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Serra R, Purgato M, Tedeschi F, Acartürk C, Karyotaki E, Uygun E, Turrini G, Winkler H, Pinucci I, Wancata J, Walker L, Popa M, Sijbrandij M, Välimäki M, Kösters M, Nosè M, Anttila M, Churchill R, White RG, Lantta T, Klein T, Wochele-Thoma T, Tarsitani L, Barbui C. Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model. Eur J Psychotraumatol 2024; 15:2355828. [PMID: 38828909 PMCID: PMC11149571 DOI: 10.1080/20008066.2024.2355828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/13/2024] [Indexed: 06/05/2024] Open
Abstract
Background: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs.
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Affiliation(s)
- Riccardo Serra
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marianna Purgato
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Ceren Acartürk
- Department of Psychology, Koc University, Istanbul, Türkiye
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ersin Uygun
- Department of Psychology, Koc University, Istanbul, Türkiye
- Trauma and Disaster Mental Health, Bilgi University, Istanbul, Türkiye
| | - Giulia Turrini
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Johannes Wancata
- Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lauren Walker
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Mariana Popa
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maritta Välimäki
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
- School of Public Health, University of Helsinki, Helsinki, Finland
| | - Markus Kösters
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, T U Dresden, Chemnitz, Germany
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Michela Nosè
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Minna Anttila
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ross G. White
- School of Psychology, Queen’s University Belfast, Belfast, UK
| | - Tella Lantta
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia
| | - Thomas Klein
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, T U Dresden, Chemnitz, Germany
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | | | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Corrado Barbui
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Jiang W, Yang Y, He Y, Liu Q, Deng X, Hua Y, Hayixibayi A, Ni Y, Guo L. Contribution of diversity of social participation on the mental health of humanitarian migrants during resettlement. Epidemiol Psychiatr Sci 2024; 33:e29. [PMID: 38779823 DOI: 10.1017/s2045796024000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
AIMS By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences. METHODS Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed. RESULTS Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = -0.62 [95% confidence interval (CI), -1.07 to -0.17] for one type of social participation; β = -0.57 [95% CI, -1.04 to -0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65-0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61-0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress. CONCLUSIONS The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.
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Affiliation(s)
- Weiqing Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yuwei Yang
- Institute of Infectious Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Yitong He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qianyu Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xueqing Deng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yilin Hua
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Alimila Hayixibayi
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Yanyan Ni
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
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Baumgartner JS, Renner A, Wochele-Thoma T, Wehle P, Barbui C, Purgato M, Tedeschi F, Tarsitani L, Roselli V, Acartürk C, Uygun E, Anttila M, Lantta T, Välimäki M, Churchill R, Walker L, Sijbrandij M, Cuijpers P, Koesters M, Klein T, White RG, Aichberger MC, Wancata J. Impairments in psychological functioning in refugees and asylum seekers. Front Psychol 2024; 14:1295031. [PMID: 38259575 PMCID: PMC10801113 DOI: 10.3389/fpsyg.2023.1295031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version's total and six subdomains' scores ('mobility', 'life activities', 'cognition', 'participation', 'self-care', 'getting along') as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in 'mobility' and 'participation', followed by 'life activities' and 'cognition'. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in 'participation', while past events of being close to death were associated with fewer issues with 'self-care'. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.
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Affiliation(s)
- Josef S. Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Antonia Renner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Peter Wehle
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Psychosocial Services in Vienna, Vienna, Austria
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Roselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Ceren Acartürk
- Department of Psychology, College of Social Sciences and Humanities, Koc University, Istanbul, Türkiye
| | - Ersin Uygun
- Emergency and Disaster Management, Vocational School of Health Services, Bilgi University, Istanbul, Türkiye
| | - Minna Anttila
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tella Lantta
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Rachel Churchill
- Centre for Reviews and Dissemination, Faculty of Social Sciences, University of York, York, United Kingdom
| | - Lauren Walker
- Centre for Reviews and Dissemination, Faculty of Social Sciences, University of York, York, United Kingdom
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Markus Koesters
- Department of Psychiatry and Psychotherapy ll, District Hospital Guenzburg, Ulm University, Ulm, Germany
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Thomas Klein
- Department of Psychiatry and Psychotherapy ll, District Hospital Guenzburg, Ulm University, Ulm, Germany
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Ross G. White
- Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Marion C. Aichberger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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