Addressing Social Determinants to Reduce Refugee Mental Health Disparities

解决社会决定因素以减少难民心理健康差异

• 批准号: 8719694
• 负责人: JESSICA R GOODKIND
• 金额: $ 38.43万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-12 至 2018-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8719694
• 关键词: Address; Adult; Advocacy; Advocate; Affect; African; Agreement; Area; Caring; Clinical; Communities; Control Groups; Data; Disadvantaged; Discrimination; Distress; Economics; Education; Effectiveness; Effectiveness of Interventions; Elements; Employment; Enrollment; Exposure to; Goals; Health; Health Services Accessibility; Housing; Immigrant; Intervention; Interview; Knowledge; Learning; Legal; Low income; Mediating; Mental Depression; Mental Health; Mental Health Services; Methods; Minority; Modeling; Participant; Pathway interactions; Personal Satisfaction; Pharmaceutical Preparations; Physical environment; Population; Post-Traumatic Stress Disorders; Poverty; Psyche structure; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Refugees; Research; Resources; Role; Services; Social Environment; Social isolation; Social support; Stress; Symptoms; Testing; Time; Trauma; Trust; United States; Universities; Work; base; clinically significant; college; cost; cost effective; depressive symptoms; design; dosage; empowerment; evidence base; experience; health disparity; improved; innovation; migration; psychoeducation; psychological distress; response; social; social health determinants; social stigma; socioeconomics; stressor; therapy outcome; undergraduate student; universal prevention

DESCRIPTION (provided by applicant): The goal of this study is to test an ecological/empowerment approach to reducing mental health disparities among socioeconomically disadvantaged Central African and Iraqi refugee adults by examining the effectiveness of a community-based advocacy, learning, and social support intervention (Refugee Well-being Project, RWP) that addresses social determinants of mental health and incorporates an evidence-based trauma treatment (Narrative Exposure Therapy, NET) for refugees with PTSD. The waitlist randomized controlled trial with 180 African and Iraqi refugee adults is innovative and significant because it will rigorously test the effectiveness of addressin social determinants of mental health (poverty, social and physical environments, access to services, marginalization) to reduce mental health disparities, as well as examine the impact of a community-based, mutual learning intervention on improving engagement and retention in evidence-based trauma-focused treatment for those who need it. The RWP intervention emphasizes a sustainable and replicable partnership model between refugee resettlement agencies and universities/colleges that involves refugee adults and undergraduate advocates working together to: a) increase refugees' abilities to navigate their new communities; b) improve refugees' access to community resources; c) enhance meaningful social roles by valuing refugees' culture, experiences, and knowledge; d) reduce refugees' social isolation; and e) increase communities' responsiveness to refugees. The RWP intervention is administered by university undergraduate students enrolled in a service learning course, and has two elements: 1) Learning Circles, which involve cultural exchange and one-on-one learning opportunities, and; 2) Advocacy, which involves collaborative efforts to mobilize community resources related to health, housing, employment, education, and legal issues. Pilot testing of RWP demonstrated feasibility, appropriateness, acceptability, and preliminary evidence that the intervention decreased Hmong, Central African, and Iraqi participants' psychological distress and increased protective factors. A mixed methods strategy with data collected from each participant at four time points over a period of 14 months will be used to test the effectiveness of the 6- month intervention to reduce psychological distress (PTSD, depression, and culturally-specific distress), increase protective factors (access to resources, English proficiency, environmental mastery, mental health service use, and social support), and engage and retain refugee adults with PTSD in an evidence-based trauma treatment (NET). Mechanisms of intervention effectiveness will be explored by testing mediating relationships between protective factors and psychological distress. Qualitative components of interviews with refugee participants and paired qualitative interviews with refugees and undergraduates will explore participants' experiences in the intervention, inform interpretation of quantitative data, and investigate unexpected impacts.

描述（由申请人提供）：本研究的目的是通过检查基于社区的宣传、学习和社会支持的有效性，测试一种生态/赋权方法，以减少社会经济弱势的中非和伊拉克难民成年人的心理健康差异干预措施（难民福祉项目，RWP），解决心理健康的社会决定因素，并为患有创伤后应激障碍（PTSD）的难民提供循证创伤治疗（叙事暴露疗法，NET）。这项对 180 名非洲和伊拉克成年人难民进行的候补随机对照试验具有创新性和重要意义，因为它将严格测试解决心理健康社会决定因素（贫困、社会和物质环境、获得服务的机会、边缘化）以减少心理健康差异的有效性，并研究基于社区的相互学习干预措施对提高有需要的人参与和保留基于证据的创伤治疗的影响。 RWP 干预措施强调难民安置机构和大学/学院之间建立可持续和可复制的伙伴关系模式，其中涉及成年人难民和本科生倡导者共同努力：a) 提高难民在新社区中航行的能力； b) 改善难民获得社区资源的机会； c) 通过重视难民的文化、经验和知识来增强有意义的社会角色； d) 减少难民的社会孤立； e) 提高社区对难民的响应能力。 RWP 干预由参加服务学习课程的大学本科生实施，有两个要素：1）学习圈，涉及文化交流和一对一的学习机会； 2) 倡导，包括共同努力调动与健康、住房、就业、教育和法律问题相关的社区资源。 RWP的试点测试证明了其可行性、适当性、可接受性，初步证据表明该干预措施减少了苗族、中非和伊拉克参与者的心理困扰并增加了保护因素。混合方法策略将在 14 个月的时间内从每个参与者的四个时间点收集数据，用于测试 6 个月干预措施的有效性，以减少心理困扰（PTSD、抑郁和文化特异性困扰），增加保护因素（获得资源、英语水平、环境掌握、心理健康服务使用和社会支持），并让患有创伤后应激障碍（PTSD）的成年难民参与基于证据的创伤治疗（NET）。将通过测试保护因素与心理困扰之间的中介关系来探索干预效果的机制。对难民参与者的访谈的定性部分以及对难民和本科生的配对定性访谈将探讨参与者在干预中的经历，为定量数据的解释提供信息，并调查意外的影响。