Stress and Coping in the Lives of Recent Immigrants and Refugees: Considerations for Counseling

Role of Social Support on Mental Health Among Resettled Bhutanese Refugees in Ohio

More than 80% of Bhutanese refugees have resettled in the United States. Social support can lead to better resilience against poor mental health outcomes among this population. This study assessed the role of social support on mental health among the resettled Bhutanese adults in Central Ohio. This study used data collected by the Ohio Department of Mental Health and Addiction Services on 200 Bhutanese adults in Columbus. Social support was measured using a 12-item perceived social support scale. The 25-item Hopkins Symptoms Checklist was used to quantify depression and anxiety experienced in the past month. One-in-three participants reported mental health problems. Compared to participants with high social support, those with medium (OR 5.28, 95% CI 2.09-13.37) and low social support (OR 10.94, 95% CI 2.53-47.33) had more than 5- and 10-fold increased odds of mental health problems respectively. Future studies could further explore the role of social support on mental health during relocation, resettlement, and acculturation processes.

Suicide in first-generation Australian migrants, 2006-2019: a retrospective mortality study

Background

This study addressed the limited understanding of suicide risk and patterns among migrants in Australia. It examined national-level suicide rates and trends in the Australian population to identify migrant groups which are disproportionately affected by suicide.

Methods

The National Coronial Information System was used to identify suicide cases from 2006 to 2019. Incident rate ratios (IRR) with 95% confidence intervals (CI) evaluated suicide risk for migrant groups compared to Australian-born and migrants from English-speaking countries. Age-standardised suicide rates (ASR) per 100,000 and average annual percentage change (AAPC) were calculated to compare suicide rates and trends.

Findings

Compared to the Australian-born population, all migrant males and females had significantly lower suicide risk, except females from Oceania countries. Females from European (IRR 1.28, 95% CI 1.13, 1.14) and Oceanian countries (IRR 1.25; 95% CI 0.95, 1.66) had an elevated suicide risk compared to female migrants from English-speaking countries. Male migrants from Oceania (ASR 20.4, AAPC 1.0 (-3.6, 5.8)) and Africa (ASR 18.0, AAPC -0.4 (-5.5, 4.9)) have high ASR with no significant changes in trend over the study duration. Female African migrants had an ASR of 5.3 per 100,000, which increased by 8% (95% CI 1.4, 15.0) between 2006 and 2019.

Interpretation

Migrants from Oceania and African countries are disproportionately affected by suicide mortality compared to other migrant groups in Australia. Further research is needed to identify the risk factors and develop suicide prevention strategies for these groups.

Funding

Suicide Prevention Australia, Australian Research Council.

Community Solutions to Increase the Healthfulness of Grocery Stores: Perspectives of Immigrant Parents

Grocery store environments are recognized as one of the most crucial community settings for developing and maintaining healthy nutritional behaviors in children. This is especially true for disadvantaged ethnic minority families, such as immigrants, who reside in the Detroit Metropolitan area and have historically experienced inequities that result in poor health outcomes. Rates of obesity and type II diabetes have affected Detroit 38% more than the rest of the state and nationwide. In 2019, almost 54% of children aged 0-17 in Metro Detroit lived in poverty, and 21.6% experienced food insecurity, compared with the state level of 14.2%. Moreover, nearly 50% of ethnic minority children in Metro Detroit consume sports drinks, and 70% consume soda or pop in an average week. The primary purpose of this study was to explore immigrant parents' perspectives on (1) how in-store Sugar-Sweetened Beverage (SSB) marketing impacts the purchasing behaviors of parents and the eating behaviors of toddlers, and the secondary objective was to (2) determine strategies to reduce SSB purchases and consumption within grocery environments from the viewpoints of immigrant parents. A qualitative multiple-case study design was used to achieve the aims of this study. Semi-structured individual interviews were completed with 18 immigrant parents of children aged 2 to 5 years old who were consumers in 30 independently owned full-service grocery stores within the immigrant enclaves of Detroit, Dearborn, Hamtramck, and Warren, Michigan. Three key thematic categories emerged from the parents' narratives. These themes were: (1) non-supportive grocery store environments; (2) acculturation to the American food environment; and (3) strategies to support reduced SSB consumption among young immigrant children. The findings of this study revealed widespread SSB marketing targeting toddlers within the participating independently owned grocery stores. Even if families with young children practiced healthy nutritional behaviors, the prices, placements, and promotion of SSBs were challenges to establishing and sustaining these healthy eating habits. The parents believed that planning and implementing retail-based strategies in collaboration with families and considering families' actual demands would assist in managing children's eating patterns and reducing early childhood obesity.

The Immigrant Experience and Alcohol Use: Heart Rate as a Source of Risk and Resilience

The immigration experience in the USA has been linked to a wide range of behavioral and physical outcomes. Studies report that immigrants, relative to native-born citizens, are less likely to develop alcohol use habits despite facing hardship during the acculturation process. Limited research, however, has examined whether and to what extent resting heart rate (RHR) plays a role in accounting for individual differences in the acculturation process in the USA. To begin to address this gap in research, cross-sectional self-report data (N = 4775) from a nationally representative sample of US adults are analyzed to examine the association between the immigrant experience, alcohol use, and drunkenness. The role of low, mean, and high RHR on this association is investigated. The results reveal that respondents with higher levels of the immigrant experience report lower levels of alcohol use and drunkenness. RHR partially conditions the relationship between the immigrant experience and alcohol use, whereby respondents with higher levels of the immigrant experience and high RHR report less alcohol use and drunkenness, compared to more native respondents with low RHR. Immigrant experience and alcohol use were associated, but not with drunkenness among respondents with average RHR levels, relative to those with low RHR levels. The results suggest that RHR may be a potential source of both risk for and resilience to the development of alcohol use behaviors among immigrants going through the acculturation process in the USA.

The association of stress and work hours with sleep duration and insomnia symptoms among U.S.-born and Foreign-born Black adults

OBJECTIVE

To examine associations between stress and work hours with sleep duration and insomnia symptoms among U.S.-born and Foreign-born Black adults.

DESIGN

A cross-sectional analysis of the National Health Interview Survey.

PARTICIPANTS

Black adults (N = 16,315) with a mean age of 40 ± 0.1 years, mostly women (52.7%), college graduates (40.7%), and U.S.-born (82.5%).

MEASUREMENTS

Participants self-reported sleep duration, insomnia symptoms, frequent stress (yes/no), and work hours in the prior week (1-39 hours, 40 hours, ≥41 hours). Poisson regression with robust variance was used to test associations overall and by nativity.

RESULTS

Working ≥41 hours, frequent stress, and short sleep duration (<7 hours) were reported by 22%, 24.9%, and 43% of participants, respectively. U.S.-born and Foreign-born Black adults who reported frequent stress and working ≥41 hours vs. 40 hours had 60% and 19% higher prevalence of short sleep duration (adjusted prevalence ratio [aPR] = 1.60, 95% confidence interval [CI]: 1.47, 1.74 and aPR = 1.19, 95% CI: 1.12, 1.25, respectively). Foreign-born Black adults who worked 1-39 hours vs. 40 hours, had higher prevalence of short sleep duration, aPR = 1.18, 95% CI: 1.01, 1.37. U.S.-born Black adults who worked ≥41 hours vs. 40 hours had higher prevalence of insomnia symptoms (trouble falling asleep: aPR = 1.33 [95% CI: 1.13, 1.56], trouble staying asleep: aPR = 1.33 [95% CI: 1.16, 1.53]).

CONCLUSION

Frequent stress and working ≥41 hours are likely salient determinants of sleep health for U.S. and Foreign-born Black individuals. Further, less work hours (Foreign-born) while longer work hours (U.S.-born) were associated with short sleep duration. Stress and work hours may be factors for sleep health interventions among Black adults.

Reception Operators’ Perception of the Labor Market Integration of Refugees in Light of the Social Cognitive Career Theory

The millions of refugees living abroad are supported by reception operators in integrating into the hosting country’s labor market. Because the operators are usually not experts in career counseling, it is essential to investigate how they act and consequently interpret their role in supporting the labor integration process, which could, at least in part, explain the weaknesses in the migrants’ labor situation. The study is based on fourteen narrations from reception operators on migrants whom they have followed for a career-counseling intervention. The Social Cognitive Career Theory has been the theoretical reference both to define the hypotheses to be tested and the coding of the narratives. The main result is that operators tend to contribute in the final part of the process, i.e., when the migrants have to identify their professional goals and choose which actions to take to achieve them. Furthermore, they view their role as prescriptive and substitutive, not as supporting self-awareness, contextual knowledge, and the choice process. This can produce immediate actions of finding employment, often of low quality, rather than developing interests and projections towards a career that creates satisfaction, and adverse reactions in qualified migrants.

Adult attachment, stress-coping, and resilience in first-generation immigrants in the United States

Introduction

Previous studies have shown correlations between adult attachment, stress-coping, and resilience, but little is known about how attachment and stress-coping affect resilience, particularly among first-generation immigrants. This study explored relationships among adult attachment, stress-coping, and resilience for first-generation immigrants.

Method

A quantitative cross-sectional design was used to assess associations between adult attachment and stress-coping with resilience among first-generation immigrants. Thirty-five participants answered an online Qualtrics survey. A simple linear regression analysis was conducted to analyze the results.

Results

The results indicated statistically significant correlations between avoidance scores and annual household income but not between resilience and education, resilience and income, and stress-coping scores and education and income. Positive reinterpretation growth was positively correlated with resilience, while denial and behavioral disengagement were negatively correlated. Adult attachment and number of years in the United States were not significantly statistically related to resilience.

Conclusion

The findings indicate high income may be associated with attachment avoidance, and increases in positive coping strategies and decreases in negative coping strategies are associated with resilience among first-generation immigrants. Understanding influences on first-generation immigrants to engage in stress-coping skills may inform the development and implementation of occupational therapy, including programs and interventions for successful client-centered outcomes.

Shifting Priorities and Neoliberal Ideologies in Refugee Health Intervention Design in the US

We discuss the design of a technology-based vaccine education intervention for Somali refugees in the US. Originally conceived of as a culturally and linguistically appropriate project to be co-designed by refugees, funder demands for a "social enterprise" led to future iterations being developed for a "generic" audience. We explore epistemological negotiations and shifting priorities that shaped intervention design, highlighting how nonprofits engage neoliberal ideologies such as "social enterprise" and "design thinking" while attempting to meet community needs. We argue that social enterprises and design thinking can suffuse neoliberal ideologies into nonprofits to the detriment of community-engaged solutions.

New directions in the mental health care of migrants, including refugees-A randomized controlled trial investigating the efficacy of value-based counselling

OBJECTIVE

Specialized literature has identified a need for evidence-based, low-threshold, short-term, and intracultural psychological interventions that can be made available to migrants, including refugees, who suffer from psychological symptoms in host countries. The objective of the present study is to measure the efficacy of value-based counselling (VBC) as such an intervention.

METHOD

We conducted a pragmatic, rater-blinded randomized controlled trial employing a pre-post control group design to assess the efficacy of VBC based on a study sample of 103 migrants, including refugees, who resided in Germany at the time. A set of instruments was used to evaluate primary outcome measures of depression, posttraumatic stress disorder (PTSD) symptoms, perceived stress, generalized anxiety, and somatic complaints.

RESULTS

Per protocol analysis included 42 participants in the VBC group, and 43 in the waiting list. Compared with participants in the waiting-list group, the VBC group, following an average of four counselling sessions, experienced a clinically meaningful reduction of depression (adjusted difference 7.06, 95% CI [4.86, 9.26], effect size 0.68, p < .001), PTSD (adjusted difference 17.15, 95% CI [10.49, 23.81], effect size 0.76, p < .001), perceived stress (adjusted difference 9.25, 95% CI [6.23, 12.27], effect size 0.75, p < .001), anxiety (adjusted difference 5.34, 95% CI [3.47, 7.20], effect size 0.70, p < .001), and somatic complaints (adjusted difference 5.52, 95% CI [3.30, 7.74], effect size 0.72, p < .001). The positive outcomes were maintained at 3-month follow-up. Utilization of mental health services was significantly reduced at the 3-month follow-up conducted with participants of the VBC group.

CONCLUSIONS

VBC, a culturally sensitive and strength-based mental health service, is an effective short-term intervention which meets the specific mental health needs of migrants, including refugees.

Correlates of Undiagnosed Hypertension Among Chinese and Korean American Immigrants

Asian Americans are more likely to be unaware that they have hypertension compared to non-Hispanic white Americans, despite having higher risk of hypertension at lower body-mass indices. Furthermore, immigrants are more likely than their United States (U.S.)-born counterparts to have undiagnosed hypertension, placing them at greater risk of subsequent morbidity and mortality. This study examines the social determinants of undiagnosed hypertension among Asian American immigrants. Using a study of foreign-born Chinese and Korean Americans between the ages of 50-75 years-old recruited from physicians' clinics in the Baltimore-Washington DC Metropolitan Area (n = 355), we used blood pressure readings measured by trained staff members, self-reported diagnosis by a medical professional, and self-reported hypertension medication use to determine hypertension status-whether patients were non-hypertensive, had diagnosed hypertension, or had undiagnosed hypertension. Using multinomial logistic regression, we examined how demographic, socioeconomic, and immigration-related factors were associated with hypertension status. Results indicated that older age, male gender, Korean subgroup, and marital status were associated with having diagnosed hypertension compared to being non-hypertensive. Lack of health insurance was the strongest predictor of having undiagnosed hypertension compared to being non-hypertensive. Acculturation variables had no strong associations with hypertension status. We then explored correlates of health insurance status for Chinese and Korean American immigrants. Those without health insurance were more likely to have lower income and to be not currently employed. Our findings point to the importance of increasing health insurance access for Asian American immigrant groups to ensure that hypertension is not left undiagnosed and untreated.

Conceptualizing Mental Health Through Bhutanese Refugee Lens: Findings from a Mixed Methods Study

Despite the rapidly growing need to understand mental health challenges faced by refugee subpopulations, there is a dearth of literature exploring mental health conceptualization through the unique refugee lens. Guided by historical trauma theory, we gathered data using a two-phase explanatory sequential mixed-methods study (quantitative: n = 40; qualitative: n = 6) in a Midwestern U.S. region to understand mental health conceptualization from the Bhutanese refugee perspective by examining the cultural meaning and perception of mental health, describing experiences of mental health problems, and examining cultural protective factors and coping strategies. We argue that recognition of refugees' conceptualization of mental health and identification of cultural protective factors is paramount to healing. Findings emphasize the need to understand historical and cultural perspectives in cross-cultural contexts for the development and implementation of culturally responsive services. Our study also contributes to emerging knowledge on methodological rigor in research among understudied, hard-to-reach, small populations.

The Work Environment of Immigrant Employees in Sweden—a Systematic Review

The aim of this systematic review was to summarize and synthesize research results focusing on the work environment of employees with an immigrant background in Sweden. We focus on the main conditions identified in the working environment of immigrant employees and how these conditions may affect their health and well-being. The concept of “minority stress” and the attachment theory are used to understand and interpret the findings. We systematically searched for literature published between the years of 1990 and 2020 in four databases, Web of Science, PubMed, SocIndex, and Academic Search Elite. We started the selection process by reading title and abstracts, then proceeded to read a selection of full-text studies and eliminated those that did not fulfil the inclusion criteria. We did a quality assessment on the full-text studies based on the MMAT-tool, and then performed a narrative synthesis of the results. The results show that immigrants experience several stressors in their work environment, including physical, psychological, and social risks. These risks are, among other things, associated with the nature of the jobs that immigrants are overrepresented in, with minority-related stressors such as discrimination, harassment, and threats on the basis of ethnic background, and with the lack of social support from managers and colleagues. Results also highlight beneficial factors in the immigrants’ working environment and show the importance of a supportive, inclusive, and empowering management. Our main conclusion is that Swedish workplaces need to introduce more active measures to raise awareness of and combat workplace discrimination, work harder to promote inclusion at the workplace, and eliminate physical, psychological, and social health hazards specific to immigrant employees. The leadership and management have an important role to play here, as does the employees’ trade unions and its special functions.

A multidimensional examination of psychological distress among Latina mothers with and without HIV

The Latino population is disproportionally affected by HIV in the United States. Latina women, in particular, have significantly higher rates of HIV diagnosis than their White counterparts. Latinas with HIV who are primary family caregivers face multidimensional challenges from caregiving demands to stressors related to chronic illness, acculturation, family functioning, and socioeconomic disparities, which may contribute to higher psychological distress than Latina mothers without HIV. However, to date, scant research has focused on the mental health needs of Latina mothers living with HIV (MLHs) and how these needs are similar or different to Latina mothers without HIV. Thus, using a multidimensional approach we: (a) examined the associations between HIV status, acculturation, family functioning, socioeconomic status, and psychological distress among Latina mothers and (b) identified how these associations differed between Latina mothers with and without HIV. Cross-sectional, self-reported data were obtained via face-to-face interviews from 221 Latina MLHs and 116 Latina neighborhood control mothers (NCMs) living without HIV in Los Angeles, California. Results from multivariate ordinary least square regressions showed that higher acculturation was associated with psychological distress among MLHs, whereas higher levels of family conflict and education were associated with psychological distress among NCMs. Findings highlight the differential mental health needs of Latina mothers based on HIV status. Our study findings provide social work implications for culturally responsive interventions that can address multidimensional stressors experienced by marginalized Latinas MLHs.

A Critical Appraisal: Development and Use of Perceived Stress Scale in U.S. Immigrants

Few studies have critically appraised Perceived Stress Scale (PSS) in immigrants. The purpose of the article is to determine if PSS is adequately developed and properly used with U.S. immigrants. Searching via PubMed and PsycINFO databases resulted in 10 research papers published between 2009 and 2019 that met the selection criteria and were integrated for this review. Most of the studies do not have adequate theoretical models and do not have proper consideration of socio-cultural factors. Five studies used the PSS translated into different languages but only one study validated the translated version. Six studies reported the reliability of the PSS. The PSS-14 and PSS-10 may be appropriately used in immigrants to measure psychological stress. Some issues, such as the PSS's reliability and validity, need to be addressed in future use in immigrants.

Venezuelan Forced Migration to Peru During Sociopolitical Crisis: an Analysis of Perceived Social Support and Emotion Regulation Strategies

While many studies have examined the impact of forced migration on Venezuelan migrants in Latin America, to date scholars have not examined the effect of certain coping mechanisms, namely social support and emotion regulation. Using data from 386 Venezuelan migrants living in Peru (M = 20.22 years, SD = 1.33, 46.4% women), we investigated whether perceived social support from three different sources (family, friends, and significant other) correlated with emotion regulation strategies (cognitive reappraisal and suppression) while controlling for the type of cohabitation and time of residence. The results (1) confirmed the originally proposed internal structure of the Multidimensional Perceived Social Support Scale and Emotion Regulation Questionnaire, showing reliability and validity even in a sample of migrants. Findings demonstrated that (2) perceived social support from family positively predicted cognitive reappraisal strategy when including friends and significant other as covariates; (3) Venezuelans who have resided longer in Peru compared to more recent migrants used cognitive reappraisal strategy at a higher rate despite perceiving low family social support; (4) Venezuelans who resided in Peru for a longer period of time reported higher suppression strategy use when having low significant other support; and (5) there were gender differences regarding cognitive reappraisal as a dependent variable. More specifically, in men, family was a better predictor than friend or significant other support, while among women, family and significant other had the biggest impact. These results demonstrate the importance of social support elements and time of residence on the healthy management of emotions under difficult circumstances, such as forced migration.

The central role of social support in the health of Chinese and Korean American immigrants

Prior research contends that social support positively influences health by optimizing individuals' psychological processes such as appraisals, emotions, and sense of control-known as stress-buffering effects. This study tests this theoretical concept by examining whether the association between social support and health can be explained by the psychological processes of perceived stress and distress among Chinese and Korean American immigrants. Furthermore, we examine what predicts social support in this population, with a particular focus on factors related to immigration. Using a total sample of 400 Chinese and Korean American immigrants, we examine the association between social support and self-rated health (SRH), accounting for demographic factors, socioeconomic status, perceived stress, and perceived distress using multivariable logistic regression models. We conducted a mediation analysis using the Karlson, Holm, and Breen (KHB) method to determine whether perceived stress and distress partly explained the association between social support and SRH. Findings showed a strong total effect of higher social support on better SRH. Furthermore, mediation was detected, with perceived stress and distress explaining 42.98% of the total effect of social support on SRH. Multivariable linear regression models revealed that social support among Chinese and Korean American immigrants was associated with marital status, employment, ethnic identity, and acculturative stress. This study highlights the centrality of social support for Chinese and Korean American immigrants, which lowers perceived stress and distress, leading to better overall health. By confirming these stress-buffering effects, our findings suggest that bolstering social support among vulnerable Chinese and Korean American immigrant populations can have a positive effect on health by optimizing stress appraisals.

The Influence of Premigration Trauma Exposure and Early Postmigration Stressors on Changes in Mental Health Over Time Among Refugees in Australia

As a result of the precarious conditions in which they migrate, refugees are likely to have experiences that increase their risk of mental health problems. Refugees tend to be predisposed to relatively high levels of distress upon resettlement, and a key predictor of these issues is traumatic experiences that occur before their arrival. Despite high initial levels of ill-health, on average, refugees tend to experience mental health recovery over time. However, both levels of mental health upon settlement and recovery over time may be negatively influenced by stressors in the postsettlement period. The present study examined changes in psychological distress and posttraumatic stress symptoms over 5 years among 2,169 refugees from various backgrounds, predominately from Iraq and Afghanistan, who participated in the Building a New Life in Australia (BNLA) study. A multivariate latent growth curve model found mental ill-health decreased on average, β = -.21 for distress and β ₌ -.31 for PTSD, ps < .001, and premigration trauma exposure predicted more initial PTSD symptoms and reduced recovery over time, β_Intercept = .21, β_Slope = -.54, p < .001. Postmigration stressors, such as loneliness, financial concerns, and cultural integration, predicted higher levels of mental health problems as well as reduced recovery over time. These findings suggest that beyond trauma exposure, the mental health of refugees upon resettlement and their recovery over time is impacted by stressors in the early resettlement period, which has important implications for interventions and services to support and encourage well-being in refugee populations.

Surrendering to social emptiness: Chronic social exclusion longitudinally predicts resignation in asylum seekers

The current knowledge of the long-term consequences of social exclusion mostly relies on theoretical assumptions. (Williams, 2009, Adv. Exp. Soc. Psychol., 41, 275) hypothesized that chronic ostracism drives individuals into a stage of resignation (depression, alienation, unworthiness, helplessness). We focused on asylum seekers (N = 112) as a social group at risk of experiencing prolonged instances of exclusion. Applying a three-wave longitudinal design with a three-month interval between each wave, we sought to advance the knowledge of the temporal development of chronic social exclusion. Cross-lagged panel analyses showed that social exclusion influenced the development of feelings of resignation in the long term, from baseline to six months and between three and six months. In the same time frame, the perception of social exclusion became stable and chronic. These findings provide empirical evidence that chronic exclusion predicts resignation and shed light on the temporal development of the detrimental impact that pervasive exclusion can have on people belonging to marginalized social groups.

Psychological Antecedents of Refugee Integration (PARI)

The successful management of refugee immigration, including refugee integration in host societies, requires a sound understanding of underlying psychological processes. We propose the psychological antecedents of refugee integration (PARI) model, highlighting perceived forcedness (i.e., coercion and loss of control from “push” factors) and ensuing perils (risks and potential suffering during migration) as distinctive factors of refugee (vs. voluntary) migration. According to our model, perceptions and subjective representations of forcedness and associated perils activate specific psychological processes relevant to refugee integration and thus moderate responses to the demands and stressors of the immigration situation. We conceptualize these distinctive influences for integration-relevant processes in both refugees and in residents. By pinpointing the unique features of refugee migration, PARI generates novel and specific hypotheses about psychological processes predicting refugee integration. For instance, refugees’ memories of forcedness and associated perils should lead to a high level of preoccupation with the restoration of basic needs after arrival in a receiving country that interferes with integration-related activities. Conversely, residents’ perceptions of forcedness and related perils may enhance empathy with refugees but may also magnify feelings of anxiety and threat. Implications for refugee integration are discussed for the domains of occupational work, education, and mental health.

"Living like I am in Thailand": stress and coping strategies among Thai migrant masseuses in Oslo, Norway

Background

Migrants experience stress before, during and after migrating to a new country, all of which influences their mental wellbeing. In Norway, migration from Thailand is highly gendered as most Thai migrants are women who migrate to live with their Norwegian spouse. Massage shops, often owned by Thai entrepreneurs, are a locale where women use their cultural knowledge to bridge into the local economy. There is little knowledge about Thai migrant masseuses’ experience of stress in daily life and associated coping strategies. The objective of this inquiry was to examine stressors and coping strategies among Thai migrant masseuses in Oslo, Norway.

Methods

We conducted in-depth interviews with 14 Thai migrants who were working as masseuses in Oslo, Norway. We asked participants about their health, experiences of stress, and coping strategies and subsequently analyzed the data using thematic analysis.

Results

Stress in participants’ lives related to settling in, loneliness, finances and spousal relationships. Of these, relationship conflict was the largest source of stress. Women largely embraced self-coping strategies and utilized Thai cultural practices and Buddhist cognitive thinking. Once relationship conflict became untenable, participants fought to change their situation. Limited fluency in Norwegian, Thai stigma about mental health and limited knowledge of the Norwegian health system were barriers to seeking healthcare.

Conclusions

Migrants in our study often adopted “Thainess”, the use of Thai cultural practices and Buddhist cognitive thinking, as a strategy for coping with stress. Preferences for self-coping, mental health stigma, and linguistic competency are important considerations when designing mental wellbeing interventions for Thai women. Use of an interpreter or systems navigator can help overcome language barriers. Clinicians can take detailed case histories to better understand Thai patients’ stress, coping strategies and wellbeing. Health policy makers could consider network approaches, including using Thai health systems navigators to bridge the health system and Thai communities.

Psychology of Working Theory With Refugee Persons: Applications for Career Counseling

The world is facing the largest number of displaced persons in history, with many refugee persons seeking safety in the United States. Among many challenges, refugee persons may face difficulty when navigating the world of work in the United States. We conceptualize career-related barriers for refugee persons residing in the United States, including economic constraints, acculturation challenges, and health disparities. Given these challenges, we describe the relevance of psychology of working theory as a potential theoretical model from which to conceptualize career concerns in refugee persons. Finally, based on previous research, we provide implications for counselors working with refugee persons with vocational concerns, as well as suggested areas for future research.

Subjective Well-Being of Afghan Refugees in Pakistan: The Moderating Role of Perceived Control in Married Men

The purpose of this study was to examine the role of perceived control in moderating the effects of acculturative stress on the well-being of first generation Afghan married men refugees (N = 137, 25-50 years) residing in Lahore, Pakistan. The participants completed a survey questionnaire comprising a demographic information sheet, the Multidimensional Acculturative Stress Scale (Jibeen, Khalid, International Journal of Intercultural Relations 34:233-243, 2010), the Cognitive Stress Scale (Cohen et al., Journal of Health and Social Behavior 24:385-396, 1983), the Positive Affect & Negative Affect Schedule (Watson et al., Journal of Personality & Social Psychology 47:1063-1070, 1988), and the Satisfaction with Life Scale (Diener et al., Journal of Personality Assessment 49:1-5, 1985). The results of moderated regression analyses revealed that perceived control can reduce the effect of stressful circumstances on satisfaction with life and increase positive psychological affect. The results could have implications for developing social and clinical therapeutic interventions towards a greater sense of self-determination and positive well-being to improve the refugees' ability to take control of their lives.

Prevalence of Stress and Associated Factors among Regular Students at Debre Birhan Governmental and Nongovernmental Health Science Colleges North Showa Zone, Amhara Region, Ethiopia 2016

BACKGROUND

Stress is very common among medical students across the globe with the prevalence of 80%. In Ethiopia, the prevalence is 47.7% among college students. Unless it is managed early, it leads to deterioration of academic performance and overall dissatisfaction with life and different serious health problems including anxiety, depression, and suicide. The objective of this study is to assess the prevalence of academic related stress among Debre Birhan governmental and nongovernmental health science college regular students 2015/16.

METHOD

A cross-sectional study was conducted on a sample of 422 health science students selected by stratified proportional random sampling at Debre Birhan governmental and nongovernmental health science colleges in North Shewa zone, Amhara region, Ethiopia in 2016. Data was collected using the Depression Anxiety Stress Scaling (DASS-21). The level of significance of association for multivariable was determined at P value <0.05.

RESULT

Prevalence of stress among Debre Birhan governmental and nongovernmental health science college regular students is 4.1%. There is a significant association between stress and sex AOR = 8.525 (1.023, 71.077), fear of examination AOR = 5.096 (1.183, 21.96), living in uncomfortable environment AOR = 14.86 (3.84, 57.515), and perceived present illness AOR = .030 (0.003, 0.286). Depression and anxiety were also seen among 19.7% and 23.6%, respectively.

CONCLUSION

According to this study, the prevalence of stress among governmental and nongovernmental health science college regular students is not high. However, depression and anxiety were found to be higher than stress and they need immediate management plan. Colleges had better prepared simple screening tool and support students to prevent stress before they cause severe mental health problems.

“They Were Going to Kill Me”: Resilience in Unaccompanied Immigrant Minors

Unaccompanied and undocumented immigrant minors (UUIM) have become the focus of increased attention. Unfortunately, public discourse is often decontextualized, simplistic, and polarized. Empirical literature fails to capture the experiences of UUIM and identify strategies to promote their well-being. In this article we begin to address these gaps through qualitative inquiry. We analyzed written narratives of 292 Latino UUIM using a theoretical thematic analysis. Participants described motives for, and experiences of, the migration process. Guided by Ungar et al.’s (2007) conceptualization of resilience, five subthemes emerged: access to material resources, relationships, identity and cohesion, social justice, and perilous journey. The results from our study highlight (a) the youth’s difficult and often traumatic experiences in their homeland, (b) the factors that made migrating to the United States appealing to them, and (c) the dangerous journey they experienced. Implications for practice, research, and advocacy are discussed.

Ethnic Identity and Perceived Stress Among Ethnically Diverse Immigrants

Recent empirical research suggests that having a strong ethnic identity may be associated with reduced perceived stress. However, the relationship between perceived stress and ethnic identity has not been tested in a large and ethnically diverse sample of immigrants. This study utilized a multi-group latent class analysis of ethnic identity on a sample of first and second generation immigrants (N = 1603), to determine ethnic identity classifications, and their relation to perceived stress. A 4-class ethnic identity structure best fit the data for this immigrant sample, and the proportion within each class varied by ethnicity, but not immigrant generation. High ethnic identity was found to be protective against perceived stress, and this finding was invariant across ethnicity. This study extends the findings of previous research on the protective effect of ethnic identity against perceived stress to immigrant populations of diverse ethnic origins.

Cultural competence in working with the Arab Australian community: a conceptual review and the experience of the Arab Council Australia (ACA) gambling help counselling service

Although Culturally And Linguistically Diverse (CALD) communities participate less in gambling than the general population, those who gamble are more likely to show signs of disordered gambling (Moore and Ohtsuka International Gambling Studies, 1, 87–101, 2001; Raylu and Oei Clinical Psychology Review, 23, 1087–1114, 2004; Yamine and Thomas The impact of gaming on specific cultural groups, Victorian Casino and Gaming Authority, Melbourne, 2000). Research data on gambling problems and interventions in the Arab Australian community are extremely scarce. Therefore, this article will present an overview of the Arab Australian community and cultural issues regarding gambling within the Arab Australian community. Identifying these issues is important to work effectively with Arab Australians clients and those from other CALD backgrounds. The article also presents a conceptual review of peer-reviewed research articles on cultural competence in working with the Arab clients, the overview of Arab migration history to Australia and a summary of recent events that suggest a tension between Arab and non-Arab Australian communities. Observations and experiences that were encountered during the gambling counselling service operating in the Australian Arab community in New South Wales are also discussed. The research data to validate the effectiveness and positive impact of cultural competence are still in its early stages. However, a small number of community education resources have been available for working with the Arab community. From the data in annual reviews on the Arab Council Australia gambling counselling service, it was identified that cultural beliefs and expectations influence risk-taking decisions, identification of gambling issues, and preference of help seeking within the client’s social network. Further, culturally-specific sensitive issues related to political and global security events, which in turn influenced openness and willingness for the help-seeking of the Arab Australians, were identified. In conclusion, we propose that recognising diversity within the Arab Australian community is a prerequisite for increasing cultural competence and cultural sensitivity for helping professionals working with Arab Australians.

Friendship and internal migration in Brazil: Vulnerability and coping

Friendship has been investigated in the context of international migration, but little is known about the subject in relation to internal migration, a phenomenon of great social importance in Brazil. The purpose of this article is to present and discuss data obtained in an investigation on the relations between internal migration and friendship as perceived by citizens from the state of Espírito Santo who were living in other states of Brazil, in the North, Northeast, Midwest, South and Southeast regions. Twenty adults born in the state and who had migrated to another Brazilian state participated in the investigation. The participants have been interviewed about how they perceived the relationship between friendship and migration and the data were subjected to thematic content analysis. Among the results difficulties to maintain friendships with people of the place of origin as well as difficulties in forming new friendships were observed. Friends were considered relevant for adaptation to the new state, affecting the perception of the same. The article also discusses the origin of friends, the perception of cultural differences and difficulties to make friends in another state. It is concluded that friends play a relevant role in the lives of Brazilian internal migrants and further investigations are necessary.

Mental health and migration: depression, alcohol abuse, and access to health care among migrants in Central Asia

One-fifth of Kazakhstan's population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N = 450). We used survey logistic regression adjusted for clustering of workers within stalls. Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia.

Predictors of Coping Strategies Employed by Iraqi Refugees in Jordan

The purpose of this study was to examine coping strategies used by Iraqi refugees in Jordan based on their demographic details. A cross-sectional design was used. A representative sample of 333 refugees living in Jordan participated in the study. The Cope inventory and the demographic details were compiled to produce and collate the relevant data. Being older, female, educated, single, and living with more than three family members was associated with greater use of the problem solving coping strategy. Being female, educated, and unemployed was associated with greater use of the active emotional coping strategy. In addition, being older, male, illiterate, unemployed, and living with less than three family members was associated with greater use of the avoidant emotional coping strategy. This study recommends a multidisciplinary approach intervention as being the best method of addressing and fulfilling the health and socioeconomic needs of older, male, illiterate, unemployed people.

The Impact of Religious Coping on the Acculturative Stress and Alcohol Use of Recent Latino Immigrants

Religion plays a prominent role in Latino culture and could be influential during difficult life transitions, such as those experienced during the immigration process. This study examines relations between religious coping, acculturative stress, and alcohol use in a sample of 415 recent Latino immigrants. Higher levels of acculturative stress were associated more positive and negative religious coping. Positive religious coping was related to lower alcohol use. Negative religious coping moderated the relationship between acculturative stress and alcohol use. Participants who used more negative religious coping had higher rates of alcohol use when experiencing high levels acculturative stress. Implications for culturally tailored prevention/interventions are discussed.

A Dream Best Forgotten

Refugees are often forced into states of imposed vulnerability in which loss is common and migration is normative. Karen refugees from Myanmar have endured a long civil war with the Burmese government, followed by their forced relocation to refugee camps and subsequent global resettlement. This phenomenological study aimed to understand the meanings ascribed to pre-resettlement stress among resettled Karen refugees. We interviewed six participants who were identified through purposeful sampling in a Karen refugee community. Using phenomenological analysis, we identified and interpreted 286 meaning units. The meaning units were then grouped into four themes: (a) Loss From Oppression, (b) Resignation and Acceptance in a Context of Regular Violence, (c) Ongoing Insecurity While Confined in Camps, and (d) Redefined Selfhood. The results provide a contextual understanding of the pre-resettlement stressors experienced by Karen refugees.

Incorporating Preliminary Mental Health Assessment in the Initial Healthcare for Refugees in New Jersey

The study aims to assess the feasibility of introducing a mental health screening tool into the initial health care assessment for refugees in New Jersey, US. A semi-structured interview was conducted with a convenience sample of professionals providing refugee health care in New Jersey and in a number of other states. There is a widespread appreciation of the need to consider the mental and emotional issues of the refugees as a priority in healthcare services. A mental health screening tool is required for practice in NJ. Community resources should be coupled with early screening for better refugee mental health outcomes.

"Nature is there; its free": Urban greenspace and the social determinants of health of immigrant families

In this article, we draw on a 2012 Montreal-based study that examined the embodied, every day practices of immigrant children and families in the context of urban greenspaces such as parks, fields, backyards, streetscapes, gardens, forests and rivers. Results suggest that activities in the natural environment serve as a protective factor in the health and well-being of this population, providing emotional and physical nourishment in the face of adversity. Using the Social Determinants of Health model adopted by the World Health Organization (WHO, 1998), we analyze how participants accessed urban nature to minimize the effects of inadequate housing, to strengthen social cohesion and reduce emotional stress. We conclude with a discussion supporting the inclusion of the natural environment in the Social Determinants of Health Model.

A comparison of White and Hispanic women's stories of adjustment to the birth of a child

As part of a larger project designed to inform prevention and treatment of postpartum depression and promote positive mother-child relationships in diverse families, this study describes personal stories of postnatal adjustment from 14 White and 9 Hispanic women recruited from prenatal care clinics. Qualitative interviews conducted in the mothers' primary language (English or Spanish) were analyzed using a modified grounded theory content-analysis approach. The coding scheme developed to capture the women's discourse about their experiences included child temperament and health; intergenerational patterns; work demands and job loss; schedule changes; increased responsibilities; difficulties with parenting tasks; emotional distress; social stressors and resources; coping strategies; and changes in work, personal, social, and marital domains. More White mothers than Hispanic mothers reported changes in time structure, work stressors, use of psychotropic medication, informational support, and social support from other mothers and professionals; however, within-group differences were more evident than were cross-group ethnic differences. Analyses of qualitative interviews led to the integration of Belsky's Determinants of Parenting Model (1984) and the Double ABCX Model of Family Adjustment and Adaptation (McCubbin & Patterson, 1983) into a hybrid third theoretical framework.

Prediction of adaptation difficulties by country of origin, cumulate psychosocial stressors and attitude toward integrating: a Swedish study of first-generation immigrants from Somalia, Vietnam and China

BACKGROUND

Different types of accumulated stress have been found to have negative consequences for immigrants' capacity to adapt to the new environment. It remains unclear which factors have the greatest influence.

AIMS

The study investigated whether immigrants' experience of great difficulty in adapting to a new country could best be explained by (1) country of origin, (2) exposure to accumulated stressors before arrival or (3) after arrival in the new country and/or (4) reserved attitude toward integrating into the new society.

METHODS

The 119 first-generation immigrants from Somalia, Vietnam and China, living in Malmö, Sweden, were interviewed in a standardized manner.

RESULTS

Experiencing great difficulty in adapting to Sweden was independent of length of residence, but significantly related to all four influences, studied one at a time. Country of origin was also related to stressors and attitude. When the effects of the other influences were mutually controlled for, only exposure to accumulated stressors in Sweden (and especially experiencing discrimination/xenophobia/racism) accounted for great adaptation difficulty. Stressors in Sweden had a greater effect if the immigrant had been exposed to stressors earlier.

CONCLUSIONS

Immigrants' long-term experiences of great difficulty in adapting to a new country were explained primarily by exposure to accumulated stressors while moving to and living in the new country, rather than by their backgrounds or attitudes toward integrating. This suggests promoting strategies to avoid discrimination and other stressors in the host country.

Coping, acculturation, and psychological adaptation among migrants: a theoretical and empirical review and synthesis of the literature

Given the continuous, dynamic demographic changes internationally due to intensive worldwide migration and globalization, the need to more fully understand how migrants adapt and cope with acculturation experiences in their new host cultural environment is imperative and timely. However, a comprehensive review of what we currently know about the relationship between coping behavior and acculturation experience for individuals undergoing cultural changes has not yet been undertaken. Hence, the current article aims to compile, review, and examine cumulative cross-cultural psychological research that sheds light on the relationships among coping, acculturation, and psychological and mental health outcomes for migrants. To this end, this present article reviews prevailing literature pertaining to: (a) the stress and coping conceptual perspective of acculturation; (b) four theoretical models of coping, acculturation and cultural adaptation; (c) differential coping pattern among diverse acculturating migrant groups; and (d) the relationship between coping variabilities and acculturation levels among migrants. In terms of theoretical understanding, this review points to the relative strengths and limitations associated with each of the four theoretical models on coping-acculturation-adaptation. These theories and the empirical studies reviewed in this article further highlight the central role of coping behaviors/strategies in the acculturation process and outcome for migrants and ethnic populations, both conceptually and functionally. Moreover, the review shows that across studies culturally preferred coping patterns exist among acculturating migrants and migrant groups and vary with migrants' acculturation levels. Implications and limitations of the existing literature for coping, acculturation, and psychological adaptation research are discussed and recommendations for future research are put forth.

Health inequalities among workers with a foreign background in Sweden: do working conditions matter?

Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18-65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status.