Globalisation and advances in transport and communication have led to an upsurge in international travel and migration. Furthermore, skirmishes, political strife and environmental calamities continue to generate large sporadic movements of people across national frontiers (Slewa-Younan et al., 2017; Salami, Salma, & Hegadoren, 2019). Migrant and refugee inhabitants go through stress attributed to problematic migration journeys as well as trials associated with moving from familiar grounds, adapting to strange nations, and a lack of support resources. Therefore, immigrants are highly predisposed to mental health disorders. Many studies have examined the plight of immigrants in foreign countries, particularly concerning access and utilisation of health services. Some of the notable challenges include learning foreign languages, seeking employment, traversing outlandish cultural and social systems as well as experiencing racism and prejudice (Dubus & LeBoeuf, 2019; Salami et al., 2019). The most common mental health disorders among refugees include post-traumatic stress disorder (PTSD), anxiety and depression (Kanagaratnam, Pain, McKenzie, Ratnalingam, & Toner, 2017; Giacco, Laxhman, & Priebe, 2018; Jongedijk, Eising, van der Aa, Kleber, & Boelen, 2020). This review appraises three studies examining the issue of anxiety among refugees and the role of professional interpreters in reducing anxiety.
The first study by Dong (2019) delved into the association between refugees and trauma. The author explained the factors that contribute to trauma, anxiety and mental distress among refugees. These include the need to face different cultures in foreign countries and poor living conditions due to the inability to secure employment. Language barrier hampers communication and leads to cultural isolation, which affect the refugees’ ability to interact with their surroundings. Adapting to a new culture entails disregarding one’s cultural identity and taking on new roles to fit into the new environment. Dong (2019) asserted that sharing similar cultures would make it easier for refugees to share their traumatic experiences without fear of judgement. It would also boost their resilience and create a sense of belonging. The suggested ways of lessening trauma in refugees include enhancing their comfort and developing a positive relationship between clients. Even though Dong (2019) mentions language barrier as a problem contributing to mental distress among refugees, he does not acknowledge the role of professional interpreters in improving the situation. Having professional interpreters could help circumvent the language barrier problem by helping refugees to express themselves freely and accurately (Jaeger, Pellaud, Laville, & Klauser, 2019), thereby creating a comfortable environment. Therefore, this study failed at exploring the contribution of professional interpreters in terms of anxiety because it only addressed traumatic experiences among refugees without an in-depth examination of anxiety in refugees, which is the main focus of this study.
The second study by Showstack (2019) examined the issue of language barriers in the healthcare system. Some of the common language barrier scenarios included speaking English to Limited English Proficiency (LEP) Hispanic patients, communicating with the patients using poor Spanish, using ad hoc interpreters, or facilitating communication through professional interpreters. The inability of patients to communicate effectively with their healthcare providers led to trauma. Showstack (2019) also highlighted the dangers of using ad hoc interpreters and stated that involving children as interpreters subjected them to trauma. Professional interpreters alleviate part of the anxiety experienced by refugees by facilitating effective communication. However, the scarcity of skilled interpreters has led to the use of non-professional interpreters (Celik & Cheesman, 2018). The risks of violation of confidentiality, translation slip-ups, and poor patient outcomes are higher when untrained interpreters are engaged (Eklöf, 2018; Hjern, 2018; Kasten, Berman, Ebright, Mitchell, & Quirindongo-Cedeno, 2020). Other options suggested by Showstack (2019) such as remote interpreting through audio and video devices cause trauma because patients prefer face-to-face communication. Furthermore, remote interpretation could fail in urgent situations. Using family members as interpreters could be effective. However, the main problem is maintaining the privacy and confidentiality of medical reports and safeguarding them from trauma and anxiety due to inadequate knowledge of medical terminology as opposed to professional interpreters. This study underscores the importance of professional interpreters in medical settings and highlights the challenges associated with using ad hoc interpreters. However, it does not address these factors in the context of refugees.
The third study by van Loon, van Schaik, Dekker and Beekman (2011) examined why Moroccan and Turkish migrants in the Netherlands abandoned treatment for anxiety and depressive disorders. Language barrier was the key problem responsible for dropping out, which could be solved by training therapists who share the same culture as the immigrants. Doing so would develop beneficial therapeutic relationships between clients and therapists, thereby enhancing treatment adherence. Migrant participants were to receive questionnaires to evaluate their responses, with the primary measure being staying on treatment. The article focuses on training of therapists to meet the cultural needs of Moroccan and Turkish immigrants. Intercultural training includes the proper use of professional interpreters among other cultural nuances that affect treatment. However, the trial does not involve the direct use of interpreters during treatment. If the migrant patients were allowed to have professional interpreters, trusting relationships would be built, which would encourage them to continue with treatment.
The review of the literature has shown that interpreters play a critical role in the provision of medical and mental health care to refugees. However, the direct effect of professional interpreters in reducing anxiety in refugees has not been studied extensively, which points to a gap that needs to be filled by conducting more primary studies on the area. Another gap that should be addressed is the effective strategies of training interpreters for medical and mental health settings.
References
- Celik, F., & Cheesman, T. (2018). Non-professional interpreters in counselling for asylum seeking and refugee women Filiz Celik, Tom Cheesman. Torture Journal, 28(2), 85-98.
- Dong, Y. (2019). Refugees and trauma. Asian Journal of Social Science Studies, 4(4), 79-85.
- Dubus, N., & LeBoeuf, H. S. (2019). A qualitative study of the perceived effectiveness of refugee services among consumers, providers, and interpreters. Transcultural Psychiatry, 56(5), 827-844.
- Eklöf, N. (2018). Somali asylum seekers and refugees in Finnish health care–Focus on privacy and the use of interpreters. Web.
- Giacco, D., Laxhman, N., & Priebe, S. (2018). Prevalence of and risk factors for mental disorders in refugees. Seminars in Cell & Developmental Biology, 77, 144-152.
- Hjern, A. (2018). Health of refugee and migrant children: Technical guidance. Web.
- Jaeger, F. N., Pellaud, N., Laville, B., & Klauser, P. (2019). The migration-related language barrier and professional interpreter use in primary health care in Switzerland. BMC Health Services Research, 19(429), 1-10. doi:10.1186/s12913-019-4164-4
- Jongedijk, R. A., Eising, D. D., van der Aa, N., Kleber, R. J., & Boelen, P. A. (2020). Severity profiles of posttraumatic stress, depression, anxiety, and somatization symptoms in treatment seeking traumatized refugees. Journal of Affective Disorders, 266, 71-81.
- Kanagaratnam, P., Pain, C., McKenzie, K., Ratnalingam, N. & Toner, B. (2017). Recommendations for Canadian mental health practitioners working with war-exposed immigrants and refugees. Canadian Journal of Community Mental Health, 36(Special issue), 107-119.
- Kasten, M. J., Berman, A. C., Ebright, A. B., Mitchell, J. D., & Quirindongo-Cedeno, O. (2020). interpreters in healthcare: A concise review for clinicians. The American Journal of Medicine, 133(4), 424-428.
- Salami, B., Salma, J., & Hegadoren, K. (2019). Access and utilization of mental health services for immigrants and refugees: Perspectives of immigrant service providers. International Journal of Mental Health Nursing, 28(1), 152-161.
- Showstack, R. (2019). Patients don’t have language barriers; the healthcare system does. Emergency Medicine Journal, 36(10), 580–581.
- Slewa-Younan, S., Guajardo, M. G. U., Yaser, A., Mond, J., Smith, M., Milosevic, D.,… Jorm, A. F. (2017). Causes of and risk factors for posttraumatic stress disorder: The beliefs of Iraqi and Afghan refugees resettled in Australia. International Journal of Mental Health Systems, 11(4), 1-11. doi:10.1186/s13033-016-0109-z
- van Loon, A., van Schaik, D. J., Dekker, J. J., & Beekman, A. T. (2011). Effectiveness of an intercultural module added to the treatment guidelines for Moroccan and Turkish patients with depressive and anxiety disorders. BMC Psychiatry, 11(1), 1-7.