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Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations

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 (31 January 2022) | Viewed by 51257

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Shameran Slewa-Younan

E-Mail Website
Chief Guest Editor
School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
Interests: mental health literacy of refugee and other culturally and/or linguistically diverse (cald) groups; mental health stigma
Dr. Greg Armstrong

E-Mail Website
Guest Editor
Nossal Institute for Global Health, Melbourne School of Population and Global Health, Melbourne University, Melbourne, Victoria, Australia
Interests: population mental health; self-harm and suicide prevention; low and middle-income countries; migrant and refugee groups

Special Issue Information

Dear Colleauges,

Mental health promotion is a wide-ranging concept influenced by cultural, socioeconomic, and political factors. Nonetheless, the goal of mental health promotion is to positively influence the determinants of mental health by undertaking effective multilevel interventions across numerous sectors, settings, and environments. Within populations such as refugee groups, exposure to pre-migratory traumatic events combined with stressors during their travel and following migration and resettlement can lead to a higher risk of the development of psychological distress and mental ill health. As such, mental health promotion efforts are needed to ensure that systems are in place to support refugees to maintain good mental health, to enhance understanding and engagement with mental healthcare where it is needed, and to provide mental health services that are effective for such heterogeneous populations.

This Special Issue of IJERPH seeks to invite researchers in mental health, public health, and policy and social sciences to submit high-quality research that focuses on improving our understanding of how to promote mental health and best care practices for refugees and other culturally and/or linguistically diverse migrant populations.

Dr. Shameran Slewa-Younan
Dr. Greg Armstrong
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Mental health promotion
  • Refugees
  • Culturally and/or linguistically diverse groups

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Published Papers (11 papers)

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Research

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15 pages, 336 KiB  
Article
Physical Activity Experiences of South Asian Migrant Women in Western Australia: Implications for Intervention Development
by Alexis Pullia, Zakia Jeemi, Miguel Reina Ortiz and Jaya A. R. Dantas
Int. J. Environ. Res. Public Health 2022, 19(6), 3585; https://doi.org/10.3390/ijerph19063585 - 17 Mar 2022
Cited by 7 | Viewed by 3146
Abstract
The benefits of physical activity are widely recognised; however, physical activity uptake remains low in South Asian populations. South Asian migrant women face health risks as they adapt to new cultures, and these risks are often intensified through their limited participation in physical [...] Read more.
The benefits of physical activity are widely recognised; however, physical activity uptake remains low in South Asian populations. South Asian migrant women face health risks as they adapt to new cultures, and these risks are often intensified through their limited participation in physical activity as one of the behaviours that promote positive health outcomes. Three focus group discussions with sixteen South Asian migrant women aged between 33 and 64 years, with a median age of 48 years and who live in Western Australia, were conducted. Thematic analysis of the transcribed qualitative data was completed to explore and uncover South Asian women’s experiences with physical activity, as well as their motivation, beliefs, attitudes, and knowledge about physical activity. Five major themes emerged after coding and analysing the data. The themes included the women’s knowledge of physical activity, their general attitudes and beliefs surrounding physical activity, the advantages and disadvantages of participation in physical activity, their experiences with physical activity, and the barriers, challenges, and facilitators surrounding physical activity. Recommendations are proposed to increase physical activity among this group to improve overall health and wellbeing and implications for intervention development are discussed. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
18 pages, 355 KiB  
Article
Mental Health in the Transit Context: Evidence from 10 Countries
by Maria Caterina Gargano, Dean Ajduković and Maša Vukčević Marković
Int. J. Environ. Res. Public Health 2022, 19(6), 3476; https://doi.org/10.3390/ijerph19063476 - 15 Mar 2022
Cited by 4 | Viewed by 3703
Abstract
Most interventions for mental health and psychosocial support (MHPSS) have been developed in contexts and with populations that differ significantly from the realities of migration. There is an urgent need for MHPSS in transit; however, transit-specific aspects of MHPSS provision are often neglected [...] Read more.
Most interventions for mental health and psychosocial support (MHPSS) have been developed in contexts and with populations that differ significantly from the realities of migration. There is an urgent need for MHPSS in transit; however, transit-specific aspects of MHPSS provision are often neglected due to the inherent challenges transit poses to traditional conceptualizations of practice. The Delphi method, which consisted of three iterative rounds of surveys, was applied with the goal of identifying challenges to and adaptations of MHPSS in the transit context. Twenty-six MHPSS providers working with refugees in 10 European transit countries participated; 69% of participants completed all three survey rounds. There was consensus that a flexible model of MHPSS, which can balance low intensity interventions and specialized care, is needed. Agreement was high for practice-related and sociopolitical factors impacting MHPSS in transit; however, the mandate of MHPSS providers working in the transit context achieved the lowest consensus and is yet to be defined. There is a need to rethink MHPSS in the refugee transit context. Providing MHPSS to refugees on the move has specificities, most of which are related to the instability and uncertainty of the context. Future directions for improving mental health protection for refugees, asylum seekers, and migrants in transit are highlighted. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
17 pages, 341 KiB  
Article
Impact of a Pilot Peer-Mentoring Empowerment Program on Personal Well-Being for Migrant and Refugee Women in Western Australia
by Shelley Gower, Zakia Jeemi, Niranjani Wickramasinghe, Paul Kebble, David Forbes and Jaya A R Dantas
Int. J. Environ. Res. Public Health 2022, 19(6), 3338; https://doi.org/10.3390/ijerph19063338 - 11 Mar 2022
Cited by 10 | Viewed by 4510
Abstract
The Empowerment and Peer Mentoring of Migrant and Refugee Women study (EMPOWER) examined the effectiveness of a participatory, peer mentoring program specifically tailored for migrant and refugee women to build ability, confidence, and knowledge to seek employment, a known contributor to mental health [...] Read more.
The Empowerment and Peer Mentoring of Migrant and Refugee Women study (EMPOWER) examined the effectiveness of a participatory, peer mentoring program specifically tailored for migrant and refugee women to build ability, confidence, and knowledge to seek employment, a known contributor to mental health and wellbeing. Female migrant mentors (n = 21) supported five cohorts of mentees (n = 32), predominantly from Middle Eastern and Asian backgrounds, over a period of 3–12 months each between September 2019 and November 2021. The program consisted of both individual mentoring and group workshops facilitated by content experts and the research team. The mental health and wellbeing outcomes for the mentees were explored through individual interviews with both mentors and mentees. Results indicate the program helped participants develop social connections, self-esteem, self-efficacy, and personal health and safety skills. There are ongoing mental health needs in this cohort related to competing priorities and trauma. The development of trusting, respectful relationships with mentors who are committed and flexible is essential for positive wellbeing outcomes. Peer mentoring programs for migrant and refugee women can enhance mental health and wellbeing outcomes and facilitate independence. Mentors need resources to provide appropriate mental and physical health support for some groups. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
21 pages, 555 KiB  
Article
Promoting Mental Health and Wellbeing in Multicultural Australia: A Collaborative Regional Approach
by Ilse Blignault, Hend Saab, Lisa Woodland, Klara Giourgas and Heba Baddah
Int. J. Environ. Res. Public Health 2022, 19(5), 2723; https://doi.org/10.3390/ijerph19052723 - 26 Feb 2022
Cited by 7 | Viewed by 5871
Abstract
Migrant communities are often under-served by mental health services. Lack of community engagement results in missed opportunities for mental health promotion and early intervention, delayed care, and high rates of untreated psychological distress. Bilingual clinicians and others who work with these communities lack [...] Read more.
Migrant communities are often under-served by mental health services. Lack of community engagement results in missed opportunities for mental health promotion and early intervention, delayed care, and high rates of untreated psychological distress. Bilingual clinicians and others who work with these communities lack linguistically and culturally appropriate resources. This article reports on the implementation and evaluation of a community-based group mindfulness program delivered to Arabic and Bangla-speaking communities in Sydney, Australia, including modifications made to the content and format in response to the COVID-19 pandemic. The program was positioned within a stepped-care model for primary mental health care and adopted a collaborative regional approach. In addition to improved mental health outcomes for face-to-face and online program participants, we have documented numerous referrals to specialist services and extensive diffusion of mindfulness skills, mostly to family members, within each community. Community partnerships were critical to community engagement. Training workshops to build the skills of the bilingual health and community workforce increased the program’s reach. In immigrant nations such as Australia, mainstream mental health promotion must be complemented by activities that target specific population groups. Scaled up, and with appropriate adaptation, the group mindfulness program offers a low-intensity in-language intervention for under-served communities. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
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16 pages, 363 KiB  
Article
Professional Mental Health Help-Seeking Amongst Afghan and Iraqi Refugees in Australia: Understanding Predictors Five Years Post Resettlement
by Ana-Marija Tomasi, Shameran Slewa-Younan, Renu Narchal and Pilar Rioseco
Int. J. Environ. Res. Public Health 2022, 19(3), 1896; https://doi.org/10.3390/ijerph19031896 - 8 Feb 2022
Cited by 13 | Viewed by 4467
Abstract
The current longitudinal study sought to identify predictors of professional help seeking for mental health problems amongst Afghan and Iraqi refugees five years post-settlement utilising the Building a New Life in Australia dataset (BNLA). Data were collected via face-to-face or phone interviews across [...] Read more.
The current longitudinal study sought to identify predictors of professional help seeking for mental health problems amongst Afghan and Iraqi refugees five years post-settlement utilising the Building a New Life in Australia dataset (BNLA). Data were collected via face-to-face or phone interviews across five waves from October 2013 to March 2018. Afghan and Iraqi born refugees numbering 1180 and over 18 years of age with a permanent humanitarian visa were included in this study. The results suggest differences in help-seeking behaviors amongst the two ethnic groups. Amongst the Afghan sample, older adults with high psychological distress were more likely to seek help, while living in regional Australia, not requiring interpreters, and knowing how to find out information about government services were related to lower likelihood of help-seeking. Within the Iraqi sample, poor overall health and knowing how to find out about services were related to a greater likelihood of help-seeking, while fewer financial hardships decreased the likelihood of help-seeking. Amongst those with probable PTSD, disability was associated with an increased likelihood of help-seeking while experiencing fewer financial hardships and living in regional Australia resulted in a lower likelihood of help-seeking in this group. These results have implications for promotional material and mental health interventions, suggesting that more integrated services tailored to specific characteristics of ethnic groups are needed. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
16 pages, 1084 KiB  
Article
Trauma, Post-Traumatic Stress Disorder, and Mental Health Care of Asylum Seekers
by Rafael Youngmann, Rachel Bachner-Melman, Lilac Lev-Ari, Hadar Tzur, Ravit Hileli and Ido Lurie
Int. J. Environ. Res. Public Health 2021, 18(20), 10661; https://doi.org/10.3390/ijerph182010661 - 12 Oct 2021
Cited by 4 | Viewed by 3300
Abstract
Asylum seekers in Israel from East Africa frequently experienced traumatic events along their journey, particularly in the Sinai Peninsula, where they were subjected to trafficking and torture. Exposure to trauma has implications for rights that are contingent on refugee status. This retrospective chart [...] Read more.
Asylum seekers in Israel from East Africa frequently experienced traumatic events along their journey, particularly in the Sinai Peninsula, where they were subjected to trafficking and torture. Exposure to trauma has implications for rights that are contingent on refugee status. This retrospective chart review aimed to characterize the types of traumas experienced by 219 asylum seekers (149 men) from Eritrea and Sudan who sought treatment at a specialized mental health clinic in Israel, and to compare the mental health of trauma victims (n = 168) with that of non-trauma victims (n = 53). About 76.7% of the asylum seekers had experienced at least one traumatic event, of whom 56.5% were diagnosed with post-traumatic stress disorder (PTSD). Most reported traumas were experienced en route in the Sinai, rather than in the country of origin or Israel. Few clinical differences were observed between trauma victims and non-trauma victims, or between trauma victims with and without a PTSD diagnosis. Our findings emphasize the importance of accessibility to mental and other health services for asylum seekers. Governmental policies and international conventions on the definition of human trafficking may need to be revised, as well as asylum seekers’ rights and access to health services related to visa status. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
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13 pages, 363 KiB  
Article
Mental Illness Stigma and Associated Factors among Arabic-Speaking Religious and Community Leaders
by Klimentina Krstanoska-Blazeska, Russell Thomson and Shameran Slewa-Younan
Int. J. Environ. Res. Public Health 2021, 18(15), 7991; https://doi.org/10.3390/ijerph18157991 - 28 Jul 2021
Cited by 8 | Viewed by 3908
Abstract
Evidence suggests that Arabic-speaking refugees in Australia seek help from informal sources, including religious and community leaders, when experiencing mental health issues. Despite their significant influence, there is scarce research exploring attitudes of Arabic-speaking leaders toward mental illness. The current exploratory study explored [...] Read more.
Evidence suggests that Arabic-speaking refugees in Australia seek help from informal sources, including religious and community leaders, when experiencing mental health issues. Despite their significant influence, there is scarce research exploring attitudes of Arabic-speaking leaders toward mental illness. The current exploratory study explored mental illness stigma and various factors among Arabic-speaking religious and community leaders. This study uses a subset of data from an evaluation trial of mental health literacy training for Arabic-speaking religious and community leaders. Our dataset contains the pre-intervention survey responses for 52 Arabic-speaking leaders (69.2% female; mean age = 47.1, SD = 15.3) on the ability to recognise a mental disorder, beliefs about causes for developing mental illness, and two stigma measures, personal stigma, and social distance. Being female was associated with a decrease in personal stigma. An increase in age was associated with an increase in personal stigma. Correct recognition of a mental disorder was associated with decreased personal stigma, and after adjusting for age and gender, significance was retained for the I-would-not-tell-anyone subscale. Endorsing the cause “being a person of weak character” was associated with an increase in personal stigma. There is an urgent need for future research to elucidate stigma to develop effective educational initiatives for stigma reduction among Arabic-speaking leaders. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)

Review

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15 pages, 715 KiB  
Review
How Are Non-Medical Settlement Service Organizations Supporting Access to Healthcare and Mental Health Services for Immigrants: A Scoping Review
by Ayesha Ratnayake, Shahab Sayfi, Luisa Veronis, Sara Torres, Sihyun Baek and Kevin Pottie
Int. J. Environ. Res. Public Health 2022, 19(6), 3616; https://doi.org/10.3390/ijerph19063616 - 18 Mar 2022
Cited by 1 | Viewed by 2974
Abstract
Following resettlement in high-income countries, many immigrants and refugees experience barriers to accessing primary healthcare. Local non-medical settlement organizations, such as the Local Immigration Partnerships in Canada, that support immigrant integration, may also support access to mental health and healthcare services for immigrant [...] Read more.
Following resettlement in high-income countries, many immigrants and refugees experience barriers to accessing primary healthcare. Local non-medical settlement organizations, such as the Local Immigration Partnerships in Canada, that support immigrant integration, may also support access to mental health and healthcare services for immigrant populations. This scoping review aims to identify and map the types and characteristics of approaches and interventions that immigrant settlement organizations undertake to support access to primary healthcare for clients. We systematically searched MEDLINE, Social Services Abstracts, CINAHL, and PsycInfo databases from 1 May 2013 to 31 May 2021 and mapped research findings using the Social-Ecological Model. The search identified 3299 citations; 10 studies met all inclusion criteria. Results suggest these organizations support access to primary healthcare services, often at the individual, relationship and community level, by collaborating with health sector partners in the community, connecting clients to health services and service providers, advocating for immigrant health, providing educational programming, and initiating community development/mobilization and advocacy activities. Further research is needed to better understand the impact of local non-medical immigrant settlement organizations involved in health care planning and service delivery on reducing barriers to access in order for primary care services to reach marginalized, high-need immigrant populations. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
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41 pages, 2886 KiB  
Review
Mental Health Screening Approaches for Resettling Refugees and Asylum Seekers: A Scoping Review
by Olivia Magwood, Azaad Kassam, Dorsa Mavedatnia, Oreen Mendonca, Ammar Saad, Hafsa Hasan, Maria Madana, Dominique Ranger, Yvonne Tan and Kevin Pottie
Int. J. Environ. Res. Public Health 2022, 19(6), 3549; https://doi.org/10.3390/ijerph19063549 - 16 Mar 2022
Cited by 20 | Viewed by 9619
Abstract
Refugees and asylum seekers often face delayed mental health diagnoses, treatment, and care. COVID-19 has exacerbated these issues. Delays in diagnosis and care can reduce the impact of resettlement services and may lead to poor long-term outcomes. This scoping review aims to characterize [...] Read more.
Refugees and asylum seekers often face delayed mental health diagnoses, treatment, and care. COVID-19 has exacerbated these issues. Delays in diagnosis and care can reduce the impact of resettlement services and may lead to poor long-term outcomes. This scoping review aims to characterize studies that report on mental health screening for resettling refugees and asylum seekers pre-departure and post-arrival to a resettlement state. We systematically searched six bibliographic databases for articles published between 1995 and 2020 and conducted a grey literature search. We included publications that evaluated early mental health screening approaches for refugees of all ages. Our search identified 25,862 citations and 70 met the full eligibility criteria. We included 45 publications that described mental health screening programs, 25 screening tool validation studies, and we characterized 85 mental health screening tools. Two grey literature reports described pre-departure mental health screening. Among the included publications, three reported on two programs for women, 11 reported on programs for children and adolescents, and four reported on approaches for survivors of torture. Programs most frequently screened for overall mental health, PTSD, and depression. Important considerations that emerged from the literature include cultural and psychological safety to prevent re-traumatization and digital tools to offer more private and accessible self-assessments. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
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14 pages, 631 KiB  
Review
Refugee Women with a History of Trauma: Gender Vulnerability in Relation to Post-Traumatic Stress Disorder
by Macarena Vallejo-Martín, Ana Sánchez Sancha and Jesús M. Canto
Int. J. Environ. Res. Public Health 2021, 18(9), 4806; https://doi.org/10.3390/ijerph18094806 - 30 Apr 2021
Cited by 25 | Viewed by 4871
Abstract
Refugees represent a population whose living conditions have a strong impact on their mental health. High rates of post-traumatic stress disorder (PTSD), more than other mental disorders, have been found in this group, with women having the highest incidence. The objective of the [...] Read more.
Refugees represent a population whose living conditions have a strong impact on their mental health. High rates of post-traumatic stress disorder (PTSD), more than other mental disorders, have been found in this group, with women having the highest incidence. The objective of the present systematic review was to identify and examine studies from the last fifteen years on the relationship between the impact of traumatic experiences and PTSD psychopathology in refugee women. Twelve studies were included, from which the overall results approved this relation. In addition, six of these studies show that exposure to sexual trauma in refugee women is associated with the high odds of being at risk for PTSD. These findings suggest that gender-related traumatic experiences can explain the high rate of PTSD in refugee women and highlight the unmet need for psychosocial health care in this population. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
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Other

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7 pages, 301 KiB  
Brief Report
Screening for Posttraumatic Stress Symptoms in Young Refugees: Comparison of Questionnaire Data with and without Involvement of an Interpreter
by Lauritz Rudolf Floribert Müller, Johanna Unterhitzenberger, Svenja Wintersohl, Rita Rosner and Julia König
Int. J. Environ. Res. Public Health 2021, 18(13), 6803; https://doi.org/10.3390/ijerph18136803 - 24 Jun 2021
Cited by 3 | Viewed by 2154
Abstract
Background: The substantial number of young refugees who have arrived in Europe since 2015 requires rapid screening to identify those in need of treatment. However, translated versions of screening measures are not always available, necessitating the support of interpreters. The Child and [...] Read more.
Background: The substantial number of young refugees who have arrived in Europe since 2015 requires rapid screening to identify those in need of treatment. However, translated versions of screening measures are not always available, necessitating the support of interpreters. The Child and Adolescent Trauma Screen (CATS) is a validated questionnaire for posttraumatic stress symptoms. Here, we report on the psychometric properties of the CATS in a sample of young refugees as a function of interpreter involvement. Methods: A total of N = 145 (Mage = 16.8, SD = 1.54; 93% male) were assessed with the CATS, with half of the screenings conducted with and half without interpreters. Post hoc analyses included calculating internal consistency using Cronbach’s α. We used confirmative factor analysis to investigate the factor structure. Results: The CATS total scale showed good reliability (α = 0.84). Differences in psychometric properties between the interpreter vs. the no interpreter group were minor and tended to be in favor of the interpreter group. Results of a confirmatory factor analysis were acceptable after the exclusion of items with low item-scale correlations. Conclusions: The sample and the administration of the assessment represent the situation of young refugees in Germany, where resources are low and translated versions not always available. The CATS may be a helpful screening tool for clinicians working with young refugees, even when administered with an interpreter. Limitations include the post hoc design of the analysis without randomization of participants and the lack of a third comparison group using translated questionnaire versions. Full article
(This article belongs to the Special Issue Mental Health Promotion for Refugees and Other Culturally and/or Linguistically Diverse Migrant Populations)
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