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.

Disentangling Support for Violent and Non-violent Radicalization among Adolescents: A Latent Profile Analysis.

Although support for violent and non-violent radicalization can co-occur, only a few adolescents who support non-violent radicalization also support or engage in violent acts. Yet, little is known about what factors are associated with adolescents' paths towards or away from violent and/or non-violent radicalization. Within a socio-ecological and positive youth development framework, this study investigates profiles of support for violent and non-violent radicalization among adolescents attending high schools in Quebec (Canada) and whether such profiles are differently associated with experiences of social adversity, school-, family- and peer-related factors and psychological distress. Adolescents (N = 1911; Mage = 15.7; SDage = 0.98; 48.7% girls) completed an online survey during school hours. A Latent Profile Analysis on scores of support for violent and non-violent radicalization was conducted. A multinomial logistic regression was used to explore the associations between profiles and variables of interest. We identified six profiles of adolescents. The heterogeneity of profiles suggested multiple and complex combinations of support for violent and non-violent radicalization as well as their co-existence in some but not all profiles. Adolescents who reported less discrimination, more positive school experiences and more family support were less likely to belong to profiles that supported violence. Primary prevention efforts in the field of support for violent radicalization must adopt a socio-ecological and social justice approach and consider the diversity of adolescents' profiles, attitudes and experiences.

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.

The unsanitary other and racism during the pandemic: analysis of purity discourses on social media in India, France and United States of America during the COVID-19 pandemic.

The global rise of populism and concomitant polarizations across disenfranchised and marginalized groups has been magnified by so-called echo chambers, and a major public health crisis like the COVID-19 pandemic has only served to fuel these intergroup tensions. Media institutions disseminating information on ways to prevent the propagation of the virus have reactivated a specific discursive phenomenon previously observed in many epidemics: the construction of a defiled 'Other'. With anthropological lenses, discourse on defilement is an interesting path to understand the continuous emergence of pseudo-scientific forms of racism. In this paper, the authors focus on 'borderline racism', that is the use of an institutionally 'impartial' discourse to reaffirm the inferiority of another race. The authors employed inductive thematic analysis of 1200 social media comments reacting to articles and videos published by six media in three different countries (France, United States and India). Results delineate four major themes structuring defilement discourses: food (and the relationship to animals), religion, nationalism and gender. Media articles and videos portrayed Western and Eastern countries through contrasting images and elicited a range of reaction in readers and viewers. The discussion reflects on how borderline racism can be an appropriate concept to understand the appearance of hygienic othering of specific subgroups on social media. Theoretical implications and recommendations on a more culturally sensitive approach of media coverage of epidemics and pandemics are discussed.

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.

Cumulative and independent effects of experiences of social adversity on support for violent radicalization during the COVID-19 pandemic: the mediating role of depression.

PURPOSE: Social adversity experiences have increased during the pandemic and are potential risk factors for both depression and support for violent radicalization (VR). However, the cumulative and independent effects of various social adversity experiences on support for VR have yet to be explored. This paper examines the cumulative and independent effects of COVID- and non-COVID-related discrimination, exposure to violence, traditional and cyberbullying victimization on support for VR. In addition, we investigate whether depression mediates the relationship between these forms of social adversity and support for VR. METHODS: A total of 6003 young adults (Mage = 27, SDage = 4.40, range 18-35) living in metropolitan areas in Canada responded to an online survey. We used multivariable regression models, controlling for socio-demographic characteristics, to infer covariate adjusted associations between social adversity measures and support for VR. Additionally, we conducted a formal mediation analysis to estimate the proportion mediated by depression. RESULTS: There was a cumulative relationship between experiences of social adversity and support for VR (ß = 1.52; 95% CI: 1.32, 1.72). COVID-related discrimination and cyberbullying victimization were independently associated with stronger support for VR. Depression partially mediated the effect of cumulative social adversity, COVID-related discrimination and cyberbullying on support for VR. CONCLUSION: Prevention programs during the present pandemic should prioritize decreasing discrimination and providing psychosocial support to depressed young adults who experience social adversity. Practitioners should prioritize developing programs that foster digital literacy skills and critical thinking among young adults to address the concerning impact of cyberbullying on support for VR.

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.

Guidelines for Training in Cultural Psychiatry.

This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)'s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA's Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011.

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.

Psychological distress among adults from the urban and rural areas affected by the Ebola virus disease in the Democratic Republic of the Congo.

PURPOSE: Ebola virus disease (EVD) is associated with high anxiety and multiple bereavement that can induce severe psychological distress (SPD) in individuals living in affected communities. Using data from the EVD and Mental Health project (EboMH), this study assessed the prevalence and determinants of SPD symptoms in a representative sample of adults in communities affected by EVD. METHODS: A representative sample of 1614 adults (50% women) aged 18-85 years completed measures assessing exposure level to EVD, stigmatization related to EVD, and psychological distress. RESULTS: In total, 45.58% of individuals from the cities and villages affected by EVD reported SPD. Results showed significant differences for residence area, employment, age, education level, and religion, but not for gender. Exposure level to EVD (ß = 0.11, p < 0.001; OR = 1.12, 95% CI [1.08-1.16]), stigmatization related to EVD (ß = 0.06, p < 0.001; OR = 1.06, 95% CI [1.05-1.07]), and living in rural areas (ß = 0.67, p < 0.001; OR = .51, 95% CI [.36-.72]) predicted SPD symptoms. CONCLUSIONS: Evidence-based global mental health programs in high-risk mortality epidemic contexts should take into account the high psychological distress in the affected areas.

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, Mage  = 16.71; SDage  = 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.

Socio-cultural correlates of self-reported experiences of discrimination related to COVID-19 in a culturally diverse sample of Canadian adults.

Minorities and marginalized groups have increasingly become the target of discriminatory actions related to the COVID-19 pandemic. Detailed information about the manifestation of COVID-related discrimination is required to develop preventive actions that are not stigmatizing for such groups. The present study investigates experiences of perceived discrimination related to COVID-19 and its socio-cultural correlates in a culturally diverse sample of adults in Quebec (Canada). An online survey was completed by 3273 Quebec residents (49 % 18-39 years old; 57 % female; 49 % White). We used multivariate binomial logistic regression models to assess prevalence of COVID-related discrimination and to investigate socio-cultural correlates of reasons and contexts of discrimination. COVID-related discrimination was reported by 16.58 % of participants. Non-white participants, health-care workers and younger participants were more likely to experience discrimination than White, unemployed and older participants, respectively. Discrimination was reported primarily in association with participants' ethno-cultural group, age, occupation and physical health and in the context of public spaces. Participants of East-Asian descent and essential workers were more likely to report discrimination because of their ethnicity and occupation, respectively. Although young people experienced discrimination across more contexts, older participants were primarily discriminated in the context of grocery stores and because of their age. Our findings indicate that health communication actions informed by a social pedagogy approach should target public beliefs related to the association of COVID-19 with ethnicity, age and occupation, to minimize pandemic-related discrimination. Visible minorities, health-care workers and seniors should be protected and supported, especially in public spaces.

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.

Mental Health of Refugee Children and Youth: Epidemiology, Interventions, and Future Directions.

The number of refugee youth worldwide receives international attention and is a top priority in both academic and political agendas. This article adopts a critical eye in summarizing current epidemiological knowledge of refugee youth mental health as well as interventions aimed to prevent or reduce mental health problems among children and adolescents in both high- and low-to-middle-income countries. We highlight current challenges and limitations of extant literature and present potential opportunities and recommendations in refugee child psychiatric epidemiology and mental health services research for moving forward. In light of the mounting xenophobic sentiments we are presently witnessing across societies, we argue that, as a first step, all epidemiological and intervention research should advocate for social justice to guarantee the safety of and respect for the basic human rights of all refugee populations during their journey and resettlement. A constructive dialogue between scholars and policy makers is warranted.

"I Look at You and See You Looking at Me": Role Boundaries in a Dynamic Research Relationship in Qualitative Health Research With Refugees.

In institutional ethical and deontological guidelines, there is a prevailing, static understanding of the research partnership, with a clear boundary between researcher and participant. In this article, we argue that such a static understanding may run the risk of impeding the development of an enhanced contextual and dynamic intersubjective understanding of the research partnership and its impact on the growing importance of role boundaries in qualitative research. Drawing from a refugee health study on trauma and forced migration, we explore the different ways in which participants and the researcher engaged with the researcher's multiple positions and role boundaries. In doing so, we aim to contribute to a reflective research practice by providing tools to recognize signs of potential harm and offer potential vehicles of reconstruction and agency within the intersubjective space of a dynamic research relationship, within a continuous, shared renegotiation process of role boundaries.

Ebola and Localized Blame on Social Media: Analysis of Twitter and Facebook Conversations During the 2014-2015 Ebola Epidemic.

This study aimed to analyze main groups accused on social media of causing or spreading the 2014-2016 Ebola epidemic in West Africa. In this analysis, blame is construed as a vehicle of meaning through which the lay public makes sense of an epidemic, and through which certain classes of people become "figures of blame". Data was collected from Twitter and Facebook using key word extraction, then categorized thematically. Our findings indicate an overall proximate blame tendency: blame was typically cast on "near-by" figures, namely national governments, and less so on "distant" figures, such as generalized figures of otherness ("Africans", global health authorities, global elites). Our results also suggest an evolution of online blame. In the early stage of the epidemic, blame directed at the affected populations was more prominent. However, during the peak of the outbreak, the increasingly perceived threat of inter-continental spread was accompanied by a progressively proximal blame tendency, directed at figures with whom the social media users had pre-existing biopolitical frustrations. Our study proposes that pro-active and on-going analysis of blame circulating in social media can usefully help to guide communications strategies, making them more responsive to public perceptions.

Building Communities in Tense Times: Fostering Connectedness Between Cultures and Generations through Community Arts.

The worldwide upsurge in social polarizations generates intercommunity tensions that challenge the social fabric of urban neighborhoods and undermine the relationships between their members. Because community arts can foster the creation of connections between people that would not have been in contact otherwise, they are often perceived as being powerful tools to foster community resilience. Through a multiple case study approach, this article describes how three community arts projects, carried out in two socioeconomically deprived neighborhoods of Montreal (Canada), influenced the social relationships between participants from diverse ethnocultural backgrounds and generations. Using participant observation and arts-based data collection methods (photography, video, and arts productions), the authors examine how the three projects illustrate (a) the interactive processes at play, (b) the transmission and hybridization of stories and images of adversity and resiliency, and (c) the access to a collective voice.

The mental health professional at the feet of the Ebola virus: individual treatment and global mental challenges.

SummaryMental health professionals form an important component of the response teams currently working in the Democratic Republic of the Congo to treat what is historically the second-largest Ebola outbreak. They provide psychological treatment to patients under extraordinary conditions, helping them cope with anxiety and the daily death of other patients.Declaration of interestNone.

A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project.

BACKGROUND: Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families. METHODS: The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention. DISCUSSION: Data from our overall research strategy will help test the effectiveness of the ACCESS Open Minds transformation, refine it further, and inform its scale-up. The process by which our research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholder groups and address unique considerations in designing evaluations of complex healthcare interventions in multiple, diverse contexts. Our approach will generate both concrete evidence and nuanced insights, including about the challenges of conducting research in real-world settings. More such innovative approaches are needed to advance youth mental health services research. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov, ISRCTN23349893 (Retrospectively registered: 16/02/2017).