Discrimination and Social Exclusion of People Experiencing Mental Disorders in Burkina Faso: A Socio-anthropological Study.

Stigma has been pointed out as a barrier to mental healthcare in sub-Saharan Africa. Among the manifestations of stigma, the use of physical restraints is condemned as a form of violation of basic human rights. Research on this phenomenon is limited in West Africa and more particularly in Burkina Faso. This study explores the phenomenon of stigma of individuals experiencing mental disorders in Bobo-Dioulasso (Burkina Faso). As part of 8 months of socio-anthropological fieldwork, we interviewed 94 informants (7 focus groups and 25 individual interviews) to document exclusionary practices, their perceptions, and justifications. Exclusionary practices can be divided in five subgroups: ignoring, physically and sexually abusing, abandoning, banning, and restraining. Some practices were linked to a lack of financial and material resources, while others were justified by an inferior moral status. We observed differences in the type of exclusion experienced between men and women. Restrictive, abusive, and exclusionary measures are common in Bobo-Dioulasso. These practices can either be understood as part of families' adaptative strategies when dealing with chronic conditions, as part of security measures in the case of patients with aggressive behaviors, or as part of punitive measures when transgressions are committed. We conclude the article by addressing the tensions between local and global meanings of stigma.

Itinéraires thérapeutiques et accès aux soins en santé mentale : une ethnographie au Burkina Faso.

INTRODUCTION: In Burkina Faso, there is a lack of studies on perceptions of existing mental healthcare systems. This limits understanding patients’ treatment pathways and barriers to care utilization. As in many countries in sub-Saharan Africa, this lack of information contributes to the difficulty of health systems to adapt the available care to patients’ realities and needs. PURPOSE OF RESEARCH: In this study, participant observations were made in different care settings in the city of Bobo-Dioulasso. Seven focus groups and 25 individual interviews were conducted to question knowledge, perception, and use of existing services. Different actors were interviewed: patients, caregivers, family members and key informants. The data were subjected to a descriptive thematic analysis. RESULTS: Three systems of care were identified: 1) psychiatric care was associated with a diagnostic function and the management of serious pathologies, or ones triggered by “natural” causes, 2) traditional care was seen as having a healing function for “supernatural” pathologies, but was associated with a risk of fraud, and 3) informal care provided by the family was identified as the mainstay of the therapeutic pathways. CONCLUSIONS: This study reveals that through the diversity of resources consulted, the family members represent the main provider of care. Also, financial constraints constitute the main obstacle to seeking care. These findings lead us to make recommendations regarding the development of public policies at the national level as well as regarding the organization of health services in the city of Bobo-Dioulasso.

Hurtful Gifts? Trauma and Growth Transmission Among Local Clinicians in Postearthquake Haiti.

Although working with trauma survivors can be a source of both deleterious and positive transformations in mental health professionals, little is known about the experience of clinicians in shared traumatic contexts, particularly in the Global South, where most humanitarian crises occur. In collective disasters or armed conflicts, the personal and professional experiences of mental health staff inform each other, situating the clinical space at the intersection between singular and collective spheres. Drawing on an intersubjective and socioecological perspective, this qualitative study explored the ways in which working in a shared traumatic context affected mental health and psychosocial staff in postearthquake Haiti. We interviewed 22 local mental health workers in the capital, Port-au-Prince, 2.5 years after the 2010 disaster. We coded and thematically analyzed interviews using an iterative process, based on grounded theory principles. Thematic analysis uncovered four dynamic poles in clinicians' narratives: balancing duty and desire to help, experiencing fragility and strength, negotiating separation and connection, and sharing hurt and hope. Our findings suggest clinicians considered their work mainly as a source of strength in the face of adversity, whereas experiences of trauma and growth transmissions were mutual and intimately intertwined. We discuss the complexities of clinical work in shared traumatic settings as well as the dynamic interplay between professionals' experiences of suffering and growth. We conclude with recommendations on ways to involve local mental health clinicians in postdisaster contexts while addressing the special needs that they may have to process their own trauma.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) ¿Regalos Hirientes? trauma y transmisión del crecimiento entre clínicos locales en Haití Post-Terremoto TRAUMA Y TRANSMISIÓN DEL CRECIMIENTO EN HAITÍ Aunque trabajar con sobrevivientes a trauma puede ser una fuente de transformaciones deletéreas y positivas en los profesionales de salud mental, se conoce poco acerca de la experiencia de clínicos en contextos traumáticos compartidos, particularmente en el Sur Global, donde ocurre la mayoría de las crisis humanitarias. En desastres colectivos o conflictos armados, las experiencias personales y profesionales del personal de salud mental se influyen mutuamente situando el espacio clínico en la intersección entre las esferas colectiva e individual. Utilizando una perspectiva intersubjetiva y socioecológica, este estudio cualitativo exploró las formas en que el trabajar en un contexto compartido traumático afectó al personal de salud mental y psicosocial (MHPSS, por su sigla en inglés) en Haití post-terremoto. Entrevistamos a 22 trabajadores de salud mental locales en la capital, Puerto Príncipe, 2.5 años después del desastre de 2010. Codificamos y analizamos temáticamente las entrevistas usando un proceso iterativo, basado en teoría fundamentada. Los análisis temáticos descubrieron cuatro polos dinámicos en las narrativas de los clínicos: equilibrando deber y deseo de ayudar, experimentando fragilidad y fuerza, negociando separación y conexión, y compartiendo daño y esperanza. Nuestros hallazgos sugieren que los clínicos consideraban su trabajo principalmente como una fuente de fuerza ante la adversidad, mientras que las experencias de trauma y transmisión de crecimiento fueron mutuos e intimamente entrelazados. Discutimos las complejidades del trabajo clínico en escenarios traumáticos compartidos así como también la interacción dinámica entre las experiencias de sufrimiento y crecimiento de los profesionales. Concluimos con recomendaciones en formas para involucrar a los clínicos de salud mental locales en contextos post-desastre mientras se abordan las necesidades especiales que puedan tener para procesar su propio trauma.

The mothering experience of women with FGM/C raising 'uncut' daughters, in Ivory Coast and in Canada.

BACKGROUND: While Female Genital Cutting (FGM/C) is a deeply entrenched cultural practice, there is now mounting evidence for a gradual decline in prevalence in a number of geographical areas in Africa and following migration to non-practicing countries. Consequently, there is now a growing number of women with FGM/C who are raising 'uncut' daughters. This study used a qualitative methodology to investigate the experience of women with FGM/C raising daughters who have not been subjected to the ritual. The aim of this study was to shed light on mothers' perception of the meaning and cultural significance of the practice and to gain insight into their mothering experience of 'uncut' girls. METHODS: To this end, in-depth interviews were conducted with fifteen mothers living in Abidjan, Ivory Coast and in Montreal, Canada (8 and 7, respectively). RESULTS: Thirteen mothers intrinsically refused to perpetuate FGM/C onto their daughters and two diasporic mothers were in favour of FGM/C but forewent the practice for fear of legal repercussions. Whether the eschewing of FGM/C was deliberate or legally imposed, raising 'uncut' daughters had significant consequences in terms of women's mothering experiences. Mothers faced specific challenges pertaining to community and family pressure to have daughters undergo FGM/C, and expressed concerns regarding their daughters' sexuality. Conversely, women's narratives were also infused with pride and hope for their daughters, and revealed an accrued dialogue between the mother-daughter dyad about cultural norms and sexuality. Interestingly, women's mothering experience was also bolstered by the existence of informal networks of support between mothers with FGM/C whose daughters were 'uncut'. These communities of mothers engaged in open dialogue about the consequences of FGM/C and offered reciprocal solidarity and support in their decision to forego FGM/C for their children. CONCLUSION: Women with FGM/C who are raising 'uncut' daughters in their homeland and in their country of immigration vastly report a positive experience. However, they also face specific challenges related to immigration, psychosocial, and psychosexual considerations, which must be tackled from a multidisciplinary perspective.

Children of extremist parents: Insights from a specialized clinical team.

BACKGROUND: Data on children who grow up with parents adhering to violent extremism is scant. This makes it extremely delicate to inform policies and clinical services to protect such children from potential physical and psychological harm. OBJECTIVE: This paper explores the predicament of children whose caretakers were referred to a specialized clinical team in Montreal (Canada) because of concerns about risks or actual involvement in violent extremism processes. METHODS: This paper uses a mixed methods concurrent triangulation design. Quantitative data was obtained through a file review (2016-2020). Qualitative data was collected through semi-structured interviews and a focus group with the team practitioners. RESULTS: Clinicians reported the presence of stereotypes in the health and social services network frequently representing religious extremist parents as potentially dangerous or having inappropriate parenting skills while minimizing the perception of risk for parents adhering to political extremism. Children displayed high levels of psychological distress, mainly related to family separation, parental psychopathology, and conflicts of loyalty stemming from familial or social alienation. CONCLUSIONS: Training practitioners to be aware of their own personal and institutional bias may help them to understand the predicament of extremist parents' children and implement systemic, trauma and attachment informed interventions.

Cumulative Contexts of Vulnerability to Intimate Partner Violence Among Women With Disabilities, Elderly Women, and Immigrant Women: Prevalence, Risk Factors, Explanatory Theories, and Prevention.

Some groups of women are more vulnerable to intimate partner violence (IPV) due to particular risks and/or experiences: women with disabilities, elderly women, and immigrant women (DEI). Too often, their reality goes unnoticed, especially for those belonging to more than one of these groups. In this literature review, researchers used an intersectional approach to document the similarities and differences in how DEI women experience IPV, in terms of forms and consequences, as well as related risk factors, explanatory theories, and prevention strategies. Researchers selected 56 articles for review based on the following inclusion criteria: studies on adults living in a situation of IPV, studies on one of the three demographics under study (DEI), studies about one or multiple research questions, and studies based on empirical data relying on research methodology in either French or English. Researchers evaluated each selected article for its quality according to a chart that was specially developed for this review. The results highlight existing "intersections" between these groups to help understand the influence of belonging to more than one vulnerability group on these women's experiences with IPV. The importance to better training social workers and developing policies and programs that target the social determinants of health to prevent IPV experienced by DEI is also discussed.

PROTOCOL: Are tools that assess risk of violent radicalization fit for purpose? A systematic review.

This is the protocol for a Campbell systematic review. The main objective of this project is to gather, critically appraise, and synthesize evidence about the appropriateness and utility of tools used to assess the risk of violent radicalization.

Perceived discrimination and its association with psychological distress among newly arrived immigrants before and after September 11, 2001.

OBJECTIVES: We compared the evolution of perception of discrimination from 1998 to 2007 among recent Arab (Muslim and non-Muslim) and Haitian immigrants to Montreal; we also studied the association between perception of discrimination and psychological distress in 1998 and 2007. METHODS: We conducted this cross-sectional comparative research with 2 samples: one recruited in 1998 (n = 784) and the other in 2007 (n = 432). The samples were randomly extracted from the registry of the Ministry of Immigration and Cultural Communities of Quebec. Psychological distress was measured with the Hopkins Symptom Checklist-25. RESULTS: The perception of discrimination increased from 1998 to 2007 among the Arab Muslim, Arab non-Muslim, and Haitian groups. Muslim Arabs experienced a significant increase in psychological distress associated with discrimination from 1998 to 2007. CONCLUSIONS: These results confirm an increase in perception of discrimination and psychological distress among Arab Muslim recent immigrant communities after September 11, 2001, and highlight the importance this context may have for other immigrant groups.

Common mental health problems in immigrants and refugees: general approach in primary care.

BACKGROUND: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. METHODS: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. RESULTS: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. INTERPRETATION: Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

Collective identity, social adversity and college student sympathy for violent radicalization.

Identity issues have been at the forefront in studies on determinants of youth violent radicalization. Identity uncertainty and identity fusion appear to be associated with quests for meaning, which may find some answers in extremist discourses and radical engagements. This process has been considered to be particularly important for second-generation migrants who have to negotiate multiple identities, sometimes in situations of social adversity. This paper aims to understand the relations between collective identity, social adversity (discrimination and exposure to violence), and sympathy for violent radicalization in College students in Quebec. This mixed-method study consisted of a large online survey conducted at eight colleges in Quebec. Multilevel analysis accounted for the clustered nature of data while generalized additive mixed models were used to study nonlinear relations. Results highlight the complex associations between collective identity and youth sympathy for violent radicalization. They confirm that negative public representations of minority communities may lead to more sympathy for violent radicalization. Although results suggest that strong enough identities can act as protective anchorages for youth, they also indicate that when collective identity becomes too central in personal identity this may accentuate othering processes and legitimize violence toward the out-group. These results have implications for prevention programs. They indicate that improving the public image of minority communities through mainstream media or the social media may increase youth public self-esteem and decrease their sympathy for violent radicalization. They also invite the education field to foster the development of strong plural identities.

A repeated cross-sectional study of sympathy for violent radicalization in Canadian college students.

The upsurge in violent radicalization is associated with a global increase in social inequalities and conflicts related to different markers of identity. To date, literature on the factors associated with legitimizing violence toward others is cross-sectional and does not provide information on the possible change of this phenomenon over time. Such information is necessary to design primary prevention programs that are adapted to and address a rapidly evolving social context. We use a repeated cross-sectional study design to explore the association between sociodemographic characteristics and scores on the Sympathy for Violent Radicalization Scale (SVR) in Quebec (Canada) college students at 2 times points. Results from an online survey completed by students of 6 colleges in 2015 (n = 854) and 2017 (n = 702) indicate that although overall scores on the SVR scale remained stable, there were changes in the association between age, identity, and the outcome at the two time points. Specifically, scores on the SVR were significantly higher among younger students in 2017 than in 2015. In addition, in 2017 we observed a relationship between collective identity and SVR that was not present in 2015. These results align with other recent studies in Canada and the U.S. documenting the emergence of new forms of youth politicized bullying associated with race, ethnicity, and religion. A close monitoring of the phenomenon is warranted to both better understand the impact of populist policies on the increase in hate incidents and crimes and develop programs to address these forms of violence from a public health perspective. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Perception that "everything requires a lot of effort": transcultural SCL-25 item validation.

This brief report illustrates how the migration context can affect specific item validity of mental health measures. The SCL-25 was administered to 432 recently settled immigrants (220 Haitian and 212 Arabs). We performed descriptive analyses, as well as Infit and Outfit statistics analyses using WINSTEPS Rasch Measurement Software based on Item Response Theory. The participants' comments about the item You feel everything requires a lot of effort in the SCL-25 were also qualitatively analyzed. Results revealed that the item You feel everything requires a lot of effort is an outlier and does not adjust in an expected and valid fashion with its cluster items, as it is over-endorsed by Haitian and Arab healthy participants. Our study thus shows that, in transcultural mental health research, the cultural and migratory contexts may interact and significantly influence the meaning of some symptom items and consequently, the validity of symptom scales.

From the family universe to the outside world: family relations, school attitude, and perception of racism in Caribbean and Filipino adolescents.

Caribbean and Filipino immigrant families in Canada have much in common: the women have often immigrated as domestic workers, first-generation children may be separated from their parents for long periods, and they must deal with negative stereotypes of their ethnic group. This transcultural study looks at the associations between family relations and adolescents' perceptions of both their own group and the host society, and analyzes how these affect their mental health. The results suggest that family cohesion plays a key role in shaping adolescents' perceptions of racism in the host country and in promoting a positive appraisal of their own community, thus highlighting the need for a systemic understanding of family and intergroup relations.

North African and Latin American parents' and adolescents' perceptions of physical discipline and physical abuse: when dysnormativity begets exclusion.

This research documents the cultural norms around physical discipline and physical abuse among immigrant parents and youth, and assesses the impact that perceived divergences in these norms have on the relation between the family and the outer social world. Interviews were conducted with 10 parents and 10 adolescents from North African Arab countries, and 10 parents and 10 adolescents from Latin America living in Canada. Results highlight that divergent discipline practices were perceived by participants as an important source of tension when they were accompanied with a demeaning image, projected by the host society onto the immigrant family.

Second-generation Western Muslims: A qualitative analysis of multiple social identities.

The relationships between social identities are important when discussing the national and religious identities of Muslims in Western contexts. This study explored the identity narratives of second-generation Muslim young adults to consider the relevance of bicultural identity and acculturation theories commonly employed in research with this group. The sample comprised 20 Muslim young adults of diverse ethnicities and backgrounds from Montreal, Berlin, and Copenhagen who participated in semi-structured interviews that explored how they negotiate their social identities in light of their unique life course trajectories. This article focuses on two major themes underlying second-generation identity development: the importance of personal experience in the development of social identities; and the enmeshment of multiple social identities. We then discuss the results of our findings in light of the complex nature of social identity, group membership, and political categorization.

Current Challenges in Addressing Youth Mental Health in the Context of Violent Radicalization.

Although structural violence and social inequality affect youth physical and mental health throughout the world,1 the problem of violent radicalization (VR) has more recently emerged as an area of concern for professionals working with youth. Radicalization is a dynamic, complex process that is generated and fueled by intercommunity frictions and conflicting political, social, and economic discourses and interests.2 It takes the form of a shift away from a moderate point of view to a rigid one that rejects the status quo and demands drastic societal change, although not necessarily through violence.2 Violent radicalization is when radicalization includes the support of or the plan to use violent measures, including hate crimes and incidents and/or mass killings, often targeting a group characteristic (race, religion, gender orientation and identity, or political views), to achieve one's goals of social change.

Impact of the Charter of Quebec Values on psychological well-being of francophone university students.

This paper discusses results from a pilot study conducted in the spring of 2014 among young adults living in Montreal. The main objective of this study was to assess the relation between perception of the Charter of Quebec Values, 1 self-identification, perception of intercommunity relations, perceived discrimination, and psychological well-being in young students enrolled in undergraduate or graduate programs of a francophone university in Montreal. A total of 441 students (30.5% male, 69.5% female) took part in a web survey designed by the research team. The data analyses and results suggest that the debate around the Charter of Quebec values was associated with a shift from a predominantly positive perception of intercommunity relations to a predominantly negative one, particularly among women, immigrants, and those who self-identified as cultural or religious minorities. In addition, more than 30% of participants reported having experienced some form of ethnic or religious discrimination since the Charter was released (personally or as a witness). This was particularly the case among immigrants, as well as those who self-identified as bicultural or from cultural or religious minority groups. This study's results thus highlight the exacerbation of intercommunity tensions linked to the public debate around identity and intercommunity relations in Quebec.

From social adversity to sympathy for violent radicalization: the role of depression, religiosity and social support.

BACKGROUND: Discrepancies among studies suggest that the relation between social adversity and sympathy for violent radicalization (SVR) is multifaceted and may differ according to social context. This paper examines the role of depression, religiosity and social support in the relation between social adversity (i.e., discrimination and exposure to violence) and SVR among college students in Quebec, Canada. METHODS: A total of 1894 students responded to an online questionnaire posted on the internet of eight colleges. Multilevel analyses were first conducted to account for the clustered nature of the data, followed by mediation and moderation analyses. RESULTS: First generation migrants reported less SVR than second generation youth and non-immigrants. The mediating and/or moderating role of depression, religiosity and social support was examined through causal inference models. Depression mediated the relation between social adversity and SVR, with depression scores accounting for 47% and 25% of the total effect between discrimination and exposure to violence and SVR scores, respectively. Religiosity and social support moderated the association between social adversity and SVR. CONCLUSIONS: These results suggest that prevention programs should consider violent radicalization as a systemic issue which involves both minorities and the majority, although the specific balance between risk and protective factors may be influenced by local dynamics. They also question intervention measures targeting specifically migrants or ethno-cultural communities because of the risk of increasing profiling and stigmatization. Prevention programs should prioritize decreasing discrimination in colleges, as well as the provision of psychosocial support to depressed youth who experience social adversity.