Insights from the EQUALS4COVID19 study on migrant mental health in Portugal: a cross-sectional mixed-methods approach.

BACKGROUND: The COVID-19 pandemic and related disruptive consequences in the economic, health, and educational sectors have impacted people's lives, contributing to a context of increased economic and social vulnerability. The pandemic has revealed and accentuated social inequalities and discrimination based on racial or ethnic origin. This study aimed to contribute to the promotion of the mental health and well-being of migrant populations living in Portugal via the definition of an analytical framework and recommendations emerging from the EQUALS4COVID19 project. METHODS: To gather information on the impact of the COVID-19 pandemic and resilience determinants among immigrants, a mixed-methods approach was implemented in 2022, combining a cross-sectional survey targeting immigrant adults in Portugal, focus groups with immigrants, focus groups with healthcare professionals, and in-depth individual interviews with stakeholders involved in the implementation of measures related to mental health and well-being during the pandemic. The analysis followed an integrated framework; quantitative data informed the script of qualitative data collection methods, and qualitative analysis informed the reinterpretation of quantitative data. RESULTS: The survey with 604 Brazilian and Cape Verdean immigrants revealed that gender (being a woman) was associated with both psychological distress and depression-related symptomatology and that the perception of discrimination was a major risk factor for psychological suffering, while perceived social support and individuals' resilience characteristics were protective factors. Qualitative data provided deeper insights into these findings, revealing the ways mental health is affected by social structures, such as gender and ethnic hierarchies. Migrants tend to work in precarious jobs requiring physical presence, which, together with dense housing conditions, puts them at higher risk of infection. The deterioration of the economic conditions of the general population has also increased the perception of ethnic-racial discrimination, which was found to be related to the increase in insecurity and anxiety-related symptomatology among the migrant population. Newly arrived migrants, with reduced support networks, experienced a greater sense of insecurity as well as concern and anguish regarding relatives who live far away, in their home country. Migrant women reported greater family-related distress, including work-life balance problems. CONCLUSIONS: Proposals to address mental health inequalities should be considered in the context of the necessary global changes both at the societal level and in the delivery of mental health services. Additionally, they should be considered with the active involvement of migrants, families, and communities in the design and delivery of mental health promotion and care processes.

Mental Health and Well-Being of Migrant Populations in Portugal Two Years after the COVID-19 Pandemic.

In Portugal, like in other European countries, the COVID-19 pandemic aggravated the risk of poverty and social exclusion faced by migrants. This study aimed to assess mental health and well-being, and their social determinants, among Brazilian and Cape Verdean immigrant populations two years after the COVID-19 pandemic while exploring the role of positive psychological factors such as resilience and perceived social support. We conducted a cross-sectional survey combining online and face-to-face questionnaires for data collection between February and November 2022 on dimensions of mental health considered potentially relevant to the post-pandemic context: psychological distress, anxiety, and depression. Overall, 604 immigrants were included (322 Brazilian and 282 Cape Verdean); 58.5% of those surveyed were women and 41.5% were men. The results revealed that gender (being a woman) was associated with both psychological distress and depression, higher education was associated with anxiety, and that, for the three mental health dimensions under analysis, the perception of discrimination and resilience were negative and positive predictors, respectively. Findings can inform the design and implementation of relevant public mental health promotion programs with a focus on equity targeted to the general population. Such programs would help to address the psychological and social impacts of this long-term, insidious global pandemic that has challenged governments, health care systems, health care professionals, individuals, families, and communities worldwide.

Exploring the Effects of the COVID-19 Pandemic on Mental Health and Well-Being of Migrant Populations in Europe: An Equity-Focused Scoping Review.

The pandemic is aggravating health inequalities, particularly mental health inequalities, while revealing the social determinants of these inequalities, including migration as a social determinant that mediates the interaction of social, economic, cultural, institutional, and structural factors with health indicators. Therefore, it is of most relevance to identify the multiple interconnected factors that influence the mental health and well-being of migrant populations. A scoping review was developed to map the research performed in this area and to identify any gaps in knowledge, following the PRISMA extension for scoping reviews. MEDLINE, Scopus, and WHO Global Health research databases on COVID-19 were searched from January 2020 to October 2021. The review followed the inclusion criteria Population/Concept/Context (PCC): Population-Adult International migrants (including refugees, asylum seekers, and undocumented migrants); Concept-determinants of (and factors influencing) mental health and well-being; Context-COVID-19 anywhere in the world. Of the sixty-five selected studies, eleven were from European countries and were the focus of this review with special attention to health inequalities experienced by migrants in Europe. The results cover a diversity of themes related to the effects of COVID-19 on the mental health of migrants (country-level environmental factors, social determinants of mental health, mental health indicators and outcomes), responses (such as solidarity and resilience), populations, and study methods. The evidence found can inform recommendations and interventions focused on health promotion and mitigation of the inequalities accentuated by the pandemic.

Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways.

The increasing number of international migrants (ranging from 153 million in 1990 to ~272 million in 2019) brought to attention the wide variation of national contexts concerning the policy measures to protect migrants' rights and ensuring their equal access to basic and essential services, namely in health. Sexual and Reproductive Health (SRH) is a key component to the overall health and quality of life and is impacted by power inequities inherent to society's institutions, environment, economics, and culture. In Portugal, guidelines for intervention in SRH are insufficient, a gap that is more pronounced with migrant populations due to the absence of culturally sensitive indicators to assess and monitor SRH. The aim of this work was 2-fold: to identify good practices in the SRH field, with a particular focus, whenever possible, on migrant populations, and to identify relevant and inclusive indicators to monitor SRH in Portugal. A Delphi panel (via online survey) with 66 experts (researchers, teachers, and health professionals) and 16 stakeholders (non-governmental organizations, civil society, and governmental organizations) was implemented in two rounds. Panelists were asked to state their level of agreement (5-point Likert-type scale) regarding four different SRH areas: Sexual Health, Reproductive Health, Social-Structural Factors, and Good Practices. Items were based on literature review and a World Café with 15 experts and stakeholders. Participation rate was 68% and response rate was 97% on the first round. From the initial list of 142 items, a total of 118 (83%) items were approved by consensus. Findings may provide extended opportunities for the healthcare system to engage in better informed decisions and more inclusive and integrative strategies regarding SRH, contributing to build political measures toward sexual and reproductive justice.

MAternal Mental Health in the WORKplace (MAMH@WORK): A Protocol for Promoting Perinatal Maternal Mental Health and Wellbeing.

Women are exposed to increased burden of mental disorders during the perinatal period: 13-19% experience postpartum depression. Perinatal psychological suffering affects early mother-child relationship, impacting child's emotional and cognitive development. Return-to-work brings additional vulnerability given the required balance between parenting and job demands. The MAternal Mental Health in the WORKplace (MAMH@WORK) project aims to develop and evaluate the effectiveness of a brief and sustainable intervention, promoting (a) maternal mental health throughout pregnancy and first 12 months after delivery, and (b) quality of mother-child interactions, child emotional self-regulation, and cognitive self-control, while (c) reducing perinatal absenteeism and presenteeism. MAMH@WORK is a three-arm randomized controlled trial. A short-term cognitive-behavioral therapy-based (CBT-based) psychoeducation plus biofeedback intervention will be implemented by psychiatrists and psychologists, following a standardized procedure manual developed after consensus (Delphi method). Participants (n = 225, primiparous, singleton pregnant women at 28-30 weeks gestational age, aged 18-40 years, employed) will be randomly allocated to arms: CBT-based psychoeducation intervention (including mindfulness); psychoeducation plus biofeedback intervention; and control. Assessments will take place before and after delivery. Main outcomes (and main tools): mental health literacy (MHLS), psychological wellbeing (HADS, EPDS, KBS, CD-RISC, BRIEF COPE), quality of mother-child interaction, child-mother attachment, child emotional self-regulation and cognitive self-control (including PBQ, Strange Situation Procedure, QDIBRB, SGS-II, CARE-Index), job engagement (UWES), and presenteeism. Intention-to-treat and per-protocol analyses will be conducted; Cohen's d coefficient, Cramer's V and odds ratio will be used to assess the effect size of the intervention. MAMH@WORK is expected to contribute to mental health promotion during the perinatal period and beyond. Its results have the potential to inform health policies regarding work-life balance and maternal mental health and wellbeing promotion in the workplace.

Functional Health Literacy: Psychometric Properties of the Newest Vital Sign for Portuguese Adolescents (NVS-PTeen).

Self-management of health requires skills to obtain, process, understand, and use health-related information. Assessment of adolescents' functional health literacy requires valid, reliable, and low-burden tools. The main objective of this study was to adapt and study the psychometric properties of the Newest Vital Sign for the Portuguese adolescents' population (NVS-PTeen). Classic psychometric indicators of reliability and validity were combined with item response theory (IRT) analyses in a cross-sectional survey, complemented with a 3-month test-retest assessment. The NVS-PTeen was self-administered to students enrolled in grades 8 to 12 (12 to 17 years old) in a school setting. Overall, 386 students (191 girls) from 16 classes of the same school participated in the study (mean age = 14.5; SD = 1.5). Internal reliability of the NVS-PTeen was α = 0.60. The NVS-PTeen total score was positively and significantly correlated with Portuguese (r = 0.28) and mathematics scores (r = 0.31), school years (r = 0.31), and age (r = 0.19). Similar to the original scale (for the U.S.), the NVS-PTeen is composed of two dimensions, reading-related literacy and numeracy. Temporal reliability is adequate, though with a learning effect. IRT analyses revealed differences in difficulty and discriminative capacity among items, all with adequate outfit and infit values. Results showed that the NVS-PTeen is valid and reliable, sensible to inter-individual educational differences, and adequate for regular screening of functional health literacy in adolescents.

Psychological distress, burnout, job satisfaction and intention to quit among primary healthcare nurses.

Addressing the worldwide challenge of shortage of nurses contributes to the national and international efforts to enhance the health and well-being of the global population. The main aim of this research is to investigate the level and the relationship between psychological distress, burnout, job satisfaction and intention to quit among primary healthcare nurses in public and private practices while accounting for their socio-demographic characteristics. This was a cross sectional study of 173 primary health care nurses. The Oldenburg Burnout Inventory and General Health Questionairre-12 were used to assess burnout and psychological distress among nursing staff. High psychological distress was present in 21.38% of all respondents and was significantly related to intention to quit. The results indicated a mean job satisfaction score of 3.54 with higher job satisfaction among private vs. public sector nurses. Furthermore, nurses with higher burnout levels and lower job satisfaction were more likely to consider leaving the profession compared with those with lower burnout and higher job satisfaction. The study provides valuable insight for managers of general healthcare practice and healthcare policy makers in effectively managing and retaining primary healthcare nurses.

Fertility, Migration and Acculturation (FEMINA): a research protocol for studying intersectional sexual and reproductive health inequalities.

BACKGROUND: The existing knowledge on the interplay between reproductive and sexual health, migration and acculturation is recent and inconsistent, particularly on the sociocultural motives and constraints regarding fertility. Therefore, sexual and reproductive health (SRH) surveys are needed to provide accurate and comparable indicators to identify and address SRH inequalities, with specific focus on under researched aspects, such as the interrelation between migration and gender. FEMINA (FErtility, MIgratioN and Acculturation) aims to investigate intersectional SRH inequalities among Cape Verdean immigrant and Portuguese native families and how they impact on fertility in Portugal. This study will use a comprehensive approach exploring simultaneously the components of SRH, namely regarding identities, perceptions and practices of both women and men among lay people and relevant experts and stakeholders. The project has three main goals: 1) to identify social determinants of SRH among Cape Verdean immigrant and Portuguese native men and women of reproductive age; 2) to gain understanding of the diversity of the sexual and reproductive experiences and expectations of Cape Verdean immigrant and Portuguese native men and women of reproductive age, considering the singularities of their migratory, social and family dynamics; and 3) to produce recommendations for policy makers, employers and service providers on how to better address the SRH needs of Portuguese-born and immigrant populations. METHODS: The study will address these goals using a mixed methods approach, including: a cross-sectional telephone survey with a probabilistic sample of 600 Cape Verdean immigrant and 600 Portuguese native women and men (women aged 18 to 49 and men aged 18 to 54), residents of the Greater Lisbon Area; a qualitative research through in-depth interviews with a subsample of 30 Cape Verdean immigrants and 30 Portuguese native men and women; and a Delphi technique for finding consensus on good practices in SRH for the entire population with a special emphasis on immigrants, namely extra-EU migrants. DISCUSSION: Data will be used to produce a comprehensive set of indicators to monitor SRH in Portugal, to foster a greater understanding of its specificities and challenges to policy and decision makers, and to provide targeted recommendations to promote inclusive and migrant sensitive SRH services.

Defining a Brief Intervention for the Promotion of Psychological Well-being among Unemployed Individuals through Expert Consensus.

BACKGROUND: Epidemiologic evidence highlights the harmful consequences of unemployment on health and well-being. This emphasizes the need to design low-cost interventions to prevent the adverse mental health effects of unemployment. The main aim of this study was to create expert-consensus regarding development and implementation of a brief, sustainable, and effective intervention program for promoting mental health among unemployed. METHODS: The Delphi technique entailed a selected panel of 75 experts from various relevant professional backgrounds. Panel members were asked to state their level of agreement (5-point Likert scale) regarding (a) required characteristics for an effective mental health intervention for unemployed people and (b) key variables for assessing the effectiveness of that intervention. Consensus was obtained throughout two rounds of data collection through e-mail contact, with structured questionnaires. Items of the questionnaire were based on literature reviews about community-based interventions for unemployed individuals. RESULTS: Overall, 46 experts collaborated with the Delphi process (final participation rate: 61.3%). Based on a review of the literature, 185 items were identified and grouped into two broad categories (set of characteristics of the intervention and set of variables for effectiveness assessment), aggregating a total of 11 dimensions. The two Delphi rounds resulted in the selection of 35 characteristic items for the intervention program and 54 variables for its effectiveness assessment. Brief group interventions were considered to be effective and sustainable for mental health promotion in unemployment conditions if targeting mental health literacy, training interpersonal skills, and job-search skills. CONCLUSION: As agreed by the panel of experts, a brief, sustainable and effective intervention can be developed and implemented by accounting for unemployed capacity-building for mental health self-care and adequate job-searching attitudes and skills. These results should be further implemented in community and multisector-based standardized interventions, targeting mental health among unemployed people, ensuring adequate conditions for its effectiveness assessment.