The link between ethnicity, social disadvantage and mental health problems in a school-based multiethnic sample of children in The Netherlands

Differences in Anxiety and Depression Among Migrant and Non-Migrant Primary School Children in The Netherlands

This is the first Dutch study investigating symptoms of five DSM-IV-classified anxiety disorders and depression in a large sample of pre-adolescent children with and without a migration background, adjusting for socioeconomic position (SEP) and social preference. Both are potential explanatory factors for differences in mental health among migrant children. We measured anxiety and depression scores with the self-report Revised Child Anxiety and Depression Scale (RCADS) in 2063 children (aged 8-13 years, 55% girls) in the Netherlands. Surinamese/Antillean, Turkish, and Moroccan children reported significantly higher anxiety scores than Dutch children. SEP and peer rejection partly explained higher anxiety scores. Surinamese/Antillean and Turkish children reported comparable depression scores to Dutch children, but Moroccan children reported lower depression scores after adjusting for SEP and peer rejection. Girls reported higher anxiety and depression levels across all four subgroups. Although differences between children with or without a migration background were small, these may increase in later life as the prevalence of anxiety and depression increases with age.

Early emotional and behavioural problems predict use of habilitation services among children: Findings from a longitudinal follow-up study

PURPOSE

To explore the association between early emotional and behavioural problems and use of habilitation services among children in Sweden.

METHODS

In this longitudinal cohort study, we used data on children, 3-5 years of age, whose mothers (n = 7343) and fathers (n = 6322) had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems, and who were followed for approximately 6.5 years with regard to use of habilitation services. The relations between emotional and behavioural problems and use of habilitation services were explored through cox regression models.

RESULTS

In unadjusted models, children with identified emotional and behavioural problems were more likely to utilise habilitation services compared to those with no identified problems. These associations were shown for both mothers' (HR: 5.02) and fathers' (HR: 4.25) SDQ ratings. In adjusted cox-regression models, the associations remained significant for both mothers' (AHR: 4.24) and fathers' (AHR: 4.03) ratings.

CONCLUSIONS

Early emotional and behavioural problems predict later habilitation service use among children in Sweden. Assessment of these problems in all children at child health services could facilitate early identification and timely interventions. Habilitation centres in Sweden could integrate mental health care into the standard treatment for children using these services.

Community indicators for mental health in Europe: a scoping review

Background

Community indicators may predict and influence individuals` mental health, and support or impede mental health management. However, there is no consensus on which indicators should be included in predictions, prognostic algorithms, or management strategies for community-based mental health promotion and prevention approaches. Therefore, this scoping review provides an overview of relevant community-level indicators for mental health in the general as well as risk populations in a European context.

Methods

We conducted a scoping review in the following electronic databases: PubMed, Embase, and PsycInfo. Eligible studies focused on context factors such as either the physical or social environment, reporting at least one mental health outcome and referring to a European population. Publications between 2012 and March 8, 2022 are considered.

Results

In total, the search yielded 12,200 identified records. After the removal of duplicates, 10,059 records were screened against the eligibility criteria. In total, 169 studies were included in the final analysis. Out of these included studies, 6% focused on pan-European datasets and 94% on a specific European country. Populations were either general or high-risk populations (56 vs. 44%, respectively) with depressive disorder as the main reported outcome (49%), followed by general mental health (33%) and anxiety (23%). Study designs were cross-sectional studies (59%), longitudinal (27%), and others (14%). The final set of indicators consisted of 53 indicators, which were grouped conceptually into 13 superordinate categories of community indicators. These were divided into the domains of the physical and social environment. The most commonly measured and reported categories of community indicators associated with mental health outcomes were social networks (n = 87), attitudinal factors toward vulnerable groups (n = 76), and the characteristics of the built environment (n = 56).

Conclusion

This review provides an evidence base of existing and novel community-level indicators that are associated with mental health. Community factors related to the physical and social environment should be routinely recorded and considered as influencing factors or potentially underestimated confounders. The relevance should be analyzed and included in clinical outcomes, data, monitoring and surveillance as they may reveal new trends and targets for public mental health interventions.

Birth and Health Outcomes of Children Migrating With Parents: A Systematic Review and Meta-Analysis

Objective

To examine the birth and health outcomes of children migrating with parents internationally and domestically, and to identify whether the healthy migration effect exist in migrant children.

Methods

Five electronic databases were searched for cross-sectional, case-control, or cohort studies published from January 1, 2000 to January 30, 2021and written by English language, reporting the risk of health outcomes of migrant children (e.g., birth outcome, nutrition, physical health, mental health, death, and substance use) We excluded studies in which participants' age more than 18 years, or participants were forced migration due to armed conflict or disasters, or when the comparators were not native-born residents. Pooled odd ratio (OR) was calculated using random-effects models.

Results

Our research identified 10,404 records, of which 98 studies were retrained for analysis. The majority of the included studies (89, 91%) focused on international migration and 9 (9%) on migration within country. Compared with native children, migrant children had increased risks of malnutrition [OR 1.26 (95% CI 1.11-1.44)], poor physical health [OR 1.34 (95% CI 1.11-1.61)], mental disorder [OR 1.24 (95% CI 1.00-1.52)], and death [OR 1.11 (95% CI 1.01-1.21)], while had a lower risk of adverse birth outcome [OR 0.92 (95% CI 0.87-0.97)]. The difference of substance use risk was not found between the two groups.

Conclusion

Migrant children had increased risk of adverse health outcomes. No obvious evidence was observed regarding healthy migration effect among migrant children. Actions are required to address the health inequity among these populations.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42021214115.

Experiences of Discrimination and Everyday Racism Among Children and Adolescents With an Immigrant Background - Results of a Systematic Literature Review on the Impact of Discrimination on the Developmental Outcomes of Minors Worldwide

Experiences of discrimination such as everyday racism can negatively affect the mental and physical health of children and adolescents with an immigrant background and impair their integration process in the host societies. Although experiences of racism are part of the everyday life of many minors affected by the process of "Othering" (e.g., those with an immigrant background), an overview of empirical findings is missing for this age group worldwide. A systematic review was conducted to identify and analyze international research on the impact of discrimination on the developmental outcomes and integration of immigrant children and adolescents. Three scientific databases were systematically searched up to June 11, 2021. A total of k = 4,769 identified publications were reviewed based on inclusion and exclusion criteria in terms of the PICOS format by independent reviewers. Thirty-four primary studies published between 1998 and 2021 met all inclusion criteria. The samples examined were mainly migrant youth (k = 30), with only k = 2 studies assessing refugee youth and k = 1 study assessing both migrant and refugee youth. The majority of included studies assessed perceived discrimination, with only k = 1 study directly assessing experiences of racism. The association between discrimination or racism and developmental outcomes was assessed by the included studies within the three main topics of (a) mental and physical health-related outcomes (k = 30, e.g., self-esteem, depressive symptoms), (b) school-related outcomes (k = 6, e.g., academic achievement), and (c) other developmental outcomes (k = 13, e.g., misconduct or delinquency). Data collection procedures were implemented, and findings on minors' developmental outcomes and integration process who experience discrimination and racism were summarized and discussed. The current review suggests experienced (racial) discrimination as a negative predictor of children and adolescents' (mental) health-related outcomes, while no clear results could be found for the association between discrimination and school-related outcomes. A need for more empirical research focusing on the path and (possibly) indirect link between discrimination and children and adolescents' school-related outcomes as well as resulting school recommendations and the chosen career path was derived.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=260291], identifier [CRD42021260291].

The Impact of Community Mental Health Programs for Australian Youth: A Systematic Review

Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people’s mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10–25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n = 16), case management (n = 9), integrated ‘one-stop-shop’ (n = 6) and lifestyle (n = 6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people’s life trajectory.

The Positive Impact and Associated Mechanisms of Physical Activity on Mental Health in Underprivileged Children and Adolescents: An Integrative Review

(1) Background: Review-based studies are required to consider the different designs and data that describe the association between physical activity and mental health for underprivileged children and adolescents. There is a particular need to identify mechanisms which could explain the association, and factors which influence the association in this population group. (2) Methods: An integrative review with a systematic search was conducted in three stages: (i) a systematic literature search on four databases from inception until May 2020. Studies were eligible if they examined underprivileged children, involved moderate to vigorous physical activity (MVPA) and had a focus on at least one outcome measure related to mental health. (ii) Two critical appraisal tools were used to assess quality across different study designs. (iii) Synthesis was undertaken in four stages, examining social, internal and physical outcomes and mechanisms. (3) Results: A total of 16 studies were included (2 qualitative; 12 quantitative and 2 mixed methods). Fifteen (15/16; 93.8%) showed an association between MVPA and a significant improvement in at least one mental health outcome. The most studied outcomes included: internal aspects (n = 14), significant effects were identified in 12/14 studies; social aspects (n = 6), significant effects were identified across all studies and finally physical aspects (n = 5), significant effects were found in 3/5 studies. Autonomy support was identified as a mechanism to explain the change, whilst age and gender influenced the strength of the association. (4) Conclusions: The findings provide confirmation of the link between MVPA and the improved mental health and wellbeing of disadvantaged children and adolescents. Future research must consider the long-term effect through longitudinal studies, along with determining whether any specific types of PA are more impactful than others.

Immigration background and adolescent mental health problems: the role of family affluence, adolescent educational level and gender

PURPOSE

European studies demonstrated that immigrant adolescents are at a higher risk for mental health problems than native adolescents, but little is known about the role of socioeconomic status (SES) and gender in this association. This study examined to what extent differences in the mental health problems of non-western immigrant and native Dutch adolescents were explained by adolescents' family affluence and educational level and differed with the adolescents' family affluence, educational level, and gender.

METHODS

Adolescents in a Dutch nationally representative sample of 11-16-year old native Dutch (n = 5283) and non-western immigrants (n = 1054) reported on their family affluence, own educational level, conduct problems, emotional symptoms, peer relationship problems, and hyperactivity-inattention problems.

RESULTS

Non-western immigrant adolescents were at a higher risk for conduct problems and peer relationship problems than native Dutch adolescents, but family affluence and educational level explained only a very small proportion of these differences. With two exceptions, differences in the mental health problems of non-western immigrants and natives were highly comparable for different family affluence levels, educational levels, and for boys and girls. Only for natives, a higher family SES was related to less conduct problems. Furthermore, only for non-western immigrants a high family SES related to more hyperactivity-inattention problems.

CONCLUSIONS

Our findings illustrate that the association between immigration background and adolescent mental health problems is largely independent of SES and gender. Future studies should include other factors to facilitate our understanding of the association between immigration background and adolescent mental health problems.

Associations between Ethnic Minority Status and Popularity in Adolescence: the role of Ethnic Classroom Composition and Aggression

Although there are theoretical reasons to expect an association between ethnic minority status and popularity, research on this topic is scarce. Therefore, this association was investigated including the moderating role of the ethnic classroom composition and the mediating role of aggression. Data from the longitudinal Dutch SNARE (Social Network Analysis of Risk behavior in Early adolescence) project were used among first-year students (comparable to 5th grade) (N = 1134, N_classrooms = 51, M = 12.5 years, 137 non-Western ethnic minority students). Popularity and aggression were assessed with peer nominations. Multi-level Structural Equation Models showed that ethnic minority status was indirectly associated with higher popularity, through higher aggression. Moreover, with increasing numbers of ethnic minority students in the classroom, popularity levels of both ethnic majority and ethnic minority students decreased. Only when differences in aggression between ethnic minority and majority students were included in the analyses, while the ethnic classroom composition was not included, lower popularity levels were found for ethnic minority than ethnic majority students. Scientific and practical implications of this study were addressed in the discussion.

Migration, ethnicity and psychoses: evidence, models and future directions

There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.

[How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe]

OBJECTIVE

To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe.

METHOD

A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described.

RESULTS

50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained.

CONCLUSIONS

There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood.

Correlates of mental disorders among minority Arab adolescents in Israel: results from the Galilee Study

BACKGROUND

The Galilee Study is the first large epidemiological study to compare correlates of mental disorders between two Arab Palestinian minority groups of adolescents in Israel.

METHODS

A two-stage cross-sectional study, carried out between 2012 and 2014, included all 9th grade students from 5 Arab localities, representative of 77% of the Muslim and 100% of Druze citizens in Israel. During the screening stage, 1639 students completed the Strengths and Difficulties Questionnaire in the classroom (response rate = 69.3%). During the follow-up stage, 704 adolescent-mother dyads were interviewed at home; using the Development and Well-Being Assessment, the General Health Questionnaire (GHQ)-12, the Subjective Feeling of Discrimination Index (FDI), and socio-demographic questions (response rate = 84.4%).

RESULTS

Prevalence of any disorder, internalizing or externalizing disorders among Muslim adolescents were 19.2, 15.8 and 4.2%, respectively and among Druze adolescents 10.9, 5.9 and 5.5%, respectively. Muslim adolescents were 3.2 times more likely than Druze adolescents to have an internalizing disorder, while Druze were 2 times more likely than Muslim to have an externalizing disorder. Males were at higher risk than females for externalizing disorders in both populations, though among Druze the risk was more striking. Learning disabilities increased the likelihood of having an externalizing disorder in both populations. Risk factors for internalizing disorders among Muslim adolescents were female gender, a very low socio-economic level, few siblings, LD, high maternal GHQ-12 score and high FDI; and for externalizing disorders, male gender, a relatively low socio-economic level but not the lowest, learning disability and high maternal GHQ-12 score.

CONCLUSIONS

We found an association between religion/ethnicity and internalizing and externalizing disorders as well as a strong correlation between religion/ethnicity and socio-economic variables. Therefore, we tend to conclude that not religion per se but the multifaceted socio-cultural and economic factors that characterize religious groups are associated with mental disorders. Very low socio-economic level and feeling discriminated which were traits connected only to Muslim adolescents, were associated with internalizing disorders. When preparing preventive measures aimed at furthering mental health among minority adolescents, authorities should focus on improving the socio-economic status of minorities and reducing institutional and personal discrimination. The educational and mental health establishments could undertake measures to improve resilience and coping strategies of Muslim families living in the most adverse conditions, such as providing special support through the school counseling services and coordinating, at the ministerial levels, school and community health services in order to carry out joint preventive programs and referrals to specialist services when needed.

Overview of European forensic youth care: towards an integrative mission for prevention and intervention strategies for juvenile offenders

All over Europe youth delinquency is decreasing; our understanding of the factors related to juvenile delinquency and the characteristics of effective forensic youth care has increased substantially. However, effective prevention and intervention strategies are not always employed due to financial, demographical and socio-political challenges countries face, while the burden of mental health in juvenile justice populations is high. With this commentary, we highlight the importance of international collaboration to set out a direction to improve forensic youth care, to bundle our strengths and overcome our challenges. It is a continuation of the course that was set out by Doreleijers and Fegert (Child Adolesc Psychiatry Ment Health 5:20, 2011), in their editorial they highlighted the importance of collaboration and presented an overview of the state of the art on forensic youth care in eight European countries (and Russia). With this manuscript, we present an overview of statistics in juvenile justice of all European countries and present an integrated mission statement for forensic youth care, which was formulated in a keynote debate at the 6^th biennial congress of the European Association for Forensic Child and Adolescent Psychiatry, Psychology and other involved professions (EFCAP).

Effects over time of self-reported direct and vicarious racial discrimination on depressive symptoms and loneliness among Australian school students

BACKGROUND

Racism and racial discrimination are increasingly acknowledged as a critical determinant of health and health inequalities. However, patterns and impacts of racial discrimination among children and adolescents remain under-investigated, including how different experiences of racial discrimination co-occur and influence health and development over time. This study examines associations between self-reported direct and vicarious racial discrimination experiences and loneliness and depressive symptoms over time among Australian school students.

METHODS

Across seven schools, 142 students (54.2% female), age at T1 from 8 to 15 years old (M = 11.14, SD = 2.2), and from diverse racial/ethnic and migration backgrounds (37.3% born in English-speaking countries as were one or both parents) self-reported racial discrimination experiences (direct and vicarious) and mental health (depressive symptoms and loneliness) at baseline and 9 months later at follow up. A full cross-lagged panel design was modelled using MPLUS v.7 with all variables included at both time points.

RESULTS

A cross-lagged effect of perceived direct racial discrimination on later depressive symptoms and on later loneliness was found. As expected, the effect of direct discrimination on both health outcomes was unidirectional as mental health did not reciprocally influence reported racism. There was no evidence that vicarious racial discrimination influenced either depressive symptoms or loneliness beyond the effect of direct racial discrimination.

CONCLUSIONS

Findings suggest direct racial discrimination has a persistent effect on depressive symptoms and loneliness among school students over time. Future work to explore associations between direct and vicarious discrimination is required.

Effect of personal characteristics, victimization types, and family- and school-related factors on psychological distress in adolescents with intellectual disabilities

The purpose of this study was to determine the prevalence of bullying victimization among adolescents with intellectual disabilities and the influence of victimization experience on their mental health in Taiwan. Data on 706 adolescents from the 2011 Special Needs Education Longitudinal Study were analyzed. Multivariate regression analysis was applied to variables comprising 7 items of psychological distress, 4 types of bullying victimization, and family-, school-, and peer-related factors. Approximately 70% of the survey respondents had experienced at least one type of victimization, and 44% of them had experienced at least two types of victimization. Exclusion (50%) and verbal bullying (70%) were the most commonly reported types. In addition, exclusion and verbal bullying were found to be significantly associated with psychological distress in these adolescents. Our findings suggest that victimization is a common experience among adolescents with disabilities, and a notable risk factor for the psychological well-being of adolescents with intellectual disabilities. However, a good relationship with parents and peers can relieve psychological distress and its effect on mental health.

Associations of multicultural status with depressive mood and suicidality among Korean adolescents: the roles of parental country of birth and socioeconomic position

Background

The mental health of the offspring of immigrants is a major public health concern. In this study, we examined associations of multicultural status and parental country of birth with adolescent mental health in South Korea, and assessed the effect of socioeconomic position (SEP) on these associations.

Methods

We used four waves of the Korea Youth Risk Behavior Web-based Survey (KYRBS) between 2011 and 2014, including 294,324 participants (149,219 boys and 145,105 girls aged 13–18 years) as study subjects. KYRBS is a cross-sectional survey conducted annually by the Korea Centers for Disease Control and Prevention. The participants in the KYRBS were drawn as stratified multistage clustered samples from Korean middle schools and high schools. We calculated the age-adjusted 12-month prevalence of depressive mood and suicidal behaviors by parental country of birth, and estimated the effects of SEP indicators on the relationship.

Results

The age-standardized prevalence of suicidality (suicide ideation, plans, and attempts) was significantly different between multicultural and non-multicultural boys. The impact of multicultural status on mental health varied with parental foreign-born status and maternal country of birth. Compared with non-multicultural counterparts, boys with Japan-born mothers showed lower prevalence ratios (PRs) of suicidal plans (PR = 0.34, 95% CI 0.16–0.70). Girls with Japan-born mothers also showed lower PRs of depressive mood (PR = 0.77, 95% CI 0.63–0.95) and suicidal ideation (PR = 0.59, 95% CI 0.41–0.83), while adolescents with Korean-Chinese mothers showed similar PRs. Boys with foreign-born fathers as well as boys with two foreign-born parents were at a greater risk of suicidality than non-multicultural boys. The magnitude of the relationship between multicultural status and mental health outcomes was generally attenuated after adjusting for SEP indicators.

Conclusions

In general, adolescents with Japan-born mothers showed lower PRs of depressive mood and suicidality than non-multicultural adolescents, while those with Korean-Chinese mothers showed similar PRs. Boys who had foreign-born fathers generally showed greater PRs of depressive mood and suicidality than non-multicultural boys. To ensure the effective implementation of policies to reduce mental health problems among multicultural adolescents in South Korea, detailed information should be considered regarding the cultural and socioeconomic backgrounds of families, such as parental country of birth and SEP.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4044-y) contains supplementary material, which is available to authorized users.

Factors associated with psychiatric symptoms and psychiatric disorders in ethnic minority youth

While ethnic diversity is increasing in many countries, ethnic minority youth is less likely to be reached, effectively treated and retained by youth mental health care compared to majority youth. Improving understanding of factors associated with mental health problems within socially disadvantaged ethnic minority youth is important to tailor current preventive and treatment interventions to the needs of these youth. The aim of this study was to explore factors at child, family, school, peer, neighbourhood and ethnic minority group level associated with mental health problems in Moroccan-Dutch youth (n = 152, mean age 13.6 ± 1.9 years). Self-reported and teacher-reported questionnaire data on psychiatric symptoms and self-report interview data on psychiatric disorders were used to divide children into three levels of mental health problems: no symptoms, only psychiatric symptoms and psychiatric disorders. Psychiatric symptoms and/or disorders were associated with more psychopathic traits, a higher number of experienced trauma and children in the family, and more conflicts with parents, affiliation with delinquent peers, perceived discrimination and cultural mistrust. Psychiatric symptoms and/or disorders were also associated with less self-esteem, parental monitoring, affiliation with religion and orientation to Dutch or Moroccan culture, and a weaker ethnic identity. For youth growing up in a disadvantaged ethnic minority position, the most important factors were found at family (parent-child relationship and parenting practices) and ethnic minority group level (marginalization, discrimination and cultural mistrust). Preventive and treatment interventions for socially disadvantaged ethnic minority youth should be aimed at dealing with social disadvantage and discrimination, improving the parent-child relationship and parenting practices, and developing a positive (cultural) identity.

School-based screening for psychiatric disorders in Moroccan-Dutch youth

BACKGROUND

While ethnic diversity is increasing in many Western countries, access to youth mental health care is generally lower among ethnic minority youth compared to majority youth. It is unlikely that this is explained by a lower prevalence of psychiatric disorders in minority children. Effective screening methods to detect psychiatric disorders in ethnic minority youth are important to offer timely interventions.

METHODS

School-based screening was carried out at primary and secondary schools in the Netherlands with the Strengths and Difficulties Questionnaire (SDQ) self report and teacher report. Additionally, internalizing and psychotic symptoms were assessed with the depressive, somatic and anxiety symptoms scales of the Social and Health Assessment (SAHA) and items derived from the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS). Of 361 Moroccan-Dutch youths (ages 9 to 16 years) with complete screening data, 152 children were diagnostically assessed for psychiatric disorders using the K-SADS. The ability to screen for any psychiatric disorder, and specific externalizing or internalizing disorders was estimated for the SDQ, as well as for the SAHA and K-SADS scales.

RESULTS

Twenty cases with a psychiatric disorder were identified (13.2 %), thirteen of which with externalizing (8.6 %) and seven with internalizing (4.6 %) diagnoses. The SDQ predicted psychiatric disorders in Moroccan-Dutch youth with a good degree of accuracy, especially when the self report and teacher report were combined (AUC = 0.86, 95 % CI = 0.77-0.94). The SAHA scales improved identification of internalizing disorders. Psychotic experiences significantly predicted psychiatric disorders, but did not have additional discriminatory power as compared to screening instruments measuring non-psychotic psychiatric symptoms.

CONCLUSIONS

School-based screening for psychiatric disorders is effective in Moroccan-Dutch youth. We suggest routine screening with the SDQ self report and teacher report at schools, supplemented by the SAHA measuring internalizing symptoms, and offering accessible non-stigmatizing interventions at school to children scoring high on screening questionnaires. Further research should estimate (subgroup-specific) norms and optimal cut-offs points in larger groups for use in school-based screening methods.

Prevalence, impact and cultural context of psychotic experiences among ethnic minority youth

BACKGROUND

The risk for psychotic disorders is increased for many ethnic minority groups and may develop in early childhood. This study investigated whether the prevalence of psychotic experiences (PE) with high impact is higher among ethnic minority youth compared to majority youth and examined the significance of these PE.

METHOD

A school-based study assessed a large community sample of 1545 ethnic minority and majority children in The Netherlands (mean age 12.98 ± 1.81 years). The Dutch (n = 702, 45.4%), Moroccan-Dutch (n = 400, 25.9%) and Turkish-Dutch (n = 170, 11.0%) ethnic groups could be studied separately. Self-report questionnaires on PE, impact and cultural context were administered.

RESULTS

Prevalence of PE with high impact was 3.1% in Dutch, 9.5% in Moroccan-Dutch and 7.1% in Turkish-Dutch youth. Compared to Dutch youth, odds ratios were 3.0 [95% confidence interval (CI) 1.7-5.1] for Moroccan-Dutch youth and 2.2 (95% CI 1.1-4.6) for Turkish-Dutch youth. Differences were not explained by cultural or religious differences.

CONCLUSIONS

The increased risk for psychotic disorders in ethnic minorities may already be detectable in childhood, since PE with high impact were more common among ethnic minority youth compared to majority youth. The additional measurement of impact of PE appears to be a valid approach to identify those children at risk to develop psychotic or other more common psychiatric disorders.