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Fernández Capriles I, Armijos A, Angulo A, Schojan M, Wainberg ML, Bonz AG, Tol WA, Greene MC. Improving Retention in Mental Health and Psychosocial Support Interventions: An Analysis of Completion Rates across a Multi-Site Trial with Refugee, Migrant, and Host Communities in Latin America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:397. [PMID: 38673310 PMCID: PMC11049853 DOI: 10.3390/ijerph21040397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Research on mental health and psychosocial support (MHPSS) interventions within refugee and migrant communities has increasingly focused on evaluating implementation, including identifying strategies to promote retention in services. This study examines the relationship between participant characteristics, study setting, and reasons for intervention noncompletion using data from the Entre Nosotras feasibility trial, a community-based MHPSS intervention targeting refugee, migrant, and host community women in Ecuador and Panama that aimed to promote psychosocial wellbeing. Among 225 enrolled women, approximately half completed the intervention, with varying completion rates and reasons for nonattendance across study sites. Participants who were older, had migrated for family reasons, had spent more time in the study community, and were living in Panamá (vs. Ecuador) were more likely to complete the intervention. The findings suggest the need to adapt MHPSS interventions to consider the duration of access to the target population and explore different delivery modalities including the role of technology and cellular devices as reliable or unreliable source for engaging with participants. Engaging younger, newly arrived women is crucial, as they showed lower completion rates. Strategies such as consulting scheduling preferences, providing on-site childcare, and integrating MHPSS interventions with other programs could enhance intervention attendance.
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Affiliation(s)
- Isabella Fernández Capriles
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | | | | | | | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA;
| | - Annie G. Bonz
- HIAS, Silver Spring, MD 20910, USA; (M.S.); (A.G.B.)
| | - Wietse A. Tol
- Global Health Section, Department of Public Health, University of Copenhagen, 1172 Copenhagen, Denmark;
- Athena Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - M. Claire Greene
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
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Veronese G, Mahamid F, Bdier D. Transgenerational trauma and collective resilience: A qualitative analysis of the experiences of settler-colonial violence among three generations of Palestinian refugees. Int J Soc Psychiatry 2023; 69:1814-1824. [PMID: 37283084 DOI: 10.1177/00207640231175787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Palestinian people have endured collective dispossession and social suffering for 74 years from the so-called Al-Nakba (Palestinian catastrophe). AIMS The present exploratory work sought to analyze experiences of settler-colonial violence over three generations of Palestinian refugees. METHODS Forty-five participants (Mage = 44.45; range 13-85) were recruited via snowball sampling and interviewed to explore their understanding of transgenerational and collective trauma. Interviews were analyzed through thematic content analysis, resulting in four emerging themes distributed among the three generations. RESULTS The four themes encompassed (1) The impact of Al-Nakba, (2) Hardships, challenges, and quality of life, (3) Coping strategies, and (4) Dreams and hopes for the future. The results have been discussed using local idioms of distress and resilience. CONCLUSIONS The Palestinian experience of transgenerational trauma and resilience depicts a portrait of extreme trauma and endurance that cannot be reduced to the mere nosographic collection of Western-informed psychiatric symptoms. Instead, a human rights approach to Palestinian social suffering is most recommended.
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Affiliation(s)
- Guido Veronese
- Department of Human Sciences and Education 'R.Massa', University of Milano-Bicocca, Milano, Italy
- Department of Psychology, Stellenbosch University, South Africa
| | - Fayez Mahamid
- Department of Human Sciences, An-Najah National University, Nablous, State of Palestine
| | - Dana Bdier
- Department of Human Sciences and Education 'R.Massa', University of Milano-Bicocca, Milano, Italy
- Department of Human Sciences, An-Najah National University, Nablous, State of Palestine
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Jarvis GE, Kirmayer LJ. Global migration: Moral, political and mental health challenges. Transcult Psychiatry 2023; 60:5-12. [PMID: 36919356 DOI: 10.1177/13634615231162282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Global migration is expected to continue to increase as climate change, conflict and economic disparities continue to challenge peoples' lives. The political response to migration is a social determinant of mental health. Despite the potential benefits of migration, many migrants and refugees face significant challenges after they resettle. The papers collected in this thematic issue of Transcultural Psychiatry explore the experience of migration and highlight some of the challenges that governments and healthcare services need to address to facilitate the social integration and mental health of migrants. Clinicians need training and resources to work effectively with migrants, focusing on their resilience and on long-term adaptive processes. Efforts to counter the systemic discrimination and structural violence that migrants often face need to be broad-based, unified, and persistent to make meaningful change. When migrants are free to realize their talents and aspirations, they can help build local communities and societies that value diversity.
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Affiliation(s)
- G Eric Jarvis
- Division of Social & Transcultural Psychiatry, McGill University.,Culture and Mental Health Research Unit, Institute for Community & Family Psychiatry. Jewish General Hospital, Montreal
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University.,Culture and Mental Health Research Unit, Institute for Community & Family Psychiatry. Jewish General Hospital, Montreal
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Grabo J, Leavey G. Geographical Disparities and Settlement Factors and Mental Health of Refugees Living in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4409. [PMID: 36901421 PMCID: PMC10002295 DOI: 10.3390/ijerph20054409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Approximately half of all refugees living in Germany experience discrimination, which may negatively affect their mental health. Moreover, German refugees have experienced hostility, especially in eastern regions. (2) Aims: We examined the effect of perceived discrimination on refugees' mental health in Germany, with a particular focus on possible regional differences of refugee mental health and perceived discrimination. (3) Method: The data of 2075 refugees who arrived in Germany between 2013 and 2016, from a large-scale survey, was analysed using binary logistic regression. The refugee health screener, 13-item version, was used to assess psychological distress. All effects were investigated for the entire sample and both sexes independently. (4) Results: A third of refugees experienced discrimination which increased the risk of psychological distress (OR = 2.25 [1.80, 2.8]). Those living in eastern Germany were more than twice as likely to report experiences of discrimination, compared to their counterparts living in western Germany (OR = 2.52 [1.98, 3.21]). Differences were noted between males and females, and religious attendance. (5) Conclusions: Perceived discrimination is a risk factor for refugee mental health, particularly female refugees in eastern Germany. An east-west regional difference may be explained by socio-structural factors, rural placement, differential historical exposure to migrant populations, and a greater presence of right-wing and populist parties in eastern Germany.
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Affiliation(s)
- Julian Grabo
- Global Health, Maastricht University, 6221 LK Maastricht, The Netherlands
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine BT51 5SA, UK
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Morales FR, Nguyen-Finn KL, Haidar M, Mercado A. Humanitarian crisis on the US-Mexico border: Mental health needs of refugees and asylum seekers. Curr Opin Psychol 2022; 48:101452. [PMID: 36084505 DOI: 10.1016/j.copsyc.2022.101452] [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: 07/11/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 01/28/2023]
Abstract
Families and youth from the Northern Triangle of Central America seeking asylum in the U.S. report substantial trauma exposure and post-traumatic stress symptoms. Sexual and gender minorities of this population especially present unique circumstances and thus challenges and needs. However, with immigration along the southern U.S. border at a 21-year high, health and social resources for refugees and asylum seekers are being strained. Accordingly, the primary aim of this review is to raise awareness about migration-related trauma and the mental health needs among Central American and LGBTQ + refugees and asylum seekers in the U.S.-Mexico border. The authors also discuss practical, clinical, and advocacy implications to improve the mental health of refugees and asylum seekers entering the United States.
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Affiliation(s)
- Frances R Morales
- Department of Psychological Science, University of Texas Rio Grande Valley, TX, USA
| | - Kim L Nguyen-Finn
- School of Rehabilitation Services & Counseling, University of Texas Rio Grande Valley, TX, USA
| | - Makram Haidar
- School of Medicine Department of Psychiatry, University of Texas Rio Grande Valley, TX, USA
| | - Alfonso Mercado
- Department of Psychological Science, University of Texas Rio Grande Valley, TX, USA; School of Medicine Department of Psychiatry, University of Texas Rio Grande Valley, TX, USA.
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van Eggermont Arwidson C, Holmgren J, Gottberg K, Tinghög P, Eriksson H. Living a frozen life: a qualitative study on asylum seekers' experiences and care practices at accommodation centers in Sweden. Confl Health 2022; 16:47. [PMID: 36071462 PMCID: PMC9450398 DOI: 10.1186/s13031-022-00480-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background Forced migrants fleeing conflict and violence face a high risk of mental health problems due to experiences before displacement, perilous journeys, and conditions in the new host societies. Asylum seekers seem to be in particularly vulnerable situations, indicated by higher prevalence rates of mental health problems compared to resettled refugees. Asylum seekers’ mental health is highly influenced by the conditions they face in host countries while awaiting a decision on their case. In Sweden, 40% of asylum seekers reside in state-provided accommodation centers during the asylum process. Collective accommodation centers for asylum seekers have been said to impose restrictive social conditions and to be associated with poorer mental health outcomes than other housing forms (e.g., self-organized housing). However, there seems to be a scarcity of qualitative studies exploring the experiences of asylum seekers in different contexts. The aim of this study was therefore to explore the experiences of asylum seekers and how they manage their mental wellbeing while living at accommodation centers in Sweden. Methods Fourteen semi-structured interviews with asylum seekers were conducted at two accommodation centers in Sweden. Participants were recruited using purposeful sampling and represented a diverse group of asylum seekers regarding age, background, and gender. The data was analyzed using content analysis. Results Three overarching categories were identified; 1) Frozen life, 2) Constant worrying and “overthinking”, and 3) Distractions and peer support. Participants experienced a state of being that could be characterized as a frozen life, which was associated with intense feelings of psychological distress, mostly described as manifesting itself in consuming patterns of ruminative thoughts, for instance overthinking and constant worrying. However, despite high levels of distress, participants demonstrated agency in managing negative mental health outcomes through self-care practices, peer support, and the development of care practices in caring for others in need. Conclusion This study offers new insights into the everyday challenges that asylum seekers at accommodation centers face. Furthermore, it offers valuable observations of how asylum seekers at accommodation centers cope through self-care practices, peer support, and care practices in caring for peers in need. In order to enable sustainable and empowering support, mental health and psychosocial support services must identify and address both challenges and strengths, be grounded in the lived reality of asylum seekers, and build on existing resources. Moreover, further policy work needs to be done to enable faster asylum processes.
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Affiliation(s)
- Charlotta van Eggermont Arwidson
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. .,Department of Health Sciences, Swedish Red Cross University, Huddinge, Sweden.
| | - Jessica Holmgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Kristina Gottberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Petter Tinghög
- Department of Health Sciences, Swedish Red Cross University, Huddinge, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Henrik Eriksson
- Department of Health Sciences, University West, Trollhättan, Sweden
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Mattar S, Gellatly R. Refugee mental health: Culturally relevant considerations. Curr Opin Psychol 2022; 47:101429. [DOI: 10.1016/j.copsyc.2022.101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
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Chavez-Baray SM, Martinez O, Chaparro P, Moya EM. The Use of Photovoice Methodology to Assess Health Needs and Identify Opportunities Among Migrant Transgender Women in the U.S.-Mexico Border. Front Public Health 2022; 10:865944. [PMID: 35664104 PMCID: PMC9160798 DOI: 10.3389/fpubh.2022.865944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
Psychosocial, social and structural conditions have rarely been studied among transgender women in the U.S.-Mexico Border. This study used Photovoice methodology to empower migrant transgender women of color (TWC) to reflect on realities from their own perspectives and experiences and promote critical dialogue, knowledge, and community action. Sixteen participants documented their daily experiences through photography, engaged in photo-discussions to assess needs and identify opportunities, and developed a community-informed Call to Action. Four major themes emerged from the participants' photographs, discussions, and engagement: (1) mental health, (2) migration experiences and challenges, (3) stigma, discrimination, and resiliency, and (4) impact of the COVID-19 pandemic. Through active community engagement, a Call to Action was developed. A binational advisory committee of decision makers and scholars reviewed a set of recommendations to better respond to the needs of TWC in the U.S.-Mexico Border. Photovoice served as an empowerment tool for TWC to assess the myriad of syndemic conditions, including mental health, stigma, discrimination and COVID-19, affecting them daily and identify initiatives for change.
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Affiliation(s)
- Silvia M. Chavez-Baray
- Department of Social Work, University of Texas at El Paso, El Paso, TX, United States,Chicano Studies, College of Liberal Arts, University of Texas at El Paso, El Paso, TX, United States,Border Biomedical Research Center, College of Science, University of Texas at El Paso, El Paso, TX, United States,*Correspondence: Silvia M. Chavez-Baray
| | - Omar Martinez
- School of Social Work, College of Public Health, Temple University Philadelphia, Philadelphia, PA, United States,Omar Martinez
| | - Perla Chaparro
- Department of Social Work, University of Texas at El Paso, El Paso, TX, United States
| | - Eva M. Moya
- Department of Social Work, University of Texas at El Paso, El Paso, TX, United States,Border Biomedical Research Center, College of Science, University of Texas at El Paso, El Paso, TX, United States,Eva M. Moya
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Bäärnhielm S, Schouler-Ocak M. Training in cultural psychiatry: Translating research into improvements in mental health care for migrants. Transcult Psychiatry 2022; 59:111-115. [PMID: 35442116 DOI: 10.1177/13634615221089384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This special issue of Transcultural Psychiatry on training in cultural psychiatry discusses translating research into improvements in mental health care for refugees and migrants. This topic is timely because, in addition to a global increase in migration, the number of forcibly displaced people is growing rapidly due to war and conflicts. We know that migrants, particularly refugees, are at increased risk of psychiatric disorders, including psychotic disorders and post-traumatic stress. Despite this, there is evidence of major disparities in care for minorities, migrants, and refugees. The gap between needs related to mental health care for migrants, refugees, and minority groups and available services points to the need to improve accessibility and adapt systems, services, and interventions. Health professionals have a key role in ensuring the quality of care. Their capacity to cope with new challenges depends on their competence, knowledge, skills, and attitudes toward their patients' needs. Mental health professionals need training in working with cultural diversity and structural competence to understand, treat, and support migrant and refugee patients-and to respond to racial discrimination. Mental health care services need to reduce barriers to providing adequate resources, including supporting skills training for mental health professionals. Hopefully, this thematic special issue will motivate further research, discussion, and sharing of local experience and pedagogical methods in this vital field.
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Asif Z, Kienzler H. Structural barriers to refugee, asylum seeker and undocumented migrant healthcare access. Perceptions of doctors of the world caseworkers in the UK. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
In this paper, I set out the challenges of care for refugees and suggest approaches to assessment and intervention. I discuss clinical interventions that can address the immediate concern of the clinician in a bio-psycho-social framework, and the value of considering eco-social and structural influences that can hinder recovery and perpetuate inequalities. Refugees face multiple adversities before, during and after escaping from life-threatening situations, political violence, torture and persecution. They present with complex health needs and encounter hostility from host countries and public services, which see their needs as an additional demand on the public purse. Regrettably, existing care practice and training of professionals do not often include skills for working across cultures, including cultural formulations and fair assessment, cultural adaptation of interventions, cultural competence and cultural consultation methods, including clinical ethnography and exploration of cultural identity and explanatory models. There are little data on effective and kind models of interpretation and translation. Care systems are rarely designed to fully address the needs of refugees. Health practitioners are not trained to address structural and institutional racism and discrimination, which leads to exclusion of the most marginalised, with little attention to social justice and fair processes as part of appropriate healthcare.
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Affiliation(s)
- Kamaldeep Bhui
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; East London NHS Foundation Trust, UK; Oxford Health NHS Foundation Trust, UK; and World Psychiatric Association Collaborating Centre in Research, Training, Policy and Practice, UK
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Martínez-Martínez OA, Valenzuela-Moreno KA, Coutiño B. Effect of comorbidities and risk conditions on death from COVID-19 in migrants in Mexico. Int J Equity Health 2021; 20:257. [PMID: 34922533 PMCID: PMC8683816 DOI: 10.1186/s12939-021-01599-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/28/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Comorbidities increase the risk of death for patients with COVID-19, however, little is known about how it affects the prognosis of migrants who contract the virus. Therefore, this article aims to determine which comorbidities and risk conditions are associated with the probability of death among migrants infected with COVID-19 in Mexico. METHODS We use a sample of migrants with a positive diagnosis for COVID-19 (N = 2126) registered in the public database published in the National Epidemiological Surveillance System of the Mexican Ministry of Health; the technique used was a Probit regression. RESULTS The findings show that most of the comorbidities commonly associated with death from COVID-19 in the native-born population were actually not significant when present in migrants infected with COVID-19. Additionally, migrants have lower comorbidities than locals. The results further indicate that the factors related to the death of migrants infected with COVID-19 are: age, intubation, nationality group, pneumonia and the Health Care Management of Patients. CONCLUSIONS In contrast to preceding studies with native-born populations with COVID-19, where pre-existing diseases aggravated the diagnosis of COVID-19 and sometimes led to death, in the case of migrants, only pneumonia was the significant comorbidity associated with mortality among migrants diagnosed with COVID-19.
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Affiliation(s)
- Oscar A. Martínez-Martínez
- Department of Social and Political Sciences, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Álvaro Obregón, Lomas de Santa Fe, 01219 México, Mexico
| | - Karla A. Valenzuela-Moreno
- International Studies Department, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Álvaro Obregón, Lomas de Santa Fe, 01219 México, Mexico
| | - Brenda Coutiño
- Department of Social and Political Sciences, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Álvaro Obregón, Lomas de Santa Fe, 01219 México, Mexico
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Abstract
This article introduces a thematic issue of Transcultural Psychiatry with selected papers from the McGill Advanced Study Institute in Cultural Psychiatry on "Pluralism and Polarization: Cultural Contexts and Dynamics of Radicalization," which took place June 20-22, 2017. The ASI brought together an interdisciplinary group scholars to consider the role of social dynamics, cultural contexts and psychopathology in radicalization to violent extremism. Papers addressed four broad topics: (1) current meanings and uses of the term radicalization; (2) personal and social determinants of violent radicalization, including individual psychology, interpersonal dynamics, and wider social-historical, community and network processes; (3) social and cultural contexts and trajectories of radicalization including the impact of structural and historical forces associated with colonization and globalization as well as contemporary political, economic and security issues faced by youth and disaffected groups; and (4) approaches to community prevention and clinical intervention to reduce the risk of violent radicalization. In this introductory essay, we revisit these themes, define key terms, and outline some of the theoretical and empirical insights in the contributions to this issue. Efforts to prevent violent radicalization face challenges because social media and the Internet allow the rapid spread of polarizing images and ideas. The escalation of security measures and policies also serves to confirm the worldview of conspiracy theory adherents. In addition to addressing the structural inequities that fuel feelings of anger and resentment, we need to promote solidarity among diverse communities by building a pluralistic civil society that offers a meaningful alternative to the violent rhetorics of us and them.
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Affiliation(s)
- Cécile Rousseau
- Division of Social & Transcultural Psychiatry, McGill University, Montreal, Canada
| | - Neil K Aggarwal
- New York State Psychiatric Institute and Columbia University, New York
| | - Laurence J Kirmayer
- Division of Social & Transcultural Psychiatry, McGill University, and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
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