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PubMed1994

Epidemic cholera during refugee resettlement in Malawi.

BACKGROUND: In June 1988 a cholera epidemic occurred in a Mozambican refugee population resettling in southern Malawi. METHODS: A case-control study was conducted to determine possible risk factors for disease. The characteristics of 48 refugee households with any member(s) hospitalized for suspected cholera were compared to 441 randomly sampled refugee households without hospitalizations. RESULTS: Vibrio cholerae 01 was isolated from 50% (5/10) of case-patient stool cultures. Having any water containers with > or = 10 T capacity was associated with a significantly lower odds of suspected cholera in households (adjusted odds ratio [aOR] = 0.02, 95% confidence interval [CI] : 0.003-0.12), as was having metal cooking pots (aOR = 0.3, 95% CI : 0.12-0.7), after adjusting for length of residence and socioeconomic status (logistic regression model). Households with two or more children < 5 years old were at markedly increased odds of suspected cholera (P < 0.0001). These results suggest that water containers and cooking pots served important preventive functions during this cholera outbreak. Young children may have contributed to cholera transmission, but the reason(s) remains undetermined.

Adolescent↗
PubMed1995

Posttraumatic stress disorder across two generations of Cambodian refugees.

OBJECTIVE: To examine the expression of war-related trauma as manifested by DSM-III-R rates of posttraumatic stress disorder (PTSD) and major depressive disorder in two generations of Cambodian refugees living in the western United States. METHOD: A probability sample of 209 Khmer adolescents and one of their parents were interviewed using portions of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version and the PTSD section of the Diagnostic Interview for Children and Adolescents. Interviews were conducted in English by a master's-level clinician with a Khmer interpreter. RESULTS: PTSD was found to be significantly related across parent-child generations. A nonsignificant generational trend was also found for depressive disorders. A number of environmental variables measured in the study (amount of reported war trauma, loss, living arrangements, treatment received, socioeconomic status) were not related to these findings. Parents were more likely to report an earlier onset of PTSD symptoms. CONCLUSIONS: This study suggests that PTSD in refugees may cluster in families. Whether this phenomenon is caused by a genetic susceptibility to trauma awaits further research. PTSD and depressive disorders in refugee populations, while often comorbid, appear to follow different courses over time.

Adolescent↗
PubMed1983

Migration and mental health among Hmong refugees. Association of pre- and postmigration factors with self-rating scales.

To date there have been no epidemiological studies of a refugee population using self-rating scales. This method was used in a study of Hmong refugees in Minnesota. Self-reported symptoms were compared with premigration and postmigration factors to assess those characteristics associated with increased symptom reporting. Relatively few premigration factors influenced these self-reports, whereas several postmigration factors were significantly correlated with symptoms. These findings suggest certain interventions which might enhance the adjustment of subsequent refugees.

Adult↗
PubMed1990

Welfare status and psychosocial adjustment among 100 Hmong refugees.

Although the mental health of recently employed persons has been well studied, the mental health of welfare recipients is not well understood. Among our increasing refugee population, many receive welfare benefits at some point. The Hmong are among those who are highly represented among welfare recipients in several areas of the United States. Do psychiatrists have anything to contribute toward the resolution of high welfare rates? This question is especially relevant in refugee populations who are at increased risk for several psychiatric disorders, including depression, paranoia, and adjustment disorders. This study was undertaken among 100 Hmong refugees who had been in the United States for 8 years. Indices of mental health included two rating scales (the Zung Depression Scale and the SCL-90), five-axis DSM-III diagnoses, Hamilton Anxiety and Depression Scales, Global Assessment Scale, Brief Psychiatric Rating Scale, Inpatient Multidimensional Scale, and Mini-Mental State Exam. These indices were compared with current welfare status and the duration of time on welfare. Other comparisons with welfare included demographic characteristics, material possessions, acculturation characteristics, health and social problems, and nonoccupation avocations. Results indicate that welfare recipients show lower acculturation and elevated psychiatric symptom levels. Suggestions for ameliorating this situation are extrapolated from studies in the literature on chronically unemployed persons.

Acculturation↗
PubMed1995

Depression and posttraumatic stress disorder among a community sample of adolescent and young adult Afghan refugees.

This study was designed to determine the prevalence of posttraumatic stress disorder (PTSD) and other psychiatric disorders among a community sample of adolescent and young adult refugees from Afghanistan. The study also measured the correlation of their current psychiatric disorders with the number of traumatic events experienced, parental acculturation and distress, and other important demographic factors. Thirty-eight refugees between 12 and 24 years of age were interviewed with the Structured Clinical Interview for DSM-III-R. Five subjects met DSM-III-R criteria for PTSD, 11 subjects met the criteria for major depression, and 13 had either PTSD or major depression or both. Significant positive correlations were found between the subjects' psychiatric diagnosis and the total number of traumatic events experienced and the parental level of psychological distress (especially maternal distress). There were negative correlations between children's symptomatology and a measure of maternal acculturation. These results suggest that a significant proportion of adolescent and young adult Afghan refugees in the community suffer from severe but undiagnosed psychiatric disorders.

Acculturation↗
PubMed1995

Interpretation of symptom presentation and distress. A Southeast Asian refugee example.

Symptom expression or the manifestation of distress is greatly influenced by one's cultural background. This exploratory study investigated symptom presentation of distress among a community sample of Vietnamese, Chinese-Vietnamese, Cambodian, and Lao refugees. The study examined whether or not the Western-designed distress measure used in the study was culturally sensitive enough to accurately capture culturally framed expressions of distress. The results of the factor analyses showed that the four Southeast Asian refugee groups did not express distress in three separate factors as devised in the original measure. Instead, a single robust factor emerged. The single factor comprised items from the depression, anxiety, somatic, and psychosocial dysfunction subscales. The items that made up the single factor strongly resemble the construct for the diagnosis of neurasthenia. Researchers have found neurasthenia to be a culturally sanctioned Asian cultural idiom of distress. The findings strongly suggested that this Southeast Asian refugee population expressed distress in a pattern of symptoms more consistent with Asian nosology. The clinical and research implications of the results of this exploratory study are also discussed.

Acculturation↗
PubMed1998

Gender differences in psychological distress among Southeast Asian refugees.

The focus of this study was to examine gender differences in levels and predictors of psychological distress in a community sample of Southeast Asian refugees. Although previous studies with clinical samples of Southeast Asian refugees have found gender differences in the degree of psychological distress, the few community-based studies have been inconclusive. This community study found that there were gender differences in the predictors of distress and that refugee women reported significantly higher levels of psychological distress than their male counterparts. Implications of the findings are discussed.

Adaptation, Psychological↗
PubMed2002

The mental health of war-wounded refugees: an 8-year follow-up.

The complex nature of recent wars and armed conflicts has forced many war-injured persons into exile. To investigate their long-term mental health, three instruments for assessing mental health (HSCL-25, PTSS-10, and a Well-Being scale) were presented to 44 war-wounded refugees from nine different countries 8 years after arrival in Sweden. The prevalence of psychiatric symptoms was high and corresponds to findings in previous studies of refugee patient populations. A lower level of mental health was associated with higher education, unemployment, and poor physical health. The findings suggest a high psychiatric morbidity and a need for psychiatric interventions in this refugee group. Methodological issues to be considered in research on sequels of war traumas are discussed.

Adult↗
PubMed2002

The effects of September 11 on traumatized refugees: reactivation of posttraumatic stress disorder.

Secondary traumatization from the tragic events of September 11, 2001 was studied among an ethnically diverse group of refugees who had been previously traumatized in their native war torn countries. A brief clinically oriented questionnaire was developed and administered to a clinic population of Vietnamese, Cambodian, Laotian, Bosnian and Somalian refugees in the Intercultural Psychiatric Program at Oregon Health & Science University. Traumatic symptoms and responses to the widely televised images from September 11 were assessed among the five ethnic groups, and the differential responses among patients with posttraumatic stress disorder (PTSD), depression, and schizophrenia also were assessed. The strongest responses were among Bosnian and Somalian patients with PTSD, and the Somalis had the greatest deterioration in their subjective sense of safety and security. Regardless of ethnic group, PTSD patients reacted most intensely, and patients with schizophrenia the least. Although patients largely returned to their baseline clinical status after two to three months, this study shows that cross-cultural reactivation of trauma has a significant clinical impact. It is essential that clinicians anticipate PTSD symptom reactivation among refugees when they are reexposed to significant traumatic stimuli.

Adult↗
PubMed1994

Cultural themes in family stress and violence among Cambodian refugee women in the inner city.

Cambodian refugee women frequently face the cumulative trauma of war experiences and cultural adaptation to the American inner-city environment. This qualitative study investigated cultural beliefs, coping strategies, and management of family stress among Cambodian refugee women living in the inner-city environment. Focused and open-ended interviews were conducted in the informants' homes using the Cambodian language. Stressful and violent events were managed by nonconfrontation and withdrawal. These two themes are hypothesized as the culturally identified means by which inner-city Cambodian refugee women control and harmonize situations of stress. Further study is needed to develop the theoretical base for developing culturally sensitive nursing intervention strategies with this high risk population.

Adaptation, Psychological↗
PubMed2005

A follow-up study of mental health and health-related quality of life in tortured refugees in multidisciplinary treatment.

Longitudinal studies of traumatized refugees are needed to study changes in mental health over time and to improve health-related and social interventions. The aim of this study was to examine changes in symptoms of PTSD, depression, and anxiety, and in health-related quality of life during treatment in traumatized refugees. The study group comprises 55 persons admitted to the Rehabilitation and Research Centre for Torture Victims in 2001 and 2002. Data on background, trauma, present social situation, mental symptoms (Hopkins Symptom Checklist-25, Hamilton Depression Scale, Harvard Trauma Questionnaire), and health-related quality of life (WHO Quality of Life-Bref) were collected before treatment and after 9 months. No change in mental symptoms or health-related quality of life was observed. In spite of the treatment, emotional distress seems to be chronic for the majority of this population. Future studies are needed to explore which health-related and social interventions are most useful to traumatized refugees.

Adult↗
PubMed2003

The dual imperative in refugee research: some methodological and ethical considerations in social science research on forced migration.

Social scientists doing fieldwork in humanitarian situations often face a dual imperative: research should be both academically sound and policy relevant. We argue that much of the current research on forced migration is based on unsound methodology, and that the data and subsequent policy conclusions are often flawed or ethically suspect. This paper identifies some key methodological and ethical problems confronting social scientists studying forced migrants or their hosts. These problems include non-representativeness and bias, issues arising from working in unfamiliar contexts including translation and the use of local researchers, and ethical dilemmas including security and confidentiality issues and whether researchers are doing enough to 'do no harm'. The second part of the paper reviews the authors' own efforts to conduct research on urban refugees in Johannesburg. It concludes that while there is no single 'best practice' for refugee research, refugee studies would advance its academic and policy relevance by more seriously considering methodological and ethical concerns.

Altruism↗
PubMed2005

Exploring the 'fit' between people and providers: refugee health needs and health care services in Mt Roskill, Auckland, New Zealand.

The needs of refugees and the struggles on the part of service providers to address this diverse population have received limited attention within the academic literature. This paper profiles Hauora o Puketapapa/Roskill Union and Community Health Centre (HoP), which is a non-profit, community owned and operated health clinic designed to deliver accessible, affordable and appropriate primary health care services to low-income groups in the Mt Roskill area of Auckland, New Zealand. The clinic's locality has undergone considerable demographic change over recent years with the arrival of refugees from diverse backgrounds. This situation has resulted in new sets of health needs and expectations which need to be addressed. The study took place in 2002-2003 and employed qualitative methods. In-depth interviews with community representatives, clinic users and health service staff members revealed that refugees face considerable barriers in accessing and utilising health services. Similarly, we found that health practitioners face the daunting task of endeavouring to meet these needs in an effective and culturally appropriate manner within a limited funding environment. We conclude that, despite these challenges, HoP has successfully established itself as a well-regarded place of primary health care. In so doing, it has strengthened the capacity of the local community to respond to the changing policy environment. However, long-term sustainability issues remain unless resourcing issues are adequately addressed.

Community Health Services↗
PubMed1995

Prevalence of hypercholesterolaemia and coronary heart disease risk factors among southeast Asian refugees in a primary care clinic.

The National Cholesterol Education Program's guidelines for the detection, evaluation, and treatment of high serum cholesterol in adults were employed in screening 155 Southeast Asian refugees in a primary care clinic in Seattle, Washington. In order to determine the need for a therapeutic intervention, information also was collected on the presence of other coronary heart disease (CHD) risk factors. Male gender (39%), cigarette smoking (27%) and hypertension (26%) were the most common CHD risk factors; diabetes mellitus, obesity, a family or prior history of CHD or cerebral/peripheral vascular disease were each noted in less than 10%. The mean serum total cholesterol was 194 mg/dl. Thirty-seven (24%) patients required further lipoprotein analysis based on cholesterol level, history of CHD and risk factors for CHD. Twenty-one (66%) of 32 patients who underwent lipoprotein analysis (14% of all patients) were candidates for a therapeutic intervention for hypercholesterolaemia. Additionally, 14 (44%) patients undergoing lipoprotein analysis had depressed high-density lipoprotein levels (< 35 mg/dl). We conclude that CHD risk factors including hypercholesterolaemia are common in Southeast Asian refugee clinic patients and that in many, a therapeutic intervention may well be justified. Southeast Asian refugees should be routinely screened for hypercholesterolaemia and other CHD risk factors in accordance with the National Cholesterol Education Program's guidelines.

Adult↗
PubMed2006

Refugees and medical student training: results of a programme in primary care.

CONTEXT: Medical schools have responded to the increasing diversity of the population of the USA by incorporating cultural competency training into their curricula. This paper presents results from pre- and post-programme surveys of medical students who participated in a training programme that included evening clinical sessions for refugee patients and related educational workshops. METHODS: A self-assessment survey was administered at the beginning and end of the academic year to measure the cultural awareness of participating medical students. RESULTS: Over the 3 years of the programme, over 133 students participated and 95 (73%) completed pre- and post-programme surveys. Participants rated themselves significantly higher in all 3 domains of the cultural awareness survey after completion of the programme. CONCLUSIONS: The opportunity for medical students to work with refugees in the provision of health care presents many opportunities for students, including lessons in communication, and scope to learn about other cultures and practise basic health care skills. An important issue to consider is the power differential between those working in medicine and patients who are refugees. To avoid reinforcing stereotypes, medical programmes and medical school curricula can incorporate efforts to promote reflection on provider attitudes, beliefs and biases.

Adult↗
PubMed2005

'They first killed his heart (then) he took his own life'. Part 1: a review of the context and literature on mental health issues for refugees and asylum seekers.

This is the first in a two-part series of papers examining mental health issues for refugees and asylum seekers. Beginning with the suicide of an asylum seeker in Scotland, the paper emphasizes mental health issues for adult and child asylum seekers, stress and memory, suicide, self-harm, risk and protective factors, compulsory health treatments and the prevention of mental illness. It sets the scene for the second paper by drawing implications for nursing practice in the community. Although most literature on refugee and asylum seeker mental health exists outside of nursing scholarship, a majority of the issues reviewed in this paper are mutual challenges for all in the health and helping professions. Nurses interested in refugee and migration issues face two intertwined challenges: that of how to assist migrants with their diverse mental health needs and how, at the same time, to contribute to a society that can promote mental health for all by taking on both the difficulties and opportunities posed by cultural diversity.

Adult↗
PubMed1996

Why aid agencies need better understanding of the communities they assist: the experience of food aid in Rwandan refugee camps.

Refugee views on food aid reveal the ignorance of the international community regarding Rwandan culture, economy and politics. This ignorance carries a number of costs. On one level, the main cost is that a professional service is not carried out to the best of one's ability. Ignorance of Rwanda's North-South divide, for instance, has caused agencies to be insensitive to in-camp discrimination based upon regional identity and its impact on programme activities. On a deeper level, agency ignorance about Rwandan culture, economy and the dynamics of camp politics, reduces refugee confidence in humanitarian agencies and workers. Better information would not only result in the greater likelihood of appropriate responses to specific needs, but would also encourage greater credibility in the political arena where the ultimate stake is to see lasting peace and a dignified return of refugees to their homes.

Agriculture↗
PubMed1999

Specificity of notification for tuberculosis among screened refugees in NSW.

OBJECTIVE: Epidemiological surveillance of tuberculosis (TB) in Australia is dependent on the accuracy of the notification data. We have investigated the specificity of TB notification for the diagnosis of this disease. METHOD: We used data from notifications to the NSW Department of Health to identify members of a cohort of refugees who were screened between 1984 and 1993 and subsequently developed TB during that period. We reviewed notification data and, in most instances, case notes and x-ray films, to independently confirm or refute the diagnosis of TB. RESULTS: Two hundred and fifty members of the cohort were identified in the notification database. After excluding refugees on treatment prior to arrival in Australia, and those who were notified as 'quiescent' and 'atypical' cases, there were 189 cases notified as active TB. There was evidence to support the diagnosis of active TB in 125 cases (66%) and evidence that subjects did not have active disease in 60 cases (32%). We could not determine the status of the remaining four notified cases. CONCLUSION: This study has shown that, in a population of refugees subject to screening, nearly one-third of cases notified as active tuberculosis from the study population were actually not active tuberculosis cases. IMPLICATIONS: The use of the TB notification database may result in overestimation of the incidence of TB in population groups who are subject to active screening.

Bias↗