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Understanding the Mental Health of Refugees: Trauma, Stress, and the Cultural Context

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Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

At the end of 2016, there were a record-high 65.6 million people forcibly displaced according to the United Nations High Commissioner for Refugees (United Nations High Commissioner for Refugees, Figures at a glance 2017 [Internet], 2018). With 300,000 new people displaced in 2016, there were 20 people newly displaced every minute of 2016. Most refugees flee their homes with little time to prepare and, in turn, frequently are ill-equipped with the financial, linguistic, and other resources needed to address the challenges of the journey that lies ahead. The nature of the pre-migration and flight experiences for refugees, which are frequently marked by fear, forced departure, and experiences of torture and trauma, distinguishes them from other voluntary migrants. Since 1975 approximately 3 million individuals have been resettled in the USA (approximately 2 million adults and 1 million children) (Office of Refugee Resettlement, Fiscal year 2012 refugee arrivals [Internet], 2013); this represents a significant population to respond to clinically. Importantly, status as a forcibly displaced person seeking refuge is not in itself a psychiatric condition—refugee status is a sociopolitical phenomenon with common downstream psychosocial effects. As refugees resettle in third-party countries, often after prolonged stays in refugee camps in a country or countries outside of their home, many experience mental health problems associated with past trauma, ongoing stress, or both. In order to effectively serve resettled refugee and migrant communities, mental health professionals including researchers, clinicians, educators, and policy makers need to understand the impact of the refugee experience and cultural contexts on psychosocial functioning. This chapter will review the unique mental health challenges and culturally responsive assessments and treatments targeting some of the world’s most vulnerable and resilient populations.

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References

  1. United Nations High Commissioner for Refugees. Figures at a glance 2017 [Internet]. 2018 [cited 2018 Aug 7]. Available from: http://www.unhcr.org/en-us/figures-at-a-glance/html.

  2. Stein B. The refugee experience: defining the parameters of a field of study. Int Migr Rev. 1981;15(1–2):320–30.

    Google Scholar 

  3. Office of Refugee Resettlement. Fiscal year 2012 refugee arrivals [Internet]. 2013 [cited 2018 Aug 7]. Available from: https://www.acf.hhs.gov/orr/resource/fiscal-year-2012-refugee-arrivals.

  4. United Nations High Commissioner for Refugees. U.S. resettlement facts 2018 [Internet]. 2018 [cited 2018 Aug 8]. Available from: http://www.unhcr.org/en-us/us-refugee-resettlement-facts.html.

  5. Papadopoulos RK. Refugees, trauma and adversity-activated development. Eur J Psychother Couns. 2007;9(3):301–12.

    Article  Google Scholar 

  6. United Nations High Commissioner for Refugees. Frequently asked questions about resettlement [Internet]. 2012 [cited 2018 Aug 7]. Available from: http://www.unhcr.org/protection/resettlement/4ac0873d6/frequently-asked-questions-resettlement.html.

  7. United Nations High Commissioner for Refugees. UNHCR global trends 2011: a year of crises [Internet]. 2012 [cited 2018 Aug 7]. Available from: http://www.unhcr.org/en-us/statistics/country/4fd6f87f9/unhcr-global-trends-2011.html.

  8. United Nations High Commissioner for Refugees. UNHCR projected global resettlement needs 2018 [Internet]. 2017 [cited 2018 Aug 7]. Available from: http://www.unhcr.org/en-us/protection/resettlement/593a88f27/unhcr-projected-global-resettlement-needs-2018.html.

  9. Kleijn WC, Hovens JE, Rodenburg JJ. Posttraumatic stress symptoms in refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins symptom checklist–25 in different languages. Psychol Rep. 2001;88(2):527–32.

    Article  CAS  PubMed  Google Scholar 

  10. Montgomery E, Foldspang A. Criterion-related validity of screening for exposure to torture. Dan Med Bull. 1994;41(5):588–91.

    CAS  PubMed  Google Scholar 

  11. Burnett A, Peel MR. Asylum seekers and refugees in Britain: health needs of asylum seekers and refugees. Br Med J. 2001;322(7285):544–7.

    Article  CAS  Google Scholar 

  12. Cardozo BL, Vergara A, Agani F, Gotway CA. Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo. JAMA. 2000;284(5):569–77.

    Article  Google Scholar 

  13. Onyut LP, Neuner F, Schauer E, Ertl V, Odenwald MG, Schauer M, et al. The Nakivale Camp mental health project: building local competency for psychological assistance to traumatised refugees. Intervention. 2004;2(2):90–107.

    Google Scholar 

  14. Betancourt TS, Newnham EA, Birman D, Lee R, Ellis BH, Layne CM. Comparing trauma exposure, mental health needs, and service utilization across clinical samples of refugee, immigrant, and U.S.-origin children. J Trauma Stress. 2017;30(3):209–18.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Association AP. Resilience & recovery after war: refugee children and families in the United States. 2010.

    Google Scholar 

  16. Tyrer RA, Fazel M. School and community-based interventions for refugee and asylum seeking children: a systematic review. PLoS One. 2014;9(2):e89359.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Betancourt TS, Newnham EA, Layne CM, Kim S, Steinberg AM, Ellis BH, et al. Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States. J Trauma Stress. 2012;25(6):682–90.

    Article  PubMed  Google Scholar 

  18. Ellis BH, Macdonald HZ, Klunk-Gillis J, Lincoln AK, Strunin L, Cabral HJ. Discrimination and mental health among Somali refugee adolescents: the role of acculturation and gender. Am J Orthopsychiatry. 2010;80(4):564–75.

    Article  PubMed  Google Scholar 

  19. Miller K, Weine S, Ramic A, Brkic N, Bjedic Z, Smajkic A, et al. The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. J Trauma Stress. 2002;15(5):377–87.

    Article  PubMed  Google Scholar 

  20. Ellis B, Lincoln AK, Abdi S, Nimmons E, Issa O, Decker S. “We all have stories”: black Muslim immigrants’ experience with the police. Race Justice. 2018; https://doi.org/10.1177/2153368718754638.

  21. Birman D, Ho J, Pulley E, Batia K, Everson ML, Ellis BH, et al. Mental health interventions for refugee children in resettlement. Chicago: National Child Traumatic Stress Network; 2005.

    Book  Google Scholar 

  22. Kira I, Lewandowski L, Templin T, Ramaswamy V, Ozkan B, Mohanesh J. The effects of perceived discrimination and backlash on Iraqi refugees’ mental and physical health. J Muslim Ment Health. 2010;5(1):59–81.

    Article  Google Scholar 

  23. Telzer EH. Expanding the acculturation gap-distress model: an integrative review of research. Hum Dev. 2010;53(6):313–40.

    Article  Google Scholar 

  24. Nicholson B. The influence of pre-emigration and postemigration stressors on mental health: a study of Southeast Asian refugees. Soc Work Res. 1997;21(1):19–31.

    Article  Google Scholar 

  25. Hobfoll S. Conservation of resources: a new attempt at conceptualizing stress. Am Psychol. 1989;44(3):513–24.

    Article  CAS  PubMed  Google Scholar 

  26. Porter M, Haslam N. Forced displacement in Yugoslavia: a meta-analysis of psychological consequences and their moderators. J Trauma Stress. 2001;14(4):817–34.

    Article  CAS  PubMed  Google Scholar 

  27. Murray KE, Davidson GR, Schweitzer RD. Review of refugee mental health interventions following resettlement: best practices and recommendations. Am J Orthopsychiatry. 2010;80(4):576–85.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–14.

    Article  PubMed  Google Scholar 

  29. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49.

    Article  CAS  PubMed  Google Scholar 

  30. Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights. 2015;15(1):1–41.

    Article  Google Scholar 

  31. Davidson GR, Murray KE, Schweitzer R. Review of refugee mental health and wellbeing: Australian perspectives. Aust Psychol. 2008;43(3):160–74.

    Article  Google Scholar 

  32. Fazel M, Reed RV, Panter-Brick C, Stein A. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet. 2012;379(9812):266–82.

    Article  PubMed  Google Scholar 

  33. Momartin S, Silove D, Manicavasagar V, Steel Z. Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia. J Affect Disord. 2004;80(2):231–8.

    Article  PubMed  Google Scholar 

  34. Ao T, Taylor E, Lankau E, Sivilli T, Blanton C, Shetty S, et al. An investigation into suicides among Bhutanese refugees in the U.S. 2009–2012: stakeholders report. Centers for Disease Control and Prevention; 18 Oct 2012.

    Google Scholar 

  35. Schinina G, Sharma S, Gorbacheva O, Mishra AK. Who am I? Assessment of psychosocial needs and suicide risk factors among Bhutanese refugees in Nepal and after the third country resettlement. International Organization for Migration. 2011.

    Google Scholar 

  36. Ellis BH, Lankau EW, Ao T, Benson MA, Miller AB, Shetty S, et al. Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior. Am J Orthopsychiatry. 2015;85(1):43–55.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Meyerhoff J, Rohan KJ, Fondacaro K. Suicide and suicide-related behavior among Bhutanese refugees resettled in the United States. Asian Am J Psychol. 2018;9(4):270–83.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ao T, Shetty S, Sivilli T, Blanton C, Ellis H, Geltman P, et al. Suicidal ideation and mental health of Bhutanese refugees in the United States. J Immigr Minor Health. 2016;18(4):828–35.

    Article  PubMed  Google Scholar 

  39. Centers for Disease Control and Prevention. Fatal injury reports, national, regional and state, 1981–2016 [Internet]. 2012 [cited 2018 Aug 7]. Available from: http://www.cdc.gov/injury/wisqars/fatal_injury_reports.html.

  40. Ferrada-Noli M, Asberg M, Ormstad K. Suicidal behavior after severe trauma. Part 2: the association between methods of torture and of suicidal ideation in posttraumatic stress disotrder. J Trauma Stress. 1998;11(1):113–24.

    Article  CAS  PubMed  Google Scholar 

  41. Johansson K, Ekblad S, Lindencrona F, Shahnavaz S. Promoting mental health and preventing mental dsorder among refugees in western countries. Int J Ment Health Promot. 2009;11(1):32–44.

    Article  Google Scholar 

  42. Bhui K, Abdi A, Abdi M, Pereira S, Dualeh M, Robertson D, et al. Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees. Soc Psychiatry Psychiatr Epidemiol. 2003;38(1):35–43.

    Article  PubMed  Google Scholar 

  43. Barnevik-Olsson M, Gillberg C, Fernell E. Prevalence of autism in children of Somali origin living in Stockholm: brief report of an at-risk population. Dev Med Child Neurol. 2010;52(12):1167–8.

    Article  PubMed  Google Scholar 

  44. Hutchingson G, Haasen C. Migration and schizophrenia: the challenges for European psychiatry and implications for the future. Soc Psychiatry Psychiatr Epidemiol. 2004;39(5):350–7.

    Article  Google Scholar 

  45. Lie B. A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatr Scand. 2002;106(6):415–25.

    Article  CAS  PubMed  Google Scholar 

  46. Westermeyer J, Neider J, Callies A. Psychosocial adjustment of Hmong refugees during their first decade in the United States: a longitudinal study. J Nerv Ment Dis. 1989;177(3):132–9.

    Article  CAS  PubMed  Google Scholar 

  47. Silove D, Steel Z, Bauman A, Chey T, McFarlane A. Trauma, PTSD and the longer-term mental health burden amongst Vietnamese refugees. Soc Psychiatry Psychiatr Epidemiol. 2007;42(6):467–76.

    Article  PubMed  Google Scholar 

  48. Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun C-A. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005;294(5):571–9.

    Article  CAS  PubMed  Google Scholar 

  49. Steel Z, Silove D, Phan T, Bauman A. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. Lancet. 2002;360(9339):1056–62.

    Article  PubMed  Google Scholar 

  50. Majka L, Mullan B. Employment retention, area of origin and type of social support among refugees in the Chicago area. Int Migr Rev. 1992;26(3):899–926.

    Article  Google Scholar 

  51. Weine SM, Vojvoda D, Becker DF, McGlashan TH, Hodzic E, Laub D, et al. PTSD symptoms in Bosnian refugees 1 year after resettlement in the United States. Am J Psychiatr. 1998;155(4):562–4.

    Article  CAS  PubMed  Google Scholar 

  52. Vromans L, Schweitzer RD, Brough M, Correa-Velez I, Murray K, Lenette C. Contributions of loss events to loss distress and trauma symptoms in recently resettled refugee women at risk. J Loss Trauma. 2017;22(4):357–70.

    Article  Google Scholar 

  53. Lustig SL, Kia-Keating M, Knight WG, Geltman P, Ellis H, Kinzie JD, et al. Review of child and adolescent refugee mental health. J Am Acad Child Adolesc Psychiatry. 2004;43(1):24–36.

    Article  PubMed  Google Scholar 

  54. Goldin S, Hägglöf B, Levin L, Persson LÅ. Mental health of Bosnian refugee children: a comparison of clinician appraisal with parent, child and teacher reports. Nord J Psychiatry. 2008;62(3):204–16.

    Article  PubMed  Google Scholar 

  55. Sack WH, Him C, Dickason D. Twelve-year follow-up study of Khmer youths who suffered massive war trauma as children. J Am Acad Child Adolesc Psychiatry. 1999;38(9):1173.

    Article  CAS  PubMed  Google Scholar 

  56. Pieloch KA, McCullough MB, Marks AK. Resilience of children with refugee statuses: a research review. Can Psychol. 2016;57(4):330–9.

    Article  Google Scholar 

  57. Weine S. Family roles in refugee youth resettlement from a prevention perspective. Child Adolesc Psychiatr Clin N Am. 2008;17(3):515–32.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 2004;59(1):20–8.

    Article  PubMed  Google Scholar 

  59. Masten AS. Ordinary magic: resilience processes in development. Am Psychol. 2001;56(3):227–38.

    Article  CAS  PubMed  Google Scholar 

  60. Tempany M. What research tells us about the mental health and psychosocial wellbeing of Sudanese refugees: a literature review. Transcult Psychiatry. 2009;46(2):300–15.

    Article  PubMed  Google Scholar 

  61. Correa-Velez I, Gifford SM, McMichael C. The persistence of predictors of wellbeing among refugee youth eight years after resettlement in Melbourne, Australia. Soc Sci Med. 2015;142:163–8.

    Article  PubMed  Google Scholar 

  62. Murray KE, Zautra AJ. Community resilience: fostering recovery, sustainability, and growth. In: Ungar M, editor. The social ecology of resilience: culture, context, resources, and meaning. New York: Springer; 2011. p. 337–46.

    Google Scholar 

  63. Del Giudice M, Hinnant JB, Ellis BJ, El-Sheikh M. Adaptive patterns of stress responsivity: a preliminary investigation. Dev Psychol. 2012;48(3):775–90.

    Article  PubMed  Google Scholar 

  64. Matsuoka JK, Breaux C, Ryujin DH. National utilization of mental health services by Asian Americans/Pacific Islanders. J Community Psychol. 1997;25(2):141–5.

    Article  Google Scholar 

  65. Ellis BH, Lincoln AK, Charney ME, Ford-Paz R, Benson M, Strunin L. Mental health service utilization of Somali adolescents: religion, community, and school as gateways to healing. Transcult Psychiatry. 2010;47(5):789–811.

    Article  PubMed  Google Scholar 

  66. Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among US children: variation by ethnicity and insurance status. Am J Psychiatr. 2002;159(9):1548–55.

    Article  PubMed  Google Scholar 

  67. Otto MW, Hinton D, Korbly NB, Chea A, Ba P, Gershuny BS, et al. Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther. 2003;41(11):1271–6.

    Article  PubMed  Google Scholar 

  68. Tribe R. Mental health of refugees and asylum-seekers. Adv Psychiatr Treat. 2002;8(4):240–7.

    Article  Google Scholar 

  69. Marshall JK, Cooper LA, Green AR, Bertram A, Wright L, Matusko N, et al. Residents’ attitude, knowledge, and perceived preparedness toward caring for patients from diverse sociocultural backgrounds. Health Equity. 2017;1(1):43–9.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Farmer PE, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical medicine (Policy Forum). PLoS Med. 2006;3(10):e449.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Daniel EV, Knudsen JC. Mistrusting refugees. Berkeley: University of California Press; 1995.

    Google Scholar 

  72. Scuglik DL, Alarcón RD, Lapeyre AC, Williams MD, Logan KM. When the poetry no longer rhymes: mental health issues among Somali immigrants in the USA. Transcult Psychiatry. 2007;44(4):581–95.

    Article  PubMed  Google Scholar 

  73. Hollifield M. Building new bridges in primary care. Gen Hosp Psychiatry. 2004;26(4):253–5.

    Article  PubMed  Google Scholar 

  74. Hundley G, Lambie G. Russian speaking immigrants from the Commonwealth of Independent States in the United States: implications for mental health counselors. J Ment Health Couns. 2007;29(3):242–58.

    Article  Google Scholar 

  75. Nadeau L, Measham T. Immigrants and mental health services: increasing collaboration with other service providers. Can Child Adolesc Psychiatry Res. 2005;14(3):73–6.

    Google Scholar 

  76. Murphy D, Ndegwa D, Kanani A, Rojas-Jaimes C, Webster A. Mental health of refugees in inner-London. Psychiatrist. 2002;26(6):222–4.

    Google Scholar 

  77. Osterman J, de Jong J. Cultural issues and trauma. In: Friedman MJ, Keane TM, Resick PA, editors. Handbook of PTST: science and practice. New York: Guilford Press; 2007. p. 425–46.

    Google Scholar 

  78. Delgado M, Jones K, Rohani M. Social work practice with refugee and immigrant youth in the United States. Boston: Pearson; 2005.

    Google Scholar 

  79. Guerin B, Guerin P, Diiriye RO, Yates S. Somali conceptions and expectations concerning mental health: some guidelines for mental health professionals. N Z J Psychol. 2004;33(2):59–67.

    Google Scholar 

  80. Kleinman A. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley: University of California Press; 1980.

    Google Scholar 

  81. Im H, Ferguson A, Hunter M. Cultural translation of refugee trauma: cultural idioms of distress among Somali refugees in displacement. Transcult Psychiatry. 2017;54(5–6):626–52.

    Article  PubMed  Google Scholar 

  82. Weiss M. The explanatory model interview catalogue (EMIC): framework for comparative study of illness experience. Transcult Psychiatry. 1997;34(2):235–63.

    Article  Google Scholar 

  83. Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, et al. Measuring trauma and health status in refugees: a critical review. JAMA. 2002;288(5):611–21.

    Article  PubMed  Google Scholar 

  84. Wong EC, Marshall GN, Schell TL, Elliott MN, Hambarsoomians K, Chun C-A, et al. Barriers to mental health care utilization for U.S. Cambodian refugees. J Consult Clin Psychol. 2006;74(6):1116–20.

    Article  PubMed  Google Scholar 

  85. Alvarez M. The experience of migration: a relational approach in therapy. J Fem Fam Ther. 1999;11(1):1–29.

    Article  Google Scholar 

  86. Hou F, Beiser M. Learning the language of a new country: a ten-year study of English acquisition by South-East Asian refugees in Canada. Int Migr. 2006;44(1):634–40.

    Article  Google Scholar 

  87. Koivunen J. The middle of everywhere: helping refugees enter the American community. Fam Consum Sci Res J. 2009;37(3):413–5.

    Article  Google Scholar 

  88. Kirmayer LJ, Groleau D, Guzder J, Blake C, Jarvis E. Cultural consultation: a model of mental health service for multicultural societies. Can J Psychiatr. 2003;48(3):145–53.

    Article  Google Scholar 

  89. Hess J, Barr S, Hunt G. The practice of family mentoring and advocacy: a theoretical investigation of critical issues. Fam Soc. 2009;90(2):189–95.

    Article  Google Scholar 

  90. Ellis BH, MacDonald HZ, Lincoln AK, Cabral HJ. Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. J Consult Clin Psychol. 2008;76(2):184–93.

    Article  PubMed  Google Scholar 

  91. Mann CM, Fazil Q. Mental illness in asylum seekers and refugees. Prim Care Ment Health. 2006;4:57–66.

    Google Scholar 

  92. Gagnon A, Tuck J. A systematic review of questionnaires measuring the health of resettling refugee women. Health Care Women Int. 2004;25(2):111–49.

    Article  PubMed  Google Scholar 

  93. Bracken P. Cultural syndromes and cognitive psychology. Transcult Psychiatry. 2002;39(2):214–9.

    Article  Google Scholar 

  94. Summerfield D. A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Soc Sci Med. 1999;48(10):1449–62.

    Article  CAS  PubMed  Google Scholar 

  95. Barrett P, Moore A, Sonderegger R. The FRIENDS program for young former-Yugoslavian refugees in Australia: a pilot study. Behav Chang. 2000;17(3):124–33.

    Article  Google Scholar 

  96. Centers for Disease Control and Prevention. Immigrant and refugee health [Internet]. 2016 [cited 2018 Aug 7]. Available from: https://www.cdc.gov/immigrantrefugeehealth/index.html.

  97. Ellis BH, Miller AB, Baldwin H, Abdi S. New directions in refugee youth mental health services: overcoming barriers to engagement. J Child Adolesc Trauma. 2011;4(1):69–85.

    Article  Google Scholar 

  98. Weinstein C, Fucetola R, Mollica R. Neuropsychological issues in the assessment of refugees and victims of mass violence. Neuropsychol Rev. 2001;11(3):131–41.

    Article  CAS  PubMed  Google Scholar 

  99. Van Wyk S, Schweitzer R. A systematic review of naturalistic interventions in refugee populations. J Immigr Minor Health. 2013;16(5):968–77.

    Google Scholar 

  100. Slobodin O, de Jong JT. Mental health interventions for traumatized asylum seekers and refugees: what do we know about their efficacy? Int J Soc Psychiatry. 2015;61(1):17–26.

    Article  PubMed  Google Scholar 

  101. Silove D. Treatment of refugees at the crossroads: the need for an evidence base. Aust N Z J Psychiatry. 2012;46(10):921–3.

    Article  PubMed  Google Scholar 

  102. Hinton DE, Chhean D, Pich V, Safren SA, Hofmann SG, Pollack MH. A randomized controlled trial of cognitive-behavior therapy for Cambodian refugees with treatment-resistant PTSD and panic attacks: a cross-over design. J Trauma Stress. 2005;18(6):617–29.

    Article  PubMed  Google Scholar 

  103. Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. J Consult Clin Psychol. 2004;72(4):579–87.

    Article  PubMed  Google Scholar 

  104. Neuner F, Kurreck S, Ruf M, Odenwald M, Elbert T, Schauer M. Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cogn Behav Ther. 2010;39(2):81–91.

    Article  PubMed  Google Scholar 

  105. Fox PG, Rossetti J, Burns KR, Popovich J. Southeast Asian refugee children: a school-based mental health intervention. Int J Psychiatr Nurs Res. 2005;11(1):1227–36.

    PubMed  Google Scholar 

  106. Palic S, Elklit A. An explorative outcome study of CBT-based multidisciplinary treatment in a diverse group of refugees from a Danish treatment centre for rehabilitation of traumatized refugees. Torture. 2009;19(3):248–70.

    PubMed  Google Scholar 

  107. Baker F, Jones C. The effect of music therapy services on classroom behaviours of newly arrived refugee students in Australia: a pilot study. Emot Behav Diffic. 2006;11(4):249–60.

    Article  Google Scholar 

  108. Nose M, Ballette F, Bighelli I, Turrini G, Purgato M, Tol W, et al. Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: systematic review and meta-analysis. PLoS One. 2017;12(2):1–17.

    Article  CAS  Google Scholar 

  109. Dossa P. Exploring the disjuncture between the politics of trauma and everyday realities of women in Afghanistan. J Muslim Ment Health. 2010;5(1):8–21.

    Article  Google Scholar 

  110. Von Peter S. The experience of “mental trauma” and its transcultural application. Transcult Psychiatry. 2008;45(4):639–51.

    Article  Google Scholar 

  111. Bolton P, Bass J, Betancourt T, Speelman L, Onyango G, Clougherty KF, et al. Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. JAMA. 2007;298(5):519–27.

    Article  CAS  PubMed  Google Scholar 

  112. Meffert SM, Abdo AO, Alla OAA, Elmakki YOM, Omer AA, Yousif S, et al. A pilot randomized controlled trial of interpersonal psychotherapy for Sudanese refugees in Cairo, Egypt. Psychol Trauma Theory Res Pract Policy. 2014;6(3):240.

    Article  Google Scholar 

  113. Rousseau C, Lacroix L, Bagilishya D, Heusch N. Working with myths: creative expression workshops for immigrant and refugee children in a school setting. Art Ther. 2003;20(1):3–10.

    Article  Google Scholar 

  114. Smajkic A, Weine S, Djuric-Bijedic Z, Boskailo E, Lewis J, Pavkovic I. Sertraline, paroxetine, and venlafaxine in refugee posttraumatic stress disorder with depression symptoms. J Trauma Stress. 2001;14(3):445–52.

    Article  CAS  PubMed  Google Scholar 

  115. Saxe GN, Ellis BH, Brown AD. Trauma systems therapy for children and teens. 2nd ed. New York: The Guilford Press; 2016.

    Google Scholar 

  116. Sonne C, Carlsson J, Bech P, Mortensen EL. Pharmacological treatment of refugees with trauma-related disorders: what do we know today? Transcult Psychiatry. 2017;54(2):260–80.

    Article  PubMed  Google Scholar 

  117. Mendenhall TJ, Kelleher MT, Baird MA, Doherty WJ. Overcoming depression in a strange land: a Hmong woman’s journey in the world of western medicine. In: Kessler R, Stafford D, editors. Collaborative medicine case studies: evidence in practice. New York: Springer; 2008. p. 327–40.

    Chapter  Google Scholar 

  118. Lin K-M, Fancher T, Cheung F. Psychopharmacology for refugees and asylum seekers. In: Bughra D, Craig T, Bhui K, editors. Mental health of refugees and asylum seekers. Oxford: Oxford University Press; 2010.

    Google Scholar 

  119. Hays PA. Addressing cultural complexities in practice: assessment, diagnosis, and therapy. 2nd ed. Washington, DC: American Psychological Association; 2008.

    Book  Google Scholar 

  120. Cox LG, Simpson A. Cultural safety, diversity and the servicer user and carer movement in mental health research. Nurs Inq. 2015;22(4):306–16.

    Article  PubMed  Google Scholar 

  121. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118(4):293–302.

    Article  PubMed  PubMed Central  Google Scholar 

  122. National Child Traumatic Stress Network. Child and adolescent refugee trauma [Internet]. 2013 [cited 2018 Aug 7]. Available from: http://www.nctsn.org/trauma-types/refugee-and-war-zone-trauma.

  123. Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J, TFoCP S. Culturally competent healthcare systems: a systematic review. Am J Prev Med. 2003;24(3):68–79.

    Article  PubMed  Google Scholar 

  124. Brach C, Fraserirector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57(4 suppl):181–217.

    Article  PubMed  PubMed Central  Google Scholar 

  125. Jezewski MA. Culture brokering in migrant farmworker health care. West J Nurs Res. 1990;12(4):497–513.

    Article  CAS  PubMed  Google Scholar 

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Ellis, B.H., Winer, J.P., Murray, K., Barrett, C. (2019). Understanding the Mental Health of Refugees: Trauma, Stress, and the Cultural Context. In: Parekh, R., Trinh, NH. (eds) The Massachusetts General Hospital Textbook on Diversity and Cultural Sensitivity in Mental Health. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-20174-6_13

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