Mental Health of Refugees : Etiology and Treatment

The book provides a comprehensive review of mental health in refugees by discussing its multiple dimensions, and analyzing epidemiology, etiology, and culturally adapted assessment and treatment. Key topics include why certain refugees cope successfully with traumatic experiences while others do not, and the biological, psychological, and social processes underlying posttraumatic stress disorder, common mental disorders, substance abuse and personality disorders. The text examines topics such as complexities of diagnosis, treatment, and recovery for refugees. Furthermore, the roles of culture, social support, and mental health workers in the process of overcoming mental health problems in refugees are discussed. Together, the chapters provide an in-depth examination of the current understood causes, and impacts of mental health problems and treatment of refugees to inform future work in the field. The book gives its readers a solid basis for understanding mental health problems of refugees and sets out to present practitioners with a state-of-the-art summary of all the latest developments and practical guidance. Furthermore, this book provides the practitioner with instructions on how culturally adapted treatments can be used not only with adults, but also with children and young people to help the practitioner to prepare for working with this difficult client group. Drawing from a range of different fields of study, this text will appeal to readers across psychological, mental health, medical, and academic disciplines. Acknowledgement Contents 1: Mental Health of Adult Refugees 1.1 Introduction 1.2 Host Countries of Refugees and Asylum Seekers 1.3 Risk of Mental Disorders 1.4 Post-migration Stressors 1.5 Detained Refugees and Asylum Seekers 1.6 Long-Term Effects 1.7 Prevention of Mental Health Problems 1.8 COVID-19 Pandemic 1.9 Summary of Risk and Protective Factors 1.10 Prevalence of Mental Disorders 1.11 Post-traumatic Stress Disorder 1.11.1 Prevalence 1.11.2 Cross-Cultural Factors 1.11.3 Complex Post-traumatic Stress Disorder 1.12 Anxiety and Depressive Disorder 1.13 Alcohol and Substance Abuse 1.14 Personality Disorders 1.15 Psychosis 1.16 Other Mental Health Problems 1.16.1 Suicidal Ideation and Suicide 1.16.2 Grief 1.16.3 Embitterment 1.17 Intimate Partner Violence 1.17.1 Prevalence of Intimate Partner Violence in Refugees 1.17.2 Cultural Values 1.17.3 Factors Influencing Intimate Partner Violence 1.17.4 Somatic Injuries 1.17.5 Risk of Mental Health Problems 1.17.6 Prevention 1.17.7 Poly-Victimization 1.18 Health Status of Asylum Seekers and Refugees 1.18.1 Somatization 1.18.2 Noncommunicable Diseases 1.18.3 Mental Health Consequences 1.18.4 Recent Developments 1.19 Migrant Mental Health and Aging References 2: Mental Health of Refugee Minors 2.1 Introduction 2.2 Prevalence of Mental Disorders 2.3 Unaccompanied Children 2.3.1 Chronic Trajectory of Mental Health Symptoms 2.4 Refugee Minors Living with Family 2.5 Child Marriage 2.6 Resignation Syndrome 2.7 Executive Functioning 2.8 Substance Abuse 2.9 Other Psychological Problems 2.10 Negative and Protective Factors 2.10.1 Parenting Behavior and Social Support 2.10.2 Attachment 2.10.3 Violence in Host Country References 3: Social Support and Resilience: Impact on Mental Health 3.1 Introduction 3.2 Resilience 3.2.1 Social Identity 3.2.2 Loss of Social Support 3.3 Post-traumatic Growth 3.3.1 Post-traumatic Growth in Refugees and Asylum Seekers 3.4 Resilience in Children and Adolescents 3.4.1 Refugee Youth 3.4.2 Family Stress Model and Resilience 3.5 Mental Health Stigma 3.5.1 Cultural Differences 3.5.2 Screening for Mental Health and Cultural Differences 3.6 Social-Cultural Determinants of Mental Health Inequalities 3.6.1 Discrimination 3.6.2 Integration Versus Acculturation 3.6.3 Differences Between Parents and Children 3.7 Social Support 3.7.1 Social Support and (Mental) Health 3.7.2 Social Support in Refugee Children 3.8 Concluding Remarks References 4: Cultural Adaptations of Mental Health Care 4.1 Introduction 4.2 Use of Mental Health Services 4.2.1 Cross-Cultural Variation in Symptomatology 4.2.2 Mental Health Diagnosis 4.2.3 Use of Interpreters 4.3 Cultural Identity 4.4 Culture and Mental Health 4.5 Barriers to Mental Health Care 4.6 Stigma Reduction Intervention 4.7 Explanatory Models of Mental Illness 4.8 Cultural Factors in Clinical Practice 4.8.1 Readiness of Psychotherapists to Work with Refugees 4.8.2 Cultural Competence of Mental Health Workers 4.8.3 The Role of Interpreters 4.9 Adaptation of Psychotherapy in Low- and Middle-Income Countries 4.10 Outcome of Interventions Across Different Racial/Ethnic Groups 4.10.1 Interventions for Young Refugees 4.10.2 Qualitative Research 4.11 Culturally Adapted Cognitive Behavior Therapy 4.12 Guidelines for Cultural Adaptation References 5: Assessment of Mental Health Problems 5.1 Introduction 5.2 Culture-Bound Values of Diagnosis 5.2.1 Lay Explanatory Models of Mental Illness 5.2.2 Impact of Patient Language Proficiency on the Quality of Assessment 5.2.3 Scoring of Questionnaires May Be Primed by Culture 5.2.4 Concluding Remarks 5.3 Cultural Formulation Interview 5.3.1 Research into the Usability of the Cultural Formulation Interview 5.4 Questionnaires 5.5 Assessment of Adults 5.5.1 Screeners to Assess Mental Health Problems 5.5.2 General Psychopathology 5.5.3 Post-traumatic Stress 5.5.4 Depressive Symptoms 5.5.5 Somatic Symptoms 5.5.6 Symptoms of Insomnia 5.5.7 Grief 5.5.8 Embitterment 5.5.9 Post-migration Living Difficulties 5.5.10 General Well-Being and Health Status 5.6 Assessment of Children and Adolescents 5.6.1 General Psychopathology 5.6.2 Depressive Symptoms 5.6.3 Post-traumatic Stress 5.7 Other Issues Relevant for Assessment 5.7.1 Assessing Partner Violence 5.7.2 Internet-Based Tools for Screening of Refugee Mental Health 5.7.3 Hierarchical Screening Model 5.8 Concluding Remarks References 6: Mental Health and Social Support Interventions 6.1 Introduction 6.2 Mental Health Gap Action Programme 6.3 Problem Management Plus 6.4 Problem Management Plus in Conflict-Affected Individuals 6.4.1 Gender-Based Violence 6.5 Group Problem Management Plus 6.5.1 Concluding Remarks 6.6 Problem Management Plus: Refugees and Asylum Seekers 6.6.1 Adapted Problem Management Plus 6.6.2 Concluding Remarks 6.7 Common Elements Treatment Approach 6.8 Skills-Training of Affect Regulation: A Culture-Sensitive Approach 6.9 Integrative Adapt Therapy 6.10 Method for the Empowerment of Trauma Survivors 6.11 Self-Help Plus 6.12 Value Based Counseling 6.13 Other Interventions 6.13.1 Depression 6.14 Digital Mental Health 6.15 Stepped Care References 7: Psychological Interventions for Post-traumatic Stress Disorder in Adults 7.1 Introduction 7.2 Prolonged Exposure for Post-traumatic Stress Disorder 7.2.1 Dissociation and Depersonalization 7.2.2 Cultural Factors 7.3 Imagery Rescripting 7.3.1 Refugees 7.4 Cognitive Processing Therapy 7.4.1 Refugees 7.4.2 Cognitive Therapy 7.4.3 Refugees 7.5 Mindfulness-Based Cognitive Therapy 7.5.1 Refugees 7.6 Stress Management 7.7 Eye Movement Desensitization and Reprocessing Therapy (EMDR) 7.7.1 Refugees 7.8 Narrative Exposure Therapy 7.8.1 Refugees 7.8.2 Brief Version of Narrative Exposure Therapy 7.8.3 Lay Counselors 7.8.4 Trauma-Informed Community-Based Intervention (NETfacts) 7.8.5 Concluding Remarks 7.9 Skills Training in Affect and Interpersonal Regulation (STAIR) 7.10 Pharmacotherapy 7.11 Concluding Remarks 7.11.1 Predictors of Treatment Outcome 7.11.2 Treatment Through the Internet 7.11.3 Post-migration Stressors References 8: Psychological Interventions for Refugee Minors 8.1 Introduction 8.2 Unaccompanied Refugee Minors 8.3 Treatment for Post-traumatic Stress in Children and Youth 8.3.1 Clinical Guidelines 8.4 Eye Movement Desensitization and Reprocessing (EMDR) 8.4.1 EMDR in Refugee Youngsters 8.5 Cognitive Behavioral Writing Therapy 8.5.1 Writing for Recovery 8.6 Narrative Exposure Therapy and KIDNET 8.6.1 War-Affected and Refugee Children and Adolescents 8.7 Trauma-Focused Cognitive Behavioral Therapy 8.7.1 Refugee Minors 8.8 START: Stress-Traumasymptoms-Arousal-Regulation Treatment 8.9 Integrated Treatment for Complex Trauma (ITCT) 8.10 Common Elements in Various Therapies 8.11 School-Based Interventions 8.11.1 Teaching Recovery Techniques 8.11.2 Early Childhood Education Program for Refugee Children 8.12 Family Interventions 8.13 Art Therapy/Music Therapy 8.13.1 Externalizing Problems 8.14 Anxiety and Depression 8.14.1 Early Adolescent Skills for Emotions (EASE) 8.14.2 Internet-Based Interventions 8.15 Concluding Remarks References 9: Substance Abuse, Personality Disorders, and Severe Mental Illness 9.1 Introduction 9.1.1 Psychosis 9.1.2 Asylum Seekers 9.2 Use of Mental Health Service 9.3 Alcohol and Substance Abuse 9.4 Substance Abuse and Intimate Partner Violence 9.5 Substance Abuse and Comorbid Post-traumatic Stress Disorder 9.6 Psychological Interventions for Comorbid Post-traumatic Stress and Substance Use Disorders 9.7 Practical Recommendations 9.7.1 Screening for Substance Abuse 9.7.2 Which Intervention? 9.8 Personality Disorder 9.9 Personality Traits 9.10 Treatment of Personality Pathology 9.10.1 Cognitive Therapy 9.10.2 Dialectical Behavior Therapy 9.10.3 Schema-Focused Therapy 9.10.4 Transference-Focused Therapy 9.10.5 Mentalization-Based Treatment 9.10.6 Which Intervention Is the Most Effective? 9.11 Treatment of Personality Pathology in Non-Western Cultures 9.12 Interventions for Adolescents with Personality Pathology 9.13 Personality Disorder and Substance Abuse 9.14 Psychosis 9.14.1 Differential Diagnosis 9.14.2 Young People 9.15 Prevention of Mental Disorders 9.16 Concluding Remarks References