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Masaki CØ, Vindbjerg E, Mortensen EL, Bruhn M, Carlsson J. The impact of temporary residence permit on symptom severity and treatment outcome among refugees with PTSD. J Psychiatr Res 2024; 179:133-140. [PMID: 39293118 DOI: 10.1016/j.jpsychires.2024.09.011] [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: 03/06/2024] [Revised: 08/28/2024] [Accepted: 09/09/2024] [Indexed: 09/20/2024]
Abstract
Despite an increased focus on the impact of post-migratory factors on the health of trauma-affected refugees, research on the influence of residence permit is limited. This influence may manifest on the outcome of psychiatric treatment. Accordingly, the aim of this study was to examine the role of temporary residence permit on symptom severity and treatment outcome among trauma-affected refugees in PTSD treatment. The sample consisted of 897 patients, who were allocated into three groups based on their residence permit: temporary residence permit, permanent residence permit, and Danish citizenship. The outcome measures were symptoms of PTSD (Harvard Trauma Questionnaire), depression and anxiety (Hopkins Symptom Checklist-25 and Hamilton Depression and Anxiety Rating Scales), quality of life (WHO-5 Well-being Index), and functioning (The Sheehan Disability Scale), evaluated before and after psychiatric treatment. Temporary residents tended to have less severe symptoms prior to treatment. Overall, no significant differences were observed between the three groups on treatment outcome. However, Danish citizens had a poorer treatment outcome on Hamilton Depression Scale compared with temporary residents. This study is one of the first to investigate treatment implications of residence permit in a clinical setting. The interactions between mental health and individual post-migratory factors are complex. Further research is still needed to understand how residence status affects mental health and treatment outcomes for refugees.
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Affiliation(s)
- Chiaki Ørum Masaki
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark.
| | - Erik Vindbjerg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Maja Bruhn
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Serra R, Purgato M, Tedeschi F, Acartürk C, Karyotaki E, Uygun E, Turrini G, Winkler H, Pinucci I, Wancata J, Walker L, Popa M, Sijbrandij M, Välimäki M, Kösters M, Nosè M, Anttila M, Churchill R, White RG, Lantta T, Klein T, Wochele-Thoma T, Tarsitani L, Barbui C. Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model. Eur J Psychotraumatol 2024; 15:2355828. [PMID: 38828909 PMCID: PMC11149571 DOI: 10.1080/20008066.2024.2355828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/13/2024] [Indexed: 06/05/2024] Open
Abstract
Background: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs.
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Affiliation(s)
- Riccardo Serra
- World Health Organization 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
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marianna Purgato
- World Health Organization 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
| | - Federico Tedeschi
- World Health Organization 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
| | - Ceren Acartürk
- Department of Psychology, Koc University, Istanbul, Türkiye
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ersin Uygun
- Department of Psychology, Koc University, Istanbul, Türkiye
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Giulia Turrini
- World Health Organization 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
| | | | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Johannes Wancata
- Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lauren Walker
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Mariana Popa
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maritta Välimäki
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
- School of Public Health, University of Helsinki, Helsinki, Finland
| | - Markus Kösters
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, T U Dresden, Chemnitz, Germany
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Michela Nosè
- World Health Organization 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
| | - Minna Anttila
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ross G. White
- School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Tella Lantta
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia
| | - Thomas Klein
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, T U Dresden, Chemnitz, Germany
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | | | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Corrado Barbui
- World Health Organization 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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Wilson C, Misajon R, Brooker J. Self-compassion and self-coldness and their relationship with psychological distress and subjective well-being among community-based Hazaras in Australia. Transcult Psychiatry 2024; 61:229-245. [PMID: 38327149 DOI: 10.1177/13634615241227683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Hazaras are a newly emerging community in Australia and limited research has explored their mental health. The first aim of this study was to explore levels of psychological distress and subjective well-being reported by Hazaras in Australia, and whether scores on psychosocial variables (self-compassion, self-coldness, acculturation, resilience, spirituality), psychological distress and domains of subjective well-being differed by sociodemographic groups. The second aim had two parts: (a) to examine bivariate relationships between the psychosocial variables, psychological distress and subjective well-being; and (b) to examine whether the psychosocial predictor variables independently contributed to subjective well-being and psychological distress when controlling for sociodemographic characteristics. Seventy-two Hazaras (58 men and 14 women), with a mean age of 28.82 years (SD = 8.84) and average length of time residing in Australia of 10.17 years (SD = 4.11), completed an online survey. There were sociodemographic differences in relation to key variables of interest; for example, participants who did not have family members in Australia reported lower levels of global life satisfaction. Moderate negative relationships were found between self-compassion and psychological distress and between self-coldness and subjective well-being. Self-coldness, self-compassion, resilience and acculturation contributed uniquely to psychological distress and subjective well-being when controlling for sociodemographic variables. Although migration programmes that provide permanent residency and allow family members to join refugees in Australia are limited, they appear important. Many of the difficulties facing Hazaras are ongoing, external and beyond their control (e.g. visa status); however, there is a possibility that self-compassion can play a role as a protective factor.
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Strupf M, Wiechers M, Bajbouj M, Böge K, Karnouk C, Goerigk S, Kamp-Becker I, Banaschewski T, Rapp M, Hasan A, Falkai P, Jobst-Heel A, Habel U, Stamm T, Heinz A, Hoell A, Burger M, Bunse T, Hoehne E, Mehran N, Kaiser F, Hahn E, Plener P, Übleis A, Padberg F. Predicting treatment outcomes of the Empowerment group intervention for refugees with affective disorders: Findings from the MEHIRA project. J Affect Disord 2023; 323:241-250. [PMID: 36427652 DOI: 10.1016/j.jad.2022.11.050] [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: 06/22/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research on outcome predictors in the field of transcultural treatment for refugees and asylum seekers (RAS) is scarce. We aimed to evaluate predictors of outcome of a group intervention (Empowerment) for RAS with affective disorders which was incorporated at level three of the stratified stepped-care model within the Mental Health in Refugees and Asylum Seekers (MEHIRA) project. METHODS A predictor analysis was performed at level three of the MEHIRA project, where 149 refugees with moderate depressive symptoms were treated either with Empowerment or Treatment-as-usual (TAU). Outcome measures were depression severity as assessed by patient-rated Patient Health Questionnaire 9 (PHQ-9) and clinician-rated Montgomery Asberg Depression Rating Scale (MADRS). Regression models with change scores (T1-T0) of PHQ-9 and MADRS as dependent variables were fit. Predictor selection was a mixed-method approach combining testing of literature-based hypotheses and explorative hypothesis-generating analyses of multiple baseline variables. RESULTS Intention-to-treat (ITT) analyses revealed significant linear relationships between change in PHQ-9 and baseline depression severity (β = -0.35, t = -3.27, p = .002) and perceived self-efficacy (β = -0.24, t = -2.26, p = .027) in the treatment (verum) condition. MADRS change scores were predicted by baseline depression severity (β = -0.71, t = -8.65, p < .001) in the treatment (verum) condition. LIMITATIONS Due to small cell numbers, single predictors could not be evaluated reliably. CONCLUSIONS Severity of depression and self-efficacy at baseline were predictors of symptom improvement at level three (Empowerment) of the MEHIRA project. Comorbidity and trauma indicators did not predict outcomes in the treatment (verum) condition, pointing towards broad applicability of the Empowerment intervention in refugee populations.
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Affiliation(s)
- Michael Strupf
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany.
| | - Maren Wiechers
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Carine Karnouk
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany; Charlotte Fresenius Hochschule, University of Applied Sciences, Munich, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Marburg, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University Augsburg, BKH Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Andrea Jobst-Heel
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Ute Habel
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | | | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Andreas Hoell
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Max Burger
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Tilmann Bunse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University Augsburg, BKH Augsburg, Augsburg, Germany
| | - Edgar Hoehne
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nassim Mehran
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Mitte, Berlin, Germany
| | - Franziska Kaiser
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Aline Übleis
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
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Nordbrandt MS, Vindbjerg E, Mortensen EL, Carlsson J. Chronicity of posttraumatic stress disorder and comorbid pain as predictors of treatment response for trauma-affected refugees. J Trauma Stress 2022; 35:1393-1404. [PMID: 35446986 DOI: 10.1002/jts.22839] [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] [Received: 09/01/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022]
Abstract
Predictors of treatment outcomes have received limited attention in the field of trauma-affected refugees. Symptom chronicity is potentially a particularly relevant predictor, as it would instruct earlier interventions for a population less familiar with psychiatric treatment options, and its identification may also reduce or delay the onset of comorbidities, such as chronic pain. Accordingly, this study examined the impacts of posttraumatic stress disorder (PTSD) chronicity and baseline comorbid pain on treatment response in trauma-affected refugees. Multiple regression was used to analyze data from a randomized controlled trial of 318 trauma-affected refugees with PTSD that was conducted at a specialized psychiatric clinic in Denmark. Treatment response was measured by changes in symptoms of PTSD (Harvard Trauma Questionnaire) and depression (Hopkins Symptom Checklist-25). Duration of functional impairment was found to be a significant predictor of PTSD outcomes, p = .003, ΔR2 = .02, f2 = .03; it was not predictive of outcomes for depression. Baseline pain severity was a significant predictor of outcomes for both PTSD, p = .009, ΔR2 = .02, f2 = .02, and depression, p = .041, ΔR2 = .01, f2 = .01. These findings suggest that trauma-affected refugees with long-lasting functional impairment and a high pain score are likely to show less improvement from treatments for PTSD and depression. This points to a need for early intervention to prevent chronic functional impairment and suggests comorbid pain is an important therapeutic target.
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Affiliation(s)
- Maja Sticker Nordbrandt
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Erik Vindbjerg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Cloitre M. Complex post-traumatic stress disorder: a much needed diagnosis. BJPsych Open 2022; 8:e177. [PMID: 36176218 PMCID: PMC9634558 DOI: 10.1192/bjo.2022.566] [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] [Indexed: 11/23/2022] Open
Abstract
This commentary conveys appreciation for a recent review of the rates of complex post-traumatic stress disorder (CPTSD) among refugees, describes the relevance of CPTSD to the refugee experience and discusses implications for assessment and treatment, the effective development of which requires collaboration among researchers, clinicians and individuals with lived experience.
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Affiliation(s)
- Marylene Cloitre
- National Center for PTSD, Division of Dissemination and Training, Palo Alto Veterans Association Healthcare System, California, USA; and Department of Psychiatry and Behavioral Sciences, Stanford University, California, USA
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Marshall C. The inter-agency standing committee (IASC) guidelines on mental health and psychosocial support (MHPSS) in emergency settings: a critique. Int Rev Psychiatry 2022; 34:604-612. [PMID: 36502397 DOI: 10.1080/09540261.2022.2147420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The bio-medical model of 'mental health' and 'mental illness' that relates to the relationship between wellbeing and distress informs psychopathology and dominates conceptualisation in many Western Educated Industrialised Rich Democratic (WEIRD) populations. This paper aims to critique the model, questioning the appropriateness of psychopathology as a conceptual framework when working as a Western trained clinician with populations such as in China, Japan, Asia, the Middle-East and Africa. The paper also considers the cultural appropriateness of western notions of psychopathology when working inter-culturally in relation to the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings, and the Review of the Implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.
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Affiliation(s)
- Claire Marshall
- Department of Professional Psychology, School of Psychology, University of East London, London, UK
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8
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Evaluating the procedural validity of the multilingual computer assisted self interview (MultiCASI) in a refugee population. Psychiatry Res 2022; 312:114529. [PMID: 35398659 DOI: 10.1016/j.psychres.2022.114529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
Abstract
Multimedia-based administration of questionnaires, presenting items both in writing and spoken word, offers numerous potential benefits in transcultural psychiatry, such as improved comprehension of each question, ease of administration, prevention of missing or arbitrary responses, and obviating subsequent data entry. The concept has become known as "Computer-Assisted Self Interviewing" (CASI), and while preliminary results are promising, previous studies have not directly compared CASI to paper-and-pen administration in a large and representative sample of refugees. The aim of this study was to evaluate the procedural validity of multilingual CASI in comparison to paper-based-administration. The Hopkins Symptom Checklist-25 anxiety and depression subscales were administered in both modalities with a total of N = 281 participants from sites in Australia, New Zealand, and Denmark. We evaluated potential deviations in both the raw item and scale scores in each modality, while psychometric properties of each subscale were compared for an Arabic-speaking subsample (n = 125). Results showed no significant differences between raw item- or scale score across the two modalities, nor between the level of construct validity. In conclusion, this study supports a wider adaptation of multilingual CASI in the context of transcultural psychiatry, both for purposes of screening and treatment evaluation.
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Tay AK, Carlsson J. Psychosocial treatment outcomes of common mental disorders vary widely in persons in low- and middle-income countries affected by humanitarian crises and refugees in high-income countries. BJPsych Open 2022; 8:e100. [PMID: 35642349 PMCID: PMC9230631 DOI: 10.1192/bjo.2022.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This commentary discusses methodological and contextual factors that might account for variations in psychosocial treatment outcomes found in persons in low- and middle-income countries affected by humanitarian crises and refugees. Factors discussed are related to cultural adaptations, content and intensity of treatment, population characteristics and factors related to research design.
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Affiliation(s)
- Alvin Kuowei Tay
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Australia
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Denmark; and Department of Clinical Medicine, University of Copenhagen, Denmark
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Lai H, Due C, Ziersch A. The relationship between employment and health for people from refugee and asylum-seeking backgrounds: A systematic review of quantitative studies. SSM Popul Health 2022; 18:101075. [PMID: 35601219 PMCID: PMC9118911 DOI: 10.1016/j.ssmph.2022.101075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/05/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background For the general population, the positive effects of paid employment on health and wellbeing are well established. However, less is known for people from refugee and asylum-seeking backgrounds. This review aims to systematically summarise the quantitative literature on the relationship between employment and health and wellbeing for refugees and asylum seekers. Method A search strategy was conducted in online databases, including MEDLINE, PsychINFO, EMCARE, SCOPUS, CINHAL, ProQuest and Web of Science. Articles were screened against inclusion and exclusion criteria. Studies published in English between 2000 to October 2021 were included if they used quantitative methods to consider the relationship between employment and health for refugees and asylum seekers in resettlement countries. Study quality was assessed using The Joanna Briggs Institute's Critical Appraisal Tools. Findings were synthesised using a narrative approach. Results Seventy-two papers were identified. The majority of papers (N = 58, 81%) examined the association between employment and mental health outcomes. Overall, while there were inconsistencies in the findings, employment had a positive effect on mental health particularly in reducing levels of psychological distress and depression. Though more limited in number, the papers examining physical health suggest that people who are employed tend to have better physical health than unemployed persons. There was some evidence to support the bi-directional relationship between employment and health. Poor mental and physical health negatively impacted the odds of employment and occupational status of refugees. Conclusion Good quality employment is an essential component of refugee resettlement and this review found that in general employment is also beneficial for refugee health, particularly aspects of mental health. More research regarding the effects of employment on physical health is required. The effects of refugee-specific factors such as gender roles, torture, and trauma on the relationship between employment and health also require further investigation.
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Affiliation(s)
- Huyen Lai
- College of Medicine and Public Health, Flinders University, Australia
| | - Clemence Due
- College of Medicine and Public Health, Flinders University, Australia
- School of Psychology, Adelaide University, Australia
| | - Anna Ziersch
- College of Medicine and Public Health, Flinders University, Australia
- Flinders Health and Medical Research Institute, Flinders University, Australia
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Mixing Job Training with Nature-Based Therapy Shows Promise for Increasing Labor Market Affiliation among Newly Arrived Refugees: Results from a Danish Case Series Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084850. [PMID: 35457716 PMCID: PMC9031245 DOI: 10.3390/ijerph19084850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 01/27/2023]
Abstract
The unemployment rate among newly arrived refugees in European countries is high and many experience mental health problems. This has negative consequences on integration and mental well-being. In this case series study we investigated the effect of a 30-week program that included horticulture activities, nature-based therapy, and traditional job training on job market affiliation and mental well-being. Fifty-two refugees met initial screening criteria and twenty-eight met all inclusion criteria and were enrolled. The program took place in a small community and consisted of informal therapeutic conversations, exercises aimed at reducing psychological stress, increasing mental awareness and physical wellbeing. At the end of the program traditional job market activities were led by social workers. Provisionary psychiatric interviews showed that at baseline 79% met criteria for either an anxiety, depression, or PTSD diagnosis. After the program, statistical analyses revealed an increase in the one-year incidence of job market affiliation (n = 28) and an increase in mental health according to two of four questionnaire measures (nrange = 15–16). The results strengthen the hypothesis that horticulture and nature-based therapy can help refugees enter the job market. However, the small sample size emphasizes the need for methodologically stronger studies to corroborate these preliminary findings.
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12
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Opaas M, Wentzel-Larsen T, Varvin S. Predictors of the 10 year course of mental health and quality of life for trauma-affected refugees after psychological treatment. Eur J Psychotraumatol 2022; 13:2068910. [PMID: 35957631 PMCID: PMC9359185 DOI: 10.1080/20008198.2022.2068910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Trauma-affected refugee patients benefit from psychological treatment to different degrees. Only a handful of studies has investigated potential predictors of treatment outcome that could throw light on the great variability in outcomes reported for this group. Such knowledge may be vital to better tailor prevention and treatment efforts to the needs of different individuals and subgroups among these patients. Objective: In a naturalistic and longitudinal study, the aim was to analyse demographics and traumatic exposure as potential predictors of the participants' long-term trajectories of mental health symptoms and quality of life. Method: A group of 54 multi-origin adult refugee patients with complex traumatic exposure, such as armed conflicts, persecution, torture, and childhood adversities, were interviewed face to face over up to 10 years; at therapy admittance, and at varying points in time during and after psychotherapy. Checklists of war-related and childhood trauma, mental health symptoms, and quality of life were included in the interviews. In linear mixed effects analyses, interaction was analysed with potential predictors included separately because of the sample size. Time was modelled as continuous from inclusion into the study. Results: Gender predicted the course of symptoms of post-traumatic stress, anxiety, and depression, and of quality of life in physical health and social relationships. Childhood family violence and experiences of torture predicted the course of depression, whereas the extent of exposure to war-related trauma events and having experienced torture predicted the course of anxiety. Conclusions: The results indicated greater chronicity in male refugees, in refugees who had experienced domestic violence during childhood, in refugees who had experienced torture, and in refugees with more numerous types of potentially traumatic war-related experiences. The findings highlight the need for gender-sensitive research, rehabilitative efforts, and treatment. HIGHLIGHTS In a 10 year longitudinal and naturalistic therapy follow-up study of traumatized refugees, female gender, childhood trauma, war trauma, and torture predicted mental health and quality of life outcomes.Male participants responded less than females to therapy.
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Affiliation(s)
- Marianne Opaas
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Sverre Varvin
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Sandahl H, Carlsson J, Sonne C, Mortensen EL, Jennum P, Baandrup L. Investigating the link between subjective sleep quality, symptoms of PTSD and level of functioning in a sample of trauma-affected refugees. Sleep 2021; 44:6168908. [PMID: 33710347 DOI: 10.1093/sleep/zsab063] [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: 10/06/2020] [Revised: 02/01/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To examine whether baseline sleep quality is associated with baseline symptoms of posttraumatic stress disorder (PTSD) and level of functioning, and whether baseline sleep quality and improvement of sleep quality are specific predictors of change in PTSD symptoms and level of functioning. METHODS Data were derived from a four-armed randomised controlled superiority trial (N=219 trauma-affected refugees). All four groups received treatment as usual consisting of a 10-12 months bio-psycho-social treatment program with an additional differential treatment component added to each arm. We performed bivariate correlation analyses, multiple linear regression analyses and mediation analyses to examine associations between baseline sleep quality, change in sleep quality and treatment response for PTSD symptoms and level of functioning. RESULTS Baseline sleep quality correlated with symptoms of PTSD (r = .33) and level of functioning (r=0.15). Baseline sleep quality, improvement of sleep quality and improvement of general well-being were predictors of treatment response for symptoms of PTSD and level of functioning when controlling for age, gender, and baseline symptoms of PTSD and depression. CONCLUSIONS We found that good sleep quality at baseline and improvement of sleep quality were predictors of PTSD treatment response. However, treatment response was more closely associated with improvement in general well-being. The results indicate that the effect of improved sleep quality was partly mediated by a more general mental state improvement. Further research is needed to differentiate if a selected subgroup of patients may profit from sleep enhancing treatment.
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Affiliation(s)
- Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Denmark
| | - Lone Baandrup
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
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