Sofrimento e saúde mental entre migrantes venezuelanos no município de Rio de Janeiro / Suffering and mental health among venezuelan migrants in the city of Rio de Janeiro

A migração venezuelana destaca-se entre os principais fluxos globais de deslocamento humano, sendo o Brasil, um dos países de acolhimento desta população. Neste processo, a migração e outros fatores podem ser produtores de sofrimento entre migrantes. A heterogeneidade dos sentidos socioculturais de saúde e doença demandam exploração das noções de sofrimento e saúde mental. Esta dissertação pretende explorar e analisar os sentidos de sofrimento e saúde mental entre migrantes venezuelanos. Para tanto, foram realizadas seis entrevistas do tipo episódicas com migrantes venezuelanos residentes na cidade do Rio de Janeiro há um ano ou mais. Foram abordadas as experiências e narrativas das fases pré e pós-migratórias relativas ao sofrimento, saúde mental e estratégias de cuidado. Para a análise utilizados conceitos e noções de governo humanitário, transnacionalidade, sofrimento social e aflição. Os resultados apontam para sentidos do sofrimento de ordem relacional e social, nas quais questões como a separação/reunião familiar, precariedade, direitos trabalhistas, filas no comércio, o luto, racismo e xenofobia, problemas de nervos e estresse, sintomas psicossomáticos, relação médico-paciente fazem parte das experiências associadas ao sofrimento e seu alívio. Conclui-se que o sofrimento entre os interlocutores desta pesquisa, apresenta-se de ordem social e relacional, produzindo conexões transnacionais entre Brasil e Venezuela, sem reduzir-se a individualismos psicológicos. O sofrimento transnacional, portanto, representa categoria descritiva de concepções sociorrelacionais e multisituadas.

Venezuelan migration stands out among the main global flows of human displacement, with Brazil being one of the host countries for this population. In this process, migration and other factors can produce suffering among migrants. The heterogeneity of the sociocultural meanings of health and illness demands an exploration of the notions of suffering and mental health. This dissertation intends to explore and analyze the meanings of suffering and mental health among Venezuelan migrants. To this end, six episodic interviews were carried out with Venezuelan migrants residing in the city of Rio de Janeiro for a year or more. The experiences and narratives of the pre and post-migration phases related to suffering, mental health and care strategies were addressed. For the analysis, concepts and notions of humanitarian government, transnationality, social suffering and affliction were used. The results point to relational and social meanings of suffering, in which issues such as separation/family reunion, precariousness, labor rights, queues at commerce, grief, racism and xenophobia, nervous and stress problems, psychosomatic symptoms, medical relationship -patient are part of the experiences associated with suffering and its relief. It is concluded that the suffering among the interlocutors of this research is of a social and relational nature, producing transnational connections between Brazil and Venezuela, without being reduced to psychological individualisms. Transnational suffering, therefore, represents a descriptive category of socio-relational and multi-situated conceptions.

El sentido de la violencia y el desplazamiento / The sense of violence and displacement

La teoría expuesta en el presente texto se relaciona con los sentimientos de las perso-nas víctimas del desplazamiento forzado; además del sometimiento al ser parte de una estructura sociocultural que vulnera su dignidad e identidad, obligándolo a permanecer oculto y en silencio porque el miedo no le ofrece alternativas. Dado lo anterior se men-cionan elementos afines con el sentido del sufrimiento y su relación con el significado y significantes de la violencia y el desplazamiento, señalando transformaciones del sen-tido de ambos fenómenos socioculturales a partir de la implicación psicosocial, esgri-miendo reflexiones que surgen de algunas prácticas investigativas y de intervención en una situación concreta en tiempo, lugar y espacio

The theory presented in this text is related to the feelings of the victims of forced displacement; in addition to the subjugation of being part of a sociocultural structure that violates their dignity and identity, forcing them to remain hidden and silent because fear does not offer alternatives. Given the above, elements related to the meaning of suffering and its relationship with the meaning and signifiers of violence and displacement are mentioned, pointing out transformations of the meaning of both sociocultural phenomena from the psychosocial implication, wielding reflections that arise from some research and intervention practices in a concrete situation in time, place and space

Relationships between cultural adaptation and immigrants' well-being / Relações entre adaptação cultural e bem-estar de imigrantes / Relaciones entre la adaptación cultural y el bienestar de inmigrantes

The present study aimed to evaluate the predictive relationship of socio-demographic variables, cultural adaptation and hope on general well-being (GWB), subjective (SWB), social (SoWB) and psychological (PWB) and in the meaning of life. The participants consisted of 108 immigrants. The instruments used were: bio sociodemographic questionnaire, Mental Health Continuum - Short Form, Dispositional Hope Scale, Acculturation Measures and Meaning of Life Questionnaire. In general, only sociocultural adaptation showed a positive predictive relationship with all types of well-being studied, nonetheless this measure presented a negative predictive relationship regarding the presence of meaning in life. Psychological adaptation was predictively and positively related only to SWB. The perception of cultural distance negatively affected SoWB. The presence of meaning was also negatively predicted by the type of immigration and age. The search for meaning was negatively predicted only by income. The results are important for a better understanding of factors that influence the experience of immigrants in Brazil. (AU)

O presente estudo objetivou avaliar a relação preditiva de variáveis sociodemográficas, adaptação cultural e esperança sobre o bem-estar geral (BEG), subjetivo (BES), social (BESo) e psicológico (BEP) e no sentido de vida. Os participantes consistiram em 108 imigrantes. Os instrumentos utilizados foram: questionário biossociodemográfico, Mental Health Continuum - Short Form, Escala de Esperança, Acculturation Measures e Questionário de Sentido de Vida. De forma geral, apenas a adaptação sociocultural apresentou relação preditiva positiva com todos os tipos de bem-estar estudados, além de uma relação preditiva negativa com a presença de sentido de vida. A adaptação psicológica relacionou-se preditiva e positivamente apenas com BES. A percepção de distância cultural afetou negativamente BESo. A presença de sentido de vida foi negativamente predita pelo tipo de imigração e idade. A busca por sentido foi negativamente predita pela renda. Os resultados são importantes para a melhor compreensão de fatores que influenciam a vivência de imigrantes no Brasil. (AU)

El presente estudio objetivó evaluar la relación predictiva de variables sociodemográficas, adaptación cultural y esperanza sobre el bienestar general (BEG), subjetivo (BES), social (BESo) y psicológico (BEP) y en el sentido de la vida. Participaron 108 inmigrantes. Los instrumentos utilizados fueron: cuestionario biossociodemográfico, Mental Health Continuum - Short Form, Escala de Esperanza, Acculturation Measures y Cuestionario de Sentido de la Vida. En general, solo la adaptación sociocultural mostró una relación predictiva positiva con todos los tipos de bienestar estudiados, además de una relación predictiva negativa con la presencia de sentido de vida. La adaptación psicológica solamente se relaciona de manera predictiva y positiva con el BES. La percepción de distancia cultural afectó negativamente al BESo. La presencia de sentido de vida fue predicha negativamente por el tipo de inmigración y edad. La búsqueda por sentido fue predicha negativamente por los ingresos. Los resultados son importantes para una mejor comprensión de los factores que influyen en la experiencia de los inmigrantes en Brasil. (AU)

Elderly and forced displacement in Colombia / Vejez y deplazamiento forzado en Colombia

Abstract Objective: To describe the experiences of older adults around forced displacement due to the Colombian armed conflict. Methods: Interpretive-comprehensive study, with a hermeneutical approach; several types of sampling were carried out. The participants were 12 people aged over 60 years, who reported having being displaced and who participated in the SABE Colombia Survey. The data were encoded using the Atlas.ti software. A process of condensation of central analytical, support and emerging categories was made. Results: The displacement generated by the armed conflict has been decisive in the current life conditions of the participants. They know that they are survivors of someone else's violence; there is dislocation, loss of territory, de-anchoring, lack of protection and insecurity. To the stigma of old age, it is added being displaced and being strangers in a place where they don't belong. They live the violent uprooting of their lands and the confusion of their identity; they found themselves in a foreign scene where they were the unusual and the strangers; from receiving threats, they passed to be labeled as 'threatening'. This forced displacement stems from violence, but also from fear, and it marks the trajectory of life for older people who experience a prolonged struggle for survival in often hostile environments, living "permanently" displaced. Conclusion: When there is displacement, older people are not only shed of their land and their home, but also from their cosmos and their vital referents; in addition, it changes their life trajectory and their place in the world. Interventions should be designed based on specific particular and contextual analyses.

Resumen Objetivo: Describir las vivencias y experiencias de adultos mayores en torno al desplazamiento forzado por efectos del conflicto armado. Métodos: Estudio interpretativo-comprensivo, con un enfoque hermenéutico. Los participantes fueron 12 personas mayores de 60 años que reportaron haber sido desplazadas y que participaron en de la Encuesta SABE Colombia. Los datos se codificaron utilizando el software Atlas.ti. Se hizo un proceso de condensación de categorías analíticas centrales, de soporte y emergentes. Resultados: El desplazamiento generado por el conflicto armado ha sido decisivo en las actuales condiciones de vida de los participantes. Saben que son sobrevivientes de una violencia ajena, hay desubicación, desterritorializacion, desanclaje, desprotección, inseguridad. Al estigma de la vejez se le suma el ser desplazados y extraños en un lugar donde no tienen lugar. Viven el desarraigo violento de sus tierras, la confusión de su identidad, se encontraron en un escenario ajeno donde ellos eran los raros y los extraños, de recibir amenazas pasaron al señalamiento de ser amenazantes. Este desplazamiento forzado nace de la violencia, pero también del miedo y marca la trayectoria de vida a las personas mayores quienes experimentan una prolongada lucha por la supervivencia en entornos a menudo hostiles, viven desplazados "permanentemente". Conclusión: Cuando hay desplazamiento, las personas mayores no solo se despojan de su tierra, de su casa, sino de su cosmos, de sus referentes vitales y se modifica su trayectoria de vida y su lugar en el mundo. Las intervenciones deben ser diseñadas basadas en análisis particulares y contextuales específicos.

Mapeamento de políticas públicas para os refugiados no Brasil / Mapping public policies for refugees in Brazil / Mapeo de políticas públicas para los refugiados en Brasil

Frente à chegada de imigrantes refugiados ao Brasil, surge a preocupação acerca do alcance das políticas públicas estabelecidas para o acolhimento dessas pessoas no país. Para tanto, realizou-se a revisão documental e de literatura buscando mapear as legislações e documentos de órgãos oficiais sobre os refugiados, bem como a produção acadêmica sobre os eixos temáticos políticas públicas, saúde e xenofobia, no período entre 2007 a 2017. Não foram encontrados artigos brasileiros sobre refugiados e xenofobia. A falta de políticas públicas ampla foi um aspecto diagnosticado pelas produções relacionadas aos eixos saúde e políticas públicas. O problema das migrações forçadas tende a atingir cada vez mais o Brasil, de forma que este estudo pode contribuir para a sofisticação das estruturas legislativas e sociais para lidar com o acolhimento de refugiados no Brasil.(AU)

Faced with the arrival of refugee immigrants to Brazil, there is concern about the scope of the public policies established for the reception of these people in the country. A documentary and literature reviews were carried out to map the legislation and documents of institutional bodies on refugees and the academic production on the thematic axes public policies, health and xenophobia in the period between 2007 and 2017. No results were found for Brazilian articles on refugees and xenophobia, the lack of broad public policies was an aspect diagnosed by the productions related to health and public policies. The problem of forced migration tends to reach Brazil more and more, this study can contribute to the sophistication of the legislative and social structures to deal with the proper reception of refugees in Brazil.(AU)

Frente a la llegada de inmigrantes refugiados a Brasil, surge la preocupación sobre el alcance de las políticas públicas establecidas para la acogida de esas personas en el país. Para ello, se realizó una revisión documental y de literatura buscando mapear las legislaciones y documentos de órganos oficiales sobre los refugiados y la producción académica basada en los ejes temáticos políticas públicas, salud y xenofobia en el período entre 2007 a 2017. No se encontraron artículos brasileños relacionando refugiados y xenofobia, la falta de políticas públicas amplias fue un aspecto diagnosticado por las producciones relacionadas a los ejes salud y políticas públicas. El problema de las migraciones forzadas tiende a atingir cada vez más a Brasil, de forma que este estudio puede contribuir a la sofisticación de las estructuras legislativas y sociales para tratar con la acogida de refugiados en Brasil.(AU)

Imigração haitiana no Rio Grande do Sul: aspectos psicossociais, aculturação, preconceito e qualidade de vida / Haitian immigration in Rio Grande do Sul, Brazil: psychosocial aspects, acculturation, prejudice and quality of life / Inmigración haitiana en Rio Grande del Sur, Brasil: aspectos psicosociales, aculturación, prejuicio y calidad de vida

Este estudo traça um panorama da imigração haitiana no Rio Grande do Sul, quanto a aspectos psicossociais, perfil sociodemográfico e socioeconômico, orientações aculturativas, preconceito e qualidade de vida. A pesquisa, de delineamento quantitativo transversal, contou com a participação de 67 imigrantes haitianos, com idades entre 19 e 58 anos (M = 33,87; DP = 5,47). A amostra é predominantemente composta por homens (77,6%), com alta escolaridade (M = 10,5; DP = 4,53) e que falam o idioma português (56,7%). A orientação aculturativa mais frequente é a de integração, que é mais presente entre homens, quem acessou o sistema brasileiro de assistência social; os mais jovens, os com maior fluência em outros idiomas e os que chegaram há mais tempo no Brasil. Além disso, o preconceito percebido e a qualidade de vida obtiveram resultados mais significativos em comparação a estudos com imigrantes haitianos realizados em outros países. (AU)

The present study traces a panorama of Haitian immigration in Rio Grande do Sul, Brazil, regarding psychosocial aspects, sociodemographic and socioeconomic profile, acculturative orientations, prejudice and quality of life. Participants included 67 Haitian immigrants, aged between 19 and 58 years old M=33.87; DP=5.47). The sample was predominantly male (77.6%), presented high schooling (M = 10.5; SD = 4.53) and spoke the Portuguese language (56.7%). The predominant acculturative orientation is integration, which is more present among men; those who accessed the Brazilian social assistance system; the youngest; those with more fluency in other languages, and the ones that have been in Brazil for the longest amount of time. In addition, perceived prejudice and quality of life obtained significantly higher results in comparison to studies with Haitian immigrants carried out in other countries. (AU)

Este estudio traza un panorama de la inmigración haitiana en Río Grande del Sur en Brasil, con relación a los aspectos psicosociales, perfil sociodemográfico y socioeconómico, orientaciones aculturativas, prejuicio y calidad de vida. La investigación, de delineamiento cuantitativo transversal, contó con la participación de 67 inmigrantes haitianos con edades entre19 y 58 años (M=33.87; DP=5.47). La muestra fue predominantemente compuesta por hombres (77.6%), con alta escolaridad (M = 10.5; SD = 4.53)y que hablan portugués (56.7%). La orientación aculturativa más frecuente es la de integración, que se encuentra más presente entre los hombres,entre los que accesaron al sistema brasileño de asistencia social, entre los más jóvenes, los con mayor fluidez en otros idiomas y, los que llegaron hace más tiempo a Brasil. Además, el prejuicio percibido y la calidad de vida obtuvieron resultados más significativos en comparación a estudios con inmigrantes haitianos realizados en otros países. (AU)

Narrativas femininas e saúde mental: a saída da República Democrática do Congo e o refúgio no Rio de Janeiro / Female narratives and mental health: the departure from Democratic Republic of Congo and the refuge in Rio de Janeiro

O objetivo central desta dissertação é refletir sobre o processo de refúgio e a relação deste com a saúde mental de mulheres naturais da República Democrática do Congo (RDC), residentes no Rio de Janeiro. Essa dissertação foi realizada a partir de um estudo qualitativo, de abordagem etnográfica, composto por observação participante e entrevistas, realizado em uma instituição de acolhimento a esta população - a Caritas RJ. A partir das falas dessas mulheres, este trabalho traz ponderações sobre como o Brasil que, até o momento, detém uma legislação favorável à questão do refúgio (lei 9.474 de 1997), na realidade, não apresenta providências de acordo com o que se comprometeu e contribui para a manutenção de vulnerabilidades. Ao analisar as trajetórias das mulheres negras, congolesas, refugiadas em território nacional, me apoio nos conceitos de precarização da vida e sofrimento social, para associar os contextos de violência persistentes e suas interferências em quadros mentais. Neste sentido, foi possível notar a ampla capacidade de resiliência apresentada por elas e sua relação com a religião e a cultura. Entre os adoecimentos, foi observado maior presença de quadros de natureza somatoforme, ansiosa e depressiva (Transtornos Mentais Comuns - TMC). Diante deste contexto, as propostas da Saúde Mental Global (SMG), com tratamentos baseados em evidências e particularizados entre diferentes culturas, podem beneficiar esse grupo

The main goal of this dissertation is to reflect on the refugee process and the relationship between it and the mental health of women from the Democratic Republic of Congo (DRC) residing at Rio de Janeiro. This is a qualitative study with an ethnographic approach composed of participant observation and interviews, performed at a host institution for this population - Caritas RJ. Based on the statements of these women, this work brings forward considerations about how Brazil, which until now has legislation favorable to the issue of refuge (Law 9.474 of 1997), in fact, does not present provisions according to what it has committed and contributes to the maintenance of vulnerabilities. In analyzing the trajectories of black Congolese women refugees in the national territory, I use as a theoretical base the concepts of precariousness of life and social suffering in order to associate persistent contexts of violence and their interference in mental conditions. In this sense, it was possible to note the wide capacity of resilience presented by them and their relation to religion and culture. Among the diseases, there was a greater presence of somatoform, anxious and depressive conditions (Common Mental Disorders - CMD). Given this context, Global Mental Health (MCH) proposals with evidence-based and individualized treatments among different cultures may benefit this group

Red de soporte social y apoyo comunitario en miembros de una organización de desplazados por violencia política residentes en Cañete, Perú / Social Support Network and Community Support Among Members of an Organization of Persons Displaced by Political Violence Residing in Cañete, Peru

Resumen El objetivo de la presente investigación fue determinar la relación entre la red de soporte social y el apoyo comunitario en los miembros de una organización de personas desplazadas por violencia política. Para tal fin, el estudio descriptivo-correlacional incluyó a 80 participantes (49 mujeres y 31 hombres) con una edad promedio de 45.79 años (DE = 11.41), quienes residían en una provincia de Lima y provenían, en su mayoría, del departamento de Ayacucho. Se les administró el Cuestionario de Red Social (SNQ) y el Cuestionario de Apoyo Comunitario Percibido (PCSQ). Entre los principales resultados, se encontró que el componente Integración y Participación Comunitaria del PCSQ correlaciona con dos funciones y dos categorías del SNQ. Se presenta asociación positiva estadísticamente significativa con la función guía cognitiva (r s = .32), la función socialización (r s = .24) y la categoría satisfacción (r s = .24) y asociación negativa y estadísticamente significativa con la categoría heterogeneidad (r s = -.23). Se discuten las implicancias de los presentes hallazgos.

Abstract: The present study's aim was to determine the relationship between the social support network and community support among members of an organization of persons displaced by political violence. The correlational-descriptive research included 80 individuals (49 females and 31 males) with a mean age of 45.79 years old (SD = 11.41),who reside in a province of Lima and came, mostly, from the department of Ayacucho. Participants completed the Social Network Questionnaire (SNQ), as well as the Perceived Community Support Questionnaire (PCSQ). Among the main findings, we found that the Integration component and Community Participation from the PCSQ correlate with two functions and two categories from the SNQ. Specifically there is a statistically significant positive association with the Cognitive Guide function (r s = .32), the Socialization function (r s = .24) and the Satisfaction category (r s = .24); and a statistically significant negative association with the Heterogeneity category (r s = -.23).Implications of the results obtained will be discussed in the present paper.

Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review

Objective: There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services. Methods: The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017. The following keywords were used: migration, mental health, mental health services, stress, posttraumatic stress disorder, and trauma. Results: Migration is associated with specific stressors, mainly related to the migratory experience and to the necessary process of acculturation occurring in adaptation to the host country. These major stressors have potential consequences in many areas, including mental health. The prevalence of PTSD among migrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers. Conclusions: Mental health professionals must be trained to recognize and provide appropriate care for posttraumatic and/or stress-related disorders among migrants.

Desigualdades en la continuidad de la atención ambulatoria de población desplazada en Colombia 2012-2013 / Inequalities in the continuity of outpatient care to displaced population in Colombia, 2012 - 2013

RESUMEN Objetivo Establecer desigualdades en la continuidad de la atención ambulatoria de la población desplazada con diagnóstico de depresión. Métodos Estudio transversal a partir del registro clínico, del periodo entre el 1 de junio de 2012 y 30 de junio de 2013, sobre las personas con diagnóstico de depresión y clasificadas según desplazamiento. Se usó el odds ratio para la asociación entre tipo de población y control profesional ambulatorio, ajustado por sexo, edad, afiliación y región. Resultados Sobre 74 713 registros: 3 149 de desplazados y 71 564 no desplazados; se encontró 24 % más atención ambulatoria en los no desplazados (OR: 1,24 p<0.001; IC 1,10-1,39), la ventaja fue mayor al ajustar por afiliación al sistema. En el grupo de desplazados se encontró mayor atención ambulatoria en los hombres frente a las mujeres (OR: 1,40 p<0.001 IC: 1,08-1,83). Fue mayor también la desventaja para aquellas, con respecto a mujeres no desplazadas (OR: 1,26 p<0.001 IC: 1,10-1,44). Si bien estos resultados se obtuvieron en la atención de depresión leve y moderada, no en grave, la primera fue diagnosticada en el 92 % de las personas. Discusión El registro de prestaciones demostró desigualdades en la continuidad de la atención ambulatoria y aunque su calidad ha mejorado, su cobertura todavía es incompleta. En el primer año con plan único del Sistema de Salud, parece que las coberturas no lograron por sí solas evitar diferencias en la atención de la población desplazada. Se necesita mejorar el registro y la interoperabilidad, para políticas de salud con enfoque de equidad.(AU)

ABSTRACT Objective To establish inequalities in the continuity of outpatient care to displaced population diagnosed with depression. Methods A cross-sectional study, based on clinical records, was performed during the period between June 1, 2012 and June 30, 2013, on population diagnosed with depression and reduced to displaced population. The odds ratio was used to associate the type of population with the outpatient care control by professionals, adjusted by sex, age, affiliation and region. Results The following information was obtained from 74 713 records: 3 149 related to displaced population and 71 564 to non-displaced population; non-displaced population had 24 % more ambulatory care (OR: 1.24 p<0.001; CI 1.10 to 1.39), and the advantage was greater when adjusting the information to data, based on affiliation to the health system. In the displaced population group, men had greater rates of outpatient care compared to women (OR:1.40 p<0.001 CI: 1.08 to 1.83). The disadvantage was also high for non-displaced women (OR:1.26 p<0.001 CI: 1.10 to 1.44). Although these results were obtained for outpatient care in mild and moderate depressive patients, severe depression was excluded; the first type of depression was diagnosed in 92 % of people. Discussion The performance record showed inequalities in the continuity of outpatient care and, despite the improvement of quality, its coverage is still incomplete. During the first year of the unified plan for the Health System, apparently, the coverage has not achieved to avoid by itself differences in care of displaced population. Improvement of records and interoperability is necessary for designing health policies with an equitable approach.(AU)

A Predictive Model on North Korean Refugees' Adaptation to South Korean Society: Resilience in Response to Psychological Trauma

PURPOSE: This study investigated prediction of North Korean refugees' adaptation to the South Korean society and verified the goodness of fit between a hypothetical model and actual data in order to suggest the best model. METHODS: This survey was conducted with 445 North Korean refugees living in a metropolitan area. Data were collected from September 1st to November 20th, 2012, and analyzed using SPSS Windows 18.0 and AMOS 17.0. RESULTS: Traumatic experiences of North Korean refugees increased self-efficacy and psychological trauma. Acculturation stress decreased self-efficacy and increased passive coping. Self-efficacy affected active and passive coping, decreased psychological trauma, and increased resilience. Resilience is successful adaptation and refers to North Korean refugees' abilities to adapt effectively to stress. In particular, self-efficacy as the main parameter affecting resilience was confirmed. CONCLUSIONS: The results suggest that resilience can be improved through self-efficacy. It was the most significant factor decreasing psychological trauma and increasing resilience. Therefore, we need to develop programs for self-efficacy. The results also provide basic data for policy making for North Korean refugees.

Do relatório ao relato, da alienação ao sujeito: a experiência de uma prática clínica com refugiados em uma instituição de saúde / From story to narrative, from alienation to subject: clinic with asylum seekers / Du récit à la parole, de l'aliénation au sujet: clinique en institution avec des demandeurs d'asile / Del relato a la palabra, de la alienación a lo sujeto: la experiencia de una práctica clínica con los refugiados en una institución de salud

Neste artigo, buscaremos evidenciar a especificidade e os limites de uma consulta transcultural no Serviço de Psiquiatria do Hospital Avicenne (França) com sujeitos requerentes de refúgio, originários principalmente da África e Ásia do Sul, atendidos por distúrbios psicotraumáticos. Tratar-se-á de tentar mostrar que uma abordagem clínica, que leve em conta o contexto sociopolítico e a situação jurídica desses pacientes "migrantes", irá possibilitar a emergência da palavra do sujeito. A partir da construção de dois fragmentos de caso, mostraremos como as representações político-sociais acerca do "migrante", "refugiado", "vítima", "suspeito", deixam suas marcas concretas e simbólicas nos sujeitos bem como influenciam os modos de condução do trabalho clínico. Isso nos permitirá, em um segundo momento, questionar a noção de alienação. Por fim, iremos lançar uma proposição clínica que tem a finalidade de esvaziar o espaço da consulta em psicoterapia das amarras impostas pelas representações sociais que calam o sujeito...

In this article, we will aim to highlight the specificity and limits of a transcultural consultation in the Psychiatry Service of the Avicenne Hospital (France) with asylum seekers from Africa and South Asia affected by traumatic experiences that resulted in psychological disturbances. We will try to show that a clinical approach that takes into account the social and political context and the legal status of these "migrant" patients will allow the emergence of the word of the subject. Based on the construction of two case fragments, we will demonstrate how the political and social representations concerning the "migrant", "refugee", "victim", "suspect" leave their concrete and symbolic marks in the subject as well as influence the way the therapy is carried out. This will allow us, in a second step, to question the notion of alienation. Lastly, we will make a clinical proposition that aims to empty the clinical space from the constraints imposed by social representations that silence the subject...

Cet article interroge les spécificités et les limites de la consultation de psycho-traumatologie du service de psychiatrie de l'hôpital Avicenne avec des demandeurs d'asile originaires principalement d'Asie du Sud et d'Afrique. Seul un abordage clinique qui prend en compte la particularité du contexte socio-politique et de la situation juridique des patients peut permettre au sujet de faire entendre sa parole. A partir de deux cas cliniques, nous montrerons comment les représentations qui entourent le sujet, successivement catégorisé comme migrant, réfugiés, victime ou suspect, ont un impact concret et symbolique sur le patient et sur la dynamique clinique. A partir de ce constat, nous interrogerons la notion d'aliénation. Dans un troisième temps, nous ferons des propositions cliniques afin de dégager l'espace clinique des impositions aliénantes qui imposent le silence au sujet...

En este artículo, se destaca la especificidad y los límites de un servicio de consulta de psiquiatría transcultural en el Servicio de Psiquiatría del Hospital Avicena (Francia) con los solicitantes de refugio, originarios principalmente de África y Asia del Sur, y que buscan atención psicológica por presentaren trastornos psicotraumáticos. Se trata de demostrar que un enfoque clínico que tiene en cuenta el contexto socio-político y la situación jurídica de los pacientes 'migrantes' permitirá la reaparición de la palabra al sujeto. Desde la construcción de dos fragmentos clínicos, tratamos de mostrar cómo las representaciones políticas y sociales del "migrante", "refugiado", "víctima", "sospechoso" dejan sus marcas concretas y simbólicas en los sujetos así como influyen en nuestra forma de conducir el trabajo clínico. Esto nos permitirá, en un segundo momento, cuestionar la noción de alienación. Por último, vamos a lanzar una proposición clínica que tiene como objetivo eliminar de la consulta en psicoterapia las limitaciones impuestas por las representaciones sociales que callan a los hombres...

A Study of Predictive Factors Affecting Health: Promoting Behaviors of North Korean Adolescent Refugees / 예방의학회지

OBJECTIVES: The present study aimed to analyze the factors that could affect the health-promoting behaviors of North Korean adolescent refugees residing in South Korea. METHODS: Questions about their sociodemographic variables, subjective health status, healthy living habits, and health-promoting behaviors were asked. RESULTS: Statistically significant differences were found in religion (t=2.30, p<0.05), having family members in South Korea (t=2.02, p<0.05), and subjective health status (t=4.96, p<0.01). Scores on health-responsible behaviors were higher with higher age (t=2.90, p<0.01) and for subjects without family or friends (t=2.43, p<0.05). Higher physical-activity behaviors were observed in males (t=3.32, p<0.01), in those with better subjective health status (t=3.46, p<0.05) and lower body mas index (t=3.48, p<0.05), and in smokers (t=3.17, p<0.01). Nutritional behaviors were higher in those who followed a religion (t=2.17, p<0.05). Spiritual growth behaviors were higher in those who followed a religion (t=4.21, p<0.001), had no family in South Korea (t=2.04, p<0.05), and had higher subjective health status (t=5.74, p<0.01). Scores on interpersonal relationships and stress-management behaviors were higher for those with higher subjective health status. A multiple regression analysis showed greater effects on health-promoting behaviors when subjective health status was better. Older people and non-smokers exhibited more health-responsible behaviors, while more physical-activity behaviors and spiritual growth activities were observed when subjective health status was better. Interpersonal relationship behaviors had positive effects on those with good subjective heath status and on non-smokers. CONCLUSIONS: Based on the results of the current study, an alternative was suggested for promoting health in North Korean adolescent refugees.

A Study of Mental Health Literacy Among North Korean Refugees in South Korea / 예방의학회지

OBJECTIVES: This study aimed to investigate North Korean refugees' knowledge of mental illnesses and treatments and analyze the factors affecting this knowledge. METHODS: Subjects were selected via a snowball sampling method, and the survey outcomes of 152 North Korean refugee participants were analyzed. The factors affecting knowledge of mental illnesses were analyzed via a regression analysis by constructing a multivariate model with mental illness knowledge score as the dependent variable. RESULTS: The North Korean refugees' mental illness scores ranged from 3 to 24 points, with an average score of 13.0. Regarding the factors that influence mental illness knowledge, the subjects with South Korean spouses and those who had spent more time in South Korea had higher knowledge scores. Furthermore, the subjects who considered the mental health of North Korean refugees to be a serious issue revealed lower knowledge scores than those who did not believe it was a serious issue. The subjects who visit psychiatric clinics showed higher knowledge scores than those who do not. The South Korean subjects who had at least a college education exhibited higher scores than did those without advanced education. The subjects who are satisfied with life in South Korea manifested a higher mental illness knowledge score than those who are not. CONCLUSIONS: This study is significant as being the first study to ever measure and evaluate the level of North Korean refugees' knowledge of mental illnesses. In addition, the evaluations of North Korean refugees' mental illness knowledge and influencing factors while residing in South Korea created basic data that formed the foundation of an effort to enhance mental health literacy and provide proper mental health services. The results of this study can be utilized to solve mental health problems that might frequently occur during the unification process of North and South Korea in the future.

Development and Effects of a Health Education Program for North Korean Preschool Defectors

PURPOSE: This study was conducted to develop a health education program for preschoolers who have defected from North Korea with their mothers, and to evaluate the effects on health knowledge and behavior. METHODS: A non-equivalent control group pre-post test design was used with 58 preschoolers who were assigned to either the experimental or control group (29 for each group). The program was composed of five sessions in health education and contracts. To test the effectiveness of the intervention, health knowledge and behaviors, and total bacterial colony counts on hands were measured at one pretest and two post tests (1 week and 4 weeks after the intervention ended). Data were analyzed using the SAS program. RESULTS: Health knowledge and behavior in the experimental group increased significantly compared to the control group. The effects of the intervention were evident even at 4 weeks after the intervention ended. Total bacterial colony counts in the experimental group decreased significantly at the 1 and 4 week posttest intervention compared to the control group. CONCLUSION: Results indicate that this program is effective in improving health knowledge and behavior in these children and therefore can be utilized to ensure efficient management their health care.

Adaptation Experiences in South Korea of Men defecting from North Korea

PURPOSE: The study was done to explore meanings and essence of the experience in South Korea of men defectors from North Korea. METHODS: Data were collected from March, 2011 to May, 2012, through in-depth interviews with ten men defectors. Data analysis was conducted using the process of hermeneutic phenomenological reflection. RESULTS: Eight essential themes were extracted; 'buoyant expectation for a new life', 'feeling guilty about family left behind in North Korea', 'inability to become acclimatized due to communication difficulties', 'inability to socialize with South Koreans due to different lifestyles', 'finding strength through trustworthy acquaintances', 'continuing reconciliation with oneself while trying to assimilate into South Korean culture', 'self-realization of one's original self', and 'continuing to feel out the possibility of a future in South Korea'. CONCLUSION: The findings indicate that North Korean men who defect to South Korea shape their identity through three phases: forming self-image during escape from North Korea, trying to become accustomed to South Korean society, and finding their own identity by self-realization of their original self. Eventually, the whole process enables them to recover their identity, to feel a sense of belonging, and to discover possibilities for a better future.

Desplazamiento forzado, niñez y adolescencia: escenarios en relación con su estabilización socioeconómica / Forced displacement, childhood and adolescence: scenarios regarding socioeconomic stability

Objetivo Describir y analizar escenarios de estabilización socioeconómica para población en situación de desplazamiento forzado, en los que se preste especial atención a la situación de niños, niñas y adolescentes. Métodos Se utiliza, a partir de talleres de expertos, el método Analytic Hierarchy Process (AHP), elaborado por el profesor Thomas Saaty con participación investigadores, ONG y de comunidades en situación de desplazamiento del Área Metropolitana de Bucaramanga. Resultados El resultado parcial de esta investigación muestra como algunos adultos mayores de comunidades en situación de desplazamiento forzado prefieren adaptarse a los centros urbanos, antes que retornar sus lugares de origen, en particular cuando se trata de la protección y el bienestar de sus hijos menores. El índice de consistencia y la relación de consistencia del método están dentro de los parámetros previstos. Conclusión Es necesario repensar los programas de estabilización socioeconómica promovidos por el gobierno en relación con la población en situación de desplazamiento forzado, en particular cuando se prevén situaciones que comprometen el bienestar de los niños, niñas y adolecentes.

Objective Describing and analysing socio-economic stabilisation scenarios for populations which have been forcibly displaced paying special attention to the situation of children and adolescents. Method The analytic hierarchy process (AHP) multi-criteria decision-making method developed by Professor Thomas Saaty was used through expert workshops, involving researchers, leaders of NGOs and displaced communities living in the city of Bucaramanga. Results The partial result of this research showed that some elderly adults from forcibly displaced communities preferred to adapt themselves to urban centres, rather than return to their places of origin, particularly when it came to protecting younger children and dealing with their welfare. The method's consistency index and consistency ratio came within the expected parameters. Conclusion Government-promoted social and economic stabilisation programmes must be rethought regarding forcibly displaced populations, particularly when situations are envisaged involving the welfare of children and adolescents.

Health Knowledge, Health Promoting Behavior and Factors Influencing Health Promoting Behavior of North Korean Defectors in South Korea

PURPOSE: The purpose of this study was to identify health knowledge, health promoting behavior and factors influencing health promoting behavior of North Korean defectors in South Korea. METHODS: Participants in this study were 410 North Korean defectors, over 20 years of age residing in Seoul. They were recruited by snowball sampling. Data were collected from April to June, 2010. Health knowledge, health promoting behavior, self-efficacy, perceived barriers to health promoting behavior and social support were measured by structured questionnaires, and perceived physical and mental health status were measured by one item with 10-point numeric rating scale. The data were analyzed using t-test, ANOVA, and multiple regression. RESULTS: Health knowledge, health promoting behavior, and perceived barriers to health promoting behavior were moderate while self-efficacy and social support were high. Factors influencing health promoting behavior of the participants were found to be self-efficacy, social support and perceived barrier to health promoting behavior. CONCLUSION: The results of this study indicate that nursing intervention programs enhancing self-efficacy, social support and reducing perceived barriers to health promoting behavior need to be developed for North Korean defectors in South Korea.