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Hinchey LME, Grasser LR, Saad B, Gorski K, Pernice F, Javanbakht A. The Predictive Utility of Trauma Subtypes in the Assessment of Mental Health Outcomes for Persons Resettled as Refugees. J Immigr Minor Health 2023; 25:274-281. [PMID: 36260186 PMCID: PMC9991939 DOI: 10.1007/s10903-022-01407-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/24/2022]
Abstract
Pre-migration trauma, a psychological risk factor for refugees, is often measured using cumulative indices. However, recent research suggests that trauma subtypes, rather than cumulative trauma, may better predict psychological outcomes. This study investigated the predictive utility of trauma subtypes in the assessment of refugee mental health. Multiple regression was used to determine whether cumulative trauma or trauma subtypes explained more variance in depression, anxiety, and post-traumatic stress disorder (PTSD) symptom scores in 70 Syrian and Iraqi refugees. Subtype models performed better than cumulative trauma models for PTSD (cumulative R2 = 0.138; subtype R2 = 0.32), anxiety (cumulative R2 = 0.061; subtype R2 = 0.246), and depression (cumulative R2 = 0.041; subtype R2 = 0.184). Victimization was the only subtype significantly associated with PTSD (p < 0.001; r2 = 0.210), anxiety (p < 0.001; r2 = 0.162), and depression (p = 0.002; r2 = 0.140). Cumulative trauma was predictive of PTSD symptoms only (p = 0.003; r2 = 0.125). Trauma subtypes were more informative than cumulative trauma, indicating their utility for improving predictive efforts in research and clinical contexts.
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Affiliation(s)
- Liza Marie-Emilie Hinchey
- Department of Theoretical and Behavioral Foundations, Wayne State University, 5425 Gullen Mall Education Building, Room 351, Detroit, MI, 48202, USA.
| | - Lana Ruvolo Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Bassem Saad
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Kathleen Gorski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
| | - Francesca Pernice
- Department of Theoretical and Behavioral Foundations, Wayne State University, 5425 Gullen Mall Education Building, Room 351, Detroit, MI, 48202, USA
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA
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Feyissa IF, Noh Y, Yoon MS. Post-Migration Life Adversity and Mental Health of Refugees and Asylum Seekers: The Mediating Role of Resilience between Perceived Discrimination, Socio-Economic Strains, Structural Strains, and Mental Health. Behav Sci (Basel) 2022; 12:bs12070208. [PMID: 35877278 PMCID: PMC9311976 DOI: 10.3390/bs12070208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
This study made a claim that perceived discrimination, socio-economic strain, and structural strain on displaced people have an adverse impact on their mental health. Our claim also acknowledges that these people potentially have a unique set of strengths and abilities that they rely on to overcome their immediate and future problems. The aim of this study is thus to examine the relationship between post-migration life adversity and mental health problems, and assess the potential mediating role of resilience among asylum seekers and refugees (219 asylum seekers and 42 recognized refugees) living in South Korea. Structural equation modelling was used to examine hypothesized pathways between post-migration life adversity, mental health and resilience. Fit indices showed adequate to excellent fit of the examined models with mental health as the outcome. Mental health was positively regressed on PMLA and negatively regressed on R. In addition, R partially mediated the association between PMLA and MH. In addition to providing the academic contributions of this study to the ongoing study of resilience and its social welfare implications, the result of the study indicated the necessity of improving the present and future socio-environmental factors that foster resilience among refugees and asylum seekers.
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Affiliation(s)
- Israel Fisseha Feyissa
- School of Global Studies, Global Migration Research Canter, Kyungsung University, Busan 48434, Korea; or
| | - Yeop Noh
- Department of Social Welfare, Jeonbuk National University, Jeonju 54896, Korea;
| | - Myeong Sook Yoon
- Department of Social Welfare, Jeonbuk National University, Jeonju 54896, Korea;
- Correspondence:
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3
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Prevalence of mental disorders in refugees and asylum seekers: a systematic review and meta-analysis. Glob Ment Health (Camb) 2022; 9:250-263. [PMID: 36618716 PMCID: PMC9806970 DOI: 10.1017/gmh.2022.29] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Studies have identified high rates of mental disorders in refugees, but most used self-report measures of psychiatric symptoms. In this study, we examined the percentages of adult refugees and asylum seekers meeting diagnostic criteria for major depressive disorder (MDD), post-traumatic stress disorder, bipolar disorder (BPD), and psychosis. METHODS A systematic literature search in three databases was conducted. We included studies examining the prevalence of MDD, post-traumatic stress disorder, BPD, and psychosis in adult refugees according to a clinical diagnosis. To estimate the pooled prevalence rates, we performed a meta-analysis using the Meta-prop package in Stata (PROSPERO: CRD42018111778). RESULTS We identified 7048 records and 40 studies (11 053 participants) were included. The estimated pooled prevalence rates were 32% (95% CI 26-39%; I 2 = 99%) for MDD, 31% (95% CI 25-38%; I 2 = 99.5%) for post-traumatic stress disorder, 5% (95% CI 2-9%; I 2 = 97.7%) for BPD, and 1% (95% CI 1-2%; I 2 = 0.00%) for psychosis. Subgroup analyses showed significantly higher prevalence rates of MDD in studies conducted in low-middle income countries (47%; 95% CI 38-57%, p = 0.001) than high-income countries studies (28%; 95% CI 22-33%), and in studies which used the Mini-International Neuropsychiatric Interview (37%; 95% CI 28-46% p = 0.05) compared to other diagnostic interviews (26%; 95% CI 20-33%). Studies among convenience samples reported significant (p = 0.001) higher prevalence rates of MDD (35%; 95% CI 23-46%) and PTSD (34%; 95% CI 22-47%) than studies among probability-based samples (MDD: 30%; 95% CI 21-39%; PTSD: 28%; 95% 19-37%). CONCLUSIONS This meta-analysis has shown a markedly high prevalence of mental disorders among refugees. Our results underline the devastating effects of war and violence, and the necessity to provide mental health intervention to address mental disorders among refugees. The results should be cautiously interpreted due to the high heterogeneity.
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Tong H, Lung Y, Lin SL, Kobayashi KM, Davison KM, Agbeyaka S, Fuller-Thomson E. Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging. Int J Soc Psychiatry 2021; 67:747-760. [PMID: 33176526 DOI: 10.1177/0020764020971003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Psychological distress is associated with a range of negative outcomes including lower quality of life and an increased risk of premature all-cause mortality. The prevalence of, and factors associated with, psychological distress among middle-aged and older Canadians are understudied. Using the Canadian Longitudinal Study on Aging (CLSA) baseline data, this study examined factors associated with psychological distress among adults between 45 and 85 years, including refugee status and a wide range of sociodemographic, health-related and social support characteristics. Psychological distress was measured by Kessler's Psychological Distress Scale-K10 scores. Bivariate and multivariable binary logistic regression analyses were conducted. The prevalence of psychological distress was significantly higher among the 244 refugees (23.8%), compared to 23,149 Canadian-born Canadians (12.8%) and 4,765 non-refugee immigrants (12.6%), despite the fact that the average time the refugees had lived in Canada was more than four decades. The results of the binary logistic regression analysis indicated refugees had twice the age-sex adjusted odds of psychological distress (OR = 2.31, 95% CI: 1.74, 3.07). Even after further adjustment for 16 potential risk factors, a significant relationship remained between refugee status and psychological distress (OR = 1.56; 95% CI = 1.12, 2.17). Other significant factors associated with psychological distress included younger age, female gender, visible minority status, lower household income, not having an undergraduate degree, multimorbidities, chronic pain, and lack of social support. Policies and interventions addressing psychological distress among Canadians in mid- to later life should target refugees and other vulnerable groups.
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Affiliation(s)
| | - Yu Lung
- University of Toronto, Toronto, ON, Canada
| | | | | | - Karen M Davison
- Kwantlen Polytechnic University and University of Hawai'I, Surrey, BC, Canada
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McQuaid JH, Silva MA, McKenzie KC. Surviving violent, traumatic loss after severe political persecution: lessons from the evaluation of a Venezuelan asylum seeker. BMJ Case Rep 2021; 14:e239025. [PMID: 33758042 PMCID: PMC7993358 DOI: 10.1136/bcr-2020-239025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2021] [Indexed: 11/03/2022] Open
Abstract
In July 2019, the United Nations High Commissioner for Refugees (UNHCR) released a report urging the Venezuelan government to take immediate action to address the 'grave violations of economic, social, civil, political and cultural rights' occurring in the country. This case study highlights the human rights violations occurring in Venezuela through the case of a Venezuelan woman who experienced political persecution and traumatic loss resulting from her opposition to the ruling socialist party. As the clinical team of evaluators explored the mental health effects of surviving threats on her own life and the politically motivated assassination of her husband, it was agreed that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition did not fully capture the extent of her suffering. Case discussion broadens the lens beyond the client's experiences of posttraumatic stress disorder (PTSD) and depression to include persistent complex bereavement disorder, and emphasises the importance of addressing the sequelae of traumatic loss in a multifaceted way that broadens understanding of emotional functioning postmigration.
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Affiliation(s)
- Jennifer H McQuaid
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Katherine C McKenzie
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Rodolico A, Vaccino N, Riso MC, Concerto C, Aguglia E, Signorelli MS. Prevalence of Post-Traumatic Stress Disorder Among Asylum Seekers in Italy: A Population-Based Survey in Sicily. J Immigr Minor Health 2021; 22:634-638. [PMID: 31863404 DOI: 10.1007/s10903-019-00948-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Italian coasts are docking berths for the majority of boats carrying asylum seekers coming from Middle East and Sub-Saharan countries. These people escaped from their home countries in an effort to survive war, hunger and torture. These experiences might have affected their mental health, which became more endangered during their journey. The main aim of our work was to assess the prevalence of post-traumatic stress disorder (PTSD) in asylum seekers in a first aid facility, where immigrants were aided after their arrival. Thus, we designed a cross-sectional survey with paper-and-pen questionnaires. The setting was the C.A.R.A. (Centro Accoglienza Richiedenti Asilo) in Mineo (Sicily). Participants were asked for general information. They also completed the PTSD Checklist of the DSM-IV (PCL-C) and the Harvard Trauma Questionnaire (HTQ). We collected 140 questionnaires and the PCL-C was completed by 98 residents; 44% of responders were considered affected by PTSD. Although we used a conservative cut-off, PTSD prevalence was found to be much higher than that in the general population.
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Affiliation(s)
- Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy. .,U.O.C. Clinica Psichiatrica, A.O.U. Policlinico-Vittorio Emanuele, Presidio "G. Rodolico", Catania, Italy.
| | - Noemi Vaccino
- Department of Mental Health and Addiction (DSM-DP), Mental Health Centre (CSM) of Scandiano, Reggio Emilia, Italy
| | - Maria C Riso
- Italian Red Cross, Local Branch of Catania, Catania, Italy
| | - Carmen Concerto
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.,U.O.C. Clinica Psichiatrica, A.O.U. Policlinico-Vittorio Emanuele, Presidio "G. Rodolico", Catania, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.,U.O.C. Clinica Psichiatrica, A.O.U. Policlinico-Vittorio Emanuele, Presidio "G. Rodolico", Catania, Italy
| | - Maria S Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.,U.O.C. Clinica Psichiatrica, A.O.U. Policlinico-Vittorio Emanuele, Presidio "G. Rodolico", Catania, Italy
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7
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Aragona M, Petta AM, Kiaris F, Begotaraj E, Lai C, Spitoni GF. Empathy, PTSD, and Migration in African Refugees. Psychiatry 2021; 84:84-86. [PMID: 33164706 DOI: 10.1080/00332747.2020.1833654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nosè M, Tarsitani L, Tedeschi F, Lotito C, Massetti P, Purgato M, Roselli V, Todini L, Turrini G, Barbui C. Association of traumatic events with levels of psychological distress and depressive symptoms in male asylum seekers and refugees resettled in Italy. BMC Psychiatry 2020; 20:576. [PMID: 33261576 PMCID: PMC7709257 DOI: 10.1186/s12888-020-02988-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years there has been a progressive rise in the number of asylum seekers and refugees displaced from their country of origin, with significant social, economic, public health and mental health implications. The aim of this study is to (1) describe the level of psychological distress and frequency of psychiatric disorders in a sample of male asylum seekers and refugees across different ethnic groups resettled in Italy; (2) establish whether the number of traumatic events experienced before, during and after the migration process is associated with level of psychological distress and depressive symptoms. METHODS In two large Italian catchment areas, over a period of 1 year a consecutive series of male asylum seekers and refugees, aged 18 or above and included in the Italian protection system, were screened for psychological distress and psychiatric disorders using validated questionnaires. RESULTS During the study period, 252 male asylum seekers or refugees were recruited. More than one-third of the participants (34.5%) showed clinically relevant psychological distress, and one-fourth (22.2%), met the criteria for a psychiatric diagnosis, mainly Post Traumatic Stress Disorder and depressive disorders. The number of traumatic events turned out to be a risk factor for both clinically relevant psychological distress and depressive disorders. Receiving good social support emerged as a protective factor, while migrants with unclear status were at higher risk of psychological distress than those holding or awaiting a permission. DISCUSSION In an unselected sample of male asylum seekers and refugees, after around 1 year of resettlement in Italy, the frequency of psychological distress and psychiatric disorders was substantial and clinically relevant. The association between traumatic events, especially post-migration problems, and mental health conditions suggests the need of developing services to assist refugees and asylum seekers to address the multi-faceted problems they experience, such as social support in host country, legal problems concerning permit status and asylum procedure, and family reunification, as well as addressing trauma and mental health issues.
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Affiliation(s)
- Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
| | - Lorenzo Tarsitani
- Department of Neurosciences and Mental Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Claudia Lotito
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Paola Massetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Valentina Roselli
- Department of Neurosciences and Mental Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Liliana Todini
- Department of Neurosciences and Mental Health, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Gleeson C, Frost R, Sherwood L, Shevlin M, Hyland P, Halpin R, Murphy J, Silove D. Post-migration factors and mental health outcomes in asylum-seeking and refugee populations: a systematic review. Eur J Psychotraumatol 2020; 11:1793567. [PMID: 33312450 PMCID: PMC7717836 DOI: 10.1080/20008198.2020.1793567] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/24/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
The present systematic review examined post-migration variables impacting upon mental health outcomes among asylum-seeking and refugee populations in Europe. It focuses on the effects of post-settlement stressors (including length of asylum process and duration of stay, residency status and social integration) and their impact upon post-traumatic stress disorder, anxiety and depression. Twenty-two studies were reviewed in this study. Length of asylum process and duration of stay was found to be the most frequently cited factor for mental health difficulties in 9 out of 22 studies. Contrary to expectation, residency or legal status was posited as a marker for other explanatory variables, including loneliness, discrimination and communication or language problems, rather than being an explanatory variable itself. However, in line with previous findings and as hypothesised in this review, there were statistically significant correlations found between family life, family separation and mental health outcomes.
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Affiliation(s)
- Christina Gleeson
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
| | - Rachel Frost
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
| | - Larissa Sherwood
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
- Centre for Global Health, Trinity College, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
| | - Philip Hyland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Rory Halpin
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
- Department of Rehabilitation, Spiritan Asylum, Services Initiative, Dublin, Ireland
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Ventriglio A, Bellomo A, Petito A, Pascucci M, Cuozzo E, Vitrani G, Stella E, Borraccino L, Varlese MP, Bhugra D. Factors Associated to the Onset of Mental Illness Among Hospitalized Migrants to Italy: A Chart Review. J Immigr Minor Health 2020; 23:425-433. [PMID: 33030664 DOI: 10.1007/s10903-020-01105-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
Migration is a complex phenomenon and mental illness among immigrants remains a major matter of concern in Italy and worldwide. 243 medical and pharmacy records of patients admitted to University of Foggia hospital between 2004 and 2018 were retrospectively screened and included in the study. Socio-demographic data and clinical characteristics of inpatients were compared in those with and without first-episode of mental illness (FEMI). Subjects (140 men, 103 women; aged 34.4 ± 10.2 years) represented 6.66 ± 3.73% of all hospitalizations in 15 years. Nearly half of them (48.5%) had emigrated from other European countries. 30.8% were diagnosed with a DSM-IV TR unspecified psychosis. 103 patients (42.3%) were in first-lifetime episodes of mental illness. Factors significantly associated with FEMI were: younger age, sex (men), immigrating from Africa, poor language proficiency, lower amount of prescribed psychotropics. Mental health among immigrants is of major concern in Italy. Our findings report on factors possibly associated to the onset of mental illness among immigrant psychiatric inpatients.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy.
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Annamaria Petito
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Marco Pascucci
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Edwige Cuozzo
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Giovanna Vitrani
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Eleonora Stella
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Luisa Borraccino
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
| | - Maria Pia Varlese
- Department of Clinical and Experimental Medicine, University of Foggia, presso Policlinico "Riuniti" di Foggia, Foggia, 71121, Italy
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11
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Sengoelge M, Solberg Ø, Nissen A, Saboonchi F. Exploring Social and Financial Hardship, Mental Health Problems and the Role of Social Support in Asylum Seekers Using Structural Equation Modelling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6948. [PMID: 32977521 PMCID: PMC7579644 DOI: 10.3390/ijerph17196948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022]
Abstract
Asylum seekers are exposed to a range of social and financial difficulties suggested to adversely impact mental health. Uprooted social networks and living conditions during the asylum seeking process potentially predispose this population to low access to social support. The aim of this study was to examine the relationship between social and financial hardship and mental health problems, and assess the potential mediating role of social support among asylum seekers. Cross sectional survey data from a cohort of asylum seekers in Sweden (N = 455) were subjected to structural equation modelling for examining hypothesized pathways between social and financial hardship, common mental health problems (CMHPs) and social support. Fit indices showed adequate to excellent fit of the examined models with CMHPs as the outcome (all CFI ≥ 0.951, RMSEA < 0.05, SRMR < 0.056). CMHPs were positively regressed on social and financial hardship (B = 0.786, S = 0.102, p < 0.001) and negatively regressed on social support (B = -0.103, SE = 0.032, p = 0.001). Social support mediated the association between social and financial hardship and CMHPs (effect estimate = 0.075, 95% CI = 0.032-0.136). The results point to the importance of social and living conditions of asylum seekers and indicate that social support is both socially patterned and may act as a mitigating resource to inform interventions and policies.
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Affiliation(s)
- Mathilde Sengoelge
- Department of Health Sciences, Red Cross University College, 141 57 Huddinge, Sweden; (Ø.S.); (A.N.); (F.S.)
| | - Øivind Solberg
- Department of Health Sciences, Red Cross University College, 141 57 Huddinge, Sweden; (Ø.S.); (A.N.); (F.S.)
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway
| | - Alexander Nissen
- Department of Health Sciences, Red Cross University College, 141 57 Huddinge, Sweden; (Ø.S.); (A.N.); (F.S.)
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway
| | - Fredrik Saboonchi
- Department of Health Sciences, Red Cross University College, 141 57 Huddinge, Sweden; (Ø.S.); (A.N.); (F.S.)
- Division of Insurance Medicine, Department of Clinical Neuroscience, 171 77 Stockholm, Sweden
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12
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Richa S, Herdane M, Dwaf A, Bou Khalil R, Haddad F, El Khoury R, Zarzour M, Kassab A, Dagher R, Brunet A, El-Hage W. Trauma exposure and PTSD prevalence among Yazidi, Christian and Muslim asylum seekers and refugees displaced to Iraqi Kurdistan. PLoS One 2020; 15:e0233681. [PMID: 32579560 PMCID: PMC7313973 DOI: 10.1371/journal.pone.0233681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 05/11/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is unreliable, and negligible information on the mental health and trauma-exposure of asylum-seekers and displaced refugees in the Iraqi Kurdistan region. OBJECTIVES To evaluate how responsible the ethno-religious origins are, for the prevalence of trauma exposure and post-traumatic stress disorder (PTSD) in displaced Iraqi asylum-seekers and refugees residing in the Iraqi Kurdistan region. METHODS Structured interviews with a cross-sectional sample of 150 individuals, comprised of three self-identified ethno-religious groups (50 participants in each): Christians, Muslims, and Yazidis. RESULTS 100% prevalence of trauma exposure and 48.7% of current PTSD among refugees, 70% PTSD rate of Yazidi participants, which is significantly higher (p < 0.01) compared to 44% of Muslim participants and 32% of Christian participants. These findings were corroborated using the self-rated PTSD, DSM-5 Checklist, with more severe PTSD symptom scores (p < 0.001) obtained among Yazidis (43.1; 19.7), compared to Muslims (31.3; 20.1) and Christians (29.3; 17.8). Self-rated depressive symptoms (Patient Health Questionnaire-9) were also higher (p < 0.007) among Yazidis (12.3; 8.2) and Muslims (11.7; 5.9), compared to Christians (8.1; 7).
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Affiliation(s)
- Sami Richa
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Marie Herdane
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Azzam Dwaf
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Rami Bou Khalil
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Fadi Haddad
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Rhéa El Khoury
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Myriam Zarzour
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Anthony Kassab
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Ramez Dagher
- Faculty of Medicine, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Alain Brunet
- McGill University/Douglas Mental Health University Institute, Montréal (Qc), Canada
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France
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Identifying the critical time points for mental health of asylum seekers and refugees in high-income countries. Epidemiol Psychiatr Sci 2019; 29:e61. [PMID: 31576800 PMCID: PMC8061286 DOI: 10.1017/s204579601900057x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS High heterogeneity was found in the prevalence rates of mental disorders in adult asylum seekers and refugees in high-income countries. This may be related to different problems. Among them, there is a changing exposure to risk and protective factors for mental health at different phases of these people's life before migration, and during the migratory journey and resettlement. This study aimed at identifying and distinguishing time points in which distinct risk and protective factors for the mental health of asylum seekers and refugees may occur. METHODS Systematic review and narrative synthesis. A systematic search was carried out for the period January 2017-August 2019, given the existence of systematic reviews of the evidence up to January 2017. RESULTS Two hundred and fifty-two studies were identified with our search and 31 studies were included. The critical time points identified are: (a) before the travel; (b) during the travel; (c) at initial settlement in the host country; (d) when attempting to integrate in the host country; (e) when the immigration status is challenged or revoked. Some factors such as sense of belonging in the host country can be risk factors or protective factors depending on the time point. CONCLUSIONS These five critical time points can guide the development and selection of well-timed preventive and treatment interventions. They could also be used to stratify samples in epidemiological studies and meta-analyses. At present, we know much more on risk factors than on protective factors. Knowing more about protective factors may inform the development of interventions to foster them.
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14
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Assessing Predictors of Emotional Distress by Immigrant Type: An Exploration of Adult Refugees, Asylees, and SIV Holders in Maryland. J Immigr Minor Health 2019; 22:50-60. [PMID: 31346844 DOI: 10.1007/s10903-019-00917-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stressors and trauma experienced by persons fleeing harm or persecution can cause elevated distress. This study assessed predictors of elevated distress among newly arrived refugees, asylees, and Special Immigrant Visa (SIV) holders in Maryland. A secondary analysis of Refugee Health Screener-15 data from 4385 refugees, asylees, and SIV holders arriving in Maryland from 2014 to 2017 was conducted. Mean scores were compared across immigrant groups, and positive screening predictors were identified using logistic regression. Mean scores were highest among SIV holders and lowest among asylees. Compared to refugees, SIV holders had greater odds of screening positive; significance was reduced after adjusting for covariates. A significant interaction term was found for SIV women, who had 1.74 greater odds than SIV males. Distress varied between immigrant groups, with asylees having lowest odds of screening positive. SIV women's significant results may owe to acculturation distress, disrupted gender expectations, and resettlement difficulties.
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15
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Leiler A, Bjärtå A, Ekdahl J, Wasteson E. Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden. Soc Psychiatry Psychiatr Epidemiol 2019; 54:543-551. [PMID: 30580381 DOI: 10.1007/s00127-018-1651-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In 2015, there was a high influx of refugees to Sweden, creating an extreme situation where individuals were forced to remain in large housing facilities for long periods. The present study aims to describe the mental health and quality of life of these individuals. METHODS Data, based on 510 individuals, were obtained by means of a questionnaire at open screenings conducted at or nearby refugee housing facilities. Of the participating refugees, 367 were asylum seekers and 143 had received a residence permit but were still awaiting a more permanent housing solution. The questionnaire included measures of depressive symptoms (PHQ-9), symptoms of anxiety (GAD-7), risk of having post-traumatic stress disorder (PC-PTSD), and quality of life (WHOQOL-BREF). RESULTS Of the total sample, 56-58.4% reported clinically significant levels of symptoms of depression, anxiety and risk of having PTSD. Prevalence estimates were higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated negatively with mental health outcomes. CONCLUSIONS Individuals residing in refugee housing facilities show high levels of psychological distress and rate their quality of life as low. Asylum seekers score higher than those having received a residence permit. These results are troublesome since the wait time for asylum decisions has lengthened considerably after 2015. The results of the present study calls for the urgency of societal actions to shorten the asylum process and improve conditions at the housing facilities.
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Affiliation(s)
- Anna Leiler
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden.
| | - Anna Bjärtå
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
| | - Elisabet Wasteson
- Department of Psychology, Mid Sweden University, 831 25, Östersund, Sweden
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16
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Amaddeo F, Barbui C. Celebrating the 40th anniversary of the Italian Mental Health reform. Epidemiol Psychiatr Sci 2018; 27:311-313. [PMID: 29530111 PMCID: PMC6998997 DOI: 10.1017/s2045796018000112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/07/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- F. Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - C. Barbui
- Section of Psychiatry, University of Verona, Italy
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17
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Ostuzzi G, Barbui C, Hanlon C, Chatterjee S, Eaton J, Jones L, Silove D, Ventevogel P. Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance. BMC Med 2017; 15:197. [PMID: 29224570 PMCID: PMC5724240 DOI: 10.1186/s12916-017-0960-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/18/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Populations exposed to humanitarian emergencies are particularly vulnerable to mental health problems, including new onset, relapse and deterioration of psychotic disorders. Inadequate care for this group may lead to human rights abuses and even premature death. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), and its adaptation for humanitarian settings (mhGAP-HIG), provides guidance for management of mental health conditions by non-specialised healthcare professionals. However, the pharmacological treatment of people with non-affective psychosis who do not improve with mhGAP first-line antipsychotic treatments is not addressed. In order to fill this gap, UNHCR has formulated specific guidance on the second-line pharmacological treatment of non-affective psychosis in humanitarian, non-specialised settings. METHODS Following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a group of international experts performed an extensive search and retrieval of evidence on the basis of four scoping questions. Available data were critically appraised and summarised. Clinical guidance was produced by integrating this evidence base with context-related feasibility issues, preferences, values and resource-use considerations. RESULTS When first-line treatments recommended by mhGAP (namely haloperidol and chlorpromazine) are not effective, no other first-generation antipsychotics are likely to provide clinically meaningful improvements. Risperidone or olanzapine may represent beneficial second-line options. However, if these second-line medications do not produce clinically significant beneficial effects, there are two possibilities. First, to switch to the alternative (olanzapine to risperidone or vice versa) or, second, to consider clozapine, provided that specialist supervision and regular laboratory monitoring are available in the long term. If clinically relevant depressive, cognitive or negative symptoms occur, the use of a selective serotonin reuptake inhibitor may be considered in addition or as an alternative to standard psychological interventions. CONCLUSIONS Adapting scientific evidence into practical guidance for non-specialised health workers in humanitarian settings was challenging due to the paucity of relevant evidence as well as the imprecision and inconsistency of results between studies. Pragmatic outcome evaluation studies from low-resource contexts are urgently needed. Nonetheless, the UNHCR clinical guidance is based on best available evidence and can help to address the compelling issue of undertreated, non-affective psychosis in humanitarian settings.
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Affiliation(s)
- Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Charlotte Hanlon
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, 6th Floor College of Health Sciences Building, Tikur Anbessa Hospital, PO 9086, Addis Ababa, Ethiopia.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Sudipto Chatterjee
- Sangath Centre, Porvorim, Goa, India.,School of Population Health, Melbourne, Australia
| | - Julian Eaton
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.,CBM International, Bensheim, Germany
| | - Lynne Jones
- FXB Center for Health & Human Rights, Harvard University, Boston, USA
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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