Cultural Consensus Model of Depression Beliefs Among Afghan Refugees

This study describes gender-specific beliefs about depression among Afghan refugees, a population shown to be highly distressed. A 73-item questionnaire covering causes, symptoms, and treatments of depression, developed through free-listing techniques and supplemented with items from existing scales, was administered to a non-random sample of 50 men and 43 women in San Diego County. Demographic information and data on baseline distress levels were also collected. The Cultural Consensus Model was used to estimate the culturally correct answer for each question, and to assess the proportion of shared beliefs within and between groups. Results from consensus analysis indicated a homogenous response pattern present for each group, and collectively when groups were combined. The proportion of shared beliefs across all depression domains was significantly (p \u3c .05) higher among women (.52) than in men (.46). Women also reported significantly higher agreement in terms of depression causality (women = .54, men = .42). Equal agreement (.45) was observed in groups regarding symptoms. Items relating to treatments were the most widely recognized by men (.53) and women (.57); however, significant differences in agreement were not observed. Results did not vary by demographic characteristics or by distress experiences for either group. Causes were associated with cultural conflicts and social isolation; women classified more somatic items, and both groups believed that treatments for depression included seeking professional help as well as lay techniques such as engaging in religious activities and exercise. Understanding cultural beliefs about depression among Afghan refugees could provide insights into the cultural and social reasons that influence help-seeking behaviors and the presentation of depressive symptoms in clinical settings, in turn, leading to improvements in service provision and depression care

An Intentional Wholeness Focus and the Association With Burnout in Graduate Students

Rates of stress, anxiety, depression, and burnout for university students are concerning. As in other competitive professional fields, graduate students in occupational therapy, physical therapy, and speech language pathology face many performance pressures. Creating supportive learning and wholeness climates along with individual grit, resilience, and healthy spirituality have the potential to positively impact these pressures. The study’s purpose was to examine factors related to burnout within an institution committed to creating supportive learning and wholeness environments. Three hundred and fifty-three graduate students from occupational therapy, physical therapy, and speech language pathology graduate programs were recruited to participate in a cross-sectional survey exploring student functioning using primarily validated measures. Hierarchical multiple regressions were utilized to test the unique contributions of perceived learning and wholeness climates, demographics, mental health factors, and potential coping factors to better understand burnout/disengagement and burnout/exhaustion. All models accounted for a significant amount of the variance in both burnout/disengagement (38.2%) and burnout/exhaustion (46.9%). Higher student perceptions of positive wholeness and learning climates, grit, and personal spirituality/peace suggested lower burnout/disengagement, but spirituality/meaning had an unexpected negative outcome. Burnout/exhaustion was negatively associated with anxiety, depression, and spirituality/faith while positively with spirituality/peace. Overall, students’ views of the university providing a supportive wholeness and learning climate as well as their personal grit was associated with lower burnout. Depression and anxiety were negatively associated with burnout/exhaustion. Spirituality was more complicated with variation in risk versus supportive factors. Results may help guide future studies, provide suggestions for specific programming, and promote supportive university environments

Afghan mental health and psychosocial well-being: Thematic review of four decades of research and interventions

Background Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations. Aims We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions. Method In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support. Results Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body–mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture. Conclusions We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.publishedVersio

Determinants of Health Care Services Utilization among First Generation Afghan Migrants in Istanbul

There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live

Economic integration of Afghan refugees in the US, 1980-2015

Using 1990 5% Census and American Community Survey data, we examine the economic integration of Afghan refugees to the US, focusing on employment rates and income levels. First-wave Afghan refugees (those arriving 1980-90) have made significant income and employment gains, while poverty rates and reliance on government assistance have decreased dramatically. The most recent wave is not doing as well at comparable points in time. Controlling for factors such as cultural capital, cost of living, and length of residence in the US, Afghan refugees' incomes are the lowest of seven refugee/immigrant comparison groups. This is largely explained by lower employment levels, especially among less-educated Afghan women and highly educated Afghan women and men. Factors explaining this may include Afghans' strong gender division of labour, greater levels of physical and mental disability resulting from pre-migration and migration traumas, and inability to develop occupational niches providing pipelines to jobs for recent arrivals and less-educated women. Highly educated Afghan refugees' lower income is largely explained by the low incomes of those who earned their credentials outside the US. Although unmeasured, we suspect some of the unexplained direct negative effect of Afghan refugees on income is explained by anti-Muslim and anti-Afghan prejudice

Discrimination and distress among Afghan refugees in northern California: The moderating role of pre- and post-migration factors

<div><p>This study investigates the effect of perceived discrimination on the mental health of Afghan refugees, and secondly, tests the distress moderating effects of pre-migration traumatic experiences and post-resettlement adjustment factors. In a cross-sectional design, 259 Afghans completed surveys assessing perceived discrimination and a number of other factors using scales developed through inductive techniques. Multivariable analyses consisted of a series of hierarchical regressions testing the effect of perceived discrimination on distress, followed by a sequential analysis of moderator variables. Perceived discrimination was significantly associated with higher distress, and this relationship was stronger among those with a strong intra-ethnic identity and high pre-resettlement traumatic experiences. The expected buffering effects of civic engagement, ethnic orientation (e.g. integration), and social support were not significant. Discrimination is a significant source of stress for Afghan refugees, which may exacerbate stresses associated with other pre- and post-migration stressors. Future research is needed to tailor interventions that can help mitigate the stress associated with discrimination among this highly vulnerable group.</p></div

A Qualitative Study Exploring the Psychosocial Needs of Male Undocumented Afghan Migrants in Istanbul, Turkey

(1) Background: Refugees and asylum-seekers from Afghanistan have been shown to be highly distressed as a result of pre- and post-resettlement traumas. However, little is known about the challenges that Afghan migrants endure while residing in Turkey, a population that has grown at unprecedented rates in recent years, and largely deemed illegal by Turkish asylum and settlement laws; (2) Methods: We conducted interviews with 15 Afghan males residing in Istanbul, Turkey in late 2015. A qualitative content analysis technique informed by Qualitative Description was used to analyze the data; (3) Results: Narratives revealed that motives for migrating to Turkey are driven by both a humanitarian need for protection against persecution and economic deprivation. While they are in transit, we observed that Afghan migrants are victimized, exposed to multiple traumas; and, in Turkey experience poverty, unemployment, and exploitation while living in poor conditions and receive no social assistance. Lastly, interviews revealed that their hopes reflect their motives for migrating, that is, to have a stable life and to support their families back home where ever they end up resettling; and (4) Conclusions: Our qualitative interviews clarified the harrowing and demoralizing transit experiences and the depth of exploitation and precarious living conditions that Afghans currently face. Findings have implications for asylum policies, and for delivering culturally-competent interventions that promote the overall well-being of Afghans in Turkey

Discrimination and other resettlement factors explaining psychological distress (TBDI).

<p>Discrimination and other resettlement factors explaining psychological distress (TBDI).</p