Purpose The purpose of this paper is to explore the “active ingredients” of integrated behavioral health care (IBHC) from the perspective of Karen refugee participants in an IBHC intervention. Design/methodology/approach This paper is based on in-depth, semi-structured interviews with participants (n=40) who have received an IBHC intervention for one year. These qualitative data are supplemented by descriptive quantitative data from those same participants. Findings This research suggested that IBHC increased awareness and access to behavioral health services, and that IBHC may be especially amenable to treating complex health conditions. The research also found that IBHC provided a point of regular contact for patients who had limited time with their primary care providers, which helped to enhance access to and engagement with health care. Practical implications IBHC has the potential to meet the complex needs of Karen resettled refugees living in an urban setting in the USA. Originality/value IBHC is a promising approach to help meet the mental health needs of refugees in the USA. There are, however, gaps in knowledge about the “active ingredients” of IBHC. This paper helps fill these gaps by studying how IBHC works from the perspective of a group of Karen refugees; these are critical perspectives, missing in the literature, which must be heard in order to better address the complex conditions and needs of resettled refugees.

Testimony therapy can provide low-cost, brief, simple, and culturally adaptable psychosocial services in low-income countries (Agger, Raghuvanshi, Khan, Polatin, & Laursen, 2009). Nonetheless, there have been no well-controlled studies of testimony therapy. We report the analyses of a randomized controlled trial designed to assess the effectiveness of testimony therapy plus a culturally adapted ceremony in reducing mental health symptoms among Khmer Rouge torture survivors from across Cambodia. Using multilevel modeling, we compared symptoms of posttraumatic stress disorder, anxiety, and depression between a treatment (n = 45) and a control group (n = 43) at baseline, 3 months, and 6 months. We found that testimony therapy plus ceremony significantly reduced symptoms of posttraumatic stress disorder (d = 0.49), anxiety (d = 0.44), and depression (d = 0.53).

Research shows an unequal distribution of anxiety disorder symptoms and diagnoses across social groups. Bridging stress process theory and the sociology of diagnosis and drawing on the National Longitudinal Study of Adolescent to Adult Health, we examine inequity in the prevalence of anxiety symptoms versus diagnosis across social groups (the "symptom-to-diagnoses gap"). Bivariate findings suggest that while several disadvantaged groups are more likely to experience symptoms of anxiety, they are not more likely to receive a diagnosis. Multivariate results indicate that after controlling for anxiety symptoms: (1) Being female still predicts an anxiety disorder diagnosis, and (2) Native American, white, and Hispanic/Latino respondents are more likely than black respondents to receive an anxiety disorder diagnosis. We conclude by reflecting on the implications of race and gender bias in diagnosis and the health trajectories for persons with undiagnosed anxiety disorders.

Refugees and torture survivors often present with complex physical, mental, and social conditions. Collaborative care is a promising service delivery approach that addresses the needs of patients with complex conditions. This article reviews the broader field of collaborative care with a focus on content areas relevant to refugees and torture survivors. Doing so, it identifies the potential benefits and limitations of integrated care for these populations, and it highlights future research directions for collaborative care with torture survivors and refugees. Meta-analyses based on research in diverse populations suggest that collaborative care is effective in reducing symptoms of depression and anxiety and in increasing treatment satisfaction and medication adherence. Randomized controlled trials suggest positive results for collaborative care on posttraumatic stress disorder, severe and persistent mental illness, and key chronic health conditions. Research, however, shows inconsistent results for collaborative care on substance abuse, quality of life, and cost-effectiveness, as well as in older adult populations. Although the research on collaborative care is mostly promising in areas directly relevant to refugees and torture survivors, there is limited research on collaborative care with these populations and what does exist provides inconsistent results. Considering the complex needs of and barriers to care faced by refugees and torture survivors, as well as the evidence for the efficacy of collaborative care in relation to key difficulties experienced by these populations, we argue that there is a clear need and an evidence-based justification for additional research on collaborative care with refugees and torture survivors.

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