Table 4 - uploaded by Chesmal Siriwardhana
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Background
The rising global burden of forced migration due to armed conflict is increasingly recognised as an important issue in global health. Forced migrants are at a greater risk of developing mental disorders. However, resilience, defined as the ability of a person to successfully adapt to or recover from stressful and traumatic experiences, h...
Contexts in source publication
Context 1
... included in the final in-depth review had pub- lication dates ranging from 2000 to 2013, 12 of which were primarily quantitative studies (Tables 2 and 3) and 1 study was of mixed-method design [25]. The remaining 10 were qualitative studies (Table 4). The majority of Table 2 Overview of quantitative studies (Continued) ...
Context 2
... studies were conducted in HIC set- tings [38][39][40]45,46] and the other five in LMIC settings [41][42][43][44]47]. There was a wide variation in sample sizes, Table 4 Overview and summary of qualitative study findings (Continued) Fernando, [44] 43 Sri Lankans Resilience construct examined through focus groups. Some elements of resilience are common across ethnic-cultural groups while other differed across ethnicities. ...
Context 3
... methods were used by some studies [45,47]. Findings and conclusions from these studies in relation to resilience and mental health are summarised in Table 4. Resilience in these populations affected by conflict-driven forced migration was concluded to be influenced by social complexities, family and community cohesion, family and community support, individual personal qualities, collective identity, supportive primary relationships and religion. ...
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Background:
The combination of global demographic changes and a growing number of humanitarian crises in middle-income countries that have a higher life expectancy has led to an increase in the number of older populations affected by humanitarian crises. The aim of this review was to systematically examine evidence on the health needs of older popu...
Citations
... Some HCWs who maintain positive psychological adaptation during or after assisting refugees may be referred to as "resilient" [26]. In this study, we define resilience according to Masten's [27] definition: "the capacity of a dynamic system to adapt successfully to disturbances that threaten system function, viability, or development" (p. 6). ...
Due to occupational exposure to potentially traumatic events, health care workers (HCWs) may be at risk of developing posttraumatic stress (PTS) symptoms or probable posttraumatic stress disorder (PTSD). This study examined probable PTSD, coping, and resilience among national HCWs working in Greece. A total of 17.9% of the sample of participants (N = 112) met the screening criteria for probable PTSD. Logistic regression models were constructed to assess if trauma coping self-efficacy (CSE) and resilience predicted probable PTSD, and the results indicated that lower trauma CSE significantly predicted probable PTSD in unadjusted models (OR = 0.89, 95% CI, 0.82, 0.96, p < 0.01) and adjusted models (OR = 0.90, 95% CI, 0.83, 0.97, p < 0.01). Our study findings suggest that organizations that employ HCWs may support their workers through ongoing screening, assessment, and training that enhances coping self-efficacy.
... D isplaced people experience disparities in mental health due to multiple processes: exposure to violence (including structural violence) in their home countries; flight from their homes under life-threatening conditions; separation from family, friends, and community; temporary or extended encampment in unsafe environments without adequate food, education, and health care; and the stress of rebuilding their lives in a new country. Given these challenges, it is not surprising that forcibly displaced people typically have higher rates of psychological distress than the general population (Fazel et al., 2005;Morina et al., 2018;Siriwardhana et al., 2014). Psychological distress is often exacerbated by fear, marginalization, lack of access to resources, and uncertainty related to legal status, and growing evidence suggests that the effects of being undocumented and/or living in a mixed status household impact the mental health of immigrant families across generations (Almeida et al., 2016). ...
Eliminating mental health disparities requires simultaneously addressing numerous determinants of health, including social inequities. Although emphasis on multilevel change is growing, interventions typically involve separate efforts or people focusing on each level. We propose a trans-level conceptual model for mental health intervention that simultaneously facilitates change across multiple intersecting levels with four guiding principles: (1) emphasis on structural change; (2) involvement of people experiencing health and social inequities in achieving structural change by addressing the necessary preconditions of access to resources for basic needs, community membership and belonging, and knowledge or information to participate in social change efforts; (3) valuing and building on the expertise and strengths of individuals, families, and communities experiencing health inequities; and (4) dismantling unequal power dynamics of helping relationships through a focus on mutual learning and support and cocreation of change. Tracing the trajectory of a 23-year community-based mental health intervention partnership (the Refugee and Immigrant Well-Being Project), we illustrate the trans-level intervention model and describe its impact on individual mental health and sustainable change at multiple levels.
... Previous studies of MENA immigrants have focused on intimate partner violence (IPV) (Barkho et al., 2010;Kulwicki & Miller, 1999), service utilization by victims of IPV (Abu-Ras, 2007;Kulwicki et al., 2010), stigma associated with and attitudes toward mental health (Ahmed et al., 2011), barriers to acculturation (Al Wekhian, 2015), and suicidal ideation (Stark et al., 2022). Such studies have found that forced migrants have an elevated risk of mental health disorders such as PTSD and major depressive disorders (Siriwardhana et al., 2014;Steel et al., 2011). Importantly, mental health stigma, a lack of knowledge about mental health care, and cultural practices can inhibit refugees from seeking mental health services, resulting in diagnostic underreporting (Shannon et al., 2016). ...
The study identifies acculturative challenges and opportunities experienced by Arab-speaking MENA refugees in the United States. The research team conducted 24 semi-structured interviews with refugee parents (11 fathers and 13 mothers) in Arabic. The findings reveal two main categories: (a) acculturative challenges and (b) opportunities and hopes for a better future in the United States. Refugees described several acculturative challenges, including the language barrier, unrealized mental health issues, intimate partner violence (IPV), and the added struggle of COVID-19. Refugees faced several challenges, but their stressors were mitigated by their hope for a better future for their children. Findings suggest practitioners must introduce early interventions targeted at family conflict resolution in Arabic. Future research should explore culturally acceptable mental health interventions and gender-specific resources for IPV.
... Common mental health problems among displaced populations are made worse by psychosocial stressors such as financial hardships (including unemployment), legal status (non-recognition of refugees), and anxiety about children's futures (particularly in terms of education and higher education). For example, evidence suggests that the mental health impact of armed conflict is further exacerbated by post-migration stressors, such as economic difficulties, discrimination, enculturation, parenting, and employment (Fazel et al., 2011;Saechao et al., 2012;Siriwardhana et al., 2014). Post-migration stressors have consistently been found to predict levels of distress as powerfully as prior war exposure (Miller & Rasmussen, 2017). ...
... Latinos may be uniquely vulnerable to traumas derived from familial histories of forced migration (e.g., due to domestic crime and war, economic turmoil, etc. in their home countries) [109,110]. Among racial/ethnic minority immigrants (broadly), deep, historic practices of large-scale resource and labor extraction coupled with present-day hyper-local domination by multinational corporations in their home countries may fuel opioid use by corroding wealth development prospects (as a protective factor) and positive cultural identity development [111]. ...
Issues
To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors.
Approach
Using the “risk environment” framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer‐reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual‐level risk factors.
Key Findings
Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder.
Implications
There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk‐phenomena tied to multi‐level forms of entrenched disenfranchisement.
Conclusion
There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
... Most resilience research has focused on adult or adolescent resilience, usually as a response to trauma and other adversities. 16 However, some key developmental tasks are likely unique or particularly pronounced in childhood, such as the development of emotional bonds with caregivers, meaning there are likely differences in resilience factors in children compared with adults and adolescents. 10 There is an emerging need for research to examine socioecological factors in childhood, particularly given that children have less capacity to shape their environments compared with adolescents and adults. ...
Introduction
It is important to promote resilience in preadolescence; however, there is limited research on children’s understandings and experiences of resilience. Quantitative approaches may not capture dynamic and context-specific aspects of resilience. Resilience research has historically focused on white, middle-class Western adults and adolescents, creating an evidence gap regarding diverse experiences of resilience in middle childhood which could inform interventions. East London’s Muslim community represents a diverse, growing population. Despite being disproportionately affected by deprivation and racial and cultural discrimination, this population is under-represented in resilience research. Using participatory and arts-based methods, this study aims to explore lived experiences and perceptions of resilience in black and South Asian Muslim children living in East London.
Methods and analysis
We propose a qualitative study, grounded in embodied inquiry, consisting of a participatory workshop with 6–12 children and their parents/carers to explore lived experiences and perceptions of resilience. Participants will be identified and recruited from community settings in East London. Eligible participants will be English-speaking Muslims who identify as being black or South Asian, have a child aged 8–12 years and live in East London. The workshop (approx. 3.5 hours) will take place at an Islamic community centre and will include body mapping with children and a focus group discussion with parents/carers to explore resilience perspectives and meanings. Participants will also complete a demographic survey. Workshop audio recordings will be transcribed verbatim and body maps and other paper-based activities will be photographed. Data will be analysed using systematic visuo-textual analysis which affords equal importance to visual and textual data.
Ethics and dissemination
The Queen Mary Ethics of Research Committee at Queen Mary University of London has approved this study (approval date: 9 October 2023; ref: QME23.0042). The researchers plan to publish the results in peer-reviewed journals and present findings at academic conferences.
... Indeed, other studies have suggested that postmigration factors are a significant predictor of mental health difficulties, above and beyond pre-migration trauma (Chen et al., 2017;Schweitzer et al., 2011). Future research should investigate the role of post-migration stressors as well protective factors such as social support or resilience, as it has been implicated in promoting better psychological outcomes in refugee groups (Hecker et al., 2018;Schweitzer et al., 2006;Siriwardhana et al., 2014). Focusing on improving refugees' social support and integration following migration is essential to prevent poor mental health outcomes (Akar & Erdogdu, 2019;Hynie, 2018). ...
Background
After the Syrian civil war, millions of Syrian refugees migrated to neighboring countries, with the majority settling in Turkey. The prevalence of mental disorders is notably higher among refugee populations. However, prior research on Syrian refugees have mostly used variable-centred approaches which have known limitations. Thus, the present study sought to examine the occurrence and co-occurrence of traumatic experiences among Syrian refugees living in Turkey using latent class analysis (LCA). Additionally, this study aimed to identify the associations between latent class membership and trauma-related psychopathology.
Methods
Participants included 593 Syrian refugees living in Turkey. LCA was used to identify latent classes of trauma exposure. Demographic predictors of the latent classes were examined, and associations with PTSD, CPTSD, depression, and anxiety were also explored.
Results
Three latent classes were identified based on trauma exposure: a “multiple traumas” class, a “war and human suffering” class, and a “low exposure, combat-exposed” class. Odds of PTSD, CPTSD, depression, or anxiety diagnosis did not differ significantly between classes, except the “multiple traumas” class, who were more likely to meet the criteria for anxiety diagnosis compared to the “low exposure” class.
Limitations
Historic psychiatric symptoms or post-migration stressors could not be accounted for in this study, which may explain the lack of significant differences in most mental health outcomes by trauma exposure class.
Discussion
The latent classes identified in this study correspond with previous research regarding trauma in Syrian refugees. However, this study largely failed to find significant differences in mental health diagnoses between classes. Future research should consider the effect of post-migration stressors in refugee populations, which may play a crucial role in mental health outcomes.
... The challenges associated with settling into high-income countries may be due to social and cultural experiences that differ significantly from refugees' previous ways of living in ways that For parents especially, navigating childcare and school-related systems challenges may also contribute to negative post-migration outcomes. The consequences of these stressors can be cumulative-that is, the more prolonged displacement is perpetuated over time and under stressful conditions, the higher the risk of long-term consequences on an individual's mental health (Siriwardhana et al., 2014). Acculturative stress has also been proposed to be greater for those, like refugees, who did not choose to migrate, and who may thus experience the pressures to change more negatively than those who have actively chosen to migrate (Berry et al., 1987). ...
This study explored changes in shared decision-making roles (day-to-day, financial, and major life decisions) and their relationships to perceived stress among 148 Syrian refugee parents after resettling in Toronto using a generalized estimated equation model. Parents were categorized as “towards shared” decision-making for 20.3%, 23.0%, and 21.6% of day-to-day, major life, and financial decisions, respectively. In families where both parents were unemployed, those who “always shared” making financial decisions had significantly lower perceived stress than those “towards shared” (p = .02). Understanding the cultural contexts of gender roles and the impact of acculturation may help promote better post-migration strategies.
... However, some studies indicate that some HCWs may display positive psychological adaptation (Ogińska-Bulik & Zadworna-Cieślak, 2018). In the current study, positive psychological adaptation is defined as psychological well-being or satisfaction (Ward & Kennedy, 1999) that can occur due to protective factors, such as effective coping (Sharma et al., 2017;Siriwardhana et al., 2014). It remains unclear whether Greek HCWs who assist refugees and asylum seekers experience psychological distress or may report factors associated with positive psychological adaptation; however, this information is crucial for informing efforts to prevent negative mental health outcomes in HCWs. ...
Abstract
Greek health care workers (HCWs) working with refugee and asylum-seeker populations may be at risk of trauma exposure and related distress. The current study sought to further understand the factors that may promote or hinder psychological adaptation among HCWs working with trauma-exposed refugee populations in Greece. Participants were HCWs (N = 20) who completed semistructured interviews. Thematic analysis procedures identified three main themes: vicarious traumatization, (b) mismatch of expectations, and (c) difficulty coping. Our study findings highlight the need to provide adequate training, supervision, and mental health support for HCWs to prevent mental health issues in this population. Additional studies are necessary to understand the long-term consequences of working with refugee populations and explore ways to assist HCWs with self-care.
... Refugees, or people who are forced to flee their homes for fear of violence or persecution, have a vastly increased risk for mental health disorders (i.e. depression, anxiety, post-traumatic stress disorder (PTSD)) compared to general adult populations (Bogic et al., 2015;Siriwardhana et al., 2014). Refugees resettled in high income countries, e.g. ...
... Recent literature calls for new research to focus on the interrelated, multi-level determinants that influence mental health outcomes among resettled refugee women (Hawkins et al., 2021;Siriwardhana et al., 2014;Wachter et al., 2016). Therefore, the objective of this research is to develop a deep understanding of mental health experiences among resettled African refugee women in the context of their broader refugee experience to generate a framework for understanding mental health experiences among African refugee women living in the US to inform strategies for mental health interventions based on real world contexts. ...
African refugee women resettled in the United States are exposed to multiple risk factors for poor mental health. Currently, no comprehensive framework exists on which to guide mental health interventions specific to this population. Through a community-based participatory research partnership, we interviewed N = 15 resettled African refugees living in Rhode Island. Here we (1) describe how meanings of mental health within the African refugee community vary from US understandings of PTSD, depression, and anxiety and (2) generate a framework revealing how mental health among participants results from interactions between social support, African sociocultural norms, and US norms and systems. Multiple barriers and facilitators of mental wellbeing lie at the intersections of these three primary concepts. We recommend that public health and medicine leverage the strength of existing community networks and organisations to address the heavy burden of poor mental health among resettled African refugee women.
