Family-Based Mental Health Promotion for Somali Bantu and Bhutanese Refugees: Feasibility and Acceptability Trial

Theresa S Betancourt, Jenna M Berent, Jordan Freeman, Rochelle L Frounfelker, Robert T Brennan, Saida Abdi, Ali Maalim, Abdirahman Abdi, Tej Mishra, Bhuwan Gautam, John W Creswell, William R Beardslee, Theresa S Betancourt, Jenna M Berent, Jordan Freeman, Rochelle L Frounfelker, Robert T Brennan, Saida Abdi, Ali Maalim, Abdirahman Abdi, Tej Mishra, Bhuwan Gautam, John W Creswell, William R Beardslee

Abstract

Purpose: There are disparities in mental health of refugee youth compared with the general U.S.

Population: We conducted a pilot feasibility and acceptability trial of the home-visiting Family Strengthening Intervention for refugees (FSI-R) using a community-based participatory research approach. The FSI-R aims to promote youth mental health and family relationships. We hypothesized that FSI-R families would have better psychosocial outcomes and family functioning postintervention compared with care-as-usual (CAU) families. We hypothesized that FSI-R would be feasible to implement and accepted by communities.

Methods: A total of 40 Somali Bantu (n = 103 children, 58.40% female; n = 43 caregivers, 79.00% female) and 40 Bhutanese (n = 49 children, 55.30% female; n = 62 caregivers, 54.00% female) families were randomized to receive FSI-R or CAU. Refugee research assistants conducted psychosocial assessments pre- and post-intervention, and home visitors delivered the preventive intervention. Multilevel modeling assessed the effects of FSI-R. Feasibility was measured from retention, and acceptability was measured from satisfaction surveys.

Results: The retention rate of 82.50% indicates high feasibility, and high reports of satisfaction (81.50%) indicate community acceptance. Across communities, FSI-R children reported reduced traumatic stress reactions, and caregivers reported fewer child depression symptoms compared with CAU families (β = -.42; p = .03; β = -.34; p = .001). Bhutanese FSI-R children reported reduced family arguing (β = -1.32; p = .04) and showed fewer depression symptoms and conduct problems by parent report (β = -9.20; p = .04; β = -.92; p = .01) compared with CAU. There were no significant differences by group on other measures.

Conclusions: A family-based home-visiting preventive intervention can be feasible and acceptable and has promise for promoting mental health and family functioning among refugees.

Keywords: Family functioning; Intervention; Prevention; Refugees; Youth mental health.

Conflict of interest statement

Conflicts of Interest: All authors have declared that they have no competing or potential conflicts of interest in relation to this work.

Published by Elsevier Inc.

Figures

Figure 1.. FSI-R Intervention Modules
Figure 1.. FSI-R Intervention Modules
Figure 2.. CONSORT Flow Diagram
Figure 2.. CONSORT Flow Diagram
a When children and caregivers moved away, the study team attempted to locate them for post-assessment b Primary analyses included all randomized families with data for at least one time point, using 20 multiply imputed data sets to account for missingness. c Two Bhutanese families (n= 5, 2 children, 3 caregivers) were excluded from analysis due absence of both baseline and follow up assessments. Baseline data were lost due to a technology malfunction. Post-test data were not collected because the family moved or declined to participate in the post-assessment.

References

    1. U.S. Department of State. Refugee admissions. Available at: . Accessed February 10, 2019.
    1. United Nations High Commissioner for Refugees. Global trends: forced displacement in 2016. Available at: . Accessed February 1, 2019.
    1. Reed RV, Fazel M, Jones L, Panter-Brick C, Stein A. Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors. Lancet 2012;379:250–265. doi: 10.1016/S0140-6736(11)60050-0.
    1. Bronstein I, Montgomery P. Psychological distress in refugee children: a systematic review. Clin Child Fam Psych 2011;14(1):44–56. doi: 10.1007/s10567-010-0081-0.
    1. Hynie M. The social determinants of refugee mental health in the post-migration context: a critical review. Can J Psychiatry 2018;63(5):297–303. doi: 10.1177/0706743717746666.
    1. Frounfelker RL, Assefa MT, Smith E, Hussein A, Betancourt TS. "We would never forget who we are": resettlement, cultural negotiation, and family relationships among Somali Bantu refugees. Eur Child Adolesc Psychiatry 2017;26(11):1387–1400. doi: 10.1007/s00787-017-0991-1.
    1. Postelnicescu C. Europe's new identity: the refugee crisis and the rise of nationalism. Eur J Psychol 2016;12(2):203–209. doi: 10.5964/ejop.v12i2.1191
    1. de Anstiss H, Ziaian T, Procter N, Warland J, Baghurst P. Help-seeking for mental health problems in young refugees: a review of the literature with implications for policy, practice, and research. Transcult Psychiatry 2009;46(4):584–607. doi: 10.1177/1363461509351363.
    1. Silove D, Ventevogel P, Rees S. The contemporary refugee crisis: an overview of mental health challenges. World Psychiatry 2017; 16(2):130–139. doi: 10.1002/wps.20438.
    1. Murray KE, Davidson GR, Schweitzer RD. Review of refugee mental health interventions following resettlement: best practices and recommendations. Am J Orthopsychiatry 2010;80(4):576–585. doi: 10.1111/j.1939-0025.2010.01062.x.
    1. Besteman C. Making refuge, Somali Bantu refugees and Lewiston, Maine. Durham, NC: Duke University Press, 2016.
    1. Rizal D. The unknown refugee crisis: expulsion of the ethnic Lhotsampa from Bhutan. Asian Ethnicity 2004;5(2 ):151–177. doi: 10.1080/1463136042000221861.
    1. Embassy of the United States. US ambassador bids farewell to 90,000th refugee to resettle to the United States. Available at: . Accessed February 6, 2019.
    1. Center for Disease Control. Suicide and suicidal ideation among Bhutanese refugees – United States, 2009-2012. MMWR 2013;62(26):533–536.
    1. Betancourt TS, Frounfelker R, Mishra T, Hussein A, Falzarano R. Addressing health disparities in the mental health of refugee children and adolescents through community-based participatory research: a study in 2 communities. Am J Public Health 2015;105(S3):S475–482. doi: 10.2105/AJPH.2014.302504.
    1. Brown FL, Mishra T, Frounfelker RL, et al. 'Hiding their troubles': a qualitative exploration of suicide in Bhutanese refugees in the USA. Glob Ment Health (Camb) 2019;6:e1. doi: 10.1017/gmh.2018.34.
    1. Israel BA, Coombe CM, Cheezum RR, et al. Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health 2010; 100(11):2094–2102. doi: 10.2105/AJPH.2009.170506.
    1. Minkler M. Linking science and policy through community-based participatory research to study and address health disparities. Am J Public Health 2010;1(S1):S81–87. doi: 10.2105/AJPH.2009.165720.
    1. Beardslee WR, Wright EJ, Gladstone TR, Forbes P. Long-term effects from a randomized trial of two public health preventive interventions for parental depression. J Fam Psychol 2007;21(4 ):703–713. doi: 10.1037/0893-3200.21.4.703.
    1. Betancourt TS, Ng LC, Kirk CM, et al. Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial. J Child Psychol Psychiatry 2017;58(8):922–930. doi:10.1111/jcpp.12729.
    1. Podorefsky D, McDonald-Dowdell M, Beardslee WR. Adaptation of preventive interventions for a low-income, culturally diverse community. J Am Acad Child Adolesc Psychiatry 2001;40(8):879–886. doi: 10.1097/00004583-200108000-00008.
    1. Betancourt TS, Newnham EA, Birman D, Lee R, Ellis BH, Layne CM. Comparing trauma exposure, mental health needs, and service utilization across clinical samples of refugee, immigrant, and U.S.-origin children. J Trauma Stress 2017;30(3):209–218. doi: 10.1002/jts.22186.
    1. KoBoToolbox [computer program]. Cambridge, MA: KoBoToolbox; 2012.
    1. Betancourt T, Frounfelker RL, Berent JM, Suarez-Orozco MM. Addressing mental health disparities in refugee children through family and community-based prevention In: Suarez-Orozco MM, ed. Humanitarianism and Mass Migration: Confronting the World Crisis. Oakland, CA: University of California Press, 2018:137–164.
    1. World Health Organization. Process of translation and adaptation of instruments. Available at: . Accessed February 5, 2019.
    1. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977;1(3):385–401. doi: 10.1177/014662167700100306.
    1. Eaton WW, Smith C, Ybarra M, Muntaner C, Tien A. Center for Epidemiologic Studies depression scale: review and revision (CESD and CESD-R). In: Maruish ME, ed. The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults. Mahwah, NJ: Lawrence Erlbaum Associates Publishers, 2004:363–377.
    1. World Health Organization. WHO disability assessment schedule 2.0 WHODAS 2.0. Available at: . Accessed February 2, 2019.
    1. Pynoos RS, Rodriguez N, Steinberg AS, et al. The UCLA PTSD reaction index for DSM IV (Revision 1). Los Angeles, CA: UCLA Trauma Psychiatry Program, 1998.
    1. Achenbach TM. Manual for the youth self-report and 1991 profile. Burlington, VT: Department of Psychiatry, University of Vermont, 1991.
    1. Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 1993;6(4):459–473. doi: 10.1002/jts.2490060405.
    1. Derogatis LR, Lipman R, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behav Sci 1974; 19(1): 1–15. doi: 10.1002/bs.3830190102.
    1. Fosco GM, Van Ryzin MJ, Connell AM, Stormshak EA. Preventing adolescent depression with the family check-up: Examining family conflict as a mechanism of change. J Fam Psychol 2016;30(1):82–92. doi: 10.1037/fam0000147.
    1. Ying Y-W, Lee PA, Tsai JL. Psychometric properties of the intergenerational congruence in immigrant families: child scale in Chinese Americans. J Comp Fam Stud 2004;35(1):91–103. doi: 10.1093/swr/28.1.56.
    1. Essau CA, Sasagawa S, Frick PJ. Psychometric properties of the Alabama Parenting Questionnaire. J Child Fam Stud 2006;15(5):595–614. doi: 10.1007/s10826-006-9036-y.
    1. StataCorp [computer program]. Stata Statistical Software: Release 15. College Station, TX: StataCorp; 2017.
    1. Plumpton CO, Morris T, Hughes DA, White IR. Multiple imputation of multiple multi-item scales when a full imputation model is infeasible. BMC Res Notes 2016;9:45. doi: 10.1186/s13104-016-1853-5.
    1. Rubin DB. Multiple imputation for nonresponse in surveys. New York, NY: Wiley & Sons, 1987.
    1. Pfeiffer E, Sachser C, Rohlmann F, Goldbeck L. Effectiveness of a trauma-focused group intervention for young refugees: a randomized controlled trial. J Child Psychol Psychiatry 2018;59(11):1171–1179. doi: 10.1111/jcpp.12908.
    1. Newman SD, Andrews JO, Magwood GS, Jenkins C, Cox MJ, Williamson DC. Community advisory boards in community-based participatory research: a synthesis of best processes. Prev Chronic Dis 2011;8(3):A70.

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