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

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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 ac- tivities among Haitian migrants, as well as cognitive interviews with select survey partici- pants. 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 anx- iety 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 coun- teract 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 Uni versity 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
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