Is cultural appropriateness culturally specific? Intersectional insights from a community-based participatory mental health intervention study conducted with diverse cultural groups.

Growing evidence supports the importance of culturally appropriate mental health interventions, yet it is not always feasible to develop culturally grounded interventions or adapt existing interventions for each cultural group. In addition, these approaches do not recognize the multiple intersecting aspects of culture and identity that individuals, families, and communities possess. Thus, an essential question is whether culturally appropriate mental health interventions have to be culturally specific.

From multilevel to trans-level interventions: A critical next step for creating sustainable social change to improve mental health.

Eliminating mental health disparities requires simultaneously addressing numerous determinants of health, including social inequities. Although emphasis on multilevel change is growing, interventions typically involve separate efforts or people focusing on each level. We propose a conceptual model for mental health intervention that simultaneously facilitates change across multiple intersecting levels with four guiding principles: (1) emphasis on structural change; (2) involvement of people experiencing health and social inequities in achieving structural change by addressing the necessary preconditions of access to resources for basic needs, community membership and belonging, and knowledge or information to participate in social change efforts; (3) valuing and building on the expertise and strengths of individuals, families, and communities experiencing health inequities; and (4) dismantling unequal power dynamics of helping relationships through a focus on mutual learning and support and cocreation of change.

Measuring culturally and contextually specific distress among Afghan, Iraqi, and Great Lakes African refugees.

Culturally and contextually valid measurement of psychological distress is critical, given the increasing numbers of forcibly displaced people and transnational migration. This study replicates an inductive process that elicited culturally specific expressions, understandings, and idioms of distress among Afghans to develop culturally specific measures of distress for Great Lakes Africans and Iraqis and expands this methodology to include a focus on the contexts of refugees resettled in the United States. To create the measures, we adapted Miller et al.

Predictors of mental health outcomes of three refugee groups in an advocacy-based intervention: A precision medicine perspective.

Objective: Precision medicine is an area with great potential for mental health, but has made limited gains prognostically in predicting effective treatments. For refugees exposed to violence, culture may be a crucial factor in predicting treatment outcomes.

Method: For this study, 290 participants from three regions (Afghanistan, the Great Lakes region of Africa, and Iraq and Syria) participated in a randomized controlled trial of an advocacy-based intervention.

The impact of postresettlement stressors and access to health care on health outcomes in recently resettled refugees in the United States.

This mixed-methods study examines mechanisms connecting the deployment of economic, social, and health care resources to emotional distress and physical health outcomes. Examining such mechanisms is critical for informing strategies, policies, and other interventions for reducing health disparities and improving refugee health in the United States and other resettlement contexts. Data for this study were collected as part of a randomized control trial in a mid-sized city in the Southwestern United States.

Persistence of the association between mental health and resource access: A longitudinal reciprocal model in a diverse refugee sample.

Stress associated with resource deprivation is an active social determinant of mental health. However, mixed findings around the strength of this association and its persistence over time obscure optimal interventions to improve mental health in forcibly displaced populations. A reciprocal model was analyzed between resource access and measures of depression, anxiety and posttraumatic stress (PTSD) symptoms at three different assessments conducted 6 months apart (Time [T] 1, T2, and T3).

Measuring Latinx/@ immigrant experiences and mental health: Adaptation of discrimination and historical loss scales.

Migration processes encompass uncertainty, discrimination, racism, stigma, social isolation, lack of access to resources, fear of deportation, and family separation, having a critical impact on the health of Latinx/@ immigrants in the United States. It is essential to accurately measure the ways in which social, legal, economic, and political contexts impact mental health. This article discusses adaptation and use of discrimination and historical loss measures in a multilevel community-based advocacy, learning, and social support intervention (Immigrant Well-Being Project) with Latinx/@ immigrants in New Mexico, using participatory research approaches.

Geocultural variation in correlates of psychological distress among refugees resettled in the United States.

Attention to cultural variability in mental health symptoms could inform intervention targets; however, this is currently a neglected area of study. This study examined whether the associations between common mental health disorder (CMD) symptoms and predictors of CMDs varied cross-culturally. Participants were 290 refugees from three geocultural regions (Afghanistan, Great Lakes region of Africa, and Iraq and Syria) who recently resettled in the United States and completed assessments of CMD symptoms and predictors.

A Mixed Method Study of the Effects of Post-Migration Economic Stressors on the Mental Health of Recently Resettled Refugees.

After years of emphasis on pre-migration trauma as the major determinant of refugee mental health, researchers have begun to explore the effects of post-migration stressors on refugees' distress. However, few studies have brought together refugees' emic understandings of the effects of economic stressors on their mental health with quantitative datasets to further explore the salience of stress processes as an explanatory mechanism. In qualitative interviews, 40% of 290 recently resettled adult refugees noted that economic stressors were a major source of distress and described pathways through which these stressors negatively influenced their mental health by limiting their ability to learn English, obtain meaningful employment, access healthcare, maintain contact with their families, and integrate in their communities.

Production and maintenance of the institutional in/visibility of sexual and gender minority students in schools.

This research investigates how school professionals, as institutional actors, influence school climates experienced by lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth. Although research links institutional characteristics to outcomes for LGBTQ youth, scholars do not yet fully understand the mechanisms. We address this gap through a mesolevel analysis of staff perspectives on schools' responsibilities to LGBTQ students.

Innovative participatory bilingual data analysis with Latinx/@ immigrants: Language, power, and transformation.

Objective: The insights of Latinx/@ immigrants are essential to developing interventions that better address complex multilevel phenomena impacting mental health. Despite important advances in methods that genuinely embody participatory research practices, attention to collaborative data collection, analysis, and dissemination are limited. Our aim is to describe the development and implementation of research practices to address these gaps through an emphasis on and understanding of the centrality of language in collaborative research processes.

Randomized Controlled Trial of a Multilevel Intervention to Address Social Determinants of Refugee Mental Health.

Understanding processes that support the well-being of the unprecedented numbers of forcibly displaced people throughout the world is essential. Growing evidence documents post-migration stressors related to marginalization as key social determinants of refugee mental health. The goal of this RCT was to rigorously test a social justice approach to reducing high rates of distress among refugees in the United States.

REFUGEE MENTAL HEALTH AND HEALING: UNDERSTANDING THE IMPACT OF POLICIES OF RAPID ECONOMIC SELF-SUFFICIENCY AND THE IMPORTANCE OF MEANINGFUL WORK.

Although refugees who are accepted for resettlement in a third country are guaranteed certain rights and experience safety from war and persecution, they face many mental health challenges. Using qualitative methods and constructivist grounded theory, we explored culturally-specific perspectives on trauma and recovery among Burundian, Congolese and Iraqi refugees resettled in the United States. Eighteen semi-structured interviews provided extensive data on the meaning of productivity and work, the ways in which they index normalcy and self-sufficiency, and how they create security that facilitates the healing process.

Family Separation and the Impact of Digital Technology on the Mental Health of Refugee Families in the United States: Qualitative Study.

Background: Conflicts around the world have resulted in a record high number of refugees. Family separation is a critical factor that impacts refugee mental health. Thus, it is important to explore refugees' ability to maintain contact with family members across the globe and the ways in which they attempt to do so.

Ecological Networks and Community Attachment and Support Among Recently Resettled Refugees.

Interventions aimed at enhancing mental health are increasingly centered around promoting community attachment and support. However, few have examined and tested the specific ecological factors that give rise to these key community processes. Drawing from insights from the ecological network perspective, we tested whether spatial and social overlap in routine activity settings (e.

"My World is Upside Down": Transnational Iraqi Youth and Parent Perspectives on Resettlement in the United States.

The U.S. war with Iraq led to the displacement of millions of Iraqis, many of whom have resettled in the United States as refugees.

Understanding the mental health consequences of family separation for refugees: Implications for policy and practice.

Consistent evidence documents the negative impacts of family separation on refugee mental health and concerns for the welfare of distant family members and desire to reunite with family members as priorities for refugees postmigration. Less is known about refugees' emic perspectives on their experiences of family separation. Using mixed methods data from a community-based mental health intervention study, we found that family separation was a major source of distress for refugees and that it was experienced in a range of ways: as fear for family still in harm's way, as a feeling of helplessness, as cultural disruption, as the greatest source of distress since resettlement, and contributing to mixed emotions around resettlement.

"Seeing the Life": Redefining self-worth and family roles among Iraqi refugee families resettled in the United States.

Social and geographic displacement is a global phenomenon that precipitates novel stressors and disruptions that intersect with longstanding familial and social roles. Among the displaced are war-torn Iraqi refugee families, who must address these new obstacles in unconventional ways. This study explores how such disruptions have influenced associations between gender and apparent self-worth experienced by Iraqi refugee families upon relocation to the United States.

Perceptions and use of community- and school-based behavioral health services among urban American Indian/Alaska Native youth and families.

Understanding youths' awareness and use of behavioral health services is important for improving services and engagement. Interviews and focus groups were conducted with students, parents, and teachers/staff in an urban area to understand awareness and use of a school's Native-tailored and -staffed school-based behavioral health center (NT-BHC) and community-based services. Results showed overwhelmingly positive responses regarding NT-BHC staff and services, with concerns focused on too few staff and services, and on privacy and confidentiality, as well as important differences in awareness and use of behavioral health services among youth, parents, and teachers/staff, valuable for improving engagement with and services for AI/AN youth.

Challenges and Innovations in a Community-Based Participatory Randomized Controlled Trial.

Randomized controlled trials (RCTs) are a long-standing and important design for conducting rigorous tests of the effectiveness of health interventions. However, many questions have been raised about the external validity of RCTs, their utility in explicating mechanisms of intervention and participants' intervention experiences, and their feasibility and acceptability. In the current mixed-methods study, academic and community partners developed and implemented an RCT to test the effectiveness of a collaboratively developed community-based advocacy, learning, and social support intervention.

Reconsidering culturally competent approaches to American Indian healing and well-being.

There is an urgent need to eliminate mental health disparities experienced by American Indians and Alaska Natives (AI/ANs). Service providers and researchers often address these disparities by focusing on low rates of participation in Western mental health services. In part, this reflects limited understandings of the sociopolitical and historical context of AI/AN mental health problems.

Reducing mental health disparities through transformative learning: a social change model with refugees and students.

Distribution of power and resources greatly impacts the mental health of individuals and communities. Thus, to reduce mental health disparities, it is imperative to address these social determinants of mental health through social change. Engaging in social change efforts requires people to critically engage with present conditions on personal, local, national, and global levels and to develop knowledge, capacity, and experience with envisioning and creating more equitable conditions.

Reducing refugee mental health disparities: a community-based intervention to address postmigration stressors with African adults.

Refugees resettled in the United States have disproportionately high rates of psychological distress. Research has demonstrated the roles of postmigration stressors, including lack of meaningful social roles, poverty, unemployment, lack of environmental mastery, discrimination, limited English proficiency, and social isolation. We report a multimethod, within-group longitudinal pilot study involving the adaptation for African refugees of a community-based advocacy and learning intervention to address postmigration stressors.