Cultural Responsiveness in Trauma-Informed Care for Immigrant and First-Generation Populations in Urban Behavioral Health Settings
Abstract
This review examines how culturally responsive, trauma-informed behavioral health can be strengthened for immigrant and first-generation populations in urban settings. It synthesizes multidisciplinary literature published through 2023 on migration-related adversity, cultural interpretations of trauma, intergenerational stress, language access, family and community influences, institutional trust, workforce competence, and organizational readiness. The review adopts a critical narrative approach, integrating evidence from global, African, and Nigerian contexts to assess how cultural and structural conditions shape engagement, assessment, treatment, and recovery. The findings indicate that trauma among immigrant and first- generation populations cannot be understood adequately through standardized clinical frameworks alone. Cultural identity, migration history, socioeconomic position, family expectations, racialization, language, and legal or institutional experiences influence how distress is expressed, interpreted, and addressed. Culturally responsive assessment requires cultural humility, context-sensitive measurement, recognition of idioms of distress, and careful attention to post-migration stressors. Language-concordant care and qualified interpretation are essential to therapeutic communication, while family, community, spiritual, and indigenous healing resources may strengthen recovery when incorporated safely and collaboratively. The review further identifies institutional mistrust, discrimination, financial barriers, fragmented services, and insufficient workforce preparation as persistent obstacles to equitable care. The study concludes that trauma-informed practice becomes genuinely responsive only when cultural meaning and structural inequity are embedded within clinical and organizational decision- making. It recommends sustained investment in interpreter services, culturally informed workforce development, reflective supervision, community partnerships, disparity monitoring, and policies that reduce coercive and administrative barriers. Future research should prioritize longitudinal, community-engaged, and culturally validated studies across diverse immigrant generations and urban populations. Particular attention should be given to examining intersectional and intergenerational pathways to resilience.
Keywords
cultural responsiveness; trauma-informed care; immigrant populations; first- generation populations; urban behavioral health; cultural humility.
References
Abdi, S.M., Miller, A.B., Agalab, N.Y. and Ellis, B.H. (2022) ‘Partnering with refugee communities to improve mental health access: Going from “why are they not coming” to “what can I (we) do differently?”’, Cultural Diversity and Ethnic Minority Psychology, 28(3), pp. 370–378. DOI: 10.1037/cdp0000476. Aggarwal, N.K., Jarvis, G.E., Gómez-Carrillo, A., Kirmayer, L.J. and Lewis-Fernández, R. (2020) ‘The Cultural Formulation Interview since DSM-5: Prospects for training, research, and clinical practice’, Transcultural Psychiatry, 57(4), pp. 496–514. DOI: 10.1177/1363461520940481. Akhigbe, R., Falemi, A. and Akin-Oluyomi, O.T. (2023) ‘A conceptual model for improving customer experience using workforce behavior and real-time operational data’, International Journal of Multidisciplinary Research and Growth Evaluation, 4(6), pp. 1322–1338. DOI: 10.54660/.IJMRGE.2023.4.6.1322-1338. Badu, E., O’Brien, A.P., Mitchell, R. and Osei, A. (2020) ‘Mediation and moderation effects of health system structure and process on the quality of mental health services in Ghana – structural equation modelling’, PLOS ONE, 15(5), e0233351. DOI: 10.1371/journal.pone.0233351. Balogun, C.T. and Sabboh, G.M. (2021) ‘Psycho-sociological factors as determinants of juvenile delinquency among adolescents in junior secondary schools in Patani Local Government Area of Delta State, Nigeria’, International Journal of Academic Management Science Research, 5(10), pp. 34–40. Bauer, A.M. and Alegría, M. (2010) ‘Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: A systematic review’, Psychiatric Services, 61(8), pp. 765–773. DOI: 10.1176/ps.2010.61.8.765. Blackmore, R., Boyle, J.A., Fazel, M., Ranasinha, S., Gray, K.M., Fitzgerald, G., Misso, M. and Gibson-Helm, M. (2020) ‘The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis’, PLOS Medicine, 17(9), e1003337. DOI: 10.1371/journal.pmed.1003337. Bunn, M., Khanna, D., Farmer, E., Esbrook, E., Ellis, H., Richard, A. and Weine, S. (2023) ‘Rethinking mental healthcare for refugees’, SSM – Mental Health, 3, 100196. DOI: 10.1016/j.ssmmh.2023.100196. Cleary, M. and Hungerford, C. (2015) ‘Trauma-informed care and the research literature: How can the mental health nurse take the lead to support women who have survived sexual assault?’, Issues in Mental Health Nursing, 36(5), pp. 370–378. DOI: 10.3109/01612840.2015.1009661. Crush, J. and Tawodzera, G. (2014) ‘Medical xenophobia and Zimbabwean migrant access to public health services in South Africa’, Journal of Ethnic and Migration Studies, 40(4), pp. 655–670. DOI: 10.1080/1369183X.2013.830504. Derr, A.S. (2016) ‘Mental health service use among immigrants in the United States: A systematic review’, Psychiatric Services, 67(3), pp. 265–274. DOI: 10.1176/appi.ps.201500004. DeSa, S., Gebremeskel, A.T., Omonaiye, O. and Yaya, S. (2022) ‘Barriers and facilitators to access mental health services among refugee women in high-income countries: A systematic review’, Systematic Reviews, 11, Article 62. DOI: 10.1186/s13643-022- 01936-1. Diri, B.H. (2023) ‘Language barriers: An overview for efficiency in Nigeria’s health system’, Journal of Health, Applied Sciences and Management, 7(1), pp. 85–90. DOI: 10.4314/johasam.v7i1.9. Dombou, C., Omonaiye, O., Fraser, S., Cénat, J.M., Fournier, K. and Yaya, S. (2023) ‘Barriers and facilitators associated with the use of mental health services among immigrant students in high-income countries: A systematic scoping review’, PLOS ONE, 18(6), e0287162. DOI: 10.1371/journal.pone.0287162. Escamilla, S. and Saasa, S. (2020) ‘Gendered patterns in depression and anxiety among African immigrants in the United States’, Journal of Evidence-Based Social Work, 17(4), pp. 392–405. DOI: 10.1080/26408066.2020.1748153. Ezeani, P.T. and Sabboh, G.M. (2021) ‘Psychosocial predictors of the changing role of husbands as breadwinners in a depressed economy in Ibadan Metropolis, Oyo State, Nigeria’, British Journal of Education, Learning and Development Psychology, 4(2), pp. 31–42. DOI: 10.52589/BJELDP-ZU3KSUJU. Ezeani, P.T., Ogu, C. and Sabboh, G.M. (2023) ‘Parental involvement as correlate of career decision-making among secondary school students in Oyo State, Nigeria’, British Journal of Multidisciplinary and Advanced Studies: Arts, Humanities and Social Sciences, 4(4), pp. 106–115. DOI: 10.37745/bjmas.2022.0260. Falemi, A., Akhigbe, R. and Akin-Oluyomi, O.T. (2020) ‘A conceptual supply chain talent development model for capability building across distributed operations’, International Journal of Multidisciplinary Research and Growth Evaluation, 1(5), pp. 439–456. DOI: 10.54660/.IJMRGE.2020.1.5.439-456. Falemi, A., Akhigbe, R. and Akin-Oluyomi, O.T. (2023) ‘A proposed framework for integrating employee retention systems with operational productivity metrics’, International Journal of Advanced Multidisciplinary Research and Studies, 3(1), pp. 1704–1724. DOI: 10.62225/2583049X.2023.3.1.5339. Fennig, M. and Denov, M. (2021) ‘Interpreters working in mental health settings with refugees: An interdisciplinary scoping review’, American Journal of Orthopsychiatry, 91(1), pp. 50–65. DOI: 10.1037/ort0000518. Fortuna, L.R., Porche, M.V. and Alegría, M. (2008) ‘Political violence, psychosocial trauma, and the context of mental health services use among immigrant Latinos in the United States’, Ethnicity & Health, 13(5), pp. 435–463. DOI: 10.1080/13557850701837286. Hagan, S., Hunt, X., Kilian, S., Chiliza, B. and Swartz, L. (2020) ‘Ad hoc interpreters in South African psychiatric services: Service provider perspectives’, Global Health Action, 13(1), Article 1684072. DOI: 10.1080/16549716.2019.1684072. Hook, J.N., Davis, D.E., Owen, J., Worthington, E.L. Jr. and Utsey, S.O. (2013) ‘Cultural humility: Measuring openness to culturally diverse clients’, Journal of Counseling Psychology, 60(3), pp. 353–366. DOI: 10.1037/a0032595. Huo, Y., Couzner, L., Windsor, T., Laver, K., Dissanayaka, N.N. and Cations, M. (2023) ‘Barriers and enablers for the implementation of trauma-informed care in healthcare settings: A systematic review’, Implementation Science Communications, 4, Article 49. DOI: 10.1186/s43058-023-00428-0. Hynie, M. (2018) ‘The social determinants of refugee mental health in the post-migration context: A critical review’, The Canadian Journal of Psychiatry, 63(5), pp. 297–303. DOI: 10.1177/0706743717746666. Im, H. and Swan, L.E.T. (2021) ‘Working towards culturally responsive trauma-informed care in the refugee resettlement process: Qualitative inquiry with refugee-serving professionals in the United States’, Behavioral Sciences, 11(11), Article 155. DOI: 10.3390/bs11110155. Im, H., Ferguson, A. and Hunter, M. (2017) ‘Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement’, Transcultural Psychiatry, 54(5–6), pp. 626–652. DOI: 10.1177/1363461517744989. Im, H., Rodriguez, C. and Grumbine, J.M. (2021) ‘A multitier model of refugee mental health and psychosocial support in resettlement: Toward trauma-informed and culture-informed systems of care’, Psychological Services, 18(3), pp. 345–364. DOI: 10.1037/ser0000412. Jack-Ide, I.O. and Uys, L. (2013) ‘Barriers to mental health services utilization in the Niger Delta region of Nigeria: Service users’ perspectives’, Pan African Medical Journal, 14, Article 159. DOI: 10.11604/pamj.2013.14.159.1970. Këllezi, B., Wakefield, J., Bowe, M., Stevenson, C. and McNamara, N. (2021) ‘Healthcare provision inside immigration removal centres: A social identity analysis of trust, legitimacy and disengagement’, Applied Psychology: Health and Well-Being, 13(3), pp. 578–601. DOI: 10.1111/aphw.12263. Kenny, M.A., Grech, C. and Procter, N. (2022) ‘A trauma-informed response to COVID-19 and the deteriorating mental health of refugees and asylum seekers with insecure status in Australia’, International Journal of Mental Health Nursing, 31(1), pp. 62–69. DOI: 10.1111/inm.12932. Kern, M.R., Duinhof, E.L., Walsh, S.D., Cosma, A., Moreno-Maldonado, C., Molcho, M., Currie, C. and Stevens, G.W.J.M. (2020) ‘Intersectionality and adolescent mental well- being: A cross-nationally comparative analysis of the interplay between immigration background, socioeconomic status and gender’, Journal of Adolescent Health, 66(6S), pp. S12–S20. DOI: 10.1016/j.jadohealth.2020.02.013. Kirmayer, L.J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A.G., Guzder, J., Hassan, G., Rousseau, C. and Pottie, K. (2011) ‘Common mental health problems in immigrants and refugees: General approach in primary care’, CMAJ, 183(12), pp. E959–E967. DOI: 10.1503/cmaj.090292. Kpobi, L.N.A. and Swartz, L. (2019) ‘Muslim traditional healers in Accra, Ghana: Beliefs about and treatment of mental disorders’, Journal of Religion and Health, 58(3), pp. 833–846. DOI: 10.1007/s10943-018-0668-1. Lewis-Fernández, R. and Kirmayer, L.J. (2019) ‘Cultural concepts of distress and psychiatric disorders: Understanding symptom experience and expression in context’, Transcultural Psychiatry, 56(4), pp. 786–803. DOI: 10.1177/1363461519861795. Li, S.S.Y., Liddell, B.J. and Nickerson, A. (2016) ‘The relationship between post-migration stress and psychological disorders in refugees and asylum seekers’, Current Psychiatry Reports, 18(9), Article 82. DOI: 10.1007/s11920-016-0723-0. Madigoe, T., Burns, J., Zhang, M. and Subramaney, U. (2017) ‘Towards a culturally appropriate trauma assessment in a South African Zulu community’, Psychological Trauma: Theory, Research, Practice, and Policy, 9(3), pp. 274–281. DOI: 10.1037/tra0000231. Mak, C. and Wieling, E. (2022) ‘A systematic review of evidence-based family interventions for trauma-affected refugees’, International Journal of Environmental Research and Public Health, 19(15), Article 9361. DOI: 10.3390/ijerph19159361. Mancenido, A., Williams, E.C. and Hajat, A. (2020) ‘Examining psychological distress across intersections of immigrant generational status, race, poverty, and gender’, Community Mental Health Journal, 56(7), pp. 1269–1274. DOI: 10.1007/s10597-020-00584-w. Mattar, S. and Gellatly, R. (2022) ‘Refugee mental health: Culturally relevant considerations’, Current Opinion in Psychology, 47, 101429. DOI: 10.1016/j.copsyc.2022.101429. Matthews, M. and Van Wyk, J. (2018) ‘Towards a culturally competent health professional: A South African case study’, BMC Medical Education, 18, Article 112. DOI: 10.1186/s12909-018-1187-1. Mbazzi, F.B., Dewailly, A., Admasu, K., Duagani, Y., Wamala, K., Vera, A., Bwesigye, D. and Roth, G. (2021) ‘Cultural adaptations of the standard EMDR protocol in five African countries’, Journal of EMDR Practice and Research, 15(1), pp. 29–43. DOI: 10.1891/EMDR-D-20-00028. Ohunyon, G., Ayinde, M. and Ojukwu, P.U. (2023) ‘The impact of multidisciplinary collaboration on patient outcomes in emergency departments’, International Journal of Advanced Multidisciplinary Research and Studies, 3(6), pp. 2727–2741. DOI: 10.62225/2583049X.2023.3.6.6029. Onche, V.O., Adenekan, E.T. and Sabboh, G.M. (2021) ‘Influence of personal and professional attributes of secretaries on organisational success of universities in Oyo State, Nigeria’, International Journal of Science Academic Research, 2(4), pp. 1355–1359. Oyarekua, T.A. and Sabboh, G.M. (2021) ‘Parenting styles and effortful control as predictors of mental health among secondary school adolescents in Akinyele Local Government Area, Oyo State, Nigeria’, International Journal of Academic Multidisciplinary Research, 5(10), pp. 108–114. Patel, A.R. and Hall, B.J. (2021) ‘Beyond the DSM-5 diagnoses: A cross-cultural approach to assessing trauma reactions’, Focus, 19(2), pp. 197–203. DOI: 10.1176/appi.focus.20200049. Peñuela-O’Brien, E., Wan, M.W., Edge, D. and Berry, K. (2023) ‘Health professionals’ experiences of and attitudes towards mental healthcare for migrants and refugees in Europe: A qualitative systematic review’, Transcultural Psychiatry, 60(1), pp. 176–198. DOI: 10.1177/13634615211067360. Pittaway, T., Riggs, E. and Dantas, J.A.R. (2023) ‘Intergenerational conflict among resettled South Sudanese in Australia’, Transcultural Psychiatry, 60(2), pp. 215–225. DOI: 10.1177/13634615221105115. Purtle, J. (2020) ‘Systematic review of evaluations of trauma-informed organizational interventions that include staff trainings’, Trauma, Violence, & Abuse, 21(4), pp. 725– 740. DOI: 10.1177/1524838018791304. Raghavan, S.S. (2019) ‘Cultural considerations in the assessment of survivors of torture’, Journal of Immigrant and Minority Health, 21(3), pp. 586–595. DOI: 10.1007/s10903-018-0787- 5. Reeves, E. (2015) ‘A synthesis of the literature on trauma-informed care’, Issues in Mental Health Nursing, 36(9), pp. 698–709. DOI: 10.3109/01612840.2015.1025319. Renzaho, A.M.N., Dhingra, N. and Georgeou, N. (2017) ‘Youth as contested sites of culture: The intergenerational acculturation gap amongst new migrant communities—Parental and young adult perspectives’, PLOS ONE, 12(2), e0170700. DOI: 10.1371/journal.pone.0170700. Sabboh, G.M. (2021) ‘Psychosocial factors as predictors of moral disengagement among in- school adolescents in Ibadan Metropolis’, International Journal of Academic Information Systems Research, 5(10), pp. 1–7. Sabboh, G.M. (2022) Development and validation of the revised self-esteem scale for Nigerian adolescents and youths. Master’s thesis. Moscow, Russia: National Research University Higher School of Economics. DOI: 10.13140/RG.2.2.32753.45926. Sabboh, G.M. (2023) Relationship of perceived stress, hopelessness and self-esteem with attitude towards suicide among people in Nigeria. Master’s thesis. Moscow, Russia: National Research University Higher School of Economics. DOI: 10.13140/RG.2.2.21009.40802. Sabboh, G.M. and Alausa, S.S. (2021) ‘School climate, self-efficacy, social media and peer pressure as correlates of aggressive behaviour among secondary school adolescents in Ibadan Metropolis, Oyo State, Nigeria’, International Journal of Academic Management Science Research, 5(11), pp. 43–51. Sabboh, G.M. and Ojo, Y. (2023) ‘Influence of peer approval seeking, socio-economic status and locus of control on academic self-handicapping behaviour of undergraduates in Oyo State, Nigeria’, British Journal of Multidisciplinary and Advanced Studies: Education, Learning, Training & Development, 4(4), pp. 98–112. DOI: 10.37745/bjmas.2022.0264. Sabboh, G.M. and Olugbade, D. (2021) ‘Influence of teaching styles and parental bonding on academic boredom among undergraduates in Oyo State, Nigeria’, African Journal of Social Sciences and Humanities Research, 4(1), pp. 122–133. Sabboh, G.M. and Yusuff, A.O. (2021) ‘Influence of psycho-social factors as predictors of child abuse among junior secondary school students in Kaduna Metropolis of Kaduna State’, International Journal of Academic and Applied Research, 5(8), pp. 18–24. Schlechter, P., Wilkinson, P.O., Knausenberger, J., Wanninger, K., Kamp, S., Morina, N. and Hellmann, J.H. (2021) ‘Depressive and anxiety symptoms in refugees: Insights from classical test theory, item response theory and network analysis’, Clinical Psychology & Psychotherapy, 28(1), pp. 169–181. DOI: 10.1002/cpp.2499. Sweeney, A., Clement, S., Filson, B. and Kennedy, A. (2016) ‘Trauma-informed mental healthcare in the UK: What is it and how can we further its development?’, Mental Health Review Journal, 21(3), pp. 174–192. DOI: 10.1108/MHRJ-01-2015-0006. Thela, L., Tomita, A., Maharaj, V., Mhlongo, M. and Burns, J.K. (2017) ‘Counting the cost of Afrophobia: Post-migration adaptation and mental health challenges of African refugees and migrants in South Africa’, Transcultural Psychiatry, 54(5–6), pp. 715–732. DOI: 10.1177/1363461517745472. Tujague, N.A. and Ryan, K.L. (2021) ‘Ticking the box of “cultural safety” is not enough: Why trauma-informed practice is critical to Indigenous healing’, Rural and Remote Health, 21(3), Article 6411. DOI: 10.22605/RRH6411. Viruell-Fuentes, E.A., Miranda, P.Y. and Abdulrahim, S. (2012) ‘More than culture: Structural racism, intersectionality theory, and immigrant health’, Social Science & Medicine, 75(12), pp. 2099–2106. DOI: 10.1016/j.socscimed.2011.12.037. Wada, Y.H., Rajwani, L., Anyam, E., Karikari, E., Njikizana, M., Srour, L. and Khalid, G.M. (2021) ‘Mental health in Nigeria: A neglected issue in public health’, Public Health in Practice, 2, 100166. DOI: 10.1016/j.puhip.2021.100166. Walker, R. and Vearey, J. (2023) ‘“Let’s manage the stressor today”: Exploring the mental health response to forced migrants in Johannesburg, South Africa’, International Journal of Migration, Health and Social Care, 19(1), pp. 1–15. DOI: 10.1108/IJMHSC-11-2021- 0103. Wyatt, G.E., Thames, A., Simbayi, L., Stein, D.J., Burns, J. and Maselesele, M. (2017) ‘Trauma and mental health in South Africa: Overview’, Psychological Trauma: Theory, Research, Practice, and Policy, 9(3), pp. 249–251. DOI: 10.1037/tra0000144. Wylie, L., Van Meyel, R., Harder, H., Sukhera, J., Luc, C., Ganjavi, H., Elfakhani, M. and Wardrop, N. (2018) ‘Assessing trauma in a transcultural context: Challenges in mental health care with immigrants and refugees’, Public Health Reviews, 39, Article 22. DOI: 10.1186/s40985-018-0102-y. Yusuf, A.O. and Sabboh, G.M. (2021) ‘Psychological factors as correlates of suicidal ideation among university students in Lagos State’, International Journal of Academic and Applied Research, 5(9), pp. 1–7. Yusuf, A.O., Sabboh, G.M. and Asiyanbi, M. (2023) ‘Correlates of academic buoyancy among undergraduates in the Ibadan Metropolis’, International Journal of Academic Information Systems Research, 7(1), pp. 1–10.
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