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Elshahat S, Moffat T, Gagnon O, Charkatli L, Gomes-Szoke ED. The relationship between diet/nutrition and the mental health of immigrants in Western societies through a holistic bio-psycho-socio-cultural lens: A scoping review. Appetite 2023; 183:106463. [PMID: 36682625 DOI: 10.1016/j.appet.2023.106463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/20/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Epidemiological evidence suggests that diet and nutrition not only impact individuals' physical health but also shape their mental health (MH). The nutrition/diet-MH relationship may be critical among immigrants due to socioeconomic and sociocultural factors. Despite the complex nutrition/diet-MH relationship, most scholarship in this area employs a biomedical perspective. This scoping review of 63 studies deployed a holistic bio-psycho-socio-cultural framework to examine the relationship between diet/nutrition and immigrants' MH. Five automated databases (Embase, PubMed, Medline, PsycINFO and Anthropology Plus) were systematically searched for relevant articles from Western countries. A bio-psycho-socio-cultural conceptual model guided the analysis of the multi-faceted diet/nutrition-MH relationship. Consumption of fruit/vegetables, unsaturated fats, vitamin D-rich foods and whole grains was significantly positively related to MH. Reported pathways included enhanced self-esteem and ability to stay physically active. Energy-dense food consumption emanating from unhealthful dietary acculturation to the Western lifestyle was associated with poor MH through various mechanisms, including exhaustion and worry about developing non-communicable diseases. Food insecurity and related hunger were significantly positively associated with depression and anxiety among immigrants through different pathways, including family conflicts, homesickness, social exclusion, feelings of shame/stigma, and helplessness related to not affording nutritious foods that meet one's cultural dietary requirements. Ethnic food consumption appeared to mitigate MH issues and enhance immigrants' well-being. A bio-psycho-socio-cultural-informed model is needed to gain an in-depth and encompassing understanding of immigrant MH as it relates to diet/nutrition. The first iteration of such a model is presented in this review alongside an illustration of how it may be used to strengthen an analysis and understanding of the multi-faceted diet/nutrition-MH relationship amongst immigrants and inform public health professionals and dieticians/practitioners.
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Affiliation(s)
- Sarah Elshahat
- Department of Anthropology, Faculty of Social Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Tina Moffat
- Department of Anthropology, Faculty of Social Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Olivia Gagnon
- Department of Neuroscience, Faculty of Science, Carleton University, Ottawa, Ontario, Canada
| | - Lein Charkatli
- Department of Psychology, Neuroscience, & Behavior, Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Biology, Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Emily D Gomes-Szoke
- Department of Biology, Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada
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2
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Ali-Naqvi O, Alburak TA, Selvan K, Abdelmeguid H, Malvankar-Mehta MS. Exploring the Impact of Family Separation on Refugee Mental Health: A Systematic Review and Meta-narrative Analysis. Psychiatr Q 2023; 94:61-77. [PMID: 36690848 DOI: 10.1007/s11126-022-10013-8] [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] [Accepted: 12/26/2022] [Indexed: 01/25/2023]
Abstract
The refugee crisis is spreading rapidly, with the number of global refugees this decade doubling in comparison to the last, leading to further concern regarding asylum policies and their psychological impacts. The aim of this systematic review is to further emphasize the correlation between familial separation and the risk of mental health disorders in refugees. This particular review uses quantitative and qualitative data sourced from a variety of countries to comparatively view the mental health status of approximately 8,737 refugees ages 15 and older. This was done to determine if familial separation could potentially impact their overall quality of life. As a result, separation from one's family was found to be correlated with symptoms of posttraumatic stress disorder, depression, anxiety, adult separation anxiety disorder, intermittent explosive disorder, and more. Studies reported a high variance in the prevalence of mental health disorders when models were adjusted for family separation. Methods to improve asylum procedure and mental health services for refugees is taken into consideration.
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Affiliation(s)
- Ozaay Ali-Naqvi
- Department of Human Health and Nutritional Sciences, The University of Guelph, Guelph, ON, Canada.,RefuHope, London, Canada
| | - Tariq A Alburak
- RefuHope, London, Canada.,Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Kavin Selvan
- RefuHope, London, Canada.,Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hana Abdelmeguid
- RefuHope, London, Canada.,Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada. .,Ivey Eye Institute, St. Joseph's Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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3
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Phillimore J, D'Avino G, Strain-Fajth V, Papoutsi A, Ziss P. Family reunion policy for resettled refugees: Governance, challenges and impacts. FRONTIERS IN HUMAN DYNAMICS 2023. [DOI: 10.3389/fhumd.2023.1075306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The past decade has seen renewed efforts to establish resettlement as a durable solution for refugees, both as a protection tool and a mechanism to equitably distribute them among countries. Although the right to a family life is widely recognised as a fundamental human right, whether refugees can arrive with their family or be reunited with family once resettled varies across receiving countries. Little is known about family reunion policies in countries leading the resettlement efforts, and about the impact of these policies on the lives and experiences of resettled refugees. This paper addresses this gap though a systematic scoping review of academic and policy literature on family reunion policies for resettlement refugees, and on the impact of such policy on their lives. Based on a review of 42 papers published between 2010 and 2021, we outline the policies implemented in different receiving countries to enable resettled refugees to reunite with family, documenting at the same time the challenges refugees face in the process, as well as the impact of policy on their experiences. The findings evidence a tension between the refugees' own understanding of family and definitions of family in policy in receiving countries, which often results in family separation or reconfiguration. Additionally, high costs and other administrative barriers, as well as long waiting times associated with family reunification, lead to delayed or denied reunion, having detrimental effects on resettled refugees' well-being in the present and on their future prospects.
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Gartley T, Due C. The Interpreter Is Not an Invisible Being: A Thematic Analysis of the Impact of Interpreters in Mental Health Service Provision with Refugee Clients. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12181] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Clemence Due
- School of Psychology, The University of Adelaide,
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Joly MP, Wheaton B. Human rights in countries of origin and the mental health of migrants to Canada. SSM Popul Health 2020; 11:100571. [PMID: 32322655 PMCID: PMC7160446 DOI: 10.1016/j.ssmph.2020.100571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 11/15/2022] Open
Abstract
This study explores the effect of human rights violations in countries of origin on migrants' mental health, using archival data on human rights violations from 1970-2011, merged to a representative probability sample of 2412 adults living in a large Canadian metropolitan area. The context of exit is defined at the country level, as opposed to self-reported individual experiences of trauma. While most studies start from a question about direct exposure to human rights violations, they may miss the effect of the national-level social context - threat, instability, disruption of lives, and uncertainty - on mental health. Findings indicate that high levels of human rights violations in countries of origin have long-term effects on migrants' mental health. The impact of human rights violations is substantially explained by the combined effect of stressors both before and after migration, suggesting a cumulative process of stress proliferation following this context of exit.
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Affiliation(s)
- Marie-Pier Joly
- Institute of Sociology, University of Göttingen, Platz der Göttinger Sieben 3, 37073, Göttingen, Germany
| | - Blair Wheaton
- Department of Sociology, University of Toronto, 725 Spadina Avenue, Toronto, Ontario, M5S 2J4, Canada
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Henkelmann JR, de Best S, Deckers C, Jensen K, Shahab M, Elzinga B, Molendijk M. Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: systematic review and meta-analysis. BJPsych Open 2020; 6:e68. [PMID: 32611475 PMCID: PMC7443922 DOI: 10.1192/bjo.2020.54] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The number of refugees is at its highest since the Second World War and on the rise. Many refugees suffer from anxiety, depression and post-traumatic stress disorder (PTSD), but exact and up-to-date prevalence estimates are not available. AIMS To report the pooled prevalence of anxiety and mood disorders and PTSD in general refugee populations residing in high-income countries and to detect sources of heterogeneity therein. METHOD Systematic review with meta-analyses and meta-regression. RESULTS Systematic searches (final search date 3 August 2019) yielded 66 eligible publications that reported 150 prevalence estimates (total sample N = 14 882). Prevalence rates were 13 and 42% (95% CI 8-52%) for diagnosed and self-reported anxiety, 30 and 40% (95% CI 23-48%) for diagnosed and self-reported depression, and 29 and 37% (95% CI 22-45%) for diagnosed and self-reported PTSD. These estimates are substantially higher relative to those reported in non-refugee populations over the globe and to populations living in conflict or war settings, both for child/adolescent and adult refugees. Estimates were similar over different home and resettlement areas and independent of length of residence. CONCLUSIONS Our data indicate a challenging and persisting disease burden in refugees due to anxiety, mood disorders and PTSD. Knowing this is relevant for the development of public health policies of host countries. Scalable interventions, tailored for refugees, should become more readily available.
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Affiliation(s)
- Jens-R Henkelmann
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University, The Netherlands
| | - Sanne de Best
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University
| | - Carla Deckers
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University
| | - Katarina Jensen
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University
| | - Mona Shahab
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University; and Clinical Epidemiological Department, Leiden University Medical Center
| | - Bernet Elzinga
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University
| | - Marc Molendijk
- Faculty of Social and Behavioural Sciences, Clinical Psychology Department, Leiden University; and Leiden Institute of Brain and Cognition, Leiden University Medical Center, The Netherlands
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Tay AK, Mohsin M, Rees S, Tam N, Kareth M, Silove D. The structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua. Soc Psychiatry Psychiatr Epidemiol 2019; 54:771-780. [PMID: 30778622 DOI: 10.1007/s00127-019-01666-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Refugees may be at risk of experiencing a complicated form of bereavement. As yet, however, the nosological status of this putative category across cultures remains in question. We apply qualitative and quantitative methods to investigate the manifestations, prevalence, factorial structure and psychosocial correlates of complicated bereavement amongst refugees from West Papua, a population with no past exposure to western concepts of grief or to formal mental health services. METHODS Qualitative methods (focus groups and informant interviews) were used to identify cultural expressions of complicated bereavement derived from international classification systems, that is, DSM 5 persistent complex bereavement disorder (PCBD) and ICD-11 prolonged grief disorder (PGD) in developing a structured interview applied by trained field workers. Participants were adult West Papuan refugees and their offspring recruited from households (n = 486, response 85.8%) across nine villages in a remote town in Papua New Guinea. RESULTS The qualitative data obtained from focus groups (n = 20) and informant interviews (n = 4) with local psychiatrists supported the cultural validity of complicated bereavement. 16% (n = 78) of the sample met criteria for PCBD based on DSM-5 criteria and 103 (21%) met criteria for PGD based on ICD-11 criteria. Confirmatory factor analysis yielded a six-factor model of complicated bereavement with a moderately good fit to the data. The model included dimensions of anger/negative appraisal (AN), avoidance/giving up, estrangement from others, and confusion and diminished identity. In contrast, the DSM-5 three-factor model and the ICD-11 two-factor model each yielded a poor fit. Cumulative traumatic losses (β = 0.16, P = 0.03), duration since displacement [(β = 0.10, P = 0.02)] and postmigration living difficulties (β = 0.20, P = 0.01) were associated with an aggregated index of complicated bereavement, supporting the concurrent validity of the structure identified. CONCLUSIONS Culture and exposure to persecution and displacement may contribute to the content and configuration of the complicated bereavement reaction, an issue that requires recognition in international classification systems and clinical practice.
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Affiliation(s)
- Alvin Kuowei Tay
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia.
| | - Mohammed Mohsin
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Susan Rees
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Natalino Tam
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Moses Kareth
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
| | - Derrick Silove
- Centre for Population Mental Health Research, Liverpool Hospital and Psychiatry Research and Teaching Unit, School of Psychiatry, Cnr Forbes and Campbell Streets, University of New South Wales, Liverpool NSW 2170, Sydney, NSW, 2052, Australia
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8
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Tay AK, Rees S, Tam N, Kareth M, Silove D. Developing a measure of adaptive stress arising from the psychosocial disruptions experienced by refugees based on a sample of displaced persons from West Papua. Int J Methods Psychiatr Res 2019; 28:e1770. [PMID: 30740811 PMCID: PMC6877204 DOI: 10.1002/mpr.1770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/23/2018] [Accepted: 12/01/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We report the testing and refinement of the Adaptive Stress Index (ASI), a psychosocial assessment tool designed to measure the longer terms stressors of adapting to the psychosocial disruptions experienced by refugees. METHODS The ASI is based on a theoretical model, the Adaptation and Development After Persecution and Trauma (ADAPT), which postulates that five psychosocial domains are disrupted by conflict and displacement, namely, safety and security, attachment, access to justice, roles and identities, and existential meaning. We used confirmatory factor analysis (CFA) and item response theory (IRT) to shorten and refine the measure based on data obtained from 487 refugees participating in a household survey in Papua New Guinea (response rate: 85.8%). RESULTS CFA allowed the exclusion of low loading items (<0.5) and locally dependent items. A good fit was found for single models representing each of the five ASI domains. A graded response IRT model identified items with the highest discrimination and information content in each of the five derived scales. CONCLUSIONS The analysis produced a shortened and refined ASI for use amongst refugee populations. The study offers a guide to adapting measures of stress for application to diverse populations exposed to mass conflict and refugee displacement.
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Affiliation(s)
- Alvin Kuowei Tay
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Rees
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalino Tam
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Moses Kareth
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Derrick Silove
- The Academic Mental Health Unit, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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9
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Pentoxifylline prevents post-traumatic stress disorder induced memory impairment. Brain Res Bull 2018; 139:263-268. [DOI: 10.1016/j.brainresbull.2018.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/11/2018] [Accepted: 03/15/2018] [Indexed: 02/07/2023]
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10
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Psychological and psychosocial interventions for refugee children resettled in high-income countries. Epidemiol Psychiatr Sci 2018; 27:117-123. [PMID: 29122044 PMCID: PMC6998960 DOI: 10.1017/s2045796017000695] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Large numbers of refugee children are arriving in high-income countries. The evidence to date suggests that they have mental health needs that are higher than for the general population and that these are exacerbated by the numbers of traumatic events they have experienced and the post-migration stressors they continue to be exposed to. The importance of a thorough and thoughtful assessment is discussed. Treatments of note are described for post-traumatic stress disorder, family functioning, general mental health problems and school environments. Future opportunities to operationalise outcome measures, develop multimodal interventions and utilise implementation science methodology are considered.
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11
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Galina VF, Silva TBBD, Haydu M, Martin D. A saúde mental dos refugiados: um olhar sobre estudos qualitativos. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2017. [DOI: 10.1590/1807-57622016.0929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As experiências que levam pessoas a solicitarem refúgio envolvem fatores com potencial de desencadear desordens mentais. O objetivo desta revisão de literatura é apresentar o estado da arte sobre a saúde mental dos refugiados. O levantamento dos artigos foi realizado na coleção Social Science Citation Index® na Web of Science™. Foram identificados 35 estudos qualitativos em periódicos internacionais de 1993 a janeiro de 2016. A análise focou na saúde mental de refugiados adultos, na saúde mental de refugiados na infância e adolescência, e nos cuidados em saúde de refugiados. Houve um aumento desta produção nos últimos anos, e os estudos evidenciaram temas como: a diversidade cultural, a importância da família e das redes de apoio, a atuação dos profissionais envolvidos com estes grupos, a presença ou não de doença mental, as intervenções e o comprometimento com os direitos humanos.
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12
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Silove D, Ventevogel P, Rees S. The contemporary refugee crisis: an overview of mental health challenges. World Psychiatry 2017; 16:130-139. [PMID: 28498581 PMCID: PMC5428192 DOI: 10.1002/wps.20438] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
There has been an unprecedented upsurge in the number of refugees worldwide, the majority being located in low-income countries with limited resources in mental health care. This paper considers contemporary issues in the refugee mental health field, including developments in research, conceptual models, social and psychological interventions, and policy. Prevalence data yielded by cross-sectional epidemiological studies do not allow a clear distinction to be made between situational forms of distress and frank mental disorder, a shortcoming that may be addressed by longitudinal studies. An evolving ecological model of research focuses on the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the background disruptions of core psychosocial systems, the scope extending beyond the individual to the conjugal couple and the family. Although brief, structured psychotherapies administered by lay counsellors have been shown to be effective in the short term for a range of traumatic stress responses, questions remain whether these interventions can be sustained in low-resource settings and whether they meet the needs of complex cases. In the ideal circumstance, a comprehensive array of programs should be provided, including social and psychotherapeutic interventions, generic mental health services, rehabilitation, and special programs for vulnerable groups. Sustainability of services, ensuring best practice, evidence-based approaches, and promoting equity of access must remain the goals of future developments, a daunting challenge given that most refugees reside in settings where skills and resources in mental health care are in shortest supply.
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Affiliation(s)
- Derrick Silove
- School of Psychiatry, University of New South Wales, and Psychiatry Research and Teaching Unit, Academic Mental Health Centre, Southwestern Sydney Local Health District, Sydney, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Susan Rees
- School of Psychiatry, University of New South Wales, and Psychiatry Research and Teaching Unit, Academic Mental Health Centre, Southwestern Sydney Local Health District, Sydney, Australia
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13
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McBride J, Russo A, Block A. The Refugee Health Nurse Liaison: a nurse led initiative to improve healthcare for asylum seekers and refugees. Contemp Nurse 2016; 52:710-721. [DOI: 10.1080/10376178.2016.1238774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jacquie McBride
- Monash Health, Refugee Health, 122 Thomas Street, Dandenong, VIC, Australia
| | - Alana Russo
- Monash Health, Refugee Health, 122 Thomas Street, Dandenong, VIC, Australia
| | - Andrew Block
- Monash Health, Refugee Health, 122 Thomas Street, Dandenong, VIC, Australia
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14
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Tay AK, Rees S, Chen J, Kareth M, Silove D. Factorial structure of complicated grief: associations with loss-related traumatic events and psychosocial impacts of mass conflict amongst West Papuan refugees. Soc Psychiatry Psychiatr Epidemiol 2016; 51:395-406. [PMID: 26228854 DOI: 10.1007/s00127-015-1099-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/11/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Definitions of complicated grief vary across diagnostic systems, being represented as persistent complex bereavement (PCB) in DSM-5 and prolonged grief disorder (PGD) in the proposed revision of the ICD system. A past study in a high-income country has identified a six-factor structure for complicated grief, but there are no data testing this or any other model across cultures. The present study reports findings from a survey amongst West Papuan refugees (n = 230, response rate = 92 %) residing in Port Moresby, Papua New Guinea. MATERIALS AND METHODS We applied culturally adapted measures of conflict-related traumatic event (TEs) (drawing specifically on domains of conflict and loss), symptoms of complicated grief adapted and modified to the culture, and a multidimensional psychosocial index of the broader effects of conflict and displacement. RESULTS Confirmatory factor analysis yielded a single higher order construct of complicated grief comprising six factors of yearning/preoccupation; shock/disbelief; anger/negative appraisal; behavioural change; estrangement from others/impairment; and a novel dimension of confusion/diminished identity. In contrast, our analysis failed to support DSM or ICD models of PCB or PGD. A Multiple Indicators Multiple Causes (MIMIC) model revealed that traumatic loss and the sense of injustice each were associated with the unitary construct of complicated grief and its subdomains of yearning/preoccupation; shock/disbelief; anger/negative appraisal (exclusive to injustice); and estrangement from others/social impairment (exclusive to TE domain of conflict and loss). CONCLUSIONS Conflict and loss associated with feelings of injustice may be especially pathogenic in generating the anger/negative appraisal component of complicated grief amongst refugees.
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Affiliation(s)
- Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia. .,Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia.
| | - Susan Rees
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.,Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia.,The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia
| | - Jack Chen
- Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia.,The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.,Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.,Centre for Population Mental Health Research, Liverpool Hospital, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia.,The Ingham Institute, Applied Medical Research Centre, Liverpool, NSW, Australia
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15
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Rees S, Tay AK, Kareth M, Silove D. No justice in sight: The mental health and wellbeing of West Papuan refugees. Aust N Z J Psychiatry 2016; 50:96-7. [PMID: 26316002 DOI: 10.1177/0004867415603215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Susan Rees
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Liverpool, NSW 2170, Australia
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16
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Tay AK, Rees S, Chen J, Kareth M, Silove D. Pathways from conflict-related trauma and ongoing adversity to posttraumatic stress disorder symptoms amongst West Papuan refugees: The mediating role of anxiety and panic-like symptoms. Compr Psychiatry 2015; 63:36-45. [PMID: 26555490 DOI: 10.1016/j.comppsych.2015.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although the relationship involving exposure to traumatic events (TEs), conditions of adversity, and posttraumatic stress disorder (PTSD) is well established in the refugee field, the psychological factors mediating the relevant pathways are not as clearly delineated. In the present path analysis, we examined a model in which anxiety and panic-like symptoms mediated the path between conflict-related TEs, ongoing adversity, and PTS symptoms amongst 230 refugees from West Papua. METHODS Culturally adapted measures were applied to assess TE exposure, ongoing adversity, anxiety, panic-like, PTS, and depressive symptoms. RESULTS Our model identified two pathways leading from conflict-related exposure to PTS symptoms, one a direct path, the other mediated by a sequence of ongoing adversity, anxiety and panic-like symptoms. Older refugees from West Papua had higher levels of anxiety and panic-like symptoms than the younger adult generation born in PNG. CONCLUSIONS Our findings suggest that a focus on reducing anxiety and panic together with addressing social deprivations and threats may improve anxiety and panic amongst refugees, ultimately improving outcomes for PTS symptoms.
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Affiliation(s)
- Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia.
| | - Susan Rees
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia
| | - Jack Chen
- Simpson Centre for Health Services Research, University of New South Wales
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of NSW, NSW, Australia
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Tay AK, Rees S, Chen J, Kareth M, Silove D. Pathways involving traumatic losses, worry about family, adult separation anxiety and posttraumatic stress symptoms amongst refugees from West Papua. J Anxiety Disord 2015; 35:1-8. [PMID: 26275507 DOI: 10.1016/j.janxdis.2015.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/02/2015] [Accepted: 07/04/2015] [Indexed: 11/15/2022]
Abstract
There is some evidence that adult separation anxiety disorder (ASAD) symptoms are closely associated with posttraumatic stress disorder (PTSD) amongst refugees exposed to traumatic events (TEs), but the pathways involved remain to be elucidated. A recent study suggests that separation anxiety disorder precedes and predicts onset of PTSD. We examined a path model testing whether ASAD symptoms and worry about family mediated the path from traumatic losses to PTSD symptoms amongst 230 refugees from West Papua. Culturally adapted measures were applied to assess TE exposure and symptoms of ASAD and PTSD. A structural equation model indicated that ASAD symptoms played an important role in mediating the effects of traumatic losses and worry about family in the pathway to PTSD symptoms. Although based on cross-sectional data, our findings suggest that ASAD symptoms may play a role in the path from traumatic losses to PTSD amongst refugees. We propose an evolutionary model in which the ASAD and PTSD reactions represent complementary survival responses designed to protect the individual and close attachments from external threats.
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Affiliation(s)
- Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, NSW, Australia.
| | - Susan Rees
- Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, NSW, Australia
| | - Jack Chen
- Simpson Centre for Health Services Research, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, NSW, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, NSW, Australia
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Tay AK, Rees S, Chan J, Kareth M, Silove D. Examining the broader psychosocial effects of mass conflict on PTSD symptoms and functional impairment amongst West Papuan refugees resettled in Papua New Guinea (PNG). Soc Sci Med 2015; 132:70-8. [DOI: 10.1016/j.socscimed.2015.03.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tay AK, Rees S, Chen J, Kareth M, Lahe S, Kitau R, David K, Sonoling J, Silove D. Associations of Conflict-Related Trauma and Ongoing Stressors with the Mental Health and Functioning of West Papuan Refugees in Port Moresby, Papua New Guinea (PNG). PLoS One 2015; 10:e0125178. [PMID: 25923209 PMCID: PMC4414604 DOI: 10.1371/journal.pone.0125178] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 03/22/2015] [Indexed: 11/23/2022] Open
Abstract
Documentation is limited in relation to the mental health of the people of West Papua, a territory that has been exposed to decades-long political persecution. We examined associations of traumatic events (TEs) and current stressors with mental disorder and functioning, amongst 230 West Papuan refugees residing in six settlements in Port Morseby, Papua New Guinea (PNG). We used culturally adapted modules to assess exposure to TEs and mental disorders. Current stressors and functioning were assessed using modifications of measures developed by the World Health Organization (WHO). 129 of 230 respondents (56%) reported exposure to at least one traumatic event (TE), including: political upheaval (36.5%), witnessing or hearing about family members tortured and murdered (33.9%), and not being able to access medical care for family members (33%). One fifth of respondents (47, 20.4%) experienced exposure to high levels of TEs (16 to 23). 211 (91.7%) endorsed at least one or more ongoing stressors, including: exposure to illicit substance use in the community (91.7%), problems with safety and the protection of women (89.6%), no access to legal rights and citizenship (88.3%), and lack of adequate shelter and facilities (85.2%). A quarter (26.9%) met criteria for one or more current mental disorder, and 69.1% reported functional impairment ranging from mild to extreme. Mental disorder was associated with being male (adjusted odds ratio=2.00; 95% CI=1.01-3.97), and exposure to the highest category of ongoing stressors (AOR=2.89; 95% CI=1.08-7.72). The TE count showed a dose-response pattern in its relationship with functional impairment, the greatest risk (AOR=11.47; 95% CI=2.11-62.37) being for those experiencing the highest level of TE exposure (16-23 events). West Papuans living in settlements in Port Moresby reported a range of TEs, ongoing stressors and associated mental disorders characteristic of populations exposed to mass conflict and persecution, prolonged displacement, and ongoing conditions of extreme hardship.
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Affiliation(s)
- Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia
- South Western Sydney Clinical School, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Susan Rees
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Jack Chen
- South Western Sydney Clinical School, Liverpool Hospital, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Simpson Centre for Health Services Research, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sylvester Lahe
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea (UPNG), Port Moresby, Papua New Guinea
| | - Russell Kitau
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea (UPNG), Port Moresby, Papua New Guinea
| | - Kura David
- Port Moresby General Hospital and School of Medicine and Health Sciences, University of Papua New Guinea (UPNG), Port Moresby, Papua New Guinea
| | - Joyce Sonoling
- Port Moresby General Hospital and School of Medicine and Health Sciences, University of Papua New Guinea (UPNG), Port Moresby, Papua New Guinea
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, Australia
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Slewa-Younan S, Mond JM, Bussion E, Melkonian M, Mohammad Y, Dover H, Smith M, Milosevic D, Jorm AF. Psychological trauma and help seeking behaviour amongst resettled Iraqi refugees in attending English tuition classes in Australia. Int J Ment Health Syst 2015; 9:5. [PMID: 25972917 PMCID: PMC4429497 DOI: 10.1186/1752-4458-9-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/12/2015] [Indexed: 11/12/2022] Open
Abstract
Background To examine levels of psychological distress and help seeking behaviour in resettled refugees attending English tuition classes in Australia, and their associations with participants’ demographic characteristics. Methods Data was collected by bilingual interviewers between March and November 2013. A volunteer sample of attendees of Adult Migrant English Programs (AMEP) in Western Sydney were recruited. Participants were two hundred and twenty five Iraqi refugees resettled in Western Sydney, who had left Iraq no earlier than 1991, were fluent in Arabic and/or English, and were between the ages of 18 and 70. The chief outcome measures used were the Kessler Psychological Distress Scale (K-10) as well as The Harvard Trauma Questionnaire (HTQ). Results On the K-10, 39.8% of participants had severe psychological distress, 19.4% moderate distress, and 40.7% had low to mild distress. Ninety-five percent of participants reported having experienced one or more potentially traumatic event (PTE) as defined by the HTQ prior to leaving Iraq, with a mean of 14.28 events (SD = 8.69). Thirty-one percent of participants met the threshold (≥2.5) for clinically significant PTSD symptomatology, with a significantly higher occurrence among participants with lower education attainment (χ2 (3) = 8.26, p = .04). Of those participants with clinically significant PTSD symptomatology according to the HTQ, only 32.9% reported ever having ever sought help for a mental health problem. Conclusions The high level of distress found in this sample, combined with low uptake of mental health care, highlights the need for programs targeted to promote help-seeking among Iraqi refugees who have resettled in Australia. Further, the higher level of PTSD symptomatology found amongst those with lower education attainment has mental health promotion and treatment implications. Specifically, in designing service and treatment programs, consideration should be given to the possible impact excessive levels of psychological distress may have on learning in refugees, to ensure that those who have been unable to develop proficiency in the English language receive effective care.
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Affiliation(s)
- Shameran Slewa-Younan
- Mental Health, School of Medicine, The University of Western Sydney, Locked Bag 1797 Penrith South DC, NSW Australia
| | - Jonathan M Mond
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Elise Bussion
- Mental Health, School of Medicine, The University of Western Sydney, Sydney, Australia
| | - Maral Melkonian
- Mental Health, School of Medicine, The University of Western Sydney, Sydney, Australia
| | - Yaser Mohammad
- Mental Health, School of Medicine, The University of Western Sydney, Sydney, Australia
| | - Hanan Dover
- Mental Health, School of Medicine, The University of Western Sydney, Sydney, Australia
| | | | - Diana Milosevic
- South Western Sydney Local Health District Eastern Campus, Liverpool Hospital, Sydney, Australia
| | - Anthony Francis Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Shawyer F, Enticott JC, Doherty AR, Block AA, Cheng IH, Wahidi S, Meadows GN. A cross-sectional survey of the mental health needs of refugees and asylum seekers attending a refugee health clinic: a study protocol for using research to inform local service delivery. BMC Psychiatry 2014; 14:356. [PMID: 25539842 PMCID: PMC4296526 DOI: 10.1186/s12888-014-0356-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/10/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers have high rates of risk factors for mental disorders. In recent years, Australia has experienced a rapid increase in asylum seeker arrivals, creating new challenges for services in areas with high settlement numbers. This paper describes the design, including analytic framework, of a project set in a refugee health service in the state of Victoria, Australia, as part of their response to meeting the mental health needs of their burgeoning local population of refugees and asylum seekers. In order to assist service planning, the primary aim of this study is to determine: 1) an overall estimate of the prevalence of psychiatric disorders; 2) the specific prevalence of post-traumatic stress disorder 3) the perceived need and unmet need for mental health treatment. The secondary aim of the study is to establish matched risk ratios based on an Australian-born matched comparison group from the 2007 National Survey of Mental Health and Well-Being. METHODS/DESIGN A cross-sectional survey is used to estimate the prevalence of psychiatric disorders in refugees and asylum seekers attending a local refugee health service. Measures include the Kessler Psychological Distress Scale-10, the Post-Traumatic Stress Disorder-8, the General-practice User's Perceived-need Inventory together with service utilisation questions from the National Survey of Mental Health and Well-Being. Data collected from refugees and asylum seekers (n = 130) is matched to existing data from Australian-born residents drawn from the 2007 National Survey of Mental Health and Well-Being (n = 520) to produce estimates of the risk ratio. DISCUSSION The paper describes a prototype for what is possible within regular services seeking to plan for and deliver high quality mental health care to refugees and asylum seekers. A novel project output will be the development and dissemination of an epidemiological methodology to reliably compare mental health status in a relatively small target sample with a matched comparator group.
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Affiliation(s)
- Frances Shawyer
- Department of Psychiatry, Monash University, Clayton, VIC, 3800, Australia.
| | - Joanne C Enticott
- Department of Psychiatry, Monash University, Clayton, VIC, 3800, Australia. .,Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, VIC, 3800, Australia.
| | - Anne R Doherty
- Mental Health Program, Monash Health, Dandenong, VIC, 3075, Australia.
| | - Andrew A Block
- General Medicine Program and Refugee Health, Monash Health, Dandenong, VIC, 3175, Australia. .,Department of Medicine, Monash University, Clayton, VIC, 3800, Australia.
| | - I-Hao Cheng
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, VIC, 3800, Australia.
| | - Sayed Wahidi
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, VIC, 3800, Australia.
| | - Graham N Meadows
- Department of Psychiatry, Monash University, Clayton, VIC, 3800, Australia. .,Mental Health Program, Monash Health, Dandenong, VIC, 3075, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia.
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