Evaluating a Mental Health Program for Palestinian Refugees in Lebanon

Medecins sans Frontière, an international non-governmental organization, initiated a mental health program for Palestinian refugees living in Lebanon. To evaluate the impact of the program after its completion, focus groups were conducted with three target groups: (1) patients, (2) staff, and (3) local community stakeholders. Participants voiced overall satisfaction with the program. The program provided easy access, good quality care, decreased stigma, as perceived by participants, and revealed a sense of community contentedness. In addition, several short-term outcomes were achieved, such as increasing the numbers of patients visiting the center/ receiving mental health treatment. However, lack of planning for sustainability and proper procedures for hand-over of the program constituted a major downfall. Program discontinuation posed ethical dilemmas, common in provisional interventions in underprivileged refugee communities.     

Testing a Dimensional Versus a Typological Approach to the Communal Coping Model in the Context of Type 2 Diabetes

ABSTRACT

The impact of type 2 diabetes (T2D) is far reaching, influencing the lives of both patients and their families. The communal coping model argues that people cope with stress in the context of their relationships, including family relationships, and that coping responses are both cognitive and behavioral in nature. According to the model, communal coping exists along two continuous dimensions: (a) appraisal, which assesses whether people’s cognitions are individual or shared, and (b) action, which pertains to whether people engage in sole or joint behavior to diminish the negative effects of their stress. Theoretically, the dimensions of communal coping cross to create four distinct types of coping. However, this typology has not been statistically tested in existing research, so one goal of this study was to test the typology. A second goal was to assess how the dimensions and types of communal coping are related to family cohesion and individual T2D outcomes. In partial support of the communal coping model, three types of coping emerged, and overall, coping together was beneficial for patient outcomes.     

Predictors of Contraception Use Among Syrian Refugees in Lebanon: Results from a Cross-Sectional Study

Maternal and Child Health Journal - The aim of this study is to explore the factors that could predict contraceptive use. This will help develop interventions to increase the use of family planning...     

Harboring illnesses: on the association between disease and living conditions in a Palestinian refugee camp in Lebanon

This research examined the association between the domestic built environment in a Palestinian refugee camp in Beirut, Lebanon, and the presence of illness among household members. Data on the domestic built environment, socio-demographics and health were collected in 860 households. The association between the presence of illness among household members and three environmental indices, namely infrastructure and services, housing conditions, and crowding was evaluated. These indices were based on a number of items that reflected the existing problems in the domestic built environment. The main finding was the positive association between poor housing conditions and the presence of illness among household members. Households with 8 - 15 housing problems were twice more likely to report the presence of illness than those with less than four housing problems (OR=2.08, 95% CI=1.40 - 3.11). This research contributes to the understanding of the influence of the built environment on the health of a refugee population.     

The Promotive Effects of Social Support for Parental Resilience in a Refugee Context: a Cross-Sectional Study with Syrian Mothers in Lebanon

Prevention Science - Exposure to war trauma increases the risk of negative individual and family-level outcomes. However, not all trauma-exposed individuals exhibit mental health or family...     

Prevalence of Chronic Disease and Insurance Coverage among Refugees in the United States

Little is known about the health status of refugees beyond the immediate post-arrival period in the US. Using data from the 2003 New Immigrant Survey, a nationally representative survey of immigrants who had recently become legal permanent residents, we determined the prevalence of chronic conditions and health insurance coverage among adult refugees who had lived in the US for at least 1?year (n?=?490). We compared their health status with that of other immigrants (n?=?3,715) using multivariable logistic regression. The median duration of US residency was 5.6 and 8.0?years among refugees and other immigrants, respectively. Refugees were more likely than other immigrants to report at least one chronic condition (24.7 vs. 15.6?%, P?<?0.001). After adjusting for sociodemographic differences, the odds of the following conditions remained significantly higher among refugees: arthritis (adjusted odds ratio [AOR]?=?1.67, 95?% confidence interval [CI]?=?1.07, 2.61), heart disease (AOR?=?2.49, 95?% CI?=?1.30, 4.74), stroke (AOR?=?5.87, 95?% CI?=?1.27, 27.25), activity-limitation due to pain (AOR?=?1.96, 95?% CI?=?1.31, 2.93), and any chronic condition (AOR?=?1.37, 95?% CI?=?1.03, 1.81). Although similar percentages of refugees (49.0?%) and other immigrants (47.4?%) were uninsured, 46.5?% of refugees with chronic conditions lacked health insurance. Refugees have a high burden of chronic disease and would benefit from expanded insurance coverage for adults with preexisting conditions.     

The epidemiology of leishmaniases in Lebanon

The prevalence of leishmaniasis in Lebanon was studied in 1993-97 for a Lebanese population sample of about 81,000 subjects (60% rural and 40% urban) constituting roughly 3.4% of the total population. The prevalence of cutaneous leishmaniasis was found to be 0.18% in the rural versus 0.41% in the urban areas. Visceral leishmaniasis was practically non-existent in both environments. In addition, skin tests were done and anti-Leishmania antibodies were sought in a sample of the population at risk in the rural area. Skin tests were positive in 2.5% of the tested subjects, and 1% of the normal population had elevated levels of anti-Leishmania antibodies. The difference between the prevalence of clinical disease and positive skin testing and/or antibodies may be due to the existence of past or present subclinical disease. An unexpected finding was that the prevalent dermotropic parasite in Lebanon belongs to the L. donovani complex. Further characterization of the isolates by molecular techniques and definition of the transmission cycle of this parasite may explain our epidemiological findings.     

High Prevalence of Chronic Non-Communicable Conditions Among Adult Refugees: Implications for Practice and Policy

The global rise in non-communicable disease (NCD) suggests that US-based refugees are increasingly affected by chronic conditions. However, health services have focused on the detection of infectious disease, with relatively limited data on chronic NCDs. Using data from a retrospective medical record review of a refugee health program in the urban Northeast (n = 180), we examined the prevalence of chronic NCDs and NCD risk factors among adult refugees who had recently arrived in the US, with attention to region of origin and family composition. Family composition was included because low-income adults without dependent children are at high risk of becoming uninsured. We found that half of the adult refugees in this sample had at least one chronic NCD (51.1%), and 9.5% had three or more NCDs. Behavioral health diagnoses were most common (15.0%), followed by hypertension (13.3%). Half of adults were overweight or obese (54.6%). Chronic NCDs were somewhat more common among adults from Iraq, but this difference was not significant (56.8 vs. 44.6%). Chronic NCDs were common among adults with and without dependent children (61.4 vs. 44.6%, respectively), and these two groups did not significantly differ in their likelihood of having a chronic NCD after adjustment for age and gender (AOR = 0.78, 95% CI = 0.39, 1.55). This study suggests that chronic NCDs are common among adult refugees in the US, including refugees at high risk for uninsurance. We propose that refugee health services accommodate screening and treatment for chronic NCDs and NCD risk factors, and that insurance outreach and enrollment programs target recently arrived refugees.     

The impact of conflict on children: the Palestinian experience

Violence permeates all parts of the West Bank and Gaza Strip. Since the onset of the Al-Aqsa Intifada on the September, 28, 2000, through October 31, 2003, more than 51,000 Palestinians have been injured and 2700 have been killed. Palestinian children suffer from various physical aliments due to their disadvantaged situation, including 10% who suffer from moderate to severe malnutrition. The children also suffer from significant mental health disorders, including 33% with acute levels of posttraumatic stress disorder, 49% with moderate levels and 15.6% low levels. In "hot" areas, 55% of the children have acute levels of posttraumatic stress disorder, 35% moderate levels, and 9% low levels.     

Kidnapping and Mental Health in Iraqi Refugees: The Role of Resilience

Although kidnapping is common in war-torn countries, there is little research examining its psychological effects. Iraqi refugees (N = 298) were assessed upon arrival to the U.S. and 1 year later. At arrival, refugees were asked about prior trauma exposure, including kidnapping. One year later refugees were assessed for posttraumatic stress disorder (PTSD) and major depression disorder (MDD) using the SCID-I. Individual resilience and narratives of the kidnapping were also assessed. Twenty-six refugees (9 %) reported being kidnapped. Compared to those not kidnapped, those who were had a higher prevalence of PTSD, but not MDD, diagnoses. Analyses examining kidnapping victims revealed that higher resilience was associated with lower rates of PTSD. Narratives of the kidnapping were also discussed. This study suggests kidnapping is associated with PTSD, but not MDD. Additionally, kidnapping victims without PTSD reported higher individual resilience. Future studies should further elucidate risk and resilience mechanisms.     

The providers of health services in Lebanon: a survey of physicians

Background  

Emerging from civil distress carries with it major challenges to reforming a health system. One such challenge is to ensure an adequate supply of competent human resources. The objective of this study was to assess the supply of physicians in Lebanon in 1998, with an assessment of their practice patterns and capacity building.     

The Health Profile and Chronic Diseases Comorbidities of US-Bound Iraqi Refugees Screened by the International Organization for Migration in Jordan: 2007–2009

More than 63,000 Iraqi refugees were resettled in the United States from 1994 to 2010. We analyzed data for all US-bound Iraqi refugees screened in International Organization for Migration clinics in Jordan during June 2007–September 2009 (n = 18,990), to describe their health profile before arrival in the United States. Of 14,077 US-bound Iraqi refugees ≥15 years of age, one had active TB, 251 had latent TB infection, and 14 had syphilis. No HIV infections were reported. Chronic diseases comorbidities accounted for a large burden of disease in this population: 35% (n = 4,105) of screened Iraqi refugees had at least one of three chronic medical conditions; hypertension, diabetes mellitus, or obesity. State health departments and clinicians who screen refugees need to be aware of the high prevalence of chronic diseases among Iraqi refugees resettled in the United States. These results will help public health specialists develop policies to reduce morbidity and mortality among US-bound Iraqi refugees.     

Peer Reviewed: Chronic Disease and Its Risk Factors Among Refugees and Asylees in Massachusetts, 2001-2005

Introduction

Better understanding of the health problems of refugees and people who are granted political asylum (asylees) in the United States may facilitate successful resettlement. We examined the prevalence of risk factors for and diagnoses of chronic disease among these groups in Massachusetts.

Methods

We retrospectively analyzed health screening data from 4,239 adult refugees and asylees who arrived in Massachusetts from January 1, 2001, through December 31, 2005. We determined prevalence of obesity/overweight, hypertension, coronary artery disease (CAD), diabetes, and anemia. Analyses included multivariate logistic regression to determine associations between CAD and diabetes with region of origin.

Results

Almost half of our sample (46.8%) was obese/overweight, and 22.6% had hypertension. CAD, diabetes, and anemia were documented in 3.7%, 3.1%, and 12.8%, respectively. People from the Europe and Central Asia region were more likely than those from other regions to have CAD (odds ratio, 5.55; 95% confidence interval, 2.95-10.47).

Conclusions

The prevalence of obesity/overweight and hypertension was high among refugees and asylees, but the prevalence of documented CAD and diabetes was low. We noted significant regional variations in prevalence of risk factors and chronic diseases. Future populations resettling in the United States should be linked to more resources to address their long-term health care needs and to receive culturally appropriate counseling on risk reduction.     

Communication and Cybercoping: Coping With Chronic Illness Through Communicative Action in Online Support Networks

Computer-mediated communication, specifically blogs, has expanded the range of the communicative action of patients with chronic disease from information seeking to information forwarding. The authors examine the effects of these 2 types of communicative action on perceived affective and physical coping outcomes. Using a survey dataset of 254 chronic disease patients, the authors tested 2 models using structural equation modeling: first, the effects of communicative action about chronic illness on coping outcomes; and second, the mediating role of emotion-focused and problem-focused coping processes. Findings indicate overall positive effects of communicative action on coping processes and outcomes, yet with different magnitudes of effects depending on the dimensions of communication behavior, the coping process, and outcome. Implications for patients and health care providers are discussed.     

Relations Between Trauma Experiences and Psychological, Physical and Neuroendocrine Functioning Among Somali Refugees: Mediating Role of Coping with Acculturation Stressors

Refugees may be prone to stress-related psychological and physical health disorders, coupled with disturbances of hypothalamic-pituitary-adrenal functioning reflected by cortisol levels. It was suggested that traumatic encounters would directly influence stress-related outcomes, as well as indirectly influence them by undermining refugees' ability to cope with acculturation challenges. Somali refugees to Canada (N = 90) consistently reported encountering trauma, which was related to poorer self-reported outcomes (trauma symptoms, depressive affect, physical health), and these relations were mediated by increased use of emotion-focused (especially avoidant) coping strategies. Trauma symptoms and multiple traumatic experiences were associated with an exaggerated morning cortisol rise, but with a blunted response to stressor reminder cues. This blunted cortisol reactivity among participants encountering prior trauma was mediated by their increased propensity to cope by means of passive resignation. Evidently, refugees were at risk for stress-related dysfunction long after migrating, and the diminished capacity to cope with acculturation challenges was particularly important in this regard.     

The Relationship of Father Parenting Capacity Variables to Perceived Uncertainty in Youth With a Chronic Illness

This study examined the relationship between father parenting capacity variables and youth illness uncertainty. Thirty-seven youth (ages 8–18) with a chronic illness and their fathers participated. Fathers completed the Parenting Stress Index–Short Form, the Child Vulnerability Scale, and the Parent Protection Scale, and the youth completed the Children's Uncertainty in Illness Scale. Regression analyses indicated that father-reported parenting stress and child vulnerability was associated with youth-reported illness uncertainty. Paternal overprotection was not related to uncertainty. Results address a gap in the pediatric chronic illness literature, and suggest that the influences of fathers' parenting characteristics are important to understanding youth adjustment to chronic illness.     

The appropriateness of use of coronary angiography in Lebanon: implications for health policy

BACKGROUND: Lebanon, characterized by a free-market health care system, has one of the highest reported per capita rates of cardiac catheterization facilities and coronary angiographies in the world. The aim of this study is to evaluate the appropriateness of performance of coronary angiography procedures in Lebanon. METHODS: Data derived from the 2004 Lebanese Interventional Coronary Registry (LICOR) included 5418 patients aged 30 years and older who had not undergone prior percutaneous coronary intervention or coronary artery bypass grafting. Appropriateness was evaluated based on the Class I indications of the ACC/AHA guidelines for coronary angiography. FINDINGS: The overall rate of appropriate procedures was 54.7% (95% CI 53.3-56.0%). Appropriateness varied significantly by gender and across administrative regions. Compared with females, males were more likely to be referred appropriately for coronary angiography (OR = 1.28, 95% CI = 1.15-1.44). Appropriateness was lowest (OR = 0.89, 95% CI = 0.71-1.12) in the region where the per capita density of cardiac catheterization labs increased by six-fold in the latter 2 years. The majority of the patients (84.3%) were not evaluated by any of the non-invasive tests prior to angiography, with only 10.8%, 4% and 1.5% of the patients referred for an exercise stress test, stress echocardiography and thallium stress tests, respectively. DISCUSSION: Findings indicate a high rate of procedures conducted without appropriate indications and a low utilization rate of pre-interventional non-invasive testing. This may be attributed to three factors: a surplus of catheterization facilities in certain regions, the insignificant cost gradient between non-invasive testing and coronary angiography, and the wide case-based reimbursement of coronary angiography, unlike non-invasive testing, by public insurance schemes.