Quality of Life and Health of Refugees & Oregon's Latino Community

Ronald Mize, PhDMehra Shirazi, PhD

Neema Mohammad Nader, FNP-C, DNP,

Refugee/Migrant Status & Stress Outbreaks of civil wars: > 42.4 million refugees have relocated to the United States. Traumatic stresses: risk for multiple health related problems, including chronic pain syndromes.40% of asylum seekers and refugees suffer from depression, anxiety, and PTSDCorrelation between somatic complaints and underlying mental health issues.

Pain & Depression Occur together: 30-50% of time

Association between mental health disorders including anxiety, panic attacks, PTSD, and other affective traits and physical complaints of nonspecific chest pain, migraines, insomnia, fatigue, and chronic non-malignant pain

Neurobiological changes from chronic stress → development of CNS sensitization

Both are difficult to treat

W hat Is The Link Between Pain & Depression?

Biopsychological perspective: Common pathways and neurotransmitters

● Nociceptive and affective pathways: norepinephrine and serotonin

● Elevated systemic inflammatory markers

Depression: greater sensitivity to pain and a risk factor for opioid use

Uncontrolled or chronic pain→ new onset of depressive disorders

Treatment ApproachPain interferes with recognition of depression

● Pain questionnaires that capture depressive disorders

Selecting a treatment approach that address both:

● Combination of antidepressants and CBT

○ Optimize outcome

○ Reduce polypharmacy

○ Eliminate stigma of treating psychiatric conditions: huge in refugee patients

Antidperesants SRNIs

1. Duloxetine: FDA approved for treatment of depression, neuropathic pain, chronic musculoskeletal pain, including OA and CLBP, and fibromyalgia

2. Venlafaxine: structurally similar to tramadol → greater analgesic potential

3. Milnacipran:

SSRIs

● 1st line tx for depression: good choice if somatic complaints are prominent symptoms of depression

TCAs

● Dual effect of treating depression and pain:

○ Anticholinergic burden

○ Cardiotoxicity

How About Opioids? Reserved for pain unresponded to first-line treatments

● Star low

● Titrat slow

● Dispense frequently and monitor closely

○ Caution: Increased MED (> 38mg/day ) increased risk of depression over time

Marijuana??

● Effectiveness for chronic and neuropathic pain is supported by evidence

● If psychiatric comorbidity, regular use may worsen anxiety, depression, and other psychotic symptoms

Other treatment approaches CBT:

● Small to moderate effects on pain and depression

Mindfulness/Meditation

● Small to no effect on effect on reducing pain intensity

● Moderately improve depression and anxiety

Relaxation therapy and hypnotherapy

● Effective in chronic pain and depression/anxiety

KNOW YOUR POPULATION: WE ARE TALKING ABOUT REFUGEES

SOMALI WOMEN’S HEALTH: A COLLABORATIVE INQUIRY INTO LIFE

EXPERIENCES OF SOMALI WOMEN IN OREGON

Mehra Shirazi, Ph.DAssistant Professor

Women, Gender, and Sexuality StudiesOregon State University

2017 NPO Conference

Objective

➢The objective of this study was to better understand how Muslim Somali refugee women experience, navigate and learn about preventive health.

Introduction ➢ The largest single African group to be granted asylum in US history

➢ 1991 civil war and ongoing political conflicts in Somalia:➢ Over a million Somalis fled to neighboring countries ➢ Two million internally displaced persons➢ 1991- 2000: up to 100,000 Somalis arrived in the U.S

➢ Approximately 10,000-15,000 Somalis live in Oregon➢Refugee Status ➢Many are single mothers with children

➢ Somali refugees face various disparities in accessing preventive health care.

➢Government-based Refugee Services

Somalia

Methods➢ Community Based Participatory Research Framework

➢ “Community-based participatory research is a "collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities." WK Kellogg Foundation Community Health Scholars Program

➢ Partnered with Oregon Somali Family Education Center➢ Establish trusting and collaborative relationship➢ Developed research questions, survey questions and focus group

interview guide

➢Four semi-structured focus groups (1.5-2 hour each)➢ Participants: N=31 Somali women➢ Ages:19-74, four age categories➢ Interviewed 2 key informants

Findings

Age:➢ 19-29 (33%)➢ 30-39 (27%)➢ 40-49 (20%)➢ ≥ 50 (20%)

Marital Status: ➢ Married (55%)➢ Single (27%)➢ Widowed (18%)

Education Attainment:➢ Less than Elementary School (32% )➢ Elementary School (26%) ➢ High School (32%)➢ Some College (.06%)➢ Unknown (~ 10% )

Employment Status :➢ Employed (21%)➢ Unemployed-Looking for work (33%) ➢ Unemployed-Not looking for work (46%)

Findings

Health Insurance: ➢ Yes (90.32%)➢ No (9.68%)

Communication with Health Provider:➢ Use a translator (75% )

➢ Professional Translator (64%) ➢ Spouse (16%)➢ Children (12%)➢ Friend (4%)➢ Relative (4%)

Income:➢ Less than 10,000(32.25%)➢ 10,000-19,999 (19.35%)➢ 20,000-29,999 (19.35%)➢ 30,000-39,999(0)➢ 40,000 and over(3.23%)➢ Don't know/Declined to state (25.8%)

Years in the U.S :➢ 0-5 (28.57%)➢ 5-10(42.86%)➢ 11-15 (21.43%)➢ >15 (3.57%)➢ Declined (3.57%)➢ Average (8.17 years)

Theme # 1 : Encountering Institutional Barriers and Lack of

Culturally Appropriate Health Services

➢Health beliefs and Health Literacy➢Misinformation and stigma➢ Not commonly discussed in the community

➢ Low awareness /insufficient information➢Limited access to relevant health information➢Lack of culturally-competent health care providers and health education materials➢Language barrier

➢Low perceived risk of cancer➢Not as common in home country➢Symptom-driven health access

Theme # 1: Encountering Institutional Barriers and Lack of Culturally

Appropriate Health Services

” My doctor told me how to do it but I don’t know what the doctor was doing. I have

diabetes, no one told me why procedures were being performed.”

“no one knows why we do this, the doctor said to do this...”

Theme # 1 : Need for Culturally-Tailored Preventive Health Information

“We would love to know, have classes on how to prevent and

education in the household, and know the symptoms, need to have

education to get help.”

Theme # 3: Cultural Identity, Discrimination

“I’m black first of all, then you’re are Muslim, Before I wore the hijab I was just black so I had that issue of being African

American, then I wore the hijab so I have an issue being Muslim because people are

always worried about me being a Terroist and something like that.”

“It doesn’t really bother me because I know who I am.”

Theme # 4: Recognizing Mental Health Care Needs Specific to Somali Refugee Women

“A lot of Somali moms are put in this situation; single mother and

they have to raise kids by themselves. They are trying to get

a job but they don’t speak the language.

Conclusion

➢ Oregon Somali refugee women faces various health challenges

➢ Numerous challenges to navigating health care and preventative services exist

➢Communication barriers

➢Cultural History

➢Lack of culturally-appropriate health information

➢Systematic Racism and Discrimination

Recommendations

➢Continual relationship and collaboration with the Somali community, community leaders, health care providers and policy makers.

➢Further community engage research with the Somali community

➢Culture care and perservation➢Design and development of culturally

appropriate health education materials

The State of Latina/o Oregon

Ronald L. Mize, Ph.D.Associate Professor of Language, Culture, and Society

Oregon State University

Presented at 2017 NPO Conference, Refugee/Latino Health

Oregon Latinos and Health