Mental Health of Refugees and Torture Survivors: A Critical Review of Prevalence, Predictors, and Integrated Care

Civilian war trauma and torture rank among the most traumatic life experiences; exposure to such experiences is pervasive in nations experiencing both internal and external conflict. This has led to a high volume of refugees resettling throughout the world with mental health needs that primary care physicians may not be screening for and prepared to effectively address. In this article, we review the literature on demographics, predictors, mental health outcomes of torture, and integrated care for the mental health needs of refugees. We searched PubMed and PSYCINFO databases for original research articles on refugees and mental health published in the English language between 2010 and present. Nine percent of 720 adults in conflict areas in Nepal, with predominance of literate married males, met the threshold for Post-Traumatic Stress Disorder (PTSD), 27.5% for depression, and 22.9% for anxiety. While, PTSD rate has been documented as high as 88.3% among torture survivors from Middle East (ME), Central Africa (CA), South Asia (SA), Southeast Europe (SE). Depression was recorded as high as 94.7% among 131 African torture survivors and anxiety as high as 91% among 55 South African torture survivors. Torture severity, post-migration difficulties, and wait time to receive clinical services were significantly associated with higher rate of mental health symptoms. Mental health screening is not a standard component of initial physical exams for refugees, yet these individuals have had high trauma exposure that should inform clinical care. Integrated care models are lacking but would greatly benefit this community to prevent progression to greater severity of mental health symptoms.

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Online Problem-Solving Training with and without Peer Support in Veterans with Unmet Mental Health Needs: A Pilot Study of Feasibility, User Acceptability and Patient Engagement (Preprint)

10.2196/preprints.29559 ◽

2021 ◽

Author(s):

Kyle Possemato ◽

Justina Wu ◽

Carolyn Greene ◽

Rex MacQueen ◽

Daniel Blonigen ◽

...

Keyword(s):

Mental Health ◽

Pilot Study ◽

Problem Solving ◽

Peer Support ◽

Health Needs ◽

Mental Health Needs ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Unmet Mental Health

BACKGROUND Electronic health (eHealth) tools have the potential to meet the mental health needs of individuals who have barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase engagement with eHealth. OBJECTIVE This pilot study aimed to 1) test the feasibility and acceptability of a novel, completely automated online system to recruit, screen, enroll, assess, randomize and then deliver an intervention to a national sample of military veterans with unmet mental health needs, 2) investigate whether phone-based peer support increased usage of an online problem-solving training compared to self-directed use and 3) generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research. METHODS Veterans (n=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to self-directed use of an online problem-solving training called Moving Forward (n=28), peer supported Moving Forward (n=27), or a waitlist control (n=26) (ClinicalTrials.gov NCT03555435). Participants completed pre and post study measures (8 weeks later) of problem-solving skills and confidence as well as mental health symptoms. Satisfaction was assessed at post-treatment and objective use of Moving Forward was measured with number of log-ins. RESULTS Automated recruitment, enrollment and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% retention. Peer support was delivered with high fidelity and was associated with favorable patient satisfaction. Participants randomized to receive peer support had significantly more Moving Forward logins than self-directed Moving Forward participants, and those who received peer support had greater decreases in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support. CONCLUSIONS Enrolling and assessing individuals in eHealth studies without human contact is feasible, but different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in online interventions and in reducing symptoms. Future research should investigate when and for whom peer support of eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for online problem-solving training. CLINICALTRIAL ClinicalTrials.gov NCT03555435

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Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

Sports Medicine - Open ◽

10.1186/s40798-019-0220-1 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 10

Author(s):

Rosemary Purcell ◽

Kate Gwyther ◽

Simon M. Rice

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Sports Medicine ◽

Elite Athletes ◽

Health Needs ◽

Mental Health Needs ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Health And Wellbeing ◽

The Right

Abstract The current ‘state of play’ in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete’s mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete’s overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete’s mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

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Bridging Hospital and Community Care for Homeless Adults with Mental Health Needs: Outcomes of a Brief Interdisciplinary Intervention

The Canadian Journal of Psychiatry ◽

10.1177/0706743718772539 ◽

2018 ◽

Vol 63 (11) ◽

pp. 774-784 ◽

Cited By ~ 3

Author(s):

Vicky Stergiopoulos ◽

Agnes Gozdzik ◽

Rosane Nisenbaum ◽

Janet Durbin ◽

Stephen W. Hwang ◽

...

Keyword(s):

Mental Health ◽

Service Use ◽

Health Needs ◽

Mental Health Needs ◽

Mental Health Symptoms ◽

Homeless Adults ◽

Health Symptoms ◽

Discharge From Hospital ◽

Post Hoc ◽

Interdisciplinary Intervention

Objective: This study examines health and service use outcomes and associated factors among homeless adults participating in a brief interdisciplinary intervention following discharge from hospital. Method: Using a pre-post cohort design, 223 homeless adults with mental health needs were enrolled in the Coordinated Access to Care for the Homeless (CATCH) program, a 4- to 6-month interdisciplinary intervention offering case management, peer support, access to primary psychiatric care, and supplementary community services. Study participants were interviewed at program entry and at 3- and 6-month follow-up visits and assessed for health status, acute care service use, housing outcomes, mental health, substance use, quality of life, and their working alliance with service providers. Linear mixed models and generalized estimating equations were performed to examine outcomes longitudinally. Additional post hoc analyses evaluated differences between CATCH participants and a comparison group of homeless adults experiencing mental illness who received usual services over the same period. Results: In the pre-post analyses, CATCH participants had statistically significant improvements in mental and physical health status and reductions in mental health symptoms, substance misuse, and the number of hospital admissions. The strength of the working alliance between participants and their case manager was associated with reduced health care use and mental health symptoms. Post hoc analyses suggest that CATCH may be associated with statistically significant improvements in mental health symptoms in the study population. Conclusions: A brief interdisciplinary intervention may be a promising approach to improving health outcomes among homeless adults with unmet health needs. Further rigorous research is needed into the effectiveness of brief interventions following discharge from hospital.

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Integrated Care: Meeting Mental Health Needs After the Gulf Oil Spill

Psychiatric Services ◽

10.1176/appi.ps.201300470 ◽

2014 ◽

Vol 65 (3) ◽

pp. 280-283 ◽

Cited By ~ 18

Author(s):

Howard J. Osofsky ◽

Joy D. Osofsky ◽

John H. Wells ◽

Carl Weems

Keyword(s):

Mental Health ◽

Integrated Care ◽

Oil Spill ◽

Health Needs ◽

Mental Health Needs ◽

Gulf Oil Spill

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Torture, War Trauma, and Mental Health Symptoms of Newly Arrived Karen Refugees

Journal of Loss and Trauma ◽

10.1080/15325024.2014.965971 ◽

2015 ◽

Vol 20 (6) ◽

pp. 577-590 ◽

Cited By ~ 22

Author(s):

Patricia J. Shannon ◽

Gregory A. Vinson ◽

Elizabeth Wieling ◽

Tonya Cook ◽

James Letts

Keyword(s):

Mental Health ◽

War Trauma ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Karen Refugees

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4.2 THE UNIVERSITY OF NEW MEXICO JOURNEYS CLINIC: AN INTEGRATED CARE APPROACH TO ADDRESSING MATERNAL MENTAL HEALTH NEEDS

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2016.07.457 ◽

2016 ◽

Vol 55 (10) ◽

pp. S7

Author(s):

Anilla Del Fabbro

Keyword(s):

Mental Health ◽

New Mexico ◽

Integrated Care ◽

Maternal Mental Health ◽

Health Needs ◽

Mental Health Needs ◽

University Of New Mexico ◽

Care Approach ◽

The University

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What can Somali community talk about mental health tell us about our own? Contextualizing the symptoms of mental health

International Journal of Migration Health and Social Care ◽

10.1108/ijmhsc-03-2018-0020 ◽

2019 ◽

Vol 15 (2) ◽

pp. 133-149

Author(s):

Juanita Ryan ◽

Pauline B. Thompson Guerin ◽

Fatuma Hussein Elmi ◽

Bernard Guerin

Keyword(s):

Mental Health ◽

Explanatory Models ◽

Original Research ◽

Health Issues ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Content Type ◽

Psychological Suffering ◽

Somali Refugee ◽

Practical Implications

Purpose The purpose of this paper is to review all the research on Somali refugee communities’ “explanatory models” of “mental health” or psychological suffering, and also report original research in order to allow for more contexts on their “mental health” terms to emerge. Design/methodology/approach The authors talked in a conversational manner with a small number (11) of Somali people (10 females and 1 male), but this was done intensively over time and on multiple occasions. They discussed their community terms for “mental health” issues but in their own contexts and with their own examples. Findings The results showed that Somali as a community had three main groupings of symptoms: Jinn or spirit possession; waali or “craziness”; and a group of terms for serious anxieties, rumination, worrying and thinking too much. What was new from their broader descriptions of context was that the community discourses were based on particular contexts of the person and their behavior within their life history, rather than aiming to universal categories like the DSM. Practical implications Both research and practice on mental health should focus less on universal diagnoses and more on describing the contexts in which the symptoms emerge and how to change those contexts, especially with refugee and other less well-understood groups. Originality/value The review and original results support symptom-based or contextual approaches to mental health; we should treat the “mental health” symptoms in their life contexts rather than as a disease or disorder. We can learn from how Somali describe their “mental health” symptoms rather than treat their descriptions as crude forms of the “correct” western diagnostics.

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