The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences.

Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann-Whitney U and Kruskal-Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r = .53, p < .01) and between post-migration difficulties and mental health (r = .33, p < .01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal-Wallis H = 14.76, p < .05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments.

Conceptualizing Mental Health Through Bhutanese Refugee Lens: Findings from a Mixed Methods Study.

Despite the rapidly growing need to understand mental health challenges faced by refugee subpopulations, there is a dearth of literature exploring mental health conceptualization through the unique refugee lens. Guided by historical trauma theory, we gathered data using a two-phase explanatory sequential mixed-methods study (quantitative: n = 40; qualitative: n = 6) in a Midwestern U.S. region to understand mental health conceptualization from the Bhutanese refugee perspective by examining the cultural meaning and perception of mental health, describing experiences of mental health problems, and examining cultural protective factors and coping strategies. We argue that recognition of refugees' conceptualization of mental health and identification of cultural protective factors is paramount to healing. Findings emphasize the need to understand historical and cultural perspectives in cross-cultural contexts for the development and implementation of culturally responsive services. Our study also contributes to emerging knowledge on methodological rigor in research among understudied, hard-to-reach, small populations.

Group-Based Intervention Models in Treating Refugee Mental Health in High-Income Countries: A Systematic Review.

Refugees within the post-migration context experience higher rates of mental health symptoms due to a variety of pre- and post-migration factors. However, there is a lack of research in understanding best practices in culturally grounded interventions aimed at improving well-being outcomes. Recent research shows group interventions are a potential pathway to mental health treatment for refugees. This systematic review aimed to (1) assess best practices among group-based interventions within the refugee context, (2) provide literature-informed guidance on best practices within group-based interventions for this population, and (3) examine the impact of group-based interventions on the mental health outcomes of adult refugees in the post-migration context in high-income countries. A systematic literature search was conducted using Academic Search Complete, Social Work Abstracts, and PsycINFO. A total of 2,243 studies were identified, with 19 meeting the inclusion criteria to be from a peer-reviewed journal article; be published from 2003 to 2023; be written in English; have a study population of refugees in the post-resettlement context in a high-income country; include a group-based intervention model; and be quantitative or mixed methods. Results demonstrated that group-based interventions improve mental health symptoms, including post-traumatic stress disorder, depression, and anxiety. Studies varied on their use of culturally grounded mechanisms in developing and implementing interventions. Future research is needed to understand the longitudinal impacts of group-based interventions on mental health and better support current practices to facilitate access to intervention implementation.

Racial and Ethnic Disparities in the Physical Health Outcomes of Children in Foster Care: A Systematic Review.

Children of color-especially Black and Indigenous children-are disproportionately overrepresented in foster care and experience barriers in accessing services and receiving physical and behavioral healthcare compared to their White counterparts. Although racial disparities in mental health outcomes of children in foster care have been examined systematically, less is known about racial disparities in their physical health outcomes. This systematic review aimed to examine disparities in physical health outcomes (i.e., general health, developmental delays and disability, chronic illness, health-compromising behaviors, all-cause mortality) of children in foster care by their race and ethnicity (PROSPERO ID: CRD42021272072). Systematic literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 6,102 unique studies identified, 24 met inclusion criteria: peer-reviewed journal article; published from 1991 to 2021; written in English; involved children in the U.S. foster care system; children were primarily in family-based placements; included health outcomes; included children's race and ethnicity; conducted quantitative analyses; and had an observational study design. There was limited evidence to suggest racial disparities among physical health domains examined, in part, due to the small number of studies, variability across study measures and designs, how race and ethnicity were categorized, and how related results were reported. Research that disaggregates results by more nuanced race and ethnicity categories, goes beyond including race and ethnicity as control variables, and uses more robust study designs to understand where racial disparities lie is necessary to inform practice and policy efforts to attain race and health equity in child welfare.

Child Welfare System-Level Factors Associated with All-Cause Mortality Among Children in Foster Care in the United States, 2009-2018.

Little is known about the impact of child welfare system-level factors on child mortality as an outcome within foster care. Using data from the Adoption and Foster Care Analysis and Reporting System, 2009-2018, we examined the associations between county-level sociodemographic, foster care performance, and judicial reform characteristics with all-cause mortality rates. Results of random effects negative binomial regression analyses showed that higher proportions of younger children (<1 year: IRR = 1.06, 95% CI [1.02, 1.11]; 5-9 years: IRR = 1.05, 95% CI [1.01, 1.09]); children of color (i.e., non-Hispanic Asian: IRR = 1.07, 95% CI [1.01, 1.13]; multiracial: IRR = 1.03, 95% CI [1.01, 1.04]; non-Hispanic Black: IRR = 1.02, 95% CI [1.01, 1.02]; Hispanic: IRR = 1.01, 95% CI [1.01, 1.02]); and male children (IRR = 1.10, 95% CI [1.05, 1.15]) were associated with higher mortality risks at the county level. Current class action lawsuits (IRR = 0.79, 95% CI [0.63, 0.99]) and active consent decrees (IRR = 0.77, 95% CI [0.63, 0.94]) were associated with lower mortality risks. None of the foster care performance characteristics (e.g., foster care entry, placement stability, permanency) were associated with mortality risks. These findings have implications for addressing health disparities and reforming foster care systems through programmatic and policy efforts.

The hidden minority: Discrimination and mental health among international students in the US during the COVID-19 pandemic.

International students in the US occupy a precarious position at the intersection of immigration policy and global education mobility, one made more challenging by the disparate impact of COVID-19 on college students' mental health. Few studies, however, have explored the pandemic's effects on mental well-being among the international student population in the US. Our study aims to provide initial empirical evidence on the mental health status of these students, with a specific focus on discrimination, loneliness, anxiety, and depression. We propose a mediation framework and estimate the mediating effects of loneliness and anxiety in the relationships between discrimination and depression in a sample of US-based international students (N = 103). We collected cross-sectional data from July to August 2020, using a 50-item online survey instrument with three open-ended questions. Mediation analyses using PROCESS Macro were used to analyse quantitative data and thematic analysis was used to analyse qualitative data. Findings showed that higher levels of discrimination were significantly associated with higher levels of loneliness. Higher levels of loneliness were significantly associated with higher levels of anxiety, which in turn led to high levels of depressive symptoms. Our study contributes to understanding the needs and capacities of international students in the wake of COVID-19 and simultaneously provides pragmatic program and policy implications for inclusive higher education environments and the overall health and well-being of this crucial US student population.