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Daniel NA, Liu X, Thomas ET, Eraneva-Dibb E, Ahmad AM, Heneghan C. Brief CBT-based psychological interventions to improve mental health outcomes in refugee populations: a systematic review and meta-analysis. Eur J Psychotraumatol 2024; 15:2389702. [PMID: 39212049 PMCID: PMC11370682 DOI: 10.1080/20008066.2024.2389702] [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] [Received: 03/20/2024] [Revised: 07/09/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Background: Refugees, asylum seekers, and internally displaced people experience a high burden of mental health problems owing to their experiencing traumas and stressful events.Objective: To summarise the available evidence and analyse the efficacy of brief psychological interventions (< 3 months) on improving mental health outcomes, including depression, anxiety, and post-traumatic stress disorder (PTSD)-related symptoms in refugees.Method: We searched Medline, EMBASE, PsycINFO, CINAHL, and Global Index Medicus from inception to 19 December 2023. We included controlled studies using any cognitive behavioural therapy (CBT) or CBT-based therapies delivered over a short time (< 3 months), which reported mental health outcomes pre-and post-intervention. We conducted meta-analyses using random effects to derive pooled summary statistics. The quality of the evidence was assessed with the Cochrane Risk of Bias (RoB2) and ROBINS-I tools. This study is registered on the Open Science Framework, DOI 10.17605/OSF.IO/9CXU4.Results: 34 eligible studies across 37 publications were retrieved for analysis, and 33 studies with 4479 participants were included in the meta-analysis. There was an overall improvement in immediate mental health outcomes for all three domains, with analysis of 13 studies on anxiety outcomes (SMD -1.12, 95% CI -1.72 to -0.52), 20 studies on depression (SMD -1.04, 95% CI -1.97 to -0.11), and 24 studies on PTSD (SMD -0.82, 95% CI -1.20 to -0.45). At 3 to 6-month follow-up, however, analysis of mental health outcomes shows no significant change from baseline, with a SMD of 0.24 (95% CI -0.94 to 1.42) across 4 studies, -0.73 (95% CI -2.14 to 0.68) across 9 studies, and 0.29 (95% CI -0.94 to 1.53) across 12 studies for anxiety, depression, and PTSD respectively.Conclusion: Low-quality evidence shows brief psychological interventions have a positive immediate effect on refugees and internally displaced people's mental well-being. However, these effects do not persist in the short-term follow up. Heterogeneity was high, even among subgroups, impacting our findings' generalisability.
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Affiliation(s)
- Nadia A. Daniel
- Magdalen College, University of Oxford, Oxford, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Xin Liu
- Magdalen College, University of Oxford, Oxford, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Elizabeth T. Thomas
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily Eraneva-Dibb
- Magdalen College, University of Oxford, Oxford, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Al-Maz Ahmad
- Department of Computing, Imperial College London, London, UK
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Bacher J, Stadler C, Unternaehrer E, Brunner D. Testing the effectiveness of the culturally adapted skills training START NOW to reduce mental health problems in adolescent refugees: study protocol for a randomized controlled trial. Front Public Health 2024; 12:1408026. [PMID: 38919921 PMCID: PMC11196762 DOI: 10.3389/fpubh.2024.1408026] [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: 03/27/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
Background Adolescent refugees are particularly vulnerable to mental health problems, as they experience many risk factors associated with their resettlement at crucial stages of their physical and emotional development. However, despite having a greater healthcare needs than others, they face significant barriers to accessing healthcare services. Therefore, this study aims to test the effectiveness of a low-threshold, culturally adapted version of the skills training START NOW - START NOW Adapted - in reducing mental health problems among adolescent refugees. Methods We will recruit 80 adolescent refugees (15-18 years) with symptoms of anxiety and depression or high perceived stress in Northwestern Switzerland. They will be randomly assigned to one of two study groups: an intervention group, receiving START NOW Adapted, and a control group, receiving treatment as usual (TAU). The intervention will last 10 weeks and will consist of one-hour sessions per week provided by a trained facilitator with the same cultural background, in the respective language. Assessments to collect depressive and anxious symptoms, perceived stress, social-ecological resilience, and emotion recognition abilities will be conducted pre-intervention, post-intervention (11 weeks later) and at the 3-month follow-up. Multilevel models will be computed with primary and secondary outcome measures as dependent variables. An effect of at least moderate size will be considered clinically relevant. Discussion This randomized controlled trial aims to investigate the effectiveness of a culturally adapted version of START NOW, providing valuable insights to improve current health promotion for adolescent refugees in Switzerland (or rather lack thereof). Ultimately, the effects of START NOW may facilitate integration and promote healthy development while decreasing costs associated with treating migration- or conflict-related trauma.Clinical trial registration: ClinicalTrials.gov, identifier: NCT06324864.
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Affiliation(s)
- Janine Bacher
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Basel, Switzerland
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Della Rocca B, Bello R, Carbone M, Pezzella P, Toni C, Sampogna G, Tarsitani L, Luciano M, Fiorillo A. Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions. Int J Soc Psychiatry 2024; 70:653-666. [PMID: 38069651 DOI: 10.1177/00207640231214964] [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: 06/02/2024]
Abstract
BACKGROUND According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children. METHODS The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using ("immigrants" OR "migration" OR "asylum seekers" OR "refugees") AND ("promotion" OR "prevention") AND ("mental health" OR "mental disorders" OR "psych*") AND ("children" OR "adolescents" OR "young adults") as search string. Fourteen articles qualified for the detailed review. RESULTS AND CONCLUSIONS The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed.
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Affiliation(s)
- Bianca Della Rocca
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Rosaria Bello
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Marco Carbone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Claudia Toni
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | | | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Largo Madonna delle Grazie, Naples, Italy
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Bleile ACE, Koppenol-Gonzalez GV, Orech B, Verreault K, Jordans MJD. Evaluating a Movement-Based Mental Health Promotion Intervention for Refugee Children in Uganda: A Quasi-Experimental Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-16. [PMID: 38564186 DOI: 10.1080/15374416.2024.2330073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Mental health promotion interventions are widely implemented in humanitarian settings and low- and middle-income contexts (LMICs), yet evidence on effectiveness is scarce and mixed. This study evaluated the movement-based mental health promotion intervention "TeamUp" in Bidibidi refugee settlement, in Northern Uganda. METHOD A quasi-experimental study including four schools (two per arm) assessed the outcomes of 10- to 15-year-old South Sudanese and Ugandan children (n = 549). Randomly allocated, they either participated in up to 11 TeamUp sessions (n = 265) provided by trained facilitators; or belonged to a control group, which continued care as usual (n = 284). Primary outcomes measured psychosocial wellbeing, friendships and attitude to school; secondary outcomes included traumatic distress, depressive symptoms, quality of life, physical health, bullying, interoceptive awareness, and irritability. Data were collected at baseline and endline. RESULTS Children joining TeamUp, showed significantly more improvements on primary outcomes: emotional and psychosocial wellbeing (Mdiff = -1.49, SE = 0.6, p = .01), satisfaction with and attitude toward school (-0.57, SE = 0.2, p = .004); and secondary outcomes: traumatic stress (2.64, SE = 0.8, p < .001), health-related quality of life (-1.56, SE = 0.4, p = .001), physical health (-0.78, SE = 0.3, p = .014) and the TeamUp mechanisms of action scale (-3.34, SE = 0.9, p < .001), specifically the subscales social connectedness (-0.74, SE = 0.3, p = .007) and sense of agency (-0.91, SE = 0.3, p = .005), compared to the control group. No significant differences were found on bullying, interoceptive awareness, irritability and depressive symptoms. CONCLUSION The results are promising for TeamUp as a mental health promotion intervention for children affected by armed-conflict, displacement and on-going adversity. Further research will need to assess the intervention's effectiveness.
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Affiliation(s)
- Alexandra C E Bleile
- Research and Development Department, War Child
- Amsterdam Institute of Social Science Research, University of Amsterdam
| | | | - Bruce Orech
- Research and Development Department, War Child
| | | | - Mark J D Jordans
- Research and Development Department, War Child
- Amsterdam Institute of Social Science Research, University of Amsterdam
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Giordano F, Salimbeni CT, Jefferies P. The Tutor of Resilience Program with Children Who Have Experienced Maltreatment: Mothers' Involvement Matters. Child Psychiatry Hum Dev 2024; 55:295-307. [PMID: 35916984 PMCID: PMC10891266 DOI: 10.1007/s10578-022-01393-w] [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] [Accepted: 06/15/2022] [Indexed: 11/03/2022]
Abstract
Resilience is a dynamic process involving the presence and interaction of personal and environmental factors that modify the impact of adversity. Resilience-building interventions are therefore important for improving trauma-related outcomes in children and caregivers exposed to adversity. This study examines the impact of the Tutor of Resilience (TOR) program on beneficiaries' trauma-related symptoms and on mother-child interactions in a group of children exposed to maltreatment (N = 186; mean age = 11.95; SD = 2.50). Assessments were completed at baseline and post-intervention. RM-ANOVAs indicated significant improvements for most trauma symptoms (anxiety, anger, post-traumatic stress, and disassociation, but not depression) in the intervention group relative to a control group (N = 88; mean age = 10.76; SD = 2.57), and indicated further improvements to anxiety and dissociation for the intervention group when mothers were involved. Mother-child interactions also improved over time, as did their overall trauma symptoms and distress. Findings support the effectiveness of the ToR, especially when involving mothers.
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Affiliation(s)
- F Giordano
- Department of Psychology - Resilience Research Unit, Università Cattolica del Sacro Cuore Largo Gemelli 1, Milan, MI, 20121, Italy.
| | - C Taurelli Salimbeni
- Department of Psychology - Resilience Research Unit, Università Cattolica del Sacro Cuore Largo Gemelli 1, Milan, MI, 20121, Italy
| | - P Jefferies
- Family and Community Resilience, Canada Research Chair in Child, Resilience Research Centre Dalhousie University, PO Box 15000, Halifax, NS, B3H4R2, Canada
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Mattelin E, Paidar K, Söderlind N, Fröberg F, Korhonen L. A systematic review of studies on resilience and risk and protective factors for health among refugee children in Nordic countries. Eur Child Adolesc Psychiatry 2024; 33:667-700. [PMID: 35445318 PMCID: PMC10894096 DOI: 10.1007/s00787-022-01975-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/09/2022] [Indexed: 11/03/2022]
Abstract
The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0-18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.
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Affiliation(s)
- Erica Mattelin
- 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
| | - Kristina Paidar
- Department of Child and Adolescent Psychiatry, Region Halland, Kungsbacka, Sweden
| | - Natalie Söderlind
- Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Frida Fröberg
- 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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McEwen FS, El Khatib H, Hadfield K, Pluess K, Chehade N, Bosqui T, Skavenski S, Murray L, Weierstall-Pust R, Karam E, Pluess M. Feasibility and acceptability of phone-delivered psychological therapy for refugee children and adolescents in a humanitarian setting. Confl Health 2024; 18:7. [PMID: 38218936 PMCID: PMC10787498 DOI: 10.1186/s13031-023-00565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Refugee children are at high risk of mental health problems but face barriers to accessing mental health services, a problem exacerbated by a shortage of mental health professionals. Having trained lay counsellors deliver therapy via telephone could overcome these barriers. This is the first study to explore feasibility and acceptability of telephone-delivered therapy with refugee children in a humanitarian setting. METHODS An evidence-based intervention, Common Elements Treatment Approach, was adapted for telephone-delivery (t-CETA) and delivered by lay counsellors to Syrian refugee children in informal tented settlements in the Beqaa region of Lebanon. Following delivery of t-CETA, semi-structured interviews were conducted with counsellors (N = 3) and with children who received t-CETA (N = 11, 45% female, age 8-17 years) and their caregivers (N = 11, 100% female, age 29-56 years) (N = 25 interviews). Thematic content analysis was conducted separately for interviews with counsellors and interviews with families and results were synthesized. RESULTS Three themes emerged from interviews with counsellors and four themes from interviews with families, with substantial overlap between them. Synthesized themes were: counselling over the phone both solves and creates practical and logistical challenges; t-CETA is adapted to potential cultural blocks; the relationship between the counsellor and the child and caregiver is extremely important; the family's attitude to mental health influences their understanding of and engagement with counselling; and t-CETA works and is needed. Counselling over the phone overcame logistical barriers, such as poor transportation, and cultural barriers, such as stigma associated with attending mental health services. It provided a more flexible and accessible service and resulted in reductions in symptoms for many children. Challenges included access to phones and poor network coverage, finding an appropriate space, and communication challenges over the phone. CONCLUSIONS Despite some challenges, telephone-delivered therapy for children shows promising evidence of feasibility and acceptability in a humanitarian context and has the potential to increase access to mental health services by hard-to-reach populations. Approaches to addressing challenges of telephone-delivered therapy are discussed. Trial Registration ClinicalTrials.gov ID: NCT03887312; registered 22nd March 2019.
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Affiliation(s)
- Fiona S McEwen
- Biological and Experimental Psychology, School of Biological and Behavioural Science, G.E. Fogg Building, Queen Mary University of London, Mile End Road, London, UK
- Department of War Studies, King's College London, Strand, London, UK
| | - Hania El Khatib
- Biological and Experimental Psychology, School of Biological and Behavioural Science, G.E. Fogg Building, Queen Mary University of London, Mile End Road, London, UK
| | - Kristin Hadfield
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Karen Pluess
- Biological and Experimental Psychology, School of Biological and Behavioural Science, G.E. Fogg Building, Queen Mary University of London, Mile End Road, London, UK
| | | | - Tania Bosqui
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, American University of Beirut, Beirut, Lebanon
| | | | - Laura Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Elie Karam
- Institute for Development, Research, Advocacy and Applied Care, Achrafieh, St. George Hospital Street, Beirut, Lebanon
- Saint Georges Hospital University Medical Center, Achrafieh, Beirut, Lebanon
- Saint Georges University of Beirut, Beirut, Lebanon
| | - Michael Pluess
- Biological and Experimental Psychology, School of Biological and Behavioural Science, G.E. Fogg Building, Queen Mary University of London, Mile End Road, London, UK.
- School of Psychology, University of Surrey, Guildford, UK.
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Bachem R, Levin Y, Yuval K, Langer NK, Solomon Z, Bernstein A. Complex posttraumatic stress disorder in intergenerational trauma transmission among Eritrean asylum-seeking mother-child dyads. Eur J Psychotraumatol 2024; 15:2300588. [PMID: 38190253 PMCID: PMC10776052 DOI: 10.1080/20008066.2023.2300588] [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] [Received: 09/04/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
Background: Traumatic stress among forcibly displaced people has a variety of adverse consequences beyond individual mental health, including implications for poor socioemotional developmental outcomes for their children post-displacement.Objective: This study explored the intergenerational transmission of maternal ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) and depression among asylum-seeking mothers for their children's internalizing and externalizing difficulties.Method: Participants were 127 trauma-affected Eritrean mothers of preschool-aged children in Israel. The severity of child difficulties was compared between mothers with probable ICD-11 CPTSD (94.5% comorbid depression), ICD-11 PTSD (48.5% comorbid depression), unimorbid depression, and healthy mothers, using multivariate analyses of variance, while controlling for children's direct exposure to adverse life experiences.Results: Probable ICD-11 CPTSD and PTSD were present in 23.6% and 26.0% of mothers, respectively. Relative to maternal PTSD, CPTSD was significantly and strongly associated with elevated child internalizing symptoms (d = 2.44) and marginally significantly, although strongly, associated with child externalizing symptoms (d = 1.30). Post-hoc exploratory analyses documented that, relative to maternal PTSD and depression, CPTSD and depression comorbidity was marginally significantly but strongly associated with child internalizing (SMD = .67), but not externalizing symptoms (SMD = .35).Conclusions: Findings implicate maternal CPTSD and comorbid depression in child socio-emotional development and inform clinical assessment, prevention, and intervention to attenuate poor development among children in unstable post-displacement settings.
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Affiliation(s)
- Rahel Bachem
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Yafit Levin
- School of Social Work, Ariel University, Ariel, Israel
| | - Kim Yuval
- Observing Minds Lab, Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Nora Korin Langer
- Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
- the I-Core Research Center for Mass Trauma, Tel-Aviv, Israel
| | - Amit Bernstein
- Observing Minds Lab, Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
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Biset G, Goshiye D, Gedamu S, Tsehay M. The effect of conflict on child and adolescent health in Amhara region, Ethiopia: Cross-Sectional Study. BMC Pediatr 2023; 23:463. [PMID: 37710207 PMCID: PMC10500724 DOI: 10.1186/s12887-023-04282-w] [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] [Received: 09/21/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Currently, conflict become common phenomenon in the world affecting the lives of millions of children. Due the continued conflict in Ethiopia millions of children are suffering from extreme levels of violence, lack of basic humanitarian needs, and lack of health services. OBJECTIVE This study was designed to assess the effect of conflict on child and adolescent health in Amhara region, September 2022. METHODS A community-based cross-sectional study was employed among children agedd < 18 years in conflict affected areas of Amhara region. The sample size was determined using a single population proportion formula. Data was collected through face-to-face interviews of children or child legal guardians. Data was cleaned, verified, and entered into EpiData version 3.1 and analysis was done using SPSS version 24 statistical software. RESULT Seven hundred and ninety-eight children agedd less than 18 years were involved with a response rate of 94.33 percent. More than one thirds (276, 34.59%) of children were displaced due to the conflict. Three hundred and thirty one (41.48%) children get diseased with the majority didn't receive treatment. More than two thirds (557, 69.80%) of children had experienced violence of different types. One hundred and thirty four (41.23%) children had acute malnutrition with two third (66.42%) of them had severe acute malnutrition. CONCLUSION Conflict had deadly impacts on the lives of children and adolescents. It causes massive displacement, lack of basic humanitarian needs, extreme level of violence, hunger and malnutrition, and lack of health services. The government and other national and international humanitarian aids should give special attention to children living in war zone of Amhara region. In addition, rehabilitation services and resilience training should be designed and provided to children affected by the conflict.
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Affiliation(s)
- Gebeyaw Biset
- Department of Pediatric and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, PO. Box 1145, Dessie, Ethiopia.
| | - Debrnesh Goshiye
- Department of Pediatric and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, PO. Box 1145, Dessie, Ethiopia
| | - Sisay Gedamu
- Department of Adult Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mekonnen Tsehay
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Yu R, Perera C, Sharma M, Ipince A, Bakrania S, Shokraneh F, Sepulveda JSM, Anthony D. Child and adolescent mental health and psychosocial support interventions: An evidence and gap map of low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1349. [PMID: 37621301 PMCID: PMC10445093 DOI: 10.1002/cl2.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Background Mental disorders affect about one in seven children and adolescents worldwide. Investment in effective child and adolescent mental health prevention, promotion and care is essential. To date, however, the evidence from this field is yet to be comprehensively collected and mapped. Objectives The objective of this evidence and gap map (EGM) is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in lower-middle-income countries (LMICs). Search Methods We searched for studies from a wide range of bibliographic databases, libraries and websites. All searches were conducted in December 2021 and covered the period between 2010 and 2021. Selection Criteria We included evidence on the effectiveness of any Mental Health and Psychosocial Support (MHPSS) interventions targeting children and adolescents from 0 to 19 years of age in LMICs. The map includes systematic reviews and effectiveness studies in the form of randomised control trials and quasi-experimental studies, and mixed-methods studies with a focus on intervention effectiveness. Data Collection and Analysis A total of 63,947 records were identified after the search. A total of 19,578 records were removed using machine learning. A total of 7545 records were screened independently and simultaneously by four reviewers based on title and abstract and 2721 full texts were assessed for eligibility. The EGM includes 697 studies and reviews that covered 78 LMICs. Main Results School-based interventions make up 61% of intervention research on child and adolescent mental health and psychosocial support. Most interventions (59%) focusing on treating mental health conditions rather than preventing them or promoting mental health. Depression (40%, N = 282) was the most frequently researched outcome sub-domain analysed by studies and reviews, followed by anxiety disorders (32%, N = 225), well-being (21%, N = 143), and post-traumatic stress disorder (18%, N = 125). Most included studies and reviews investigated the effectiveness of mental health and psychosocial support interventions in early (75%, N = 525) and late adolescence (64%, N = 448). Conclusions The body of evidence in this area is complex and it is expanding progressively. However, research on child and adolescent MHPSS interventions is more reactive than proactive, with most evidence focusing on addressing mental health conditions that have already arisen rather than preventing them or promoting mental health. Future research should investigate the effectiveness of digital mental health interventions for children and adolescents as well as interventions to address the mental health and psychosocial needs of children in humanitarian settings. Research on early childhood MHPSS interventions is urgently needed. MHPSS research for children and adolescents lacks diversity. Research is also needed to address geographical inequalities at the regional and national level. Important questions also remain on the quality of the available research-is child and adolescent MHPSS intervention research locally relevant, reliable, well-designed and conducted, accessible and innovative? Planning research collaborations with decision-makers and involving experts by experience in research is essential.
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Affiliation(s)
- Ruichuan Yu
- UNICEF Innocenti—Global Office of Research and Foresight, UNICEF HQFlorenceItaly
| | - Camila Perera
- UNICEF Innocenti—Global Office of Research and Foresight, UNICEF HQFlorenceItaly
| | - Manasi Sharma
- UNICEF Innocenti—Global Office of Research and Foresight, UNICEF HQFlorenceItaly
| | - Alessandra Ipince
- UNICEF Innocenti—Global Office of Research and Foresight, UNICEF HQFlorenceItaly
| | - Shivit Bakrania
- UNICEF Innocenti—Global Office of Research and Foresight, UNICEF HQFlorenceItaly
| | - Farhad Shokraneh
- UNICEF Innocenti—Global Office of Research and Foresight, UNICEF HQFlorenceItaly
| | | | - David Anthony
- UNICEF Innocenti—Global Office of Research and Foresight, UNICEF HQFlorenceItaly
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Spaas C, Said-Metwaly S, Skovdal M, Primdahl NL, Jervelund SS, Hilden PK, Andersen AJ, Opaas M, Soye E, Watters C, Verelst A, Derluyn I, Colpin H, Haene LD. School-based Psychosocial Interventions' Effectiveness in Strengthening Refugee and Migrant Adolescents' Mental Health, Resilience, and Social Relations: A Four-country Cluster Randomized Study. PSYCHOSOCIAL INTERVENTION 2023; 32:177-189. [PMID: 37691715 PMCID: PMC10484026 DOI: 10.5093/pi2023a12] [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: 01/04/2023] [Accepted: 05/30/2023] [Indexed: 09/12/2023]
Abstract
School-based psychosocial interventions are increasingly put forward as a way to support young refugees' and migrants' well-being and mental health in resettlement. However, the evidence on these interventions' effectiveness remains scarce and scholars denounce particular gaps in the evidence to date, pointing to a lack of large-scale, controlled studies and studies including social outcome measures. This cluster randomized study aims to strengthen the evidence base on school-based psychosocial interventions for refugee and migrant youth by assessing the effect of two interventions, Classroom Drama and Welcome to School, on youth's mental health, resilience, and social relations in Belgium, Denmark, Norway, and the United Kingdom. Multilevel analyses were conducted separately for the two interventions (Classroom Drama, n = 307, ages 11-19; Welcome to School, n = 251, ages 11-23), using separate no-treatment control groups. Our analyses indicated a significant main, positive effect of Classroom Drama on perceived family support, and an effect on perceived support from friends that was moderated by country: in the United Kingdom, the intervention group reported an increase in perceived friend support, whereas the control group reported a decrease. Furthermore, baseline resilience moderated the effect of the Classroom Drama intervention on behavioral difficulties and well-being. No effects of Welcome to School on any of the outcome variables were found. Overall, this study provides novel, nuanced evidence on school-based psychosocial interventions for refugee and migrant adolescents.
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Affiliation(s)
- Caroline Spaas
- KU Leuven UniversityBelgiumKU Leuven University, Belgium;
| | - Sameh Said-Metwaly
- KU Leuven UniversityBelgiumKU Leuven University, Belgium;
- Damanhour UniversityEgyptDamanhour University, Egypt;
| | - Morten Skovdal
- University of CopenhagenDenmarkUniversity of Copenhagen, Denmark;
| | | | | | - Per Kristian Hilden
- Norwegian Centre for Violence and Traumatic Stress StudiesOsloNorwayNorwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway;
| | - Arnfinn J. Andersen
- Norwegian Centre for Violence and Traumatic Stress StudiesOsloNorwayNorwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway;
| | - Marianne Opaas
- Norwegian Centre for Violence and Traumatic Stress StudiesOsloNorwayNorwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway;
| | - Emma Soye
- University of SussexSchool of Education and Social WorkUKSchool of Education and Social Work, University of Sussex, UK;
| | - Charles Watters
- University of SussexSchool of Education and Social WorkUKSchool of Education and Social Work, University of Sussex, UK;
| | - An Verelst
- Ghent UniversityBelgiumGhent University, Belgium
| | - Ilse Derluyn
- Ghent UniversityBelgiumGhent University, Belgium
| | - Hilde Colpin
- KU Leuven UniversityBelgiumKU Leuven University, Belgium;
| | - Lucia De Haene
- KU Leuven UniversityBelgiumKU Leuven University, Belgium;
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12
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Al-Shatanawi TN, Khader Y, ALSalamat H, Al Hadid L, Jarboua A, Amarneh B, Alkouri O, Alfaqih MA, Alrabadi N. Identifying psychosocial problems, needs, and coping mechanisms of adolescent Syrian refugees in Jordan. Front Psychiatry 2023; 14:1184098. [PMID: 37426088 PMCID: PMC10325618 DOI: 10.3389/fpsyt.2023.1184098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
Background Refugees who have fled war zones are at a heightened risk of psychosocial problems that can impact their ability to function in day-to-day life and place a significant burden on the family structure. This study aimed to assess the psychosocial problems and needs and coping mechanisms of Adolescent Syrian refugees in Jordan. Methods Between October and December 2018, we conducted a qualitative study using semi-structured interviews with a sample of key and individual informants. Our sample included 20 primary healthcare professionals, 20 schoolteachers, 20 Syrian parents, and 20 adolescents aged 12-17 years. All interviews were transcribed verbatim, and we utilized thematic analysis to group, categorize, and analyze the original Arabic language transcripts. To ensure thorough analysis, we adopted a bottom-up inductive approach that covered the six-phase iterative process proposed by Braun and Clarke. Results The main psychosocial problems encountered by Syrian adolescents included stress, depression, loneliness, lack of a sense of security, isolation, aggressiveness, fear of war, and family disintegration. Almost all schoolteachers reported that they observed that Jordanian adolescents are more settled, self-confident, and financially stable relative to their Syrian peers. The Jordanian government and community were praised for their support, including education, recreational centers, health services, and awareness campaigns. Going to school, praying and reading the Holy Quran, listening to music, and talking to friends and engaging with them were reported as the main coping mechanisms. The majority of respondents said that more services are still needed for adolescents, including more places for entertainment, psychosocial support and psychological counseling, medical care, job creation, and providing health insurance. Conclusion Syrian refugees are aware of the psychological aspects of their situation, but they are not always able to access clinic-based humanitarian assistance for mental health and psychosocial support. Stakeholders must interact with refugees to learn about their needs and develop services that are appropriate for their culture.
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Affiliation(s)
- Tariq N. Al-Shatanawi
- Department of Public Health and Community Medicine, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Yousef Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Husam ALSalamat
- Department of Public Health and Community Medicine, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | | | - Alaa Jarboua
- Department of Legal Medicine, Toxicology and Forensic Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Basil Amarneh
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alkouri
- Faculty of Nursing, Yarmouk University, Irbid, Jordan
| | - Mahmoud A. Alfaqih
- Department of Physiology and Biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- Department of Biochemistry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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13
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Diab M, Veronese G, Abu Jamei Y, Hamam R, Saleh S, Zeyada H, Kagee A. Psychosocial concerns in a context of prolonged political oppression: Gaza mental health providers' perceptions. Transcult Psychiatry 2023; 60:577-590. [PMID: 34986045 DOI: 10.1177/13634615211062968] [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: 11/17/2022]
Abstract
In this qualitative exploratory study, we investigated the perspectives of mental health providers in Gaza, Palestine, regarding the primary concerns of their clients who are exposed to low-intensity warfare and structural violence. We conducted qualitative interviews with 30 psychologists, social workers, psychiatric nurses, and psychiatrists providing services to communities in Gaza. Participants were asked to discuss their clients' most commonly occurring mental health problems, diagnoses, and psychosocial conditions. Thematic analysis identified one superordinate theme (Impact of the Blockade on Mental Health and Quality of Life) and four second-order themes (Concerns about Social Problems, General Concerns about Quality of Life, Concerns about the Mental Health of the Community, and Concerns Related to Children's Mental Health). Participants indicated that the social and political dimensions of mental health and the economic, educational, and health-related consequences of the ongoing blockade of Gaza were the main determinants of psychological burden among their clients. Findings demonstrated the importance of adopting an approach to mental health that includes understanding psychological indicators in a broader framework informed by human rights and social justice. Implications for research and clinical work are discussed, including the role of investments in social capital that may provide individuals with access to resources such as social support, which may in turn promote overall mental health.
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Affiliation(s)
- Marwan Diab
- Gaza Community Mental Health Programme
- Stellenbosch University
| | | | | | - Rawia Hamam
- Gaza Community Mental Health Programme
- Stellenbosch University
| | - Sally Saleh
- Gaza Community Mental Health Programme
- Stellenbosch University
| | - Hasan Zeyada
- Gaza Community Mental Health Programme
- Stellenbosch University
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14
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Abdelhamid S, Lindert J, Fischer J, Steinisch M. Negative and protective experiences influencing the well-being of refugee children resettling in Germany: a qualitative study. BMJ Open 2023; 13:e067332. [PMID: 37076150 PMCID: PMC10124287 DOI: 10.1136/bmjopen-2022-067332] [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: 04/21/2023] Open
Abstract
OBJECTIVE Conflict, forced migration and searching for safety in a foreign land are all experiences common to refugee children. They experience potentially traumatic events that are distinct from the general population, yet current adverse childhood experience (ACE) studies do not cover these events. Studies that do examine refugee children's experiences typically focus on a single stage of migration or adversities from the community, offering insight into only a fraction of their realities. This study aimed to identify potentially traumatising and protective experiences subjectively perceived as influencing refugee children's well-being from all stages of migration and all socio-ecological levels. DESIGN Qualitative study with thematic analysis of semi-structured individual and group interviews. Themes were organised within a socio-ecological model. SETTING Non-profit organisations, youth welfare facilities and societies that organise civic engagement for refugee families in the Rhine-Neckar region in Germany provided rooms where interviews could be conducted. PARTICIPANTS Refugee parents and children who spoke one of the four most common languages of those seeking asylum in Germany in 2018 were included. This study excluded refugees who were not fleeing a conflict area. Forty-seven refugee parents and 11 children (aged 8-17 years) from Syria, Iraq, Palestine, Afghanistan and Eritrea participated. RESULTS Eight major themes emerged from interviews including six reflecting potentially negative experiences and two potentially protective themes. These themes evolved from experiences such as family dispersion, displacement, rigorous immigration and national policies, as well as constructive parenting and community support. CONCLUSION It is increasingly important to identify these diverse experiences as the refugee population continues to grow, and the increased prevalence of poor health outcomes in refugee children continues to be widely documented. Identifying ACEs specifically relevant to refugee children could contribute to understanding potential pathways and could further serve as a starting point for tailored interventions.
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Affiliation(s)
- Shaymaa Abdelhamid
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Heidelberg University, Heidelberg, Germany
| | - Jutta Lindert
- Department of Social Work and Health, University of Applied Sciences Emden/Leer, Emden, Germany
| | - Joachim Fischer
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Heidelberg University, Heidelberg, Germany
| | - Maria Steinisch
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of Public Health, Social and Preventive Medicine, Heidelberg University, Heidelberg, Germany
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15
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Arega NT. Mental Health and Psychosocial Support Interventions for Children Affected by Armed Conflict in low-and middle-income Countries: A Systematic Review. CHILD & YOUTH CARE FORUM 2023:1-26. [PMID: 37360764 PMCID: PMC9990564 DOI: 10.1007/s10566-023-09741-0] [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] [Accepted: 02/22/2023] [Indexed: 06/28/2023]
Abstract
Background . Armed conflicts continue to threaten a vast number of children across the world, especially in low-and middle-income countries (LMICs). Evidence-based interventions are vital to adequately address the mental health needs in these groups. Objective . This systematic review aims to provide a comprehensive update of the most current developments in mental health and psychosocial support (MHPSS) interventions for children affected by armed conflict in LMICs, since 2016. Such an update may be useful in determining where the current focus of interventions lies and whether there are changes in types of interventions that are commonly implemented. Methods . The main medical, psychological and social sciences databases (PubMed, PsycINFO, Medline) were searched to identify interventions aimed at improving or treating mental health problems in conflict-affected children in LMICs. For the period 2016-2022, a total of 1243 records were identified. Twenty-three articles met the inclusion criteria. A bio-ecological lens was used to organize the interventions and the presentation of findings. Results . Seventeen forms of MHPSS interventions with a wide range of treatment modalities were identified in this review. The reviewed articles focused mainly on family-based interventions. Very few studies empirically evaluated community-level interventions. Conclusion . Current focus of interventions is family-based; the addition of caregiver wellbeing and parenting skills components had the potential to enhance the effects of interventions designed to improve children's mental health. Future trials for MHPSS interventions need to give more attention to community-level interventions. Community-level supports such as person-to-person support, solidarity groups, and dialogue groups stand to reach large numbers of children and families.
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Affiliation(s)
- Natnael Terefe Arega
- PhD in Applied Developmental Psychology, Institute of Education and Behavioral Sciences, Ambo University, Ambo, Ethiopia
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16
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Weitzman A, Camacho GB, Robles A, Blanton M, Swindle J, Huss K. Costa Rica as a Destination for Migrants in Need of International Protection: IMR Country Report. INTERNATIONAL MIGRATION REVIEW 2023; 57:436-448. [PMID: 37009048 PMCID: PMC10063213 DOI: 10.1177/01979183221104473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this IMR Country Report, we draw attention to Costa Rica as a strategic location for expanding research and theory on migrants in need of protection (MNP), who have migrated abroad primarily to evade an imminent threat to their survival. MNP constitute an increasing share of all international migrants in Costa Rica and worldwide, yet research on these migrants and their migration dynamics remains comparatively underdeveloped relative to research on migrants who relocate abroad primarily in pursuit of material gains, social status, or family reunification. As we highlight, Costa Rica is an instrumental site to deepen understandings of MNP populations and migration dynamics because its large and rapidly growing MNP population is incredibly diverse with respect to national origins, demographic characteristics, and underlying motivations for migration. This diversity presents ample opportunities to better understand heterogeneity in the different types of threats MNP seek to evade; how and why MNP incorporation is shaped by individuals' demographic attributes and pre-migration threats; and how the social networks of various MNP subpopulations develop and overlap with time. Moreover, the geographic concentration of MNP in two regions in Costa Rica lends itself to primary data collection among this population and generates opportunities for estimating local MNPs' demographic characterization, even in the absence of a reliable sampling frame.
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Affiliation(s)
- Abigail Weitzman
- Department of Sociology & Population Research Center, University of Texas
| | | | - Arodys Robles
- Centro Centroamericano de Población, Universidad de Costa Rica
| | - Matthew Blanton
- Department of Sociology & Population Research Center, University of Texas
| | | | - Katarina Huss
- Department of Sociology & Population Research Center, University of Texas
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Impact of the Russian Invasion on Mental Health of Adolescents in Ukraine. J Am Acad Child Adolesc Psychiatry 2023; 62:335-343. [PMID: 36441074 DOI: 10.1016/j.jaac.2022.07.845] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/21/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Very limited evidence is available on the psychological impact of war on adolescents in Ukraine. This study compared war experiences and posttraumatic stress disorder (PTSD), anxiety and depression in adolescents living in war-torn and peaceful regions of Ukraine, more than 2 years after Russia first invaded in 2014. METHOD The cross-sectional study included 2,766 students aged 11 to 17 years living in the war-torn Donetsk region and in Kirovograd in central Ukraine. Self-reported PTSD, depression, and anxiety were assessed by Harvard Trauma Questionnaire, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7. Data were collected from September 2016 to January 2017. Binary and multinomial logistic regression models were used to examine the association between PTSD, anxiety, and depression and regions. RESULTS War trauma and daily stress were higher in adolescents in the Donetsk region; 881 (60.2%) adolescents had witnessed armed attacks, 204 (13.9%) were victims of violence, and 409 (27.9%) were forced to leave their homes. They also had significantly increased risks for PTSD (odds ratio [OR] 4.11, 95% CI 2.37-7.13), severe anxiety (OR 3.10, 95% CI 1.83-5.27), and moderately severe/severe depression (OR 2.65, 95% CI 1.79-3.92). CONCLUSION Traumatic events and daily stress were strongly associated with psychological distress in adolescents living in a war-torn region in Ukraine. These findings can help in understanding, measuring, and addressing the long-term impact that the current escalating war in Ukraine will have on adolescents' mental health and social functioning.
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Luttenberger K, Najem C, Rosenbaum S, Sifri C, Kind L, Baggenstos B. A Climbing (Bouldering) Intervention to Increase the Psychological Well-Being of Adolescents in the Bekaa Valley in Lebanon-Study Protocol for a Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4289. [PMID: 36901303 PMCID: PMC10002189 DOI: 10.3390/ijerph20054289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Adolescent refugees in Lebanon and Lebanese youth are both at high risk of suffering from reduced psychological well-being. Sport is an evidence-based strategy for improving mental and physical health, and climbing is a type of sport that may positively impact both. The aim of this study is to test the effect of a manualized, psychosocial group climbing intervention on the well-being, distress, self-efficacy, and social cohesion of adolescents in Lebanon. In addition, the mechanisms behind psychological changes will be investigated. (2) Methods: In this mixed-methods waitlist-controlled study, we are allocating a minimum of 160 participants to an intervention (IG) or a control group (CG). The primary outcome is overall mental well-being (WEMWBS) after the 8-week intervention. Secondary outcomes include distress symptoms (K-6 Distress Scale), self-efficacy (General Self-Efficacy Scale; GSE), and social cohesion. Potential mechanisms of change and implementation factors are being investigated through qualitative interviews with a subgroup of 40 IG participants. (3) Conclusions: The results may contribute to knowledge of sports interventions and their effects on psychological well-being and will provide insights regarding low-intensity interventions for supporting adolescent refugees and host populations in conflict-affected settings. The study was prospectively registered at the ISRCTN platform (current-controlled trials). ISRCTN13005983.
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Affiliation(s)
- Katharina Luttenberger
- Department Medical Psychology and Medical Sociology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Charbel Najem
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9052 Ghent, Belgium
- Department of Physiotherapy, Faculty of Public Health, Antonine University, Baabda, Lebanon
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW, Sydney 2052, Australia
| | - Charles Sifri
- ClimbAID Lebanon, Branch of ClimbAID, 8048 Zurich, Switzerland
| | - Leona Kind
- Department Medical Psychology and Medical Sociology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Beat Baggenstos
- ClimbAID Lebanon, Branch of ClimbAID, 8048 Zurich, Switzerland
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Venta A, Alfano C. Can Sleep Facilitate Adaptation for Immigrant High Schoolers? Longitudinal Relations Between Sleep Duration, Acculturative Stress, and Acculturation. Child Psychiatry Hum Dev 2023; 54:147-153. [PMID: 34427824 DOI: 10.1007/s10578-021-01234-2] [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] [Accepted: 08/15/2021] [Indexed: 01/25/2023]
Abstract
Rising rates of youth migration are occurring globally and, thus, the adaptation of immigrant youth to their host country's cultural norms is a pressing public health concern. Indeed, both acculturation and acculturative stress are associated with mental health for immigrant youth. The broad aim of this study was to examine how sleep duration would prospectively relate to acculturation (Short Acculturation Scale) and acculturative stress (Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale) following migration for N = 110 immigrant high school students across 1 year. We hypothesized that acculturation would increase, and acculturative stress would decrease over the course of 1 year of data collection. We found evidence of both anticipated longitudinal changes, with significant slope parameters that were of opposite direction (i.e., acculturation positive, acculturative stress negative). Longer sleep duration at baseline was predictive of both greater increase in acculturation and greater decrease in acculturative stress over 1 year.
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Affiliation(s)
- Amanda Venta
- Department of Psychology, University of Houston, 4849 Calhoun Rd., Room 373, Houston, TX, 77204-6022, USA.
| | - Candice Alfano
- Department of Psychology, University of Houston, 4849 Calhoun Rd., Room 373, Houston, TX, 77204-6022, USA
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20
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Carroll HA, Kvietok A, Pauschardt J, Freier LF, Bird M. Prevalence of common mental health disorders in forcibly displaced populations versus labor migrants by migration phase: A meta-analysis. J Affect Disord 2023; 321:279-289. [PMID: 36367496 PMCID: PMC9831668 DOI: 10.1016/j.jad.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022]
Abstract
Migration is not an event, but an interactive process whereby individuals on the move make decisions in their social and political contexts. As such, one expects migrant mental health to change over time. To examine this relationship, we conducted a meta-analysis, the first to our knowledge, to identify the impact of migration phase and migration type on the prevalence of mental health in migrant populations. We searched PubMed, PsycInfo, and Embase for studies published between January 1, 2010, and January 1, 2020 (Prospero ID: 192751). We included studies with international migrants reporting prevalence rates for post-traumatic stress disorder (PTSD), depression, and/or anxiety. The authors extracted data from eligible studies and tabulated mental health prevalence rates, relevant migration condition (e.g., migration type or phase), and methods (e.g., sample size). Full text review resulted in n = 269 manuscripts included in the meta-analysis examining PTSD (n = 149), depression (n = 218), and anxiety (n = 104). Overall prevalence was estimated for PTSD (30.54 %, I2 = 98.94 %, Q = 10,443.6), depression (28.57 %, I2 = 99.17 %, Q = 13,844.34), and anxiety (25.30 %, I2 = 99.2 %, Q = 10,416.20). We also estimated the effect of methodological and migration factors on prevalence in PTSD, depression, and anxiety. Our findings reveal increased prevalence of mental health due to forced migration and being in the journey phase of migration, even when accounting for the influence of methods.
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Affiliation(s)
- Haley A Carroll
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Andrea Kvietok
- Department of Sociology, University of California San Diego, La Jolla, CA, USA.
| | - Julia Pauschardt
- Department of Health Policy, London School of Economics, London, United Kingdom
| | - Luisa F Freier
- Department of Social and Political Science, Universidad del Pacífico, Lima, Peru
| | - Matthew Bird
- Graduate School, Universidad del Pacífico, Lima, Peru
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Derluyn I, Orsini G, Verhaeghe F, Elhaj R, Lietaert I, Pfeiffer E. The impact of trauma and daily hardships on the mental health of unaccompanied refugee minors detained in Libya. BJPsych Open 2023; 9:e8. [PMID: 36601723 PMCID: PMC9885330 DOI: 10.1192/bjo.2022.622] [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] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The high trauma load and prevalence of mental distress in unaccompanied refugee minors (URMs) who resettle in Western (European) countries is well documented. However, the lack of studies investigating the potentially most vulnerable population, URMs who are currently on the move in transit countries such as Libya, is alarming. AIMS To document the mental health of URMs detained in Libya and the possible associations with trauma, flight and daily hardships. METHOD In total n = 99 (94.9% male; n = 93) URMs participated in this cross-sectional study conducted in four detention centres near the Libyan capital Tripoli. Data were collected via standardised questionnaires in an interview format and analysed using structured equation modelling. RESULTS Participants reported high rates of trauma, especially within Libya itself. Reports of daily hardships in detention ranged between 40 and 95% for basic needs and between 27 and 80% for social needs. Higher social needs were associated with increased anxiety symptoms (β = 0.59; P = 0.028) and increased pre-migration (β = 0.10; P = 0.061) and peri-migration trauma (β = 0.16; P = 0.017) with symptoms of depression. Similarly, higher levels of pre-migration trauma were associated with higher post-traumatic stress disorder levels (β = 0.17; P = 0.010). CONCLUSIONS The rates of daily hardships and traumatic events are higher compared with those recorded for URMs living in asylum centres in Europe. The emotional, social and cognitive development of detained URMs is severely threatened in both the short and long term. This paper outlines some of the most detrimental effects of migration policies on URMs transiting through Libya.
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Affiliation(s)
- Ilse Derluyn
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Giacomo Orsini
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Floor Verhaeghe
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | | | - Ine Lietaert
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium; and UNU-CRIS, Brugge, Belgium
| | - Elisa Pfeiffer
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
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Biset G, Goshiye D, Melesse N, Tsehay M. Post-traumatic stress disorders among children and adolescents in conflict-affected zones of Amhara region, February 2022. Front Psychol 2023; 13:1052975. [PMID: 36687911 PMCID: PMC9845561 DOI: 10.3389/fpsyg.2022.1052975] [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: 09/24/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Background To date, conflict is causing extreme social crises worldwide, with children representing the most vulnerable group, often experiencing severe trauma and violence in conflict-ridden areas. Posttraumatic stress disorders (PTSDs) are the most widely reported psychological problem in the aftermath of conflict. However, less attention has been given to children living in conflict-prone areas of the world. Objective The present study aimed to assess posttraumatic stress disorders among children and adolescents in conflict-affected zones of the Amhara region in Ethiopia from January to February 2022. Method A community-based cross-sectional study was employed from January to February 2022. A multistage random sampling technique was employed to recruit the study participants. A structured interviewer-administered questionnaire was designed to collect the desired data. Data were verified, coded, and entered into EpiData version 3.1 and analyzed using SPSS version 24 statistical software. Result A total of 846 children with a response rate of 94.33% were screened for trauma. Subsequently, 557 (69.80%) children had experienced trauma. Of these 557 children who had experienced trauma, 203 (36.45%) developed posttraumatic stress disorders. Based on these results, this study recommends that mass screening of children and adolescents for posttraumatic stress disorders and rehabilitation services be undertaken, including resilience training and psychosocial support.
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Affiliation(s)
- Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Dream Science and Technology College, Dessie, Ethiopia
| | - Debrnesh Goshiye
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Mekonnen Tsehay
- Department of Psychiatric Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Sender H, Orcutt DM, Btaiche R, Dabaj J, Nagi Y, Abdallah R, Corona S, Moore PH, Fouad PF, Devakumar DD. Social and cultural conditions affecting the mental health of Syrian, Lebanese and Palestinian adolescents living in and around Bar Elias, Lebanon. J Migr Health 2022; 7:100150. [PMID: 36686967 PMCID: PMC9850173 DOI: 10.1016/j.jmh.2022.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An estimated 1.5 million displaced Syrians live in Lebanon, sharing neighbourhoods and communal spaces with longer-term Lebanese and Palestinian residents. The Syrian Civil War has lasted over one decade. Protracted mass displacement means that many young people are growing up in neighbourhoods, towns and cities which include comparable numbers of recently displaced and longer-term residents. In this study, we explore adolescent mental health and the intersections between Syrians, Lebanese and Palestinians in the town of Bar Elias, where comparable numbers of displaced people and citizens live. We conducted semi-structured interviews with 30 adolescents in April 2019. We found that Palestinian, Syrian and Lebanese adolescents in Bar Elias identified the same shared conditions as affecting their mental health, although with different impacts on each individual. Sometimes, this difference accords with nationality, but it is also determined by gender and different physical and cognitive abilities. We conclude that recently displaced and host community adolescents can be seen to be affected by shared conditions, and that intersectional identities affect how adolescent mental health is affected by these conditions. We argue that investments in shared infrastructures can support the improvement of mental health for all adolescents.
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Affiliation(s)
- Hannah Sender
- Institute for Global Prosperity, University College London, UK,Corresponding author at: Institute for Global Prosperity, University College London, UK.
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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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Rizzi D, Ciuffo G, Sandoli G, Mangiagalli M, de Angelis P, Scavuzzo G, Nych M, Landoni M, Ionio C. Running Away from the War in Ukraine: The Impact on Mental Health of Internally Displaced Persons (IDPs) and Refugees in Transit in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16439. [PMID: 36554321 PMCID: PMC9778520 DOI: 10.3390/ijerph192416439] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
A growing body of research highlights how communities traumatized by conflict and displacement suffer from long-term mental and psychosocial illnesses. The Russian army's attack on Ukraine has resulted in an estimated 10 million people being internally or externally displaced from Ukraine, of whom more than 3.8 million have left Ukraine to seek refuge elsewhere in Europe. Soleterre has decided to launch an intervention to provide psychological support to Ukrainian refugees and IDPs, aimed at containing war trauma, assessing the severity of symptoms, and enabling those affected to receive psychological support. The intervention model envisioned the administration of an intake form to provide a rapid collection of qualitative and quantitative information for those arriving in Poland or Lviv from Ukraine. Our results showed how most of the samples reported high or very high levels of anxiety, depression, and sleep disturbances. Moreover, results highlighted how being close to families or being able to keep in touch with them work as a protective factor in enhancing resilience, as well as a support network. These findings underscored the importance of re-thinking our perception of "family" in a broader sense, considering the new facets it can take on in post-conflict situations.
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Affiliation(s)
- Damiano Rizzi
- Fondazione Soleterre Strategie di Pace Onlus, 20123 Milan, Italy
- Unità di Medicina d’Urgenza, Dipartimento di Medicina Interna, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giulia Ciuffo
- CRIdee, Dipartimento di Psicologia, Università Cattolica, 20123 Milan, Italy
| | - Giulia Sandoli
- Fondazione Soleterre Strategie di Pace Onlus, 20123 Milan, Italy
| | - Matteo Mangiagalli
- Fondazione Soleterre Strategie di Pace Onlus, 20123 Milan, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Unità di Terapia Intensiva, Università degli Studi di Pavia, 27100 Pavia, Italy
| | | | - Gioele Scavuzzo
- Fondazione Soleterre Strategie di Pace Onlus, 20123 Milan, Italy
| | | | - Marta Landoni
- CRIdee, Dipartimento di Psicologia, Università Cattolica, 20123 Milan, Italy
| | - Chiara Ionio
- CRIdee, Dipartimento di Psicologia, Università Cattolica, 20123 Milan, Italy
- Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milan, Italy
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Im H, George N, Swan LE. Born in displacement: Psychosocial and mental health impacts of country of birth among urban Somali refugee youth. Glob Public Health 2022; 17:3426-3439. [DOI: https:/doi.org/10.1080/17441692.2022.2106378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 07/18/2022] [Indexed: 06/22/2023]
Affiliation(s)
- Hyojin Im
- Ph.D., MA, MSW, Associate Professor, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole George
- MSW, Doctoral Student, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura E.T. Swan
- Ph.D., LCSW, Postdoctoral Research Associate, Department of Population Health Sciences, University of Wisconsin - Madison, Madison, WI, USA
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Im H, George N, Swan LET. Born in displacement: Psychosocial and mental health impacts of country of birth among urban Somali refugee youth. Glob Public Health 2022; 17:3426-3439. [PMID: 35923097 DOI: 10.1080/17441692.2022.2106378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Urban refugees often face tremendous adversities during displacement that exacerbate mental health and psychosocial outcomes. Given the lack of research on how extended displacement affects mental health in urban refugee youth, this study examines the differential effects of country of birth on trauma exposure and psychosocial factors that influence mental health experiences among Somali refugee youth in urban Kenya (n = 303). Findings reveals that childhood trauma and impeded social functioning predicted mental health outcomes. Being born in Kenya was a significant predictor of poor mental health despite there being no significant difference in trauma exposures and psychosocial factors between Somali-born and Kenya-born youth. This difference can be attributed to prolonged displacement, disrupted development of cultural identity, and discrimination experienced in the host country. Given the widely devastating effects of childhood trauma and community violence, mental health interventions need to be two-prolonged: addressing and preventing intergenerational trauma sequelae through family-based interventions; and community-level programs and advocacy for safety and protection for the displaced. Our findings also emphasize that future interventions for urban refugee communities should be inclusive to all community members, considering shared vulnerability to community violence as well as intergenerational transmission of traumas through childhood adversities and lacking support.
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Affiliation(s)
- Hyojin Im
- Ph.D., MA, MSW, Associate Professor, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole George
- MSW, Doctoral Student, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Laura E T Swan
- Ph.D., LCSW, Postdoctoral Research Associate, Department of Population Health Sciences, University of Wisconsin - Madison, Madison, WI, USA
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28
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Johnson SL, Kim ET, Rieder AD, Green EP, Finnegan A, Chase RM, Zayzay J, Puffer ES. Pathways from parent mental health to child outcomes in Liberia: Testing cross-sectional and longitudinal serial mediation models. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Im H, Swan LET. Trauma exposure, social functioning, and common mental health disorders in Somali refugee male and female youth: An SEM analysis. Int J Soc Psychiatry 2022; 68:1539-1551. [DOI: https:/doi.org/10.1177/00207640211037726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Background: Refugee youth often face numerous adversities before and during forced migration. Although experiences vary across settings and subpopulations, common mental disorders are prevalent among refugee youth who are displaced in low- and middle-income countries. It is important to examine how risk factors are intricately linked and contribute to common mental health issues to inform clinical practice and social policy. Aims: This study aims to test the pathways from risk factors previously identified as determinants of Somali refugee youth mental health (i.e. trauma exposure, substance use, social functioning, aggression) to symptoms of PTSD, depression, anxiety, and somatic pains. Method: We collected survey data in 2013, using snowball sampling to recruit Somali refugee youth (15–35 years old) living in Eastleigh, Kenya. We ran three structural equation models to assess paths from trauma exposure to mental health symptoms, through psychosocial factors including substance use, aggression, and functional impairment. We first conducted this analysis with a mixed-gender sample ( N = 305) and then assessed gender differences by running one model for male participants ( n = 124) and another for female participants ( n = 181). Results: In the mixed-gender sample, trauma exposure directly predicted substance use and both directly and indirectly predicted aggression, functional impairment, and mental health symptoms. Substance use directly predicted aggression and functional impairment, and substance use both directly and indirectly predicted mental health symptoms. The split-gender models revealed gender differences, with only functional impairment directly predicting mental health symptoms in the male sample and with many significant direct and indirect pathways in the female sample. Conclusions: This study shows the role of trauma exposure, substance use, aggression, and social functioning in determining mental health outcomes among refugee youth and how CMD symptoms are differently manifested across genders in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, Richmond, USA
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30
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Bizuneh SM. Resilience in Deafness, Adolescence and Gender. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1145-1153. [PMID: 36439672 PMCID: PMC9684370 DOI: 10.1007/s40653-022-00468-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 06/16/2023]
Abstract
Deaf and hearing Adolescents are facing the adversity of life like social expectations, academic and economic demands. The purpose of this study was to describe deaf and female adolescents' resilience with their respective counterparts using the Connor-Davidson Resilience Scale (CD-RISC-25). Methods: The study was conducted on 160 adolescent (80 deaf [40 female] and 80hearing [40 female]) students who were selected based on multistage sampling. Quantitative and qualitative data collections were made through the questionnaire as well as interview. The study employed Mean, Standard Deviation, independent t-test, and Analysis of Variance (ANOVA). The results revealed that hearing adolescent students' average resilience score was significantly greater than deaf students. It was also shown that female adolescent students' level of average resilience score was found significantly less than their counterparts. Analysis of variance revealed that there was a significant difference in resilience score among deaf female, deaf male, hearing female, and hearing male adolescent students in which deaf female adolescent students' resilience score was the lowest. The difference in resilience between deaf and hearing students signified deaf students' capability to cope with stressors and academic demands was less than their counterparts, and the resilience of deaf female students was found the lowest among the groups. This calls for health and psychological professional and families to provide adequate support for deaf and female adolescents to develop resilience.
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Affiliation(s)
- Shambel Molla Bizuneh
- Department of Psychology, College of Education and Behavioral Sciences, Dar University, P.O. Box 79, Bahir, Ethiopia
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31
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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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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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Salihu D, Wong EML, Kwan RYC, Ho GWK, Chutiyami M, Surajo KS, Bello UM, Ibrahim AA, Ali MU, Wang S, Bashir K, Jalo HA, Haddad MM, Suleiman AD, Ajio DK, Ali GM, Leung DYP. Anxiety, depression and stress among internally displaced persons and host community in an armed conflict region: A comparative study. Psychiatry Res 2022; 315:114700. [PMID: 35803168 DOI: 10.1016/j.psychres.2022.114700] [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: 12/01/2021] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/29/2022]
Abstract
This study compares the psychological profile of Internally Displaced Persons (IDPs) and individuals living in host communities in the war-affected setting. We conducted a cross-sectional survey from October-November 2019. Subjects were recruited from six IDPs camps and the surrounding host communities within the metropolis of Maiduguri, Nigeria by convenience sampling. Data were collected using the Hausa version of Depression Anxiety Stress Scale-21, and analysed by logistic regression using adjusted odds ratio (AOR) at 95% Confidence Interval (CI). A total of 562 subjects were recruited. Living in IDP camp was the most significantly predictor of depression, anxiety, and stress. The common predictors were living in an IDP camp, and marital status (separated). Aged 18-29years was a protective factor compared to those ≥50years. Living in IDP camps, separated from partners, lack of education and pre-conflict employment were significant predictors of depression, anxiety and stress.
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Affiliation(s)
- D Salihu
- School of Nursing, The Hong Kong Polytechnic University, HKSAR, China.
| | - E M L Wong
- School of Nursing, Tung Wah College, HKSAR, China
| | - R Y C Kwan
- School of Nursing, Tung Wah College, HKSAR, China.
| | - G W K Ho
- School of Nursing, The Hong Kong Polytechnic University, HKSAR, China
| | - M Chutiyami
- School of Nursing, Institute of Health and Management, Sydney, Australia
| | - K S Surajo
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - U M Bello
- Department of Physiotherapy and paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - A A Ibrahim
- Department of Physiotherapy, Muhammad Abdullahi Wase Teaching Hospital, Hospitals Management Board, Kano, Nigeria
| | - M U Ali
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, HKSAR, China
| | - S Wang
- School of Nursing, The Hong Kong Polytechnic University, HKSAR, China
| | - K Bashir
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - H A Jalo
- State Specialist Hospital, Damaturu, Damaturu, Yobe State, Nigeria
| | - M M Haddad
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - A D Suleiman
- Shehu Sule College of Nursing and Midwifery, Damaturu, Damaturu, Yobe State, Nigeria
| | - D K Ajio
- Department of Nursing Science, Faculty of Medical Sciences University of Jos, Jos, Plateau State, Nigeria
| | - G M Ali
- 461 Nigerian Air Force Hospital, Kaduna, Kaduna State, Nigeria
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, HKSAR, China
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Due C, Walsh M, Aldam I, Winter A, Cooper S, Sheriff J, Ziersch A. Perinatal care for women with refugee backgrounds from African countries: a qualitative study of intersections with psychological wellbeing. BMC Pregnancy Childbirth 2022; 22:628. [PMID: 35941567 PMCID: PMC9358632 DOI: 10.1186/s12884-022-04957-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Experiences with healthcare services, including perinatal healthcare services, contribute to psychological wellbeing for refugees post-resettlement. To address the paucity of literature examining the relationship between perinatal healthcare and psychological wellbeing in women with refugee backgrounds from African countries this study aimed to: (1) understand the relationship between psychological wellbeing and perinatal care amongst this population, and; (2) identify areas for improved perinatal healthcare services to ensure positive wellbeing outcomes in this population. Methods A total of 39 participants were included in the study. Nineteen women from seven African countries participated in interviews – seven both prior to and after having their babies, two only while pregnant and ten only after their baby had been born. In addition, interviews were conducted with 20 service providers. Interviews were thematically analysed. Results Four key themes were identified, covering continuity of care, cultural safety of care, agency in decision making, and ongoing impacts of perinatal care experiences. Conclusions The results highlighted the need for changes to perinatal healthcare provision at the systems level, including implementing a continuity of care model, and ensuring women’s access to individualised, trauma-informed perinatal services which attend to the cultural and psychosocial resettlement needs of this population. These findings informed recommendations for improving perinatal healthcare services and better psychological outcomes – and in turn broader health outcomes – for African-background refugee mothers.
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Affiliation(s)
- Clemence Due
- The School of Psychology, The University of Adelaide, Adelaide, SA, Australia. .,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Moira Walsh
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Isadora Aldam
- The School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Amelia Winter
- The School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Susan Cooper
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Josephine Sheriff
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Anna Ziersch
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [DOI: https:/doi.org/10.1007/s10597-021-00928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 06/22/2023]
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36
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Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [PMID: 35013831 DOI: 10.1007/s10597-021-00928-0] [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: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth.
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Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, VA, 23284, USA.
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin - Madison, 610 Walnut St., Madison, WI, 53726, USA
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Hecker T, Kyaruzi E, Borchardt J, Scharpf F. Factors Contributing to Violence Against Children: Insights From a Multi-informant Study Among Family-Triads From Three East-African Refugee Camps. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14507-NP14537. [PMID: 33926287 DOI: 10.1177/08862605211013960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parental violence poses a considerable, yet mitigable risk for the mental health and well-being of refugee children living in resource-poor refugee camps. However, little is known about potential risk factors for parental violence in these settings. Using an ecological systems perspective and a multi-informant approach, we investigated ontogenic (parental childhood experiences of violence), microsystem (parents' and children's psychopathology) and exosystem (families' monthly household income) risk factors for child-directed parental violence in a sample of 226 Burundian families living in refugee camps in Tanzania. Data were collected through individual structured clinical interviews with mothers, fathers, and children. In the child-report path model [χ2 (6) = 7.752, p = .257, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.036 (p = .562)], children's posttraumatic stress disorder (PTSD) symptoms, externalizing symptoms and paternal PTSD symptoms were positively associated with violence by both parents. Maternal psychosocial impairment was positively associated with child-reported paternal violence. In the parent-report path model [χ2 (6) = 7.789, p = .254, CFI = 0.97, RMSEA = 0.036 (p = .535)], children's externalizing problems as well as a lower monthly household income were positively related to maternal violence. Each parent's childhood victimization was positively linked to their use of violence against children. Maternal psychosocial impairment and paternal alcohol abuse were positively associated with paternal violence. Child and paternal psychopathology, maternal psychosocial impairment, parents' childhood victimization, and families' socioeconomic status may be important targets for prevention and intervention approaches aiming to reduce parental violence against refugee children living in camps.
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Affiliation(s)
- Tobias Hecker
- Bielefeld University, Bielefeld, Germany
- University of Zurich, Switzerland
| | - Edna Kyaruzi
- Dar Es Salaam University College of Education, Dar es Salaam, Tanzania
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Fabbri C, Powell-Jackson T, Leurent B, Rodrigues K, Shayo E, Barongo V, Devries KM. School violence, depression symptoms, and school climate: a cross-sectional study of Congolese and Burundian refugee children. Confl Health 2022; 16:42. [PMID: 35870935 PMCID: PMC9308201 DOI: 10.1186/s13031-022-00475-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Forcibly displaced children are at increased risk of violence and mental health disorders. In refugee contexts, schools are generally perceived as protective environments where children can build a sense of belonging and recover from trauma. Evidence shows that positive school climates can support student skills development and socio-emotional wellbeing and protect them against a host of adverse outcomes. However, schools are also places where children may experience violence, from both teachers and peers. Prevalence estimates of violence against children in humanitarian settings are scarce and evidence on the relationship between school climate and student outcomes in these contexts is non-existent. The aim of the study is to estimate the prevalence of school-based violence against children and to explore the association between perceptions of school climate and students' experiences and use of violence and their depression symptoms. We relied on data from a cross-sectional survey of students and teachers in all primary and secondary schools in Nyarugusu Refugee Camp in Tanzania, conducted as part of a cluster randomised controlled trial, to compute prevalence estimates and used mixed logistic regression analysis to assess the association between school climate and students' outcomes. We found that students in Nyarugusu experienced high levels of violence from both peers and teachers in both primary and secondary schools in the camp, with little difference between boys and girls. Nearly one in ten students screened positive for symptoms of depression. We found that opportunities for students and teachers to be involved in decision-making were associated with higher odds of violent discipline and teachers' self-efficacy was a significant protective factor against student depression symptoms. However, generally, school-level perceptions of school climate were not associated with student outcomes after adjusting for potential confounders. Our findings suggest that interventions to prevent and respond to teacher and peer violence in schools and to support students' mental health are urgently needed. Our results challenge the assumption that education environments are inherently protective for children and call for further investigation of norms around violence among students and teachers to better understand the role of school climate in refugee settings.
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Affiliation(s)
- Camilla Fabbri
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.
| | - Timothy Powell-Jackson
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK
| | - Baptiste Leurent
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK
- University College London, London, UK
| | | | - Elizabeth Shayo
- National Institute for Medical Research, 3 Barack Obama Dr, P.O. Box 9653, 11101, Dar es Salaam, Tanzania
| | - Vivien Barongo
- National Institute for Medical Research, 3 Barack Obama Dr, P.O. Box 9653, 11101, Dar es Salaam, Tanzania
| | - Karen M Devries
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK
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Kelstrup L, Carlsson J. Trauma-affected refugees and their non-exposed children: A review of risk and protective factors for trauma transmission. Psychiatry Res 2022; 313:114604. [PMID: 35580432 DOI: 10.1016/j.psychres.2022.114604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 01/12/2023]
Abstract
The rates of posttraumatic stress syndrome (PTSD) are high among refugee populations. At the same time, evidence is emerging of intergenerational transmission of psychopathology. The objective of this study was to examine the current knowledge on risk and protective factors for adverse mental health outcomes in the non-exposed offspring of trauma-affected refugees. A systematic search was undertaken from 1 January 1981 to 5 February 2021 (PubMed, Embase, PSYCInfo). Studies were included if they reported on families of trauma-exposed refugee parents and mental health outcomes in their non-exposed children. The search yielded 1415 results and twelve articles met inclusion criteria. The majority of studies emphasized the negative effects of parental mental health symptoms. There was substantial evidence of an association between parental PTSD and increased risk of psychological problems in offspring. Parenting style was identified as both a potential risk and protective factor. Risk/protective factors at the individual and family level were identified, but findings were inconclusive due to sample sizes and study designs. There is a need for evidence-based interventions aimed at improving child outcomes, especially by improving parental mental health and reinforcing parenting skills. Future research should aim to incorporate broader aspects of child development.
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Affiliation(s)
- Laura Kelstrup
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Simenec TS, Reid BM. Refugee Children and Interventions for Depression: A Review of Current Interventions and Implications of the Ecological Context. TRAUMA, VIOLENCE & ABUSE 2022; 23:877-890. [PMID: 35722702 DOI: 10.1177/1524838020979844] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As of 2018, over 25.4 million people worldwide meet the criteria to be considered refugees, the highest number on record. Over half of these individuals are under 18 years old, leaving approximately 12 million children to cope with the trauma and stress typically encountered by refugees. Increased rates of depression in this population are well-documented in the literature. This article reviews the ecological determinants of depression for displaced children and current empirical methods for alleviating depression across contexts. PubMed and PsycINFO databases were reviewed for articles that met the following criteria for inclusion: published between January 1, 2000, and April 16, 2020; peer-reviewed empirical article; in English; reviewed an intervention targeting depression; and included a sample of refugees 18 years of age or younger. Sixteen interventions met inclusion criteria and were assessed using an ecological framework. The programs were analyzed for several methodological and outcome factors including intervention type, retention rate, participant demographics, participant country of origin and host country, ecological framework, and effectiveness. Major findings suggest that interventions including caregivers, involving the child's community, addressing multiple contexts, and that are culturally informed may improve outcomes. This article presents research surrounding risk and protective factors for depression within each context to inform existing interventions and presents additional avenues for services to meet the needs of refugee youth across contexts.
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Affiliation(s)
- Tori S Simenec
- Institute of Child Development, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Brie M Reid
- Institute of Child Development, University of Minnesota, Twin Cities, Minneapolis, MN, USA
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Unaccompanied migrant youth from Central America: Challenges and opportunities. Curr Opin Psychol 2022; 47:101415. [DOI: 10.1016/j.copsyc.2022.101415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022]
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Fine SL, Kane JC, Spiegel PB, Tol WA, Ventevogel P. Ten years of tracking mental health in refugee primary health care settings: an updated analysis of data from UNHCR's Health Information System (2009-2018). BMC Med 2022; 20:183. [PMID: 35570266 PMCID: PMC9109385 DOI: 10.1186/s12916-022-02371-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study examines mental, neurological, and substance use (MNS) service usage within refugee camp primary health care facilities in low- and middle-income countries (LMICs) by analyzing surveillance data from the United Nations High Commissioner for Refugees Health Information System (HIS). Such information is crucial for efforts to strengthen MNS services in primary health care settings for refugees in LMICs. METHODS Data on 744,036 MNS visits were collected from 175 refugee camps across 24 countries between 2009 and 2018. The HIS documented primary health care visits for seven MNS categories: epilepsy/seizures, alcohol/substance use disorders, mental retardation/intellectual disability, psychotic disorders, severe emotional disorders, medically unexplained somatic complaints, and other psychological complaints. Combined data were stratified by 2-year period, country, sex, and age group. These data were then integrated with camp population data to generate MNS service utilization rates, calculated as MNS visits per 1000 persons per month. RESULTS MNS service utilization rates remained broadly consistent throughout the 10-year period, with rates across all camps hovering around 2-3 visits per 1000 persons per month. The largest proportion of MNS visits were attributable to epilepsy/seizures (44.4%) and psychotic disorders (21.8%). There were wide variations in MNS service utilization rates and few consistent patterns over time at the country level. Across the 10 years, females had higher MNS service utilization rates than males, and rates were lower among children under five compared to those five and older. CONCLUSIONS Despite increased efforts to integrate MNS services into refugee primary health care settings over the past 10 years, there does not appear to be an increase in overall service utilization rates for MNS disorders within these settings. Healthcare service utilization rates are particularly low for common mental disorders such as depression, anxiety, post-traumatic stress disorder, and substance use. This may be related to different health-seeking behaviors for these disorders and because psychological services are often offered outside of formal health settings and consequently do not report to the HIS. Sustained and equitable investment to improve identification and holistic management of MNS disorders in refugee settings should remain a priority.
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Affiliation(s)
- Shoshanna L Fine
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jeremy C Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
| | - Paul B Spiegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Arq International, Diemen, the Netherlands
| | - Peter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Scharpf F, Mueller SC, Hecker T. The executive functioning of Burundian refugee youth: Associations with individual, family and community factors. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2022. [DOI: 10.1016/j.appdev.2022.101399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lasater ME, Flemming J, Bourey C, Nemiro A, Meyer SR. School-based MHPSS interventions in humanitarian contexts: a realist review. BMJ Open 2022; 12:e054856. [PMID: 35450900 PMCID: PMC9024269 DOI: 10.1136/bmjopen-2021-054856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/20/2022] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of this review is to elucidate the characteristics of school-based mental health and psychosocial support (MHPSS) interventions in humanitarian contexts and the hypothesised mechanisms by which they influence well-being or learning outcomes. METHODS We conducted a realist review and searched PubMed, Embase, Global Health, CINAHL, PsychInfo, PILOTS and grey literature through January 2022. Eligible studies included children age 6-12 years, were conducted in humanitarian contexts in low-income or middle-income countries, and focused on universal MPHSS prevention in an educational setting, using any study design. Data were extracted and analysed using narrative synthesis and realist analysis techniques to create 'context-mechanism-outcome' configurations that were iteratively developed to modify, refine and substantiate programme theories. RESULTS Twenty-seven articles, representing 19 studies, were included in the review. We analysed data from 26 articles. Eleven evidenced-informed programme theories were developed at the levels of the child (n=4), teacher (n=3), caregiver (n=2), school environment (n=1) and school managers/administrators (n=1). At the child level, mechanisms related to strengthening coping skills, emotion regulation, interpersonal relationships led to improved psychosocial well-being or learning outcomes. At the teacher level, coping skills and the provision of support to students were linked to psychosocial well-being and learning outcomes. At the caregiver level, strengthening interpersonal bonds trigger improved psychosocial well-being, and at the school environment level, fostering feelings of security was linked to psychosocial well-being and learning outcomes. We did not find any evidence supporting the programme theory at the school managers/administrators level. We found limited evidence of positive impacts of the included interventions to support these programme theories. CONCLUSIONS These programme theories are a promising start towards ensuring school-based MHPSS interventions in humanitarian contexts better address the well-being and learning needs of children. Future research is needed to support these programme theories and enhance the evidence base.
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Affiliation(s)
- Molly E Lasater
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Flemming
- The MHPSS Collaborative, hosted by Save the Children Denmark, Copenhagen, Denmark
| | - Christine Bourey
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ashley Nemiro
- The MHPSS Collaborative, hosted by Save the Children Denmark, Copenhagen, Denmark
| | - Sarah R Meyer
- The MHPSS Collaborative, hosted by Save the Children Denmark, Copenhagen, Denmark
- Department of Population and Family Health, Columbia University, New York, New York, USA
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Mulligan CJ, Clukay CJ, Matarazzo A, Hadfield K, Nevell L, Dajani R, Panter-Brick C. Novel GxE effects and resilience: A case:control longitudinal study of psychosocial stress with war-affected youth. PLoS One 2022; 17:e0266509. [PMID: 35377919 PMCID: PMC8979449 DOI: 10.1371/journal.pone.0266509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Responses to early life adversity differ greatly across individuals. Elucidating which factors underlie this variation can help us better understand how to improve health trajectories. Here we used a case:control study of refugee and non-refugee youth, differentially exposed to war-related trauma, to investigate the effects of genetics and psychosocial environment on response to trauma. We investigated genetic variants in two genes (serotonin transporter, 5-HTT, and catechol-O-methyltransferase, COMT) that have been implicated in response to trauma. We collected buccal samples and survey data from 417 Syrian refugee and 306 Jordanian non-refugee youth who were enrolled in a randomized controlled trial to evaluate a mental health-focused intervention. Measures of lifetime trauma exposure, resilience, and six mental health and psychosocial stress outcomes were collected at three time points: baseline, ~13 weeks, and ~48 weeks. We used multilevel models to identify gene x environment (GxE) interactions and direct effects of the genetic variants in association with the six outcome measures over time. We did not identify any interactions with trauma exposure, but we did identify GxE interactions with both genes and resilience; 1) individuals with high expression (HE) variants of 5-HTTLPR and high levels of resilience had the lowest levels of perceived stress and 2) individuals homozygous for the Val variant of COMT with high levels of resilience showed stable levels of post-traumatic stress symptoms. We also identified a direct protective effect of 5-HTTLPR HE homozygotes on perceived insecurity. Our results point to novel interactions between the protective effects of genetic variants and resilience, lending support to ideas of differential susceptibility and altered stress reactivity in a cohort of war-affected adolescents.
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Affiliation(s)
- Connie J. Mulligan
- Department of Anthropology, University of Florida, Gainesville, Florida, United States of America
- Genetics Institute, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Christopher J. Clukay
- Department of Anthropology, University of Florida, Gainesville, Florida, United States of America
- Genetics Institute, University of Florida, Gainesville, Florida, United States of America
| | - Anthony Matarazzo
- Department of Anthropology, University of Florida, Gainesville, Florida, United States of America
- Genetics Institute, University of Florida, Gainesville, Florida, United States of America
| | - Kristin Hadfield
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Lisa Nevell
- Department of Anthropology, University of Florida, Gainesville, Florida, United States of America
- Genetics Institute, University of Florida, Gainesville, Florida, United States of America
| | - Rana Dajani
- Department of Biology and Biotechnology, Faculty of Science, The Hashemite University, Zarqa, Jordan
| | - Catherine Panter-Brick
- Department of Anthropology, Yale University, New Haven, Connecticut, United States of America
- Jackson Institute of Global Affairs, Yale University, New Haven, Connecticut, United States of America
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McEwen FS, Popham C, Moghames P, Smeeth D, de Villiers B, Saab D, Karam G, Fayyad J, Karam E, Pluess M. Cohort profile: biological pathways of risk and resilience in Syrian refugee children (BIOPATH). Soc Psychiatry Psychiatr Epidemiol 2022; 57:873-883. [PMID: 35041012 PMCID: PMC8960581 DOI: 10.1007/s00127-022-02228-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023]
Abstract
The BIOPATH cohort was established to explore the interplay of psychosocial and biological factors in the development of resilience and mental health problems in Syrian refugee children. Based in Lebanon, a middle-income country significantly impacted by the refugee crisis, it is the first such cohort of refugees in the Middle East. Families were recruited from informal tented settlements in the Beqaa region using purposive cluster sampling. At baseline (October 2017-January 2018), N = 3188 individuals participated [n = 1594 child-caregiver dyads; child gender, 52.6% female; mean (SD) age = 11.44 (2.44) years, range = 6-19]. Re-participation rate at 1-year follow-up was 62.8%. Individual interviews were conducted with children and primary caregivers and biological samples collected from children. Measures include: (1) children's well-being and mental health problems (using tools validated against clinical interviews in a subsample of the cohort); (2) psychosocial risk and protective factors at the level of the individual (e.g. coping strategies), family (e.g. parent-child relationship), community (e.g. collective efficacy), and wider context (e.g. services); (3) saliva samples for genetic and epigenetic (methylation) analyses; (4) hair samples to measure cortisol, dehydroepiandrosterone (DHEA) and testosterone. This cohort profile provides details about sampling and recruitment, data collection and measures, demographic data, attrition and potential bias, key findings on resilience and mental health problems in children and strengths and limitations of the cohort. Researchers interested in accessing data should contact Professor Michael Pluess at Queen Mary University of London, UK (e-mail: m.pluess@qmul.ac.uk).
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Affiliation(s)
- Fiona S McEwen
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Cassandra Popham
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | | | - Demelza Smeeth
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Bernadette de Villiers
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Dahlia Saab
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
- Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, Balamand University, El-Koura, Lebanon
| | - John Fayyad
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
- Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, Balamand University, El-Koura, Lebanon
| | - Elie Karam
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
- Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, Balamand University, El-Koura, Lebanon
| | - Michael Pluess
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.
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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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Jankovic-Rankovic J, Oka RC, Meyer JS, Snodgrass JJ, Eick GN, Gettler LT. Transient refugees' social support, mental health, and physiological markers: Evidence from Serbian asylum centers. Am J Hum Biol 2022; 34:e23747. [PMID: 35349201 DOI: 10.1002/ajhb.23747] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Refugees seeking safety across international borders are often exposed to a wide breadth of psychosocially stressful experiences that may fracture existing sources of social support and impair the generation of new social relationships, with implications for their long-term health and resilience. Using data from recently settled refugees in two asylum centers in Serbia, we examined the associations between social support, mental health, and physiological markers. METHODS In this mixed-method study of refugees (age 18-50 years, n = 76), we collected key socio-demographic information and conducted semi-structured interviews about refugees' journey and stay in Serbia, trauma/loss, and their sources of social support. We also collected self-reported measures of mental well-being as well as physiological markers relevant to repeated exposure to chronic psychosocial stress (fingernail cortisol and dried blood spots for analysis of Epstein-Barr virus [EBV] antibody titers). RESULTS We found that refugees with longer journeys reported lower social support than those with shorter journeys. Refugees with lower social support reported poorer mental well-being, greater PTSD-related symptoms, and higher recent perceived stress than those with higher social support. We also observed that refugees with lower social support and higher recent stress, respectively, tended to exhibit higher fingernail cortisol levels. However, we did not observe comparable patterns linking EBV antibodies with psychosocial functioning. CONCLUSION Our cross-sectional findings are consistent with the notion that social support is likely to be a critical component in effective interventions aimed at mitigating the adverse health effects of relocation-related illnesses and poor social functioning as they await resettlement.
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Affiliation(s)
| | - Rahul C Oka
- Department of Anthropology, University of Notre Dame, Notre Dame, Indiana, USA
| | - Jerrold S Meyer
- Psychological and Brain Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Lee T Gettler
- Department of Anthropology, University of Notre Dame, Notre Dame, Indiana, USA.,Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, USA
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Interparental conflict and depressive symptoms among Chinese adolescents: A longitudinal moderated mediation model. Dev Psychopathol 2022; 35:972-981. [PMID: 35249580 DOI: 10.1017/s0954579422000190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While the detrimental effect of interparental conflict on adolescent depression is well-established, the underlying mechanisms linking the two continue to be inadequately understood. This study investigated the mediating role of family functioning and the moderating role of cultural beliefs about adversity in the association between interparental conflict and adolescent depression. The samples included 651 Chinese adolescents (mean age at Time 1 = 13.27 years; 56.5% girls) from a two-wave longitudinal study with data spanning 1 year. The findings from path modeling analyses provided evidence for the mediating role of family functioning; these findings indicated that interparental conflict can damage family functioning, which in turn exacerbates the risk of adolescent depression. The moderating role of cultural beliefs about adversity was also demonstrated by interactions between interparental conflict and cultural beliefs about adversity, as well as, family functioning and cultural beliefs about adversity. The results indicated a buffering role of cultural beliefs about adversity on the deleterious effect of interparental conflict on adolescent depression. They also suggested that lower levels of family functioning was associated with increased depression among adolescents were lower in cultural beliefs about adversity.
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Sharma M, Perera C, Ipince A, Bakrania S, Shokraneh F, Idele P, Anthony D, Banati P. PROTOCOL: Child and adolescent mental health and psychosocial support interventions: An evidence and gap map of low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1221. [PMID: 36908659 PMCID: PMC8848633 DOI: 10.1002/cl2.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This is the protocol for a Campbell review. The objective of this evidence and gap map is to provide an overview of the existing evidence on the effectiveness of interventions aimed at promoting mental health and reducing or preventing mental health conditions among children and adolescents in low- and middle-income countries.
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Affiliation(s)
| | | | | | | | | | | | | | - Prerna Banati
- UNICEF West and Central Africa Regional OfficeDakarSenegal
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