To the Editor:
Alduraidi et al.'s (2020) article, “Social Determinants of Resilience Among Syrian Refugees in Jordan,” which appeared in the August 2020 issue of Journal of Psychosocial Nursing and Mental Health Services, examined associations between sociodemographic factors in a population comprised of individuals ages 18 to 69 who migrated to Amman, Jordan. The study addressed a relevant global health issue and calls for changes in social structures that negatively affect Syrian refugees in Jordan.
The outcomes of the study revealed the negative implications of sociocultural, economic, and political factors on a person's mental health. Through cross-sectional, descriptive research, the investigators reported that resilience scores among Syrian refugees were statistically lower than other populations in Jordan (Alduraidi et al., 2020). Another descriptive, correlational study revealed significant associations between depression symptom severity and perceived health among Palestinian refugees in Amman, Jordan, where approximately one half (75/177, 42.4%) of participants reported symptoms of major depression and 20% (35/177) rated their health as fair or poor (Alduraidi & Waters, 2018). These refugees also live in poverty, which is common among immigrant and refugee communities around the globe (Alduraidi et al., 2020; Alduraidi & Waters, 2018).
Research on immigrant or refugee populations in the United States indicates similar findings. Correlations between sociodemographic variables and health outcomes among U.S. undocumented Hispanic immigrants have been found (Fleming et al., 2017). Community-based participatory research conducted in Orange County, North Carolina reported that undocumented Hispanic immigrants' health and well-being were shaped by their experiences and feelings of discrimination and marginalization in the United States (Fleming et al., 2017). Most of these individuals are unemployed or have unsteady employment; experience occupational illnesses, injuries, or infectious diseases due to dangerous work conditions; are at increased risk for depression, anxiety, and posttraumatic stress disorder; misuse alcohol or substances to cope with stress; have limited access to care; and lack basic human rights as a result of their marginalized social position in the United States (Fleming et al., 2017).
Unless nurses explore the area of global health and social justice or take leading roles in changing social and political factors that affect the health of immigrant or refugee populations globally, then a dynamic of health conditions are likely to continue to be disproportionately reflected in these populations, thereby breaching the social contract held by nurses to protect public health. As the largest health care sector internationally, it is nursing's mission to respond to this calling and address sociopolitical factors that negatively affect the health of human beings and human rights worldwide (Alduraidi et al., 2020; Alduraidi & Waters, 2018; Fleming et al., 2017).
Francisco Brenes, MSN, APRN-BC, FNP, PMHNP
Visiting Assistant Teaching Professor
Florida International University
Nicole Wertheim College of Nursing and
- Alduraidi, H., Dardas, L. A. & Price, M. M. (2020). Social determinants of resilience among Syrian refugees in Jordan. Journal of Psychosocial Nursing and Mental Health Services, 58(8), 31–38 doi:10.3928/00989134-20200624-04 [CrossRef]
- Alduraidi, H. & Waters, C. (2018). Depression, perceived health, and right-of-return hopefulness of Palestinian refugees. Journal of Nursing Scholarship, 50(2), 163–171 doi:10.1111/jnu.12363 [CrossRef]
- Fleming, P. J., Villa-Torres, L., Taboada, A., Richards, C. & Barrington, C. (2017). Marginalization, discrimination and the health of Latino immigrant day labourers in a central North Carolina community. Health & Social Care in the Community, 25(2), 527–537 doi:10.1111/hsc.12338 [CrossRef]
Refugees, displaced persons, asylum seekers, and illegal immigrants are among the most vulnerable and under-served populations in today's world. Not only are these special populations deprived of numerous health services, but they are also severely understudied and often excluded from health research. Because of the legal, political, and cultural considerations that separate these individuals from their host communities, differences in the perceived and observed health status and health-related quality of life continue to exist and deepen. Acculturation efforts in many cases are either missing or random and humble. Governments of the host countries, non-governmental organizations, and civil society organizations need to invest more time, money, and effort in bridging the gap between these vulnerable groups and the host communities.
Nurses, specifically community/public health nurses, are in the front-lines of caring for refugees and illegal immigrants. In fact, nurses are among the most important professionals capable of providing psychosocial support and mental health services to refugees and illegal immigrants, as well as providing physical health care to avoid any unnecessary deaths, illnesses, or disabilities. Therefore, it can be argued that nurses are the closest to refugees and illegal immigrants, which—in addition to their training in leadership and evidence-based practice—qualifies them to lead the efforts of acculturation and bridging the gap. In their research, nurse researchers investigate the social, cultural, environmental, and political factors that contribute to refugees' and illegal immigrants' physical and mental health. This investigation reflects a caring perspective, in which nurse researchers look to the individuals, families, and groups within these communities with a holistic approach, aiming to promote their health and minimize their suffering.
Hamza Alduraidi, PhD, MPH, RN
Assistant Dean for Quality Affairs
The University of Jordan, School of Nursing