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Chokroverty L. Management of Psychiatric Emergencies Among Migrant Youth in Institutional and Community Settings. Child Adolesc Psychiatr Clin N Am 2024; 33:219-236. [PMID: 38395507 DOI: 10.1016/j.chc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Migrant youth commonly access mental health care for the first time during emergencies, rather than through ambulatory means. Suicidal behaviors may occur more often among migrants than nonmigrant youth, and they may suffer from post-traumatic stress, depression, anxiety, and display disruptive behaviors more frequently than their nonmigrant counterparts. Brief emergency interventions include safety planning, psychoeducation, parent training on communication and establishing routines, and behavioral therapies like activity scheduling and sleep hygiene.
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Affiliation(s)
- Linda Chokroverty
- Department of Psychiatry and Behavioral Sciences, Montefiore Health Systems/ Albert Einstein College of Medicine, Bronx, NY, USA; Department of Pediatrics, Montefiore Health Systems/ Albert Einstein College of Medicine, Bronx, NY, USA.
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Andrade AS, Roca JS, Pérez SR. Children's Emotional and Behavioral Response Following a Migration: A Scoping Review. J Migr Health 2023; 7:100176. [PMID: 37034241 PMCID: PMC10074795 DOI: 10.1016/j.jmh.2023.100176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/03/2023] [Accepted: 03/08/2023] [Indexed: 03/22/2023] Open
Abstract
Background Migration is a present and pressing global phenomenon, as climate change and political instability continue to rise, more populations will be forced to relocate. Efficient strategies must be in place to aid the transition of vulnerable populations - such as children - and strategic interventions designed based on an understanding of their particular needs and risks. Aim of the review This article reviewed recent research regarding the mental health of migrant children identifying a wide array of common characteristics to their emotional and behavioral responses following a migration, and compiled an extensive list of protective and risk factors. 48 studies were selected from Proquest, WOS, SCOPUS, and Pubpsych published between 2015 and 2022 covering studies of children around the world. Findings The migration-related factors that most negatively impacted children's mental health were experiences such as discrimination, loss of access to governmental and educational resources, premigration trauma, loss of community, cultural distance and acculturation, the burden on the family unit, and socioeconomic difficulties. Thus, with the right interventions and policy changes, it is possible to make migration a non-traumatic experience in order to avoid the common emergence of depressive symptoms, PTSS (post-traumatic stress symptoms), anxiety, and other mental health issues. Supporting the family unit's transition, encouraging peer connections, and directing government aid to expedite resources upon arrival will serve as protective factors for children while they integrate into their new environment.
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Affiliation(s)
- Alejandra Salazar Andrade
- Universitat Autònoma de Barcelona Department of Basic, Developmental and Educational Psychology, Spain
- Corresponding author.
| | - Josefina Sala Roca
- Department of Educational Theories and Social Pedagogy, Universitat Autònoma de Barcelona, Spain
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Özlü-Erkilic Z, Diehm R, Wenzel T, Bingöl Ҫağlayan RH, Güneş H, Üneri ÖŞ, Winter S, Akkaya-Kalayci T. Transcultural differences in suicide attempts among children and adolescents with and without migration background, a multicentre study: in Vienna, Berlin, Istanbul. Eur Child Adolesc Psychiatry 2022; 31:1671-1683. [PMID: 34050830 PMCID: PMC9666344 DOI: 10.1007/s00787-021-01805-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
While suicide can occur throughout the lifespan, worldwide suicide is the second leading cause of death among young people aged between 15 and 29 years. The aim of this multicentre study, conducted in Austria, Germany and Turkey, is to investigate the transcultural differences of suicide attempts among children and adolescents with and without migration background. The present study is a retrospective analyses of the records of 247 young people, who were admitted after a suicide attempt to Emergency Outpatient Clinics of Departments of Child and Adolescent Psychiatry of the collaborating Universities including Medical University of Vienna, Charité University Medicine Berlin and Cerrahpaşa School of Medicine and Bakirkoy Training and Research Hospital for Mental Health in Istanbul over a 3-year period. The results of the present study show significant transcultural differences between minors with and without migration background in regard to triggering reasons, method of suicide attempts and psychiatric diagnosis. The trigger event "intra-familial conflicts" and the use of "low-risk methods" for their suicide attempt were more frequent among patients with migration background. Moreover among native parents living in Vienna and Berlin divorce of parents were more frequent compared to parents living in Istanbul and migrants in Vienna. These results can be partly explained by cultural differences between migrants and host society. Also disadvantages in socio-economic situations of migrants and their poorer access to the healthcare system can mostly lead to acute and delayed treatments. Larger longitudinal studies are needed to understand better the impact of migration on the suicidal behaviour of young people.
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Affiliation(s)
- Zeliha Özlü-Erkilic
- Department of Child and Adolescent Psychiatry, Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Robert Diehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Wenzel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - R Hülya Bingöl Ҫağlayan
- Department of Child and Adolescents Psychiatry, Cerrahpaşa School of Medicine, İstanbul University-Cerrahpaşa, Kocamustafapasa Cd. No: 53, Fatih, Istanbul, Turkey
| | - Hatice Güneş
- Department of Psychology, İstanbul Gelisim University, Cihangir Mahallesi Şehit Jandarma Komando Er Hakan Oner Sk. No:1, Avcilar, Istanbul, Turkey
- Department of Child and Adolescent Psychiatry, Bakirkoy Training and Research Hospital for Mental Health and Neurological Disorders, Zuhuratbaba Mah. Dr Tevfik Sağlam Cad. No:25/2, Bakirköy, Istanbul, Turkey
| | - Özden Şükran Üneri
- Department of Child and Adolescents Psychiatry, Ankara City Hospital, AYBÜ Ankara Şehir Hastanesi Çocuk Hastanesi 06800 Bilkent, Ankara, Turkey
| | - Sibylle Winter
- Departement of Child and Adolescent Psychiatry, Psychsomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Virchow, Augustenbruger Platz 1, 13353, Berlin, Germany
| | - Türkan Akkaya-Kalayci
- Department of Child and Adolescent Psychiatry, Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Flury RM, Brockhus L, Müller M, Henssler J, Exadaktylos AK, Klukowska-Rötzler J. Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13196. [PMID: 36293777 PMCID: PMC9602638 DOI: 10.3390/ijerph192013196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems than adults. The study at hand aimed to characterise those adolescents presenting to the ED triaged with a chief complaint regarding mental health. Furthermore, the goal was to assess sex differences in terms of diagnosis, suicidal ideation, substance use, as well as social impact. METHODS We conducted a single-centre, retrospective review of presentations to our adult ED related to the mental health of adolescents aged 16 to 18 years, covering the period from January 2013 to July 2017. Anonymised data were extracted from medical reports referring to the ED visits that were triaged as mental-health-related, and we assessed these for diagnosis, acute and previous suicidal ideation, history of self-harm, external aggression, substance use and social problems. We focused on patient characterisation and defining sex differences. RESULTS Data were analysed for a total of 612 consultations by adolescents who presented to our ED with problems related to mental health. Women accounted for 61.1% of cases. The most frequent diagnoses were reactions to severe stress and adjustment disorders (19.1%), followed by alcohol use disorders (17.6%), intentional self-harm (17.3%), and affective disorders (13.7%). Males had lower odds for intentional self-harm (OR 0.10, 95% 0.05-0.21, p < 0.001) as well as disorders of personality and behaviour (OR 0.09, 95% 0.21-0.37, p < 0.001), whereas they had higher odds of being admitted due to use of alcohol (OR 2.51, 95% 1.65-3.83, p < 0.001). Of all cases, 31.7% reported acute suicidal ideation, with a significantly lower odds ratio in males (OR 0.58, 95% 0.41-0.84, p = 0.004). The most common source for referral to the ED was family members (25.2%). Males had twice the odds of reporting alcohol consumption as well as use of cannabis (in both cases p < 0.001). In 27.9% of all cases, familial problems were reported, with males having significantly lower odds of being exposed to these (OR 0.64, 95% 0.44-0.94, p = 0.021), whereas they had higher odds of reporting educational problems (OR 1.68, 95% 1.04-2.72, p = 0.035). CONCLUSIONS Adolescents aged sixteen to eighteen years presenting to the ED with problems related to mental health are an important subgroup of ED presentations and should be thoroughly assessed for suicidal ideation, substance use, as well as familial and educational problems. Assessment and establishment of post-ED care are of particular importance in this vulnerable patient group.
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Affiliation(s)
- Raffaela M. Flury
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
| | - Lara Brockhus
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
| | - Jonathan Henssler
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, DE-50937 Cologne, Germany
- Charité University Medicine, St Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, DE-10117 Berlin, Germany
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
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Schwarz T, Schmidt AE, Bobek J, Ladurner J. Barriers to accessing health care for people with chronic conditions: a qualitative interview study. BMC Health Serv Res 2022; 22:1037. [PMID: 35964086 PMCID: PMC9375930 DOI: 10.1186/s12913-022-08426-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 08/05/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to gain a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es in Austria's fragmented social health insurance system. METHODS Using a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (persons with lived/ personal experience, i.e., service users, patient advocates or family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque's model of access, a conceptual framework used to evaluate access broadly according to different dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness. RESULTS The findings from the 25 expert interviews were organised within Levesque's conceptual framework. They highlight a lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, and throughout the care process. On the supply side, patterns of poor patient-provider communication, lack of a holistic therapeutic approach, an urban-rural divide, strict separation between social care and the healthcare system and limited consultation time were among the barriers identified. On the demand side, patients' ability to perceive a need and to subsequently seek and reach healthcare services was an important barrier, closely linked to a patient's socio-economic status, health literacy and ability to pay. CONCLUSIONS While studies on unmet needs suggest a very low level of barriers to accessing health care in the Austrian context, our study highlights potential 'invisible' barriers. Barriers to healthcare access are of concern for patients with chronic conditions, underlining existing findings about the need to improve health services according to patients' specific needs. Research on how to structure timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care would be paramount.
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Affiliation(s)
- Tanja Schwarz
- Austrian National Public Health Institute, Addiction Competence Centre, Stubenring 6, 1010, Vienna, Austria
| | - Andrea E Schmidt
- Austrian National Public Health Institute, Competence Centre on Climate and Health, Stubenring 6, 1010, Vienna, Austria.
| | - Julia Bobek
- Austrian National Public Health Institute, Health Economics and Health Systems Analysis, Stubenring 6, 1010, Vienna, Austria
| | - Joy Ladurner
- Austrian National Public Health Institute, Psychosocial Health, Stubenring 6, 1010, Vienna, Austria
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Vloet TD, Fekete S, Gerlach M, Romanos M. [The Pharmacological Management of Emergencies in Child and Adolescent Psychiatry]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2021; 50:262-274. [PMID: 34668770 DOI: 10.1024/1422-4917/a000833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Pharmacological Management of Emergencies in Child and Adolescent Psychiatry Abstract. Emergencies in child and adolescent psychiatry are highly prevalent and often pose significant challenges to physicians, since substantial danger to the patient or others must be avoided through the application of largely moderate interventions. Besides using de-escalating strategies and exploiting psychotherapeutic options, the physician frequently employs psychopharmacological interventions. because of a lack of systematically assessed data, however, in emergencies in child and adolescent psychiatry most administrations of psychotropic drugs occur "off label." This review deduces practice-relevant recommendations for the pharmacological management of occurring child and adolescent emergencies such as acute suicidality, acute psychotic episodes, delirium, disorders of consciousness, acute intoxication, and alcohol withdrawal syndrome. We discuss the issue of quality and safety in pharmacological emergency strategies.
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Affiliation(s)
- Timo D Vloet
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg
| | - Stefanie Fekete
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg
| | - Manfred Gerlach
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg
| | - Marcel Romanos
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg
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Characterizing individuals accessing mental health services in the UAE: a focus on youth living in Dubai. Int J Ment Health Syst 2021; 15:29. [PMID: 33789685 PMCID: PMC8011192 DOI: 10.1186/s13033-021-00452-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background Most mental health issues develop during adolescence, therefore identifying youth mental health needs and pathways to care is critical to improve prevention. To date, studies have typically focused on Western samples, while the impact of cultural diversity on perception of health and illness, and pathways to care, remain poorly understood. To address the shortage of studies conducted in the Arab world, and particularly in the United Arab Emirates (UAE), the present investigation aims to identify the characteristics of youth accessing mental health services in Dubai. Methods Data was collected retrospectively from patients’ records at Rashid Hospital Child Psychiatry Service. Information collected included demographics, life stressors, symptoms duration, main diagnosis, and presence/absence of psychotic features in patients’ symptomatology. The relationship between demographic and clinical variables was explored using Chi-square tests and negative binomial regression models. Results The sample included 99 treatment-seeking young patients (mean age 15.3; SD = 1.7); 47.5 % were Emirati (UAE national) and 52.5 % were non-Emirati patients. In our treatment-seeking youth sample Depressive disorders represented the most frequent diagnosis, followed by Bipolar and related disorders, Anxiety and stress related disorders, and Schizophrenia and psychotic disorders. Compared to Emirati patients, non-Emirati patients were more likely to report relationships with friends as a source of stress. Female help-seekers, compared to males, were more likely to report stressful relationships with family members, and to receive a diagnosis of Depressive disorders. The duration of symptoms before seeking help was significantly predicted by family stress, gender, self-harm behavior, a symptomatology with psychotic features, and a diagnosis of Anxiety disorders. Conclusions The present study contributes to characterizing youth accessing mental health services at Rashid Hospital’s Child Psychiatry service in Dubai. An overall prevalence of poor family functioning among help-seeking youth, and the importance of peer support for expatriate youth were highlighted. Gender differences in perceived stressors, diagnoses and help-seeking behavior suggest the need to promote help-seeking among young boys. While presentation with psychotic features seems to lead to quicker access to medical care, self-harm and anxiety appear to delay help-seeking. The potential implications of our results for promoting youth wellbeing in the region are discussed.
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Akkaya-Kalayci T, Kothgassner OD, Wenzel T, Goreis A, Chen A, Ceri V, Özlü-Erkilic Z. The Impact of the COVID-19 Pandemic on Mental Health and Psychological Well-Being of Young People Living in Austria and Turkey: A Multicenter Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239111. [PMID: 33291276 PMCID: PMC7730981 DOI: 10.3390/ijerph17239111] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 01/10/2023]
Abstract
Little is known about the impact of the COVID-19 pandemic on the mental health and psychological well-being of young people. The aim of this study is to investigate the psychological well-being and changes in the mental-health state of young people living in Austria and Turkey. By using an anonymous online survey, we recruited 1240 people aged 15-25 years from these two countries. We used the "Psychological General Well-being" and a self-created questionnaire to capture individual experiences during the COVID-19 pandemic and quarantine period. The native Turks indicated higher "anxiety" (ps < 0.010), lower "vitality" (ps < 0.011), and lower "general health" (ps < 0.011) than native Austrians or Austrian migrants and increased "depression" (p = 0.005) and lower "self-control" (p = 0.022), than Austrian migrants. Moreover, 50.9% of native Turks reported a decrease in their mental health status, compared to 31.1% of native Austrians and 23.7% of Austrian migrants. Participants with financial problems (OR = 1.68) and prior mental health problems (i.e., already in treatment by the time of COVID-19, OR = 5.83) reported a higher probability for a worsening in their mental health status. Our results show that the COVID-19 pandemic impaired the psychological well-being and mental health of young people. Especially people in Turkey were most affected, probably due to the stringent policies to fight COVID-19.
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Affiliation(s)
- Türkan Akkaya-Kalayci
- Department of Child and Adolescent Psychiatry, Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
| | - Thomas Wenzel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Scientific Section on Psychological Aspects of Torture and Persecution, World Psychiatric Association (WPA), 1226 Thônex, Switzerland;
| | - Andreas Goreis
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria;
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Anthony Chen
- Scientific Section on Psychological Aspects of Torture and Persecution, World Psychiatric Association (WPA), 1226 Thônex, Switzerland;
| | - Veysi Ceri
- Department of Child Development, Faculty of Health Sciences, Batman University, Batman Üniversitesi, Merkez Kampüsü, 72060 Batman, Turkey;
| | - Zeliha Özlü-Erkilic
- Department of Child and Adolescent Psychiatry, Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-140-4003-0180
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Schouler-Ocak M, Graef-Calliess IT, Bajbouj M, Plener PL. [Mental Disorders among Refugees]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:453-457. [PMID: 33172360 DOI: 10.1024/1422-4917/a000769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mental Disorders among Refugees Abstract. Children and adolescents with migration and refugee backgrounds are subject to various health-related, psychosocial, sociocultural, and economic burdens that may influence the prevalence, manifestation, course, and treatment as well as prognosis of mental disorders. In addition, they are particularly disadvantaged by numerous barriers to accessing the mental healthcare and treatment granted natives. The so-called transition gap only exacerbates the situation. As a solution, we provide recommendations for improving the mental healthcare of children and adolescents with a migration and refugee background analogous to the situation for adults. For inpatient settings, where mental healthcare is inadequate, we recommend the establishment of so-called adolescent wards under child and adolescent and adult psychiatric-psychotherapeutic management, with appropriate nursing and therapeutic staffing as well as a special "transition management" including the training of intercultural competence.
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Affiliation(s)
| | - Iris T Graef-Calliess
- Klinik für Allgemeinpsychiatrie und Psychotherapie, KRH Psychiatrie GmbH, KRH Psychiatrie Wunstorf
| | - Malek Bajbouj
- Klinik für Psychiatrie und Psychotherapie, CBF, Universitätsmedizin Berlin
| | - Paul L Plener
- Universitätsklinik für Kinder- und Jugendpsychiatrie der Medizinischen Universität Wien/AKH Wien
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Özlü-Erkilic Z, Wenzel T, Kothgassner OD, Akkaya-Kalayci T. Transcultural Differences in Risk Factors and in Triggering Reasons of Suicidal and Self-Harming Behaviour in Young People with and without a Migration Background. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186498. [PMID: 32906614 PMCID: PMC7557370 DOI: 10.3390/ijerph17186498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 01/20/2023]
Abstract
Minors with and without migration background can have different risk factors and triggering reasons for self-harming and suicidal behaviour. We retrospectively analysed the data of 192 children and adolescents to investigate the transcultural differences in self-harming, as well as suicidal behaviour in Austrian, Turkish, and Bosnian/Croatian/Serbian (BCS)-speaking patients, who were treated in an emergency out-patient clinic in Vienna. Our results showed transcultural differences in both behaviours. In all groups, females had higher rates of suicide attempts and self-harming behaviour than males. While Turkish-speaking patients received treatment more often, after attempted suicide, Austrians and BCS-speaking patients needed treatment more often for acute stress disorder. Suicide attempts and self-harming behaviours were triggered most frequently by intrafamilial problems, but more frequently in migrant patients. Turkish-speaking patients were at a more than 2 times (OR = 2.21, 95%CI: 1.408–3.477) higher risk for suicide attempts, and were triggered almost 3 times (OR = 2.94, 95%CI: 1.632–5.304) more often by interfamilial conflicts. The suicide attempts of BCS-speaking minors were more often caused by relationship and separation crises (OR = 2.56, 95%CI: 1.148–5.705). These transcultural differences in suicidal and self-harming behaviour of minors, demand an increase of transcultural competence to provide optimal treatment of migrant children.
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Affiliation(s)
- Zeliha Özlü-Erkilic
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Wenzel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
| | - Türkan Akkaya-Kalayci
- Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria;
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
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Gutmann MT, Aysel M, Özlü-Erkilic Z, Popow C, Akkaya-Kalayci T. Mental health problems of children and adolescents, with and without migration background, living in Vienna, Austria. Child Adolesc Psychiatry Ment Health 2019; 13:35. [PMID: 31528201 PMCID: PMC6737609 DOI: 10.1186/s13034-019-0295-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to their indigenous peers, migrant children and adolescents are at increased risk for mental health problems. The aim of our study was to compare psychological disorders of children and adolescents with Turkish migration background and their native Austrian peers. METHODS We analysed 302 children and adolescents aged between 7 and 18 years. The sample consisted of 100 Austrian and 100 Turkish outpatients with mental health problems, and 102 healthy controls, 52 with Austrian and 50 with Turkish background, recruited from various Viennese local child and youth centres. RESULTS Native patients had more frequently externalizing problems (42.1%) compared to the Turkish-speaking sample (28%). However, in the control group, Turkish-speaking children and adolescents had higher levels of internalizing, depressive and anxiety symptoms compared to their native peers. CONCLUSIONS We found noticeable differences in psychological problems among children and adolescents with and without migration background. We assume that migration-related stress factors are responsible for these differences. Also, children and adolescents with migration background seek for psychological help less frequently than their indigenous peers.
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Affiliation(s)
- Maria Teresa Gutmann
- 0000 0004 0520 9719grid.411904.9Department of Child and Adolescent Psychiatry and Psychotherapy, General Hospital Baden-Mödling, Fürstenweg 8, 2371 Hinterbrühl, Austria
| | - Metin Aysel
- 0000 0004 1937 0650grid.7400.3Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Rämistrasse 71, 8006 Zurich, Switzerland
| | - Zeliha Özlü-Erkilic
- 0000 0000 9259 8492grid.22937.3dOutpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Christian Popow
- 0000 0000 9259 8492grid.22937.3dDepartment of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Türkan Akkaya-Kalayci
- 0000 0000 9259 8492grid.22937.3dOutpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Shrestha AK, Özlü-Erkilic Z, Popow C, Ohmann S, Akkaya-Kalayci T. Transcultural differences of psychologically traumatised children and adolescents. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2019; 33:61-71. [PMID: 30707405 PMCID: PMC6561986 DOI: 10.1007/s40211-019-0300-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/05/2019] [Indexed: 01/05/2023]
Abstract
Background The symptoms following a traumatic event as well as the coping strategies can be culture specific. The objective of the present study was to analyse the transcultural differences of psychologically traumatized children and adolescents with and without migration background. Methods The medical files of 199 psychologically traumatized children and adolescents (99 native Austrian, 100 Turkish-speaking) who were treated at the Department of Child and Adolescent Psychiatry in Vienna were retrospectively analysed. Results The most frequently observed causes of trauma in patients with Turkish migration background were intra-familial conflicts, forced separation from parent(s), and conforming to a new environment. In native Austrian patients, forced separation from parent(s) and divorce or separation of parents were the leading causes of trauma. Trauma-related symptoms like changed mood, cognitive and perceptual disturbance, social withdrawal, sleeping problems, somatisation and behavioural problems were similarly observed in both groups; “sleeping problems” were more often observed in Austrian patients, and “behavioural problems” were more often observed in Turkish patients. More Austrian patients (32.7%) obtained psychiatric and psychotherapeutic treatment. Turkish-speaking patients mostly obtained psychiatric treatment only. Patients with migration background were more compliant compared to indigenous patients. Conclusions Both study groups differed in type, causes and symptoms of trauma, and in preferred therapy. Turkish-speaking patients were more compliant with therapy, as they received culture and language-sensitive medical advice and treatment in their mother tongue. Considering the cultural background of patients can optimize service delivery and therapy outcomes among children and adolescents with stressful and traumatic experiences.
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Affiliation(s)
- Amesh K Shrestha
- Department of Urology, General Hospital of Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - Zeliha Özlü-Erkilic
- Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian Popow
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Türkan Akkaya-Kalayci
- Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Franzen M, Keller F, Brown RC, Plener PL. Emergency Presentations to Child and Adolescent Psychiatry: Nonsuicidal Self-Injury and Suicidality. Front Psychiatry 2019; 10:979. [PMID: 32010000 PMCID: PMC6978280 DOI: 10.3389/fpsyt.2019.00979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
Nonsuicidal Self-Injury (NSSI) and suicidality are common reasons for emergency presentations in child and adolescent psychiatry. Therefore, we focused on reasons for emergency presentations as well as specific characteristics of those presenting with NSSI or suicidality to an emergeny psychiatric service. We analyzed data from a German university hospital regarding emergency presentations during a 78 months' period. NSSI and suicidality were rated according to the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Data from 546 emergency presentations was recorded, of which 347 (63.5%) presented for NSSI or suicidality. Given the high percentage, thorough assessment of sucidality as well as providing adequate treatment in emergency settings to establish further care, is of utmost importance.
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Affiliation(s)
- Monika Franzen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.,Department of Ear-Nose-Throat, Vidia Hospital Karslruhe, Karslruhe, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Rebecca C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
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Akkaya-Kalayci T, Kapusta ND, Winkler D, Kothgassner OD, Popow C, Özlü-Erkilic Z. Triggers for attempted suicide in Istanbul youth, with special reference to their socio-demographic background. Int J Psychiatry Clin Pract 2018; 22:95-100. [PMID: 28899223 DOI: 10.1080/13651501.2017.1376100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Suicidal behavior of young people is a topic of utmost importance because suicide is irreversible, and should be prevented. Knowing about the psychosocial background and the triggering events could help in preventing suicidal behavior. We therefore aimed at identifying psychosocial factors that may trigger suicidal behavior in youth. METHODS We analyzed retrospectively the standardized records of 2232 youths aged ≤25 years, who were treated after a suicide attempt at emergency units of public hospitals in Istanbul, Turkey during a period of 1 year. We describe this population according to sex and socio-economic conditions, like educational, occupational, relationship status and link them with their reported reasons for suicide attempts. RESULTS The majority of patients were female (81.6%, N = 1822 females, 18.4%, N = 410 males). Independent of their educational and occupational background, patients indicated most frequently intra-familial problems (females 45.8%, males 30.5%), intrapersonal problems (females 19.9%, males 18.5%), and relationship problems (females 11.3%, males 23.9%) as triggering reasons. CONCLUSIONS Because intra-familial problems were the most frequently reported triggers of suicide attempts, preventive measures should focus on handling intra-familial conflicts. As sex differences were observed for the second-most common trigger-reasons, prevention should also focus on differentially handling intrapersonal and relationship conflicts better.
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Affiliation(s)
- Türkan Akkaya-Kalayci
- a Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Nestor D Kapusta
- b Department of Psychoanalysis and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Dietmar Winkler
- c Department for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Oswald D Kothgassner
- d Division of Clinical Psychology , Medical Directorate of the Vienna General Hospital - Medical University Campus , Vienna , Austria.,e Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Christian Popow
- e Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Zeliha Özlü-Erkilic
- a Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
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