Migrant Health Research Articles

Ethics in Mental Health Research with Haitian Migrants: Lessons from a Community-Based Study in Santiago, Chile.

Migration research poses several unique challenges and opportunities. Conducting ethical global health practice, especially when studying migrant mental health, is of particular concern. This article explores seven challenges and lessons learned in our mixed-methods study conducted to assess the impact of the migration experience on Haitian migrants' mental health in Santiago, Chile. The primary challenges were recruiting in a highly mobile population, building trust and community participation, overcoming language barriers, safety considerations during the Covid-19 pandemic, mitigating potential negative impacts of research on the community, providing psychological support, and finding meaningful ways to benefit the community. We propose moving toward a better and more ethical migrant research practice by ensuring language accessibility, hiring community members for the study team, working with local institutions and nongovernmental organizations, and maintaining sustainable connections.

The Climate Migrant: Health Risks Before, During, and After Migration

The climate crisis and migrant health are closely intertwined. Climate change is rapidly altering the planet, and migrants are experiencing new and overlapping health consequences as a result. In this article, three subsets of migrants affected by the climate crisis are identified, and the health needs of each are delineated. Climate-precipitated migrants were forced to move as a result of a climate impact like a hurricane or drought. Climate-impacted migrants may have migrated initially for reasons unrelated to the climate crisis, but the social and occupational factors they encounter increase their risk of climate-related health effects during and after migration. Climate workers, the third type of migrant identified, move into regions affected by climate disasters to aid in clean-up and rebuilding, facing significant occupational and environmental health risks. All three types of climate migrants are increasing, but little attention is given to the health and safety of these migrants. Frontline clinicians and community health centers play an increasingly important role regarding climate-related health conditions; up-to-date training of and support for clinicians can reduce climate-related morbidity and mortality, but clinicians on their own are unprepared to systematically address climate health inequity. Regulation needs to anticipate the health impacts of the advancing climate crisis by reinforcing the migration system to enable movement after a crisis and increasing worker protections to facilitate faster and safer climate response and post-disaster recovery.

Botánicas Function as Health Care Safety Nets Among Hispanic American Immigrants: A Brief Report.

As the U.S. population becomes more racially/ethnically diverse, the Hispanic American immigrant population has slowly grown in recent years. In the face of anti-immigrant policies, limited access to care, fear of deportation, discrimination, stigmatization, poverty, and other stressors, Hispanic American immigrants seek services from botánicas for religious, spiritual, medical, and psychosocial health reasons, including the accessibility and affordability of services from folk practitioners in these herbal dispensaries. Hispanics are the primary consumers of herbal remedies and complementary and alternative medicines in the United States. The purpose of this article is to emphasize the critical role of botánicas in the health and wellness of Hispanic American immigrants. Recommendations for health professionals are provided in the care of Hispanic Americans who utilize folk, traditional, and herbal medicines for health and healing.

How integration of refugees into national health systems became a global priority: a qualitative policy analysis.

Despite a long history of political discourse around refugee integration, it wasn't until 2016 that this issue emerged as a global political priority. Limited research has examined the evolution of policies of global actors around health service provision to refugees and how refugee integration into health systems came onto the global agenda. This study seeks to fill this gap. Drawing on a document review of 20 peer-reviewed articles, 46 global policies and reports, and 18 semi-structured interviews with actors representing various bilateral, multilateral and non-governmental organizations involved with refugee health policy and funding, we analyze factors that have shaped the global policy priority of integration. We use the Shiffman and Smith Policy Framework on determinants of political priority to organize our findings. Several important factors generated global priority for refugee integration into national health systems. Employing the above-mentioned framework, actor power increased due to network expansion through collaborations between humanitarian and development actors. Ideas took hold through the framing of integration as a human rights and responsibility sharing. While political context was influenced through several global movements, it was ultimately the influx of Syrian refugees into Europe and the increasing securitization of the refugee crisis that led to key policies, and critically, global funding to support integration within refugee hosting nations. Finally, issue characteristics, namely the magnitude of the global refugee crisis, its protractedness and the increasing urbanicity of refugee inflows, led integration to emerge as a manageable solution. The past decade has seen a substantial reframing of refugee integration, along with increased financing sources and increased collaboration, explains this shift towards their integration into health systems. However, despite the emergence of integration as a global political priority, the extent to which efforts around integration have translated into action at the national level remains uncertain.

Reflections on arts-based research methods in refugee mental health: The role of creative exercises in nurturing positive coping with trauma and exile

Abstract In the field of refugee mental health research, scholars have emphasized the ethical obligation for research practices to benefit participants. They have proposed that research participation itself can promote positive coping in the aftermath of migration. In this article, we aim to advance the understanding of the benefits of arts-based research methods (ABRM) in how they may nurture participants’ positive coping during their experiences as research participants. To do so, we depart from the findings from three drama-based mental health interventions conducted with refugee and migrant young people resettled in Europe on the role creative processes might play in fostering coping. We develop a reflection on how ABRM may tap into these processes to strengthen refugees’ coping and well-being, ultimately supporting ethical research practices. In the final section, we discuss the value of integrating ABRM in refugee mental health research that embeds similar creative processes in their methodological repertoire.

Does health insurance participation matter in shaping African immigrants' physical health in Guangzhou, China? The role of mental health

AbstractChina is a burgeoning immigrant‐receiving country, and policies on immigration are just beginning to be developed. While African immigration to China was uncommon 30 years ago, China has gradually become a major destination for African immigrants due to its robust economy, welcoming universities, and low cost of living. Currently, there are increasing numbers of African students and professionals who are migrating to China to study or work. The health status of African migrants in China shapes their wellbeing, which plays a key role in strengthening long‐term cooperative relations between China and African countries. Although previous literature has examined the socioeconomic status of these African immigrants, the role of health insurance participation in shaping the health status of African immigrants remains obscure in China. Using data from the 2019 questionnaire‐survey in Guangzhou, China, this paper investigates the underlying mechanism driving African immigrants' health insurance participation as critical to their physical and mental health. Our results demonstrate that health insurance participation is a pivotal factor in the overall health of African immigrants; specifically, purchasing health insurance and one's mental and physical health can be characterised as a feedback loop. Purchasing health insurance can positively impact mental health, and consequently, better mental health can improve physical health. Good physical health also tends to bolster mental health. Therefore, policies aimed at improving African immigrants' mental and physical health are expected to encourage them to purchase health insurance above their present low level of insurance participation. The proposal here is that health policymaking for immigrants should include the interaction mechanism between physical and mental health rather than focus only on physical health conditions.

Unpacking gender-specific risk and protective factors for mental health status among Congolese refugees in Uganda

ABSTRACT Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations. Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups. Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males. Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive.

Social Determinants of Mental Health among Refugees in Germany - The Influence of Postmigratory Social Isolation and Resources on Psychopathology and Utilization Behavior

The mental health of refugees is influenced by a variety of pre-, peri- and postmigratory factors. It remains largely unclear how social determinants influence the utilization of psychiatric-psychotherapeutic treatment. We applied a questionnaire survey to 189 refugees from a clinical sample in a psychiatric hospital and from a control sample, which was not in treatment. The influence of social factors on psychopathology and utilization of care was analyzed by means of a CHAID algorithm. The total sample was highly stressed (54% PTSD and 41.4% depression symptoms). Patients were more severely affected in all psychometric scales as well as in traumatization and they were less able to draw on resources such as a social network or residence permit. The strongest predictor for psychotherapeutic-psychiatric treatment was social isolation in the living environment. For patients, the lack of a work permit was the strongest predictor of depression symptoms. The results point to the importance of postmigratory social determinants for the mental health of refugees. In particular, stable social relationships, together with formal factors such as work permit and residence title, should help to reduce mental distress and the need for psychiatric treatment.

'You are making it sound like you are talking to a child': exploring community sentiment on developing and disseminating tailored sexual health education resources for migrants.

Health communication is a critical component of public health, which includes health education resources. Resource effectiveness is improved where health literacy demands, including the cultural appropriateness of resources, match the intended audience. International guidelines support the tailoring of resources for migrants from culturally and linguistically diverse backgrounds (CaLD). Five focus groups (n = 18) and interviews (n = 9) with people from CaLD migrant backgrounds explored community perspectives on sexual health resources developed by a state department of health, specifically clarity, comprehensiveness, cultural appropriateness and strategies for dissemination. We identified three major thematic areas relating to simplicity, cultural norms and beliefs and dissemination. Participants recommended resource delivery in different formats as part of a broader intervention. Generally, sexual health information was deemed appropriate and easily understood. However, the resources used simplified language that participants reported was vague and inaccurate at times, potentially contributing to misinformation and reinforcing stigma relating both to the status of being a migrant and sexual health. Findings suggest the need for more nuanced health resource development beyond translation and language simplification. Resources developed in different formats, including different health literacy demands, using approaches that engage the target group in design and dissemination and contextualized within a comprehensive health promotion project, are likely to be more effective.

A Bibliometric Analysis of Refugee Health Publications in the Nursing Field by Visual Mapping Method

Introduction Millions of people worldwide are forced to migrate to another country and nurses are the key professional for providing necessary health care to this population. Providing nursing care to refugees or immigrants requires diverse transcultural professional competencies based on standardized guidelines.ObjectivesThis study was aimed to examine the bibliographic characteristics of quantitative studies conducted on refugees in the nursing field.MethodsThe data were obtained from articles scanned in the Web of Science Core Collection database. The 1672 articles that were published between 1980-and 2023 and met the inclusion criteria were analyzed using VOSviewer and Microsoft 365 Excel software. The PRISMA 2020 Checklist was used for reporting.ResultsMost publications were made in 2020. The United Kingdom, the United States, Canada, and Australia have the highest number of publications, citations, and international cooperation. Additionally, “mental health” is one of the most used keywords in the studies.Conclusions The findings show the importance of empowering nurses working in this field, especially in determining the needs related to mental health services for refugees. The increased migration rates and the growing need for refugee health care highlighted the importance of investment in nursing research within this field. Nurses and researchers should aim to establish partnerships and share best practices with the leading countries. Furthermore, nurses require specialized training to competently evaluate and provide nursing care and mental health services to this vulnerable population. Policymakers must prioritize international collaboration, equitable healthcare, and the integration of mental health services within healthcare systems to improve refugee health and reduce barriers between them and health services.Disclosure of InterestNone Declared

The convergence of higher education and digital technologies for the sexual and reproductive health of women refugees: A narrative review

This narrative review delineates the barriers that women refugees and asylum seekers face regarding their sexual and reproductive health (SRH), exploring how digital tools and higher education play transformative roles in facilitating information and communication pertaining to SRH. Further, this review explores the unique role that colleges and universities in the United States can play in leveraging digital technologies to support the healthcare needs of women migrants. The authors also lean into their own experiences as higher education teachers and practitioners to contextualize these findings and advocate for the health, rights and dignity of women and migrants. The article concludes that institutions of higher education (HEIs) are strategically positioned to provide services for and shape discourse surrounding women migrant SRH. By investing in and expanding online resources, counselling and telehealth services, multilingual literacy programmes and other support platforms, as well as by centring migrant and transnational epistemologies, HEIs in the United States can be key support systems for forced migrants, empowering these students to make informed choices about their bodies and sexualities, access vital care and thrive in their new communities. This narrative review recommends future research and practice at the intersections of refugee studies, digital technologies and higher education.

Evaluation of a scalable psychosocial intervention for refugees in Greece

IntroductionThe world of the third millennium is witnessing the highest levels of displacement on record. To meet the specific needs of this vulnerable population, a task-shifting approach is developed, where individuals with refugee background and lived experience are trained and supervised my mental health professionals to provide emotional and practical support to members of their communities.ObjectivesThe evaluation of a scalable psychosocial intervention for refugees based on the task-shifting approach.MethodsThe intervention consisted of sessions of Problem Management Plus (PM+) and peer case management delivered by a team of community psychosocial workers (trained refugees). The sample consisted of 173 participants, Arabic- and Farsi-speakers male and female, recognized refugees, and asylum seekers. Anxiety, depression, and psychological distress were measured before and after the intervention using the Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire - 9 (PHQ-9), and Psychological Outcome Profiles (Psychlops) scales respectively. Repeated measures analysis of variance (ANOVA) was adopted to evaluate the difference in the degree of change across patients’ characteristics over the follow up period. Statistical significance was set at p<0.05 and analyses were conducted using SPSS statistical software (version 26.0).ResultsSignificant decreases were found in all post-test scales, indicating diminution of anxiety, depression symptoms, and psychological distress. Large effects sizes were found in all scales.ConclusionsThe findings support that task-shifting approach incorporating PM+ and case management is effective for the mental health of refugees. Peer support could be included in a stepped care model for refugee mental health and well-being in high-income countries. For future research a randomized controlled trial is proposed as a study protocol.Disclosure of InterestNone Declared

IJCM_17A: Infant and young child feeding practices among Refugees in Gangavalli block of Salem district: cross-sectional study.

Background: Refugees often face worse health outcomes due to barriers including language, cultural differences, inaccessibility to health care services. World Health Organization works around the globe to secure the health of refugees & migrants and to achieve universal health coverage through implementation of “Health and Migration Programme” (2020). Children are more vulnerable & easily prone to malnutrition in refugee & migrant population. Infant and Young child feeding practice is a key area to improve child survival and promote healthy growth. Objectives: 1. To estimate the prevalence of early initiation of breastfeeding and exclusive breastfeeding of refugee children under two years of age. 2. To determine the factors influencing the feeding practices of children under 2 years among refugee children. Methodology: A Cross-sectional study was conducted among 97 refugee children under two years of age in Gangavalli block of Salem district over period of 1month (September 2023). Data collection was done using interviewer administered semi-structured questionnaire and statistical analysis done-IBM SPSS Version 21. Results: Early initiation of breastfeeding (within 1 hour of birth) was done in 53.6% children (52 out of 97). Only 26.8% children received Exclusive breastfeeding for more than 5 months of age. 64.9% children initiated on complementary feeding around 6-8 months of age. 76.3% children received semi-solid foods/soft foods during weaning. Only 5% children have Minimum Diet Diversity. Conclusion: The low rates of early initiation of breastfeeding and exclusive breastfeeding for over 5 months of age highlight a concerning trend. Additionally, the delayed initiation of complementary feeding with minimal diet diversity in majority of children suggests a critical need for targeted interventions to improve and promote appropriate infant and young child feeding practices within this vulnerable population.

Between Delusions and Borders: Diagnosing Delusional Disorder in Migratory Contexts

Introduction The mental health of immigrants is a significant, yet often overlooked, aspect of public health. This case study highlights the intersection of migration and mental health, focusing on a patient with delusional disorder. It is particularly relevant for psychiatrists due to the unique challenges in diagnosing and treating mental health conditions in migrant populations, who often face cultural, linguistic, and systemic barriers in accessing care.ObjectivesThe primary objective of this case study is to elucidate the diagnostic and clinical challenges encountered in managing delusional disorder in a migrant patient. The case study presented aims to provide insights into how delusional beliefs can precipitate and perpetuate the process of migration.Methods The case study was developed through comprehensive psychiatric interviews during the patient’s stay in a Psychiatric Inpatient Unit, supplemented by a targeted literature review on PubMed using “delusion disorder” and “immigration” as keywords.Results The patient, a 44-year-old Indian male, was a functional young adult until 2007 when he began exhibiting symptoms of delusional disorder. His delusions progressively evolved from local scenarios to national and eventually to a global scale. The initial delusions were focused on personal and professional conspiracies within his home country, leading to his first internal migration. As the condition worsened, his delusions expanded, fueling a belief in a widespread conspiracy that transcended national borders. This escalation of delusional beliefs became the primary motivation for the patient’s international migration. He changed countries four times, each move driven by an attempt to escape the perceived threats and conspiracies associated with his delusional disorder. The patient’s journey through various countries was a direct result of the intensifying nature of his condition.ConclusionsThis case study accentuates the profound impact that a delusional disorder can have as a driver and catalyst of international migration, influencing the individual’s decision-making process and shaping the migratory experiences. It emphasizes the necessity for psychiatrists to consider the unique socio-cultural contexts of migrant patients in diagnosis and treatment. The case study advocates for a comprehensive treatment approach, integrating psychiatric care with a nuanced understanding of the migrant’s experiences and challenges. This multifaceted approach is crucial in addressing the complex needs of patients with delusional disorder in migrant populations.Disclosure of InterestNone Declared

“There is No Time” to be a Good Biocitizen: Lived Experiences of Stress and Physical Activity Among Mexican Immigrants in New York City

This paper explores the ways in which Mexican immigrants experience, narrate, and describe stress and the extent to which it impacts their efforts at engaging in physical activity using a biocitizenship framework. Data were derived from a mixed-method study among Mexicans living in New York City recruited from a large Catholic church. The qualitative sample of 25 participated in quantitative and qualitative components of the study and as such we include some of these quantitative indicators as descriptors. Our main qualitative findings reveal that study participants experience stress and time constraint as factors that contribute to the waning of their physical and mental well-being. As such, time constraints for many of our participants were among the factors that contributed to high perceived levels of stress. They attributed this to their difficulty maintaining a physically active lifestyle due to factors like the fast-paced lifestyle in New York, working long hours, and not having enough time to exercise, though some important differences in narratives were noted across gender. Findings have implications for interventions aimed at improving the health of immigrants in general and Mexican immigrants in New York City specifically.

Current challenges in school-based health center care: COVID, mental health care, immigrant youth, expansion of telemedicine

School based health centers (SBHCs) have been providing preventive, acute and chronic care in schools across the United States (US) for the past 40 years. A discussion of that care is provided in a companion article to this one. Several major societal issues of the 2020s, affecting the care provided in SBHCs, have taken place over the past 4 years. These issues, which will be discussed in this article, include the following: 1. The COVID pandemic had a major impact on utilization and services required at SBHCs, both at the peak of the pandemic, when schools were closed and since the peak of the pandemic, when schools reopened. 2. The transformation of mental health services, due both to increasing mental health needs of youth, as well as progression to new therapeutic modalities, has required expansion of services provided at SBHCs. 3. New immigrant health care needs and services have required a response by SBHCs to the substantial increase of new immigrants, most of whom are impacted by significant trauma, entering public schools nationally. 4. Telehealth integration into SBHC medical and mental health services, and its expansion to incorporate new technologies, have provided avenues for increased provision of services by SBHCs.

JOURNEY TO WOMEN'S HEALTH WITH THE TRACES OF MIGRATION: STRUGGLE AND HOPE

The main purpose of this study is to explain the effects of migration, especially on women's health, and to compile the struggles experienced in this complex process, gender inequality and the effects of migration on health of women, who are the most victims of migration. Migration brings with it a variety of challenges to women's health, but it also reveals the battle for survival. During migration, women have to cope with violence, abuse, trauma and barriers to accessing health services. In addition, the impact of migration on women's social roles and sexual and reproductive health should not be forgotten. This review aims to raise awareness of migrant women's health problems and proposes solutions by describing migrant women's interactions with health systems, the challenges they face in this process and the roles of health professionals.

Tuberculosis in elderly Australians: a 10-year retrospective review.

This report describes the epidemiology of active tuberculosis (TB) in elderly Australians (≥65 years) with analysis of the factors associated with TB disease and successful treatment outcomes. A retrospective study of TB cases reported to the National Notifiable Diseases Surveillance System over a 10-year period from 2011 to 2020 was conducted. Cases were stratified by sex, age, risk factors, drug resistance, treatment type and outcome. Notification rates and incidence rate ratios with 95% confidence intervals were calculated and factors associated with treatment success analysed using multivariable logistic regression. A total of 2231 TB cases among elderly people were reported over the study period, with a 10-year mean incidence rate of 6.2 per 100 000 population. The median age of cases was 75 years (range 65-100 years); most were male (65%) and born overseas (85%). Multivariable analysis found that successful treatment outcome was strongly associated with younger age, while unsuccessful treatment outcome was associated with being diagnosed within the first 2years of arrival in Australia, ever having resided in an aged-care facility and resistance to fluoroquinolones. Compared to other low-incidence settings in the Western Pacific Region, TB incidence in elderly people is low and stable in Australia, with most cases occurring among recent migrants from TB-endemic settings. Continued efforts to reduce TB importation and address migrant health, especially among elderly people, are important.

EVALUATION OF SELF-COMPETENCY OF FAMILY PHYSICIANS AND FAMILY HEALTH WORKERS IN PROVIDING HEALTH SERVICES TO SYRIAN CHILDREN: AN EXAMPLE FROM ANKARA, TÜRKİYE

Objective: Türkiye is an immigrant-intensive country and primary health care services are the first health institution to apply for migrant children. In this research, it is aimed to evaluate how competent family physicians and family health workers working at where high Syrian migration population live consider themselves in providing health services to Syrian children. 
 Methods:This research was conducted among 224 family health physician and 250 family health workers in seven districts with a high migrant population in Ankara, Türkiye. Language knowledge and abroad experience was asked to the participants. The questionnaire included the participants’ education on migrant health, their experience in providing health care to migrant people. Multinomial logistic regression analysiswas used to evaluate factors associated with experiencing difficulties in servingimmigrant children.
 Results:Over the third-four of the family physicians (78.9%) and more than one-third of the family health workers (31.6%) knew at least one foreign language (p

Immigrant-blind care: How immigrants experience the “inclusive” health system as they access care

A growing body of scholarship examines the varying impact of legal status and race on accessing healthcare. However, a notable gap persists in comprehending the supplementary mechanisms that hinder immigrants' pathway to seek care. Drawing on ethnographic observations in various clinical settings and in-depth interviews with 28 healthcare professionals and 12 documented Haitian immigrants in a city in Upstate New York, between 2019 and 2021, I demonstrate the tension between the conceptualization and implementation of inclusive care practices by healthcare providers. I argue that the mere expansion and adoption of inclusive discourse among providers do not inherently ensure equity and the removal of barriers to healthcare access. This work contributes to the social study of medicine and race and ethnic studies by introducing the innovative concept of “immigrant-blind.” Through this concept, the research sheds light on how providers' conceptualization of inclusivity proclaims medical encounters to be devoid of stratifications and rationalizes their practices which mask the profound impact of immigration status and immigration on immigrant health. Furthermore, these practices reinforce existing divisions within care settings and medical encounters, where immigration laws and enforcement practices operate and further exacerbate stratifications. By examining providers' uninformed implementation of culturally competent care practices, the findings reveal that providers stigmatize and essentialize immigrants during medical encounters. This highlights the imperative for a more nuanced and informed approach to healthcare provision, where genuine inclusivity is upheld, and barriers to access are dismantled to foster equitable and dignified healthcare experiences for all.