Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

(see Appendix 2, available at [www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.090313/-/DC1][1] for summary of recommendations and clinical considerations)









There are more than 200 million international migrants worldwide,[1][2] and this movement of people has implications for individual and

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Evidence-based clinical guidelines for immigrants and refugees

This report presents the major findings of the second cycle of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003). In this initiative, data are collected every five years on child maltreatment reported to, and investigated by, child welfare agencies in Canada. The CIS is a collaborative effort of many partners: the federal, provincial and territorial governments; university-based researchers; the First Nations Child & Family Caring Society; child advocacy groups; and most important, child welfare service providers across the country.

Canadian Incidence Study of Reported Child Abuse and Neglect. 2000.

With the global increase in the number of refugees and asylum seekers, mental health professionals have become more aware of the need to understand and respond to the mental health needs of forced migrants. This critical review summarizes the findings of recent systematic reviews and primary research on the impact of post-migration conditions on mental disorders and PTSD among refugees and asylum seekers. Historically, the focus of mental health research and interventions with these populations has been on the impact of pre-migration trauma. Pre-migration trauma does predict mental disorders and PTSD, but the post-migration context can be an equally powerful determinant of mental health. Moreover, post-migration factors may moderate the ability of refugees to recover from pre-migration trauma. The importance of post-migration stressors to refugee mental health suggests the need for therapeutic interventions with psychosocial elements that address the broader conditions of refugee and asylum seekers' lives. However, there are few studies of multimodal interventions with refugees, and even fewer with control conditions that allow for conclusions about their effectiveness. These findings are interpreted using a social determinants of health framework that connects the risk and protective factors in the material and social conditions of refugees' post-migration lives to broader social, economic and political factors.

https://journals.sagepub.com/doi/pdf/10.1177/0706743717746666

The Social Determinants of Refugee Mental Health in the Post-Migration Context: A Critical Review.

The number of refugees across the globe is at an alarming high and is expected to continue to rise for the foreseeable future. As a result, finding durable solutions for refugees has become a major challenge worldwide. The literature reviewed and policy implications discussed in this article are based on the premise that one of the major solutions to the refugee crisis must be refugee resettlement in new host countries. For such a solution to succeed, however, requires relatively favorable attitudes by members of host societies, protection of the well-being of refugees, and effective integration of refugees into new host countries. In this context, we begin by reviewing the literature on determinants of public attitudes toward refugees, the acculturation of refugees in host societies, and factors affecting refugee mental health, all of which are directly relevant to the success of the resettlement process. We then turn our attention to the policy implications of these literatures, and discuss strategies for improving public attitudes toward refugees and refugee resettlement in host countries; for improving the resettlement process to reduce mental health challenges; and for supporting the long-term acculturation and integration of refugees in their new homes.

The Global Refugee Crisis: Empirical Evidence and Policy Implications for Improving Public Attitudes and Facilitating Refugee Resettlement

Background: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. Methods: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. Results: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. Interpretation: Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

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Common mental health problems in immigrants and refugees: general approach in primary care

Background: Child maltreatment is a significant worldwide public health problem. We conducted an evidence review on the screening, prevention, and treatment primary care practitioners can offer to prevent or reduce morbidity and/or mortality from child maltreatment in newly arriving immigrants and refugees. We also examined culturally specific clinical and equity issues. Methods: Using the GRADE approach, we systematically assessed evidence on screening, prevention, and intervention for child maltreatment. We then examined the benefits, harms, applicability, clinical considerations, and implementation issues relevant to recently settled immigrants and refugees. Results: Ethnic minority children in Canada and the United States (US) are over-screened and over-reported for child maltreatment, as compared to general population children. Screening instruments for child maltreatment are based on risk assessment and have unacceptably high false positive rates, which are associated with significant harms because of the risk of mislabeling parents for child maltreatment. Trauma-focused Cognitive Behavioral Therapy and theoretically-driven parenting programs may help reduce maltreatment or alleviate consequences related to it. Nurse home visitation programs with families living in disadvantaged conditions can reduce risk, child injuries, and trauma related to maltreatment and improve child developmental outcomes. Interpretation: Evidence against routine screening for child maltreatment outweigh benefits of screening because of harms from false labeling. Home visitation preventive strategies, however, may be effective for recently-settled immigrant and refugee families who live in high risk conditions and need support.

Appendix 12: Child maltreatment: evidence review for newly a rriving immigrants and refugees

Department of Psychology (Hassan), University of Quebec at Montreal, Transcultural Research and Intervention team, CSSS de la Montagne and the Groupe de Recherche et d’Action contre la Victimisation des Enfants (GRAVE), Montreal; Departments of Psychiatry; Epidemiology, Biostatistics, and Occupational Health; and Medicine (Thombs), McGill University and Jewish General Hospital, Montreal; Department of Psychiatry, Division of Social and Transcultural Psychiatry (Rousseau), McGill University, Transcultural Research and Intervention Team, CSSS de la Montagne, Montreal; Division of Social & Transcultural Psychiatry (Kirmayer), McGill University, Culture & Mental Health Research Unit, Sir Mortimer B. Davis-Jewish General Hospital, Montreal; Department of Family Medicine, Schulich School of Medicine and Dentistry (Feightner), University of Western Ontario; Campbell and Cochrane Equity Methods Group, Centre for Global Health, Institute of Population Health (Ueffing), University of Ottawa; Departments of Family Medicine and Epidemiology and Community Medicine, Centre for Global Health, Institute of Population Health and C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyere Research Institute (Pottie), University of Ottawa. Canadian Collaboration for Immigrant and Refugee Health (CCIRH)

Appendix 13: Intimate partner violence: evidence review for newly a rriving immigrants and refugees

Sur la corde raide: Penser les modalités de formation en prévention de la radicalisation violente

On retrouve un imperatif de formation des professionnels des milieux de la sante et de l’education dans la plupart des plans de lutte contre la radicalisation violente dont se sont dotes nombre de gouvernements. Peu d’etudes ont cependant evalue ces formations ou pense les processus qu’elles mobilisent. A partir de l’analyse qualitative de formations portant sur la prevention de la radicalisation violente au Quebec, cet article interroge les modalites de transmission de savoirs sur une telle thematique. En decrivant les mouvements que certains contenus ont suscites au sein des groupes de participants, nous proposons que la capacite a contenir l’incertitude et l’angoisse que genere l’ampleur des phenomenes de polarisation et leurs derives violentes est un des defis principaux de ces formations. Enfin, les dispositifs favorisant l’etablissement d’un climat de confiance dans le cadre des formations sont discutes de facon plus large.

Ghayda Hassan

Papers

Common mental health problems in immigrants and refugees: general approach in primary care

Appendix 12: Child maltreatment: evidence review for newly a rriving immigrants and refugees

Appendix 13: Intimate partner violence: evidence review for newly a rriving immigrants and refugees

Sur la corde raide: Penser les modalités de formation en prévention de la radicalisation violente

Sur la corde raide