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Vostanis P, Sofios P, Petrali A, O’Reilly M. A national mental health cascade training programme for practitioners supporting unaccompanied minors in Greece. Clin Child Psychol Psychiatry 2024; 29:833-849. [PMID: 38520182 PMCID: PMC11188549 DOI: 10.1177/13591045241242324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. METHODS The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. RESULTS Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. CONCLUSIONS Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures.
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Affiliation(s)
- Panos Vostanis
- Department of Media, Communication and Sociology, University of Leicester, UK
| | | | | | - Michelle O’Reilly
- Department of Media, Communication and Sociology, University of Leicester, UK
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Prod'hom D, Rosselet Amoussou J, Plessen KJ, Cuissart de Grelle N, Gaultier S. Adaptative Skills and Global Functioning of Unaccompanied Migrant Minors in Europe: A Systematised Review. Int J Public Health 2024; 69:1606625. [PMID: 38988503 PMCID: PMC11233468 DOI: 10.3389/ijph.2024.1606625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Objectives This systematised review aimed to examine European literature reporting data about adaptative skills and global external functioning of unaccompanied minors (UAMs). Methods We conducted a systematised screening of four databases (APA PsycINFO Ovid, Medline Ovid ALL, Embase.com and Web Of Science Core Collection) using a research strategy including social, scholarly and behavioural abilities as well as externalising problems associated with the target population of UAMs. Thirty articles were included using pre-defined inclusion and exclusion criteria. Results Our review showed that despite high levels of internalising disorders, socio-behavioural and educational adjustment of UAMs remained positive. It demonstrated how this population displays a strong desire for academic success and prosocial behaviours instead of aggressivity in everyday life. Nevertheless, our review drew attention to the strong tendency of UAMs to internalise their disorders and display chronic distress and problematic behaviours which increased with time spent in the host country. Conclusion Our study draws attention to the risk of underestimating the real mental health needs of refugees, due to preserved external functioning combined with significant settlement pressures.
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Affiliation(s)
- Dimitri Prod'hom
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Kerstin Jessica Plessen
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Sydney Gaultier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Boateng GO, Wachter K, Schuster RC, Burgess TL, Bunn M. A Scoping Review of Instruments Used in Measuring Social Support among Refugees in Resettlement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:805. [PMID: 38929051 PMCID: PMC11203988 DOI: 10.3390/ijerph21060805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
This study aimed to systematically review current research on the application of existing social support scales in research with refugees in resettlement, assess their quality, and identify gaps in measurement to enhance research and practice. A scoping review was conducted on the extant literature published until March 2023. A team of researchers conducted search, sorting, and data extraction processes following best practices for scale development and validation. Of the 1185 studies collected from the search process, 41 articles were retained in the final analysis, from which 17 distinct social support instruments used in research with resettled refugees were identified. An assessment of all 17 instruments showed the presence of one or more limitations associated with construct, criterion, convergent, and/or discriminant validity. Test of reliability was assessed in all studies, with a range of 0.80 to 0.90. Our findings show that most of the research evaluating social support among resettled refugees is conducted without measurement instruments adequately validated in the resettlement context. This analysis highlights the need for rigorously developed social support scales that reflect the lived experiences, needs, and priorities of resettled refugees.
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Affiliation(s)
- Godfred O. Boateng
- School of Global Health, York University, Toronto, ON M3J 1P3, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON M3J 1P3, Canada
| | - Karin Wachter
- School of Social Work, Arizona State University, Phoenix, AZ 85004, USA; (K.W.); (T.L.B.)
| | - Roseanne C. Schuster
- School of Human Evolution and Social Change, Arizona State University, Phoenix, AZ 85069, USA;
| | - Tanya L. Burgess
- School of Social Work, Arizona State University, Phoenix, AZ 85004, USA; (K.W.); (T.L.B.)
| | - Mary Bunn
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL 60612, USA;
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Solhaug AK, Oppedal B, Røysamb E, Calam R. Life Satisfaction among Unaccompanied Refugee Minors: Associations with Traumatic Events and Daily Hassles. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:597-610. [PMID: 38938943 PMCID: PMC11199432 DOI: 10.1007/s40653-023-00579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 06/29/2024]
Abstract
While there is a growing literature about mental health problems among unaccompanied asylum-seeking and refugee minors (URMs), far less is known about their wellbeing. Such information is important as a subjective sense of wellbeing is associated with a variety of positive health and psychosocial outcomes. The aim of this study was to examine life satisfaction and the association with traumatic events, daily hassles, and asylum status among URMs in Norway. We collected self-report questionnaire data from URMs living in Norway (n = 173, 90.80% male, 71.1% from Afghanistan). Mean age was 16.62 (SD = 1.74) years, and they reported clinically relevant post-traumatic stress symptoms. We explored variation in life satisfaction, URM-specific daily hassles and traumatic events. We also investigated a mediation model, in which we assumed that daily hassles mediated the association between traumatic events and life satisfaction. The participants reported low life satisfaction (M = 4.28, SD = 2.90, 0-10 scale). A negative outcome of the asylum process and URM-specific daily hassles were associated with reduced life satisfaction. URM-specific daily hassles accounted for the relation between traumatic events and life satisfaction. The youth had been exposed to several traumatic events yet the effect of these on life satisfaction appeared indirect, via an increase in URM-specific daily hassles. Reducing the number of, or help URM cope with, URM-specific daily hassles may increase their life satisfaction.
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Affiliation(s)
- Anne Kristine Solhaug
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Brit Oppedal
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Espen Røysamb
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Rachel Calam
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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5
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Norton J, Gandubert C, Pellissier S, Chaudieu I, Gaultier S. Trauma and mental health in young adults who arrived in France as unaccompanied and separated migrant children. L'ENCEPHALE 2024; 50:154-161. [PMID: 37121807 DOI: 10.1016/j.encep.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES The mental health of unaccompanied and separated minors (UASC) has been widely studied but not their first years of adulthood, often characterised by uncertainty after leaving child protection. The aim of this study was to estimate the prevalence of psychiatric disorders using standardised and validated research instruments and examine the effect of exposure to trauma. METHODS One hundred and ten youth (92.7% male, median age 19.7 [18.1-22.8]) from Chambery, Montpellier and La Rochelle were recruited to a cross-sectional exploratory study. During a face-to-face interview, somatoform disorder, anxiety, and depression were assessed using the Patient Health Questionnaire (score≥10) and post-traumatic stress disorder (PTSD) with the PTSD Checklist for DSM-5 (score≥33). Traumatic life events were assessed using the Life Events Checklist. RESULTS Of the youth, 19.3% had a probable somatoform disorder, 17.6% anxiety, 28.7% depression, and 20% PTSD. The number of traumatic life events increased the risk of depression (multi-adjusted OR (95%CI): 1.56 (1.25-1.96)), PTSD (1.60 (1.23-2.08)), somatoform disorder (1.41 (1.10-1.82), and anxiety (1.33 (1.02-1.72)). Physical assault was the type of event positively associated with the most disorders (P≤0.01, except for anxiety), followed by witnessing sudden and violent death (P≤0.01 for depression and PTSD) and sexual assault (P=0.002 for PTSD). CONCLUSION Our study highlights the high prevalence of psychiatric disorders in young adults who arrived as UASC and the impact on their mental health of cumulative trauma and exposure to interpersonal and violent traumatic life events. A greater focus on their mental health with regular assessments is needed in order to provide rapid and adapted care.
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Affiliation(s)
- Joanna Norton
- University of Montpellier, Inserm U1298, 34295 Montpellier Cedex 5, France.
| | | | - Sonia Pellissier
- Interuniversity Laboratory of Psychology (LIP/PC2S), University Savoie Mont-Blanc, University Grenoble Alpes, 38040 Grenoble Cedex 9, France
| | - Isabelle Chaudieu
- University of Montpellier, Inserm U1298, 34295 Montpellier Cedex 5, France
| | - Sydney Gaultier
- Interuniversity Laboratory of Psychology (LIP/PC2S), University Savoie Mont-Blanc, University Grenoble Alpes, 38040 Grenoble Cedex 9, France; Department of Psychiatry, Lausanne University Hospital, 1004 Lausanne, Switzerland
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Erlewein K, Gossmann E, Fegert JM. Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia's invasion of Ukraine in 2022. Child Adolesc Psychiatry Ment Health 2024; 18:42. [PMID: 38553764 PMCID: PMC10981359 DOI: 10.1186/s13034-024-00732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND With Russia's invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription. MAIN BODY In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems. CONCLUSION As children's and adolescents' mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.
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Affiliation(s)
- Katrin Erlewein
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstrasse 5, 89075, Ulm, Germany.
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Ulm, Germany.
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany.
| | - Emily Gossmann
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstrasse 5, 89075, Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstrasse 5, 89075, Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
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Behrendt M, Vervliet M, Rota M, Adeyinka S, Uzureau O, Rasmussen A, Glaesmer H, Lietaert I, Derluyn I. A conceptual study on the relationship between daily stressors, stressful life events, and mental health in refugees using network analysis. Front Psychol 2023; 14:1134667. [PMID: 37599778 PMCID: PMC10438848 DOI: 10.3389/fpsyg.2023.1134667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction There is growing recognition that daily stressors, such as social and material deficiencies, can be highly detrimental to the mental health of refugees. These stressors are in addition to stressful life events, which have been widely studied in the context of migration and forced displacement. Despite increasing evidence for an ecological model, there is still no consensus regarding the conceptualization of these highly influential factors. In particular, the demarcation of daily stressors from stressful life events and the categorization of daily stressors require further examination in order to develop usable and accurate tools for researchers, design effective interventions for practitioners and assist politicians in designing meaningful policies. Methods To address these challenges, we used data from a sample of 392 unaccompanied young refugees from diverse backgrounds and employed network analysis to examine the relationships between daily stressors, stressful life events, and symptoms of depression, anxiety, and post-traumatic stress. Results Our findings highlight the significant relationship between daily stressors and mental health, particularly depression. Meaningful clusters of daily stressors include material stressors, social stressors, and social exclusion stressors. Conclusion Our results demonstrate the importance of considering daily stressors in the mental health of refugees and suggest that using a network approach offers a viable way to study these complex interrelationships. These findings have implications for researchers, practitioners, and policymakers in understanding and addressing the mental health needs of refugees.
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Affiliation(s)
- Malte Behrendt
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Marianne Vervliet
- Department of People and Well-Being, Thomas More University of Applied Sciences, Mechelen, Belgium
| | - Marina Rota
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Sarah Adeyinka
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Océane Uzureau
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Andrew Rasmussen
- Culture, Migration, and Community, Department of Psychology, Fordham University, New York, NY, United States
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Medical Faculty, The University of Leipzig Medical Center, Leipzig, Germany
| | - Ine Lietaert
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
- Institute on Comparative Regional Integration Studies, United Nations University, Bruges, Belgium
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
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Hornfeck F, Eglinsky J, Garbade M, Rosner R, Kindler H, Pfeiffer E, Sachser C. Mental health problems in unaccompanied young refugees and the impact of post-flight factors on PTSS, depression and anxiety-A secondary analysis of the Better Care study. Front Psychol 2023; 14:1149634. [PMID: 37408964 PMCID: PMC10318408 DOI: 10.3389/fpsyg.2023.1149634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
Background Unaccompanied young refugees (UYRs) show elevated levels of mental distress such as post-traumatic stress symptoms (PTSS), depression, and anxiety. The individual post-arrival situation in the host country plays an important role in increasing or reducing mental health risks for these vulnerable children and youth. The study aims at examining the impact of pre- and post-migration factors on the mental health of UYRs. Methods A cross-sectional survey of N = 131 young refugees (81.7% male, M = 16.9 years old) was conducted in 22 children and youth welfare service (CYWS) facilities in Germany. The participants provided information about pre- and post-flight experiences. Standardized measures were used to assess post-traumatic stress symptoms (CATS-2), symptoms of depression (PHQ-9), and anxiety (GAD-7). Daily stressors were assessed with the Daily Stressors Scale for Young Refugees (DSSYR), sociocultural adaptation with the Brief Sociocultural Adaptation Scale (BSAS), satisfaction with social support with the Social Support Questionnaire (SSQ6-G). Results Our results demonstrated clinical levels of PTSS in 42.0% of the participants, depression in 29.0%, and anxiety in 21.4%. Hierarchical regression analyses revealed that a higher number of traumatic events and social daily stressors predicted higher levels in all three domains of mental health problems. PTSS and anxiety were also predicted by the distress related to the residence status, depressive symptoms were additionally predicted by sociocultural adaptation, less family contact and length of stay. The satisfaction with social support was not a significant predictor in the regression models. Conclusion Unaccompanied young refugees in CYWS facilities are a highly vulnerable population. As traumatic events, daily stressors and level of contact to family directly impacted UYRs mental health, interventions should be trauma-focused, but also contain modules on how to cope with daily stressors. On the policy and practical level, stakeholders in host countries are called for establishing measures to reduce post-migration stressors and enhance support for UYRs on all levels.
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Affiliation(s)
| | - Jenny Eglinsky
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Maike Garbade
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | | | - Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
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Vega Potler NJ, Zhang J, Hackley B, Choi J, Xie X, Punsky B, Pineda L, Shapiro A. Persistence of Emotional Distress in Unaccompanied Migrant Children and Adolescents Primarily From the Northern Triangle of Central America. JAMA Netw Open 2023; 6:e2318977. [PMID: 37338902 PMCID: PMC10282890 DOI: 10.1001/jamanetworkopen.2023.18977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/03/2023] [Indexed: 06/21/2023] Open
Abstract
Importance In the US, unaccompanied migrant children and adolescents (hereinafter referred to as children) are predominantly from Central America's Northern Triangle. While unaccompanied migrant children are at high risk for psychiatric sequelae due to complex traumatic exposures, longitudinal investigations of psychiatric distress after resettlement are lacking. Objective To identify factors associated with emotional distress and longitudinal changes in emotional distress among unaccompanied migrant children in the US. Design, Setting, and Participants For this retrospective cohort study, the 15-item Refugee Health Screener (RHS-15) was administered between January 1, 2015, and December 31, 2019, to unaccompanied migrant children as part of their medical care to detect emotional distress. Follow-up RHS-15 results were included if they were completed before February 29, 2020. Median follow-up interval was 203 days (IQR, 113-375 days). The study was conducted in a federally qualified health center that provides medical, mental health, and legal services. Unaccompanied migrant children who completed the initial RHS-15 were eligible for analysis. Data were analyzed from April 18, 2022, to April 23, 2023. Exposures Traumatic events before migration, during migration, during detention, and after resettlement in the US. Main Outcomes and Measures Emotional distress, including symptoms of posttraumatic stress disorder, anxiety, and depressive symptoms, as indicated by the RHS-15 (ie, score ≥12 on items 1-14 or ≥5 on item 15). Results In total, 176 unaccompanied migrant children completed an initial RHS-15. They were primarily from Central America's Northern Triangle (153 [86.9%]), were mostly male (126 [71.6%]), and had a mean (SD) age of 16.9 (2.1) years. Of the 176 unaccompanied migrant children, 101 (57.4%) had screen results above the positive cutoff. Girls were more likely to have positive screen results than boys (odds ratio, 2.48 [95% CI, 1.15-5.34]; P = .02). Follow-up scores were available for 68 unaccompanied migrant children (38.6%). On the follow-up RHS-15, most scored above the positive cutoff (44 [64.7%]). Three-quarters of unaccompanied migrant children who scored above the positive cutoff initially continued to have positive scores at follow-up (30 of 40), and half of those with negative screen scores initially had positive scores at follow-up (14 of 28). Female vs male unaccompanied migrant children (unstandardized β = 5.14 [95% CI, 0.23-10.06]; P = .04) and initial total score (unstandardized β = 0.41 [95% CI, 0.18-0.64]; P = .001) were independently associated with increased follow-up RHS-15 total score. Conclusions and Relevance The findings suggest that unaccompanied migrant children are at high risk for emotional distress, including symptoms of depression, anxiety, and posttraumatic stress. The persistence of emotional distress suggests that unaccompanied migrant children would benefit from ongoing psychosocial and material support after resettlement.
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Affiliation(s)
- Natan J. Vega Potler
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Jessica Zhang
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Barbara Hackley
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Xianhong Xie
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Brenda Punsky
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Lisa Pineda
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Alan Shapiro
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
- Department of Pediatrics, Montefiore Medical Center, Bronx, New York
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10
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Andersson ES, Øverlien C. Navigating cultural transitions during resettlement: the case of unaccompanied refugee minors. Front Psychol 2023; 14:1080072. [PMID: 37228345 PMCID: PMC10203603 DOI: 10.3389/fpsyg.2023.1080072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Refugees face the process of cross-cultural transitions upon arrival in their host country. This process is commonly referred to as acculturation and can be particularly challenging for asylum-seeking children and adolescent unaccompanied by a caregiver. To more effectively facilitate unaccompanied refugee minors (URMs) resettlement, this study sought to obtain an enhanced understanding of the acculturation processes of these youth'. Methods Thus, interviews with 48 URMs, all of whom arrived before the age of 16 years, were analyzed in two steps. First, how the youth described their host country's society and culture, followed by how they navigated within this societal and cultural landscape during resettlement. Results The youth described how they navigated the Norwegian cultural and societal landscape by gaining cultural competence, adapting and finding ways to contribute, which made it easier for the youth to gain access to the society, to succeed as well as enhance their sense of agency. However, the youths also reported having to navigate between the expectations of their original and host country cultures, struggling with finding a balance between the two cultures. Discussion The youth' acculturation processes seemed to be the result of both their own needs, wishes and behavior as well as specific features in their host country culture, which supports the notion that acculturation processes to some degree are context- and culture-dependent. Knowledge regarding the cultural and societal framework that these youth face and how they navigate within it during resettlement is critical for identifying possible cross-cultural challenges and promoting positive developmental tracks. To understand more about acculturation and integration processes, future research should include specific cultural and societal features as well as immigrants' own perspectives and experiences during resettlement.
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Affiliation(s)
- Elin Sofia Andersson
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Carolina Øverlien
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Department of Social Work, Stockholm University, Stockholm, Sweden
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11
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Kvestad I, Bøe T, Sayyad N, Skogen JC, Randal S, Lehmann S. Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors-a comparison with youth in foster care. Eur Child Adolesc Psychiatry 2023; 32:439-449. [PMID: 34537879 PMCID: PMC10038941 DOI: 10.1007/s00787-021-01876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.
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Affiliation(s)
- Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Nawar Sayyad
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Sølve Randal
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Bergen, Norway
| | - Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health Promotion and development, Faculty of Psychology, University of Bergen, Bergen, Norway
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12
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Norton J, Gandubert C, Chaudieu I, Pellissier S, Gaultier S. Association between uncertainty regarding right-to-stay and mental health in unaccompanied and separated migrant children (UASC) reaching adulthood: findings from France. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02442-y. [PMID: 36806952 DOI: 10.1007/s00127-023-02442-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE There is substantial evidence suggesting high levels of mental health problems in unaccompanied and separated children (UASC). However, there is less focus on the first years of adulthood characterised by increased vulnerability and fear of expulsion. We aimed to describe the mental health of UASC on reaching adulthood, and how this was affected by uncertainty regarding their right-to-stay in France. METHODS One hundred and ten youth aged 18-22 were recruited via child protection reception centres. We administered the Patient Health Questionnaire somatic (PHQ-15), anxiety (GAD-7) and depression (PHQ-9) modules, the Post-Traumatic Stress Disorder Checklist (PCL-5) and Connor-Davidson Resilience Scale (CD-RISC-10). Logistic regression analysis was performed with the dependent variable, a secure (versus uncertain) situation, defined as (1) detaining a residence permit and being in school, an apprenticeship or a salaried job, or (2) waiting for residence permit whilst occupying a salaried job. RESULTS Of the sample, 19.3% reached criteria for a probable somatic disorder, 17.6% for anxiety and 28.7% for depression (score ≥ 10); 41.8% were in an uncertain situation regarding their right-to-stay. Uncertainty was associated with higher anxiety ((OR per Interquartile range (95% CI), 1.77 (1.05-2.98)) and post-traumatic stress symptoms (2.05 (1.06-4.00)), lower resilience (0.50 (0.27-0.91)), and participants rating their anxiety (p = 0.02) and depressive symptoms (p = 0.003) as more severe since reaching adulthood. CONCLUSIONS Our findings suggest uncertainty regarding right-to-stay is associated with increased mental health symptoms, specifically anxiety and trauma-induced stress, thereby highlighting the vulnerability of UASC in their first years of adulthood. This calls for greater support during this transition period with regular symptom monitoring for timely psychological interventions.
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Affiliation(s)
- Joanna Norton
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France.
| | - Catherine Gandubert
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France
| | - Isabelle Chaudieu
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France
| | - Sonia Pellissier
- LIP/PC2S, University Savoie Mont-Blanc, University Grenoble Alpes, Chambery, France
| | - Sydney Gaultier
- LIP/PC2S, University Savoie Mont-Blanc, University Grenoble Alpes, Chambery, France
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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13
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McDiarmid S, Osman F, Sarkadi A, Durbeej N. Associations between social factors and school belonging among newcomer and non-newcomer youth in Sweden. PLoS One 2023; 18:e0280244. [PMID: 36735695 PMCID: PMC9897537 DOI: 10.1371/journal.pone.0280244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023] Open
Abstract
Feeling a sense of belonging at school is associated with important positive outcomes for youth and requires youth to engage in positive social relationships. Yet there is a limited understanding of the social factors most associated with youths' school belonging and limited evidence about whether correlates of school belonging vary for marginalized groups like newcomers compared to majority groups. Sweden provides an important context for investigation of these issues because, over the past two decades, the country has experienced an influx of asylum seekers and educational reforms that have altered the composition and functioning of Swedish secondary schools. This study addresses these gaps by (1) investigating which of eight social factors are associated with school belonging among diverse Swedish youth, and (2) examining whether newcomer status moderates the relationship between social factors and school belonging. Hierarchical regression and moderation analyses were used to analyze data from 14 to 19 year-old (n = 233) newcomers and non-newcomers in Sweden. An exploratory factor analysis revealed that the school belonging measure contained two factors: positive perceptions and negative perceptions (reverse coded). For both, stronger school belonging was associated with lower perceived ethnic discrimination. Positive perceptions of school belonging were also associated with more prosocial behaviours and lower emotional problems. Negative perceptions of school belonging were associated with more peer problems. Notably, quantity and quality of peer relationships were not associated with school belonging. There was no consistent evidence of newcomer status moderating the relationship between social factors and school belonging. These results highlight factors associated with school belonging which are modifiable and amenable to intervention or impact by policy-ethnic discrimination, prosocial behaviour, and emotional and peer problems. The absence of moderation by newcomer status suggests that school belonging interventions or related policies are likely to affect newcomer and non-newcomer students similarly.
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Affiliation(s)
- Serena McDiarmid
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Fatumo Osman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Natalie Durbeej
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
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14
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Hocking DC, Sundram S. Age and environmental factors predict psychological symptoms in adolescent refugees during the initial post-resettlement phase. Child Adolesc Psychiatry Ment Health 2022; 16:105. [PMID: 36539785 PMCID: PMC9768994 DOI: 10.1186/s13034-022-00538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adolescent refugees are at high risk of developing mental disorders but are often not recognised early. This pilot study aimed to identify early putative risk factors associated with psychological symptoms in newly resettled refugee youth at potential risk of subsequently developing mental disorders. METHODS Newly resettled adolescent refugees were recruited through English language schools in Melbourne, Australia. Participants were assessed with the MINI-Kid, Achenbach Youth Self-Report and Reaction of Adolescents to Traumatic Stress scale. Parents completed a mental health screening separately. Linear regression models were used to identify predictive factors associated with symptom ratings. RESULTS Seventy-eight, ostensibly well, refugee adolescents (mean age = 15.0 ± 1.6 years) resettled in Australia for 6.1 ± 4.2 months were assessed. Levels of anxiety, depression and post-traumatic stress symptoms were considerably lower than in mainstream population data. Prior displacement was a key determinant of symptomatology. Transitory displacement, irrespective of duration, was associated with elevated scores for depression (t (47) = -4.05, p < 0.0001), avoidance/numbing (U = 466, p < .05) and total trauma (U = 506, p < .05) symptoms. Older age was a unique predictor of depression (F (1,74) = 8.98, p < .01), internalising (F(1,74) = 6.28, p < .05) and total (F(1,74) = 4.10, p < .05) symptoms, whilst parental depression symptoms (t = 2.01, p < 0.05), displacement (t = 3.35, p < 0.01) and, expectedly, trauma exposure (t = 3.94, p < 0.001) were unique predictors of post-traumatic stress symptoms. CONCLUSIONS Displaced status, older age, and parental symptoms predicted psychological symptoms in adolescent refugees in an initial relatively asymptomatic post-resettlement phase. The early recognition of at-risk refugee youth may provide an opportunity for preventative mental health interventions.
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Affiliation(s)
- Debbie C. Hocking
- Cabrini Outreach, 183 Wattletree Road, Malvern, VIC 3144 Australia ,grid.1002.30000 0004 1936 7857Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC 3800 Australia
| | - Suresh Sundram
- Cabrini Outreach, 183 Wattletree Road, Malvern, VIC 3144 Australia ,grid.1002.30000 0004 1936 7857Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC 3800 Australia ,grid.419789.a0000 0000 9295 3933Mental Health Program, Monash Health, 246 Clayton Road, Clayton, VIC 3168 Australia
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15
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Cardenas P, Ásgeirsdóttir BB, Sam DL, Doná G. Stressful life events, psychological symptoms, and social support of children and young asylum-seekers in Iceland. Scand J Public Health 2022:14034948221142080. [DOI: 10.1177/14034948221142080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Children and young asylum-seekers are often exposed to stressful life events (SLEs) and risk developing psychological symptoms. However, risk and protective factors can positively and negatively influence this vulnerable group’s mental health. Aims: To examine the SLE experiences and psychological symptoms of children and youth who seek refuge in Iceland. And to study the role that gender, travelling (un)accompanied and perceived social support play in the development of psychological symptoms for this population. Methods: Participants were 75 children and youth of ages 13 to 24 years who sought asylum in Iceland ( M = 19.7, SD =3.0, 66.7% male). Sociodemographic and social support data were collected via face-to-face interviews, with the help of interpreters when required, while SLEs, post-traumatic stress, depression, anxiety and behavioural symptoms measures were administered to participants. Results: The results indicated that participants who travelled alone to Iceland had experienced more SLEs than those who travelled accompanied. SLE experiences were associated with post-traumatic stress disorder (PTSD) and other psychological symptoms. Results also revealed that SLE and perceived peer support played a significant role in predicting PTSD symptoms. Conclusions: Children and young asylum-seekers are exposed to a high number of SLEs, which increases their risk of developing psychological problems. This potential risk underlines the need for early assessments and intervention. Moreover, higher levels of social support were related to less severe PTSD symptoms, suggesting that social resources act as protective factors for these children and youth in helping them cope with SLEs.
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Affiliation(s)
| | | | | | - Giorgia Doná
- Department of Social Sciences, School of Education and Communities,University of East London, UK
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16
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Moe G, Ytterhus B. Health and meaning through "doings": A qualitative study with young unaccompanied refugees in Norway. Soc Sci Med 2022; 315:115542. [PMID: 36434891 DOI: 10.1016/j.socscimed.2022.115542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/21/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Young unaccompanied refugees who settle in a new country are at substantial risk of developing health problems while striving to uphold a meaningful, new life. We lack knowledge about how they use their personal agency to self-care in the context of their local communities. This article examines how young unaccompanied refugees create healthy identities and looks into the social structures that promote health in their everyday life. METHODS Nineteen in-depth interviews were conducted with young unaccompanied refugees settled in Norway, originating from Afghanistan, Eritrea, and Syria. Interpretive phenomenological analysis was used. Our theoretical framework combined Antonovsky's (1987) theory of health, Honneth's (2005) philosophy of recognition, and Prilleltensky's (2020) social psychological concept of mattering. RESULTS Young unaccompanied refugees create healthy identities through "doings", i.e. meaningful activities that provide recognition and the feeling of adding value. They confirm health as a relational phenomenon, including horizontal relations at, for example, school, work, gym, and other leisure activities in the local community. Vertical relations involving legal status, residence permits, and community values, were also highly important. The participants' relation to parents/families in their country of origin was often complex, associated both with burdensome obligations to provide and a potential to care and matter. CONCLUSION Young unaccompanied refugees are dependent on inclusive, supportive policies and structures which enable them to develop healthy identities. These findings should encourage policymakers and society to strengthen and expand arenas for "doings" and meaning for young unaccompanied refugees.
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Affiliation(s)
- Gjertrud Moe
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Faculty of Medicine and Health Science.Haakon, Jarls Gt. 11, N- 7491, Trondheim, Norway.
| | - Borgunn Ytterhus
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Faculty of Medicine and Health Science.Haakon, Jarls Gt. 11, N- 7491, Trondheim, Norway.
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17
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Mental health in refugee children. Curr Opin Psychol 2022; 48:101460. [PMID: 36130437 DOI: 10.1016/j.copsyc.2022.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 01/28/2023]
Abstract
Almost half of the world's forcibly displaced population are children, most commonly originating from Syria, Iraq, and Afghanistan. Health disparities are well documented, especially for mental health, but not consistent across groups, time or context. Despite high exposure to trauma and stress, refugee children also show remarkable resilience. An ecological model of refugee health including both risk and resilience factors is therefore recommended. The model also includes the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the disruptions of basic systems affecting both the individual and families as a whole, offering a framework to better understand the health disparities and appropriate interventions for refugee children.
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18
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Guessoum SB, Minassian S, de Staël P, Touhami F, DiGiovanni M, Radjack R, Moro MR, Benoit L. Multimodal co-therapy for unaccompanied minors: a qualitative study. Child Adolesc Psychiatry Ment Health 2022; 16:81. [PMID: 36344979 PMCID: PMC9641960 DOI: 10.1186/s13034-022-00518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Unaccompanied refugee minors-or unaccompanied minors-are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients' experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care. METHODS MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). RESULTS Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one's story can "set us free" if guided carefully by care providers. CONCLUSION This study suggests that MUCTUM therapy may efficiently support unaccompanied minors' mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.
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Affiliation(s)
- Sélim Benjamin Guessoum
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014, Paris, France. .,Université Paris Cité, PCPP, Paris, France. .,Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France.
| | - Sevan Minassian
- grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France
| | - Pauline de Staël
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France
| | - Fatima Touhami
- grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France
| | - Madeline DiGiovanni
- grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, USA
| | - Rahmeth Radjack
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Laelia Benoit
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France ,grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, USA
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19
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Namer Y, Freţian A, Podar D, Razum O. Asylum seeking and refugee adolescents' mental health service use and help-seeking patterns: a mixed-methods study. NPJ MENTAL HEALTH RESEARCH 2022; 1:18. [PMID: 37521499 PMCID: PMC9628352 DOI: 10.1038/s44184-022-00019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
Almost a third of all people who entered Germany to seek protection since 2010 were under the age of 18. Asylum-seeking and refugee (ASR) adolescents in Germany face reduced entitlements to healthcare and experience barriers in accessing mental healthcare, despite documented mental health needs. This mixed-methods study aims to describe the mental health needs and service use of ASR adolescents in Germany and identify the predictors of their help-seeking patterns. Here we report findings of cross-sectional data collected between February 2019 and November 2020 in schools and refugee accommodations in three German federal states. Our subsample consists of ASR between the ages of 11 and 18, coming from Syria, Afghanistan, and Iraq (N = 216). Cross-sectional data are supplemented by semi-structured interviews with nine mental health professionals in one region of the study. Our findings reveal an underutilization of mental health services relative to the emotional difficulties reported. Perceived and experienced access barriers, age, and externalizing and internalizing symptoms predict different help-seeking patterns. Psychotherapy-related social resources, as well as reporting of emotional difficulties, are predictors of actual or intended psychotherapeutic service utilization. Based on our quantitative and qualitative findings, we highlight the need for widespread, accessible, and low-threshold mental health initiatives designed to work with ASR adolescents, for additional assistance in navigating the mental healthcare system, as well as for support to important people in ASR adolescents' lives who fill the gap between mental health needs and accessible mental healthcare services.
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Affiliation(s)
- Yudit Namer
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Alexandra Freţian
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Diana Podar
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
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20
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Daniel-Calveras A, Baldaquí N, Baeza I. Mental health of unaccompanied refugee minors in Europe: A systematic review. CHILD ABUSE & NEGLECT 2022; 133:105865. [PMID: 36095862 DOI: 10.1016/j.chiabu.2022.105865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nearly half of the refugee and asylum seeking population in Europe is under the age of 18, and many of these individuals are unaccompanied children and adolescents. OBJECTIVE The aim of this systematic review is both to summarize findings regarding the prevalence of mental health disorders among unaccompanied refugee minors (URM) in European countries since the last available systematic review (October 2017), and to describe associated risk factors. METHODS Five databases were systematically searched for articles published between October 1, 2017 and May 1, 2022. RESULTS The findings from 23 studies conducted in 9 countries which examined 80,651 child and adolescent URM are explained. Afghanistan was the most common country of origin in the majority of studies and >75 % of the subjects were boys. Most of the studies (N = 13, 56.5 %) assessed posttraumatic stress disorder (PTSD) prevalence. We found a high prevalence of mental health disorders among URM children and adolescents, which varied considerably between studies, ranging from 4.6 % to 43 % for (PTSD), 2.9 % to 61.6 % for depression, 32.6 % to 38.2 % for anxiety and 4 to14.3 % for behavioral problems. Two studies looking at suicide attempts and deaths, also observed higher rates in URM compared to the host population of the same age. The studies looking at mental health risk factors suggest that levels of social support in the host country, rearing environment, and other factors are associated with psychopathology. Moreover, a meta-analysis of four studies regarding PTSD in URM and accompanied refugee minors (ARM) showed a lower prevalence among ARM: -1.14 (95%CI:-1.56-0.72). CONCLUSIONS PTSD, depression and anxiety are the most prevalent problems among the URM population in Europe. Early intervention in host countries is needed in order to improve mental health outcomes for this vulnerable population and avoid possible neglect.
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Affiliation(s)
| | - Nuria Baldaquí
- Psychiatry and Psychology Department, Hospital Clínic de Barcelona, SGR-881 Barcelona, Spain
| | - Inmaculada Baeza
- Universitat de Barcelona, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, ISCIII, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (CERCA-IDIBAPS), Barcelona, Spain.
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21
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Eruyar S, Hunt S, O’Reilly M, Alowaybil R, Vostanis P. Responsiveness of support systems to address refugee young people’s mental health needs: Stakeholder perspectives from Turkey and the UK. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2123697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Affiliation(s)
- Seyda Eruyar
- Department of Psychology, Necmettin Erbakan University, Konya, Turkey
| | - Sarah Hunt
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
| | - Michelle O’Reilly
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
| | - Reem Alowaybil
- Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Panos Vostanis
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
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22
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Sukale T, Witt A, Dixius A, Möhler E, Fegert JM. Kinder und Jugendliche mit Fluchterfahrungen. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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23
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Demazure G, Baeyens C, Pinsault N. Review: Unaccompanied refugee minors' perception of mental health services and professionals: a systematic review of qualitative studies. Child Adolesc Ment Health 2022; 27:268-280. [PMID: 34128313 DOI: 10.1111/camh.12486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Unaccompanied refugee minors (URMs) are a population at risk of mental health problems and a population with whom the therapeutic alliance can be difficult to set up. The therapeutic alliance's quality can impact the result and effectiveness of psychotherapeutic interventions. The aim of the present study was to gather URMs' points of view about mental health services and mental health professionals (MHP) in the host country. A summary of interviews conducted with URMs will allow a better understanding of their perception and expectations. METHODS Seven databases were searched with English and French keywords. In the end, nine studies were selected. RESULTS The review of the interviews shows that URMs do not have a clear perception of MHP - it seems difficult for them to trust MHP, but also to understand the value of sharing past painful experiences to reduce current symptoms. They can have a negative perception of mental health and consider that this is not a priority. URMs prefer to focus on day-to-day problems, do activity-based interventions and do group sessions to value social interactions. CONCLUSIONS Clinical and methodological implications are discussed. The development of an instrument to evaluate therapeutic care for URMs could be interesting for future research and for clinicians.
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Affiliation(s)
- Gwladys Demazure
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | - Céline Baeyens
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | - Nicolas Pinsault
- Univ. Grenoble-Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France.,Univ. Grenoble-Alpes/Critical Thinking Federation FED 4270, Grenoble, France
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Salmon M, Sibeoni J, Harf A, Moro MR, Ludot-Grégoire M. Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur. Front Psychiatry 2022; 13:897002. [PMID: 35958663 PMCID: PMC9358691 DOI: 10.3389/fpsyt.2022.897002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Aims Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade. Methods This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult. Results The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria. Conclusion This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research. Protocol PROSPERO registration number CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.
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Affiliation(s)
- Mathilde Salmon
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Aurélie Harf
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
| | - Maude Ludot-Grégoire
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
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Gewirtz A, Muldrew L, Sigmarsdóttir M. Mental health, risk and resilience among refugee families in Europe. Curr Opin Psychol 2022; 47:101428. [DOI: 10.1016/j.copsyc.2022.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
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Nilsen SA, Kvestad I, Randal SB, Hysing M, Sayyad N, Bøe T. Mental health among unaccompanied refugee minors after settling in Norway: A matched cross-sectional study. Scand J Public Health 2022:14034948221100103. [PMID: 35684945 DOI: 10.1177/14034948221100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: To describe the mental health of unaccompanied refugee minors (URMs) settled in Norway and compare their responses to an age- and sex-matched sample of Norwegian young people. Methods: The data were from the Pathways to Independence study of URMs aged 15-20 years (n = 81; 82.7% male; response rate 80%) conducted in 2018-2019 in the Bergen municipality, Norway. The data from the URMs were linked to an age- and sex-matched group of young people from the Norwegian youth@hordaland study conducted in 2012 (n = 324). Mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ). Results: URMs were more likely to agree with most items pertaining to emotional problems, peer problems and prosocial subscales than Norwegian young people. Few differences were found for items on the conduct problems and hyperactivity-inattention problems scales. Poor psychometric properties, including weak factor loadings and low internal consistency, were detected for the SDQ subscales among URMs, except for the emotional problems subscale, indicating that the originally proposed five-factor model fitted the data poorly. Conclusions: URMs appear to have moderately more emotional problems than Norwegian young people. They are more likely to report being alone, getting along better with adults than with their peers and being bullied, but also report being more helpful and sharing with others. Studies with larger samples of URMs should determine the most appropriate factor structure of the SDQ when administered to URM samples.
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Affiliation(s)
- Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway
| | - Sølve Bjørn Randal
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Norway
| | - Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway.,Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | - Nawar Sayyad
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Norway
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway.,Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
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Pfeiffer E, Behrendt M, Adeyinka S, Devlieger I, Rota M, Uzureau O, Verhaeghe F, Lietaert I, Derluyn I. Traumatic events, daily stressors and posttraumatic stress in unaccompanied young refugees during their flight: a longitudinal cross-country study. Child Adolesc Psychiatry Ment Health 2022; 16:26. [PMID: 35361239 PMCID: PMC8974188 DOI: 10.1186/s13034-022-00461-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Unaccompanied young refugees constitute an especially vulnerable population, reporting high rates of trauma and mental health problems. There is a significant gap in the literature on trauma and posttraumatic stress symptoms (PTSS) in unaccompanied young refugees who are still on the move and live in precarious circumstances such as refugee camps. This study therefore aimed to contribute to this gap by investigating pre- and peri-migration (potentially) traumatic experiences of unaccompanied young refugees; longitudinal trajectories of trauma, daily stressors and PTSS; and the impact of gender, trauma, and daily stressors on PTSS over time. METHODS This longitudinal, mixed-method, and multi-country study was conducted in various settings (e.g. refugee camps, reception centers) across nine European countries. A heterogeneous sample of N = 187 unaccompanied young refugees (78.4% male) from 29 different countries was assessed via interviews at 3 time-points during a period of 27 months. Data was analyzed via growth curve modelling. RESULTS Prevalence rates of (potentially) traumatic experiences ranged from 29.5 to 91.9%. Peri-migration traumatization remained stable over time (b = - 0.02; p = 0.371), but the number of reported daily stressors (b = - 0.24; p = 0.001) and PTSS scores significantly decreased over time (b = - 0.98; p = 0.004). Females reported higher PTSS compared with males at baseline (p = 0.002), but gender did not influence the longitudinal trajectory of PTSS. The pre-migration trauma load and daily stressors at baseline did not have a significant effect on PTSS at baseline or on the longitudinal trajectory. CONCLUSIONS This is the first study to document not only the high numbers of traumatic events for unaccompanied young refugees pre- and peri- migration, but also the continued traumatization during flight, as well as high rates of daily stressors and PTSS. Humanitarian and political assistance is urgently needed to curb the often life-threatening conditions unaccompanied young refugees face during migration.
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Affiliation(s)
- Elisa Pfeiffer
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhoevelstraße 1, 89075, Ulm, Germany.
| | - Malte Behrendt
- grid.5342.00000 0001 2069 7798Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Sarah Adeyinka
- grid.5342.00000 0001 2069 7798Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Ines Devlieger
- grid.5342.00000 0001 2069 7798Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Marina Rota
- grid.5342.00000 0001 2069 7798Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Océane Uzureau
- grid.5342.00000 0001 2069 7798Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Floor Verhaeghe
- grid.5342.00000 0001 2069 7798Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Ine Lietaert
- grid.5342.00000 0001 2069 7798Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium ,grid.452077.30000 0004 5373 9896The United Nations University Institute On Comparative Regional Integration Studies (UNU-CRIS), Potterierei 72, 8000 Brugge, Belgium
| | - Ilse Derluyn
- grid.5342.00000 0001 2069 7798Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
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Rondung E, Leiler A, Sarkadi A, Bjärtå A, Lampa E, Löfving SG, Calam R, Oppedal B, Keeshin B, Warner G. Feasibility of a randomised trial of Teaching Recovery Techniques (TRT) with refugee youth: results from a pilot of the Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT). Pilot Feasibility Stud 2022; 8:40. [PMID: 35164865 PMCID: PMC8843024 DOI: 10.1186/s40814-022-00998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Although post-traumatic stress is prevalent among unaccompanied refugee minors (URM), there are few evidence-based psychological interventions for this group. Teaching Recovery Techniques (TRT) is a brief, manualised intervention for trauma-exposed youth, which has shown promising results in exploratory studies. The aim of the present study was to assess the feasibility of conducting a randomised controlled trial (RCT) evaluating the use of TRT among URM by investigating key uncertainties relating to recruitment, randomisation, intervention delivery and data collection. Methods A 3-month long non-blinded internal randomised pilot trial with a parallel-group design assessed the feasibility of a planned nationwide multi-site RCT. URM with or without granted asylum were eligible if they were 14 to 20 years old, had arrived in Sweden within the last 5 years and had screened positive for symptoms of post-traumatic stress disorder (PTSD). Quantitative data were collected pre- and post-intervention, and 18 weeks after randomisation. On-site individual randomisation (1:1) followed directly after pre-intervention assessment. Participants allocated to the intervention were offered seven weekly group-based TRT sessions. Quantitative pilot outcomes were analysed using descriptive statistics. Qualitative information was gathered through on-site observations and follow-up dialogue with group facilitators. A process for Decision-making after Pilot and feasibility Trials (ADePT) was used to support systematic decision-making in moving forward with the trial. Results Fifteen URM (mean age 17.73 years) with PTSD symptoms were recruited at two sites. Three of the youths were successfully randomised to either TRT or waitlist control (TRT n = 2, waitlist n = 1). Fourteen participants were offered TRT for ethical reasons, despite not being randomised. Six (43%) attended ≥ 4 of the seven sessions. Seventy-three percent of the participants completed at least two assessments, with a response rate of 53% at both post-intervention and follow-up. Conclusions The findings demonstrated a need for amendments to the protocol, especially with regard to the procedures for recruitment and randomisation. Upon refinement of the study protocol and strategies, an adequately powered RCT was pursued, with data from this pilot study excluded. Trial registration ISRCTN47820795, prospectively registered on 20 December 2018
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Bürgin D, Anagnostopoulos D, Vitiello B, Sukale T, Schmid M, Fegert JM. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry 2022; 31:845-853. [PMID: 35286450 PMCID: PMC9209349 DOI: 10.1007/s00787-022-01974-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.
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Affiliation(s)
- David Bürgin
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany ,grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | | | | | - Benedetto Vitiello
- grid.7605.40000 0001 2336 6580Division of Child Neurology and Psychiatry, Department of Public Health and Pediatric Sciences, Regina Margherita Pediatric Hospital, University of Turin, Turin, Italy
| | - Thorsten Sukale
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany
| | - Marc Schmid
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M. Fegert
- grid.410712.10000 0004 0473 882XDepartment of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073 Ulm, Germany
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Höhne E, van der Meer AS, Kamp-Becker I, Christiansen H. A systematic review of risk and protective factors of mental health in unaccompanied minor refugees. Eur Child Adolesc Psychiatry 2022; 31:1-15. [PMID: 33169230 PMCID: PMC9343263 DOI: 10.1007/s00787-020-01678-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
In recent years, there has been a rising interest in the mental health of unaccompanied minor refugees (UMR), who are a high-risk group for mental disorders. Especially the investigation of predictive factors of the mental health of young refugees has received increasing attention. However, there has been no review on this current issue for the specific group of UMR so far. We aimed to summarize and evaluate the existing findings of specific risk and protective factors to identify the most verified influences on the mental health of UMR. Therefore, we conducted a systematic literature search. Study designs were limited to quantitative cross-sectional and longitudinal designs. Eight databases were searched in four different languages and article reference lists of relevant papers were screened. 27 studies were included (N = 4753). Qualitative synthesis revealed the number of stressful life events to be the most evaluated and verified risk factor for mental health of UMR. A stable environment and social support, on the other hand, can protect UMR from developing poor mental health. Besides that, several other influencing factors could be pointed out, such as type of accommodation, family contact, gender and cultural competences. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible. This review helps to improve our understanding of determinants of UMRs mental health and thus to provide more targeted treatment. Furthermore, it provides information on how to prevent the development of mental health problems by specifying factors that can be modified by different health and immigration sectors in advance. Further research is needed focusing on the interaction between the various predictive factors.
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Affiliation(s)
- Edgar Höhne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps-University Marburg, Schützenstraße 49, 35039, Marburg, Germany.
| | - Anna Swantje van der Meer
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35037 Marburg, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps-University Marburg, Schützenstraße 49, 35039 Marburg, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35037 Marburg, Germany
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31
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Xiong T, Milios A, McGrath PJ, Kaltenbach E. The influence of social support on posttraumatic stress symptoms among children and adolescents: a scoping review and meta-analysis. Eur J Psychotraumatol 2022; 13:2011601. [PMID: 35340789 PMCID: PMC8942489 DOI: 10.1080/20008198.2021.2011601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Several risk and protective factors play a role in the development of posttraumatic stress symptoms (PTSS) in children and youth. The evidence for social support (SS) as a protective factor is rising; however, a review of the evidence is lacking. OBJECTIVE This scoping review and meta-analysis aims to map out and synthesize the present research on the influence of social support on PTSS in children and adolescents. METHOD The literature searched through PubMed, MEDLINE, Embase, PsycInfo, and CINAHL identified 3629 abstracts. Ninety articles published from 1999 to 2020 were selected, including a total of 77,439 participants. RESULTS Most papers focused on social and emotional support from family members (36/88) and peers (26/88); other types of support (e.g., informational support and support from professionals) were not widely reported. The cross-sectional studies illustrated an overall significant, but weak, negative correlation between global social support and PTSS. A similar weak negative association was found between family support and PTSS. The association between peer support and PTSS was not significant. For longitudinal studies, 4 of 5 indicated that SS was a significant negative predictor of PTSS. CONCLUSIONS There was conceptual, methodological, and statistical heterogeneity of the identified studies. This review suggests a weak negative relationship between global SS and PTSS in children and adolescents. Higher global SS was related to less PTSS. The evidence regarding family support revealed a more stable negative relationship with PTSS than that for peer support. Investigating social support without specifying the form of support confounds the effect. Studies on informational, teacher, or professional support seem to be lacking. More studies are needed on the longitudinal effects of SS on PTSS.
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Affiliation(s)
- Ting Xiong
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Athena Milios
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick J McGrath
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Elisa Kaltenbach
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
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Höhne E, Banaschewski T, Bajbouj M, Böge K, Sukale T, Kamp-Becker I. Prevalences of mental distress and its associated factors in unaccompanied refugee minors in Germany. Eur Child Adolesc Psychiatry 2021:10.1007/s00787-021-01926-z. [PMID: 34919189 DOI: 10.1007/s00787-021-01926-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
Prevalences for mental disorders within minor refugees are comparatively high and heterogeneous. To reduce heterogeneity and identify high-risk subgroups, we compared unaccompanied refugee minors (URM) to accompanied refugee minors (ARM) regarding depressive symptoms and mental distress. Furthermore, we examined associative factors of mental distress in URM on a broad scale. We conducted a survey with a cross-sectional design in four German University hospitals. The sample consisted of n = 172 URM and n = 52 ARM aged 14-21. Depressive symptoms were assessed via the Patient Health Questionnaire (PHQ-9). Mental distress was assessed by the Refugee Health Screener (RHS-15). Mann-Whitney test was used to examine differences between URM and ARM. Associated factors of mental distress were evaluated via a stepwise multiple regression analysis. URM showed significantly higher mean scores for PHQ-9 (p < .001) and RHS-15 (p < .001) compared to ARM indicating medium effect sizes. Furthermore, URM were significantly more likely to surpass the cut-off for depression (61.6% vs. 30.8%) and overall mental distress (81.4% vs. 53.8%) compared to ARM. The factors Number of stressful life events (SLE), Female gender, and Fear of deportation were found to be associated with an increased mental distress in URM, whereas Weekly contact to a family member, School attendance, and German language skills were accompanied with lower distress scores. All six factors accounted for 32% of the variance of mental distress in URM (p < .001). Within minor refugees, URM are a highly vulnerable subgroup, which should receive particular attention and more targeted measures by health authorities. Our results indicate that these measures should comprise a rapid promotion of family contact, school attendance, language acquisition, and the fast processing of asylum applications. However, the cross-sectional design limits the interpretability of the results.
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Affiliation(s)
- E Höhne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, University Hospital of Marburg and Philipps-University Marburg, Marburg, Germany.
| | - T Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - M Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - K Böge
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - T Sukale
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - I Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, University Hospital of Marburg and Philipps-University Marburg, Marburg, Germany
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Inofuentes RA, Fuente LDL, Ortega E, García-García J. Victimización y Problemas de Conducta Externalizante y Antisocial en Menores Extranjeros no Acompañados en Europa: Revisión Sistemática. ANUARIO DE PSICOLOGÍA JURÍDICA 2021. [DOI: 10.5093/apj2021a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Inofuentes RA, Fuente LDL, Ortega E, García-García J. Victimización y Problemas de Conducta Externalizante y Antisocial en Menores Extranjeros no Acompañados en Europa: Revisión Sistemática. ANUARIO DE PSICOLOGÍA JURÍDICA 2021. [DOI: 10.5093/apj2021a27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Dybdahl R, Sørensen T, Hauge HA, Røsvik K, Lien L, Eide K. Same but different: meaning-making among refugee and non-refugee youths. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2021. [DOI: 10.1108/ijmhsc-02-2021-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
There is substantial research on the experiences, needs and well-being of unaccompanied refugee adolescents, but less is known about existential aspects of their lives. The purpose of the current study is to explore existential meaning-making among unaccompanied refugee children.
Design/methodology/approach
The informants in this study are young unaccompanied refugees (n = 30) living in Norway, and young Norwegians (n = 46). The authors undertook a secondary analysis of in-depth qualitative refugee interview data and a quantitative analysis of questionnaire data from Norwegian informants.
Findings
Both the refugee youths and the Norwegian youths expressed that social relationships and connections to others were most important for meaning. Moreover, both groups emphasized the importance of relatedness and generativity, i. e. commitment to worldly affairs beyond one’s immediate needs. The main differences between the two groups were related to the significance attached to religion and to loneliness.
Research limitations/implications
The comparison between the two groups is only possible to some degree. Secondary analyses have some limitations, as well as strengths.
Practical implications
The findings may be useful for supporting young refugees, as they provide insights into less-studied aspects of their lives.
Originality/value
The originality of this study lies in the focus on and broad interpretation of meaning, of secondary data analyses, and of comparisons between youths that are refugees versus non-refugees.
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Stein J, Niemeyer H, Meyer C, Wirz C, Eiling A, Gruzman R, Heeke C, Stammel N, Knaevelsrud C. Posttraumatic stress in adult civilians exposed to violent conflict, war and associated human rights abuses in the Eastern Mediterranean Region: A systematic review and meta-analysis. J Affect Disord 2021; 294:605-627. [PMID: 34332362 DOI: 10.1016/j.jad.2021.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Eastern Mediterranean Region (EMR) is the stage of the world's most violent conflicts and the origin of the largest refugee population worldwide. These conflicts can result in symptoms of posttraumatic stress (PTS). To date, no comprehensive meta-analysis on proportions of PTS in civilians from the EMR has been conducted. Sample characteristics, methodological, conflict-related and displacement-related factors might affect rates of PTS. METHODS A systematic literature search for studies investigating PTS in adult civilians from the EMR was conducted until March 2020 and resulted in 118 individual study samples that were suitable for inclusion. A quality assessment was conducted. A random effects meta-analysis on proportions and sensitivity analyses were performed, and a 95% prediction interval was calculated. Subgroup analyses to identify moderators (e.g. diagnostic instruments, displacement) were conducted. RESULTS The quality of the included study samples varied. The pooled estimate of proportions from all 118 study samples was 0.31 (95% CI: 0.27 - 0.35). Heterogeneity was considerable (Q = 10151.58, p < .0001; I2 = 98.64%). The prediction interval was 0.01 to 0.76. The results remained unchanged after excluding nine outlier study samples. Heterogeneity remained high in all subgroups (range of I2: 87.91 to 99.62). LIMITATIONS Due to heterogeneity the pooled estimate cannot be interpreted. Moderators contributing to heterogeneity could not be detected. CONCLUSIONS The proportion of symptoms of PTS in civilians from the EMR varies considerably. The prediction interval indicates that the true rate falls between 1% and 76%. Future studies need to identify variables that affect heterogeneity.
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Affiliation(s)
- Jana Stein
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany.
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Caroline Meyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christina Wirz
- Division of Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Rebecca Gruzman
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nadine Stammel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Mattelin E, Khanolkar AR, Fröberg F, Jonsson L, Korhonen L. 'Long journey to shelter': a study protocol: a prospective longitudinal analysis of mental health and its determinants, exposure to violence and subjective experiences of the migration process among adolescent and young adult migrants in Sweden. BMJ Open 2021; 11:e043822. [PMID: 34593481 PMCID: PMC8487179 DOI: 10.1136/bmjopen-2020-043822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION According to the UN Refugee Agency (UNHCR), around 40% of the 79.5 million forcibly displaced persons in the end of the year 2019 were children. Exposure to violence and mental health problems such as posttraumatic stress disorder are frequently reported among migrant children, but there is a knowledge gap in our understanding of the complex longitudinal interplay between individual, social and societal risk and resilience factors that impact mental health and well-being, quality of life and ability to function and adapt. There is also an urgent societal need to facilitate interdisciplinary and intersectoral collaborative efforts to develop effective methods to prevent, detect and respond to the needs of the migrants. This project will study adolescent and young adult migrants in Sweden using multiple methods such as quantitative analysis of data from a prospective cohort study and qualitative analysis of data gathered from teller-focused interviews. The aim is to understand how different factors impact mental health and integration into the Swedish society. Furthermore, individual experiences related to the migration process and exposure to violence will be studied in detail. METHODS AND ANALYSIS Study participants will include 490 migrants aged 12-25 years recruited through social services, healthcare, social media and the civil society. A subsample of adolescents (n=160) will be re-interviewed after 1 year. Data are collected using structured and semi-structured interviews along with saliva and hair sampling. Measures include sociodemographic data, longitudinal data on mental health and its determinants, including genotypes and stress-hormone levels, access to healthcare and the process of migration, including settlement in Sweden. ETHICS AND DISSEMINATION The Regional Ethics Board of Linköping (2018/292-31 and 2018/504-32) and the National Ethics Board (2019-05473,2020-00949 and 2021-03001) have approved the study. Results will be made available to participants, their caregivers, professionals working with migrants, researchers and the funders.
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Affiliation(s)
- Erica Mattelin
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Amal R Khanolkar
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Frida Fröberg
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Linda Jonsson
- Department of Social Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Laura Korhonen
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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van Es CM, Sleijpen M, Velu ME, Boelen PA, van Loon RE, Veldman M, Kusmallah N, Ekster PJC, Mooren T. Overcoming barriers to mental health care: multimodal trauma-focused treatment approach for unaccompanied refugee minors. Child Adolesc Psychiatry Ment Health 2021; 15:53. [PMID: 34592993 PMCID: PMC8482361 DOI: 10.1186/s13034-021-00404-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the feasibility of a short-term, multimodal trauma-focused treatment approach adapted specifically for unaccompanied refugee minors (URMs) in the Netherlands. This approach aims to overcome barriers to mental health care and to reduce symptoms of posttraumatic stress disorder (PTSD) and depression. METHODS An uncontrolled study was conducted, evaluating the main request for help, treatment integrity and feasibility, and the course of symptoms of PTSD (Children's Revised Impact of Event Scale-13) and depression (Patient Health Questionnaire modified for Adolescents). RESULTS In total, 41 minors were included in the study. Most participants were male (n = 27), predominately from Eritrea (75.6%) with a mean age of 16.5 (SD = 1.5). Minors mostly reported psychological problems, such as problems sleeping, and psychosocial problems, including worries about family reunification. Deviations from the approach were made to meet the current needs of the minors. Factors limiting the feasibility of the approach were often related to continuous stressors, such as news concerning asylum status. CONCLUSIONS The results provide a first indication that this approach partly overcomes barriers to mental health care and emphasize the added value of collaborating with intercultural mediators and offering outreach care. TRIAL REGISTRATION The study was registered in the Netherlands Trial Register (NL8585), 10 April 2020, Retrospectively registered, https://www.trialregister.nl/trial/8585 .
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Affiliation(s)
- Carlijn M. van Es
- grid.5477.10000000120346234Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands ,grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Marieke Sleijpen
- grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Merel E. Velu
- grid.5477.10000000120346234Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands ,grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Paul A. Boelen
- grid.5477.10000000120346234Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands ,grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Renate E. van Loon
- grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands ,Nidos, Utrecht, the Netherlands
| | - Marjan Veldman
- grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands ,Ouder- en Kind Team Amsterdam, Amsterdam, the Netherlands
| | - Nebil Kusmallah
- Nidos, Utrecht, the Netherlands ,grid.12380.380000 0004 1754 9227Faculty of Social Sciences, Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paula J. C. Ekster
- grid.468637.80000 0004 0465 6592De Evenaar, Center for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands
| | - Trudy Mooren
- grid.5477.10000000120346234Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands ,grid.491097.2ARQ Centrum’45, partner in ARQ National Psychotrauma Centre, Diemen, The Netherlands
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Yektaş Ç, Erman H, Tufan AE. Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey. Nord J Psychiatry 2021; 75:420-426. [PMID: 33591886 DOI: 10.1080/08039488.2021.1880634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM We aimed to determine traumatic events, mental health problems and predictors of PTSD in a sample of conditional refugee children. METHODS The sociodemographic features, chief complaints, traumatic experiences and psychiatric diagnoses according to DSM-5 were evaluated retrospectively. RESULTS 20.7% (n = 70) of children experienced the armed conflict or exposed to firefights at their country of origin. Most common diagnoses were anxiety disorders (n = 82, 24.3%), major depressive disorder (n = 52, 15.4%) and PTSD (n = 43, 12.7%). Age, number of traumatic experiences, explosion and sexual violence are the most important predictors for PTSD. CONCLUSIONS Our results suggest that the number of traumas exposed as well as their nature predicted PTSD diagnosis. Refugee children have increased risk for psychiatric problems after migration and resettlement underlining the importance of an adequate follow-up for mental health and ensuring social support networks.
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Affiliation(s)
- Çiğdem Yektaş
- Department of Child and Adolescent Psychiatry, Associate Professor in Üsküdar University NP Hospital, Üsküdar University, İstanbul, Turkey
| | - Hakan Erman
- Child and Adolescent Psychiatrist, Güven Hospital, Ankara, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Child and Adolescent Psychiatrist, Abant İzzet Baysal Universtiy, Bolu, Turkey
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Jin SS, Dolan TM, Cloutier AA, Bojdani E, DeLisi L. Systematic review of depression and suicidality in child and adolescent (CAP) refugees. Psychiatry Res 2021; 302:114025. [PMID: 34090083 DOI: 10.1016/j.psychres.2021.114025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
Child adversity and trauma has been shown to have incredible detrimental effects physically and mentally in the subsequent adult life. Importantly, refugee minors are especially vulnerable to trauma. Thus far there are numerous studies examining cohorts of child and adolescent refugees and their impact on mental health in general and post-traumatic stress disorder (PTSD), but none have focused specifically on depression and suicide. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the current systematic review. 25 articles out of 2660 queried were identified to be included in the review. Overall, CAP refugees have increased risk for major depressive disorder and suicidality compared to the general population to which they have immigrated, regardless of origin. Due to the differences in the assessment tools used, it is hard to parse out if mood disturbance was secondary to major depressive disorder (MDD) or PTSD, or that suicidality is independent or a sequela of MDD/PTSD. Given the vulnerability of CAP refugees after trauma future studies are needed to further elucidate their risk of concurrent depression and suicidality, so as to facilitate appropriate treatment.
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Affiliation(s)
- Shawn S Jin
- Harvard South Shore Psychiatry Residency Training Program; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, VA Boston Healthcare System.
| | - Terrance M Dolan
- Harvard South Shore Psychiatry Residency Training Program; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, VA Boston Healthcare System
| | - Alesia A Cloutier
- Harvard South Shore Psychiatry Residency Training Program; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, VA Boston Healthcare System
| | - Ermal Bojdani
- Columbia University Vagelos College of Surgeons and Physicians; New York State Psychiatric Institute; New York Presbyterian Hospital/Columbia
| | - Lynn DeLisi
- Department of Psychiatry, Harvard Medical School, Boston, MA; Cambridge Health Alliance
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Dangmann C, Solberg Ø, Andersen PN. Health-related quality of life in refugee youth and the mediating role of mental distress and post-migration stressors. Qual Life Res 2021; 30:2287-2297. [PMID: 33713322 PMCID: PMC8298353 DOI: 10.1007/s11136-021-02811-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study is to explore how potentially traumatic events (PTEs) from war and flight influence health-related quality of life (HRQoL) in young refugees after recent resettlement. In a model based on earlier theory, we tested if post-migration stressors and mental distress mediated the effect of PTEs on HRQoL, individually and in serial. We also explored how different types of post-migration stressors influenced different dimensions of HRQoL. METHODS This study used a cross-sectional design where 160 Syrian youth recently resettled in Norway completed questionnaires at school between May and December 2018. Correlations between types of post-migration stressors and dimensions of HRQoL were explored and a serial multiple mediator model was tested. Models were adjusted for age and gender, using two types of mental distress; post-traumatic stress disorder (PTSD) and general mental distress. RESULTS Higher levels of PTEs reduced experienced HRQoL, but this direct effect was mediated by post-migration stressors alone and in serial with mental distress. Despite high levels of mental distress, this did not affect HRQoL independently, only in serial mediation with increased post-migration stressors. Economic concerns and discrimination were types of post-migration stressors affecting several dimensions of HRQoL. CONCLUSION Quality of life in refugee is affected by past events from war, stressors in current resettlement and elevated mental distress through complex interrelations. The study reiterates the importance of considering structural and everyday post-migration stressors in policy and intervention to improve the health and wellbeing of refugee youth.
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Affiliation(s)
- Cecilie Dangmann
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hamarvegen 112, 2418, Elverum, NO, Norway.
| | - Øivind Solberg
- Section for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Per Normann Andersen
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
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Kvestad I, Randal SB, Sayyad N, Lehmann S, Bøe T. Study design: Pathways to Independence - A study of unaccompanied minor refugees settled in a Norwegian city municipality. Scand J Public Health 2021:14034948211025446. [PMID: 34213364 DOI: 10.1177/14034948211025446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aim of the 'Pathways to Independence' study was to gain knowledge of how to facilitate a healthy development for unaccompanied refugee minors (URMs) after settling in Norwegian municipalities. METHODS The project is located in the URM child welfare services (URM CWS) of the Bergen municipality. We invited 101 URMs older than 15 years connected to the URM CWS to participate in a comprehensive survey. Of the invited, 81 consented to participate. The survey included questions on the user's experiences and satisfaction with the URM CWS, and questions related to schooling, social support and activities after settlement. We also included standardized and validated questionnaires on potential traumatic events, mental and somatic health, protective factors and quality of life. These questionnaires have previously been used in two Norwegian epidemiological studies, the 'Youth@Hordaland' and 'Young in Foster care', facilitating comparison of the results with other youth populations in Norway. CONCLUSION Results from the project will be valuable in the process of reaching knowledge-based recommendations for successful settlement of URMs.
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Affiliation(s)
- Ingrid Kvestad
- Regional Centre for Child Mental Health and Welfare, NORCE Norwegian Research Centre, Norway
| | - Sølve Bjørn Randal
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Norway
| | - Nawar Sayyad
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Norway
| | - Stine Lehmann
- Regional Centre for Child Mental Health and Welfare, NORCE Norwegian Research Centre, Norway.,Department of Health Promotion and Development, University of Bergen, Norway
| | - Tormod Bøe
- Regional Centre for Child Mental Health and Welfare, NORCE Norwegian Research Centre, Norway.,Department of Psychosocial Science, University of Bergen, Norway
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Andersson ES, Skar AS, Jensen TK. Unaccompanied refugee minors and resettlement: Turning points towards integration. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/ejsp.2761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Tine K. Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies Oslo Norway
- Department of Psychology University of Oslo Oslo Norway
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Hoell A, Kourmpeli E, Salize HJ, Heinz A, Padberg F, Habel U, Kamp-Becker I, Höhne E, Böge K, Bajbouj M. Prevalence of depressive symptoms and symptoms of post-traumatic stress disorder among newly arrived refugees and asylum seekers in Germany: systematic review and meta-analysis. BJPsych Open 2021; 7:e93. [PMID: 33938425 PMCID: PMC8142547 DOI: 10.1192/bjo.2021.54] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In total numbers, Germany has faced the largest number of refugees and asylum seekers (RAS) in Europe in the past decade. Although a considerable proportion have experienced traumatic and stressful life events, there is no systematic review to date examining the prevalence of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms in RAS in Germany. AIMS To calculate the prevalence of depressive symptoms and PTSD symptoms in the general population of RAS living in Germany after the year 2000 and explore the impact of study- and participant-related characteristics on prevalence estimates. METHOD We systematically searched PubMed, CINAHL, PsycINFO, PSYNDEX, Academic Search Complete, Science Direct and Web of Science from January 2000 to May 2020 to identify articles reporting prevalence of depressive symptoms and PTSD in RAS in Germany (PROSPERO registration number: CRD42020182796). RESULTS In total, 31 different surveys met inclusion criteria with 20 surveys reporting prevalence estimates of depressive symptoms and 25 surveys symptoms of PTSD. Based on screening tools, the pooled prevalence estimate of PTSD symptoms was 29.9% (95% CI 20.8-38.7%) and of depressive symptoms 39.8% (95% CI 29.8-50.1%). Heterogeneity was large within and between subgroups. In multivariate meta-regressions on depressive symptoms, heterogeneity was largely explained by survey period, length of field period and study quality. CONCLUSIONS Prevalence rates of depressive symptoms and PTSD symptoms in RAS are notably large. They exceed the prevalence in the general German population. As a result of high heterogeneity, however, pooled prevalence rates should be interpreted with caution.
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Affiliation(s)
- Andreas Hoell
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Germany
| | - Eirini Kourmpeli
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Germany
| | - Hans Joachim Salize
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Campus Innenstadt, Clinic of the Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps-University Marburg, Germany
| | - Edgar Höhne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps-University Marburg, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité Universitätsmedizin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité Universitätsmedizin, Germany
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Durbeej N, McDiarmid S, Sarkadi A, Feldman I, Punamäki RL, Kankaanpää R, Andersen A, Hilden PK, Verelst A, Derluyn I, Osman F. Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial): study protocol for a cluster randomized controlled trial. Trials 2021; 22:98. [PMID: 33509268 PMCID: PMC7841907 DOI: 10.1186/s13063-020-04995-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools. METHODS This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI). DISCUSSION This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools. TRIAL REGISTRATION ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.
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Affiliation(s)
- Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Serena McDiarmid
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Inna Feldman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Raija-Leena Punamäki
- Faculty of Social Sciences, Psychology, FI- 30014, University of Tampere, Tampere, Finland
| | - Reeta Kankaanpää
- Faculty of Social Sciences, Psychology, FI- 30014, University of Tampere, Tampere, Finland
| | - Arnfinn Andersen
- Norwegian Centre for Violence and Traumatic Stress Studies, NO-0409 Oslo, Norway
| | - Per Kristian Hilden
- Norwegian Centre for Violence and Traumatic Stress Studies, NO-0409 Oslo, Norway
| | - An Verelst
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Ilse Derluyn
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Fatumo Osman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
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Scharpf F, Mkinga G, Masath FB, Hecker T. A socio-ecological analysis of risk, protective and promotive factors for the mental health of Burundian refugee children living in refugee camps. Eur Child Adolesc Psychiatry 2021; 30:1651-1662. [PMID: 32959157 PMCID: PMC8505296 DOI: 10.1007/s00787-020-01649-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/13/2020] [Indexed: 11/30/2022]
Abstract
Children and adolescents' mental health risk and resilience arise from a complex interplay of factors on several socio-ecological levels. However, little is known about the factors that shape the mental health of refugee youth living in refugee camps close to ongoing conflict. We conducted a cross-sectional study with a representative sample of 217 Burundian refugee children aged 7-15 and their mothers residing in refugee camps in Tanzania to investigate associations between risk, protective and promotive factors from various ecological levels (individual, microsystem, exosystem), and children's post-traumatic stress disorder (PTSD) symptoms, internalizing and externalizing problems, and prosocial behavior. Data were collected using structured clinical interviews and analyzed using multiple regression models. Exposure to violence across all contexts and engagement coping were risk factors for PTSD symptoms and internalizing problems, while only violence by mothers seemed to increase children's vulnerability for externalizing problems. A differential impact of violence exposures on prosocial behavior was observed. Higher-quality friendships appeared to protect youth from PTSD symptoms and externalizing problems, while they also promoted children's prosocial behavior, just as mothers' social support networks. Prevention and intervention approaches should integrate risk, protective and promotive factors for refugee youth's mental health across multiple ecological contexts and take into account context-specific and adaptive responses to war and displacement.
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Affiliation(s)
- Florian Scharpf
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany.
| | - Getrude Mkinga
- Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Faustine Bwire Masath
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501 Bielefeld, Germany ,Vivo International, Konstanz, Germany
| | - Tobias Hecker
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501 Bielefeld, Germany ,Department of Psychology, University of Zurich, Zurich, Switzerland
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47
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Bamford J, Fletcher M, Leavey G. Mental Health Outcomes of Unaccompanied Refugee Minors: a Rapid Review of Recent Research. Curr Psychiatry Rep 2021; 23:46. [PMID: 34196826 PMCID: PMC8249279 DOI: 10.1007/s11920-021-01262-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE To examine mental health outcomes of unaccompanied refugee minors during global policy shift. Additionally, to consider mental health service delivery and placement type for this group. METHODS A rapid systematic search of research published since 2018 which related to mental health outcomes of unaccompanied refugee minors. Data extracted, risk of bias assessed and outcomes reviewed qualitatively. RESEARCH FINDINGS We found 181 papers, of which 14 met inclusion criteria. This review found consistently high levels of PTSD and PTSS among URMs in various contexts. Exposure to trauma, being unaccompanied (compared to accompanied), being female and being older are associated with poor outcomes. Depression and anxiety were consistently high among URMs and associated with discrimination, limited language attainment and daily hassles. High rates of mental illness and symptoms among unaccompanied refugee minors were consistent across national and settlement contexts but the quality of the evidence is variable with significant heterogeneity of assessment. We relate persistence of poor mental health outcomes with problems accessing mental health services and discuss the role of key post-migration factors influencing outcomes-in particular placement type and the use of detention centres.
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Affiliation(s)
- Jordan Bamford
- grid.4777.30000 0004 0374 7521Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Mark Fletcher
- grid.4777.30000 0004 0374 7521Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland, UK.
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48
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Solberg Ø, Nissen A, Vaez M, Cauley P, Eriksson AK, Saboonchi F. Children at risk: A nation-wide, cross-sectional study examining post-traumatic stress symptoms in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden between 2014 and 2018. Confl Health 2020; 14:67. [PMID: 33024451 PMCID: PMC7531165 DOI: 10.1186/s13031-020-00311-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background The objective of the present study was to assess nation-wide, representative prevalence estimates for symptom-defined posttraumatic stress disorder (PTSD) within populations of refugee minors from Afghanistan, Syria and Iraq resettled in Sweden. Methods A nation-wide, cross-sectional, questionnaire study with a stratified sample of refugee minors, aged 16–18 years, from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018 (N = 5071) was conducted. The response rate was 22.3%, leaving n = 1129 refugee minors (boys 53.1% / girls 46.9%) in the final sample. Symptom-defined prevalences of PTSD were measured using CRIES-8 with ≥17 as cut-off. Data were analyzed using frequency distributions, and strata-specific PTSD prevalences with 95% confidence intervals (95% CIs), were estimated. The association between migratory status on arrival (unaccompanied vs. accompanied) and PTSD was estimated using crude and adjusted odds ratios (OR) utilizing logistic regression analyses with 95% CIs. Results Overall, the weighted PTSD prevalence was 42% (95% CI 38.9–45.1), with minors from Afghanistan presenting the highest prevalence (56.9, 95% CI 51.5–62.2), compared to minors from Iraq (36.8, 95% CI 28.9–45.4) and Syria (33.4, 95% CI 29.4–37.6). Unaccompanied minors from Afghanistan had higher odds of PTSD compared to accompanied minors from Afghanistan (OR = 1.92, 95% CI 1.08–3.40). Gender differences were non-significant. Conclusions High prevalences of symptom-defined PTSD among refugee minors in general and in unaccompanied minors from Afghanistan in particular, were revealed. Findings calls for continued efforts to support this especially vulnerable group.
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Affiliation(s)
- Øivind Solberg
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, P.box 181, 0409 Oslo, Nydalen Norway.,Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
| | - Alexander Nissen
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division for Forced migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Marjan Vaez
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Unit of Mental Health, Children and Youth, The Public Health Agency of Sweden, Solna, Sweden
| | - Prue Cauley
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, P.box 181, 0409 Oslo, Nydalen Norway
| | - Anna-Karin Eriksson
- Unit of Mental Health, Children and Youth, The Public Health Agency of Sweden, Solna, Sweden
| | - Fredrik Saboonchi
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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49
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Walg M, Angern JS, Michalak J, Hapfelmeier G. [Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:369-379. [PMID: 32880227 DOI: 10.1024/1422-4917/a000749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial Abstract. Unaccompanied minor refugees (UMR) are a group particularly vulnerable to mental illness. They pose a great challenge not only for child and youth psychiatric and psychotherapeutic care, but also for youth-welfare institutions. The study examines the effectiveness of Stabilization Training for Adolescent Refugees with Trauma Induced Disorders in inpatient youth-welfare facilities. Methods: We conducted a randomized controlled trial with pre-post design in a naturalistic setting, randomly assigning 9 housing groups for UMRs to the intervention or waiting control condition. The mental stress of 46 UMRs was assessed by both self-report and educational staff-report. Two educational staff members conducted the Stabilization Training for Adolescent Refugees with Trauma Induced Disorders as an intervention in each of the respective residential groups. Results: Participation in training led to a reduction in subjective general psychological stress. At the end of the training, psychological stress in self-judgment was significantly lower in the intervention group than in the waiting control condition. The effectiveness of the training is apparently not reflected by educational staff assessments. Conclusions: Stabilization training is a suitable instrument for the preclinical care of UMR and thus an essential basis for further psychotherapy.
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Affiliation(s)
- Marco Walg
- Zentrum für seelische Gesundheit des Kindes- und Jugendalters, Sana-Klinikum Remscheid
| | - Johanna Sophie Angern
- Zentrum für seelische Gesundheit des Kindes- und Jugendalters, Sana-Klinikum Remscheid
| | - Johannes Michalak
- Department für Psychologie und Psychotherapie, Universität Witten/Herdecke
| | - Gerhard Hapfelmeier
- Zentrum für seelische Gesundheit des Kindes- und Jugendalters, Sana-Klinikum Remscheid
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50
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Distorted Time Perspective in Adolescent Afghan and Syrian Refugees Is Associated With Psychological Distress. J Nerv Ment Dis 2020; 208:729-735. [PMID: 32541396 DOI: 10.1097/nmd.0000000000001194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Young refugees are a high-risk group for mental disorders, particularly for posttraumatic stress disorder (PTSD). Individuals with PTSD suffer from an altered time perspective with a focus on negative experiences in the past and a disregard for positive life events and the future. This study investigates time perspectives and psychological distress in 30 adolescent refugees from Syria and Afghanistan in Germany. Time perspective was assessed using the Zimbardo Time Perspective Inventory. The refugees exhibited a distorted time perspective that is common for individuals with PTSD: a high orientation toward the negative past and a low orientation toward the positive past and future. A high orientation toward the negative past was associated with high levels of general psychological distress, PTSD symptoms, and depression. A low orientation toward the future was related to high levels of anxiety. Taking time perspective and corresponding beliefs into consideration may be advantageous when treating refugees with trauma-related disorders.
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