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Background Previous research on employee well-being for those who have experienced social and economic disadvantage and those with previous or existing mental health conditions has focused mainly on programmatic interventions. The purpose of this research was to examine how organisational structures and processes (such as policies and culture) influence well-being of employees from these types of backgrounds. Methods A case study ethnographic approach which included in-depth qualitative analysis of 93 semi-structured interviews of employees, staff, and managers, together with participant observation of four social enterprises employing young people. Results The data revealed that young people were provided a combination of training, varied work tasks, psychosocial support, and encouragement to cultivate relationships among peers and management staff. This was enabled through the following elements: structure and space; funding, finance and industry orientation; organisational culture; policy and process; and fostering local service networks . . The findings further illustrate how organisational structures at these workplaces promoted an inclusive workplace environment in which participants self-reported a decrease in anxiety and depression, increased self-esteem, increased self-confidence and increased physical activity. Conclusions Replicating these types of organisational structures, processes, and culture requires consideration of complex systems perspectives on implementation fidelity which has implications for policy, practice and future research.

Background: The inclusion of complex post-traumatic stress disorder (CPTSD) in ICD-11 represents a turning point for the field of traumatic stress, with accumulative evidence of this disorder in refugees and displaced populations. Objective: The objectives of this systematic review are to examine, in refugee and displaced populations: 1) the prevalence of CPTSD; 2) factors contributing to CPTSD; and 3) and associations between CPTSD and other common mental disorders including: PTSD, depression, anxiety and somatisation. Method: We followed the Joanna Briggs Institute Methodology for Systematic Reviews. Papers published in English language were included, with date of publication between 1987 and June 2019. We searched six relevant databases: MEDLINE, PsycINFO, Embase, Scopus, CINAHL, and PILOTS, and the grey literature. We included observational studies with prevalence data on CPTSD. Results: 19 articles met all inclusion criteria. Quality assessment was performed on each included study using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Based on this, 13 moderate and high-quality studies were included in our narrative synthesis. The included studies reported prevalence of CPTSD in refugees and displaced populations ranging from 2% to 86%. Conclusions: Reasons for the wide variation in prevalence may include contextual and geographical differences, the influence of post-migration difficulties, and sample population characteristics such as treatment seeking versus general population. We found higher prevalence rates (range: 16-82%) in more studies with treatment seeking samples, followed by convenience and snowball samples (40-51%), and lower rates in more studies utilising random sampling techniques (2-86%). Consistent with the broader literature, the studies in our review supported an association for complex post-traumatic stress disorder with prolonged, repeated trauma, and post-migration living difficulties, with the latter association being specific to refugee and displaced populations. Further research on this construct in this population group, including effective treatments, is required. * Complex traumatic stress disorder in refugees and forcibly displaced populations.

PurposeThe Women Aware with Their Children study was created because prospective data are required to accurately guide prevention programmes for intimate partner violence (IPV) and to improve the mental health and resettlement trajectories of women from refugee backgrounds in Australia.Participants1335 women (685 consecutively enrolled from refugee backgrounds and 650 randomly selected Australian-born) recruited during pregnancy from three public antenatal clinics in Sydney and Melbourne, Australia. The mean age was 29.7 years among women from refugee backgrounds and 29.0 years among women born in the host nation. Main measures include IPV, mood, panic, post-traumatic stress disorder, disability and living difficulties.Findings to datePrevalence of IPV at all three time points is significantly higher for refugee-background women. The trend data showed that reported IPV rates among Australian-born women increased from 25.8% at time 1 to 30.1% at time 3, while for refugee-background women this rate declined from 44.4% at time 1 to 42.6% at time 3. Prevalence of major depressive disorder (MDD) at all three time points is higher for refugee-background women. MDD among Australian-born women significantly declined from 14.5% at time 1 to 9.9% at time 3, while for refugee-background women it fluctuated from 25.1% at time 1 to 17.3% at time 2 and to 19.1% at time 3.Future plansWe are currently examining trajectories of IPV and mental disorder across four time points. Time 4 occurred during the COVID-19 pandemic, enabling a unique opportunity to examine the impacts of the pandemic over time. Time 5 started in August 2021 and time 6 will begin approximately 12 months later. The children at time 5 are in the early school years, providing the capacity to examine behaviour, development and well-being of the index child.

The aim was to compare, for the first time in a large systematic study, women born in conflict-affected countries who immigrated to Australia with women born in Australia for attitudes towards gender roles and men's use of IPV and the actual prevalence of IPV. The study also examined if any associations remained across the two timepoints of pregnancy and postpartum. Women were interviewed during their first visit to one of three Australian public hospital antenatal clinics and re-interviewed at home six months after giving birth. A total of 1111 women completed both interviews, 583 were born in conflict-affected countries and 528 born in Australia. Associations between attitudes towards gender roles and men's use of IPV, socio-demographic characteristics and reported actual experiences of IPV were examined using bivariate and multiple logistic regression analyses. Attitudes toward inequitable gender roles including those that condone men's use of IPV, and prevalence of IPV, were significantly higher (p<0.001) among women born in conflict-affected countries compared to Australia-born women. Women born in conflict-affected countries with the strongest held attitudes towards gender roles and men's use of IPV had an adjusted odds ratio (aOR) of 3.18 for IPV at baseline (95% CI 1.85-5.47) and an aOR of 1.83 for IPV at follow-up (95% CI 1.11-3.01). Women born in Australia with the strongest held attitudes towards gender roles and IPV had an aOR of 7.12 for IPV at baseline (95% CI 2.12-23.92) and an aOR of 10.59 for IPV at follow-up (95% CI 2.21-50.75). Our results underscore the need for IPV prevention strategies sensitively targeted to communities from conflict-affected countries, and for awareness among clinicians of gender role attitudes that may condone men's use of IPV, and the associated risk of IPV. The study supports the need for culturally informed national strategies to promote gender equality and to challenge practices and attitudes that condone men's violence in spousal relationships.

ObjectivesSexual abuse is a strong predictor of future psychiatric problems. A more nuanced qualitative understanding of mental health outcomes, in the context of interpersonal responses from family members towards survivors after sexual abuse, may help to better inform prevention and interventions.DesignA mixed-methods approach included a qualitative timeline method to map and identify contextual factors and mediating emotional responses associated with mental disorder following sexual abuse.SettingParticipants were adult survivors of sexual abuse, seeking support from the Sexual Assault Counselling Service, Sydney Local Health District, Australia.ParticipantsThirty women 18 years and older with current or past mental disorder or symptoms were interviewed between August 2015 and May 2016.Outcome measuresA qualitative timeline interview and the Mini-International Neuropsychiatric Interview (MINI, 5.5.0) were applied.ResultsThe MINI prevalence of current post-traumatic stress disorder was 96.6% (n=28) and of major depressive disorder was 82.8% (n=24). More than half (53%) reported suicidal ideation at some time in their lives. Women exposed to childhood sexual abuse reported being ignored, not believed, or threatened with retribution on disclosing the abuse to others, usually adult family members, at or close to the time of the violation(s). Participants described experiences of self-blame, betrayal, and psychosocial vulnerability as being the responses that connected negative disclosure experiences with mental disorder. Participant accounts suggest that these reactions created the foundations for both immediate and long-term adverse psychological outcomes.ConclusionA more in-depth understanding of the type and emotional impact of negative responses to disclosure by parents and other family members, and the barriers to adequate support, validation and trust, may inform strategies to avert much of the longer-term emotional difficulties and risks that survivors encounter following childhood abuse experiences. These issues should receive closer attention in research, policy, and practice.

Despite the well-established benefits of antenatal education (ANE) and breastfeeding for mothers, there is a paucity of evidence about the uptake of ANE and breastfeeding amongst women from refugee backgrounds or its associations with sociodemographic factors. The current study is a cross-sectional survey at two time points examining the prevalence of ANE attendance, breastfeeding, and intimate partner violence (IPV) amongst 583 women refugees resettled in Australia and a control group of 528 Australian-born women. Multi-logistic regression was used to explore bivariate associations between ANE attendance, breastfeeding, IPV, and sociodemographic characteristics (parity, maternal employment, and education). Refugee-background women compared to Australian-born women have lower ANE utilization (20.4% vs. 24.1%), higher rates of breastfeeding on hospital discharge (89.3% vs. 81.7%), and more IPV reports (43.4% vs. 25.9%). Factors such as nulliparity, higher level of education, and employment predict higher rates of ANE and breastfeeding adoption. In contrast, IPV is a risk factor for ANE underutilization. Further, of the women from refugee backgrounds who accessed ANE services, 70% attended clinics designed for women from non-English-speaking backgrounds. These findings support the need to ensure effective screening and interventions for IPV during antenatal care and to better understand the role of culture as a protective or risk factor for breastfeeding initiation.

Intimate Partner Violence (IPV) is a major public health issue, including during pregnancy where it poses a serious risk to the woman’s health. Influenza-Like Illness (ILI) also causes significant morbidity for women during pregnancy. It may be possible that ILI in pregnancy is associated with IPV, and that depression and trauma history play a role in the connection. 524 Australia-born women and 578 refugee-background women participated in the study. Baseline participants were randomly recruited and interviewed from antenatal clinics between January 2015 and March 2016, and they were reinterviewed six months post-partum. Bivariate and path analysis were used to assess links between IPV, depression and ILI. One in 10 women (10%; 111 out of 1102) reported ILI during their pregnancy period and this rate was significantly (p < 0.001) higher for women born in conflict-affected countries (13%; 76 out of 578) as compared to Australian-born women (7%; 35 out of 524). In both groups, Time 1 traumatic events, IPV and depression symptoms were significantly associated with ILI at Time 2. A significant association between IPV at Time 1 and ILI at Time 2 was fully mediated by depression symptoms at Time 1 (Beta = 0.36 p < 0.001). A significant direct path was shown from depression symptoms to ILI (Beta = 0.26, p < 0.001). Regardless of migration history, pregnant women who have experienced IPV and depression are more likely to report influenza-like symptoms in pregnancy. This may suggest that trauma and depression negatively affect immunity, although it could also indicate a connection between depressive symptoms and physical experiences of ILI.

Hesitancy about the COVID-19 vaccine in high-income countries can be caused by diverse psychological and social factors. Few studies on vaccine concerns have examined the interplay of the effects of mental disorders, social and economic factors, gender and refugee status. To investigate these issues, this article reports findings from the 2023 wave of a longitudinal study involving 709 women who are mothers of young children in Australia, both refugees and Australian-born. Respondents were asked if they had any worries or fears about receiving the COVID-19 vaccine. In previous waves they completed standardized assessments of mental health and sociodemographic factors. An open-ended question provided insights into the reasons for self-reported vaccine concerns. Descriptive statistics and binary logistic regression analyses were conducted, and demographic adjusted logistic regression undertaken separately for Australian-born and refugee women. Formal comparisons of effect sizes between Australian-born and refugee women were performed, with Cohen's d quantifying the magnitude of these differences. Qualitative responses were coded by topic and ranked by frequency. More than half of the respondents reported worries about receiving a COVID-19 vaccine. Concerns were significantly higher for younger age women, those with a lower educational level and those with a history of mood disorder, panic disorder or separation anxiety disorder. Vaccine hesitancy was associated with poorer quality of life, living difficulties and disability among refugee women only. Separation anxiety disorder and a younger age were associated with an increased odds among Australian-born women only. The newness of the vaccine and concern about side effects were the greatest concerns among respondents who reported hesitancy. Young mothers with mental health problems and lower education need to be sensitively targeted to improve COVID-19 vaccine uptake. Mental health and public health professionals need to be aware of differences reported for women from refugee background. Improved quality of life and economic status will increase vaccine uptake among socioeconomically challenged communities. •Findings from an Australian longitudinal study involving 709 young mothers.•Highlights the role of mental health conditions in vaccine hesitancy in this group.•Involves both Australian-born and refugee women, allowing for comparisons.

Summary Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as ‘complex interventions’ that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly. Lay Summary Work integration social enterprises (WISEs) are hybrid organizations that operate as businesses with a social purpose. WISEs focus on employment of people excluded from open employment, often as a result of discriminatory attitudes and practices of employers to people from minority groups and those experiencing disability or health-related problems. There is a lack of research on the ways in which a WISE could positively impact on individual health and well-being. We interviewed employees, managers and enterprise partners, together with participant observation, across four social enterprises to understand these dynamics. Through a number of strategies including flexible workplace structures, a culture of acceptance and support, encouragement to take risks and make mistakes and creative use of space, the participants described changes to health and well-being such as decreased symptoms of anxiety and depression, increased social connections, improved physical activity and increased confidence and self-esteem. Results show a mix of strategies combined with individually tailored support; this has implications for the type of research that is appropriate to understand these impacts. We conclude with suggestions on how future research could use complex research designs to understand how WISEs can influence health and well-being.

Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted. To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk. This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018. One-hour interviews covering mental health, intimate partner violence, and other social measures. World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed. Overall, 1335 women (84.8% overall response rate), comprising 685 (51.3%) from conflict-affected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflict-affected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124 [42.9%] vs 133 [20.5%]; P < .001). Women who identified as refugees were less likely to identify 5 or more supportive family or friends compared with women born in the host nation (36 [12.5%] vs 297 [45.7%]; P < .001). A greater proportion of women who identified as refugees reported experiencing 3 or more financial stressors compared with women born in the host nation (65 [22.5%] vs 41 [6.3%]; P < .001). Women who identified as refugees had the highest prevalence of MDD (94 [32.5%]), followed by women from other conflict-affected backgrounds (78 [19.7%]), and women born in the host nation (94 [14.5%]). Women identifying as refugees reported a higher prevalence of MDD and all the indicators of adversity related to that disorder. Even after risk factors were accounted for, refugee status was associated with risk of MDD. Assessing whether women attending an antenatal clinic self-identify as refugees may offer an important indicator of risk of MDD and a range of associated psychosocial adversities.