Addressing Social Determinants to Reduce Refugee Mental Health Disparities

描述(由申请人提供)：这项研究的目标是测试一种生态/赋权方法，通过检查以社区为基础的倡导、学习和社会支持干预(难民福祉项目，RWP)的有效性，减少社会经济上处于不利地位的中部非洲和伊拉克难民成年人的心理健康差距，该项目解决心理健康的社会决定因素，并纳入针对患有创伤后应激障碍的难民的基于证据的创伤治疗(叙述性暴露疗法，NET)。这项有180名非洲和伊拉克成年难民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的社会决定因素(贫困、社会和物质环境、获得服务的机会、边缘化)以减少心理健康差距的有效性，并审查以社区为基础的相互学习干预措施对改善基于证据的创伤治疗的参与度和留存率的影响。RWP干预强调难民重新安置机构和大学/学院之间的可持续和可复制的伙伴关系模式，让难民成人和本科生倡导者共同努力：a)提高难民适应新社区的能力；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；以及e)提高社区对难民的反应能力。RWP干预由注册参加服务学习课程的大学本科生管理，包括两个要素：1)学习圈，涉及文化交流和一对一学习机会；2)倡导，涉及合作努力，动员与健康、住房、就业、教育和法律问题有关的社区资源。RWP的试点测试证明了可行性、适当性和可接受性，初步证据表明，干预减少了苗族、中非和伊拉克参与者的心理痛苦，增加了保护因素。采用混合方法策略，在14个月的四个时间点收集每个参与者的数据，以测试为期6个月的干预措施的有效性，以减少心理痛苦(创伤后应激障碍、抑郁和特定于文化的痛苦)，增加保护因素(获得资源、英语熟练程度、环境掌握、精神卫生服务使用和社会支持)，并吸引和留住患有创伤后应激障碍的成年难民接受循证创伤治疗(NET)。通过检验保护性因素与心理困扰之间的中介关系来探讨干预效果的机制。对难民参与者的访谈和对难民和本科生的定性访谈的定性部分将探索参与者在干预中的经验，为量化数据的解释提供信息，并调查意外影响。

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.