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Wichmann MLY, Pawils S, Richters J, Metzner F. School-Based Interventions for Child and Adolescent Victims of Interpersonal Violence. TRAUMA, VIOLENCE & ABUSE 2023; 24:1743-1762. [PMID: 35482522 DOI: 10.1177/15248380221078892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Interpersonal violence against children and adolescents can affect their mental health and functioning in the long term. To reduce mental health problems in children and adolescents, school-based mental health interventions have been shown to be beneficial. A review of school-based interventions designed to mitigate posttraumatic symptoms after interpersonal violence is lacking to date. METHODS We searched for original studies published in English or German until November 2019 in 6 electronic databases. Supplementary search strategies to reduce publication bias were implemented. Peer-reviewed original studies assessing school-based interventions for children and adolescents under the age of 21 after interpersonal violence were included. Relevant data was extracted, synthesised and assessed qualitatively. The methodological quality of included studies was assessed. RESULTS Of 5,021 unduplicated publications, 15 studies met eligibility criteria. The included studies were almost exclusively conducted in the USA; over half utilised a randomised-controlled design. Studies mainly focussed on Posttraumatic Stress Disorder (PTSD) or depression. In all studies, implemented interventions partially or fully mitigated posttraumatic symptoms. Nine school-based interventions, five of which were based on cognitive behavioural therapy (CBT), were identified. School staff were often involved in intervention implementation besides mental health professionals. CONCLUSIONS School-based interventions can be beneficial to reduce mental health problems in children and adolescents after interpersonal violence. Trained school staff aided by mental health professionals can implement trauma-informed practices at school. While school-based interventions may be a feasible way to provide children and adolescents with accessible mental health care, further research on school-based trauma interventions outside the USA is necessary.
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Affiliation(s)
- Michelle L-Y Wichmann
- Department of Educational Science, University of Siegen, Faculty II, (Chair for) Educational Science with Focus on Special Education, Siegen, Germany
| | - Silke Pawils
- Center for Psychosocial Medicine, Institute and Outpatients Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Richters
- Department of Educational Science, University of Siegen, Faculty II, (Chair for) Educational Science with Focus on Special Education, Siegen, Germany
| | - Franka Metzner
- Department of Educational Science, University of Siegen, Faculty II, (Chair for) Educational Science with Focus on Special Education, Siegen, Germany
- Center for Psychosocial Medicine, Institute and Outpatients Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Veeser J, Barkmann C, Schumacher L, Zindler A, Schön G, Barthel D. Post-traumatic stress disorder in refugee minors in an outpatient care center: prevalence and associated factors. Eur Child Adolesc Psychiatry 2023; 32:419-426. [PMID: 34524524 DOI: 10.1007/s00787-021-01866-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Due to their likelihood for experiencing a number of traumatic events, refugee minors have an increased risk of developing post-traumatic stress disorder (PTSD). However, the prevalence of PTSD in refugee children varies widely between studies, and it remains somewhat unclear what factors increase children's risk of PTSD. This study aimed to assess the prevalence of PTSD in a clinical outpatient sample of refugee minors, and to evaluate the association of different risk factors with a PTSD diagnosis. N = 417 refugee minors were recruited from an outpatient clinical center in Hamburg, Germany. The median age was 15.4 years and 74.6% of the minors were male. As part of the standard diagnostic process, their social history and a potential PTSD diagnosis using the Module K of the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was assessed. The predictive value of age, gender, number of interpersonal traumatic events, un-/accompanied status, presence of family member in the host country, flight duration, residence status, and time since arrival in the host country were investigated using logistic regression analysis. The prevalence of PTSD among the young refugee patients was 61.6%. Significant predictors of a PTSD diagnosis were number of interpersonal traumatic life events, age, residence status, and time since arrival in the host country. The prediction model explained 33.8% of variance of the outcome with the number of interpersonal traumatic events having the largest contribution (20.8%). The high prevalence of PTSD among refugee minors in outpatient care emphasizes the need to establish appropriate care structures and train specialists in the treatment of PTSD.
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Affiliation(s)
- Jakob Veeser
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
| | - Lea Schumacher
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Areej Zindler
- Outpatient Center GmbH, Refugee Outpatient Clinic, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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3
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Hahnefeld A, Münch K, Aberl S, Henningsen P, Mall V. Versorgung traumatisierter Vorschulkinder. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Walg M, Löwer F, Bender S, Hapfelmeier G. Domain-specific discrepancies between self- and caseworkers’ proxy- reports of emotional and behavioral difficulties in unaccompanied refugees. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2022. [DOI: 10.1080/13632752.2022.2129369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Marco Walg
- Department of Child and Adolescent Psychiatry, Sana-Klinikum , Remscheid, Germany
| | | | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Gerhard Hapfelmeier
- Department of Child and Adolescent Psychiatry, Sana-Klinikum , Remscheid, Germany
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Costa D, Biddle L, Bozorgmehr K. Association between psychosocial functioning, health status and healthcare access of asylum seekers and refugee children: a population-based cross-sectional study in a German federal state. Child Adolesc Psychiatry Ment Health 2021; 15:59. [PMID: 34641919 PMCID: PMC8513294 DOI: 10.1186/s13034-021-00411-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The mental health condition and healthcare needs of asylum seeking and refugee (ASR) children may go unrecognized if barriers to healthcare access exist accompanied by exclusive focus on somatic illness. We analysed the relationship between psychosocial functioning, health status and healthcare access of ASR children. METHODS During 2018, 560 ASR adults in 58 collective accommodations in Germany's 3rd largest federal state were randomly sampled and assessed. The parent-reported Strengths and Difficulties Questionnaire (SDQ) was used to assess child psychosocial functioning. SDQ dimensions (Emotional, Conduct, Peer, Hyperactivity, Prosocial, Total) were compared by demographics (sex, age, region of origin, time since arrival, subjective social status), health status (long-lasting illness, physical limitation, pain) and healthcare access (utilization: paediatrician, specialist, dentist, psychologist, hospital/emergency department, prescribed medicines; and unmet needs: for paediatrician/specialist, reduced spending to cover healthcare cost). Age and sex-adjusted odds ratios (AOR, 95%CI-Confidence Intervals) for scoring in borderline/abnormal ranges in SDQ dimensions were estimated through logistic regression depending on children' health status and healthcare access. RESULTS We analysed parents' answers pertaining to 90 children aged 1-17 years old, 57% of which were girls and 58% with (Eastern or Western) Asian nationality. Scoring in the borderline/abnormal range of the SDQ Total Difficulties score was associated with feeling bodily pain (compared to no pain, AOR, 95%CI = 3.14, 1.21-8.10) and with an unmet need for a specialist during the previous year (4.57, 1.09-19.16). Borderline/abnormal SDQ Emotional scores were positively associated with a long-lasting illness (5.25, 1.57-17.55), physical limitation (4.28, 1.49-12.27) and bodily pain (3.00, 1.10-8.22), and negatively associated with visiting a paediatrician (0.23, 0.07-0.78), specialist (0.16, 0.04-0.69), and the emergency department (0.27, 0.08-0.96). CONCLUSION Poor psychosocial functioning among ASR children is associated with somatic problems, unmet medical needs, and lower healthcare utilisation. Somatic clinical encounters with ASR should include children' mental health symptomatology assessment, especially in those with worst physical health conditions.
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Affiliation(s)
- Diogo Costa
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, P.o. Box 10 01 31, 33501, Bielefeld, Germany.
| | - Louise Biddle
- Section of Health Equity Studies & Migration, Dept. of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, P.o. Box 10 01 31, 33501, Bielefeld, Germany
- Section of Health Equity Studies & Migration, Dept. of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Distribution and management of the pediatric refugee population with renal replacement: A German pediatric cohort. Pediatr Nephrol 2021; 36:271-277. [PMID: 31897711 DOI: 10.1007/s00467-019-04374-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
With migration rising, the pediatric nephrology community is faced with challenges concerning the management of end-stage kidney disease (ESKD) in the pediatric refugee population. Data on the care of the pediatric refugee cohort on renal replacement therapy (RRT) is not available. A survey conducted by us in 2018 showed that the group of refugee children arriving to Germany during the years 2015-2017 accounts for approximately 20% of the total pediatric dialysis population in Germany. Provision of (medical) care for these children and their families is often hampered by psychosocial problems, cultural differences, language barriers, and administrative issues. Treating centers need to provide additional human as well as financial and logistic resources. In this educational review, we raise awareness and discuss possible challenges occurring in the treatment of refugee children with ESKD.
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Beißert H, Gönültaş S, Mulvey KL. Social Inclusion of Refugee and Native Peers Among Adolescents: It is the Language that Matters! JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30:219-233. [PMID: 31206919 PMCID: PMC7065049 DOI: 10.1111/jora.12518] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study investigated the role of refugee status and language skills for adolescents' inclusion or exclusion decisions in hypothetical intergroup scenarios. 100 German adolescents (Mage = 13.65 years, SD = 1.93) were presented three scenarios in which groups of adolescents are planning leisure time activities, and peers from their own country (Germany) versus another country (Syrian refugees) with either good or bad German skills want to join them. Whereas adolescents' inclusion decisions did not differ between the German protagonist and the Syrian one with good German skills, the Syrian protagonist with bad German skills was less likely to be included than either of the other two. These findings have implications for understanding the role of language in adolescents' inclusion decisions.
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Affiliation(s)
- Hanna Beißert
- Leibniz Institute for Research and Information in Education
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Streeck-Fischer A. Borderland and Borderline: Understanding and Treating Adolescent Migrants in Crisis. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676609666190415144153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background::
Much of the literature on adolescent refugees has focused on their
experiences of trauma, and trauma-focused psychotherapy has been emphasized. In addition
to having experienced trauma, adolescents with refugee or migration backgrounds are confronted
with distinct challenges in the process of identity formation. These problems result
from the normal processes of identity formation and restructuring during adolescence (the socalled
second individuation phase) complicated by their transition from their culture of origin
to the new culture. This process has been called a third individuation phase. These teenagers
live on the border between two worlds and are called borderland adolescents.
Method::
This paper describes the developmental processes of young migrants, using case
examples to illustrate how the migrant experience affects development, particularly identity
development.
Discussion::
Splitting, which is part of normal adolescent development, also occurs during the
process of adaptation to a new culture. Although the process of splitting can support the integration
into the new culture, it can also lead to dangerous polarization with borderline features. It is
important to take this into account in psychotherapeutic work with borderland adolescents.
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Santos-Hövener C, Kuntz B, Frank L, Koschollek C, Ellert U, Hölling H, Thamm R, Schienkiewitz A, Lampert T. Zur gesundheitlichen Lage von Kindern und Jugendlichen mit Migrationshintergrund in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1253-1262. [DOI: 10.1007/s00103-019-03012-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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[Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities]. Prax Kinderpsychol Kinderpsychiatr 2019; 68:488-502. [PMID: 31480942 DOI: 10.13109/prkk.2019.68.6.488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities Unaccompanied minor refugees (UMR) who arrive in Germany are generally placed in institutional child care facilities. UMR are a very burdened group, however other children and adolescents in institutional care are burdened as well, and their quality of life is often reduced. The aim of the current study was thus to compare quality of life and behavioral problems of UMR in child care facilities with those of other resident adolescents. For a total of 50 UMR, data regarding behavioral problems was available, for 41 UMR ratings on quality of life, both from external assessments. Two parallel comparison samples of other adolescents in the same institutional care facilities were drawn with adolescents with and without a migration background. Results show that in general, UMR show fewer behavioral problems than the other two groups, especially in externalizing behavior. For internalizing behavior, no differences were evident. For quality of life, no differences could be found between the three groups of inhabitants in institutional care. This indicates that the same factors determining quality of life are present in all three groups, but that the underlying mental problems are different in UMR than in other adolescents. Thus, staff in institutional care should possibly work differently with these group of adolescents than with other inhabitants and should be educated respectively.
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11
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Scheiber B, Greinz G, Hillebrand JB, Wilhelm FH, Blechert J. Resilienztraining für unbegleitete minderjährige Flüchtlinge. KINDHEIT UND ENTWICKLUNG 2019. [DOI: 10.1026/0942-5403/a000287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Die hohen Flüchtlingszahlen und die fortlaufende Ankunft schwer traumatisierter unbegleiteter minderjähriger Flüchtlinge (UMF) verschärfen die Suche nach wirksamen und niederschwelligen Präventions- und Interventionsprogrammen. Die vorliegende Pilotstudie evaluiert die Effektivität eines nicht-indizierten, sechs Sitzungen umfassenden Resilienztrainings für UMF. Teilnehmende (N = 55) wurden in einem randomisiert-kontrollierten Wartelistendesign vor (T1) und nach (T2) dem Gruppenprogramm untersucht. Abhängige Variablen waren das allgemeine Wohlbefinden sowie Symptome von Traumafolgestörungen. Weiter wurden aus mehreren Perspektiven (Teilnehmer, Dolmetscher, Gruppenleitende, Betreuende) qualitative Daten erfasst. Während Traumafolgestörungssymptome unverändert blieben, berichtete die Interventionsgruppe nach dem Programm einen Anstieg im Wohlbefinden, nicht jedoch die Kontrollgruppe. Die qualitativen Daten wiesen perspektivenübergreifend auf positive Veränderungen in mehreren Funktionsbereichen hin. Ein kurzes Resilienztraining hat somit das Potential Verbesserungen zu bewirken. Für eine Minderung von Traumafolgestörungssymptomen sind jedoch wohl längere bzw. traumaspezifischere Interventionen erforderlich.
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Affiliation(s)
| | | | | | | | - Jens Blechert
- Fachbereich Psychologie der Universität Salzburg, Österreich
- Centre for Cognitive Neuroscience der Universität Salzburg, Österreich
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Barthel D, Ravens-Sieberer U, Schulte-Markwort M, Klasen F, Zindler A. Klinisch-psychologische Diagnostik in einer Flüchtlingsambulanz für Kinder und Jugendliche. KINDHEIT UND ENTWICKLUNG 2019. [DOI: 10.1026/0942-5403/a000286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Für geflüchtete Kinder und Jugendliche wird in der Flüchtlingsambulanz des Universitätsklinikums Hamburg-Eppendorf ambulante psychiatrisch-psychotherapeutische und psychosoziale Versorgung angeboten. Seit Oktober 2016 durchlaufen die Patienten einen standardisierten klinisch-psychologischen Diagnostikprozess, welcher die Behandlungsplanung unterstützen soll. Von den N = 134 untersuchten Patienten im Alter von 8 bis 20 Jahren wurden n = 90 (69.8 %) mit einer gegenwärtig vorliegenden PTBS diagnostiziert. Weiterhin wiesen n = 67 (50.0 %) der Geflüchteten eine mittelgradige oder schwere depressive Episode auf. Nahezu alle Patienten gaben an, in ihrem Herkunftsland mehrfach interpersonelle Gewalt erlebt zu haben. Als Behandlungsziel wurde am häufigsten ein besserer Umgang mit negativen Gefühlen und Gedanken formuliert. Diese Ergebnisse demonstrieren, dass es sich bei den untersuchten geflüchteten Kindern und Jugendlichen, um eine äußerst stark belastete Gruppe mit hohem Behandlungsbedarf handelt.
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Affiliation(s)
- Dana Barthel
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
| | - Ulrike Ravens-Sieberer
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
| | - Michael Schulte-Markwort
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
| | - Fionna Klasen
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
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Prevalence of mental disorders in young refugees and asylum seekers in European Countries: a systematic review. Eur Child Adolesc Psychiatry 2019; 28:1295-1310. [PMID: 30151800 PMCID: PMC6785579 DOI: 10.1007/s00787-018-1215-z] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/16/2018] [Indexed: 12/27/2022]
Abstract
The European Union member states received about 385,000 asylum applications from children and adolescents below 18 years in 2015, and 398,000 in 2016. The latest political crises and war have led to an upsurge in refugee movements into European countries, giving rise to a re-evaluation of the epidemiology of psychiatric disorders and mental health problems among young refugees and asylum seekers. We systematically searched five electronic databases and reference lists of pertinent review articles. We then screened the results of forward citation tracking of key articles for relevant studies in the field for the period from January 1990 to October 2017. We dually reviewed citations and assessed risk of bias. We reported the results narratively, as meta-analyses were impeded due to high heterogeneity. We included 47 studies covered in 53 articles. Overall, the point prevalence of the investigated psychiatric disorders and mental health problems varied widely among studies (presenting interquartile ranges): for posttraumatic stress disorder between 19.0 and 52.7%, for depression between 10.3 and 32.8%, for anxiety disorders between 8.7 and 31.6%, and for emotional and behavioural problems between 19.8 and 35.0%. The highly heterogeneous evidence base could be improved by international, methodologically comparable studies with sufficiently large sample sizes drawn randomly among specific refugee populations. The prevalence estimates suggest, nevertheless, that specialized mental health care services for the most vulnerable refugee and asylum-seeking populations are needed. REGISTRATION: The systematic review protocol was registered in PROSPERO on October 19th, 2017 with the number: CRD42017080039 and is available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=80039.
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Kloning T, Nowotny T, Alberer M, Hoelscher M, Hoffmann A, Froeschl G. Morbidity profile and sociodemographic characteristics of unaccompanied refugee minors seen by paediatric practices between October 2014 and February 2016 in Bavaria, Germany. BMC Public Health 2018; 18:983. [PMID: 30086731 PMCID: PMC6081864 DOI: 10.1186/s12889-018-5878-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/24/2018] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to investigate the morbidity profile and the sociodemographic characteristics of unaccompanied refugee minors (URM) arriving in the region of Bavaria, Germany, between October 2014 and February 2016. Methods The retrospective cross sectional study included 154 unaccompanied refugee minors between 10 and 18 years of age. The data was derived from medical data records of their routine first medical examination in two paediatric practices and one collective housing for refugees in the region of Bavaria, Germany. Results Only 12.3% of all participants had no clinical finding at arrival. Main health findings were skin diseases (31.8%) and mental disorders (25%). In this cohort the hepatitis A immunity was 92.8%, but only 34.5% showed a constellation of immunity against hepatitis B. Suspect cases for tuberculosis were found in 5.8% of the URM. There were no HIV positive individuals in the cohort. Notably, 2 females were found to have undergone genital mutilations. Conclusions The majority of arriving URM appear to have immediate health care needs, whereas the pathologies involved are mostly common entities that are generally known to the primary health care system in Germany. Outbreaks due to hepatitis A virus are unlikely since herd immunity can be assumed, while this population would benefit from hepatitis B vaccination due to low immunity and high risk of infection in crowded housing conditions. One key finding is the absence of common algorithms and guidelines in health care provision to URM.
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Affiliation(s)
- Teresa Kloning
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Thomas Nowotny
- Privatärztliche Kinder- und Jugendarztpraxis, Stephanskirchen, Germany
| | - Martin Alberer
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Axel Hoffmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
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Buchmüller T, Lembcke H, Busch J, Kumsta R, Leyendecker B. Exploring Mental Health Status and Syndrome Patterns Among Young Refugee Children in Germany. Front Psychiatry 2018; 9:212. [PMID: 29887810 PMCID: PMC5981028 DOI: 10.3389/fpsyt.2018.00212] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/04/2018] [Indexed: 11/24/2022] Open
Abstract
Refugee children share a large number of pre-, peri-, and post-migration risk factors, which make them vulnerable for developing mental health concerns. Within the last few years, a large number of families with young children have sought refuge in Germany. However, children's mental health status in Germany is mostly unclear. A central aim of developmental psychopathology is to understand how risk factors lead to the emergence of mental health concerns. One approach to investigating this association is the study of specificity, which describes the idea that specific risk factors are related to specific psychological outcomes. The aim of our study was to assess the mental health status of young refugee children in Germany, and to explore a potential refugee-specific mental health pattern. In two studies, we assessed mental health outcomes of 93 children from Syria or Iraq, aged 1.5-5 years, who recently arrived in Germany. The results were compared to U.S. norm data of typically developing children, and to norm data of a clinical sample in order to explore mental health patterns. In the first study (n = 35), we used standardized screening tools for parents (CBCL 1.5-5). In the second study (n = 58), mental health states of refugee children were assessed by caretakers (CTRF 1.5-5). In comparison to U.S. norm data of normally developing children, refugee parents reported more mental health concerns for their children, especially on syndrome scales of internalizing difficulties. A comparison to U.S. clinical reference data showed a specific mental health pattern, characterized by increased levels of anxiety/depression, attention problems, and withdrawal behavior. Caretakers, too, reported more mental health problems compared to typically developing children, albeit to a smaller extent. However, a comparison to clinically-referred children only led to partial confirmation of a specific mental health pattern. Our studies offer important insights into the mental health status and pattern of young refugee children, which is essential for preventing the onset of psychopathology and for offering tailored interventions.
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Affiliation(s)
- Thimo Buchmüller
- Department of Developmental Psychology, Faculty of Psychology, Ruhr-University Bochum Bochum, Germany
| | - Hanna Lembcke
- Department of Developmental Psychology, Faculty of Psychology, Ruhr-University Bochum Bochum, Germany
| | - Julian Busch
- Department of Developmental Psychology, Faculty of Psychology, Ruhr-University Bochum Bochum, Germany
| | - Robert Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum Bochum, Germany
| | - Birgit Leyendecker
- Department of Developmental Psychology, Faculty of Psychology, Ruhr-University Bochum Bochum, Germany
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Sukale T. Die Herausforderung in der therapeutischen Arbeit mit Flüchtlingen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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[Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders]. Prax Kinderpsychol Kinderpsychiatr 2017; 65:707-728. [PMID: 27923340 DOI: 10.13109/prkk.2016.65.10.707] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.
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Bozorgmehr K, Mohsenpour A, Saure D, Stock C, Loerbroks A, Joos S, Schneider C. [Systematic review and evidence mapping of empirical studies on health status and medical care among refugees and asylum seekers in Germany (1990-2014)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:599-620. [PMID: 27090243 DOI: 10.1007/s00103-016-2336-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Owing to a lack of routine statistics on the health status and medical care of asylum seekers, empirical studies play a major role in the mapping of these aspects. OBJECTIVES The aim of this review is to provide a comprehensive overview of the research landscape in this area, synthesizing knowledge from empirical studies and identifying evidence gaps. METHODS A three-tiered search strategy included searching for empirical studies in national/international databases and on the internet, screening reference lists, and contacting experts. Studies meeting predefined inclusion criteria were thematically organized and described in a narrative synthesis. RESULTS The searches generated 1,190 hits; 52 articles met the inclusion criteria. Of these, 41 were quantitative studies (78.9 %), 10 qualitative (19.2 %), and 1 was a review (1.9 %). A total of 30 primary articles (58.9 %) analyzed mental health aspects, followed by infectious diseases (n = 12, 23.5 %). Qualitative studies, mainly ethnographies and case studies, explored mental health and social determinants of health, providing evidence for the impact of living conditions on health and medical care. Few studies analyzed chronic diseases (n = 3) or childhood illnesses (n = 6). No studies analyzed the health needs or medical care of asylum-seeking women during pregnancy and child birth. In 62.7 % of the primary studies, a single sampling point was used to recruit asylum seekers. Nationwide external validity was given in two quantitative studies. CONCLUSION The priority research areas identified are chronic diseases and childhood and maternal health. The divergency and heterogeneity of the studies hamper a comprehensive and comparable acquisition of knowledgeand emphasize the need for collaborative research to close the existing evidence gaps.
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Affiliation(s)
- Kayvan Bozorgmehr
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
| | - Amir Mohsenpour
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Daniel Saure
- Institut für Medizinische Biometrie und Informatik (IMBI), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Christian Stock
- Institut für Medizinische Biometrie und Informatik (IMBI), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Adrian Loerbroks
- Institut für Arbeitsmedizin und Sozialmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Stefanie Joos
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Christine Schneider
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
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Metzner F, Reher C, Kindler H, Pawils S. [Psychotherapeutic treatment of accompanied and unaccompanied minor refugees and asylum seekers with trauma-related disorders in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 59:642-51. [PMID: 27090242 DOI: 10.1007/s00103-016-2340-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Germany is one of the most important host countries for minor refugees and asylum seekers in Europe. The number of children who leave their home country has significantly risen worldwide in recent years; a further rise is to be expected due to the increasing number of crisis zones. A literature review demonstrates the state of research on traumatization, post-traumatic stress disorders and psychotherapy in minor refugees and asylum seekers. EXPOSURE TO VIOLENCE AND POST-TRAUMATIC STRESS DISORDERS Many minor refugees and asylum seekers have made mainly interpersonal traumatic experiences within their home country or during their flight and develop simple or complex post-traumatic stress disorders. Left untreated, there is a risk of chronification. HEALTH CARE SITUATION The psychotherapeutic treatment of minor refugees and asylum seekers in Germany takes place primarily in specialized psychosocial treatment centers. For an involvement of therapists in private practices, a reduction of organizational barriers as well as evidence-based treatment methods for interpreter-aided psychotherapy of minor refugees and asylum seekers that also consider their developmental state, are still lacking. CONCLUSION In research, as well as in practice, there is further need for an early and systematic identification and treatment of minor refugees and asylum seekers with post-traumatic stress disorders or high risk of disease in Germany.
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Affiliation(s)
- Franka Metzner
- Poliklinik und Institut für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Cornelia Reher
- Flüchtlingsambulanz für Kinder und Jugendliche, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Heinz Kindler
- Abteilung Familie und Familienpolitik, Deutsches Jugendinstitut, München, Deutschland
| | - Silke Pawils
- Poliklinik und Institut für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Abstract
Unseen Suffering - Therapy for Traumatized Refugee Children In March 2015 the psychological counselling service (Psychologische Familien- und Lebensberatung) of Caritas Ulm initiated a psychotherapy project for traumatized minor refugees. Besides individual and group therapy, networking and qualification of qualified personnel and volunteers, in autumn 2015 we started offering our services on-site in a large collective accommodation for asylum seekers in Ulm. This was mainly because - in contrast to unaccompanied, mostly adolescent, minor refugees - our services appeared to reach children only by chance. In our opinion this is mostly due to the fact that children's suffering is often far less noticed. This paper describes our first year's project work, followed by reports on the use of psychodrama groups with refugee children and on the therapeutic work in a collective accommodation for asylum seekers.
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Mannhart A, Freisleder FJ. Traumatisierung bei unbegleiteten minderjährigen Flüchtlingen. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0199-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dixius A, Möhler E. [A complex crisis intervention for a 16-year-old pregnant girl after unaccompanied emigration from Eritrea]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 45:69-74. [PMID: 27642798 DOI: 10.1024/1422-4917/a000458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Unaccompanied refugee minors are frequently confronted with multiple, potentially traumatizing events; girls tend to show most profound traumatizations. A 16-year-old female refugee minor was admitted to a child psychiatric ward over the weekend for acute suicidal behavior. The girl had fled unaccompanied from Eritrea and was living in a shelter home for adolescents. Pregnancy (23 weeks p. c.) had been diagnosed the previous day, stemming from several rapes that had occurred on her journey through Sudan and Nigeria. The girl had repressed all signs of the pregnancy from her consciousness. However, when it became medically undeniably apparent, she tried to end her life by jumping out of a window. The shelter home staff requested a psychiatric indication for termination of the pregnancy. Implications of medical indications for psychiatric reasons at a pregnancy state of 23 weeks as well as ethical aspects and considerations with regard to posttraumatic symptomatology are discussed in the following case report.
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Affiliation(s)
- Andrea Dixius
- 1 SHG-Kliniken Sonnenberg, Kleinblittersdorf, Deutschland
| | - Eva Möhler
- 1 SHG-Kliniken Sonnenberg, Kleinblittersdorf, Deutschland
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Unterhitzenberger J, Eberle-Sejari R, Rassenhofer M, Sukale T, Rosner R, Goldbeck L. Trauma-focused cognitive behavioral therapy with unaccompanied refugee minors: a case series. BMC Psychiatry 2015; 15:260. [PMID: 26497391 PMCID: PMC4619299 DOI: 10.1186/s12888-015-0645-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Unaccompanied refugee minors (URMs) are a group who are vulnerable to developing posttraumatic stress symptoms (PTSS). However, they rarely receive the treatment that is indicated and there are no treatment studies focusing exclusively on this group of adolescents. This case study evaluates the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for URMs with PTSS. METHOD A health care utilization sample of N = 6 was assessed prior to and after treatment with TF-CBT. Therapists were asked to report differences in treatment application and content in comparison to TF-CBT standard protocol. RESULTS We found moderate to high levels of PTSS at baseline and a clinically significant decrease in symptoms at posttest. Some modifications to the TF-CBT protocol were made with regard to affective modulation which required more sessions than usual whereas fewer caregiver sessions were conducted. CONCLUSION TF-CBT is feasible in reducing PTSS in severely traumatized URMs. Further research with controlled trials is necessary. TRIAL REGISTRATION The trial registration: ClinicalTrials.gov Identifier NCT01516827. Registered 13 December 2011.
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Affiliation(s)
- Johanna Unterhitzenberger
- Catholic University Eichstätt-Ingolstadt, Clinical and Biological Psychology, Ostenstrasse 25, 85071, Eichstätt, Germany.
| | - Rima Eberle-Sejari
- Catholic University Eichstätt-Ingolstadt, Clinical and Biological Psychology, Ostenstrasse 25, 85071, Eichstätt, Germany.
| | - Miriam Rassenhofer
- University Ulm, Clinic for Child and Adolescent Psychiatry, Steinhövelstrasse 5, 89075, Ulm, Germany.
| | - Thorsten Sukale
- University Ulm, Clinic for Child and Adolescent Psychiatry, Steinhövelstrasse 5, 89075, Ulm, Germany.
| | - Rita Rosner
- Catholic University Eichstätt-Ingolstadt, Clinical and Biological Psychology, Ostenstrasse 25, 85071, Eichstätt, Germany.
| | - Lutz Goldbeck
- University Ulm, Clinic for Child and Adolescent Psychiatry, Steinhövelstrasse 5, 89075, Ulm, Germany.
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Eberle-Sejari R, Nocon A, Rosner R. Zur Wirksamkeit von psychotherapeutischen Interventionen bei jungen Flüchtlingen und Binnenvertriebenen mit posttraumatischen Symptomen. KINDHEIT UND ENTWICKLUNG 2015. [DOI: 10.1026/0942-5403/a000171] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Trotz hoher Zahlen junger Flüchtlinge und der häufig hohen Belastung mit Symptomen einer Posttraumatischen Belastungsstörung (PTBS) gibt es Unsicherheiten über Therapiemöglichkeiten und deren Effektivität in dieser Patientengruppe. Zur Untersuchung der Wirksamkeit unterschiedlicher Interventionen wurde ein systematischer Review durchgeführt. Nach einer Literaturrecherche mit 798 Treffern erfüllten zehn Studien die Einschlusskriterien. Acht Studien konnten signifikante Reduktionen der PTBS-Symptomatik feststellen. Vielversprechend erscheinen dabei folgende Therapien: Narrative Expositionstherapie für Kinder, „Meditation-Relaxation”, Eye Movement Desensitization and Reprocessing und „Rapid-Ed-Therapie”. Aufgrund der dürftigen Studienlage und methodischer Mängel ist eine genauere Empfehlung allerdings schwierig.
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Affiliation(s)
| | - Agnes Nocon
- Katholische Universität Eichstätt-Ingolstadt
| | - Rita Rosner
- Katholische Universität Eichstätt-Ingolstadt
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Kangaslampi S, Garoff F, Peltonen K. Narrative exposure therapy for immigrant children traumatized by war: study protocol for a randomized controlled trial of effectiveness and mechanisms of change. BMC Psychiatry 2015; 15:127. [PMID: 26081580 PMCID: PMC4469253 DOI: 10.1186/s12888-015-0520-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Millions of children worldwide suffer from posttraumatic stress disorder (PTSD) symptoms and other mental health problems due to repeated exposure to war or organized violence. Forms of cognitive-behavioral therapy (CBT) are the most commonly used treatment for PTSD and appear to be effective for children as well, but little is known about the mechanisms of change through which they achieve their effectiveness. Here we present the study protocol of a randomized controlled trial (RCT) studying the effectiveness and mechanisms of change of Narrative Exposure Therapy (NET), a CBT-based, manualized, short-term intervention for PTSD symptoms resulting from repeated traumatization, in immigrant children traumatized by war. METHODS/DESIGN We are conducting a multicentre, pragmatic RCT in a usual care setting. Up to 80 9-17-year-old immigrant children who have experienced war and suffer from PTSD symptoms will be randomized into intervention (NET) and control (treatment as usual, TAU) groups of equal sizes. The effectiveness of NET treatment will be compared to both a waiting list and the parallel TAU positive control group, on the primary outcomes of PTSD and depressive symptoms, psychological distress, resilience, and level of cognitive performance. The effects of the intervention on traumatic memories and posttraumatic cognitions will be studied as potential mechanisms of change mediating overall treatment effectiveness. The possible moderating effects of peritraumatic dissociation, level of cognitive performance, and gender on treatment effectiveness will also be considered. We hypothesize that NET will be more effective than a waitlist condition or TAU in reducing PTSD and other symptoms and improving resilience, and that these effects will be mediated by changes in traumatic memories and posttraumatic cognitions. DISCUSSION The results of this trial will provide evidence for the effectiveness of NET in treating trauma-related symptoms in immigrant children affected by war. The trial will also generate insights into the complex relationships between PTSD, memory functions, posttraumatic cognitions and cognitive performance in children, and help guide the future development and implementation of therapeutic interventions for PTSD in children. TRIAL REGISTRATION ClinicalTrials.gov NCT02425280 . Registered 15 April 2015.
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Affiliation(s)
- Samuli Kangaslampi
- School of Social Sciences and Humanities/Psychology, FI-33014, University of Tampere, Tampere, Finland.
| | - Ferdinand Garoff
- Institute of Behavioural Sciences/Psychology, FI-00014, University of Helsinki, Helsinki, Finland.
| | - Kirsi Peltonen
- School of Social Sciences and Humanities/Psychology, FI-33014, University of Tampere, Tampere, Finland.
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26
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Stotz SJ, Elbert T, Müller V, Schauer M. The relationship between trauma, shame, and guilt: findings from a community-based study of refugee minors in Germany. Eur J Psychotraumatol 2015; 6:25863. [PMID: 26105045 PMCID: PMC4478074 DOI: 10.3402/ejpt.v6.25863] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 05/16/2015] [Accepted: 05/20/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The relationships between traumatic stress and self-conscious emotions, such as shame and guilt, remain to be fully explored, especially in refugees, who frequently are exposed to a multitude of stressors. OBJECTIVE The aim of the present study was to investigate shame and guilt in refugee minors and to assess to what extent a greater cumulative exposure to traumatic stressors would result not only in more severe posttraumatic stress disorder (PTSD) symptoms but also in higher levels of shame and guilt. METHODS Thirty-two male refugee minors, who were all below the age of 18 when they sought asylum in Germany, agreed to participate. At the time of the assessment, the age ranged from 11 to 20 years. Eighteen refugees had arrived without relatives in their host country ("unaccompanied minors"). In structured diagnostic interviews, a PTSD diagnosis was established using the UCLA PTSD Index. Posttraumatic guilt was assessed by means of the Trauma-related Guilt Inventory, and the Shame Variability Questionnaire was used to record the intensity, duration, and frequency of shame episodes. RESULTS Feelings of guilt and shame as well as trauma symptoms were all associated with the number of traumatic event types subjects had experienced. Posttraumatic guilt and shame were both correlated with PTSD symptom severity. CONCLUSIONS The findings indicate that cumulative stress such as exposure to multiple traumatic events poses a risk factor for the mental health including greater suffering and functional impairment due to shame and guilt.
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Affiliation(s)
- Sabrina J Stotz
- Department of Psychology, University of Konstanz, Konstanz, Germany;
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Veronika Müller
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Maggie Schauer
- Department of Psychology, University of Konstanz, Konstanz, Germany
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Ruf-Leuschner M, Roth M, Schauer M. Traumatisierte Mütter – traumatisierte Kinder? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2014. [DOI: 10.1026/1616-3443/a000237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hintergrund: Die Prävalenz von Traumafolgestörungen bei erwachsenen Flüchtlingen ist bekanntermaßen hoch. Gleichzeitig zeigen auch Flüchtlingskinder multiple psychische Auffälligkeiten und Funktionseinschränkungen. Theorien zu generationsübergreifender Traumatisierung vermuten, dass die Posttraumatische Belastungsstörung (PTBS) der Eltern sowie familiäre Gewalt die psychische Gesundheit der Kinder maßgeblich beeinflussen. Doch auch andere Faktoren wie eigene traumatische Erfahrungen im Herkunfts- und Aufnahmeland oder die Lebensbedingungen im Exil stehen möglicherweise mit der psychischen Gesundheit der Kinder in Zusammenhang. Fragestellung: Ziel der vorliegenden Arbeit ist es, den Zusammenhang von PTBS, weiteren Traumafolgeerkrankungen und Gewalterfahrungen von Flüchtlingsmüttern und ihren Kindern transgenerational zu untersuchen. Methode: 41 Flüchtlingsmütter und ihre Kinder (Alter 11-18 Jahre) wurden mit Hilfe von standardisierten, psychodiagnostischen Instrumenten unabhängig voneinander interviewt. Bei den Kindern wurde das Ausmaß der erlebten familiären Gewalt, erlebte traumatische Ereignisse, Ängstlichkeit, Depressivität sowie PTBS erfasst. Bei den Müttern wurde das Ausmaß der erlebten familiären Gewalt in der Kindheit, Gewalterfahrungen in der Partnerschaft in den letzten 12 Monaten ebenso wie andere traumatische Ereignisse sowie PTBS und Depressivität erhoben. Ergebnisse: Die Schwere der PTBS-Symptomatik bei den Müttern zeigt keinen direkten Zusammenhang mit der PTBS-Symptomatik, der Ängstlichkeit und der Depressivität der Kinder. Die Schwere der mütterlichen PTBS-Symptomatik ist aber mit der vom Kind erlebten familiären Gewalt positiv assoziiert. Die von den Kindern berichtete Anzahl unterschiedlicher traumatischer Ereignistypen und das Ausmaß der familiären Gewalt korrelieren wiederum positiv sowohl mit deren PTBS-Symptomatik als auch mit deren Depressivität und Ängstlichkeit. Schlussfolgerung: Die Ergebnisse veranschaulichen, dass nicht die PTBS-Symptomatik der Mutter, sondern die von den Kindern selbst erlebten traumatischen Erfahrungen, einschließlich der erlebten familiären Gewalt, mit den Traumafolgeerkrankungen der Kinder in Zusammenhang stehen. Die PTBS-Symptomatik der Mutter steht jedoch mit der vom Kind erlebten familiären Gewalt in Zusammenhang. Psychotherapeutische, trauma-fokussierte Interventionen sind daher sowohl für Mütter als auch Kinder indiziert. Darüber hinaus können Elterntrainings sinnvoll sein, um langfristig den Zyklus der Gewalt zu durchbrechen.
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Affiliation(s)
| | - Maria Roth
- Kompetenzzentrum Psychotraumatologie Universität Konstanz & vivo international
| | - Maggie Schauer
- Kompetenzzentrum Psychotraumatologie Universität Konstanz & vivo international
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[Child sexual abuse. Epidemiology, clinical diagnostics, therapy, and prevention]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:199-207. [PMID: 23361204 DOI: 10.1007/s00103-012-1598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The article provides an overview of the research on sexual abuse and the current political developments in Germany. First, the terminology of sexual child abuse is discussed, followed by the presentation of epidemiological data. The section on diagnostics and therapy shows that--because of mostly nonspecific indicators--the diagnosis of child sexual abuse is very difficult to define. Child sexual abuse is discussed as a traumatic experience for children and adolescents with different psychiatric and physical diseases. Current studies have shown that especially cognitive behavioral therapeutic-oriented approaches are effective in curing posttraumatic stress disorders. Based on the new German Child Protection Act, the focus lies on the clarification of confidentiality for medical professionals and their right to consulting services for child protection. In conclusion, guidelines and minimum standards for a child prevention and protection model are presented as well as institutional recommendations addressed to all institutions (also clinical) that take care of or treat children and adolescents.
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29
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Ruf M, Schauer M, Neuner F, Catani C, Schauer E, Elbert T. Narrative exposure therapy for 7- to 16-year-olds: a randomized controlled trial with traumatized refugee children. J Trauma Stress 2010; 23:437-45. [PMID: 20684019 DOI: 10.1002/jts.20548] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The authors examined the effectiveness of narrative exposure therapy for children (KIDNET) in treating posttraumatic stress disorder (PTSD) in refugee children living in exile. Twenty-six children traumatized by organized violence were randomly assigned to KIDNET or to a waiting list. Significant treatment by time interactions on all PTSD-relevant variables indicated that the KIDNET group, but not the controls, showed a clinically significant improvement in symptoms and functioning. Success of the KIDNET group remained stable at 12-month follow-up. This study confirms previous findings that, if left untreated, PTSD in children may persist for an extended period. However, it also shows that it is possible to effectively treat chronic PTSD and restore functioning in traumatized refugee children in only 8 treatment sessions.
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Affiliation(s)
- Martina Ruf
- University of Konstanz and Vivo, Konstanz, Germany.
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