Hidden scars: the persistent multifaceted health and psychosocial consequences for Syrian torture survivors.

Background: The impact on the physical and mental health of those who survived torture and their close circles in the Syrian regime's detention facilities remains under-studied.Objective: This qualitative study explored Syrian refugees' narrations of captivity and torture, and the consequences of such extreme traumatic events on their physical and psychosocial health.Method: Thirteen audio-recorded interviews were conducted in Arabic with Syrian refugees. Study participants were at least 19 years of age, resided in diverse urban areas of Jordan, had experienced captivity and torture in Syrian detention facilities, and voluntarily agreed to participate in the study. Participation was anonymous, only oral consent was required, and no incentives were provided to participants. Interviews were transcribed and translated into English by a team of researchers, followed by analysis of repetitive themes according to the narrative paradigm.Results: Analysis of interviews elicited three major themes: extreme traumatic experiences of torture, and its physical and psychosocial health consequences. The first major theme was divided into two sub-themes: torture experienced by the participants themselves, and torture experienced by participants' close circles. The second major theme, pertaining to physical health, was divided into two sub-themes: acute and chronic health sequelae. The third major theme, related to psychosocial health, was divided into four sub-themes: mental health symptomatology, impacts on professional life, impacts on interpersonal relationships, and social consequences.Conclusions: Torture experiences of Syrian refugees had adverse consequences for the physical and psychosocial health, functioning, and the overall well-being of survivors and their close circles. Interventions may seek to improve both the acute and chronic health consequences, as well as the mental health symptoms and associated impacts on livelihood, professional, and relationship dynamics. They should span clinical, legal, and advocacy spheres, given that a holistic approach may contribute immensely to survivors' healing process.

The torture endured and witnessed by survivors and their close circles in the Syrian regime's detention facilities was severely traumatizing and had persistent, life-altering implications.Survivors suffered from both acute and chronic physical health consequences as a result of abuse inflicted during torture and detention facility conditions. The psychosocial health ramifications included mental health symptoms, impact on interpersonal relationships, professional challenges, and social difficulties, posing multifaceted barriers to healing.Survivors and their close circles would benefit from a holistic approach to trauma-informed interventions that may require a multidisciplinary network of services with specialized providers for extended periods.

Traumatised youth harbour feelings of revenge: investigating the association between PTSD symptomatology, vengeance, and willingness to forgive among the Congolese adolescent refugees in Uganda.

Background: Prolonged conflicts in the Democratic Republic of Congo (DRC) have caused widespread psychological trauma among civilians leading to maladaptive coping strategies across generations. Despite this occurrence, empirical studies on the prevalence of trauma and its impact on attitudes towards revenge and forgiveness, particularly among the youth, are scarce. This study aims to clarify the relationship between Post Traumatic Stress Disorder (PTSD) symptom severity and the desires for forgiveness and revenge among Congolese adolescents residing in Uganda.Methods: We analysed data from 269 adolescent refugees from the DRC living in the Nakivale refugee settlement in Southwestern Uganda. The assessment included exposure to war-related traumatic events and the MINI-KID for DSM-V PTSD symptom severity. The Heartland Forgiveness and Vengeance Scales measured willingness to forgive and feelings of vengeance.Results: Exposure to war-related traumatic events was notably high in our sample, with severe deprivation of food (260 [97%]), exposure to armed combat (249 [93%]), witnessing bombing, burning, or destruction of houses (245 [91%]), disappearance of family members (239 [89%]), and seeing dead bodies (236 [88%]). PTSD symptom severity was negatively associated with willingness to forgive (b = -0.48; 95% CI -0.71--0.25; p < .001) and positively associated with vengeance (b = 0.18; 95% CI 0.04-0.32; p = .011).Conclusion: PTSD symptom severity reduces the willingness to forgive and increases the desire for vengeance among adolescent refugees. Mental health clinicians and policymakers should consider addressing maladaptive coping behaviours related to feelings of revenge and unwillingness to forgive in their support strategies for refugees.

Children and adoscent refugees experience different traumatic events.PTSD symptomatology is positively associated with feelings of vengeance.PTSD symptoms severity negatively correlates with willingness to forgive.

Father-separation and well-being in forcibly displaced Syrian children.

Forcibly displaced children often face separation from their parents, particularly fathers. These children endure the hardships of war, displacement, and the loss of a key attachment figure. Despite the critical role of attachment in children's well-being during periods of heightened stress, the impact of separation due to war and displacement has received little attention in empirical work. Findings from 1544 Syrian refugee children (Mage = 10.97, SD = 2.27) living in informal settlements in Lebanon with their mothers (Mage = 38.07, SD = 8.49), including 367 father-separated children, show that father-separated children experienced more war-related events and worse refugee environments. Structural equation modelling showed that beyond the direct relation of war exposure and quality of the refugee environment on well-being, father separation was uniquely related to more depressive symptoms and worse self-development, but not to anxiety, PTSD, or externalising problems in children. Maternal parenting did not explain these outcomes, though it had a protective function for children's well-being.

The Tulumbe! Partnership: a case study in developing a community-led research agenda to address HIV among African immigrants in the United States.

Grassroots, community organizations are trusted resources within communities, which puts them in an ideal position to effectively engage individuals impacted by health inequities in defining meaningful research priorities. A community-centered approach to HIV research is critical for African immigrants living in the United States, who experience stigma and other socio-structural barriers to HIV prevention, care, and research engagement. Supporting community organizations with financial resources and capacity building activities to lead the development of research agendas ensures better alignment with community interests and fosters sustainability. We developed a community-initiated and -led research engagement project-Tulumbe!, which prioritized community leadership in all project activities. Community forums, health care provider and community questionnaires, interviews, and report-back sessions were held to examine the research interests and health concerns voiced by African immigrants. The iterative, community-led engagement process of more than 200 African immigrants, health providers, and researchers resulted in a community-defined research agenda with six areas of focus: family communication; self-efficacy for African immigrant women; deconstructing masculinity for African immigrant men; sexual health education for African immigrant youth; HIV stigma; and health literacy. Time, resources, and flexibility are needed to develop a viable community-led research partnership. Investing in community leadership not only produced a patient-centered research agenda but also led to community ownership of the process and results; thus, all partners were committed to sustaining the work.

"Business as usual won't work ": Therapists' experiences and preparedness for providing refugees with trauma-related interventions.

OBJECTIVE: Worldwide, the numbers of refugees and displaced people being exposed to traumatic and inhumane experiences are escalating, resulting in an enhanced need for appropriate psychological management of trauma in this at-risk group. This study explores therapists' perspectives on and preparedness for supporting adult refugees with trauma-related interventions. METHOD: Therapists (N = 17), with varying ranges of experiences supporting adult refugee clients, were recruited nationally, and participated in semi-structured interviews, exploring their experiences and preparedness for therapeutically supporting refugee clients with trauma-related interventions. Data were analyzed using reflexive thematic analysis. A Patient Public Involvement (PPI) approach was embedded within this study. RESULTS: Five major themes were developed throughout the analysis: (i) Therapists' Fears and Apprehensions in Meeting Client Complexities, (ii) Preparation and Support for Competency Development, (iii) Adjusting Preconceptions of the Nature of Therapeutic Work, (iv) Humanity Within the Therapeutic Relationship, and (v) Balancing Therapeutic Meaningfulness and Hardships. CONCLUSION: Therapist training must reflect trauma-informed care and inter-cultural awareness to allow therapists to feel better prepared within mainstream and specialist services. Further, therapists' well-being needs to be prioritized to prevent vicarious trauma, burn-out and ultimately, improve interventions for clients.

Pregnancy outcomes of forced migrants in the Netherlands: A national registry-based study.

Background: The rise of global forced migration urges healthcare systems to respond to the needs of forced migrants (FM) during pregnancy and childbirth. Yet, comprehensive data on the health outcomes of pregnant FM in destination countries remain scarce. This study aimed to describe the characteristics and maternal and perinatal outcomes of pregnancy in this specific migrant population on a national scale in the Netherlands and to explore differences from other populations. Methods: The Dutch perinatal registry was linked to national migration data to analyze pregnancy outcomes in FM (2014-2019), using non-migrants (NM) and resident migrants (RM) as reference populations. We reported outcome rates (% [95 % CI]) for a range of primary and secondary pregnancy outcomes. Primary outcomes included perinatal mortality, small for gestational age infants (SGA), preterm birth, and emergency cesarean section (CS), for which we also calculated the crude relative risk (RR [95 % CI]) of FM compared to NM and RM. In addition, we conducted binary logistic regression analyses on primary outcomes to report adjusted odds ratios (aORs [95 % CIs]) while controlling for multiple births, maternal age and parity. Findings: Compared to the NM group, the FM group had increased risks of perinatal mortality (RR 1.50 [95 % CI 1.20-1.88]), SGA (1.65 [1.59-1.71], and emergency CS (1.19 [1.13-1.25]). Compared to RM, FM still had elevated risks of SGA (1.17 [1.13-1.22]). In contrast, the risk of preterm birth was lower in FM than in NM (0.81 [0.76-0.86]) and RM (0.83 [0.77-0.88]). These differences were confirmed in the adjusted analysis. Differences in secondary outcomes included higher rates of late antenatal care in FM (29.4 % [28.5-30.3]) than in NM (6.7 % [6.6-6.9]) and RM (15.5 % [15.1-15.9]). Rates of planned CS were similarly elevated (14.3 % [95 % CI 13.7-14.8] versus 7.·8 % [7.7-7.8] and 9.6 % [9.5-9.7]), while FM had lower rates of postpartum hemorrhage (3.9 % [3.6-4.2]) versus 6.8 % [6.8-6.9] and 5.7 % [5.6-5.9]). Conclusion: This first Dutch registry-based study demonstrated increased risks of multiple, though not all, adverse pregnancy outcomes in forced migrants. Our results emphasize the imperative to further unravel and address migration-related disparities, dismantle structural barriers to health among forced migrants, and improve the inclusivity of data systems. Collaborative policy, clinical practice, and research efforts are essential to ensure equitable care for every individual, regardless of migration status.

Sexual and gender-based violence among adolescents and young adults in refugee settlements and host communities: A case of Palorinya Refugee Settlement in Obongi District, Uganda.

OBJECTIVE: This study established the prevalence and correlates of Sexual and Gender-Based Violence (SGBV) among adolescents and young adults aged 13-24 in refugee and host communities in Obongi District of Uganda as of June 2022. STUDY DESIGN: The study was cross-sectional and the participants were adolescents (13-19 years) and young adults (20-24 years) in both refugee and host communities. METHODS: Using a stratified sampling technique 801 participants were identified in the settlement's five zones and interviewed using a semi-structured questionnaire. The main outcome of interest was the experience of SGBV in previous 12 months and factors associated with it were determined using modified Poisson multivariable regression analysis technique. RESULTS: Most of the respondents (82.7 %) perceived SGBV occurred in their community and 13.6 % reported that they had experienced it in the previous 12 months. However, less than half (48 %) of those who experienced it reported the incident to the police or other authorities. Factors significantly associated with SGBV were being female (APR = 1.70, 95 % CI: 1.08-2.70), attaining vocational/tertiary education (APR = 2.18, 95 % CI: 1.02-4.69), being married [monogamous marriage (APR = 2.64, 95 % CI: 1.53-4.55), polygamous marriage (APR = 3.58, 95%CI: 1.86-6.89)], and being Ugandan (APR = 2.20, 95 % CI: 1.33-3.63). CONCLUSION: The findings highlight a concerning prevalence of SGBV among adolescents and young adults within both refugee and host communities, compounded by substantial under-reporting to authorities. Urgent attention is needed to implement targeted interventions that prioritize the protection of women, married individuals, and Ugandan households in and around settlements, while also providing comprehensive support for survivors. Further research should be conducted to explore the connection between tertiary education and SGBV to inform prevention strategies.

Barriers of Ukrainian refugees and migrants in accessing German healthcare.

BACKGROUND: This study focused on Ukrainian refugees and migrants, a population that, with an ongoing war, is expected to grow in Germany. Over 1 million Ukrainians with exceptional legal status and access to public insurance in Germany significantly burden governmental services, especially German healthcare. It is thus essential to facilitate their integration into the healthcare system and ensure its proper usage. Identifying the obstacles Ukrainian refugees and migrants encounter while accessing healthcare services is crucial to ease their integration. METHODS: A qualitative study was conducted from February 2023 to April 2023. Thirty semi-structured interviews were performed with Ukrainian migrants and refugees. The interviews were transcribed verbatim, organized, and categorized. Thematic analysis was performed to identify barriers related to the use of German healthcare services. To assess possible differences in the experiences of Ukrainian refugees and migrants, the responses of these two groups for each topic were analysed separately. RESULTS: Ukrainian migrants and refugees experience similar barriers while accessing German healthcare services. Predominantly, language barriers and a lack of understanding of the German healthcare system posed the main barriers in both groups. Additionally, structural challenges, such as differences in referral processes, appointment scheduling, and consultation duration, presented further challenges. CONCLUSION: This research study emphasizes the importance of addressing cultural and structural barriers to improve healthcare accessibility and utilization for Ukrainian refugees and migrants in Germany to better facilitate their integration into the healthcare system.

Knowledge and attitudes of healthcare personnel about vaccination of migrant and refugee children and adolescents.

Background: The number of migrants to Greece has increased considerably the last decade. This study assessed the knowledge and attitudes of healthcare personnel (HCP) toward vaccination of newly-arrived children and adolescents in the Aegean islands, a major port of entry of migrants and refugees to Europe. Methods: The study was conducted from September 2020 to January 2021. All (166) HCP employed in the public health sector of the Aegean islands were invited to participate. A structured questionnaire was used to collect demographic data and data about their knowledge and attitudes toward vaccinations for migrant and refugees. Results: A total of 120 HCP participated (72 % response rate), including 54 (45 %) physicians, 43 nurses (35.8 %), and 23 health visitors (19.2 %). Sixty-seven (55.8 %) HCP were aware of the national vaccination guidelines. Health visitors had higher rates of knowledge about the national vaccination guidelines, compared with nurses and physicians (87% versus 44,2% and 51,9%; p-value-0.001). Overall, 73 (60.8 %) HCP were aware of vaccinations during the first examination upon arrival. Primary-healthcare physicians were more likely to be aware about the time of vaccine administration compared with hospital-based physicians (74 % versus 50 %; p-value = 0.006). Out of 120 HCP, 45 % knew that vaccination guidelines apply to all newly-arrived migrant and refugees and 65 % that vaccinations are free-of-charge. Overall, 67.5 % of participants supported no serology testing before vaccination, 21.8 % were against free-of-charge vaccinations, and 55 % recommended only priority vaccinations. Conclusions: There is a need to increase HCP' awareness and knowledge through training programs and tailored protocols focusing on vaccinations for newly-arrived migrant and refugee children and adolescents in order to promote effective vaccination of this vulnerable population.

Sexual and reproductive health focus group discussions with Syrian men and women living as refugees in the Bekaa Valley, Lebanon.

Background: Conflict in Syria since 2011 led to over one million Syrians fleeing to Lebanon, predominantly from economically disadvantaged areas with low literacy and high child marriage rates. Over 90% live in extreme poverty, in informal tented settlements with minimal access to education, healthcare or employment. Displacement and poverty have further increased early marriages and unplanned pregnancies, and curtailed access to sexual and reproductive healthcare (SRH) in the Bekaa valley. This is exacerbated by increasing rates of sexual and gender-based violence (SGBV), intimate partner violence and domestic violence. Study design: We aimed to explore SRH beliefs and practices and teach on key SRH topics through focus group discussions (FGD) and questionnaires, co-designed with Syrian practitioners, conducted with Syrian men and women. FGD were recorded, transcribed and thematically analysed. Questionnaires collected demographics and explored SRH beliefs and practices. Findings: 24 FGD with 203 participants, 72.4% female and 27.6% men. 90.1% participants were married with an average age-gap of 6.3 years between partners. Teenage marriage rates were 55.6% for women, and 47.4% delivered their first child before the age of 20. 43.6% participants were not using any contraception. Findings demonstrate the impacts of SRH cultural norms and changes due to displacement, financial crisis, and increased exposure to technology and NGOs. Conclusions: SRH is multifaceted and contested, requiring systemic improvements in access to care, employment and education. This small but important proof-of-concept study demonstrates the possibility of engaging men and women in SRH discussion; paramount to empowering communities and challenging intergenerational SGBV.

Identifying the Health Educational Needs of Refugees: Empirical Evidence from a Delphi Study.

Refugees experience poorer health outcomes especially which can be exacerbated by or can be a result of low health literacy of refugee populations. To address poor health outcomes, health literacy, and health usage in refugee populations, it is essential to develop health educational interventions for refugees' healthcare integration. To do so, learning objectives must be identified based on refugees' health knowledge gaps. Therefore, the overall aim of this study is to identify these knowledge gaps. A modified Delphi method was employed for this study with three rounds of survey: the first to identify learning objectives, the second to prioritise learning objectives, and the third to categorise the learning objectives as not recommended, partially recommended, or highly recommended. An overarching theme of utilising the healthcare system and its various services effectively and efficiently was recognised to be an important learning objective for educational interventions to address refugees' health integration. Overall, learning objectives within the theme self-care and preventative health were ranked as most important.

Social and emotional well-being intervention to reduce stress, anxiety, and depression among Ukrainian refugees resettled in Massachusetts.

BACKGROUND: Mental health problems are high among refugees due to their traumatic experiences of fleeing war and witnessing disasters and deaths due to violence and conflict. Refugees are exposed to various socio-cultural stressors during their migration journey before, during, and after arriving at the host country, which may increase their risk of mental health problems. Strength-based interventions may be beneficial to address their socio-cultural and psychological stressors by strengthening individual's strengths to address their problems. AIMS: This study evaluated the effect of a Social and Emotional Wellbeing intervention on mental health (stress, anxiety, and depression) and emotional health outcomes (coping, self-efficacy, social support, and conflict resolution) among Ukrainian refugees in Massachusetts. METHODS: We implemented intervention (once-weekly/5-week) among 31 Ukrainian refugees with pre-and post-assessment of mental and emotional health outcomes (2022-2023). The intervention consisted 5-module: managing stress and mind-body exercise, strengthening communication and social networking, problem-solving, and creating a healthy family environment. Validated scales were used to measure mental and emotional health outcomes, such as the Hopkins-Symptom-Checklist-25 for anxiety and depression and the Cohen-Perceived-Stress scale for stress. Paired t-test was used for data analysis. RESULTS: The pre versus post-intervention proportion reduced for anxiety (61.29% vs. 22.58%) and depression (58.06% vs. 22.58%). The mean scores significantly decreased from pre- to post-intervention by 6.26 points for stress, by 7.07 points for anxiety, and by 6.29 points for depression (both p's < .01). The mean scores significantly increased for coping (by 15.71), emotion-focused engagement (4.48), problem-focused engagement (4.80), social support (8.77), problem-focused coping self-efficacy (14.93), stop unpleasant emotions and thoughts (12.74), and friends networking (3.48; all p's < .01). CONCLUSIONS: The stress, anxiety, and depression were reduced, and coping, self-efficacy, and social support networking skills were improved among Ukrainians after intervention. This program should be replicated in the larger community for a wider benefit.

"It spreads like wildfire": mothers' gatherings for vaccine acceptance.

This case study describes the design, implementation, and evaluation of an initiative to increase COVID-19 vaccine confidence and uptake among refugee and immigrant women in Clarkston, Georgia. Applying the principles and practices of human-centered design, Mothers x Mothers was co-created by Refugee Women's Network and IDEO.org as a series of gatherings for refugee and immigrant mothers to discuss health issues, beginning with the COVID-19 vaccine. The gatherings included both vaccinated and unvaccinated mothers and used a peer support model, with facilitation focused on creating a trusting environment and supporting mothers to make their own health decisions. The facilitators for Mothers x Mothers gatherings were community health workers (CHWs) recruited and trained by Refugee Women's Network. Notably, these CHWs were active in every phase of the initiative, from design to implementation to evaluation, and the CHWs' professional development was specifically included among the initiative's goals. These elements and others contributed to an effective public health intervention for community members who, for a variety of reasons, did not get sufficient or appropriate COVID-19 vaccine information through other channels. Over the course of 8 Mothers x Mothers gatherings with 7 distinct linguistic/ethnic groups, 75% of the unvaccinated participants decided to get the COVID-19 vaccine and secured a vaccine referral.

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis - update from 2017 to 2023.

Background: Antimicrobial resistance (AMR) is a critical global health concern. A previous systematic review showed that migrants in Europe are at increased risk of AMR. Since the COVID-19 pandemic there have been rapid changes in patterns of antibiotic use, AMR, and migration. We aimed to present an updated evidence synthesis on the current distribution of AMR among migrants in Europe. Methods: We carried out a systematic review and meta-analysis in accordance with PRISMA guidelines (PROSPERO ID: CRD42022343263). We searched databases (MEDLINE, Embase, PubMed and Scopus) from 18 January 2017 until 18 January 2023 to identify primary data from observational studies reporting any laboratory-confirmed AMR among migrants in the European Economic Area (EEA) and European Union-15 (EU-15) countries using over 7 key search terms for migrants and over 70 terms for AMR and countries in Europe. Outcomes were infection with, or colonisation of AMR bacteria. Methodological quality was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Observational Studies. We meta-analysed the pooled-prevalence of infection and/or colonisation of AMR organisms. Findings: Among 630 articles, 21 observational studies met the inclusion criteria and were included in this review. The pooled prevalence for any detected AMR was 28.0% (95% CI 18.0%-41.0%, I 2  = 100%) compared to a 25.4% seen in the previous review; gram-negative bacteria 31.0% (95% CI 20.0%-44.0%, I 2  = 100%), and methicillin-resistant staphylococcus aureus 10.0% (95% CI 5.0%-16.0%, I 2  = 99%). Drug-resistant bacteria were more prevalent in community settings in large migrant populations (pooled prevalence: 41.0%, 95% CI 24.0%-60.0%, I 2  = 99%) than in hospitals (21.0%, 95% CI 12.0%-32.0%, I 2  = 99%). AMR estimates in 'other' migrants were 32.0%, (95% CI 12.0%-57.0%, I 2  = 100%) and 28.0% (95% CI 18.0%-38.0%, I 2 = 100%) in forced migrants. No firm evidence of AMR acquisition with arrival time or length of stay in the host country was found. Interpretation: Studies investigating AMR in migrants are highly heterogenous. However, since the COVID-19 pandemic, migrants may be at higher risk of acquiring resistant bacteria, particularly gram-negative bacteria, within community settings such as refugee camps and detention centres in Europe. Our study highlights the importance of infrastructure and hygiene measures within these settings, to mitigate transmission of resistant pathogens. Policy-makers should screen for AMR in migrants prior to departure from countries of origin, where feasible, and upon arrival to a new country to ensure optimal health screening, infection control and effective treatment. Funding: There was no funding source for this study.

Loneliness and social isolation amongst refugees resettled in high-income countries: A systematic review.

Refugees encounter multiple psychosocial stressors post-resettlement which increases their risk of developing a mental illness. Loneliness and social isolation are commonly reported in the refugee population and have been demonstrated to be associated with multiple physical and mental health comorbidities in the general population. However, no study to date has systematically reviewed how loneliness and social isolation may affect refugees who have resettled in high-income countries. This systematic review aims to study the prevalence, risk factors, consequences, and interventions for loneliness and social isolation among refugees who have resettled in high-income countries. Systematic searches on five electronic databases yielded 2950 papers, of which 69 were deemed eligible following a double-blinded review by title and abstract then later by full text. From the included studies, it was found that the reported range of prevalence rates of loneliness (15.9-47.7%) and social isolation (9.8-61.2%) were higher than population norms. Risk factors associated with loneliness and social isolation included family separation, acculturative stress, being female or a parent and a current diagnosis of a mental illness. Loneliness and social isolation were found to be associated with depression, post-traumatic stress disorder (PTSD), psychological distress as well as physical health problems. Only three interventions addressing loneliness and social isolation were identified which demonstrates the importance of integrating social support in refugee psycho-social support programs. In summary, loneliness and social isolation were reported by a large proportion of refugees who have resettled in high-income countries. Whilst certain risk factors were pre-migratory and static, most were post-migratory in nature and were found to adversely affect mental and physical health. Thus, interventions focused on reducing loneliness and social isolation that are guided by the needs of refugee communities are urgently required.

Interventions to promote mental health in the Occupied Palestinian Territories and Palestinian refugees: A scoping review.

BACKGROUND: The long history of the Palestinian-Israeli conflict has resulted in a public and mental health crisis. Despite the significant mental health burdens facing the Palestinian population in the Occupied Palestinian Territories (OPT) and refugee camps, this issue remains comprehensively unexplored. AIMS: This scoping review identified mental health interventions and assessed their effectiveness among populations in the OPT and Palestinian refugee camps, while addressing delivery challenges. METHOD: A scoping review was conducted using 14 databases to include relevant studies published through March 2024 using PRISMA guidelines for scoping reviews. RESULTS: Analyzing 31 intervention studies meeting the inclusion/exclusion criteria, revealed varied outcomes in interventions targeting post-traumatic stress disorder, depression, and overall mental well-being. CONCLUSIONS: While some interventions showed potential, others had limited effectiveness, underscoring the complexity of mental health needs in conflict zones. Gender- and risk-specific effectiveness was observed, emphasizing the need for tailored approaches. Challenges like low attendance rates and systemic barriers hindered intervention success. The profound impact of war on children stresses the urgency for targeted interventions. Empowerment and community connectedness are vital for resilience, along with the importance of family and community involvement and research that balances the need for strong evaluation designs with the need for ongoing mental health services. Advocacy for systemic changes is crucial to implement the complex sustainable interventions necessary to assure mental health in any population. This review highlights the importance of holistic, contextually relevant approaches for mental health intervention in OPT and refugee camps, emphasizing rigorous evaluations and community-driven approaches.

Predicting Mental Health Care Enrollment and Treatment Uptake among Newly Arrived Refugees in U.S. Resettlement Programs.

This article examines variables that predict mental health care enrollment and engagement among refugees. The authors explore a mental health care model designed to identify mental health needs early among refugee arrivals that may interfere with adjustment and overall health outcomes using data from a Midwest refugee resettlement program. Using ecological models of mental distress and theories on help-seeking behaviors, the authors used logistic and count regressions to predict enrollment in mental health care services and utilization rates. Gender, nationality, and presenting problems were significant predictors of enrollment and length of engagement in services. The findings provide guidance to practitioners and resettlement agencies on refugee mental health and opportunities to increasing access and engagement in mental health care.

Navigating wellness through integration: coping strategies for depression among Syrian refugees in Norway.

BACKGROUND: Refugees frequently face the challenges of adapting to unfamiliar environments and new cultural contexts. Such adaptations emphasize the importance of coping strategies during resettlement and for individuals to successfully integrate in the new communities. Particularly for Syrian refugees in Norway, many of whom have escaped war and conflict, understanding their ways of coping with mental health problems, such as depression, is pivotal. METHOD: This study used a cross-sectional study design to explore the relationship between integration aspects and coping strategies for depression from the Syrian population living in Norway. Syrian participants (N = 96) answered questions from the Brief COPE, the Hopkins symptom checklist (HSCL-13), and the Immigration Policy Lab index (IPL-12/24). RESULTS: Hierarchical multiple regression analysis indicated that employing a problem-focused coping strategy was significantly associated with better psychological and social integration outcomes among Syrian refugees in Norwegian society. CONCLUSION: The study suggests that certain aspects of integration, such as feeling a sense of belonging and actively seeking help, significantly improve mental health outcomes for Syrian refugees. Emphasizing problem-focused coping strategies could be vital in facilitating the successful integration of refugees into Norwegian society.

Feasibility and Acceptability Study of a Culturally Adapted Web-Based Intervention to Reduce Suicidal Ideation for Syrian Asylum Seekers and Refugees in the United Kingdom: Protocol for a Mixed Methods Study.

BACKGROUND: The war in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life-changing events, resulting in high rates of anxiety, depression, posttraumatic stress disorder, and suicidal ideation (SI). To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the United Kingdom. The study revealed the importance of understanding their lived experience with migration and the acculturative process in providing treatment for SI. This study will now assess the feasibility and acceptability of the culturally adapted intervention for this population. OBJECTIVE: The first phase of the study will include recruiting participants and delivering the web-based intervention (1) to assess the feasibility of meeting recruitment goals and recruitment rates and (2) to assess the feasibility of outcome measures. The second phase of the study will include one-to-one semistructured interviews (1) to assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates and barriers and facilitators to engagement and (2) to assess the acceptability of the intervention in terms of its cultural relevance and appropriateness. METHODS: This is a protocol for a single-group, noncontrolled, mixed methods feasibility and acceptability study of a culturally adapted web-based intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. The study will assess the feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures using individual participant tracking forms, which will be analyzed quantitatively. The suitability and acceptability of the intervention will be assessed using one-to-one semistructured interviews with 12 participants who completed the intervention, which will be analyzed qualitatively. RESULTS: Recruitment began in February 2024 and will run until 30 participants are recruited to the study or until the end of July 2024. Thus far, 19 participants have provided informed consent, 16 were eligible and enrolled, and 12 have completed a postintervention interview. No data have been analyzed. The study, including the write-up period, is expected to end in December 2024. CONCLUSIONS: Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI was culturally adapted in collaboration with Syrian asylum seekers and refugees in the United Kingdom. This study will now assess the feasibility and acceptability of the intervention and culturally appropriate recruitment strategies. TRIAL REGISTRATION: ISRCTN ISRCTN11417025; https://www.isrctn.com/ISRCTN11417025. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56957.