ABSTRACT
The authors used semistructured interviews to examine exile-related stressors affecting a sample of 28 adult Bosnian refugees in Chicago. The interviews covered 3 areas: life in prewar Bosnia, the journey of exile, and, most centrally, life in Chicago. Primary sources of exile-related distress included social isolation and the loss of community, separation from family members, the loss of important life projects, a lack of environmental mastery, poverty and related stressors such as inadequate housing, and the loss of valued social roles. The implications of these findings for mental health interventions with refugees are considered, and the value of narrative methods in research with refugee communities is discussed.
Subject(s)
Narration , Refugees/psychology , Stress, Psychological/psychology , Adaptation, Psychological , Adult , Bosnia and Herzegovina/ethnology , Environment , Family/psychology , Female , Housing/standards , Humans , Male , Mental Disorders/ethnology , Mental Disorders/psychology , Middle Aged , Social Identification , Social Isolation/psychology , Stress Disorders, Post-Traumatic/ethnology , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires , United StatesABSTRACT
A controlled study of the impact of brief, transitional acute care in reducing psychiatric treatment costs for people in rural areas is presented. Treatment emphasized home-based counseling and support, 24-hour rapid response, rural outreach, and intensive support management. The objective was to avert hospitalizations when possible, expedite discharge, and reduce likelihood of readmission, while maintaining comparable or superior clinical outcome. One-hundred eighty-two participants were randomly assigned to the experimental group or a routine care control group. Clinical and utilization data tracked at initial contact, 2 weeks, 6 months, and 12 months suggest substantially lower hospital utilization for the experimental group. Clinical outcomes were comparable between groups.
