Social Stressors, Social Support, and Mental Health Among Haitian Migrants in the Dominican Republic

Pan American Journal Comunicación breve / Brief communication of Public Health

Social stressors, social support, and mental health among Haitian migrants in the Dominican Republic

Bonnie N. Kaiser,1 Hunter M. Keys,2 Jennifer Foster,3 and Brandon A. Kohrt 4

Suggested citation Kaiser BN, Keys HM, Foster J, Kohrt BA. Social stressors, social support, and mental health among Haitian migrants in the Dominican Republic. Rev Panam Salud Publica. 2015;38(2):157–62.

ABSTRACT This mixed-method study explored the social world of Haitian migrants, examining forms of social support and social stress, as well as their relationship to mental health. Among six Hai- tian migrant communities in the Cibao Valley of the Dominican Republic, a community-based survey (n = 127) was conducted to assess migration experiences, current stressors, mental health, and functioning. In addition, to explore perceptions and experiences of migration, social interactions, and mental health, the study drew upon in-depth interviews and free-listing activities among Haitian migrants, as well as cognitive interviews with select survey participants. Depressive, anxiety, and mental distress survey scores were associated with 1) negative social interactions (including interrogation or deportation, perceived mistreatment by Domin- icans, and overcrowding) and 2) lack of social support, including migrating alone. Mental distress scores were higher among women, and being married was associated with higher anxiety scores, potentially reflecting unmet social expectations. In qualitative data, participants emphasized a lack of social support, often referred to as tèt ansanm (literally meaning “heads together” in Haitian Creole or Kreyòl and roughly defined as solidarity or reciprocal social collaboration). The authors of the study propose that the practice of tèt ansanm—also termed konbit, and, in the Dominican Republic, convite—could be used as a means of facilitating positive-contact events among Haitians and Dominicans. These interactions could help counteract social stress and build social capital in settings similar to those of the study.

Key words Mental health; social capital; social support; migration; Haiti; Dominican Republic; Caribbean region; Americas.

For migrant populations, life in a host mental health (2). Strengthening social Social capital has been considered an community can entail multiple psychoso- capital has thus become a focus of public important buffer against social stress, cial stressors, including adjustment to a health and policy goals. Social capital re- defined as stress that arises from nega- new culture, changes in identity, and fers to social cohesion, support, and/or tive interpersonal relationships (3). These institutional and interpersonal discrimi- participation within a group (bonding) factors collectively represent the “social nation (1). Post-migration social sup- and with the broader social structure world,” a term used in this report to de- port can be an important contributor to (bridging). scribe both positive and negative aspects of the social environment. 1 Duke Global Health Institute, Duke University, 3 School of Nursing, Emory University, Atlanta, Durham, North Carolina, United States of Georgia, United States of America. Migration in the Americas is an impor America. Send correspondence to: Bonnie N. 4 Department of Psychiatry & Behavioral Sciences tant process that drives much economic Kaiser, [email protected] and Global Health Institute, Duke University, 2 Amsterdam Institute for Social Science Research, Durham, North Carolina, United States of activity. There are nearly 60 million University of Amsterdam, Amsterdam, Netherlands. America. international migrants in the Western

Rev Panam Salud Publica 38(2), 2015 157 Brief communication Kaiser et al. • Social stressors, social support, and mental health of Haitian migrants

Hemisphere (4). While most Latin Amer- Study overview A household-level census in each of ican countries are net emigration cen- the six communities facilitated random ters, there is increasing “south-to-south” The original field project was support- sampling, which used probability of se- movement among Latin American states ed by a research partnership among Em- lection proportional to size of the com- (4). A case in point is the Caribbean is- ory University (Atlanta, Georgia, United munity for the cross-sectional survey land shared by Haiti and the Domin- States); Universidad Autonoma de Santo (n = 127). Multivariable linear regression ican Republic. There, migration has Domingo (San Francisco de Macorís, models were constructed using back- profoundly shaped the development of Dominican Republic); and Hospital San ward selection of significant (α < 0.05) both countries. Haitian migrants are Vicente de Paúl (San Francisco de predictors for the BDI, BAI, KDI, and overwhelmingly undocumented and of- Macorís) to conduct a mixed-methods KFA scores, accounting for clustering ef- ten live in communities without basic ser- study of mental health and migration ex- fects at the community level. vices. A legacy of anti-Haitian discrimi- periences. Six predominantly migrant Qualitative data used for this report nation (antihaitianismo) has contributed communities were identified through included audio-recorded in-depth inter- to their status as a nearly invisible pop- in-country discussions with research views with Haitian migrants (n = 21), ulation. For example, in response to the partners and community members. The free-list data collected during develop- cholera outbreak, Dominican authorities communities were located throughout ment of the KFA, and cognitive inter- undertook a campaign of forced expul- Duarte Province, which has a total pop- views. Table 1 provides an overview of sions of Haitian migrants (5), while more ulation of 310 000. One community was study participant characteristics (with recent legislation effectively stripped en- in the urban core of a large city, and the additional details provided in (7)). In- tire generations of Haitian-descended remaining five were in rural settings. depth interviews drew on a purposive Dominicans of their right to citizenship Rural communities in Duarte Province sample of Haitian migrants and focused (6). Unsurprisingly, mental health needs tend to be more mixed, with Haitian on migration experiences, perceptions of Haitian migrants remain largely unex- migrants, including Haitian-descended and experiences of discrimination, clini- plored and underserved (7). persons, living alongside Dominicans. cal experiences, treatment-seeking be- This contrasts with communities found havior, and causes and symptoms of THE SOCIAL WORLD OF in other parts of the country known as mental distress. Interviews were tran- HAITIAN MIGRANTS bateyes—communities almost exclusive- scribed verbatim into Kreyòl (Haitian ly composed of Haitian agricultural Creole) by Haitian research assistants To address this knowledge and service workers and their families. Traditional- and translated into English by bilingual gap, a field study was completed in the ly, bateyes were constructed at the be- speakers. Transcripts were read closely Cibao Valley from March–April 2011 (7). hest of large Dominican ingenios (sugar for instances of social interactions. Using ethnographic and epidemiologic companies) (9). The study was approved by the Emory methods, this study found a positive as- Quantitative data were collected University Institutional Review Board sociation between perceived discrimina- through a community-based, cross-sec- and the Ethics Committee of Hospital tion and symptoms of mental illness. tional survey that assessed mental health San Vicente de Paúl. All participants gave Haitian migrants often described harm- using culturally adapted instruments— verbal informed consent. No identifying ful social interactions with Dominicans the Beck Depression Inventory (BDI) and information was recorded with quanti and fellow migrants using the term imil the Beck Anxiety Inventory (BAI)—plus tative data, and audio transcripts were yasyon (humiliation). At the same time, two locally developed instruments: the de-identified. Three multilingual (Kreyòl– they expressed the desire for increased Kreyòl Distress Idioms (KDI) scale and Spanish–French), Haitian-born, locally social cooperation with their Dominican the Kreyòl Function Assessment (KFA) hired research assistants collected data neighbors. Across multiple forms of data (10). The adapted BDI and BAI under- from the Haitian participants. The sec- collection, themes of social capital and went a rigorous process of cross-cultural ond author (HMK), an American profi- social stress arose—findings that de- adaptation in Haiti to ensure that the cient in Kreyòl, French, and Spanish, co- mand greater scrutiny. adapted instruments achieved semantic, ordinated the study. This report draws upon data from the technical, content, criterion, and concep- field study to explore the impact of the tual equivalence. The KDI drew on eth- Tèt ansanm (“heads together”): social world on mental health of Haitian nographically identified idioms of dis- perceptions of social support in migrants in the Dominican Republic. Of tress, locally salient ways of experiencing migrant communities particular interest are the context and and expressing cognitive, emotional, and content of social interactions and how somatic suffering. The KFA was devel- Results of the free-list activity that they may serve as either sources of sup- oped based on a free-listing activity informed the function assessment pro- port or stress. The report concludes that among a convenience sample of Haitian vided insight into migrants’ perceived there is a need to explore potential migrants (21 men and 23 women). This responsibility toward the community. avenues to promote social capital to en- activity asked participants to identify the Responses about caring for one’s com- hance mental health. The goal of the re- necessary tasks for caring for one’s self, munity were largely focused on social port is to shed more light on the mental family, and community. The most com- interactions and building solidarity, such health of this population with the practi- monly cited tasks were used to develop as participating in tèt ansanm (literally cal application of informing mental separate male and female function as- meaning “heads together” in Kreyòl and health interventions and policies in the sessments, which ask participants to re- roughly defined as reciprocal social col- region (8). port difficulty completing each task (7). laboration); living in peace; and having

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TABLE 1. Characteristics of migrant Haitians participating in in-depth interviews and being married was associated with a survey, Dominican Republic, March–April 2011 higher level of anxiety symptoms, and number of people living in the household Characteristic Number (%) was associated with increased experience In-depth interview (n = 21) of mental distress. The positive associa- Sex: female 6 (28.6) tion between anxiety and marriage could Age (years) 20–29 11 (52.4) be explained by worry for a spouse’s 30–39 6 (28.6) safety or the stress of trying to meet fam- 40–49 2 (9.5) ily obligations amid difficult conditions. Unknown 2 (9.5) These associations suggest that social Occupation Rice farm laborer 9 (42.9) stress—such as that brought about by Market vendor 5 (23.8) overcrowding and failure to meet role ex- Construction worker 2 (9.5) pectations—might play a stronger role in Other/unknown 5 (23.8) mental health than soial support poten- Survey (n = 127) Sex: female 53 (41.7) tially provided by co-habitants. Mean age (standard deviation): 33.4 (8.9) Past interrogation or deportation, or Married 23 (18.4) knowing another migrant who had had Mean household size (range): 4.42 (1–16) either of those two experiences, was also Migrated alone 46 (36.8) First time in Dominican Republic at time of survey 26 (20.8) associated with higher anxiety symp Knew someone in Dominican Republic before migrating 67 (54.0) tomology. Immigration authorities were Had job arranged in advance 16 (12.8) said to make arbitrary arrests, leaving Engage in periodic trips to Haiti 100 (78.7) some Haitian participants feeling like Sends remittances back to Haiti 100 (79.4) Report that “Dominicans mistreat Haitians in my community” 36 (28.8) “little toys.” Similarly, perceptions that Past experience of interrogation or deportation—self 13 (10.4) Dominicans mistreat Haitians were posi- Past experience of interrogation or deportation—knowing another 31 (25.0) tively associated with depressive symptoms and functional impairment. Finally, Mental health outcomes Mean score (95% Confidence interval) Haitian migrant women reported more Adapted Beck Depression Inventory 27.1 (25.2, 29.0) mental distress and functional impair- Adapted Beck Anxiety Inventory 16.2 (14.7, 17.7) ment than men (7), suggesting important Adapted Kreyòl Distress Idioms 14.5 (13.1, 15.9) Adapted Kreyòl Function Assessment 18.5 (17.4, 19.5) gender implications in potential social support interventions for this population, outlined in more detail below. meetings. Ways to support the physical they have difficulty carrying out a task community, such as cleaning and hy- included in the function assessment and Social expectations and social stress. Fur giene, were secondary. Interestingly, in a were asked to provide reasons, res ther evidence that social stress is particu- previous study in Haiti, activities in sup- ponses often reflected similar themes. larly salient within this migrant popula- port of the physical community, such as Although most reasons for functional tion was obtained from qualitative data planting trees, cleaning, and repairing difficulty referenced economic problems collected in tandem with survey data. the road, were more common among (65.9%), almost all others were social: Among the 52 participants indicating participants’ responses (9). mistreatment by Dominicans (16.7%), particularly severe depressive symptoms The concept of tèt ansanm (also termed lack of solidarity (9.5%), and not being in (as indicated by scores of 2 or 3 for any of konbit, and, in the Dominican Republic, one’s own country (4.8%). Thus, nearly the items listed in Table 3), cognitive in- convite) arose frequently not only in the 30% of reasons for functional difficulty terviewing was used to explore reasons free-lists but also in survey responses were related to impaired social relation- for those experiences. While many re- and interviews. Tèt ansanm can be used ships. Many responses specifically refer- sponses focused on economic hardship to refer to solidarity as well as a form of enced a need for tèt ansanm. Thus, this (50.0%), a notable proportion of respons- collaborative action in which community key Haitian form of social support ap- es (23.1%) attributed depressive symp- members assemble to support a neighbor pears to be lacking for this migrant pop- toms to social interactions or social stress in completing a task requiring many la- ulation, and its absence is used to com- (Table 3). For example, many responses borers. Rather than expecting payment, municate a broader lack of solidarity and focused on family responsibilities, par- participants expect reciprocation when social support. ticularly failure to meet obligations to they need equivalent support. As tèt an- children. Another common thread was sanm is considered central to communal Social support, social stress, and that many depressive symptoms arise life for Haitians, many migrants bemoan mental health outcomes due to negative social interactions, gen- its absence in the Dominican Republic. erally involving mistreatment by Domin- Interview participants pointed to both A lack of social support was associated icans, though sometimes including other the transient nature of migration and with worse mental health outcomes in Haitians. Finally, a lack of support struc- a general lack of support structure the survey findings (Table 2). Migrating ture or help in the community was (ankadreman) to explain migrants’ lack of to the Dominican Republic alone was as- reported to leave some feeling a sense of ability to realize tèt ansanm. Furthermore, sociated with higher depression, anxiety, failure or fear. These data suggest that when survey participants indicated that and mental distress scores. Interestingly, social stress and failure to meet social

Rev Panam Salud Publica 38(2), 2015 159 Brief communication Kaiser et al. • Social stressors, social support, and mental health of Haitian migrants

TABLE 2. Results of multivariable linear regression models for Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Kreyòl Distress Idioms (KDI), and Kreyòl Function Assessment (KFA) total scores among Haitian migrants, Dominican Republic, March–April 2011a,b

BDI (n = 123) BAI (n = 122) KDI (n = 120) KFA (n = 124) Variable aβ (95% CIc) P aβ (95% CI) P aβ (95% CI) P aβ (95% CI) P Came to the Dominican Republic 5.2 (1.5, 8.9) 0.01 3.5 (0.4, 6.6) 0.03 3.7 (0.7, 6.7) 0.02 – – alone Reports that Dominicans mistreat 7.6 (3.8, 11.3) 0.001 –d – – – 2.7 (0.2, 5.2) 0.03 Haitians Interrogated or deported – – 3.5 (0.4, 6.5) 0.03 – – – – (self or acquaintance) Married – – 3.8 (0.1, 7.6) 0.04 3.6 (0.03, 7.2) 0.05 Female – – – – 3.0 (0.3, 5.7) 0.03 2.1 (–0.03, 4.2) 0.05 Number of people in household – – – – 0.4 (0.03, 0.9) 0.04 – – Community Fe = 10.8 0.001 F = 6.7 0.001 F = 5.5 0.001 F = 3.3 0.01 a Model fit r( 2): BDI = 0.38; BAI = 0.32; KDI = 0.35; KFA: = 0.18. b Variables considered for inclusion were: “age,” “sex,” “marital status,” “education,” “length of time in DR,” “migrated alone,” “knew someone in the DR prior to migrating,” “engages in periodic round-trips between Haiti and the DR,” “number of household members,” “feels that Dominicans mistreat Haitians,” “ever been interrogated or deported or knew someone who had been interrogated or deported,” and “community of residence.” The following item was added to the regression model for the KFA: “If reason cited for function impairment is antihaitianism.” c CI: confidence interval. d Not applicable. e F-test for significant differences in outcome scores across levels of the categorical variable “community of residence.”

TABLE 3. Reasons for endorsement of items from the Beck Depression Inventory: the role of social interactions and social stressors in selected responses from cognitive interviews with Haitian migrants, Dominican Republic, March–April 2011

Item Sample responses Failure At 37 years of age I can’t do anything for my children. That makes me not have hope. (Male, 37 years old) Because we don’t have a support structure, someone to help us. (Male, 36 years old) Guilt/regret I see myself with too many children; I can’t give them a good education; I can’t raise my kids well. (Female, 31 years old) Self-dislike Lots of times after you see how [Dominicans] treat us, we [feel we] shouldn’t have come here. (Female, unknown age) Because I’m not useful for my wife. (Male, 40 years old) The misery I experience; the Dominicans say whatever they want. They don’t respect us. (Female, 43 years old) There’s no help for me facing the problems that come my way. (Female, 31 years old) Thoughts of suicide Because I can’t see how I can help my children. (Female, 32 years old) Worthlessness Because if my parents have nothing I can’t help them; for me when I look at myself I’m worth nothing. (Female, 39 years old) Because the way I was living, now I come to see that I’m worthless before other people. I feel like I’ve become “worse” in the eyes of Haitians here. (Male, unknown age) Crying Dominicans humiliate me; they treat me like garbage. (Female, unknown age) Fear of bad things happening I don’t have people here with me; if bad things happen I don’t have help. Dominicans don’t really respect Haitians, they do with us as they want. expectations represent an important men I send money, even if it’s not much. I able to maintain communication through tal health burden among Haitian mi- help them. We all help our families. Even phone calls, but attempts to visit family grants in this study. those of us that don’t make much money, members placed undocumented Hai- In-depth interviews provided a more we help our families” (Male rice farm la- tians at risk of deportation: “You know nuanced understanding of the ways that borer). Nevertheless, many Haitian mi- we’re outside immigration. We don’t social expectations contribute to mental grants indicated a profound sense of have papers; we’re really not legal. Our distress among migrants. Although com- guilt or failure to live up to expectations, heads get loaded (tèt chaje) [we worry]” munication with family members in Hai- whether due to lack of money to support (Street vendor). ti was thought to provide some social their family in Haiti, lack of ability to Lack of documentation and fear of support, for many Haitian migrants, fa- feed or educate their children, or being deportation—daily stressors that worsen milial and other social relationships rep- otherwise unable to fulfill their roles. mental health—also disrupt migrants’ resented a central cause of distress. Par- Participants also reported feeling support systems and strain coping mech- ticipants spoke of the high expectations ashamed for their friends to see how they anisms. Ultimately, failure to meet social held by their family and friends who re- live. expectations, encounters with the immi- main in Haiti, including that migrants In addition to the burden of trying to gration system, and attempts to maintain will earn sufficient money to support the meet social expectations, attempts to family relationships only compounded family through remittances. Sending re- maintain familial relationships often ex- migrants’ own feelings of misery (lamizè) mittances was commonly practiced, al- acerbated stressors inherent to the mi- due to living apart from their family and beit often with difficulty: “Every month, grant experience. Haitian migrants were support system.

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Strengthening social capital for A key way forward is through posi- way, such as exploring it as a potentially Haitian migrants tive-contact events modeled on the con- culturally salient measure of collective vite/konbit. In the Dominican Republic, efficacy or social capital. This study suggests multiple ways in the convite developed among rural farm- which the social world of Haitian mi- ers to share tasks, while in Haiti, an iden- Conclusions grants in the Dominican Republic fails to tical structure is the konbit, synonymous provide a buffer against mental distress to tèt ansanm. The common etymological This study explored whether the so- and in fact exacerbates mental ill-health. root of this cooperative system reflects cial world of Haitian migrants in the Do- On one hand, migrants pointed to a the two countries’ shared customs and minican Republic represents a source of general lack of support and particular- values. Positive-contact events, such as support or stress. Findings suggest that ly the absence of tèt ansanm, an impor workshops, community meetings, and social stressors and failure to meet social tant form of solidarity in Haiti. In addi- leisure activities, will likely have greater expectations represent causes of mental tion, the presence of others—including acceptance by local communities if they distress. In addition, tèt ansanm, a key housemates and spouses—seemed to be are based on this shared history. Further- form of social support and solidarity in largely a source of distress in the com- more, it may be worthwhile to consider Haiti, was markedly lacking within this munity-based survey (i.e., social burden the convite/konbit as appropriate venues migrant population. The authors sug- rather than social support). Based on this for microfinance or health insurance col- gest that interventions derived from a study’s qualitative data, this association lectives among friends and family. Final- shared convite/konbit model of social in- could be explained through the stress of ly, this strategy would certainly gain teraction could provide a key means of failing to meet social expectations, which greater traction if regional and national improving both Haitian–Dominican re- extends to family in Haiti. Finally, life for governmental and nongovernmental or- lations and mental health outcomes by Haitian migrants is one disproportion- ganizations, with budgetary and political strengthening bonding and bridging so- ately marked by social stress via negative capacity, assume a central role in devel- cial capital. interactions with both Dominicans and oping and promoting such interventions. fellow migrants. Acknowledgments. The authors To counteract social stress and build Limitations thank the research assistants who collect- social capital in this setting, interventions ed data for this study, namely Mere should seek to bond migrants within This study had some limitations. First, Dieuliphene, Willy Altindor, Jean Peter their social group and bridge them to the the quantitative analysis was limited by Osirias, and Jhefri Augustin Reyes larger social matrix of Dominican society. the 1) small sample size, 2) purposely Reinoso. They also thank Dhaysi Batista In migrant communities, Haitian “cul- selected communities, and 3) cross-sec- Berroa, Rossemary Ausuncion Hierro ture brokers”—long-term residents with tional survey design, which prevented Burgos, and Ivette Esperanza Hierro connections in the area and Spanish- drawing conclusions regarding causali- Burgos for their time in transcribing language proficiency—could support ty. Second, the qualitative data analysis Spanish audio files. Bethany Battig, Jean newly arrived migrants and educate local was conducted in English, potentially Verneus, and Brian Gross translated Dominican clinicians on important losing sight of nuance. Third, female Spanish and Kreyòl documents into cross-cultural aspects of treating Haitian gender was not associated with higher English. Without the support of Rosa patients. Local community health work- BDI scores in this population, despite a Ypania Burgos Minaya, Rafael Alvarez ers could be trained to provide mental gendered risk with the same Kreyòl BDI Castillo, Ambrosio Rosario, and Luis health services according to a model pi- among a population in Haiti’s Central Adolfo Dominguez Garcia, this study loted in Haiti that includes recognition of Plateau (12). This may reflect regional would not have been possible. common mental disorders and basic ther- differences in the cultural and linguistic apeutic and counseling skills (11). Recog- applicability of Kreyòl-adapted items of Conflicts of interest. None. nizing that the activities of tèt ansanm are the BDI (12). traditionally gender-separated in Haiti, In contrast, the locally developed Disclaimer. Authors hold sole respon interventions should actively involve KDI tool appeared to function well in sibility for the views expressed in the both genders to ensure that migrant this Haitian population. Future studies manuscript, which may not necessarily women, who appear to bear a greater should assess engagement in and per- reflect the opinion or policy of the RPSP/ mental illness burden, fully benefit. ceptions of tèt ansanm in a more rigorous PAJPH and/or PAHO.

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press-releases/dominican-republic- tina y el Caribe: asunto prioritario para la editors. Global mental health: anthropo- amnesty-international-calls-the-domin- salud pública. Rev Panam Salud Publica. logical perspectives. Walnut Creek, CA: ican-republic-to-stop-forcible-deporta- 2005;18(4-5):229–40. Left Coast Press; 2015. Pp. 277–90. tion-o Accessed on 3 August 2012. 9. Martinez S. From hidden hand to heavy 12. Wagenaar BH, Hagaman AK, Kaiser BN, 6. Archibold RC. Dominicans of Haitian de- hand: sugar, the state, and migrant labor McLean KE, Kohrt BA. Depression, sui scent cast into legal limbo by court. New in Haiti and the Dominican Republic. Lat cidal ideation, and associated factors: a York Times. Oct 24 2013. Pp. A1, A6. Am Res Rev. 1999:34(1):57–84. cross-sectional study in rural Haiti. BMC 7. Keys HM, Kaiser BN, Foster JW, Burgos 10. Kaiser BN, Kohrt BA, Keys HM, Khoury Psychiatry. 2012:12:149. Minaya RY, Kohrt BA. Perceived discrimi- NM, Brewster AR. Strategies for assessing nation, humiliation, and mental health: a mental health in Haiti: local instrument de- mixed-methods study among Haitian mi- velopment and transcultural translation. grants in the Dominican Republic. Ethn Transcult Psychiatry. 2003:15(4):532–58. Health 2015:20(3):219–40. 11. Kaiser BN, McLean KE. “Thinking too 8. Kohn R, Levav I, de Almeida JM, Vicente much” in the Central Plateau: an appren- B, Andrade L, Caraveo-Anduaga JJ, et al. ticeship approach to treating local distress Manuscript received on 30 November 2014. Revised Los trastornos mentales en América La- in Haiti. In: Kohrt B, Mendenhall E, version accepted for publication on 8 May 2015.

RESUMEN Este estudio de método mixto exploró el mundo social de los migrantes haitianos, mediante el análisis de las formas de apoyo social y el estrés social, así como su re lación con la salud mental. Se llevó a cabo una encuesta comunitaria (n = 127) en seis Factores estresantes comunidades migratorias haitianas del Valle de Cibao de la República Dominicana sociales, apoyo social y para evaluar las experiencias de migración, los factores estresantes actuales, la salud salud mental en los mental y el desempeño. Además, con objeto de explorar las percepciones y las experiencias de migración, las interacciones sociales, y la salud mental, el estudio se basó en migrantes haitianos de la entrevistas exhaustivas y actividades de enumeración libre por parte de los migrantes República Dominicana haitianos, así como en entrevistas cognoscitivas dirigidas a algunos participantes se- leccionados. Las puntuaciones de la encuesta correspondientes a depresión, ansiedad y aflicción mental se asociaron con 1) las interacciones sociales negativas (incluidos los interrogatorios o la deportación, el tratamiento por parte de los dominicanos perci- bido como inadecuado, y el hacinamiento) y 2) la falta de apoyo social, incluida la migración en solitario. Las puntuaciones correspondientes a aflicción mental fueron mayores en las mujeres, mientras que la condición de casado se asociaba con puntuaciones mayores de ansiedad, lo que podría reflejar la existencia de expectativas sociales no satisfechas. En cuanto a los datos cualitativos, los participantes recalcaron la falta de apoyo social, a menudo denominado tèt ansanm (que literalmente significa “cabezas juntas” en criollo haitiano o Kreyòl y se define aproximadamente como soli- daridad o colaboración social recíproca). Los autores del estudio proponen que la práctica del tèt ansanm (también denominada konbit y, en la República Dominicana, convite) podría usarse como un medio para facilitar los acontecimientos de contacto positivo entre haitianos y dominicanos. Estas interacciones podrían ayudar a contra rrestar el estrés social y promover el capital social en entornos similares a los del estudio.

Palabras clave Salud mental; capital social; apoyo social; migración; Haití; República Dominicana; Región del Caribe; Américas.

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