking register data. To facilitate stratified analyses by refugees' country of birth, the 2009 cohort was followed for 7 years with regard to specialized healthcare and antidepressant prescription due to CMDs. Hazard ratios with 95% confidence intervals were computed in crude and adjusted models.

RESULTS

Refugees in the 2009 cohort with 7-year follow-up had a 25% lower risk for treated CMDs, compared with the Swedish-born. Stratified analysis by country of birth showed a similarly lower risk regarding treated CMDs among refugees from all countries but Iran [hazard ratios (95% confidence intervals): 1.15 (1.05-1.26)] than their Swedish-born peers. No substantial effect of time period of resettlement was observed in the risk for treated CMDs in refugees.

CONCLUSIONS

Treatment for CMDs is lower in young refugees than in the majority population in Sweden, is stable across time, but varies with country of birth. Strategies to improve access to mental healthcare for young refugees are warranted.

Migration and Psychosis: Specificity and Burden on the Mental Health System in Italy

In the last years, there has been a huge migratory flow to Italy. Migration is a risk factor for the development of psychopathology, especially psychosis and posttraumatic stress disorder. We aimed at investigating the burden and characteristics of psychotic features among immigrants in Lombardy, one of the most involved regions. A total of 7819 patients had at least one psychiatric appointment in 2013, 10.3% of them where immigrants. Patients from Africa showed a significant higher rate of psychosis, psychiatric onset, compulsory admissions, and number of professional appointments. Our result can confirm a cultural specificity of psychotic manifestations and their burden on the mental health system.

Trauma exposure, mental health and tobacco use among vulnerable Syrian refugee youth in Jordan

BACKGROUND

Little is known about tobacco use among youth exposed to armed conflicts, or the influence of trauma on tobacco use in this context. This study examined patterns of smoking by tobacco product and gender among Syrian refugee youth living in host communities in Jordan and assessed the associations of post-traumatic stress disorder (PTSD) and depression symptoms, trauma exposure and social support with current smoking status in boys and girls.

METHODS

Syrian refugee students (mean [standard deviation] age = 14.9 [1.33] years) were identified through the public school system. Data were collected using an online Arabic questionnaire that included questions about demographics, trauma exposure, current smoking (cigarette and waterpipe), PTSD, depression and perceived social support. Logistic regression was used to assess the adjusted effects of independent variables on current smoking status.

RESULTS

One in 7 boys and one in 14 girls were current smokers, with boys reporting greater tobacco use than girls. Among boys, current smokers reported significantly higher family member loss and lower perceived family social support than nonsmokers; among girls, current smokers also reported significantly higher family member loss as well as greater PTSD symptoms and lower perceived significant other/special person social support.

CONCLUSIONS

Tobacco use is established among this vulnerable group. The findings highlight the potential role of psychosocial support for tobacco prevention and cessation strategies.

Negotiating Identity and Belonging in a New Space: Opportunities and Experiences of African Youths in South Australia

This paper was part of a large study that aimed to explore determinants of increased suicides among African youths in South Australia. As part of this larger study, narratives from participants indicated that identity crisis could be a potential determinant of suicide. This paper reports on how African youths negotiate and form identity in Australia. A qualitative inquiry was undertaken with 31 African youths using a focus group and individual interviews. Data analysis was guided by a framework for qualitative research. These youths negotiated multiple identities, including those of race, gender, ethnicity and their origin. ‘Freedom and opportunity’, ‘family relationships’, ‘neither belonging here nor there’ and ‘the ability to cope against the paradox of resourcefulness in Australia’ appeared to be important themes in negotiating individual identities. An opportunity was used to acknowledge privileges available in Australia relative to Africa. However, the extent to which individuals acted on these opportunities varied, affecting a person’s sense of purpose, identity formation and belonging in Australia. The loss of social networks following migration, and cultural differences between African and Australian societies, shaped the experience of belonging and identity formation. These findings are crucial as they indicate the need for policies and practices that consider experiences of youths as they form their identity in Australia. Further studies with large numbers of participants are needed to explore these issues further among African youths in Australia.

Psychiatric symptoms in traumatized Syrian refugee children settled in Hatay

Aim: After the beginning of the Syrian civil war in 2011, its cruelty and violence forced about millions to leave their homes. These experiences might create serious mental problems, especially in children and adolescents who might have an increased risk of developing post-traumatic stress disorder (PTSD) and depression. In this study, we aimed to investigate the mental health status of Syrian refugee children who exposed to a variety of traumatic events.Method: The sample consisted of 1518 drug-naive Syrian refugee children and adolescents aged between 8 and 16 years who were admitted to the Child and Adolescent Psychiatry Department in Hatay State Hospital between June 2016 and December 2018. The CRIES-13 (Children's Revised Impact of Event Scale-13) was used to evaluate PTSD symptoms and CDI (Children's Depression Inventory) was used to examine depressive symptoms. The sample was divided into three groups according to the type of trauma and the CRIES-13 and CDI scores were compared between the groups.Results: The mean age of the children was 12.4 ± 3.1. 46.9% of the children were male and 53.1% were female. The total score and intrusion and arousal subscores of CRIES-13 were significantly different between the three groups. The total CDI score was also significantly different between the three groups. The likelihood rates of PTSD and depression differed significantly between the groups.Conclusion: Traumatized Syrian refugee children may present PTSD symptoms more likely than depressive symptoms. War-related traumatic experiences may have more adverse effects on Syrian children's psychology than other traumas.

The importance of faith-based mental healthcare in African urbanized sites

PURPOSE OF REVIEW

This review highlights what current research says about how local beliefs and norms can facilitate expansion of mental healthcare to meet the large unmet need for services in Africa.

RECENT FINDINGS

In contemporary Africa, religious beliefs exert important influences on mental health as well as the way people with mental illnesses are viewed and cared for. Mental healthcare practices based on traditional and other religious beliefs, and offered by complementary and alternative health providers (CAPs), reflect the people's culture and are often preferentially sought by a majority of the population. Despite important differences in the worldviews of CAPs and biomedical mental healthcare practitioners in regard to causal explanations, there are nevertheless overlaps in the approaches of both sectors to the management of mental health conditions. These overlaps may provide a platform for collaboration and facilitate the scaling-up of evidence-based mental health services to underserved African populations, especially those residing in ever-expanding urban centres.

SUMMARY

Faith-based mental healthcare is an important but informal component of the mental health system in much of Africa. Collaboration between its practitioners and biomedical practice may help to bridge the large treatment gap for mental health conditions on the continent.

EPA guidance on cultural competence training

The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value.

Prevalence of eating disorder is lower in migrants than in the Australian-born population

OBJECTIVES

There are limited data on the epidemiology of eating disorders (ED) in migrants. Recent Scandinavian research suggests that migrants are at lower risk of eating disorders, however, to our knowledge there have not been comparable studies exploring eating disorders in Australian adult populations. We sought to explore the prevalence of EDs in first-generation migrants to Australia in comparison with the Australian-born population. A secondary aim was to explore ED prevalence across first-generation migrants from different regions of birth (Europe, Asia, Africa, and Other).

METHODS

We conducted sequential cross-sectional population surveys in South Australian individuals aged over 15 years in 2015 and 2016 (n = 6052). Demographic data were collected and migration status was inferred based on a country of birth outside Australia. Questions asked regarding disordered eating were based on the Eating Disorders Examination.

FINDINGS

The 3-month prevalence of any ED was found to be significantly lower in first-generation migrants born outside Australia (4.5%, 95% CI 3.6-5.6) in comparison to the Australian-born population (6.4%, 95% CI 5.7-7.2). People born in countries in Africa (11.0% 95% CI 6.1-19.1) had a significantly higher prevalence of EDs than those born in Asia (4.0% 95% CI 2.7-5.8).

CONCLUSIONS

First-generation migrants to Australia may be at lower risk of eating disorders compared to their Australia-born peers, suggesting support for a 'healthy immigrant effect'.

Patterns of psychiatric hospitalizations among migrant workers and asylum-seekers in Israel: a single hospital archive study, 2005-2011

Aim: Migrants have increased risk for psychiatric hospitalizations. Over the last decades Israel has become a destination for migration of migrant workers and asylum-seekers.Methods: The current retrospective study retrieved socio-demographic, clinical and migration-related chart data for 117 migrants admitted to a major Israeli psychiatric hospital between 2005-2011, to delineate characteristics and risk-factors for psychiatric hospitalizations. Multivariate logistic regression analyses were performed to predict re-hospitalization.Results: Of the study sample, 61% were single men, 20% had been exposed to trauma, 15% had prior psychiatric hospitalizations and 24% had attempted suicide. Approximately, 76% were involuntarily hospitalized and diagnosed with psychosis. None were diagnosed with PTSD. Approximately, 20% were re-hospitalized. Factors significantly associated with re-hospitalization were male gender (OR = 15.2, 95%, CI 1.8-126.9, p = 0.012), prior psychiatric hospitalization (OR = 15.4, 95% CI 2.1-111.9, p < 0.01), being single (OR = 5.96, 95% CI1.14-31.07, p = 0.03) and traumatic exposure (OR = 4.75, 95% CI: 1.17-19.36, p= 0.03). Shorter duration in Israel, unemployment, asylum-seekers, no temporary-visa and use of restraints were more prevalent among those re-hospitalized.Conclusion: Identification of migrants at risk and trauma-informed, culturally relevant services can reduce hospitalizations.

Assessing and Improving the Quality in Mental Health Services

Background: The mental health of the population consists of the three essential pillars of quality of life, economy, and society. Mental health services take care of the prevention and treatment of mental disorders and through them maintain, improve, and restore the mental health of the population. The purpose of this study is to describe the methodology for qualitative and quantitative evaluation and improvement of the mental health service system. Methods: This is a narrative review study that searches the literature to provide criteria, indicators, and methodology for evaluating and improving the quality of mental health services and the related qualitative and quantitative indicators. The bibliography was searched in popular databases PubMed, Google Scholar, CINAHL, using the keywords “mental”, “health”, “quality”, “indicators”, alone or in combinations thereof. Results: Important quality indicators of mental health services have been collected and presented, and modified where appropriate. The definition of each indicator is presented here, alongside its method of calculation and importance. Each indicator belongs to one of the eight dimensions of quality assessment: (1) Suitability of services, (2) Accessibility of patients to services, (3) Acceptance of services by patients, (4) Ability of healthcare professionals to provide services, (5) Efficiency of health professionals and providers, (6) Continuity of service over time (ensuring therapeutic continuity), (7) Efficiency of health professionals and services, (8) Safety (for patients and for health professionals). Discussion/Conclusions: Accessibility and acceptability of service indicators are important for the attractiveness of services related to their use by the population. Profitability indicators are important economic indicators that affect the viability and sustainability of services, factors that are now taken into account in any health policy. All of the indicators mentioned are related to public health, affecting the quality of life, morbidity, mortality, and life expectancy, directly or indirectly. The systematic measurement and monitoring of indicators and the measurement and quantification of quality through them, are the basis for evidence-based health policy for improvement of the quality of mental health services.

Migrant Workers and Psychological Health: A Systematic Review

Migrant workers show an increase in the incidence of serious, psychotic, anxiety, and post-traumatic disorders due to a series of socio-environmental variables, such as loss of social status, discrimination, and separations from the family. The purpose is to elaborate a systematic review and highlight the prevailing psychological pathologies of these workers and categories most at risk. Our research included articles published from 2009 to 2019 on the major databases (Pub Med, Cochrane Library, and Scopus) using a combination of some keywords. The online search indicated 1.228 references. Using inclusion and exclusion criteria, we analyzed 127 articles, in particular 12 reviews and 115 original articles. Principal emerging disorders from the research are depressive syndrome (poor concentration at work, feeling down, or anger and somatization), anxiety, alcohol or substance abuse, and poor sleep quality. This causes low life conditions, which is also due to marginalization from the social context and strenuous work; in fact, migrant workers may suffer verbal or physical abuse, and they are often employed in dangerous, unhealthy jobs. It is therefore essential to increase the role of occupational medicine and promote wellbeing for this vulnerable job category.