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Robinson A, Musotsi P, Khan ZRA, Nellums L, Faiq B, Broadhurst K, Renolds G, Pritchard M, Smith A. Opportunities and practices supporting responsive health care for forced migrants: lessons from transnational practice and a mixed-methods systematic review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2025; 13:1-182. [PMID: 40326302 DOI: 10.3310/mrwk3419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2025]
Abstract
Background For those displaced across borders, significant adversity before, during and after displacement journeys, including attitudes and structures in countries of transit and arrival, contributes to considerable risk of poor physical and mental health, and poor and exclusionary experiences of health care. Objectives We aimed to understand the opportunities and practices that can support better healthcare responses for forced migrants. Design We integrated (1) local stakeholder perspectives, from workshops and dialogue; (2) evidence and knowledge from a mixed-methods systematic review; and (3) learning from five case examples from current international practice. Review methods and data sources We ran database searches (American Psychological Association PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, National Institute for Health and Care Research Journals Library) in February 2022, searched relevant agency websites and conducted backward and forward citation searches, extracted data, assessed methodological quality and integrated qualitative and quantitative findings. Case examples We studied three services in the UK, one in Belgium and one in Australia, conducting semistructured interviews with providers, collaborators and service users, and making site visits and observations if possible. Results The review identified 108 studies. We identified six domains of impact: (1) benefit from and creation of community, including linkages with formal (health) services; (2) the formation of networks of care that included traditional and non-traditional providers; (3) proactive engagement, including conducting care in familiar spaces; (4) considered communication; (5) informed providers and enhanced attitudes; and (6) a right to knowledge (respecting the need of new arrivals for information, knowledge and confidence in local systems). The case examples drew attention to the benefits of a willingness to innovate and work outside existing structures, 'micro-flexibility' in interactions with patients, and the creation of safe spaces to encourage trust in providers. Other positive behaviours included engaging in intercultural exchange, facilitating the connection of people with their cultural sphere (e.g. nationality, language) and a reflexive attitude to the individual and their broader circumstances. Social and political structures can diminish these efforts. Limitations Review: wide heterogeneity in study characteristics presented challenges in drawing clear associations from the data. Case examples: we engaged only a small numbers of service users and only with service users from some services. Conclusions We found that environments that enable good health and enable people to live lives of meaning are vital. We found that these environments require flexibility and reflexivity in practice, intercultural exchange, humility and a commitment to communication. We suggest that a broader range of caring practitioners can, and should, through intentional and interconnected practice, contribute to the health care of forced migrants. Opening up healthcare systems to include other state actors (e.g. teachers and settlement workers) and a range of non-state actors, who should include community leaders and peers and private players, is a key step in this process. Future work Future work should focus on the health and health service implications of immigration practices, the inclusion of peers in a range of healthcare roles, alliance-building across unlikely collaborators and the embedding of intercultural exchange in practice. Study registration This study is registered as PROSPERO (CRD42021271464). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132961) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 13. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Amy Robinson
- Lancaster Patient Safety and Health Services Research Unit, University Hospitals of Morecambe Bay NHS Trust, Lancaster, UK
| | | | | | | | | | - Kofi Broadhurst
- Lancaster Patient Safety and Health Services Research Unit, University Hospitals of Morecambe Bay NHS Trust, Lancaster, UK
| | | | - Michael Pritchard
- Lancaster Patient Safety and Health Services Research Unit, University Hospitals of Morecambe Bay NHS Trust, Lancaster, UK
| | - Andrew Smith
- Lancaster Patient Safety and Health Services Research Unit, University Hospitals of Morecambe Bay NHS Trust, Lancaster, UK
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Costa N, Olson R, Mescouto K, Setchell J, Plage S, Dune T, Creese J, Suleman S, Prasad-Ildes R, Ng ZY. Non-clinical Psychosocial Mental Health Support Programmes for People with Diverse Language and Cultural Backgrounds: A Critical Rapid Review. Cult Med Psychiatry 2025:10.1007/s11013-024-09893-1. [PMID: 39881104 DOI: 10.1007/s11013-024-09893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2024] [Indexed: 01/31/2025]
Abstract
Low accessibility to mainstream psychosocial services disadvantages culturally and linguistically diverse (CALD) populations, resulting in delayed care and high rates of unsupported psychological distress. Non-clinical interventions may play an important role in improving accessibility to psychosocial support, but what characterises best practice in this space remains unclear. This critical rapid review addressed this gap by searching for, and critically analysing, existing research on non-clinical psychosocial support services, drawing from a critical realist framework and Brossard and Chandler's (Brossard and Chandler, Explaining mental illness: Sociological perspectives, Bristol University Press, 2022) taxonomy of positions on culture and mental health. We searched PubMed, PsycInfo, LILACS, Scopus and Sociological Abstracts to identify non-clinical psychosocial support interventions for first-generation immigrant CALD populations delivered by lay-health workers. Thirty-eight studies were included: 10 quantitative, 7 mixed-methods and 21 qualitative. Most studies were conducted in North America (n = 19) and Europe (n = 7), with few conducted in low-income countries (Tanzania and Lebanon, n = 3 each, Kenya [n = 1]). Studies often focussed on specific interventions (e.g. psychoeducation) for targeted populations (e.g. refugees, Latinx immigrants); multimodal interventions (e.g. psychological support and food distribution) for broad populations were less common. Thirty-five different outcome scales were identified across quantitative and mixed-methods studies, with most covering depression, stress and trauma. Most studies identified significant improvements for at least one psychosocial outcome despite interventions being relatively short in sessions. Findings from qualitative studies highlighted varied engagement with theory-informed models of service, and identified important barriers to non-clinical psychosocial support services, including precarious resourcing. Our analysis suggests most studies were underpinned by split-relativist frameworks and focussed on interventions aimed at helping clients navigate the eurocentricity and complexity of mainstream services. Recognising the eurocentrism of universalist frameworks, working from a culturally relativist position, prioritising social determinants of health and using models that centre clients, flexibility, context, culture and community are likely to ensure best practice for non-clinical psychosocial support interventions.
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Affiliation(s)
- Nathalia Costa
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia.
- The University of Queensland cLinical TRials cApability Team (ULTRA TEAM), Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
| | - Rebecca Olson
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Karime Mescouto
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Stefanie Plage
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Tinashe Dune
- Australian College of Applied Psychology, Sydney, New South Wales, Australia
| | - Jennifer Creese
- University of Leicester, George Davies Centre, Leicester, UK
| | | | | | - Zheng Yen Ng
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Queensland, Australia
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Giles CJ, Västhagen M, van Leuven L, Edenius A, Ghaderi A, Enebrink P. The efficacy of psychological prevention, and health promotion interventions targeting psychological health, wellbeing or resilience among forced migrant children and youth: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2025; 34:123-140. [PMID: 38627307 PMCID: PMC11805832 DOI: 10.1007/s00787-024-02424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 03/18/2024] [Indexed: 02/08/2025]
Abstract
There are over 40 million displaced children and youth worldwide and there is a need promote their mental wellbeing. This study aimed to synthesize evidence regarding promotion interventions to increase wellbeing, resilience, and quality of life (primary outcomes), and prevention interventions to reduce internalizing and externalizing symptoms (secondary outcomes) in this population. The review protocol was registered with PROSPERO (CRD42022329978). Medline, PsycINFO, and Web of Science were searched. Inclusion criteria were: ≥ 10 participants, sample ≤ 18 years of age, no parental participation, explicated forced migrant populations, implementation in non-clinical context, and validated measures. Fifteen studies (N interventions = 18, N participants = 5741) were eligible. Two studies included outcomes related to wellbeing and quality of life. The remaining studies reported depression, PTSD, anxiety, internalizing and externalizing behaviours, and behavioural and emotional problems. There was only sufficient data to perform random-effects meta-analysis of depression scores. No significant effects were observed in comparison to control condition in randomized trials (n = 4994, k = 5) but a small significant positive trend was observed in within-group analyses (n = 537, k = 12). Cochrane's risk of bias tools and the GRADE certainty of evidence tool were applied. No studies achieved low risk of bias and certainty of evidence was very low. In sum, there remains a dearth of rigorous intervention studies investigating the effects of promotive and preventative psychological interventions on the wellbeing, resilience, and quality of life of forcibly displaced minors. However, the few eligible studies in this review indicate promise.
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Affiliation(s)
- Clover Jack Giles
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden.
| | - Maja Västhagen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Livia van Leuven
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Edenius
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Chow D, Matungwa DJ, Blackwood ER, Pronyk P, Dow D. A scoping review on peer-led interventions to improve youth mental health in low- and middle-income countries. Glob Ment Health (Camb) 2024; 12:e1. [PMID: 39781336 PMCID: PMC11704389 DOI: 10.1017/gmh.2024.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 11/09/2024] [Accepted: 11/29/2024] [Indexed: 01/12/2025] Open
Abstract
Youth living in low- and middle-income countries (LMICs) have an increased vulnerability to mental illnesses, with many lacking access to adequate treatment. There has been a growing body of interventions using task sharing with trained peer leaders to address this mental health gap. This scoping review examines the characteristics, effectiveness, components of peer delivery and challenges of peer-led mental health interventions for youth aged 10-24 in LMICs. A key term search strategy was employed across MEDLINE, Embase, Web of Science, Global Health and Global Index Medicus. Eligibility criteria included young people aged 10-24 and a peer-led component delivered in any setting in an LMIC. Study selection and extraction were conducted independently by the first and second authors, with discrepancies resolved by the senior author. Study characteristics were summarised and presented descriptively. The search identified 5,358 citations, and 19 studies were included. There were 14 quantitative, four qualitative and one mixed methods study reporting mental health outcomes. Types of interventions were heterogenous but fell within three broad categories: (1) peer education and psychoeducation, (2) peer-led psychotherapy and counselling and (3) peer support. All studies reported improved mental health outcomes as a result of the peer-led interventions. Peer-led interventions are versatile in terms of both the types of interventions and mode of delivery. Lived experience, mutual respect and reduced stigma make this method a highly unique and effective way to engage this age group. However, implementing peer-led youth interventions is not without challenges. Adequate training, supervision, cultural appropriateness and support from established institutions are critical to safeguarding and ensuring the sustainability of such programs. Our findings suggest that peer-led models are a valuable intervention strategy that policymakers can leverage in current and future efforts to address youth mental health in LMICs. Future areas of research should expand to include the perspectives of other key stakeholders involved in the implementation of peer-led mental health interventions, focusing on factors including fidelity, feasibility and acceptability to enhance implementation insights.
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Affiliation(s)
| | | | | | - Paul Pronyk
- Centre for Outbreak Preparedness, Duke-NUS Medical School, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore
| | - Dorothy Dow
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Christian Medical Center-Duke Collaboration, Moshi, Tanzania
- Department of Pediatrics, Infectious Diseases, Duke University Medical Center, Durham, NC, USA
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Atik D, İnel Manav A, Tar Bolacalı E. The Effect of Psychoeducation on Attitudes toward Violence and Risky Behaviors among Refugee Adolescents. Behav Sci (Basel) 2024; 14:549. [PMID: 39062372 PMCID: PMC11273866 DOI: 10.3390/bs14070549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
This study was conducted to examine the effect of psychoeducation on attitudes toward violence and risky behaviors among refugee adolescents. This was a randomized controlled experimental study conducted with refugee adolescents (n = 101) studying in a high school in southern Turkey. After psychoeducation, it was determined that there was a significant decrease in the prevalence of antisocial behaviors, alcohol use, suicidal thoughts, unhealthy eating habits, and school dropout thoughts among adolescents according to the subdimensions of the risky behavior scale. Psychoeducation was found to be effective in reducing attitudes toward violence and preventing risky behaviors among refugee adolescents.
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Affiliation(s)
- Derya Atik
- Department of Nursing, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye 80000, Türkiye;
| | - Ayşe İnel Manav
- Department of Nursing, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye 80000, Türkiye;
| | - Edanur Tar Bolacalı
- First and Emergency Aid Program, Department of Medical Services and Techniques, Vocational School of Health Services, Kırsehir Ahi Evran University, Kırsehir 40100, Türkiye;
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Freeman JA, Desrosiers A, Schafer C, Kamara P, Farrar J, Akinsulure-Smith AM, Betancourt TS. The adaptation of a youth mental health intervention to a peer-delivery model utilizing CBPR methods and the ADAPT-ITT framework in Sierra Leone. Transcult Psychiatry 2024; 61:3-14. [PMID: 37822245 PMCID: PMC11708923 DOI: 10.1177/13634615231202091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Low- and middle-income countries (LMICs) carry a significant proportion of the global burden of untreated mental health disorders. Peer-delivered programs offer LMICs with limited mental health professionals an opportunity to increase mental health service access. This study describes the process of adapting a lay-worker-delivered evidence-based youth mental health intervention to a peer-delivery model in Sierra Leone using participatory methods. We convened Youth Community Advisory Boards (YCABs) as partners to develop a peer-delivery model for an evidence-based intervention. In collaboration with YCABs, the Assessment, Decision, Administration, Production, Topical experts, Integration, Training, Testing (ADAPT-ITT) framework was applied to guide the adaptation. The ADAPT-ITT framework is an eight-step process to adapt evidence-based interventions. The ADAPT-ITT framework facilitated the adaptation of the Youth Readiness Intervention (YRI), an evidence-based mental health program intervention that has been delivered by adult lay-workers to the youth peer-delivery platform in Sierra Leone. The YCABs identified program modifications, including the incorporation of storytelling, refinement of metaphors, and alterations to make delivery more accessible to low-literacy youth with particular attention to gender. YCABs also provided recommendations on how to support youth facilitators in providing psychosocial support, emphasizing self-care and boundary setting to ensure high-quality intervention delivery and do-no-harm principles. Study findings suggest that the ADAPT-ITT framework can be feasibly applied to guide the intervention adaptation process in LMICs. The use of participatory methods generated modifications that reflected youth experiences, needs, and concerns as facilitators and participants. Next steps include refinement and pilot testing of the adapted intervention.
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Affiliation(s)
- Jordan A Freeman
- School of Social Work Research Program on Children and Adversity, Boston College, USA
| | | | - Carolyn Schafer
- School of Social Work Research Program on Children and Adversity, Boston College, USA
| | | | - Jordan Farrar
- School of Social Work Research Program on Children and Adversity, Boston College, USA
| | | | - Theresa S Betancourt
- School of Social Work Research Program on Children and Adversity, Boston College, USA
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7
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Arega NT. Mental Health and Psychosocial Support Interventions for Children Affected by Armed Conflict in low-and middle-income Countries: A Systematic Review. CHILD & YOUTH CARE FORUM 2023:1-26. [PMID: 37360764 PMCID: PMC9990564 DOI: 10.1007/s10566-023-09741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 06/28/2023]
Abstract
Background . Armed conflicts continue to threaten a vast number of children across the world, especially in low-and middle-income countries (LMICs). Evidence-based interventions are vital to adequately address the mental health needs in these groups. Objective . This systematic review aims to provide a comprehensive update of the most current developments in mental health and psychosocial support (MHPSS) interventions for children affected by armed conflict in LMICs, since 2016. Such an update may be useful in determining where the current focus of interventions lies and whether there are changes in types of interventions that are commonly implemented. Methods . The main medical, psychological and social sciences databases (PubMed, PsycINFO, Medline) were searched to identify interventions aimed at improving or treating mental health problems in conflict-affected children in LMICs. For the period 2016-2022, a total of 1243 records were identified. Twenty-three articles met the inclusion criteria. A bio-ecological lens was used to organize the interventions and the presentation of findings. Results . Seventeen forms of MHPSS interventions with a wide range of treatment modalities were identified in this review. The reviewed articles focused mainly on family-based interventions. Very few studies empirically evaluated community-level interventions. Conclusion . Current focus of interventions is family-based; the addition of caregiver wellbeing and parenting skills components had the potential to enhance the effects of interventions designed to improve children's mental health. Future trials for MHPSS interventions need to give more attention to community-level interventions. Community-level supports such as person-to-person support, solidarity groups, and dialogue groups stand to reach large numbers of children and families.
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Affiliation(s)
- Natnael Terefe Arega
- PhD in Applied Developmental Psychology, Institute of Education and Behavioral Sciences, Ambo University, Ambo, Ethiopia
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Moayerian N, Stephenson M, Abu Karaki M, Abbadi R. Exploring Syrian Refugees' Access to Medical and Social Support Services Using a Trauma-Informed Analytic Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2031. [PMID: 36767397 PMCID: PMC9914972 DOI: 10.3390/ijerph20032031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Even after arrival in new countries, refugees may be exposed to traumatic events. This state is exacerbated by contextual stressors, including the resettlement process, asylum proceedings and threats of deportation. This paper is rooted in a trauma-informed framework. We interviewed 16 male Syrian refugee migrant workers employed on a Jordanian farm during crop harvesting season to explore the quality and level of medical care and mental health services they received in light of the framework's principal dimensions (e.g., safety, trust, intersectionality). We found that this vulnerable group of individuals is living a marginal and marginalized existence and depends on the goodwill of the growers for whom they work to treat them with a modicum of dignity and respect. Second, their itinerancy makes it difficult for this population to take advantage of available medical and mental health services at the nation's major refugee camps. Finally, our interlocutors preferred their current lives, as isolating and limiting as they are, as superior to full-time residence in the camps, because they perceive their present way of life as according a measure of dignity, self-direction and autonomy they could not enjoy in the camps.
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Affiliation(s)
- Neda Moayerian
- School of Urban Planning, University of Tehran, Tehran 14155-6619, Iran
| | - Max Stephenson
- Institute for Policy and Governance, School of Public and International Affairs Virginia Tech, Blacksburg, VA 24061, USA
| | - Muddather Abu Karaki
- Department of Media and Strategic Studies, Al-Hussein Bin Talal University, Ma’an 71111, Jordan
| | - Renad Abbadi
- Department of English Language and Literature, Al-Hussein Bin Talal University, Ma’an 71111, Jordan
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Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [DOI: https:/doi.org/10.1007/s10597-021-00928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 06/22/2023]
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Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [PMID: 35013831 DOI: 10.1007/s10597-021-00928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, VA, 23284, USA.
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin - Madison, 610 Walnut St., Madison, WI, 53726, USA
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Al-Tamimi SAGA, Leavey G. Community-Based Interventions for the Treatment and Management of Conflict-Related Trauma in Low-Middle Income, Conflict-Affected Countries: a Realist Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:441-450. [PMID: 35600528 PMCID: PMC9120315 DOI: 10.1007/s40653-021-00373-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 06/15/2023]
Abstract
Where low- and middle-income countries have limited economic resources to provide individualized mental health services to people exposed to conflict, community-based interventions may be more appropriate. We aimed to evaluate community level interventions for improving mental health outcomes in Low- and Middle-income countries (LMIC). A realist review of community-based interventions (CBIs) to improve mental health for people in LMIC following conflict. Five databases (Cochrane, PubMed, PsychINFO, Medline, and CINAHL) and a manual search of individual papers. We found 1318 articles, of which 29 were selected. Out of the 29 primary articles, 19 showed successful results, 4 showed mixed results, 1 showed inconclusive results, and 1 showed unsuccessful results. After analyzing the results, we found 3 mechanisms that may influence the effectiveness of these CBIs: the use of lay community members as intervention deliverers, the application of transdiagnostic approaches, and customized outcome assessment tools. Community-based approaches to improve mental health in LMICs are rare and evidence for their effectiveness is limited. Interventions that have a wide scope, train lay mental health workers, and use contextually adapted outcome assessment tools show promise.
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Im H, Swan LET, Warsame AH, Isse MM. Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya. Int J Soc Psychiatry 2022; 68:134-146. [DOI: https:/doi.org/10.1177/0020764020978685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Background: Comorbid common mental disorders (CMDs) are pervasive in refugee populations. However, limited research has explored psychosocial factors for mental disorder comorbidity in Somali refugee samples. Aims: This study aims to explore potential risk and protective factors for comorbid depression-anxiety and comorbid depression-PTSD by examining associations between trauma exposure, psychosocial factors, and mental health symptoms among a sample of Somali refugees displaced in urban Kenya. Methods: We used snowball sampling to recruit Somali youth aged 15 to 35years( N = 250, n = 143 female, n = 88 male, n = 19 unknown gender). We measured 16 common types of trauma exposure and three psychosocial factors (endorsing violence, willingness to share problems, and symptom awareness) and used the HSCL-25 and PCL-C to capture individual and comorbid CMD symptoms, using guided cutoff points and/or algorithms. We then ran a series of logistic regression analyses to examine relationships between trauma exposure, psychosocial factors, and individual and comorbid CMD symptoms. Results: Findings showed that increased trauma exposure predicted symptoms of individual and comorbid CMDs. Increased symptom awareness and endorsement of violence predicted comorbid depression-PTSD and comorbid anxiety-depression symptoms, respectively. Willingness to share problems buffered depressive symptoms but did not predict comorbidity. Conclusions: These findings revealed the high CMD comorbidity prevalence with differential effects of trauma and psychosocial factors on individual or comorbid mental disorders. This study suggests a need for transdiagnostic approaches that cut across Western diagnostic boundaries and consider culturally responsive and relevant items for mental health measures.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, Richmond, USA
| | - Laura ET Swan
- School of Social Work, Virginia Commonwealth University, Richmond, USA
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Im H, Swan LE, Warsame AH, Isse MM. Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya. Int J Soc Psychiatry 2022; 68:134-146. [PMID: 33300411 DOI: 10.1177/0020764020978685] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Comorbid common mental disorders (CMDs) are pervasive in refugee populations. However, limited research has explored psychosocial factors for mental disorder comorbidity in Somali refugee samples. AIMS This study aims to explore potential risk and protective factors for comorbid depression-anxiety and comorbid depression-PTSD by examining associations between trauma exposure, psychosocial factors, and mental health symptoms among a sample of Somali refugees displaced in urban Kenya. METHODS We used snowball sampling to recruit Somali youth aged 15 to 35years(N = 250,n = 143 female, n = 88 male, n = 19 unknown gender). We measured 16 common types of trauma exposure and three psychosocial factors (endorsing violence, willingness to share problems, and symptom awareness) and used the HSCL-25 and PCL-C to capture individual and comorbid CMD symptoms, using guided cutoff points and/or algorithms. We then ran a series of logistic regression analyses to examine relationships between trauma exposure, psychosocial factors, and individual and comorbid CMD symptoms. RESULTS Findings showed that increased trauma exposure predicted symptoms of individual and comorbid CMDs. Increased symptom awareness and endorsement of violence predicted comorbid depression-PTSD and comorbid anxiety-depression symptoms, respectively. Willingness to share problems buffered depressive symptoms but did not predict comorbidity. CONCLUSIONS These findings revealed the high CMD comorbidity prevalence with differential effects of trauma and psychosocial factors on individual or comorbid mental disorders. This study suggests a need for transdiagnostic approaches that cut across Western diagnostic boundaries and consider culturally responsive and relevant items for mental health measures.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, Richmond, USA
| | - Laura Et Swan
- School of Social Work, Virginia Commonwealth University, Richmond, USA
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Brouzos A, Vatkali E, Mavridis D, Vassilopoulos SP, Baourda VC. Psychoeducation for Adults with Post-Traumatic Stress Symptomatology: A Systematic Review and Meta-Analysis. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Weise C, Grupp F, Reese JP, Schade-Brittinger C, Ehring T, Morina N, Stangier U, Steil R, Johow J, Mewes R. Efficacy of a Low-threshold, Culturally-Sensitive Group Psychoeducation Programme for Asylum Seekers (LoPe): study protocol for a multicentre randomised controlled trial. BMJ Open 2021; 11:e047385. [PMID: 34649846 PMCID: PMC8522658 DOI: 10.1136/bmjopen-2020-047385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/16/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Despite high levels of mental distress, accessing psychological treatment is difficult for asylum seekers in Western host countries due to a lack of knowledge about mental disorders, and the health system, as well as due to cultural and language barriers. This study aims to investigate whether brief culturally sensitive and transdiagnostic psychoeducation is effective in increasing mental health literacy. METHODS AND ANALYSIS The study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either culturally sensitive, low-threshold psychoeducation ('Tea Garden' (TG)) or a waitlist (WL) control group. It takes place at four study sites in Germany. A total of 166 adult asylum seekers who report at least mild mental distress will be randomly assigned. The TG consists of two 90 min group sessions and provides information about mental distress, resources and mental health services in a culturally sensitive manner. The primary outcome is the percentage of participants in the TG, as compared with the WL, achieving an increase in knowledge concerning symptoms of mental disorders, individual resources and mental healthcare from preintervention to postintervention. The further trajectory will be assessed 2 and 6 months after the end of the intervention. Secondary outcomes include changes in mental distress, openness towards psychotherapy and resilience. Furthermore, healthcare utilisation and economics will be assessed at all assessment points. ETHICS AND DISSEMINATION The study has been approved by the Ethics Commission of the German Psychological Society (ref: WeiseCornelia2019-10-18VA). Results will be disseminated via presentations, publication in international journals and national outlets for clinicians. Furthermore, intervention materials will be available, and the existing network will be used to disseminate and implement the interventions into routine healthcare. TRIAL REGISTRATION NUMBER DRKS00020564; Pre-results. PROTOCOL VERSION 2020-10-06, version number: VO2F.
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Affiliation(s)
- Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Freyja Grupp
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Coordinating Centre for Clinical Trials Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Carmen Schade-Brittinger
- Coordinating Centre for Clinical Trials Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Thomas Ehring
- Department of Psychology, Clinical Psychology and Psychological Treatment, Ludwig-Maximilians-University Munich, Munchen, Germany
| | - Nexhmedin Morina
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany
| | - Ulrich Stangier
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Regina Steil
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Johannes Johow
- Coordinating Centre for Clinical Trials Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Ricarda Mewes
- Faculty of Psychology, Outpatient Unit for Research, Teaching and Practice, University of Vienna, Vienna, Austria
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van Es CM, Sleijpen M, Velu ME, Boelen PA, van Loon RE, Veldman M, Kusmallah N, Ekster PJC, Mooren T. Overcoming barriers to mental health care: multimodal trauma-focused treatment approach for unaccompanied refugee minors. Child Adolesc Psychiatry Ment Health 2021; 15:53. [PMID: 34592993 PMCID: PMC8482361 DOI: 10.1186/s13034-021-00404-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the feasibility of a short-term, multimodal trauma-focused treatment approach adapted specifically for unaccompanied refugee minors (URMs) in the Netherlands. This approach aims to overcome barriers to mental health care and to reduce symptoms of posttraumatic stress disorder (PTSD) and depression. METHODS An uncontrolled study was conducted, evaluating the main request for help, treatment integrity and feasibility, and the course of symptoms of PTSD (Children's Revised Impact of Event Scale-13) and depression (Patient Health Questionnaire modified for Adolescents). RESULTS In total, 41 minors were included in the study. Most participants were male (n = 27), predominately from Eritrea (75.6%) with a mean age of 16.5 (SD = 1.5). Minors mostly reported psychological problems, such as problems sleeping, and psychosocial problems, including worries about family reunification. Deviations from the approach were made to meet the current needs of the minors. Factors limiting the feasibility of the approach were often related to continuous stressors, such as news concerning asylum status. CONCLUSIONS The results provide a first indication that this approach partly overcomes barriers to mental health care and emphasize the added value of collaborating with intercultural mediators and offering outreach care. TRIAL REGISTRATION The study was registered in the Netherlands Trial Register (NL8585), 10 April 2020, Retrospectively registered, https://www.trialregister.nl/trial/8585 .
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Affiliation(s)
- Carlijn M. van Es
- grid.5477.10000000120346234Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands ,grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Marieke Sleijpen
- grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Merel E. Velu
- grid.5477.10000000120346234Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands ,grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Paul A. Boelen
- grid.5477.10000000120346234Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands ,grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Renate E. van Loon
- grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands ,Nidos, Utrecht, the Netherlands
| | - Marjan Veldman
- grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands ,Ouder- en Kind Team Amsterdam, Amsterdam, the Netherlands
| | - Nebil Kusmallah
- Nidos, Utrecht, the Netherlands ,grid.12380.380000 0004 1754 9227Faculty of Social Sciences, Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paula J. C. Ekster
- grid.468637.80000 0004 0465 6592De Evenaar, Center for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands
| | - Trudy Mooren
- grid.5477.10000000120346234Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands ,grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
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Im H, Swan LET, Heaton L. Polyvictimization and mental health consequences of female genital mutilation/circumcision (FGM/C) among Somali refugees in Kenya. Women Health 2020; 60:636-651. [DOI: https:/www.tandfonline.com/doi/abs/10.1080/03630242.2019.1689543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 06/22/2023]
Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Laura E. T. Swan
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lindsay Heaton
- School of Social Work, Catholic University of America, Washington, DC, USA
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Champine RB, Lang JM, Nelson AM, Hanson RF, Tebes JK. Systems Measures of a Trauma-Informed Approach: A Systematic Review. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:418-437. [PMID: 31469452 PMCID: PMC7003149 DOI: 10.1002/ajcp.12388] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Interest in trauma-informed approaches has grown substantially. These approaches are characterized by integrating understanding of trauma throughout a program, organization, or system to enhance the quality, effectiveness, and delivery of services provided to individuals and groups. However, variation in definitions of trauma-informed approaches, coupled with underdeveloped research on measurement, poses challenges for evaluating the effectiveness of models designed to support a trauma-informed approach. This systematic review of peer-reviewed and gray literature identified 49 systems-based measures that were created to assess the extent to which relational, organizational, and community/system practices were trauma-informed. Measures were included if they assessed at least one component of a trauma-informed approach, were not screening or diagnostic instruments, were standardized, were relevant to practices addressing the psychological impacts of trauma, were printed in English, and were published between 1988 and 2018. Most (77.6%) measures assessed organizational-level staff and climate characteristics. There remain several challenges to this emerging field, including inconsistently reported psychometric data, redundancy across measures, insufficient evidence of a link to stakeholder outcomes, and limited information about measurement development processes. We discuss these opportunities and challenges and their implications for future research and practice.
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Affiliation(s)
- Robey B. Champine
- Child Health and Development Institute of Connecticut,
Farmington, CT 06032
- Yale School of Medicine, Division of Prevention and
Community Research, New Haven, CT 06511
- Michigan State University, College of Human Medicine,
Division of Public Health, Flint, MI 48502
| | - Jason M. Lang
- Child Health and Development Institute of Connecticut,
Farmington, CT 06032
- UCONN Health, Department of Psychiatry, Farmington, CT
06032
- Child Study Center, Yale Schools of Medicine, New Haven, CT
06511
| | - Ashley M. Nelson
- Child Health and Development Institute of Connecticut,
Farmington, CT 06032
| | - Rochelle F. Hanson
- Medical University of South Carolina, Department of
Psychiatry and Behavioral Sciences, Charleston, SC 29425
| | - Jacob K. Tebes
- Yale School of Medicine, Division of Prevention and
Community Research, New Haven, CT 06511
- Yale School of Public Health, New Haven, CT 06511
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Im H, Swan LET, Heaton L. Polyvictimization and mental health consequences of female genital mutilation/circumcision (FGM/C) among Somali refugees in Kenya. Women Health 2019; 60:636-651. [PMID: 31711407 DOI: 10.1080/03630242.2019.1689543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Female genital mutilation or circumcision (FGM/C) is a perilous social and cultural practice that affects the physical, mental, and psychological health of affected women. It is widespread around the world, affecting 200 million women and girls. This study aimed to explore the relation of FGM/C to mental and physical conditions in Somali refugees displaced in a low-resource setting, applying the concept of poly-victimization to reveal multifaceted trauma sequelae. Data for this cross-sectional study with 143 female Somali youth living in Eastleigh, Kenya were collected between April and May in 2013. FGM/C was strongly associated with negative physical and mental health outcomes, including post-traumatic stress disorder and depressive, anxiety, and somatic symptoms. Logistic regression analysis revealed that separation from a parent and poly-victimization experiences were significantly associated with FGM/C experience. The results also showed that FGM/C and other traumas did not occur singly but were indicative of cumulative adversities, especially for women who were socially vulnerable and marginalized. The results of this study highlight the practice of FGM/C in the context of other adverse living conditions of refugees and the importance of attending to other co-occurring risk factors that prevail with FGM/C practice in the ecological system of refugee forced migration.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University , Richmond, Virginia, USA
| | - Laura E T Swan
- School of Social Work, Virginia Commonwealth University , Richmond, Virginia, USA
| | - Lindsay Heaton
- School of Social Work, Catholic University of America , Washington, DC, USA
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Lee YJ, Kim HW. Association of Traumatic Events, Post Traumatic Stress Disorder and Sexual Autonomy among Female University Students of North Korean Defectors. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2019; 25:46-59. [PMID: 37679929 DOI: 10.4069/kjwhn.2019.25.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To determine associations of traumatic events and post-traumatic stress disorder (PTSD) with sexual autonomy and identify factors influencing sexual autonomy among female university students of North Korean defectors. METHODS A cross-sectional, descriptive study was performed with a total of 103 female students who completed a structured online self-report survey from January 7 to March 31, 2018. This study was conducted using questionnaires on interpersonal trauma scale, the Traumatic Scale for North Korean Refugees (TSNKR), and sexual autonomy measurement for college students. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficients, and multiple linear regression with SPSS WIN 23.0 program. RESULTS Traumatic events, PTSD, and sexual autonomy scores were 3.96±3.07, 31.47±10.75, and 52.66±6.89, respectively. PTSD was positively correlated with traumatic events (r=.22, p=.030). Sexual autonomy was inversely correlated with PTSD (r=-.25, p=.010). Contraceptive use, PTSD, and voluntary sexual debut explained 26% of sexual autonomy of participants. CONCLUSION To improve sexual autonomy of young women from North Korea, reproductive intervention programs including contraception, sexual assertiveness training, and psychoeducation to reduce PTSD need to be developed and implemented.
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Affiliation(s)
- Young Jin Lee
- Graduate Student, College of Nursing, Seoul National University, Seoul, Korea.
| | - Hae Won Kim
- Graduate Student, College of Nursing, Seoul National University, Seoul, Korea.
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