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Schoenberger SF, Schönenberg K, Fuhr DC, Nesterko Y, Glaesmer H, Sondorp E, Woodward A, Sijbrandij M, Cuijpers P, Massazza A, McKee M, Roberts B. Mental healthcare access among resettled Syrian refugees in Leipzig, Germany. Glob Ment Health (Camb) 2024; 11:e25. [PMID: 38572249 PMCID: PMC10988152 DOI: 10.1017/gmh.2024.16] [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: 06/29/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 04/05/2024] Open
Abstract
Our aim was to examine mental health needs and access to mental healthcare services among Syrian refugees in the city of Leipzig, Germany. We conducted a cross-sectional survey with Syrian refugee adults in Leipzig, Germany in 2021/2022. Outcomes included PTSD (PCL-5), depression (PHQ-9), anxiety (GAD-7) and somatic symptom (SSS-8). Descriptive, regression and effect modification analyses assessed associations between selected predictor variables and mental health service access. The sampling strategy means findings are applicable only to Syrian refugees in Leipzig. Of the 513 respondents, 18.3% had moderate/severe anxiety symptoms, 28.7% had moderate/severe depression symptoms, and 25.3% had PTSD symptoms. A total of 52.8% reported past year mental health problems, and 48.9% of those participants sought care for these problems. The most common reasons for not accessing mental healthcare services were wanting to handle the problem themselves and uncertainty about where to access services. Adjusted Poisson regression models (n = 259) found significant associations between current mental health symptoms and mental healthcare service access (RR: 1.47, 95% CI: 1.02-2.15, p = 0.041) but significance levels were not reached between somatization and trust in physicians with mental healthcare service access. Syrian refugees in Leipzig likely experience high unmet mental health needs. Community-based interventions for refugee mental health and de-stigmatization activities are needed to address these unmet needs in Leipzig.
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Affiliation(s)
- Samantha F. Schoenberger
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kim Schönenberg
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Daniela C. Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Research Group Implementation Research and Mental Health, Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany
- Health Sciences, University of Bremen, Bremen, Germany
| | - Yuriy Nesterko
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
- Research Department, Center ÜBERLEBEN, Berlin, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Egbert Sondorp
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Aniek Woodward
- Department of Global Health, KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Pérez-Vázquez S, Bonilla-Campos A. Women Refugee's Perceptions, Experiences and Coping Mechanisms in Situations of Sexual and Gender-Based Violence (SGBV): A Metasynthesis. TRAUMA, VIOLENCE & ABUSE 2023; 24:3313-3327. [PMID: 36189681 DOI: 10.1177/15248380221126470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Women represent almost half of the 20 million refugees worldwide, and although they play a key role in their communities, their voices and needs are often missing from research and policies directed to this population. A qualitative systematic review, or metasynthesis, was conducted to examine the experiences, perceptions, coping mechanisms, and psychological discourses of women refugees in situations of sexual and gender-based violence (SGBV) that occur during the travel, interception, and destination migratory stages. A systematic search was conducted on five multidisciplinary databases and was complemented with a manual search, resulting on a total of 511 articles which were screened for eligibility. Only qualitative, peer-reviewed, and English-written research articles were selected, and they were required to (1) focus on women refugees above 15 years of age and (2) report on their experiences, perceptions, psychological discourses, and/or coping with SGBV during their migration across countries (international migration). Ultimately, a total of 14 qualitative research articles were selected for the review. Using the thematic synthesis approach as a guideline, the results were summarized in the following themes: experiences of SGBV, perception of SGBV, perception of the risk factors creating and perpetuating their vulnerability, coping with SGBV, barriers to help-seeking, and psychological consequences. Despite the broad search, only information about some types of SGBV experiences from Asian and African refugee communities was found. Nonetheless, the available qualitative information on this topic is effectively integrated, knowledge gaps are identified, and future research, interventions, and policies using an integrated and culturally sensitive framework are suggested.
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Pinchuk I, Goto R, Kolodezhny O, Pimenova N, Skokauskas N. Dynamics of hospitalizations and staffing of Ukraine's mental health services during the Russian invasion. Int J Ment Health Syst 2023; 17:20. [PMID: 37355602 DOI: 10.1186/s13033-023-00589-4] [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: 02/24/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Since February 2022, the people of Ukraine have experienced devastating losses due to the Russian invasion, increasing the demand for mental healthcare across the nation. Using longitudinal data on mental health facilities across the nation up to summer 2022, we aimed to provide an updated picture of Ukrainian mental health services during the 2022 Russian invasion. METHODS We conducted a nationwide longitudinal study on Ukrainian inpatient mental health facilities during the Russian invasion since February 2022. We obtained responses from the heads of 30 inpatient mental health facilities, which represent 49.2% of all psychiatric hospitals in Ukraine. Information on hospitalizations and the number, displacement, and injuries of staff in April and July-September 2022 was obtained from each facility. RESULTS Facilities across Ukraine reported similar staff shortages in both April and August-September 2022, despite an increase in the number of hospitalizations in July 2022 and a similar percentage of hospitalizations related to war trauma (11.6% in July vs. 10.2% in April, Wilcoxon signed-rank test P = 0.10). Hospitalizations related to war trauma became more dispersed across the nation in July 2022, likely reflecting the return of internally and externally displaced persons to their original locations. CONCLUSIONS The mental health needs and services changed drastically in the first half-year of the Russian invasion of Ukraine, with those in need more dispersed across the country over time. International aid may need to be scaled up to stably provide mental healthcare, given the displacement of the mental healthcare workforce.
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Affiliation(s)
- Irina Pinchuk
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Ryunosuke Goto
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Oleksiy Kolodezhny
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Nataliia Pimenova
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Norbert Skokauskas
- Regional Centre for Children and Youth Mental Health and Child Welfare - Central Norway, IPH, Norwegian University of Science and Technology, RKBU Midt-Norge, NTNU, Postboks 8905 MTFS, NO-7491, Trondheim, Norway.
- Child and Adolescent Psychiatry Section, World Psychiatric Association (WPA), Geneva, Switzerland.
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Goto R, Pinchuk I, Kolodezhny O, Pimenova N, Skokauskas N. Mental health services in Ukraine during the early phases of the 2022 Russian invasion. Br J Psychiatry 2023; 222:82-87. [PMID: 36458514 DOI: 10.1192/bjp.2022.170] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND In February 2022, Russia began its invasion of Ukraine. War increases the demand for mental healthcare among affected populations, but with devastating losses across the nation, it is unclear if Ukrainian mental health services are able to meet the needs of the people. AIMS We aimed to evaluate the state of Ukrainian in-patient mental health services, which remains the backbone of the nation's psychiatric services, early in the 2022 Russian invasion. METHOD We conducted a nationwide cross-sectional study on Ukrainian in-patient mental health facilities during the 2022 Russian invasion. Using an online questionnaire, we obtained responses from the heads of 32 in-patient mental health facilities across Ukraine, representing 52.5% of all in-patient mental health facilities in the nation. We gathered information on hospital admissions, staff, humanitarian aid received and the additional needs of each facility. RESULTS Hospital admissions were reduced by 23.5% during the war (April 2022) compared with before the war (January 2022). Across facilities, 9.6% of hospital admissions in April 2022 were related to war trauma, with facilities reporting percentages as high as 30.0%. Facilities reported reductions in staff, with 9.1% of total medical workers displaced and 0.5% injured across facilities. One facility reported that 45.6% of their total medical workers were injured. Although facilities across Ukraine have received humanitarian aid (such as medical supplies, food, volunteers), they reported additionally needing equipment as well as more staff. CONCLUSIONS The mental health service structure in Ukraine has been severely damaged during the 2022 invasion, with staff shortages despite a significant number of hospital admissions related to war trauma.
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Affiliation(s)
- Ryunosuke Goto
- Department of Pediatrics, The University of Tokyo Hospital, Japan
| | - Irina Pinchuk
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Ukraine
| | - Oleksiy Kolodezhny
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Ukraine
| | - Nataliia Pimenova
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Ukraine
| | - Norbert Skokauskas
- Regional Centre for Children and Youth Mental Health and Child Welfare - Central Norway, IPH, Norwegian University of Science and Technology, Norway; and Chair, Child and Adolescent Psychiatry Section, World Psychiatric Association
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The Syrian regime's apparatus for systemic torture: A qualitative narrative study of testimonies from survivors. BMC Psychiatry 2022; 22:787. [PMID: 36514026 PMCID: PMC9746173 DOI: 10.1186/s12888-022-04425-w] [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: 07/06/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite broad interest of the Syrian refugee plight in the academic and media circles, there are still limited studies analyzing the lived experiences of torture survivors under the Syrian regime. This qualitative study interviewed torture survivors to examine the form and function of the Syrian regime's security apparatus, and the personal aftermath of survivors. METHODS Thirteen in-depth interviews were conducted in Arabic with Syrian refugees who endured torture. Study participants were at least 19 years of age, resided as refugees in Jordan, and voluntarily agreed to participate in the study. Participation was anonymous and no incentives were provided. Only oral consent was required. Audio-recorded interviews were transcribed and translated to English, and then analyzed for repetitive themes utilizing the narrative approach. RESULTS Major themes were observed across three experience-phases: pre-captivity, during captivity, and post-captivity. The pre-captivity phase included two sub-themes: the Syrian regime's initial detection and arrest system, and the intelligence system. The captivity phase was also divided into two sub-themes: environmental conditions in detention facilities, and torture methods including physical and psychological torture. Some of the environmental conditions in detention facilities included lack of sanitation, crowding, starvation, and withholding of medical care. Torture methods encompassed beatings, electric shocks, nail-pulling, hanging, drowning, suffocation, rape, and the witnessing of killing, sexual assault, or torture of others. The post-captivity phase included their release from captivity, escaping Syria, and post-displacement conditions and activism. CONCLUSIONS The Syrian regime employs a vast security apparatus to track, detain, interrogate, torture, and subjugate its civilian population. A systematic mechanism commences even before captivity and continues for years after release, with negative implications on the well-being of survivors, their families, and the Syrian people as a collective community. The Syrian war saw a shift toward mass detention, torture as a form of social punishment, subjugation, and indeterminate imprisonment. Intervention agencies, host countries, and policymakers must be informed of survivors' experiences to better address their needs. Moreover, the international community must advocate for a firm stance against torture, demand justice, and prosecute all parties engaged in perpetuating such extreme forms of suffering and trauma.
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Kokun O. The Ukrainian Population’s War Losses and Their Psychological and Physical Health. JOURNAL OF LOSS & TRAUMA 2022. [DOI: 10.1080/15325024.2022.2136612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Oleg Kokun
- G.S. Kostiuk Institute of Psychology of National Academy of Educational Sciences of Ukraine, Kyiv, Ukraine
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Kheirallah KA, Al-Zureikat SH, Al-Mistarehi AH, Alsulaiman JW, AlQudah M, Khassawneh AH, Lorettu L, Bellizzi S, Mzayek F, Elbarazi I, Serlin IA. The Association of Conflict-Related Trauma with Markers of Mental Health Among Syrian Refugee Women: The Role of Social Support and Post-Traumatic Growth. Int J Womens Health 2022; 14:1251-1266. [PMID: 36092127 PMCID: PMC9462433 DOI: 10.2147/ijwh.s360465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Syrian refugee women not only suffered the refuging journey but also faced the burden of being the heads of their households in a new community. We aimed to investigate the mental health status, traumatic history, social support, and post-traumatic growth (PTG) of Syrian refugee women. Methods A cross-sectional study was conducted using a structured interviewer-administered survey between August and November 2019. Syrian refugee women who head their households and live outside camps were eligible. The survey included items investigating socio-demographic characteristics and conflict-related physical trauma history. The Refugee Health Screener-15 (RHS-15) scale was used to screen for emotional distress symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), with a score range of 0−4 and higher scores indicating emotional distress. The Multidimensional Scale of Perceived Social Support (MSPSS) was utilized to assess the perceived support from family, friends, and significant others (score range 1−7), with scores of 3−5 and 5.1−7.0 representing moderate and high support, respectively. The PTG Inventory (PTGI) scale investigated the positive transformation following trauma; the score range was 0−5, and the cutoff point of ≥3 defined moderate-to-high growth levels. Results Out of 140 invited refugee women, 95 were included, with a response rate of 67.9%. Their mean (SD) age was 41.30 (11.75) years, 50.5% were widowed, and 17.9% reported their husbands as missing persons. High levels of conflict-related traumatic exposure were found, including threats of personal death (94.7%), physical injury (92.6%), or both (92.6%); and a history of family member death (92.6%), missing (71.6%), or injury (53.7%). The mean (SD) RHS-15 score was above average (2.08 (0.46)), and most women (90.5%) were at high risk for depression, anxiety, and PTSD symptoms. The mean (SD) MSPSS score was 5.08 (0.71), representing moderate social support, with friends’ support being the highest (5.23 (0.85)). The mean (SD) PTGI score was 2.44 (0.48), indicating low growth, with only 12.6% of women experiencing moderate-to-high growth levels. Spiritual change and personal strength had the highest sub-scores, with moderate-to-high growth levels experienced by 97.9% and 84.2%, respectively. Most women were more optimistic and religious, had feelings of self-reliance and better difficulties adapting, and were stronger than they thought. Statistically significant correlations of MSPSS and its subscales with RHS-15 and PTGI were detected. Conclusion Significant but unspoken mental health problems were highly prevalent among Syrian refugee women and an imminent need for psychological support to overcome traumatic exposure. The role of social support seems to be prominent and needs further investigation.
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Affiliation(s)
- Khalid A Kheirallah
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sarah H Al-Zureikat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Mohammad AlQudah
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Adi H Khassawneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Saverio Bellizzi
- World Health Organization (WHO), Jordan Country Office, Amman, Jordan
| | - Fawaz Mzayek
- School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ilene A Serlin
- International Institute for Advanced Training in Dance Movement Therapy, San Francisco, CA, USA
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Jolof L, Rocca P, Mazaheri M, Okenwa Emegwa L, Carlsson T. Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies. Confl Health 2022; 16:46. [PMID: 36071504 PMCID: PMC9450290 DOI: 10.1186/s13031-022-00481-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background A significant proportion of the global population is displaced, many being women. Qualitative studies can generate in-depth findings that will contribute to an understanding of their experiences, but there is a need for further synthetization efforts. The aim was to provide a comprehensive perspective about adult women’s experiences of armed conflicts and forced migration, focusing on women in or from countries in the Middle East, Balkans, or Africa. Methods Systematic review of English reports presenting empirical qualitative studies published in scientific journals 1980 or later, utilizing searches performed in September 2021 within three databases combined with manual screening. Of the 3 800 records screened in total, 26 were included. Methodological details and quality were appraised using pre-specified extraction and appraisal tools. The findings within the included reports were analyzed with thematic analysis. Results Most reports utilized interviews, including in total 494 participants, and were appraised as having insignificant methodological limitations. The first theme concerns changed living conditions, involving reduced safety, insufficient access to resources meeting basic needs, forced migration as a last resort, and some positive effects. The second theme concerns the experienced health-related consequences, involving psychological distress, risks during pregnancy and childbirth, exposure to violence and discrimination as a woman, as well as a lack of adequate healthcare services and social support. The third theme concerns the resources and strategies that enhance resilience, involving social support and family life, as well as utilization of internal resources and strategies. Conclusion When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-022-00481-x.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected By War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected By War and Torture, Malmö, Sweden
| | - Monir Mazaheri
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Leah Okenwa Emegwa
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden. .,The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Kaufmann C, Zehetmair C, Jahn R, Marungu R, Cranz A, Kindermann D, Friederich HC, Bozorgmehr K, Nikendei C. Maternal mental healthcare needs of refugee women in a State Registration and Reception Centre in Germany: A descriptive study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1608-1617. [PMID: 34250665 DOI: 10.1111/hsc.13508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 04/28/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
Pregnant refugees and new mothers are at high risk of developing mental health problems. Previous research has highlighted an increase in adverse pre-, peri- and postpartum outcomes in refugee women and their newborns. This descriptive study aimed to present the characteristics and needs of refugee women who attended a psychosocial walk-in clinic addressing pregnant refugees' and new mothers' maternity mental healthcare needs in a state registration and reception centre in Germany. We assessed all patients that consulted the clinic and received interventions during the first 28 weeks after it opened, collecting information on symptoms, diagnoses, attitudes towards and experience of pregnancy, birth, obstetric care and applied psychosocial interventions during consultations. Between November 2017 and May 2018, N = 120 pregnant refugees and new mothers attended the clinic. Most patients were diagnosed with post-traumatic stress-, adjustment- or depressive disorder. While 69.6% of the women reported physical and mental health problems during pregnancy, 87.4% experienced obstetric complications. Trauma-informed and psychoeducational interventions were primarily used during counselling sessions. Our data underpin the glaring disparities in refugee maternal healthcare in Germany. Maternal care designed to meet the specific needs of pregnant refugees and mothers is essential. More targeted, evidence-based and cost-effective interventions are needed. Our psychosocial walk-in clinic is a first step towards ensuring primary care delivery for refugee women during the particularly vulnerable period of pregnancy and early motherhood.
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Affiliation(s)
- Claudia Kaufmann
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Catharina Zehetmair
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Rosa Jahn
- Department for General Medicine and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
| | - Rosi Marungu
- Department for General Medicine and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
| | - Anna Cranz
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - David Kindermann
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department for General Medicine and Health Services Research, University Hospital of Heidelberg, Heidelberg, Germany
- Department for Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Germany
| | - Christoph Nikendei
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
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Mobaraka J, Elkazzaz L, Rizkalla N. Challenges of Researchers in Conducting International Study during the Eruption of COVID-19: Student and Mentor Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:844. [PMID: 35055666 PMCID: PMC8775695 DOI: 10.3390/ijerph19020844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/14/2021] [Accepted: 01/07/2022] [Indexed: 11/16/2022]
Abstract
Conducting an international research study may bear various challenges; however, during the global COVID-19 crisis, such a study undertakes unpredictable trajectories. This paper explores the challenges experienced by researchers studying Syrian refugees' physical and mental health and aid workers serving under humanitarian organizations in Lebanon. It includes information about the changes in the study's goals and design with the emergence and spread of SARS-CoV-2, as necessitated by the circumstances COVID-19 imposed. It focuses on the unique perspectives of the research team of two students and their mentor who faced multiple challenges while involved in the study, and their narratives and subjective experiences that led to new opportunities for growth in the project. The research team specifically engaged in humanistic and existential psychology in order to conduct research in a manner conducive to personal and professional development, productivity and growth. To conclude, the researchers propose recommendations to the academic community on mitigating some of the challenges faced when conducting international research, and suggestions to the humanitarian sector serving vulnerable populations in conflict zones during COVID-19.
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Affiliation(s)
- Jenail Mobaraka
- Center for Middle Eastern Studies, University of California Berkeley, 340 Stephens Hall, Berkeley, CA 94720-2314, USA;
| | - Lian Elkazzaz
- Global Studies, University of California Berkeley, 101 Stephens Hall, Berkeley, CA 94720-2306, USA;
| | - Niveen Rizkalla
- Center for Middle Eastern Studies, University of California Berkeley, 340 Stephens Hall, Berkeley, CA 94720-2314, USA;
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Rahmani M, Muzwagi A, Pumariega AJ. Cultural Factors in Disaster Response Among Diverse Children and Youth Around the World. Curr Psychiatry Rep 2022; 24:481-491. [PMID: 35953637 PMCID: PMC9371955 DOI: 10.1007/s11920-022-01356-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Disasters and traumatic events are ever present globally but disproportionally impact culturally diverse low resource environments. Culture is an important context through which people experience disasters, develop adaptive strategies, and process external aid and support. This is even more critical for children and youth who are in the process of forming their cultural/ethnic identities. This review identifies literature on these important aspects of culture in disaster response. RECENT FINDINGS The literature supports that culture influences the experience of disasters, the development of coping and adaptational approaches, and the acceptability of external aid and support, especially mental health services. Cultural humility, awareness, and sensitivity are crucial in addressing the traumatic impact of disasters in children and youth, especially in the areas of the world that are most at risk for them.
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Affiliation(s)
- Mariam Rahmani
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Springhill 2 Building, 4197 NW 86th Terrace, Gainesville, FL, 32606, USA.
| | - Ashraf Muzwagi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Springhill 2 Building, 4197 NW 86th Terrace, Gainesville, FL 32606 USA
| | - Andres J. Pumariega
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida College of Medicine, Springhill 2 Building, 4197 NW 86th Terrace, Gainesville, FL 32606 USA
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Al-Natour A, Morris EJ, Mohammad Al-Ostaz S. Through Her Eyes: The Impact of War on Syrian Refugee Families. J Transcult Nurs 2021; 33:26-32. [PMID: 34323146 DOI: 10.1177/10436596211026367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Syrian war conflict ended with devastating impact on Syrian refugee women and their children. A few studies have been done that explored the impact of the civil war and displacement of Syrian families from a cultural perspective. The purpose of this study was to highlight the experiences of the Syrian war-refugee families who have sought shelter in a host country. METHOD A descriptive phenomenological study was conducted using a semistructured interview approach among 16 Syrian refugee women who were approached from two Jordanian health care centers. RESULTS The main themes discussed how the war ended with financial and social stress, family violence, and hazardous effects on women and children health. CONCLUSION This article introduced how culture and religion influence how family unit and members responded to war stressors. This study provided transcultural nursing knowledge, allowing nurses to be grounded in individualized culturally specific care.
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Abstract
Women are the silent sufferers of war, they have higher rates of anxiety and depression after terror events than men who have been similarly exposed. In this study, we aim to explore the prevalence of anxiety, depression and suicidal thoughts/attempts among Iraqi women post-conflict. A sample of 1000 women was collected in this cross-sectional study that was conducted in Baghdad city from January through September 2020. Their mental state was addressed by assessing anxiety and depression on symptomatic basis using standard questions from the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) scale. The results showed that the vast majority (91.1%) of the sampled women had experienced war-related trauma since 2003. Anxiety symptoms were reported by 39.7% of the women, depressive symptoms by 34.2% and suicidal thoughts/attempts by 35.8%. More than two-thirds of the women experienced difficulties in their social life and relationships. The majority of the studied women had negative expectations regarding their future and more than half of them expressed their intention to emigrate. The findings of this study indicate that anxiety, depression and suicidal thoughts/attempts are prevalent among this sample of Iraqi women post-conflict. Significant associated factors were losing a husband and having early married girls in the household.
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Affiliation(s)
- Riyadh K Lafta
- Family and Community Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq
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14
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Zehetmair C, Kindermann D, Tegeler I, Derreza-Greeven C, Cranz A, Friederich HC, Nikendei C. A Qualitative Evaluation of a Mother and Child Center Providing Psychosocial Support to Newly Arrived Female Refugees in a Registration and Reception Center in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094480. [PMID: 33922525 PMCID: PMC8122916 DOI: 10.3390/ijerph18094480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/29/2022]
Abstract
Female refugees are frequently exposed to sexualized, gender-based violence and harassment before, during, and after their flight. Yet female refugee-specific care and protection needs are rarely addressed in host countries. This study aimed to evaluate a mother and child center (MUKI) for female refugees in a reception and registration center in Germany. In 2017, we conducted semi-structured qualitative interviews with 16 female refugees attending the MUKI and with its five main staff members. We asked the participants about the MUKI’s relevance, encountered difficulties, and suggestions for improvement. The interviewees appreciated the MUKI’s sheltered environment, care services, and socializing opportunities, as well as its women-only concept. Overall, the participants saw overexertion, social engagement-related difficulties, and the MUKI’s noisy environment as key attendance barriers. Interviewed staff primarily reported problems regarding the working conditions, including the high staff and attendee turnover and low general service awareness. The participants advocated an expansion of the MUKI program. The MUKI project underlines that providing newly arrived, vulnerable female refugees with sheltered surroundings and psychosocial services is an essential step toward addressing female refugees’ specific care needs.
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15
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The Impact of War-Related Stress on Coronary Artery Disease Severity in War Survivors: A SYNTAX Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063233. [PMID: 33800972 PMCID: PMC8004035 DOI: 10.3390/ijerph18063233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022]
Abstract
Background: Due to the strong relationship between stress and heart disease, particularly acute myocardial infarction (MI), this study investigated the complexity of coronary artery disease (CAD) among Syrian refugee patients referred to Jordan University Hospital and its relation to war-related stressors. Methods: This is a retrospective study that utilized the SYNTAX I score in order to evaluate all Syrian refugees that underwent coronary artery catheterization at Jordan University Hospital during the period between May of 2014 and December of 2017. Results: There was a significant association between war-related stressors and high SYNTAX score (SX score), thus indicating a higher complexity of CAD in Syrian war survivors with higher stress scores. The strongest war-related correlation was observed with crossing green-lines, in which Syrian refugee patients who had crossed such lines had significantly higher SYNTAX scores. Regression analysis demonstrated that war stressors were positive predictors of increased SYNTAX scores even when adjusted for conventional CAD risk factors. Surprisingly, none of the CAD risk factors were significantly associated with SYNTAX score. Conclusion: Our findings suggest that exposure to multiple war-related stressors may increase the complexity and severity of CAD in Syrian war survivors. Thus, special attention, efforts, and resources should be allocated to screen for such vulnerable patients in order to provide them with the appropriate healthcare.
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16
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Rizkalla N, Adi S, Mallat NK, Soudi L, Arafa R, Segal SP. Manzuaat wa Musharadat, Uprooted and Scattered: Refugee Women Escape Journey and the Longing to Return to Syria. Front Psychol 2021; 12:537131. [PMID: 33603695 PMCID: PMC7884327 DOI: 10.3389/fpsyg.2021.537131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Violent conflict forced millions of Syrians to flee their homes to host countries. This study examines Syrian refugee women's experiences from the war's outset through their journey to Jordan. It addresses the toll this journey had on their lives. METHODS Twenty-four in-depth interviews were completed with Syrian refugee women who currently reside in urban areas of Jordan. Researchers translated, transcribed, and analyzed the interviews using group narrative methodology. RESULTS The Syrian women had unique nostalgic memories of times before the war. They experienced atrocities during the war that forced their decision to escape Syria. Their journey narratives testify of internal displacement, personal and collective traumatic journeys via legal and illegal routes. Almost all the women were placed in refugee camps during their transitions to host country residency. In Jordan, they faced diverse hurdles of displacement and extremely different realities compared to the ones they had in Syria. Despite how very different but difficult each of their journeys were, every single woman longed to return home to Syria. CONCLUSIONS This study presents a new understanding of the role and process of the journeys undertaken and highlights the concept of "return" as the defining element for Syrian refugee women. Regardless of the hardships women endured to escape their homeland to find safety, "return" marks an ending to their horror journey and the beginning of a new journey of hope for a better future.
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Affiliation(s)
- Niveen Rizkalla
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Suher Adi
- Political Science & Middle Eastern Studies, University of California, Berkeley, Berkeley, CA, United States
| | - Nour Khaddaj Mallat
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Laila Soudi
- School of Medicine, Stanford University, Stanford, CA, United States
| | - Rahma Arafa
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Steven P. Segal
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
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17
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Rizkalla N, Mallat NK, Arafa R, Adi S, Soudi L, Segal SP. "Children Are Not Children Anymore; They Are a Lost Generation": Adverse Physical and Mental Health Consequences on Syrian Refugee Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228378. [PMID: 33198333 PMCID: PMC7696198 DOI: 10.3390/ijerph17228378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
This research examines Syrian refugee mothers’ accounts of the physical and mental health of their children being affected by war traumas and displacement challenges. Open-ended audio-recorded interviews were conducted in Arabic with 23 mothers residing in Jordan. Using a narrative approach in the data collection and analysis, five major themes were identified: (1) children were exposed to diverse war traumatic experiences in Syria; (2) the escape journey and refugee camps threatened children’s lives; (3) displacement and family stressors exposed children to poverty, hostility from local peers, educational and recreational challenges, child labor, and domestic violence (these three major themes were considered as trauma related variables); (4) children were not only directly affected physically and mentally by their own traumatic experiences and displacement stressors, but these experiences were mediated and magnified by familial interrelated processes, evidenced in intergenerational transmission of trauma, harsh parenting style, parental control, and parentification; and (5) adverse consequences of both trauma related variables and family processes directly and indirectly traumatized children and adversely impacted their physical and mental health. We examined the themes that emerged from the data in view of three theoretical frameworks and the impact of trauma in the family system on child development. To conclude, humanitarian organizations that provide services and interventions to refugees need to take into account familial processes and not only individual factors affecting refugee children’s physical and mental health. Further implications on policies and trauma research are discussed.
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Affiliation(s)
- Niveen Rizkalla
- Mack Center on Mental Health & Social Conflict, School of Social Welfare, University of California Berkeley, 120 Haviland Hall, #7400, Berkeley, CA 94720, USA;
- Correspondence: ; Tel.: +1-510-230-6422
| | - Nour K. Mallat
- School of Public Health, University of California Berkeley, 2121, Berkeley Way #5302, Berkeley, CA 94704, USA; (N.K.M.); (R.A.)
| | - Rahma Arafa
- School of Public Health, University of California Berkeley, 2121, Berkeley Way #5302, Berkeley, CA 94704, USA; (N.K.M.); (R.A.)
| | - Suher Adi
- Political Science & Middle Eastern Studies, University of California Berkeley, 210 Barrows Hall #1950, Berkeley, CA 94720, USA;
| | - Laila Soudi
- School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA;
| | - Steven P. Segal
- Mack Center on Mental Health & Social Conflict, School of Social Welfare, University of California Berkeley, 120 Haviland Hall, #7400, Berkeley, CA 94720, USA;
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18
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Affiliation(s)
- Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
| | - Julia Schellong
- Department of Psychosomatic Medicine and Psychotherapy, Carl Gustav Carus University Hospital of Dresden, Technical University of Dresden, Germany
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19
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McGrath M, Acarturk C, Roberts B, Ilkkursun Z, Sondorp E, Sijbrandij M, Cuijpers P, Ventevogel P, McKee M, Fuhr DC. Somatic distress among Syrian refugees in Istanbul, Turkey: A cross-sectional study. J Psychosom Res 2020; 132:109993. [PMID: 32172038 DOI: 10.1016/j.jpsychores.2020.109993] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 12/12/2022]
Affiliation(s)
- M McGrath
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
| | - C Acarturk
- Department of Psychology, Koç University, Istanbul, Turkey.
| | - B Roberts
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
| | - Z Ilkkursun
- Department of Psychology, Koç University, Istanbul, Turkey
| | - E Sondorp
- KIT Royal Tropical Institute, Amsterdam, The Netherlands.
| | - M Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
| | - P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
| | - P Ventevogel
- Public Health Section, Division of Programme Management and Support, United Nations High Commissioner for Refugees, Geneva, Switzerland.
| | - M McKee
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
| | - D C Fuhr
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, United Kingdom.
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20
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Traumatic Experiences and Mental Health Risk for Refugees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061943. [PMID: 32188119 PMCID: PMC7143439 DOI: 10.3390/ijerph17061943] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023]
Abstract
Refugees who settle in Western countries exhibit a high rate of mental health issues, which are often related to experiences throughout the pre-displacement, displacement, and post-displacement processes. Early detection of mental health symptoms could increase positive outcomes in this vulnerable population. The rates and predictors of positive screenings for mental health symptoms were examined among a large sample of refugees, individuals with special immigrant visas, and parolees/entrants (N = 8149) from diverse nationalities. Logistic regression analyses were used to determine if demographic factors and witnessing/experiencing violence predicted positive screenings. On a smaller subset of the sample, we calculated referral acceptance rate by country of origin. Refugees from Syria, Iraq, and Afghanistan were most likely to exhibit a positive screening for mental health symptoms. Refugees from Sudan, Iraq, and Syria reported the highest rate of experiencing violence, whereas those from Iraq, Sudan, and the Democratic Republic of Congo reported the highest rate of witnessing violence. Both witnessing and experiencing violence predicted positive Refugee Health Screener-15 (RHS-15) scores. Further, higher age and female gender predicted positive RHS-15 scores, though neither demographic variable was correlated with accepting a referral for mental health services. The findings from this study can help to identify characteristics that may be associated with risk for mental health symptoms among a refugee population.
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