Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya.

Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth.

"We Learn and Teach Each Other": Interactive Training for Cross-Cultural Trauma-Informed Care in the Refugee Community.

This paper introduces culturally responsive and trauma-informed mental health training modules to build and enhance competences and partnerships among mental health professionals and refugee community leaders, while facilitating intercultural, mutual learning between participants from various cultural and professional backgrounds. Focus group interviews and participant self-reflections with the training participants (N = 54) were analyzed using thematic analysis. Findings revealed an enhanced understanding of culturally unique as well as universal trauma responses and coping in the refugee community, which led to the building and strengthening of a sense of community and an expansion of social networks and support systems. This study highlights the effectiveness of interactive learning and knowledge transference among participants with various cultural and professional backgrounds, showing that face-to-face interactions and mutual learning reportedly facilitated building relationships and trust among participants and especially those between refugee/immigrant community leaders and service providers.

Polyvictimization and mental health consequences of female genital mutilation/circumcision (FGM/C) among Somali refugees in Kenya.

Female genital mutilation or circumcision (FGM/C) is a perilous social and cultural practice that affects the physical, mental, and psychological health of affected women. It is widespread around the world, affecting 200 million women and girls. This study aimed to explore the relation of FGM/C to mental and physical conditions in Somali refugees displaced in a low-resource setting, applying the concept of poly-victimization to reveal multifaceted trauma sequelae. Data for this cross-sectional study with 143 female Somali youth living in Eastleigh, Kenya were collected between April and May in 2013. FGM/C was strongly associated with negative physical and mental health outcomes, including post-traumatic stress disorder and depressive, anxiety, and somatic symptoms. Logistic regression analysis revealed that separation from a parent and poly-victimization experiences were significantly associated with FGM/C experience. The results also showed that FGM/C and other traumas did not occur singly but were indicative of cumulative adversities, especially for women who were socially vulnerable and marginalized. The results of this study highlight the practice of FGM/C in the context of other adverse living conditions of refugees and the importance of attending to other co-occurring risk factors that prevail with FGM/C practice in the ecological system of refugee forced migration.

Building Social Capital Through a Peer-Led Community Health Workshop: A Pilot with the Bhutanese Refugee Community.

Despite the high health and mental health care needs, resettled refugees often face cultural and linguistic challenges that hinder the access to appropriate and timely interventions and services. Additionally, such concepts as preventive health or mental health treatment are foreign to this population, which creates additional burdens to the refugee community that already have difficulty navigating a complex health care system in the U.S. To address multiple and complex gaps in health and mental health support for the refugee community, requested is an innovative approach that can convey culturally responsive and effective interventions for health promotion, such as peer-based health education. Few studies have been conducted on the effectiveness of peer-led community health interventions with refugee populations in the U.S. resettlement context. However, peer-led interventions have been shown to be effective when working with cultural minorities and interventions in an international context. Adopting a social capital framework, the current study conducted qualitative evaluation on the impact of a pilot peer-led community health workshop (CHW) in the Bhutanese refugee community. A hybrid thematic analysis of focus group discussion data revealed the improvement in health promotion outcomes and health practice, as well as perceived emotional health. The results also showed that the peer-led CHW provided a platform of community building and participation, while increasing a sense of community, sense of belonging and unity. The findings posit that a peer-led intervention model provides culturally responsive and effective tools for building social capital and promoting community health in the refugee community.

Gendered Health Outcome Among Somali Refugee Youth in Displacement: A Role of Social Support and Religious Belief.

This study examines the factors influencing physical health status, specifically focusing on the gender differences in risk and promotive factors affecting health outcomes among Somali refugee youth displaced in Nairobi, Kenya (n = 227). A survey was used to assess participants' physical health along with psychosocial factors, somatic symptoms, and demographic characteristics. The study shows that religious belief and somatic symptoms among the total sample were significant predictors in influencing the outcome of physical health. A moderated mediation analysis and logistic regression analyses also revealed gender differences in associated factors as well as health status; female participants reported higher somatic symptoms, associated with a decline in physical health, whereas the protective effect of social support and religious belief promote was found only among male counterparts. Future studies and interventions would be benefited from a gender-specific approach to health promotion and coping mechanisms in this population.

Twindemic Threats of Weeds Coinfected with Tomato Yellow Leaf Curl Virus and Tomato Spotted Wilt Virus as Viral Reservoirs in Tomato Greenhouses.

Tomato yellow leaf curl virus (TYLCV) and tomato spotted wilt virus (TSWV) are well-known examples of the begomovirus and orthotospovirus genera, respectively. These viruses cause significant economic damage to tomato crops worldwide. Weeds play an important role in the ongoing presence and spread of several plant viruses, such as TYLCV and TSWV, and are recognized as reservoirs for these infections. This work applies a comprehensive approach, encompassing field surveys and molecular techniques, to acquire an in-depth understanding of the interactions between viruses and their weed hosts. A total of 60 tomato samples exhibiting typical symptoms of TYLCV and TSWV were collected from a tomato greenhouse farm in Nonsan, South Korea. In addition, 130 samples of 16 different weed species in the immediate surroundings of the greenhouse were collected for viral detection. PCR and reverse transcription-PCR methodologies and specific primers for TYLCV and TSWV were used, which showed that 15 tomato samples were coinfected by both viruses. Interestingly, both viruses were also detected in perennial weeds, such as Rumex crispus, which highlights their function as viral reservoirs. Our study provides significant insights into the co-occurrence of TYLCV and TSWV in weed reservoirs, and their subsequent transmission under tomato greenhouse conditions. This project builds long-term strategies for integrated pest management to prevent and manage simultaneous virus outbreaks, known as twindemics, in agricultural systems.

Impacts of COVID-19 on Refugee Service Provision and Community Support: A Rapid Assessment during the Pandemic.

The coronavirus (COVID-19) pandemic has significant impacts on refugee populations and created social, economic as well as public health crises that led to multipronged challenges and barriers to resettlement services and community support. This study aims to explore the impacts of the pandemic on refugee service provision from the standpoint of refugee-serving professionals, refugee community leaders, and volunteers. Using rapid evaluation and appraisal methods, we conducted individual and focus group interviews with 42 key stakeholders in refugee services, followed by a brief online survey with 69 service providers. A thematic analysis revealed how preexisting are conflated with emergent barriers during the pandemic and how such cumulative adversities experienced by the refugee community have widened the gaps in social services and healthcare as well as social support within the refugee community. This study proposes several implications for future research and policy in social work with refugee populations during the post-COVID time.

Trauma exposure, social functioning, and common mental health disorders in Somali refugee male and female youth: An SEM analysis.

BACKGROUND: Refugee youth often face numerous adversities before and during forced migration. Although experiences vary across settings and subpopulations, common mental disorders are prevalent among refugee youth who are displaced in low- and middle-income countries. It is important to examine how risk factors are intricately linked and contribute to common mental health issues to inform clinical practice and social policy. AIMS: This study aims to test the pathways from risk factors previously identified as determinants of Somali refugee youth mental health (i.e. trauma exposure, substance use, social functioning, aggression) to symptoms of PTSD, depression, anxiety, and somatic pains. METHOD: We collected survey data in 2013, using snowball sampling to recruit Somali refugee youth (15-35 years old) living in Eastleigh, Kenya. We ran three structural equation models to assess paths from trauma exposure to mental health symptoms, through psychosocial factors including substance use, aggression, and functional impairment. We first conducted this analysis with a mixed-gender sample (N = 305) and then assessed gender differences by running one model for male participants (n = 124) and another for female participants (n = 181). RESULTS: In the mixed-gender sample, trauma exposure directly predicted substance use and both directly and indirectly predicted aggression, functional impairment, and mental health symptoms. Substance use directly predicted aggression and functional impairment, and substance use both directly and indirectly predicted mental health symptoms. The split-gender models revealed gender differences, with only functional impairment directly predicting mental health symptoms in the male sample and with many significant direct and indirect pathways in the female sample. CONCLUSIONS: This study shows the role of trauma exposure, substance use, aggression, and social functioning in determining mental health outcomes among refugee youth and how CMD symptoms are differently manifested across genders in this population.

Born in displacement: Psychosocial and mental health impacts of country of birth among urban Somali refugee youth.

Urban refugees often face tremendous adversities during displacement that exacerbate mental health and psychosocial outcomes. Given the lack of research on how extended displacement affects mental health in urban refugee youth, this study examines the differential effects of country of birth on trauma exposure and psychosocial factors that influence mental health experiences among Somali refugee youth in urban Kenya (n = 303). Findings reveals that childhood trauma and impeded social functioning predicted mental health outcomes. Being born in Kenya was a significant predictor of poor mental health despite there being no significant difference in trauma exposures and psychosocial factors between Somali-born and Kenya-born youth. This difference can be attributed to prolonged displacement, disrupted development of cultural identity, and discrimination experienced in the host country. Given the widely devastating effects of childhood trauma and community violence, mental health interventions need to be two-prolonged: addressing and preventing intergenerational trauma sequelae through family-based interventions; and community-level programs and advocacy for safety and protection for the displaced. Our findings also emphasize that future interventions for urban refugee communities should be inclusive to all community members, considering shared vulnerability to community violence as well as intergenerational transmission of traumas through childhood adversities and lacking support.

Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya.

BACKGROUND: Comorbid common mental disorders (CMDs) are pervasive in refugee populations. However, limited research has explored psychosocial factors for mental disorder comorbidity in Somali refugee samples. AIMS: This study aims to explore potential risk and protective factors for comorbid depression-anxiety and comorbid depression-PTSD by examining associations between trauma exposure, psychosocial factors, and mental health symptoms among a sample of Somali refugees displaced in urban Kenya. METHODS: We used snowball sampling to recruit Somali youth aged 15 to 35years(N = 250,n = 143 female, n = 88 male, n = 19 unknown gender). We measured 16 common types of trauma exposure and three psychosocial factors (endorsing violence, willingness to share problems, and symptom awareness) and used the HSCL-25 and PCL-C to capture individual and comorbid CMD symptoms, using guided cutoff points and/or algorithms. We then ran a series of logistic regression analyses to examine relationships between trauma exposure, psychosocial factors, and individual and comorbid CMD symptoms. RESULTS: Findings showed that increased trauma exposure predicted symptoms of individual and comorbid CMDs. Increased symptom awareness and endorsement of violence predicted comorbid depression-PTSD and comorbid anxiety-depression symptoms, respectively. Willingness to share problems buffered depressive symptoms but did not predict comorbidity. CONCLUSIONS: These findings revealed the high CMD comorbidity prevalence with differential effects of trauma and psychosocial factors on individual or comorbid mental disorders. This study suggests a need for transdiagnostic approaches that cut across Western diagnostic boundaries and consider culturally responsive and relevant items for mental health measures.

A multitier model of refugee mental health and psychosocial support in resettlement: Toward trauma-informed and culture-informed systems of care.

Refugees endure tremendous trauma during migration and resettlement. Despite the wide range of needs and challenges refugees have, previous research on refugee mental health has concentrated on the clinical treatment of certain common mental disorders related to premigration trauma. This narrow attention creates an environment in which positive mental health and social functioning are seen merely as a lack of mental illness among refugee populations. The consequences of such a focus are increased stigma of mental health issues and a negligence of other psychosocial needs critical to the community integration of refugee newcomers. There are few models and studies that focus on service delivery and systematic approaches to guide coordination of mental health services and psychosocial supports for refugee newcomers. To fill such gaps, this paper provides a framework to align stratified interventions and addresses the multilayered mental health needs in refugee communities. We have adopted and applied a multitier mental health and psychosocial support (MHPSS) model developed by the Inter-Agency Standing Committee to provide a holistic framework for a system of care. We have also proposed a two-pillar approach, trauma-informed and culture-informed care, which is embedded into each tier of the MHPSS program. This approach is designed to fill the gaps between mainstream mental health services and refugee resettlement programs, both of which tend to work in silos. Using the case of a statewide refugee mental health initiative in Virginia, we discuss the challenges and opportunities of programs to build capacity and partnerships for coordinated care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Working towards Culturally Responsive Trauma-Informed Care in the Refugee Resettlement Process: Qualitative Inquiry with Refugee-Serving Professionals in the United States.

Trauma-informed care (TIC) approaches have gained popularity in various contexts of human services over the past decades. However, relatively little has been explored about how it is applicable and built into services for refugee populations in resettlement programs. This study explores the current status of the application of TIC in refugee-serving agencies and identifies perceived and experienced challenges and opportunities for culturally responsive TIC in the United States. As designed as part of the evaluation of state-wide refugee health promotion programs, this study conducted individual interviews with 78 refugee service providers from five resettlement sites. Despite the burgeoning interest and attempt to embrace TIC, our findings show that there is clear inconsistency and inexperience in TIC adaptation in resettlement programs. This study highlights that TIC that is culturally responsive and relevant to refugee trauma and acculturation experiences is a vital way to address the chasms between refugee-specific programs and mainstream services including mental health care systems. This study also discusses community resources and opportunities to bridge the deep divide and substantial gaps between mental health services and refugee resettlement services and to address comprehensive needs around mental health and wellness in the refugee community.

Risk and Protective Factors for Common Mental Disorders among Urban Somali Refugee Youth.

The purpose of this study was to explore exposure to trauma as well as demographic and psychosocial factors as predictors of mental health symptoms among Somali refugees in Kenya. Participants were recruited via snowball sampling to complete a survey and included 86 Somali refugee youth, aged 15 to 34 years, who were living in Eastleigh. We measured trauma using a total traumas experienced variable as well as four trauma types categories (pre-migration/migration trauma, post-migration trauma, family trauma, and individual trauma). We measured anxiety and depression symptoms using the Hopkins Symptom Checklist-25 (HSCL-25) and PTSD using the PTSD Check List - Civilian Version (PCL-C). We ran descriptive statistics followed by multiple linear regression models with trauma exposure, education, gender, and willingness to share problems as predictors of mental health symptoms. Out of 12 possible traumatic events, most participants (83.7%) reported experiencing at least one trauma, and participants reported experiencing an average of 3.76 total traumas. The regression models predicted between 11.5% and 35.5% of the variance of the mental health symptoms. Willingness to share problems was a significant predictor of decreased mental health symptoms in most models. These findings highlight the role of trauma exposure and psychosocial factors in predicting Somali refugee mental health and indicate that implementing programs to encourage problem sharing may help address Somali refugee mental health needs. Further research is needed to explore the differential impact of trauma exposure and various psychosocial factors on Somali refugee mental health.

Capacity Building for Refugee Mental Health in Resettlement: Implementation and Evaluation of Cross-Cultural Trauma-Informed Care Training.

Refugee mental health needs are heightened during resettlement but are often neglected due to challenges in service provision, including lack of opportunities for building capacity and partnership among providers. We developed and implemented culturally-responsive refugee mental health training, called Cross-Cultural Trauma-Informed Care (CC-TIC) training. We evaluated CC-TIC, using a free listing and semi-structured retrospective pre- and post-training evaluation with five localities in two states in the U.S. The results showed significant improvement in providers' knowledge of trauma impacts, cultural expressions of trauma/stress-related symptoms, and culturally-responsive trauma-informed care. Trauma-informed care specific to refugee resettlement was regarded as the most helpful topic and community partnership building as the most requested area for future training. This study emphasizes that culturally-responsive trauma-informed approaches can help bridge gaps between mental health care and resettlement services and promote exchanges of knowledge and expertise to build collaborative care and community partnership.

Constructing health capital in ecological systems: A qualitative evaluation of community-based health workshops in the refugee community.

Refugee communities face numerous health and mental health concerns both during and after resettlement. Health issues, already deteriorated by chronic poverty, malnutrition and poor living conditions, are exacerbated by acculturative challenges, such as cultural and language barriers, stigma, and lack of resources and information. Since such needs in refugee communities affect both individual and collective capacity, it is important to consider policy environment and socioecological contexts for cultural adjustment and community resources for navigating systems, rather than individual health behaviours and communication skills only. To expand our understanding of health promotion capacity and resources, a broad and context-dependent concept will be necessary. Adopting a concept of health capital, this study aims to explore the impact of community-based health workshops, while expanding and redefining the framework in the context of health promotion efforts for the refugee community in resettlement. As part of community-based participatory research, this qualitative study conducted seven focus group discussions (FGDs) with 22 Bhutanese refugees in 2014. Using a hybrid thematic analysis, themes emerged from the FGD data were organised and categorised into health capitals in ecological systems. The participants reported enhanced confidence and capacity for health promotion at individual, family and community levels. Given the interdependent coping and lifestyles of refugee communities, impacts on the participants' interactions and relations with family and community were significant, which emphasises the importance of assessment of interventions beyond an individualistic approach. The findings of this study underscore the vital role of varied forms of health capital in promoting health in the refugee community and connecting members to needed health resources and information. Health capital is an old and yet still new concept with a great potential to broaden our understanding of health resources by elaborating the impacts and interactions in individuals, family and community for health promotion.

Trauma-Informed Psychoeducation for Somali Refugee Youth in Urban Kenya: Effects on PTSD and Psychosocial Outcomes.

The current study developed and implemented a trauma-informed psychoeducation (TIPE) intervention that is culturally relevant to urban Somali refugees in Nairobi, Kenya. A total of 141 Somali refugee youth completed 12 sessions of peer-led TIPE intervention. A series of pre- and post-tests revealed that TIPE made positive impacts on PTSD symptoms and psychosocial factors, with a differential effect observed according to baseline PTSD symptom report. Participants with high baseline PTSD scores (i.e. above clinical threshold) reported a significant decrease in PTSD symptoms and increase in perceived social support. In the meantime, those with no to mild baseline PTSD symptoms showed an increase in self-awareness of trauma responses and thus PTSD symptom report within the range of normalcy. This research supports the effect of a culturally relevant psychoeducation intervention in addressing the high mental health and psychosocial needs of the marginalized urban Somali refugee community in low resource settings.

Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement.

Westernized approaches to mental health care often place limited emphasis on refugees' own experiences and cultural explanations of symptoms and distress. In order to effectively assess community mental health needs and develop interventions grounded in local needs, mental health programs need to be informed by an understanding of cultural features of mental health, including cultural idioms of distress (CIDs). The current study aims to explore CIDs among Somali refugees displaced in Kenya to understand mental health needs in cultural context and serve the community in a culturally responsive and sensitive manner. This research was conducted as a two-phase qualitative study. First, key informant interviews with Somali mental health stakeholders generated a list of 7 common Somali CIDs: buufis, buqsanaan, welwel, murug, qaracan, jinn, and waali. Typologies of each CID were further explored through four focus group interviews with Somali community members. The findings from a template analysis revealed Somali lay beliefs on how trauma and daily stressors are experienced and discussed in the form of CIDs and how each term is utilized and understood in attributing symptoms to associated causes. This study highlights the need to incorporate colloquial terms in mental health assessment and to adopt a culturally relevant framework to encourage wider utilization of services and religious/spiritual support systems.

Mental health risks and stressors faced by urban refugees: Perceived impacts of war and community adversities among Somali refugees in Nairobi.

BACKGROUND: There is a gap in understanding of refugee mental health risks unique to urban areas of low-income countries. MATERIAL: A qualitative rapid appraisal using focus group interviews with community stakeholders explored main stressors pervasive by Somali refugees in Nairobi, Kenya. DISCUSSION: This study identified the intersection of war trauma and daily stressors that affect both functional and structural challenges and risk of mental health issues among Somali urban refugees. CONCLUSION: Findings underscore the importance of understanding mental health in the broader context of community adversities, suggesting development of contextually informed interventions responsive to complex needs of urban refugees.

Colorectal cancer screening among Korean American immigrants: unraveling the influence of culture.

Screening for colorectal cancer (CRC) is underutilized among ethnic minority groups, particularly among Korean American immigrants. To explore the role of cultural and health beliefs in CRC screening, a structured questionnaire was administered to 281 Korean American immigrants aged between 50 and 88 in the New York metropolitan area. Results showed that 20% of the sample had undergone a fecal occult blood test within the past year, and 35% of the respondents had received a sigmoidoscopy and/or colonoscopy within the previous five years. Binary logistic regression analyses revealed significant predictors including health belief constructs, such as perceived seriousness of cancer and confidence in screening uptake, and gender-specific cultural beliefs and attitudes about CRC screening. Perceived helplessness lowered CRC screening among the women, while fatalism lowered it among the men. The findings reinforce a need for cultural-and gender-specific intervention strategies to increase CRC screening in this particularly vulnerable population.