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RESEARCH ABSTRACTS

Mental & Physical Health

GENERAL

IMPACT OF IMMIGRATION DETENTION AND TEMPORARY PROTECTION ON THE MENTAL HEALTH OF REFUGEES

The British Journal of Psychiatry, 2006, vol. 188, no.1, pp. 58-64.

Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., and Susljik, I.

Abstracted by Laura Egan

Policies directed towards refugees are currently shifting in Western developed countries with Australia leading the movement. With the changing attitudes and terms of visas, Steel et al set out to examine the long-term effects such policies have on the mental health of refugees when they are faced with mandatory detention and temporary protection. This study was based in Australia where policy in the past two decades has changed fundamentally in two ways. First, those arriving by boat or without valid entry visas are subjected to compulsory detention for the duration of the asylum determination procedure. Secondly, new temporary protection visas limit a holder’s access to healthcare, education and ability to work, with no opportunity for overseas travel; they are considered ineligible for migration to family reunions. The authors employed an applied multilevel model to test the hypothesis that each of these policies contributes to ongoing post-traumatic stress disorder (PTSD), depression and associated disabilities in refugees.

The group examined for this study is that of Sabaean-Mandaeans refugees, a small pre-Christian sect originating from Iran and Iraq who have suffered long-term discrimination and persecution which escalated prior to and during the Iraq war in 2003. A total of 241 refugees participated, with the group split almost evenly between those holding either a temporary or a permanent visa. A variety of measures, including two psychometrically tested symptom measures, were used to examine and compare pre-migration trauma, post-migration living difficulties, immigration detention experiences and symptoms along with psychiatric status and disabilities.

Through the study the authors concluded that the refugees who possess temporary protection visas have higher rates of PTSD, depression, and disability versus those who have permanent visas. Temporary protection leaves refugees with greater insecurity and more susceptibility to stressors, especially as the length of detention increases. The implication of this small study allows for the conclusions to reach across country borders, showing that prolonged detention has a long-term impact on the psychological well-being of refugees, and the idea of temporary protection leaves the sense of certainty out of the equation that is a fundamental part of permanent protection. With procedures changing in the developed world, the policies towards refugees and the repercussions on the refugees’ mental health need to be examined more in-depth and on a wider scale across Western developed countries.

 

 

REFUGEE'S RESPONSES TO MENTAL HEALTH SCREENING: A RESETTLEMENT INITIATIVE

International Social Work, 1 April 2003 , vol. 46, no. 2, pp. 235-250(16)

Ovitt N., Larrison C.R., and Nackerud L.

Abstracted by Cindy Bosley

Much research has shown a higher incidence of mental health problems among refugees as compared to the general population. In addition to the challenges of treating refugees' mental health problems, there is also a great challenge in diagnosing them. Other research has shown that there are several major barriers preventing or hindering diagnoses and subsequent treatment. These barriers include refugees not seeking help, lack of accessibility of services, linguistic and cultural barriers in diagnosis and treatment, and conflicting resettlement goals. This article describes a small study of a screening test used to identify mental health problems in Bosnian refugees shortly after arriving in the U.S. The screening tool that is used is the Hopkins Symptom Checklist (HSCL-25), which has been translated into four languages, including Bosnian. The HSCL-25 lists common symptoms of various mental health problems, and asks the respondents to identify any symptoms they are experiencing. The checklist was administered to eight recently-arrived, adult Bosnian refugees, and the results showed most of the refugees reporting at least some symptoms of mental health problems, with one refugee meeting the official criteria warranting treatment. The researchers immediately followed the HSCL-25 with a client questionnaire about the screening instrument and process. The client questionnaire asked questions such as: Was the checklist easy to understand, were the items in the checklist upsetting or difficult to answer, and do you feel that this was an appropriate time to consider these kinds of questions? The refugees responded quite positively to the screening process, noting that the HSCL-25 was helpful, important to refugees, and administered as an appropriate time. Most of the eight refugees also indicated that they had not been screened in this manner before in the resettlement process, nor had anyone even asked these types of questions. The overall conclusions of this study are that the HSCL-25 is an appropriate instrument to use with recently-arrived, adult Bosnian refugees resettled in the U.S., and the HSCL-25 can assist mental health professionals in identifying refugees with symptoms of mental health problems.

 

 

TRAINING REFUGEE MENTAL HEALTH PROVIDERS: ETHNOGRAPHY AS A BRIDGE TO MULTICULTURAL PRACTICE

Human Organization, Summer 2004, vol. 63, No. 2, pp 203-208 (6)

Elzbieta M. Gozdziak

Abstracted by Alexandra Nichols

Over the past decade there has been a significant increase in the number of refugees and internally displaced people around the globe. While this number has increased and continues to do so, the number of programs providing psychological services to such refugees has also simultaneously grown. This significant and rapid expansion of mental health programs in both western and nonwestern countries leads us to the question of whether mental health professionals in this field are in fact adequately trained and prepared to address the particular needs of a diverse range of refugees. The article attempts to address this issue through a close look at the various aspects of Western training programs for mental health professions as well as an exploration of the ways in which anthropology can contribute to the mental health field. The article initially gives an explanation for the possible growth of this field, being due not only to a common assumption that all refugees having been exposed to armed conflict and civil strife are in need of immediate access to counseling and psychological service but also due to a substantial increase in the number of diagnoses of post-traumatic stress disorder (PTSD). Gozdziak provides us with several examples of the prominence of mental health professionals in refugee settings including such areas as Rwanda, Kosovo, Bosnia-Herzegovina and Croatia. It is important to note as Gozdziak points out that while these programs are developed and expanded in the West they are then implemented in nonwestern countries. Therefore these programs are implemented through the use of western trained mental health professionals which leads to various drawbacks and shortcomings. Gozdziak argues that Western psychiatry and psychology are not equipped to properly and adequately serve refugees. She initially focuses her argument on a variety of inadequacies and gaps in the training provided to these professionals. Some examples include training programs not providing certificate or degrees focusing on refugees and immigration issues, courses taught solely by adjunct professors, a lack of financial support for this area of study and inadequate course content. The largest problem according to Gozdziak however is the cultural and philosophical gap that remains. Western training programs for mental health professionals rely on biomedical models and Western diagnostic categories not taking into consideration indigenous cultural habits and ways of expressing distress and fear. To address this, the article continues with an analysis of what exactly suffering means and to then explore the term “to medicalize human suffering,” putting a medical slant on issues that were not previously considered medical issues. This has resulted in what is called the “trauma model.” Though many suggest the model is applicable to nonwestern societies, Gozdziak argues that in fact the value system by which it is supported is not in fact in line with the majority of the values refugees tend to hold true. To ameliorate this situation Gozdziak suggests an increase in the use of anthropological studies in training mental health professionals to work in the refugee field. By exploring the work and research of Harvard psychiatrist Arthur Kleinman, Gozdziak argues for an increased use of anthropological and ethnographic studies to bridge the gaps and to incorporate the social and cultural aspects rather than continuing a sole medical and psychiatric approach when working with refugees with respect to the mental health field.

 

 

IS WESTERN MENTAL HEALTH CARE APPROPRIATE FOR REFUGEES?

Refugee Participation Network, Issue: Number 11, October 1991, pp. 25-7

Maurice Eisenbruch

Based on research with Cambodian refugees, the author argues that mental health care should include refugees’ own perceptions of the meaning of their trauma, the way in which they express their distress and an understanding of the strategies they use to overcome it. If refugees express the symptoms of ‘post traumatic stress disorder’, this may be the sign of constructive methods of coping with a devastatingly traumatic experience, and not necessarily indicate a disorder. ‘Western’ approaches to therapy may hence be inappropriate.

 

 

GROUP TREATMENT OF EXILED SURVIVORS OF TORTURE

American Journal of Orthopsychiatry, Volume 60, Number 1, January 1990, pp. 135-42

Y. Fischman and J. Ross

Although the symptoms of victims of forced exile and torture can be considered to indicate a type of post-traumatic stress disorder, standard treatment approaches fall short of alleviating the problems of this growing population. A model for time- limited group treatment is presented, and the importance of placing such traumatic experiences in a sociopolitical context is emphasized. The model is illustrated by descriptions of work with a group made up of Central and South American refugees. Therapeutic techniques are proposed that focus on symptoms of torture- related post-traumatic stress disorder, allowing members to attain gradual psychological reorganization.

 

 

CLINICAL ISSUES IN MENTAL HEALTH SERVICE DELIVERY TO REFUGEES

The American Psychologist, Volume 46, Number 6, June 1991, pp. 642

Elizabeth Gong-Guy, Richard B. Cravens, and Terence Patterson

The authors put forth suggestions for improving mental health services for refugees by emphasizing diagnostic assumptions and treatment approaches, recognizing potential problems associated with the use of interpreters and paraprofessionals, and examining the role of consultation, prevention, and outreach services in addressing refugee mental health concerns.

 

 

CONFLICT BETWEEN CURRENT KNOWLEDGE ABOUT POSTTRAUMATIC STRESS DISORDER AND ITS ORIGINAL CONCEPTUAL BASIS,

The American Journal of Psychiatry, Volume 152, Number 12, December 1995, pp. 1705-13

Rachel Yehuda and Alexander McFarlane

The authors’ goal was the explore the historical, political, and social forces that have played a major role in the acceptance of the idea of trauma as a cause of the specific symptoms of posttraumatic stress disorder (PTSD) and to discuss the impact that current research findings have had on some of the initial conceptualizations of the disorder. The conceptual origins of PTSD are described, and the literature on the prevalence, longitudinal course, phenomenology, and neurobiology of PTSD is reviewed. Paradoxically, there are a series of findings that support the idea that PTSD is a distinct diagnostic entity, but these are different from those originally developed from psychosocial theory and stress research. PTSD has been a controversial diagnosis and is again at a vulnerable point. It is imperative that the field address how current findings challenge the original conceptualizations of this disorder so that the next generation of conceptual issues can be formulated.

 

 

REFUGEE SURVIVORS OF TORTURE: TRAUMA AND TREATMENT

Professional Psychology: Research and Practice, 2001, vol. 32, no. 5, pp. 443-451(9)

Gorman, W

Abstracted by Jaime Rall

Given the author's assertion that the practice of torture has increased in recent years, and the unprecedented numbers of torture-surviving refugees fleeing to the United States, the need for psychologists to be prepared and able to work with torture survivors is increasingly well-documented. Refugees are generally typified by having endured extreme abuses of human rights, and the resulting trauma is often exacerbated by the processes of exile, resettlement, status determinations, and the stresses of cross-cultural transitions. The experience of torture " "the deliberate, systematic or wanton infliction of suffering" (p. 443) " can be further psychologically debilitating. Common psychological sequelae include "blame and shame", somaticization (experience of physical symptoms in response to psychological concerns), denial, repression, and conditions of helplessness, guilt, depression, or post-traumatic stress disorder [PTSD]. These symptoms often represent techniques for coping with the extreme cruelty of the torture situation that are now maladaptive in a new setting. Unless treated, these symptoms can shut down" and emotionally isolate the person experiencing them. Despite the clear need for psychotherapeutic treatment for torture survivors, there has been a lack of professionals who are qualified, willing, and emotionally prepared to work with this challenging population. In addition, physical health concerns have often been emphasized in refugee services, to the neglect of mental health needs. This article argues that, for reasons of professional responsibility and social justice, psychologists must assist these survivors in their recovery. A well-developed practice framework for serving this population should incorporate knowledge of refugee and torture experiences with multicultural principles, the psychology of trauma recovery and rehabilitation, and concepts of power and liberation. Multicultural competence includes knowledge of cultural contexts, traditions, understandings, and norms, as well as culturally-specific strengths, supports, vulnerabilities, and risks. Trauma recovery principles are central to the treatment of these multiply traumatized clients. Herman's stage model of trauma rehabilitation (1992) is recommended as a treatment framework for torture survivors. The first stage is establishment of immediate safety in the therapeutic relationship and in the environment, by addressing the client's immediate economic, legal, or medical problems before psychological concerns. The second stage is the reconstruction process, by re-visiting, re-interpreting and re-framing the traumatic experiences in terms that are meaningful and affirming to the client. In this stage, the psychologist must also beware vicarious trauma that s/he might experience after hearing horrifying narratives. The third stage is reconnection, with one's own identity and in relationship with others. A multidisciplinary approach to refugee services can facilitate the use of this model. Finally, concepts of power and liberation are integral to the treatment of refugees. The alienation, domination, and defenselessness inherent in the torture situation, and the added dislocation of exile, underscore the client's experience of power relationships. The use of Herman's stage model within a multicultural framework can systematically address the internalized oppression suffered by survivors, and validate the truth of the injustices they have survived. Engaging in psychological interventions with torture survivors is thus an important way that psychologists can meaningfully promote social justice.

 

 

IMMIGRANT AND REFUGEE COMMUNITIES: RESILIENCY, TRAUMA, POLICY, AND PRACTICE

In Practicing Social Justice, 2003 (edited by Stretch, J J, Burkemper, E M, Hutchison, W J, Wilson, J), pp. 135-158(24)

Schmitz C L, Jacobus M V, Stakeman C, Valenzuela G A, Sprankel J

Abstracted by Jaime Rall

The unprecedented numbers of refugees migrating to the United States call for a reassessment of community responses to refugee needs. This chapter opens with an overview of the stressors and obstacles facing refugee families and children throughout the displacement process, and that must inform community responses. Refugees experience extreme stress and trauma at various points in displacement: when fleeing their homeland under conditions of persecution, violence, or oppression; when networks, income, social status, security, and support are lost during the migration process; and when enduring substandard living conditions and acculturating to new cultural norms and practices in the host country. Acculturation is particularly stressful inasmuch as interaction with the new culture may disrupt traditional social, familial, and gender roles. The authors also cite restrictive immigration policies in the United States as having made the latter acculturation process even more difficult for many newcomers (e.g. the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), The Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA), and the Anti-Terrorism and Effective Death Penalty Act (AEDP) in 1996). Models are then outlined that can be used in host communities (and specifically by social work professionals in these communities) when crafting creative responses to the challenges facing these populations. According to the authors, "[s]ocially just social services are needed to assist refugee communities in coping with not only past traumas and conflicts, but also stresses associated with adjusting to their new environments" (p. 145). Social work practice frameworks that underlie socially just" work with refugees are emphasized, with special reference to strengths-focused perspectives, cross-cultural competence, and empowerment practice. With reference to these frameworks, the range of intervention techniques and settings that can serve refugees is broad, including: counseling services, mental health interventions (especially for PTSD, depression, grief and trauma), policy and advocacy activities, community-building activities, mediation between the refugee and needed services, and the development of refugee organizations. Finally, a community exemplar is presented. The small metropolitan area of Portland, Maine, offers a clear demonstration of how refugee resettlement services, the school system, city departments, and other non-profit services can ideally coordinate their work for the benefit and empowerment of refugee families. Available services include trauma recovery, health clinics, grief counseling, language and job training/placement, inclusive policies and programs in the public school system, and advocacy and empowerment services that address larger policy issues and promote the formation of refugee-focused community organizations. This community exemplifies how a holistic community response, typified by well-coordinated networks and multidisciplinary approaches that combine advocacy with community building, empowerment, and recovery/healing services, best serve refugees. The authors close with a call to social work professionals to strengthen their dedication to the needs and rights of immigrants and refugees to the United States, particularly those who may be negatively affected by the political repercussions of the events of September 11, 2001.

 

 

REFUGEES' RESPONSES TO MENTAL HEALTH SCREENING: A RESETTLEMENT INITIATIVE

International Social Work, 1 April 2003 , vol. 46, no. 2, pp. 235-250(16)

Ovitt N., Larrison C.R., and Nackerud L.

Abstracted by Cindy Bosley

Much research has shown a higher incidence of mental health problems among refugees as compared to the general population. In addition to the challenges of treating refugees' mental health problems, there is also a great challenge in diagnosing them. Other research has shown that there are several major barriers preventing or hindering diagnoses and subsequent treatment. These barriers include refugees not seeking help, lack of accessibility of services, linguistic and cultural barriers in diagnosis and treatment, and conflicting resettlement goals. This article describes a small study of a screening test used to identify mental health problems in Bosnian refugees shortly after arriving in the U.S. The screening tool that is used is the Hopkins Symptom Checklist (HSCL-25), which has been translated into four languages, including Bosnian. The HSCL-25 lists common symptoms of various mental health problems, and asks the respondents to identify any symptoms they are experiencing. The checklist was administered to eight recently-arrived, adult Bosnian refugees, and the results showed most of the refugees reporting at least some symptoms of mental health problems, with one refugee meeting the official criteria warranting treatment. The researchers immediately followed the HSCL-25 with a client questionnaire about the screening instrument and process. The client questionnaire asked questions such as: Was the checklist easy to understand, were the items in the checklist upsetting or difficult to answer, and do you feel that this was an appropriate time to consider these kinds of questions? The refugees responded quite positively to the screening process, noting that the HSCL-25 was helpful, important to refugees, and administered as an appropriate time. Most of the eight refugees also indicated that they had not been screened in this manner before in the resettlement process, nor had anyone even asked these types of questions. The overall conclusions of this study are that the HSCL-25 is an appropriate instrument to use with recently-arrived, adult Bosnian refugees resettled in the U.S., and the HSCL-25 can assist mental health professionals in identifying refugees with symptoms of mental health problems.

 

 

PSYCHOLOGICAL WELL-BEING OF REFUGEE CHILDREN

Child Abuse and Neglect, Volume 17, Number 6, November/December 1993, pp. 843-54

M. Ajdukovic and D. Ajdukovic

Two groups of refugee families participated in a program aimed at preventing children's mental health problems. The program attempted to gain insight into the character and scope of problems of refugee families and to develop and implement a spectrum of interventions that would meet their specific psychological needs. Data about the family situation and the psychosocial adaptation of refugee children to displacement was gathered during detailed structured interviews with the mothers, while the study families were accommodated either in a shelter or with host families. A considerable range of stress-related reactions among displaced children were identified. Refugee children exhibited a significantly higher incidence of stress reactions if their mothers had difficulty coping with stress of displacement. The findings also indicated that children in the collective shelter were at greater mental health risk than their peers housed with host families.

 

 

REFUGEE WOMEN AND THEIR MENTAL HEALTH: SHATTERED SOCIETIES, SHATTERED LIVES; PARTS 1 AND 2

Women and Therapy, Volume 13, Numbers 1, 2 and 3, 1993

E. Cole, E. D. Rothblum, and O. M. Espin

This special issue focuses on understanding the plight of women refugees throughout the world, before and after resettlement. Also included is a section on the challenges and rewards of working with refugee women. Volume 13, Number 3 moves from theory to practice; it explores processes of recovery from the traumas experienced by refugee women and offers a variety of models for the application of feminist theory.

 

 

POPULAR MEDIA AS PUBLIC SPHERICULES' FOR DIASPORIC COMMUNITIES

International Journal of Cultural Studies, June 2001, Volume 4, Number 2, pp. 131-147(17)

Cunningham S.

Queensland University of Technology

The dynamics of 'diasporic' video, television, cinema, music and Internet use - where peoples displaced from homelands by migration, refugee status or business and economic imperative use media to negotiate new cultural identities - offer challenges for how media and culture are understood in our times. Drawing on research published in Floating Lives: The Media and Asian Diasporas, on dynamics that are industrial (the pathways by which these media travel to their multifarious destinations), textual and audience-related (types of diasporic style and practice where popular culture debates and moral panics are played out in culturally divergent circumstances among communities marked by internal difference and external 'othering'), the article will interrogate further the nature of the public sphericules' formed around diasporic media.

 

 

REFUGEE FAMILIES IN THERAPY: FROM REFERRALS TO THERAPUTIC CONVERSATIONS

Journal of Family Therapy, May 2001, Volume 23, Number 2, pp. 119-135(17)

Sveaass N., Reichelt S.

Psychosocial Centre for Refugees, 0864 Oslo, Norway, Institute of Psychology, University of Oslo, Norway

Refugee families referred for therapy present a wide array of problems and expectations, not always in accordance with what therapy may offer. Major differences between referring professionals, families and therapists regarding problem definitions and solutions may complicate collaboration. Interventions that may overcome these barriers and move initial interviews into a therapeutic context are described. Three patterns regarding referral process, problem presentation and expectations (here called referral contexts) are outlined: "the relational", where families ask for psychological and interpersonal assistance, "the unfocused", where families are referred to therapy without expressing any wish for it, and "the fixed solution", where families seek support for solutions that are not of a therapeutic nature. The interventions described form part of a negotiation where motives and interest for therapy are explored and agreements regarding further therapy are outlined.

 

 

EMERGING PARADIGMS IN THE MENTAL HEALTH CARE OF REFUGEES

Social Science and Medicine, June 2001, Volume 52, Numnber 11, pp. 1709-1718(10)

Watters C.

European Center for the Study of the Social Care of Minority Groups and Refugees, University of Kent at Canterbury, Canterbury, CT2 7LZ, Kent, UK

Over the past decade the approaches adopted towards the mental health care of refugees by a range of national and international healthcare organisations have been the subject of a sustained and growing critique. Much of this critique has focused on the way in which Western psychiatric categories have been ascribed to refugee populations in ways which, critics argue, pay scant attention to the social, political and economic factors that play a pivotal role in refugees' experience. Rather than portraying refugees as ''passive victims'' suffering mental health problems, critics have argued that attention should be given to the resistance of refugees and the ways in which they interpret and respond to experiences, challenging the external forces bearing upon them. In this paper a range of issues concerning the mental health care of refugees will be examined. These include the role of psychiatric diagnosis in relation to refugees' own perceptions of their need and within the context of general health and social care provision. In examining services the emergence of new paradigms in mental health care is identified. These include the growth of holistic approaches that take account of refugees' own experiences and expressed needs and which address the broader social policy contexts in which refugees are placed. A three-dimensional model for the analysis of the interrelationship between ''macro'' level institutional factors in the mental health of refugees and the individual treatment of refugees within mental health services is proposed.

 

 

MENTAL HEALTH STATUS IN REFUGEES: AN INTEGRATIVE REVIEW OF CURRENT RESEARCH

Issues in Mental Health Nursing, 1 June 2000, Volume 21, Number 4, pp. 397-410(14)

Keyes E. F.

The purpose of this integrative review was to assess the results of current published quantitative research about refugees and their mental health status. An extensive literature review using several approaches was performed. A group of 12 articles met inclusion criteria for this study sample (N = 12). All 12 studies showed negative mental health status in the refugees sampled. Mental health outcomes included posttraumatic stress disorder, depression, anxiety, psychosis, and dissociation. This review revealed a lack of culturally sensitive understandings and diagnostic measures in the majority of current published quantitative research on refugees. The scope of this research for health professionals is broad, as the number of refugees continues to rise. Recommendations for clinicians include an expanded range of practice to incorporate refugee-specific assessment and treatment.

 

 

REFUGEE FAMILIES' EXPERIENCE OF RESEARCH PARTICIPATION

Journal of Traumatic Stress, July 2000, Volume 13, Number 3, pp. 413-426(14)

Dyregrov K., Dyregrov A., Raundalen M.

kdyregro@online.no

Center for Crisis Psychology, Fabrikkgt. 5, 5059 Bergen, Norway

Because refugees can experience crisis, bereavement, and traumatization, there has been a rapid increase of research carried out with refugees. This study investigated how refugee families respond to participation in research. A previous study explored how adults and children had communicated about the difficult question of repatriation after arriving in a new country. Did the in-depth interviews harm or benefit them? Are there any ethical risks in research on traumatized refugees? From an original sample of 74 Bosnian refugees (5"73 years), 30 family members from 9 families including 14 children aged 6 to 19, were re-interviewed. The refugees rated participation as positive. A few parents lacked information that could have enabled them to inform the children better before the interviews. The study shows that studies on traumatized/bereaved populations can have beneficial effects.

 

 

PROMOTING THE PSYCHOLOGICAL WELL-BEING OF REFUGEE CHILDREN

Clinical Child Psychology and Psychiatry, October 2000, Volume 5, Number 4, pp. 541-554(14)

Davies M., Webb E.

Preswylfa Child and Family Centre, University of Wales College of Medicine, UK

Meeting the mental health needs of Somali refugee children in Wales creates significant difficulties for service provision. Some case examples are provided. The children's needs, the services received and the plight of refugee children are discussed in the context of the following key areas: (i) the child (aspects of development); (ii) the referred problem; (iii) the war/refugee context; (iv) Somali culture; and (v) the host culture. Developmental factors relating to the vulnerability of refugee boys in the host culture are identified. Based on their experiences and with the benefit of recent literature, the authors recommend a coordinated and culturally sensitive approach to the care of refugee children and their families.

 

 

ORGANIZED VIOLENCE AND MENTAL HEALTH OF REFUGEE CHILDREN IN EXILE: A SIX-YEAR FOLLOW-UP

Acta Paediatrica, 7 June 2000, Volume 89, Number 6, pp. 722-727(6)

Hjern A., Angel B.

Centre for Epidemiology, Swedish National Board of Health and Welfare, SE-106 30 Stockholm, Sweden

In an earlier study we described a high rate of poor mental health in 63 refugee children from Chile and the Middle East during the first 18 mo of exile. In this follow-up study the mental health of 49 of these children is described in parent, teacher and child interviews 6-7 years after settlement in Sweden. The level of poor mental health in parent interviews has improved from 47% 18 mo after settlement to 22% (p < 0.01 in paired t-test) at follow-up. Conclusions: Eighteen percent of 34 children still in primary school were judged by their teachers to show deviant behaviour in the classroom. Three children were found to suffer from either re-experience or avoidance of painful memories, whereas only one neurologically impaired child fulfilled the criteria of PTSD according to DSM-IV. Recent stress in the family sphere and exposure to acts of organized violence in the country of origin are identified as the major determinants of poor mental health.

AFRICA

ONWARD THROUGH STRENGTH: COPING AND PSYCHOLOGICAL SUPPORT AMONG REFUGEE YOUTH RETURNING TO ERITREA FROM SUDAN

Journal of Refugee Studies, 1 March 2001, Volume 14, Number 1, pp. 43-69(27)

Farwell N.

School of Social Work, University of Washington, Seattle, Washington

The experience of Eritrean young people in dealing with war-related traumatic events is a complex phenomenon, as indicated in this qualitative study of refugee youth returning to their homeland from exile in Sudan. The youth described a wide range of responses to war-related events, and utilized a variety of types and levels of coping responses. Themes that emerge from these responses include inner strength, separation and loss, community solidarity, concerns about subsistence, the importance of education, and the desire for a peaceful future. Families, elders, community solidarity, and combatants constituted important sources of psychological support. Based on the youths' coping resources and their own recommendations, interventions are proposed to provide psychosocial support to young people during reintegration. Intervention areas include guidance and support, organized youth activities, continuity of education, and mentored economic development and community-building activities. Programme recommendations, while emanating from the Eritrean context, can be modified to fit specific circumstances of returning refugees in other developing countries emerging from war.

ASIA

UNDERSTANDING MENTAL HEALTH NEEDS OF SOUTHEAST ASIAN REFUGEES: HISTORICAL, CULTURAL, AND CONTEXTUAL CHALLENGES

Clinical Psychology Review , 1 May 2004 , vol. 24, no. 2, pp. 193-213(21)

Hsu E., Davies C.D., and Hansen D.J.

Abstracted by Cindy Bosley

Providing mental health services for refugees is challenging for many reasons, most notably language and cultural barriers. Many clinicians tend to make generalizations about refugees as one group, and still others group large geographic regions of refugees together (i.e. Asians). This article explores the historical, cultural, and contextual challenges of providing mental health support to Southeast Asian Refugees (SEARs). After exploring these challenges, the authors then give an overview of common mental health problems among SEARs, followed by an outline of clinical implications. This information is obtained from a variety of prior research over the past 25 years, including numerous clinical research studies. The authors' primary conclusion is that the complex background and experiences of each individual SEAR must be thoroughly examined if any treatment of mental health problems is to be effective. Examining historical factors is important because the type of loss or trauma that a refugee has faced can influence their mental health problems (and associated symptoms) as well as their reactions to treatment. Thus, historical factors should be taken into account during diagnosis and treatment. Cultural factors will also affect the types of mental health problems and their reactions to treatment, but these factors will also influence refugees' attitudes towards treatment and clinicians in general. For example, children and adolescent SEARs often learn English very quickly and thus acquire large responsibilities within their family. Because this runs counter to the value of respecting and obeying elders, SEARs often develop mental health problems because of their conflicting roles within the family. These, and other issues such as gender roles, sexuality, and religious beliefs, must be taken into account when diagnosing and treating SEARs. Contextual factors in the resettlement process can include financial strains, language difficulties, the employment situation, discrimination, safety, and others. These challenges must also be explored to develop a holistic picture of SEARs and their mental health situation. The most common mental health problems among SEARs are depression, anxiety, posttraumatic stress disorder (PTSD), adjustment disorder, and somatization of mental problems. The authors provide numerous statistics of various mental health problems among particular groups with Southeast Asia , as well as statistics among Southeast Asian youth. Resilience against mental health problems among SEARs can be attributed to factors such as language proficiency, presence of close family members, social support networks within the ethnic community, and others. Based on these examinations of the common mental health problems and associated challenges, the authors conclude with an assessment of clinical implications. These implications include recommendations for assessing mental health problems and for treating mental health problems (long and short-term). The primary recommendation of the authors is to approach each patient (or potential patient) as an individual, and explore the often complex situation of each SEAR. Classifying all SEARs into one, monolithic group will only lead to false generalizations, errant diagnoses, and ineffective treatment.

 

 

THE APPLICATION OF FAMILY SYSTEMS THEORY TO MENTAL HEALTH SERVICES FOR SOUTHEAST ASIAN REFUGEES

Journal of Multicultural Social Work, Volume 2, Number 1, 1992, pp. 1-13

P. Kelley

This paper describes a training project of work with Southeast Asian refugees using an integrated family systems approach. The author found using a model integrating a structural, strategic, life cycle, and Milan systematic therapy helpful at three levels of the project work: consulting with agencies serving the population, training students for this work, and intervening clinically with the refugees themselves.

 

 

COUNSELING INDOCHINESE REFUGEE WOMEN RAPE SURVIVORS

Administration in Social Work, Volume 45, Number 3, September 1992, pp. 19-25

Carrington U. Nguyen

This study is based on the author’s experience as a counselor of rape survivors and traumatized refugees at two refugee camps in Malaysia. Analysis of the work revealed a particular mental dissonance in the women which resulted from the clash between their culture and new self-concepts necessary for their recovery. It was demonstrated that counseling methods that emphasize self-esteem, personal values, and self-sufficiency are necessary for the recovery of traumatized people in host countries such as Australia and Canada. Information on clients’ psychological and social issues and needs can increase the awareness of support groups regarding this matter. Establishment and training of these women’s groups, composed of volunteers having the same cultural background as the clients, will facilitate the survivors’ access to professional services.

 

 

SOCIAL WORK INTERVENTIONS TO ALLEVIATE CAMBODIAN REFUGEE PSYCHOLOGICAL DISTRESS

International Social Work, Volume 37, Number 1, January 1994, pp. 23-5

S.B. Strober

The poll taken at random among 102 Cambodian refugees (May-Aug 1989) served to determine the extent of environmental social support and refugee characteristics in the process of acculturation. Fifty percent of the variation is explained by education, the time spent in the country, and the impact of psychological decline. In addition, the date showed that there was a slight correlation between the observed social support and acculturation adjustment, and that there was a strong correlation between the latter and the lack of psychological decline. Furthermore, there was no significant correlation between the observed social support and psychological collapse. Results suggest that the observed family and community support does not promote acculturation, but rather a lower incidence of psychological decline. In addition, it suggests that traditional family and community support does not count when it comes to alleviating emotional problems. Social work, education, psychological collapse, conjugal support and the amount of time spent in the country offer usable information in the application of social work to the task of reducing emotional problems of these people.

 

 

DEPRESSION AND ACADEMIC ACHIEVEMENT AMONG INDOCHINESE REFUGEE UNACCOMPANIED MINORS IN ETHNIC AND NON-ETHNIC PLACEMENTS

American Journal of Orthopsychiatry, Volume 57, Number 4, October 1987, pp. 536-47

Z. Porte and J. Torney-Purta

A study examined the effects of critical elements in the past and present life experiences of Indochinese minors on their adaptation to the U.S. Of particular concern was whether life satisfaction and depression, the balance of American versus ethnic identity, and academic achievement could be predicted on the basis of placement mode (Caucasian or ethnic foster care, group home, or own family). The refugee adolescents who were resettled with ethnic foster families were significantly less depressed and had higher grade-point-averages than those in foster care with Caucasian families or in group homes. The ongoing presence of an adult of similar ethnicity to the adolescent appeared to mitigate against the stress of adaptation to a new country.

 

 

ADJUSTMENT AND IDENTITY FORMATION OF LAO REFUGEE ADOLESCENTS

Smith College Studies in Social Work, Volume 58, Number 3, June 1988, pp. 157-81

A. Schapiro

An exploratory study was undertaken to ascertain how Laotian refugee adolescents are adjusting to life in the U.S., with particular focus on areas that impact identity formation. Potential problem areas examined were family relationships, school functioning, social status and acceptance, peer relationships, and future planning. The primary stressor encountered by the subjects on their arrival in the U.S. was racial prejudice; other significant factors included academic and language deficits, conflicts with parents, difficulty finding an appropriate peer group, and problems adjusting to lowered social and economic status. All but 3 subjects appeared to be functioning well, although 9 showed signs of depression. Outreach to this group by culturally sensitive and compassionate social workers is warranted.

 

 

PSYCHOLOGICAL TRAUMA AND DEPRESSION IN A SAMPLE OF VIETNAMESE PEOPLE IN THE UNITED STATES

Health and Social Work, Volume 18, Number 3, August 1993, pp. 184-94

T. V. Tran

This article investigates the relationships among premigration stresses, nightmares, acculturation stresses, personal efficacy, and depression in a sample of 147 adult Vietnamese Americans. The analysis revealed that premigration stresses, nightmares, and acculturation stresses had significant indirect effects on depression. Acculturation stresses diminish personal efficacy, and a weakness of personal efficacy leads to higher depression. Age, gender, marital status, and English language ability also exert differential effects on premigration stresses, nightmares, acculturation stresses, personal efficacy, and depression. Health care professionals, social workers, health care organizations, and social work researchers should be more culturally sensitive when planning and implementing services and developing research instruments.

 

 

SYMPTOMS OF WAR TRAUMA INDUCED PSYCHIATRIC DISORDERS: SOUTHEAST REFUGEES AND VIETNAME VETERANS

International Migration Review, Volume 21, Number 3, Fall 1987, pp. 820-32

Lynn R. August and Barbara A. Gianola

The symptomology of Southeast Asian refugees suffering from mental health disorders is compared with that of Vietnam war veterans suffering from psychiatric disorders related to war trauma, based on a review of published data. Both of these groups share common unresolved feelings and have similar clinical manifestations resulting from the intensity of wartime atrocities. Similarities in the symptoms presented by these two groups suggest that Southeast Asian refugees may also suffer from the same type of war trauma induced psychiatric disorder as the Vietnam war veterans.

 

 

THE PSYCHOSOCIAL IMPACT OF WAR TRAUMA AND TORTURE ON SOUTHEAST ASIAN REFUGEES

The American Journal of Psychiatry, Volume 144, Number 12, December 1987, pp. 1567-72

Richard F. Mollica, Grace Wyshak, and James Lavelle

More than 700,000 refugees from Southeast Asia have settled in the U.S. since 1975. Although many have suffered serious trauma, including torture, few clinical reports have described their trauma-related symptoms and psychosocial problems. The authors conducted a treatment study of 52 patients in a clinic for Indochinese. They found that these patients were a highly traumatized group: each had experienced a mean of 10 traumatic events and 2 torture experiences. Many of the patients had concurrent diagnoses of major affective disorder and posttraumatic stress disorder as well as medical and social disabilities associated with their history of trauma. The authors also found that Cambodian women without spouses demonstrated more serious psychiatric and social impairments than all other Indochinese patient groups.

 

 

UNDERSTANDING MENTAL HEALTH NEEDS OF SOUTHEAST ASIAN REFUGEES: HISTORICAL, CULTURAL, AND CONTEXTUAL CHALLENGES

Clinical Psychology Review , 1 May 2004 , vol. 24, no. 2, pp. 193-213(21)

Hsu E., Davies C.D., and Hansen D.J.

Abstracted by Cindy Bosley

Providing mental health services for refugees is challenging for many reasons, most notably language and cultural barriers. Many clinicians tend to make generalizations about refugees as one group, and still others group large geographic regions of refugees together (i.e. Asians). This article explores the historical, cultural, and contextual challenges of providing mental health support to Southeast Asian Refugees (SEARs). After exploring these challenges, the authors then give an overview of common mental health problems among SEARs, followed by an outline of clinical implications. This information is obtained from a variety of prior research over the past 25 years, including numerous clinical research studies. The authors' primary conclusion is that the complex background and experiences of each individual SEAR must be thoroughly examined if any treatment of mental health problems is to be effective. Examining historical factors is important because the type of loss or trauma that a refugee has faced can influence their mental health problems (and associated symptoms) as well as their reactions to treatment. Thus, historical factors should be taken into account during diagnosis and treatment. Cultural factors will also affect the types of mental health problems and their reactions to treatment, but these factors will also influence refugees' attitudes towards treatment and clinicians in general. For example, children and adolescent SEARs often learn English very quickly and thus acquire large responsibilities within their family. Because this runs counter to the value of respecting and obeying elders, SEARs often develop mental health problems because of their conflicting roles within the family. These, and other issues such as gender roles, sexuality, and religious beliefs, must be taken into account when diagnosing and treating SEARs. Contextual factors in the resettlement process can include financial strains, language difficulties, the employment situation, discrimination, safety, and others. These challenges must also be explored to develop a holistic picture of SEARs and their mental health situation. The most common mental health problems among SEARs are depression, anxiety, posttraumatic stress disorder (PTSD), adjustment disorder, and somatization of mental problems. The authors provide numerous statistics of various mental health problems among particular groups with Southeast Asia , as well as statistics among Southeast Asian youth. Resilience against mental health problems among SEARs can be attributed to factors such as language proficiency, presence of close family members, social support networks within the ethnic community, and others. Based on these examinations of the common mental health problems and associated challenges, the authors conclude with an assessment of clinical implications. These implications include recommendations for assessing mental health problems and for treating mental health problems (long and short-term). The primary recommendation of the authors is to approach each patient (or potential patient) as an individual, and explore the often complex situation of each SEAR. Classifying all SEARs into one, monolithic group will only lead to false generalizations, errant diagnoses, and ineffective treatment.

 

 

THE PSYCHOLOGICAL STATUS OF VIETNAMESE CHINESE WOMEN IN REFUGEE CAMPS

Journal of Women and Social Work, Volume 4, Number 3, Fall 1989, pp. 51-64

R. H. Nishimoto, K. L. Chau, and R. W. Roberts

The psychological resources that refugee women bring to bear in refugee camps are important predictors of their and their families" eventual adaptation to their country of final settlement. Reported on is a study of the psychological status of 59 Vietnamese Chinese women in refugee camps in Hong Kong who were awaiting permanent resettlement. The study also examined factors that affected the mental health of these refugees such as the women's report of stressful life events, the availability of social supports, and various aspects of their experience in the refugee camps. Implications for social work services and social policy are presented.

 

 

THE INFLUENCE OF CULTURE ON PSYCHIATRIC ASSESSMENT: THE VIETNAMESE REFUGEE

Psychiatric Services, Volume 48, Number 1, January 1997, pp. 86-90

Tuong Phan and Derrick Silove

The influence of culture on psychiatric diagnostic assessments remains controversial. The authors outline differences between the emic approach to assessment, which is informed by ethnographic concepts of the centrality of culture in shaping the psyche and its expressions, and the etic approach, which downplays cultural effects and focuses on the universal elements in manifestations of psychological distress. Based on the experience of assessing Vietnamese refugees in Australia, the authors explore semantic, contextual, and conceptual factors that may impede the psychiatric assessment of patients from other cultures. Areas of misinterpretation are illustrated using examples from the Vietnamese language. The authors discuss how variations in politicohistorical experiences within ethnic populations may result in differences in the modes of expressing and understanding mental illness. Recognition of the tension between etic and emic perspectives allows the clinician to draw on the most useful elements of each in assessing and treating individual patients.

 

 

ALIENATION AMONG VIETNAMESE REFUGEES IN THE UNITED STATES: A CAUSAL APPROACH

Journal of Social Service Research, Volume 11, Number 1, 1987, pp. 59-75

Tran T. Van, R. Wright, and C. H. Mindel

According to a survey conducted in 1979, alienation is ranked third among the six areas representing serious problems for Vietnamese refugees. It is preceded only by loss of role identity and loss of self-esteem. A study developed and tested a causal model of alienation among a probability sample of Vietnamese refugees. The findings indicated that marital status, social support, social interaction anxiety, self-identity, and length of time in the U.S. directly predict feelings of alienation. The social support variable, however, was the most important predictor. Background variables for the most part had no notable direct effects on alienation.

 

 

CULTURAL TRANSITIONS IN FIRST-GENERATION IMMIGRANTS: ACCULTURATION OF SOVIET JEWISH REFUGEE ADOLESCENTS AND PARENTS

Journal of Cross-Cultural Psychology, July 2001, Volume 32, Number 4, pp. 456-477(22)

Birman D., Trickett E.J.

Georgetown University Medical Center, University of Maryland

This article focuses on the process of acculturation for first-generation Soviet Jewish refugee adolescents and their parents who have resettled in the United States. First, the extent of acculturation to the new and the old culture is assessed independently. Second, acculturation is assessed multidimensionally, including the constructs of language competence, behavioral acculturation, and cultural identity. Third, the extent to which life stage differences at immigration affect the acculturation process is assessed. Overall, the data suggest that acculturation appears to occur in a linear pattern over time for most dimensions of acculturation, with acculturation to the American culture increasing and acculturation to the Russian culture decreasing. However, Russian language competence for the parents did not diminish with length of residence in the country. Furthermore, an unexpected acculturative gap was observed between parents and children with respect to Russian identity, with adolescents being more identified with the Russian culture than their parents.

 

 

REFUGEE EXPERIENCES AND SOUTHEAST ASIAN WOMEN'S MENTAL HEALTH

Western Journal of Nursing Research, March 2000, Volume 22, Number 2, pp. 144-168(25)

Davis R.E.

Millersville University

The wars in Southeast Asia displaced thousands of families from Cambodia, Laos, and Vietnam. The upheavals led to a number of waves of immigration to the United States. Current research supports hypotheses of post-traumatic stress disorder diagnoses in refugees from the wars in Vietnam but omits pertinent cultural factors. This phenomenological study of 19 women from Southeast Asia examines the meanings of their refugee experiences. Open-ended interviews with these women reveal themes of survival, despair, and isolation. Health care providers may notice cultural bereavement as opposed to post-traumatic stress disorder, reflecting a psychological resilience not extensively explored previously. Developing empathetic interactions and including important ethnic identity factors in caring for refugee women appear essential in providing appropriate health care.

EUROPE

COMMUNITY CONTACT AND MENTAL HEALTH AMONGST SOCIALLY ISOLATED REFUGEES IN EDINBURG

Journal of Refugee Studies, Volume 15, Number 1, pp.71-80, 2002

Ager, Alastair, Margaret Malcolm, Sana Sadollah, and Fiona O’May

Abstracted by Kim Bell

Mental Health is a field that until recently was not commonly implemented or integrated into international aid practice when working with refugees and asylum seekers. When mental health professionals work with refugees and asylum seekers, the focus tends to be on their history, such as how past events in their countries of origin as well as their experiences of flight impacted them. However, the focus in this article is on refugees’ post-migration experience after resettlement, specifically with social isolation. The study was a needs assessment in advance of a project and through the study, participants’ priorities were ascertained in regard to supportive actions from the planned service. The study specifically examined the relationship between community contact and mental health as an indicator of post-migratory adjustment. There were twenty-six refugee participants and all lived in the Edinburgh area and were identified by the Scottish Refugee Council as experiencing social isolation. Fourteen of the participants originated from other European countries, eight were from Africa, and four were from Asia. They were between the ages of 20 to 45, had been living in the UK for various amounts of time, and had various marriage statuses and living situations. Although the participants had many diverse characteristics, almost half could be clinically diagnosed with an anxiety disorder and depression, and nearly one third of them had trouble sleeping. The small sample size of this study means that the statistics are unlikely to be representative of the broader population and the power of such statistics is limited. However, the high levels of anxiety and depression experienced by this group support previous studies showing that certain mental health problems are higher among refugees than the general population. What is interesting about this study is that the refugees considered adoptive activities that helped as a bridge into a host community’s culture to be more important than the provision of counseling services. This finding is supported by a study showing that psychological well-being is better among volunteer-assisted refugees because of the broader social networks connected with them. These social networks help them bridge into the host community at the mainstream, not at the margins where they are likely to feel more isolated.

 

 

MULTICULTURALISM AND SOCIAL INTEGRATION IN EUROPE

International Political Science Review/ Revue internationale de science politique, January 2001, Volume 22, Number 1, pp. 55-84(30)

Dijkstra S., Geuijen K., de Ruijter A.

Utrecht University, CERES

In an era of increasing cultural diversity within nation-sates and the deterritorialization of cultures and peoples, the notion of a national citizenship signifying a single, homogenized culture shared by all citizens has become obsolete. A possible alternative is presented in which an uncoupling of nationality and culture would lead to open and equal communication between citizens and the development of transmigrants' identities as members of a transnational and multicultural global society who may have ties with two or more nation-states.

 

 

EFFECTS OF POSTTRAUMATIC STRESS AND ACCULTURATION ON MARITAL FUNCTIONING IN BOSNIAN REFUGEE COUPLES

Journal of Traumatic Stress, April 2000, Volume 13, Number 2, pp. 205-217(13)

Spasojevi J., Heffer R.W., Snyder D.K.

Department of Psychology, Texas A&M University, College Station, Texas 77843-4235

Forty Bosnian refugee couples living in the United States completed a translated version of the PTSD Symptom Scale Self Report, the Behavioral Acculturation Scale, the Marital Satisfaction Inventory. Revised, and a demographic questionnaire. Posttraumatic stress disorder (PTSD) symptomatology was the best predictor of marital functioning and was related negatively to acculturation. After controlling for PTSD, acculturation did not predict marital functioning. Wives' marital satisfaction was best predicted by husbands' PTSD, husbands' acculturation, and their own PTSD. Husbands' marital satisfaction was not predicted significantly by any of these variables. These findings suggest several implications for mental health professionals dealing with refugees and other traumatized populations.

LATIN AMERICA

THE PSYCHOLOGICAL EFFECTS OF POLITICAL REPRESSION ON CHILEAN EXILES IN THE U.S.

American Journal of Orthopsychiatry, Volume 60, Number 1, January 1990, pp. 143-53

C. J. Gonsalves

Interviews with 32 Chilean refugees elicited descriptive findings on the effects of detention and torture and subsequent exile in the U.S. The findings suggest that exile for this group constitututes a continuation, rather than a cessation, of their suffering. Anticipatory guidance designed to prepare families for the hardships of exile, outreach programs for children and their parents, and support systems for single people are recommended as solutions to some of the difficulties experienced by the subjects.

 

 

PSYCHOSOCIAL FUNCTIONING OF CENTRAL AMERICAN REFUGEE CHILDREN

Child Welfare, Volume 71, Number 5, September/October 1992, pp. 439-56

D. S. Masser

In a qualitative study of the functioning of Central American refugee children in Los Angeles, special attention was given to two questions: what factors in a child's history appear to be the most significant? And what symptoms do these children typically manifest? Findings indicate that a combination of variables such as witnessing war violence and long separation from a primary caregiver was significant for the development of posttraumatic stress disorder.

 

 

SPIRITISM AS A FORM OF PSYCHOTHERAPY: IMPLICATIONS FOR SOCIAL WORK PRACTICE

Social Casework: The Journal of Contemporary Social Work, Volume 70, Number 8, October 1989, pp. 502-9

S. M. Berthold

There are two main spiritist traditions among Puerto Ricans: Mesa Blanca, which originated in Europe and is based on a belief in reincarnation, and Santeria, a synthesis of an African religion and Catholicism that centers on the worship of saints. Many Puerto Ricans practice a blend of these two traditions. Puerto Rican spiritists believe in a spirit world and in the duality of matter and spirit. Spirits can attach themselves to human beings and exert a profound influence on human affairs either by helping or causing harm. Some people possess special abilities to communicate with and control the spirits; centros, or spiritual churches, exist where these spiritually strong individuals can help others. Approximately one-third of all adult Puerto Ricans with mental disorders consult spiritists rather than seeking psychiatric treatment. A discussion examines the Puerto Rican practice of spiritism as a form of psychotherapy so that therapists who work with clients who believe in spiritism can be more aware of their clients" belief systems. Suggestions are made for social workers and others who work with these clients.

MIDDLE EAST

BEYOND THE BURQA: ADDRESSING THE CAUSES OF MATERNAL MORTALITY IN AFGHANISTAN

Forced Migration Review, 2004, no.19, pp. 81-89(9)

del Valle, H.

Abstracted by Teresa Braun

In this article, Herman del Valle, a humanitarian affairs officer for Médicins Sans Frontières (Doctors Without Borders), examines the status of Afghanistan’s reproductive health system in the post-Taliban era and the programs that have been implemented thus far by the United Nations (UN) and non-governmental organizations (NGOs). He addresses the restrictions in access to health care for women that existed under the Taliban regime, resulting in one of the highest maternal mortality rates in the world, and the focus that subsequent programs have given to gender inequalities as mechanisms for trying to reduce these rates. However, such programs have not had the anticipated improvement on maternal mortality rates, leading to the need for a less one-dimensional approach to the issue. Del Valle lays out three reasons for the failure, thus far, of a women’s rights-based approach to alleviating high maternal mortality in Afghanistan. First, he points to the change in access to reproductive health care being regulated by restrictive government policies and legislation to being more greatly influenced by culture and traditions, which are much more difficult for outsiders to advocate against. Second is the context from which Western workers approach women’s rights as a tool for improving health care, which he argues must be questioned as an effective tool given its tendency to be at odds with tradition. Third, even more important than culture and tradition preventing women from accessing health care, is the lack of infrastructure and health facilities in Afghanistan, as those facilities that do exist are under-staffed, under-equipped, and extremely difficult to reach via roads and existing transportation networks. Compounding these infrastructure issues are the large numbers of returning Afghans living in temporary services outside of Kabul, along with officially-recognized internally displaced persons (IDPs). These two factors have combined to result in a programmatic approach of quick impact projects, often being implemented in the limited space of IDP camps, that deal with safe environments and health education initiatives that do not prove to be sustainable or have a long-term impact on maternal mortality rates. Del Valle stresses the need to combine initiatives focused both within camps and the rest of the country, especially in rural areas, that allow for comprehensive restructuring and support of the Afghan administration in developing a nationwide infrastructure and policy. He stresses the need to meet four conditions in order to address the needs of IDPs and the general public. Reproductive health should be incorporated within a larger public health plan that is sustainable and accountable to the public, not just dependent upon NGOs. Linked to this is the need for support of the Afghan administration in delivering care and supplies, developing an infrastructure and building capacity in both rural and urban communities. Strategies to reduce maternal mortality, which incorporate the necessary equipment and staff, must target all three levels: pre-natal care, assistance during deliveries, and post-natal care. Finally, basic needs in rural and urban areas, including safe water, nutrition, and security, must become a priority. The failure to reduce maternal mortality rates cannot simply be attributed to, and excused by, entrenched social cultural traditions that diminish the importance of women’s health. The national and international communities must work together to rehabilitate the Afghan health system, including reproductive health services.

 

 

TRAUMATIC EXPERIENCE AND SLEEP DISTURBANCE IN REFUGEE CHILDREN FROM THE MIDDLE EAST

European Journal of Public Health, March 2001, Volume 11, Number 1, pp. 18-22(5)

Montgomery E., Foldspang A.

Edith_Montgomery@rct.dk, +45 33 760600, Fax: +45 33 760500

Rehabilitation and Research Centre for Torture Victims (RCT), Borgergade 13, PO Box 2107, DK-1014 Copenhagen K, Denmark

Department of Epidemiology and Social Medicine, Aarhus University, Aarhus, Denmark

Sleep disturbance is frequently reported in children after traumatic experiences associated with organized violence. The aim of this study was to identify specific traumatic risk indicators and modifying factors for sleep disturbance among recently arrived refugee children from the Middle East.

The study group comprises 311, 3-15 year old refugee children from the Middle East. On arrival in Denmark, their parents participated in a structured interview about their children's' health and history of exile and eventual exposure to war, organized violence and human right violation.

A family history of violence (grandparent's violent death before the birth of the child or parental exposure to torture) as well as a stressful present family situation (father scolds the child more than previously) were the strongest predictors of prevalent sleep disturbance in the children. Arriving in Denmark with both parents rather than one was a modifying factor, so the effect of traumatic experience on sleep patterns later in childhood was mediated through parental presence and behaviour. Conclusion. This study indicates that the family environment is of primary importance for childhood sleep disturbance following traumatic experiences connected with war and other organized violence.

NORTH AMERICA

SPIRITISM AS A FORM OF PSYCHOTHERAPY: IMPLICATIONS FOR SOCIAL WORK PRACTICE

Social Casework: The Journal of Contemporary Social Work, Volume 70, Number 8, October 1989, pp. 502-9

S. M. Berthold

There are two main spiritist traditions among Puerto Ricans: Mesa Blanca, which originated in Europe and is based on a belief in reincarnation, and Santeria, a synthesis of an African religion and Catholicism that centers on the worship of saints. Many Puerto Ricans practice a blend of these two traditions. Puerto Rican spiritists believe in a spirit world and in the duality of matter and spirit. Spirits can attach themselves to human beings and exert a profound influence on human affairs either by helping or causing harm. Some people possess special abilities to communicate with and control the spirits; centros, or spiritual churches, exist where these spiritually strong individuals can help others. Approximately one-third of all adult Puerto Ricans with mental disorders consult spiritists rather than seeking psychiatric treatment. A discussion examines the Puerto Rican practice of spiritism as a form of psychotherapy so that therapists who work with clients who believe in spiritism can be more aware of their clients’ belief systems. Suggestions are made for social workers and others who work with these clients.