“The Impact of Sexual Violence in the Democratic Republic of the Congo: Implications for the Care of Congolese Refugees” (July 2019) Allison D. Bosch
The Democratic Republic of the Congo (DRC) remains a hotbed of instability, violence, and human rights violations, driving the displacement and migration of millions of its citizens. The conflict in the DRC is characterized by widespread sexual violence. This paper assesses the profound physical and psychosocial consequences that persist through the process of migration and resettlement for victims of sexual violence from the DRC. A review of the limited survey data available indicates that providers should utilize a trauma-informed approach to best assist in the process of recovery for Congolese refugees who have experienced sexual violence. The effects of sexual violence, particularly psychosocial distress, are often compounded by pre-migration exposure to additional conflict-related traumas, and by the accumulation of post-migration stressors. By identifying and evaluating these stressors, healthcare providers can more effectively evaluate and manage the unique medical and psychosocial needs of this patient population.
Keywords: Refugees, Congolese, Trauma
“Impact of Family Separation in Refugee Populations” (August 2018) Rachel Mayo
Refugees often experience family separation after relocation to the United States and other host nations. Family separation is a significant stressor affecting overall health in various ways. This paper explores research documenting these health effects. Additionally, the paper provides a summary of barriers to family reunification, including current policies and costs. Special consideration is given to the effect of separation on children, a particularly vulnerable population. Lastly, practical topics for providers serving refugees dealing with family separation are discussed.
Keywords: Refugees, Family Reunification, Child Separation
“The Concept of Depression in Afghan Refugees” (January 2018) Thuy Ho
Depression is one of the most common issues for which patients from any population are seen by primary care providers. For patients with a refugee background, depression is especially prevalent, along with other psychological conditions such as post-traumatic stress disorder (PTSD) and anxiety. Refugees experience displacement and disruption of life during the resettlement process, and many refugees are also exposed to trauma and violence, which play a role in the development of depression. People from Afghanistan comprise a significant portion of the refugee population in Charlottesville, VA, who receive care at the University of Virginia International Family Medicine Clinic. This paper provides an overview of the conceptualization, symptoms, and treatment of depression in the cultural context of refugees from Afghanistan using a patient case and published literature, and includes an appendix of a validated, culturally-adapted symptom checklist for mental health assessment research.
Keywords: Mental Health, Afghan, Depression, Concepts of Mental Illness
“From Classroom to Clinic: A Discussion of Mental Health Access for Refugee Youth in Charlottesville, Virginia” (April 2017) Nicele Puente
This introductory study investigates mental health support available for refugees aged 14-20 in Charlottesville, Virginia, by assessing the integration of clinical and education resources to support refugee youth. The methods used include subjective survey responses from primary health care providers, public school educators, and local community managers to determine “the perception of need in this population, how effectively the existing system connects potential patients to care, and how the process of patient identification and referral can be improved.” Responses from the 18 survey participants are discussed, and facilitating and limiting factors are identified. Six recommendations based on the findings include: perform a standard baseline mental health screen on all eligible family members; make it a priority to obtain the family “flight history” soon after arrival; establish early contact between the primary care physician and the ESL and/or primary teacher; normalize mental wellness concepts and assessments with refugee families early and often; emphasize language support appropriate to the communication needs of refugee youth and their adult representatives; establish an interdisciplinary protocol specifically for the custody and communication of mental health information between appropriate providers”. Both clinicians and educators agree on the importance of considering the “life experience” of the refugee youth and the need to improve communication and collaboration to better support the young refugees in their care. Acting on this shared sentiment with a more coordinated approach would improve the identification process and allow more children in need to connect with services.
Keywords: Mental Health, Refugee Youth, Clinicians, Teachers, Resettlement, Stress, Trauma, Language Barriers, Communication, Collaboration
“Barriers to Mental Health Treatment within the Congolese Population” (October 2016) Stephanie Espinoza
Congolese refugees are one of the major groups resettled in central Virginia. This paper explores the background of this population and the recent crisis situations in the Democratic Republic of the Congo, tying this history to an increased risk for and higher prevalence of mental health illness. Barriers to mental health treatment are explored, including a different perception of mental illness, dependence on treatment within their own community, and lack of mental health screening. Possible interventions are also set forth, including community service, education, and mental health screening.
Keywords: Mental Health, Congolese, Treatment Barriers, Screening, Interventions
“Translated Mental Health Screening Tools in Refugee Populations” (August 2016) Sara Julian
Immigrant and refugee populations may be particularly vulnerable to mental health disorders, and addressing mental health issues in these populations can be very difficult. This paper asserts that many primary care providers miss diagnoses of mental health disorders, but validated screening tools can help to minimize this problem. However, translation of these tools can be challenging due to “cultural relevance, eliciting accurate answers in the face of stigma, and differences in symptom presentation and conception of disease.” In addition, clinicians must be familiar with cutoff values and appropriate usage of each screening tool. This paper focuses on well-validated translations of several tools in languages commonly encountered at the IFMC and other primary care clinics at UVA. These languages include Spanish, Nepali, and Arabic. Ideal cutoff values for screening purposes are noted with each. Screening tools explored include the Hopkins System Checklist and Harvard Trauma Questionnaire, screening tools for depression such as the PHQ-9, and additional tools for depression screening in special populations such as the Hospital Anxiety and Depression Scale (HADS) for inpatients and the Edinburgh Postnatal Depression Scale (EPDS) for pregnant women.
Keywords: Mental Health, Screening Tools, Cultural Relevance, Translation, Spanish, Nepali, Arabic, HSCL, HTQ, PHQ-9, HADS, EPDS
“An Overview of the Unique Mental Health Challenges Facing the Bhutanese Refugee Population” (November 2014) Spencer Liebman
The Lhotsampa are a Nepalese-speaking group of people who lived in Bhutan but were forced to leave in the early 1990s for political or cultural reasons. This paper provides an overview of unique mental health challenges in this population. Many of this group suffered physical torture and other abuses, including 90% who reported also suffering torture not involving the body according to one referenced study. The tortured group had significantly more PTSD, depression, and anxiety symptoms than the control group of refugees who had not been subject to torture. The torture group also complained of more musculoskeletal, vision, hearing, sleep, sexual desire, and appetite problems. The paper further discusses the diagnostic characteristics of PTSD as a diagnosis featuring western ideals, which may not appropriately capture the impact on the lives of Bhutanese or other Southeast Asian populations. Concepts of mental illness among SE Asian populations are briefly explored. Clinicians working with this population need to be alert for symptoms of depression, anxiety, and PTSD, but also need to recognize somatization, dissociation, and negative coping strategies as possible markers for greater mental health distress.
Keywords: Mental Health, Bhutanese, Torture, PTSD, Depression, Anxiety, Concepts of Mental Illness
“Emigration History and Symptom Survey” (August 2005) Brandon Webb
This project is a collection of survey tools and scoring instructions for use in screening refugees for mental health symptoms or illness. Tools for use include: Hopkins Symptom Checklist-25 Anxiety Subscale, Hopkins Symptom Checklist-25 Depression Subscale, Symptoms Checklist-90 Somatization Subscale, Harvard Trauma Questionaire PTSD Symptoms Subscale, Emigration History Questionaire, and English Proficiency Questionaire. Scoring instructions include how to score the surveys as well as cutoff values that are diagnostically significant.
Keywords: Emigration History, Symptom Survey, Screening Tools, HSCL, HTQ
“Somatization: Issues in Refugee Mental Health” (September 2003) Jennifer Edwards
Abstract: “In this review I discuss the phenomenon of somatization in the refugee population. Somatization may be defined loosely as the presentation in a medical setting with medically unexplained symptoms. However, this definition lacks both clinical and investigative utility in that it addresses neither etiology, nor the specific and quantifiable details of presentation. Thus, any discussion of somatization must begin with an attempt to resolve the prevailing and often contradictory uses of the term. In addition, such a discussion becomes increasingly complex when one applies the word, which is steeped in Western theory of the nature of mind and body experience, to cultures of an entirely foreign ken. Thus, the implications of cross-cultural study of somatization must also be addressed. Finally, I will briefly review some studies of demographic variables associated with somatization, somatization as a response to trauma, and somatization within the refugee population specifically. In conclusion, I will address an area which I believe deserves further investigation: the role of language in somatization.”
Keywords: Somatization, Mental Health, Language, Culture, Trauma