Interventions to improve the mental health or mental well-being of migrants and ethnic minority groups in Europe: A scoping review

Addressing Social Determinants of Health to Promote Health Equity for Latinx Families: A Mixed-Methods Study of the DULCE Intervention

BACKGROUND

Social determinants of health (SDOH) interventions within clinical settings have been proposed to address health-related social needs, but few studies have explored intervention needs and challenges for Latinx families. This sequential mixed-methods study examined the effect of Developmental Understanding and Legal Collaboration for Everyone (DULCE), a 6-month SDOH intervention conducted in pediatric clinics in California and Florida.

METHODS

Using survey data collected among Latinx caregivers who participated in the DULCE evaluation (n = 393), we examined changes in caregivers' depression, stress, and resilience, including differences by nativity. Qualitative interviews were conducted with DULCE participants (n = 16) across nativity to elucidate the components of the intervention that impacted caregiver outcomes.

RESULTS

DULCE led to significant increases in resilience among Latinx caregivers, especially immigrants, but no changes in depression or stress. Qualitative interviews illuminated that the following themes contributed to caregivers' resilience through the DULCE program: trusted relationship with family specialist caseworkers, connection to critical resources, addressing postpartum depression and social isolation, building caregivers' capacity to withstand challenges, and bolstering caregivers' confidence to seek resources independently.

DISCUSSION

Pediatric SDOH interventions are a promising strategy to support Latinx families in early childhood. Effective interventions for Latinx families, however, require strategies that pair resource connection with relationship building, address immigrants' and Latinx system avoidance, and incorporate additional supports or boosters for families experiencing extreme stress.

Exploring the barriers to mental health help-seeking among African Migrants in Australia: A qualitative study

BACKGROUND

The health of African migrants in Australia is a largely under-researched topic despite the steadily increasing size of the population and its uniqueness. In particular, few studies have explored the mental health of African migrants in Australia or their utilization of mental health services.

AIMS

This study explored the barriers to mental health help-seeking among first-generation African migrants in Australia.

METHODS

In this qualitative study conducted using the hermeneutical phenomenological research approach, the purposive sampling method was used to recruit participants. In-depth interviews with participants were undertaken online via Zoom, Teams, and WhatsApp calls. Interviews were recorded and transcribed verbatim, utilizing a thematic analysis as the primary data analysis method.

RESULTS

African migrants were more inclined to seek support for mental health conditions from religious figures such as priests instead of seeking professional help. Religion and poor knowledge about mental illness were highlighted as barriers to mental health help-seeking. Participants also considered cultural beliefs, fear of stigma as well as the high cost of healthcare in Australia as significant barriers to mental health help-seeking among African migrants.

CONCLUSIONS

Findings reinforce the critical need for culturally competent mental health services tailored to the beliefs, values, religion, and experiences of African and other migrant communities in Australia. Given the strong attachment of many African migrants in Australia to their cultural and religious beliefs, such services are essential for practical support and intervention.

Effectiveness of a stepped-care programme of WHO psychological interventions in a population of migrants: results from the RESPOND randomized controlled trial

Migrant populations - including labour migrants, undocumented migrants, asylum seekers, refugees, internationally displaced persons, and other populations on the move - are exposed to a variety of stressors that affect their mental health. We designed and tested the effectiveness of a stepped-care programme consisting of two scalable psychological interventions developed by the World Health Organization (WHO) and locally adapted for migrant populations. A parallel-group randomized controlled trial was conducted in Italy. We recruited migrant adults (≥18 years) with psychological distress (score of at least 16 on the Kessler Psychological Distress Scale, K10). The experimental arm received psychological first aid (PFA) and a stepped-care programme consisting of two WHO interventions adapted for this population group: first, Doing What Matters in Times of Stress (DWM) and, for participants who still reported significant levels of psychological distress after DWM, Problem Management Plus (PM+). Each intervention lasted 5-6 weeks and was delivered remotely by lay facilitators. The control arm received PFA and care as usual (CAU). The primary outcome was the change in symptoms of depression and anxiety from baseline to week 21 after randomization, measured by the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Between December 14, 2021 and April 18, 2023, 108 migrants were randomized to the stepped-care intervention and 109 to CAU. Analysis of the primary outcome revealed that participants receiving the stepped-care programme showed a greater reduction in anxiety and depression symptoms compared to those receiving CAU (coefficient: -3.460, standard error, SE: 1.050, p=0.001) at week 21. The same difference was observed at week 7 (coefficient: -3.742, SE=1.008, p<0.001) and week 14 (coefficient: -6.381, SE=1.039, p<0.001). The stepped-care programme was also associated with a greater improvement of depression and anxiety symptoms assessed separately at all timepoints, of post-traumatic stress disorder symptoms at weeks 14 and 21, and of self-assessed problems, function and well-being at all timepoints. No serious adverse events occurred. This study provides evidence supporting the stepped-care delivery of DWM and PM+ for migrant population groups with elevated distress. As these interventions are low-intensity, transdiagnostic and task-shifting, they are highly scalable. Existing evidence-based guidelines and implementation packages should be updated accordingly.

Immigration status and depression in Spain: analysis of the European Health Interview Surveys of 2014 and 2020

OBJECTIVE

We examined the association between immigration status and depression in a nationally representative sample of adults in Spain. In addition, we assessed whether this association differed by sex/gender and social support.

METHOD

We used de-identified data from the European Health Interview Survey conducted in Spain in 2014 (n=21,226) and 2020 (n=20,136). Our study outcomes were self-reported diagnosis of depression and antidepressant use. We fitted Poisson regression models to quantify the association between immigration status and each outcome, before and after adjusting for age, sex/gender, marital status, educational level, employment status, smoking status, healthcare use, social support, and self-rated health. We obtained prevalence ratios (PR) and 95% confidence intervals (95%CI). We also tested interaction terms to evaluate whether the associations of interest differed by survey year and further by sex/gender and with social support.

RESULTS

In 2014 and 2020, we observed a lower prevalence of depression among immigrant adults than among native Spanish adults (adjusted PR2014=0.53, 95%CI: 0.40- 0.70; PR2020=0.71, 95%CI: 0.55-0.91). However, for antidepressant use, this association was significant only in 2014 (adjusted PR2014=0.36, 95%CI: 0.24-0.55). Although the association of immigration status with antidepressant use differed with survey year, these associations did not change with sex/gender or social support.

CONCLUSIONS

Our findings call attention to depression and mental health-related outcomes in Spain, regardless of immigration status, sex/gender or social support.

Using normalisation process theory to identify factors facilitating the scaling up of parenting programs for immigrant parents

Objective

As most studies focus on the initial adaptation of culturally tailored parenting programs in real-world settings, scalability and sustainability remain understudied. In this study, we used normalization process theory (NPT) as a conceptual framework to identify and understand the contextual factors impacting the scalability and sustainability of a culturally tailored parenting program, Ladnaan, in three Swedish municipalities.

Method

Nineteen managers, coordinators, and group leaders completed a survey and participated in individual or focus group interviews.

Results

Our analyses showed that participants agreed on the need for the Ladnaan intervention among immigrant families. However, they were concerned that insufficient resources may hinder the recruitment and retention of parents, particularly as certain resources were allocated to the delivery of other, non-evidence-based interventions. Both managers and coordinators emphasized that embedding Ladnaan into everyday practice is conditioned on the collective work and engagement of all stakeholders, which will occur only if local authorities feel they own the program. The recruitment and retention of group leaders was mentioned as a key challenge in sustaining Ladnaan as the need for the program fluctuated over time.

Conclusion

These findings highlight the importance of promoting evidence-based programs within the services available for forcibly displaced parents, and of coordinating efforts to scale up and sustain these programs.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.