Hardship and Survival: The Impact of Migration-Related Trauma, Communal Coping, and Social Stressors on the Suicide and Mental Health Outcomes of Latina Immigrant Women

建议书摘要 移徙是健康的社会决定因素，具有深远和持久的健康后果； 这也是拉美裔移民心理健康状况出现显著差异的原因。班次在 过去几十年来自拉丁美洲的移民模式--部分是由社会政治冲突推动的，有组织地 暴力和不断演变的性别规范导致#年拉丁裔人口空前增长。 美国。拉美裔移民面临着在移民之前、期间和之后的一系列创伤经历 移徙后--包括性侵犯、自然灾害、绑架、与家人分离/和死亡 成员，以及剥夺基本需要。这些都是深度创伤的经历，与 心理健康状况不佳(创伤后应激障碍、抑郁和焦虑)。目前，自杀是一种 在美国，拉丁裔人的主要死因是，但试图确定不同的 这些因素增加了自杀的风险，并促进了拉美裔移民的韧性。此外，还有 对拉丁裔移民自杀和移民的生活经历的了解存在显著差距- 相关的创伤和了解这些妇女如何利用社区和文化资源--例如 社区应对、集体仪式和传统聚会--以应对移徙的集体影响-- 与创伤和慢性压力有关。这项探索性的顺序混合方法研究旨在产生丰富的 了解拉美裔移民遭受与移民有关的创伤、自杀和自杀的经历 思维和社会压力因素，并找出塑造这些经历的显著文化和社区因素。 这将通过以下目标来实现：1)探讨如何暴露于与移徙有关的创伤， 社区应对和社会应激源影响自杀意念和心理健康症状的风险 成年拉美裔移民(n=20)，使用个人访谈和焦点小组；1b)了解社区 提供者和团队成员(推动者、护士和临床医生)(n=16-20)关于迁移如何- 相关创伤、社区应对和社会应激源对拉美裔移民心理健康结果的影响 使用焦点小组；2)检查与移民有关的创伤、社会压力源、社区应对和其他 显著的文化、移民和社区因素影响自杀意念和心理健康症状 使用横断面调查的拉美裔移民；以及3)与社区伙伴和社区合作 解释和整合调查结果并确定影响体验的风险和复原力因素的顾问委员会 与自杀和拉丁裔移民的心理健康后果有关。这项创新研究是在一年多的时间里进行的 前期工作，包括社区参与努力、对文献和概念的系统审查 分析和概念框架开发。我们以培养PI之间的合作为中心， 导师团队，我们在Centro Sol的社区合作伙伴，以及 巴尔的摩大都市区。据我们所知，这项创新的提案将是第一个探索 与移徙有关的创伤(跨越移徙各阶段)、社会压力、社区应对和其他突出问题 文化和社区因素对拉美裔移民心理健康结果的影响。

PROPOSAL SUMMARY Migration is a social determinant of health which has profound and long-lasting health consequences, and contributes to the significant disparities in mental health outcomes experienced by Latina immigrants. Shifts in migration patterns from Latin America over the last decades – driven in part by sociopolitical conflict, organized violence, and evolving gender norms – have contributed to unprecedented growth in the population of Latinas in the US. Latina immigrants face cumulative exposure to an array of traumatic experiences before, during, and after migration – including sexual assault, natural disasters, kidnapping, separation from/and death of family members, and deprivation of basic needs. These are deeply traumatic experiences which are associated with poor mental health outcomes (posttraumatic stress disorder, depression and anxiety). Presently, suicide is a leading cause of death among Latinas in the U.S., but there is limited research seeking to identify the distinct factors that heighten the risk of suicide and that promote resilience among Latina immigrants. Furthermore, there is a significant gap in knowledge regarding Latina immigrant’s lived experiences with suicide and migration- related trauma and understanding how these women utilize communal and cultural resources – such as communal coping, collective rituals, and traditional gatherings – to cope with the collective impact of migration- related trauma and chronic stress. This exploratory sequential mixed-methods study aims to generate a rich understanding of the experiences of Latina immigrants with migration-related trauma, suicide and suicidal ideation, and social stressors, and to identify salient cultural and communal factors that shape these experiences. This will be accomplished through the following aims: 1a) explore how exposure to migration-related trauma, communal coping, and social stressors influence the risk of suicidal ideation and mental health symptoms among adult Latina immigrants (n=20) using individual interviews and focus groups; 1b) understand community providers’ and team members’ (promotoras, nurses, and clinicians) (n=16-20) perspectives of how migration- related trauma, communal coping, and social stressors impact the mental health outcomes of Latina immigrants using focus groups; 2) examine how migration-related trauma, social stressors, communal coping and other salient cultural, migratory, and communal factors impact suicidal ideation and mental health symptoms among Latina immigrants using a cross-sectional survey; and 3) collaborate with community partners and the community advisory board to interpret and integrate findings and identify risk and resilience factors that shape experiences with suicide and the mental health outcomes of Latina immigrants. This innovative study builds on over a year of preliminary work, including community engagement efforts, a systematic review of the literature and concept analysis, and conceptual framework development. We center the cultivation of collaborations between the PI, mentorship team, our community partners at Centro SOL, and the Latino(a) immigrant community in the Baltimore Metropolitan Area. To our knowledge, this innovative proposal will be the first to explore the impact of migration-related trauma (across the stages of migration), social stressors, communal coping, and other salient cultural and communal factors on the mental health outcomes of Latina immigrants.