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The Forced Migrants’ Mental Health: Challenges, Practices and Intervention

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 23284

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Special Issue Editors

Dr. Francesca Tessitore

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Guest Editor

Department of Humanities, Philosophy and Education, University of Salerno, 84084 Fisciano, SA, Italy
Interests: forced migration and mental health; trauma and narrative processes; clinical intervention within new emerging social contexts

Dr. Giorgia Margherita

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Guest Editor

Department of Humanities, University of Naples Federico II, 80133 Naples, Italy
Interests: trauma and extreme traumatization; forced migration experience; collective violence; narrative and group psychodynamic

Dr. Mauro Cozzolino

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Guest Editor

Department of Humanities, Philosophy and Education, University of Salerno, 84084 Fisciano, SA, Italy
Interests: clinical psychology; well-being and stress; clinical and psychotherapeutic interventions

Special Issue Information

Dear Colleagues,

The advances in the field of research on the mental health status of forced migrants has largely demonstrated a high risk for asylum seekers, refugees, and forcibly displaced people, compared to voluntary migrants, to develop psychological and psychopathological disturbances. Premigratory, migratory, and postmigratory traumatic experiences all contribute to configure a particularly complex concept of “forced migration trauma”, which, in order to be understood, requires a multidimensional approach able to take into consideration the individual, relational, cultural, and social dimensions of the forced migration experience. Additionally, a person-centered and culturally as well as gender-sensitive lens able to discriminate between the different experiences of forced migration is needed in order to shed light on the unique ways in which forced migrants can live the adversities, in the light of their ethnicity, cultural belonging, the specificities of their context of origin, journey experiences, and context of reception.

Recent evidence also demonstrated that the “forced migration trauma” involves not only the forced migrants themselves but also the wider contextual and social fields in which they are hosted, challenging, for example, the professionals’ practices of the mental health care services or making the mental health of the operators in contact with forced migrants at high risk of diseases and disturbances itself.

An increasing reflection on the complex nature of forced migration trauma and of its extensions to the social field might allow to develop and plan of more adequate clinical instruments and intervention projects capable to address the complexity of these experiences, promoting mental health and implementing of new and best practices capable to enrich the encounter with the “cultural other” and address his/her needs.

This Special Issue invites scholars to enhance the actual national and international debate on the aforementioned domains, welcoming contributions related, but not limited, to the following main thematic areas:

In-depth exploration of the forced migration experience: focus on its certain specific configurations and peculiarities within contexts;
Advances on the research field on the mental health status of asylum seekers, refugees and forcibly displaced people through culturally sensitive and/or gender-sensitive investigations;
Investigations on the mental health care practices for forced migrants put in place by services at national and international level;
Investigations on the mental health status of professionals and operators working with forced migrants;
Critical reflections on the methodological challenges of research and intervention within cross-cultural and transcultural settings.

Research papers, longitudinal studies, reviews, case reports, brief reports, conducted through qualitative, quantitative, or mixed methods are welcome.

Dr. Francesca Tessitore
Dr. Giorgia Margherita
Dr. Mauro Cozzolino
Guest Editors

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Keywords

forced migration experience
mental health care
methodological challenges
clinical and social intervention
cross-cultural research
transcultural practice

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Published Papers (9 papers)

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16 pages, 872 KiB

Open AccessArticle

The Danish Trauma Database for Refugees (DTD): A Multicenter Database Collaboration—Overcoming the Challenges and Enhancing Mental Health Treatment and Research for Refugees

by Marie Høgh Thøgersen, Line Bager, Sofie Grimshave Bangsgaard, Sabina Palic, Mikkel Auning-Hansen, Stine Bjerrum Møller, Kirstine Bruun Larsen, Louise Tækker, Bo Søndergaard Jensen, Søren Bothe and Linda Nordin

Int. J. Environ. Res. Public Health 2023, 20(16), 6611; https://doi.org/10.3390/ijerph20166611 - 20 Aug 2023

Cited by 1 | Viewed by 2395

Abstract

Mental health of trauma-affected refugees is an understudied area, resulting in inadequate and poorer treatment outcomes. To address this, more high-quality treatment studies that include predictive analyses, long-term evaluations, cultural adaptations, and take account for comorbidities, are needed. Moreover, given the complex intertwining of refugees’ health with post-migration stressors and other social factors, it is crucial to examine the social determinants of refugee mental health. The Danish Trauma Database for Refugees (DTD) is a multicenter research database uniting six national centers that provide outpatient treatment for trauma-affected refugees. Through the database, we collect clinical and sociodemographic data from approximately 1200 refugees annually and will merge the database with Danish population register data. The purpose of the DTD is two-fold; clinical and research. The DTD offers data-driven guidance for routine clinical treatment planning of the individual patient, as well as exceptional research opportunities for testing treatment interventions in clinical settings, with larger sample sizes, and more representative heterogeneity of the population. Complex analyses of risk and protective factors, barriers, access to treatment, and societal and transgenerational aspects of trauma are possible with the DTD. This conceptual paper introduces the DTD, the historical background, the development process and implementation strategy, and the associated challenges with developing and running a multicenter database. Most importantly, it highlights the clinical and research potential of the DTD for advancing the understanding and treatment of trauma-affected refugees. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

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15 pages, 590 KiB

Open AccessArticle

What Are the Characteristics of Torture Victims in Recently Arrived Refugees? A Cross-Sectional Study of Newly Arrived Refugees in Aarhus, Denmark

by Mette Hvidegaard, Kamilla Lanng, Karin Meyer, Christian Wejse and Anne Mette Fløe Hvass

Int. J. Environ. Res. Public Health 2023, 20(14), 6331; https://doi.org/10.3390/ijerph20146331 - 10 Jul 2023

Cited by 3 | Viewed by 2098

Abstract

Torture victims live with complex health conditions. It is essential for the rehabilitation of torture survivors that their traumas are recognized at an early stage. The aim of this study was to investigate (i) the prevalence of reported torture exposure, (ii) the association between demographic characteristics and exposure to torture, and (iii) the association between PTSD and exposure to torture among recently arrived refugees in Aarhus, Denmark. Data were extracted from health assessments of refugees arriving in Aarhus in the years 2017–2019, and 208 cases were included in the analysis. The prevalence of reported torture was 13.9% (29/208). Most torture victims were found among refugees arriving from Iran (17.0% (9/53)), Syria (9.3% (8/86)), and Afghanistan (25.0% (5/20)). Significant associations were found between reported torture exposure and male gender, Southeast Asian origin, and a diagnosis of PTSD. In the study, 24.5% (24/98) of males and 4.5% (5/110) of females had been subjected to torture. However, it is possible that the prevalence of female torture survivors is underestimated due to the taboos surrounding sexual assaults and fear of stigmatization. Nearly half of the torture victims in the study were diagnosed with PTSD (44.8% (13/29)). The results confirm that torture victims constitute a vulnerable group living with severe consequences, including mental illness such as PTSD. Furthermore, understanding the cultural perspectives of the distress among refugees is crucial in providing appropriate healthcare services. This study highlights the importance of addressing the mental health needs of torture survivors and tailoring interventions toward vulnerable refugee populations. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

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25 pages, 453 KiB

Open AccessArticle

Challenges for the Mental Health of Refugee Artists: Perspectives of the ADAPT Model

by Halina Grzymała-Moszczyńska and Małgorzata Różańska-Mglej

Int. J. Environ. Res. Public Health 2023, 20(9), 5694; https://doi.org/10.3390/ijerph20095694 - 1 May 2023

Cited by 1 | Viewed by 1959

Abstract

This study aimed to address the mental health challenges faced by refugee artists who are grantees of ICORN—the International Cities of Refuge Network—from the perspective of the extended conceptual ADAPT model. The study employed exploratory qualitative research, and data were collected through semi-structured interviews with ICORN artists in Poland, Norway, and Sweden. For data analysis, Interpretive Phenomenological Analysis (IPA) was used, whereas for the presentation of the results, the framework of the ADAPT model was applied. The results showed that the super-ordinate themes that emerged from the IPA analysis related directly to the ADAPT model and could mostly be assigned to its basic pillars: (1) Security; (2) Bonds and Networks; (3) Justice; (4) Roles and Identities; and (5) Existential Meaning. However, the model was insufficient for capturing the full diversity of experiences described by the respondents. Therefore, an extension of the model in the form of two additional pillars, Art and Body and Mind, was proposed. The findings confirm that the ADAPT model is adequate for systematizing and depicting in detail the experiences of migrants/refugees. However, further modifications of the model are necessary, particularly the additional pillar Body and Mind, which has the potential to become a separate category in other migrants’/refugees’ assessment frameworks. Moreover, Art itself could be seen as a universal bridging factor between the refugee and the host population, contributing to the refugees’ adaptation to the host society. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

17 pages, 643 KiB

Open AccessArticle

It Happened in the Desert, in Libya and in Italy: Physical and Sexual Violence Experienced by Female Nigerian Victims of Trafficking in Italy

by Sarah Adeyinka, Ine Lietaert and Ilse Derluyn

Int. J. Environ. Res. Public Health 2023, 20(5), 4309; https://doi.org/10.3390/ijerph20054309 - 28 Feb 2023

Cited by 7 | Viewed by 3134

Abstract

Nigerian girls and women constitute a large percentage of African victims of human trafficking in Italy. Extensive research has been conducted on the causes, push-and-pull factors, and the perpetrators in the phenomenon of trafficking Nigerian women and girls into Italy. However, limited data exist on the women and girls’ narratives of their experiences during their migratory journey from Nigeria to Europe. Using data collected through a mixed method, longitudinal design, 31 female Nigerian victims of trafficking in Italy were interviewed for this study. This study gives voice to the experiences of sexual violence that these women and girls encounter during transit, leading to many of them arriving in Italy severely traumatized. It also discusses the health impact of these experiences and the different survival strategies that they are forced to employ. The study shows how sexual and physical violence is employed by smugglers, traffickers, and people in authority alike. It shows that the violence experienced along the way does not end after arrival in the destination country (in this case, Italy), but is, in some cases, exacerbated and similar to previous experiences of violence. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

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12 pages, 743 KiB

Open AccessArticle

The Role of Emotion Regulation as a Potential Mediator between Secondary Traumatic Stress, Burnout, and Compassion Satisfaction in Professionals Working in the Forced Migration Field

by Francesca Tessitore, Alessia Caffieri, Anna Parola, Mauro Cozzolino and Giorgia Margherita

Int. J. Environ. Res. Public Health 2023, 20(3), 2266; https://doi.org/10.3390/ijerph20032266 - 27 Jan 2023

Cited by 10 | Viewed by 2603

Abstract

Background: Professionals working with refugees are vicariously exposed to complex traumatic experiences lived by forced migrants, which can lead to the risk of developing secondary traumatic stress, burnout, and a poor compassion satisfaction. The current study aimed to explore the effects of secondary traumatic stress on burnout and compassion satisfaction in 264 Italian professionals working with refugees and forced migrants. Moreover, it examined the mediating role of emotion regulation between secondary traumatic stress and both burnout and compassion satisfaction. Methods: A structural equation modeling (SEM) was performed to test the hypothesis. Results: The results showed that increased levels of secondary traumatic stress were associated with an increase of burnout both directly and indirectly through the mediation of emotion regulation. Emotion regulation also totally mediated the relationship between secondary traumatic stress and compassion satisfaction. Conclusions: The results suggested that prevention or interventions programs targeting emotion regulation might be important to improve the professional quality of life of operators working with refugees and forced migrants. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

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18 pages, 714 KiB

Open AccessArticle

Taking Care of Forced Migrants Together: Strengths and Weaknesses of Interorganizational Work from the Perspective of Social Workers

by Amalia De Leo, Giulia D’Adamo, Carlotta Morozzi and Caterina Gozzoli

Int. J. Environ. Res. Public Health 2023, 20(2), 1371; https://doi.org/10.3390/ijerph20021371 - 12 Jan 2023

Cited by 7 | Viewed by 2175

Abstract

The reception and taking care of forced migrants with mental health issues is undoubtedly a very complex task. The literature shows that reception systems are characterized by a high level of fragmentation due to poor collaboration among services that are required to respond to complex and multidimensional needs brought by forced migrants. Starting from the need to deepen what elements support or hinder the implementation of the services’ networks for the care and management of forced migrants, qualitative research was conducted within a constructivist paradigm. As the literature reveals a lack of studies considering the perspective of practitioners, we decided to explore the representations of professionals working with migrants in northern Italy in four different service areas (health and psychological well-being, reception, family, and legal areas). A total of 24 professionals (13 F and 11 M) with an average age of 42.4 years were involved in four focus groups according to the four areas. A paper–pencil content analysis was conducted following IPA guidelines. The results show strengths, weaknesses, and elements of improvement for service network implementation. The needs of forced migrants seem to be effectively met only through a service network that takes shape in the interweaving of social, organizational, group, and individual levels. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

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12 pages, 351 KiB

Open AccessArticle

“I’m Going to Tell You Something I Never Told Anyone”: Ethics- and Trauma-Informed Challenges of Implementing a Research Protocol with Syrian Refugees

by Lisa Matos, Monica J. Indart, Crystal L. Park and Isabel Leal

Int. J. Environ. Res. Public Health 2023, 20(2), 1261; https://doi.org/10.3390/ijerph20021261 - 10 Jan 2023

Cited by 3 | Viewed by 2589

Abstract

As research subjects, refugees have numerous potential vulnerabilities. This study aimed to examine the ethics- and trauma-informed challenges of implementing a mental health research protocol with Syrian refugees living in Portugal. Guided by the integrated meaning-making model, the research project “Journeys in Meaning” employed a mixed-methods cross-sectional design to explore posttraumatic cognitive processing in refugees using two phases of data collection: two focus groups (Phase 1) to test the protocol and 39 in-depth individual interviews (Phase 2) to implement the protocol. Results examine the strategies used to address the following: methodological challenges related to protocol design, participant recruitment, and language; ethics- and trauma-informed challenges aimed at minimizing harm and maximizing benefit to participants that followed social justice principles; and perceived compassion fatigue on the part of the researcher following repeated empathetic exposure to traumatic content. Findings suggest the need for adaptive approaches to research with refugee populations that challenge strict compliance with the traditional principles of “do no harm” and researcher neutrality, and that accommodate individual and community complexities. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

11 pages, 362 KiB

Open AccessArticle

Does Time Heal Trauma? 18 Month Follow-Up Study of Syrian Refugees’ Mental Health in Iraq’s Kurdistan Region

by Harem Nareeman Mahmood, Hawkar Ibrahim, Azad Ali Ismail and Frank Neuner

Int. J. Environ. Res. Public Health 2022, 19(22), 14910; https://doi.org/10.3390/ijerph192214910 - 12 Nov 2022

Cited by 5 | Viewed by 2265

Abstract

The findings of longitudinal studies on traumatized refugees have shown that factors related to premigration, migration, and post-migration experiences determine changes in mental health over time. The primary aim of this follow-up study was to examine the potential change in the prevalence rates of probable PTSD and depression among Syrian refugees in Iraq. An unselected group of N = 92 Syrian adult refugees was recruited from Arbat camps in Sulaymaniyah Governorate in Iraq’s Kurdistan Region, and then interviewed at two different time points between July 2017 and January 2019. Locally validated instruments were used to assess traumatic events and mental health symptoms. The primary results showed no significant change in the mean scores of PTSD and depression symptoms from the first measurement to the second measurement over the course of 18 months. On the individual level, no reliable change was found for either PTSD or depression symptoms in more than three-quarters of the participants (78.3% and 77.2%, respectively). New adversities and traumatic events that occurred over the 18 months between the interviews were a significant predictor of increasing trauma-related symptoms. After the flight from conflict settings, trauma-related disorders seem to be chronic for the majority of Syrian refugees. Further longitudinal studies are needed in order to identify specific risk factors that lead to maintaining or worsening mental health symptoms over time, and to explore effective therapeutic intervention methods for this traumatized population. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

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16 pages, 705 KiB

Open AccessConcept Paper

Addressing the Mental Health Challenges of Refugees—A Regional Network-Based Approach in Middle Hesse Germany

by Bernd Hanewald, Michael Knipper, Janneke Daub, Saskia Ebert, Christina Bogdanski, Laura Hinder, Mila Hall, Daniel Berthold and Markus Stingl

Int. J. Environ. Res. Public Health 2022, 19(20), 13436; https://doi.org/10.3390/ijerph192013436 - 18 Oct 2022

Cited by 4 | Viewed by 2511

Abstract

Refugees constitute a vulnerable group with an increased risk of developing trauma-related disorders. From a clinician’s integrative perspective, navigating the detrimental impact of the social, economic, structural, and political factors on the mental health of refugees is a daily experience. Therefore, a collective effort must be made to reduce health inequities. The authors developed a treatment concept which provides broader care structures within a scientific practitioner’s approach. The resulting “Trauma Network” addresses the structural challenges for refugees in Middle Hesse. Accompanying research provided a sound basis for further discussions with policy-makers to improve the situation for refugees in the short- and long-term. Full article

(This article belongs to the Special Issue The Forced Migrants’ Mental Health: Challenges, Practices and Intervention)

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