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: 8700506
• 负责人: JESSICA R GOODKIND
• 金额: $ 37.2万
• 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/8700506
• 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; public health relevance; 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）：这项研究的目的是测试一种生态/授权方法，以减少社会经济中的中非和伊拉克难民成年人的心理健康差异，通过检查基于社区的倡导，学习和社会支持的社会支持（RWP）的确定性的社会支持（RWP）的有效性，以研究社区的倡导，社会支持，并巩固了社会的确定性（RWP），并巩固了一定的社会支持（RWP）的有效性（RWP）治疗，净）用于PTSD的难民。与180名非洲和伊拉克难民成年人一起进行的候补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，社会和身体环境，服务，边际化，边际化）的有效性，以降低基于社区的心理健康差异，以及对基于社区学习的影响，对这些介入的影响，对这些互助的影响和重新介入互动，并依赖于范围内的研究。 RWP干预措施强调了难民安置机构与大学/学院之间可持续且可复制的伙伴关系模型，该模型涉及难民成年人和共同努力的难民成年人和本科倡导者： b）改善难民获得社区资源的机会； c）通过评估难民的文化，经验和知识来增强有意义的社会角色； d）减少难民的社会隔离； e）增加社区对难民的反应。 RWP干预措施由大学本科生进行服务，并有两个要素：1）学习圈，其中涉及文化交流和一对一的学习机会，以及； 2）倡导，其中涉及协作努力，以动员与健康，住房，就业，教育和法律问题有关的社区资源。 RWP的试点测试表明，干预措施减少了苗族，非洲和伊拉克参与者的心理困扰和增加的保护因素，这表明干预措施减少了苗族，中非和伊拉克参与者的可行性，可接受性和初步证据。在14个月内在四个时间点收集的四个时间点收集的数据的混合方法策略将用于测试6个月干预措施的有效性，以减少心理困扰（PTSD，抑郁症和特定于文化的特定因素），增加保护因素（增加资源，英国熟练度，环境精通，精神掌握，精神卫生服务，精神卫生服务的使用以及社会服务以及与PTS依次保持PTS和PTS的证据（均与PT）一起进行，并与PTS互动（网络）。通过测试保护因素与心理困扰之间的中介关系，将探索干预效率的机制。与难民参与者的访谈以及与难民和本科生配对的定性访谈的定性组成部分将探讨参与者在干预中的经验，为定量数据的解释提供了解释以及调查意外影响。