Heidi Ellis
Harvard University, Psychiatry, Department Member
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In this study, we examined the relationships among discrimination and mental health for Somali young adults, a group at risk for an unfavorable context of reception, and the way in which individual- and community-level factors explain... more
In this study, we examined the relationships among discrimination and mental health for Somali young adults, a group at risk for an unfavorable context of reception, and the way in which individual- and community-level factors explain these associations. The present study drew upon data collected during the first wave of the Somali Youth Longitudinal Study, a community-based participatory research project focused on understanding and supporting the healthy development of Somali young adults in four different regions in North America: Boston, MA, Minneapolis, MN, and Portland/Lewiston, ME in the United States and Toronto, Canada. Somali men and women aged 18-30 participated in quantitative interviews that included questions about their health, their neighborhoods, and their thoughts and feelings about their resettlement communities (N = 439). Results indicate that discrimination has a direct effect on worse mental health; this effect was mediated through both individual (marginalized acculturation style) and community-level (sense of belonging) factors. These findings suggest that factors associated with a receiving society's attitudes and behaviors, in addition to its structural supports and constraints, may be particularly important in understanding immigrant mental health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Objectives: Understanding how immigrant young adults engage with civic society over time is critical to understanding and fostering healthy development and healthy democracies. The present study examines how civic engagement and... more
Objectives: Understanding how immigrant young adults engage with civic society over time is critical to understanding and fostering healthy development and healthy democracies. The present study examines how civic engagement and antisocial attitudes/behavior of Somali young adult immigrants (ages 18-30, N = 498) in four North American regions co-occur, and change over time. Method: Using latent transition analyses, we examine latent classes of young adult males and females in relation to political and nonpolitical civic engagement and dimensions of antisocial attitudes/behavior and stability of these classes over 1 year. Results: Distinct latent classes were identified that remained consistent over time. Rates and patterns in latent class transitions varied along civically engaged/antisocial dimensions and also by gender. Conclusions: Antisocial attitudes/behavior can coexist with civic engagement. For males, sense of belonging to both Somali and American/Canadian communities was associated with lower levels of antisocial attitudes/behavior. Movement away from, or into, antisocial attitudes/behavior differs by gender and can happen either in the presence or absence of civic engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Borders and immigration/Immigration; Terrorism and society/Psychology of terrorism; Law and justice
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Trauma Systems Therapy for Refugees (TST-R) is an innovative, trauma-informed multi-tiered approach to mental health prevention and intervention with refugee children and their families. TST-R was developed as an adaptation of Trauma... more
Trauma Systems Therapy for Refugees (TST-R) is an innovative, trauma-informed multi-tiered approach to mental health prevention and intervention with refugee children and their families. TST-R was developed as an adaptation of Trauma Systems Therapy (TST), which is an organizational and clinical model that focuses on both a child’s dysregulation and the social environmental context that may be contributing to ongoing symptoms in the aftermath of trauma. TST-R adaptations address multiple barriers to care for refugees and their families through innovative mental health service delivery including multi-tiered approaches to community engagement and stigma reduction, embedding of services in the school setting, partnership building, and the integration of cultural brokering throughout all tiers of intervention to provide cultural knowledge, engagement, and attention to the primacy of resettlement stressors. TST-R has been shown to be effective in engaging refugee youth in services and r...
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Violence prevention efforts must take into consideration the potentially stigmatizing labels associated with violence, and how youth perceive different types of violence in their communities. Somali communities and individuals in North... more
Violence prevention efforts must take into consideration the potentially stigmatizing labels associated with violence, and how youth perceive different types of violence in their communities. Somali communities and individuals in North America have at times been labeled as at-risk for violence, with two notable examples being gang violence and ideologically motivated violence, or violent radicalization. Little is known, however, about how the youth themselves think about and understand these types of violence in their communities. In this article, we seek to answer the following questions: How do Somali immigrants think about violence in their communities, and the stigma related to this violence? and What are the implications of these perceptions/beliefs for violence prevention? Data are drawn from two qualitative studies conducted as part of an ongoing community-based participatory research (CBPR) collaboration between academic partners and Somali communities in three cities in Nor...
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Understanding the relationships between immigrants and refugees and the police is a critical research task with implications for both community–police partnerships and the effectiveness of law enforcement efforts. This study contributes... more
Understanding the relationships between immigrants and refugees and the police is a critical research task with implications for both community–police partnerships and the effectiveness of law enforcement efforts. This study contributes to such an understanding by examining perceptions of police and police interactions among Somali immigrants and refugees (both first and second generation) in three communities in the United States and Canada. This article presents in-depth analyses of qualitative interview data and draws upon multiple theoretical perspectives, specifically procedural justice and minority group threat theory. These perspectives have been employed to account for police–minority relationships in other works and we extend their application to a new group. We find that despite some evidence of positive interactions with police, current policing could do more to establish community trust and implement principles of procedural justice with Somalis in the United States and ...
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What is community resilience in relation to violent extremism, and how can we build it? This article explores strategies to harness community assets that may contribute to preventing youth from embracing violent extremism, drawing from... more
What is community resilience in relation to violent extremism, and how can we build it? This article explores strategies to harness community assets that may contribute to preventing youth from embracing violent extremism, drawing from models of community resilience as defined in relation to disaster preparedness. Research suggests that social connection is at the heart of resilient communities and any strategy to increase community resilience must both harness and enhance existing social connections, and endeavor to not damage or diminish them. First, the role of social connection within and between communities is explored. Specifically, the ways in which social bonding and social bridging can diminish risk for violence, including violent extremism, is examined. Second, research on the role of social connection between communities and institutions or governing bodies (termed social linking) is described. This research is discussed in terms of how the process of government partnerin...
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Most mental health services for trauma-exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We... more
Most mental health services for trauma-exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee-origin, immigrant-origin, and U.S.-origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee-origin youth (n = 60, 48.3% female, mean age = 13.07 years) and propensity-matched samples of immigrant-origin youth (n = 143, 60.8% female, mean age = 13.26 years), and U.S.-origin youth (n = 140, 56.1% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth th...
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In this chapter, we provide a brief history of school-based interventions, the connection between mental health and academics, and the provision of school-based mental health services, with a specific focus on immigrant youth. Immigrant... more
In this chapter, we provide a brief history of school-based interventions, the connection between mental health and academics, and the provision of school-based mental health services, with a specific focus on immigrant youth. Immigrant youth within the US school system are described, as well as considerations in delivering mental health services to them within the school context. Various approaches to interventions (i.e., universal, selected, and indicated) are reviewed. Case examples of interventions with good outcomes and effectiveness are showcased and professionals within a school system potentially involved in service provision are highlighted. Evaluation and sustainability of school-based mental health interventions are also discussed.
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Refugee adolescents often immigrate to a new society because of experiences of persecution and trauma, which can have profound effects on their mental health. Once they immigrate, many refugees experience stressors related to resettlement... more
Refugee adolescents often immigrate to a new society because of experiences of persecution and trauma, which can have profound effects on their mental health. Once they immigrate, many refugees experience stressors related to resettlement and acculturation in the new society. The current study examined relationships among acculturation styles and hassles and the well-being of young refugees as well as the role of gender. Data were collected from 135 young refugees (M age = 15.39, SD = 2.2; 62 % male) from Somalia resettled in the United States The findings from our study indicate that in addition to trauma history, acculturative hassles and acculturation style impact the wellbeing of Somali refugee adolescents. These findings indicate the need to understand both past experiences as well as current challenges. Potential areas for intervention are discussed.
Research Interests: Psychology, Mental Health, Depression, Public Health, Somalia, and 15 moreAcculturation, Adolescent, Medicine, Refugees, Humans, Refugee, United States, Female, Male, Persecution, Public health systems and services research, Somali, Guidance and Counseling Intervention Programs, Psychological Stress, and stressor
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Refugees are disproportionally impacted by trauma and its negative sequelae. Even after being resettled in the United States, refugees face disparities in accessing services due to the stigma attached to mental health symptoms and the... more
Refugees are disproportionally impacted by trauma and its negative sequelae. Even after being resettled in the United States, refugees face disparities in accessing services due to the stigma attached to mental health symptoms and the paucity of culturally and linguistically accessible services. Thus, there is a great need to develop methods that facilitate the engagement of refugee communities. Community-Based Participatory Research recommends the forming of equal and equitable partnerships with communities and stakeholders to enhance community capacity and ownership of the research process and outcomes (Israel et al., 1998). The present article shares one approach to operationalizing these principles with the Somali refugee community. It provides a road map of best practices in collaborating with communities and the importance of colearning and cultural humility to a successful partnership. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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During the period February 2009-February 2012, the Office of Refugee Resettlement of the U.S. Department of Health and Human Services reported 16 suicides among the approximately 57,000 Bhutanese refugees who had resettled in the United... more
During the period February 2009-February 2012, the Office of Refugee Resettlement of the U.S. Department of Health and Human Services reported 16 suicides among the approximately 57,000 Bhutanese refugees who had resettled in the United States since 2008. In 2012, the office requested assistance from CDC and the Massachusetts Department of Public Health's Refugee Health Technical Assistance Center to identify risk factors that might be associated with suicidal ideation among Bhutanese refugees. In collaboration with the Massachusetts refugee health center, CDC conducted a survey of randomly selected Bhutanese refugees in four U.S. states with large populations of resettled refugees. The results indicated significant associations between ever having expressed suicidal ideation and current self-reported symptoms of mental health disorder (e.g., anxiety, depression, or posttraumatic stress disorder) and postmigration difficulties (e.g., family conflict or inability to find work). T...
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Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in... more
Attention has been drawn to high rates of suicide among refugees after resettlement and in particular among the Bhutanese refugees. This study sought to understand the apparent high rates of suicide among resettled Bhutanese refugees in the context of the Interpersonal-Psychological Theory of Suicidal Behavior (IPTS). Expanding on a larger investigation of suicide in a randomly selected sample of Bhutanese men and women resettled in Arizona, Georgia, New York, and Texas (Ao et al., 2012), the current study focused on 2 factors, thwarted belongingness and perceived burdensomeness, examined individual and postmigration variables associated with these factors, and explored how they differed by gender. Overall, factors such as poor health were associated with perceived burdensomeness and thwarted belongingness. For men, stressors related to employment and providing for their families were related to feeling burdensome and/or alienated from family and friends, whereas for women, stressor...
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Refugee families often encounter a number of acculturative and resettlement stressors as they make lives for themselves in host countries. These difficulties may be compounded by past trauma and violence exposure, posing increased risk... more
Refugee families often encounter a number of acculturative and resettlement stressors as they make lives for themselves in host countries. These difficulties may be compounded by past trauma and violence exposure, posing increased risk for mental health problems. Greater knowledge is needed about protective processes contributing to positive development and adjustment in refugee families despite risk (e.g., resilience). The aims of this research were to identify and examine strengths and resources utilized by Somali refugee children and families in the Boston area to overcome resettlement and acculturative stressors. We used maximum variation sampling to conduct a total of 9 focus groups: 5 focus groups (total participants N = 30) among Somali refugee adolescents and youth, capturing gender and a range of ages (15 to 25 years), as well as 4 focus groups of Somali refugee mothers and fathers in groups (total participants N = 32) stratified by gender. Drawing from conservation of resources theory (COR), we identified 5 forms of resources comprising individual, family, and collective/community strengths: religious faith, healthy family communication, support networks, and peer support. "Community talk" was identified as a community dynamic having both negative and positive implications for family functioning. Protective resources among Somali refugee children and families can help to offset acculturative and resettlement stressors. Many of these locally occurring protective resources have the potential to be leveraged by family and community-based interventions. These findings are being used to design preventative interventions that build on local strengths among Somali refugees in the Boston area. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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ABSTRACT This article examines key setting events and personal factors that are associated with support for either non-violent activism or violent activism among Somali refugee young adults in the United States. Specifically, this article... more
ABSTRACT This article examines key setting events and personal factors that are associated with support for either non-violent activism or violent activism among Somali refugee young adults in the United States. Specifically, this article examines the associations of trauma, stress, symptoms of posttraumatic stress disorder (PTSD), posttraumatic growth (PTG), strength of social bonds, and attitudes towards legal and non-violent vs. illegal and violent activism. Structured interviews were conducted with a sample of Somali refugee males ages 18–25 living in the northeastern United States (N = 79). Data were analyzed using multiple linear regressions and path analysis. Greater exposure to personal trauma was associated with greater openness to illegal and violent activism. PTSD symptoms mediated this association. Strong social bonds to both community and society moderated this association, with trauma being more strongly associated with openness to illegal and violent activism among those who reported weaker social bonds. Greater exposure to trauma, PTG, and stronger social bonds were all associated with greater openness to legal non-violent activism.
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Research Interests: Psychology, Clinical Psychology, Developmental Psychology, Anxiety Disorders, Medicine, and 15 moreRomania, Affect, Humans, Child, Female, Male, Developmental disabilities, Mood Disorders, Prognosis, Body Height, Cross Sectional Studies, Child preschool, Child behavior disorders, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Refugee studies have examined both resilience and adverse outcomes, but no research has examined how different outcomes co-occur or are distinct, and the social-contextual factors that give rise to these diverse outcomes. The current... more
Refugee studies have examined both resilience and adverse outcomes, but no research has examined how different outcomes co-occur or are distinct, and the social-contextual factors that give rise to these diverse outcomes. The current study begins to address this gap by using latent profile analysis to examine the ways in which delinquency, gang involvement, civic engagement, political engagement, and openness to violent extremism cluster among Somali refugees. We then use multivariable regression analyses to examine how adversity (e.g., discrimination, trauma, and marginalization) is associated with the identified latent classes. Data were collected from 374 Somali refugee young adults (Mage = 21.30 years, SD = 2.90, range 18-30, 38% female) from 4 different North American communities. Participants completed a structured survey assessing their experiences of adversity, delinquent and/or violent attitudes and behaviors (e.g., attitudes toward violent extremism, participation in delinquent behaviors, involvement in gangs), and positive outcomes (e.g., civic and political engagement). Our findings indicate that participants fall into 5 distinct groups, and that social-contextual and individual factors are uniquely related to those groups. Specifically, strong social bonds seem to be associated with positive outcomes. These findings point to the need to further examine both positive and negative outcomes, paying special attention to social-contextual factors. (PsycINFO Database Record
Research Interests: Psychology, Clinical Psychology, Juvenile Delinquency, Political Violence and Terrorism, Radicalization, and 15 moreIslamic Studies, Forced Migration, Civic Engagement, Medicine, Counter terrorism, Psychosocial Studies, Exposure to Violence, Humans, Preventing violent extremism, Female, Male, Attitude, Gangs, Countering Violent Extremism, and Criminal Behavior
Objective: To examine violence perpetration among Somali young adults and the potential for community belonging and neighborhood cohesion to serve as protective influences. Method: Somalis (N 374) living in 4 North America cities... more
Objective: To examine violence perpetration among Somali young adults and the potential for community belonging and neighborhood cohesion to serve as protective influences. Method: Somalis (N 374) living in 4 North America cities completed verbally administered standardized instruments assessing trauma, neighborhood cohesion, Somali belongingness, and violence perpetration. Results: Younger age and greater time in the U.S./Canada were independently associated with increased odds of violence perpe-tration, and those who had experienced high levels of trauma (as compared with those with moderate or low trauma exposure) were significantly more likely to commit violence. Furthermore, higher Somali community belonging was associated with a significant reduction in the odds of violence perpetration when neighborhood cohesion was low but an increased odds of violence perpetration when cohesion was high. Conclusions: Neighborhood cohesion and community belonging are both important factors in relation to youth violence. In the context of low neighborhood cohesion, Somali communities may benefit from examining ways of bringing alienated youth back into the community. Efforts to reengage with ostracized youth and extend the same kind of protective cultural resources that benefit those youth who experience higher levels of belonging may be beneficial to both the youth and the communities in which they live.
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Research Interests: Anthropology, Mental Health, Family, Adolescent, Prosocial Behavior, and 15 moreProspective studies, Humans, Child, Adaptive behavior, Female, Male, Mental Disorders, Interpersonal Relations, Association, Psychosocial Adjustment, Military Personnel, Prospective Study, Life Change Events, Nino, and Interviews as topic
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Objectives: We examine the association between perceived discrimination, mental health, social support, and support for violent radicalization (VR) in young adults from three locations across two countries: Montréal and Toronto, Canada,... more
Objectives: We examine the association between perceived discrimination, mental health, social support, and support for violent radicalization (VR) in young adults from three locations across two countries: Montréal and Toronto, Canada, and Boston, United States. A secondary goal is to test the moderating role of location.Methods: A total of 791 young adults between the ages of 18 and 30, drawn from the Somali Youth longitudinal study and a Canada-based study of college students, participated in the study. We used multivariate linear regression to assess the association between scores on the Radical Intentions Scale (RIS) with demographic characteristics, anxiety, depression, social support, and discrimination.Results: In the full sample, discrimination, age, and gender were associated with RIS scores. When we examined moderation effects by location, RIS scores were associated with depression only in Montréal, and with social support (negatively) and discrimination in Toronto. None ...
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Refugee agencies noticed a high number of suicides among Bhutanese refugees resettled in the United States between 2009 and 2012. We aimed to estimate prevalence of mental health conditions and identify factors associated with suicidal... more
Refugee agencies noticed a high number of suicides among Bhutanese refugees resettled in the United States between 2009 and 2012. We aimed to estimate prevalence of mental health conditions and identify factors associated with suicidal ideation among Bhutanese refugees. We conducted a stratified random cross-sectional survey and collected information on demographics, mental health conditions, suicidal ideation, and post-migration difficulties. Bivariate logistic regressions were performed to identify factors associated with suicidal ideation. Prevalence of mental health conditions were: depression (21 %), symptoms of anxiety (19 %), post-traumatic stress disorder (4.5 %), and suicidal ideation (3 %), significant risk factors for suicidal ideation included: not being a provider of the family; perceiving low social support; and having symptoms of anxiety and depression. These findings suggest that Bhutanese refugees in the United States may have a higher burden of mental illness relat...
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An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this... more
An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled popul...
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ABSTRACT