Ethiopian refugees in the UK: migration, adaptation and settlement experiences and their relevance to health

Migrants' living conditions, perceived health needs and implications for the use of antibiotics and antimicrobial resistance in the United Kingdom: A qualitative study

Background and Aims

Antimicrobial resistance (AMR) is among the top public health concerns around the globe. Migrants, especially forced migrants, could be at higher risk of acquiring and transmitting AMR during their journeys or in host countries. There is limited understanding regarding migrants' living conditions and the wider factors contributing to their risk of acquiring infections, and behaviors around antimicrobial use, and AMR development. In this study, we aimed to explore transit experiences, living conditions, and antibiotic use of migrants living in the United Kingdom.

Methods

We conducted semistructured qualitative interviews with 27 participants and identified five themes regarding migrants' journey and their living conditions during transit and after arriving in the United Kingdom, their access to water, sanitation and hygiene (WASH), and their use of antibiotics.

Results

Migrants, particularly forced migrants, experienced unfavorable living conditions, poor access to WASH, and challenges in accessing healthcare, which further contributed to health conditions like urinary and skin problems. Isolation and difficulty in accessing healthcare played significant roles in migrants' perceived need for storing and using antibiotics as a safety net.

Conclusion

The findings highlight the need for coordinated and multilevel interventions to address these challenges and contribute toward tackling AMR and improving the health of this population group.

Barriers and facilitators to seeking and accessing mental health support in primary care and the community among female migrants in Europe: a "feminisms" systematic review

BACKGROUND

Recent years have seen record levels of migration to Europe. Female migrants are at heightened risk of developing mental health disorders, yet they face barriers to accessing mental health services in their host countries. This systematic review aims to summarise the barriers and facilitators to accessing mental health support for female migrants in Europe.

METHODS

The review follows PRISMA guidelines, and the protocol was pre-published on PROSPERO. Six electronic databases were searched: CINAHL, Global Health Database, Medline, PsycARTICLES, PsycINFO and Web of Science. Thematic analysis was undertaken on the identified studies. A feminist quality appraisal tool was applied.

RESULTS

Eight qualitative, six quantitative and five mixed methods studies were identified. Barriers included a lack of information, stigma, religious and cultural practices and beliefs, and a lack of consideration of gender-specific needs within the health system. Gender-sensitive services, supportive general practitioners and religious leaders facilitated access.

CONCLUSIONS

The design of mental health research, services, policies, and commissioning of support for migrants must consider female migrant needs. Mental health support services must be culturally aware and gender sensitive.

REGISTRATION

The review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42021235571.

Increased social identification is linked with lower depressive and anxiety symptoms among ethnic minorities and migrants: A systematic review and meta-analysis

Evidence suggests that social identities, which provide purpose and a sense of belonging to the social world, promote resilience against psychological strain and protect well-being. This is especially important in ethnic minorities, who experience exclusion and discrimination from the majority group, and in migrant populations where adverse experiences, such as prejudice, disconnection from previous identities and issues of integration into the host country, negatively impact well-being. Drawing from the social identity theory, a meta-analysis was conducted examining the influence of group memberships and sense of belonging on ethnic minority and migrant mental health (depression and anxiety). The final search on three databases (i.e., PubMed, PsycINFO, Web of Science) was conducted on August 9th, 2022, identifying 3236 citations before removing any duplicates within and between databases. Across the 74 studies that met the inclusion criteria for the meta-analysis, increased social identification (ethnic, national and other types of identification) was associated with low psychological symptoms. We found that social identification is protective against common psychological disorders but with small effect sizes for depression (r = - 0.09, CI = [- 0.12; - 0.06]) and anxiety (r = - 0.08, CI [- 0.12; - 0.03]). Results are discussed with regard to the role that social context plays on ethnic minority and migrant mental health and the importance of facilitating migrant integration with the host society after displacement.

Psychosocial Attributes of Housing and Their Relationship With Health Among Refugee and Asylum-Seeking Populations in High-Income Countries: Systematic Review

Objectives: Housing as a social determinant of health should provide not only shelter, but also a feeling of home. We explored psychosocial pathways creating a sense of home and influencing the relationship between housing and health among asylum seekers and refugees (ASR) in high-income countries. Methods: We performed a systematic review. To be included, studies had to be peer-reviewed, published between 1995 and 2022, and focus on housing and health of ASR in high-income countries. We conducted a narrative synthesis. Results: 32 studies met the inclusion criteria. The psychosocial attributes influencing health most often identified were control, followed by expressing status, satisfaction, and demand. Most attributes overlap with material/physical attributes and have an impact on ASR's mental health. They are closely interconnected with each other. Conclusion: Psychosocial attributes of housing play an essential role in the health of ASR; they are closely associated with material/physical attributes. Therefore, future research on housing and health of ASR should routinely study psychosocial attributes, but always in association with physical ones. The connections between these attributes are complex and need to be further explored. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021239495.

Refugee mental health and the role of place in the Global North countries: A scoping review

Post-migration factors significantly influence refugee mental health. This scoping review looks at the role of place in refugee mental health. We included 34 studies in Global North high-income countries that elaborated on the place characteristics of facilities, neighbourhoods, urban and rural areas, and countries. While the role of place remains under-theorised, all studies reveal common characteristics that support a strong relationship between place of residence, refugee mental health and wellbeing outcomes in post-migration context. Given that refugees often have little or no choice of where they ultimately live, we suggest future research should focus on how characteristics of place co-constitute post-migration refugee mental health risks, protections, and outcomes.

Acculturative Stress, Perceived Social Support, and Mental Health: The Mediating Effect of Negative Emotions Associated with Discrimination

The role of perceived social support in the acculturation process of immigrants remains unclear. In this study, we jointly evaluated the associations between acculturative stress and negative emotions associated with discrimination as antecedents of anxiety, depression, and stress symptoms in 283 immigrants living in Chile. Three competing models were tested via structural equation modelling to assess (1) the association among these variables and mental health symptoms and (2) to clarify the role of perceived social support. The third model was theoretically more adequate, showed a better fit, and explained 42.7% of the variance of mental health symptoms. In this model, perceived social support was associated with acculturative stress by reducing mental health symptomatology. Moreover, a direct relationship and an indirect relationship were found between acculturative stress (through negative emotions associated with discrimination) and mental health symptomatology. These results contribute to the understanding of the acculturation process experienced by immigrants in Chile and provide empirical evidence to be used to improve migration policies.

Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees

Background

Many refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees.

Method

We focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis.

Results

In both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help.

Conclusion

Results suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size.

Coping with Trauma and Symptoms of Post-Traumatic Stress Disorder: Exploring Intentions and Lay Beliefs about Appropriate Strategies among Asylum-Seeking Migrants from Sub-Saharan Africa in Germany

Asylum-seekers are at high risk of developing post-traumatic stress disorder (PTSD) due to frequent exposure to trauma. We investigated the coping intentions and lay beliefs about appropriate coping strategies among asylum-seekers from Sub-Saharan Africa in Germany. The study applied a methodological triangulation strategy with a vignette describing symptoms of PTSD. In a quantitative part, asylum-seekers (n = 119) that were predominantly from Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25), and a native comparison sample (n = 120) responded to questionnaires assessing coping, traumatic events, and post-traumatic symptoms. In a qualitative part, asylum-seekers (n = 26) discussed coping strategies in focus groups. In the quantitative part, asylum-seekers displayed higher intentions for religious coping, emotional support, and denial compared to the native participants. Asylum-seekers with a higher symptom load expressed lower intentions to seek instrumental support. Asylum-seekers with a lower educational level and those with a higher symptom load expressed higher intentions for substance use. In the qualitative part, we identified three superordinate themes: (a) religion, (b) social support systems, and (c) cognitive strategies. Asylum-seekers expressed coping intentions that are associated with an adaptive response to trauma. Less-educated asylum-seekers with a higher symptom load might constitute a particularly vulnerable group.

Psychological distress among Ethiopian migrant returnees who were in quarantine in the context of COVID-19: institution-based cross-sectional study

BACKGROUND

In association with the novel coronavirus (SARS-CoV-2) disease 2019 (COVID-19) pandemic, many numbers of Ethiopian migrants are returning to their home country, and they are required to stay in mandatory quarantine centers. This results in severe disruptions of life routines, social isolation, and loss of freedom. Studies on psychological distress among Ethiopian migrant returnees in the context of COVID-19 are scarce. This study aimed to investigate the prevalence of psychological distress and associated factors among migrant returnees who were in quarantine during the time of COVID-19.

METHODS

A cross-sectional study was conducted with 405 migrant returnees recruited from quarantine centers in Addis Ababa. We developed a structured questionnaire to collect data on sociodemographic, migration related, quarantine related and COVID-19 related characteristics of participants. We used the 21 item Depression, Anxiety and Stress Scale to assess psychological distress. Univariate and multivariable negative binomial regression models were fitted to assess the association between exposure variables with depression, anxiety and stress separately.

RESULTS

A little more than half of the participants (55%) had depressive symptoms; around half had anxiety symptoms (48.9%) and more than a third (35.6%) experienced symptoms of stress. We found significantly higher prevalence of anxiety (ARR = 0.59; 95% CI = 0.39, 0.91) and depressive symptoms (ARR = 0.56; 95% CI = 0.39, 0.81) among women than men. Fear of discrimination after the quarantine was significantly associated with depressive (ARR = 0.76; 95% CI = 0.63, 0.92) and anxiety symptoms (ARR = 0.77; 95% CI = 0.62, 0.97). Experiencing COVID-19 like symptoms is associated with depressive (ARR = 0.40; 95% CI = 0.25, 0.65), anxiety (ARR = 0.35; 95% CI = 0.20, 0.62) and stress symptoms (ARR = 0.43; 95% CI = 0.28, 0.66). Have no a plan of what to do after the quarantine (ARR = 1.30; 95% CI = 1.09, 1.54) was significantly associated with increasing stress scores.

CONCLUSIONS

We found a very high prevalence of depressive, anxiety and stress symptoms among Ethiopian migrant returnees who were in quarantine due to the COVID-19 pandemic. Screening, integration of mental health services with other socioeconomic and psychosocial services, and effective and efficient referral may be useful to address the burden of psychological distress in this group.

Healthcare access for asylum seekers and refugees in England: a mixed methods study exploring service users' and health care professionals' awareness

BACKGROUND

With the aim of decreasing immigration, the British government extended charging for healthcare in England for certain migrants in 2017. There is concern these policies amplify the barriers to healthcare already faced by asylum seekers and refugees (ASRs). Awareness has been shown to be fundamental to access. This article jointly explores (i) health care professionals' (HCPs) awareness of migrants' eligibility for healthcare, and (ii) ASRs' awareness of health services.

METHODS

Mixed methods were used. Quantitative survey data explored HCPs' awareness of migrants' eligibility to healthcare after the extension of charging regulations. Qualitative data from semi-structured interviews with ASRs were analyzed thematically using Saurman's domains of awareness as a framework.

RESULTS

In total 514 HCPs responded to the survey. Significant gaps in HCPs' awareness of definitions, entitlements and charging regulations were identified. 80% of HCP respondents were not confident defining the immigration categories upon which eligibility for care rests. Only a small minority (6%) reported both awareness and understanding of the charging regulations. In parallel, the 18 ASRs interviewed had poor awareness of their eligibility for free National Health Service care and suitability for particular services. This was compounded by language difficulties, social isolation, frequent asylum dispersal accommodation moves, and poverty.

CONCLUSION

This study identifies significant confusion amongst both HCP and ASR concerning eligibility and healthcare access. The consequent negative impact on health is concerning given the contemporary political climate, where eligibility for healthcare depends on immigration status.

To strive, to seek, to find, and not to yield: Narratives on the road to asylum

This study aimed to explore the ecological influences on subjective well-being identified by current and former community-dwelling asylum seekers engaged in the process of Refugee Status Determination in Australia. This article presents the qualitative component of a prospective mixed-methods study of 131 asylum seekers and refugees (T1, N = 131; T2, N = 56). The Framework Analysis method was employed to qualitatively analyse the narrative data derived from 187 semi-structured interviews documenting pre-, peri-, and post-migration experiences, and the impact of Australia's asylum policies and procedures. Four overarching themes comprising 15 sub-themes emerged: The Refugee Status Determination process (Waiting; Uncertainty; Worry); Psychosocial factors (Un/employment & gainful activity; Medicare; Accommodation; Family separation & loneliness; Loss); Health and well-being (Mental health; Physical health & somatic issues; Hopelessness; Helplessness); and Protective factors (Hope; Support & social connectivity; Religion). The complex interface between the Refugee Status Determination process, un/employment, and mental health concerns was the most salient finding. Policy implications are discussed in relation to the application of the Convention and Protocol Relating to the Status of Refugees and the Guidelines on the Judicial Approach to Expert Medical Evidence.

Traumatic events and posttraumatic stress disorder in individuals with severe mental illness in a non-western setting: Data from rural Ethiopia

Traumatic events and ensuing stress are not widely studied in individuals with severe mental illness (SMI) despite their increased vulnerability to both. Far less is known about traumatic events and posttrauma reactions in people with SMI in low-resourced settings.

OBJECTIVE

To address this gap in knowledge, our study focused on trauma and its effects for individuals with SMI and their caregivers in rural Ethiopia. Study aims were to identify events that were considered traumatic by stakeholders; characterize the mental health effects of such events; and discern events and posttrauma symptoms most relevant for SMI.

METHOD

Qualitative interviews were gathered from 48 participants in Ethiopia who included individuals with SMI, their caregivers, health care providers, and community and religious leaders.

RESULTS

Based on a combined emic and etic approach, major traumatic events included those commonly experienced in rural Ethiopia (e.g., lost property, forced marriage) and endorsed by individuals with SMI (e.g., restraining or chaining, SMI illness in a low-resourced setting). In addition, traumatic events were identified consistent with Western medical criteria (e.g., physical assault, sexual assault). Posttrauma symptoms that were commonly reported included emotions like anger and sadness; thinking too much; crying; and somatic (e.g., burning sensation) and physiological (e.g., shortness of breath) symptoms. As for symptoms consistent with the Diagnostic and Statistical Manual, we found the presence of all four symptom clusters.

CONCLUSIONS

Overall, results point to the common occurrence of traumatic events and trauma-linked symptoms for individuals with SMI and their caregivers, including as a result of SMI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Asylum seekers' and refugees' experiences of accessing health care: a qualitative study

BACKGROUND

Asylum seekers and refugees (ASRs) often experience poor health in host countries. The United Nations High Commissioner for Refugees (UNHCR) requires hosts to ensure these sanctuary seekers have access to basic health care.

AIM

To identify barriers and facilitators that affect access to health care by ASRs in Wales.

DESIGN & SETTING

Participatory research approach using qualitative focus groups across Wales, which hosts 10 000 refugees.

METHOD

Eight focus groups were undertaken with ASRs, support workers, and volunteers (n = 57).

RESULTS

Specialist NHS-funded services and grant-aided non-governmental organisations (NGOs) facilitated access to health care, including primary care. Most ASRs understood the role of general practice in providing and coordinating care, but were unaware of out-of-hours services. Reported barriers included: language difficulties, health literacy, unrecognised needs, and the cost of travel to appointments. Participants recognised the importance of mental health, but were disappointed by the state of mental health care. Some feared seeking support for mental health from their GP, and few were aware they had the right to move practice if they were unhappy. Written information about health care was not as accessible to refugees as to asylum seekers (ASs). While some participants read such material before consulting, others struggled to access information when in need. Few participants were aware of health prevention services. Even when they knew about services, such as smoking cessation, these services' difficulty in accommodating ASRs was a barrier.

CONCLUSION

The main barriers identified were: availability of interpreters; knowledge about entitlements; and access to specialist services.

Decomposing differences in depressive symptoms between older rural-to-urban migrant workers and their counterparts in mainland China

Background

There has been an increase in older rural-to-urban migrant workers (aged 50 and above) in mainland China, little known about their depressive symptoms. The aim of this study was to identify depressive symptoms among older rural-to-urban migrant workers, as well as explored the factors leading to differences in depressive symptoms between older rural-to-urban migrant workers and their rural counterparts (older rural dwellers) and urban counterparts (older urban residents) in mainland China. The results provided a comprehensive understanding of the depressive symptoms of older rural-to-urban migrant workers, and had great significance for improving the depressive symptoms for this vulnerable group.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015, and coarsened exact matching (CEM) method was employed to control confounding factors. This study employed a Chinese version 10-item short form of the Center for Epidemiologic Studies-Depression Scale (CES-D 10) to measure depressive symptoms, and used the Social-Ecological Model as a framework to explore influential factors related to depressive symptoms. Specifically, the approach of Fairlie’s decomposition was used to parse out differences into observed and unobserved components.

Results

After matching, our findings indicated that the prevalence of depressive symptoms in older rural-to-urban migrant workers was lower than older rural dwellers; and the prevalence of depressive symptoms in older rural-to-urban migrant workers was higher than older urban residents. Fairlie’s decomposition analysis indicated that type of in-house shower, sleeping time at night and ill in the last month were proved to be major contributors to the differences in depressive symptoms between older rural-to-urban migrant workers and older rural dwellers; self-reported health and sleeping time at night were proved to be major contributors to the differences in depressive symptoms between older rural-to-urban migrant workers and older urban residents.

Conclusions

Differences in depressive symptoms between older rural-to-urban migrant workers and their rural and urban counterparts did exist. Our findings contributed to a more reliable understanding in depressive symptoms among older rural-to-urban migrant workers. Our findings would be of referential significance for improving older rural-to-urban migrant workers’ depressive symptoms.

Analysis and critique of 'Transforming children and young people's mental health provision: A green paper': Some implications for refugee children and young people

Adopting a children's rights perspective, a critique and analysis underpinned by documentary research methodology was undertaken in order to assess the extent to which the government's Green Paper (Department of Health and Social Care and Department of Education, 2017. Transforming children and young people's mental health provision: a green paper. Available at: https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper (accessed 7 December 2017)) addresses the mental health and well-being needs of refugee children and young people in England and Wales, identifying strengths, limitations and challenges for future policy and practice. Findings suggest that there is much of potential benefit to refugee children and young people's future mental health and well-being. However, a paradigm shift, explicit in implications, scale and time frame, will be required, if the Green Paper is to achieve those changes in attitudes, practice and service delivery which it anticipates. We argue that this Green Paper's overarching challenge is that it is premised on Western-centric models in its understanding of the experiences of refugee children and young people, and management of trauma and mental health. It fails to recognize the meanings and significance of culture, and of diversity and difference, and the need to invest in all communities in facilitating engagement and support for children and young people's mental health issues.

Perceived stressors and coping mechanisms of female migrant domestic workers in Singapore

INTRODUCTION

Worldwide, there are between 50-67 million migrant domestic workers, the majority of whom are women. In many countries, provisions are not in place to protect female migrant domestic workers. These women may be at risk of occupational and social stressors, including exploitation and abuse, which may negatively impact on their quality of life, including psychological health. Research examining the occupational, social, and psychological needs of FMDWs from a public health perspective is critical to guide the development of policies which ensure wellbeing, prevent abuse, and align with international priorities to improve population health. Though there have been a number of high-profile incidents of exploitation and abuse, there has been limited research on the stressors experienced by these communities, their perceived impact, or coping mechanisms.

MATERIALS AND METHODS

Thematic analysis was used to analyse qualitative free-text written responses collected as part of a cross-sectional survey on the relationship between social and occupational stressors and the health and quality of life of FMDWs in Singapore. Responses correspond to open-ended questions in the qualitative component of the survey examining three domains: causes of stress, coping strategies, and what people can do to help with stress.

RESULTS

Responses from 182 FMDWs were analysed. Key themes were identified around causes of stress (including 'work and agency', 'the pervasiveness of financial need', and 'family and obligation'), coping strategies, and social support. Each theme describes key factors which contribute to the occupational and social stressors experienced and reported by FMDWs.

DISCUSSION

This research highlights the stressors FMDWs in Singapore experience, as well as key coping mechanisms. There is a clear need for policies which facilitate FMDWs' ability to utilise these coping resources, and which protect against coercive or exploitative employment conditions. Strategies are also needed to monitor and evaluate policies intended to protect FMDWs, and to strengthen the implementation of global frameworks targeted at improving workplace conditions and workers' rights.

Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK

Background

Asylum seekers and refugees (ASR) face difficulty accessing health care in host countries. In 2017, NHS charges for overseas visitors were extended to include some community care for refused asylum seekers. There is growing concern that this will increase access difficulties, but no recent research has documented the lived experiences of ASR accessing UK primary health care.

Aim

To examine ASR experiences accessing primary health care in the UK in 2018.

Design and setting

This was a qualitative community-based study. ASR were recruited by criterion-based sampling through voluntary community organisations.

Method

A total of 18 ASR completed face-to-face semi-structured recorded interviews discussing primary care access. Transcripts underwent thematic analysis by three researchers using Penchansky and Thomas’s modified theory of access.

Results

The qualitative data show that participants found primary care services difficult to navigate and negotiate. Dominant themes included language barriers and inadequate interpretation services; lack of awareness of the structure and function of the NHS; difficulty meeting the costs of dental care, prescription fees, and transport to appointments; and the perception of discrimination relating to race, religion, and immigration status.

Conclusion

By centralising the voices of ASR and illustrating the negative consequences of poor healthcare access, this article urges consideration of how access to primary care in the UK can be enhanced for often marginalised individuals with complex needs.

Qualitative exploration of the impact of employment and volunteering upon the health and wellbeing of African refugees settled in regional Australia: a refugee perspective

BACKGROUND

People from refugee backgrounds face various challenges after moving to a new country. Successfully securing employment has been linked to positive health outcomes in refugee populations; there is less research into the impact of volunteering on health outcomes in refugees, or the role of employment and volunteering in regional or rural communities. This study aims to explore how employment and volunteering influences the health and wellbeing of refugees settled in regional Australia, and identify areas for appropriate service provision.

METHODS

Nine adults of refugee background in regional Australia were purposively sampled through community organisations using word-of-mouth referrals for semi-structured interviews. Interviews were transcribed. Thematic analysis was used to uncover emergent themes and identify relationships between themes. A strengths-based theoretical framework was adopted to inform further analysis.

RESULTS

Paid work and volunteering engenders a sense of self-fulfillment and sense of belonging, facilitating successful integration into a new community. Employment further allows maintenance of an adequate standard of living, thus improving healthcare access and promoting healthy lifestyle behaviours. Adverse effects from employment include difficulties managing work-life balance, disconnect with family and loss of traditional heritage, but these were significantly outweighed by the positive effects. Volunteering provides no financial incentive, but similarly promotes community connections and positive self-worth, preparing refugees for the workforce. Both employment and volunteering held direct positive benefits for their physical and mental health, improved healthcare access and promoted cultural and social integration. These factors enabled successful settlement and subsequently improved overall wellbeing of participants. A strengths-based approach demonstrated how participants used employment as a tool for seeking purpose and ongoing self-development.

CONCLUSION

Unique experiences with employment and volunteering in a regional area amongst a refugee community were explored. Our results describe various ways in which meaningful employment and volunteering can facilitate positive health and wellbeing outcomes of refugees, and thus reinforces the importance of providing such opportunities to ensure successful settlement. The benefits of volunteering in this community have not been previously explored. Additionally, concerns expressed and recommendations suggested by participants could be used to inform future research, policy, interventions and health and employment service provision for refugee populations.

Tho' Much is Taken, Much Abides: Asylum Seekers' Subjective Wellbeing

The influence of psychosocial factors on the subjective wellbeing of asylum-seekers residing in host Western countries has scarcely been explored qualitatively. Qualitative data derived from a mixed methods prospective study investigated the subjective wellbeing of 56 community-dwelling asylum-seekers and refugees at baseline and an average of 15.7 months later. Positive and negative experiences over time were explored in relation to self-perceived emotional health. Nineteen positive and 15 negative categories of experience emerged. Distinct psychosocial and protective factors were salient regarding the valence of experiences over time, with positive experiences comprising employment, improved financial circumstances, and social support or connectivity. Negative experiences included news of adversity from one's homeland, un(der)employment, poor health, and factors relating to the refugee determination process. Positive and negative experiences were contemporaneous, indicating that employment and social support may ameliorate the detrimental impact of traversing the protracted process of refugee status determination for asylum-seekers in particular.

'Only God can promise healing.': help-seeking intentions and lay beliefs about cures for post-traumatic stress disorder among Sub-Saharan African asylum seekers in Germany

Background: Epidemiological studies have reported high rates of post-traumatic stress disorder (PTSD) among asylum seekers from Sub-Saharan Africa. In order to provide appropriate and culturally sensitive mental health care for this group, further knowledge about treatment preferences might be necessary. Objective: We aimed to provide insights into help-seeking intentions and lay beliefs about cures for PTSD held by asylum seekers from Sub-Saharan Africa living in Germany. Methods: To address this objective, we used a quantitative and qualitative methodological triangulation strategy based on a vignette describing symptoms of PTSD. In the quantitative part of the study, asylum seekers (n = 119), predominantly from Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25), and a German comparison sample without a migration background (n = 120) completed the General Help-Seeking Questionnaire (GHSQ). In the qualitative part, asylum seekers (n = 26) reviewed the results of the questionnaire survey within eight focus group discussions sampled from groups of the three main countries of origin. Results: Asylum seekers showed a high intention to seek religious, medical, and psychological treatment for symptoms of PTSD. However, asylum seekers indicated a higher preference to seek help from religious authorities and general practitioners, as well as a lower preference to enlist psychological and traditional help sources than Germans without a migration background. Furthermore, asylum seekers addressed structural and cultural barriers to seeking medical and psychological treatment. Conclusion: To facilitate access to local health care systems for asylum seekers and refugees, it might be crucial to develop public health campaigns in collaboration with religious communities. When treating asylum seekers and refugees from Sub-Saharan Africa, practitioners should explore different religious and cultural frameworks for healing and recovery in order to signal understanding and acceptance of varying cultural contexts.

Psychosocial health of asylum seeking women living in state-provided accommodation in Germany during pregnancy and early motherhood: A case study exploring the role of social determinants of health

Background

Pregnant women and new mothers seeking asylum are subject to major challenges that may affect their health and increase their vulnerability. The study aim was to investigate asylum seeking women’s experiences and perceived needs during pregnancy and early motherhood whilst living in state-provided accommodation in one federal state in Southern Germany, with a particular focus on psychosocial factors.

Methods

In this exploratory case study, individual semi-structured interviews were conducted with participants in pregnancy and up to the six-week postnatal assessment. Two female interviewers performed interviews assisted by female professional interpreters. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to content analysis of interview material.

Results

21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Women shared experiences and perceived consequences on their psychosocial health. The following five key themes were identified during content analysis: a) psychosocial stressors, b) stressful living circumstances, c) stressful relationships, d) social support and e) coping styles. Psychosocial factors were a significant source of mental stress for participants, especially due to future uncertainties linked with the asylum seeking process. Living circumstances were also marked by stressors including a lack of privacy, verbal and physical threats and experiences of powerlessness. Further strain and emotional pressure were caused by stressful relationships with the unborn child’s father. Social support and personal coping styles provided relief for some participants.

Conclusions

This study provides in-depth insights into the experiences and perceived needs of pregnant asylum seekers and new mothers living in state-provided accommodation. Key results identified psychosocial factors such as future uncertainties, stressful living circumstances and stressful relationships, as social determinants of health that were perceived to adversely affect women’s health. Adequate social support and individual coping styles increased resilience and counterbalanced psychosocial stressors during the asylum seeking process.

Culture Care Beliefs and Practices of Ethiopian Immigrants

INTRODUCTION

The purposes of this mini study were to identify and describe the culture care beliefs and practices of Ethiopian immigrants in the mid-Atlantic region of the United States and to advance the science of transcultural nursing.

METHODOLOGY

Leininger's theory of culture care diversity and universality guided the research and was the framework for the design of this qualitative ethnonursing mini study. Data were collected from 15 participants through in-depth interviews.

RESULTS

Five themes and 14 care patterns merged from the data, including preserving cultural heritage, supporting family and friends, importance of religion and prayer, valuing freedom, cultural caring, and therapeutic communication.

DISCUSSION

Participants valued health care and medical technology in the United States. They wanted nurses to inquire about their culture, language preference, food and dietary practices, and family dynamics. Perceived lack of caring by nurses and unavailability of interpreters in health care settings negatively affected access to care.

A mixed methods systematic review of studies examining the relationship between housing and health for people from refugee and asylum seeking backgrounds

Housing is an important social determinant of health and a key element of refugee integration into countries of resettlement. However, the way in which housing may affect mental and physical health for refugees and asylum seekers has not been systematically examined. This systematic review aimed to explore the effects of housing on health and wellbeing for this population, in order to identify key pathways for public health interventions. The review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Social Care Institute for Excellence (SCIE) guidelines. We identified publications through a search of Medline, PsychInfo, Scopus, Web of Science, Embase, CINAHL, Cohrane Library, Google, ProQuest, OpenGrey, MedNar and WHOLIS. Eligibility criteria included: publication in English between 1997 and 2017, with findings pertaining to the relationship between housing and health for refugees and/or asylum seekers. Out of 2371 items, 25 papers were included with a further five identified through reference lists. Eleven of the papers explored housing and health for those refugees and asylum seekers living within refugee camps, with 19 focusing on countries of resettlement. All studies identified housing issues for refugees and asylum seekers, with physical housing conditions particularly poor in refugee camps, and issues of affordability, suitability, insecure tenure and mobility as well as difficulties securing housing also highlighted in countries of resettlement. Consistent relationships were found between physical aspects of housing and physical and mental health, with other aspects of housing such as safety and overcrowding linked to mental health. There were a number of methodological issues with most of the studies, making it difficult to specify precise pathways. However, improvements to housing quality particularly in refugee camps, and targeted housing interventions more generally for refugees and asylum seekers would likely have an important public health benefit.

Migrant Live-in Caregivers Mental Health in Canada

Empirical evidence suggests rapid health decline among temporary migrant workers but there is limited knowledge about their mental health. This study explored live-in care givers' (LCs) mental health and its determinants. Using a mixed methods design, a purposeful sample of 30 LCs was recruited. Data were collected through a selfcompleted questionnaire. A third of participants reported their mental health as poor or fair. Almost half experienced major depression. The poor mental health was associated with the average working hours and living accommodation. The average resiliency scores was moderately high and appeared to function as a protective factor against mental illness. Our findings suggest LCs are at risk of compromised mental health associated to their substandard working and living conditions. These conditions originates from violation of employment contracts, unfair employment practices, and the lack of enforcement of LCs' legal and human rights.

Stress, health and quality of life of female migrant domestic workers in Singapore: a cross-sectional study

BACKGROUND

There is a global increase in migrant workers. In Singapore, there are over 230,000 migrant domestic workers (MDWs). Female MDWs may experience high levels of stress and social isolation, which may negatively impact on their health and quality of life. There have also been documented cases of abuse and exploitation. However, there is a lack of empirical research with this population. This study aimed to investigate factors impacting on the health and quality of life of female MDWs in Singapore, including socio-demographic and job related characteristics, stress, social isolation, and working management style.

METHODS

A cross-sectional survey was carried out with 182 female MDWs in Singapore. The survey examined health and quality of life (WHOQoL-Bréf), social connectedness (the Friendship Scale), and preferred and experienced working management style (the Theory X and Theory Y Questionnaire). Descriptive analyses were carried out in addition to ANOVA, t-tests, and chi-square tests, followed by a multivariate analysis using linear regression.

RESULTS

Participants were found to have good overall quality of life and satisfaction with health. Age and working experience were found to be significantly (p < 0.05) associated with overall quality of life and three domains (psychological, social, and environmental health). Agreement between experienced and preferred working management style was also found to be associated with higher quality of life scores (with the exception of the social relationships domain). Though women reported relatively good overall quality of life, more than half of participants reported feeling stressed. In addition, nearly 20% of participants reported being isolated or very isolated. Stress was identified to be associated with isolation. In the multivariate analysis, stress was found to contribute to worse quality of life in all domains except social relationships, after adjusting for confounders. Social connectedness was positively associated with all domains of quality of life, and agreement of working management style was positively associated with physical health, psychological health and environmental quality of life.

CONCLUSIONS

The findings serve as an evidence-base pointing to the need for policies aimed at decreasing stress and social isolation among female MDWs in order to improve their health and quality of life.

Exploring the Relationship between Housing and Health for Refugees and Asylum Seekers in South Australia: A Qualitative Study

Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.

Caught between a rock and a hard place: mental health of migrant live-in caregivers in Canada

Background

Canada depends on Temporary Foreign Workers (TFWs), also known as migrant workers, to fill labour shortage in agriculture, hospitality, construction, child/senior care, and other low-skilled occupations. Evidence shows that TFWs, especially women live-in caregivers (LC), constitute a vulnerable population. Their health is compromised by the precarious and harsh working and living conditions they encounter. There is a paucity of research on the mental health of LCs, their support systems and access to mental health services.

Method

In this community-based exploratory study, we used mixed methods of survey and focus groups to explore the work related experiences and mental health of migrant live-in caregivers in the Greater Toronto Area in Ontario, Canada. Convenience and snowball sampling were used to recruit participants. The inclusion criteria were: being 18 years or older, initially migrated to Canada as TFWs under LC program, resided in the Greater Toronto Area, and able to understand and converse in English based on self-report. This paper reports on the focus group results derived from inductive thematic analysis.

Results

A total of 30 women LCs participated in the study. Most of them were from the Philippines. A number of key themes emerged from the participants’ narratives: (1) precarious migration-employment status (re)produces exploitation; (2) deskilling and downward social mobility reinforce alienation; (3) endurance of hardship for family back home; (4) double lives of public cheerfulness and private anguish; and (4) unrecognized mental health needs. The study results reflected gross injustices experienced by these women.

Conclusion

A multi-faceted approach is required to improve the working and living conditions of this vulnerable group and ultimately their health outcomes. We recommend the following: government inspection to ensure employer compliance with the labour standards and provision of safe working and living conditions; change immigration policy to allow migrant caregivers to apply for permanent residence upon arrival; the TFWs Program to establish fair wages and subsidized housing so that caregivers can truly access the live-out option; and local ethno-specific, settlement and faith organizations be leveraged to provide TFWs with social support as well as information about their rights and how to access health and social care.

Prevalence and associated factors of common mental disorders among Ethiopian migrant returnees from the Middle East and South Africa

BACKGROUND

Ethiopian migrants to the Middle East and South Africa experience a range of problems at various stages of their migration including overwork, sleep deprivation, denial of food, emotional abuse, difficulty adapting to the host culture, salary denial, sexual abuse, labor exploitation, confiscation of their travel documents, confinement, denial of medication, lack of access to legal service and degrading attitude by employers, traffickers and smugglers. These experiences can be associated with different types of mental disorders. This study sought to determine the prevalence of common mental disorders (CMD) and socio-demographic and other migration related associated factors among Ethiopian migrant returnees from the Middle East and South Africa.

METHOD

A cross-sectional study was conducted using non-probability (i.e. purposive, availability and snowball) sampling techniques. Migrant returnees (n = 1036) were contacted individually at their homes in eight high prevalent immigrant returnee locations in Ethiopia. Common mental disorders were assessed using the self-reporting questionnaire (SRQ-20) and a structured questionnaire was employed to collect data on socio-demographic and migration related characteristics. Data were analyzed using descriptive statistics, univariate logistic regression, and multivariable logistic regression.

RESULTS

The prevalence of CMD among migrant returnees was found to be 27.6%. Highly prevalent specific CMD symptoms included headaches, poor appetite, being tired, sleeping problems, and feeling unhappy or nervous. Being originally from Amhara and Oromia regions, being Christian, being divorced, not receiving salary on time, not being able to contact family, unable to prepare for domestic labor abroad, lack of cross- cultural awareness, and lack of knowledge and skills for work were all important risk factors for CMD. Migrants experienced adversities at different stages of their migration which are associated with psychological distress and even to long term mental illnesses.

CONCLUSIONS

CMD symptoms were found to be prevalent among Ethiopian migrant returnees. As pre-migration factors are associated with CMD symptoms, pre-departure training could be useful to mitigate the risk factors. Creating and routinely arranging mental health interventions and rehabilitation services are advisable for returnees who are screened for, or diagnosed with, mental health problems.

Refugee experiences of general practice in countries of resettlement: a literature review

BACKGROUND

Refugees and asylum seekers often struggle to use general practice services in resettlement countries.

AIM

To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement.

DESIGN AND SETTING

Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013.

METHOD

Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed.

RESULTS

From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care.

CONCLUSION

The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management.

National Health Service Principles as Experienced by Vulnerable London Migrants in "Austerity Britain": A Qualitative Study of Rights, Entitlements, and Civil-Society Advocacy

BACKGROUND

Recent British National Health Service (NHS) reforms, in response to austerity and alleged 'health tourism,' could impose additional barriers to healthcare access for non-European Economic Area (EEA) migrants. This study explores policy reform challenges and implications, using excerpts from the perspectives of non-EEA migrants and health advocates in London.

METHODS

A qualitative study design was selected. Data were collected through document review and 22 in-depth interviews with non-EEA migrants and civil-society organisation representatives. Data were analysed thematically using the NHS principles.

RESULTS

The experiences of those 'vulnerable migrants' (ie, defined as adult non-EEA asylum-seekers, refugees, undocumented, low-skilled, and trafficked migrants susceptible to marginalised healthcare access) able to access health services were positive, with healthcare professionals generally demonstrating caring attitudes. However, general confusion existed about entitlements due to recent NHS changes, controversy over 'health tourism,' and challenges registering for health services or accessing secondary facilities. Factors requiring greater clarity or improvement included accessibility, communication, and clarity on general practitioner (GP) responsibilities and migrant entitlements.

CONCLUSION

Legislation to restrict access to healthcare based on immigration status could further compromise the health of vulnerable individuals in Britain. This study highlights current challenges in health services policy and practice and the role of non-governmental organizations (NGOs) in healthcare advocacy (eg, helping the voices of the most vulnerable reach policy-makers). Thus, it contributes to broadening national discussions and enabling more nuanced interpretation of ongoing global debates on immigration and health.

Food taboos and nutrition-related pregnancy concerns among Ethiopian women

AIMS AND OBJECTIVES

To discuss Ethiopian food taboos during pregnancy and their relation to maternal nutritional status and pregnancy outcomes.

BACKGROUND

Recent waves of migration have seen large groups of Ethiopian refugees moving to countries around the globe. This is of concern as Ethiopian women are at risk of a number of medical and pregnancy complications. Health is further compromised by poor diet and adherence to cultural food beliefs and taboos. In refugee women, many of these factors correspond with significantly higher rates of pregnancy complications and poor birth outcomes.

DESIGN

This is a discussion paper informed by a literature review.

METHODS

A search of the Scopus, PubMed, Web of Science and Academic Search Premier databases for the keywords Ethiopian, pregnancy, food and taboos was conducted in the research literature published from 1998-2015. This time is contingent with Ethiopian migration trends.

RESULTS

Ethiopian migrant women are at risk of inadequate nutrition during pregnancy. Risks include cultural factors associated with food taboos as well as issues associated with low socioeconomic status. Consequently, Ethiopian women are more likely to have nutritional deficiencies such as anaemia which have been associated with a range of pregnancy complications.

CONCLUSIONS

There are many serious consequences of poor diet during pregnancy; however, most of these can be avoided by greater awareness about the role of nutrition during pregnancy and by adopting a balanced diet.

RELEVANCE TO CLINICAL PRACTICE

There is an urgent unmet need for nutrition education among Ethiopian women. Research indicates that Ethiopian women are receptive to nutritional advice during pregnancy and also that pregnant women are generally motivated to act in the baby's interest. These factors suggest that this high-risk group would be amenable to culturally appropriate nutrition education, which would provide much-needed meaningful support in pregnancy.

Barriers to healthcare access among refugees with disabilities and chronic health conditions resettled in the US Midwest

Chronic conditions and related functional disabilities are highly prevalent among resettled refugees in the United States. There is a need to explore this population's access to appropriate healthcare services in order to identify service disparities and improve interventions. Using a community-based participatory research approach, semi-structured interviews were conducted with key informants to identify healthcare access barriers affecting disabled and chronically ill refugees. Eighteen participants were interviewed, revealing three main barriers: (1) inadequate health insurance, (2) language and communication barriers, and (3) a complex maze of service systems. These barriers were found to operate at systems, provider, and individual levels. Broad-based policy and practice interventions are required to address barriers including: an expanded pool of medical interpreters, peer navigators, innovative health information technologies, and greater collaboration and information-sharing between service systems. Further research is needed to monitor the impact the Affordable Care Act on service access of refugees with disabilities and chronic conditions.

Parenthood in transition - Somali-born parents' experiences of and needs for parenting support programmes

BACKGROUND

Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting.

METHODS

A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied.

RESULTS

A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities.

CONCLUSIONS

Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.

Cognitive assessment of refugee children: Effects of trauma and new language acquisition

Each year, approximately 60,000 children of refugee background are resettled in Western countries. This paper reviews the effects of the refugee experience on cognitive functioning. The distinctive influences for these children include exposure to traumatic events and the need to acquire a new language, factors that need to be considered to avoid overdiagnosis of learning disorders and inappropriate educational placements. Prearrival trauma, psychological sequelae of traumatic events, developmental impact of trauma, and the quality of family functioning have been found to influence cognitive functioning, learning, and academic performance. In addition, the refugee child may be semiproficient in several languages, but proficient in none, whilst also trying to learn a new language. The influence that the child's limited English proficiency, literacy, and school experience may have on academic and test performance is demonstrated by drawing on the research on refugees' English language acquisition, as well as the more extensive literature on bilingual English language learners. Implications for interventions are drawn at the level of government policy, schools, and the individual. The paper concludes with the observation that there is a major need for longitudinal research on refugee children's learning and academic performance and on interventions that will close the academic gap, thereby enabling refugee children to reach their educational potential.

Micro-provision of Social Care Support for Marginalized Communities - Filling the Gap or Building Bridges to the Mainstream?

As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro-providers - very small community-based organizations, which can work directly with individuals. These micro-providers are assumed to be able to cater for the 'seldom heard' groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer-reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small-scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self-organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community-based micro-providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization.

Associations Between Sociodemographic Characteristics, Pre Migratory and Migratory Factors and Psychological Distress Just After Migration and After Resettlement: The Indian Migration Study

BACKGROUND/OBJECTIVES

Migration is suspected to increase the risk for psychological distress for those who enter a new cultural environment. We investigated the association between sociodemographic characteristics, premigratory and migratory factors and psychological distress in rural-to-urban migrants just after migration and after resettlement.

METHODS

Data from the cross-sectional sib-pair designed Indian Migration Study (IMS, 2005-2007) were used. The analysis focused on 2112 participants aged ≥18 years from the total IMS sample (n = 7067) who reported being migrant. Psychological distress was assessed based on the responses of the 7-questions in a five-point scale, where the respondents were asked to report about their feelings now and also asked to recall these feelings when they first migrated. The associations were analyzed using multiple logistic regression models.

RESULTS

High prevalence of psychological distress was found just after migration (7.3%; 95% confidence interval [CI]: 6.2-8.4) than after settlement (4.7%; 95% CI: 3.8-5.6). Push factors as a reason behind migration and not being able to adjust in the new environment were the main correlates of psychological distress among both the male and female migrants, just after migration.

CONCLUSIONS

Rural-urban migration is a major phenomenon in India and given the impact of premigratory and migratory related stressors on mental health, early intervention could prevent the development of psychological distress among the migrants.

A longitudinal study of demographic factors associated with stressors and symptoms in African refugees

The objectives of this study were to assess differences in premigration, transit, and resettlement stressor exposure and post traumatic stress disorder (PTSD) symptoms as a function of demographic characteristics (i.e., gender, ethnicity, age, time in United States) and to examine the concurrent and longitudinal relations between stressor exposure and PTSD symptoms. The sample consisted of adult (18-78 years) Somali and Oromo refugee men and women (N = 437). Qualitative data regarding participants' self-nominated worst stressors collected at Time 2 (T2) informed the development of quantitative scales assessing premigration, transit, and resettlement stress created using items collected at Time 1 (T1). PTSD symptoms were measured at both T1 and T2. Quantitative analyses showed that levels of stressor exposure and PTSD symptoms differed as a function of refugee demographic characteristics. For example, Oromo, more recent, women, and older refugees reported more premigration and resettlement stressors. Oromo refugees and refugee men reported more PTSD symptoms in regression analyses with other factors controlled. Premigration, transit, and resettlement stressor exposure generally was associated with higher PTSD symptom levels. Results underscore the importance of assessing stress exposure comprehensively throughout the refugee experience and caution against overgeneralizing between and within refugee groups.

Ethnicity, livelihoods, masculinity, and health among Luo men in the slums of Nairobi, Kenya

BACKGROUND

Previous research suggests that ethnic self-identity has little consequence for objective health outcomes compared to the structural dimensions of ethnicity.

METHODS

Using qualitative data, we investigated perceptions of ethnicity in relation to health among Luo men in the slums of Nairobi, Kenya.

RESULTS

While recognizing the complicated cultural origin of poor health, responding Luo men stressed on gender and everyday livelihood situations as being more critical for their health than Luo customs. Recognition of the structural causes of ill-health among the men overlapped with lay notions derived from particular expressions of Luo culture in urban slum contexts. To some extent, respondents regarded the performance of their sense of ethnic identity as protective, though they also admitted to the health-damaging repercussions of some of the ways they enacted aspects of Luo culture.

CONCLUSION

Ethnic beliefs that link particular enactments of local customs with health outcomes may motivate the performance of cultural identity in ways that can produce critical health outcomes.

A comparison of female migrant workers' mental health in four cities in China

BACKGROUND

There are approximately 47.5 million female migrant workers living in major cities in China. Numerous studies have documented the marginalized living conditions confronting migrant workers in cities, such as employment difficulties, unjustifiably demanding working conditions, lack of medical insurance and social provision, poor housing conditions, unfavourable educational arrangements for migrant children, and discrimination by urban residents. In addition, female migrant workers may suffer from discrimination, exploitation and oppression.

AIM

This study aimed to explore the difficulties and perceived meaningfulness of migration and their effect on the mental health status of female migrant workers in Shanghai, Kunshan, Dongguan and Shenzhen.

METHODS

A total of 959 female migrant workers from 12 factories completed the questionnaires, which included the Brief Symptom Inventory, the Migration Stress Scale and the Meaning in Migration Scale.

RESULTS

The findings indicate that 24% of female migrant workers could be classified as having poor mental health and the percentage in Shenzhen (35%) was far greater than in the three other cities in China. 'Financial and employment-related difficulties', 'cultural differences', gender-specific stressors and 'better future for self and children' significantly accounted for the mental health outcomes of female migrant workers.

CONCLUSION

Recommendations for policy change and service initiatives targeted at improving the mental health of female migrant workers are discussed.

The hopes of West African refugees during resettlement in northern Sweden: a 6-year prospective qualitative study of pathways and agency thoughts

Background

Little is known about how positive phenomena can support resettlement of refugees in a new country. The aim of this study was to examine the hopeful thinking in a group of West African quota refugees at arrival and after 6 years in Sweden and compare these thoughts to the views of resettlement support professionals.

Method

The primary study population comprised 56 adult refugees and 13 resettlement professionals. Qualitative data were collected from the refugees by questionnaires on arrival and 6 years later. Data were collected from the resettlement professionals by interview about 3 years after arrival of the refugees. Snyder's cognitive model of hope was used to inform the comparative data analyses.

Results

Hopes regarding education were in focus for the refugees shortly after arrival, but thoughts on family reunion were central later in the resettlement process. During the later stages of the resettlement process, the unresponsiveness of the support organization to the family reunion problem became as issue for the refugees. The professionals reported a complex mix of "silent agency thoughts" underlying the local resettlement process as a contributing reason for this unresponsiveness.

Conclusion

Hopes regarding education and family reunion were central in the resettlement of West African refugees in Sweden. These thoughts were not systematically followed up by the support organization; possibly the resources for refugees were not fully released. More studies are needed to further investigate the motivational factors underpinning host community support of refugees' hopes and plans.

Trauma, exile and mental health in young refugees

OBJECTIVE

To review evidence of trauma and exile-related mental health in young refugees from the Middle East.

METHOD

A review of four empirical studies: i) a qualitative study of 11 children from torture surviving families, ii) a cohort study of 311 3-15-year-old asylum-seeking children, iii) a qualitative study of 14 members of torture surviving families and iv) a follow-up study of 131 11-23-year-old refugees.

RESULTS

The reactions of the children were not necessarily post-traumatic stress disorder specific. Seventy-seven per cent suffered from anxiety, sleep disturbance and/or depressed mood at arrival. Sleep disturbance (prevalence 34%) was primarily predicted by a family history of violence. At follow-up, 25.9% suffered from clinically relevant psychological symptoms. Traumatic experiences before arrival and stressful events in exile predicted internalizing behaviour, witnessing violence and frequent school changes in exile predicted externalizing behaviour. School participation, Danish friends, language proficiency and mother's education predicted less long-term psychological problems.

CONCLUSION

Psychological problems are frequent in refugee children, but the extents are reduced over time in exile. Traumatic experience before arrival is most important for the short-term reaction of the children while aspects of life in exile are important for the children's ability to recover from early traumatization.

Constructing illness: how the public in eight Western nations respond to a clinical description of "schizophrenia"

According to classic and contemporary social theory, the community is crucial to how individuals respond to the onset of health problems. Cultural response to symptoms provides the foundation for lay diagnosis; offers a gauge for marking individual and societal health literacy; and reflects the cultural embeddedness of modern medical knowledge. Using data collected between 2004 and 2007 from the Stigma in Global Context - Mental Health Study (SGC-MHS) on the recognition of schizophrenia from vignettes describing individuals meeting DSM-IV criteria, we examine the nature and correlates of lay diagnosis. Focusing on Western societies in the SGC-MHS, we ask three questions regarding problem recognition in Bulgaria (N = 255), Cyprus (N = 253), Germany (N = 382), Hungary (N = 352), Iceland (N = 291), Spain (N = 327), Great Britain (N = 289), and the United States (N = 449): (1) What is the cross-national variation in recognition of schizophrenia as a mental illness? (2) Is lay diagnosis associated with individuals' socio-demographic characteristics and/or their evaluation of underlying causes? (3) Are lay diagnoses likely to shape the nature and direction of the illness career? We find lay diagnosis of "mental illness" to be high across these Western nations with some, though modest, difference across countries. Variation for the more specific diagnosis of "schizophrenia" is greater, though fairly consistent in country ordering. Lay diagnoses are shaped most consistently by attributions, inconsistently by socio-demographics, and generally associated with respondents' treatment recommendations and expected outcomes. In light of assumptions about public beliefs and knowledge that often underlie research, community efforts, clinical programs, and health policy, these findings suggest that a greater understanding of the complexities of lay diagnosis is warranted.

Help-seeking for mental health problems in young refugees: a review of the literature with implications for policy, practice, and research

The large and diverse bodies of literature on refugee child and adolescent mental health have not been matched by a commensurate interest in help-seeking. Most help-seeking research has centred on Western and, to a lesser extent, non-refugee ethnic minority adult populations. An emerging child and adolescent help-seeking literature consistently reports widespread underutilization of mental health services by children in the general population. Current research and opinion suggest a similar trend for refugee and other ethnic minority children. While service underutilization appears to be an issue for all children, those from refugee backgrounds may be at increased risk of mental health problems and have greater difficulty accessing mental health care. From a policy and practice perspective, the most important explanation for low uptake of services by refugee families concerns an overall failure of Western mental health systems to accommodate the needs of ethnically diverse populations in general and refugees in particular. In order to effectively plan for the mental health needs of refugee children and adolescents, Western host country governments need a clear understanding of help-seeking behaviour.

Sexual maltreatment of unaccompanied asylum-seeking minors from the Horn of Africa: a mixed method study focusing on vulnerability and prevention

OBJECTIVES

The study described in this paper sought to identify the social, cultural, and political factors that effect African unaccompanied asylum-seeking minors' (UASM) vulnerability to sexual maltreatment in England. It aimed to illuminate how child protection measures could be strengthened for this highly marginalized group.

METHODS

A mixed method approach was used. Former UASM from Ethiopia, Eritrea and Somalia who had been sexually maltreated in the UK were interviewed in-depth. Prior to the interviews they all completed a questionnaire which captured their biographical details as well as sensitive but factual information.

RESULTS

Of the 53 (N=53) former UASM who participated in the study only 2 were males. Most arrived in the UK aged 15-17. A range of sexual maltreatment, from sexual harassment to rape was reported. Three quarters experienced more than 1 incident. Most initial incidents happened in the first 12 months of their arrival in the UK. Two perpetrators were female carers. Many participants reported being groomed and sexually maltreated by people from their own country. Many described being seriously sexually maltreated, particularly by groups of young males living in the same accommodation or nearby, some reportedly also asylum seekers. Participants that had been warned of the dangers of sexual maltreatment were more likely to both disclose and to seek professional help.

CONCLUSIONS

Professionals should assume that UASM will suffer sexual maltreatment in their host country if not protected adequately, which they are unlikely to disclose. They are likely to need more protection from outside sources and help to develop their personal resources than many have received in the past.

PRACTICE IMPLICATIONS

Preventative measures include provision of safer environments, ideally single sex housing; more monitoring and supervision; more opportunities to develop trustworthy relationships and have emotional needs met; greater opportunities to develop language skills/access to interpretation; early information regarding the social system, culture, and sexual maltreatment; and improved professional awareness and competence in dealing with minors from other cultures.