Mental health needs of sex trafficking survivors in New York City: Reflections on exploitation, coping, and recovery
Sharing Power and Building Trust: Recommendations for Conducting Research with Sex Trafficking Survivors
More research is needed on the mental health sequelae of sex trafficking in the U.S. to build a more effective response to the mental health needs of survivors. This commentary provides recommendations on how to conduct research that shares power and builds trust, amplifying the voices of survivors.
Mental health problems among children in Sierra Leone: Assessing cultural concepts of distress
Parenting and discipline in post-conflict Sierra Leone
BACKGROUND:While the literature on physical punishment concludes that it has negative effects on children, the practice remains common in many countries. In post-conflict countries with nongovernmental organizations (NGO) operating in child protection, traditional disciplinary practices may conflict with international child rights agendas. The country of Sierra Leone has a unique history of conflict, abject poverty, low literacy, and weak governance - often, NGO agents are responsible for providing social services that the government is unable to consistently provide. OBJECTIVE:We examined how Sierra Leonean caregivers think about appropriate discipline for children, and whether they perceived any changes in their attitudes toward disciplinary practices since the end of the war. PARTICIPANTS AND SETTING/METHODS:We collected data from parents and caregivers in urban, peri-urban, and rural areas of Sierra Leone's four districts. METHODS:We used focus groups (12 groups, nâ€‰=â€‰92) and individual interviews (nâ€‰=â€‰21) to collect data in 2013. Focus groups and interviews were conducted by research assistants fluent in Krio and English. We used a thematic content analysis approach. RESULTS:We found that physical discipline-"beating"-was widely acceptable and common. A few parents mentioned other means of discipline, such as withholding food. Parents widely agreed that parenting had changed since the war, and reported that child rights movements supported by NGOs had made it more difficult to discipline their children in traditional ways. CONCLUSIONS:Discipline was seen a central component of child-rearing and a means of ensuring safe and proper development. This may be a protective mechanism in the precarious, high poverty environment of post-war Sierra Leone. The negative responses of parents to NGO efforts to reduce physical punishment and other forms of child abuse suggest that grassroots approaches are needed to address this pervasive problem.
Trait emotional intelligence, coping, and occupational distress among resettlement workers
OBJECTIVE:Trait emotional intelligence has recently emerged as a negative predictor of work-related distress. However, research that considers the mechanisms underlying the relationship between trait emotional intelligence and distress is lacking, in particular among workers with emotionally intensive occupations. The purpose of this study was to analyze the mediating pathway of coping behaviors in the relations between trait emotional intelligence, and work-related distress outcomes, namely secondary traumatic stress and job burnout in a sample of refugee resettlement workers. METHOD/METHODS:Participants were 210 resettlement workers from six organizations in the United States who completed a questionnaire. Questions included self-reported measures of secondary traumatic stress, burnout, trait emotional intelligence, coping behaviors, and history of trauma. The majority of participants identified as White (64.9%) and female (73.6%). The average participant was 32.96 years old (SD = 10.22) and was employed in the same position for 2.64 years (SD = 4.67). RESULTS:Unhealthy coping (e.g., substance use and denial), emerged as a significant mediator of the relations between trait emotional intelligence and the outcomes, with 43% and 64% of the total effects for secondary traumatic stress and burnout mediated. Specifically, trait emotional intelligence negatively related to secondary traumatic stress and burnout via a reduction in unhealthy coping behaviors, rather than an increase in healthy coping ones. CONCLUSIONS:Training programs promoting the psychological well-being of employees often focus on the promotion of healthy coping practices. These results suggest the potential value of including trait emotional intelligence training in the development of such programs. (PsycINFO Database Record
Secondary Traumatic Stress and Burnout Among Refugee Resettlement Workers: The Role of Coping and Emotional Intelligence
To promote a better understanding of the impact of refugee resettlement work on refugee resettlement workers, this study examined the prevalence rates of deleterious mental health and occupational outcomes, such as secondary traumatic stress and burnout, among a sample of 210 refugee resettlement workers at six refugee resettlement agencies in the United States. The study also explored coping mechanisms used by service providers to manage work-related stress and the influence of such strategies and emotional intelligence on secondary traumatic stress and burnout. Our findings show that certain coping strategies, including self-distraction, humor, venting, substance use, behavioral disengagement, and self-blame, were strongly related to deleterious outcomes, Î²s = .18 to .38, ps = .023 to < .001. Emotional intelligence was a negative correlate for all outcomes, Î²s = -.25 to -.30, ps < .001, above and beyond the effects of trauma, coping styles, job, and demographic characteristics. These findings have potential implications for clinical training and organizational policy regarding refugee mental health.
Exploring Female Genital Cutting Among Survivors of Torture
Though the practice of female genital cutting (FGC) has been framed as a form of gender-based torture, few studies have examined the prevalence and impact of the practice among documented survivors of torture. This article presents a secondary analysis of data from 514 African-born women at an interdisciplinary clinic for survivors of torture. Results indicate few demographic differences between those who experienced FGC and those who had not, though a larger proportion of the FGC group were West African and identified as Muslim. Many with FGC were in the process of applying for asylum, reported sexual and psychological torture, and cited gender as a basis for their persecution. The FGC group evidenced unique correlates related to immigration status and psychological and sexual torture experiences that the non-FGC group did not. Findings indicate that female survivors of torture with FGC represent a distinct group with specific mental health needs.
Knowledge and attitudes toward female genital cutting among West African male immigrants in New York City
In this project, we explored knowledge and attitudes toward female genital cutting (FGC) in a survey of 107 West African immigrants, including 36 men. Men in this study were as knowledgeable about the health consequences of FGC as women, though with a less nuanced understanding. They also rejected the practice at rates comparable to women. Despite this knowledge and rejection of FGC, most men did not express a personal preference for women with or without FGC in intimate relationships. Future research and interventions must explore men's opposition to FGC and emphasize the impact of FGC on their partners' gynecological and reproductive health.
Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Post-conflict Sierra Leone
BACKGROUND: Little attention has been paid to potential relationships between mental health, trauma, and personal exposures to Ebola virus disease (EVD) and health behaviors in post-conflict West Africa. We tested a conceptual model linking mental health and trauma to EVD risk behaviors and EVD prevention behaviors. METHODS AND FINDINGS: Using survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines associations between war exposures, post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, and personal EVD exposure (e.g., having family members or friends diagnosed with EVD) and EVD-related health behaviors among 1,008 adults (98% response rate) from 63 census enumeration areas of the Western Rural and Western Urban districts randomly sampled at the height of the EVD epidemic (January-April 2015). Primary outcomes were EVD risk behaviors (14 items, Cronbach's alpha = 0.84) and EVD prevention behaviors (16 items, Cronbach's alpha = 0.88). Main predictors comprised war exposures (8 items, Cronbach's alpha = 0.85), anxiety (10 items, Cronbach's alpha = 0.93), depression (15 items, Cronbach's alpha = 0.91), and PTSD symptoms (16 items, Cronbach's alpha = 0.93). Data were analyzed using two-level, population-weighted hierarchical linear models with 20 multiply imputed datasets. EVD risk behaviors were associated with intensity of depression symptoms (b = 0.05; 95% CI 0.00, 0.10; p = 0.037), PTSD symptoms (b = 0.10; 95% CI 0.03, 0.17; p = 0.008), having a friend diagnosed with EVD (b = -0.04; 95% CI -0.08, -0.00; p = 0.036), and war exposures (b = -0.09; 95% CI -0.17, -0.02; p = 0.013). EVD prevention behaviors were associated with higher anxiety (b = 0.23; 95% CI 0.06, 0.40; p = 0.008), having a friend diagnosed with EVD (b = 0.15; 95% CI 0.04, 0.27; p = 0.011), and higher levels of war exposure (b = 0.45; 95% CI 0.16, 0.74; p = 0.003), independent of mental health. PTSD symptoms were associated with lower levels of EVD prevention behavior (b = -0.24; 95% CI -0.43, -0.06; p = 0.009). CONCLUSIONS: In post-conflict settings, past war trauma and mental health problems are associated with health behaviors related to combatting EVD. The associations between war trauma and both EVD risk behaviors and EVD prevention behaviors may be mediated through two key mental health variables: depression and PTSD symptoms. Considering the role of mental health in the prevention of disease transmission may help fight continuing and future Ebola outbreaks in post-conflict Sierra Leone. This sample is specific to Freetown and the Western Area and may not be representative of all of Sierra Leone. In addition, our main outcomes as well as personal EVD exposure, war exposures, and mental health predictors rely on self-report, and therefore raise the possibility of common methods bias. However, the findings of this study may be relevant for understanding dynamics related to EVD and mental health in other major capital cities in the EVD-affected countries of West Africa.
The youth readiness intervention for war-affected youth
PURPOSE: Mental disorders are among the largest contributors to the global burden of disease. Since the cessation of the Sierra Leonean civil war in 2002, there have been few mental health resources available for war-affected youth. Co-occurring psychological problems are commonly reported by youth in the post-conflict setting, suggesting a need for evidence-based interventions that cater to comorbid psychological difficulties. This feasibility study outlines the implementation and evaluation of a mixed-methods approach for developing and piloting a culturally grounded group mental health treatment-the Youth Readiness Intervention (YRI)-for war-affected Sierra Leonean youth. METHODS: Participating youth (N = 32; 50% female; ages, 15-24 years) were allocated to one of four gender- and age-stratified groups, facilitated by gender-matched Sierra Leonean interventionists. The intervention comprised adapted cognitive behavioral therapy techniques to address issues pertinent to war-affected youth. Analyses comprised assessments of reliable symptom change, mental health, functional adaptation, and interventionist fidelity outcomes. RESULTS: The YRI was found to be acceptable, feasible and associated with reliable changes in internalizing and externalizing symptoms and improvements in functional impairments and emotion regulation (mean effect size, d = .64). CONCLUSIONS: Youth struggling with the mental health consequences of past trauma due to war merit special attention. The YRI presents a feasible and acceptable intervention for use in this low resource setting. A randomized controlled trial is planned to further test intervention effectiveness and scalability.