Alisa K. Lincoln

Mental Health of Somali Adolescent Refugees : The Role of Trauma, Stress, and Perceived Discrimination

The primary purpose of this study was to examine relations between trauma exposure, post-resettlement stressors, perceived discrimination, and mental health symptoms in Somali adolescent refugees resettled in the U.S. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135) who had resettled in the U.S. Participants were administered an interview battery comprising self-report instruments that included the UCLA Posttraumatic Stress Disorder (PTSD) Index, the War Trauma Screening Scale, the Every Day Discrimination scale, the Adolescent Post-War Adversities Scale, and the Acculturative Hassles Inventory. Results indicated that cumulative trauma was related to PTSD and depression symptoms. Further, post-resettlement stressors, acculturative stressors, and perceived discrimination were also associated with greater PTSD symptoms after accounting for trauma, demographic, and immigration variables. Number of years since resettlement in the US and perceived discrimination were significantly related to depressive symptoms, after accounting for trauma, demographic, and immigration variables. Further research elucidating the relations between post-resettlement stressors, discrimination, and mental health of refugee adolescents may inform intervention development.

Posttraumatic Stress Disorder and Completed Suicide

Most research regarding posttraumatic stress disorder (PTSD) and suicide has focused on suicidal ideation or attempts; no known study of the association between PTSD and completed suicide in a population-based sample has been reported. This study examined the association between PTSD and completed suicide in a population-based sample. Data were obtained from the nationwide Danish health and administrative registries, which include data on all 5.4 million residents of Denmark. All suicides between January 1, 1994, and December 31, 2006, were included, and controls were selected from a sample of all Danish residents. Using this nested case-control design, the authors examined 9,612 suicide cases and 199,306 controls matched to cases on gender, date of birth, and time. Thirty-eight suicide cases (0.40%) and 95 controls (0.05%) were diagnosed with PTSD. The odds ratio associating PTSD with suicide was 9.8 (95% confidence interval: 6.7, 15). The association between PTSD and completed suicide remained after controlling for psychiatric and demographic confounders (odds ratio = 5.3, 95% confidence interval: 3.4, 8.1). Additionally, persons with PTSD and depression had a greater rate of suicide than expected based on their independent effects. In conclusion, a registry-based diagnosis of PTSD based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, is a risk factor for completed suicide.

Ethical research in refugee communities and the use of community participatory methods.

This article describes the distinct challenges associated with conducting ethical research with refugees. A case example of an ongoing study of stigma and access to mental health treatment among Somali refugee adolescents resettled in the USA is presented. In developing the study, standard research paradigms were critically examined in order to take account of the unique aspects of Somali culture and experience. Community participatory methods were adopted to uphold both ethical and methodological rigor in the research. A participatory approach for developing ethical protocols within different refugee communities is recommended.

Impact of health literacy on depressive symptoms and mental health-related: quality of life among adults with addiction.

AbstractBACKGROUND: Health literacy has been linked to health status in a variety of chronic diseases. However, evidence for a relationship between health literacy and mental health outcomes is sparse. OBJECTIVE: We hypothesized that low literacy would be associated with higher addiction severity, higher levels of depressive symptoms, and worse mental health functioning compared with those with higher literacy in adults with alcohol and drug dependence. METHODS: The association of literacy with multiple mental health outcomes was assessed using multivariable analyses. Measurement instruments included the Rapid Estimate of Adult Literacy in Medicine (REALM), the Center for Epidemiologic Studies-Depression (CES-D) scale, the Mental Component Summary scale of the Short Form Health Survey, and the Addiction Severity Index for drug and alcohol addiction. Subjects included 380 adults recruited during detoxification treatment and followed prospectively at 6-month intervals for 2 years. Based on the REALM, subjects were classified as having either low (≤8th grade) or higher (≥9th grade) literacy levels. RESULTS: In longitudinal analyses, low literacy was associated with more depressive symptoms. The adjusted mean difference in CES-D scores between low and high literacy levels was 4 (P <.01). Literacy was not significantly associated with mental health-related quality of life or addiction severity. CONCLUSIONS: In people with alcohol and drug dependence, low literacy is associated with worse depressive symptoms. The mechanisms underlying the relationship between literacy and mental health outcomes should be explored to inform future intervention efforts.

Perceived discrimination, psychological distress and health

Racism and discrimination can have significant implications for health, through complex biopsychosocial interactions. Latino groups, and particularly Puerto Ricans, are an understudied population in the United States in terms of the prevalence of discrimination and its relevance to health. Participants in our study were 45- to 75-year-old (N = 1122) Puerto Ricans. The measures were perceived discrimination, depressive symptomatology (CES-D), perceived stress (PSS), self-rated health, medical conditions, blood pressure, smoking and drinking behaviours, demographics. Our findings show that 36.9 per cent of participants had at some time experienced discrimination, with men, those with more years of education, currently employed and with higher incomes being more likely to report it. Experiences of discrimination were associated with increased levels of depressive symptoms and perceived stress. When controlling for covariates, perceived discrimination was predictive of the number of medical conditions, of ever having smoked and having been a drinker, and having higher values of diastolic pressure. Depressive symptoms are a mediator of the effect of perceived discrimination on medical conditions, confirmed by the Sobel test: z = 3.57, p < 0.001. Mediating roles of perceived stress, smoking and drinking behaviours were not confirmed. Increased depressive symptoms might be the main pathway through which perceived discrimination is associated with a greater number of medical diagnoses.

Mental Health Service Utilization of Somali Adolescents: Religion, Community, and School as Gateways to Healing

This mixed-method study examines the utility of the Gateway Provider Model (GPM) in understanding service utilization and pathways to help for Somali refugee adolescents. Somali adolescents living in the Northeastern United States, and their caregivers, were interviewed. Results revealed low rates of use of mental health services. However other sources of help, such as religious and school personnel, were accessed more frequently. The GPM provides a helpful model for understanding refugee youth access to services, and an elaborated model is presented showing how existing pathways to help could be built upon to improve refugee youth access to services.

Acute stress reaction and completed suicide.

BACKGROUND Acute stress reaction is a diagnosis given immediately following the experience of an exceptional mental or physical stressor. To the best of our knowledge, no study has examined the association between acute stress reaction diagnosis and suicide. The current study examined this association in a population-based sample. In addition, we examined comorbid psychiatric diagnoses as modifiers of this association. METHODS Data for the current study were obtained from the nationwide Danish health and administrative registries, which include data for all 5.4 million residents of Denmark. All suicides between 1 January 1994 and 31 December 2006 were included and controls were selected from a sample of all Danish residents. Using this nested case-control design, we examined 9612 suicide cases and 199 306 controls matched to cases with respect to gender, date of birth and time. RESULTS In total, 95 cases (0.99%) and 165 controls (0.08%) had a diagnosis of acute stress reaction. Those diagnosed with acute stress reaction had 10 times the rate of completed suicide compared with those without this diagnosis, adjusting for the control to case matching, depression and marital status (95% confidence interval 7.7-14). Additionally, persons with acute stress reaction and depression, or acute stress reaction and substance abuse, had a greater rate of suicide than expected based on their independent effects. CONCLUSIONS Acute stress reaction is a risk factor for completed suicide.

Inflammatory bowel disease and completed suicide in Danish adults

Background: The risk of suicide is increased among people with inflammatory bowel disease (IBD); however, most of the evidence regarding this association comes from studies of all‐cause mortality, with small numbers of people who have committed suicide, or from clinical case reports. The current study examined the association between the two forms of IBD: Crohns disease (CD) and ulcerative colitis (UC), and completed suicide in a population‐based sample. Methods: Data for this nested case–control study were obtained from the Danish national healthcare and social registries. We included 27,053 cases who completed suicide between January 1, 1981, and December 31, 2006. Controls were selected from the general population and matched to cases on gender, date of birth, and calendar time (n = 551,060). Results: There was an increased rate of suicide among participants with both CD (odds ratio [OR] = 1.6, 95% confidence interval [CI]: 1.1, 2.3) and UC (OR = 1.9, 95% CI: 1.4, 2.4), when adjusting for the matched factors and identified confounders. Conclusions: The current study suggests that physicians treating IBD patients should be vigilant about expressions of suicidal ideation or signs and symptoms of self‐harm. (Inflamm Bowel Dis 2010)

The Impact of Resistance Exercise Training on the Mental Health of Older Puerto Rican Adults With Type 2 Diabetes

OBJECTIVE To determine the impact of a 16 week high-intensity progressive resistance exercise training (PRT) program on the mental health of older Puerto Rican adults with type 2 diabetes. METHODS Fifty-eight Puerto Rican adults were randomly assigned to supervised PRT (n = 29) or a control group (n = 29). A secondary analyses were conducted, and 2 mental health outcomes, the Geriatric Depression Scale and the SF-36 mental component summary score, were used to assess the impact of PRT on mental health status. At baseline, no differences were found on measures of self-reported mental health status. RESULTS PRT participants had significantly improved mental health status at follow-up (16 weeks). DISCUSSION The incorporation of exercise into treatment planning for older adults may have important benefits on their mental health status. More work is needed to understand the mechanisms by which this occurred as well as the applicability of these findings to sustainable community programs.

The association between adjustment disorder diagnosed at psychiatric treatment facilities and completed suicide

Adjustment disorder is a diagnosis given following a significant psychosocial stressor from which an individual has difficulty recovering. The individual’s reaction to this event must exceed what would be observed among similar people experiencing the same stressor. Adjustment disorder is associated with suicidal ideation and suicide attempt. However the association between adjustment disorder and completed suicide has yet to be examined. The current study is a population-based case control study examining this association in the population of Denmark aged 15 to 90 years. All suicides in Denmark from 1994 to 2006 were included, resulting in 9,612 cases. For each case, up to 30 controls were matched on gender, exact date of birth, and calendar time, yielding 199,306 controls. Adjustment disorder diagnosis was found in 7.6% of suicide cases and 0.52% of controls. Conditional logistic regression analyses revealed that those diagnosed with adjustment disorder had 12 times the rate of suicide as those without an adjustment disorder diagnosis, after controlling for history of depression diagnosis, marital status, income, and the matched factors.