B. Heidi Ellis

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.

Belonging and Connection to School in Resettlement: Young Refugees, School Belonging, and Psychosocial Adjustment:

Schools are one of the first and most influential service systems for young refugees. There is a burgeoning interest in developing school-based refugee mental health services, in part to reduce stigma and increase treatment access for this population. Despite the relevance of gaining a better understanding of how refugee students experience schools in resettlement and how this relates to psychosocial adjustment, belonging and connection to school have not been previously investigated among a population of resettled refugees. This study examines school belonging and psychosocial adjustment among a sample of 76 Somali adolescents resettled in the United States. A greater sense of school belonging was associated with lower depression and higher self-efficacy, regardless of the level of past exposure to adversities. Notably, more than one-quarter of the variation in self-efficacy was explained uniquely by a sense of school belonging. School belonging was not significantly associated with posttraumatic stress symptom severity and did not moderate the effect of exposure to adversities on psychological adjustment. These results suggest that investigating ways of improving school experiences would be particularly useful in the effort towards continued development of school-based mental health programs for young refugees.

Past horrors, present struggles: The role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone

Upon returning to their communities, children formerly associated with armed forces and armed groups--commonly referred to as child soldiers--often confront significant community stigma. Much research on the reintegration and rehabilitation of child soldiers has focused on exposure to past war-related violence and mental health outcomes, yet no empirical work has yet examined the role that post-conflict stigma plays in shaping long-term psychosocial adjustment. Two waves of data are used in this paper from the first prospective study of male and female former child soldiers in Sierra Leone. We examined the role of stigma (manifest in discrimination as well as lower levels of community and family acceptance) in the relationship between war-related experiences and psychosocial adjustment (depression, anxiety, hostility and adaptive behaviors). Former child soldiers differ from one another with regard to their post-war experiences, and these differences profoundly shape their psychosocial adjustment over time. Consistent with social stress theory, we observed that post-conflict factors such as stigma can play an important role in shaping psychosocial adjustment in former child soldiers. We found that discrimination was inversely associated with family and community acceptance. Additionally, higher levels of family acceptance were associated with decreased hostility, while improvements in community acceptance were associated with adaptive attitudes and behaviors. We found that post-conflict experiences of discrimination largely explained the relationship between past involvement in wounding/killing others and subsequent increases in hostility. Stigma similarly mediated the relationship between surviving rape and depression. However, surviving rape continued to demonstrate independent effects on increases in anxiety, hostility and adaptive/prosocial behaviors after adjusting for other variables. These findings point to the complexity of psychosocial adjustment and community reintegration in these youth and have a number of programmatic and policy implications.

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.

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.

Multi-Tier Mental Health Program for Refugee Youth

OBJECTIVE We sought to establish that refugee youths who receive a multi-tiered approach to services, Project SHIFA, would show high levels of engagement in treatment appropriate to their level of mental health distress, improvements in mental health symptoms, and a decrease in resource hardships. METHOD Study participants were 30 Somali and Somali Bantu refugee youths in the English language learner classroom in a middle school in New England. Project SHIFA is a multi-tiered program including prevention and community resilience building for the community at large, school-based early intervention groups for at-risk students, and direct intervention using an established trauma model (trauma systems therapy) for those with significant psychological distress. Data were collected from students at time of enrollment, 6-month follow-up, and 12-month follow-up. Measures used were the War Trauma Screening Scale, Adolescent Post-War Adversities Scale-Somali version, UCLA PTSD Reaction Index for DSM-IV (Revision 1), and the Depression Self-Rating Scale. RESULTS Students across all tiers of the program demonstrated improvements in mental health and resources. Resource hardships were significantly associated with symptoms of posttraumatic stress disorder over time, and the stabilization of resource hardships coincided with significant improvements in symptoms of depression and posttraumatic stress disorder for the top tier of participants. CONCLUSIONS Project SHIFA is a promising model of treatment for young refugees.

Cognitive Behavioral Therapy for Symptoms of Trauma and Traumatic Grief in Refugee Youth

The diverse clinical presentation of refugee children and adolescents after their traumatic experiences requires a treatment model that can mitigate a number of internalizing and externalizing symptoms. Refugee populations also require interventions that can adjust to the wide-ranging experiences likely encountered during preflight, flight, and resettlement. There is some evidence that immigration stressors or social stressors, such as discrimination, are associated with symptoms of posttraumatic stress disorder in refugee youth. Therefore refugee youth may benefit from multiple levels of services, ideally integrated. This article focuses on the mental and behavioral health component of services for refugee youth.

Understanding the mental health of refugees: Trauma, stress, and the cultural context

In 2011 approximately 800,000 individuals were forcibly displaced from their homes and fled their countries. While the number of refugees generated that year was the highest in over a decade [1] it represents only 2 % of the overwhelming 42.5 million forced migrants. Most refugees flee their homes with little time to prepare [2] and, in turn, frequently are ill-equipped with the financial, linguistic, and other resources needed to address the challenges of their journey that lies ahead. The nature of the pre-migration and flight experiences for refugees, which are frequently marked by fear, forced departure, and experiences of torture and trauma, distinguishes them from other voluntary migrants. As Papadopoulos [3] stated, “…it is important to remember the obvious fact that becoming a refugee is not a psychological phenomenon per se; rather, it is exclusively a sociopolitical one, with psychological implications” (p. 301). As refugees resettle in third party countries, sometimes after prolonged stays in refugee camps, many experience mental health problems associated with past trauma, ongoing stress, or both. Since 1975 approximately three million individuals have been resettled in the USA [5]; this represents an important population to respond to clinically. In order to effectively serve this population, mental health professionals including, academics, researchers, and clinicians will need to understand the impact of the refugee experience and cultural context on psychological functioning. This chapter will review the unique mental health challenges and culturally adapted assessments and treatments targeting some of the world’s most vulnerable, yet resilient, populations.

Understanding Bhutanese Refugee Suicide Through the Interpersonal-Psychological Theory of Suicidal Behavior

Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressors such as illiteracy, family conflict, and being separated from family members were more associated. IPTS holds promise in understanding suicide in the resettled Bhutanese community.

Building community resilience to violent extremism through genuine partnerships.

What is community resilience in relation to violent extremism, and how can we build it? This article explores strategies to harness community assets that may contribute to preventing youth from embracing violent extremism, drawing from models of community resilience as defined in relation to disaster preparedness. Research suggests that social connection is at the heart of resilient communities and any strategy to increase community resilience must both harness and enhance existing social connections, and endeavor to not damage or diminish them. First, the role of social connection within and between communities is explored. Specifically, the ways in which social bonding and social bridging can diminish risk for violence, including violent extremism, is examined. Second, research on the role of social connection between communities and institutions or governing bodies (termed social linking) is described. This research is discussed in terms of how the process of government partnering with community members can both provide systems for early intervention for violent extremism, as well as strengthen bonding and bridging social networks and in this way contribute broadly to building community resilience. Finally, community-based participatory research, a model of community engagement and partnership in research, is presented as a road map for building true partnerships and community engagement.