Unpacking gender-specific risk and protective factors for mental health status among Congolese refugees in Uganda.

Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations.Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups.Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males.Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive.

This research identified key differences in how specific traumatic experiences and social factors correlate with psychological distress for male and female Congolese refugees, underscoring the need for tailored support strategies.The study reveals that while discrimination is a stronger predictor of depression in men, experiences of rape are more closely linked to depression in women. Conversely, social factors like literacy and group membership offer more protection to men, whereas relationship status and community connection are more protective for women.The findings shed light on the importance of gender-sensitive mental health and psychosocial support interventions.

A qualitative evaluation of the use of Problem Management Plus (PM+) among Arabic-speaking migrants with psychological distress in France - The APEX study.

ABSTRACTBackground: Feasibility studies with non-French speaking migrants in France are needed to inform appropriate adaptation of psychosocial intervention procedures.Objective: To test the WHO Problem Management Plus (PM+) intervention protocol for Arabic-speaking migrants in the Paris metropolitan region.Methods: Between 2019 and 2021 we recruited participants from three accommodation centres receiving asylum seekers or migrants experiencing social and economic difficulties. Participants experiencing psychological distress underwent five PM + sessions with trained helpers. Feasibility was evaluated through 15 interviews with 8 participants, 4 helpers, and 3 study supervisors. Interview topics covered PM + implementation in general and for each component. We also sought to understand problems with delivery and gathered suggestions for improvement. Data were analysed thematically using a deductive approach.Results: We found implementation of PM + to be feasible, with predominantly positive reactions from participants, helpers and study staff. All intervention components were considered beneficial, with breathing exercises considered easy to implement and often sustained. Selection of problems and strategies to address them were described as challenging to execute. Psychosocial support from and rapport with helpers and the use of the native language were considered key strengths of the programme. However, we observed the need for complementary or higher intensity psychological support in some cases. Findings also highlighted the importance of addressing distress among non-specialist helpers delivering PM + . Finally, local guidance to social resources were suggested to be added in the protocol.Conclusion: PM + was well-liked and feasible, with cultural adjustments and increased access to community resources for migrants needed.

The World Health Organization Problem Management Plus (PM+) intervention was found to be a feasible and acceptable intervention for Arabic-speaking migrants in the Paris metropolitan region, with participants reporting improved mental health outcomes and satisfaction with the programme.The features of psychosocial support from and rapport with non-specialist helpers delivering PM + and the use of the native language were considered key strengths of the programme.The study documented perceived benefits of expanding PM + in scope and length, suggests the need for additional mental health services for non-specialist helpers, and highlights the importance of considering cultural and linguistic factors when providing mental health services to asylum seekers or migrants experiencing social and economic difficulties.

Profiles of posttraumatic stress disorder and negative world assumptions in treatment-seeking refugees.

Background: Refugees often suffer from trauma-related psychopathology, specifically posttraumatic stress disorder (PTSD). Negative world assumptions are strongly correlated with the development, course, and severity of PTSD.Objective: This study aimed to investigate whether there are distinct profiles of PTSD and negative world assumptions (NWA) and examine whether trauma load, torture, and gender differentially predict such symptom profiles.Method: In a sample of 225 treatment-seeking refugees who had resettled in the Netherlands, latent profile analysis was used to identify subgroups of patients sharing the same profile of PTSD and NWA symptoms. Predictors of profile membership were analyzed via multinomial logistic regression.Results: A three-profile solution yielded the best model fit: a low PTSD/low NWA profile (23.6%), a high PTSD/high NWA profile (41.8%), and a high PTSD/low NWA profile (34.7%). Participants who reported a higher trauma load, were more likely to be part of the high PTSD/high NWA profile or the high PTSD/low NWA profile in comparison to low PTSD/low NWA profile. Participants who reported having experienced torture were more likely to be part of the high PTSD/high NWA profile in comparison to low PTSD/low NWA profile. Gender did not differentiate between the profiles.Conclusions: This study reveals that among treatment-seeking refugees resettled in the Netherlands, there are distinct profiles of PTSD and NWA. These profiles indicate that PTSD and NWA are not uniformly experienced among refugees, emphasizing the diversity in their psychological responses to trauma. Among individuals experiencing severe PTSD symptoms, a subgroup was identified of individuals who additionally exhibited negative assumptions about themselves, others, and the world. Recognizing this heterogeneity is crucial in both research and clinical practice, particularly in the context of refugee mental health. Directions for future research are discussed.

Three profiles of PTSD and negative world assumptions were identified in a group of treatment-seeking refugees.Directions for future research and the importance of recognizing heterogeneity in psychological responses to traumatic experiences in refugees are discussed.

Use of an application on the measles vaccine for Warao indigenous refugees in Brazil / Uso de una aplicación sobre la vacuna contra el sarampión para los indígenas Warao refugiados en Brasil / Uso de um aplicativo sobre a vacina antissarampo para os indígenas Warao refugiados no Brasil

ABSTRACT Objective: To evaluate the need to develop an application with information about the measles vaccine for Warao indigenous people. Methods: This was a quantitative study conducted at the Espaço de Acolhimento Tapanã refugee shelter in the city of Belém, Pará, Brazil. The study sample was selected for convenience. Data were analyzed descriptively using Bioestat 5.0 software. Results: Twenty-one Warao indigenous individuals were interviewed. It was identified that 91% (n=20) had lost their vaccination card; 91% (n=20) stated they had lost their vaccination card more than three times, and 91% expressed interest in an application to store their vaccination information. Conclusions: The research provided important information for the development of a health application named WaraoMedI (Warao Measles Diversity Indigenous), as well as offered nursing professionals evidence about the challenges Warao indigenous refugees face in self-managing their vaccination information.

RESUMEN Objetivo: evaluar la necesidad de desarrollar una aplicación con información sobre la vacuna contra el sarampión para los indígenas Warao. Métodos: Estudio cuantitativo, realizado en el refugio de refugiados llamado Espacio de Acolhida Tapanã, en la ciudad de Belém, Pará, Brasil. La muestra del estudio fue por conveniencia. Los datos fueron analizados de forma descriptiva, mediante el software Bioestat 5.0. Resultados: se entrevistaron a 21 indígenas Warao. Se identificó que el 91% (n=20) perdieron su tarjeta de vacunación; el 91% (n=20) afirmó que perdió la tarjeta de vacunación más de 3 veces y el 91% afirmó que les gustaría una aplicación para guardar su información de vacunación. Conclusiones: La investigación proporcionó información importante para la construcción de una aplicación de salud llamada WaraoMedI (Warao Measles Diversity Indigenous), así como proporcionó a los profesionales de enfermería evidencia sobre las dificultades de los indígenas Warao refugiados para autogestionar información sobre vacunación

RESUMO Objetivo: avaliar a necessidade de desenvolver um aplicativo com informações sobre a vacina antissarampo para indígenas Warao. Métodos: Estudo quantitativo, realizado no abrigo de refugiados chamado Espaço de Acolhimento Tapanã, na cidade de Belém, Pará, Brasil. Amostra do estudo foi por conveniência. Os dados foram analisados de forma descritiva, por meio do software Bioestat 5.0. Resultados: foram entrevistados 21 indígenas Warao. Identificou-se que 91% (n=20) perderam o cartão de vacina; 91% (n=20) afirmaram que perderam o cartão de vacina mais de 3 vezes e 91% afirmaram que gostariam de um aplicativo para guardar suas informações de vacina. Conclusões: A pesquisa ofereceu informações importantes para a construção de um aplicativo em saúde chamado WaraoMedI (Warao Mesles Diversity Indigenous), assim como disponibilizou aos profissionais de enfermagem evidências sobre as dificuldades de os indígenas Warao refugiados autogerenciarem informações sobre vacina.

A comparison of PTSD and traumatic event rates in a clinical sample of non-refugee immigrants and native-born individuals with a psychotic disorder: a case-control study.

Background: Migration is a multi-stage social process linked to traumatic event exposure and a notably increased risk of psychosis. Although these conditions affect refugee and non-refugee immigrants, prior trauma research has focused mainly on the refugee population.Objective: To compare and describe the rate and the clinical characterization of PTSD and traumatic events between non-refugee immigrants and native-born individuals with psychotic disorder.Methods: 99 immigrants and 99 native-born individuals (n = 198) with at least one psychotic episode according to DSM-5 criteria were compared on the rate of PTSD diagnosis and traumatic events, using standardized and validated trauma scales.Results: In the non-refugee immigrant group, 31% met diagnostic criteria for PTSD compared to only 7.1% in the native-born group. Total scores in childhood trauma and last year stressful events were 1.5 and 2 times higher in non-refugee immigrants, respectively. Likewise, cumulative lifetime trauma was three times higher in non-refugee immigrants. Finally, non-refugee immigrants reported more violent and life-threatening traumatic events than native-born individuals.Conclusions: These results are relevant since they highlight that non-refugee immigrants with psychotic disorders are highly trauma-exposed, meaning a routine trauma assessment and a trauma-focused intervention for this population should be included in individualized treatment plans.

Traumatic events and PTSD rates in the non-refugee immigrant population with psychotic disorder have previously received scant attention.This study found that in a psychotic population, 31% of the non-refugee immigrants presented a PTSD diagnosis compared to only 7.1% of the native-born individuals.Compared to native-born individuals with psychosis, non-refugee immigrants with psychosis have 1.5 times more childhood trauma exposure, 2 times more stressful events in the past year and 3 times more cumulative trauma over their lifetime.

School-based Psychosocial Interventions’ Effectiveness in Strengthening Refugee and Migrant Adolescents’ Mental Health, Resilience, and Social Relations: A Four-country Cluster Randomized Study / [La eficacia de las intervenciones psicosociales centradas en la escuela para potenciar la salud mental, la resiliencia y las relaciones sociales de adolescentes refugiados y migrantes: un estudio de grupos aleatorizados en cuatro países]

School-based psychosocial interventions are increasingly put forward as a way to support young refugees’ and migrants’ well-being and mental health in resettlement. However, the evidence on these interventions’ effectiveness remains scarce and scholars denounce particular gaps in the evidence to date, pointing to a lack of large-scale, controlled studies and studies including social outcome measures. This cluster randomized study aims to strengthen the evidence base on school-based psychosocial interventions for refugee and migrant youth by assessing the effect of two interventions, Classroom Drama and Welcome to School, on youth’s mental health, resilience, and social relations in Belgium, Denmark, Norway, and the United Kingdom. Multilevel analyses were conducted separately for the two interventions (Classroom Drama, n = 307, ages 11-19; Welcome to School, n = 251, ages 11-23), using separate no-treatment control groups. Our analyses indicated a significant main, positive effect of Classroom Drama on perceived family support, and an effect on perceived support from friends that was moderated by country: in the United Kingdom, the intervention group reported an increase in perceived friend support, whereas the control group reported a decrease. Furthermore, baseline resilience moderated the effect of the Classroom Drama intervention on behavioral difficulties and well-being. No effects of Welcome to School on any of the outcome variables were found. Overall, this study provides novel, nuanced evidence on school-based psychosocial interventions for refugee and migrant adolescents.(AU)

Cada vez se proponen más las intervenciones psicosociales centradas en la escuela como ayuda al bienestar de jóvenes refugiados y migrantes en su realojamiento. No obstante hay pocas pruebas sobre la eficacia de tales intervenciones y los expertos denuncian fallas en dichas pruebas hasta el momento debido a la falta de estudios controlados a gran escala que incluyan medidas de los resultados sociales. El presente estudio de grupos aleatorizados pretende potenciar la base de pruebas sobre intervenciones psicosociales centradas en la escuela con jóvenes refugiados y migrantes analizando el efecto de dos intervenciones, “El drama en el aula” y “Bienvenido al colegio”, en la salud mental, la resiliencia y las relaciones sociales de los jóvenes en Bélgica, Dinamarca, Noruega y el Reino Unido. Se efectuaron análisis multinivel por separado para las dos intervenciones (“El drama en el aula”, n = 307, edad entre 11 y 19 años; “Bienvenido al colegio”, n = 251, edad entre 11 y 23 años) con grupos de control sin tratamiento separados. Los análisis mostraron un efecto positivo principal significativo de “El drama en el aula” en el apoyo familiar percibido y un efecto en el apoyo percibido de los amigos moderado por el país: en el Reino Unido el grupo de intervención presentó un aumento del apoyo percibido de los amigos, mientras que en el grupo control disminuyó. Además la resiliencia básica moderaba el efecto de la intervención de “El drama en el aula” en las dificultades conductuales y en el bienestar. No se apreció efecto de “Bienvenido al colegio” en ninguna de las variables resultado. En términos generales el estudio supone un inédito y detallado aval de las intervenciones psicosociales centradas en la escuela en el caso de adolescentes refugiados y migrantes.(AU)

Gender differences in substance use and associated factors among urban refugees in Uganda.

BACKGROUND: Alcohol and other substances use related problems among refugees is a global public health concern. Although there is substantial research on the use of alcohol and other substances among the refugees, little is known about gender and other factors that might be associated with the use of alcohol and other substances. Our study aimed to assess the prevalence of alcohol and substance use across gender and other specific associated factors among urban refugees living in Mbarara city, Southwestern Uganda. METHODS: In a cross-sectional study, 343 refugees were interviewed on the use of alcohol and other substances using the Alcohol Use Disorder Identification Test and the Drug Abuse Screening Test. The associated factors included, age, marital status, occupation, duration (length of stay) in Uganda, educational levels, stigma and depression. Linear regression analysis was used to examine the associations between the predictor and outcome variables. RESULTS: No significant gender difference in alcohol use was found, and the overall prevalence of hazardous, harmful or dependent alcohol use among our sample of refugees living in Mbarara city was 43%. There were however, statistically significant gender differences in the use of other substances, with a significantly higher percentage of men than women reporting intermediate, substantial, or severe substance use (45% among men, 37% among women). Higher levels of depression and being separated from one's spouse were associated with higher levels of alcohol and substance use. In addition, higher age and being male were associated with the use of substances other than alcohol. CONCLUSIONS: Our findings indicate a high prevalence of problematic alcohol and substance use among both male and female refugees. Clinical interventions focused on the treatment and prevention of alcohol and substance use among the refugee communities may benefit from focusing on depressive symptoms as well.

Problematic use of alcohol and other substances was highly prevalent in both among male than female refugees.Problematic use of alcohol and other substances was associated with symptoms of depression.Interventions focused on the treatment of problematic use of alcohol and other substances may benefit from taking depressive symptoms into consideration.

Prevalencia de síntomas mentales entre los refugiados saharauis en Tinduf, Argelia, utilizando el Cuestionario de Salud General Goldberg 28 / Prevalence of mental symptoms in the Sahrawi refugees in Tindouf camps, Algeria, determined using the Goldberg General Health Questionnaire 28

Objetivo: Estimar la prevalencia de síntomas psicopatológicos entre los refugiados saharauis y la influencia de factores sociodemográficos en la expresión fenotípica de los trastornos mentales. Diseño: Estudio descriptivo transversal. Emplazamiento: Atención primaria y hospitalaria de salud. Participantes: Trescientos ochenta y tres (383) participantes mayores de 18 años, 59,8% mujeres y 40,2% hombres, con una media de edad del 37,2 (DE = 13,0), del campamento del Aaiún y del Hospital Nacional de Rabuni. Método: Se llevó a cabo un estudio descriptivo transversal y analítico entre enero y agosto de 2017. Los participantes se seleccionaron por muestreo consecutivo. La variable principal fue la presencia de síntomas mentales, medida con el Cuestionario General de Salud de Goldberg-28. Se hizo un análisis descriptivo de cada variable sociodemográfica (edad, sexo, nivel de estudios, ocupación) y su asociación con la variable principal mediante regresión logística. Resultados: El 43,3%, IC 95% (38,4-48,3) obtuvo puntuación que sugiere la presencia de síntomas mentales. Las mujeres presentaron una puntuación media superior a los hombres, en las subescalas A (síntomas somáticos) y en la subescala B (ansiedad). Se asociaron con mayor probabilidad de tener síntomas mentales la edad mayor de 50 años y no tener nivel de estudios. Conclusiones: El estudio pone de manifiesto que la prevalencia de síntomas mentales entre los refugiados saharauis es alta, y refuerza la necesidad de más investigaciones científicas en el campo de la salud mental para poner la prevención de los trastornos mentales y la promoción de la salud mental en el foco de las políticas sanitarias.(AU)

Objective: To assess the prevalence of psychopathological symptoms among Saharawi refugees and the influence of sociodemographic factors on the phenotypic expression of mental disorders.Design: Cross-sectional descriptive study. Location: Primary and hospital health care. Participants: 383 participants over 18 years of age, 59.8% women and 40.2% men, with a mean age of 37.2 (SD = 13.0), from the Laayoune camp, and from the Rabuni National Hospital. Methodology: A descriptive, cross-sectional and analytical study was carried out between January and August 2017. Participants were selected by consecutive sampling. The main variable was the presence of mental symptoms, measured with the Goldberg General Health Questionnaire - 28. A descriptive analysis of each sociodemographic variable (age, sex, educational level, occupation) and its association with the main variable was carried out using Logistic regression. Results: 43.3%, 95%CI (38.4-48.3) obtained a score that suggests the presence of mental symptoms. Women presented a mean score higher than men, in subscales A (somatic symptoms) and in subscale B (anxiety). Age over 50 years and having no educational level were associated with a higher probability of having mental symptoms. Conclusions: The study shows that the prevalence of mental symptoms among Saharawi refugees is high, and reinforces the need for more scientific research in the field of mental health to put the prevention of mental disorders and the promotion of mental health in the focus of health policy.(AU)

No association between war-related trauma or PTSD symptom severity and epigenome-wide DNA methylation in Burundian refugees.

Background: War-related trauma is associated with varying posttraumatic stress disorder (PTSD) prevalence rates in refugees. In PTSD development, differential DNA methylation (DNAm) levels associated with trauma exposure might be involved in risk versus resilience processes. Studies investigating DNAm profiles related to trauma exposure and PTSD among refugees remain sparse.Objective: The present epigenome-wide association study investigated associations between war-related trauma, PTSD, and altered DNAm patterns in Burundian refugee families with 110 children and their 207 female and male caregivers.Method: War-related trauma load and PTSD symptom severity were assessed in structured clinical interviews with standardised instruments. Epigenome-wide DNAm levels were quantified from buccal epithelia using the Illumina EPIC beadchip.Results: Controlling for biological confounders, no significant epigenome-wide DNAm alterations associated with trauma exposure or PTSD were identified in children or caregivers (FDRs > .05). Co-methylated positions derived as modules from weighted gene correlation network analyses were not significantly associated with either war-related trauma experience in children or caregivers or with PTSD.Conclusions: These results do not provide evidence for altered DNAm patterns associated with exposure to war-related trauma or PTSD.

The study examines an understudied population in epigenome-wide association studies.Burundian refugees' war-trauma, PTSD, and DNA methylation were studied.Epigenome-wide DNA methylation was not significantly associated with war-trauma or PTSD in the conflict-affected sample.

Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis.

Background: People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders.Objective: To summarize evidence on the efficacy of psychosocial interventions aiming to promote mental health and/or to prevent mental symptoms by fostering transdiagnostic skills in forcibly displaced persons of all ages.Method: Four databases and reference lists were searched for randomized controlled trials on interventions in this population on 11 March 2022. Thirty-six studies were eligible, 32 studies (comprising 5299 participants) were included in random-effects multilevel meta-analyses examining the effects of interventions on mental symptoms and positive mental health (e.g. wellbeing) as well as moderators to account for heterogeneity. OSF Preregistration-ID: 10.17605/OSF.IO/XPMU3Results: Our search resulted in 32 eligible studies, with 10 reporting on children/adolescents and 27 on adult populations. There was no evidence for favourable intervention effects in children/adolescents, with 44.4% of the effect sizes pointing to potentially negative effects yet remaining non-significant. For adult populations, our meta-analyses showed a close-to-significant favourable effect for mental symptoms, M(SMD) = 0.33, 95% CI [-0.03, 0.69], which was significant when analyses were limited to high-quality studies and larger for clinical compared to non-clinical populations. No effects emerged for positive mental health. Heterogeneity was considerable and could not be explained by various moderators (e.g. type of control, duration, setting, theoretical basis). Certainty of evidence was very low across all outcomes limiting the generalizability of our findings.Conclusion: The present review provides at most weak evidence for an effect favouring transdiagnostic psychosocial interventions over control conditions for adult populations but not for children and adolescents. Future research should combine the imperative of humanitarian aid in face of major crises with studying the diverse needs of forcibly displaced persons to improve and tailor future interventions.

This review is the first to examine the efficacy of transdiagnostic interventions for mental health promotion and prevention of mental disorders in forcibly displaced persons of all ages.Overall, we found no favourable effect of transdiagnostic interventions in both children/adolescents and adults. Excluding studies at high risk of bias, there was weak evidence for a small favourable effect in adults, but not in children and adolescents. Thus, so far, there is weak evidence for transdiagnostic interventions in forcibly displaced persons.Research efforts need to match care needs: While most people live and need care in low-income countries, the majority of research has been conducted in high-income countries.

[Prevalence of mental symptoms in the Sahrawi refugees in Tindouf camps, Algeria, determined using the Goldberg General Health Questionnaire 28]. / Prevalencia de síntomas mentales entre los refugiados saharauis en Tinduf, Argelia, utilizando el Cuestionario de Salud General Goldberg 28.

OBJECTIVE: To assess the prevalence of psychopathological symptoms among Saharawi refugees and the influence of sociodemographic factors on the phenotypic expression of mental disorders. DESIGN: Cross-sectional descriptive study. LOCATION: Primary and hospital health care. PARTICIPANTS: 383 participants over 18 years of age, 59.8% women and 40.2% men, with a mean age of 37.2 (SD = 13.0), from the Laayoune camp, and from the Rabuni National Hospital. METHODOLOGY: A descriptive, cross-sectional and analytical study was carried out between January and August 2017. Participants were selected by consecutive sampling. The main variable was the presence of mental symptoms, measured with the Goldberg General Health Questionnaire - 28. A descriptive analysis of each sociodemographic variable (age, sex, educational level, occupation) and its association with the main variable was carried out using Logistic regression. RESULTS: 43.3%, 95%CI (38.4-48.3) obtained a score that suggests the presence of mental symptoms. Women presented a mean score higher than men, in subscales A (somatic symptoms) and in subscale B (anxiety). Age over 50 years and having no educational level were associated with a higher probability of having mental symptoms. CONCLUSIONS: The study shows that the prevalence of mental symptoms among Saharawi refugees is high, and reinforces the need for more scientific research in the field of mental health to put the prevention of mental disorders and the promotion of mental health in the focus of health policy.

Victims of armed conflict in India: psychosocial impact and available support.

India has been a part of 5 major wars since its independence in 1947 and hosts over 212,413 refugees from Sri Lanka, Tibet and Bangladesh. So, a wide spectrum of trauma survivors, both civilian and military, live in this country and require mental healthcare. We discuss the psychological impact of armed conflict and how the country and culture tint it uniquely. We not only explore the current scene but the resources available and what can be done to make such vulnerable parts of the Indian population feel safer.

The spectrum of victims of armed conflict in India and the impact on their mental health.The current deficient governmental and non-governmental psychosocial support available.Recommendations for optimum management of these trauma victims through programmes and individual therapy.

The effects of traumatic experiences during transit and pushback on the mental health of refugees, asylum seekers, and migrants.

Background: There are 26 million people recognised as refugees worldwide. Many of them spent a prolonged period of time in transit - time after they leave their country of origin and before they reach the receiving country. Transit brings numerous protection and mental health risks refugees are exposed to.Objective: The aim of this study was to assess the stressful and traumatic experiences refugees are exposed to during transit, with a special focus on the experience of pushback - the denial of access to the territory to foreign nationals and forcible return to countries of origin or neighbouring countries without an assessment of their rights to international protection, as well as the impact of these experiences on refugees' mental health and well-being.Method: 201 refugees currently residing in Serbia completed the Stressful and Traumatic Experiences in Transit questionnaire - short version (SET-SF), questionnaire for assessing stressful and traumatic experiences during pushback (SET-SF PB), Refugee Health Screener (RHS-15), and Well-being index (WHO-5).Results: The results showed that refugees experience a large number of stressful and traumatic events (M = 10.27, SD = 4.85). In addition, half of the participants experience severe symptoms of depression (50.7%), while about a third of the participants experience severe symptoms of anxiety (37.8%) and post-traumatic stress disorder (PTSD) (32.3%). Refugees who experienced pushback showed overall higher levels of depression, anxiety, and PTSD. Traumatic experiences during transit and pushback were positively related to the severity of depression, anxiety, and PTSD. In addition, traumatic experiences during pushback showed an incremental contribution in predicting refugees' mental health difficulties over and above traumatic experiences in transit.Conclusions: This study provides valuable insights into the multiple risks refugees are exposed to and emphasise the need for the provision of adequate protection and support.

There is a high prevalence of traumatic experiences refugees face during transit and pushback, a high prevalence of mental health problems, and impaired psychological well-being in refugees.Traumatic experiences contribute to mental health problems.Urgent measures are needed.

Self-efficacy and locus of control as transdiagnostic factors in Middle Eastern refugees.

Background: Many refugees report high levels of psychopathology. As a countermeasure, some psychological interventions aim at targeting mental health difficulties in refugees transdiagnostically. However, there is a lack of knowledge about relevant transdiagnostic factors in refugee populations.Objective: To inform intervention efforts empirically, we investigated whether self-efficacy and locus of control are transdiagnostically associated with symptoms of depression, anxiety, somatisation, psychological distress, and a higher-order psychopathology factor ('p') in Middle Eastern refugees residing in Germany.Method: In total, 200 Middle Eastern refugees took part in this cross-sectional study, comprising 160 male and 40 female refugees. Participants were, on average, 25.56 years old (SD = 9.19), and 182 (91%) originally came from Syria, while remaining refugees were from Iraq or Afghanistan. They completed measures of depression, anxiety, somatisation, self-efficacy, and locus of control.Results: In multiple regression models adjusting for demographic factors (gender and age), self-efficacy and external locus of control were transdiagnostically related to depression, anxiety, somatic symptoms, psychological distress, and a higher-order psychopathology factor. Internal locus of control had no detectable effect in these models.Conclusions: Self-efficacy and external locus of control appear critical in the mental health of refugees and may be important mechanisms in overcoming posttraumatic stress and resettlement stressors. Our findings support the need to target self-efficacy and external locus of control as transdiagnostic factors of general psychopathology in Middle Eastern refugees.

Middle Eastern refugees report high levels of psychopathology.Transdiagnostic interventions are often applied, yet knowledge about relevant transdiagnostic factors is scarce.Self-efficacy and external locus of control emerged as relevant transdiagnostic factors.

Community based sociotherapy for depressive symptomatology of Congolese refugees in Rwanda and Uganda (CoSTAR): a protocol for a cluster randomised controlled trial.

Background: Conflict in the Democratic Republic of Congo has led to large numbers of refugees fleeing to Uganda and Rwanda. Refugees experience elevated levels of adverse events and daily stressors, which are associated with common mental health difficulties such as depression. The current cluster randomised controlled trial aims to investigate whether an adapted form of Community-based Sociotherapy (aCBS) is effective and cost-effective in reducing depressive symptomatology experienced by Congolese refugees in Uganda and Rwanda.Methods: A two-arm, single-blind cluster randomised controlled trial (cRCT) will be conducted in Kyangwali settlement, Uganda and Gihembe camp, Rwanda. Sixty-four clusters will be recruited and randomly assigned to either aCBS or Enhanced Care As Usual (ECAU). aCBS, a 15-session group-based intervention, will be facilitated by two people drawn from the refugee communities. The primary outcome measure will be self-reported levels of depressive symptomatology (PHQ-9) at 18-weeks post-randomisation. Secondary outcomes will include levels of mental health difficulties, subjective wellbeing, post-displacement stress, perceived social support, social capital, quality of life, and PTSD symptoms at 18-week and 32-week post-randomisation. Cost effectiveness of aCBS will be measured in terms of health care costs (cost per Disability Adjusted Life Year, DALY) compared to ECAU. A process evaluation will be undertaken to investigate the implementation of aCBS.Conclusion: This cRCT will be the first investigating aCBS for mental health difficulties experienced by refugees and will contribute to knowledge about the use of psychosocial interventions for refugees at a time when levels of forced migration are at a record high.Trial registration: ISRCTN.org identifier: ISRCTN20474555.

There is a need to evaluate community-based psychosocial interventions for refugees.Community-based sociotherapy has been used to support communities in post-conflict situations but has not been evaluated in a randomised controlled trial.This protocol outlines a proposed randomised controlled trial of community-based sociotherapy adapted for Congolese refugees in Uganda and Rwanda.

Translation and validation of the Dari International Trauma Questionnaire (ITQ) in Afghan asylum seekers and refugees.

Background: The International Trauma Questionnaire (ITQ) is a standardized and validated measure aligned with the 11th version of the International Classification of Diseases (ICD-11) diagnostic criteria to assess post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). It has been translated into 25 different languages, but is yet to be translated into Dari and validated for use in the Afghan population.Objective: This study aimed (1) to translate and culturally adapt the ITQ for use in Dari; (2) to assess the construct validity and composite reliability of ICD-11 PTSD and CPTSD using the Dari ITQ; and (3) to examine the concurrent, convergent, and discriminant validity of the Dari ITQ.Method: The Dari ITQ was validated through the completion of a set of standardized measures by 305 Afghan asylum seekers and refugees in Austria. Factorial analyses and psychometric properties of the Dari ITQ were assessed using confirmatory factor analysis (CFA), bivariate correlations, and multivariate regression.Results: Asylum seekers showed significantly higher levels of ICD-11 CPTSD symptomatology and probable diagnoses of ICD-11 PTSD, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) PTSD, anxiety, depression, and psychological distress in comparison to refugees. CFA results supported the two-factor second-order model comprised of the PTSD and disturbances in self-organization (DSO) as the best fit to the data. The psychometric adequacy of this model in the Dari ITQ was evidenced by high factor loadings and excellent internal reliability. The Dari ITQ showed satisfactory concurrent, convergent, and discriminant validity.Conclusion: The current study supports the statistical validity and cultural sensitivity of the Dari ITQ in identifying symptoms of ICD-11 PTSD and CPTSD among Afghan asylum seekers and refugees.

This study provides the first translation and validation of the ITQ in Dari with an Afghan refugee population in Austria.The two-factor second-order model was supported as the best fit to the data.Additional support for the composite reliability, and concurrent, convergent, and discriminant validity was provided, suggesting the statistical validity and cultural sensitivity of the Dari ITQ in identifying symptoms of ICD-11 PTSD and CPTSD among Afghan asylum seekers and refugees.

Cross-cultural validity and psychometric properties of the International Trauma Questionnaire in a clinical refugee sample.

Background: The ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD diagnoses have been examined in several studies using the International Trauma Questionnaire (ITQ). The cross-cultural validity of the ITQ has not previously been studied using item responses theory methods focused on the issue of equal item functioning and thus comparability of scores across language groups.Objective: To investigate the cross-cultural validity of the ITQ scales considering specifically local independence of items and differential item functioning (DIF) in a cross-cultural sample of refugees.Method: Data from 490 treatment-seeking refugees were included, covering Danish, Arabic, and Bosnian languages and different levels of interpreter-assisted administration. Rasch and graphical log-linear Rasch models were used.Results: There was strong local dependence among items from the same symptom clusters in the PTSD and disorders in self-organization (DSO) scales, except between affective dysregulation items. Weak local dependence was discovered between an item from the affective dysregulation cluster and an item from the disturbed relationship cluster. There was no evidence of DIF related to language or interpreter assistance. There was evidence of DIF for two PTSD items relative to gender and time since the traumatic event. The targeting of the scales to the study population was not optimal. Reliability varied from 0.55 to 0.78 for subgroups.Conclusions: The PTSD and the DSO scales have stable psychometric properties across the Danish, Arabic, and Bosnian language versions and different levels of assisted administration. Scores are comparable across these groups. However, DIF relative to gender and time since trauma introduces considerable measurement bias. DIF-adjusted summed scale scores or estimated person parameters should be used to avoid measurement bias. Future research should investigate whether scales including more and/or alternative items that require higher levels of PTSD and DSO to be endorsed will improve targeting and measurement precision for refugee populations.

A first cross-cultural validity study of the ITQ using IRT.PTSD and DSO subscales functioned invariantly across Danish, Arabic, and Bosnian, and also across degrees of interpreter assistance. Two PTSD items did not function invariantly across gender and time since trauma.The Danish, Arabic, and Bosnian ITQ can be used for screening treatment-seeking refugees, taking into account the item bias in the PTSD subscale, and suboptimal targeting and reliability, which require extensions or modification of items.

Consecuencias psicológicas de la exposición a zonas de conflicto en niños, niñas y adolescentes / Conseqüències psicològiques de l’exposició a zones de conflicte en nens, nenes i adolescents / Children and adolescents psychological consequences of exposure to conflict zones

Una de lasprincipales víctimas de las guerras y conflictos armados son los niños, niñas y adolescentes. Las consecuenciasnegativas de los conflictos bélicos en la salud física y mental de esta población han sido señaladas en numerosasocasiones por la literatura científica. El objetivo de este estudio es presentar los resultados de las últimas inves-tigaciones sobre las consecuencias de la exposición a conflictos armados en la salud mental de los niños, niñasy adolescentes, para ayudar a los profesionales del país a tener una mayor comprensión de la problemática yabordarla de forma adecuada. Para ello, se ha llevado a cabo una revisión de artículos científicos publicados enlos últimos cinco años. El trastorno por estrés postraumático es el más observado en los estudios internaciona-les, aunque se detectan otros problemas emocionales y conductuales en los niños, niñas y adolescentes que hanvivido una situación de conflicto armado. Es importante tener en cuenta que la sintomatología clínica continúaincluso bajo medidas protectoras como un desplazamiento forzoso, así como conocer las necesidades específi-cas de esta población para adaptar la intervención clínica de manera adecuada.(AU)

One of the main victimsof wars and armed conflicts are children and adolescents. The negative consequences of war conflicts on thephysical and mental health of this population have been reported on numerous occasions in the scientific litera-ture. The aim of this study is to present the results of the latest research on the mental health consequences inchildren and adolescents who have been exposed to armed conflicts, in order to help the country's professionalsto have a better understanding of the problem and to address it in an appropriate way. To this end, a review ofscientific articles published in the last five years has been carried out. Post-traumatic stress disorder is the mostfrequently observed in international studies, although other emotional and behavioural problems are detectedin children and adolescents who have lived through a situation of armed conflict. It is important to take intoaccount that clinical symptomatology continues even under protective measures such as forced displacement,as well as to know the specific needs of this population in order to adapt the clinical intervention appropriately.(AU)

Una de les princi-pals víctimes de les guerres i conflictes armats són els nens, les nenes i els adolescents. Les conseqüències negati-ves dels conflictes bèl·lics en la salut física i mental d'aquesta població han estat assenyalades moltes vegades perla literatura científica. L'objectiu d'aquest estudi és presentar els resultats de les darreres investigacions sobre lesconseqüències de l'exposició a conflictes armats en la salut mental dels nens, nenes i adolescents, per ajudar elsprofessionals del país a tenir més comprensió de la problemàtica i abordar-la de manera adequada. Per fer-ho, s'hadut a terme una revisió d'articles científics publicats en els darrers cinc anys. El trastorn per estrès posttraumàticés el més observat als estudis internacionals, encara que es detecten altres problemes emocionals i conductualsen els nens, nenes i adolescents que han viscut una situació de conflicte armat. És important tenir en compte quela simptomatologia clínica continua fins i tot sota mesures protectores, com ara un desplaçament forçós, així comconèixer les necessitats específiques d'aquesta població per adaptar la intervenció clínica de manera adequada.(AU)

Sleep impairments in refugees diagnosed with post-traumatic stress disorder: a polysomnographic and self-report study.

Background: Post-traumatic stress disorder (PTSD) is the clinical manifestation of traumatic events and is associated with sleep disturbances. Sleep disturbances, if left untreated, may perpetuate or even worsen symptoms of PTSD. Previous studies of other PTSD populations show a higher incidence of sleep impairments and sleep disorders compared to healthy controls (HCs); however, this has never been investigated in trauma-affected refugees diagnosed with PTSD.Objectives: To examine subjective sleep quality, measure sleep architecture, and identify latent sleep disorders in refugees diagnosed with PTSD compared to HCs.Method: This comparative study included 20 trauma-affected refugees diagnosed with PTSD and 20 HC matched on age, sex, and body mass index. All participants completed self-report questionnaires assessing sleep quality, insomnia severity, and disturbing nocturnal behaviour, and all took part in a one-night polysomnography (PSG) assessment.Results: Patients reported significantly poorer subjective sleep quality, sleep latency, sleep duration, and sleep efficiency compared to HCs. Subjective reports on hours spent in bed were not significantly different between patients and HCs. Patients reported significantly higher nightmare frequency and severity compared to HCs. PSG measures showed that patients had significantly reduced sleep efficiency, more awakenings, and longer REM sleep latency, and spent more time awake, whereas there was no significant differences regarding total time in bed, total sleep time, or sleep latency. The prevalence of sleep disorders was equal between groups.Conclusions: The study identified significant impairments in several sleep domains, with a preponderance of disturbed regulation of sleep resulting in awakenings. These results indicate a need for more focus on hyperarousal and nightmares as key elements of disturbed sleep in PTSD. Furthermore, the study identified a discrepancy between subjective and objective measures concerning total sleep time, raising questions regarding the causes of 'sleep state misperception'.Trial registration: ClinicalTrials.gov identifier: NCT03535636..Trial registration: Sleep Impairments in Refugees Diagnosed with PTSD (PSG-PTSD). URL: https://clinicaltrials.gov/ct2/show/NCT03535636. ClinicalTrials.gov NCT03535636. Date of registration: 24/05/2018.

This is the first study assessing sleep impairments and sleep disorders in refugees diagnosed with post-traumatic stress disorder (PTSD) compared to healthy controls.The main finding is that both subjectively and objectively measured sleep is disrupted in refugees diagnosed with PTSD compared to healthy controls.The results suggest that these disturbances of sleep are significant targets in treatment of PTSD and stress the importance of focusing on treatment of sleep disturbances in PTSD.

Condições de saúde autorrelatadas por solicitantes de refúgio no Rio de Janeiro, Brasil, de 2010 a 2017 / Asylum seekers' self-reported health conditions in Rio de Janeiro, Brazil, from 2010 to 2017 / Condiciones de salud autoinformadas por solicitantes de refugio en Río de Janeiro, Brasil, del 2010 al 2017

No Brasil, entre 2011 e 2022, 348.067 pessoas solicitaram o reconhecimento da condição de refugiado no país. Os motivos que resultaram na migração, os riscos durante o trajeto e a transição cultural ao chegar podem estar associados a diferentes problemas de saúde. O objetivo deste estudo foi analisar as condições de saúde autorrelatadas por solicitantes de refúgio no Município do Rio de Janeiro no período de 2010 a 2017. Trata-se de um estudo transversal de dados secundários. Foram coletadas informações preenchidas nos formulários de solicitação de refúgio do Comitê Nacional para os Refugiados (Conare) de 2010 a 2017 e da entrevista social da Cáritas Arquidiocesana do Rio de Janeiro (Cáritas/RJ). Calcularam-se as taxas de prevalência de condições de saúde e respectivos intervalos de 95% de confiança (IC95%) e a razão de chances (RC) e IC95% em um modelo de regressão logística simples segundo variáveis sociodemográficas e de migração. O estudo incluiu 1.509 indivíduos. Na chegada ao Brasil, 620 (41%) relataram ter uma ou mais condições de saúde. As chances de apresentar problemas de saúde foram maiores em pessoas oriundas do Congo (RC = 18,7) e República Democrática do Congo (RC = 9,5), nos indocumentados (RC = 4,4), nas mulheres (RC = 2,1), em pessoas com Ensino Fundamental (RC = 1,9), com idade ≥ 45 anos (RC = 1,8) e entre os que vivem/viveram maritalmente (RC = 1,8 e 2,5, respectivamente). Entre as pessoas que relataram alguma condição de saúde, mais da metade informaram sentir dores (52%). É possível que as dores físicas tenham relação com estresse pós-traumático e outros sofrimentos em saúde mental, que podem se manifestar por meio de sintomas de dores somáticas.

From 2011 to 2022, 348,067 people applied for a refugee status in Brazil. The reasons that resulted in their migration, the risks during their journey, and the cultural transition upon arrival may be associated with different health problems. This study aimed to analyze the self-reported health conditions of asylum seekers in the municipality of Rio de Janeiro from 2010 to 2017. This is a cross-sectional study with secondary data. Data were collected from asylum application forms at the Brazilian National Committee for Refugees (Conare) from 2010 to 2017 and from social interviews in the Archdiocesan Caritas of Rio de Janeiro (Cáritas/RJ). The prevalence rates of health conditions, their respective 95% confidence intervals (95%CI) and odds ratio (OR) were calculated in a simple logistic regression model according to sociodemographic and migration variables. This study included 1,509 individuals. Upon arrival in Brazil, 620 (41%) reported having one or more health conditions. The chances of showing health problems were higher in people from the Congo (OR = 18.7) and the Democratic Republic of the Congo (OR = 9.5), in undocumented individuals (OR = 4.4), women (OR = 2.1), in people with elementary education (OR = 1.9), aged ≥ 45 years (OR = 1.8), and among those who live/lived maritally (OR = 1.8 and 2.5, respectively). Of those who reported a health condition, more than half claimed experiencing pain (52%). Physical pain may be related to post-traumatic stress and other mental health distress, manifesting itself by somatic pain symptoms.

En Brasil, entre el 2011 y el 2022, 348.067 personas solicitaron el reconocimiento de la condición de refugiado en el país. Los motivos que dieron lugar a la migración, los riesgos durante el trayecto y la transición cultural al llegar pueden estar asociados a diferentes problemas de salud. Este estudio tuvo como objetivo analizar las condiciones de salud autoinformadas de los solicitantes de refugio en el municipio de Río de Janeiro en el período del 2010 al 2017. Se trata de un estudio transversal de datos secundarios. Los datos se recopilaron de los formularios de solicitud de asilo del Comité Nacional para Refugiados de Brasil (Conare) del 2010 al 2017 y de la entrevista social de Caritas Arquidiocesana de Río de Janeiro (Cáritas/RJ). Se calcularon las tasas de prevalencia de las condiciones de salud y sus respectivos intervalos de 95% de confianza (IC95%) y la razón de posibilidades (RP) y el IC95% en un modelo de regresión logística simple según variables sociodemográficas y de migración. El estudio incluyó a 1.509 sujetos. A su llegada a Brasil, 620 (41%) informaron tener una o más condiciones de salud. Las posibilidades de presentar problemas de salud fueron mayores en personas procedentes de Congo (RP = 18,7) y República Democrática del Congo (RP = 9,5), en personas indocumentadas (RP = 4,4), mujeres (RP = 2,1), en personas con educación primaria (RP = 1,9), en ≥ 45 años (RP = 1,8), y entre los que viven/han vivido en una relación estable (RP = 1,8 y 2,5, respectivamente). Entre las personas que reportaron alguna condición de salud, más de la mitad relató sentir dolores (52%). Los dolores físicos pueden estar relacionados con el estrés postraumático y otros sufrimientos en salud mental que pueden presentarse mediante síntomas de dolores somáticos.