Refugee Challenges, Stressors, and Mental Health - Annotated Bibliography Example

Introduction This paper presents an annotated bibliography on the stressors affecting the mental health of migrant and refugees. The review aims at establishing the trends in factors influencing the mental health of the refugees and the barriers preventing uptake of associated services to inform policy considerations for ensuring effective service delivery. The literature search utilized different terms namely refugee challenges, mental health, stressors, traumatic events, psychological distress, immigration challenges. The literature search was further limited to include articles written in English published after 2002 providing refugee accounts in Australia. The databases utilized in the literature search include Google Scholar, MEDLINE, and CINAHL. The literature search was further narrowed to mental health services provided to refugees in Australia. The search yielded fifteen articles that became part of the present review. Selection of the articles depended on their relevance to the topic of interest and their ability to answer the study question. Schweitzer, R. D., Brough, M., Vromans, L., & Asic-Kobe, M. (2011). Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry, 45(4), 299–307. The study aimed at documenting the mental health status of refugees of Burmese backgrounds arriving in Australia. Also, the authors examined the role of gender as well as the circumstances before and after migration in predicting the mental health outcomes of the refugees. They obtained data from a sample of 70 refugees using structured interviews. The tools used for data collection included a demographic questionnaire, the Hopkins Symptoms Checklist, and the Post-migration Living Difficulties Checklist. They assessed the trauma experiences before and after migration, living difficulties, anxiety, depression, traumatization, and somatization symptoms. The researchers established that the exposure of the refugees to traumatic situations before migration as well as the harsh living conditions following migration contributed to symptoms of anxiety, traumatization, and somatization. The sample used in this study was small considering the large number of Burmese refugees according to national reports. However, the authors strong arguments regarding the impact of pre- and post-migration experiences on the mental health of refugees are directly in line with my study topic thus contributing to improving the care of refugees. Hollifield, M., Warner, T. D., Lian, N., Krakow, B., Jenkins, J. H., Kesler, J., … Westermeyer, J. (2002). Measuring trauma and health status in refugees: a critical review. Jama, 288(5), 611–621. The authors posited that refugees experience traumatic situations leading to significant health problems thus undermining their mental health. Consequently, they sought to characterize literature surrounding refugee trauma and their health, and review the instruments utilized in the measurement of refugee trauma. They conducted a literature review after obtaining publications from CINAHL, PsychInfo, Cochrane Systematic Reviews, PsychoSocial Instruments and MEDLINE. They argued that instruments utilized in measuring refugee trauma did not guarantee reliability and validity. Regardless of the authors’ claims, they did not establish specific gaps or provide tangible solutions for addressing the identified challenges. This study is relevant to my topic because it evaluates the instruments for measuring trauma amongst refugees, which is one of the stressors of their mental health. Steel, Z., Silove, D., Chey, T., Bauman, A., & Phan, T. (2005). Mental disorders, disability and health service use amongst Vietnamese refugees and the host Australian population. Acta Psychiatrica Scandinavica, 111(4), 300–309. The researchers sought to establish the prevalence of mental disorders, disabilities, and utilization of health services amongst refugees of Vietnam origin over a period of eleven (11) years. The researchers used a stratified multistage probability approach to conduct a survey on 1611 Vietnamese living in New South Wales while comparing the findings with that of 7961 respondents of Australian origin using measures such as CIDI 2.1 and MOS SF-12. The study established lower prevalence rates of mental disorders amongst Vietnamese in comparison to the Australian respondents. According to Zachary Steel, refugees settling in Western countries eventually adapt to the circumstances thus experience optimal mental health. The researcher erred in his approach by using different sample sizes in the comparative populations hence the findings are misleading. However, the findings of this study are relevant to my study because they draw a comparison between possible mental health stressors amongst refugees in comparison to the general populations. Robjant, K., Hassan, R., & Katona, C. (2009). Mental health implications of detaining asylum seekers: a systematic review. The British Journal of Psychiatry, 194(4), 306–312. The researchers found that the number of internally displaced persons, refugees, and asylum seekers keeps rising despite Western countries enacting restrictive policies allowing their detention regardless of the harmful consequences. Consequently, they sought to assess the implication of detention on the mental health of children, adolescents, and adults. They conducted a systematic review of 63 studies identified through online databases supplemented with manual reference searches. Their study ascertained that detention of refugees significantly contributed to mental disorders, PTSD, anxiety, depression, and suicide. The data provided to support the authors' claims lacks statistical inference considering that the conditions assessed equally occur in the general population hence difficult to establish any differences. Nevertheless, the review is relevant to my area of study because it focuses on the mental health stressors of detained refugees. Bogic, M., Njoku, A., & Priebe, S. (2015). The long-term mental health of war-refugees: a systematic literature review. BMC International Health and Human Rights, 15(1), 29. The study aimed at assessing the prevalence of mental health disorders and their correlation amongst war refugees. The authors based their study on the fact that little evidence existed regarding the mental health of war refugees despite their huge number across the globe. The researchers conducted a systematic review of literature obtained through online databases namely PILOTs, PsycINFO, Embase, and MEDLINE. The review involved a cumulative sample of 16,010 war refugees. The researchers established that circumstances prior and after migration significantly contributed to the prevalence of mental disorders. The researchers failed to discuss the overall statistics for mental disorders thereby giving inconclusive findings. The study provides an insight on the long-term stressors on the refugees’ mental health hence relevant to my study area. Abdelkerim, A. A., & Grace, M. (2012). Challenges to employment in newly emerging African communities in Australia: A review of the literature. Australian Social Work, 65(1), 104–119. The authors posited that African communities emerging in Australia face serious challenges while accessing employment opportunities thus negatively affecting them as well as their host nations. They conducted a literature review with the aim of assessing the employment challenges faced by African refugees in Australia. It is the author’s argument that evidence generated from previous studies should inform policy reorientation and development of social intervention programs. They established that lack of reliable professional qualifications recognition programs, cultural and linguistic challenges, and lack of culturally and linguistically diverse (CALD) counseling services as contributing factors to the unemployment of refugees. Unemployment contributes to significant stress amongst refugees hence the study is relevant to my topic of interest. Bronstein, I., & Montgomery, P. (2011). Psychological distress in refugee children: a systematic review. Clinical Child and Family Psychology Review, 14(1), 44–56. The study aimed at reviewing epidemiological evidence on mental health status of children refugees living in Western countries. The researchers utilized a Cochrane Collaboration approach to survey bibliographies, databases, and gray literature over a period of five years. The review included 3,003 children refugees who migrated from over 40 countries. The study established the factors contributing to distress amongst refugee children as traumatic encounters, and stressful conditions before and after migration. The contextual and methodological limitations of this study make it impossible to generalize its findings to other settings thus having minimal impact on the potential clinical interventions. This is based on the researchers’ assumption that all the refugees suffered similar circumstances thus investigating them uniformly. The study is very relevant because it highlights the factors that contribute to distress amongst refugee children hence useful in improving their mental health care. Steel, Z., Momartin, S., Bateman, C., Hafshejani, A., Silove, D. M., Everson, N., … others. (2004). Psychiatric status of asylum seeker families held for a protracted period in a remote detention center in Australia. Australian and New Zealand Journal of Public Health, 28(6), 527–536. The researchers sought to assess the impact of detention on the psychiatric status of refugee children and their families in Australia’s remote detention facility. They employed structured psychiatric interviews administered on the phone by three psychologists speaking the same language as the respondents. The sample for the study involved ten (10) families comprising of 20 children and 14 adults. The researchers established that all the detained refugees including adults and children presented with at least one psychiatric disorder. The prevalence of the disorders was in higher in children compared to adults, and the contributing factors to the psychological distress included traumatic experiences, detention memories, and feeling of hopelessness. The sampling size utilized in this study is insufficient to make generalized inferences and the authors ought to have provided additional evidence on the harmful detention lengths to facilitate clear policy formulation. Detention contributes to psychological distress and this study provides an insight into the psychological wellbeing of detainees thus relevant to improving their mental healthcare. Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., & Susljik, I. N. A. (2006). Impact of immigration detention and temporary protection on the mental health of refugees. The British Journal of Psychiatry, 188(1), 58–64. The authors sought to analyze the effect of mandatory detention and temporary protection measures for refugees. They sampled 241 refugees of Arab origin and who were interviewed to rule out any symptoms of major depressive episodes, PTSD, and stress associated with previous trauma, mandatory detention, and subsequent protection. They established a positive association between previous trauma, mandatory detention, and subsequent protection with mental disorders. They further argued that detaining the refugees for longer periods led to more severe symptoms. The researchers failed to provide any practical solutions for addressing preventing the psychological trauma experienced by the refugees during periods of detention. This study also provides an insight on the impact of detention on the psychological wellbeing of refugees thus unearthing some of the mental health stressors and contributing to care improvement. Sheikh-Mohammed, M., MacIntyre, C. R., Wood, N. J., Leask, J., & Isaacs, D. (2006). Barriers to access to health care for newly resettled sub-Saharan refugees in Australia. Med J Aust, 185(11–12), 594–597. The authors sought to establish the underlying factors that undermine access to quality healthcare by refugees originating from sub-Saharan Africa. They adopted a descriptive epidemiological survey design to study parents of refugee children presenting in the pediatric clinic over one year. The researchers sampled 34 families and determined that language barriers, financial constraints, and lack of knowledge on the existing healthcare services constituted the major barriers to accessing healthcare. The authors posited that most refugee families establish connections with groups of their ethnic background. This argument is misleading because not all refugees have familial or ethnic connections in their host countries. However, the study identifies some barriers preventing uptake of healthcare services by refugees thus relevant in informing intervention strategies for improving healthcare provision to the refugees. Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., … Pottie, K. (2011). Common mental health problems in immigrants and refugees: general approach in primary care. Canadian Medical Association Journal, 183(12), E959–E967. The researchers purposed to identify risk factors associated with mental health illnesses and assess relevant strategies for preventing and treating the conditions amongst immigrants. They conducted a literature review on the risk factors for mental health associated with immigrants, the implications of culture on mental state, as well as the clinical interventions for preventing mental illness amongst refugees. The researchers established the risk factors of each phase of the migration trajectory namely pre-migration, migration, as well as post-migration. They concluded that the nature of experiences during these phases contributed to mental disorders. The authors recommended a specific inquiry to address these concerns, integrating trained interpreters as well as culture brokers in healthcare provision, collaboration with families and other community organizations. By identifying the common mental health problems amongst refugees, the study is useful since it hints to some of the potential underlying factors that contribute to these conditions. Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365(9467), 1309–1314. The researchers sought to establish the prevalence of mental disorders amongst refugee populations. They conducted a systematic review of studies that entailed the diagnoses of generalized anxiety disorders, psychosis, and major depression. The study established that refugees living in western countries had a tenfold likelihood of suffering post-traumatic stress disorder in comparison to the general population with similar demographics. Based on these findings, the researchers argued that some refugees living in western countries suffer from PTSD. The methodological approaches employed under this study cannot address the question on prevalence yet the authors failed to acknowledge this shortcoming particularly their sampling approach. Steel, Z., Momartin, S., Silove, D., Coello, M., Aroche, J., & Tay, K. W. (2011). Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Social Science & Medicine, 72(7), 1149–1156. The study aimed at comparatively assessing the mental health and psychosocial outcomes of restrictive and supportive immigration policies. The researchers conducted a longitudinal survey over a period of two years including a sample of 104 refugees subjected to restrictive immigration policies. They utilized the Penn State Worry Questionnaire (PSWQ), the GHQ-30, the Hopkins Symptom Checklist, and the Harvard Trauma Questionnaire (HTQ) to collect data. The researchers used the findings to justify a rising trend of mental disorders coupled with resettlement challenges, difficulties with acculturation, and social isolation in circumstances with restrictive policies on immigration. The authors did not give sufficient justification on their use of a small sample size during this study making it difficult to generalize their findings. On the other hand, the findings provide a better understanding of the mental health stressors by evaluating their outcomes thus identifying the need for long-term care. Omeri, A., Lennings, C., & Raymond, L. (2006). Beyond asylum: implications for nursing and health care delivery for Afghan refugees in Australia. Journal of Transcultural Nursing, 17(1), 30–39. The study aimed at evaluating the accessibility, acceptability, and appropriateness of mental health services by Afghan refugees residing in New South Wales. The researchers employed focus group discussions and semi-structured interviews on a sample of 38 informants. The study unraveled emotional challenges following the immigration experiences, acculturation, the inappropriateness of the services as some of the factors jeopardizing uptake of the services. Despite the sample limitations, the researchers insist on the significance of their findings on improving the healthcare standards of refugees. Detailed assessments will be essential to realizing the statistical significance of these findings. The study provides relevant information for consideration while designing care models for asylum seekers hence useful to my study. Silove, D., Steel, Z., Bauman, A., Chey, T., & McFarlane, A. (2007). Trauma, PTSD and the longer-term mental health burden amongst Vietnamese refugees. Social Psychiatry and Psychiatric Epidemiology, 42(6), 467–476. The researchers aimed at evaluating the effect of trauma on mental distress amongst refugees from Vietnam. They employed probability sampling to include a sample of 1,161 refugees over a period of 11 years. The findings were compared with those of an Australian based sample of 7,961 respondents. Interestingly, the findings revealed a similar prevalence of PTSD in both samples. The researchers concluded that the refugees suffer PTSD despite having settled in Australia for over a decade. This study did not contribute any new evidence but controversially claimed similar prevalence rates of PTSD amongst refugees and Australians thereby warranting no interventions. However, the findings are relevant to my study since they provide an insight into the long-term implications of the mental health stressors thus creating the need for long-term mental healthcare services for the refugees Conclusion The review of literature in the present study revealed significant themes on the stressors affecting the mental health of migrants, refugees, and asylum seekers. The main themes include the association between the refugee status and mental disorders, the factors contributing to mental disorders, mental health services for refugees, and refugees detention and mental distress. According to Schweitzer, Brough, Vromans, & Asic-Kobe, (2011), refugees experience traumatic situations that predispose them to mental distress as evidenced by the symptoms of anxiety, traumatization, and somatization amongst Vietnamese refugees. Their assertions resemble those of Hollifield et al., (2002) who established the various stages of the immigration trajectory. The literature demonstrated that the specific experiences of refugees before, during, and after the immigration determine their vulnerability to mental illnesses. Evidence from the reviewed literature confirms that the refugee circumstances present challenges that contribute to the occurrence of mental illnesses. The harsh conditions before immigration and the challenges experienced following immigration contribute to mental illness. In some instances, restrictive policies occasioning the temporary detention and subsequent protection of refugees contribute to psychological distress. In addition, language barriers, acculturation challenges, lack of knowledge on the existing mental health services are some of the confounding factors contributing to distress amongst refugees in Australia. Moreover, evidence from the reviewed literature further demonstrated that emotional distress, feelings of hopelessness, and helplessness also contributed to psychological distress. Finally, the literature strongly emphasized on the effects of detention about mental distress amongst refugees. There is no doubt that restrictive policies geared towards inhibiting immigration of asylum seekers and refugees exacerbate the psychological trauma experienced by these disadvantaged groups thereby contributing to their high prevalence of mental illness. There is a rising trend of mental disorders coupled with resettlement challenges, difficulties with acculturation, and social isolation amongst refugees subjected to detention occasioned by the restrictive policies and laws on immigration. The fact presented through the literature review confirm the need for policy readjustments with the intention of overcoming the barriers jeopardizing access to quality mental health services by refugees. PART B The reviewed literature yielded a substantial amount of new evidence regarding the stressors influencing the mental health of refugees, immigrants, and asylum seekers. The new knowledge is a great contribution to my cross-cultural understanding while dealing with persons of CaLD background. I can explore the underlying factors contributing to poor uptake of mental health services amongst the refugee populations. Most importantly, I have gained the capacity to evaluate the factors affecting the mental health of these populations from their points of view while designing practical solutions that are in tandem with their circumstances. Available evidence shows that an in-depth understanding of the factors jeopardizing the uptake of mental health services contributes to effective interventions that promote the health and wellbeing of refugees (Flatau et al., 2015). Being a non-native Australian has positively and negatively contributed to my practice while working with people from CaLD backgrounds. On the positive dimension, I can appreciate some of the challenges experienced by these individuals based on my first-hand experience as I struggled to integrate and assimilate into the Australian culture. There were several cultural concerns that contradicted my perspectives based on my ethnic background, but I greatly benefited from enhanced cross-cultural understanding. As a social worker, I can approach an issue affecting a person of CaLD origin while exercising a reasonable amount of caution. It is equally advantageous while working with individuals with whom I share a similar background. However, evidence shows that intervening in the circumstances with a similar background with the social worker may awaken emotions such as sympathy that undermine the designed interventions (Momartin et al., 2006). On the flipside, attending to individuals of CaLD backgrounds may be extremely challenging especially in scenarios where they have a greater understanding of the Australian culture that is beyond the scope of my knowledge. Consequently, there is always a need for me to go an extra mile in preparation for addressing the needs of individuals from diverse backgrounds and bring them to the same understanding level as mine. Some of the societal and organizational barriers hampering my engagement in culturally safe practice with persons of CaLD origins encompass the restrictive policies established by state institutions in a bid to address social crises arising from failing political systems. According to Steel et al., (2011), persons of CaLD background face insurmountable challenges orchestrated by stringent laws and policies on refugees and asylum seeking thus equally undermining my work. Abdelkerim, A. A., & Grace, M. (2012) observed that refugees suffered serious consequences due to their inability to secure jobs in their host countries partly occasioned by the lack of robust professional qualifications recognition agreements. This significantly contributed to the rising incidence of mental distress due to a state of helplessness and hopelessness in a foreign nation (Abdelkerim & Grace, 2012; Steel et al., 2011). References Abdelkerim, A. A., & Grace, M. (2012). Challenges to employment in newly emerging African communities in Australia: A review of the literature. Australian Social Work, 65(1), 104–119. Retrieved from: http://www.tandfonline.com/doi/abs/10.1080/0312407X.2011.616958 Bogic, M., Njoku, A., & Priebe, S. (2015). The long-term mental health of war-refugees: a systematic literature review. BMC International Health and Human Rights, 15(1), 29. Retrieved from https://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/s12914-015-0064-9 Bronstein, I., & Montgomery, P. (2011). Psychological distress in refugee children: a systematic review. Clinical Child and Family Psychology Review, 14(1), 44–56. Retrieved from https://link.springer.com/article/10.1007/s10567-010-0081-0 Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365(9467), 1309–1314. Retrieved from https://link.springer.com/article/10.1007/s10567-010-0081-0 Flatau, P., Smith, J., Carson, G., Miller, J., Burvill, A., & Brand, R. (2015). The housing and homelessness journeys of refugees in Australia. Melbourne: Australian Housing and Urban Research Institute. Retrieved from http://www.ahuri.edu.au/__data/assets/pdf_file/0026/5759/AHURI_Final_Report_No256_The-housing-and-homelessness-journeys-of-refugees-in-Australia.pdf Hollifield, M., Warner, T. D., Lian, N., Krakow, B., Jenkins, J. H., Kesler, J., … Westermeyer, J. (2002). Measuring trauma and health status in refugees: a critical review. Jama, 288(5), 611–621. Retrieved from http://jamanetwork.com/journals/jama/article-abstract/195170 Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., … Pottie, K. (2011). Common mental health problems in immigrants and refugees: general approach in primary care. Canadian Medical Association Journal, 183(12), E959–E967. Retrieved from http://www.cmaj.ca/content/183/12/E959.short Martin, S., Steel, Z., Coello, M., Aroche, J., Silove, D. M., Brooks, R., & others. (2006). A comparison of the mental health of refugees with temporary versus permanent protection visas. Medical Journal of Australia, 185(7), 357. Retrieved from https://www.mja.com.au/journal/2006/185/7/comparison-mental-health-refugees-temporary-versus-permanent-protection-visas?inline=true Omeri, A., Lennings, C., & Raymond, L. (2006). Beyond asylum: implications for nursing and health care delivery for Afghan refugees in Australia. Journal of Transcultural Nursing, 17(1), 30–39. Retrieved from http://journals.sagepub.com/doi/abs/10.1177/1043659605281973 Robjant, K., Hassan, R., & Katona, C. (2009). Mental health implications of detaining asylum seekers: systematic review. The British Journal of Psychiatry, 194(4), 306–312. Retrieved from http://bjp.rcpsych.org/content/194/4/306.short Schweitzer, R. D., Brough, M., Vromans, L., & Asic-Kobe, M. (2011). Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry, 45(4), 299–307. Retrieved from http://www.tandfonline.com/doi/abs/10.3109/00048674.2010.543412 Sheikh-Mohammed, M., MacIntyre, C. R., Wood, N. J., Leask, J., & Isaacs, D. (2006). Barriers to access to health care for newly resettled sub-Saharan refugees in Australia. Med J Aust, 185(11–12), 594–597. Retrieved from https://www.mja.com.au/journal/2006/185/11/barriers-access-health-care-newly-resettled-sub-saharan-refugees-australia Silove, D., Steel, Z., Bauman, A., Chey, T., & McFarlane, A. (2007). Trauma, PTSD and the longer-term mental health burden amongst Vietnamese refugees. Social Psychiatry and Psychiatric Epidemiology, 42(6), 467–476. Retrieved from https://link.springer.com/article/10.1007/s00127-007-0194-z Steel, Z., Momartin, S., Bateman, C., Hafshejani, A., Silove, D. M., Everson, N., … others. (2004). Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia. Australian and New Zealand Journal of Public Health, 28(6), 527–536. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1467-842X.2004.tb00042.x/full Steel, Z., Momartin, S., Silove, D., Coello, M., Aroche, J., & Tay, K. W. (2011). Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Social Science & Medicine, 72(7), 1149–1156. Retrieved from http://www.sciencedirect.com/science/article/pii/S0277953611000931 Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., & Susljik, I. N. A. (2006). Impact of immigration detention and temporary protection on the mental health of refugees. The British Journal of Psychiatry, 188(1), 58–64. Retrieved from http://bjp.rcpsych.org/content/188/1/58.short Steel, Z., Silove, D., Chey, T., Bauman, A., & Phan, T. (2005). Mental disorders, disability and health service use amongst Vietnamese refugees and the host Australian population. Acta Psychiatrica Scandinavica, 111(4), 300–309. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2004.00458.x/full Read More