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Kirsch J, Maleku A, Kim YK, Aziz T, Dada S, Haran H, Kitchens K. The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences. Community Ment Health J 2024:10.1007/s10597-024-01283-6. [PMID: 38691243 DOI: 10.1007/s10597-024-01283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann-Whitney U and Kruskal-Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r = .53, p < .01) and between post-migration difficulties and mental health (r = .33, p < .01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal-Wallis H = 14.76, p < .05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments.
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Affiliation(s)
- Jaclyn Kirsch
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA.
| | - Arati Maleku
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Youn Kyoung Kim
- School of Social Work, Louisiana State University, Baton Rouge, LA, USA
| | | | | | - Hanna Haran
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Katherine Kitchens
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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Alemi Q, Panter-Brick C, Oriya S, Ahmady M, Alimi AQ, Faiz H, Hakim N, Sami Hashemi SA, Manaly MA, Naseri R, Parwiz K, Sadat SJ, Sharifi MZ, Shinwari Z, Ahmadi SJ, Amin R, Azimi S, Hewad A, Musavi Z, Siddiqi AM, Bragin M, Kashino W, Lavdas M, Miller KE, Missmahl I, Omidian PA, Trani JF, van der Walt SK, Silove D, Ventevogel P. Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions. BJPsych Open 2023; 9:e125. [PMID: 37424447 PMCID: PMC10375890 DOI: 10.1192/bjo.2023.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/23/2022] [Accepted: 01/20/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations. AIMS We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions. METHOD In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support. RESULTS Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body-mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture. CONCLUSIONS We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.
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Affiliation(s)
- Qais Alemi
- School of Behavioral Health, Loma Linda University, California, USA
| | - Catherine Panter-Brick
- Jackson Institute for Global Affairs and Department of Anthropology, Yale University, Connecticut, USA
| | | | - Mariam Ahmady
- Department of Counselling, Faculty of Psychology and Educational Sciences, Kabul University, Afghanistan
| | | | - Hafizullah Faiz
- Jalalabad Regional Management Office, Swedish Committee for Afghanistan, Jalalabad, Afghanistan
| | - Nadia Hakim
- Migration Health Unit, International Organization for Migration, Kabul, Afghanistan
| | | | | | - Roman Naseri
- Mental Health and Psychosocial Support Unit, International Medical Corps, Kabul, Afghanistan
| | | | - Sayed Javid Sadat
- Mental Health and Peacebuilding Program, International Assistance Mission, Herat, Afghanistan
| | | | - Zalmai Shinwari
- Mental Health and Psychosocial Support Unit, HealthNet TPO, Kabul, Afghanistan
| | | | - Rohullah Amin
- Faculty of Humanities and Social Sciences, Helmut-Schmidt University, Germany
| | - Sayed Azimi
- Independent Mental Health Specialist, Geneva, Switzerland
| | - Atal Hewad
- Department of Ipso Academy and Quality Management, International Psychosocial Organisation, Konstanz, Germany
| | - Zeinab Musavi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | | | - Martha Bragin
- Silberman School of Social Work, The City University of New York, New York, USA
| | - Wataru Kashino
- Prevention Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Michalis Lavdas
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | | | - Inge Missmahl
- International Psychosocial Organisation, Konstanz, Germany
| | | | | | - Sarah Kate van der Walt
- Mental Health and Psychosocial Support Unit, Première Urgence – Aide Médicale Internationale, Kabul, Afghanistan
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Moran JK, Jesuthasan J, Schalinski I, Kurmeyer C, Oertelt-Prigione S, Abels I, Stangier U, Starck A, Gutermann J, Zier U, Wollny A, Richter K, Krüger A, Schouler-Ocak M. Traumatic Life Events and Association With Depression, Anxiety, and Somatization Symptoms in Female Refugees. JAMA Netw Open 2023; 6:e2324511. [PMID: 37471088 PMCID: PMC10359962 DOI: 10.1001/jamanetworkopen.2023.24511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/04/2023] [Indexed: 07/21/2023] Open
Abstract
Importance Different types of traumatic life events have varying impacts on symptoms of depression, anxiety, and somatization. For women from areas of the world experiencing war and humanitarian crises, who have experienced cumulative trauma exposure during war and forced migration, it is not known whether cumulative trauma or particular events have the greatest impact on symptoms. Objective To examine which traumatic life events are associated with depression, anxiety, and somatization symptoms, compared with the cumulative amount, in a sample of female refugees. Design, Setting, and Participants For this cross-sectional study, data were collected in 2016 as a part of The Study on Female Refugees. The current analysis was conducted in 2022 to 2023. This multicenter study covered 5 provinces in Germany. Participants were recruited at reception centers for refugees. Women volunteered to participate and to be interviewed after information seminars at the different centers. Exposure Traumatic life events experienced by refugees from areas of the world experiencing war and humanitarian crises. Main Outcomes and Measures Demographic variables (age, country of origin, religion, education, relationship status, and children), traumatic and adverse life events, and self-reported depression, anxiety, and somatization symptoms were measured. Random forest regressions simultaneously examined the importance of these variables on symptom scores. Follow-up exploratory mediation models tested potential associative pathways between the identified variables of importance. Results For the final sample of 620 refugee women (mean [SD] age, 32.34 [10.35] years), family violence was most associated with depression (mean [SD] variable of importance [VIM], 2.93 [0.09]), anxiety (mean [SD] VIM, 4.15 [0.11]), and somatization (mean [SD] VIM, 3.99 [0.15]), even though it was less common than other traumatic experiences, including war, accidents, hunger, or lack of housing. Other factors, such as childhood sexual abuse, injury, near-death experiences, and lack of access to health care, were also important. Follow-up analyses showed partial mediation effects between these factors in their association with symptoms, supporting the unique importance of family violence in understanding mental health. Conclusions and Relevance The findings of this cross-sectional study of refugee women who experienced multiple severe traumas related to war in their home countries and danger encountered during their migration suggest that family violence was key to their current mental health problems. Culturally sensitive assessment and treatment need to place special emphasis on these family dynamics.
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Affiliation(s)
- James Kenneth Moran
- Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin, St Hedwig Hospital, Berlin, Germany
| | - Jenny Jesuthasan
- Psychiatric University Clinic Charité, St Hedwig Hospital, Berlin, Germany
| | - Inga Schalinski
- Universität der Bundeswehr München, Department of Human Sciences, Institute of Psychology, Munich, Germany
| | - Christine Kurmeyer
- Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- AG 10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
| | - Ingar Abels
- Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Annabelle Starck
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jana Gutermann
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ulrike Zier
- Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Now with Ministry of Science and Health of Rhineland-Palatinate, Mainz, Germany
| | - Anja Wollny
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Knejinja Richter
- CuraMed Tagesklinik Nürnberg, Nuremberg, Germany
- Technische Hochschule Nürnberg, Nuremberg, Germany
| | - Antje Krüger
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
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Siddiq H, Alemi Q, Lee E. A Qualitative Inquiry of Older Afghan Refugee Women's Individual and Sociocultural Factors of Health and Health Care Experiences in the United States. J Transcult Nurs 2023; 34:143-150. [PMID: 36695336 DOI: 10.1177/10436596221149692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Approximately 132,000 Afghans have resettled in the United States since the 1980s and are now aging. As older adults, sociocultural factors influence health and health-related behaviors. This study aimed to explore older Afghan refugee women's perceptions of individual and sociocultural factors of health and health care experiences. METHODS A focused ethnography methodology was conducted with 27 semi-structured interviews with older Afghan refugee women, family members, and community key informants in Southern California. Recorded interviews were transcribed and analyzed using inductive thematic analysis. RESULTS Five themes were identified as key to health promotion in the post-migration setting: (a) health promotion through Islam, (b) the centrality of family, (c) ongoing stressors that impact health, (d) needing support in navigating health services, and (e) miscommunication leading to mistrust of health care providers. DISCUSSION Health interventions should consider social and cultural contexts and faith-based and family-centered approaches when addressing older Afghan refugee women's long-term health and well-being.
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Affiliation(s)
- Hafifa Siddiq
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Eunice Lee
- University of California, Los Angeles, USA
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Nissen A, Hynek KA, Scales D, Hilden PK, Straiton M. Chronic pain, mental health and functional impairment in adult refugees from Syria resettled in Norway: a cross-sectional study. BMC Psychiatry 2022; 22:571. [PMID: 36002823 PMCID: PMC9404590 DOI: 10.1186/s12888-022-04200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Limited research exists on pain and especially the co-occurrence of pain and mental ill health in general refugee populations. The present study aimed to approximate the prevalence of chronic pain (CP) among adult refugees from Syria resettled in Norway; investigate the association between CP and mental ill health; and explore how CP and mental ill health associate with both perceived general health and functional impairment. Gender as potential effect modifier in these associations was also examined. METHODS Cross-sectional, postal survey questionnaire. INCLUSION CRITERIA ≥ 18 years old; refugee from Syria; and arrived in Norway between 2015 and 2017. Study sample was randomly drawn from full population registries, and n = 902 participated (participation rate ≈10%). CP was measured with 10 items on pain lasting for ≥ 3 consecutive months last year. Symptoms of anxiety, depression and PTSD were measured with the HSCL and HTQ scales, respectively. Ordered and binomial logistic regressions were used in analyses. Gender was tested as effect modifier with Wald test for interaction. RESULTS In the sample overall, the proportion of participants who reported severe CP was 43.1%. There was strong evidence that anxiety, depression and PTSD were associated with higher levels of CP. In fully adjusted regression models, including both CP and mental health variables, CP was strongly associated with poor perceived general health whereas mental health showed much weaker associations. The association between mental health (anxiety and PTSD) and functional impairment was highly gender specific, with strong associations in men but not in women. CP was strongly associated with functional impairment with no difference across gender. CONCLUSION The study shows a high burden of CP in a general population of adult refugees from Syria with likely substantial adverse consequences for daily functioning. The strong association between CP and mental ill health suggests personnel working with refugees' health should be attuned to their co-occurrence as both problems may need to be addressed for either to be effectively mitigated. A clear mismatch exists between the burden on health caused by pain in general refugee populations and the amount of available evidence to guide mitigating strategies. TRIAL REGISTRATION NCT03742128.
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Affiliation(s)
- Alexander Nissen
- Section for Trauma, Catastrophes and Forced Migration - Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, 0484, Oslo, Norway.
| | - Kamila Angelika Hynek
- grid.418193.60000 0001 1541 4204Division for Mental and Physical Health, Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213 Oslo, Norway
| | - David Scales
- grid.5386.8000000041936877XSection of Hospital Medicine, Division of General Internal Medicine, Department of Internal Medicine, Weill Cornell Medicine, 525 E 68th Street, Box 331, New York, NY 10065 USA
| | - Per Kristian Hilden
- grid.504188.00000 0004 0460 5461Section for Trauma, Catastrophes and Forced Migration - Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway
| | - Melanie Straiton
- grid.418193.60000 0001 1541 4204Division for Mental and Physical Health, Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213 Oslo, Norway
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Alexander N, Mathilde S, Øivind S. Post-migration Stressors and Subjective Well-Being in Adult Syrian Refugees Resettled in Sweden: A Gender Perspective. Front Public Health 2021; 9:717353. [PMID: 34568258 PMCID: PMC8458654 DOI: 10.3389/fpubh.2021.717353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
A number of post-migration stressors have been shown to adversely affect mental health in refugees resettled in high-income countries, including poor social integration, financial difficulties and discrimination, and recent evidence suggests that these effects are gender specific. Social support has been found to buffer against post-migration stress in some studies on refugee populations, though the evidence on this is mixed. The present study used cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria resettled in Sweden between 2008 and 2013 (N sample = 4,000, n respondents = 1,215, response rate 30.4%) to investigate gender-specific associations between post-migration stressors and subjective well-being (SWB) and whether these associations were modified by social support. SWB was measured with the WHO-5 Well-being Index (scaled 0-100), dichotomized into high (≥50) and low (<50) SWB. Main analyses were stratified by gender, and regressed SWB on four domains of post-migration stress (financial strain, social strain, competency strain and discrimination) using logistic regression, adjusting for sociodemographic variables and traumatic experiences. Social support was tested as an effect modifier. In fully adjusted models, main risk factors for low SWB were high financial strain, especially in males (ORhigh vs. low strain, males = 10.30 [4.91-21.6], p < 0.001 vs. ORhigh vs. low strain, females= 3.84 [1.68-8.79], p = 0.002), and high social strain, only in males (ORhigh vs. low strain, males = 9.21 [3.96-21.4], p < 0.001 vs. ORhigh vs. low strain, females = 1.03 [0.40-2.64], p = ns). There was some evidence that social support buffered the adverse association of financial strain with SWB. In conclusion, the present study found clear support of gender-specific effects of post-migration stressors on SWB. Mitigation strategies and interventions should be aware of and sensitive to these potential gendered effects, and future research exploring mental health in the context of resettlement stress should have a heightened focus on the important role of gender.
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Affiliation(s)
- Nissen Alexander
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Sengoelge Mathilde
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Solberg Øivind
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
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Ciaramella M, Monacelli N, Cocimano LCE. Promotion of Resilience in Migrants: A Systematic Review of Study and Psychosocial Intervention. J Immigr Minor Health 2021; 24:1328-1344. [PMID: 34324124 PMCID: PMC9388436 DOI: 10.1007/s10903-021-01247-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
This systematic review aimed to contribute to a better and more focused understanding of the link between the concept of resilience and psychosocial interventions in the migrant population. The research questions concerned the type of population involved, definition of resilience, methodological choices and which intervention programmes were targeted at migrants. In the 90 articles included, an heterogeneity in defining resilience or not well specified definition resulted. Different migratory experiences were not adequately considered in the selection of participants. Few resilience interventions on migrants were resulted. A lack of procedure’s descriptions that keep in account specific migrants’ life-experiences and efficacy’s measures were highlighted.
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Affiliation(s)
- Maria Ciaramella
- Department of Letters, Arts, History and Society, University of Study of Parma, Via Kennedy, 6, 43125, Parma, PR, Italy.
| | - Nadia Monacelli
- Department of Economics and Business Sciences, University of Study of Parma, Parma, Italy
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Wandschneider L, Batram-Zantvoort S, Razum O, Miani C. Representation of gender in migrant health studies - a systematic review of the social epidemiological literature. Int J Equity Health 2020; 19:181. [PMID: 33054755 PMCID: PMC7556985 DOI: 10.1186/s12939-020-01289-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory. Simultaneously, migration influences the individual as well as societal definition and perception of gender roles. An explicit gender perspective in migration-related epidemiological research can contribute to adequately analyse and interpret the health of migrants. This systematic review gives a comprehensive overview on how gender has been conceptualised, operationalised and measured in social epidemiologic studies aiming to assess the influence of gender on health among migrants. Methods We searched PubMed, Embase, CINAHL, the Cochrane Library, EconLit and PsycINFO and conducted backward reference searching. Reviewers independently selected studies, extracted data and conducted the quality assessment. Eligible studies actively aimed to understand, identify or explain the influence of gender on migrants’ health, whereby the role of gender can encompass a variety of mechanisms, processes or states of differentiation, discrimination and/or inequality. Results Almost all of the 43 studies were cross-sectional and focussed on health outcomes in the post-migration phase. The most common theme of research was the health of male migrants in the US, and in particular of men who have sex with men (MSM). All studies treated gender as a binary variable (men vs. women), without discussing additional types of gender identities. A minority of studies differentiated clearly between sex and gender. Gender was mostly operationalised through attitudes toward gender roles and gender-based discrimination, experienced at the individual level. Community and societal level gender measures capturing structural gender determinants were underrepresented. Conclusions The intersections of migration and gender suggested synergistic effects on health that only become visible when considering those two social determinants together. Future research needs to embrace a multilevel and non-binary understanding of gender and reflect on the influence of gender in the different phases of the migration journey. Systematic review registration PROSPERO CRD42019124698.
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Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany.
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
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Assessing Predictors of Emotional Distress by Immigrant Type: An Exploration of Adult Refugees, Asylees, and SIV Holders in Maryland. J Immigr Minor Health 2019; 22:50-60. [PMID: 31346844 DOI: 10.1007/s10903-019-00917-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stressors and trauma experienced by persons fleeing harm or persecution can cause elevated distress. This study assessed predictors of elevated distress among newly arrived refugees, asylees, and Special Immigrant Visa (SIV) holders in Maryland. A secondary analysis of Refugee Health Screener-15 data from 4385 refugees, asylees, and SIV holders arriving in Maryland from 2014 to 2017 was conducted. Mean scores were compared across immigrant groups, and positive screening predictors were identified using logistic regression. Mean scores were highest among SIV holders and lowest among asylees. Compared to refugees, SIV holders had greater odds of screening positive; significance was reduced after adjusting for covariates. A significant interaction term was found for SIV women, who had 1.74 greater odds than SIV males. Distress varied between immigrant groups, with asylees having lowest odds of screening positive. SIV women's significant results may owe to acculturation distress, disrupted gender expectations, and resettlement difficulties.
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Çalıkoglu EO, Aras A, Hamza M, Aydin A, Nacakgedigi O, Koga PM. Sexism, attitudes, and behaviors towards violence against women in medical emergency services workers in Erzurum, Turkey. Glob Health Action 2019; 11:1524541. [PMID: 30270761 PMCID: PMC7012005 DOI: 10.1080/16549716.2018.1524541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: In Turkey, almost every 4 out of 10 married women have been subjected to physical abuse by their spouses. Although studies on the prevalence of domestic violence in Turkey abound, little has been published about first responders’ attitudes and behaviors towards violence against women and on sexism. Objective: Our study examined the attitudes and behaviors of Erzurum City medical emergency services workers towards violence against women, and their relationship with sexist attitudes. Methods: A cross-sectional survey was conducted among 370 medical emergency service personnel using a self-administered questionnaire of 35 items, which included two scales utilizing a three-point Likert format; 15 questions measured attitudes and behaviors towards violence against women (VAW) and 12 items measured sexist attitudes. Results: The mean age of participants was 29.6 ± 8.0 years with a sex distribution of (47.6%) women and 194 (52.4%) men. Less than half of the participants (48.5%; n = 173) felt competent in recognizing and managing VAW; moreover, when faced with such cases, 18.5% (n = 67) said they would try to reconcile the victim with the perpetrator. Male participants had higher mean scores both on VAW (20.7 ± 5.2 vs. 16.9 ± 2.8; t = 7.927; p < 0.001) and on sexist attitudes (24.3 ± 5.3 vs. 18.6 ± 4.3; t = 1.714; p < 0.001). Age (B = 0.067; 95% CI: 0.014–0.119; p = 0.013) and sexism scores (B = 0.487; 95% CI: 0.407–0.566; p < 0.001) were revealed as independent significant predictors of the VAW attitude scores. Conclusions: Educational and public health measures must be instituted to change attitudes and behaviors towards violence against women; measures must focus not only on violence but also on sexism. Health care professionals need to reflect on their own gender biases in clinical practice and prevent gender discrimination.
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Affiliation(s)
- Elif Okşan Çalıkoglu
- a School of Medicine, Department of Public Health , Ataturk University , Erzurum , Turkey
| | - Aysun Aras
- a School of Medicine, Department of Public Health , Ataturk University , Erzurum , Turkey
| | - Maysa Hamza
- b Davis, School of Medicine, Department of Public Health Sciences , University of California , Davis , CA , USA
| | - Ayşegül Aydin
- a School of Medicine, Department of Public Health , Ataturk University , Erzurum , Turkey
| | - Onur Nacakgedigi
- b Davis, School of Medicine, Department of Public Health Sciences , University of California , Davis , CA , USA
| | - Patrick Marius Koga
- b Davis, School of Medicine, Department of Public Health Sciences , University of California , Davis , CA , USA
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Abraham R, Lien L, Hanssen I. Coping, resilience and posttraumatic growth among Eritrean female refugees living in Norwegian asylum reception centres: A qualitative study. Int J Soc Psychiatry 2018; 64:359-366. [PMID: 29584520 DOI: 10.1177/0020764018765237] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The links between migration and health are well documented. Being a refugee exacerbates migrants' vulnerability through trauma and loss. The aim of this study is to identify sources of resilience, coping and posttraumatic growth in female Eritrean refugees living in Norwegian asylum reception centres. METHOD The study had a qualitative, descriptive and explorative design with two focus group interviews and 10 individual in-depth interviews. Participants included 18 female Eritrean refugees aged 18-60, who had obtained refugee status and were still living in an asylum reception centre. A content-focused hermeneutic analytic approach was used. RESULTS Interviewees described the challenges of pre-flight and flight trauma, conditions at the refugee centre, communication difficulties and the 'endless' waiting for transfer to a municipality. To cope, they found it helpful to focus on the future and to think positively. Fellowship with and support from fellow Eritrean refugees were essential as they became a proxy family and provided a strong ethnic identity. Their religious belief also helped them cope and gave them hope for the future. DISCUSSION The interviewees in this study perceived their psychological problems as a normal reaction to what they had been through. Religious belief was an important resilience factor, as was social support, especially from peers. CONCLUSION The interviewees' coping was based on the realization of their psychological reactions being normal while doing their utmost to focus on their aims and hopes for the future.
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Affiliation(s)
- Ruth Abraham
- 1 Section for Psychiatry, Lovisenberg Diaconal Hospital, Oslo, Norway.,2 Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Lien
- 2 Faculty of Medicine, University of Oslo, Oslo, Norway.,3 Section for Public Health, Hedmark University College, Elverum, Norway.,4 Section for Mental Health, Innlandet Hospital Trust, Norway
| | - Ingrid Hanssen
- 5 Section for Clinical Nursing Research, Lovisenberg Diaconal University College, Oslo, Norway
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Alemi Q, Stempel C. Discrimination and distress among Afghan refugees in northern California: The moderating role of pre- and post-migration factors. PLoS One 2018; 13:e0196822. [PMID: 29782531 PMCID: PMC5962064 DOI: 10.1371/journal.pone.0196822] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/20/2018] [Indexed: 11/18/2022] Open
Abstract
This study investigates the effect of perceived discrimination on the mental health of Afghan refugees, and secondly, tests the distress moderating effects of pre-migration traumatic experiences and post-resettlement adjustment factors. In a cross-sectional design, 259 Afghans completed surveys assessing perceived discrimination and a number of other factors using scales developed through inductive techniques. Multivariable analyses consisted of a series of hierarchical regressions testing the effect of perceived discrimination on distress, followed by a sequential analysis of moderator variables. Perceived discrimination was significantly associated with higher distress, and this relationship was stronger among those with a strong intra-ethnic identity and high pre-resettlement traumatic experiences. The expected buffering effects of civic engagement, ethnic orientation (e.g. integration), and social support were not significant. Discrimination is a significant source of stress for Afghan refugees, which may exacerbate stresses associated with other pre- and post-migration stressors. Future research is needed to tailor interventions that can help mitigate the stress associated with discrimination among this highly vulnerable group.
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Affiliation(s)
- Qais Alemi
- Loma Linda University, Department of Social Work and Social Ecology, School of Behavioral Health, Loma Linda, CA, United States of America
- * E-mail:
| | - Carl Stempel
- California State University, East Bay, Department of Sociology and Social Services, Hayward, CA, United States of America
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Jesuthasan J, Sönmez E, Abels I, Kurmeyer C, Gutermann J, Kimbel R, Krüger A, Niklewski G, Richter K, Stangier U, Wollny A, Zier U, Oertelt-Prigione S, Shouler-Ocak M. Near-death experiences, attacks by family members, and absence of health care in their home countries affect the quality of life of refugee women in Germany: a multi-region, cross-sectional, gender-sensitive study. BMC Med 2018; 16:15. [PMID: 29391012 PMCID: PMC5793395 DOI: 10.1186/s12916-017-1003-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/28/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The year 2016 has marked the highest number of displaced people worldwide on record. A large number of these refugees are women, yet little is known about their specific situation and the hurdles they have to face during their journey. Herein, we investigated whether sociodemographic characteristics and traumatic experiences in the home country and during the flight affected the quality of life of refugee women arriving in Germany in 2015-2016. METHODS Six hundred sixty-three women from six countries (Afghanistan, Syria, Iran, Iraq, Somalia, and Eritrea) living in shared reception facilities in five distinct German regions were interviewed by native speakers using a structured questionnaire. Sociodemographic data and information about reasons for fleeing, traumatic experiences, symptoms, quality of life, and expectations towards their future were elicited. All information was stored in a central database in Berlin. Descriptive analyses, correlations, and multivariate analyses were performed. RESULTS The most frequent reasons cited for fleeing were war, terror, and threat to one's life or the life of a family member. Eighty-seven percent of women resorted to smugglers to make the journey to Europe, and this significantly correlated to residence in a war zone (odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.4-4.6, p = 0.003) and homelessness prior to fleeing (OR = 2.1, 95% CI = 1-4.3, p = 0.04). Overall the described quality of life by the women was moderate (overall mean = 3.23, range of 1-5) and slightly worse than that of European populations (overall mean = 3.68, p < 0.0001). The main reasons correlating with lower quality of life were older age, having had a near-death experience, having been attacked by a family member, and absence of health care in case of illness. CONCLUSIONS Refugee women experience multiple traumatic experiences before and/or during their journey, some of which are gender-specific. These experiences affect the quality of life in their current country of residence and might impact their integration. We encourage the early investigation of these traumatic experiences to rapidly identify women at higher risk and to improve health care for somatic and mental illness.
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Affiliation(s)
- Jenny Jesuthasan
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Große Hamburger Straße 5 - 11, 10115, Berlin, Germany
| | - Ekin Sönmez
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Große Hamburger Straße 5 - 11, 10115, Berlin, Germany.,Department of Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ingar Abels
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Große Hamburger Straße 5 - 11, 10115, Berlin, Germany
| | - Christine Kurmeyer
- Office of the Equal Opportunities Officer, Charité-Universitätsmedizin, Berlin, Germany
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Renate Kimbel
- Insitute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany
| | - Antje Krüger
- Insitute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Guenter Niklewski
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany.,Faculty for Social Sciences, Technical University Nuremberg GSO, Nuremberg, Germany.,Faculty for Medical Sciences, UGD University Stip, Stip, Macedonia
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Anja Wollny
- Insitute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Ulrike Zier
- Insitute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen (117), The Netherlands. .,Institute of Legal Medicine, Charité-Universitätsmedizin, Turmstr. 21, Haus N, 10559, Berlin, Germany.
| | - Meryam Shouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Große Hamburger Straße 5 - 11, 10115, Berlin, Germany.
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Refugee Health: An Ongoing Commitment and Challenge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010131. [PMID: 29342831 PMCID: PMC5800230 DOI: 10.3390/ijerph15010131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 11/22/2022]
Abstract
Refugees represent a diverse group of displaced individuals with unique health issues and disease risks. The obstacles facing this population have their origins in war, violence, oppression, exploitation, and fear of persecution. Regardless of country of origin, a common bond exists, with refugees often confronting inadequate healthcare resources, xenophobia, discrimination, and a complex web of legal barriers in their new homelands. In many cases, the plight of refugees is multigenerational, manifesting as mental health issues, abuse, poverty, and family disruption. The health trajectory of refugees remains an ongoing commitment and challenge.
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Ayvaz A, Turfan S, Kesicioglu T, Dülger C, Ayraler A, Vural A, Dikbas O. Screening for hepatitis B and C seroprevalence and prevalence of HIV infection among Afghan refugees newly arrived in coastal region Turkey in 2018: A systematic single-centre analysis. SANAMED 2018. [DOI: 10.24125/sanamed.v13i3.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Previous studies showed that refugee status have been associated with various deteriorated effects on human health including higher prevalence of hepatitis B, C and HIV infections. In this study we aim to bridge the gap between Afghan immigrants and naive Turkish population by identifying HBV, HCV and HIV profiles. In addition, a large number of laboratory parameters was collected for all participants, including hematologic and biochemical test results. Materials and Methods: We performed a retrospective review of laboratory records at a tertiary center in Northern Turkey from January 1, 2018, to April 15, 2018. Our population based study comprising hospital data of 403 Afghan refugees and 400 naive Turkish citizens. Results: Afghan refugees had higher anti-HIV seropositivity than Turkish citizens (p < 0.05). There were no difference between the two groups according to HbsAg and anti-HCV seropositivity. Also Afghan refugees had statistically lower ALT levels, higher hemoglobin levels and higher mean TSH level (p < 0.05). Mean T4 level did not show significant difference between the two groups. Conclusion: We need further investigations to find out the risk of infections that originated from immigration.
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