The epidemiology of PTSD and depression in refugee minors who have resettled in developed countries

Quality of life among residents of Gaza, Palestine: the predictive role of mental distress, fear of COVID-19, and social support

BACKGROUND

Living under siege and deteriorated health, social, educational, and economic conditions and isolation with scarce opportunities to fulfil basic needs and aspirations affect the civil population's mental health and perceived quality of life. In this cross-sectional investigation, we explored the consequences of mental distress, fear of COVID-19, and social support for QoL in the Gaza strip.

METHODS

Nine hundred seventy nine (32.9% males; 67.1% females; mean age was 35.2 years; s.d. = 11.4) adults were recruited in the Gaza strip. We used the Fear for COVID-19 scale (FCS-19), The WHOQOL-BREF Scale, Berlin Social Support Scale (BSSS), Depression Anxiety and Stress Scale (DASS). Pearson correlation coefficient was computed to assess relationships between quality of life, fear of COVID19, mental distress, and social support; a hierarchical regression analysis was used to assess the association between QoL as the dependent variable and demographic variables and fear of COVID19, mental health, and social support as the independent variables.

RESULTS

QoL was positively associated with perceived emotion, instrumental, and support seeking. Depression, anxiety, stress, and fear of COVID19 were negatively associated with quality of life. Gender was significantly associated with lower QoL. The study highlighted that the level of fear of COVID-19 was negatively influencing individuals' quality of life (QoL). This fear was negatively associated to psychological distress, gender, place of residence, and family type. Lower-educated and poorer participants had lower QoL scores. Conversely, female gender was notably linked to a lower QOL. The hierarchical regression confirmed that COVID-19 was an added burden for the Palestinian population. The fear of COVID-19 term added a 6.2% variance in QoL. In the final analysis, all predictors were statistically significant, with the fear of COVID-19 term recording a higher contribution of 22.5%, followed by depression term with 21.5%, perceived emotional 18.5%, income at 15.4%, and perceived instruments at 14.8% towards QoL.

CONCLUSIONS

Practitioners and policymakers must consider the severe violation of human rights when developing psychosocial programs to intervene in the COVID-19 crisis.

Suicidality Among Syrian Refugee Children in Jordan

History of adverse events in childhood is one of the strongest predictors of developing negative mental health outcomes with suicidality being the most devastating consequence. Syrian refugee children are at very high risk of developing mental illness, however, the prevalence and significance of suicidal thoughts among this population remains undocumented. A total of 339 Syrian refugee children and adolescents aged 10 to 17 years and their parents living in Jordan were surveyed to assess resilience, depression and suicidality. Demographics and parental depression were correlated with child suicidality. Multivariate logistic regression analyses were used to determine the predictors of suicidality within this population. A total of 94 (27.7%) children reported suicidal statements. In the multivariate analyses we found that younger children were more likely to state suicidal ideation than older children. Of the children who stated suicidal ideation, 49 were in primary school, 19 in pre-secondary and 26 in upper-secondary school. In the multivariate analyses, mild (OR 2.633 (95% CI 1.283, 5.709)) and high (OR 6.987 (95% CI 3.532, 14.614)) depression levels among the surveyed children were predictive of suicidality. Experiencing bullying was also predictive of suicidality (OR 2.181 (95% CI 1.179, 4.035)) when compared to those who did not report any bullying. We report high rates of suicidal ideation among Syrian refugee children, especially in children with exposure to pre-existing depression or bullying. Prevention through raising awareness, education and early detection of depression are needed to address suicidality in this and other vulnerable populations of children.

Adolescent patient with post traumatic stress disorder due atypical stressor: Case report

INTRODUCTION

Post-traumatic stress disorder (PTSD) is characterised by intrusive, anxious, and avoidant symptoms that are triggered after a stressful experience and affect the mood. The definition of a stressor that generates PTSD has been debated in recent years, as a clinical picture compatible with the disorder can occur after exposure to stressors that do not meet the criteria A1 of the DSM V; these stressors have been defined in the literature as "of low magnitude, uncommon, unusual or atypical".

CLINICAL CASE

We present the clinical case of a paediatric patient who developed PTSD after being exposed to an atypical stressor.

CONCLUSIONS

The literature shows these stressors to be more frequently documented in the paediatric population. We therefore suggest that cases should be analysed as a complex interweaving of variables, where one of the most important is each patient's interpretation of the event according to their life history and social context, and not because of an inherent characteristic of the stressor itself.

Development and evaluation of a training program for interpreters in the field of trauma-focused cognitive behavioral therapy

Background

The treatment of traumatized refugee minors is often challenging because of language barriers. International guidelines, therefore, recommend the use of language mediators. However, there is a scarcity of evaluated training programs that prepare language mediators to translate during psychotherapy developed specifically for this patient group, for instance trauma-focused cognitive behavioral therapy (TF-CBT).

Methods

Based on an extensive literature review and in collaboration with an expert focus group, a one-day TF-CBT-specific online training program was developed for language mediators willing to work with minor refugees, and delivered on nine occasions between November 2020 and June 2021. The participants answered pre- and post-training questions about trauma- and TF-CBT-related knowledge and attitudes relevant to therapy, as well as the perceived usefulness of the training. Bayesian estimation was used to determine pre-post changes.

Results

A total of 129 participants speaking 35 different languages participated in the training program. Analyses revealed 95% highest density intervals not containing the null with respect to knowledge gain (effect size median 0.28) and change in treatment-appropriate attitudes (effect size median 0.31). The participants rated the training as useful.

Conclusion

The TF-CBT-specific training course was successfully carried out. It was likely to disseminate both knowledge gains and a shift toward more treatment-appropriate attitudes. It was perceived as useful by the participants. Given the scarcity of evaluated training programs for language mediators working with minor refugees, the results are promising. The limitations include the lack of both a control group and the verification of the results using an external outcome measure.

Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors-a comparison with youth in foster care

Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.

Post-traumatic stress disorder in refugee minors in an outpatient care center: prevalence and associated factors

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.

Prevalence of common mental health disorders in forcibly displaced populations versus labor migrants by migration phase: A meta-analysis

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.

Stressful life events, psychological symptoms, and social support of children and young asylum-seekers in Iceland

Background:

Children and young asylum-seekers are often exposed to stressful life events (SLEs) and risk developing psychological symptoms. However, risk and protective factors can positively and negatively influence this vulnerable group’s mental health.

Aims:

To examine the SLE experiences and psychological symptoms of children and youth who seek refuge in Iceland. And to study the role that gender, travelling (un)accompanied and perceived social support play in the development of psychological symptoms for this population.

Methods:

Participants were 75 children and youth of ages 13 to 24 years who sought asylum in Iceland ( M = 19.7, SD =3.0, 66.7% male). Sociodemographic and social support data were collected via face-to-face interviews, with the help of interpreters when required, while SLEs, post-traumatic stress, depression, anxiety and behavioural symptoms measures were administered to participants.

Results:

The results indicated that participants who travelled alone to Iceland had experienced more SLEs than those who travelled accompanied. SLE experiences were associated with post-traumatic stress disorder (PTSD) and other psychological symptoms. Results also revealed that SLE and perceived peer support played a significant role in predicting PTSD symptoms.

Conclusions:

Children and young asylum-seekers are exposed to a high number of SLEs, which increases their risk of developing psychological problems. This potential risk underlines the need for early assessments and intervention. Moreover, higher levels of social support were related to less severe PTSD symptoms, suggesting that social resources act as protective factors for these children and youth in helping them cope with SLEs.

A Whole-child, whole-family approach to health assessments for asylum-seeking children

In 2020, 21% of people who sought asylum in the UK were children. This population has complex interconnecting health and social needs. Assessment requires a holistic approach, with consideration of physical and mental health in addition to social and developmental well-being, within the whole family group. A trauma-informed life-cycle and intergenerational care approach is important. This article, aimed at all health professionals who may work with asylum-seeking families, outlines the best practice principles for undertaking health assessments in migrant children and young people.

Refugee Children and Interventions for Depression: A Review of Current Interventions and Implications of the Ecological Context

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.

Community-based interventions for improving mental health in refugee children and adolescents in high-income countries

BACKGROUND

An unprecedented number of people around the world are experiencing forced displacement due to natural or man-made events. More than 50% of refugees worldwide are children or adolescents. In addition to the challenges of settling in a new country, many have witnessed or experienced traumatic events. Therefore, refugee children and adolescents are at risk of developing mental health problems such as post-traumatic stress disorder, and require appropriate and effective support within communities.

OBJECTIVES

To assess the effectiveness and acceptability of community-based interventions (RCTs only) in comparison with controls (no treatment, waiting list, alternative treatment) for preventing and treating mental health problems (major depression, anxiety, post-traumatic stress disorder, psychological distress) and improving mental health in refugee children and adolescents in high-income countries.

SEARCH METHODS

Databases searches included the Cochrane Common Mental Disorders Controlled Trials Register (all available years), CENTRAL/CDSR (2021, Issue 2), Ovid MEDLINE, Embase, six other databases, and two trials registries to 21 February 2021. We checked reference lists of included study reports.  SELECTION CRITERIA: Studies of any design were eligible as long as they included child or adolescent refugees and evaluated a community-based mental health intervention in a high-income country. At a second stage, we selected randomised controlled trials.

DATA COLLECTION AND ANALYSIS

For randomised controlled trials, we extracted data relating to the study and participant characteristics, and outcome data relating to the results of the trial. For studies using other evaluation methods, we extracted data relating to the study and participant characteristics. W derived evidence on the efficacy and availability of interventions from the randomised controlled trials only. Data were synthesised narratively.

MAIN RESULTS

We screened 5005 records and sought full-text manuscripts of 62 relevant records. Three randomised controlled trials were included in this review. Key concerns in the risk of bias assessments included a lack of clarity about the randomisation process, potential for bias is outcome measurement, and risk of bias in the selection of results. Primary outcomes There was no evidence of an effect of community-based interventions when compared with a waiting list for symptoms of post-traumatic stress (mean difference (MD) -1.46, 95% confidence interval (CI) -6.78 to 3.86: 1 study; low-certainty evidence), symptoms of depression (MD 0.26, 95% CI -2.15 to 2.67: 1 study; low-certainty evidence), and psychological distress (MD -10.5, 95% CI -47.94 to 26.94; 1 study; very low-certainty evidence).  There were no data on adverse events. Secondary outcomes Three trials reported on short-term changes in child behaviour, using different measures, and found no evidence of an effect of the intervention versus a waiting list (low to very low certainty). None of the trials reported on quality of life or well-being, participation and functioning, or participant satisfaction.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the efficacy and acceptability of community-based mental health interventions for refugee children and adolescents.

Narratives of experiences of violence of Venezuelan migrant women sheltered at the northwestern Brazilian border

Objectives

To know the experiences of Venezuelan migrant women living in shelters in Roraima state at the northwestern border between Venezuela and Brazil regarding situations of violence as part of the dynamics of everyday life.

Materials and methods

Data were collected in January 2020 through 12 focus group discussions (FGDs) with 5 to 14 Venezuelan migrant women aged 18–49 years old living transitorily in five shelters established by the United Nations High Commissioner for Refugees (UNHCR) and the Brazilian government. We obtained individual and shared views on the experiences regarding violence that migrant women may experience in their everyday life. To organize the FGDs, variations in age and the time women were living at the shelters were considered. All FGDs were held in a place at the shelter that guaranteed privacy and secrecy so that women could express themselves freely. The initial question was broad and open ended and was followed by more specific questions about situations of domestic violence and other types of violence.

Results

The main themes identified were the following: i) women’s perceptions on domestic violence, ii) women’s perceptions on how humanitarian organizations were managing the episodes of domestic violence, and iii) situations considered violence in everyday life at the shelters. The FGDs showed that the reported violence inside the shelters was high, and several forms of violence emerged. Violence was identified as physical aggression and psychological threats, and violence in everyday life at the shelter included xenophobia when the migrants went outside the shelters that was perceived and described as violence.

Conclusions

According to the perspective of Venezuelan migrant women violence was part of everyday life among those living in the UNHCR shelters at the northwestern border of Brazil-Venezuela. These women are not comfortable with this situation, and it is difficult for them to understand and handle the episodes of violence.

Causes and Risk Factor of Post-Traumatic Stress Disorder in Adult Asylum Seekers and Refugees

Objectives: To assess the causes and risk factors of post-traumatic stress disorder (PTSD) in adult asylum seekers and refugees. To explore whether the causes and risk factors of PTSD between male and female adult refugees/asylum seekers are different. Study design: Systematic review of current literature. Data Sources: PubMed, Web of Science, Scopus and Google Scholar up until February 2019. Method: A structured, systematic search was conducted of the relevant databases. Papers were excluded if they failed to meet the inclusion and exclusion criteria. Afterwards, a qualitative assessment was performed on the selected papers. Results: 12 Studies were included for the final analysis. All papers were either case studies/reports or cross-sectional studies. Traumatic events experienced by refugees/asylum seekers are the most frequently reported pre-migration causes of PTSD development, while acculturative stress is the most common post-migration stressor. There were mixed reports regarding the causes of PTSD between both genders of refugees/asylum seekers. Conclusions: This review’s findings have potential clinical application in terms of helping clinicians to risk stratify refugees/asylum seekers for PTSD development and thus aid in embarking on earlier intervention measures. However, more rigorous research similar to this study is needed for it to be implemented into clinical practice.

Psychosocial support services provided for Syrian refugees with disabilities: a systematic review and thematic analysis

This study systematically reviewed and thematically analyzed studies that investigated psychosocial support services provided to Syrian refugees with disabilities between 2011 and 2020. Nine studies published in the English language were identified from database searches (Google Scholar, PsychInfo, EBSCOhost, Web of Science, and Scopus). Results showed that the forms of psychosocial support services provided to Syrian refugees with disabilities were varied based on the nature of the study and the disability type. The results also provided detailed information about methods, participants, and findings of the identified studies. The thematic analysis results identified six themes that represent the factors related to the psychosocial support services, which were assessment, mental health, psychological well-being, rehabilitation, social participation, and vulnerability. This study provided a set of recommendations that may improve the quality of mental health and psychosocial support services provided to Syrian refugees with disabilities and their families, which are professional development, researches, and policy reforming.

Effects of COVID-19-related life changes on mental health in Syrian refugees in Turkey

BACKGROUND

Mental disorders are currently the greatest global health burden. The coronavirus diseases 2019 (COVID-19) pandemic is having an adverse impact on people's mental health, particularly in vulnerable populations, such as refugees.

AIMS

The present study was designed to examine the association between COVID-19 and changes in mental health in Syrian refugees in Turkey.

METHOD

We conducted a two-wave panel survey of a representative sample of 302 of the estimated 500 000 Syrian refugees (ages 18 and older) living under humanitarian support in Istanbul (first wave between 9 and 15 July 2020 and the follow-up between 11 and 14 September 2020). We administered seven items from the CoRonavIruS Health Impact Survey in addition to one-context specific item about life changes because of COVID-19, and measures of depression (10-item Center for Epidemiologic Study Depression Scale, CESD-10), anxiety (6-item State-Trait Anxiety Inventory, STAI-6) and perceived stress (Perceived Stress Scale, PSS-4).

RESULTS

A factor analysis yielded three COVID-19 factors, labelled 'social relationships', 'stress' and 'hope.' We conducted a series of cross-lag panel analyses to test associations between the COVID-19 factors and mental health. We found associations between all COVID-19 factors and CESD-10, between COVID-19 'stress' and STAI-6, and between COVID-19 'stress' and COVID-19 'hope' and PSS-4.

CONCLUSIONS

Our measures of life changes because of the COVID-19 pandemic are associated with changes in the mental health of Syrian refugees living in Istanbul. It is therefore important that they are provided with services to reduce what may be particularly debilitating consequences of COVID-19.

Symptoms of PTSD and Depression among Central American Immigrant Youth

The aim of this paper is to explore the mental health challenges that Central American immigrant youth face before and after arriving in the United States. This population is hard to reach, marginalized, and disproportionately exposed to trauma from a young age. This paper investigates the mental health stressors experienced by Central American immigrant youth and asylum seekers, including unaccompanied minors, surveyed in the U.S. in 2017. This mixed methods study uses qualitative data from interviews along with close-ended questions and the validated PHQ-8 Questionnaire and the Child PTSD Symptom Scale (CPSS). These new migrants face numerous challenges to mental health, increased psychopathological risk exacerbated by high levels of violence and low state-capacity in their countries of origin, restrictive immigration policies, the fear of deportation for themselves and their family members, and the pressure to integrate once in the U.S. We find that Central American youth have seen improvements in their self-reported mental health after migrating to the U.S., but remain at risk of further trauma exposure, depression, and PTSD. We find that they exhibit a disproportionate likelihood of having lived through traumatizing experiences that put them at higher risk for psychological distress and disorders that may create obstacles to integration. These can, in turn, create new stressors that exacerbate PTSD, depression, and anxiety. These conditions can be minimized through programs that aid immigrant integration and mental health.

Traumatic experiences of conditional refugee children and adolescents and predictors of post-traumatic stress disorder: data from Turkey

AIM

We aimed to determine traumatic events, mental health problems and predictors of PTSD in a sample of conditional refugee children.

METHODS

The sociodemographic features, chief complaints, traumatic experiences and psychiatric diagnoses according to DSM-5 were evaluated retrospectively.

RESULTS

20.7% (n = 70) of children experienced the armed conflict or exposed to firefights at their country of origin. Most common diagnoses were anxiety disorders (n = 82, 24.3%), major depressive disorder (n = 52, 15.4%) and PTSD (n = 43, 12.7%). Age, number of traumatic experiences, explosion and sexual violence are the most important predictors for PTSD.

CONCLUSIONS

Our results suggest that the number of traumas exposed as well as their nature predicted PTSD diagnosis. Refugee children have increased risk for psychiatric problems after migration and resettlement underlining the importance of an adequate follow-up for mental health and ensuring social support networks.

Factors influencing utilization and perception of health care: a qualitative study among traumatized Yazidi refugees in Germany

BACKGROUND

Ensuring adequate utilization of healthcare services for displaced populations is critical, yet there are well-documented treatment gaps. Yazidi women captured by the Islamic State (IS) were subjected to extreme trauma and violence. This study aims to understand perceptions of healthcare providers and utilization of these services among women who experienced extreme trauma.

METHODS

This is a qualitative study with voluntary participation offered to approximately 400 women resettled through the Special Quota Program. An empirical approach was used to collect data and a grounded theory approach was used for content analysis. Participants ranked their interactions with providers on a Likert scale. Posttraumatic stress disorder (PTSD) symptoms were assessed using the impact of event scale-revised questionnaire.

RESULTS

A total of 116 Yazidi women participated in this study. The women experienced an average of 6.8 months of captivity by IS and 93% met criteria for probable PTSD. Eighty-three percent of the women interacted with a physician; 80% found this interaction helpful. Sixty-nine percent interacted with psychologists; 61% found this interaction helpful. Six themes emerged: "reminders of trauma" and "hopelessness" in relation to the traumatic experience; "immediate relief" and "healing through pharmaceutical treatment" in relation to provider interventions, and "support" and "cultural differences" in relation to interactions with providers.

CONCLUSIONS

There exist major barriers to care for Yazidi women who experienced extreme trauma, particularly in regards to psychiatric care. Perceptions of healthcare providers and perceived effectiveness of therapy are critical factors that must be taken into consideration to improve healthcare utilization and outcomes.

Refugee Women with a History of Trauma: Gender Vulnerability in Relation to Post-Traumatic Stress Disorder

Refugees represent a population whose living conditions have a strong impact on their mental health. High rates of post-traumatic stress disorder (PTSD), more than other mental disorders, have been found in this group, with women having the highest incidence. The objective of the present systematic review was to identify and examine studies from the last fifteen years on the relationship between the impact of traumatic experiences and PTSD psychopathology in refugee women. Twelve studies were included, from which the overall results approved this relation. In addition, six of these studies show that exposure to sexual trauma in refugee women is associated with the high odds of being at risk for PTSD. These findings suggest that gender-related traumatic experiences can explain the high rate of PTSD in refugee women and highlight the unmet need for psychosocial health care in this population.

Refugee Children and Families During the COVID-19 Crisis: A Resilience Framework for Mental Health

Children and families are undergoing unprecedented stress as a result of the COVID-19 pandemic, in part, due to the disruption of daily life arising from mandated social distancing protocols. As such, the purpose of the present report is to raise awareness surrounding resilience-challenging and resilience-promoting factors for refugee children and families during the COVID-19 crisis. Issues surrounding family life, parenting, and potential for family conflict are described. Also, cultural and linguistic factors are discussed, which may limit access to information about the pandemic and, accordingly, uptake of public health recommendations. Throughout our analysis, a trauma-informed framework is utilized, whereby potential for pandemic-related disruption in triggering previous traumatic stress is considered. Furthermore, using a developmental resilience framework and building upon the inherent strengths of families and children, suggestions for developing evidence-based programming and policy are reviewed. Responses should be: (1) multilevel, (2) trauma informed, (3) family focused, (4) culturally and linguistically sensitive, and (5) access oriented. The present analysis can serve as a timely guide for informing program design and policy in the context of public health, social services, mental health, health care, resettlement services, and other refugee-serving organizations.

Asylum-Seeking Children with Medical Complexity and Rare Diseases in a Tertiary Hospital in Switzerland

The aim of this study was to assess the characteristics of asylum-seeking children with medical complexity visiting a tertiary care hospital in Switzerland, detailing their underlying medical conditions and management. Asylum-seeking patients with frequent visits between January 2016 and December 2017 were identified using administrative and electronic health records. Of 462 patients, 19 (4%) fulfilled the inclusion criteria with 811 (45%) visits. The age of the 19 patients ranged from 0 to 16.7 years (median of 7 years) with two main age groups identified: < 2 years and > 12 years. Nine (47%) patients originated from Syria. A total of 34/811(4%) visits were hospital admissions, 66/811 (8%) emergency department visits and 320/811(39%) outpatient department visits. In children < 2 years genetic diseases (5/8; 63%) and nutritional problems (6/8; 75%) were most common; in adolescents, orthopedic diseases (4/8; 50%) and mental health problems (4/8; 50%). Asylum-seeking children with medical complexity represent a small but important group of patients requiring frequent medical consultations. The high proportion of young patients with genetic diseases and severe nutritional problems suggests that new strategies are required in the management of this specific group of asylum-seeking children. This could be achieved by improved co-ordination between hospital and non-hospital care exploring options for integrated care.

A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents

In the past decade, millions of children and adolescents have been forced to flee from protracted or newly erupted violent conflicts. Forcibly displaced children are particularly vulnerable for developing mental health problems. However, a timely and systematic review of the current evidence is lacking. We conducted a systematic review of factors contributing to the mental health of refugee children across different socio-ecological levels (individual, family, community, sociocultural). We systematically searched the databases Medline, PsycINFO, Web of Science, and Cochrane for English studies published in peer-reviewed journals between August 2010 and May 2020. Of the 2413 identified studies, 63 were included in the analyses. Only 24 studies were considered to be of high quality. Pre-migration individual (risk: exposure to war-related trauma, female gender) and post-migration family factors (risk: parental mental health problems and impaired parenting, protective: family cohesion) currently have the best evidence base. Post-migration community (protective: school connectedness, support by peers) and sociocultural factors (risk: discrimination and acculturative stress, protective: integrative acculturation) have gained some support in high-income settings. Prevention and intervention approaches should integrate factors across different socio-ecological levels. More longitudinal studies and research in low- and middle-income countries are needed to advance our knowledge on causal mechanisms behind factors contributing to refugee youth's mental health.

Children at risk: A nation-wide, cross-sectional study examining post-traumatic stress symptoms in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden between 2014 and 2018

Background

The objective of the present study was to assess nation-wide, representative prevalence estimates for symptom-defined posttraumatic stress disorder (PTSD) within populations of refugee minors from Afghanistan, Syria and Iraq resettled in Sweden.

Methods

A nation-wide, cross-sectional, questionnaire study with a stratified sample of refugee minors, aged 16–18 years, from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018 (N = 5071) was conducted. The response rate was 22.3%, leaving n = 1129 refugee minors (boys 53.1% / girls 46.9%) in the final sample. Symptom-defined prevalences of PTSD were measured using CRIES-8 with ≥17 as cut-off. Data were analyzed using frequency distributions, and strata-specific PTSD prevalences with 95% confidence intervals (95% CIs), were estimated. The association between migratory status on arrival (unaccompanied vs. accompanied) and PTSD was estimated using crude and adjusted odds ratios (OR) utilizing logistic regression analyses with 95% CIs.

Results

Overall, the weighted PTSD prevalence was 42% (95% CI 38.9–45.1), with minors from Afghanistan presenting the highest prevalence (56.9, 95% CI 51.5–62.2), compared to minors from Iraq (36.8, 95% CI 28.9–45.4) and Syria (33.4, 95% CI 29.4–37.6). Unaccompanied minors from Afghanistan had higher odds of PTSD compared to accompanied minors from Afghanistan (OR = 1.92, 95% CI 1.08–3.40). Gender differences were non-significant.

Conclusions

High prevalences of symptom-defined PTSD among refugee minors in general and in unaccompanied minors from Afghanistan in particular, were revealed. Findings calls for continued efforts to support this especially vulnerable group.

Epidemiology of violence against children in migration: A systematic literature review

BACKGROUND

Children in migration experience various forms of violence before, on, and after their migration journey. Epidemiological research on the prevalence of violence in this highly vulnerable group is lacking, however.

METHOD

A PRISMA-guided systematic literature review with a three-tiered search strategy was conducted by searching academic literature databases and gray literature on websites of international organizations and by contacting experts. All empirical studies published within the last 15 years were eligible. Predefined search terms related to violence, children, epidemiology, and migration were used.

FINDINGS

Of 1014 records, 17 studies met the inclusion criteria. Sample sizes ranged from 100 to 8,047, with a total of 16,915 children (Mdn = 311). Lifetime prevalence of violence varied considerably: Child physical maltreatment ranged from 9 %-65 % and child sexual abuse from 5 %-20 %. For internally displaced children, violence often occurred at the hands of those who were responsible for their care. Unfortunately, data on the context and country in which the violence occurred-in the country of origin, on route, or in the country of arrival-were lacking.

CONCLUSION

The discrepancy between the importance of the topic and the dearth of data is striking. Filling the gaps requires not only more rigorous methodology but also more research in general on the epidemiology of violence against children in migration. We outline methodological challenges and draft an agenda for improved data on the topic. There is an urgent need for evidence that supports the development and adaptation of effective, tailored, and child-sensitive prevention and intervention programs for children in migration.

Residential mobility, mental health, and community violence exposure among Somali refugees and immigrants in North America

Refugees and immigrants resettled in high income countries often later experience a new phase of residential uncertainty in search of safe and secure housing. This study investigated the effect of past year housing stability on symptoms of posttraumatic stress disorder (PTSD) and exposure to neighborhood violence among a sample of 1^st and 2nd generation Somali young adults (N = 198) living in urban areas in North America. In one year, 8.1% of the sample experienced a forced move and 20.7% of the sample moved voluntarily. Discrimination, neighborhood violence, economic insecurity, and interpersonal conflict precipitated forced moves. Forced moves were associated with worsening PTSD symptomology over one year, while voluntary moves were associated with improvements in symptoms. The current study provides evidence of the importance of safe, stable housing for the mental health of young adult immigrants.

Effects of Narrative Exposure Therapy on Posttraumatic Stress Disorder, Depression, and Insomnia in Traumatized North Korean Refugee Youth

Refugees affected by multiple traumatic stressors are at high risk for developing trauma-related mental disorders, including posttraumatic stress disorder (PTSD), depression, and insomnia, which is sometimes overlooked. The present study examined the effectiveness of narrative exposure therapy (NET) on trauma-related symptoms in a sample of North Korean refugee youth. We focused on sleep patterns in addition to changes in symptom severity for PTSD, depression, and internalizing and externalizing symptoms. North Korean refugee youth (N = 20) with PTSD were assigned to either an NET-based treatment group or a control group, which consisted of treatment as usual (TAU). There were clinically significant reductions in PTSD, depression, and internalizing and externalizing symptoms for the NET group, Hedges' g = 3.6, but not the TAU group. The change in diagnostic status for PTSD was more notable for participants in the NET group compared to the TAU group. Of note, NET also produced a significant improvement in insomnia symptoms and sleep quality, Hedges' g = 2.1. The substantial recovery regarding overall posttraumatic symptoms in the NET group was observed 2 weeks after the end of treatment and remained stable at 6-month follow-up. The results of the present study suggest that NET may be a treatment option for traumatized North Korean refugee youth and may also be effective for the treatment of sleep problems that arise from traumatic experiences.

Post-traumatic stress disorder among Syrian adolescent refugees in Jordan

OBJECTIVE

Studies among Syrian refugees in Turkey, Lebanon and Germany showed high prevalence rates of post-traumatic stress disorder (PTSD). However, data on PTSD among Syrian adolescent refugees in Jordan are scarce. Therefore, this study aimed to assess the prevalence and severity of PTSD, and its associated factors among Syrian schoolchildren refugees resettled in Jordan.

METHODS

This cross-sectional study was conducted among Syrian schoolchildren refugees aged 12-18 years. A stratified cluster random sample was used to select male and female schoolchildren in four cities with the highest density of Syrian refugees. The Child Post-Traumatic Stress Disorder Symptom Scale (CPSS) was used to measure PTSD severity.

RESULTS

The prevalence of moderate to severe PTSD among Syrian schoolchildren refugees in Jordan was 31%. This prevalence was higher in female adolescents compared with males (P = 0.001), and in children who had one or both parents died compared with those whose parents were living together (P = 0.006). The prevalence was lower in those living in Sahab city compared with Mafraq city (P = 0.006).

CONCLUSION

PTSD is a common condition among Syrian adolescent refugees, especially among females, and those who lost one or both parents. Screening for PTSD and other mental health illnesses is highly recommended. Gender-specific psychosocial support and educational programs should be implemented.

Common mental disorders among young refugees in Sweden: The role of education and duration of residency

BACKGROUND

Studies investigating risks of common mental disorders (CMDs) in refugee youth are sparse. The current study examined health care use due to CMDs in unaccompanied and accompanied refugee youth and Swedish-born, and the role of education and residency duration.

METHODS

This longitudinal cohort study included 746,517 individuals (whereof 36,347 refugees) between 19 and 25 years, residing in Sweden in 2009. Refugees were classified as unaccompanied/accompanied. Risk estimates of CMDs, measured as health care use and antidepressant treatment, between 2010-2016 were calculated as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Highest attained education in 2009, and residency duration were examined as potential modifiers.

RESULTS

Compared to Swedish-born youth, refugees had a lower risk of treated major depressive and anxiety disorders (aHR): 0.67 (95% CI 0.63-0.72) and 0.67 (95% CI 0.63-0.71) respectively), but a higher risk for posttraumatic stress disorders (PTSD). Compared to Swedish-born, unaccompanied had a nearly 6-fold elevated risk for PTSD (aHR: 5.82, 95% CI 4.60-7.34) and accompanied refugees had a 3-fold risk of PTSD (aHR: 3.08, 95% CI 2.54-3.74). Rates of PTSD decreased with years spent in Sweden. The risk of CMDs decreased with increasing education.

LIMITATIONS

The study lacked information on pre-migration factors. There may further be a potential misclassification of untreated CMDs.

CONCLUSION

Refugees had a lower risk of treated depressive and anxiety disorders but a higher risk for PTSD. In refugees, the rates of anxiety disorders increased slightly over time whereas the rates of PTSD decreased. Last, low education was an important predictor for CMDs.

Asylum seeking children and adolescents in Australian immigration detention on Nauru: a longitudinal cohort study

INTRODUCTION

Immigration detention has a profound and negative impact on the physical health, mental health, development and social-emotional well-being of children, adolescents and their families. Australian clinicians will report results from detailed health and well-being assessments of asylum seeking children and adolescents who have experienced prolonged immigration detention.

METHODS AND ANALYSIS

This is a national, multicentre study with a longitudinal cohort design that will document health and well-being outcomes of the children and adolescents who have been detained in offshore detention on the remote island of Nauru. Outcome measures will be reported from the time arrival in Australia and repeated over a 5-year follow-up period. Measures include demographics, residency history and refugee status, physical health and well-being outcomes (including mental health, development and social-emotional well-being), clinical service utilisation and psychosocial risk and protective factors for health and well-being (eg, adverse childhood experiences). Longitudinal follow-up will capture outcomes over a 5-year period after arrival in Australia. Analysis will be undertaken to explore baseline risk and protective factors, with regression analyses to assess their impact on health and well-being outcomes. To understand how children's outcomes change over time, multilevel regression analysis will be utilised. Structural equation modelling will be conducted to explore the correlation between baseline factors, mediational factors and outcomes to assess trajectories over time.

ETHICS AND DISSEMINATION

This research project was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee. Subsequent site-specific approvals have been approved in 5 of the 11 governing bodies where the clinical consultations took place. In order to ensure this research is relevant and sensitive to the needs of the cohort, our research team includes an asylum seeker who has spent time in Australian immigration detention. Results will be presented at conferences and published in peer-reviewed Medline-indexed journals.

Cultural Competence of Professionals Working With Unaccompanied Minors: Addressing Empathy by a Shared Narrative

BACKGROUND

The number of migrant youth traveling without parents continues to rise in Europe and North America. Some of t hem leave their home countries on their own and find themselves in a new country, separated from their family and cut off from their cultural roots. Besides those who leave to study, work, and pursue a better life, others are escaping war-torn countries. They need adequate social, educational, and therapeutic spaces, where they can feel entitled to speak. Social workers often ask about how they can understand these young people better so that they can provide them with better care (cope with their trauma and suspicion, deal with the cultural distance between the adolescents and their social workers, etc).

AIM

At Cochin Hospital in Paris, we led a participative action-research program to transmit cultural competence to social workers who provide care for these youth. The aim was to develop an approach to help these young migrants to share their representations about themselves and to train these social workers to encourage this sharing in a culturally sensitive manner.

METHODS

This study used a qualitative method that mixed narrative and transcultural approaches. Two researchers met each youth and social worker with an interpreter-cultural mediator three times (once a month) to assess changes in their relationships during the study. The youth were asked to bring three items of their choice, representing their past, present, and future. They could use their imagination and creativity. We also used the circle test described by Cottle for this purpose. We used a phenomenological approach to analyze the interviews.

RESULTS AND DISCUSSION

This study included 29 young people from 13 different countries and 29 social workers. A transcultural approach appears to be a useful framework for reactivating their identity construction process. It promotes the emergence of cultural representations and takes their experiences before, during, and after migration into account. We assisted them in developing their ability to produce a thorough narrative of their bicultural adolescences and simultaneously helped their social workers to develop their cultural competence.

CONCLUSION

Together, a transcultural approach and methods stimulating the production of narrative are relevant ways to help children to describe their representations of themselves, especially those who have learned to protect themselves by remaining silent. This protocol could be useful for both preventive action and therapy for psychotrauma.

The Life Condition of Syrian Asylum Seekers in Turkey and the Effect of These Conditions on the Desire to Migrate to Europe

OBJECTIVE

In recent years, many Syrian asylum seekers has died while they were crossing over sea to migrate to Europe. We aimed to identify the determinants of choice of Syrian asylum seekers for emigration to Europe; therefore, we selected the sample from refugee mental health clinic in Turkey.

METHODS

Our sample consists of 100 Syrian who applied to the refugee mental health branch polyclinic. Participants filled out the (e1) sociodemographic form, WHO-5 well-being index, and WHOQL. Then their future plans assessed by the interviewer.

RESULTS

It was seen that people who prefer to emigrate to Europe have higher level education level, lower income status, and had worse physical conditions at home. Also, They live generally in urban area, they do not have close relatives living in Syria, have poor mental well-being and have low quality of life scores. Job duration, absence of close relatives living in Syria, having low WHOOL score and physical conditions of home were found significant in regression analysis.

CONCLUSION

We found that their economic circumstances significantly predicted their preference, unlike clinical variables. We believe in that, improving their economic conditions and the life quality of Syrian asylum seekers can prevent illegal migration by dangerous routes to Europe and policy makers over the world should consider this situation.

Long-term mental health in unaccompanied refugee minors: pre- and post-flight predictors

Unaccompanied refugee minors are a particularly vulnerable group. The aim of this study is to increase our knowledge about possible pathways to well-being and integration for unaccompanied refugee minors as they strive to establish new lives in a host county. The present study followed a group of youth who fled to Norway without their caregivers at three time points; 6 months (n = 95; M age = 13.8, 80% boys), 2 years (n = 78; M age = 16.5, 83% boys), and 5 years (n = 47; M age 20.0, 83% boys) after arrival. Linear mixed effects models were used to assess whether age, gender, and trauma exposure prior to arrival were associated with levels and changes in symptoms of posttraumatic stress (PTS), depression, anxiety, and externalizing symptoms over time. Regression analyses were conducted to examine whether daily hassles, perceived social support, and new trauma experiences predict PTS, internalization, externalization, and somatization. The mean levels of depression had decreased significantly at 5 years, but mean levels of anxiety, PTS, and externalizing symptoms did not. Females and severely trauma exposed had higher levels of symptoms. Higher age was associated with less change in symptoms of depression and posttraumatic stress over time. Five years after arrival, many still experienced clinical levels of mental health problems, and level of daily hassles was an important predictor. Support may be needed not only at arrival to handle mental health problems in general and posttraumatic stress in particular, but also after resettlement. Help to manage daily hassles may be especially important to ensure well-being and integration.

The symptom representation of posttraumatic stress disorder in a sample of unaccompanied and accompanied refugee minors in Germany: a network analysis

Background: Given the unprecedented number of traumatized refugee minors in Europe and the increased prevalence of mental disorders such as PTSD in this vulnerable population, new methodologies that help us to better understand their symptomatology are crucial. Network analysis might help clinicians to both understand which symptoms might trigger other symptoms, and to identify relevant targets for treatment. However, to date only two studies have applied the network analysis approach to an (adult) refugee population and only three studies examined this approach in children and adolescents. Objective: The aim of this study is to explore the network structure and centrality of DSM-5 PTSD symptoms in a cross-sectional sample of severely traumatized refugee minors. Method: A total of N = 419 (M age = 16.3; 90.7% male) unaccompanied (79.9%) and accompanied (20.1%) refugee minors were recruited in five studies in southern Germany. PTSD symptoms were assessed using the Child and Adolescent Trauma Screen (CATS). The network was estimated using state-of-the-art regularized partial correlation models using the R-package qgraph. Results: The most central symptoms were nightmares, physiological and psychological reactivity, and concentration problems. The strongest connections between symptoms were established for psychological and physiological reactivity, irritability/anger and self-destructive/reckless behaviour, intrusions and nightmares, nightmares and sleep disturbance, and between concentrations problems and sleep disturbance. Conclusion: This study furnishes information relevant to research and the clinical management of PTSD in refugee minors, and also in terms of comparisons with trauma-exposed children and adolescents without a migration background. Re-experiencing symptoms seem to be central in the refugee minor PTSD profile and thus merit special consideration in the diagnostic and treatment evaluation process. Investigating the PTSD network longitudinally and complementing between-subject analyses with within-subject ones might provide further insight into the symptomatology of refugee minors and how to treat them successfully.

Suicidal Ideation and Severity of Distress among Refugees Residing in Asylum Accommodations in Sweden

Refugees worldwide suffer high levels of distress and are at increased risk for death by suicide. The Refugee Health Screener (RHS) was developed to screen for emotional distress among refugees and can be used to assess distress severity. This paper examines the association between distress severity and suicidal ideation in a sample of refugees residing in asylum accommodations. Data from the RHS and item 9 on the Patient Health Questionnaire-9 (PHQ-9) was analyzed. Results showed that individuals at moderate and severe levels of distress were much more likely to exhibit suicidal ideation than individuals with low levels of distress. Even though we cannot conclude that individuals with low levels of distress do not have thoughts of ending their lives, further suicide assessment is warranted in asylum seekers with moderate to severe distress on the RHS.

Parental immigration and offspring post-traumatic stress disorder: A nationwide population-based register study

OBJECTIVES

The aim of this study was to investigate the association between parental immigration status and a diagnosis of post-traumatic stress disorder (PTSD) in their offspring.

METHODS

This nested matched case-control study was based on a Finnish national birth cohort for 1987-2010 and cases were diagnosed with PTSD by 2012 from the Care Register for Health Care. We identified 3639 cases and 14,434 controls individually matched for gender, place and date of birth (±30 days). Conditional logistic regression analyses were conducted to examine the association between parental immigration status, parents' region of birth and time since paternal immigration, and PTSD after controlling for confounding factors.

RESULTS

The likelihood of being diagnosed with PTSD was significantly increased among children with an immigrant father (OR 1.8, 95% CI 1.3 - 2.4) than those with two Finnish parents and one immigrant mother. There was no significant association between having an immigrant mother or two immigrant parents and receiving a diagnosis of PTSD. The likelihood of being diagnosed with PTSD was increased if the children's fathers had migrated less than five years before their birth (OR 1.4, 95% CI 1.03 - 1.9) and if their immigrant fathers had been born in North Africa or the Middle East (OR 2.1, 95% CI 1.4 - 3.3).

LIMITATIONS

The sample included a heterogeneous migrant group without information on the reason for migration. The cases were identified from hospital diagnosis that may have only included severe cases.

CONCLUSION

The increased likelihood of a diagnosis of PTSD underlines the need for psychosocial services among second-generation immigrants.

Trauma-focused group intervention for unaccompanied young refugees: "Mein Weg"-predictors of treatment outcomes and sustainability of treatment effects

BACKGROUND

Current research on treatment predictors and long-term effects of trauma-focused interventions for (unaccompanied) refugee minors is limited. This secondary analysis of a recent randomised controlled trial (RCT), evaluating the trauma-focused group intervention "Mein Weg" (English "My Way") compared to usual care, investigated several refugee-specific factors such as treatment predictors and sustainability of treatment gains.

METHODS

In total N = 50 participants (M _age = 17.00, 94% male) were included in this analysis. Evaluation of 3-month follow-up data included: posttraumatic stress symptoms [(PTSS) CATS-Self, CATS-Care], depression (PHQ-8), and dysfunctional posttraumatic cognitions (CPTCI-S). Baseline symptom severity of the above-mentioned measures, trauma load and socio-demographic factors were investigated as the treatment predictors.

RESULTS

Intention-to-treat-analyses (ITT) revealed the sustainability of treatment effects in self-reported PTSS (pre to post change: 6.48 ± 1.60, d = 0.62, p < 0.001; post to 3-month follow-up change: 1.41 ± 1.96, d = 0.11, p = 0.47) and depression (pre to post change: 7.82 ± 2.09, d = 0.64, p < 0.001; post to 3-month follow-up change: 1.35 ± 2.17, d = 0.05, p = 0.54). Country of origin alone was a significant predictor of the change in PTSS (b = - 8.22 ± 3.53, t(30) = - 2.33, p = 0.027), and baseline levels of depression were a significant predictor of the change in depression (b = 0.83 ± 0.19, t(33) = 4.46, p < 0.001).

CONCLUSION

This group intervention can serve as a valuable component in a stepped care approach with promising long-term effects for young refugees.Trial registration DRKS, #DRKS00010915. Registered 15 September 2016, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010915.

Posttraumatic stress disorder and emotion dysregulation among Syrian refugee children and adolescents resettled in Lebanon and Jordan

BACKGROUND

Since the outbreak of the conflict in Syria, many people, including children and adolescents, have fled their homes into neighboring countries. Little research exists on the psychosocial adjustment of refugee children and adolescents resettled in Lebanon and Jordan.

OBJECTIVE

This study investigated the prevalence and predictors of PTSD and emotion dysregulation in Syrian refugee children and adolescents who resettled in Lebanon and Jordan. It was hypothesized that a combination of pre-trauma variables (age and gender), trauma-specific variables (traumatic events and time spent in host country, and host country), and post-trauma variables (coping strategies, family relationships, and school environment) would be associated with PTSD and emotion dysregulation.

PARTICIPANTS AND SETTING

Participants were 1000 Syrian refugee children and adolescents aged 7-18 years attending formal and non-formal schools representing various governorates in Lebanon and Jordan.

METHODS

The trauma exposure scale, DSM-IV criteria for the assessment of PTSD, the Difficulties in Emotion Regulation Scale Short Form, Kidcope, Family relationship scales, and school environment scale were administered in an interview format with children and adolescents at school by two trained psychologists. Multivariate binary logistic regression was used to predict PTSD whereas hierarchical multiple regression was used to predict emotion dysregulation.

RESULTS

Results indicated that 45.6% of the refugees have developed PTSD with excessive risk for comorbidity with emotion dysregulation. Emotion dysregulation was reported by older refugee children and adolescents. The prevalence of PTSD was higher in refugee children and adolescents who had resettled in Lebanon than for those who had resettled in Jordan. Refugee children and adolescents who were exposed to higher levels of war atrocities evidenced the greatest prevalence of PTSD and emotion dysregulation. PTSD symptomatology and emotion dysregulation in children and adolescents varied according to coping styles, family relationships, and school environment. Both decreased significantly with the passage of time spent in host country.

CONCLUSIONS

The results may be used to formulate cognitive-behavioral coping interventions that can lead to optimal developmental outcomes in the posttrauma environment.

Mental health and associated stress factors in accompanied and unaccompanied refugee minors resettled in Germany: a cross-sectional study

BACKGROUND

Studies throughout Europe have shown that asylum-seeking children and adolescents (ASC) are at risk of developing mental disorders. The most common mental-health problems in ASC include posttraumatic stress symptoms (PTSS), internalizing symptoms such as depression and anxiety, and externalizing behaviour. Being an unaccompanied refugee minor (URM) was found to be highly predictive for higher levels of psychological distress within ASC. Nevertheless, and even though Germany is Europe's biggest host country for ASC, studies that reliably examine the mental health of both URM and accompanied refugee minors (ARM) in Germany with psychometrically tested measures are still lacking.

METHODS

A cross-sectional survey in 19 facilities for minor refugees in Bavaria, Germany, screening for PTSS, depression, anxiety, externalizing behaviour, and post-migration factors was conducted. Participants were 98 ASC (URM, n = 68; ARM, n = 30) primarily from Afghanistan, Syria, and Eritrea. In 35.7% of interviews, interpreters were involved.

RESULTS

Both URM and ARM reported high levels of psychological distress and large numbers of potentially traumatic events, with 64.7% of URM and 36.7% of ARM scoring above the clinical cut-off for PTSS, 42.6% of URM and 30% of ARM for depression, and 38.2% of URM and 23.3% of ARM for anxiety. The total number of traumatic experiences was found to be the most robust predictor for PTSS, depression, and anxiety. Lower levels of individual resources, lower levels of social support in the host country, and poorer German language proficiency were associated with higher levels of psychological distress within both groups. URM reported significantly more traumatic events than ARM.

CONCLUSIONS

ASC in Germany are severely distressed and burdened by the experiences of various types of potentially traumatic events. The levels of distress found in the current study correspond with rates that have been reported in previous studies with ASC throughout Europe. Limitations of the present study include the convenience sample and the cross-sectional nature of findings.

The Contribution of Posttraumatic Stress Disorder and Depression to Insomnia in North Korean Refugee Youth

Refugees are exposed to multiple traumatic and stressful events and thereby are at higher risk for developing a variety of psychological sequelae including posttraumatic stress disorder (PTSD). However, the relation of PTSD to other mental health conditions has not been fully revealed in refugee populations. The present study investigated relationships among trauma exposure, PTSD, depression, and insomnia in North Korean refugee youth. Seventy-four refugee youth were assessed for exposure to traumatic events, PTSD, depression, and insomnia symptoms. The results showed high rates of multiple trauma exposures among the refugee youth and high incidences of co-occurring symptoms of PTSD and insomnia in those who have multiple trauma. Furthermore, the overall symptoms and four cluster symptoms of PTSD were strongly correlated with insomnia in addition to depression. In the path model to predict insomnia, PTSD affected insomnia only through depression, indicating that the greater the levels of PTSD suffered, the greater the likelihood for developing sleep problems via depression. The present study indicates how sleep problems relate to trauma-related symptoms, i.e., PTSD and depression in refugee populations, and highlights the need for further investigation of the specific relation between sleep problems and trauma-related symptoms for effective evaluation and intervention.

Psychological Burden in Female, Iraqi Refugees Who Suffered Extreme Violence by the "Islamic State": The Perspective of Care Providers

Introduction: A large number of refugees suffer from mental disorders such as post-traumatic stress disorder (PTSD). In the context of a special quota project, 1100 Yazidi women from Northern Iraq who had suffered extreme violence by the so-called Islamic State (IS) were brought to Germany to receive specialized treatment. This study aims to investigate the psychological burden and trauma-related symptoms of these female IS-victims from the perspectives of their care providers. Material and methods: Care providers with various professional backgrounds (N = 96) were asked to complete a self-developed questionnaire on a Likert-type scale ranging from 1 (very low) to 7 (very high) analyzing the psychological burden and trauma-related symptoms of the IS-traumatized women since their arrival in Germany. We controlled for potential confounders, namely the care providers' personal experiences of trauma and flight, by using chi-square tests. Results: The mean psychological burden for the whole period in Germany as perceived by care providers was M = 5.51 (SD = 0.94). As the main factors of distress the care providers reported: worries about family members in Iraq (M = 6.69; SD = 0.69), worries about relatives' possibilities to be granted asylum in Germany (M = 6.62; SD = 0.68), and uncertainties regarding their future (M = 5.89; SD = 1.02). The most prominent trauma-related psychological symptoms were nightmares (M = 6.43; SD = 0.54). The care providers reported that somatic complaints have been present among the refugees in the following manifestation: pain (M = 6.24; SD = 1.08), gastrointestinal complaints (M = 4.62; SD = 1.62), and dizziness (M = 4.40; SD = 1.59). The care providers' personal experiences of trauma and flight had no significant influence on their response behavior. Discussion: Care providers working with IS-traumatized female refugees evaluate the psychological burden and trauma-related somatic and psychological symptom loads of their clients as very high. The results of this study provide important information about the perceptions of care providers working in a refugee-services context and may provide insights for the progression of specialized treatment programs and interventions for highly traumatized refugees and culture-sensitive training programs for their care providers.

Immigration and Acculturation: Impact on Health and Well-Being of Immigrants

Among migrants who arrived in the USA and Europe, communicable diseases such as dermatologic, gastrointestinal, and respiratory infections are frequent; non-communicable diseases including chronic diseases such as hypertension and diabetes, and vaccine-preventable diseases are also prevalent. Refugees are often not up to date on routine immunizations and screenings for chronic diseases and cancer. In addition, many immigrants have trauma-related mental health problems, which are often not addressed by the healthcare systems where they reside. Determining the healthcare needs of specific immigration groups should lead to the establishment of evidence-based guidelines for providing screening and healthcare services to immigrant populations, for the benefit of the individuals concerned, as well as the host countries.

Mental Health of Refugees and Asylum Seekers: Assessment and Intervention

With unprecedented numbers of displaced persons worldwide, mental health clinicians in high-income countries will increasingly encounter refugee and asylum-seeking patients, many of whom have experienced significant adversity before and after their migration. This paper presents a summary of the recent evidence on the assessment and treatment of refugees across the lifespan to inform clinicians' approaches to care of refugee patients in mental health care settings. Assessment and interventions for refugees are grounded in an ecosystemic approach which considers not only pre-migratory trauma, but social, familial, and cultural determinants of mental health in the host country. Evidence for psychotherapy and pharmacological treatments are reviewed, highlighting promising interventions while acknowledging that further research is needed. Ultimately, serving refugees necessitates a biopsychosocial approach that engages clinicians as medical experts, therapists, and advocates.