Mental health and mental health help-seeking behaviors among first-generation voluntary African migrants: A systematic review.

PURPOSE: Mental health challenges are highly prevalent in African migrants. However, understanding of mental health outcomes in first-generation voluntary African migrants is limited, despite the unique challenges faced by this migrant subgroup. This review aimed to synthesize the literature to understand the mental health challenges, help-seeking behavior, and the relationship between mental health and mental health help-seeking behavior in first-generation voluntary African migrants living outside Africa. METHODS: Medline Complete, EMBASE, CINAHL Complete, and APA PsychINFO were searched for studies published between January 2012 to December 2023. Retrieved articles were processed, data from selected articles were extracted and synthesized to address the study aims, and included studies were evaluated for risk of bias. RESULTS: Eight studies were included, including four quantitative and four qualitative studies, which focused on women with postnatal depression. Mental health challenges reported in the quantitative studies were depression, interpersonal disorders, and work-related stress. Risk (e.g., neglect from health professionals and lack of social/spousal support) and protective (e.g., sensitivity of community services and faith) factors associated with mental health were identified. Barriers (e.g., cultural beliefs about mental health and racial discrimination) and facilitators (sensitizing African women about mental health) of mental health help-seeking behavior were also identified. No significant relationship was reported between mental health and mental health help-seeking behavior, and the risk of bias results indicated some methodological flaws in the studies. CONCLUSION: This review shows the dearth of research focusing on mental health and help-seeking behavior in this subgroup of African migrants. The findings highlight the importance of African migrants, especially mothers with newborns, examining cultural beliefs that may impact their mental health and willingness to seek help. Receiving countries should also strive to understand the needs of first-generation voluntary African migrants living abroad and offer mental health support that is patient-centered and culturally sensitive.

Approaches to Assessment and Intervention With Children and Young People Who Engage in Harmful Sexual Behavior: A Scoping Review.

This paper reports the findings of a project that conducted a rapid review of evidence regarding assessment and intervention approaches responding to children and young people who engage in harmful sexual behaviors. A literature review was conducted using a systematic search of academic databases and consultation with subject matter experts. The process resulted in 27 scholarly publications being included and analyzed to explore what was known about effective approaches with children and young people who have engaged in harmful sexual behavior. The review found that the current state of knowledge was limited, with few of the included papers reporting research outcomes. In the absence of a sound evidence base, additional theoretical literature and expert commentary have been drawn upon to better understand issues in this complex practice area. A key finding of this review was that growing awareness that children and young people who engage in harmful sexual behaviors are, first and foremost, children. They should not be regarded as soon-to-be-adults who are engaging in adult offending. This shift in thinking informs contemporary assessment and intervention approaches, challenging those models that previously focused on measuring risk using forensic approaches to predict the likelihood of future offending. A critical failure to understand the needs of specific cohorts of children and young people was also evident.

Impacts of COVID-19 on African Migrants' Wellbeing, and Their Coping Strategies in Urban and Regional New South Wales, Australia: a Qualitative Study.

AIM: As the COVID-19 pandemic response continues to evolve, the need to protect more vulnerable populations in society becomes more apparent. Studies are still emerging on how different population groups have been impacted by the COVID-19 pandemic. Our study explored the impact of COVID-19 for African migrants in New South Wales, Australia, and their coping strategies. METHODS: We employed inductive, exploratory qualitative interpretive research design using individual semi-structured in-depth interviews with 21 African migrants. RESULTS: COVID-19 lockdowns disrupted the African sense of community. Social isolation, financial insecurity due to joblessness, or reduced working hours led to stress, frustration, anxiety, sadness, loneliness, and depression. On the other hand, COVID-19 lockdowns allowed for more family time, reflecting, and appreciating the gift of life and personal intellectual growth. Despite such challenges, there was much community support, especially from religious organisations. Support from government agencies was available, but access was hampered by misinformation, digital literacy, and immigration status. Holding on to religion and faith was a key coping mechanism, followed by indulging in self-care practices such as healthy eating, exercise, Yoga, meditation, sleep, and limited interaction with social media. CONCLUSION: The COVID-19 lockdown disrupted the collectivist culture of African migrants and had untoward socioeconomic impacts that affected their wellbeing, many of which reflect an exacerbation of pre-existing inequities. To ensure that African migrant COVID-19-related health and wellbeing needs are met, the African migrant community must be actively involved in every facet of the NSW COVID-19 and other future outbreak response efforts.

The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis.

BACKGROUND: Evidence exists reporting a high mental health burden among migrants globally. However, there is no global estimate of mental ill-health among African migrants despite their adverse pre-migration environments. This systematic review and meta-analysis summarise the current scholarship regarding the prevalence of anxiety, depression and Post-traumatic Stress Disorder (PTSD) in the global African migrant population. METHODS: We searched six databases (Medline (EBSCOHost), PsycINFO (EBSCOHost), Web of Science, PubMed, Scopus and Cumulative Index to Nursing and Allied Health (CINAHL) from 1st January 2000 to 31st August 2021. We screened retrieved articles using strict inclusion and exclusion criteria. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools. Random-effects meta-analyses were employed using DerSimonian and Laird estimator based on inverse variance weights. The I2 statistic was used to measure heterogeneity. RESULTS: Our search retrieved 1091 articles, of which 46 were included representing a total of 28,367 African migrants. The weighted mean age of African migrants was 32.98 years, and nearly half were male (n= 12852, 45.31%). Among the included studies, almost nine out of ten (n=41, 89.1%) were cross-sectional studies. The pooled prevalence of anxiety, depression and PTSD was 34.60%;95%CI (26.30-43.00), 33.20%;95%CI (27.70-38.37) and 37.9%;95%CI (23.5- 52.4) respectively. Significant heterogeneity (I2 >98%) existed in the prevalence estimates for anxiety, depression, and PTSD. Sub-group analyses indicate a significantly higher prevalence of anxiety and depression but PTSD for studies conducted in Africa than outside Africa. Similarly, higher prevalence rates for anxiety, depression, and PTSD were seen in studies that used a screening tool than in those that used a diagnostic tool, although a significant difference was observed for depression only. CONCLUSION: Despite significant heterogeneity among included studies, our systematic review and meta-analysis show a high prevalence of anxiety, depression, and PTSD among African migrants. Our findings underscore the need to develop and implement serious, culturally appropriate mental health interventions that address post-migration stressors that increase their risk of mental ill-health and successful integration into host communities.

Minority Stress for Care Experienced Young Queer People: A Case Study.

Young people who are placed in out-of-home care are amongst the most vulnerable in our community. Removed from or rejected by their families, they must learn to live with carers who may be strangers. They may have experienced the trauma of abuse or neglect. Post care, they may experience further social isolation and marginalisation due to limited social capital. These challenges are compounded for queer young people placed in out-of-home care. This study adopted a case study approach to explore the lived experience of two young adults growing up queer in and out of out-of-home care in Australia. Our investigation was framed by two complementary theoretical frameworks. The first, a model of minority stress, is informed by queer perspectives and enabled an exploration into the adverse impact of enduring stigma and prejudice associated with homophobia and transphobia on young people's capacity to thrive. The model of social capital was then employed to inform an analysis of relationships between queer young people in out-of-home care and trustworthy adults. The findings suggest that queer young people growing up in out-of-home care experience minoritised stress, with lasting negative implications. The presence however, of trustworthy adults who challenge dominant heteronormative assumptions and work to support queer young people can be experienced as stabilising and restorative.

Telling Our Stories: Resilience during Resettlement for African Skilled Migrants in Australia.

BACKGROUND: Emigration to Australia by people from Africa has grown steadily in the past two decades, with skilled migration an increasingly significant component of migration streams. Challenges to resettlement in Australia by African migrants have been identified, including difficulties securing employment, experiences of racism, discrimination and social isolation. These challenges can negatively impact resettlement outcomes, including health and wellbeing. There has been limited research that has examined protective and resilience factors that help highly skilled African migrants mitigate the aforementioned challenges in Australia. This paper discusses how individual and community resilience factors supported successful resettlement Africans in Australia. The paper is contextualised within a larger study which sought to investigate how belonging and identity inform Afrodiasporic experiences of Africans in Australia. METHODS: A qualitative inquiry was conducted with twenty-seven (n = 27) skilled African migrants based in South Australia, using face-to-face semi-structured interviews. Participants were not directly questioned about 'resilience,' but were encouraged to reflect critically on how they navigated the transition to living in Australia, and to identify factors that facilitated a successful resettlement. RESULTS: The study findings revealed a mixture of settlement experiences for participants. Resettlement challenges were observed as barriers to fully meeting expectations of emigration. However, there were significant protective factors reported that supported resilience, including participants' capacities for excellence and willingness to work hard; the social capital vested in community and family support networks; and African religious and cultural values and traditions. Many participants emphasised their pride in their contributions to Australian society as well as their desire to contribute to changing narratives of what it means to be African in Australia. CONCLUSIONS: The findings demonstrate that despite challenges, skilled African migrants' resilience, ambition and determination were significant enablers to a healthy resettlement in Australia, contributing effectively to social, economic and cultural expectations, and subsequently meeting most of their own migration intentions. These findings suggest that resilience factors identified in the study are key elements of integration.

BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia.

Despite decades of evidence showing that institutional and interpersonal racism serve as significant barriers to accessible healthcare for Aboriginal and Torres Strait Islander Peoples, attempts to address this systemic problem still fall short. The social determinants of health are particularly poignant given the socio-political-economic history of invasion, colonisation, and subsequent entrenchment of racialised practices in the Australian healthcare landscape. Embedded within Euro-centric, bio-medical discourses, Western dominated healthcare processes can erase significant cultural and historical contexts and unwittingly reproduce unsafe practices. Put simply, if Black lives matter in healthcare, why do Aboriginal and Torres Strait Islander Peoples die younger and experience 'epidemic' levels of chronic diseases as compared to white Australians? To answer this, we utilise critical race perspectives to theorise this gap and to de-center whiteness as the normalised position of 'doing' healthcare. We draw on our diverse knowledges through a decolonised approach to promote a theoretical discussion that we contend can inform alternative ways of knowing, being, and doing in healthcare practice in Australia.

Indigenous Children and Young People in Residential Care: A Systematic Scoping Review.

In Australia and internationally, Indigenous children are seriously overrepresented in the child welfare system. This article provides an overview of literature investigating the needs of Indigenous children in residential care facilities. The provision of culturally safe and trauma-informed therapeutic care to Indigenous children and young people in residential care recognizes that the trauma and violence that they have experienced is exacerbated by their Indigeneity due to the colonial histories presenting. Utilizing a systematic scoping review methodology, the study returned a total of 637 peer-reviewed articles that were identified and reviewed for inclusion. The process of exclusion resulted in the inclusion of eight peer-reviewed studies and 51 reports and discussion papers sourced from gray literature. Findings from this study, though dearth, indicate that trauma-informed and culturally safe interventions play a significant role in Indigenous children's health and well-being while in care. Their experiences of abuse and neglect transcend individual trauma and include intergenerational pain and suffering resulting from long-lasting impacts of colonization, displacement from culture and country, genocidal policies, racism, and the overall systemic disadvantage. As such, a therapeutic response, embedded within Indigenous cultural frameworks and knowledges of trauma, is not only important but absolutely necessary and aims to acknowledge the intersectionality between the needs of Indigenous children in care and the complex systemic disadvantage impacting them.

Boundaries of Belonging: Theorizing Black African Migrant Experiences in Australia.

As nationalist ideologies intensify in Australia, so do the experiences of 'everyday racism' and exclusion for Black African immigrants. In this article, we utilize critical theories and engage with colonial histories to contextualize Afrodiasporic experiences in Australia, arguing that the conditional acceptance of Black bodies within Australian spaces is contingent upon the status quo of the white hegemony. The tropes and discourses that render the bodies of Black African migrants simultaneously invisible and hyper-visible indicate that immigration is not only a movement of bodies, but also a phenomenon solidly tied to global inequality, power, and the abjection of blackness. Drawing on critical race perspectives and theories of belonging, we highlight through use of literature how Black Africans in Australia are constructed as 'perpetual strangers'. As moral panics and discourses of hyper-criminality are summoned, the bordering processes are also simultaneously co-opted to reinforce scrutiny and securitization, with significant implications for social cohesion, belonging and public health.

The implications of Neoliberalism on African economies, health outcomes and wellbeing: a conceptual argument.

Not only did the 2015 Ebola Outbreak in West African countries leave the whole of the sub-Saharan region with a sense of uncertainty and panic, it was also a stress test to Africa's and the wider world's capacity to respond to and mitigate humanitarian crises in the twenty-first century. One plausible conclusion drawn from the spread and impact of the pandemic is that the pace of health infrastructure development in sub-Saharan Africa has lagged behind its population and economic growth posted in the last decade (2003-2013). An exhaustive audit of health infrastructure and remedial measures is, therefore, critical in navigating Africa to sustainable growth and development in the next decade. For the next charge of growth and development to not only be robust but also more sustainable and resilient to major emergencies (such as Ebola), there is a need to edify the state of healthcare across the continent to ensure the optimisation of the human resource and to redress the gap aggravated by loss of human-hours due to poor health.

From Adversity to Stability to Integration: how One Australian Program is Making a Difference in Therapeutic Foster Care.

This paper discusses two key strategies detailing how "relationship-focused" and "trauma-informed" intervention practices, which form the basis of an Australian therapeutic program called Treatment and Care for Kids (TrACK), made a difference in the lives of highly traumatised children. The TrACK program fosters highly traumatised children who, due to the complexity of their trauma needs, cannot be placed in traditional generalist foster care. Case files of 48 children were reviewed. Children were either current or former clients over a period of 18 years since the program was initiated. In analysing the data, we noticed that children who were once highly dysregulated in the domains of foster care placement, education, arousal regulation and peer relationships were now enjoying an enhanced level of stability in their lives.