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      Women's experiences of trauma-informed care for forced migrants: A qualitative interview study

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          Abstract

          Introduction

          Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants.

          Methods

          This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation.

          Results

          Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support.

          Conclusions

          Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.

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          Most cited references41

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          Systematic text condensation: a strategy for qualitative analysis.

          To present background, principles, and procedures for a strategy for qualitative analysis called systematic text condensation and discuss this approach compared with related strategies. Giorgi's psychological phenomenological analysis is the point of departure and inspiration for systematic text condensation. The basic elements of Giorgi's method and the elaboration of these in systematic text condensation are presented, followed by a detailed description of procedures for analysis according to systematic text condensation. Finally, similarities and differences compared with other frequently applied methods for qualitative analysis are identified, as the foundation of a discussion of strengths and limitations of systematic text condensation. Systematic text condensation is a descriptive and explorative method for thematic cross-case analysis of different types of qualitative data, such as interview studies, observational studies, and analysis of written texts. The method represents a pragmatic approach, although inspired by phenomenological ideas, and various theoretical frameworks can be applied. The procedure consists of the following steps: 1) total impression - from chaos to themes; 2) identifying and sorting meaning units - from themes to codes; 3) condensation - from code to meaning; 4) synthesizing - from condensation to descriptions and concepts. Similarities and differences comparing systematic text condensation with other frequently applied qualitative methods regarding thematic analysis, theoretical methodological framework, analysis procedures, and taxonomy are discussed. Systematic text condensation is a strategy for analysis developed from traditions shared by most of the methods for analysis of qualitative data. The method offers the novice researcher a process of intersubjectivity, reflexivity, and feasibility, while maintaining a responsible level of methodological rigour.
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            Posttraumatic stress disorder in the World Mental Health Surveys

            Background Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. Methods Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. Results The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. Conclusions PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.
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              Depression and anxiety in labor migrants and refugees--a systematic review and meta-analysis.

              Prevalence rates of depression and anxiety among migrants (i.e. refugees, labor migrants) vary among studies and it's been found that prevalence rates of depression and anxiety may be linked to financial strain in the country of immigration. Our aim is to review studies on prevalence rates of depression and/or anxiety (acknowledging that Post-traumatic Stress Disorder (PTSD) is within that class of disorders), and to evaluate associations between the Gross National Product (GNP) of the immigration country as a moderating factor for depression, anxiety and PTSD among migrants. We carried out a systematic literature review in the databases MEDLINE and EMBASE for population based studies published from 1990 to 2007 reporting prevalence rates of depression and/or anxiety and or PTSD according to DSM- or ICD- criteria in adults, and a calculation of combined estimates for proportions using the DerSimonian-Laird estimation. A total of 348 records were retrieved with 37 publications on 35 populations meeting our inclusion criteria. 35 studies were included in the final evaluation. Our meta-analysis shows that the combined prevalence rates for depression were 20 percent among labor migrants vs. 44 percent among refugees; for anxiety the combined estimates were 21 percent among labor migrants vs. 40 percent among (n=24,051) refugees. Higher GNP in the country of immigration was related to lower symptom prevalence of depression and/or anxiety in labor migrants but not in refugees. We conclude that depression and/or anxiety in labor migrants and refugees require separate consideration, and that better economic conditions in the host country reflected by a higher GNP appear to be related to better mental health in labor migrants but not in refugees.
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                Author and article information

                Contributors
                Journal
                Heliyon
                Heliyon
                Heliyon
                Elsevier
                2405-8440
                29 March 2024
                15 April 2024
                29 March 2024
                : 10
                : 7
                : e28866
                Affiliations
                [a ]The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
                [b ]The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
                [c ]The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
                Author notes
                [* ]Corresponding author. Uppsala University Hospital, Akademiska sjukhuset SE-751 85, Uppsala, Sweden. tommy.carlsson@ 123456kbh.uu.se
                [1]

                Shared first author.

                Article
                S2405-8440(24)04897-7 e28866
                10.1016/j.heliyon.2024.e28866
                11002685
                38596047
                9a257dc6-ce06-488a-bba2-f77542958224
                © 2024 The Authors. Published by Elsevier Ltd.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 11 August 2023
                : 11 March 2024
                : 26 March 2024
                Categories
                Research Article

                armed conflicts,internal displacement,refugees,trauma-informed care,women

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