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Andersson J, Kankaanpää R, Peltonen K, Münger AC, Korhonen L. Examining heterogeneity: A systematic review of quantitative person-centered studies on adversity, mental health, and resilience in children and young adults with refugee backgrounds. Compr Psychiatry 2024; 135:152522. [PMID: 39142243 DOI: 10.1016/j.comppsych.2024.152522] [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: 03/16/2024] [Revised: 06/22/2024] [Accepted: 08/04/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Child and young adult refugees are a heterogeneous group comprising both vulnerable and resilient individuals. Person-centered statistical methods could help disentangle this heterogeneity, enabling tailored interventions. This systematic review examined person-centered studies on adversity, mental health, and resilience in children and young adults with refugee backgrounds to identify subgroups and assess their theoretical and practical relevance. METHODS The strategy included three search blocks: 1) refugee, 2) child and/or youth, and 3) person-centered method. Studies were identified through searches of PubMed, Academic Search Complete, Scopus, PsycINFO, CINAHL, ERIC, and Cochrane. The search included all published studies until December 2023. Studies were eligible for review if they used adversity, mental health or resilience variables as indicators in a person-centered analysis. The study population needed to have a refugee background with a mean age of ≤25. The reporting quality of the studies was assessed using the adapted version of the Guidelines for Reporting on Latent Trajectory Studies (GRoLTS) checklist. The results were analyzed in a narrative format and using summary tables. RESULTS A total of 6706 studies were initially identified, of which seven were eligible for review. The studies included 2409 individuals and were conducted in refugee camps, communities, and institutional and clinical settings across Africa, the Middle East, Europe, Asia, and North America. Five of the seven studies included adversity as an indicator, and three articles mental ill-health. Only one article specifically investigated resilience. All studies identified subgroups, but the findings regarding predictors of group membership were inconclusive. Risks for adverse outcomes, such as mental health problems, also varied across subgroups. The studies generally displayed inadequate reporting of important methodological aspects of the data analysis, a lack of theoretical consideration, and an absence of reliability testing. CONCLUSIONS The use of person-centered approaches in research on children and young adults with refugee backgrounds, focusing on adversity, mental health, and resilience, is currently limited. Nevertheless, the reviewed studies provided valuable insights into subgroups within this population, indicating that person-centered approaches can be employed when studying this group. Future research should consider theory and prior knowledge in the selection of the final number of groups, thoroughly report quality criteria, and rigorously test the reliability of classes.
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Affiliation(s)
- Johan Andersson
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Reeta Kankaanpää
- INVEST Research Flagship Centre, University of Turku, Turku, Finland
| | - Kirsi Peltonen
- INVEST Research Flagship Centre, University of Turku, Turku, Finland
| | - Ann-Charlotte Münger
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Center for Social and Affective Neuroscience 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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Harrison S, Chenhall RD, Block K, Rashid SF, Vaughan C. The impact of humanitarian emergencies on adolescent boys: Findings from the Rohingya refugee crisis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003278. [PMID: 38833449 PMCID: PMC11149876 DOI: 10.1371/journal.pgph.0003278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/05/2024] [Indexed: 06/06/2024]
Abstract
Adolescent boys (age 9-19) are impacted differently by humanitarian emergencies. However, academic research on adolescent health and child protection has tended to focus on the direct impacts of an emergency rather than indirect impacts that may arise after a crisis. We sought to identify child protection concerns affecting adolescent boys in emergency settings and boys who are more vulnerable to harm through a case study of the humanitarian response to the 2017 Rohingya refugee crisis. We collected data in the Rohingya refugee crisis in Cox's Bazar, Bangladesh between 2018-2019. This included six months of participant observation, 23 semi-structured interviews and 12 informal ethnographic interviews with humanitarian staff working in the crisis, and 10 focus group discussions with a total of 52 child protection caseworkers from four child protection organisations. Our results showed that adolescent Rohingya boys were exposed to numerous protection concerns, including child labour, drug trafficking, substance abuse, family violence, and neglect. We classified these into three main typologies: community-related violence, income-related violence, and life-stage vulnerabilities. We found that adolescent boys who were unaccompanied or separated from their caregivers, adolescent boys who were members of vulnerable households, and adolescent boys with a disability were at more risk of harm. Our findings indicate that adolescent boys are exposed to an array of impactful child protection concerns in humanitarian emergencies and that this has implications for the delivery of public health and child protection interventions. We believe that humanitarian actors should improve recognition of the complexity of adolescent boys' lives and their exposure to gender and age-based harm as a critical matter for addressing adolescent health equity.
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Affiliation(s)
- Shane Harrison
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Dean Chenhall
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Block
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Cathy Vaughan
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Mohammadi F, Oshvandi K, Shamsaei F, Khodaveisi M, Khazaei S, Masoumi SZ. Child exposure to domestic violence, substance dependence and suicide resilience in child laborers. BMC Public Health 2023; 23:467. [PMID: 36899324 PMCID: PMC10007756 DOI: 10.1186/s12889-023-15367-7] [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: 03/22/2022] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Child laborers are often defined as work that deprives children of their childhood, their potential and their dignity, and that is harmful to physical and mental development. Child laborers are one of the most vulnerable groups in domestic violence. Domestic violence severely affects the physical and mental health, and consequently affects substance dependence and resilience to suicide of these children. Accordingly, it is essential to examine domestic violence, substance dependence, and suicidal ideation in working children. OBJECTIVES the present study aimed to investigate the relationship between exposure to domestic violence and substance dependence and suicide resilience on the other among child laborers in Iran. METHODS This study employed cross-sectional research. 600 child laborers were selected via convenience and snow ball sampling from one rehabilitation and welfare center and three charity organization societies in the west of Iran, from January to August 2022. They completed questionnaires. Data were analyzed by SPSS software version 22 and with using descriptive statistics (frequency, percentage, mean and standard deviation) and ANOVA, independent t-test and the multiple linear regression model with a backward strategy. RESULTS Findings showed that exposure to domestic violence has a strong and direct correlation with substance dependence (r = 0.94, p < 0.001) and strong and indirect correlation with suicide resilience (r =- 0.91, p < 0.001). Also substance dependence has a strong and direct correlation with suicide resilience (r = -0.87, p < 0.001) in child laborers. Variables of substance dependence, suicide resilience, gender, guardian's disease status, living status and age can predict 76.51% of the variance in domestic violence in these children. CONCLUSION Child laborers experience a lot of domestic violence, which severely affects their suicide resilience and substance dependence in them. Therefore, there is an urgent need for systematic support programs with content (teaching self-care behaviors, stress management, avoiding tense and violent environments) in order to support of these children and reduce domestic violence against them and subsequently reduce substance improve abuse resilience to suicide in these children.
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Affiliation(s)
- Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Institute of Mental Health and Addiction, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Khodaveisi
- Chronic Diseases (Homecare) Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Health Sciences Research Center, Health Sciences & Technology Research Institute, Hamadan University of Medical Science, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Malama K, Logie CH, Okumu M, Hakiza R, Mwima S, Kyambadde P. Factors associated with motherhood among urban refugee adolescent girls and young women in informal settlements in Kampala, Uganda. Women Health 2023; 63:51-58. [PMID: 36529708 DOI: 10.1080/03630242.2022.2158411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa face a high risk of unintended pregnancy. This risk is compounded in informal settlements, where resources are scarce and access to sexual and reproductive health services is limited. Being a young mother in informal settlements could exacerbate existing experiences of resource scarcity and poor access to sexual and reproductive health services. To explore this, we analyzed the factors associated with motherhood among refugee AGYW in Kampala, Uganda. Between January and March 2018, peer researchers recruited refugee youth aged 15-24 and living in five informal settlements in Kampala to participate in this study. We used a backwards generalized linear model with a log binomial regression to determine if mental health, resource insecurity and sexual and reproductive health variables were associated with motherhood among study participants. Our analysis included 333 AGYW with a mean age of 19.3 years (standard deviation: 2.6). Nearly one-quarter (23 percent; n = 76) of AGYW had children. Having children was associated with greater likelihood of reporting food insecurity (adjusted prevalence ratio [aPR]: 1.96, 95 percent confidence interval [CI]: 1.07-3.61), depressive symptoms (aPR: 2.03, 95 percent CI: 1.09-3.80), and contraception uptake (aPR: 2.37, 95 percent CI: 1.58-3.56) compared to not having children. Mental health and resource insecurity interventions are required for refugee AGYW with children in informal settlements. Sexual and reproductive health services should be promoted to refugee AGYW regardless of motherhood status to prevent unplanned pregnancy.
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Affiliation(s)
- Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.,Department of Social Work and Social Administration Uganda Christian University, Mukono, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development, Kampala, Uganda
| | - Simon Mwima
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.,AIDS Control Program Republic of Uganda Ministry of Health, Kampala, Uganda
| | - Peter Kyambadde
- Most At Risk Population Initiative Mulago Hospital, Kampala, Uganda
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Meyer SR, Stark L. Development of an index to measure the strength of child protection Systems in Refugee Settings: Conceptual and practical considerations. CHILD ABUSE & NEGLECT 2022; 134:105920. [PMID: 36371849 DOI: 10.1016/j.chiabu.2022.105920] [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: 07/02/2021] [Revised: 09/02/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The United Nations Refugee Agency [UNHCR] implements a Framework for Child Protection for refugee children, based on a child protection systems-strengthening approach. Measurement of child protection system strength in humanitarian contexts is nascent, and existing methodologies do not capture the multiple components of the Framework. OBJECTIVE To develop, pilot and refine a measure of child protection system strength in humanitarian contexts. PARTICIPANTS AND SETTING The Child Protection Index [CPI] was implemented in two humanitarian contexts - Kiziba Camp, Rwanda and Kiryandongo and Adjumani refugee camps, Uganda, at two time points [Time 1 = T1; Time 2 = T2]. Data collection in Kiziba camp was conducted in December 2013 and October/November 2015, and in Kiryandongo and Adjumani in December 2014/February 2015 and June-August 2016. Participants were staff members of international non-governmental organizations (T1: n = 17, T2: n = 29), local non-governmental organizations (T1: n = 3, T2: n = 2), Government bodies (T1: n = 3, T2: n = 3) and United Nations agencies (T1: n = 14, T2: n = 9) who were purposively selected to respond to the items included in the CPI. Selection was made on the basis of identifying individuals with the most knowledge and expertise to address the questions in the CPI. METHODS We conducted a qualitative study, conducting key informant interviews based on an interview guide developed to address the items in the CPI, and tailored to the expertise of each key informant. The CPI included scoring, to translate key informants' responses to numerical scores of child protection system strength. RESULTS The pilot test conducted in Kiziba Camp indicated moderate child protection system strength, with a score of 61/100. At T2, results indicated a change in CPI score of +18.5 to 79.5. At T1, Kiryandongo refugee settlement received a total of 46/100 on the CPI, and at T2, the score improved by 13.5 points. At T1, Adjumani refugee settlement scored a total of 60/100, and at T2, received a total score change of +4.5. CONCLUSIONS Findings from implementation, adaptation, and evaluation of the CPI offer valuable insights about practicality, validity and potential breadth of measurement of child protection system strengthening in humanitarian settings.
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Affiliation(s)
- Sarah R Meyer
- Mailman School of Public Health, Columbia University, New York, NY, United States; Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377, München, Germany
| | - Lindsay Stark
- Brown School at Washington University in St Louis, St Louis, MO, United States.
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Sultana ZZ, Arefin A, Hossain A. Addressing child protection issues in Bangladesh's Rohingya and host community to improve children's health. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 5:100070. [PMID: 37383670 PMCID: PMC10306008 DOI: 10.1016/j.lansea.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
| | - Adittya Arefin
- Global Health Institute, North South University, Dhaka 1229, Bangladesh
| | - Ahmed Hossain
- Global Health Institute, North South University, Dhaka 1229, Bangladesh
- Department of Health Services Administration, University of Sharjah, United Arab Emirates
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Cohen F, Hermosilla S, Knox J, Agaba GS, Obalim G, Kajungu R, Mangen PO, Stark L. Protocol for a caregiver psychosocial support intervention for populations affected by displacement in Uganda. BMC Public Health 2021; 21:932. [PMID: 34001055 PMCID: PMC8127267 DOI: 10.1186/s12889-021-10921-7] [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] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Child psychological distress in refugee settings is a significant public health concern, which is exacerbated by poor caregiver mental health and functioning. However, there are limited studies about effective interventions to improve caregiver mental health in support of child wellbeing. The objective of the current study is to evaluate the effectiveness and implementation of the Journey of Life (JoL) intervention to improve caregiver mental health in a refugee camp in Western Uganda. METHODS A waitlist-control quasi-experimental design is being implemented in the Kiryandongo refugee settlement (intervention n = 600, control n = 600). Caregiver mental distress, measured using the Kessler-6, was selected as the primary outcome. Secondary outcomes include (a) functioning measured by the World Health Organization Disability Assessment Schedule, (b) social support measured by the Medical Outcomes Study Social Support Survey, and (c) caregiving behaviors according to the Parental Acceptance and Rejection Questionnaire and the Child Protection Index. The study aims to examine the implementation of the JoL intervention through qualitative assessments of intervention feasibility, adaptations, and reach. DISCUSSION This trial will add much-needed evidence for the implementation of caregiver psychosocial programming within the humanitarian community. Findings will be disseminated amongst local, regional, and global actors in order to guide potential scale up within humanitarian settings. TRIAL REGISTRATION Clinical Trials NCT04817098 (Registered: 3/24/21).
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Affiliation(s)
- Flora Cohen
- Washington University in St. Louis, Box 1196, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | | | - Justin Knox
- Columbia University, New York, NY, 10027, USA
| | - Gary Samuel Agaba
- Transcultural Psychosocial Organization Uganda, P.O. Box 21646, Kampala, Uganda
| | - Grace Obalim
- Transcultural Psychosocial Organization Uganda, P.O. Box 21646, Kampala, Uganda
| | - Rehema Kajungu
- Transcultural Psychosocial Organization Uganda, P.O. Box 21646, Kampala, Uganda
| | | | - Lindsay Stark
- Washington University in St. Louis, Box 1196, 1 Brookings Drive, St. Louis, MO, 63130, USA.
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A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents. Clin Psychol Rev 2020; 83:101930. [PMID: 33186775 DOI: 10.1016/j.cpr.2020.101930] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 10/13/2020] [Indexed: 12/22/2022]
Abstract
In the past decade, millions of children and adolescents have been forced to flee from protracted or newly erupted violent conflicts. Forcibly displaced children are particularly vulnerable for developing mental health problems. However, a timely and systematic review of the current evidence is lacking. We conducted a systematic review of factors contributing to the mental health of refugee children across different socio-ecological levels (individual, family, community, sociocultural). We systematically searched the databases Medline, PsycINFO, Web of Science, and Cochrane for English studies published in peer-reviewed journals between August 2010 and May 2020. Of the 2413 identified studies, 63 were included in the analyses. Only 24 studies were considered to be of high quality. Pre-migration individual (risk: exposure to war-related trauma, female gender) and post-migration family factors (risk: parental mental health problems and impaired parenting, protective: family cohesion) currently have the best evidence base. Post-migration community (protective: school connectedness, support by peers) and sociocultural factors (risk: discrimination and acculturative stress, protective: integrative acculturation) have gained some support in high-income settings. Prevention and intervention approaches should integrate factors across different socio-ecological levels. More longitudinal studies and research in low- and middle-income countries are needed to advance our knowledge on causal mechanisms behind factors contributing to refugee youth's mental health.
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