Addressing Mental Health Stigmas among Refugees: A Narrative Review from a Socio-Ecological Perspective

Huaibo Xin

doi:10.13189/ujph.2020.080202

Abstract

Mental health stigmas have been predominantly prevalent among different refugee populations resettled in both western and non-western countries. It significantly affects refugees' mental healthcare seeking behaviors. The current narrative review is to examine the anti-stigma strategies/interventions/programs that specifically address refugees' mental health stigma. Twenty-six out of 711 peer-reviewed journal articles, book chapters, commentaries, reports, dissertations, and theses published in 2019 or prior in English were included in the final themes analysis. Results were organized using a socio-ecological multilevel framework (intrapersonal, interpersonal, institutional, community, and policy levels), which include increasing refugee individuals' awareness of mental health and improving their attitudes and perceptions towards mental disorders; enhancing interpersonal interactions between refugee patients and people who can encourage them to seek mental healthcare and can provide them with culturally competent mental health services; delivering mental healthcare through schools and ethnic organizations; developing community-based bottom-up interventions and mobilizing community assets to destigmatize and normalize mental illnesses within refugee communities; and advocating for a change of social norm towards mental illnesses and mental health treatment. There is a significant lack of studies designed to explore the effectiveness of anti-stigma approaches among refugees, which leads to an urgency of developing these studies and supporting evidence-based practice.

Highlights

There was a rich body of literatures discussing mental health stigma among refugee populations over the past at least 40 decades [1-7]
76% of 41 state health coordinators reported that mental health stigma was one of the major barriers to accessing mental health services
Mental healthcare professionals further emphasized that mental illness was deeply stigmatized in refugee communities, and people from countries outside of U.S often held a very different view on mental health

Summary

Introduction

There was a rich body of literatures discussing mental health stigma among refugee populations over the past at least 40 decades [1-7]. Mental health related stigma consistently presents itself as one of the major barriers to the utilization of mental health services among a variety of western or non-western refugees [8-10]. 76% of 41 state health coordinators reported that mental health stigma was one of the major barriers to accessing mental health services. Compared to the states who did not provide refugees with mental health screening, states who provided refugees with screening services were more likely to report stigma as a barrier [8]. Two systematic reviews published in 2014 and 2015 suggested that because of social stigma attached to mental illnesses, refugees chose to express their mental health symptoms as somatic symptoms [9, 10]. Patients showed greater fear of being stigmatized and more likely hid their psychiatric symptoms if he/she came from a country where people understood psychiatry as a care system only for schizophrenics [10]

Objectives

Results

Conclusion