Table 2 Study Characteristics

Markova et al.

(2020)

Norway

[93]

Design: Quantitative Setting: Direct contact through digital means was used, including social media platforms.

Participants: Native comparison Norwegian students (n = 250)

Russia (n = 151),

Poland (n = 109),

Pakistán (n = 117),

Somalia (n = 100),

non-provided

Facilitators: Religious leaders

Traditional and informal sources of support (friends etc.) as gatekeepers to support.

Internet forums

Traditional help sources for MH were endorsed more by immigrants from Pakistan and Somalia than any other immigrant group in the study of native people from Norway.

G1*=69%

G2 = 87%

G3 = 77%

G4 = 69%

G5 = 44%

Linney et al.

(2020)

UK

[86]

Design: Qualitative focus group

Setting: Community-driven, co-produced with the Somali community in Bristol to address rising suicides within the Somali community in Bristol

Participants: Focus groups were held with separate groups for men and women N = 23

m (n = 12)

f (n = 11)

non-provided

Barriers: Stigma

Language barriers, lack of continuity and long waiting times. Lack of knowledge of MH illnesses.

Facilitators: education, training, and awareness

Increased services and older Somalis to talk to

The community provided ideas for improvements in mental illness recognition and accessing culturally safe support services

47.8%

Kiselev et al.

(2020)

Switzerland

[85]

Design: Qualitative

Setting: The study was part of the STRENGTHS project ^f, evaluating the adaptation, implementation and scaling up of Problem Management Plus (PM+)

Participants: (n = 5)

Healthcare providers (n = 5) and stakeholders (n = 5)

Syrian Key Informants - refugees and asylum seekers who had arrived after the outbreak of the Syrian war

Barriers: Language, gatekeeper-associated problems, lack of resources, lack of awareness, fear of stigma and a mismatch between the local health system and perceived needs

Multiple structural and socio-cultural barriers, with socio-cultural barriers being perceived as more pronounced.

60%

Mölsä et al.

(2019)

Finland

[99]

Design: Mixed Methods Setting: Somalis living in Helsinki with matching to Finnish pairs through the National Register.

Participants: 128 Somalis, f(n = 75), m(n = 53)

128 matched Finnish pairs, f(n = 75), m(n = 53)

All participants between the ages of 50–80

non-provided

Barriers: language, health professionals’ ignorance and insensitivity. Lack of knowledge of services, the stigma of MH within Somali society.

Structural inequalities – Somalis did not have access to private doctors.

Facilitators: sheikhs and imams

The Somali group had significantly lower access to personal/family doctors at healthcare centres. They used more nursing services than Finnish patients. Preference for traditional care, most commonly religious healing, for MH problems by most Somalis.

58.5%

Grupp et al.

(2019)

Germany

[96]

Design: Mixed Methods Setting: A survey using paper-and-pencil and online assessments.

approached in their accommodation facilities.

Participants: n = 119 asylum seekers from seven Sub-Saharan African countries, mainly Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25).

Each focus group had around 50% females.

Asylum seekers had to have flight experience and an origin in a Sub-Saharan African country.

Barriers: structural and cultural barriers to seeking medical and psychological treatment. Lack of knowledge of services

Facilitators: Family and friends, religious leaders, preference for G.Ps.

Asylum seekers showed a high intention to seek religious, medical, and psychological treatment for symptoms of PTSD. Higher preference to seek help from religious authorities and GP.

± 30%

Kohlenberger et al.

(2019)

Austria

[100]

Design: Quantitative Setting: Captured from a nationally representative survey of the population of Austria, Austrian Health Interview Survey (ATHIS) and Refugee Health and Integration Survey (ReHIS).

Participants: 515 persons

Characteristics:

18–61 years

Syrians (54%)

Iraqis (16%)

Afghans (23%)

Other citizenship (7%)

Gender: F(n = 73), M (n = 447)

non-provided

Barriers: conflicting schedules, long waiting lists, lack of knowledge, language problems

Facilitators: High usage of day-care services

Refugees used hospitals and day-care services more than the average Austrian but less specialised services afterwards. Women reported more use of services than men and more unmet needs than men.

14%

Straiton et al.

(2019)

Norway

[36]

Design: Quantitative Setting: National register-based cohort study utilising dynamic population - women living in Norway between 2009–2013 and diagnosed with at least one mood disorder were included.

Participants: Age: 16–67 years

1,834,822 women

Migrant - Born outside of

Norway with two non-Norwegian born parents.

Descendant - born in Norway, with two non-Norwegian born parents.

The majority - all other women, including Norwegian born with at least one Norwegian parent and foreign-born with at least one Norwegian parent)

Barriers: stigma, language differences, the Western conceptualisation of MH disorders, consultation fees.

Facilitators: length of stay likely to lessen barriers to access.

Migrant and descendant women were less likely to use outpatient MH services. Migrant women had fewer follow up consultations for their MH compared to the descendant and majority of Norwegian women.

100%

Carruthers & Pippa

(2019)

UK

[101]

Design: Quantitative Setting: Data from two G.P. practices in South London.

Participants: (n = 35)

Male (n = 20)

Female (n = 15).

Mean age = 35

Identified asylum seekers and refugees

Barriers: language issues and lack of interpreters, stigma, immigration concerns and information sharing.

High frequencies in psychiatric problems in refugees and asylum seekers but lesser referrals and use of secondary care compared to the UK average.

42.8%

Burchert et al. (2019)

Germany, Sweden, and Egypt

[83]

Design: Mixed Methods Setting: Step-by-Step (SBS) designed by the WHO ^c to help Syrian refugees access health systems in host countries.

Participants: n = 36

An equal number of men and women were interviewed in their host country.

Mean age = 33.8 years (SD = 10.9)

Non-provided

Barriers: unacceptance of MH problems

low technical literacy

Lack of trust in apps

Limited language skills

High cost of smartphones and mobile data packages

Facilitators: training and tutorials

Findings indicate the potential of e-health interventions in supporting the MH of refugees.

50%

Van Loenen et al.

(2018)

7 EU Countries

[82]

Design: Qualitative Setting: Fieldwork conducted in refugee reception centres in

Greece, Slovenia, Croatia, Hungary, the Netherlands, Italy, and Austria

Participants:

- 98 refugees: male (n = 65), female (n = 33) and 25

- 25 Healthcare workers: male (n = 9) and female (n = 16)

Refugees and other migrants without permanent residence permits

Barriers: Lack of information, lack of trust, time pressure, stigma, complex health and administrative systems, lack of continuity of care, language differences, gender, and culturally specific access to health care.

Facilitators: interpreters and culturally competent health providers.

Refugees wished for compassionate health care provision and formal interpreters. They also hoped for information on healthcare provision and health promotion.

33.6%

Fox & Hiam

(2018)

UK

[89]

Design: Qualitative

Setting: Case Studies

Participants: Three females, Mariam (28), originally from Eritrea, Josephine (37) who fled from Uganda and Deidre, from The Caribbean.

Both are identified as refused asylum seekers.

Separate box of definitions for immigration status including:

Refugee: Someone whose asylum application has been successful; the Government recognises they are unable to return to their country of origin owing to a well-founded fear of being persecuted for reasons provided for in the Refugee Convention 1951 or European Convention on Human Rights.

Refused asylum seeker person whose asylum application has been unsuccessful.

Asylum seeker: A person who has left their country of origin and applied for asylum in another country but whose application has not yet been concluded.

Barriers: Hostile environment policies and practices, Lack of proper information and knowledge on rights of asylum seekers and failed asylum seekers by bother providers (G.P.s and asylum or failed asylum seekers).

Facilitators: Doctors of The World, Red Cross, and churches

Recent policy changes compromise the healthcare needs of refugees, asylum seekers and failed asylum seekers.

100%

Papadopoulos et al.

(2004)

UK

[16]

Design: Mixed Methods Setting: Estimated 25,000–30,000 Ethiopian refugees in the UK at the time of the study. The study applied a multi-method participatory approach which included members of the Ethiopian community.

Participants: Ethiopians resident in the UK (n = 106)

Asylum seeker - a person who has applied to the IND* to be recognised as a refugee but who has not yet received a decision or is in the process of appealing against an initial rejection of his or her claim.

Barriers: language problems

Poor understanding of primary healthcare support.

Postmigratory stress

Culturally competent services should be provided to migrants as postmigratory stress can lead to poorer health outcomes.

52%

Pooremamali & Eklund

(2017)

Sweden

[95]

Design: Quantitative Setting: Sweden has two types of day centres accessed by people with MH: meeting place-oriented and work-oriented centres.

Participants: (n = 125)

Immigrant background (n = 56)

Native Swedes (n = 69)

Migrants living in Sweden 11–45 yrs. (M = 27, SD = 9).

Country of origin (n = 29)

Born in Sweden but considered migrant (n = 15)

Being born outside of Sweden and/or having at least one parent born in another country’’

‘’Immigrant background’’

Barriers: low educational attainment, disempowerment, low self-esteem, dissatisfaction with everyday activities. Stigma and discrimination

Facilitators: Integration due to length of stay.

Being of immigrant background and having an MH illness was a negative factor to empowerment.

59%

Morgan et al.

(2017)

UK

[94]

Design: Quantitative Setting: The UK is host to an increasing refugee and migrant population, however, continues to put restrictions on them on employment, housing, benefits, and detention for some during the process.

Participants: (n = 97)

Mean age 33.8 (SD = 8.4), range 18–59 years

57% refused asylum (n = 55)

Countries of origin (n = 25)

Female (n = 46), Male (n = 51)

non-provided

Barriers: Financial, housing,

Unsecure immigration status,

Isolation

Facilitators: information on acculturation including English language classes,

Perceptions of democracy and freedom.

Both sets of participants, asylum seekers and those who were refused asylum reported levels of anxiety, stress, depression, and PTSD. Those who were refused asylum scored higher on depression and anxiety.

47%

Ali et al.

(2016)

UK

[84]

Design: Qualitative Setting: Lower referral rates to CAHMS ^b for children from ethnic minority backgrounds. Pakistanis make up the largest ethnic minority in Peterborough.

Participant ages: 11-19yrs.

Four focus groups (FG).

FG1 - boys (n = 10)

FG2 – girls (n = 7)

FG3 boys (n = 7)

FG4 – girls (n = 9)

Participants held or were descendants of Pakistani passport holders. Parents were in transnational marriages.

Barriers: Lack of information on accessing support, stigma

Facilitators: Religious leaders, mentoring schemes with older students and information from the internet

Participants had poor awareness of MH services and treatment options. Culturally appropriate awareness of MH and support that was gender-specific were suggested.

48.4%

Loewenthal et al.

(2012)

UK

[87]

Design: Qualitative Setting: Bengali, Urdu, Tamil, and Somali speaking communities recruited through their community associations

Participants:

Bengali: 1st focus group f (n = 8). 2nd focus group f (n = 4) m (n = 2)

Urdu: 1st focus group f (n = 15),

2nd group, m (n = 6)

Tamil:1st group m(n = 10) 2nd group f(n = 8)

Somali: 1st group f(n = 14) 2nd group m(n = 10)

Validation interviews: Bengali f (n = 4) m (n = 2), Urdu f(n = 3), m (n = 3), Tamil m(n = 4), f(n = 2), Somali m(n = 3), f(n = 3)

non-provided

Barriers: Understanding of MH issues and availability of MH services

Cultural barriers

Stigma

Disclosure of MH problems

Facilitators: community-based interventions.

Awareness-raising forums.

Religious leaders

Participants did not fully understand common conceptualisations about MH issues, nor did they know how to seek mental health support.

59.2%

Tabassum et al.

(2009)

UK

[102]

Design: Qualitative Setting: The study was conducted in Darnall, Sheffield, with high unemployment and deprivation with few white residents. Interviews were held in participants homes. Females were interviewed with the whole family present due to cultural considerations.

Participants: Males (n = 22)

1st Generation females (n = 29)

2nd Generation females (n = 23)

Four individuals did not participate due to a lack of conceptual knowledge of mental health (m = 1, 1st gen f = 1, 2nd gen f = 2)

First-generation women born and grew up in Pakistan. Second-generation women born and grew up in the UK.

Barriers: lack of proficiency in English

Stigma

Isolation due to cultural proscription

Racism

Reluctance to involve others in support.

Facilitators: faith healers, G.P. and Family support

The western conceptualisation of MH may not be the same as Pakistani understanding.

Stress at home was cited as the most likely cause of mental illness. G.P consultations were favoured for accessing support, particularly by males, though the emphasis was on physical health symptoms even though it may have been for mental health.

70.2%

Whittaker et al.

(2005)

UK

[90]

Design: Qualitative. A cross-sectional study of participant individual and group interviews

Setting: Participants were recruited from a Somali community centre

Participants: Five females.

Females born in Somalia and who had been resident in the UK since they were children or adolescents. Additionally, participant born in the UK was included and analysis and discussion were provided separately as part of enriching the study.

Female refugees born in North Somalia.

To the participant born in the UK: “not a refugee but was born in the UK to a refugee family”.

Barriers: Religion, the intersection between culture and religion, stigma

Facilitators: Resilience, religion family and community

Intersections of religion and culture may hinder access to support. The complexities of approaching services due to fear of disclosures, stereotyping and individual beliefs are clinical implications in providing service options.

100%

Knipscheer & Kleber

(2001)

The Netherlands

[97]

Design: Mixed Methods Setting: Recruitment through two summer festivals in Amsterdam and The Hague. Additional data was gathered through outpatient MH* services.

Participants: Study 1: Surinamese citizens in the general population (n = 292)

m (n = 163), f (n = 129)

Study 2: Surinamese (Hindustan Surinamese Dutch, Creole Surinamese Dutch, mixed Chinese, and Javanese background) and inclusion of 89 indigenous Dutch for comparisons.

F (n = 145), M (n = 40)

People who have recently migrated from Surinam to the Netherlands.

Facilitators: Familiarity with community MH centres

Friends and family

Barriers: low education

Prejudice and misconceptions about CMHC.

Lack of support information.

Length of residence is an important predictor of both behaviour and attitudes, with the more recently migrated most in need of education on the utility of Dutch MH services.

S1 = 44%

S2 = 78%