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

Longing to belong: social inclusion and wellbeing among youth with refugee backgrounds in the first three years in Melbourne, Australia.

For young people with refugee backgrounds, establishing a sense of belonging to their family and community, and to their country of resettlement is essential for wellbeing. This paper describes the psychosocial factors associated with subjective health and wellbeing outcomes among a cohort of 97 refugee youth (aged 11-19) during their first three years in Melbourne, Australia. The findings reported here are drawn from the Good Starts Study, a longitudinal investigation of settlement and wellbeing among refugee youth conducted between 2004 and 2008. The overall aim of Good Starts was to identify the psychosocial factors that assist youth with refugee backgrounds in making a good start in their new country. A particular focus was on key transitions: from pre-arrival to Australia, from the language school to mainstream school, and from mainstream school to higher education or to the workforce. Good Starts used a mix of both method and theory from anthropology and social epidemiology. Using standardized measures of wellbeing and generalised estimating equations to model the predictors of wellbeing over time, this paper reports that key factors strongly associated with wellbeing outcomes are those that can be described as indicators of belonging e the most important being subjective social status in the broader Australian community, perceived discrimination and bullying. We argue that settlement specific policies and programs can ultimately be effective if embedded within a broader socially inclusive society - one that offers real opportunities for youth with refugee backgrounds to flourish.

Longing to belong : social inclusion and wellbeing among youth with refugee backgrounds in the first three years in Melbourne, Australia

Among the many stresses that undocumented Latino immigrants experience, worries about their legal status and preoccupation with disclosure and deportation can heighten the risk for emotional distress and impaired quality of health To better document these effects, this study examined the relationship between deportation concern and emotional and physical well-being among a group of Latino immigrants in a midwestern city One-hundred-forty-three persons were recruited through community sources Fifty-six participants (39%) expressed concern with seeking services for fear of deportation, while 87 did not endorse this concern Measures of emotional distress, Hispanic immigrant stress and subjective health status were administered Results indicate that Latino immigrants with concerns about deportation are at heightened risk of experiencing negative emotional and health states (particularly anger), Hispanic immigrant stress associated with extrafamilial factors and substandard health status Findings inform policymakers of culturally relevant stressors of undocumented Latino immigrants that help to create and perpetuate the health and mental health disparities of this group

Legal status, emotional well-being and subjective health status of Latino immigrants.

The United States today has approximately 39.9 million immigrants—the largest number in its history (Passel & Cohn, 2012; U.S. Census Bureau, 2011b). As a nation of immigrants, the United States has successfully negotiated larger proportions of newcomers in its past (14.7% in 1910 vs. 12.9% today) and is far from alone among postindustrial countries in experiencing a growth in immigration in recent decades. Notably, nearly three quarters of the foreign-born are naturalized citizens or authorized noncitizens (Congressional Budget Office [CBO], 2011). One in five persons currently residing in the United States is a firstor second-generation immigrant, and nearly a quarter of children under the age of 18 have an immigrant parent (Mather, 2009). As such, immigrants and the second generation have become a significant part of our national tapestry. Just as this demographic transformation is rapidly unfolding, the United States is facing international, domestic, and economic crises (Massey, 2010). Like other historical economic downturns (Simon, 1985), the current recession has served as a catalyst to make immigration a divisive social and political issue (Massey & Sánchez, 2010). Across the nation, immigrants have become the subject of negative media coverage (Massey, 2010; M. M. Suárez-Orozco, Louie, & Suro, 2011), hate crimes (Leadership Conference on Civil Rights Education Fund, 2009), and exclusionary political legislation (Carter, Lawrence, & Morse, 2011). Given the demographic growth, however, we now face an “integration imperative” (Alba, Sloan, & Sperling, 2011)—not only for the well-being of this new population but also for that of the nation’s social and economic future. Psychologists are, and increasingly will be, serving immigrant adults and their children in a variety of settings, including schools, community centers, clinics, and hospitals, and thus should be aware of this complex demographic transformation and consider its implications as citizens, practitioners, researchers, and faculty. This report aims specifically to describe this diverse population and address the psychological experience of immigration, considering factors that impede and facilitate adjustment. The report, which includes the recent theoretical and empirical literature on immigrants, (a) raises awareness about this growing (but poorly understood) population; (b) derives evidenceinformed recommendations for the provision of psychological services for the immigrant-origin population; and (c) makes recommendations for the advancement of training, research, and policy efforts for immigrant children, adults, older adults, and families.

Crossroads: The Psychology of immigration in the new century

The United States is a country of immigrants. With the exception of Native-Americans, every other American is, or descends from, an immigrant. First and second generation immigrant children are the most rapidly growing segment of the American population, with the great majority of this population being of non-European origin. This paper reviews the unique risk factors and mental health needs of our new immigrant populations, as well as treatment and services approaches to address their unique needs.

Mental Health of Immigrants and Refugees

One-third of the US Latino population is under the age of 18. Studies show a significant percentage of Latinos aged 12 or older use illegal substances. Acculturation, family relationships, and depression are contributing factors to this abuse. Previous studies concentrated on populations along the US-Mexico border. This study examined the relationship between illegal substance abuse, acculturation, family relationships, and depression in Latino adolescents aged 12 to 19 in Northeast Tennessee. The Pan American Youth Inventory was administered to 66 Latino youth. There was a significant relationship between substance abuse and depression, as well as substance abuse and lifetime suicide ideations.

Substance Abuse in Immigrant Latino Youth in Appalachia: Preliminary Findings

One-third of the US Latino population is under the age of 18. Studies show a significant percentage of Latinos aged 12 or older use illegal substances. Acculturation, family relationships, and depression are contributing factors to this abuse. Previous studies concentrated on populations along the U

JoAnne B. Pumariega

Papers

Mental Health of Immigrants and Refugees

Substance Abuse in Immigrant Latino Youth in Appalachia: Preliminary Findings

Substance Abuse in Immigrant Latino Youth in Appalachia: Preliminary Findings