Housing and health for people from refugee and asylum-seeking backgrounds: findings from an Australian qualitative longitudinal study.

BACKGROUND: For people from asylum-seeking and refugee backgrounds, housing and the re-establishment of home are key social determinants of health. Research highlights the inequities faced by asylum seekers and refugees in the housing markets of high-income resettlement countries, resulting in their overrepresentation in precarious housing. There is also emerging evidence of the relationship between housing and health for this population relating to lack of affordability, insecurity of tenure, and poor suitability (physical and social). The mechanisms by which housing impacts health for this group within these housing contexts, is however, understudied - especially overtime. This qualitative longitudinal study aimed to address this gap. METHODS: Semi-structured interviews were conducted with 25 people from asylum-seeking and refugee backgrounds in South Australia, recruited through a community survey. Thematic analysis of interview data across three time points over three years identified four material and psychosocial mechanisms through which housing contributed to health outcomes via psychological and physical stressors - physical environment; stability; safety; and social connections, support and services. The study also identified additional health promoting resources, particularly elements of ontological security. The dynamics of these indirect and direct mechanisms were further illuminated by considering the impact of international, national and local contexts and a range of intersecting social factors including gender, country/culture of origin, family circumstances, immigration status, language skills, income, and health status. CONCLUSIONS: Rebuilding a sense of home and ontological security is a key resettlement priority and crucial for wellbeing. More comprehensive strategies to facilitate this for refugees and asylum seekers are required.

Exploring the Role of Migration Status in Pregnancy Loss Attributions, Experiences, and Support in Australia.

While previous research has explored the impact of migration status on experiences and attributions about pregnancy loss, less common is comparative research examining similarities and differences between migrants and non-migrants. This paper reports on a cross sectional comparative study of 623 culturally and linguistically diverse (CALD) or non-CALD people living in Australia. Participants completed a survey that asked about experiences of pregnancy loss, support, and attributions about pregnancy loss. There were no differences between the two groups in terms of rates of pregnancy loss, though CALD participants reported greater distress following a loss. CALD participants reported greater reliance on partners and faith communities, and found healthcare professionals to be less supportive. CALD participants were more likely to attribute pregnancy loss to spiritual reasons (among others), and non-CALD participants to fetal abnormalities. The paper concludes by calling for awareness campaigns and professional upskilling to better ensure the needs of CALD communities.

Quality of life among people living with mental illness and predictors in Africa: a systematic review and meta-analysis.

INTRODUCTION: Quality of life (QoL) of patients with mental illness has been examined internationally but to a lesser extent in developing countries, including countries in Africa. Improving QoL is vital to reducing disability among people with mental illness. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of QoL and associated factors among people living with mental illness in Africa. METHODS: Using the PICOT approach, Scopus, MEDLINE, PsycINFO, CINAHL, Embase, the Web of Science, and Google Scholar were searched. A structured search was undertaken, comprising terms associated with mental health, mental illness, QoL, and a list of all African countries. The Joanna Briggs Institute Quality Appraisal Checklist is used to evaluate research quality. Subgroup analysis with Country, domains of QoL, and diagnosis was tested using a random-effect model, and bias was assessed using a funnel plot and an inspection of Egger's regression test. A p value, OR, and 95% CI were used to demonstrate an association. RESULTS: The pooled prevalence of poor QoL was 45.93% (36.04%, 55.83%), I2 = 98.6%, p < 0.001). Subgroup analysis showed that Ethiopia (48.09%; 95% CI = 33.73, 62.44), Egypt (43.51%; 95% CI = 21.84, 65.18), and Nigeria (43.49%; 95% CI = 12.25, 74.74) had the highest mean poor QoL prevalence of the countries. The pooled prevalence of poor QoL by diagnosis was as follows: bipolar disorder (69.63%; 95% CI = 47.48, 91.77), Schizophrenia (48.53%; 95% CI = 29.97, 67.11), group of mental illnesses (40.32%; 95% CI = 23.98, 56.66), and depressive disorders (38.90%; 95% CI = 22.98, 54.81). Being illiterate (3.63; 95% CI = 2.35, 4.91), having a comorbid medical illness (4.7; 95% CI = 2.75, 6.66), having a low monthly income (3.62; 95% CI = 1.96, 5.27), having positive symptoms (0.32; 95% CI = 0.19, 0.55), and having negative symptoms (0.26; 95% CI = 0.16, 0.43) were predictors of QoL. Thus, some factors are significantly associated with pooled effect estimates of QoL. CONCLUSIONS: The current systematic review and meta-analysis showed that almost half of patients with mental illness had poor QoL. Being illiterate, having a comorbid medical condition, having a low monthly income, having positive symptoms, and having negative symptoms of mental illness were independent predictors of poor QoL. This systematic review and meta-analysis emphasize that poor QoL of people with mental illness in Africa needs attention to reduce its negative consequences.

Internalised stigma among people with mental illness in Africa, pooled effect estimates and subgroup analysis on each domain: systematic review and meta-analysis.

BACKGROUND: Internalisation of stigma occurs when people with a stigmatised attribute, such as a mental illness, supress negative but accepted societal attitudes. However, as far as is known, there is no comprehensive picture of the prevalence of and factors associated with, internalised stigma among people living with mental illness in Africa. This systematic review and meta-analysis provide new knowledge by examining the evidence on the prevalence of internalised stigma and associated factors among people living with mental illness in Africa. METHODS: Using the population, intervention, comparison, outcome, and type of study (PICOT) approach, PubMed, Scopus, MEDLINE, PsycINFO, CINAHL, ScienceDirect, and Google Scholar were searched using a structured search comprising terms associated with mental health, mental illness, internalised stigma, and a list of all African countries. To evaluate paper quality, the Joanna Briggs Institute Quality Appraisal Checklist was used. Subgroup analysis with country and diagnosis was tested using a random-effect model, and bias was checked using a funnel plot and an inspection of Egger's regression test. A p-value, OR and 95% CI was used to demonstrate an association. RESULTS: The pooled prevalence of internalised stigma was 29.05% (25.42,32.68: I2 = 59.0%, p ≤ 0.001). In the subgroup analysis by country, Ethiopia had the highest prevalence of internalised stigma at 31.80(27.76,35.84: I2 = 25.6%, p ≤ 0.208), followed by Egypt at 31.26(13.15,49.36: I2 = 81.6%, p ≤ 0.02), and Nigeria at 24.31(17.94,30.67: I2 = 62.8%, p ≤ 0.02). Based on domains of internalised stigma, pooled prevalence was stigma resistance: 37.07%, alienation: 35.85%, experience of discrimination: 31.61%, social withdrawal: 30.81% and stereotype: 26.10%. Experiencing psychotic symptoms (1.42(0.45,2.38)), single marital status (2.78(1.49,4.06)), suicidal ideation (2.32(1.14,3.49)), drug nonadherence (1.5(-0.84,4.00)), poor social support (6.69(3.53,9.85)), being unemployed (2.68(1.71,3.65)), and being unable to read and write (3.56(2.26,4.85)) were identified as risk factors for internalised stigma. CONCLUSIONS: Internalised stigma is common among people suffering from mental illnesses in Africa. This review determined that 29% of the sample population had elevated internalised stigma scores, and there were variations by country. People experiencing mental illness who have a single marital status, suicidal behaviours, poor social support, unemployed and have poor literacy levels were at a higher risk of internalised stigma. The finding points to populations that require support to address internalised stigma and improve the mental health outcomes.

Culturally and linguistically diverse men's experiences of support following perinatal death: A qualitative study.

AIMS AND OBJECTIVES: To explore culturally and linguistically diverse men's experiences of support after perinatal death, including barriers and facilitators to support and how healthcare providers, systems and policies can best support families. BACKGROUND: Many groups of culturally and linguistically diverse families in Australia are at higher risk of experiencing perinatal death. Culturally sensitive bereavement services are essential; however, there has been no previous research specifically examining culturally and linguistically diverse men's experiences of support following perinatal death. DESIGN: Individual semi-structured interviews were completed with healthcare providers, community leaders and culturally and linguistically diverse men who had experienced a perinatal death in Australia (n = 16). Data were analysed using Thematic Analysis and COREQ guidelines were followed. RESULTS: Men's need for support following perinatal death was associated with stigma, and shaped by culturally-relevant religion and ritual, and connection to community and family. Significant barriers to men seeking and gaining support included challenges with self-advocacy and navigating the woman-centred nature of perinatal care in Australia. CONCLUSIONS: Culturally and linguistically diverse men's specific needs should be included in the development of policy and practice surrounding perinatal death. While perinatal bereavement care guidelines acknowledge the importance of culturally informed care following perinatal death, there remains a lack of culturally specific supports available, particularly for culturally and linguistically diverse men. RELEVANCE TO CLINICAL PRACTICE: Specific recommendations from this research include increasing community liaison officers or cultural consultants in hospitals and support organisations; providing culturally and linguistically diverse support groups; adopting family-centred and father-inclusive language in all perinatal death support services and ensuring clear communication and targeted assistance for culturally and linguistically diverse men to self-advocate for their baby and access to support. PATIENT OR PUBLIC CONTRIBUTION: This study came out of consultation with community members and member checking of results was conducted to ensure adequate representation of participants' views.

Culturally and Linguistically Diverse Men's Grief Experiences Following Perinatal Death in Australia.

To explore the grief experiences of men from culturally and linguistically diverse (CALD) backgrounds following perinatal death in Australia. Qualitative analysis of interview data using thematic analysis. Participants were health service providers (n = 6), and CALD community members (n = 10) who were either community leaders with experience working with CALD men following perinatal death in Australia (n = 6), or were CALD men who had lived experience of perinatal death (n = 4). Thematic analysis identified four themes related to CALD men's grief. These included the role of religion and rituals, grief as stoic, the partner- and family-centred nature of men's grief, and finally grief as ensuring and changeable over time. This research points to the strong need for CALD men's specific needs to be included in the development of policy and practice surrounding perinatal death.

Perinatal care for women with refugee backgrounds from African countries: a qualitative study of intersections with psychological wellbeing.

BACKGROUND: Experiences with healthcare services, including perinatal healthcare services, contribute to psychological wellbeing for refugees post-resettlement. To address the paucity of literature examining the relationship between perinatal healthcare and psychological wellbeing in women with refugee backgrounds from African countries this study aimed to: (1) understand the relationship between psychological wellbeing and perinatal care amongst this population, and; (2) identify areas for improved perinatal healthcare services to ensure positive wellbeing outcomes in this population. METHODS: A total of 39 participants were included in the study. Nineteen women from seven African countries participated in interviews - seven both prior to and after having their babies, two only while pregnant and ten only after their baby had been born. In addition, interviews were conducted with 20 service providers. Interviews were thematically analysed. RESULTS: Four key themes were identified, covering continuity of care, cultural safety of care, agency in decision making, and ongoing impacts of perinatal care experiences. CONCLUSIONS: The results highlighted the need for changes to perinatal healthcare provision at the systems level, including implementing a continuity of care model, and ensuring women's access to individualised, trauma-informed perinatal services which attend to the cultural and psychosocial resettlement needs of this population. These findings informed recommendations for improving perinatal healthcare services and better psychological outcomes - and in turn broader health outcomes - for African-background refugee mothers.

Overwhelming and unjust: A qualitative study of fathers' experiences of grief following neonatal death.

Limited research has examined the grief experiences of fathers following neonatal death. Using a qualitative research design, ten fathers were interviewed, and thematic analysis resulted in three overarching themes: 'A complicated grief experience: Neonatal death is highly emotional', 'Grief is multidimensional' and 'Sense of injustice'. Overall, results showed that grief was a multidimensional experience for fathers, with expressions of grief including strong feelings of anger and guilt and the manifestation of grief in physical symptoms. In addition, the findings also indicated a sense of injustice that contributed to the disenfranchisement of grief for fathers. The results of this study contribute to developing a better understanding of the grief that fathers experience following neonatal death, and can inform improvements in healthcare practices after the death of a baby in the neonatal period, including father-specific programs and adequate provision of information.

Factors contributing to men's grief following pregnancy loss and neonatal death: further development of an emerging model in an Australian sample.

BACKGROUND: Historically, men's experiences of grief following pregnancy loss and neonatal death have been under-explored in comparison to women. However, investigating men's perspectives is important, given potential gendered differences concerning grief styles, help-seeking and service access. Few studies have comprehensively examined the various individual, interpersonal, community and system/policy-level factors which may contribute to the intensity of grief in bereaved parents, particularly for men. METHODS: Men (N = 228) aged at least 18 years whose partner had experienced an ectopic pregnancy, miscarriage, stillbirth, termination of pregnancy for foetal anomaly, or neonatal death within the last 20 years responded to an online survey exploring their experiences of grief. Multiple linear regression analyses were used to examine the factors associated with men's grief intensity and style. RESULTS: Men experienced significant grief across all loss types, with the average score sitting above the minimum cut-off considered to be a high degree of grief. Men's total grief scores were associated with loss history, marital satisfaction, availability of social support, acknowledgement of their grief from family/friends, time spent bonding with the baby during pregnancy, and feeling as though their role of 'supporter' conflicted with their ability to process grief. Factors contributing to grief also differed depending on grief style. Intuitive (emotion-focused) grief was associated with support received from healthcare professionals. Instrumental (activity-focused) grief was associated with time and quality of attachment to the baby during pregnancy, availability of social support, acknowledgement of men's grief from their female partner, supporter role interfering with their grief, and tendencies toward self-reliance. CONCLUSIONS: Following pregnancy loss and neonatal death, men can experience high levels of grief, requiring acknowledgement and validation from all healthcare professionals, family/friends, community networks and workplaces. Addressing male-specific needs, such as balancing a desire to both support and be supported, requires tailored information and support. Strategies to support men should consider grief styles and draw upon father-inclusive practice recommendations. Further research is required to explore the underlying causal mechanisms of associations found.

Men's experiences and need for targeted support after termination of pregnancy for foetal anomaly: A qualitative study.

AIMS AND OBJECTIVES: To explore men's experiences of termination of pregnancy for life-limiting foetal anomaly, including how healthcare providers, systems and policies can best support men and their families. BACKGROUND: While there is a sizable body of research and recommendations relating to women's experiences of grief and support needs following a termination of pregnancy for foetal anomaly, very few studies specifically examine men's experiences. METHODS: Semi-structured interviews were completed with ten Australian men who had experienced termination of pregnancy for life-limiting foetal anomalies with a female partner between six months and 11 years ago. Interviews were completed over the telephone, and data were analysed using thematic analysis. COREQ guidelines were followed. RESULTS: Thematic analysis resulted in the identification of three over-arching themes, each with two sub-themes. First, participants described the decision to terminate their pregnancy as The most difficult choice, with two sub-themes detailing 'Challenges of decision-making' and 'Stigma surrounding TOPFA'. Second, participants described that they were Neither patient, nor visitor in the hospital setting, with sub-themes 'Where do men fit?' and 'Dual need to support and be supported'. Finally, Meet me where I am described men's need for specific supports, including the sub-themes 'Contact men directly' and 'Tailor support and services'. CONCLUSIONS: Findings indicated that termination of pregnancy for life-limiting foetal anomaly (TOPFA) is an extremely difficult experience for men, characterised by challenges in decision-making and perceived stigma. Men felt overlooked by current services and indicated that they need specific support to assist with their grief. Expansion of existing infrastructure and future research should acknowledge the central role of fathers and support them in addressing their grief following TOPFA. RELEVANCE TO CLINICAL PRACTICE: Nursing/midwifery professionals are well situated to provide men with tailored information and to promote genuine inclusion, acknowledgement of their grief, and facilitate referrals to community supports.

Grandfathers' Experiences of Grief and Support Following Pregnancy Loss or Neonatal Death of a Grandchild.

Pregnancy loss and neonatal death are recognized as distressing experiences for parents and other family members. However, no research has specifically addressed the experiences of grandfathers. This study aimed to understand grandfathers' grief experiences, and to identify supports they provide, receive, and desire following the loss of a grandchild in pregnancy or the neonatal period. Semi-structured interviews with 10 Australian grandfathers were analyzed, applying principles of thematic analysis. Three themes related to grief and three themes related to support were identified. Findings indicated that grandfathers expressed grief in a range of ways, and emotional expressiveness did not reflect the extent of their grief. Grandfathers typically provided extensive support to their child and family; however, few supports were available to help grandfathers. Recognition and validation of grandfathers' grief, early access to information, and guidance to a variety of supports including written materials, peer and professional support, is required.

Men's grief and support following pregnancy loss: A qualitative investigation of service providers' perspectives.

This study explores service providers' experiences of supporting men following a miscarriage or stillbirth in Australia. In-depth, semi-structured interviews were completed with seven service providers including midwives, grief counselors and social workers. Participants highlighted that, despite the individual nature of men's grief, there is a need to recognize and address the additional expectations and responsibilities that may compound their experience. Within an environment focused on woman-centered care, participants described creative strategies and inclusive language to promote engagement of men. Further research exploring men's grief is needed to inform training and guidelines for healthcare professionals who work with bereaved families.

Australian Heterosexual Men's Experiences of Pregnancy Loss: The Relationships Between Grief, Psychological Distress, Stigma, Help-Seeking, and Support.

This study explores experiences of pregnancy loss via a questionnaire completed by a convenience sample of 48 Australian cisgender heterosexual men. The questionnaire included measures of support following pregnancy loss, recognition of loss, perceived utility of help-seeking, perceived stigma attached to help-seeking, perinatal grief, and depression and anxiety. The questionnaire also included open-ended questions focused on help-seeking and support. Higher levels of grief were related to higher levels of both depression and anxiety. Perceptions about stigma were related to the perceived utility of help-seeking. While a majority of participants had accessed formal support services, feeling supported was unrelated to either grief or depression. Participants emphasized the utility of men's groups where members have experienced pregnancy loss, though barriers to support were also identified in terms of the unavailability of support or the perceived need to focus on a partner's loss.

Men's grief following pregnancy loss and neonatal loss: a systematic review and emerging theoretical model.

BACKGROUND: Emotional distress following pregnancy loss and neonatal loss is common, with enduring grief occurring for many parents. However, little is known about men's grief, since the majority of existing literature and subsequent bereavement care guidelines have focused on women. To develop a comprehensive understanding of men's grief, this systematic review sought to summarise and appraise the literature focusing on men's grief following pregnancy loss and neonatal loss. METHODS: A systematic review was undertaken with searches completed across four databases (PubMed, PsycINFO, Embase, and CINAHL). These were guided by two research questions: 1) what are men's experiences of grief following pregnancy/neonatal loss; and 2) what are the predictors of men's grief following pregnancy/neonatal loss? Eligible articles were qualitative, quantitative or mixed methods empirical studies including primary data on men's grief, published between 1998 and October 2018. Eligibility for loss type included miscarriage or stillbirth (by any definition), termination of pregnancy for nonviable foetal anomaly, and neonatal death up to 28 days after a live birth. RESULTS: A final sample of 46 articles were identified, including 26 qualitative, 19 quantitative, and one mixed methods paper. Findings indicate that men's grief experiences are highly varied, and current grief measures may not capture all of the complexities of grief for men. Qualitative studies identified that in comparison to women, men may face different challenges including expectations to support female partners, and a lack of social recognition for their grief and subsequent needs. Men may face double-disenfranchised grief in relation to the pregnancy/neonatal loss experience. CONCLUSION: There is a need to increase the accessibility of support services for men following pregnancy/neonatal loss, and to provide recognition and validation of their experiences of grief. Cohort studies are required among varied groups of bereaved men to confirm grief-predictor relationships, and to refine an emerging socio-ecological model of men's grief. TRIALS REGISTRATION: PROSPERO registration number: CRD42018103981.

Discrimination: a health hazard for people from refugee and asylum-seeking backgrounds resettled in Australia.

BACKGROUND: Research has shown that discrimination is harmful to health, but there is relatively little known about discrimination experienced by people from refugee and asylum-seeking backgrounds in resettlement countries and associated health effects. This qualitative-focused mixed methods paper reports on discrimination experienced by refugees and asylum seekers, responses to discrimination, and impacts on health. METHODS: As part of a broader study of housing, social inclusion and health, surveys were completed by 423 adult refugees and asylum seekers living in South Australia who had been in Australia for up to 7 years. The survey included questions on discrimination based on skin colour, ethnicity and religion, as well as questions on hope, trust, belonging, sense of control and health (including the SF-8). Semi-structured interviews were conducted with 65 survey participants, purposively sampled by visa status, continent and gender, further exploring experiences of discrimination. These and survey open-ended responses were analysed thematically. RESULTS: Twenty-two percent of survey participants reported experiences of discrimination since arriving in Australia (14% in the last year), and 90% of these felt that discrimination had harmed their health. Key settings of discrimination were public transport, within the neighbourhood, and in relation to employment. Those who reported discrimination had significantly worse mental health (p < .000) but not physical health. Discrimination was also associated with less sense of belonging (p = .001), lower levels of trust (p = .038), reduced sense of control (p = .012) and less hope (p = .006). Incidents described in interviews and the open-ended survey responses included incivility, physical assault, and denial of services, experienced across intersecting characteristics of race/ethnicity, religion, gender and visa status. Responses to discrimination spanned affective, cognitive and behavioural dimensions, ranging across types of experience, participant characteristics and context, with most individuals reporting multiple response types. While some of the responses were reported by participants as protective of health, participants' reflections indicated significant negative impacts on mental health in particular. CONCLUSION: Discrimination featured in the resettlement experiences of a significant number of refugees and asylum seekers, with participants reporting clear negative impacts on mental health. Addressing discrimination is a key resettlement and health issue requiring urgent action.

Support for family diversity: a three-country study.

OBJECTIVE: To understand levels of support for differences between families in terms of sexuality and mode of family formation across three countries. BACKGROUND: Previous research has found that attitudes towards family diversity continue to improve over time, although differences remain. METHODS: Subjects were 1605 people living in Australia, the United Kingdom or the United States who completed a questionnaire which sought to explore levels of support for a diverse range of family forms and modes of family formation. RESULTS: Religiosity, political leanings and beliefs about the importance of genetic relatedness were all correlated with level of support. Gender of participant was a predictor of level of support. Cluster analysis indicated three clusters (unsupportive, neutral and supportive) for level of support, for which both sexuality and parent status were predictors. CONCLUSION: Findings highlight the normative status of reproductive heterosex, and demonstrate the considerable value accorded to genetic relatedness.

The impact of pregnancy loss on men's health and wellbeing: a systematic review.

BACKGROUND: Research indicates that men's psychological and physical health outcomes after pregnancy loss differ from those of women. Our goal was to identify all literature with a focus on men's experiences of pregnancy loss in order to outline current evidence concerning men's wellbeing. METHODS: A systematic review of literature on men and pregnancy loss was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Joanna Briggs Institute (JBI) and Social Care Institute for Excellence (SCIE) guidelines. Literature was sourced from PsycINFO, PubMed, Scopus, CINAHL, and Google Scholar. Inclusion criteria were 1) studies that focused on pregnancy loss (including miscarriage, stillbirth, and ectopic pregnancy, 2) that men's voices were specifically represented, and 3) that studies were of primary data. RESULTS: A final sample of 29 articles was identified, of which 16 were quantitative, 10 qualitative, and 3 mixed methods. Quantitative and mixed methods studies indicated that while men tended to have less intense and less enduring levels of negative psychological outcomes than women, they are more likely to engage in compensatory behaviours, such as increased alcohol consumption. Qualitative studies indicated that men often feel that their role is primarily as a 'supporter' to their female partner, and that this precludes recognition of their own loss. These studies also reported that men may feel overlooked and marginalised in comparison to their female partners, whose pain is typically more visible. CONCLUSIONS: Further research is needed on men's experiences of pregnancy loss, focusing on cultural differences. The experience of gay and/or transgender men who face pregnancy loss is overlooked in the literature to date.

A systematic review of research on psychiatric mother-baby units.

Psychiatric mother-baby units (MBUs) are currently viewed as best practice, particularly in the UK, Australia and France, for improving outcomes for mothers and babies when the former are experiencing severe forms of mental illness. A growing number of publications have examined MBUs, but to date, there has not been a comprehensive review of these studies. As such, the systematic review reported in this paper sought to address this gap. A systematic search was conducted for peer-reviewed research and grey literature published in English between 2000 and 2015. A final sample of 44 publications were identified that reported on empirical findings with regard to MBUs. Three quarters of the studies focused on individual MBUs and most studies were quantitative. A thematic analysis of the studies identified three major themes: (1) admissions data, (2) outcomes for mothers, and (3) programmes and interventions. The analysis also identified four secondary themes: (i) follow-up after discharge, (ii) separation of mothers and babies after discharge, (iii) client satisfaction with MBUs, and (iv) partners of women admitted to MBUs. The findings of the review highlight gaps in knowledge about MBUs and provide suggestions for future research.

Healthcare experiences of gender diverse Australians: a mixed-methods, self-report survey.

BACKGROUND: To date the healthcare experiences of gender diverse Australians have received little attention. Previous international research indicates a range of both negative and positive healthcare experiences amongst this diverse population, with negative experiences being those most frequently reported. METHOD: An online survey was designed to examine the healthcare experiences of gender diverse Australians. The survey included Likert scales asking participants to rate their mental and physical health, and their experiences with psychiatrists, general practitioners and surgeons (in terms of perceived comfort, discrimination and information provision). Open-ended questions provided the opportunity for participants to further elaborate on their experiences. Data were collected between June 2012 and July 2013. Quantitative data analysis was conducted utilising SPSS 17.0, including ANCOVAs and correlations to examine the relationships between variables. Qualitative data were coded by the authors in terms of negative or positive responses and the validity of ratings were assessed utilising Cohen's kappa. RESULTS: 110 people assigned male at birth (MAAB) and 78 people assigned female at birth (FAAB) completed two separate surveys. All identified as gender diverse as defined in this paper. 70% of participants had accessed a psychiatrist. Participants MAAB rated their experiences with psychiatrists more highly than participants FAAB. 80% of participants had accessed a general practitioner. Comfort with, and respect from, general practitioners were both positively correlated with mental health, whilst discrimination was negatively correlated with mental health. 42.5% of participants had undertaken sex-affirming surgery. Those who had such surgery reported higher levels of physical and mental health than those who had not undertaken surgery. Participants MAAB reported more positive experiences of surgery than did participants FAAB. CONCLUSIONS: Findings highlight the need for increased education of medical practitioners in regards to engaging with gender diverse clients.

Wellbeing Outcomes and Risk and Protective Factors for Parents with Migrant and Refugee Backgrounds from the Middle East in the First 1000 Days: A Systematic Review.

The First 1000 Days (the period from conception to a child's second birthday) is an important developmental period. However, little is known about experiences of parents with refugee and migrant backgrounds during this period. A systematic review was conducted according to PRISMA guidelines. Publications were identified through searches of the Embase, PsycINFO, PubMed, and Scopus databases, critically appraised, and synthesised using thematic analysis. A total of 35 papers met inclusion criteria. Depressive symptomatology was consistently higher than global averages, however maternal depression conceptualisations differed across studies. Several papers reported changes in relationship dynamics as a result of having a baby post-migration. Consistent relationships were found between social and health support and wellbeing. Conceptualisations of wellbeing may differ among migrant families. Limited understanding of health services and relationships with health providers may impede help-seeking. Several research gaps were identified, particularly in relation to the wellbeing of fathers, and of parents of children over 12 months old.