Mental Health

Background

Relocation and resettlement are often accompanied by physical, mental, and social challenges for migrant youth. Community-based programs have the potential to benefit their wellbeing and resettlement. However, there is limited research on the mechanisms by which these interventions work from the perspective of youth, including during the COVID-19 pandemic. By including youth’s lived experiences, community-based programs may gain a richer understanding of how to best deliver their programs and contribute to the wellbeing of migrant youth during the pandemic.

Objectives

This study aimed to:
1) Describe migrant youth’s experiences participating in Say Ça!, a community-based welcome program in Montreal, during the pandemic; and
2) Explore the underlying processes that contribute to migrant youth’s wellbeing and resettlement from the perspectives of service users, and how these have been affected by the pandemic.
Methods.

Six youth from Say Ça! participated in a photo novella project to reflect on their experiences in the program during COVID-19 and how these contributed to their wellbeing. Semi-structured online interviews were conducted to document the meaning behind the journal entries and accompanying images.

Results

Participants identified challenges and benefits on youth wellbeing of engaging in the program during the pandemic. Lessons are drawn on the underlying processes of effective community-based welcome programs and necessary changes to best respond to the needs of migrant youth during the COVID-19 pandemic.

Globally, the COVID-19 pandemic is causing extensive morbidity and mortality and is fueling psychological distress across populations. Early evidence has shown an increase in anxiety, depression and sleep problems in the general population.1
,2
Although pandemics shatter the functioning of communities and families globally, there is a paucity of studies targeting the effects of pandemics on youth mental health.
As mental health professionals, our fields have become aware of how the COVID-19 outbreak represents an extraordinarily stressful experience for youths, including how necessary public health measures may also threaten personal and collective meaning-making, and disrupt family dynamics and youths’ usual social environment. Because of the COVID-19−related school closures and social distancing measures, millions of children have been confined at home. Although families, communities, and schools have attempted to adapt, at times successfully, many children and youth have been deprived of structured support, trapped in dysfunctional family settings, and are relying largely on peer relations through the unsupervised use of social media.3
In the absence of much needed evidence, clinical experience and available evidence on stress-related disorders in emergency settings is provisionally informing clinical practice and defining the role of child mental health services during a pandemic. Although it is impossible and premature to address all aspects of pediatric mental health during the COVID-19 pandemic, it is important to begin conceptualizing what this pandemic has meant for our practice and where and how we can promote pediatric mental health during a global emergency that is not currently remitting.

Adolescence is a critical period of development, when one-in-five psychiatric disorders emerge. Anxiety, depression, and suicide are the most common. However, most children and youth in need of mental health services in Canada do not have access to them. There is limited information about education and support programs for parents of adolescents to promote their children’s mental health, particularly among ethno-cultural populations. Moreover, the quality of studies focused on these programs is variable. An
environmental scan was conducted to identify community-based programs across Canada oriented to assist the parents of adolescents in the promotion of mental health, as well as the challenges and areas for improvement of these interventions. Alongside, a scoping review of the international and Canadian literature on this topic was carried out. This Policy Brief presents the results and recommendations of both studies.

En France, les mineurs non accompagnés (mna) rencontrent de multiples obstacles qui peuvent avoir des effets négatifs sur leur santé mentale. Les professionnels de la santé et du social qui participent à leur prise en charge doivent développer et mettre en œuvre des approches et outils adaptés aux réalités des mna et qui leur offrent un espace d’interactions le plus ouvert possible. À partir d’une revue de littérature, nous proposons dans cet article de dresser un état des lieux de la santé mentale des mna et d’identifier les approches ainsi que les outils développés et mis en œuvre par les professionnels qui visent à favoriser la communication et l’expression des mna (notamment l’approche interculturelle, le travail en interdisciplinarité, l’art-thérapie). Nous formulons en conclusion plusieurs pistes de réflexion à l’endroit des professionnels et des pouvoirs publics qui travaillent avec ce jeune public migrant.

Guide à l’intention du personnel enseignant pour favoriser le développement du bien-être et de la santé mentale en contexte scolaire au vu des nouvelles réalités imposées par la pandémie

A position statement developed by the Canadian Psychiatric Association’s (CPA) Transcultural Section and approved by the CPA Board of Directors on July 9, 2020

The field of refugee family research and intervention forms a growing field of scientific study, focussing on the refugee family as the central niche of coping with, and giving meaning to, trauma, cultural uprooting, and exile. This important new book develops an understanding of the role of refugee family relationships in post-trauma healing and provides an in-depth analysis of central clinical-therapeutic themes in refugee family psychosocial interventions. Expert contributions from across transcultural psychiatry, psychology, psychotherapy and social work have provided chapters on post-trauma reconstruction in refugee family relationships, trauma care for refugee families, and intersectorial psychosocial interventions with refugee families. This exploration of refugee family systems in both research and clinical practice aims to promote a systemic perspective in health and social services working with families in refugee mental health care.

L’étude Réactions a pour but de comprendre de façon longitudinale l’expérience des enfants et adolescents d’âge scolaire de la pandémie de la COVID19 ainsi que ses effets sur eux-mêmes et leurs parents. Plus précisément, il s’agit de :1) Dresser un portrait des connaissances et de la compréhension des jeunes de  la pandémie de la COVID19; 2)Explorer les représentations des jeunes des conséquences positives et négatives des mesures de prévention et de protection imposées en réponse à la COVID19; 3) Identifier les facteurs qui contribuent et nuisent au bien-être des enfants, des adolescents et de leur parent en contexte de confinement et de déconfinement; 4) Décrire l’évolution du bien-être, du fonctionnement parental, du fonctionnement familial et du soutien social des familles du Québec au cours de la crise de la COVID19; 5) Générer des connaissances pouvant être mobilisées par les décideurs afin d’être mieux préparés pour soutenir les familles lors de prochaines situations de crise.

The worldwide upsurge in social polarizations generates intercommunity  tensions that challenge the social fabric of urban neighborhoods and undermine the relationships between their members. Because community arts can foster the creation of connections between people that would not have been in contact otherwise, they are often perceived as being powerful tools to foster community resilience. Through a multiple case study approach, this article describes how three community arts projects, carried out in two socioeconomically deprived neighborhoods of Montreal (Canada), influenced the social relationships between participants from diverse ethnocultural backgrounds and generations. Using participant observation and arts‐based data collection methods (photography, video, and arts productions), the authors examine how the three projects illustrate (a) the interactive processes at play, (b) the transmission and hybridization of stories and images of adversity and resiliency, and (c) the access to a collective voice.

Objectives
The Ebola virus disease (EVD) is associated with major mental health consequences (e.g., depression, anxiety, PTSD). Studies have shown a need for relevant and effective programs to address mental health consequences associated to EVD. This systematic review aimed to describe programs implemented following EVD outbreaks and to evaluate their effectiveness and relevance in order to provide evidence-based data to improve mental health services.

Methods
We first searched EMBASE, PubMed, PsycINFO, PILOTS, Cochrane Library and MEDLINE for a systematic review on EVD and on MHPSS programs. Then, we searched the grey literature. The search generated 2827 publications. Eleven studies were retained according to the PRISMA statement.

Results
This systematic review revealed that most programs were implemented by international organizations in collaboration with local partners. Many of them were implemented following WHO mhGAP and Psychological First Aid guidelines. Programs were implemented in hospitals, Ebola treatment centres, communities among different categories of individuals exposed to EVD (survivors, health workers and volunteers, other frontline workers, children, adults, etc.). Only two of the identified programs which integrated cultural factors were empirically evaluated. Results from the evaluations showed mental health improvement for both children and adults.

Conclusions
This study provides the first systematic review on MHPSS programs among communities affected by EVD. This study shows the need to increase efforts to systematically document and evaluate the implemented programs. Results also provide preliminary evidence about the value of culturally sensitive MHPSS programs and of the implication of local mental health professionals.

The number of refugee youth worldwide receives international attention and is a top priority in both academic and political agendas. This article adopts a critical eye in summarizing current epidemiological knowledge of refugee youth mental health as well as interventions aimed to prevent or reduce mental health problems among children and adolescents in both high- and low-to-middle-income countries. We highlight current challenges and limitations of extant literature and present potential opportunities and recommendations in refugee child psychiatric epidemiology and mental health services research for moving forward. In light of the mounting xenophobic sentiments we are presently witnessing across societies, we argue that, as a first step, all epidemiological and intervention research should advocate for social justice to guarantee the safety of and respect for the basic human rights of all refugee populations during their journey and resettlement. A constructive dialogue between scholars and policy makers is warranted.

To date the literature on religion and mental health has focused upon Christianity. We cannot assume that these findings can be transposed onto other faith groups. In this paper I focus upon Islam, Judaism and Hinduism and discuss understandings of mental illness and the relationships between central beliefs and mental health. I discuss implications for clinical work and psychotherapy.

Introduction : La « démence » est généralement vue comme un syndrome caractérisé par le déclin d’une ou de plusieurs capacités cognitives, comme la perte de mémoire. Toutefois, perte de mémoire ne signifie pas pour autant démence. La plus fréquente des démences est la maladie d’Alzheimer dont la fréquence augmente avec le grand âge. En anthropologie de la santé, les maladies et leur expression représentent des construits socio-culturels qui ne sont pas reconnus et interprétés de la même façon par tout le monde. Par ailleurs, le contexte migratoire est source de difficultés dans le domaine de la démence. Cet article vise à discuter les liens entre vieillesse, démence et recherche d’aide dans ce contexte.
Méthode : Nous nous appuyons sur une étude qualitative exploratoire. Dix entrevues semi-structurées ont été réalisées avec des femmes et des hommes nés en Haïti et qui ont ensuite immigré au Québec. Ces entrevues nous ont permis de discuter du statut des aînés, du sens donné à la perte de mémoire et de la recherche d’aide.
Résultats : Les entrevues révèlent une pluralité des représentations à propos des pertes de mémoire et de la maladie d’Alzheimer. Elles mettent en lumière une diversité de croyances, d’attitudes et de valeurs traduisant une variabilité culturelle et sociale au sein d’une même communauté. La prise en compte du contexte permet de comprendre tantôt la transformation, tantôt la continuité des représentations et des conduites vis-à-vis des pertes de mémoire.
Conclusion : La démence ne semble pas être un phénomène qui est abordé facilement au sein de la communauté haïtienne du Québec. Au final, cette étude révèle un manque d’information à ce propos.

Les croisements entre trauma et violence sont souvent pensés sous l’angle de la violence subie, le premier s’inscrivant dans le sillage de la seconde. Les effets de la violence se traduisent alors en symptômes, mais aussi en agir, dans des cycles de répétition traumatique où la personne traumatisée peut se remettre dans des situations de risque. Qu’ils empruntent le vocabulaire de la psychanalyse ou celui d’approches biomédicales, de nombreux écrits en psychologie mettent ainsi de l’avant le caractère déstructurant de la violence traumatique.

Although structural violence and social inequality affect youth physical and mental health throughout the world, the problem of violent radicalization (VR) has more recently emerged as an area of concern for professionals working with youth. Radicalization is a dynamic, complex process that is generated and fueled by intercommunity frictions and conflicting political, social, and economic discourses and interests. It takes the form of a shift away from a moderate point of view to a rigid one that rejects the status quo and demands drastic societal change, although not necessarily through violence.² Violent radicalization is when radicalization includes the support of or the plan to use violent measures, including hate crimes and incidents and/or mass killings, often targeting a group characteristic (race, religion, gender orientation and identity, or political views), to achieve one’s goals of social change.

Around the world, armed conflicts force people to leave their homes, families, and communities in search of protection from collective violence, and seek to regain a meaningful perspective on their lives within the borders of their Western host societies. As the dynamics of organized violence and forced displacement continue to impact and disrupt relationships in refugee communities, scholars in the field of refugee trauma care have increasingly argued for the need to understand spaces that are able to restore safety, meaning, and connectedness in the process of post-trauma reconstruction within those disrupted communities. This is reflected in the growing interest in community-based psychosocial interventions. In this article, we focus on applied theatre interventions with refugee communities. In doing so, we aim to understand the restorative role of within-group interactions in applied theatre. We performed a case study of a community-based applied theatre project with Syrian refugees who were recently resettled in Belgium. The qualitative analysis that was the result of this case study allows us to develop an understanding of the various processes of coping with trauma and exile that are at play in within-group interactions between Syrian community members in applied theatre, against a background of authoritarian rule, collective violence, and forced displacement.

Highlights
Within-group interactions in applied theatre can play a r5restorative role in coping with trauma and exile in refugee communities.
The group in applied theatre provides participants a temporary safe haven.
Within-group interactions reinstall a sense of personal continuity.
Within-group interactions install a sense of hope for political and social change.
Within-group interactions enable participants to reshape cultural belonging.

Although collaborative care was adopted in several countries, including Canada, to improve the health and social services system, partnerships are often experienced as challenging. In many cases, transformative partnership remains a political rhetoric rather than a practical reality. This article presents an analysis of partnership relationships in youth mental health (YMH) using insights from game theory and a qualitative analysis of interactions during transcultural interinstitutional and interdisciplinary case discussion seminars (TIICDSs).

Drawing on the analysis of 40 seminar sessions and six focus groups with seminar participants conducted in Montréal (Canada) between October 2013 and April 2015, this article interrogates the conditions and processes present in TIICDSs that contribute to building and strengthening YMH partnerships, examining how tensions among TIICDS participants are attended to.

Research results indicate that TIICDSs can be seen as a game operating under different rules than real-life clinical work. They are characterized by the establishment of a climate of trust and respect, a high value placed on diversity and creativity, a concern for affects and power dynamics, a process of inclusive dialogue and negotiation, and a consideration for continuity. The game rules allow participants to safely apprehend a situation from a different perspective, a key competence in intercultural and collaborative YMH care. Results also indicate that participants complexify their representations by playing with divergent perceptions of people and situations and that enhanced case formulations are collective game outcomes. In light of our findings, tensions in collaborations can be seen as constituting both obstacles that can be counterproductive if not attended to, as well as powerful and useful learning tools that, under certain conditions, can support the clinical process and contribute to partnership building. Some clinical and partnership impasses may be overcome through clinical case discussions that allow partners to address these tensions and negotiate power relationships.

Background: Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families.

Methods: The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention

Background: Considering the growing number of asylum-seeking children worldwide, research
on interventions which may buffer the effects of early resettlement conditions on asylum-seeking
children’s adjustment is warranted. In Canada, creative expressive workshops for asylum-seeking
children and adolescents were implemented as a Psychological First Aid (PFA) intervention in
temporary shelters. The present exploratory study aims to describe the implementation of
these workshops to assess whether the intervention met core elements of PFA and explore its
potential in supporting the diverse needs of asylum-seeking youth in temporary shelters, adopting
a process-evaluation research approach.
Method: The intervention was evaluated via a qualitative thematic analysis of extensive field and
supervision notes and focus groups with facilitators.
Results: Preliminary results suggest that the intervention contributed to fostering emotional safety
and a sense of normalcy in children and supported the creation of connections among both children
and parents. Children’s expression of past and present experiences during the workshops was seen
as a way to promote self-efficacy in children and was reported as a potential way to provide some
comfort and hope in a time of high instability. However, the high needs of children and the lack of
resources in the temporary shelters represented significant challenges and barriers.
Conclusions: PFA using creative expression may be a promising youth mental health prevention
intervention in temporary shelters

OBJECTIVE:

The overall aim of this article is to examine the self-defined role of romantic relationships, intimacy and sexuality in recovery from severe mental illness.

METHOD:

Semistructured interviews were conducted with 35 people with severe mental illness, accompanied by participant observation. Data were analyzed using thematic analysis.

RESULTS:

The vast majority of participants considered a supportive relationship that was emotionally or sexually intimate to be a key facilitator and indicator of recovery. However, only a small minority of participants were actually in such a relationship. Participants reported numerous barriers to forming and maintaining such relationships such as financial strain and enduring stigma against people with mental illness.

Addressing relational and intimate needs have not been a focus of traditional psychiatric services. As such, some form of “supported dating” within the field of psychosocial rehabilitation may be an essential development to foster an oft-overlooked but important aspect of recovery

Recent changes in U.S. immigration policies and enforcement have precipitated a 300% rise in arrests and planned deportations. Although some family members face deportation, other family members may have state-sanctioned status. Such mixed status puts hundreds of thousands of families at risk of forced separation and associated mental health problems. Building on cross-cultural work with refugee families and other groups and on work with families separated by parental incarceration, the authors provide recommendations to guide clinicians working with families who are separated or who fear separation. Mental health problems among separated families can in part be addressed through identifying the origins of distress, elucidating family structures and roles, strengthening communication practices, linking with legal and economic resources, and facilitating decision making through distress reduction.

Le contre-transfert culturel est un concept qui souligne la dimension socioculturelle, et donc collective, du contre-transfert. Dans ce texte, nous analysons, au moyen de cinq histoires cliniques présentées dans le cadre de séminaires de discussion de cas transculturels et interinstitutionnels menés à Montréal, Canada, les diverses formes que peut prendre le contre-transfert culturel pour des cliniciens en situation d’impasse thérapeutique face à la prise en charge de familles migrantes. Nous examinons ensuite le rôle éventuel de ces séminaires dans la transformation de ce contre-transfert et dans la formulation de pistes permettant de relancer ou de soutenir le processus thérapeutique. Les résultats indiquent que les séminaires transculturels et interinstitutionnels de discussion de cas facilitent un travail d’élaboration sur les représentations collectives des cliniciens et que ce travail groupal permet de contenir et parfois de dépasser certaines situations d’échec thérapeutique.

With the sharp increase of refugees’ arrival and resettlement in western communities, adequate mental health care forms a pivotal dimension in host societies’ responses to those individuals and communities seeking protection within their borders. Here, clinical literature shows a growing interest in the development of family therapy approaches with refugees, in which therapeutic practice engages with the pivotal role of refugee family dynamics in posttrauma reconstruction and adaptation in resettlement and aims at supporting posttrauma reconstruction through strengthening capacities to restore safety, meaning and connectedness within family relationships. In this article, we focus on the narrative restoration of meaning as central mode of posttrauma reparation and explore its specific dynamics and relational complexities in the context of therapeutic practice with refugee families. Hereto, we integrate theoretical and clinical scholarly work on trauma narration and its intersection with empirical findings on trauma communication in refugee families. Furthermore, we develop case reflections to illustrate different processes of engaging with trauma narration in refugee family therapy. This analysis develops an understanding of the multivoiced ways in which refugee families engage with traumatic suffering through different modes of expression that may entail both narration and silence and explores how family therapeutic practices can engage and mobilize voices of narration and silence as relational stories of restoration.

Recent changes in U.S. immigration policies and enforcement have precipitated a 300% rise in arrests and planned deportations. Although some family members face deportation, other family members may have state-sanctioned status. Such mixed status puts hundreds of thousands of families at risk of forced separation and associated mental health problems. Building on cross-cultural work with refugee families and other groups and on work with families separated by parental incarceration, the authors provide recommendations to guide clinicians working with families who are separated or who fear separation. Mental health problems among separated families can in part be addressed through identifying the origins of distress, elucidating family structures and roles, strengthening communication practices, linking with legal and economic resources, and facilitating decision making through distress reduction.

Aim

Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes.

Method

We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post‐secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation.

Results

Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study.

Conclusions

Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.

Abstract Background

The objective of this article is to present an overview of the burden, spectrum of diseases, and risk factors for mental illness among subgroups of migrants, namely immigrants, refugees, and individuals with precarious legal status. This expert review summarizes some of the implications for primary care services in migrant receiving countries in the global North.

Methods

A broad literature review was conducted on the epidemiology of mental health disorder in migrants and refugee and on the available evidence on mental health services for this population focusing on key issues for primary care practitioners in high income countries.

Results

Although most migrants are resilient, migration is associated with an overrepresentation of mental disorder in specific subpopulations. There is general consensus that stress related disorders are more prevalent among refugee populations of all ages compared to the general population. Relative to refugees, migrants with precarious legal status may be at even higher risk for depression and anxiety disorders. Persistence and severity of psychiatric disorders among migrant populations can be attributed to a combination of factors, including severity of trauma exposures during the migration process. Exposure to stressors after resettlement, such as poverty and limited social support, also impact mental illness. Services for migrants are affected by restricted accessibility, and should address cultural and linguistic barriers and issues in the larger social environment that impact psychosocial functioning.

Conclusion

There is substantial burden of mental illness among some migrant populations. Primary care providers seeking to assist individuals need to be cognizant of language barriers and challenges of working with interpreters as well as sensitive to cultural and social contexts within the diagnosis and service delivery process. In addition, best practices in screening migrants and providing intervention services for mental disorders need to be sensitive to where individuals and families are in the resettlement trajectory.

Morocco has become a permanent transit country for tens of thousands of sub-Saharan migrants heading to Europe. Many of these migrants are women who have a precarious legal status and can no longer reach Europe, whose borders have been considerably securitized since September 11, 2001. They also have no wish to risk their lives again returning south across the Sahara Desert. This paper discusses the results of an exploratory research project conducted in Morocco on the relationships between the sub-Saharan migrant women’s traumatic experiences, social invisibility, and emotional distress in the context of a massive securitization of Euro-Mediterranean borders.

Les exemples liés à l’utilisation de l’art comme moyen d’expression et de transformation foisonnent chez les autochtones. Toutefois, nous en connaissons peu sur ce qui se produit en termes de transformations via l’art et la créativité du point de vue de l’expérience des jeunes eux-mêmes. Cette étude, s’insérant dans un devis ethnographique, porte un regard phénoménologique sur un collectif de cirque (Artcirq) dans une communauté inuit et vise à mieux comprendre le vécu des jeunes qui y participent. Nos données de recherche incluent à la fois des entrevues avec les jeunes inuit impliqués dans Artcirq, des notes et observations de terrain et des entretiens complémentaires avec divers acteurs de la communauté. Nos analyses nous amènent à décrire trois dimensions centrales à l’expérience des jeunes, relativement à Artcirq comme espace : 1) où reconnaître et développer ses forces ; 2) où se lier et appartenir et 3) où vivre sa culture inuit et la transmettre. Les implications potentiellement thérapeutiques de tels espaces communautaires au service du mieux-être des jeunes inuit sont évoquées en discussion.

Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners with crucial background information to improve their capacity to work efficiently and with maximum benefit. In this paper, we draw on experience implementing desk review guidance from the World Health Organization (WHO) and UNHCR, the United Nations Refugee Agency (2012) in four diverse humanitarian crises (earthquakes in Haiti and Nepal; forced displacement among Syrians and Congolese). We discuss critical parameters for the design and implementation of desk reviews, and discuss current challenges and future directions to improve mental health care and psychosocial support in humanitarian emergencies.

Researchers are beginning to document the experiences of lesbian, gay, bisexual and transgender (LGBT) forced migrants in settlement. However, studies exploring the perceptions of service providers working with this vulnerable population are limited. These may shed light on the challenges of meeting the needs of LGBT forced migrants, especially mental health issues and problems.

This qualitative study elicited the views of 22 Canadian service providers, including advocates, lawyers and mental health practitioners, who serve LGBT forced migrants. Grounded theory analysis revealed the following four themes: facilitating safety, buffering rejection; tracking avoidance patterns; interpreting mental health; and negotiating identity paradigms.

Participants’ accounts suggest that LGBT forced migrants may be best served by providers who understand the exigencies of establishing trust and safety for their clients; recognise their clients’ nuanced social support needs; facilitate the refugee claims process; grasp the complexity of their clients’ mental health challenges; and interrogate their own cultural biases regarding sexual orientations and gender identities.

This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS (r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8–17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4–6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0–7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3–19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented.

Since 2011, the war in Syria has resulted in mass displacement of its population both inside and outside the country. 

Although neighbouring countries have hosted most of the refugees, since the summer of 2015 a surge of Syrian citizens have crossed through Turkey into Greece, with the ultimate aim of reaching western Europe. Thousands of Syrians are being subjected to harsh natural and manmade obstacles on their journey, while receiving poor medical care along the way

AIMS:

This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.

METHODS:

We conducted a systematic literature search designed to capture clinical, social science and general literature examining the mental health of the Syrian population. The main medical, psychological and social sciences databases (e.g. Medline, PubMed, PsycInfo) were searched (until July 2015) in Arabic, English and French language sources. This search was supplemented with web-based searches in Arabic, English and French media, and in assessment reports and evaluations, by nongovernmental organisations, intergovernmental organisations and agencies of the United Nations. This search strategy should not be taken as a comprehensive review of all issues related to MHPSS of Syrians as some unpublished reports and evaluations were not reviewed.

RESULTS:

Conflict affected Syrians may experience a wide range of mental health problems including (1) exacerbations of pre-existing mental disorders; (2) new problems caused by conflict related violence, displacement and multiple losses; as well as (3) issues related to adaptation to the post-emergency context, for example living conditions in the countries of refuge. Some populations are particularly vulnerable such as men and women survivors of sexual or gender based violence, children who have experienced violence and exploitation and Syrians who are lesbian, gay, bisexual, transgender or intersex. Several factors influence access to MHPSS services including language barriers, stigma associated with seeking mental health care and the power dynamics of the helping relationship. Trust and collaboration can be maximised by ensuring a culturally safe environment, respectful of diversity and based on mutual respect, in which the perspectives of clients and their families can be carefully explored.

CONCLUSIONS:

Sociocultural knowledge and cultural competency can improve the design and delivery of interventions to promote mental health and psychosocial wellbeing of Syrians affected by armed conflict and displacement, both within Syria and in countries hosting refugees from Syria.

Background
Poverty is known as an important determinant of health, but empirical data are still missing on the relationships between poverty, other adverse living conditions, and psychological distress, particularly in low-income countries.

This study aimed to assess mental health needs and psychological distress among the poorest in rural settings in Burkina Faso where food security and access to water, electricity, schooling, and healthcare are limited.

Methods
We randomly selected 2000 individuals previously identified as indigents by a community-targeting process. Interviewers visited participants (n = 1652) in their homes and completed a questionnaire on mental health variables that included presence and intensity of anxious, depressive, psychotic, and aggressive symptoms, as well as level of psychological distress. Descriptive statistics, Spearman correlations, and logistic regressions were performed.

Results
In all, 40.2% of the sample reported 10 or more anxious/depressive symptoms in the past 30 days, and 25.5% reported having experienced at least one psychotic symptom over their lifetime, 65.6% of whom had had those symptoms for many years. The number of anxious and depressive symptoms was significantly associated with the level of psychological distress (r = 0.423, p < .001). Predictors of distress level included: poor health condition (F(1) = 23.743, p <. 001), being a woman (F(1) = 43.926, p < .001), not having any income (F(1) = 16.185, p < .001), having begged for food in the past 30 days (F(1) = 12.387, p < .001), being illiterate, and being older (F(1) = 21.487, p < .001). Approximately one third of respondents reporting anxious/depressive or psychotic symptoms (28.2 and 30.0%, respectively) had not talked about their symptoms to anyone in their social network.

Conclusions
These results suggest alarmingly high levels of psychological distress and reported symptoms among the poorest in rural settings in Burkina Faso, which can be explained by their difficult living conditions. However, these results must be interpreted from a transcultural perspective to avoid decontextualized misinterpretations. Ethnographic works are needed to document the larger context within which these distress results can be analyzed.

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15–24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross‐sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long‐term impacts on Inuit youth, as well as exposure to culturally meaningful activities.

International adoption is a relatively recent phenomenon and research in this field is emerging, particularly on issues of ethnic identity development and its implications for psychological adjustment and well-being. This article presents a critical review of the literature on ethnic identity in transracial adoptees as it relates to discrimination and psychological well-being. The review results show no clear evidence on the relation between a strong ethnic identity of origin, racial socialization efforts by parents and psychological adjustment in transracial adoptees. Studies investigating the effects of discrimination are too scarce to be conclusive. Results are discussed in light of future research and clinical recommendations

While anthropologists have reflected on ethics and power since the late 1960s, the specific dilemmas that arise in research conducted with children and youth have scarcely been addressed. Nevertheless, critical anthropology’s reflections on power relations and reflexivity can valuably contribute to the interdisciplinary debate in the field of childhood studies, by complexifying categories of voice, dependency and agency, which are often taken for granted in the ethical conversation. Drawing on ethnographic fieldwork with undocumented youth in Montreal, this article argues for the importance of a critical understanding of childhood within a wider context of interdependence, and consequently, for a redefinition of ethics as a reflexive and relational space of intersubjectivity.

Methods:

This two-year longitudinal prospective cohort study recruited patients with first-episode psychosis who were entering early intervention services in Montreal, Canada (N=223). Data on sociodemographic characteristics, symptoms, and social functioning were collected annually.

Results:

At two years, immigrants had more than three times the odds of attrition than nonimmigrants after the analysis controlled for potential confounding factors (first-generation immigrants: odds ratio [OR]=3.11, 95% confidence interval [CI]=1.01–9.57, p=.049); second-generation immigrants: OR=3.65, CI=1.07–12.50, p=.039). Medication adherence was similar among those who remained in the programs.

Conclusions:

During the two years after entering a program for first-episode psychosis, immigrants were more likely than nonimmigrants to disengage from treatment. Further research is warranted to understand this phenomenon and to improve the ability of services to engage immigrants with first-episode psychosis.