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Niemi, M., Manhica, H., Gunnarsson, D., Ståhle, G., Larsson, S. & Saboonchi, F. (2019). A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers. International Journal of Environmental Research and Public Health, 16(20), Article ID E4027.
Open this publication in new window or tab >>A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers
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2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 20, article id E4027Article in journal (Refereed) Published
Abstract [en]

Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of social participation is described in empirical research, and how it is associated with mental health outcomes.

METHODS: In total, 64 studies were identified through searches in PubMed, PsycInfo, and Sociological Abstracts. These studies describe various forms of social participation among refugees and asylum seekers, and 33 of them also addressed various forms of mental health outcomes.

RESULTS: The identified studies described forms and conditions of social participation-both in the host country and transnationally-that could be synthesized into three broad dimensions: (1) Regulatory frameworks, conditions and initiatives; (2) Established societal organizations and social structures; and (3) Community organized groups. Each of these consisted of several sub-domains. The identified dimensions of social participation were also associated with psychosocial well-being and decreased psychological distress.

CONCLUSIONS: There is a need for policies to enable and support the participation of refugees and asylum seekers in various dimensions of social structures in host societies. Social participation enhances resilience, re-establishes social lives, and acts as a protective factor against poor mental health outcomes.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
dimension, mental health, refugees and asylum seekers, social participation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3061 (URN)10.3390/ijerph16204027 (DOI)31640210 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194Public Health Agency of Sweden
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Gottvall, M., Sjölund, S., Arwidson, C. & Saboonchi, F. (2019). Health-related quality of life among Syrian refugees resettled in Sweden. Quality of Life Research
Open this publication in new window or tab >>Health-related quality of life among Syrian refugees resettled in Sweden
2019 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose The main purpose of this study was to assess health-related quality of life (HRQoL) among Syrian refugees resettled in Sweden. Further, we wanted to investigate whether sex, age, education, area of residence, cohabitation and social support were associated with HRQoL in this population. Methods This is a cross-sectional study including 1215 Syrian refugees from a randomly selected sample frame resettled in Sweden between the years 2011 and 2013. HRQoL was measured by the EQ-5D-5L descriptive system, and EQ-5D-5L index values were calculated. Associations between sex, age, education, area of residence, cohabitation, social support and EQ-5D-5L were investigated using multiple linear regression analysis. Results Depression/anxiety was the most commonly (61.9%) reported EQ-5D-5L problem among the group of Syrian refugees. The mean EQ-5D-5L index value was found to be 0.754. Male sex, younger age, cohabitation and social support were found associated with a higher EQ-5D-5L index score. Conclusions Our results concerning long-lasting health problems among the study population indicate that there is a profound need for policies and interventions promoting refugees' health. Our results also show that social support, a modifiable factor, is relevant to refugees' overall health, pointing to the importance of public health interventions and policies targeting the facilitation, mobilization and enhancing of refugees' social support.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Quality of life, Refugees, Social support, Syria, Resettlement
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3053 (URN)10.1007/s11136-019-02323-5 (DOI)31617059 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194Swedish Red Cross
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Sengoelge, M., Johnson-Singh, C. M., Mittendorfer-Rutz, E., Vaez, M. & Saboonchi, F. (2019). Identifying subgroups of refugees from Syria resettled in Sweden based on multiple trauma exposures: A latent class analysis of trauma history and mental health outcomes.. Journal of Psychosomatic Research, 125, Article ID 109814.
Open this publication in new window or tab >>Identifying subgroups of refugees from Syria resettled in Sweden based on multiple trauma exposures: A latent class analysis of trauma history and mental health outcomes.
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2019 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 125, article id 109814Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Many refugees have been subjected to pre-migratory trauma. Evidence is needed to address the heterogeneity within refugee populations in regard to patterns of multiple trauma exposures. This study identified subgroups within a refugee population displaying different profiles of multiple trauma exposures and assessed sociodemographic predictors and differences in mental health symptom severity across these classes.

METHODS: Study population consisted of 1215 refugees from Syria resettled in Sweden. Latent class analysis 3-step method for modelling predictors and outcomes and a class-specific weighted multigroup approach were used to identify classes of refugees using self-reported data on violent and non-violent trauma exposures, sociodemographic variables and symptom severity scores for depression, anxiety and PTSD.

RESULTS: Three classes were identified: class 1 'multiple violent and non-violent trauma' (39.3%, n = 546); class 2 'witnessing violence and multiple non-violent trauma' (40.8%, n = 569); and class 3 'low multiple non-violent trauma' (20.1%, n = 281). Trauma exposure and gender significantly predicted class membership. Male gender and highest severity of mental ill health defined class 1. Female gender predicted higher mental ill health within classes 1 and 2. Across all three classes living with a partner was associated with lower severity of mental ill health regardless of trauma exposure classes.

CONCLUSIONS: There are distinct patterns within refugee populations concerning exposure to multiple trauma. Violence is a primary marker for higher likelihood of multiple trauma exposures and severity of mental health. Gender predisposes individuals to trauma exposure and its outcomes differentially.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Anxiety, Depression, Latent class analysis, Multiple trauma, Post-traumatic stress disorder (PTSD), Refugees
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:rkh:diva-3035 (URN)10.1016/j.jpsychores.2019.109814 (DOI)31470254 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-09-06Bibliographically approved
Nymark, C., Henriksson, P., Mattiasson, A.-C., Saboonchi, F. & Kiessling, A. (2019). Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction. European Journal of Cardiovascular Nursing, 18(6), 512-520
Open this publication in new window or tab >>Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction
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2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 6, p. 512-520Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking.

AIM: To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay.

METHODS: A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis.

RESULTS: The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay ( P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour.

CONCLUSION: Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.

Keywords
Acute myocardial infarction, PLS regression analysis, appraisal process, patient delay, questionnaire
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2839 (URN)10.1177/1474515119844654 (DOI)31132880 (PubMedID)
Funder
Swedish Heart Lung FoundationStockholm County Council
Available from: 2019-06-12 Created: 2019-06-12 Last updated: 2019-08-14Bibliographically approved
Helgesson, M., Wang, M., Niederkrotenthaler, T., Saboonchi, F. & Mittendorfer-Rutz, E. (2019). Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden. Journal of Epidemiology and Community Health, 73(5), 407-415
Open this publication in new window or tab >>Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden
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2019 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 5, p. 407-415Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.

Methods: All non-pensioned individuals aged 19-60 years who were resident in Sweden on 31 December 2009 were included (n= 4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010-2013.

Results: Refugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.

Conclusion: Refugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.

Place, publisher, year, edition, pages
BioMed Central, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3007 (URN)10.1136/jech-2018-211177 (DOI)30755462 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07194
Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-08-06Bibliographically approved
Okenwa-Emegwa, L., Saboonchi, F., Mittendorfer-Rutz, E., Helgesson, M. & Tinghög, P. (2019). Prevalence and predictors of low future expectations among Syrian refugees resettled in Sweden. Heliyon, 5(10), Article ID e02554.
Open this publication in new window or tab >>Prevalence and predictors of low future expectations among Syrian refugees resettled in Sweden
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2019 (English)In: Heliyon, ISSN 2405-8440, Vol. 5, no 10, article id e02554Article in journal (Refereed) Published
Abstract [en]

Background Future Expectation is important for motivation and wellbeing, however drastic life events such as in refugee situations may result in low expectations. This study aims to investigate the prevalence and determinants of low future expectations among Syrian refugees resettled in Sweden. Methods A random sample of 1215 Syrian refugees resettled in Sweden responded to questionnaire. Weighted analyses and adjusted relative risks were conducted to determine the prevalences and predictors of low future expectations. Synergy index was calculated for low social support and depression in relation to low expectations. Results The prevalences of low future expectations for labour market, social and economic intergration were 10.9%, 13.4% and 14.1% respectively. Longer stay in Sweden, being older, low social support and depression were associated with low future expectations. The simultaneous presence of depression and low social support had a synergistic effect on low social expectation. Discussions Understanding and addressing factors related to low future expectations among refugees may be useful for facilitating their labour market, social and economic integration.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Psychology, Sociology, Expectations, Migration, Social support, Depression, Refugee, Labour market, Asylum, Syria, Sweden, Synergy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3067 (URN)10.1016/j.heliyon.2019.e02554 (DOI)31692714 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Red Cross
Available from: 2019-11-08 Created: 2019-11-08 Last updated: 2019-11-08Bibliographically approved
Gottvall, M., Vaez, M. & Saboonchi, F. (2019). Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden. BMC International Health and Human Rights, 19(1), Article ID 28.
Open this publication in new window or tab >>Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden
2019 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 19, no 1, article id 28Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender.

METHODS: Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework.

RESULTS: Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83-3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = -0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06-1.26). Gender did not moderate this pattern.

CONCLUSION: The results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Gender, Post-traumatic stress disorders, Protective factors, Refugees, Social support, Torture
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3044 (URN)10.1186/s12914-019-0214-6 (DOI)31488136 (PubMedID)
Available from: 2019-09-26 Created: 2019-09-26 Last updated: 2019-09-26Bibliographically approved
Vikdahl, L., Gunnarsson, D., Larsen, J., Ståhle, G. & Saboonchi, F. (2018). Mångfald och hälsa: En kartläggning av vilka kunskapsbehov som finns hos några samhällsaktörer i Södertörnregionen gällande mångfald och hälsa, med fokus på nyanländas etablering.. Huddinge: Flemingsberg Science
Open this publication in new window or tab >>Mångfald och hälsa: En kartläggning av vilka kunskapsbehov som finns hos några samhällsaktörer i Södertörnregionen gällande mångfald och hälsa, med fokus på nyanländas etablering.
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2018 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Huddinge: Flemingsberg Science, 2018. p. 34
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-2738 (URN)
Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-09Bibliographically approved
Nordhall, O., Knez, I. & Saboonchi, F. (2018). Predicting general mental health and exhaustion: the role of emotion and cognition components of personal and collective work-identity.. Heliyon, 4(8), Article ID e00735.
Open this publication in new window or tab >>Predicting general mental health and exhaustion: the role of emotion and cognition components of personal and collective work-identity.
2018 (English)In: Heliyon, ISSN 2405-8440, Vol. 4, no 8, article id e00735Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate relationships between emotion and cognition components of personal and collective work-identity and self-reported general mental health and exhaustion, in Swedish teachers (N = 768). In line with our predictions, we showed that the emotion component of personal work-identity and the cognition component of collective work-identity associated positively with general mental health and negatively with exhaustion. The reverse result was found, however, for the cognition component of personal work-identity and emotion component of collective work-identity. In general, all this indicates that person-work bonding might, to some degree, account for general mental health and exhaustion in employees. In particular, the findings suggest that general mental health and exhaustion may vary symmetrically across the: (1) Type of person-work bonding (personal vs. collective work-identity); and (2) Type of psychological component (emotion vs. cognition) involved in personal- and collective work-identity.

Keywords
Psychology
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2614 (URN)10.1016/j.heliyon.2018.e00735 (DOI)30140768 (PubMedID)
Available from: 2018-08-30 Created: 2018-08-30 Last updated: 2018-08-31Bibliographically approved
Okenwa-Emegwa, L., Saboonchi, F. & Tinghög, P. (2018). Prevalence and predictors of violence among Syrian refugee women resettled in Sweden. Paper presented at 11th European Public Health Conference Winds of change: towards new ways of improving public health in Europe Ljubljana, Slovenia 28 November–1 December 2018. European Journal of Public Health, 28(Suppl. 4), 156
Open this publication in new window or tab >>Prevalence and predictors of violence among Syrian refugee women resettled in Sweden
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl. 4, p. 156-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background Refugee women are at more risk of a continuum of violence, pre, during and post flight. After resettlement, increased family conflicts are likely, due to shifts in gender roles and changing family structures. Prevalence estimates, however, remain scarce especially for Syrian refugee women in Europe. Given that exposure to violence is a substantial risk factor for ill health and poor adaptation, this study aims to estimate the prevalence of violence in different phases of flight and associated sociodemographic factors. Methods The study is based on a random sample of 452 Syrian refugee women resettled in Sweden. Exposure to violence was operationalised as having been a victim of torture, physical or sexual violence, pre and during flight; witnessing violence was operationalised as experiencing war at close quarters, witnessing physical violence, or forced separation from loved ones, pre and during flight; family conflicts was operationalised as experiencing distressing conflicts in the family since resettlement. Descriptive analysis were conducted to estimate prevalence and logistic regression to assess associations. Weighted data produced socio-demographically representative estimates. Robust standard errors were used to obtain 95% confidence intervals for all estimates. Results About 25.1% (95% 20.9 – 29.4) of the women were exposed to violence preflight, 7.8% (95% 5.2 – 10.4) were victims during flight. Up to 93.3% (95% 90.7 – 95.9) witnessed violence preflight, 67.2% (95% 62.6 – 71.8) during flight. About 34.2% (95% 29.7 – 38.7) are experiencing distressing family conflicts.Logistic regressions showed no significant difference after controlling for age, education and marital status. Conclusions The magnitude of violence and ongoing family conflicts calls for a closer look at the plight of refugee women.Violence is widespread and not specific to any sociodemographic group, an important finding for healthcare and public health workforce to take note of. 

National Category
Health Sciences
Identifiers
urn:nbn:se:rkh:diva-2734 (URN)10.1093/eurpub/cky213.457 (DOI)
Conference
11th European Public Health Conference Winds of change: towards new ways of improving public health in Europe Ljubljana, Slovenia 28 November–1 December 2018
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-04-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5376-5048

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