Intergenerational transmission of traumatic stress and relational disruptions among Cambodian refugee families in the United States.

Cambodian refugees resettled in the United States were severely affected by genocidal trauma and have been trapped in decades of intergenerational transmission of traumatic stress and relational disruptions without much public attention. This manuscript reports on data collected as part of a Cambodian needs assessment that employed methodological principles of critical ethnography and was grounded by a human ecological theoretical model. Eighteen professionals who served Cambodian communities were interviewed. The interviews were transcribed in Khmer or/and English and analyzed using the Developmental Research Sequence resulting in three domains (Pre-Migration, During Migration, and Post Resettlement in the United States) and four categories (i.e. Impact on Self, Couple Relationships, Parent-Child Relationships, and Context) within each domain. The thematic findings emphasize intergenerational transmission of psychopathology, disruptions in parent-child relationships, and a critical need to support parents to promote positive child development within Cambodian communities.

WHO's end of TB targets: unachievable by 2035 without addressing under nutrition, forced displacement, and homelessness: trend analysis from 2015 to 2022.

Tuberculosis (TB) remains a significant global health challenge, despite the World Health Organization (WHO) actively working towards its eradication through various initiatives and programs. Undernutrition, forced displacement, and homelessness worsen TB's burden and challenge control efforts; however, there is still no adequate research that shows the trend of these underlying factors to attain the WHO's ambitious TB targets. So, this study aims to analyze the trend analysis of these underlying factors worldwide from 2015 to 2022 and their impact on the feasibility and implications of reaching the End TB targets by 2035. We utilized international databases, including UNHCR, FAO, and WHO reports, as secondary data sources. Data were extracted chronologically from 2015 to 2022 to illustrate trends in undernutrition, forced displacement, and homelessness on a global level.This trend analysis reveals that undernutrition, forced displacement, and homelessness have worsened over time. Undernutrition rose from 8.4 to 9.8% globally between 2015 and 2021, affecting 22.7 million additional individuals each year. In 2022, undernutrition affected 735 million people globally. Africa (21.9%) and Asia (10.6%) had the highest rates, while Western Europe and North America had lower rates than the global average: 3.4% and 2.5%, respectively.Similarly, the global rate of forced displacement increased from 65.1 million people in 2015 to 108.4 million in 2022, a 21% increase from 2021. This means that an extra 19 million people were displaced in 2021. Globally, homelessness, affecting 1.6 billion people, has worsened over time. Despite being a highly vulnerable group to TB, homeless individuals are often neglected in TB control efforts. Our findings underscore the critical importance of addressing undernutrition, forced displacement, and homelessness in achieving the World Health Organization's ambitious End TB targets by 2035, as highlighted through trend analysis from 2015 to 2022. Implementing policies focusing on nutrition, stable housing, and the challenges faced by displaced populations is imperative for progress toward a TB-free world.

Hair hormone data from Syrian refugee children: Perspectives from a two-year longitudinal study.

For numerous issues of convenience and acceptability, hair hormone data have been increasingly incorporated in the field of war trauma and forced displacement, allowing retrospective examination of several biological metrics thought to covary with refugees' mental health. As a relatively new research method, however, there remain several complexities and uncertainties surrounding the use of hair hormones, from initial hair sampling to final statistical analysis, many of which are underappreciated in the extant literature, and restrict the potential utility of hair hormones. To promote awareness, we provide a narrative overview of our experiences collecting and analyzing hair hormone data in a large cohort of Syrian refugee children (n = 1594), across two sampling waves spaced 12 months apart. We highlight both the challenges faced, and the promising results obtained thus far, and draw comparisons to other prominent studies in this field. Recommendations are provided to future researchers, with emphasis on longitudinal study designs, thorough collection and reporting of hair-related variables, and careful adherence to current laboratory guidelines and practices.

Interconnections between children's upbringing, camps, and post-war villages: caregivers' lived experiences in northern Uganda.

Since the end of the Second World War in 1945, the erection of camps within and across state borders has become the most common response to the influx of displaced persons. Based on empirical evidence from northern Uganda, this paper aims to provide answers to two main questions: (i) how does the camp influence and frame the upbringing of children?; and (ii) how do caregivers shape and adjust upbringing within this setting and when they return to their 'former homes' ? Interviews and focus-group discussions were conducted with 48 caregivers living in Kitgum District, northern Uganda. Deductive thematic analysis was employed to structure participants' accounts of past and present interconnections between upbringing and (previous) encampment. By paying close attention to their (counter-)narratives, people's agency and coping are emphasised through the simultaneous forging of new interconnections (that is, discontinuities) and holding on to old interconnections (that is, continuities) between upbringing, the camp, and the post-war village.

War, forced displacement, and alcohol abuse: experiences and perceptions of war-affected south Sudanese refugee youth living in Bidibidi refugee settlement in northern Uganda.

Refugees are at high risk of alcohol abuse due to their experiences of structural, physical, sexual, and psychological violence in their countries of origin, during flight, and within host communities. Given the prolonged civil war in their country, South Sudanese have continued to flee profound forms of violence and now constitute the largest population of refugees in Uganda. However, little is known about their displacement experiences, as well as the reality of alcohol use and abuse within refugee settlements. Drawing upon the direct voices of a sample of war-affected South Sudanese young people, this article explores their experiences of forced displacement and their links to alcohol abuse, as well as their perceptions regarding appropriate alcohol treatment interventions for refugees in the camp. A total of 22 semi-structured qualitative interviews were conducted with 14 refugee youth (aged 18-25) alongside eight adult key informants who work with the youth (religious leaders, sports coaches, educators, social workers, and settlement administrators). Using thematic analysis, the study revealed a series of key themes influencing and shaping the high incidence of alcohol abuse among the youth. These included traumatic wartime and migration experiences, family separation, poor prospects, and the ubiquitous availability of alcohol in the settlement. In addition, we show how alcohol operates as a strategic tool for survival for the youth, as well as highlight how these perceptions can help to inform alcohol treatment interventions in the Bidibidi refugee settlement. To our knowledge, this is the first in-depth study of alcohol abuse among war-affected South Sudanese refugee youth in Uganda, addressing a significant gap in the current literature on war-affected youth, forced displacement, and alcohol abuse. We contend that involving youth in the design of interventions can be helpful for culturally sensitive and relevant prevention, treatment, and care in refugee settings. In addition, providing employment opportunities and meaningful engagement for growth through social participation can help to address harmful alcohol use among youth in the camps.

"It will always be Temporary": A qualitative study of Syrian young adults expressing histories of collective violence and forced displacement in participatory theatre.

Given the increased prevalence of mental health problems in Syrian refugee communities, there have been efforts to develop adequate mental health care for their well-being. Herein, clinical literature is increasingly emphasizing the importance of locating refugees' healing at the nexus of personal and social realities, understanding the process of trauma narration within social restorative spaces of witnessing and communal support. Alongside this debate, there is growing interest in the relevance of participatory theatre for refugees. This innovative approach understands how voicing narratives of life histories within a broader social sphere may support personal and socio-political transformation. In this article, we aim to further the understanding of participatory theatre's relevance to these issues, focusing on the reparative dimensions of trauma narration. Based on a case study of a theatre project with Syrian young adults resettled in Belgium, we explore the different ways participants expressed experiences of collective violence and displacement in dialogue with each other, their diasporic and home communities, and their host society, and consider how these processes relate to their construction and meaning and coping with trauma. In a final section, we discuss the implications of our findings, raising questions about the value of participatory theatre as a reparative space and outlining suggestions to introduce and mobilize reparative modes of trauma narration in therapeutic practices in refugee trauma care.

Forced displacement and the health workforce crisis: Venezuelan healthcare workers in Peru.

The migration of health workforces tends to be economically based benefiting high-income countries, while draining lower-income countries of workers and skills However, national instability or civil conflict may also have the effect of forcing out health workers. However, few articles focus on the experiences of these types of migrants. Peru has become the second largest Latin American destination for Venezuelan forced displaced migrants, a number of which are health workers. While the exact numbers of these workers is unknown, it is estimated that 4000 and 3000 doctors and about 2500 nurses and health technicians from Venezuela reside in Peru. These workers find entry into the heath system difficult due to bureaucratic and costly registration and qualification validation procedures. However, during Covid-19 these conditions were relaxed, and a large number of these heath workers entered the heath workforce. These workers were primarily doctors and worked in urban medical facilities, though there was some distribution across the country's departments. This avenue to the health workforce allowed the mobilisation of dormant health skills and lifted workforce density numbers. Nonetheless, it is too early to see if there have been sustainable improvements, and it remains uncertain how these policies have contributed to the country's UHC goals. Peru's experiences raise the issue of how to mobilise dormant displaced health worker migrants.

"It opened a new door for me": A qualitative study of forcibly displaced parents' experiences of an attachment-based parenting program.

The aim of the study was to explore forcibly displaced parents' experiences of how an online attachment-based parenting program (eConnect) impacted their relationships with their teens. Data was collected from four focus group discussions with 28 parents who participated in the eConnect program. Data was analyzed using network thematic analysis. A global theme emerged from the analysis: Strengthened Parent-Teen Relationships. Four underpinning organizing themes described the process through which the parent-teen relationship was strengthened: Knowledge Served as the Foundation for Change, Increased Parental Self-Efficacy, Improved Emotional Attunement Facilitates Dyadic Affect Regulation, and Shifted Power Dynamics and Emerging Mutual Parent-Teen Partnership. Findings suggest that eConnect is promising intervention for strengthening parent-teen relationships and supporting forcibly displaced families.

Making an economic argument for investment in global mental health: The case of conflict-affected refugees and displaced people.

Mental health expenditure accounts for just 2.1% of total domestic governmental health expenditure per capita. There is an economic, as well as moral, imperative to invest more in mental health given the long-term adverse impacts of mental disorders. This paper focuses on how economic evidence can be used to support the case for action on global mental health, focusing on refugees and people displaced due to conflict. Refugees present almost unique challenges as some policy makers may be reluctant to divert scarce resources away from the domestic population to these population groups. A rapid systematic scoping review was also undertaken to identify economic evaluations of mental health-related interventions for refugees and displaced people and to look at how this evidence base can be strengthened. Only 11 economic evaluations focused on the mental health of refugees, asylum seekers and other displaced people were identified. All but two of these intervention studies potentially could be cost-effective, but only five studies reported cost per quality-adjusted life year gained, a metric allowing the economic case for investment in refugee mental health to be compared with any other health-focused intervention. There is a need for more consistent collection of data on quality of life and the longer-term impacts of intervention. The perspective adopted in economic evaluations may also need broadening to include intersectoral benefits beyond health, as well as identifying complementary benefits to host communities. More use can be also made of modelling, drawing on existing evidence on the effectiveness and resource requirements of interventions delivered in comparable settings to expand the current evidence base. The budgetary impact of any proposed strategy should be considered; modelling could also be used to look at how implementation might be adapted to contain costs and take account of local contextual factors.

Influences on reproductive decision-making among forcibly displaced women resettling in high-income countries: a scoping review and thematic analysis.

BACKGROUND: Forced displacement impacts the health, rights and safety of women, which is further compounded by gender inequality. In particular, this has consequences for forcibly displaced women's reproductive health once resettled in a new country. To ensure the reproductive health and rights of forcibly displaced women during and after resettlement, there must be careful consideration of their reproductive decision-making taking into account the context and environment of the host country. AIM: This scoping review aimed to explore the influences on reproductive decision-making among forcibly displaced women resettling in high-income countries. METHOD: A scoping review was conducted following the PRISMA-ScR for reporting. EBSCO was used to search databases covering global health, health policy, psychology, sociology, and philosophy for articles published from 1 January 2012 to 27 April 2022. Data extracted from each article included author(s), year of publication, publication type, aims/objectives, study design, sampling method, data collection or eligibility criteria, study population (i.e., sample size and characteristics), migration status, country(ies) of origin, host country(ies), key findings and limitations. Two independent reviewers screened all articles against eligibility criteria using Covidence. Data charting and thematic analysis were performed independently by one reviewer. FINDINGS: Nineteen articles published between 2013 and 2022 mostly conducted in the United States (36.8%) and Australia (21.1%), with the majority reporting on qualitative findings (68.4%), and women from a wide array of countries and cultures (most commonly African countries) were included. Influences on women's reproductive decision-making related to the contexts before displacement, during displacement, and after arrival, with influences on women's reproductive decision-making identified specific to the context. The influences before displacement included conflict; religious beliefs; socio-cultural gendered expectations; and external control over reproductive autonomy. During displacement influences included paternalism and access to education. Influences after arrival included pressure, restriction, coercion; knowledge and misconceptions; patriarchal power dynamics; and seeking empowerment. An adapted socio-ecological model was developed to interpret the findings. CONCLUSION: This review highlights the complexity and nuances within forcibly displaced women's experiences which influence their reproductive decision-making. Further research may review the evidence base to provide guidance for healthcare professionals and health policies aimed at empowering women to make autonomous reproductive decisions; develop training for healthcare professionals to prevent pressure, restriction and coercion of women's reproductive autonomy; and inform development of policy that takes an intersectional approach to women's health rights and gender equality.

Associations between affective temperament, perceived stress, and helping among Ukrainians and Poles in the context of the war in Ukraine.

The Russian aggression of Ukraine has put millions of civilians under immense stress and forced many of them to leave their homes for safety and help. Poland became one of the leading destinations for waves of Ukrainians fleeing this war. The level of perceived stress in people who experienced war depends on various factors, including individual psychological variables. The main aim of this study was to analyze perceived stress levels and the predictive role of affective temperaments, as defined by Akiskal, for perceived stress in Ukrainians and Poles during the first year of the Russo-Ukrainian war. Secondly, we studied the relationship between affective temperament, stress, and commitment to help Ukrainian refugees. Self-report data from 410 Ukrainians and 146 Poles were collected. The results of this study shed light on perceived stress in war-affected populations and the role of affective temperaments in predicting its levels. We also demonstrated the links between affective temperament, perceived stress, and involvement in helping Ukrainian refugees. Understanding the mental status of people affected by war and its predictors is crucial to providing appropriate support and assistance to those in need.

Racialization, colonialism, and imperialism: a critical autoethnography on the intersection of forced displacement and race in a settler colonial context.

Migration has been identified as a priority area for policy responses by both the federal and provincial/territorial governments yet, much of our knowledge about migration is not premised on addressing current xenophobic and racist narratives about migrants. The purpose of this research is an interrogation of Canada's colonialism, imperialism, and racialization, which produce specific oppressive policies and practices that have impacted my family. This research is premised on the understanding that in the space between what is known about migration in Canada and what is not, a great deal of narrative and interpretive work is done that makes assumptions about migrants, specifically forcibly displaced people from the Global South. Through a critical autoethnography focused on my lived experiences as a descendant of forcibly displaced Chinese-Vietnamese people living in a settler colonial nation state, this study critiques to what extent these assumptions are founded, and to what extent they represent a socio-political climate in which migration is set out as particular problems requiring a legal and policing solution. In particular, my analysis centers anti-colonialism and anti-racism, shifting to resistance to systemic violence and liberation, while considering the discursive and on-the-ground effects of racist, colonial, and imperial policies and practice. Set against the backdrop of the rise of white nationalism, xenophobia, and racism across all levels of government and academia, and the general public, the results of this study produce a counter-narrative focused on the intersection of forced displacement and race in a settler colonial context, which is both timely and urgent.

Implementing psychosocial support models in contexts of extreme adversity: lessons from a process evaluation in Colombia.

Introduction: High quality investments during early childhood allow children to achieve their full potential by setting developmental foundations. However, challenges in the scale-up of evidence-based interventions make across-the-board implementation a non-trivial matter. Moreover, extreme contextual conditions -such as community violence, forced displacement, and poverty- impose a double threat. First, by directly affecting early childhood development (ECD), forced displacement and exposure to violence during early childhood, coupled with deficits in nurturing relationships, can trigger toxic stress, affecting children's mental health and social and emotional learning. Second, contexts of extreme adversity exacerbate common implementation pitfalls in the scale-up of interventions. Recognizing and documenting "what it takes" to successfully implement "what works" can contribute to the expansion and effectiveness of evidence-based programs that promote ECD in these settings. Semillas de Apego (SA, onward), a community-based psychosocial support model for caregivers, materialized as a strategy to promote ECD in communities affected by violence and forced displacement. Methods: This article presents the results of the process evaluation of SA during the 2018-2019 implementation in Tumaco, a violence ridden municipality in the south-west border of Colombia, South America. In this phase, the program reached 714 families, 82% direct victims of violence and 57% were internally displaced. The process evaluation combined qualitative and quantitative methodological approaches to produce evidence of factors that promoted implementation quality. Results: Findings identified salient components of the program that promoted the program's acceptability, adoption, appropriateness, fidelity and sustainability: a rigorous cultural adaptation; well-structured team selection and training methodologies; and a team support and supervision protocol to provide continuous capacity building and prevent burn-out and other occupational hazards common among professionals in mental health and psychosocial support interventions. The statistical analysis using monitoring data identified key predictors of the dosage delivered (a measure of fidelity). Evidence suggests that initial attendance to the program and observable characteristics -such as educational attainment, violence victimization and employment status-predict a successful compliance (in terms of dosage to benefit from the program). Discussion: This study provides evidence for the development of structural, organizational, and procedural processes for the adoption, appropriate adaptation, and high-fidelity delivery of psychosocial support models delivered in territories affected by extreme adversity.

Beyond the drug war: violence, forced displacement, and shale gas in northeastern Mexico (2000-2020).

This article presents the results of an investigation about forced displacement in Mexico's northeastern region-bordering the United States-where many municipalities have been affected by violence and depopulation in the past two decades (2000-2020), in the context of a so-called "drug war." From a critical perspective, the study is based on a quantitative methodology using spatial and statistical analysis to try to link forced displacement-caused by criminal violence-and the presence of important hydrocarbon deposits in the region. The main finding is that the most affected municipalities by violence are located precisely in the Burgos Basin area, which has the largest shale gas reserves in the country. The evidence gathered suggests that forced displacement in these municipalities may respond to a strategic development logic where criminal violence operates for ends that transcend it and are geopolitical in nature. Supplementary Information: The online version contains supplementary material available at 10.1007/s10611-023-10095-w.

Exploring the self-preparedness of frontline healthcare workers in a low- and middle-income country from a humanitarian context during the COVID-19 pandemic: A constructivist grounded theory study.

Background: While research has been conducted on the availability, accessibility, and affordability of personal protective equipment for healthcare workers during the COVID-19 pandemic, little information is available on the ways in which health workers, especially those in humanitarian settings see themselves, and engage in self-preparedness for social, physical, and mental health and practical care in the pandemic. We sought to address this gap. Methods: We followed a constructivist grounded theory approach to guide in-depth interviews with 30 frontline doctors, nurses, and community healthcare workers recruited from the Rohingya refugee camps in Bangladesh using the purposive and snowball sampling methods. Analyses were carried out through the identification of codes in three phases: an initial line-by-line open coding, then focused axial coding, and finally selective coding. Findings: An emergent-grounded theory of "Navigating Self-Preparedness through Pandemics" was developed as we built a five-phased theoretical framework examining health worker responses with the following pillars: (a) pandemic shock; (b) pandemic awareness; (c) pandemic learning; (d) pandemic resilience, and (e) pandemic resurgence. Interpretation: The theory emerged as a realistic, socially, and culturally sensitive COVID-19 strategy to support healthcare workers. Self-preparedness was characterized by two interwoven processes: (1) the experiences of the daily life span of healthcare workers attempting to improve their own protection using all their potential while providing care for patients in a vulnerable setting and time and (2) the inseparable role of physical, psychological, social, and spiritual factors in each stage of learning during the pandemic to achieve better outcomes.

The impact of forced displacement: trauma, increased levels of inflammation and early presentation of diabetes in women Syrian refugees.

BACKGROUND: Forced displacement and war trauma cause high rates of post-traumatic stress, anxiety disorders and depression in refugee populations. We investigated the impact of forced displacement on mental health status, gender, presentation of type 2 diabetes (T2D) and associated inflammatory markers among Syrian refugees in Lebanon. METHODS: Mental health status was assessed using the Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptom Checklist-25 (HSCL-25). Additional metabolic and inflammatory markers were analyzed. RESULTS: Although symptomatic stress scores were observed in both men and women, women consistently displayed higher symptomatic anxiety/depression scores with the HSCL-25 (2.13 ± 0.58 versus 1.95 ± 0.63). With the HTQ, however, only women aged 35-55 years displayed symptomatic post-traumatic stress disorder (PTSD) scores (2.18 ± 0.43). Furthermore, a significantly higher prevalence of obesity, prediabetes and undiagnosed T2D were observed in women participants (23.43, 14.91 and 15.18%, respectively). Significantly high levels of the inflammatory marker serum amyloid A were observed in women (11.90 ± 11.27 versus 9.28 ± 6.93, P = 0.036). CONCLUSIONS: Symptomatic PTSD, anxiety/depression coupled with higher levels of inflammatory marker and T2D were found in refugee women aged between 35 and 55 years favoring the strong need for psychosocial therapeutic interventions in moderating stress-related immune dysfunction and development of diabetes in this subset of female Syrian refugees.

The effect of different types of migration on symptoms of anxiety or depression and experience of violence among people who use or inject drugs in Kachin State, Myanmar.

BACKGROUND: Evidence on the social determinants of mental health conditions and violence among people who inject or use drugs (PWUD) is limited, particularly in conflict-affected countries. We estimated the prevalence of symptoms of anxiety or depression and experience of emotional or physical violence among PWUD in Kachin State in Myanmar and examined their association with structural determinants, focusing on types of past migration (migration for any reason, economic or forced displacement). MATERIALS: A cross-sectional survey was conducted among PWUD attending a harm reduction centre between July and November 2021 in Kachin State, Myanmar. We used logistic regression models to measure associations between past migration, economic migration and forced displacement on two outcomes (1) symptoms of anxiety or depression (Patient Health Questionnaire-4) and (2) physical or emotional violence (last 12 months), adjusted for key confounders. RESULTS: A total of 406, predominantly male (96.8%), PWUD were recruited. The median age (IQR) was 30 (25, 37) years, most injected drugs (81.5%) and more commonly opioid substances such as heroin or opium (85%). Symptoms of anxiety or depression (PHQ4 ≥ 6) were high (32.8%) as was physical or emotional violence in the last 12 months (61.8%). Almost one-third (28.3%) had not lived in Waingmaw for their whole life (migration for any reason), 77.9% had left home for work at some point (economic migration) and 19.5% had been forced to leave home due to war or armed conflict (forced displacement). A third were in unstable housing in the last 3 months (30.1%) and reported going hungry in the last 12 months (27.7%). Only forced displacement was associated with symptoms of anxiety or depression [adjusted odds ratio, aOR 2.33 (95% confidence interval, CI 1.32-4.11)] and recent experience of violence [aOR 2.18 (95% CI 1.15-4.15)]. CONCLUSION: Findings highlight the importance of mental health services integrated into existing harm reduction services to address high levels of anxiety or depression among PWUD, particularly among those who have been displaced through armed conflict or war. Findings reinforce the need to address broader social determinants, in the form of food poverty, unstable housing and stigma, in order to reduce mental health and violence.

Inclusive education for children with disabilities in a refugee camp.

Children in refugee camps, and particularly those with disabilities, face unique challenges in accessing education and are at high risk of being marginalised. Best practices suggest that main-streaming is the optimal strategy for serving students with disabilities. This study examines the extent to which mainstreaming in a refugee camp helps to promote children's prosocial behaviours, taking into account their emotional and behavioural problems. In Kakuma Refugee Camp, Kenya, researchers collected data from the parents of children currently enrolled in special needs education centres (n=65) and from those formerly enrolled at these facilities who transitioned to mainstream classrooms (n=81). Children in mainstream schools functioned better in terms of prosocial behaviours, but this relationship disappeared when factoring in children's emotional and behavioural difficulties. In the context of a refugee camp, mainstreaming alone is not likely to help children's psychosocial and educational functioning, which requires dedicated supports, appropriate facilities and infrastructure, and a dual focus on disability-specific and disability-inclusive initiatives.