I. Health and wellbeing

I1 De Souza, R. (2006). 'Sailing in a new direction: multicultural mental health in New Zealand'. Australian e-Journal for the Advancement of Mental Health, 5(2) 1-11.

Research focus/aims: Discusses efforts to make mental health in New Zealand more responsive to cultural groups. This general paper describes efforts to make mental health services more multicultural. It points to the need to disentangle labels such as 'migrants, refugees and Asians' and to consider needs of long-term settled ethnic communities.

Participants: Not applicable.

Key findings/outcomes: Refers to changing migration patterns and growing Asian population. The author identifies policies that aim to improve responsiveness at national, regional and local level.

Recommendations: Recommends further discussion of the terms 'migrants, refugees and Asians' and recognition of the needs of long-term settled ethnic communities and international students.

Scope: Discussion paper.

Country research undertaken in: New Zealand.

Keywords: role of host country; health/wellbeing; host country/region: New Zealand; research methods: discussion paper; migrants, including refugees.

I2 Guerin, B., Abdi, A. and Guerin, P. (2003). 'Experiences with the medical and health systems for Somali refugees Living in Hamilton'. New Zealand Journal of Psychology, 32(1), 27-32.

Research focus/aims: Reported health status and barriers to health service use among Somali refugees.

Participants: Somali refugees in Hamilton.

Key findings/outcomes: Overall, the sample rated themselves in good health with few special health problems. The most important issue was poor English skills, limiting use of health services. Greatest barriers were payment for medical care, the doctor understanding them, availability of interpreters, satisfaction with communication and their understanding the doctor. Refugees reported that there were not enough English classes available that were affordable and appropriate.

Special issues for Somali women included poor English language skills, isolation and concerns relating to childbirth practices.

Recommendations: The authors recommend training Somali nurses, public health contacts and lay personnel to convey health information and advice. Extra emphasis needs to be given to providing public health services for women in a way that makes them feel comfortable.

Scope: Interviews with 100 refugees on health issues and access to health services.

Country research undertaken in: New Zealand.

Keywords: ethnic/cultural identity; role of host country; social exclusion; health/wellbeing; language acquisition/ESOL; economic participation; host country/region: New Zealand; source country/region: Somalia; refugees; research methods: interviews.

I3 Johnson, M. (2006). 'Integration of new migrants: health'. In S. Spencer (Ed.), Refugees and other new migrants: a review of the evidence on successful approaches to integration (pp. 57-72). Oxford: Centre on Migration, Policy and Society (COMPAS).

Research focus/aims: Investigates approaches in health that promote integration of new migrants.

Participants: Not applicable.

Key findings/outcomes: The author refers to the lack of evidence on migrant health outcomes, including refugees. Data rarely differentiates between asylum seekers, refugees and migrants. There appears to be a low uptake of many services and a need for outreach and patient education programmes. Swedish research suggests worse health outcomes and a greater probability of work-related ill-health for migrants and refugees, primarily because of the low social support available to them. Studies of migrant and refugee health in London indicate that: migrants' needs change over time; health status on arrival on average is not especially poor; disease problems are exacerbated by the conditions in which refugees live after arrival; there is little evidence of effective initial health assessment, screening, monitoring and referral. Key issues are: language; 'newness' and ignorance of the system; cultural competence of local healthcare systems and staff; disposable income and poverty and the psychological climate. Possible policy interventions include information and education for refugees, migrants, health professionals; better health assessments, proper recording of data, specialist service delivery facilities, links to and support for refugee community-based organisations and the integration of health professionals of refugee and new migrant origin.

Recommendations: The author stresses the need for better information and acceptance of the valid findings of existing reviews, along with appropriate action and resources to support them. He makes nine recommendations relating to integrated services, provision of information, improved assessment, training of healthcare workers, including refugees and better systems for exchanging information.

Scope: A review of literature on refugee and migrant health initiatives in the United Kingdom. It focuses on equality of access and responsiveness.

Country research undertaken in: United Kingdom.

Keywords: role of host country; social capital/networks; housing; language acquisition/ESOL; host country/region: United Kingdom; research methods: review; migrants, including refugees.

I4 McKelvey, R. and Sang, D. (2002). 'The prevalence of psychiatric disorders among Vietnamese children and adolescents'. The Medical Journal of Australia, 177(8), 413-417.

Research focus/aims: Prevalence of psychiatric disorders among Vietnamese children and young people.

Participants: 519 children aged 9-17 and their parents.

Key findings/outcomes: The combined prevalence of psychiatric disorders among Vietnamese children aged 9-17 was similar to that found among children in Western Australia's general population. Vietnamese children in the study were much more likely to report symptoms of a psychiatric disorder than were their parents. The great majority of disorders reported by both children and parents were anxiety disorders, especially simple and social phobias. Anxiety disorders accounted for 85 percent of disorders described by children and 88 percent of disorders described by parents. Over half the children were born in Vietnam, and of these, over half arrived in Australia between 1990 and 1995.

Almost all were rated by their parents as having adapted easily to Australian life. Almost all parents described their children's health and mental health as excellent or good.

Recommendations: The authors identify a need to develop clinical services that are sensitive to Vietnamese cultural traditions that may affect the recognition, reporting and treatment of child and adolescent psychiatric disorders.

Scope: This study was based on interviews with adults and children during which each responded to a medical questionnaire/checklist.

Country research undertaken in: Australia.

Keywords: integration/social cohesion; role of host country; health/wellbeing; children/youth; host country/region: Australia; source country/region: Vietnam; migrants, including refugees; research methods: interviews; research methods: test; migrants, including refugees.

I5 Nam, B. (In preparation). Improving our understanding of the nature of family violence in new migrant and refugee families and successful models of prevention and intervention. Wellington: Centre for Social Research and Evaluation, Ministry of Social Development.

Research focus/aims: This annotated bibliography is a work in progress and provides a summary of research relating to family violence among the refugee communities represented in New Zealand. It will be updated and changed as necessary to provide a comprehensive overview of current and emerging research for the refugee and migrant family violence project.

Participants: Not applicable.

Key findings/outcomes: The annotations summarise key points from each item and relate to a wide range of ethnic groups, including refugee groups represented in New Zealand.

Recommendations: None included.

Scope: This is an annotated bibliography covering migrant and refugee groups. Only 15 of the citations refer specifically to refugees - six are from Australia, five from the United States, one from Denmark, one from New Zealand and the origin of one is unclear.

Country research undertaken in: New Zealand.

Keywords: ethnic/cultural identity; social capital/networks; health/wellbeing; women; men; children/youth; research methods: review.

I6 Ryan, D., Dooley, B. and Benson, D. (2008). 'Theoretical perspectives on postmigration adaptation and psychological wellbeing among refugees: towards a resource based model'. Journal of Refugee Studies, 21(1), 1-18.

Research focus/aims: This paper first critically examines major theoretical approaches that have guided research on the psychological wellbeing of refugees. The authors then present their own framework of adaptation involving the concept of resources (to be understood in terms of an individual's needs, personal goals and the demands he or she encounters).

Participants: Not applicable.

Key findings/outcomes: This paper defines migrant adaptation as the process through which persons reorganise or rebuild their lives after relocating to a new sociocultural context. Different models focus on different aspects of the adaptation process. For example:

• Sociocultural models are concerned with the demands of interacting effectively in a new cultural environment (for example, Ward and Kennedy 1999^[15]).
• Social identity models focus on how individuals come to terms with changing perceptions of their ethnic identity, as a result of intercultural contact (for example, Ward et al. 2001^[16]).
• Economic approaches focus on migrants' ability to access the labour market of the host environment and regain premigration levels of occupational status (for example, Aycan and Berry 1996^[17]).
• Medical models focus on pathological conditions, the diagnosis of disorders, epidemiological studies and the treatment of pharmacological or psychotherapeutic interventions. The authors suggest that introduction of the diagnostic category of post-traumatic stress disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (American Psychiatric Association 1980)^[18] prompted much research interest in this area and resulted in an overemphasis on the effects of premigration trauma. This may have been at the expense of basic needs in the present lives of resettled refugees. The authors suggest that, while having experienced trauma may be a key aspect of psychological wellbeing of refugees, it is only part of the picture. Their view is that the discussions focused on trauma make little contribution to an understanding of the actual migrant adaptation process or how the social environment in the host country impacts on psychological wellbeing of refugees.
• A psychosocial stress model that examines wellbeing in terms of exposure to demands being stressful and access to resources that moderate their impact (Lazarus and Folkman 1984)^[19] - In this model, there is an emphasis placed on psychological resources (for example, adaptive coping strategies) and social resources (for example, supportive personal relationships). In this model, personal distress is not pathologised (as in the medical model) but is thought of as a normal response to major life changes.
• An acculturation framework developed by Berry (1997)^[20] builds on the psychosocial stress model by incorporating a sensitivity to the demands of cross-cultural transitions but, in the authors' view, exaggerates the importance of this aspect.
• Hobfoll's conservation of resources theory^[21] is based on the premise that "individuals strive to obtain, retain, protect and foster the things they value" (Hobfall 2001, 341). In this theory, resource loss is seen as a key component of the stress process. Psychological stress can arise either where individuals face a threat of resource loss, resources are actually lost or an investment of resources fails to produce an expected return. This model assumes that there is shared notion of what is perceived is loss.

The authors discuss the limitations of each of these models with respect to their ability to explain migrant adaptation. They then explain how their own resource-based model builds on the strengths of Berry's acculturation model (1997), Hobfall's conservation of resources theory (2001) and Lazarus and Folkman's (1984) psychostress model. The authors suggest that resources can be grouped under four headings:

• Personal resources, which can be physical (for example, health, energy, physical attractiveness) or psychological (skills-based or personal traits). Skills-based resources include problem solving and social skills while personal traits include self-esteem, self-efficacy and hope (which can change in response to stressful circumstances).
• Material resources include money, property, means of transport and personal possessions in general and can include paid employment.
• Social resources refer to the beneficial aspects of personal relationships including emotional, informational and tangible support, as well as the sense of identity and belonging that integration into a social network brings.
• Cultural resources include skills, knowledge and beliefs that are learned within a particular cultural setting whose value to adaptation lies in their ability to be used in such settings, or similar ones. It is this category of resource in particular that the authors believe has been overlooked in previous models. It includes linguistic skills, literacy, education, computer skills and occupational skills as well as familiarity with various services and systems, knowledge of physical surroundings and climate, and shared religious and philosophical systems, which provide people with a sense of meaning.

The authors acknowledge that there are overlaps between the four categories and that a loss or gain in one area can affect another resource category. They then outline the remainder of their model, which includes the centrality of concepts of needs, goals and demands; psychological wellbeing (and not just resource loss as in Hobfall's model); and the importance of considering all phases of the migration experience - premigration phase, the migration or flight phase and the postmigration phase.

Recommendations: The authors see the main value of their model as guiding in-depth interviews with resettled refugees. A semi-structured interview can be developed to examine the individual's resources, needs and goals in each phase (premigration, flight and postmigration) as well as the perceived constraints in the host society. They consider that allowing the refugees to describe what they perceive to be their needs and goals and the resources needed to attain them is more culturally sensitive than previous approaches.

Scope: This theoretical article presents a range of theoretical approaches taken to the study of the psychological wellbeing of refugees

Country research undertaken in: Ireland.

Keywords: integration/social cohesion: definitions or models; ethnic/cultural identity; religion; role of host country; social capital/networks; economic participation; health/wellbeing; housing; research methods: discussion paper; migrants, including refugees.

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