Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.398
Filtrar
1.
PLoS One ; 16(1): e0244347, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33395428

RESUMEN

INTRODUCTION: Pneumonia of unknown cause was detected on 30 December 2019 in China. It was categorized as an outbreak and named as COVID-19 by the World Health Organization. The pandemic affects all people, but patient groups such as hemodialysis (HD) patients have been particularly affected. We do not know if refugees suffered more during the outbreak. In this study, we compared depressive symptom frequency between Syrian refugee HD patients and Turkish ones. METHODS: The study had a single-center, cross-sectional design. Demographic and clinical data were collected retrospectively from patients' files containing details about past medical history, demographic variables and laboratory values. Validated Turkish and Arabic forms of Beck Depression Inventory (BDI) were used to assess depressive symptoms. BDI scores were compared according to nationality, demographic features and clinical data. A BDI score more than 14 was accepted as suspicion of depression. RESULTS: 119 patients were enrolled in the study. After the exclusion of 22 patients, 75 Turkish and 22 Syrian patients were included for further analysis. The median BDI (interquartile range) score for Turkish and Syrian patients were 12 (7-23) and 19.5 (12.7-25.2), respectively (p = 0.03). Suspicion of depression was present at 42.7% of Turkish, and 72.7% of Syrian HD patients (p = 0.013). Regarding all patients, phosphorus level, Kt/V, and nationality were significantly different between patients with and without suspicion of depression (p = 0.023, 0.039, 0.013, respectively). CONCLUSION: Syrian patients had higher BDI scores and more depressive symptoms than Turkish patients. Additional national measures for better integration and more mental support to Syrian HD patients are needed.


Asunto(s)
Depresión , Pandemias , Refugiados/psicología , Diálisis Renal , Adulto , Anciano , /etnología , Estudios Transversales , Depresión/epidemiología , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Siria/etnología , Turquia/epidemiología
2.
PLoS One ; 15(12): e0242046, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33347460

RESUMEN

INTRODUCTION: Delivering integrated sexual and reproductive health services (SRHS) in emergencies is important in order to save lives of the most vulnerable as well as to combat poverty, reduce inequities and social injustice. More than 60% of preventable maternal deaths occur in conflict areas and especially among the internally displaced persons (IDP). Between 2016 and 2018, unprecedented violence erupted in the Kasaï's region, in the Democratic Republic of Congo (DRC), called the Kamuina Nsapu Insurgency. During that period, an estimated three million of adolescent girls and women were forced to flee; and have faced growing threat to their health, safety, security, and well-being including significant sexual and reproductive health challenges. Between August 2016 and May 2017, the "Sous-Cluster sur les violences basées sur le genre (SC-VBG)" in DRC (2017) reported 1,429 Gender Based Violence (GBV) incidents in the 49 service delivery points in the provinces of Kasaï, Kasaï Central and Kasaï Oriental. Rape cases represented 79% of reported incidents whereas sexual assault and forced marriage accounted for respectively 11% and 4% of Gender Based Violence (GBV) among women and adolescent girls. This study aims to assess the availability of SRHS in the displaced camps in Kasaï; to evaluate the SRHS needs of young girls and women in the reproductive age (12-49). Studies of sexual and reproductive health (SRH) in the Democratic Republic of Congo (DRC) have often included adolescent girls under the age of 15 because of high prevalence of child marriage and early onset of childbearing, especially in the humanitarian context. According to the 2013 Demographic and Health Survey (DHS), about 16% of surveyed women got married by age 14 while the prevalence of early child marriage (marriage by 15) was estimated at 30%; to assess the use of SRHS services and identify barriers as well as challenges for SRH service delivery and use. Findings from this study will help provide evidence to inform towards more needs-based and responsive SRH service delivery. This is hoped for ultimately improve the quality and effectiveness of services, when considering service delivery and response in humanitarian settings. DATA AND METHODS: We will conduct a mixed-methods study design, which will combine quantitative and qualitative approaches. Based on the estimation of the sample size, quantitative data will be drawn from the community-based survey (500 women of reproductive age per site) and health facility assessments will include assessments of 45 health facilities and 135 health providers' interviews. Qualitative data will comprise materials from 30 Key Informant Interviews (KII) and 24 Focus Group Discussions (FGDs), which are believed to achieve the needed saturation levels. Data analysis will include thematic and content analysis for the KIIs and FGDs using ATLAS.ti software for the qualitative arm. For the quantitative arm, data analysis will combine frequency and bivariate chi-square analysis, coupled with multi-level regression models, using Stata 15 software. Statistic differences will be established at the significance level of 0.05. We submitted this protocol to the national ethical committee of the ministry of health in September 2019 and it was approved in January 2020. It needs further approval from the Scientific Oversee Committee (SOC) and the Provincial Ministry of Health. Prior to data collection, informed consents will be obtained from all respondents.


Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Refugiados/psicología , Servicios de Salud Reproductiva/organización & administración , Salud de la Mujer , Adolescente , Adulto , Niño , República Democrática del Congo , Femenino , Humanos , Persona de Mediana Edad , Salud Reproductiva , Salud Sexual , Adulto Joven
3.
Psychiatr Danub ; 32(Suppl 3): 320-336, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33030447

RESUMEN

The war in Bosnia and Herzegovina (1992-1995) was an extremely hard traumatic event with different losses, separations of people, injuries, hard physical and psychical suffering of everyone. Children were especially in difficult conditions. One of the most remarkable things about children, as anyone who works with them soon finds out, is their resilience. While children are vulnerable to psychic damage and, if the damage is deep enough, to delays in emotional and even physical growth, they also have an astonishing capacity to bounce back. This is one of the most rewarding things about treating traumatized children. For many children, it takes very little, perhaps only some words of understanding, to help them tap into their own ability to heal. Taking care of child war psycho-trauma was a difficult task for me, as the war-time head of Department of psychiatry, without enough knowledge in child psycho-trauma and as person with a high responsibility, to organize together with other psychological caretakers of children, especially refugee children. This presentation will be some kind of my remembrance of period of 20-25 years ago when we, I think did good work of what we could and what we knew.


Asunto(s)
Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Guerra/psicología , Adolescente , Adulto , Anciano , Bosnia y Herzegovina , Niño , Familia/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Refugiados/psicología , Resiliencia Psicológica , Trastornos por Estrés Postraumático/rehabilitación , Adulto Joven
4.
Psychiatr Danub ; 32(Suppl 3): 386-395, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33030459

RESUMEN

The use of violence and aggression on civilians during the war has become one of the most prominent military events of the 20th and 21st centuries, resulting in an increasing number of refugees and displaced persons in the midst of regional and tribal conflicts. We are witnessing a daily increase in the number of migrants when people are fleeing from their homes because of human rights violations, persecution, poverty, and conflict. When found in "host" countries, they often encounter bad conditions, with uncertainty and instability. Many come to Europe in search of economic and personal opportunities for progress, where they face different types of process of acculturation. 'Place loss', acute and chronic trauma, family disorders, and family reunification issues became more and more important issues. Refugees, asylum seekers and irregular migrants have a higher risk for certain mental health disorders, including posttraumatic stress, depression and psychosis. In addition to being exposed to various risk factors for mental disorders, migrants often face barriers to access to adequate health care to address these issues. Some of the biggest challenges for migrant populations within "host" countries include: lack of knowledge of health care rights and health systems; poor knowledge of the language; different belief systems and cultural expectations of health care; and the general lack of trust in experts and in government. The rates of depressive and anxiety disorders usually increase over time, and poor mental health is associated with poor socioeconomic conditions - particularly with social isolation and unemployment. Acculturative stress often implies a high discrepancy in the acculturation between parents and their children. This dislocation of families in new conditions has been caused by the different degrees of acceptance of "new culture" by children and parents, which causes serious difficulties, especially in bilingual terms.


Asunto(s)
Aculturación , Salud Mental/estadística & datos numéricos , Refugiados , Migrantes , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo/epidemiología , Europa (Continente) , Humanos , Refugiados/psicología , Refugiados/estadística & datos numéricos , Migrantes/psicología , Migrantes/estadística & datos numéricos
5.
PLoS One ; 15(10): e0239969, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33017408

RESUMEN

BACKGROUND: Traumatized refugees often suffer from diverse psychosomatic symptoms. Female Yazidi refugees from Northern Iraq who survived attacks of the so-called "Islamic State" were brought to Germany to receive special medical and psychotherapeutic treatment in a unique worldwide humanitarian admission program (HAP). Here, we report on their psychosomatic symptoms and helpful strategies from the perspective of care providers. METHODS: Care providers (N = 84) in this HAP were interviewed in an individual setting as well as in focus groups to gather information about the HAP beneficiaries' psychosomatic symptoms. Data analysis followed Qualitative Content Analysis by Mayring. RESULTS: The care providers reported five main psychological burdens of the Yazidis: 1) insecurity regarding loss, 2) worries about family members, 3) ambivalence about staying in Germany or returning to Iraq, 4) life between two worlds and 5) re-actualization of the traumatic experiences. The predominant psychological symptoms the care providers noticed were fear, depressive symptoms, feelings of guilt, and sleep and eating disorders. Regarding somatic symptoms, the care providers mainly received complaints about pain in the head, back, chest and stomach. Helpful strategies for providing adequate health care were care providers' cooperating with physicians, precise documentation of beneficiaries' symptoms, and additional support in directing the beneficiaries through the health care system. Regarding psychotherapy, interpreters help to overcome language barriers, onsite psychotherapy, flexible therapy appointments, psychoeducational methods, time for stabilization, and support in coping with daily life aspects. In the care providers' experience, psychotherapists have to build a relationship of trust. After grief therapy, a trauma-specific therapy in a culturally adapted way is possible. CONCLUSION: The HAP is a unique model health care program to offer highly traumatized refugees medical and psychological help. Care providers reported on several (psycho-)somatic symptoms of the traumatized women. The strategies the HAP care providers perceived as helpful can be recommended for similar projects in the future.


Asunto(s)
Personal de Salud , Trauma Psicológico/fisiopatología , Trastornos Psicofisiológicos/fisiopatología , Refugiados/psicología , Trastornos por Estrés Postraumático/fisiopatología , Adulto , Anciano , Femenino , Alemania , Humanos , Irak/etnología , Islamismo , Masculino , Persona de Mediana Edad , Trauma Psicológico/etnología , Trastornos Psicofisiológicos/etnología , Investigación Cualitativa , Trastornos por Estrés Postraumático/etnología , Encuestas y Cuestionarios , Adulto Joven
6.
Neurology ; 95(19): e2605-e2609, 2020 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-33004606

RESUMEN

OBJECTIVE: Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS: A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS: A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS: We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.


Asunto(s)
Ansiedad/epidemiología , Traumatismos Craneocerebrales/epidemiología , Depresión/epidemiología , Cefalea/epidemiología , Refugiados/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Violencia/estadística & datos numéricos , Adolescente , Adulto , Ansiedad/psicología , Conmoción Encefálica/epidemiología , Conmoción Encefálica/psicología , Traumatismos Craneocerebrales/psicología , Estudios Transversales , Depresión/psicología , El Salvador/etnología , Femenino , Guatemala/etnología , Haití/etnología , Cefalea/psicología , Honduras/etnología , Humanos , Masculino , Trastornos de la Memoria/epidemiología , Trastornos de la Memoria/psicología , México/etnología , Nicaragua/etnología , Oportunidad Relativa , Cuestionario de Salud del Paciente , Prevalencia , Trauma Psicológico/epidemiología , Trauma Psicológico/psicología , Refugiados/psicología , Estudios Retrospectivos , Distribución por Sexo , Delitos Sexuales/psicología , Delitos Sexuales/estadística & datos numéricos , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos por Estrés Postraumático/psicología , Inconsciencia/epidemiología , Inconsciencia/psicología , Estados Unidos/epidemiología , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/psicología , Adulto Joven
8.
PLoS One ; 15(10): e0239747, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33052914

RESUMEN

This study provides an exploration of the meanings of leisure for humanitarian migrants in regional Australia and these meanings' implications for health. It uses mixed-methods to explore leisure-time physical activity participation and day-to-day experiences of leisure and health. A sample representing approximately one third of the Coffs Coast adult humanitarian migrant population completed the survey, as well as 32 individuals who participated in interviews and focus groups. Findings were organised into three themes and explored issues around mental health and time for leisure, cultural differences in experiencing leisure, and the connections with experiences of other disadvantaged groups. We conclude by arguing that leisure needs to be brought to the fore of discussions around service provision and policy making concerned with the wellbeing of the refugee migrant population, particularly focusing on support for the (re)development of a vocabulary for recreation, as a step forward in the journey to healing and belonging.


Asunto(s)
Altruismo , Ejercicio Físico/fisiología , Actividades Recreativas/psicología , Recreación/fisiología , Recreación/psicología , Adulto , Australia , Femenino , Grupos Focales , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Refugiados/psicología , Migrantes/psicología , Vocabulario , Adulto Joven
9.
PLoS One ; 15(10): e0239211, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33027307

RESUMEN

BACKGROUND: The prevalence of psychological complaints is known to be very high in populations of asylum seekers. Despite this, data on the health care system's ability to adequately meet these high-risk populations' mental health needs are scarce. This article investigates how well the German outpatient health care system is able to detect and adequately treat them. METHODS: To this end, we combined data from a cross-sectional survey with billing data from the local social welfare office from the year 2015. Using descriptive statistics, the data of the cross-sectional study are used to quantify the psychological health care needs of asylum seekers while the secondary data analysis indicates the actual access to and extent of psychological treatment. RESULTS: In the cross-sectional study, 54% of patients were screened positive for symptoms of depression, 41% for symptoms of anxiety disorder and 18% for symptoms of Posttraumatic Stress Disorder. In total, 59% were screened positive for at least one of these three disorders. However, when contrasting these screening-based prevalences with the prevalences based on data from the health care system, a mismatch becomes apparent: According to the social welfare office's billing data, only 2.6% of asylum seekers received the diagnosis of depression, 1.4% were diagnosed with anxiety disorder and 2.9% with Posttraumatic Stress Disorder (PTSD). In combination, 4.9% were diagnosed with at least one of these three disorders. Overall, less than one tenth of asylum seekers with symptoms of depression, anxiety or PTSD received the corresponding diagnosis by the health care system. Among those who were diagnosed, about 45% received no treatment at all, while 38% were treated with drugs alone. Only 1% of all patients received psychotherapy. CONCLUSIONS: Psychological complaints are very common among asylum seekers, yet only a small proportion of this population receives the corresponding diagnoses and treatment. While various factors can contribute to these shortcomings, there is an urgent need to systematically address this deficit and introduce measures to improve mental health care for this high-risk population.


Asunto(s)
Salud Mental , Refugiados/psicología , Adolescente , Adulto , Antidepresivos/uso terapéutico , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/tratamiento farmacológico , Estudios Transversales , Depresión/diagnóstico , Depresión/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicoterapia , Bienestar Social , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/tratamiento farmacológico , Encuestas y Cuestionarios , Adulto Joven
10.
PLoS One ; 15(9): e0238109, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32870929

RESUMEN

BACKGROUND: The global refugee population has reached a staggering 25.9 million. Approximately 16% of global refugees resettle in high-income countries which are often culturally very different from their home countries. This can create cross-cultural challenges when accessing health services, leading to inappropriate assessments, diagnoses and treatments if cultural background is not factored in. The impact of culture on the conceptualization and experience of postpartum depression (PPD) amongst migrant women has received growing attention in recent years, however, a specific focus on refugee and asylum-seeking women is lacking. Given the unique mental health challenges refugee women face, it is hypothesized that the interplay between culture and postpartum depression amongst refugee women may differ from other migrant women. Therefore, a scoping review was conducted to characterize what is known about the impact of culture on the conceptualization and experience of PPD in refugee women resettled in high-income countries. METHODS AND FINDINGS: This study was conducted as a scoping review in accordance with the Joanna Briggs Institute's Methodology for Scoping Reviews. A systematic search of studies addressing the relationship between culture and postpartum depression amongst refugee women (including asylum-seeking women) resettled in high-income countries was conducted across 6 databases including MEDLINE, PsycINFO and SOCINDEX between June 2018 and August 2019. A total of 637 articles were found. Studies were eligible if they focused on refugee women who had a pregnancy during forced migration or upon resettlement in a high-income country and focused on the impact of culture on women's conceptualization and/or experience of PPD. Eight studies met inclusion criteria and were included in the final analysis, the majority of which were qualitatively driven. Four key themes emerged: 1) there are diverse conceptualizations and experiences of postpartum depression amongst refugee women; 2) mental health stigma has a significant impact on women's conceptualizations and experiences of postpartum depression and help-seeking behaviors; 3) cultural traditions and social support play protective roles in postpartum mental wellbeing; and, 4) host culture has a significant influence on the pregnancy and postpartum experience of refugee women. The overall themes align with those seen in the literature on migrant women in general, however significant research gaps remain. CONCLUSION: The studies identified through this scoping review provide a rich description of the significant impact culture has on the conceptualization and experience of postpartum depression among refugee women resettled in high-income countries. Though overall themes align with those seen in the literature on migrant women in general, further research is needed to better characterize how culture impacts refugee women's experiences of PPD as a distinct sub-group of migrant women.


Asunto(s)
Cultura , Depresión Posparto/psicología , Países Desarrollados , Refugiados/psicología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Percepción
11.
PLoS One ; 15(9): e0239187, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32941533

RESUMEN

OBJECTIVES: Sexual violence can have a destructive impact on the lives of people. It is more common in unstable conditions such as during displacement or migration of people. On the Greek island of Lesvos, Médecins Sans Frontières provided medical care to survivors of sexual violence among the population of asylum seekers. This study describes the patterns of sexual violence reported by migrants and asylum seekers and the clinical care provided to them. METHODS: This is a descriptive study, using routine program data. The study population consisted of migrants and asylum seekers treated for conditions related to sexual violence at the Médecins Sans Frontières clinic on Lesvos Island (September 2017-January 2018). RESULTS: There were 215 survivors of sexual violence who presented for care, of whom 60 (28%) were male. The majority of incidents reported (94%) were cases of rape; 174 (81%) of survivors were from Africa and 185 (86%) of the incidents occurred over a month before presentation. Half the incidents (118) occurred in transit, mainly in Turkey, and 76 (35%) in the country of origin; 10 cases (5%) occurred on Lesvos. The perpetrator was known to the survivor in 23% of the cases. The need for mental health care exceeded the capacity of available mental care services. CONCLUSION: Even though the majority of cases delayed seeking medical care after the incident, it is crucial that access to mental health services is guaranteed for those in need. Such access and security measures for people in transit need to be put in place along migration routes, including in countries nominally considered safe, and secure routes need to be developed.


Asunto(s)
Refugiados/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Migrantes/estadística & datos numéricos , Adolescente , Adulto , Niño , Femenino , Grecia , Humanos , Masculino , Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Campos de Refugiados/estadística & datos numéricos , Refugiados/psicología , Sociedades Médicas/estadística & datos numéricos , Migrantes/psicología
12.
Z Kinder Jugendpsychiatr Psychother ; 48(5): 369-379, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-32880227

RESUMEN

Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial Abstract. Unaccompanied minor refugees (UMR) are a group particularly vulnerable to mental illness. They pose a great challenge not only for child and youth psychiatric and psychotherapeutic care, but also for youth-welfare institutions. The study examines the effectiveness of Stabilization Training for Adolescent Refugees with Trauma Induced Disorders in inpatient youth-welfare facilities. Methods: We conducted a randomized controlled trial with pre-post design in a naturalistic setting, randomly assigning 9 housing groups for UMRs to the intervention or waiting control condition. The mental stress of 46 UMRs was assessed by both self-report and educational staff-report. Two educational staff members conducted the Stabilization Training for Adolescent Refugees with Trauma Induced Disorders as an intervention in each of the respective residential groups. Results: Participation in training led to a reduction in subjective general psychological stress. At the end of the training, psychological stress in self-judgment was significantly lower in the intervention group than in the waiting control condition. The effectiveness of the training is apparently not reflected by educational staff assessments. Conclusions: Stabilization training is a suitable instrument for the preclinical care of UMR and thus an essential basis for further psychotherapy.


Asunto(s)
Psicoterapia , Refugiados/psicología , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Estrés Psicológico/psicología , Estrés Psicológico/terapia , Adolescente , Humanos , Resultado del Tratamiento
13.
Cochrane Database Syst Rev ; 9: CD013458, 2020 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-32885850

RESUMEN

BACKGROUND: Migrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this population. OBJECTIVES: With this overview of systematic reviews, we will map the characteristics and methodological quality of existing systematic reviews and registered systematic review protocols on the promotion of mental health and prevention and treatment of common mental disorders among refugees, asylum seekers, and IDPs. The findings from this overview will be used to prioritise and inform future Cochrane reviews on the mental health of involuntary migrants. METHODS: We searched Ovid MEDLINE (1945 onwards), Ovid Embase (1974 onwards), Ovid PsycINFO, ProQuest PTSDpubs, Web of Science Core Collection, Cochrane Database of Systematic Reviews, NIHR Journals Library, CRD databases (archived), DoPHER, Epistemonikos, Health Evidence, 3ie International Initiative for Impact Evaluation, and PROSPERO, to identify systematic reviews of mental health interventions for involuntary migrants. We did not apply any restrictions on date, language, or publication status to the searches. We included systematic reviews or protocols for systematic reviews of interventions aimed at refugees, asylum seekers, and internally displaced persons. Interventions must have been aimed at mental health promotion (for example, classroom-based well-being interventions for children), prevention of mental health problems (for example, trauma-focussed Cognitive Behavioural Therapy to prevent post-traumatic stress disorder), or treatment of common mental disorders and symptoms (for example, narrative exposure therapy to treat symptoms of trauma). After screening abstracts and full-text manuscripts in duplicate, we extracted data on the characteristics of the reviews, the interventions examined in reviews, and the number of primary studies included in each review. Methodological quality of the included systematic reviews was assessed using AMSTAR 2. MAIN RESULTS: The overview includes 23 systematic reviews and 15 registered systematic review protocols. Of the 23 published systematic reviews, meta-analyses were conducted in eight reviews. It was more common for the search strategy or inclusion criteria of the reviews to state that studies involving refugees were eligible for inclusion (23/23), than for asylum seekers (14/23) or IDPs (7/23) to be explicitly mentioned. In most reviews, study eligiblity was either not restricted by participant age (9/23), or restricted to adults (10/23). Reviews commonly reported on studies of diagnosis or symptoms of post-traumatic stress disorder or trauma (11/23) and were less likely to report on depression or anxiety (6/23). In 15 reviews the intervention of interest was focused on/ specific to psychological therapy. Across all 23 reviews, the interventions most commonly identified from primary studies were general Cognitive Behavioural Therapy, Narrative Exposure Therapy, and a range of different integrative and interpersonal therapies. Even though many reviews included studies of participants without a diagnosis of a mental health problem, they often assessed mental health treatments and did not usually distinguish between promotion, prevention, and treatment in the review aims. Together the 23 systematic reviews included 336 references, of which 175 were unique primary studies. Limitations to the methodological quality of reviews most commonly related to reporting of selection criteria (21/23), absence of a protocol (19/23), reporting of study design (20/23), search strategy (22/23), and funding sources of primary studies (19/23). AUTHORS' CONCLUSIONS: Gaps exist in the evidence on mental health interventions for refugees, asylum seekers, and internally displaced persons. Most reviews do not specify that internally displaced persons are included in the selection criteria, even though they make up the majority of involuntary migrants worldwide. Reviews specific to mental health promotion and prevention of common mental disorders are missing, and there is more evidence available for adults or mixed populations than for children. The literature is focused on post-traumatic stress disorder and trauma-related symptoms, with less attention for depression and anxiety disorders. Better quality systematic reviews and better report of review design and methods would help those who may use these reviews to inform implementation of mental health interventions.


Asunto(s)
Promoción de la Salud , Trastornos Mentales/terapia , Salud Mental , Refugiados/psicología , Revisiones Sistemáticas como Asunto , Humanos , Trastornos Mentales/prevención & control , Metaanálisis como Asunto , Refugiados/clasificación , Trastornos por Estrés Postraumático/terapia
14.
PLoS Med ; 17(9): e1003283, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32877401

RESUMEN

BACKGROUND: Since 2011, the protracted Syrian war has had tragic consequences on the lives of the Syrian people, threatening their stability, health, and well-being. The most vulnerable are children, who face interruption of schooling and child labor. This study explored the relationship between social capital and the physical health and emotional well-being of Syrian refugee working children in rural areas of Lebanon. METHODS AND FINDINGS: In this cross-sectional study, we surveyed 4,090 Syrian refugee children working in the Bekaa Valley of Lebanon in 2017. Children (8-18 years) gave direct testimony on their living and social environment in face-to-face interviews. Logistic regressions assessed the association of social capital and social cohesion with the health and emotional well-being of Syrian refugee working children; specifically, poor self-rated health, reporting a health problem, engaging in risky health behavior, feeling lonely, feeling optimistic, and being satisfied with life. Of the 4,090 working children in the study, 11% reported poor health, 16% reported having a health problem, and 13% were engaged in risky behaviors. The majority (67.5%) reported feeling lonely, while around 53% were optimistic and 59% were satisfied with life. The study findings suggest that positive social capital constructs were associated with better health. Lower levels of social cohesion (e.g., not spending time with friends) were significantly associated with poor self-rated health, reporting a physical health problem, and feeling more lonely ([adjusted odds ratio (AOR), 2.4; CI 1.76-3.36, p < 0.001], [AOR, 1.9; CI 1.44-2.55, p < 0.001], and [AOR, 0.5; CI 0.38-0.76, p < 0.001], respectively). Higher levels of social support (e.g., having good social relations), family social capital (e.g., discussing personal issues with parents), and neighborhood attachment (e.g., having a close friend) were all significantly associated with being more optimistic ([AOR, 1.5; CI 1.2-1.75, p < 0.001], [AOR, 1.3; CI 1.11-1.52, p < 0.001], and [AOR, 1.9; CI 1.58-2.29, p < 0.001], respectively) and more satisfied with life ([AOR, 1.3; CI 1.01-1.54, p = 0.04], [AOR, 1.2; CI 1.01-1.4, p = 0.04], and [AOR, 1.3; CI 1.08-1.6, p = 0.006], respectively). The main limitations of this study were its cross-sectional design, as well as other design issues (using self-reported health measures, using a questionnaire that was not subject to a validation study, and giving equal weighting to all the components of the health and emotional well-being indicators). CONCLUSIONS: This study highlights the association between social capital, social cohesion, and refugee working children's physical and emotional health. In spite of the poor living and working conditions that Syrian refugee children experience, having a close-knit network of family and friends was associated with better health. Interventions that consider social capital dimensions might contribute to improving the health of Syrian refugee children in informal tented settlements (ITSs).


Asunto(s)
Calidad de Vida/psicología , Refugiados/psicología , Adolescente , Niño , Trabajo Infantil , Estudios Transversales , Emociones , Femenino , Humanos , Líbano/etnología , Masculino , Oportunidad Relativa , Capital Social , Medio Social , Apoyo Social , Siria
15.
PLoS Med ; 17(9): e1003337, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32956381

RESUMEN

BACKGROUND: Globally, the number of refugees and asylum seekers has reached record highs. Past research in refugee mental health has reported wide variation in mental illness prevalence data, partially attributable to methodological limitations. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies. METHODS AND FINDINGS: A comprehensive search of electronic databases was undertaken from 1 January 2003 to 4 February 2020 (MEDLINE, MEDLINE In-Process, EBM Reviews, Embase, PsycINFO, CINAHL, PILOTS, Web of Science). Quantitative studies were included if diagnosis of mental illness involved a clinical interview and use of a validated assessment measure and reported at least 50 participants. Study quality was assessed using a descriptive approach based on a template according to study design (modified Newcastle-Ottawa Scale). Random-effects models, based on inverse variance weights, were conducted. Subgroup analyses were performed for sex, sample size, displacement duration, visa status, country of origin, current residence, type of interview (interpreter-assisted or native language), and diagnostic measure. The systematic review was registered with PROSPERO (CRD) 42016046349. The search yielded a result of 21,842 records. Twenty-six studies, which included one randomised controlled trial and 25 observational studies, provided results for 5,143 adult refugees and asylum seekers. Studies were undertaken across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406). The prevalence of posttraumatic stress disorder (PTSD) was 31.46% (95% CI 24.43-38.5), the prevalence of depression was 31.5% (95% CI 22.64-40.38), the prevalence of anxiety disorders was 11% (95% CI 6.75-15.43), and the prevalence of psychosis was 1.51% (95% CI 0.63-2.40). A limitation of the study is that substantial heterogeneity was present in the prevalence estimates of PTSD, depression, and anxiety, and limited covariates were reported in the included studies. CONCLUSIONS: This comprehensive review generates current prevalence estimates for not only PTSD but also depression, anxiety, and psychosis. Refugees and asylum seekers have high and persistent rates of PTSD and depression, and the results of this review highlight the need for ongoing, long-term mental health care beyond the initial period of resettlement.


Asunto(s)
Trastornos Mentales/epidemiología , Refugiados/psicología , Ansiedad/epidemiología , Trastornos de Ansiedad , Depresión/epidemiología , Trastorno Depresivo , Femenino , Humanos , Masculino , Salud Mental/tendencias , Prevalencia , Trastornos por Estrés Postraumático/epidemiología
16.
Health Rep ; 31(8): 3-12, 2020 08 19.
Artículo en Inglés | MEDLINE | ID: mdl-32816413

RESUMEN

BACKGROUND: Few studies of the healthy immigrant effect (HIE) have examined the mental health outcomes of Canadian-born individuals on a national scale compared with immigrants by admission category. This study fills this gap by examining the self-reported mental health (SRMH) of immigrants by admission category and other immigration dimensions (e.g., source world region and duration since landing) and making comparisons with Canadian-born respondents to a population-based survey. DATA AND METHODS: Based on four cycles (2011 to 2014) of the Canadian Community Health Survey (CCHS) linked to the Longitudinal Immigration Database (IMDB), odds ratios of high (i.e., excellent or very good) SRMH among Canadian-born respondents and IMDB-linked immigrants are compared using logistic regression. Among the IMDB immigrant population, high SRMH was also examined according to the above-mentioned immigration dimensions. Adjusted results were hierarchically controlled for age, sex, social and economic factors, and sense of belonging. RESULTS: Age-sex adjusted results show that immigrants, especially refugees, are less likely than the Canadian-born population to report high mental health levels, but these differences disappeared after full adjustment. The odds of immigrants having high SRMH differed more by source world region and duration since landing. For example, fully adjusted results show support for the HIE, with recent immigrants (interviewed within 10 years of landing) more likely to report high SRMH than either the Canadian-born population or established immigrants. Greater odds of high SRMH among recent immigrants also holds across admission classes and for selected world regions. DISCUSSION: This study provides new evidence on differences in mental health between Canadian-born individuals and immigrants by various characteristics. Results support a deterioration of the HIE in SRMH and identify factors significantly associated with SRMH. This study can also serve as a baseline for further studies on the impact of COVID-19 on immigrants' mental health by immigrant category.


Asunto(s)
Emigrantes e Inmigrantes/psicología , Estado de Salud , Salud Mental , Refugiados/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Niño , Infecciones por Coronavirus/psicología , Bases de Datos Factuales , Emigración e Inmigración , Grupos Étnicos , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias , Neumonía Viral/psicología , Autoinforme , Adulto Joven
17.
BMC Infect Dis ; 20(1): 592, 2020 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-32778060

RESUMEN

BACKGROUND: Treatment of tuberculosis infection (TBI) in individuals at high risk for tuberculosis (TB) disease is a priority for TB elimination in the US. Newly arrived refugees in Middle Tennessee are screened for TBI, but factors associated with gaps in the TBI care cascade are not well characterized. METHODS: We assessed the TBI care cascade from US entry to completion of treatment for refugees who resettled in Middle Tennessee from 2012 through 2016. We assessed factors associated with treatment initiation and completion using logistic regression models. RESULTS: Of 6776 refugees who completed initial health screening, 1681 (25%) screened positive for TBI, 1208 were eligible for treatment, 690 started treatment, and 432 completed treatment. Male sex (Odds Ratio [OR]: 1.42; 95% Confidence Interval [CI]: 1.06, 1.89) and screening with interferon gamma release assay compared to tuberculin skin test (OR: 2.89; 95% CI: 1.59, 5.27) were associated with increased treatment initiation; living farther away from TB clinic was associated with decreased treatment initiation (OR: 0.91; 95% CI: 0.83, 0.99). Existing diabetes (OR: 7.27; 95% CI: 1.93, 27.30), receipt of influenza vaccination (OR: 1.65; 95% CI: 1.14, 2.40) and region of origin from South-Eastern or Southern Asia (ORSEAsia: 2.30; 95% CI: 1.43, 3.70; ORSAsia: 1.64; 95% CI: 1.02, 2.64) were associated with increased treatment completion. Six refugees developed TB disease after declining (n = 4) or partially completing (n = 2) TBI treatment; none who completed treatment developed TB disease. CONCLUSIONS: We determined gaps in the TBI care cascade among refugees in Middle Tennessee. Further assessment of barriers to treatment initiation and completion and interventions to assist refugees are warranted to improve these gaps and prevent TB disease.


Asunto(s)
Refugiados/psicología , Tuberculosis/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Tamizaje Masivo , Oportunidad Relativa , Estudios Retrospectivos , Tennessee , Tuberculosis/tratamiento farmacológico , Adulto Joven
18.
Epidemiol Psychiatr Sci ; 29: e154, 2020 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-32787983

RESUMEN

Forced migrants are at an increased risk of mental disorder compared to host country populations. To effectively address this, programmatic and policy responses need to be underpinned by rigorous evidence. Drawing on our experience conducting a systematic review of post-migration risk factors for mental disorder among asylum seekers and our appraisal of related systematic reviews, this paper discusses four challenges facing the field: (1)The reliance on Western conceptions of mental health.(2)The investigation, to date, of a relatively narrow range of potential risk factors.(3)The lack of consistency in the measurement and reporting of risk factor variables.(4)The use of the legal term 'asylum seeker' to define study populations.We suggest potential ways forward, including using mental health measures developed in collaboration with communities affected by forced migration, the examination of key risk factors around homelessness and workers' rights, the development of a core set of risk factors to be investigated in each study, and defining study populations using the conceptual category of 'sanctuary seekers' - people who have fled their country and are asking another country for safety and residence.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Trastornos Mentales , Refugiados/psicología , Migrantes/psicología , Vivienda , Humanos , Trastornos Mentales/etnología , Trastornos Mentales/psicología , Salud Mental , Política
19.
PLoS Med ; 17(8): e1003235, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32760068

RESUMEN

BACKGROUND: Temporal patterns in the frequency and characteristics of self-harm episodes across the Australian asylum seeker population may have implications for self-harm prevention and public health policy. The aim of this study was to examine how the distribution of self-harm episodes and method(s) of self-harm used across the Australian asylum seeker population vary according to the 24-hour cycle, day, and month, and to establish a basis for further research. METHODS AND FINDINGS: We conducted an observational study of all 949 self-harm incidents reported across the Australian asylum seeker population (representing a monthly average of 28,992 adults) between 1 August 2014 and 31 July 2015, obtained by Freedom of Information (FOI) from the Department of Immigration. Time of self-harm, day, and month of occurrence were investigated across all five Australian asylum seeker populations (i.e., community-based arrangements, community detention, onshore immigration detention, offshore immigration detention [Nauru], and offshore immigration detention [Manus Island]). Significant variations in distributions over the 24-hour cycle were observed by processing arrangements. Compared with the average distribution across all other processing arrangements, self-harm more commonly occurred among community-based asylum seekers (36.3%) between 12:00 AM and 3:59 AM (p < 0.001), in asylum seekers on Manus Island (36.4%) between 4:00 PM and 7:59 PM (p = 0.02), and among asylum seekers in onshore detention (20.4%) between 8:00 PM and 11:59 PM (p < 0.001). Compared with the average distribution across all other methods, self-poisoning (by medication) (25%) was significantly more likely to occur between 12:00 AM and 3:59 AM (p = 0.009), and self-battery (42%) between 8:00 AM and 11:59 AM (p < 0.001). The highest and lowest monthly self-harm episode rates for the whole asylum seeker population were in August (2014) (5 episodes per 1,000 asylum seekers; 95% confidence interval [CI] 1-11) and in both January and February (2015) (2.1 episodes per 1,000 asylum seekers; 95% CI 0.6-7.2), respectively; however, the overlapping CIs indicate no statistically significant differences across the months. When examining monthly trends by processing arrangements, we observed that self-harm was significantly more likely to occur in August (2014) than other months of the year among asylum seekers in onshore detention (19%) (p < 0.001), in January (2015) on Manus Island (18%) (p = 0.002), and in October (2014) on Nauru (15%) (p < 0.001). The main study limitations were that we could not investigate certain characteristics associated with self-harm (e.g., gender, country of origin), as the Department of Immigration did not routinely collect such data. There was also the potential risk of making a type 1 error, given the exploratory nature of the comparisons we undertook; we minimised this by lowering our significance threshold from 0.05 to 0.01. CONCLUSIONS: Self-harm in the Australian asylum seeker population was found to vary according to time of day and month of the year, by processing arrangements. A series of procedure-related and detention-related factors were observed to be associated with the temporal variations in self-harm. These findings should form the basis for further investigation into temporal variations in self-harm among asylum seekers, which may in turn lead to effective self-harm prevention strategies.


Asunto(s)
Ritmo Circadiano , Vigilancia de la Población , Refugiados/psicología , Estaciones del Año , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Adulto , Australia/epidemiología , Ritmo Circadiano/fisiología , Femenino , Humanos , Masculino , Vigilancia de la Población/métodos , Conducta Autodestructiva/diagnóstico , Factores de Tiempo , Adulto Joven
20.
Public Health ; 186: 52-56, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32771661

RESUMEN

OBJECTIVES: Lockdown measures in response to the coronavirus disease 2019 (COVID-19) pandemic can have serious mental health effects on the population, especially in vulnerable groups, such as those living in poor socio-economic conditions, those who are homeless, migrant workers and asylum seekers/refugees. In addition, these vulnerable groups frequently have greater difficulty accessing health services and in treatment adherence. The aim of this study is to estimate the impact of the COVID-19-related lockdown on service utilisation and follow-up adherence in an Italian mental health outpatient service for migrants and individuals in socio-economic difficulties. STUDY DESIGN: The design of this study is a retrospective cross-sectional study. METHODS: All patients who visited the mental health outpatient service in the months of February and March in the years 2017-2020 were included in the study. To compare service utilisation before and after the lockdown, the number of patients who visited the mental health outpatient service for psychiatric interview were recorded. Follow-up adherence was calculated as the percentage of patients who visited in February and subsequently attended a follow-up visit in March of the same year. RESULTS: The number of patients who visited the outpatient service between February 2017 and February 2020 was continuously increasing. In March 2020, fewer patients visited the service for psychiatric interview, in line with the introduction of lockdown measures. In addition, the number of the patients who visited in February 2020 and returned for their follow-up visits in March 2020 declined from approximately 30% over the same months in 2017-2019 to 17.53% in March 2020. CONCLUSIONS: The lockdown-related reduction in numbers of patients accessing the mental health service makes it difficult to help vulnerable populations during a period of time in which their mental health needs are expected to increase. Moreover, the reduction seen in follow-up compliance increases the risk of treatment discontinuation and possible relapse. Proactive alternative strategies need to be developed to reach these vulnerable populations.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Emigrantes e Inmigrantes/psicología , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Pobreza , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Adulto , Infecciones por Coronavirus/epidemiología , Estudios Transversales , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Personas sin Hogar/psicología , Personas sin Hogar/estadística & datos numéricos , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Refugiados/psicología , Refugiados/estadística & datos numéricos , Estudios Retrospectivos , Poblaciones Vulnerables , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA