Addressing Social Determinants to Reduce Refugee Mental Health Disparities

描述（由申请人提供）：本研究的目的是通过检验基于社区的倡导、学习和社会支持干预（难民福利项目，RWP）的有效性，测试一种生态/赋权方法，以减少社会经济上处于不利地位的中非和伊拉克成年难民的心理健康差异，该干预解决了心理健康的社会决定因素，并结合了创伤治疗（叙事暴露疗法，NET）。对180名非洲和伊拉克成年难民进行的候补名单随机对照试验具有创新性和重要意义，因为它将严格检验解决心理健康的社会决定因素（贫穷、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，并审查基于社区的、相互学习干预提高参与和保持对那些有需要的循证创伤为重点的治疗。RWP干预强调难民安置机构和大学/学院之间可持续和可复制的伙伴关系模式，涉及难民成年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、经验和知识来加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，包括两个要素：1)学习圈，包括文化交流和一对一的学习机会；2)宣传，包括协同努力，动员与卫生、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、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困扰，增加了保护因素。采用混合方法策略，在14个月的时间里从每个参与者收集了四个时间点的数据，用于测试6个月干预的有效性，以减少心理困扰（创伤后应激障碍，抑郁症和文化特异性困扰），增加保护因素（获取资源，英语熟练程度，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的成年难民接受循证创伤治疗（NET）。通过检验保护因素与心理困扰之间的中介关系，探讨干预效果的机制。对难民参与者的定性访谈以及对难民和本科生的成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.