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Beason T, Knox J, Lever N, Hoover S, Dubin M, Gordon-Achebe K. Using a Culturally Responsive, Antiracist, and Equitable Approach to School Mental Health. Child Adolesc Psychiatr Clin N Am 2024; 33:541-556. [PMID: 39277311 DOI: 10.1016/j.chc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Amidst a national youth mental health crisis, comprehensive school mental health systems offer an opportunity to promote positive mental health for all students. To advance health equity, schools benefit from a culturally responsive, antiracist, and equitable (CARE) framework to address the youth mental health crisis. This article describes how to integrate CARE practices within a multi-tiered system of support for mental health in schools. The strategies align with a trauma-informed approach and aim to enhance the capacity of comprehensive school mental health systems to promote positive mental health and well-being for all students.
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Affiliation(s)
- Tiffany Beason
- Department of Psychiatry, University of Maryland, Baltimore, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Jerica Knox
- Department of Psychiatry, University of Maryland, Baltimore, 737 West Lombard Street, Baltimore, MD 21201, USA
| | - Nancy Lever
- Department of Psychiatry, University of Maryland, Baltimore, 737 West Lombard Street, Baltimore, MD 21201, USA
| | - Sharon Hoover
- Department of Psychiatry, University of Maryland, Baltimore, 737 West Lombard Street, Baltimore, MD 21201, USA
| | - Malka Dubin
- Department of Psychiatry, University of Maryland, Baltimore, 737 West Lombard Street, Baltimore, MD 21201, USA
| | - Kimberly Gordon-Achebe
- Department of Psychiatry, University of Maryland, Baltimore, 737 West Lombard Street, Baltimore, MD 21201, USA
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Hosseini Z, Motamedi M. Home, School, and Community-based Services for Forcibly Displaced Youth and Their Families. Child Adolesc Psychiatr Clin N Am 2024; 33:677-692. [PMID: 39277319 DOI: 10.1016/j.chc.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Forced displacement can expose youth to unimaginable levels of traumatic life events. We discuss how home-based, school-based, and community-based services can be strategically situated to address the psychological sequelae of such events. Given the systemic challenges that refugee youth face when establishing trust in their new environments, are often from collectivist cultural backgrounds, espouse stigma towards professional help seeking, and must prioritize accessing services for their basic needs, these types of settings can be particularly relevant. In the administration of such services, we advocate for an intentional approach to addressing basic needs as well as using cultural brokers, validated measures, and family- and school-based interventions.
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Affiliation(s)
- Zainab Hosseini
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Building 420, Mail Code 3096, Stanford, CA, 94305, USA.
| | - Mojdeh Motamedi
- Refugee Health Alliance, 8861 Villa La Jolla Drive, #12062 La Jolla, CA 92036, USA
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Dangmann C, Kleppang AL, Leonhardt M. Health assessments of refugee minors arriving in Norway - a modified Delphi study among health professionals in primary care settings. BMC Public Health 2024; 24:2487. [PMID: 39267001 PMCID: PMC11395643 DOI: 10.1186/s12889-024-19871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 08/23/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Refugee minors are considered particularly vulnerable to negative health consequences from war, flight and resettlement. Offering health assessments after arrival in a host country could uncover unmet health needs and provide access to treatment. In Norway, a national guide describes these assessments, but little is known about its implementation especially for refugee minors. Thus, the aim of this study was first to explore how health assessments of refugee minors are carried out, second how health professionals perceive the needs of refugee minors and third, the competencies they perceive as necessary to meet the needs of refugee minors. METHOD A modified Delphi study in three rounds was conducted using online surveys and one focus group to collect data on the needs and resources of refugee minors, essential factors for a good and health assessment practice. Participants were 54 health professionals responsible for early health assessments of refugee minors, throughout the Norwegian municipalities, working in primary care settings. Quantitative data was analysed descriptively, and qualitative data with content analysis. RESULTS Health assessments of refugee minors were predominantly conducted by public health nurses, but the organisational structures surrounding assessments varied greatly according to the size of the municipalities and to how much resources were allocated. The feeling of safety was found to be paramount to ensure a good start in a new country for refugee minors. The top four competences professionals should have, were 'general communication skills', a 'health professional background', 'expertise in children's health' and 'knowledge about the national guide'. To ensure good health services for refugee minors, improved, more comprehensive, and mandatory directives for children and young individuals was highlighted. CONCLUSION Although most refugee minors were invited and attend health assessments, one third of participating municipalities did not offer health assessments to all newcomers and the organisation and content of the assessments were diverse. Several topics, especially mental health, were postponed or not routinely addressed, contrasting with current knowledge of unmet health needs for this group. Missing documentation, practical barriers and providing general health information took time away from doing the actual assessments. The perceived needs of refugee minors were safety and stability, combined with meaningful activities, thus a coordinated effort from several services is necessary. Suggestions for improvements were more time given to assessments, better organisation and co-operation, improved competence and guidelines adjusted for age.
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Affiliation(s)
- Cecilie Dangmann
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Hamarvegen 112, Elverum, NO, 2418, Norway.
| | - Annette Løvheim Kleppang
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Hamarvegen 112, Elverum, NO, 2418, Norway
| | - Marja Leonhardt
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, 2381, Norway
- Faculty of Health Science, VID Specialized University, Oslo, Norway
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Kankaanpää R, Vänskä M, Opaas M, Spaas C, Derluyn I, Jervelund SS, Skovdal M, Durbeej N, Osman F, De Haene L, de Smet S, Andersen AJ, Hilden PK, Verelst A, Peltonen K. Psychometric properties of the Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan, Syria, and Somalia. Eur J Psychotraumatol 2024; 15:2349445. [PMID: 38753438 PMCID: PMC11100434 DOI: 10.1080/20008066.2024.2349445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
Background: High levels of post-traumatic stress are well documented among refugees. Yet, refugee adolescents display high heterogeneity in their type of trauma and symptom levels.Objective: Following the recurrent plea for validated trauma screening tools, this study investigated the psychometric properties of the Children's Revised Impact of Event Scale (CRIES-8) among refugee adolescents from Afghanistan (n = 148), Syria (n = 234), and Somalia (n = 175) living in Europe.Method: The model fit for the confirmatory factor structures was tested, as well as measurement invariance between the three groups. The robustness of results was evaluated by testing measurement invariance between recently arrived and settled adolescents, and between different response labelling options. Reliability (α, ω, and ordinal α), criterion validity, and prevalence estimates were calculated.Results: The intrusion subscale showed a better stable model fit than the avoidance subscale, but the two-factor structure was mainly supported. Configural measurement invariance was achieved between Afghan and Somali adolescents, and strong measurement invariance between Syrian and Somali adolescents. The results were robust considering the time living in the host country and response labelling styles. Reliability was low among Afghan and Syrian adolescents (.717-.856), whereas it was higher among Somali adolescents (.831-.887). The total score had medium-sized correlations with emotional problems (.303-.418) and low correlations with hyperactivity (.077-.155). There were statistically significant differences in symptom prevalence: Afghan adolescents had higher prevalence (55.5%) than Syrian (42.8%) and Somali (37%) adolescents, and unaccompanied refugee minors had higher symptom prevalence (63.5%) than accompanied adolescents (40.7%).Conclusions: This study mostly supports the use of the CRIES-8 among adolescents from Afghanistan, Syria, and Somalia, and even comparative analyses of group means. Variation in reliability estimates, however, makes diagnostic predictions difficult, as the risk of misclassification is high.
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Affiliation(s)
- Reeta Kankaanpää
- Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
- INVEST Research Flagship Centre, University of Turku, Turku, Finland
| | - Mervi Vänskä
- Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Marianne Opaas
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
| | - Caroline Spaas
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Ilse Derluyn
- Centre for the Social Study of Migration and Refugees, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
| | | | - Morten Skovdal
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Fatumo Osman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Lucia De Haene
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Sofie de Smet
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Arnfinn J. Andersen
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
| | - Per Kristian Hilden
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
| | - An Verelst
- Centre for the Social Study of Migration and Refugees, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
| | - Kirsi Peltonen
- INVEST Research Flagship Centre, University of Turku, Turku, Finland
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Fortuna LR, Porche MV. Upholding the Human Rights and Well-Being of Refugee Children Through Effective Clinical Care. Child Adolesc Psychiatr Clin N Am 2024; 33:111-124. [PMID: 38395499 PMCID: PMC10894321 DOI: 10.1016/j.chc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Refugee children are often exposed to adversities and traumatic experiences that can harm the mental health and well-being of refugee children. These include human trafficking and exploitation and dangers in detention centers and refugee camps. All these adverse events can be traumatic and contribute to poor mental health, including posttraumatic stress, anxiety, depression, and substance use disorders. Therefore, the assessment of refugee children and adolescents should include screening and identification for these experiences, provision of evidence-based trauma treatment, and social supports to promote their well-being and thriving.
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Affiliation(s)
- Lisa R Fortuna
- University of California Riverside, School of Medicine Education Building 2, 5th Floor, Psychiatry and Neurosciences, 900 University Avenue, Riverside, CA 92521, USA.
| | - Michelle V Porche
- University of California, Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, 7M10, San Francisco, CA 94110, USA
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Fennig M. Cross-culturally adapting the GHQ-12 for use with refugee populations: Opportunities, dilemmas, and challenges. Transcult Psychiatry 2024; 61:168-181. [PMID: 38233737 PMCID: PMC10943620 DOI: 10.1177/13634615231223884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
This article discusses the opportunities, dilemmas, and challenges involved in the cross-cultural adaptation (CCA) of psychological scales for use with refugee populations. It draws on insights derived from an attempt to adapt the 12-item General Health Questionnaire (GHQ-12) to the particular culture and context of Eritrean refugees residing in Israel. Multiple techniques including expert translations, a focus-group discussion, a survey, and piloting, were employed to attain a cross-cultural and conceptually equivalent measure. During the CCA process, the research team encountered issues pertaining to conceptual non-equivalence, the structure of the measure's responses and scoring system, and acceptability. These issues required the team to move beyond semantic translation by adapting certain items. This study demonstrates the compromises which need to be made in the adaptation process and indicates the potential bias which each of these compromises introduces. Despite its limitations, CCA does appear to significantly improve detection of mental health symptoms in refugee populations. Overall, the results of the present study provide support for the notion that the sensitive and appropriate assessment of individuals from refugee backgrounds requires adopting a rigorous, systematic, and contextual approach to instrument adaptation, with an emphasis on the integration of idioms of distress as well as the adaptation of Likert-type scales.
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Affiliation(s)
- Maya Fennig
- The Bob Shapell School of Social Work, The Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv-Yafo, Israel
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Bernhardt K, Le Beherec S, Uppendahl JR, Fleischmann M, Klosinski M, Rivera LM, Samaras G, Kenney M, Müller R, Nehring I, Mall V, Hahnefeld A. Young children's development after forced displacement: a systematic review. Child Adolesc Psychiatry Ment Health 2024; 18:20. [PMID: 38303022 PMCID: PMC10835848 DOI: 10.1186/s13034-024-00711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES To examine the impact of displacement experiences on 0- to 6-year-old children's social-emotional and cognitive development, as well as influencing factors on reported outcomes. STUDY DESIGN We systematically searched MEDline, Psyndex, Cochrane Library, Web of Science, Elsevier, TandF, Oxford Journal of Refugee Studies, Journal of Immigrant & Refugee Studies, and Canada's Journal on Refugees for existing literature regarding social-emotional and cognitive outcomes in children directly exposed to forced displacement due to political violence. Results were synthesized in the discussion and displayed using harvest plots. RESULTS Our search generated 9,791 articles of which 32 were selected for review and evaluation according to NICE criteria. Included studies provided results for 6,878 forcibly displaced children. Measured outcomes were diverse and included areas such as peer relations, prosocial behavior, family functioning, play, intelligence, learning performance, and language development. Repeated exposure to adverse experiences, separation from parents, parental distress, as well as duration and quality of resettlement in the host country were reported as influencing factors in the reviewed studies. CONCLUSION As protective factors like secure and stable living conditions help to promote children's development, we call for policies that enhance participation in the welcoming society for refugee families. Early integration with low-threshold access to health and educational facilities can help to mitigate the wide-ranging negative consequences of forced displacement on young children's development.
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Affiliation(s)
- Katharina Bernhardt
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany.
| | - Saskia Le Beherec
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
| | - Jana R Uppendahl
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Melia Fleischmann
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Klosinski
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Luisa M Rivera
- Department of Anthropology, Emory University, Atlanta, GA, USA
| | - Georgia Samaras
- Department of Science, Technology and Society, Technical University of Munich, Munich, Germany
| | - Martha Kenney
- Department of Women and Gender Studies, San Francisco State University, San Francisco, CA, USA
| | - Ruth Müller
- Department of Science, Technology and Society, Technical University of Munich, Munich, Germany
- School of Management, Technical University of Munich, Munich, Germany
- School of Life Sciences, Technical University of Munich, Munich, Germany
| | - Ina Nehring
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Volker Mall
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
| | - Andrea Hahnefeld
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
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Bernhardt K, Le Beherec S, Uppendahl J, Baur MA, Klosinski M, Mall V, Hahnefeld A. Exploring Mental Health and Development in Refugee Children Through Systematic Play Assessment. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01584-z. [PMID: 37624478 DOI: 10.1007/s10578-023-01584-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
To evaluate a standardized play observation as a measure of young children's mental health and development in a clinical and refugee population. We conducted individual play observations with 70 refugee children aged 3- to 6-years and compared them to a clinical group of 111 age-matched children regarding their level of play development, social interaction during play, traumatic re-enactments, and emotionless-cold play. Additionally, we assessed children's mental health, social-emotional development and markers of adversity by parent and educator report as well as their IQ-test scores and learning performance and related these factors to the play variables. Play variables were significantly correlated with IQ-test scores (r = 0.184, p = 0.037), learning performance (r = 0.208, p = 0.010) and vocabulary (r = 0.208, p = 0.021) in the comparison group and with social-emotional development in educator report (r = 0.368, p = 0.011), time spent in Germany (r = 0.342, p < 0.001) and parental distress (r = - 0.292, p = 0.034) in the refugee group. Children with more parent-reported adverse experiences showed less social-interactive play in the overall sample (r = - 0.178, p = 0.011). Our child-centered approach to standardized play observation augments information obtained from parent and educator reports and can provide valuable insights in subgroups where other commonly used tests are not available or applicable.
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Affiliation(s)
| | - Saskia Le Beherec
- Technical University of Munich, Munich, Germany
- kbo Kinderzentrum, Munich, Germany
| | | | | | | | - Volker Mall
- Technical University of Munich, Munich, Germany
- kbo Kinderzentrum, Munich, Germany
| | - Andrea Hahnefeld
- Technical University of Munich, Munich, Germany
- kbo Kinderzentrum, Munich, Germany
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Abdelhamid S, Lindert J, Fischer J, Steinisch M. Negative and protective experiences influencing the well-being of refugee children resettling in Germany: a qualitative study. BMJ Open 2023; 13:e067332. [PMID: 37076150 PMCID: PMC10124287 DOI: 10.1136/bmjopen-2022-067332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE Conflict, forced migration and searching for safety in a foreign land are all experiences common to refugee children. They experience potentially traumatic events that are distinct from the general population, yet current adverse childhood experience (ACE) studies do not cover these events. Studies that do examine refugee children's experiences typically focus on a single stage of migration or adversities from the community, offering insight into only a fraction of their realities. This study aimed to identify potentially traumatising and protective experiences subjectively perceived as influencing refugee children's well-being from all stages of migration and all socio-ecological levels. DESIGN Qualitative study with thematic analysis of semi-structured individual and group interviews. Themes were organised within a socio-ecological model. SETTING Non-profit organisations, youth welfare facilities and societies that organise civic engagement for refugee families in the Rhine-Neckar region in Germany provided rooms where interviews could be conducted. PARTICIPANTS Refugee parents and children who spoke one of the four most common languages of those seeking asylum in Germany in 2018 were included. This study excluded refugees who were not fleeing a conflict area. Forty-seven refugee parents and 11 children (aged 8-17 years) from Syria, Iraq, Palestine, Afghanistan and Eritrea participated. RESULTS Eight major themes emerged from interviews including six reflecting potentially negative experiences and two potentially protective themes. These themes evolved from experiences such as family dispersion, displacement, rigorous immigration and national policies, as well as constructive parenting and community support. CONCLUSION It is increasingly important to identify these diverse experiences as the refugee population continues to grow, and the increased prevalence of poor health outcomes in refugee children continues to be widely documented. Identifying ACEs specifically relevant to refugee children could contribute to understanding potential pathways and could further serve as a starting point for tailored interventions.
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Affiliation(s)
- Shaymaa Abdelhamid
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Heidelberg University, Heidelberg, Germany
| | - Jutta Lindert
- Department of Social Work and Health, University of Applied Sciences Emden/Leer, Emden, Germany
| | - Joachim Fischer
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Heidelberg University, Heidelberg, Germany
| | - Maria Steinisch
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of Public Health, Social and Preventive Medicine, Heidelberg University, Heidelberg, Germany
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Nagy E, Herpertz SC, Schohl K, Zehetmair C, Gebhardt N, Friederich HC, Nikendei C. The refugee and asylum seeker mental health treatment screener (RAS-MT-screener): Feasibility and psychometric properties of a questionnaire detecting refugees' and asylum seekers' need and urgency for mental health treatment. Gen Hosp Psychiatry 2023; 83:43-50. [PMID: 37099868 DOI: 10.1016/j.genhosppsych.2023.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/04/2023] [Accepted: 03/23/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Refugees and asylum seekers are highly vulnerable to the development of mental health problems, yet oftentimes their need is underestimated. We aimed to develop a culturally sensitive screening tool for primary care settings assessing the urgency and need for mental health treatment to close this gap. METHOD Items for the screening tool were selected out of an item pool generated by a group of clinical experts based on the data obtained from n = 307 asylum seekers in a refugee state registration and reception center in Germany. Out of these, n = 111 attended a psychosocial walk-in clinic, and clinicians' ratings of urgency and need for mental health treatment were added. RESULTS The resulting questionnaire comprised 8 items assessing urgency and 13 items assessing need for mental health treatment. Sensitivity was =0.74 and specificity =0.70. Participants of clinical and non-clinical samples differ highly significantly (p < .001). Cross-cultural validity was shown by comparing measurement invariance for different countries of origin. CONCLUSION The RAS-MT-Screener is a clinically and cross-culturally valid screening tool in primary care settings for the urgency and need for mental health treatment with acceptable psychometric properties. Future research on its external and construct validity is warranted.
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Affiliation(s)
- Ede Nagy
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Sabine C Herpertz
- Center for Psychosocial Medicine, Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katharina Schohl
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Catharina Zehetmair
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany; Center for Psychosocial Medicine, Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Nadja Gebhardt
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
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Chierici DK, Hamdan AC. Cognitive evaluation in unaccompanied refugee children: a systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022079. [PMID: 37194839 DOI: 10.1590/1984-0462/2023/41/2022079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/30/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study aims to identify what existing literature has shown about possible cognitive alterations in unaccompanied refugee children. DATA SOURCES The search was performed in the Web of Science, PsycInfo, Scopus, and PubMed databases, including articles published in any year and in any language. The research was submitted to the Prospero protocol (ID: CRD42021257858), and the quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. DATA SYNTHESIS Memory and attention are the main topics identified, largely because they are related to symptoms of post-traumatic stress disorder. However, low specificity was observed in the conduction of cognitive assessments, leading to relevant inconsistencies in the collected data. CONCLUSIONS The use of psychological assessment instruments that are either poorly adapted or not adapted at all to the populations studied casts doubt on the validity of the data produced so far.
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Magwood O, Bellai-Dussault K, Fox G, McCutcheon C, Adams O, Saad A, Kassam A. Diagnostic test accuracy of screening tools for post-traumatic stress disorder among refugees and asylum seekers: A systematic review and meta-analysis. J Migr Health 2022; 7:100144. [PMID: 36568829 PMCID: PMC9772565 DOI: 10.1016/j.jmh.2022.100144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Refugees and asylum seekers often experience traumatic events resulting in a high prevalence of post-traumatic stress disorder (PTSD). Undiagnosed PTSD can have detrimental effects on resettlement outcomes. Immigration medical exams provide an opportunity to screen for mental health conditions in refugee and asylum seeker populations and provide links to timely mental health care. Objective To assess the diagnostic accuracy of screening tools for PTSD in refugee and asylum seeker populations. Methods We systematically searched Medline, Embase, PsycINFO, CENTRAL and CINAHL up to 29 September 2022. We included cohort-selection or cross-sectional study designs that assessed PTSD screening tools in refugee or asylum seeker populations of all ages. All reference standards were eligible for inclusion, with a clinical interview considered the gold standard. We selected studies and extracted diagnostic test accuracy data in duplicate. Risk of bias and applicability concerns were addressed using QUADAS-2. We meta-analyzed findings using a bivariate random-effects model. We partnered with a patient representative and a clinical psychiatrist to inform review development and conduct. Results Our review includes 28 studies (4,373 participants) capturing 16 different screening tools. Nine of the 16 tools were developed specifically for refugee populations. Most studies assessed PTSD in adult populations, but three included studies focused on detecting PTSD in children. Nine studies looked at the Harvard Trauma Questionnaire (HTQ) with diagnostic cut-off points ranging from 1.17 to 2.5. Meta-analyses revealed a summary point sensitivity of 86.6% (95%CI 0.791; 0.917) and specificity of 78.9% (95%CI 0.639; 0.888) for these studies. After evaluation, we found it appropriate to pool other screening tools (Posttraumatic Stress Disorder Checklist, the Impact of Event Scale, and the Posttraumatic Diagnostic Scale) with the HTQ. The area under the curve for this model was 79.4%, with a pooled sensitivity of 86.2% (95%CI 0.759; 0.925) and a specificity of 72.2% (95%CI 0.616; 0.808). Conclusions Our review identified several screening tools that perform well among refugees and asylum seekers, but no single tool was identified as being superior. The Refugee Health Screener holds promise as a practical instrument for use in immigration medical examinations because it supports the identification of PTSD, depression, and anxiety across diverse populations. Future research should consider tool characteristics beyond sensitivity and specificity to facilitate implementation in immigration medical exams. Registration Open Science Framework: 10.17605/OSF.IO/PHNJV.
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Affiliation(s)
- Olivia Magwood
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, 125 University, Ottawa, ON K1N 6N5, Canada
| | - Kara Bellai-Dussault
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Grace Fox
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Chris McCutcheon
- Interdisciplinary School of Health Sciences, University of Ottawa, 125 University, Ottawa, ON K1N 6N5, Canada
| | - Owen Adams
- Canadian Medical Association, 1410 Blair Towers Place, Suite 500, Ottawa, ON K1J 9B9, Canada
| | - Ammar Saad
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
- Pinecrest-Queensway Community Health Centre, 1365 Richmond Rd #2, Ottawa, ON K2B 6R7, Canada
- Ottawa Newcomer Health Centre, 291 Argyle, Ottawa, ON K2P 1B8, Canada
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13
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Acuña MA, Franke TM, Lipscomb AE. Coping and Resilience: PTSD Screening and Brief Intervention for Underrepresented Students at a Public University. SOCIAL WORK 2022; 67:321-330. [PMID: 35856686 DOI: 10.1093/sw/swac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 06/15/2023]
Abstract
The undetected and untreated PTSD symptoms (difficulty paying attention, nightmares and difficulty sleeping, irritability or aggression, flashbacks, diminished interest in activities, self-destructive behavior, and feeling isolated) of college students may interfere with their relationships, well-being, learning, and academic success. To examine the feasibility, acceptability, and impact of providing a short-term trauma-specific evidence-based group intervention, Coping & Resilience (C&R), an adaptation of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) was implemented at a large urban public university. Fifty college students (54 percent male, 90 percent students of color), with a mean PTSD symptom score of 34 at pretest (considered in the moderate range of symptom severity) participated in C&R groups. As expected, student PTSD symptoms improved after group participation. A Quade test showed a significant decrease in the scores from pretest to follow-up for PTSD and two subscales (intrusion and avoidance). Large public universities serving underrepresented students are uniquely positioned to become trauma- and resilience-informed systems and to provide trauma support services to promote student well-being.
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Affiliation(s)
- M Alejandra Acuña
- PhD, LCSW, PPSC, is associate professor, Department of Social Work, College of Social and Behavioral Sciences, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA 91330, USA
| | - Todd M Franke
- PhD, is professor, University of California, Los Angeles, Los Angeles, CA, USA
| | - Allen E Lipscomb
- PsyD, LCSW, is associate professor, California State University, Northridge, Northridge, CA, USA
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14
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Bürgin D, Anagnostopoulos D, Vitiello B, Sukale T, Schmid M, Fegert JM. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry 2022; 31:845-853. [PMID: 35286450 PMCID: PMC9209349 DOI: 10.1007/s00787-022-01974-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.
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Affiliation(s)
- David Bürgin
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | | | - Benedetto Vitiello
- Division of Child Neurology and Psychiatry, Department of Public Health and Pediatric Sciences, Regina Margherita Pediatric Hospital, University of Turin, Turin, Italy
| | - Thorsten Sukale
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany.
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15
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Donnelly O, Leavey G. Screening Tools for Mental Disorders Among Female Refugees: a Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:209-219. [PMID: 35600514 PMCID: PMC9120328 DOI: 10.1007/s40653-021-00375-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 06/15/2023]
Abstract
Female refugees are particularly vulnerable to mental disorders but assessment may be complex and challenging. Various screening tools have been developed for this population, but little is known about their usefulness. The main aim is to examine the literature on the effectiveness of screening tools for mental health problems among female refugees. Systematic review of PubMed, PsycINFO and Embase to locate all published work. Comprehensive search terms were used and inclusion and exclusion criteria were formulated. The initial search yielded 877 articles, of which 757 were removed after titles and abstracts were reviewed. Then, 121 full-text versions of articles were examined and 96 excluded according to the criteria. A total of 25 articles were included in this systematic review in accordance with the PRIMSA guidelines. Twenty screening tools were evaluated. There is a lack of tools used to screen refugee women, and in particular those in emergency settings. Cultural factors may not be accounted for in the development of screening instruments. Further research in this field can help inform public health policies to address social, educational and occupational inclusion for refugee women in different contexts.
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Affiliation(s)
| | - Gerard Leavey
- Bamford Centre of Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland
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16
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Björkenstam E, Helgesson M, Norredam M, Sijbrandij M, de Montgomery CJ, Mittendorfer-Rutz E. Differences in psychiatric care utilization between refugees, non-refugee migrants and Swedish-born youth. Psychol Med 2022; 52:1365-1375. [PMID: 32914741 DOI: 10.1017/s0033291720003190] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The study aimed to examine differences in, and characteristics of psychiatric care utilization in young refugees who came to Sweden as unaccompanied or accompanied minors, compared with that of their non-refugee immigrant and Swedish-born peers. METHODS This register-linkage cohort study included 746 688 individuals between 19 and 25 years of age in 2009, whereof 32 481 were refugees (2896 unaccompanied and 29 585 accompanied) and 32 151 non-refugee immigrants. Crude and multivariate Cox regression models yielding hazard ratios (HR) and 95% confidence intervals (CI) were conducted to investigate subsequent psychiatric care utilization for specific disorders, duration of residence and age at migration. RESULTS The adjusted HRs for psychiatric care utilization due to any mental disorder was significantly lower in both non-refugee and refugee immigrants when compared to Swedish-born [aHR: 0.78 (95% CI 0.76-0.81) and 0.75 (95% CI 0.72-0.77, respectively)]. Within the refugee group, unaccompanied had slightly lower adjusted risk estimates than accompanied. This pattern was similar for all specific mental disorders except for higher rates in schizophrenia, reaction to severe stress/adjustment disorders and post-traumatic stress disorder. Psychiatric health care utilization was also higher in immigrants with more than 10 years of residency in Sweden entering the country being younger than 6 years of age. CONCLUSIONS For most mental disorders, psychiatric health care utilization in young refugees and non-refugee immigrants was lower than in their Swedish-born peers; exceptions are schizophrenia and stress-related disorders. Arrival in Sweden before the age of 6 years was associated with higher rates of overall psychiatric care utilization.
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Affiliation(s)
- Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Marie Norredam
- Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, University of Copenhagen, Copenhagen K, Denmark
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, The Netherlands
| | - Christopher Jamil de Montgomery
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, University of Copenhagen, Copenhagen K, Denmark
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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17
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Due C, Currie E. Practitioner competencies for working with refugee children and young people: A scoping review. Transcult Psychiatry 2022; 59:116-129. [PMID: 34860624 DOI: 10.1177/13634615211043765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Research indicates that refugee and asylum seeker children and young people often require specialised psychological support. Competencies have been established as helpful in guiding the training, education and ongoing professional development of practitioners working in specialised areas. To date there has been no comprehensive review of the literature concerning practitioner competencies for working with refugee or asylum seeker children and young people. This scoping review therefore aimed to synthesise all literature regarding practitioner competencies that are considered important for working in the area of mental health with refugee and asylum seeker children and young people. Literature was sourced from PsycINFO, Scopus, and PubMed. Studies were included if they: a) were published in peer-reviewed journals, b) were published in English, c) were published in the last 25 years, d) collected primary data, e) related to children and/or young people (defined as aged under 25) with refugee or asylum seeker backgrounds, and f) discussed practitioner competencies (in relation to refugee or asylum seeker children or young people). Nine articles met criteria and a deductive thematic analysis identified six key competencies: 1) knowledge of the complexity of needs of refugees; 2) use of holistic approaches; 3) ability to work in co-ordination with others in the child's network; 4) ability to build therapeutic relationships; 5) seeking feedback; and 6) cultural competency. Further empirical research that directly aims to identify practitioner competencies, from both the practitioner and client perspective, will support the challenging work done by practitioners working with refugee and asylum seeker children and young people.
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Affiliation(s)
- Clemence Due
- School of Psychology, 1066The University of Adelaide, Adelaide, Australia
| | - Emma Currie
- School of Psychology, 1066The University of Adelaide, Adelaide, Australia
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18
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Magwood O, Kassam A, Mavedatnia D, Mendonca O, Saad A, Hasan H, Madana M, Ranger D, Tan Y, Pottie K. Mental Health Screening Approaches for Resettling Refugees and Asylum Seekers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3549. [PMID: 35329237 PMCID: PMC8953108 DOI: 10.3390/ijerph19063549] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
Refugees and asylum seekers often face delayed mental health diagnoses, treatment, and care. COVID-19 has exacerbated these issues. Delays in diagnosis and care can reduce the impact of resettlement services and may lead to poor long-term outcomes. This scoping review aims to characterize studies that report on mental health screening for resettling refugees and asylum seekers pre-departure and post-arrival to a resettlement state. We systematically searched six bibliographic databases for articles published between 1995 and 2020 and conducted a grey literature search. We included publications that evaluated early mental health screening approaches for refugees of all ages. Our search identified 25,862 citations and 70 met the full eligibility criteria. We included 45 publications that described mental health screening programs, 25 screening tool validation studies, and we characterized 85 mental health screening tools. Two grey literature reports described pre-departure mental health screening. Among the included publications, three reported on two programs for women, 11 reported on programs for children and adolescents, and four reported on approaches for survivors of torture. Programs most frequently screened for overall mental health, PTSD, and depression. Important considerations that emerged from the literature include cultural and psychological safety to prevent re-traumatization and digital tools to offer more private and accessible self-assessments.
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Affiliation(s)
- Olivia Magwood
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON K1N 7K4, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5, Canada;
- Pinecrest-Queensway Community Health Centre, 1365 Richmond Rd #2, Ottawa, ON K2B 6R7, Canada
- Ottawa Newcomer Health Centre, 291 Argyle, Ottawa, ON K2P 1B8, Canada
| | - Dorsa Mavedatnia
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; (D.M.); (M.M.)
| | - Oreen Mendonca
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
| | - Ammar Saad
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 5B2, Canada
| | - Hafsa Hasan
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON M5T 3M6, Canada
| | - Maria Madana
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; (D.M.); (M.M.)
| | - Dominique Ranger
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
| | - Yvonne Tan
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- Faculty of Arts and Sciences, Queen’s University, 99 University Ave, Kingston, ON K7L 3N6, Canada
| | - Kevin Pottie
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- Department of Family Medicine, Western University, London, ON N6A 3K7, Canada
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19
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Ibrahim H, Catani C, Neuner F. The posttraumatic stress interview for children (KID-PIN): development and validation of a semi-structured interview of PTSD symptoms among displaced children in the Middle East. PeerJ 2022; 9:e12403. [PMID: 35003912 PMCID: PMC8684325 DOI: 10.7717/peerj.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 10/07/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In populations affected by mass disaster such as armed conflict and displacement, children are at risk of developing mental ill-health, in particular post-traumatic stress disorder (PTSD). Valid and reliable screening instruments are needed to assess the severity of PTSD symptoms among children and to identify individuals in need of treatment. METHOD In the context of an ongoing war in the Middle East, we developed the KID-PIN as a semi-structured interview for PTSD symptoms that can be administered by trained paraprofessionals. To achieve a culturally and contextually appropriate instrument, the development was based on open-ended interviews with affected children and involved both local and international experts. Using the KID-PIN and instruments for constructs associated with PTSD, 332 Iraqi and Syrian displaced children were interviewed. A subset of the sample (n = 86) participated in validation interviews based on experts applying the Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version (CAPS-CA-5). RESULTS The KID-PIN demonstrated excellent internal consistency (Cronbach's alpha = 0.94) with good convergent validity. Confirmatory factor analyses of the KID-PIN showed an acceptable fit with the DSM-5 and other common models; the best fit was reached with the Hybrid model. Receiver operating characteristic analyses indicated that the cut-off score of 28 or higher on the KID-PIN is the optimum cut-off for a probable PTSD diagnosis. CONCLUSION The utility of the newly developed KID-PIN as a screening instrument for PTSD in children is supported by the measure's high internal consistency and good convergent and structural validity, as well as its diagnostic accuracy.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany.,vivo International, Konstanz, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany.,vivo International, Konstanz, Germany
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany.,vivo International, Konstanz, Germany
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20
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Verhagen IL, Noom MJ, Lindauer RJL, Daams JG, Hein IM. Mental health screening and assessment tools for forcibly displaced children: a systematic review. Eur J Psychotraumatol 2022; 13:2126468. [PMID: 36212114 PMCID: PMC9542271 DOI: 10.1080/20008066.2022.2126468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: An unprecedentedly large number of people worldwide are forcibly displaced, of which more than 40 percent are under 18 years of age. Forcibly displaced children and youth have often been exposed to stressful life events and are therefore at increased risk of developing mental health issues. Hence, early screening and assessment for mental health problems is of great importance, as is research addressing this topic. However, there is a lack of evidence regarding the reliability and validity of mental health assessment tools for this population. Objective: The aim of the present study was to synthesise the existing evidence on psychometric properties of patient reported outcome measures [PROMs] for assessing the mental health of asylum-seeking, refugee and internally displaced children and youth. Method: Systematic searches of the literature were conducted in four electronic databases: MEDLINE, PsycINFO, Embase and Web of Science. The methodological quality of the studies was examined using the COSMIN Risk of Bias checklist. Furthermore, the COSMIN criteria for good measurement properties were used to evaluate the quality of the outcome measures. Results: The search yielded 4842 articles, of which 27 met eligibility criteria. The reliability, internal consistency, structural validity, hypotheses testing and criterion validity of 28 PROMs were evaluated. Conclusion: Based on the results with regard to validity and reliability, as well as feasibility, we recommend the use of several instruments to measure emotional and behavioural problems, PTSD symptoms, anxiety and depression in forcibly displaced children and youth. However, despite a call for more research on the psychometric properties of mental health assessment tools for forcibly displaced children and youth, there is still a lack of studies conducted on this topic. More research is needed in order to establish cross-cultural validity of mental health assessment tools and to provide optimal cut-off scores for this population. HIGHLIGHTS Research on the psychometric properties of mental health screening and assessment tools for forcibly displaced children and youth is slowly increasing.However, based on the current evidence on the validity and reliability of screening and assessment tools for forcibly displaced children, we are not able to recommend a core set of instruments. Instead, we provide suggestions for best practice.More research of sufficient quality is important in order to establish crsoss-cultural validity and to provide optimal cut-off scores in mental health screening and assessment tools for different populations of forcibly displaced children and youth.
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Affiliation(s)
- Ilse L Verhagen
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marc J Noom
- Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
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21
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Okoli CTC, Seng S. Factors associated with posttraumatic growth among healthcare workers at an academic-medical center: A correlational study. Perspect Psychiatr Care 2022; 58:87-96. [PMID: 33931878 DOI: 10.1111/ppc.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Posttraumatic growth (PTG) can occur after experiencing traumatic events. Our purpose was to examine factors associated with PTG experiences of healthcare workers within an academic-medical center. DESIGN AND METHODS A correlational study was conducted using a convenience sample of 479 healthcare workers at a large academic-medical center. FINDINGS Having children living at home, serving the pediatric population, longer duration of alcohol abstinence, and having received treatment for trauma were significantly associated with greater PTG scores. Compared to nondirect care staff, advance practice providers, nursing staff, social work/psychologists, and pharmacy staff had significantly lower PTG scores. PRACTICE IMPLICATIONS Understanding the positive psychological changes that occur in workers after trauma experiences may provide insight to guide interventions that promote healthcare worker wellbeing.
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Affiliation(s)
| | - Sarret Seng
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
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22
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Chipalo E. Is Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Effective in Reducing Trauma Symptoms among Traumatized Refugee Children? A Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:545-558. [PMID: 34790283 PMCID: PMC8586102 DOI: 10.1007/s40653-021-00370-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED In 2019, more than 25.9 million children under 18 were displaced due to unending political conflicts. Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) has a high level of empirical evidence to support its efficacy in processing trauma and behavioral problems in non-refugee children. Yet, little is known about its long-term effectiveness in refugee children. This study conducted a systematic review that assessed the evidence of the effectiveness of TF-CBT in reducing trauma symptoms among refugee children under 18 years of age. A systematic review was conducted from peer-reviewed literature databases (12 databases): PsycINFO, PubMed, Scopus, Google Scholar, ProQuest Dissertations and Theses (PQDT), Cochrane Library, MEDLINE, PROSPERO, EBSCOHost, Campbell Collaboration Library of Systematic Reviews, Social Sciences Index, and grey literature sources published from 1990 to 2019. The search yielded 1650 articles, and 4 peer reviewed studies were identified that met inclusion criteria and yielded a sample size of 64 refugee children from 21 different countries. All 4 studies provided evidence that supported TF-CBT's effectiveness in decreasing trauma symptoms and sustainment during the follow-up assessment among refugee children participants. Despite TF-CBT effectiveness for trauma symptoms treatment, there is still limited evidence to suggest that TF-CBT is effective for all refugee children due to the pilot nature of the studies, and its underutilization in traumatized refugee children from different cultural backgrounds. Future studies should conduct more TF-CBT interventions with diverse refugee children to provide more empirical support for its effectiveness with that population. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00370-0.
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Affiliation(s)
- Edson Chipalo
- School of Social Work, The University of Alabama, Little Hall, 670 Judy Bonner Drive, Tuscaloosa, AL 35401 USA
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23
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Taipale H, Niederkrotenthaler T, Tanskanen A, Cullen AE, Helgesson M, Berg L, Sijbrandij M, Klimek P, Mittendorfer-Rutz E. Persistence of antidepressant use among refugee youth with common mental disorder. J Affect Disord 2021; 294:831-837. [PMID: 34375210 DOI: 10.1016/j.jad.2021.07.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/18/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objective of this study was to investigate whether persistence of antidepressant use differs between refugee youth and Swedish-born youth after a diagnosis of a common mental disorder (CMD), and if clinical and sociodemographic factors are associated with antidepressant discontinuation. METHODS Youth aged 16-25 years, with an incident diagnosis of CMD (depression, post-traumatic stress disorder (PTSD), anxiety disorders) accessing specialized healthcare in Sweden 2006-2016 were included. New users were identified with a one-year washout period. Refugees (N=1575) were compared with Swedish-born youth (N=2319). Cox regression models [reported as adjusted Hazard Ratios (HRs) with 95% confidence intervals (CIs)] were used to investigate factors associated with discontinuation of antidepressant use. RESULTS Among youth (mean age 20.9 years, SD 2.7, 50% females), the median duration of antidepressant use differed considerably between refugee (101 days, IQR 31-243) and Swedish-born youth (252 days, IQR 101-558). Refugees were more likely to discontinue treatment (HR 1.61, 95% CI 1.47-1.77). Factors associated with an increased risk for discontinuation in refugees included ≤5 years duration of formal residency (HR 1.28, 95% CI 1.12-1.45), antidepressant type, and dispensing lag (time from prescription to dispensing) of >7 days (1.43, 1.25-1.64), whereas PTSD (0.78, 0.64-0.97) and anxiolytic use (0.79, 0.64-0.96) were associated with a lower discontinuation risk. LIMITATIONS Only persons treated in specialized healthcare could be included. CONCLUSION The relatively short treatment durations among refugee youth suggest that antidepressant treatment may not be optimal in CMD, and better monitoring of treatment as well as transcultural education of healthcare personnel are warranted.
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Affiliation(s)
- Heidi Taipale
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Niuvanniemi Hospital, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| | - Thomas Niederkrotenthaler
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Antti Tanskanen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Niuvanniemi Hospital, Kuopio, Finland
| | - Alexis E Cullen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Peter Klimek
- Section for Science of Complex Systems, Medical University of Vienna, Vienna, Austria; Complexity Science Hub Vienna, Vienna, Austria
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Mental Health of Refugee and Non-refugee Migrant Young People in European Secondary Education: The Role of Family Separation, Daily Material Stress and Perceived Discrimination in Resettlement. J Youth Adolesc 2021; 51:848-870. [PMID: 34686949 DOI: 10.1007/s10964-021-01515-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
While scholarly literature indicates that both refugee and non-refugee migrant young people display increased levels of psychosocial vulnerability, studies comparing the mental health of the two groups remain scarce. This study aims to further the existing evidence by examining refugee and non-refugee migrants' mental health, in relation to their migration history and resettlement conditions. The mental health of 883 refugee and 483 non-refugee migrants (mean age 15.41, range 11-24, 45.9% girls, average length of stay in the host country 3.75 years) in five European countries was studied in their relation to family separation, daily material stress and perceived discrimination in resettlement. All participants reported high levels of post-traumatic stress symptoms. Family separation predicted post-trauma and internalizing behavioral difficulties only in refugees. Daily material stress related to lower levels of overall well-being in all participants, and higher levels of internalizing and externalizing behavioral difficulties in refugees. Perceived discrimination was associated with increased levels of mental health problems for refugees and non-refugee migrants. The relationship between perceived discrimination and post-traumatic stress symptoms in non-refugee migrants, together with the high levels of post-traumatic stress symptoms in this subsample, raises important questions on the nature of trauma exposure in non-refugee migrants, as well as the ways in which experiences of discrimination may interact with other traumatic stressors in predicting mental health.
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Frederiksen NW, Christoffersen NM, Haugaard AK, Ahmadi A, Poulsen A, Norredam M, Kruse A. Health screening among children newly granted asylum in Denmark. Acta Paediatr 2021; 110:2389-2395. [PMID: 33866596 DOI: 10.1111/apa.15879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 03/14/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
AIM To describe the findings and recommendations of the general health assessment (GHA) of newly resettled refugee children in Denmark. METHODS This cross-sectional study included children (aged <18 years) undergoing GHA from 2017 to 2019 at a university hospital Section of Immigrant Medicine. GHA was offered to all refugees newly resettled in the Municipality of Copenhagen. It comprised of a structured questionnaire, clinical examination, blood test and recommendations. RESULTS In the study period, 107 children were eligible, 100 children had a GHA performed and of whom all were included in the study. Trauma was reported in 61% (n = 61/100) of children. The median duration of the asylum-seeking process was 18 months (IQR: 8-24), and the highest number of relocations was nine. Latent tuberculosis (n = 2/100 [2%]) was the only infectious disease diagnosed. Specific recommendations for follow-up were frequent and included referral to specialist departments (n = 26/100 [26%]), suggestions for family doctor (n = 96/100 [96%]) and for municipality (n = 62/100 [62%]). CONCLUSION Self-reported trauma was frequent among 100 newly resettled refugee children. For most children, the asylum process was protracted and included several relocations. Specific follow-up recommendations were given to the vast majority. GHA may contribute to improving health, which could possibly support integration for the child and family.
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Affiliation(s)
- Nicoline Willum Frederiksen
- Department of Infectious Diseases Immigrant Health Clinic Copenhagen University Hospital Hvidovre Denmark
- Department of Paediatrics and Adolescence Copenhagen University Hospital Hvidovre Denmark
| | - Nanna Marie Christoffersen
- Global Health Unit Department of Paediatrics and Adolescence Health Copenhagen University Hospital ‐ Rigshospitalet Copenhagen Denmark
| | - Anna Karen Haugaard
- Global Health Unit Department of Paediatrics and Adolescence Health Copenhagen University Hospital ‐ Rigshospitalet Copenhagen Denmark
| | - Afsaneh Ahmadi
- Department of Infectious Diseases Immigrant Health Clinic Copenhagen University Hospital Hvidovre Denmark
| | - Anja Poulsen
- Global Health Unit Department of Paediatrics and Adolescence Health Copenhagen University Hospital ‐ Rigshospitalet Copenhagen Denmark
| | - Marie Norredam
- Department of Infectious Diseases Immigrant Health Clinic Copenhagen University Hospital Hvidovre Denmark
- Danish Research Centre for Migration Ethnicity and Health University of Copenhagen Copenhagen Denmark
| | - Alexandra Kruse
- Department of Infectious Diseases Immigrant Health Clinic Copenhagen University Hospital Hvidovre Denmark
- Department of Paediatrics and Adolescence Copenhagen University Hospital Hvidovre Denmark
- Global Health Unit Department of Paediatrics and Adolescence Health Copenhagen University Hospital ‐ Rigshospitalet Copenhagen Denmark
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Nehring I, Sattel H, Al-Hallak M, Sack M, Henningsen P, Mall V, Aberl S. The Child Behavior Checklist as a Screening Instrument for PTSD in Refugee Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:521. [PMID: 34207254 PMCID: PMC8235248 DOI: 10.3390/children8060521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/30/2022]
Abstract
Thousands of refugees who have entered Europe experienced threatening conditions, potentially leading to post traumatic stress disorder (PTSD), which has to be detected and treated early to avoid chronic manifestation, especially in children. We aimed to evaluate and test suitable screening tools to detect PTSD in children. Syrian refugee children aged 4-14 years were examined using the PTSD-semi-structured interview, the Kinder-DIPS, and the Child Behavior Checklist (CBCL). The latter was evaluated as a potential screening tool for PTSD using (i) the CBCL-PTSD subscale and (ii) an alternative subscale consisting of a psychometrically guided selection of items with an appropriate correlation to PTSD and a sufficient prevalence (presence in more than 20% of the cases with PTSD). For both tools we calculated sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Depending on the sum score of the items, the 20-item CBCL-PTSD subscale as used in previous studies yielded a maximal sensitivity of 85% and specificity of 76%. The psychometrically guided item selection resulted in a sensitivity of 85% and a specificity of 83%. The areas under the ROC curves were the same for both tools (0.9). Both subscales may be suitable as screening instrument for PTSD in refugee children, as they reveal a high sensitivity and specificity.
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Affiliation(s)
- Ina Nehring
- Department of Social Pediatrics, Technische Universität München, D-81377 Munich, Germany; (M.A.-H.); (V.M.)
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, D-81377 Munich, Germany; (H.S.); (M.S.); (P.H.); (S.A.)
| | - Maesa Al-Hallak
- Department of Social Pediatrics, Technische Universität München, D-81377 Munich, Germany; (M.A.-H.); (V.M.)
| | - Martin Sack
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, D-81377 Munich, Germany; (H.S.); (M.S.); (P.H.); (S.A.)
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, D-81377 Munich, Germany; (H.S.); (M.S.); (P.H.); (S.A.)
| | - Volker Mall
- Department of Social Pediatrics, Technische Universität München, D-81377 Munich, Germany; (M.A.-H.); (V.M.)
| | - Sigrid Aberl
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, D-81377 Munich, Germany; (H.S.); (M.S.); (P.H.); (S.A.)
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Hahnefeld A, Sukale T, Weigand E, Münch K, Aberl S, Eckler LV, Schmidt D, Friedmann A, Plener PL, Fegert JM, Mall V. Survival states as indicators of learning performance and biological stress in refugee children: a cross-sectional study with a comparison group. BMC Psychiatry 2021; 21:228. [PMID: 33941110 PMCID: PMC8091678 DOI: 10.1186/s12888-021-03233-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/22/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Our goal was to accurately detect young children at risk for long-term psychiatric disturbances after potentially traumatic experiences in the course of relocation. In addition to detailed assessment of parent-rated parent and child symptomatology, we focused on disruptive behaviors in the education environment summarized as survival states, as these frequently lead to clinical referral. METHODS We screened 52 refugee children aged 3-7 (M = 5.14 years, SD = 1.17) for symptoms of Posttraumatic Stress Disorder (PTSD) with the Child and Adolescent Trauma Screening (CATS) in parent rating. The parents' mental health was assessed using the Refugee Health Screener (RHS-15). Furthermore, the child's educators were asked to evaluate the pathological survival states of the child and we made a general assessment of the children's symptoms with the Strengths and Difficulties Questionnaire (SDQ) rated by parents and educators. Children in the refugee sample completed a working memory learning task (Subtest Atlantis from the Kaufmann Assessment Battery for Children, KABC-II) and delivered saliva samples for testing of the cortisol level. RESULTS The parental rating of their child's PTSD symptoms was significantly related to their own mental well-being (r = .50, p < .001). Children with survival states in educator ratings exhibited weaker learning performance (F = 3.49, p < .05) and higher evening cortisol levels (U = 113, z = - 1.7, p < .05, one-tailed). CONCLUSIONS Survival states are promising indicators for children's learning performance and distress level complementary to parent rating of child PTSD, which is highly intercorrelated with the parents' own symptom load. TRIAL REGISTRATION Trial registration number: DRKS00021150 on DRKS Date of registration: 04.08.2020 retrospectively registered.
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Affiliation(s)
- Andrea Hahnefeld
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany. .,kbo Kinderzentrum, Heiglhofstr. 65, 81377, Munich, Germany.
| | - Thorsten Sukale
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Elena Weigand
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Katharina Münch
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany ,kbo Kinderzentrum, Heiglhofstr. 65, 81377 Munich, Germany
| | - Sigrid Aberl
- Munich Municipal Hospital Group, Department of Child and Adolescent Psychosomatic Medicine, Kölner Platz 1, 80804 Munich, Germany
| | - Lea V. Eckler
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany
| | - Davin Schmidt
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany
| | - Anna Friedmann
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany ,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18-20, 1090 Wien, Austria
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Volker Mall
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany ,kbo Kinderzentrum, Heiglhofstr. 65, 81377 Munich, Germany
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Müller LRF, Gossmann K, Schmid RF, Rosner R, Unterhitzenberger J. A pilot study on ecological momentary assessment in asylum-seeking children and adolescents resettled to Germany: Investigating compliance, post-migration factors, and the relation between daily mood, sleep patterns, and mental health. PLoS One 2021; 16:e0246069. [PMID: 33524043 PMCID: PMC7850498 DOI: 10.1371/journal.pone.0246069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background Asylum-seeking children and adolescents (ASCs) resettled to western countries show elevated levels of psychological distress. While research on the mental health of ASCs is increasing, less is known about their day-to-day living experiences such as their daily mood, sleep patterns, and post-migration factors. Moreover, no examination in situ, using smartphone-assisted ecological momentary assessment (EMA), has been conducted up to now among ASCs. Furthermore, we do not know if screening measures succeed in reflecting the daily mood of ASCs experienced in everyday life. Methods We undertook a smartphone-assisted EMA study over a two-week period with 3 measurements a day. Participants were N = 40 ASCs from 10 different countries who had resettled to Germany. They completed standardized questionnaires screening for history of trauma and clinical symptoms (post-traumatic stress symptoms, depression, and anxiety) that were carried out in interview-like settings, and they participated in the subsequent EMA where they rated mood, sleep parameters, and post-migration factors on a daily basis. Multilevel models of clinical symptoms, daily mood, and sleep parameters were computed based on a total of 680 measurements. Results The multiply traumatized and highly distressed participants reported different levels of discrimination, and various social activities and contacts in the EMA. The overall compliance rate was shown to be 40.5%. Higher PTSS and anxiety scores were associated with lower levels of daily mood and poorer outcomes of some sleep parameters. Depression scores were not associated with any of the variables assessed in the EMA. Conclusions Smartphone-assisted EMA among ASCs resettled to Germany proved to be implementable despite a rather low compliance rate. Not only do ASCs show high symptom levels, they are also affected by these symptoms in their daily lives. The results emphasize the need for concise screenings and psychological treatment for this high-risk population. Limitations include the convenient nature of the sample and the lack of a comparison group.
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Affiliation(s)
| | - Katharina Gossmann
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Regina F. Schmid
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
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Durbeej N, McDiarmid S, Sarkadi A, Feldman I, Punamäki RL, Kankaanpää R, Andersen A, Hilden PK, Verelst A, Derluyn I, Osman F. Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial): study protocol for a cluster randomized controlled trial. Trials 2021; 22:98. [PMID: 33509268 PMCID: PMC7841907 DOI: 10.1186/s13063-020-04995-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools. METHODS This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI). DISCUSSION This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools. TRIAL REGISTRATION ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.
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Affiliation(s)
- Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Serena McDiarmid
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Inna Feldman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
| | - Raija-Leena Punamäki
- Faculty of Social Sciences, Psychology, FI- 30014, University of Tampere, Tampere, Finland
| | - Reeta Kankaanpää
- Faculty of Social Sciences, Psychology, FI- 30014, University of Tampere, Tampere, Finland
| | - Arnfinn Andersen
- Norwegian Centre for Violence and Traumatic Stress Studies, NO-0409 Oslo, Norway
| | - Per Kristian Hilden
- Norwegian Centre for Violence and Traumatic Stress Studies, NO-0409 Oslo, Norway
| | - An Verelst
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Ilse Derluyn
- Faculty of Psychology and Educational Sciences, Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Fatumo Osman
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, BMC, Husargatan 3, 753 27 Uppsala, Sweden
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
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Eiset AH, Loua AS, Kruse A, Norredam M. The health status of newly arrived asylum-seeking minors in Denmark: a nationwide register-based study. Int J Public Health 2020; 65:1763-1772. [PMID: 33084920 DOI: 10.1007/s00038-020-01501-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Asylum-seeking minors are known to be at increased risk of physical and mental diseases compared to both native children and adult asylum seekers. We present a nationwide register-based study based on the health assessment of 7210 newly arrived minors in Danish asylum centres from 1 January 2011 to 31 December 2015. METHODS We describe socio-demographic characteristics, trauma history and symptoms of physical and mental health. To associate the reporting of traumatic events and signs of anxiety or depression, we performed logistic regression analysis. RESULTS We found a high, albeit varying, prevalence of traumatic experiences, sleeping and eating problems, and head- and toothache. In the subgroup that was assessed for need of urgent support, more than two of every five minor scored above the threshold. In the subgroup examined by a doctor, one of every four had at least one abnormal finding. CONCLUSIONS The prevalence of trauma and mental health symptoms and the association of the two were striking. Our findings underline that timely recognition and appropriate treatment of childhood traumas should be given high priority in the receiving communities.
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Affiliation(s)
- Andreas Halgreen Eiset
- Centre for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Arendse Sander Loua
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Alexandra Kruse
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Paediatrics, Copenhagen University Hospital, Hvidovre, Denmark
| | - Marie Norredam
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Asylum-Seeking Children with Medical Complexity and Rare Diseases in a Tertiary Hospital in Switzerland. J Immigr Minor Health 2020; 23:669-679. [PMID: 33083944 PMCID: PMC8233290 DOI: 10.1007/s10903-020-01100-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 02/06/2023]
Abstract
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.
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Abstract
Armed conflicts continue to occur in some regions of the globe, mostly in developing countries. These man-made disasters affect all segments of the population; however, some groups are more vulnerable and suffer more seriously from the unfavorable consequences of such conflicts. Among these, the pediatric population deserves special attention because they cannot protect themselves, and hence carry a higher threat of injuries and probability of death during conflicts. In addition, children who do survive the disaster are more prone to exploitation. Pediatric victims, including those who sustain acute kidney injury or those suffering from chronic kidney disease before armed conflicts, face higher risks of morbidity and mortality as a result of treatment problems, specifically limited dialysis options. Displaced children, forced to flee their homes as a result of armed conflicts, are also at risk for various health problems because they may not find ideal circumstances for disease treatment. Making preparations in anticipation of armed conflicts, such as disaster-relief scenarios and action plans, may be useful to decrease the death toll in these children, who are dependent on their caregivers for survival. Adopting principles of disaster nephrology may contribute to improved survival chances of pediatric kidney patients in chaotic circumstances.
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Back Nielsen M, Carlsson J, Køster Rimvall M, Petersen JH, Norredam M. Risk of childhood psychiatric disorders in children of refugee parents with post-traumatic stress disorder: a nationwide, register-based, cohort study. LANCET PUBLIC HEALTH 2020; 4:e353-e359. [PMID: 31279418 DOI: 10.1016/s2468-2667(19)30077-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/15/2019] [Accepted: 05/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children of refugees are often exposed to the consequences of parental post-traumatic stress disorder (PTSD), potentially leaving them vulnerable to intergenerational transmission of psychopathology. The present study aimed to determine whether parental PTSD is associated with childhood psychiatric morbidity among children of refugees. METHODS This study is a two-generation nationwide cohort study using the Danish Immigration Services database. We followed up children younger than 18 years with at least one refugee parent until psychiatric contact, end of the study, their 18th birthday, emigration, or death. We excluded children if their parents were diagnosed only with psychiatric diagnoses other than PTSD or if they had received a psychiatric contact before parental PTSD diagnosis. Information on parental PTSD and offspring psychiatric morbidity was obtained from the Danish Psychiatric Central Research Register. We used Cox proportional hazards regression models to assess the risk of psychiatric contacts among children of refugees with PTSD compared with children of refugees with no psychiatric diagnosis. FINDINGS Between Jan 1, 1995, and Dec 31, 2015, 102 010 refugees obtained residency permission in Denmark and 62 239 biological children of refugees were born in Denmark before Dec 31, 2015. 51 793 were eligible and included in the study (median follow-up 7·15 years [IQR 3·37-11·78]); of these, 1307 (2·5%) children had a psychiatric contact. 7486 (14·5%) children of refugees were exposed to parental PTSD. Parental PTSD significantly increased the risk of psychiatric contact in offspring (hazard ratio 1·49 [95% CI 1·17-1·89] for paternal PTSD, p=0·0011; 1·55 [1·20-2·01] for maternal PTSD, p=0·00084) after adjustment for sociodemographic variables. INTERPRETATION Children of refugees exposed to parental PTSD are at increased risk of psychiatric morbidity. Targeted screening and interventions are necessary to prevent psychiatric morbidity and ensure access to adequate care. FUNDING Section for Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital Hvidovre.
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Affiliation(s)
- Maj Back Nielsen
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Køster Rimvall
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Denmark
| | - Jørgen Holm Petersen
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Norredam
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark.
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Frounfelker RL, Miconi D, Farrar J, Brooks MA, Rousseau C, Betancourt TS. Mental Health of Refugee Children and Youth: Epidemiology, Interventions, and Future Directions. Annu Rev Public Health 2020; 41:159-176. [PMID: 31910713 PMCID: PMC9307067 DOI: 10.1146/annurev-publhealth-040119-094230] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The number of refugee youth worldwide receives international attention and is a top priority in both academic and political agendas. This article adopts a critical eye in summarizing current epidemiological knowledge of refugee youth mental health as well as interventions aimed to prevent or reduce mental health problems among children and adolescents in both high- and low-to-middle-income countries. We highlight current challenges and limitations of extant literature and present potential opportunities and recommendations in refugee child psychiatric epidemiology and mental health services research for moving forward. In light of the mounting xenophobic sentiments we are presently witnessing across societies, we argue that, as a first step, all epidemiological and intervention research should advocate for social justice to guarantee the safety of and respect for the basic human rights of all refugee populations during their journey and resettlement. A constructive dialogue between scholars and policy makers is warranted.
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Affiliation(s)
| | - Diana Miconi
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada; , ,
| | - Jordan Farrar
- Research Program on Children and Adversity, School of Social Work, Boston College, Chestnut Hill, Massachusetts 02467, USA; ,
| | | | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montreal, QC H3A 1A1, Canada; , ,
| | - Theresa S Betancourt
- Research Program on Children and Adversity, School of Social Work, Boston College, Chestnut Hill, Massachusetts 02467, USA; ,
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Björkenstam E, Helgesson M, Norredam M, Sijbrandij M, de Montgomery CJ, Mittendorfer-Rutz E. Common mental disorders among young refugees in Sweden: The role of education and duration of residency. J Affect Disord 2020; 266:563-571. [PMID: 32056927 DOI: 10.1016/j.jad.2020.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Christopher Jamil de Montgomery
- Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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36
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Psychological morbidity among forcibly displaced children-a literature review. Ir J Med Sci 2020; 189:991-997. [PMID: 31993955 DOI: 10.1007/s11845-020-02186-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/23/2020] [Indexed: 01/05/2023]
Abstract
In 2018, nearly 75 million people were displaced from their place of origin of which 20.4 million are considered as refugees. Children constitute over half of this population. A review of the currently available literature regarding the psychological impact of forced displacement on children was performed with the concept examined under three stages of flight: pre-migration, intra-migration and post-migration. The resilience of children despite adversities is explored. Post-traumatic stress disorder (PTSD), depression and anxiety are the most commonly studied effects of forced migration on children. Rates range from 20 to 52.7%, 23 to 44.1% and 38.3 to 69% respectively. PTSD is associated with pre-migration disturbances such as witnessing death or torture of relatives, assaults and separation from family. Intra-migration difficulties relate to the hazardous journey, length of detention, type of facility and failed asylum application. Post-migration difficulties highlighted are insecure asylum status, housing worries, multiple relocations and poor acculturation technique and are more related to depression and anxiety. Despite these challenges and the tremendous horror witnessed, the majority of children report good functionality in their host countries in the long-term. The purpose of this report is to provide an overview of the factors contributing to the manifestation of mental health issues in child refugees as well as to examine mechanisms which enhance successful resettling in the host society. Health and social care providers must understand the complex interplay between the damaging effects of displacement, and the innate protective factors that persecuted children possess. Management should involve a holistic approach that considers children, families and native communities.
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Zwi K, Sealy L, Samir N, Hu N, Rostami R, Agrawal R, Cherian S, Coleman J, Francis J, Gunasekera H, Isaacs D, Larcombe P, Levitt D, Mares S, Mutch R, Newman L, Raman S, Young H, Norwood C, Lingam R. Asylum seeking children and adolescents in Australian immigration detention on Nauru: a longitudinal cohort study. BMJ Paediatr Open 2020; 4:e000615. [PMID: 32201744 PMCID: PMC7073805 DOI: 10.1136/bmjpo-2019-000615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Karen Zwi
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia.,Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Louise Sealy
- Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Nora Samir
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
| | - Nan Hu
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
| | - Reza Rostami
- School of Psychiatry, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
| | - Rishi Agrawal
- General Paediatrics, Women's and Children's Hospital Adelaide Division of Paediatric Medicine, North Adelaide, South Australia, Australia
| | - Sarah Cherian
- Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Jacinta Coleman
- Adolescent Medicine, Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Josh Francis
- Paediatric Infectious Diseases, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Hasantha Gunasekera
- School of Paediatrics, The University of Sydney, Sydney, New South Wales, Australia
| | - David Isaacs
- Paediatric Infectious Diseases, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Penny Larcombe
- Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David Levitt
- Department of Paediatrics, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
| | - Raewyn Mutch
- Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Louise Newman
- Child Psychiatry, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia.,Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Helen Young
- Paediatrics, Royal North Shore Hospital School, Saint Leonards, New South Wales, Australia
| | - Christy Norwood
- Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
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Happle C, Dopfer C, Ernst D, Kleinert E, Vakilzadeh A, Hellms S, Evlampidou I, Hillermann N, Schmidt RE, Behrens GMN, Müller F, Wetzke M, Jablonka A. Pediatric Healthcare Utilization in a Large Cohort of Refugee Children Entering Western Europe During the Migrant Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224415. [PMID: 31718046 PMCID: PMC6888204 DOI: 10.3390/ijerph16224415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
: Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants. MATERIALS AND METHODS We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in 2015-2016. RESULTS The mean age of all included refugees was 9 years (60.8% male). The majority came from the eastern Mediterranean region. During a mean camp inhabitance of 34 days, 57.6% needed primary healthcare, with a significant inverse correlation of healthcare seeking frequency with age and duration of camp inhabitance. Infants and unaccompanied minors displayed particular high demands for medical help. DISCUSSION Our analysis showed that pediatric primary healthcare in pediatric and adolescent refugees are most sought during the first period upon arrival with particular demand in infants, toddlers, and unaccompanied minors. Based on this data, future care taking strategies should be adapted accordingly.
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Affiliation(s)
- Christine Happle
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, 30625 Hannover, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, 30625 Hannover, Germany
| | - Diana Ernst
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
| | - Evelyn Kleinert
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | | | - Susanne Hellms
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Nele Hillermann
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | - Reinhold E. Schmidt
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Georg M. N. Behrens
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, 37073 Göttingen, Germany; (E.K.); (N.H.); (F.M.)
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany; (C.H.); (C.D.); (M.W.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
| | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (D.E.); (R.E.S.); (G.M.N.B.)
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-5337; Fax: +49-511-532-5324
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Veronese G, Pepe A, Sala G, Vigliaroni M. Measuring subjective well-being in an understudied population of young Western-African IDPs and refugees. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2019. [DOI: 10.1108/ijmhsc-07-2018-0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to report a real-life empirical case and discuss some caveats emerged in measuring subjective well-being (SWB) in an understudied population of adolescents refugees from West Africa.
Design/methodology/approach
During the process of translation and cultural adaptation of the subjective well-being assessment scale in the target population, the model of measurement presented some weakness with regard to content validity criteria.
Findings
This leads to a partial revision of the model and the development of new locally-based domains of SWB.
Originality/value
Context-specific factors’ robustness showed the dynamic and culture-informed nature of the SWB construct. Practical and theoretical implications of using quantitative questionnaires in non-western contexts characterized by high grades of insecurity and instability will be discussed.
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Kameg BN. Management of mental health conditions in refugee youth: An overview for the psychiatric-mental health nurse practitioner. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:179-186. [PMID: 31523884 DOI: 10.1111/jcap.12253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/07/2019] [Accepted: 09/01/2019] [Indexed: 11/29/2022]
Abstract
TOPIC In 2017, there were a total of 70 million forcibly displaced individuals or refugees, worldwide. Unfortunately, over 50% of refugees are under the age of 18 years. Refugee youth are at-risk for a variety of mental health conditions. PURPOSE The purpose of this report is to provide psychiatric-mental health nurse practitioners (PMHNPs) with an understanding of unique cultural implications in refugee youth, risk factors towards the development of psychiatric illness, and means to identify those at-risk for sequelae or those meeting diagnostic criteria. Also presented are foundational treatment and management implications to ensure the provision of culturally sensitive and efficacious care to this unique population. SOURCES USED Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications pertaining to mental health issues in refugee youth spanning from 2013 to present. Reference lists of identified articles were also searched. CONCLUSIONS A variety of risk and protective factors are discussed, spanning from premigration, during flight, and postsettling periods. PMHNPs must be proficient in screening and diagnosis of mental health conditions in refugee youth and implementation of pharmacological and psychotherapeutic interventions. PMHNPs must also be well versed in community-based resources that can be utilized to promote optimal outcomes.
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Affiliation(s)
- Brayden N Kameg
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Hirani K, Mutch R, Payne D, Cherian S. Complexities of conducting research in adolescent refugees resettling in Australia. J Paediatr Child Health 2019; 55:890-894. [PMID: 31228322 DOI: 10.1111/jpc.14550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/02/2019] [Indexed: 11/28/2022]
Abstract
Adolescent refugees resettling in Australia are a vulnerable and marginalised population. Dedicated research to help better understand their health-care needs remains scarce. There are multiple complexities which may deter health professionals from conducting research with this population. Health-care system barriers, such as lack of adolescent- and refugee-specific health-care services, complicate comprehensive data collection. Limited investigator knowledge pertaining to culturally appropriate research in a population with limited English proficiency or a history of trauma can have an impact on adolescent participation and retention in research studies. Additional ethical and legal issues relating to adolescent consent and confidentiality, which include suicidality and physical or sexual abuse, can arise during research and cause potential harm to adolescents if not managed appropriately. This article highlights current knowledge and understanding relating to these issues along with recommendations to address barriers and safeguard adolescents, with the aim of promoting high-quality research that will benefit resettling adolescent refugees.
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Affiliation(s)
- Kajal Hirani
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Raewyn Mutch
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
| | - Donald Payne
- Headspace, Perth, Western Australia, Australia.,Youth Cancer Services, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sarah Cherian
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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Veronese G, Pepe A, Sala G, Yamien I, Vigliaroni M. Positive experience, psychological functioning, and hope for the future as factors associated with mental health among young Sub-Saharan internally displaced people (IDP): A quantitative pilot study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2019. [DOI: 10.1080/00207411.2019.1635849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Guido Veronese
- Human Sciences, University of Milano-Bicocca, Milan, Italy
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Mitra R, Hodes M. Prevention of psychological distress and promotion of resilience amongst unaccompanied refugee minors in resettlement countries. Child Care Health Dev 2019; 45:198-215. [PMID: 30661259 DOI: 10.1111/cch.12640] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/05/2019] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
AIM As increasing numbers of unaccompanied refugee minors (URMs) are arriving in Europe, there is a need to investigate which factors promote psychological resilience and improve their mental health. This review aims to identify preventive post settlement influences, including living arrangements, access to mental health services, and effective treatments that may improve mental health outcomes. METHODS A systematic literature review was conducted of published papers in any language for children (<18 years) entering a host country, unaccompanied and seeking asylum. Specific studies were eligible if they examined any treatment or nontreatment influences on mental health or psychological resilience for the URM. Thirteen published quantitative studies were identified. RESULTS URMs in more supportive living arrangements including foster care had lower risk of PTSD and lower depressive symptoms compared with those in semi-independent care arrangements. URMs living in reception settings that restricted freedom had more anxiety symptoms. Regarding help seeking, one study found only 30% of URMs had foster parents or guardians who could detect a mental health need. Two papers found the URMs had low levels of contact with mental health services despite the high prevalence of psychiatric symptoms. URMs were less likely than accompanied children to receive trauma-focused interventions, cognitive therapy, or even practical assistance with basic social needs. With regard to treatment evaluation, only case series were identified. Three studies found cognitive behavioural therapy improved PTSD symptoms and mental health outcomes. A less structured approach (mental health counselling alone) did not improve functional health outcomes. CONCLUSION Higher support living arrangements with low restrictions are associated with lower psychological distress. Most URMs are not receiving psychological interventions, and there is a dearth of studies evaluating treatment effectiveness for this group. There is an urgent need for more research to investigate pathways to mental health services and treatment efficacy in this vulnerable group.
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Affiliation(s)
- Ritu Mitra
- CAMHS, CNWL NHS Foundation Trust, London, UK
| | - Matthew Hodes
- CAMHS, CNWL NHS Foundation Trust, London, UK.,Academic Unit of Child and Adolescent Psychiatry, St Mary's Campus, Imperial College, London, UK.,Centre for Psychiatry, Imperial College London, UK
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Addressing Marginality and Exclusion: The Resettlement Experiences of War-Affected Young People in Quebec, Canada. CHILDREN (BASEL, SWITZERLAND) 2019; 6:children6020018. [PMID: 30704146 PMCID: PMC6406435 DOI: 10.3390/children6020018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/25/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022]
Abstract
Accessing meaningful forms of support can be an onerous experience for young people resettling from war-affected contexts. In addition to facing linguistic and financial barriers in this process, these young people negotiate care systems that are often structurally and culturally insensitive to their unique needs, values, beliefs, and intersectional experiences of oppression. Drawing on interviews with 22 young people from war-affected areas living in Quebec, Canada, this paper critically examines how dominant cultural norms and social relations in Quebec's health, social and educational services network shape their experiences in seeking care, healing and belonging. Alternative care systems and approaches, as proposed by the participants, are then explored. The findings emphasize the need for spaces and care services where war-affected young people's identities and lived realities are validated and represented.
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Abstract
Following the civil war in Syria, there has been a growing interest in the impact of war, violent conflict, and refuge on the development and mental health of refugee children in general and Syrian refugee children in particular. The objective of this paper is threefold: (a) to critically review the existing literature on the psychological functioning of Syrian refugee children, with a particular focus on those residing in the urban areas or camps in Turkey; (b) to identify the main theoretical and methodological problems of this emerging literature; and (c) to suggest guidelines for how to improve research and practice in this field. The reviewed literature predominantly focuses on psychological trauma, trauma-related symptomatology or other maladaptive functioning in children, and psychosocial interventions conducted toward alleviating these issues. This paper will summarize the research findings in the above-mentioned topics to discern what can be known from the existing literature on Syrian refugee children.
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Psychiatric screening and interventions for minor refugees in Europe: an overview of approaches and tools. Eur J Pediatr 2018; 177:163-169. [PMID: 29124447 DOI: 10.1007/s00431-017-3027-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Currently hundreds of thousands of minor refugees entered Europe. This group has been exposed to traumatic events pre-, during, and post-migration and is at increased risk of developing psychiatric disorders. In this article, we describe the results of our literature search on screening and interventions for post-traumatic stress disorder (PTSD) in minor refugees, in order to make recommendations for clinical practice. Results show that studies on diagnostic accuracy of assessment instruments and efficacy of mental healthcare interventions in this population are lacking. Traumatic experiences pre-flight, during the flight and at resettlement, superimposed by parental PTSD, and other contextual factors, might lead to more than 25% of minor refugees developing PTSD. CONCLUSION To enhance the number of minor refugees recognized with PTSD, we recommend the use of a brief screening instrument. A public health approach, focusing on environmental supportive factors is the first step in treatment for this group, followed by short-term psychological group interventions focusing on psycho-education and stress reduction. Minor refugees with no improvement in PTSD symptoms by these interventions need referral to specialized mental health care services. Mental health providers should be culturally competent. What is Known: • Post-traumatic stress disorder, anxiety, sleeping problems, and depression are the most common psychiatric disorders in minor refugees. • Evidence based methods on screening and interventions in minor refugees with psychiatric disorders are lacking. What is New: • In the absence of validated screening tools a best practice reliable, quick and child-friendly tool is presented. • A layered system for mental health care and psychosocial support in minor refugees is explained.
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Abstract
PURPOSE OF REVIEW The current article reviews recent literature related to three groups whose health is affected by barriers to the healthcare system: refugee and immigrant populations; youth who are lesbian, gay, bisexual, transgender, queer, or questioning; and those with mental health problems. RECENT FINDINGS Refugee and immigrant populations are increasing worldwide, and recent work has focused on improving their access to mental, dental, and preventive care. Lesbian, gay, bisexual, transgender, queer, or questioning youth have unique healthcare needs but frequently lack a support system and may not be forthcoming about their sexuality or sex identity. A rising number of children are being diagnosed with mental health disorders, but due to multiple factors, youth are not receiving the care they need. SUMMARY Pediatric healthcare providers should be aware of the unique challenges faced by youth displaced from their country of origin, who are lesbian, gay, bisexual, or transgender or are questioning their sexuality or sex identity, and who struggle with mental health disorders. Toolkits, other educational resources, and novel technological advances can assist pediatricians in ensuring optimal health care of these at-risk groups.
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