Modeling Psychological Functioning in Refugees.

BACKGROUND: Refugee trauma survivors often experience posttraumatic stress disorder, other anxiety disorders, depression, and somatization. As a result, many suffer a disproportionate vulnerability to a variety of interpersonal, health, and social problems. OBJECTIVE: The study purpose was to develop a preliminary predictive model identifying high-risk refugee trauma survivors based on levels of trauma and psychological functioning. METHOD: A subset of 449 Somali and Oromo refugee trauma survivors was randomly selected from a larger study for secondary data analysis. Data from the PTSD Checklist-Civilian version, the Revised Hopkins Symptom Checklist, and the Sheehan Disability Inventory contributed to a psychological functioning score. A researcher-developed survey contributed to a composite trauma score. RESULTS: Predictors associated with functioning level differed by gender. Of interest, caring for children and increasing coping strategies were related to lower functioning in women. The regression relationship between trauma and functioning was linear in men but quadratic in women. CONCLUSION: Understanding the mechanisms linking trauma and function is implicated in the assessment of risk among trauma survivors. Predictive models inform the effective psychosocial interventions targeting those at greatest risk.

Mothering during war and postwar in Bosnia.

The study aim was to describe displaced Bosnian mothers' experiences caring for their children during and immediately after the war (1992-1995). Mothers described their progression into war, through war, and into vastly changed lives. Using ethnographic methods, narrative data were collected near Sarajevo, Bosnia, from 14 displaced women who participated in one to three interviews each between 1996 and 1999. Data from the semistructured interviews were analyzed to determine patterns in participants' descriptions of mothering during war. Four common themes of mothering were identified in the data: "on the move," "I have to feed them," "living somewhere in between," and "still living the war inside." As care providers and policy makers develop initiatives to improve the health of women and children during complex humanitarian emergencies, there is much to learn from the narratives of Bosnian women about their extraordinary struggle to protect the lives of their children amid violence and loss.

Somali and Oromo refugee women: trauma and associated factors.

AIM: This paper reports a study identifying the demographic characteristics, self-reported trauma and torture prevalence, and association of trauma experience and health and social problems among Somali and Oromo women refugees. BACKGROUND: Nearly all refugees have experienced losses, and many have suffered multiple traumatic experiences, including torture. Their vulnerability to isolation is exacerbated by poverty, grief, and lack of education, literacy, and skills in the language of the receiving country. METHOD: Using data from a cross-sectional population-based survey, conducted from July 1999 to September 2001, with 1134 Somali and Oromo refugees living in the United States of America, a sub-sample of female participants with clearly identified parenting status (n = 458) were analysed. Measures included demographics, history of trauma and torture, scales for physical, psychological, and social problems, and a post-traumatic stress symptom checklist. FINDINGS: Results indicated high overall trauma and torture exposure, and associated physical, social and psychological problems. Women with large families reported statistically significantly higher counts of reported trauma (mean 30, P < 0.001) and torture (mean 3, P < 0.001), and more associated problems (P < 0.001) than the other two groups. Women who reported higher levels of trauma and torture were also older (P < 0.001), had more family responsibilities, had less formal education (P < 0.001) and were less likely to speak English (P < 0.001). CONCLUSION: These findings suggest a need for nurses, and especially public health nurses who work with refugee and immigrant populations in the community, to develop a more comprehensive understanding of the range of refugee women's experiences and the continuum of needs post-migration, particularly among older women with large family responsibilities. Nurses, with their holistic framework, are ideally suited to partner with refugee women to expand their health agenda beyond the biomedical model to promote healing and reconnection with families and communities.