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1.
Psychiatr Serv ; 74(2): 158-165, 2023 02 01.
Article in English | MEDLINE | ID: mdl-35833254

ABSTRACT

OBJECTIVE: Forcibly displaced persons may be at elevated risk for poor mental health outcomes because of the COVID-19 pandemic. This study sought to examine associations between COVID-19-related socioeconomic insecurity and mental health outcomes among asylum seekers. METHODS: The authors evaluated the association between the degree of food, housing, and income insecurity related to the pandemic and mental health outcomes among East African asylum seekers in a high-risk, postdisplacement setting in the Middle East (i.e., Israel). RESULTS: Anxiety symptom severity (p=0.03) as well as the rate of suicidal ideation among women (odds ratio [OR]=2.81, p=0.016) were significantly elevated in a community sample of asylum seekers during the COVID-19 pandemic (N=66) relative to a similar sample (N=158) from the same community and context assessed before the pandemic. No differences between the two groups were observed for severity or rate of probable depression or posttraumatic stress disorders. In addition, among the sample assessed during the pandemic, socioeconomic insecurity due to the pandemic was strongly associated with elevated symptom severity and probable anxiety, depression, and posttraumatic stress disorders as well as suicidal ideation (R2 range=0.19-0.35; OR range=4.54-5.46). CONCLUSIONS: Findings are consistent with growing evidence of a mental health crisis among asylum seekers that is linked to COVID-19 control policies and residential status policies. The results highlight the risk for suicidal ideation linked to intersectional marginalization among female asylum seekers. These findings may inform postdisplacement policy making, social justice advocacy, humanitarian aid, and clinical science and practice to mitigate poor mental health outcomes associated with COVID-19 among forcibly displaced persons.


Subject(s)
COVID-19 , Refugees , Stress Disorders, Post-Traumatic , Humans , Female , Mental Health , Pandemics , COVID-19/epidemiology , COVID-19/complications , Stress Disorders, Post-Traumatic/psychology , Refugees/psychology , Income
2.
Emotion ; 23(3): 622-632, 2023 Apr.
Article in English | MEDLINE | ID: mdl-35925708

ABSTRACT

We sought to, first, better understand the role of emotional responding, and specifically shame and guilt, in trauma recovery among asylum-seekers following forced displacement; and, second, to explore whether therapeutic effects of a mindfulness- and compassion-based intervention on trauma recovery among asylum-seekers are mediated by therapeutic effects of the intervention on shame and guilt. Study aims were tested through a randomized waitlist-controlled trial of a 9-week Mindfulness-Based Trauma Recovery for Refugees program among a community sample of 158 Eritrean asylum-seekers (55.7% female) residing in an unstable high-risk urban postdisplacement setting in the Middle East (Israel). First, in a cross-product test of parallel mediation, we found that shame, but not guilt, mediated the preintervention associations between traumatic stress exposure history, as well as current postmigration living difficulties, and current posttraumatic stress (abShame = .035, 95% CI [.024, .048], abShame = .183, 95% CI [.122, .249]) and depression (abShame = .384, 95% CI [.234, .55], abShame = .405, 95% CI [1.117, 2.693]) symptom severity. Second, in a linear mixed effects model of mediation, we found that reduced shame from pre- to postintervention, mediated the effect of MBTR-R, relative to waitlist control, on improved posttraumatic stress (ACMEShame = -.18, BCa 95% CI [-.34, -.04]) and depression (ACMEShame = -1.78, BCa 95% CI [-3.29, -.29]) symptom severity outcomes. Findings provide insight into the potential role of shame in trauma- and stress-related recovery among FDPs (forcibly displaced people). Findings indicate that mindfulness- and compassion-based training promotes trauma recovery, in part, through reducing feelings of shame postdisplacement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Subject(s)
Mindfulness , Refugees , Stress Disorders, Post-Traumatic , Humans , Female , Male , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Post-Traumatic/psychology , Refugees/psychology , Shame , Guilt
3.
J Consult Clin Psychol ; 90(2): 107-122, 2022 Feb.
Article in English | MEDLINE | ID: mdl-35343723

ABSTRACT

OBJECTIVE: Mindfulness- and compassion-based interventions may represent a promising intervention approach to the global mental health crisis of forced displacement. Specifically, Mindfulness-Based Trauma Recovery for Refugees (MBTR-R)-a mindfulness- and compassion-based, trauma-sensitive, and socioculturally adapted intervention for refugees and asylum-seekers-has recently demonstrated randomized control evidence of therapeutic efficacy and safety. Yet, little is known about potential mechanisms underlying these therapeutic effects for trauma recovery and for refugees and asylum-seekers. METHOD: Thus, we examined adaptive and maladaptive forms of self-referentiality, namely self-compassion and self-criticism, as mechanisms of action for trauma recovery in a randomized wait-list control trial of MBTR-R among a community sample of 158 traumatized and chronically stressed asylum-seekers (46% female) in an urban postdisplacement setting (Middle East). Self-compassion and self-criticism were measured vis-à-vis an experimental Self-Referential Encoding Task (SRET) designed to quantify cognitive processes underlying self-compassion and self-criticism using diffusion modeling, a computational modeling approach to quantify cognitive processes underlying decision-making from behavioral reaction time data. RESULTS: Findings indicate that self-compassion and self-criticism were associated with trauma- and stress-related psychopathology at preintervention. Relative to wait-list controls, MBTR-R led to significant elevation in self-compassion, and reduction in self-criticism, from pre to postintervention. Finally, pre to postintervention change in self-criticism significantly mediated therapeutic effects of MBTR-R on depression and posttraumatic stress disorder (PTSD) outcomes, while pre to postintervention change in self-compassion only mediated therapeutic effects on PTSD outcomes. CONCLUSIONS: Findings speak to the importance of (mal)adaptive self-referentiality as a target mechanism in MBIs and trauma recovery broadly, and among refugees and asylum-seekers specifically. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
Mindfulness , Refugees , Stress Disorders, Post-Traumatic , Female , Humans , Male , Refugees/psychology , Self-Assessment , Self-Compassion , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy
4.
Behav Res Ther ; 145: 103941, 2021 10.
Article in English | MEDLINE | ID: mdl-34385088

ABSTRACT

OBJECTIVE: The study of safety and adverse effects of mindfulness-based interventions (MBIs) is limited. We propose a novel reliable change index (RCI) approach to experience sampling (ES) data to begin to understand the common domains, frequency, severity, risk for, and context of adverse responding to mindfulness meditation practice and brief MBI. METHODS: Over the course of a 21-day MBI among 82 meditation-naïve participants, we estimated (i) momentary adverse effects during mindfulness meditation practice and (ii) sustained adverse effects in daily living following the intervention. RESULTS: First, RCI analyses of experience sampling of mindfulness meditation document that 87% of participants demonstrated at least one momentary adverse effect during meditation, most commonly anxiety; and subject-level temporal variability or instability in experience samples of daily living did not account for momentary adverse effects attributed to mindfulness meditation sessions. Second, 25% of participants experienced a sustained adverse effect in daily living at post-intervention. Yet, neither momentary adverse effects to meditation nor vulnerability factors at pre-intervention predicted adverse effects at post-intervention. CONCLUSIONS: Findings illustrate that mindfulness meditation may be transiently anxiogenic for many participants, yet, these experiences are unlikely to constitute objective harm per se. Furthermore, observed deterioration in daily living post-intervention cannot be attributed to momentary adverse effects in response to mindfulness meditation. We speculate that observed deterioration in daily living post-intervention may thus be better explained by increased awareness to internal states following mindfulness training. Findings highlight the potential utility of applying a RCI approach to intensive ES measurement to quantify adverse effects of mindfulness training specifically and mental health interventions broadly.


Subject(s)
Meditation , Mindfulness , Anxiety/therapy , Ecological Momentary Assessment , Humans
5.
Transcult Psychiatry ; 58(2): 268-282, 2021 04.
Article in English | MEDLINE | ID: mdl-33292082

ABSTRACT

There is an important, long-standing debate regarding the universality vs. specificity of trauma-related mental health symptoms in socio-culturally and linguistically diverse population groups, such as refugees and asylum seekers. Network theory, an emerging development in the field of psychological science, provides a novel data analytic methodology to evaluate and empirically examine long-standing questions about the structure and function of posttraumatic stress symptoms. We sought to empirically model the functional network of posttraumatic stress symptoms among East African refugees who survived multiple potentially traumatic events. A sample of 148 Sudanese and Eritrean male asylum seekers (M(SD)age = 32.60(7.13) were recruited from the community in Israel. The nature and function(s) of posttraumatic symptoms (Harvard Trauma Questionnaire) were modeled using regularized partial correlation models to derive a network of symptoms. Spinglass and exploratory graph analysis walktrap algorithms were then used to identify functional "circuits of symptoms" or clusters of nodes within the network. Analyses revealed a functional symptom circuitry that shares features with the predominant western model of posttraumatic stress disorder; as well as unique functional clusters of symptoms inconsistent with nosology and symptomatology observed in studies of Western populations. Findings may have important implications for theory, classification, assessment, candidate mechanisms that may drive and maintain posttraumatic stress, and in turn may inform prevention or treatment for socio-culturally diverse forcibly displaced population groups.


Subject(s)
Refugees , Stress Disorders, Post-Traumatic , Adult , Humans , Male , Mental Health , Population Groups , Surveys and Questionnaires
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