Post-migration Risk Factors Research Articles

Social Determinants and Mental Health in Newly Arrived Young Migrants in Spain

IntroductionResearch has shown that factors related with the migratory process (such as travelling alone, living away from family, and discrimination after arrival) considerably increase the risk of mental health problems in young migrants. Moreover, they are among the most vulnerable migration groups with a high risk of social exclusion.ObjectivesTo identify coping strategies and behavioural changes used to deal with perceived discrimination and its impact on the emotional well-being and mental health of newly arrived young migrants in Spain.MethodsA subsample of 15 audio-recorded in-depth qualitative interviews were analysed from the national action-research Migrasalud project (II IN 190517 EN 162 FA 01). The interviews were transcribed, translated from Arabic to Spanish, and analysed through content analysis.ResultsMost participants were males (93.3%; n=14), ranging from 18 to 20 years, and from Morocco (93.3%; n=14). All participants were from foster care placements in Barcelona and arrived to Spain as minors. Newly arrived young migrants reported that they perceived themselves as being healthy before the migratory process. Adverse experiences during the journey and discrimination after arrival impacted their well-being and mental health. Specifically, they reported perceived discrimination in their daily life due to culture, language, or origin. This negatively impacted their well-being and mental health, increasing their emotional distress response and ‘undervalued or inferior’ and ‘vulnerable’ feelings about themselves. Concerning coping with discrimination, they reported using internalised coping strategies such as ‘ignoring’ or ‘not responding’ for fear of having their legal documents revoked or not obtaining them. Their behavioural changes often occurred when they perceived unfair treatment or prejudice towards their migrant status or their socioeconomics, culture or religion. These changes were motivated by being more accepted by the local community by ‘westernisation or cultural assimilation’ and by ‘creating a good image’ of oneself and its culture.ConclusionsFindings establish that the cumulative experience of post-migration stressors (such as discrimination) negatively impacts their mental health and well-being in the long term. This suggests the need for specific policies and services to address this population’s effects of post-migration risk factors. Further research is needed to explore the causes and effects of perceived discrimination on mental health more closely and to develop more targeted and effective interventions.Disclosure of InterestNone Declared

Is self-compassion relevant for refugees? A cross-sectional study of the relationship between self-compassion and depression among Kurdish refugees in Norway

Extensive research presents self-compassion as beneficial for mental health in a wide range of samples. However, knowledge about the role of self-compassion for mental health in refugee population is scarce. The purpose of this exploratory cross-sectional study was to explore the association between self-compassion and depression in a sample of Kurdish refugees in Norway (N = 106, 59.4% women). An online survey including questions about post-migration work-related stress, the Self-Compassion Scale Short-Form (SCS-SF), and Major Depressive Inventory (MDI) was distributed. The results showed that self-compassion was strongly associated with depressive symptoms (r = −0.61, p < .01). In a multiple regression analysis, work-related stress (β = −0.24, p < .001) and negative subscale of self-compassion compassion (β = .54, p < .001) predicted unique variance in depression. A moderation analysis using Hayes “Power” macro showed that level of self-compassion did not moderate the effects of post-migration work-related stress on depressive symptoms. The results indicate that even though self-compassion contributed significantly to levels of depression, it could not fully protect against post-migration risk factors. The study may provide a useful framework for guiding research, clinical practice, and mental health prevention in refugee populations.

Diversity competence training for health professionals in Europe: a modified delphi study investigating relevant content for short or online courses

BackgroundDiversity is a reality in our societies, requiring health professionals to adapt to the unique needs of all patients, including migrants and ethnic minorities. In order to enable health professionals to meet related challenges and reduce health disparities, long and demanding training courses have been developed. But due to busy schedules of professionals and often scarce resources, a need for shorter training courses exists. This study aims to investigate which topics and methods should be prioritised in designing basic diversity training courses that provide health professionals the opportunity to foster this competence.MethodsThe study provided an expert panel of 31 academic and clinical migrant health experts with the content and methods of an existing diversity training course. The panel was asked to prioritise training topics and teaching methods in a two-stage process, using an adapted Delphi method. In the first stage, experts rated 96 predefined items, commented on those items, provided answers to eight open-ended questions and suggested additional content for a short course. In the second stage, they commented on the ratings from Round 1, and rated new suggested content. Consensus for training topics was set to 80% and for teaching methods 70%.ResultsThe entire panel deemed ‘health effects of migration (pre-, during- and post-migration risk factors)’ to be important or very important to include in a short/online, basic diversity training (100% consensus). Other high-scoring items and therefore topics to be included in trainings were ‘social determinants of health’ (97%) and ‘discrimination within the healthcare sector’ (also 97%). A general trend was to focus on reflective practice since almost all items regarding reflection reached consensus. ‘Reflection on own stereotypes and prejudices’ (97%) was the highest-rated reflection item. ‘Opportunities and best practices in working with interpreters’ was the highest-scoring skills item, both on consensus (96%) and mean value (5.77).ConclusionsExperts’ prioritizations of teaching content and methods for diversity training can help the design of short (online) trainings for health professionals and reduce unnecessary course content, thereby fostering professional development and enabling diversity competence trainings to be implemented also when time and/or financial resources are limited.

Associations among migration risk factors, cultural identity conflict, and psychological symptoms among Syrian emerging adults with refugee backgrounds in the Netherlands.

In the present study, we examined relations between premigration, perimigration, and postmigration risk factors (i.e., potentially traumatic events [PTEs], postmigration living problems [PMLPs], stressful life events) and psychological symptoms (i.e., anxiety/depression, posttraumatic stress) in Syrian emerging adults with refugee backgrounds; we also tested cultural identity conflict as a possible mediator of these relations. We expected that greater exposure to migration risk factors was associated with more psychological symptoms and that higher cultural identity conflict would contribute to these associations. We used data from the first wave of Karakter, a longitudinal study of 158 Syrians with refugee backgrounds (69.0% men, age range 18-35). Participants completed a questionnaire assessing PTEs, PMLPs, stressful life events, cultural identity conflict, and symptoms of anxiety/depression and posttraumatic stress. Correlational analyses indicated that more PTEs and stressful life events were related to higher levels of cultural identity conflict and more psychological symptoms. Furthermore, greater cultural identity conflict was associated with more psychological symptoms. We did not observe indirect effects of cultural identity conflict in the mediation analyses. Results suggest that postmigration stressors and cultural identity conflict are associated with psychological symptoms among Syrian emerging adults who have resettled in the Netherlands.

Diversity competence: what should be prioritised in an online course? An adapted delphi study

Abstract Background Population diversity is a reality in our societies and requires health systems and health professionals to adapt to the needs of diverse patient groups, including migrants and ethnic minorities. This study aims to investigate topics and methods that should be prioritised in an online course on diversity competence in healthcare delivery to improve health care encounters and provide health services that meet the unique needs of all patients in order to reduce health disparities. Methods The study uses an adapted Delphi method including two rounds, combining some open-ended questions with pre-defined items, asking 31 European academic experts and health professionals within the field of migrant health to rate training content and teaching methods. Consensus for training topics was set to 80% and for teaching methods 70%. Results The only item reaching 100% consensus as being important or very important to include was ‘health effects of migration (pre-, mid- and post-migration risk factors)’. Other high-scoring items were ‘social determinants of health’ (97%) and ‘discrimination within the healthcare sector’ (also 97%). A general trend was to focus more on reflective practice since almost all items in the reflection section reached consensus. ‘Reflection on own stereotypes and prejudices’ reached the highest consensus in this section (97%). Conclusions Experts’ prioritisations of teaching content and methods for diversity training can help the design of short online trainings for health professionals and reduce extensive course content, thereby fostering professional development and enabling diversity competence trainings to be implemented in cases of scarce resources. Key messages • Trend toward more focus on ‘diversity’ and less focus on ‘culture, and the inclusion of social determinants of health and awareness of stereotypes and bias in training of health professionals. • Diversity competence training should use reflective exercises and activities as teaching methods in online training.

Investigating the post-migration risk factors of unaccompanied minor refugees’ mental health – From a systems perspective in Austria

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

A System Model of Post-Migration Risk Factors Affecting the Mental Health of Unaccompanied Minor Refugees in Austria-A Multi-Step Modeling Process Involving Expert Knowledge from Science and Practice.

Various studies have indicated that unaccompanied minor refugees (UMRs) have a higher risk of suffering from mental health problems than do accompanied minor refugees and general population norm. However, only a few studies provide data on UMRs regarding post-migration risk factors, their interrelations, and their influence on mental health. In this study, system models of post-migration risk factors for mental health and their interactions were developed in the case of Austria. In three consecutive interactive workshops with scientists and practitioners, fuzzy-logic cognitive mapping techniques were used to integrate the experts’ knowledge. The resulting final system model consists of 11 risk factors (e.g., social contacts in the host country, housing situation, or professional health care services). The model provides a deeper insight into the complexity of interrelated direct, indirect, and reciprocal relations, as well as self-reinforcing triads. This systemic approach provides a sound basis for further investigations, taking into account the inherent complex multifactorial dependencies in this topic.

Post-migration risks, developmental processes, and learning among Syrian refugee children in Lebanon

Refugee children face significant adversities that can threaten critical developmental processes and hamper learning outcomes. This study examines how post-migration risk factors at the community, household, and individual level experienced by primary school-aged Syrian refugee children in Lebanon (N = 448, Age M = 9.08, SD = 1.90) are associated with cognitive, emotional, and behavioral developmental processes as well as literacy and numeracy performance. We identified several risk factors, including attending a lower grade than their age-expected grade level, that uniquely predict Syrian refugee children's developmental processes and academic outcomes. Children's executive function and behavioral regulation, but not internalizing symptoms, partially mediated the relations between risk factors and academic outcomes.

T123. RISK FACTORS FOR PSYCHOTIC DISORDERS WITHIN MIGRANT GROUPS IN CANADA

BackgroundAlthough there is a large evidence base suggesting elevated rates of psychotic disorder for some migrant groups, relative to the non-migrant host population, less is known about factors that modify the risk of psychosis within migrant groups. Our objective was to assess whether pre-migration, migration-related, and post-migration factors were associated with an elevated risk of psychotic disorder among first-generation migrants in Ontario, Canada.MethodsUsing linked population-based health administrative data, we constructed a retrospective cohort of first-generation migrants to Ontario over a 20-year period between 1992 and 2012. We identified first onset non-affective psychotic disorders using a validated algorithm. Pre-migration factors included sex, country of origin, education, occupation, marital status, and language. Migration-related factors included age at migration, year of migration, duration of residence, and migrant class. Post-migration factors included rural place of residence and neighbourhood-level indicators of marginalization. We used Poisson regression models to compute incidence rate ratios for each pre-migration, migration-related, and post-migration factor to assess its magnitude of effect on the risk of developing psychosis, relative to migrants who did not develop psychotic disorder.ResultsOur cohort included over two million first-generation migrants over the 20-year period. Preliminary findings suggest that males, refugees, and people who set up residence in urban centres have higher rates of psychotic disorder, and people who are older at the time of migration and those who set up residence in high-income areas have lower rates of psychotic disorder. Full results for pre-migration, migration-related, and post-migration risk factors will be presented.DiscussionMigrant status is one of few well-established risk factors for psychotic disorder, yet we have limited understanding of the underlying etiology. The findings from this study help to identify high-risk groups to target for intervention. Improving our understanding of key risk factors for psychotic disorders within migrant groups is crucial for informing prevention and early intervention efforts.

Seeking sanctuary: rethinking asylum and mental health.

Forced migrants are at an increased risk of mental disorder compared to host country populations. To effectively address this, programmatic and policy responses need to be underpinned by rigorous evidence. Drawing on our experience conducting a systematic review of post-migration risk factors for mental disorder among asylum seekers and our appraisal of related systematic reviews, this paper discusses four challenges facing the field: (1)The reliance on Western conceptions of mental health.(2)The investigation, to date, of a relatively narrow range of potential risk factors.(3)The lack of consistency in the measurement and reporting of risk factor variables.(4)The use of the legal term 'asylum seeker' to define study populations.We suggest potential ways forward, including using mental health measures developed in collaboration with communities affected by forced migration, the examination of key risk factors around homelessness and workers' rights, the development of a core set of risk factors to be investigated in each study, and defining study populations using the conceptual category of 'sanctuary seekers' - people who have fled their country and are asking another country for safety and residence.

Reframing resilience: Strengthening continuity of patient care to improve the mental health of immigrants and refugees

Refugee and immigrant populations experience many pre- and post-migration risk factors and stressors that can negatively impact their mental health. This qualitative study aimed to explore the system-level issues that affect the access to, as well as quality and outcomes of mental health care for immigrants and refugees, with a particular focus on challenges in the continuity of patient care. A multidisciplinary group of health providers, including nurses, identified six themes including (i) perceived access to care; (ii) coordination amongst health care providers; (iii) patient connections with community organizations; (iv) coordinated care planning; (v) organizational protocols, policies and procedures and (vi) systemic and health care training needs. Although patient resilience is seen as a pivotal way for vulnerable populations to cope with hardship, there is a clear need for creating a resilient health care system that is able to anticipate and adapt to adverse situations. The findings from this study have implications for nurses, who are uniquely positioned to advocate for public health policy that improves the continuity of health care by creating systemic resilience.

Exploring Mental Health Status and Syndrome Patterns Among Young Refugee Children in Germany.

Refugee children share a large number of pre-, peri-, and post-migration risk factors, which make them vulnerable for developing mental health concerns. Within the last few years, a large number of families with young children have sought refuge in Germany. However, children's mental health status in Germany is mostly unclear. A central aim of developmental psychopathology is to understand how risk factors lead to the emergence of mental health concerns. One approach to investigating this association is the study of specificity, which describes the idea that specific risk factors are related to specific psychological outcomes. The aim of our study was to assess the mental health status of young refugee children in Germany, and to explore a potential refugee-specific mental health pattern. In two studies, we assessed mental health outcomes of 93 children from Syria or Iraq, aged 1.5–5 years, who recently arrived in Germany. The results were compared to U.S. norm data of typically developing children, and to norm data of a clinical sample in order to explore mental health patterns. In the first study (n = 35), we used standardized screening tools for parents (CBCL 1.5-5). In the second study (n = 58), mental health states of refugee children were assessed by caretakers (CTRF 1.5–5). In comparison to U.S. norm data of normally developing children, refugee parents reported more mental health concerns for their children, especially on syndrome scales of internalizing difficulties. A comparison to U.S. clinical reference data showed a specific mental health pattern, characterized by increased levels of anxiety/depression, attention problems, and withdrawal behavior. Caretakers, too, reported more mental health problems compared to typically developing children, albeit to a smaller extent. However, a comparison to clinically-referred children only led to partial confirmation of a specific mental health pattern. Our studies offer important insights into the mental health status and pattern of young refugee children, which is essential for preventing the onset of psychopathology and for offering tailored interventions.

Mental Health of Syrian Asylum Seekers in Turkey: The Role of Pre-Migration and Post-Migration Risk Factors

Syrian people fleeing their countries due to internal conflicts can be at high risk for mental health problems because they have to deal with multiple stressor events like traumatic events, forced migration, and living difficulties. The aim of the present study was to investigate the relative contribution of pre-migration traumatic events and post-migration living difficulties to mental health outcomes of Syrian asylum seekers residing in Turkish camps. One hundred eleven asylum seekers, living in three different camps located on the Syrian border of Turkey were administered an interview package including informed consent form, socio-demographic form, Harvard Trauma Questionnaire Revised Part I and IV, Post-Migration Living Difficulties and Hopkins Symptom Checklist-25. Hierarchical regression analyses yielded that loss of loved ones among pre-migration traumatic events was found as a significant predictor for post-traumatic stress and depression whereas loss of culture and support among post-migration li...

Psychological distress in torture survivors: pre- and post-migration risk factors in a US sample.

To investigate the relationships between sociodemographic, pre- and post-migration variables with prevalence of psychological distress and global functioning in a heterogeneous sample of torture survivors. Clients referred from resettlement agencies via the Office of Refugee Resettlement (ORR) to a community clinic in the United States (N = 278) were interviewed with structured, translated questionnaires. Univariate and multivariate logistic regression analyses determined the associations of sociodemographic, pre-, and post-migration risk factors with posttraumatic stress disorder (PTSD), depression, anxiety, and global functioning. Regression data indicate that length of time between arrival in US and clinical services was significantly associated with PTSD and depression; participants receiving services after 1 year of resettlement were more likely to experience PTSD (adjusted OR = 3.29) and depression (adjusted OR = 4.50) than participants receiving services within 1 year. Anxiety was predicted by female gender (adjusted OR = 3.43), age over 40 years (adjusted OR = 3.12), Muslim religion (adjusted OR = 2.64), and receiving medical services (AOR 3.1). Severely impaired global functioning was associated with female gender (adjusted OR = 2.75) and unstable housing status (adjusted OR = 2.21). Findings highlight the importance of examining post-migration variables such as length of time in country prior to receiving services in addition to pre-migration torture history upon relocated torture survivors. Clinicians and policy-makers should be aware of the importance of early mental health screening and intervention on reducing the psychiatric burden associated with torture and forced relocation.

The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group.

The purpose of this study was to determine in Vietnamese ex-political detainees newly arrived into the United States a) the prevalence of torture and psychiatric symptoms and b) the dose-effect relationships between cumulative torture experience and the psychiatric symptoms of posttraumatic stress disorder (PTSD) and major depression. The study population included Vietnamese ex-political detainees (N = 51) and a comparison group (N = 22). All respondents received culturally validated instruments with known psychometric properties including Vietnamese versions of the Hopkins Symptom Checklist-25 and the Harvard Trauma Questionnaire. The ex-political detainees, in contrast to the comparison group, had experienced more torture events (12.2 SD = 4.2 vs. 2.6 SD = 3.1) and had higher rates of PTSD (90% vs. 79%) and depression (49% vs. 15%). Dose-effect relationships between cumulative torture experience and psychiatric symptoms were positive with the PTSD subcategory of "increased arousal" revealing the strongest association. These findings provide evidence that torture is associated with psychiatric morbidity in Vietnamese refugees. The demonstration of significant dose-effect responses supports the hypothesis that torture is a major risk factor in the etiology of major depression and PTSD. The generalizability of these results to other torture survivor groups is unknown. The interaction between torture and other pre- and post-migration risk factors over time in different cultural settings still needs to be examined.