Prevalence of Perceived Stress, Anxiety, and Depression in HCW in Kosovo during the COVID-19 Pandemic: A Cross-Sectional Survey.

A pandemic may have a negative impact on healthcare workers' (HCW) mental health. In this cross-sectional study, we assess the self-reported prevalence of stress, anxiety, and depression and identify their predictive factors among HCW in Kosovo. The online questionnaire collected data on socio-demographics (sex, age, occupation, education, workplace) and the presence and severity of depression, anxiety, and stress through the 21-item Depression, Anxiety, and Stress Scale (DASS-21) questionnaire. Descriptive statistics, t-test, and linear logistic regression were used to analyze the data. Of the 545 respondents, the majority were male (53.0%), under 60 years of age (94.7%), and married (81.7%). Most of them were physicians (78.2%), while the remaining were nurses, midwives, and other health professionals (22%). Prevalence rates for moderate to extremely high stress, anxiety, and depressive symptoms were 21.9%, 13.0%, and 13.9%, respectively. The nurses reported significantly higher mean scores for depression and anxiety than the physicians (p < 0.05). Being married, having poor health, not exercising, and reporting "burnout" from work significantly predicted higher levels of depressive, anxiety, and stress symptoms among health workers (p < 0.05). Most HCWs (71.6%) reported a mild, moderate, or severe mental health burden, and certain factors predicted higher levels of such burden.

War and displacement stressors and coping mechanisms of Syrian urban refugee families living in Istanbul.

The overall purpose of this study was to achieve a contextual understanding of war and displacement stressors and coping mechanisms among urban refugee families from Syria living in Istanbul. This study was informed primarily by Walsh's family resilience framework and Weine's Family Consequences of Refugee Trauma empirical model. Qualitative family interviews were conducted with a purposive sample of 30 Syrian refugee families from the Çapa and Esenler neighborhoods of Istanbul. Data were analyzed using a grounded theory approach and Atlas/ti software. The analysis identified a total of 21 war and displacement stressors for families across 3 categories: (a) Surviving war and border crossing; (b) Living as urban refugees, and; (c) Parenting children in refuge. The analysis also identified a total of 16 coping mechanisms for families across 4 themes: (a) Flexible and reciprocal family organization; (b) Hopeful family beliefs and communication; (c) Staying connected with family in Syria and in exile, and; (d) Making the best of living in a new country. These findings underlie the need for several practice and policy priorities including: (a) Increasing the number of children attending Turkish schools and decreasing child labor; (b) Incorporating faith into psycho-social and mental health interventions, and; (c) Developing family focused interventions conducted by community-based lay providers that draw upon empirical models of family stressors and coping. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fostering Resilience: Protective Agents, Resources, and Mechanisms for Adolescent Refugees' Psychosocial Well-Being.

BACKGROUND: Adolescent refugees face many challenges but also have the potential to become resilient. The purpose of this study was to identify and characterize the protective agents, resources, and mechanisms that promote their psychosocial well-being. METHODS: Participants included a purposively sampled group of 73 Burundian and Liberian refugee adolescents and their families who had recently resettled in Boston and Chicago. The adolescents, families, and their service providers participated in a two-year longitudinal study using ethnographic methods and grounded theory analysis with Atlas/ti software. A grounded theory model was developed which describes those persons or entities who act to protect adolescents (Protective Agents), their capacities for doing so (Protective Resources), and how they do it (Protective Mechanisms). Protective agents are the individuals, groups, organizations, and systems that can contribute either directly or indirectly to promoting adolescent refugees' psychosocial well-being. Protective resources are the family and community capacities that can promote psychosocial well-being in adolescent refugees. Protective mechanisms are the processes fostering adolescent refugees' competencies and behaviors that can promote their psychosocial well-being. RESULTS: Eight family and community capacities were identified that appeared to promote psychosocial well-being in the adolescent refugees. These included 1) finances for necessities; 2) English proficiency; 3) social support networks; 4) engaged parenting; 5) family cohesion; 6) cultural adherence and guidance; 7) educational support; and 8) faith and religious involvement. Nine protective mechanisms identified were identified and grouped into three categories: 1) Relational (supporting, connecting, belonging); 2) Informational (informing, preparing), and; 3) Developmental (defending, promoting, adapting). CONCLUSIONS: To further promote the psychosocial well-being of adolescent refugees, targeted prevention focused policies and programs are needed to enhance the identified protective agents, resources, and mechanisms. Because resilience works through protective mechanisms, greater attention should be paid to understanding how to enhance them through new programs and practices, especially informational and developmental protective mechanisms.

Thriving, Managing, and Struggling: A Mixed Methods Study of Adolescent African Refugees' Psychosocial Adjustment.

OBJECTIVES: The purpose of this mixed method study was to characterize the patterns of psychosocial adjustment among adolescent African refugees in U.S. resettlement. METHODS: A purposive sample of 73 recently resettled refugee adolescents from Burundi and Liberia were followed for two years and qualitative and quantitative data was analyzed using a mixed methods exploratory design. RESULTS: Protective resources identified were the family and community capacities that can promote youth psychosocial adjustment through: 1) Finances for necessities; 2) English proficiency; 3) Social support networks; 4) Engaged parenting; 5) Family cohesion; 6) Cultural adherence and guidance; 7) Educational support; and, 8) Faith and religious involvement. The researchers first inductively identified 19 thriving, 29 managing, and 25 struggling youths based on review of cases. Univariate analyses then indicated significant associations with country of origin, parental education, and parental employment. Multiple regressions indicated that better psychosocial adjustment was associated with Liberians and living with both parents. Logistic regressions showed that thriving was associated with Liberians and higher parental education, managing with more parental education, and struggling with Burundians and living parents. Qualitative analysis identified how these factors were proxy indicators for protective resources in families and communities. CONCLUSION: These three trajectories of psychosocial adjustment and six domains of protective resources could assist in developing targeted prevention programs and policies for refugee youth. Further rigorous longitudinal mixed-methods study of adolescent refugees in U.S. resettlement are needed.

Developing preventive mental health interventions for refugee families in resettlement.

In refugee resettlement, positive psychosocial outcomes for youth and adults depend to a great extent on their families. Yet refugee families find few empirically based services geared toward them. Preventive mental health interventions that aim to stop, lessen, or delay possible negative individual mental health and behavioral sequelae through improving family and community protective resources in resettled refugee families are needed. This paper describes 8 characteristics that preventive mental health interventions should address to meet the needs of refugee families, including: Feasibility, Acceptability, Culturally Tailored, Multilevel, Time Focused, Prosaicness, Effectiveness, and Adaptability. To address these 8 characteristics in the complex environment of refugee resettlement requires modifying the process of developmental research through incorporating innovative mental health services research strategies, including: resilience framework, community collaboration, mixed methods with focused ethnography, and the comprehensive dynamic trial. A preventive intervention development cycle for refugee families is proposed based on a program of research on refugees and migrants using these services research strategies. Furthering preventive mental health for refugee families also requires new policy directives, multisystemic partnerships, and research training.

Secondary migration and relocation among African refugee families in the United States.

The purpose of this study was to understand the secondary migration and relocation of African refugees resettled in the United States. Secondary migration refers to moves out of state, while relocation refers to moves within state. Of 73 recently resettled refugee families from Burundi and Liberia followed for 1 year through ethnographic interviews and observations, 13 instances of secondary migration and 9 instances of relocation were identified. A family ecodevelopmental framework was applied to address: Who moved again, why, and with what consequences? How did moving again impact family risk and protective factors? How might policies, researchers, and practitioners better manage refugees moving again? Findings indicated that families undertook secondary migration principally for employment, affordable housing, family reunification, and to feel more at home. Families relocated primarily for affordable housing. Parents reported that secondary migration and relocation enhanced family stability. Youth reported disruption to both schooling and attachments with peers and community. In conclusion, secondary migration and relocation were family efforts to enhance family and community protective resources and to mitigate shortcomings in resettlement conditions. Policymakers could provide newly resettled refugees jobs, better housing and family reunification. Practitioners could devise ways to better engage and support those families who consider moving.