Addressing Social Determinants to Reduce Refugee Mental Health Disparities

描述（申请人提供）：本研究的目标是通过检查基于社区的宣传、学习和社会支持干预的有效性，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（难民福利项目），解决心理健康的社会决定因素，并纳入循证创伤治疗（叙事暴露疗法，NET）为难民与创伤后应激障碍。这项有180名非洲和伊拉克难民成年人参加的等待名单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的有效性（贫困、社会和物质环境、获得服务的机会、边缘化），以减少心理健康方面的差距，并审查以社区为基础，相互学习干预措施，以改善对有需要者的循证创伤治疗的参与和保留。由难民成年人和大学生倡导者共同努力的学院，以：a）提高难民在新社区中的能力; 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，加强有意义的社会作用; d）减少难民的社会孤立;（e）加强社区对难民的反应。RWP干预措施由参加服务学习课程的大学本科生管理，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）宣传，涉及协同努力，调动与卫生、住房、就业、教育和法律的问题有关的社区资源。RWP的试点测试证明了可行性，适当性，可接受性和初步证据表明，干预减少苗族，中非和伊拉克参与者的心理困扰，并增加了保护因素。将采用混合方法策略，在14个月期间的4个时间点收集每位参与者的数据，以测试6个月干预措施减少心理困扰的有效性（创伤后应激障碍，抑郁症和文化特有的痛苦），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），参与并留住患有创伤后应激障碍的难民成年人进行循证创伤治疗（NET）。干预有效性的机制将通过测试保护因素和心理困扰之间的中介关系进行探索。与难民参与者的访谈以及与难民和大学生的配对定性访谈的定性组成部分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。

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.