Çetrez Önver A, DeMarinis Valerie, Sundvall Maria, Fernandez-Gonzalez Manuel, Borisova Liubov, Titelman David
Faculty of Theology, Uppsala University, Uppsala, Sweden.
Public Mental Health Promotion Research Area, Innlandet Hospital Trust, Brumunddal, Norway.
Front Sociol. 2021 Apr 26;6:551105. doi: 10.3389/fsoc.2021.551105. eCollection 2021.
This public mental health study highlights the interactions among social determinants and resilience on mental health, PTSD and acculturation among Iraqi refugees in Sweden 2012-2013. The study aims to understand participants' health, resilience and acculturation, paying specific attention to gender differences. The study, using a convenience sampling survey design ( = 4010, 53.2% men), included measures on social determinants, general health, coping, CD-RISC, selected questions from the EMIC, PC-PTSD, and acculturation. Gender differences and reported differences between life experiences in Iraq and Sweden were strong. In Sweden, religious activity was more widespread among women, whereas activity reflecting religion and spirituality as a coping mechanism decreased significantly among men. A sense of belonging both to a Swedish and an Iraqi ethnic identity was frequent. Positive self-evaluation in personal and social areas and goals in life was strong. The strongest perceived source of social support was from parents and siblings, while support from authorities generally was perceived as low. Self-rated health was high and the incidence of PTSD was low. A clear majority identified multiple social determinants contributing to mental health problems. Social or situational and emotional or developmental explanations were the most common. In general, resilience (as measured with CD-RISC) was low, with women's scores lower than that of men. Vulnerability manifested itself in unemployment after a long period in Sweden, weak social networks outside the family, unsupportive authorities, gender differences in acculturation, and women showing more mental health problems. Though low socially determined personal scores of resilience were found, we also identified a strong level of resilience, when using a culture-sensitive approach and appraising resilience as expressed in coping, meaning, and goals in life. Clinicians need to be aware of the risks of poorer mental health among refugees in general and women in particular, although mental health problems should not be presumed in the individual patient. Instead clinicians need to find ways of exploring the cultural and social worlds and needs of refugee patients. Authorities need to address the described post-migration problems and unmet needs of social support, together comprising the well-established area of the social determinants of health.
这项公共心理健康研究突出了2012 - 2013年瑞典伊拉克难民中社会决定因素与心理健康、创伤后应激障碍（PTSD）及文化适应之间的相互作用。该研究旨在了解参与者的健康状况、恢复力和文化适应情况，特别关注性别差异。该研究采用便利抽样调查设计（n = 4010，53.2%为男性），纳入了关于社会决定因素、总体健康、应对方式、Connor-Davidson韧性量表（CD-RISC）、从“文化与心理健康问卷”（EMIC）中选取的问题、创伤后应激障碍检查表平民版（PC-PTSD）以及文化适应的测量。性别差异以及在伊拉克和瑞典生活经历方面所报告的差异都很显著。在瑞典，宗教活动在女性中更为普遍，而作为一种应对机制反映宗教和灵性的活动在男性中显著减少。同时拥有瑞典和伊拉克族群身份认同感的情况很常见。在个人和社会领域的积极自我评价以及生活目标都很强。最强的社会支持来源被认为是父母和兄弟姐妹，而来自当局的支持总体上被认为较低。自我评定的健康状况良好，创伤后应激障碍的发病率较低。绝大多数人指出多种社会决定因素导致心理健康问题。社会或情境以及情感或发展方面的解释最为常见。总体而言，（用CD-RISC测量的）恢复力较低，女性得分低于男性。脆弱性表现为在瑞典长期停留后的失业、家庭以外薄弱的社会网络、不提供支持的当局、文化适应方面的性别差异以及女性存在更多心理健康问题。尽管发现社会决定因素导致的个人恢复力得分较低，但当采用文化敏感方法并从应对方式、意义和生活目标方面评估所表现出的恢复力时，我们也确定了较高水平的恢复力。临床医生需要意识到难民尤其是女性心理健康较差的风险，尽管不应在个体患者中假定存在心理健康问题。相反，临床医生需要找到探索难民患者文化和社会世界及需求的方法。当局需要解决所描述的移民后问题以及未得到满足的社会支持需求，这些共同构成了既定的健康社会决定因素领域。
