Silencing or silent transmission? An exploratory study on trauma communication in Kurdish refugee families

Trauma communication in refugee families is increasingly recognized as an important relational dynamic influencing psychosocial well-being, yet studies exploring interactional dynamics and meaning making at play in intra-family trauma communication remain scarce. This article reports on a qualitative study with Kurdish refugee families including parents (N = 10) and children (N = 17) resettled in Belgium, aiming to explore practices on trauma communication within refugee family relationships. In a multiple-phased qualitative design, semi-structured family interviews and participant observation administered in the homes of the participant families are followed by parental interviews involving a tape-assisted recall procedure to investigate observed intergenerational trauma communication and parent-child interactions. Data analysis shows parents and children seldom explicitly talked about the families' lived experiences of trauma. This silence was especially related to parental wishes to avoid their children's future involvement in violence. However, findings also indicate how the intra-family transmission of memories of collective violence occurs in many subtle ways. Four modes of indirect trauma communication could be distinguished: (1) focusing on the repetition of violence in the present; (2) transmission of the collective trauma history; (3) family storytelling; and (4) interaction with meaningful objects of the past. These findings shed light onto the interwoven nature of personal-familial and collective trauma and loss and illuminate the meanings of silence and disclosure in the context of the Kurdish diaspora. In the final section, we discuss our findings and outline its clinical implications for family therapeutic practices in refugee trauma care.

"It will always be Temporary": A qualitative study of Syrian young adults expressing histories of collective violence and forced displacement in participatory theatre

Given the increased prevalence of mental health problems in Syrian refugee communities, there have been efforts to develop adequate mental health care for their well-being. Herein, clinical literature is increasingly emphasizing the importance of locating refugees' healing at the nexus of personal and social realities, understanding the process of trauma narration within social restorative spaces of witnessing and communal support. Alongside this debate, there is growing interest in the relevance of participatory theatre for refugees. This innovative approach understands how voicing narratives of life histories within a broader social sphere may support personal and socio-political transformation. In this article, we aim to further the understanding of participatory theatre's relevance to these issues, focusing on the reparative dimensions of trauma narration. Based on a case study of a theatre project with Syrian young adults resettled in Belgium, we explore the different ways participants expressed experiences of collective violence and displacement in dialogue with each other, their diasporic and home communities, and their host society, and consider how these processes relate to their construction and meaning and coping with trauma. In a final section, we discuss the implications of our findings, raising questions about the value of participatory theatre as a reparative space and outlining suggestions to introduce and mobilize reparative modes of trauma narration in therapeutic practices in refugee trauma care.

Children of extremist parents: Insights from a specialized clinical team

BACKGROUND

Data on children who grow up with parents adhering to violent extremism is scant. This makes it extremely delicate to inform policies and clinical services to protect such children from potential physical and psychological harm.

OBJECTIVE

This paper explores the predicament of children whose caretakers were referred to a specialized clinical team in Montreal (Canada) because of concerns about risks or actual involvement in violent extremism processes.

METHODS

This paper uses a mixed methods concurrent triangulation design. Quantitative data was obtained through a file review (2016-2020). Qualitative data was collected through semi-structured interviews and a focus group with the team practitioners.

RESULTS

Clinicians reported the presence of stereotypes in the health and social services network frequently representing religious extremist parents as potentially dangerous or having inappropriate parenting skills while minimizing the perception of risk for parents adhering to political extremism. Children displayed high levels of psychological distress, mainly related to family separation, parental psychopathology, and conflicts of loyalty stemming from familial or social alienation.

CONCLUSIONS

Training practitioners to be aware of their own personal and institutional bias may help them to understand the predicament of extremist parents' children and implement systemic, trauma and attachment informed interventions.

Moving Forward in Mental Health Care for Refugee, Asylum-Seeking, and Undocumented Children: Social Determinants, Phased Approach to Care, and Advocacy

Given the current political and climate crisis, the number of forcedly displaced individuals continues to rise, posing new challenges to host societies aiming to support and respond to the needs of those fleeing war or persecution. In this article, we turn our attention to current and historical sociopolitical contexts influencing the mental health of forcedly displaced children (ie, refugee, asylum-seeking, and undocumented) during their resettlement in high-income countries, proposing timely ways to respond to evolving needs and recommendations to redress ubiquitous structural inequities that act as barriers to education and care for the children, youth, and families seeking sanctuary.

Prevalence and Factors Related to Post-traumatic Stress Disorder and Depression Symptoms Among Children and Adolescents Survivors and Orphans of Ebola Virus Disease in Democratic Republic of the Congo Eastern Regions During the COVID-19 Pandemic

PURPOSE

Although previous studies have shown a high prevalence of mental health problems among adult Ebola virus disease survivors, no studies have yet been conducted on mental health problems among children and adolescents in affected regions. Consequently, the current study aimed to examine the prevalence and factors associated with depression and post-traumatic stress disorder (PTSD) among children and adolescent survivors and orphans by utilizing a cross-sectional survey following the 2018-2020 epidemic in Eastern Democratic Republic of the Congo.

METHODS

A total of 146 survivors (mean age = 13.62, standard deviation [SD] = 2.50, 49.32% female), 233 orphans (mean age = 13.18, SD = 2.96, 53.32% female), and 34 orphan-survivor participants (mean age = 13.39, SD = 2.87, 44.12% female) were recruited. Participants completed measures assessing depression and PTSD symptoms, traumatic experiences, and stigma related to Ebola and COVID-19.

RESULTS

The prevalence of depression and PTSD symptoms was 87.32% and 44.42%, respectively. Results showed significant differences in depression and PTSD symptoms between orphan-survivors (100% and 97.06%), survivors (90.21% and 75.86%), and orphans (83.48% and 16.52%; χ2(2) = 9.02; p = .011 and χ2(2) = 168.85; p < .001). Experience of traumatic events, Ebola stigmatization, and COVID-19 stigmatization positively predicted depression and PTSD symptoms. The regression models explained 61%-72% of the variance of depression and PTSD.

DISCUSSION

The results reveal that the Ebola virus disease and its associated grief severely jeopardize the mental health of children and adolescents in affected regions. Despite the relative paucity of resources, intervention programs may be helpful to minimize associated stigma and promote psychological support.

Prevalence and determinants of anxiety, depression and comorbid anxiety-depression symptoms among adolescents in Ebola-affected zones

BACKGROUND

Ebola virus disease (EVD) has been shown to be associated with poor mental health in affected zones. However, no study has yet explored its impact on adolescents' mental health.

AIMS

This study aimed to assess the prevalence and risk factors associated with depression and anxiety symptoms among adolescents in EVD-affected areas in the Equateur Province of the Democratic Republic of the Congo during the COVID-19 pandemic.

METHOD

A provincial sample of adolescents aged 12-17 years (M = 14.84, s.d. = 1.49) living in the 18 urban and rural areas affected by the 2018 EVD outbreak completed a two-wave longitudinal survey. Surveys assessed symptoms of depression and anxiety, exposure to Ebola, social support and sociodemographic information.

RESULTS

A total of 490 participants completed the baseline and follow-up surveys, 50% of whom were female. Elevated and worsened depressive symptoms were observed among participants from the baseline (56.94%) to the follow-up (91.43%; z = -11.37, P < 0.001), whereas anxiety symptoms decreased from the baseline (36.33%) to follow-up (24.90%; z = 4.06, P < 0.001). The final generalised estimating equation model showed that anxiety symptoms decreased over time (B = -3.92, P < 0.001), while depression symptoms increased (B = 4.79, P < 0.001). Stigmatisation related to Ebola positively predicted anxiety (B = 5.41, P < 0.001) and depression symptoms (B = 0.4452, P = 0.009). Social support negatively predicted anxiety (B = -1.13, P = 0.004) and depression (B = -0.98, P < 0.001) symptoms but only moderated the association between stigmatisation and depression symptoms (B = -0.67, P < 0.001).

CONCLUSIONS

Most adolescents living in EVD-affected areas experience mental health issues. Stigmatisation related to EVD and living in urban areas are the most consistent predictors of mental health problems. Nevertheless, social support remains a protective factor for depression and anxiety symptoms and a necessary resource for building resilience.

[Pregnant women's use of tobacco and electronic cigarettes: A cross sectional survey]

OBJECTIVES

The article aims to describe tobacco and e-cigarette use among pregnant women: estimate the prevalence, identify the determinants and motivations of these behaviours.

METHODS

Cross-sectional, multicentre, descriptive observational study using self-administered questionnaires for pregnant women who visited ELENA healthcare centers in May 2021.

RESULTS

Of 223 patients, 38% were smokers before pregnancy and 16% continued to smoke during pregnancy. Nearly all the smokers (98%) declared that they had reduced or stopped their tobacco use, mostly without help. Young age, lack of professional activity, an unfavourable reaction to the announcement of the pregnancy, heavy smoking before the pregnancy and the presence of a smoker spouse were associated with smoking during pregnancy. Our study identified 10% of vapers before pregnancy and 7.2% during pregnancy. Of those who vaped during pregnancy, 81% were smokers before pregnancy. Most of them used a nicotine containing liquid and 38% of vapers combined smoking and e-cigarettes during pregnancy. There was no association between vaping during pregnancy and smoking cessation. A minority of women had received information about smoking during pregnancy.

CONCLUSIONS

The use of electronic cigarettes by pregnant women is a poorly-known reality in France, yet it concerns approximately 7% of the women in our sample. Prospective studies on larger numbers are needed to assess the prevalence of vaping among French pregnant women and its evolution during pregnancy.

Risk behaviors and well-being among Egyptian and Roma adolescents in Albania during the COVID-19 pandemic: Vulnerability and resilience in a positive youth development perspective

Introduction

Egyptian and Roma communities represent two of the most deprived and stigmatized ethnic minorities in Albania. However, research investigating vulnerability and well-being in youth from these communities is scant. Even less is known among Egyptian and Roma adolescents who dropped-out of school. Within a Positive Youth Development framework, we investigated among Egyptian and Roma adolescents: (1) risk behaviors, well-being, and developmental assets (personal and contextual); (2) associations of developmental assets with risk behaviors and well-being; (3) specificities by ethnicity, gender, and education.

Methods

A total of 201 Egyptian and Roma adolescents (Mage = 16.63, SDage = 1.80; 47% girls; 53% school dropouts) completed a series of questionnaires in a community setting in August 2020 (first wave of the COVID-19 pandemic).

Results

Binomial, Poisson and linear regression models indicated that Egyptian and Roma adolescents reported similar and high levels of risk behaviors, with boys reporting overall more risk behaviors than girls. Low level of well-being and of personal and contextual assets were reported. Girls reported higher family assets, positive values and social competencies than boys. The situation of adolescents attending school was overall not better than that of youth who had dropped out. Higher positive identity was associated with higher well-being.

Discussion

Intervention and prevention efforts are urgently needed to support minority adolescents' development during and in the aftermath of the pandemic. They should address the structural factors which limit the availability of personal and contextual resources in minority youth's lives. Interventions aimed at building safer neighborhoods and providing safe access to schools for minority youth should be a priority and are essential to prevent the widening of inequalities during and after this health emergency.

Preference for online social interactions and support for violent radicalization among college and university students

Young people are at increased risk of supporting violent radicalization (VR), and VR processes are increasingly happening online. Despite the important role that online socialization plays in the lives of digital natives as well as in VR processes, empirical research aimed to investigate the association between online socialization and support for VR among young people is scant. This article examines the association between preference for online social interactions and support for VR among students and investigates whether this association is moderated by social support and collective self-esteem and mediated by depressive symptoms. A total of 5,598 Canadian college and university students (M_age = 22.75, SD_age = 7.45) responded to an online survey. We implemented multivariable mixed-effects regression models, stratified and mediation analyses. Greater preference for online social interactions was associated with stronger support for VR. Preference for online social interactions was a risk factor for VR, particularly at low levels of public self-esteem and social support as well as at high levels of importance attributed to one's group identity. Depressive symptoms partially mediated this association. Programs aimed to foster and value multiple identities and increase social support in educational settings are urgently needed to address the possible negative consequences of the online space on young people's mental health and support for violence. Prevention programs should address the provision of psychosocial support to students reporting depressive symptoms and help them build and maintain a supportive social network, as well as enhance inclusion at the societal level and across educational institutions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Virtual patients, digital twins and causal disease models: paving the ground for in silico clinical trials

Computational models are being explored to simulate in silico the efficacy and safety of drug candidates and medical devices. Disease models that are based on patients' profiling data are being produced to represent interactomes of genes or proteins and to infer causality in the pathophysiology {AuQ: Edit OK?}, which makes it possible to mimic the impact of drugs on relevant targets. Virtual patients designed from medical records as well as digital twins were generated to simulate specific organs and to predict treatment efficacy at the individual patient level {AuQ: Edit OK?}. As the acceptance of digital evidence by regulators grows, predictive artificial intelligence (AI)-based models will support the design of confirmatory trials in humans and will accelerate the development of efficient drugs and medical devices.

Violent Radicalization, Mental Health, and Gender Identity: Considerations for Future Research

ABSTRACT

This study examines the association between gender identity, mental health, social adversity, and sympathy for violent radicalization (VR). Data were collected through an online survey in Canada. A total of 6003 eligible participants who were residents of Montreal, Toronto, Calgary, or Edmonton and aged from 18 to 35 years were included. We used Fisher exact test to assess gender differences in gender-based discrimination and we used analysis of variance tests to assess differences in scores on bullying, mental health, and sympathy for VR. We used linear regression to assess the relationship between mental health, social adversities, and sympathy for VR. Individuals who self-identified as trans and gender diverse had greater sympathy for VR than females did, experienced online victimization more frequently, and reported higher levels of psychological distress than both male and female participants. Our findings indicate that more research is needed on the association between social adversity and support for VR among this vulnerable population.

Education as a protective factor for mental health risks among youth living in highly dangerous regions in Afghanistan

BACKGROUND

Children in Afghanistan live in dangerous areas, and have been exposed to traumatic events and chaotic education. Progress has been made on access to education for girls who were the most affected by traditional attitudes against engagement in education.

OBJECTIVES

The objectives were to evaluate the mental health of Afghan children living in regions of conflict and the association of mental health with school attendance for girls and boys.

METHOD

The study included 2707 school aged children in eight regions of Afghanistan (16 provinces) residing in households recruited through a multi-stage stratified cluster sampling strategy in 2017. The level of terrorist threat was evaluated by the intensity of terrorist attacks recorded that year in each province. Child mental health was assessed with the parental report Strengths and Difficulties Questionnaire (SDQ) along with information on school attendance, sociodemographic characteristics and geographic location.

RESULTS

A total of 52.75% of children had scores above threshold for the SDQ total difficulties score, 39.19% for emotional difficulties, 51.98% for conduct challenges, and 15.37% for hyperactivity/inattention. Peer relationship problems were high (82.86%) and 12.38% reported that these problems impacted daily life. The level of terrorist threat was associated with SDQ total difficulties (Adjusted Odds Ratio [AOR] = 4.08, P < 0.0001), with youth in regions with high levels of terrorist threat more likely to have problems than youth in regions with low or medium levels of danger, independent of region and ethnicity. School attendance was negatively associated with emotional symptoms (AOR = 0.65, P < 0.0001) and mental health difficulties with impairment (AOR = 0.67, P = 0.007), but positively associated with peer relationships difficulties (AOR = 1.96, P > 0.0001). Conduct (AOR = 1.66, P < .0001) and SDQ total difficulties (AOR = 1.22, P = 0.019) were higher among boys. Overall, gender did not modify the relationship between school attendance and child mental health.

CONCLUSION

Attending school is essential for children's mental health, across gender, and should be supported as a priority in Afghanistan despite the return of the Taliban.

Collective case formulation in situations of violent radicalization: A critical perspective in training

Case formulation is used in clinical training to weave together theoretical perspectives and support a shared plan of action. Although a cornerstone of clinical practice, critical social theorists have highlighted the risks of depoliticizing political struggles and of reifying and fixing subjects when using psychopathology and case formulation to address situations of injustice. In the field of violent radicalization, this risk is increased by the extreme affects evoked by terror in practitioners and in societies. This article explores the challenges of training clinicians in the field of violent radicalization. It does so by analyzing a Community of Practice (CoP) that was developed to support practitioners involved in this domain of practice in Quebec, Canada. Four focus groups with CoP participants and participant observation of nine CoP meetings were conducted. Thematic and narrative analyses were used to explore the training potential of the CoP and to identify the discursive processes and group dynamics associated with this modality. Results indicate that the diversity of professional perspectives and social positionalities in the group plays a central role in helping participants become aware of their biases and in developing more complex understandings of cases and of their social embedding. Results also suggest that the collective holding of risk is key to preserve practitioners' investment in patients involved with violent radicalization. The sensitive issue of partnership between health and social services and security agencies is also addressed. Results suggest that CoPs with strong leadership allow for experiential training to enhance clinical and critical thinking.

The CoVivre Program: Community Development and Empowerment to Address the Inequalities Exacerbated by the COVID-19 Pandemic in the Greater Montreal Area, Canada

The COVID-19 pandemic had devastating effects around the world, yet it was not experienced equally by all. The emergence of the virus has been linked with the intensification of discrimination and inequities, as well as other systemic issues already present in society prior to the pandemic. The CoVivre Program was created with the mission to facilitate and accelerate initiatives aimed at reducing socioeconomic and health disparities caused by the COVID-19 pandemic in the Greater Montreal Area. CoVivre aims to inform, protect, and support communities, with an emphasis on communities experiencing marginalization, such as ethnic and religious minorities, refugees, asylum seekers, and precarious workers. This mission is guided by the latest research and CoVivre’s values of community empowerment, partnership, democratic communications, and cultural competency, among others. This article describes the process of planning and implementing the program and its components: Communications, Outreach and Awareness Raising, and Psychosocial Support and Mental Health, with a description of one project per component. It also aims to identify obstacles and facilitators of the program, to reflect on their relation with local and global ecosystems and their relationship to community action, and to examine community mobilization as expressing both resilience and resistance to top-down impositions.

COVID-19 vaccine hesitancy among young adults in Canada

OBJECTIVES

Vaccine hesitancy is a multifaceted decision process that encompasses various factors for which an individual may choose to get vaccinated or not. We aimed to identify the relationship between COVID-19 conspiracy theories, general attitudes towards vaccines, current COVID-19 vaccine factors, and COVID-19 vaccine hesitancy.

METHODS

The present research is a multi-province cross-sectional study design. Survey data were collected in May and June 2021 (n=4905) in the Canadian provinces of Alberta, Ontario, and Quebec. Multivariate ordinal regression models were used to assess the association between vaccine hesitant profiles and COVID-19 conspiracy theories, general attitudes towards vaccines, and specific factors pertaining to COVID-19 vaccines.

RESULTS

Participants were aged 18 to 40 years and 59% were women. Individuals with low income, with low educational attainment, and/or who are unemployed were more likely to be vaccine hesitant. COVID-19 conspiracy theory beliefs and general attitudes towards vaccines are significantly associated with greater hesitancy for the COVID-19 vaccine. Vaccine factors including pro-vaccine actions and opinions of friends and family and trust in scientists and government as well as the country in which a vaccine is manufactured are associated with less vaccine hesitancy.

CONCLUSION

Conspiracy theories are distinct from criticism and concerns regarding the vaccine. Nevertheless, poverty, low level of education, and distrust towards the government are associated with higher odds of being vaccine hesitant. Results suggest it is imperative to deliver transparent and nuanced health communications to address legitimate distrust towards political and scientific actors and address the societal gap regarding general attitudes towards vaccines as opposed to focusing solely on COVID-19.

Safe enough? Rethinking the concept of cultural safety in healthcare and training

Refining the cultural safety concept to include an acknowledgement of both the discomfort inherent in training and care and the time needed to overcome multiple layers of oppression may partially buffer the feelings of failure or fraud that often arise from unrealistic expectations regarding equity, diversity and inclusion policies.

Vaccination of children in marginalized neighbourhoods: Equity and diversity challenges with COVID-19 vaccination campaigns

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated social inequities along ethnic, racial and socio-economic lines, with significant harmful consequences for children. Building on the lessons learned from community-based initiatives, this commentary proposes a reflection around equity, diversity, and inclusion challenges embedded in child vaccination campaigns during an emergency context. We argue that building equitable and inclusive practices around marginalized communities' child vaccination is a multifaceted challenge. Beyond good intentions-wanting to protect children-the risks and benefits associated with highlighting diversity in each intervention need to be carefully considered, especially when it comes to a contested/polarizing procedure such as vaccination with a novel type of vaccine. Often, a one-size-fits-all approach negates and perpetuates structural inequities. In other cases, highlighting diversity and inequities may inadvertently increase stigma and discrimination, and further harm or infantilize targeted communities. By providing multiple perspectives, a transdisciplinary approach can support decision-making in a crisis context.

In-hospital outcomes of SARS-CoV-2-infected health care workers in the COVID-19 pandemic first wave, Quebec, Canada

Background

Health care workers (HCW), particularly immigrants and ethnic minorities are at increased risk for SARS-CoV-2 infection. Outcomes during a COVID-19 associated hospitalization are not well described among HCW. We aimed to describe the characteristics of HCW admitted with COVID-19 including immigrant status and ethnicity and the associated risk factors for Intensive Care unit (ICU) admission and death.

Methods

Adults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Canada were included. Demographics, comorbidities, occupation, immigration status, country of birth, ethnicity, workplace exposures, and hospital outcomes (ICU admission and death) were obtained through a chart review and phone survey. A Fine and Gray competing risk proportional hazards model was used to estimate the risk of ICU admission among HCW stratified by immigrant status and region of birth.

Results

Among 1104 included persons, 150 (14%) were HCW, with a phone survey participation rate of 68%. HCWs were younger (50 vs 64 years; p<0.001), more likely to be female (61% vs 41%; p<0.001), migrants (68% vs 55%; p<0.01), non-White (65% vs 41%; p<0.001) and healthier (mean Charlson Comorbidity Index of 0.3 vs 1.2; p<0.001) compared to non-HCW. They were as likely to be admitted to the ICU (28% vs 31%; p = 0.40) but were less likely to die (4% vs. 17%; p<0.001). Immigrant HCW accounted for 68% of all HCW cases and, compared to Canadian HCW, were more likely to be personal support workers (PSW) (54% vs. 33%, p<0.01), to be Black (58% vs 4%) and to work in a Residential Care Facility (RCF) (59% vs 33%; p = 0.05). Most HCW believed that they were exposed at work, 55% did not always have access to personal protective equipment (PPE) and 40% did not receive COVID-19-specific Infection Control (IPAC) training.

Conclusion

Immigrant HCW were particularly exposed to COVID-19 infection in the first wave of the pandemic in Quebec. Despite being young and healthy, one third of all HCW required ICU admission, highlighting the importance of preventing workplace transmission through strong infection prevention and control measures, including high COVID-19 vaccination coverage.

Enacted Ebola Stigma and Health-related Quality of Life in Post Ebola Epidemic: A Psychosocial Mediation Framework Through Social Support, Self-Efficacy, and Coping

On-site experiences and reports have shown that the multiple outbreaks of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) resulted in pervasive experience of stigma against many people who have recovered from EVD as well as their families and close relatives. Three evidence-based protective factors which are supposed to mitigate the impact of enacted Ebola stigma on health-related quality of life (HRQoL) of individuals in this epidemic context were identified. We expected that positive religious coping, perceived social support, and general self-efficacy would mediate the relationship between enacted Ebola stigma and HRQoL. These hypotheses were tested through multiple mediation model using the structural equation modeling among a large sample of adult populations (N = 1614; 50% women) in the province of Equateur in the DRC, in the aftermath of the 9th Ebola outbreak. The mediation model yielded adequate fit statistics and the results provided strong evidence that higher levels of enacted Ebola stigma were associated with lower HRQoL. They confirmed the synergetic mediating effects of positive religious coping, perceived social support from family (but not from others sources) and general self-efficacy. Futher exploratory findings revealed that the perceived social support from family buffered the impact of enacted Ebola stigma on HRQoL. If replicated by a longitudinal study, our findings lay a solid foundation for empirical-based community mental health interventions for reducing enacted Ebola stigma and promoting HRQoL during epidemics, especially in the DRC.

Mental distress before and during the COVID-19 pandemic: A longitudinal study among communities affected by Ebola virus disease in the DR Congo

BACKGROUND

Associated with high mortality rate, fear, and anxiety, Ebola Virus Disease (EVD) is a significant risk factor for mental distress. This longitudinal study aims to investigate the prevalence and predictors associated with mental distress among populations affected by EVD outbreaks in the Province of Equateur in DR Congo.

METHODS

Surveys were administered in zones affected by the 2018 EVD outbreak in Equateur Province with a 16-month interval. Measures assessed sociodemographic characteristics, mental distress (GHQ-12), COVID-19 and EVD exposure and related stigmatization, and Resilience. Models of logistic regression and path analysis were used to estimate factors related to mental distress outcomes.

RESULTS

Prevalence of mental distress decreased from Wave 1 to Wave 2 (Mental distress_T1= 57.04%, Mental distress_T2= 40.29%, x²= 23.981, p<.001). Clinical mental distress score at follow-up was predicted by greater levels of exposure to Ebola at baseline (B= .412, p<.001) and at Wave 2 (B= .453, p<.001) as well as Ebola stigmatization at baseline (B= .752, p<.001), and Protestant religion (B= .474, p=.038). Clinical mental distress score at follow-up was significantly associated with higher levels of exposure to COVID-19 (B= .389, p=.002) and COVID-19 related stigmatization (B= .480, p<.001). COVID-19 related stigmatization partially mediated the association between exposure to EVD (Time 1) and mental distress (B= .409, p<.001).

CONCLUSIONS

Although a decrease in mental distress symptoms was observed, its prevalence remains high. The results show that mental health programs need to develop better health and education communication strategies to reduce stigmatization.

A contextualized perspective on research participation in collaborative refugee research: A multi-site exploration of relational dynamics in collaborative research

OBJECTIVE

An increasing body of literature emphasizes the role of refugees' social context, with social conditions both at home and in the host society having an impact on the possibility of power redistribution and the mobilization of agency in collaborative research practices. Our aim is to develop a contextualized understanding of research participation for refugees in collaborative research in order to further enhance insights on the potential strengths and pitfalls of collaborative refugee research.

METHOD

We closely study the various relational contexts that shape refugees' research participation and that may have an influence on power dynamics in collaborative research. In the present study, we explore participants' adaptation of research participation by means of an interpretive cross-case analysis of three psychosocial intervention studies sharing a collaborative approach with refugee participants, refugee families, refugee communities, and professional partners at different stages in the research process.

RESULTS

We identify the developed collaborative strategies in our three case studies and provide an outline of the ways refugees mobilize research participation through these identified collaborative strategies, from within the relational contexts of the family, community, and institutional actors.

CONCLUSIONS

This analysis shows how research participation operates as a relational forum in which refugees continuously navigate and negotiate within and between multiple relational contexts. We argue that performing research participation, as a way of relating to a relational context, is both an interactive and a dynamic process. For research practice, our analysis addresses the importance of an in-depth understanding of participants' relational contexts to foster both a reflective research practice and trustful research relationships between researchers and participants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Intercultural Training in Tense Times: Cultural Identities and Lived Experiences Within a Community of Practice of Youth Mental Health Care in Montréal

This article presents an analysis of the lived experiences of youth mental health practitioners taking part in Transcultural Interinstitutional and Interdisciplinary Case Discussion Seminars (TIICDS), an intercultural training initiative developed in Montréal (Québec, Canada), while considering the current context of increasing social polarizations. Using insights from the community of practice (CoP) framework and drawing on the analysis of 21 seminar sessions and 26 semi-structured individual interviews, this article examines the relation between the local sociopolitical context, the participants' verbalization about their identities, and the affect and cognition evoked by the training. Results indicate that TIICDSs present several features of a CoP and that intercultural training needs to build on both theoretical and experiential knowledge, while considering local contextual elements. These include historical and contemporary social representations and power differentials between groups, the cultural identities of trainees, and the institutions and sociopolitical structures in which clinical practices take place. These elements, we argue, are sensitive and potentially conflictual but can be addressed through supportive and reflexive group-based initiatives such as CoPs that bring together practitioners on a regular basis and provide them with a 'culturally safe enough' space in which they can learn to complexify their understanding of clinical situations.

Prevalence and risk factors of depression symptoms among rural and urban populations affected by Ebola virus disease in the Democratic Republic of the Congo: a representative cross-sectional study

OBJECTIVES

High mortality rates, anxiety and distress associated with Ebola virus disease (EVD) are risk factors for mood disorders in affected communities. This study aims to document the prevalence and risk factors associated with depressive symptoms among a representative sample of individuals affected by EVD.

DESIGN

Cross-sectional study.

SETTING

The current study was conducted 7 months (March 11, 2019 to April 23, 2019) after the end of the ninth outbreak of EVD in the province of Equateur in the Democratic Republic of the Congo (DRC).

PARTICIPANTS

A large population-based sample of 1614 adults (50% women, Mage=34.05; SD=12.55) in health zones affected by the ninth outbreak in DRC.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants completed questionnaires assessing EVD exposure level, stigmatisation related to EVD and depressive symptoms. The ORs associated with sociodemographic data, EVD exposure level and stigmatisation were analysed through logistic regressions.

RESULTS

Overall, 62.03% (95% CI 59.66% to 64.40%) of individuals living in areas affected by EVD were categorised as having severe depressive symptoms. The multivariable logistic regression analyses showed that adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms (respectively, OR 1.94 (95% CI 1.22 to 3.09); OR 2.34 (95% CI 1.26 to 4.34)). Individuals in the two higher categories of stigmatisation were two to four times more at risk (respectively, OR 2.42 (95% CI 1.53 to 3.83); OR 4.73 (95% CI 2.34 to 9.56)). Living in rural areas (OR 0.19 (95% CI 0.09 to 0.38)) and being unemployed (OR 0.68 (95% CI 0.50 to 0.93)) increased the likelihood of having severe depressive symptoms.

CONCLUSIONS

Results indicate that depressive symptoms in EVD affected populations is a major public health problem that must be addressed through culturally adapted mental health programs.

Meaning in Life, Future Orientation and Support for Violent Radicalization Among Canadian College Students During the COVID-19 Pandemic

The COVID-19 pandemic has increased levels of uncertainty and social polarization in our societies, compromising young people's capacity to envision a positive future and maintain a meaningful sense of purpose in life. Within a positive youth development framework, the present study investigates the associations of a positive future orientation, presence of and search for meaning in life, and support for violent radicalization (VR) in a diverse sample of Canadian college students. In addition, we investigate the moderating role of future orientation in the association between presence of and search for a meaning in life and support for VR. A total of 3,100 college students in Québec (Canada) (69% female; M _age = 18.57, SD _age = 1.76) completed an online survey during the second wave of the COVID-19 pandemic. Results from linear mixed-effects models indicate that a positive future orientation and a higher presence of a meaning in life were negatively and independently associated with support for VR. Search for meaning in life was not associated with support for VR. The magnitude of the negative association between presence of a meaning in life and support for VR was greater among students with a more positive future orientation. Schools and colleges are in a privileged position to implement preventive interventions to support a positive future orientation and the presence of a meaning in life among young people during these challenging and uncertain times and reduce the risk of violence related to extreme ideologies in our rapidly changing society.

Severe Anxiety and PTSD Symptoms Among Ebola Virus Disease Survivors and Healthcare Workers in the Context of the COVID-19 Pandemic in Eastern DR Congo

Ebola virus disease (EVD) survivors and healthcare workers (HCWs) face stress, fear, and stigma during the COVID-19 pandemic that can induce severe symptoms of anxiety and post-traumatic stress disorder (PTSD). We examined the prevalence and factors related to severe PTSD and anxiety symptoms, using a representative sample of survivors of the 2018-2020 EVD epidemic in DR Congo in comparison HCWs. Five hundred sixty-three participants (55.25% women, 309 survivors, 202 HCWs, and 52 HCWs and survivors) completed questionnaires assessing anxiety, PTSD, exposure to EVD and COVID-19, stigmatization related to EVD and COVID-19, interpersonal traumas, social support. During the COVID-19 pandemic, 45.6 and 75.0% of survivors and HCWs reported severe symptoms of PTSD and anxiety. Significant difference was observed among the three groups for both PTSD (53.7% survivors, 37.1% HCWs, and 30.8% HCWs-survivors, χ²= 18.67, p < 0.0001) and anxiety (88.3% survivors, 56.9% HCWs, and 65.4% HCWs- survivors, χ²= 67.03, p < 0.0001). Comorbidity of severe PTSD and anxiety symptoms was 42.3% between the three groups. Results revealed that exposure to EVD (b = 0.53; p = 0.001; b = 0.12; p = 0.042), EVD-related stigmatization (b = 0.14; p = 0.018; b = 0.07; p = 0.006), COVID-19-related stigmatization (b = 0.22; p < 0.0001; b = 0.08; p = 0.0001) and social support (b = -0.30; p < 0.0001; b = -0.14; p < 0.0001) predicted severe PTSD and anxiety symptoms. The last models explained 63.8 and 56.4% of the variance of PTSD and anxiety. Symptoms of PTSD and anxiety are common among EVD survivors and HCWs during the COVID-19 pandemic. Culturally-sensitive programs that address stigma are necessary to mitigate the cumulative effects of EVD and the COVID-19 pandemic on EVD survivors and HCWs.

Ethnoracial Differences in Coercive Referral and Intervention Among Patients With First-Episode Psychosis

OBJECTIVE

Using a retrospective sample, the authors sought to determine whether Black patients with first-episode psychosis (FEP) in Canada were at a higher risk for coercive referral and coercive intervention than non-Black patients with FEP.

METHODS

Retrospective data from patients referred to an FEP program in 2008-2018 were collected via chart review (N=208). The authors used chi-square and logistic regression analyses to explore the relationships among race-ethnicity, diagnosis of psychosis, and coercive referral and intervention.

RESULTS

Results showed that Black persons of Caribbean or African descent with FEP were significantly more likely to be coercively referred (χ²=9.24, df=2, p=0.010) and coercively treated (χ²=9.21, df=2, p=0.010) than were non-Black individuals with FEP. Age and violent or threatening behavior were predictors of coercive referral. Ethnoracial status, age, and violent or threatening behavior were predictors of coercive intervention.

CONCLUSIONS

This study contributes to the dearth of research on Black Canadians and offers insight into factors that may place patients with FEP at risk for coercive treatment. More research is needed to explore the role that ethnoracial status may play in hospital admissions and to uncover the role of racial prejudices in the assessment of danger.

Negotiating Safety and Wellbeing: The Collaboration Between Faith-Based Communities and Public Health During the COVID-19 Pandemic

The COVID-19 pandemic led to lockdown measures where congregational faith-based activities were prohibited. With time, the collateral impacts of confinement emerged as priorities, and impositions had to be balanced with the collaboration of the population. In this process, faith-based organizations played a key role in encouraging their congregations to adhere to lockdown measures while fostering their mental wellbeing and resilience. This paper describes the process of establishing a collaborative negotiation among the Montreal Regional Public Health Unit, the police, and the Muslim and Jewish communities, examining the role of mediation in this context. Despite some obstacles, such as communication difficulties and decision-making limitations, the collaborative approach seems to buffer the escalation of intercommunity tension and to promote communities' commitment to physical distancing measures and should be considered in times of pandemic for a more inclusive public health approach.

Corrigendum: The Transcultural Community Resilience Scale: Psychometric Properties and Multinational Validity in the Context of the COVID-19 Pandemic

[This corrects the article DOI: 10.3389/fpsyg.2021.713477.].

Collective identity, social adversity and college student sympathy for violent radicalization

Identity issues have been at the forefront in studies on determinants of youth violent radicalization. Identity uncertainty and identity fusion appear to be associated with quests for meaning, which may find some answers in extremist discourses and radical engagements. This process has been considered to be particularly important for second-generation migrants who have to negotiate multiple identities, sometimes in situations of social adversity. This paper aims to understand the relations between collective identity, social adversity (discrimination and exposure to violence), and sympathy for violent radicalization in College students in Quebec. This mixed-method study consisted of a large online survey conducted at eight colleges in Quebec. Multilevel analysis accounted for the clustered nature of data while generalized additive mixed models were used to study nonlinear relations. Results highlight the complex associations between collective identity and youth sympathy for violent radicalization. They confirm that negative public representations of minority communities may lead to more sympathy for violent radicalization. Although results suggest that strong enough identities can act as protective anchorages for youth, they also indicate that when collective identity becomes too central in personal identity this may accentuate othering processes and legitimize violence toward the out-group. These results have implications for prevention programs. They indicate that improving the public image of minority communities through mainstream media or the social media may increase youth public self-esteem and decrease their sympathy for violent radicalization. They also invite the education field to foster the development of strong plural identities.

Evaluation of a training program on the prevention of violent radicalization for health and education professionals

This article presents a preliminary evaluation of training sessions promoting a systemic approach to violent radicalization (VR) offered to first-line health and education professionals in Quebec. We describe the rationale and content for the training program, its general principles and implementation modalities. The mixed-method evaluation indicated that the participants felt the training increased their level of confidence in dealing with VR in their work. It appeared that training also shifted participants' attitudes significantly on four items with decreases: (1) worry about the extent of VR of young people in Quebec; (2) belief that VR should automatically be reported to the police; (3) thinking that Islam favors VR; and (4) assumption that enhanced security measures would have a deterrent effect on VR. The conclusion discusses the challenges associated with violent radicalization training programs, emphasizing the delicate ethical and political questions related to the provision of training on this socially divisive topic.

Transnational evaluation of the Sympathy for Violent Radicalization Scale: Measuring population attitudes toward violent radicalization in two countries

Countering violent radicalization is a priority in many countries, prompting research that assesses attitudes and beliefs about violent radicalization in the general population. The majority of violent radicalization assessments have been developed among specific populations, with limited investigation into the generalizability and cross-cultural applicability of measurement tools. A transcultural investigation raises questions about the implicit assumptions and norms that inform instrument development. This research examined the psychometric properties of the Sympathy for Violent Radicalization Scale (SyfoR), a measure developed for use with Pakistani and Bangladeshi immigrant groups in the UK, in two convenience samples of youth and young adults in North America and Western Europe. We investigated the factor structure, reliability, and construct validity of adapted versions of the SyfoR among convenience samples of youth and young adults living in Belgium (N = 2014) and in Quebec, Canada (N = 1364) via online surveys administered to students engaged in secondary and post-secondary education. Results indicate that, in both samples, a reduced, 8-item version of the SyfoR has a 3-factor structure with good model fit statistics using confirmatory factor analysis and good internal consistency reliability. More studies are needed to assess the appropriateness of the SyfoR for use in diverse contexts and among diverse populations. The potential usefulness and harmfulness of measures of violent radicalization should balance the benefits of obtaining local data with the risks associated with pathologizing social dissent.

Ebola virus disease, stigmatization, peritraumatic distress, and posttraumatic stress disorder in the Democratic Republic of the Congo: A moderated mediation model

BACKGROUND

Mechanisms worsening the development of Posttraumatic stress disorder (PTSD) symptoms among individuals affected by high-mortality epidemics are unclear. This study examined the prevalence of PTSD and related risk factors among populations affected by the Ebola virus disease (EVD) outbreak, and investigated whether peritraumatic distress mediates the impact of exposure level to EVD on PTSD symptoms, and the moderation role of stigmatization.

METHODS

The sample included 1614 participants (50% women) affected by EVD in Democratic Republic of the Congo (DRC). Participants completed the PTSD Check-List for DSM-5, Peritraumatic Distress Inventory, and measures evaluating levels of exposure and stigmatization related to EVD. Descriptive analyses and a moderated mediation model were computed.

RESULTS

A total of 58.81% participants (95% CI: 56.41%; 61.21%) met PTSD diagnostic criteria. Participants living in rural areas presented greater risk, while there is no significant difference between men and women. Peritraumatic distress mediated partially the association between exposure to EVD and PTSD symptoms. Moreover, this relationship was moderated by stigmatization related to EVD.

LIMITATIONS

As the design was cross-sectional, this study could not examine the causality of PTSD symptoms among communities affected by EVD.

CONCLUSIONS

This study shows high prevalence rates and important risk factors associated with PTSD in populations affected by EVD. It indicates elements that could help to develop and implement prevention and intervention programs in affected communities.

Radicalization to Violence: A View from Cultural Psychiatry

This article introduces a thematic issue of Transcultural Psychiatry with selected papers from the McGill Advanced Study Institute in Cultural Psychiatry on "Pluralism and Polarization: Cultural Contexts and Dynamics of Radicalization," which took place June 20-22, 2017. The ASI brought together an interdisciplinary group scholars to consider the role of social dynamics, cultural contexts and psychopathology in radicalization to violent extremism. Papers addressed four broad topics: (1) current meanings and uses of the term radicalization; (2) personal and social determinants of violent radicalization, including individual psychology, interpersonal dynamics, and wider social-historical, community and network processes; (3) social and cultural contexts and trajectories of radicalization including the impact of structural and historical forces associated with colonization and globalization as well as contemporary political, economic and security issues faced by youth and disaffected groups; and (4) approaches to community prevention and clinical intervention to reduce the risk of violent radicalization. In this introductory essay, we revisit these themes, define key terms, and outline some of the theoretical and empirical insights in the contributions to this issue. Efforts to prevent violent radicalization face challenges because social media and the Internet allow the rapid spread of polarizing images and ideas. The escalation of security measures and policies also serves to confirm the worldview of conspiracy theory adherents. In addition to addressing the structural inequities that fuel feelings of anger and resentment, we need to promote solidarity among diverse communities by building a pluralistic civil society that offers a meaningful alternative to the violent rhetorics of us and them.

Discrimination and Sympathy for Violent Radicalization Among College Students in Quebec (Canada): The Protective Role of Intrinsic and Extrinsic Religiosity

ABSTRACT

The present study examines the moderating role of total, intrinsic, and extrinsic religiosity in the relation between perceived discrimination and sympathy for violent radicalization (VR) among college students in Quebec, Canada. A total of 931 students responded to an online questionnaire and were included in this study. Linear mixed-effects models were conducted to account for the clustered nature of the data, and moderation was assessed via interaction analysis using cross-product terms in the models. Findings indicated that both intrinsic and extrinsic religiosity had a protective role in the link between perceived discrimination and sympathy for VR and buffered the effects of sadness in response to discrimination on sympathy for VR, but not the effects of anger in response to discrimination. These results provide evidence of the protective role of religiosity in Canada, a social context characterized by an increase in religious discrimination, but which also supports religious diversity.

Canadian Health Personnel Attitudes Toward Refugee Claimants' Entitlement to Health Care

Health care personnel attitudes toward refugee claimant entitlement to health care are influenced by multilevel factors including institutional and societal culture. Although individual attitudes may be modified through training, macro- and meso-issues require system-level interventions. This paper analyzes the role of individual-, institutional-, and city-level factors in shaping attitudes toward refugee claimants' access to health care among Canadian health care personnel. A total of 4207 health care personnel in 16 institutions located in Montreal and Toronto completed an online survey on attitudes regarding health care access for refugee claimants. We used multilevel logistic regression analysis to identify individual-, institutional-, and city-level predictors of endorsing access to care. Participants who had prior contact with refugee claimants had greater odds of endorsing access to care than those who did not (OR 1.13; 95% CI 1.05, 1.21). Attitudes varied with occupation: social workers had the highest probability of endorsing equal access to health care (.83; 95% CI .77, .89) followed by physicians (.77; 95% CI .71, .82). An estimated 7.97% of the individual variation in endorsement of equal access to health care was attributable to differences between institutions, but this association was no longer statistically significant after adjusting for city residence. Results indicate that the contexts in which health care professionals live and work are important when understanding opinions on access to health care for vulnerable populations. They suggest that institutional interventions promoting a collective mission to care for vulnerable populations may improve access to health care for precarious status migrants.

The Transcultural Community Resilience Scale: Psychometric Properties and Multinational Validity in the Context of the COVID-19 Pandemic

Few instruments assess community resilience. In the midst of the COVID-19 pandemic, the capacity of communities to support resilience of members deserves to be assessed to develop programs for improving mental health of affected populations. This article presents the development of the Ottawa-Community Resilience Scale (O-CRS), its underlying factorial structure and transcultural validity with a multilingual (English, French, Creole, Kinyarwanda), multinational (DR Congo, Haiti, Rwanda, Togo) and multicultural sample affected by this pandemic. A sample of 1,267 participants (40.9% women) were recruited in the four countries: DRC (n = 626, 43.4% women), Haiti (n = 225, 42.0% women), Rwanda (n = 174, 40.5% women), and Togo (n = 242, 33.2% women), with a mean age of 32 (SD = 10.1). They completed measures assessing individual resilience, depression and the O-CRS. Exploratory and confirmatory Factor Analyses, Cronbach alpha, coefficient H and the McDonald's Omega, and bivariate regression were used to estimate the underlying components of the O-CRS, its internal consistency and concurrent validity. Parallel factorial analysis and confirmatory factor analysis results revealed an excellent fit 3-factor structure. Internal consistency coefficients varied between 0.82 and 0.95. The O-CRS showed a good construct validity with a positive association with individual resilience and negative association with depression score. Developed with a collaborative approach involving researchers, practitioners, and clients/patients, the O-CRS and its three factors (community strengths and support, community trust and faith, and community values) demonstrated excellent psychometric properties for assessing community resilience among adults during the COVID-19 pandemic.

Egyptian and Roma Adolescents' Perspectives on Their Developmental Assets in Albania During the COVID-19 Pandemic

This mixed-method study explores the accessibility of developmental assets among Egyptian and Roma minority youth in Albania during the COVID-19 pandemic. Six focus groups were conducted in August 2020 with Egyptian (n = 16) and Roma (n = 15) adolescents (14-20 years, M_age  = 16.71; SD_age  = 2.00; 14 girls and 17 boys). In addition, adolescents rated how much they experienced each developmental asset. Descriptive and thematic analyses highlighted: (1) low developmental assets and barriers to accessing resources, (2) mental health concerns and coping strategies, (3) the role of proximal contexts of life, and (4) experiences within the society in terms of discrimination, integration, and contribution to society. Inter-sectoral community-based interventions are urgently needed to mitigate the impact of the pandemic on minority youth.

[Place of molecular imaging in the management of prostate cancer]

In the management of prostate cancer in recent years, innovative therapies have appeared requiring precise and reliable disease detection. In 2021, new generation imaging (PET/CT, multiparametric MRI, PET/MRI) have their place at all stages of the prostate cancer natural history to help target the lesion(s) and guide therapy and improve the results obtained. PSMA PET/CT is currently the leader in this type of imaging with a complete offer during the disease: both from diagnosis, to recurrence or in the oligo-metastatic and metastatic stage resistant to castration with a pivotal role in the PSMA theranostic approach. However, multiparametric MRI also has many detection advantages when the prostate is left in place, which suggests the potential major benefit of hybrid PSMA PET/MRI imaging.

[External validation of nomogram for the prediction of recurrences of pregnancy-associated breast cancer]

OBJECTIVE

Diagnosis and therapeutics are challenging in pregnancy-related breast cancer and a multidisciplinary approach is therefore essential. A nomogram predictive of recurrence at 36 months of PABC has recently been developed, the aim was to evaluate it on an independent cohort.

PATIENTS AND METHODS

This was a monocentric retrospective study including all patients with PABC between January 2004 and March 2018. A Kaplan-Meier method was used for the analysis of recurrence-free survival. Nomogram performance was analysed on 3 indicators: discrimination by a receiver operator characteristic curve (ROC), calibration and net clinical benefit by a decision curve analysis.

RESULTS

Forty-one patients have been included. The survival rate was 83 % at 3 years. The nomogram showed acceptable discrimination capacities on receiver-operator characteristic analysis (c-index: 0.78). Decision-curve analysis showed a positive net-benefit for relapse probability ranges between 5 % and 35 %.

CONCLUSION

The performance of this prediction model is acceptable but the net clinical benefit low. In conclusion, prediction of recurrence remains challenging with a continued need for more precise tools.