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Barbo G. Analysis and Evaluation of Intersectionality Theory for the Study of Access to Mental Health Services of Children With Refugee Background. ANS Adv Nurs Sci 2024; 47:263-273. [PMID: 37192600 DOI: 10.1097/ans.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Multiple and complex factors contribute to the health inequities faced by refugee children accessing mental health care. Nurses play a critical role in addressing health inequities through education, practice, policy, and research. Intersectionality theory holds the potential to support nursing research that seeks to critically examine intersecting social identities and power structures that impact health inequities experienced by refugee children with mental health difficulties. Using Fawcett's framework, this article examined intersectionality theory and its applicability to the topic of inquiry. The findings revealed that much work is still required for intersectionality theory to meet the criteria for theory evaluation.
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Affiliation(s)
- Geneveave Barbo
- Author Affiliation: College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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2
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Zheng C, Martin-Herz SP, Abath CB, Scharf RJ. Motor Impairment Referrals to an International Child Development Clinic: It is Not Always Cerebral Palsy. Pediatr Neurol 2024; 155:167-170. [PMID: 38663153 DOI: 10.1016/j.pediatrneurol.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/21/2023] [Accepted: 02/10/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The majority of the estimated 50 to 100 million children living with disability worldwide reside in low- or middle-income countries. As families migrate to avoid humanitarian crises, children with developmental disability and delay warrant particular attention in refugee and international health settings. During transitions, medical documentation may be lost and diagnoses may not be fully understood, contributing to the challenges of determining etiologies of motor impairment. METHODS Of the first 100 refugee children who were referred to the Child Development Clinic, we identified a subset of children referred for motor impairment or cerebral palsy. Data on their presentation, diagnoses following evaluation, and therapeutic services required was collected by retrospective chart review. RESULTS Twenty children were referred for motor impairment and cerebral palsy. Average age was 8.9 years; 45% were female. Eight children were eventually diagnosed with cerebral palsy, and 12 had alternate or inconclusive diagnoses. Microcephaly was more common in children diagnosed with cerebral palsy. CONCLUSIONS The frequent differences between referral and final diagnoses in refugee children referred for cerebral palsy highlights the need for pediatricians' careful examination and diagnostic reasoning upon initial presentation.
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Affiliation(s)
- Christie Zheng
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Susanne P Martin-Herz
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | | | - Rebecca J Scharf
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia.
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Parviainen H, Kiviruusu O, Lämsä R, Skogberg N, Castaneda AE, Santalahti P. Psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived asylum-seeking children in Finland. Child Psychiatry Hum Dev 2023; 54:1699-1709. [PMID: 35587841 PMCID: PMC10582122 DOI: 10.1007/s10578-022-01371-2] [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] [Received: 07/11/2021] [Revised: 03/11/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
This study examined psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived accompanied asylum-seeking children in the age groups of 2-6 years (n = 93) and 7-12 years (n = 91). Children and parents were assessed using mental health and trauma measures (SDQ, HSCL-25 and PROTECT). The prevalence of total difficulties was 34.9% among 2-6-year-olds and 29.6% among 7-12-year-olds. The most common symptoms in both age groups were peer problems, followed by conduct problems among 2-6-year-olds and emotional symptoms among 7-12-year-olds. In both age groups, the children's emotional symptoms were associated with the parents' anxiety and depression as well as the trauma symptoms, while the conduct problems were only associated with the parents' trauma symptoms. In conclusion, peer problems as well as conduct problems and emotional symptoms are common among recently arrived asylum-seeking children. To support the mental health of these children, both children and parents need adequate support.
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Affiliation(s)
- Heidi Parviainen
- Department of Public Health, University of Turku, FI-20014, Turku, Finland.
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Olli Kiviruusu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Riikka Lämsä
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Natalia Skogberg
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anu E Castaneda
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Päivi Santalahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Child Psychiatry, University of Turku, Turku, Finland
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Al-Janaideh R, Speidel R, Colasante T, Malti T. Evaluating a Social-Emotional Training Program for Refugee Families and Service Providers: Pilot Study. JMIR Form Res 2023; 7:e42606. [PMID: 37145855 PMCID: PMC10199395 DOI: 10.2196/42606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/07/2023] [Accepted: 02/26/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Refugee children are often exposed to adversities that present a threat to their healthy development. Promoting refugee children's social-emotional capacities may be an opportune, strengths-based avenue to nurture their resilience, coping strategies, and mental health outcomes amid these risks. Furthermore, supporting caregivers' and service providers' capacities to provide strengths-based care may result in more sustainable, caring environments for refugee children. However, culturally adapted initiatives that aim to promote social-emotional capacities and mental health in refugee children, caregivers, and service providers are limited. OBJECTIVE In this pilot study, we aimed to assess the feasibility and efficacy of a brief, 3-week social-emotional training program for refugee caregivers of children aged between 2 and 12 years and service providers who support refugees. This study had 3 central objectives. First, we examined whether refugee caregivers' and service providers' knowledge of core social-emotional concepts increased from pre- to posttraining, whether these increases were maintained 2 months later, and whether caregivers and service providers reported a high use of training-based strategies after the training. Second, we assessed if refugee caregivers reported any improvements in their children's social-emotional capacities and mental health from pre- to posttraining and 2 months later. Finally, we evaluated whether caregivers and service providers experienced any improvements in their own mental health symptoms from pre- to posttraining and 2 months later. METHODS A total of 50 Middle Eastern refugee caregivers of children (n=26) aged between 2 and 12 years and service providers (n=24) were recruited using convenience sampling and participated in a 3-week training program. Training sessions were delivered via a web-based learning management system and involved a combination of asynchronous (video-based) and synchronous (web-based live group) sessions. The training was evaluated using an uncontrolled pre-, post-, and 2-month follow-up design. Caregivers and service providers reported their understanding of social-emotional concepts and mental health at pre-, post-, and 2 months after training and reported their use of training strategies after training. Caregivers reported their children's social-emotional capacities and mental health through a presurvey, a series of postsurveys (after each module session and 1 week after the training), and a 2-month follow-up survey. The participants also reported their demographic information. RESULTS Caregivers' and service providers' knowledge of social-emotional concepts increased significantly from pre- to posttraining, and the service providers' knowledge increase was sustained at the 2-month follow-up. Both caregivers and service providers reported high levels of strategy use. Furthermore, 2 markers of children's social-emotional development (ie, emotion regulation and sadness over wrongdoing) improved after training. CONCLUSIONS The findings highlight the potential of strengths-based, culturally adapted social-emotional initiatives to support refugee caregivers' and service providers' abilities to provide high-quality social-emotional care to refugee children.
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Affiliation(s)
- Redab Al-Janaideh
- Research and Assessment, Centre for Leadership and Learning, York Region District School Board, York Region, ON, Canada
| | - Ruth Speidel
- Centre for Child Development, Mental Health and Policy, Department of Psychology, University of Toronto, Mississauga, ON, Canada
| | | | - Tina Malti
- Faculty of Education, Leipzig University, Leipzig, Germany
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Hoffman SJ, Vukovich MM, Fulkerson J, Gewirtz A, Robertson CL, Fredkove WM, Gaugler J. The Impact of Parent Torture and Family Functioning on Youth Adjustment in War-Affected Families: A Path Analysis Describing Intergenerational Trauma and the Family System. JOURNAL OF FAMILY NURSING 2023:10748407231164747. [PMID: 37029558 DOI: 10.1177/10748407231164747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The direct exposure to physical or psychological trauma from torture or war leads to well-documented individual health consequences. Less understood are the inclusive and intergenerational effects of war trauma on family systems and youth adjustment. The purpose was to examine mechanisms in war-affected families that explained the significant emotional and behavioral consequences of intergenerational trauma in youth through the use of multiple methods. Quantitative assessments of maternal and paternal caregivers and youth characterized associations between parent torture, parent mental health distress, parent physical health problems, family functioning, and youth adjustment. Narrative statements further contextualized processes through which the trauma of a parent impacted youth and family systems. The research was conducted in partnership with local, refugee-serving community-based organizations. The study sample included parents and youth in 96 Karen families, originating from Burma in Southeast Asia, who had been resettled to the United States through the U.S. Refugee Admissions Program. Path analysis results indicated that parent torture (β = -0.173) had statistically significant negative direct effects on youth adjustment. Parent torture had a negative indirect effect on youth adjustment through the mental health (β = -0.345) and physical health problems of parents (β = -0.305), and youth gender (β = 0.126) and trauma exposure of youth (β = -0.048). Family functioning type demonstrated a positive direct effect on youth adjustment (β = 0.449). Family type had an indirect effect on youth adjustment through youth gender (β = 0.142), youth trauma exposure (β = -0.165), parent physical health problems (β = -0.202), and parent mental health (β = 0.509). The current study developed and tested the first model of intergenerational trauma's effects on the adjustment of Karen refugee youth. Results emphasize that individual recovery from torture must be accompanied by adjunct interventions focused on family systems and youth adjustment, to holistically address intergenerational sequala of trauma.
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Kaptan SK, Yilmaz B, Varese F, Andriopoulou P, Husain N. What works? Lessons from a pretrial qualitative study to inform a multi-component intervention for refugees and asylum seekers: Learning Through Play and EMDR Group Traumatic Episode Protocol. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:361-381. [PMID: 35700344 PMCID: PMC10084026 DOI: 10.1002/jcop.22908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
Almost half of the trials failed to recruit their targeted sample size of which 89% could be preventable. Successful implementation of mental health trials in a context of forcibly displaced individuals can be even more challenging. Mental health difficulties have the potential to impact parenting skills, which are linked to poor development in children, while parenting interventions can improve parents' mental health and parenting behaviors. However, the evidence on parenting interventions for refugees is limited. A parenting intervention, Learning Through Play Plus Eye Movement Desensitization and Reprocessing Group Treatment Protocol, has been designed to address parental mental health. This pretrial qualitative study, conducted with refugees, asylum seekers and professionals, aimed to explore their perceptions of the intervention and to identify barriers and recommendations for better engagement, recruitment, and delivery. Three themes were generated from thematic analysis: the content of the intervention, suggestions for improvement and implementation, and understanding the role of the facilitator. These themes provided insights into the issues that might predict the barriers for delivery of the intervention and offered several changes, including destigmatization strategies to improve engagement.
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Affiliation(s)
- Safa Kemal Kaptan
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Betul Yilmaz
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Filippo Varese
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
- Complex Trauma and Resilience Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | | | - Nusrat Husain
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
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Youth-identified Considerations for Programming to Support Newcomers’ Healthy Development: A Group Concept Mapping Study. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09695-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
There is a well-documented need for more responsive promotion and prevention programming for young immigrants and refugees in the context of mental health and healthy development. Incorporating the voice of newcomers in the development of promotion and prevention efforts could assist in producing culturally-relevant materials and improve program outcomes.
Objective
Our goal was to utilize youth voice to identify considerations for developing programming to support newcomer youths’ healthy development.
Methods
We employed mixed methods and analyzed data using concept mapping. A total of 37 newcomers between the ages of 14 and 22 participated in focus groups to share their ideas for creating programming that would focus on relationships and well-being. Relevant responses were collated, cleaned, and generated into unique statements, and then sorted individually by 26 youth into thematically similar categories. We used multidimensional scaling and hierarchal cluster analysis to produce a concept map.
Results
Six concepts, in rank order of importance, emerged as follows: create a space for sharing; discuss relational issues; teach strategies for adjusting to a new country; teach wellness skills; have feel-good activities; and plan for diversity.
Conclusions
Participants’ lived experience and their own attendance in programming at newcomer organizations assisted them in brainstorming what types of activities, topics, and skills would be helpful for other newcomer youth, as well as considerations for facilitators implementing such programming. Promotion and prevention efforts intended for newcomer youth may benefit by incorporating ideas from the concept map.
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Cohodes EM, Kribakaran S, Odriozola P, Bakirci S, McCauley S, Hodges HR, Sisk LM, Zacharek SJ, Gee DG. Migration-related trauma and mental health among migrant children emigrating from Mexico and Central America to the United States: Effects on developmental neurobiology and implications for policy. Dev Psychobiol 2021; 63:e22158. [PMID: 34292596 PMCID: PMC8410670 DOI: 10.1002/dev.22158] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022]
Abstract
Children make up over half of the world's migrants and refugees and face a multitude of traumatic experiences prior to, during, and following migration. Here, we focus on migrant children emigrating from Mexico and Central America to the United States and review trauma related to migration, as well as its implications for the mental health of migrant and refugee children. We then draw upon the early adversity literature to highlight potential behavioral and neurobiological sequalae of migration-related trauma exposure, focusing on attachment, emotion regulation, and fear learning and extinction as transdiagnostic mechanisms underlying the development of internalizing and externalizing symptomatology following early-life adversity. This review underscores the need for interdisciplinary efforts to both mitigate the effects of trauma faced by migrant and refugee youth emigrating from Mexico and Central America and, of primary importance, to prevent child exposure to trauma in the context of migration. Thus, we conclude by outlining policy recommendations aimed at improving the mental health of migrant and refugee youth.
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Affiliation(s)
- Emily M Cohodes
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sahana Kribakaran
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Paola Odriozola
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sarah Bakirci
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sarah McCauley
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - H R Hodges
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Lucinda M Sisk
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sadie J Zacharek
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Dylan G Gee
- Department of Psychology, Yale University, New Haven, Connecticut, USA
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El-Khani A, Cartwright K, Maalouf W, Haar K, Zehra N, Çokamay-Yılmaz G, Calam R. Enhancing Teaching Recovery Techniques (TRT) with Parenting Skills: RCT of TRT + Parenting with Trauma-Affected Syrian Refugees in Lebanon Utilising Remote Training with Implications for Insecure Contexts and COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168652. [PMID: 34444403 PMCID: PMC8394916 DOI: 10.3390/ijerph18168652] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022]
Abstract
Child psychosocial recovery interventions in humanitarian contexts often overlook the significant effect that caregivers can have on improving children’s future trajectory. We enhanced the well-established, evidenced-based child trauma recovery programme Teaching Recovery Techniques (TRT) intervention with parenting sessions, i.e., TRT + Parenting (TRT + P), which aims to improve parent mental health and their ability to support their children’s mental health. We describe the findings of a three-arm randomised controlled trial comparing enhanced TRT + P vs. TRT and waitlist. The primary aim was to test if children in the enhanced arm of the programme show improved child and caregiver mental health. We recruited 119 Syrian refugee children and one of their caregivers in Beqaa Valley in Lebanon. They were randomised to the TRT, TRT + P, or waitlist control group. Data were collected at baseline and 2 weeks and 12 weeks post intervention. Training of facilitators was via remote training from the United Kingdom. Results showed a highly consistent pattern, with children in the enhanced TRT + P group showing the greatest levels of improvement in behavioural and emotional difficulties compared to children in the TRT or waitlist control groups. Caregivers in the TRT + P group also reported significant reductions in depression, anxiety, and stress. Findings indicate that the addition of the evidence-based parenting skills components has the potential to enhance the effects of interventions designed to improve children’s mental health in contexts of trauma, conflict, and displacement. Implications for COVID-19 remote learning are also discussed.
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Affiliation(s)
- Aala El-Khani
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, Division of Operations, United Nations Office on Drugs and Crime (UNODC), Wagramer Strasse 5, A-1400 Vienna, Austria; (W.M.); (K.H.)
- Division of Psychology & Mental Health, University of Manchester, Manchester M13 9WL, UK;
- Correspondence:
| | - Kim Cartwright
- Greater Manchester Mental Health NHS Foundation Trust, Complex Trauma and Resilience Research Unit, Research and Innovation Office, Manchester M13 9WL, UK;
| | - Wadih Maalouf
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, Division of Operations, United Nations Office on Drugs and Crime (UNODC), Wagramer Strasse 5, A-1400 Vienna, Austria; (W.M.); (K.H.)
| | - Karin Haar
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, Division of Operations, United Nations Office on Drugs and Crime (UNODC), Wagramer Strasse 5, A-1400 Vienna, Austria; (W.M.); (K.H.)
| | - Nosheen Zehra
- Global Mental Health and Cultural Psychiatry Research Group, Manchester M13 9PL, UK;
| | | | - Rachel Calam
- Division of Psychology & Mental Health, University of Manchester, Manchester M13 9WL, UK;
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Gredebäck G, Haas S, Hall J, Pollak S, Karakus DC, Lindskog M. Social cognition in refugee children: an experimental cross-sectional study of emotional processing with Syrian families in Turkish communities. ROYAL SOCIETY OPEN SCIENCE 2021; 8:210362. [PMID: 34386252 PMCID: PMC8334827 DOI: 10.1098/rsos.210362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
More than 5.6 million people have fled Syria since 2011, about half of them children. These children grow up with parents that often suffer from war-related mental health problems. In this study, we assess emotional processing abilities of 6-18 year-old children growing up in families that have fled from Syria and reside in Turkish communities (100 families, 394 individuals). We demonstrate that mothers', but not fathers', post-traumatic stress (PTS) impacts children's emotional processing abilities. A 4% reduction of mothers' PTS was equivalent to 1 year of development in children, even when controlling for parents' traumatic experiences. Making a small investment in increased mental health of refugee mothers might have a positive impact on the lives of their children.
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Affiliation(s)
| | - Sara Haas
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Jonathan Hall
- Department of Peace and Conflict Research, Uppsala University, Uppsala, Sweden
| | - Seth Pollak
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Dogukan Cansin Karakus
- Göttingen Graduate School of Social Sciences, University of Göettingen, Göttingen, Germany
| | - Marcus Lindskog
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Stupar D, Stevanovic D, Vostanis P, Atilola O, Moreira P, Dodig-Curkovic K, Franic T, Doric A, Davidovic N, Avicenna M, Multazam IN, Nussbaum L, Thabet AA, Ubalde D, Petrov P, Deljkovic A, Monteiro AL, Ribas A, Jovanovic M, Joana O, Knez R. Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries. Child Adolesc Psychiatry Ment Health 2021; 15:26. [PMID: 34090487 PMCID: PMC8180049 DOI: 10.1186/s13034-021-00378-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 05/27/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). METHODS Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12-18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. RESULTS The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2-8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2-10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. CONCLUSIONS Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.
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Affiliation(s)
- Dusko Stupar
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Dejan Stevanovic
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Panos Vostanis
- School of Psychology, Leicester University, Leicester, UK
| | - Olayinka Atilola
- Department of Behavioural Medicine, Lagos State University College of Medicine Ikeja, Lagos, Nigeria
| | - Paulo Moreira
- Lusíada University, Porto, Portugal
- CIPD, Porto, Portugal
| | | | - Tomislav Franic
- Child and Adolescent Psychiatry, School of Medicine, University of Split, Split, Croatia
| | - Ana Doric
- Department of Psychology, Faculty of Humanities and Social Sciences, Rijeka, Croatia
| | - Nikolina Davidovic
- Child and Adolescent Psychiatry, School of Medicine, University of Split, Split, Croatia
| | - Mohamad Avicenna
- Faculty of Psychology, State Islamic University Syarif Hidayatullah, Jakarta, Indonesia
| | | | - Laura Nussbaum
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Abdul Aziz Thabet
- School of Public Health, Gaza Branch, Al Quds University, Jerusalem, Palestinian Territories, Israel
| | - Dino Ubalde
- Department of Psychology, St. Dominic College of Asia, City of Bacoor, Bacoor, Philippines
| | - Petar Petrov
- Department of Child and Adolescent Psychiatry, University Hospital St. Marina, Varna, Bulgaria
| | | | | | - Adriana Ribas
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Rajna Knez
- Department of Pediatrics, Skaraborgs Hospital Skövde, Skövde, Sweden.
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Unaccompanied minors’ experiences of narrative exposure therapy. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Despite the understanding that unaccompanied minors’ (UAM) experience high rates of post-traumatic stress, the provision of evidence-based trauma-focused therapies is low for this population. Narrative exposure therapy (NET) is an effective short-term intervention for treating post-traumatic stress disorder (PTSD) after multiple traumatic experiences, such as those experienced by UAM. Within the existing literature, there is a lack of research investigating unaccompanied minors’ experiences of NET or any trauma-focused therapy. Participants were four UAM experiencing PTSD who formed part of a pilot delivery of NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted and transcripts were analysed using interpretative phenomenological analysis (IPA). This project identified five themes that encapsulated unaccompanied minors’ experiences of receiving NET, including the process of preparing for this therapy, what it was like to receive it, and the differences they identified at the end of treatment. The significance of this taking place within a safe therapeutic relationship was explored within the context of the attachment losses experienced by UAM, and the impact this has on emotion regulation was considered. The potential of a reduction in PTSD symptoms facilitating a positive spiral in adolescence was reflected on within this paper.
Key learning aims
(1)
To understand the experience of unaccompanied asylum-seeking minors (UAM) receiving narrative exposure therapy (NET) for post-traumatic stress disorder.
(2)
To understand the key concerns and motivators for UAM when considering engaging in NET.
(3)
To understand how these experiences relate to theoretical frameworks and the existing literature relating to emotional difficulties in adolescence.
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Stiles DA, Alaraudanjoki E, Wilkinson LR, Ritchie KL, Brown KA. Researching the Effectiveness of Tree of Life: an Imbeleko Approach to Counseling Refugee Youth. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:123-139. [PMID: 33708288 PMCID: PMC7900289 DOI: 10.1007/s40653-019-00286-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
With the growing worldwide refugee crisis, there is a need for evidence-based interventions that specifically deal with the consequences of cumulative trauma-exposure in refugee youth. Refugee children have unique service needs and differ from their non-refugee peers in terms of sociocultural trauma, language, culture, and educational barriers. This article explains the complexities associated with understanding refugee youth and presents a proposal for studying the possible benefits of Tree of Life therapy. At the present time, Tree of Life therapy has no evidence-base because the published studies of Tree of Life with refugee and/or immigrant youth have sample sizes of one, six, eight, and twenty-nine. As a culturally-grounded, strength-based group counseling approach, Tree of Life therapy addresses traumatic experiences, recognizes participants' cultural differences, highlights individual skills, and aids in instilling both confidence and hope for the future. Ncazelo Ncube, the co-founder and main developer of Tree of Life, describes this therapy as a collective narrative practice that considers cultural beliefs and values (2006, 2010, 2018, 2019). The proposed research design is to study the effectiveness of the Tree of Life in Canada, the United States, the United Kingdom, and South Africa. The research plan is to use pragmatic, group-randomized controlled trials in the "real world" settings of schools and agencies in each of the four countries. In addition, the article describes the development of the Roots and Wings Questionnaire for Children and Youth, a culturally relevant, child-friendly questionnaire. The Tree of Life is a readily available therapy with great potential for helping traumatized refugee youth as well as other trauma-impacted young people worldwide.
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Affiliation(s)
- Deborah A. Stiles
- Applied Educational Psychology and School Psychology, Webster University, 470 Lockwood Ave, St. Louis, MO 63119 USA
| | - Esa Alaraudanjoki
- Applied Educational Psychology and School Psychology, Webster University, 470 Lockwood Ave, St. Louis, MO 63119 USA
| | - Lisa R. Wilkinson
- Applied Educational Psychology and School Psychology, Webster University, 470 Lockwood Ave, St. Louis, MO 63119 USA
| | - Keary L. Ritchie
- Applied Educational Psychology and School Psychology, Webster University, 470 Lockwood Ave, St. Louis, MO 63119 USA
| | - Kelly Ann Brown
- Applied Educational Psychology and School Psychology, Webster University, 470 Lockwood Ave, St. Louis, MO 63119 USA
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Scharpf F, Mkinga G, Masath FB, Hecker T. A socio-ecological analysis of risk, protective and promotive factors for the mental health of Burundian refugee children living in refugee camps. Eur Child Adolesc Psychiatry 2021; 30:1651-1662. [PMID: 32959157 PMCID: PMC8505296 DOI: 10.1007/s00787-020-01649-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/13/2020] [Indexed: 11/30/2022]
Abstract
Children and adolescents' mental health risk and resilience arise from a complex interplay of factors on several socio-ecological levels. However, little is known about the factors that shape the mental health of refugee youth living in refugee camps close to ongoing conflict. We conducted a cross-sectional study with a representative sample of 217 Burundian refugee children aged 7-15 and their mothers residing in refugee camps in Tanzania to investigate associations between risk, protective and promotive factors from various ecological levels (individual, microsystem, exosystem), and children's post-traumatic stress disorder (PTSD) symptoms, internalizing and externalizing problems, and prosocial behavior. Data were collected using structured clinical interviews and analyzed using multiple regression models. Exposure to violence across all contexts and engagement coping were risk factors for PTSD symptoms and internalizing problems, while only violence by mothers seemed to increase children's vulnerability for externalizing problems. A differential impact of violence exposures on prosocial behavior was observed. Higher-quality friendships appeared to protect youth from PTSD symptoms and externalizing problems, while they also promoted children's prosocial behavior, just as mothers' social support networks. Prevention and intervention approaches should integrate risk, protective and promotive factors for refugee youth's mental health across multiple ecological contexts and take into account context-specific and adaptive responses to war and displacement.
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Affiliation(s)
- Florian Scharpf
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501, Bielefeld, Germany.
| | - Getrude Mkinga
- Department of Educational Psychology and Curriculum Studies, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Faustine Bwire Masath
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501 Bielefeld, Germany ,Vivo International, Konstanz, Germany
| | - Tobias Hecker
- Department of Psychology, Bielefeld University, P. O. Box 100131, 33501 Bielefeld, Germany ,Department of Psychology, University of Zurich, Zurich, Switzerland
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15
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A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents. Clin Psychol Rev 2020; 83:101930. [PMID: 33186775 DOI: 10.1016/j.cpr.2020.101930] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 10/13/2020] [Indexed: 12/22/2022]
Abstract
In the past decade, millions of children and adolescents have been forced to flee from protracted or newly erupted violent conflicts. Forcibly displaced children are particularly vulnerable for developing mental health problems. However, a timely and systematic review of the current evidence is lacking. We conducted a systematic review of factors contributing to the mental health of refugee children across different socio-ecological levels (individual, family, community, sociocultural). We systematically searched the databases Medline, PsycINFO, Web of Science, and Cochrane for English studies published in peer-reviewed journals between August 2010 and May 2020. Of the 2413 identified studies, 63 were included in the analyses. Only 24 studies were considered to be of high quality. Pre-migration individual (risk: exposure to war-related trauma, female gender) and post-migration family factors (risk: parental mental health problems and impaired parenting, protective: family cohesion) currently have the best evidence base. Post-migration community (protective: school connectedness, support by peers) and sociocultural factors (risk: discrimination and acculturative stress, protective: integrative acculturation) have gained some support in high-income settings. Prevention and intervention approaches should integrate factors across different socio-ecological levels. More longitudinal studies and research in low- and middle-income countries are needed to advance our knowledge on causal mechanisms behind factors contributing to refugee youth's mental health.
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Eruyar S, Vostanis P. Feasibility of group theraplay with refugee children in Turkey. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Zahid is a 10-year-old boy who moved to the United States 18 months ago with his parents and 3 younger siblings. He and his family are refugees from Syria. Zahid was born in Syria after an uncomplicated pregnancy and delivery. Zahid's parents first became concerned about Zahid's development when he was 9 months old because he had not started cooing or babbling and did not respond to his name. At 3 years, a doctor in Syria expressed concern that Zahid may have autism spectrum disorder; however, his parents did not know what symptoms triggered the concern and believed his behavior was because of his ongoing exposure to trauma.Zahid underwent a full evaluation 1 year ago in the United States and was found to meet the criteria for autism spectrum disorder. Coaching was provided to his parents in obtaining appropriate educational support for their son, and a referral was placed for applied behavior analysis (ABA) to be provided by an organization in the community. After several meetings between the parents and school administration, an Individualized Education Program was initiated. Despite acceptance into a community-based ABA program, Zahid has not begun the intervention because of transportation difficulties. In-home ABA was offered but was refused by the family.The family is under significant stress. Zahid is nonverbal and has displayed behaviors affecting safety, including wandering/eloping and turning on kitchen appliances resulting in a kitchen fire. Zahid's mother completed high school, and his father completed sixth grade. Both parents speak limited English, and neither is employed. The family receives financial support through the government, but this will be ending soon. Zahid's father is concerned that employment outside of the home will further limit his ability to transport Zahid to necessary appointments. Zahid's mother does not drive. Zahid's father requests that the physician provide a letter requesting exemption from requirements to participate in work or training programs because of Zahid's needs. How would you respond to this overwhelmed father?
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Weine S, Brahmbatt Z, Cardeli E, Ellis H. Rapid Review to Inform the Rehabilitation and Reintegration of Child Returnees from the Islamic State. Ann Glob Health 2020; 86:64. [PMID: 32587814 PMCID: PMC7304453 DOI: 10.5334/aogh.2835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background An estimated 49,000 women and children who lived in the Islamic State are being held in the Al-Hol refugee camp in Syria. Several countries have repatriated some of these women and children, though most have thus far refused to do so. Many countries are asking whether it is possible to successfully rehabilitate and reintegrate this group and how the evidence base could inform their approach. Objective The overall objective of this paper is to inform the rehabilitation and reintegration of child returnees from the Islamic State by rapidly reviewing the evidence on children exposed to trauma and adversity. Methods A rapid review was conducted to identify pertinent evidence regarding outcomes, risk and protective factors, and interventions and to build a framework that could guide policies and practices. Prior work in the areas of refugee children, war-impacted children, child criminal gang members, child victims of maltreatment, and child victims of sex trafficking was reviewed. Evidence was collected and analyzed from 31 prior reviews and studies. Findings The Rehabilitation and Reintegration Intervention Framework (RRIF) incorporates five levels (individual, family, educational, community, and societal) and identifies five primary goals: 1) promoting individual mental health and well-being; 2) promoting family support; 3) promoting educational success; 4) promoting community support; and 5) improving structural conditions and protecting public safety. Implementing this framework requires public-private partnership with extensive civil society involvement. Conclusions Rehabilitation and reintegration programs should be based on the evidence of prior work with children exposed to trauma and adversity. RRIF defines a multi-level approach that encompasses promoting individual mental health and well-being, family support, educational success, community support, structural conditions, and public safety. Further multi-disciplinary research is needed to develop evidence in several identified areas concerning child health and developmental problems, family custody, faith and religiosity, and violent extremism assessment and prevention.
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Blackmore R, Gray KM, Boyle JA, Fazel M, Ranasinha S, Fitzgerald G, Misso M, Gibson-Helm M. Systematic Review and Meta-analysis: The Prevalence of Mental Illness in Child and Adolescent Refugees and Asylum Seekers. J Am Acad Child Adolesc Psychiatry 2020; 59:705-714. [PMID: 31778780 DOI: 10.1016/j.jaac.2019.11.011] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/25/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Over half of the world's refugee population are under the age of 18 years. This systematic review aims to summarize the current body of evidence for the prevalence of mental illness in child and adolescent refugee populations. METHOD Eight electronic databases, gray literature, and Google Scholar were searched for articles from 1 January 2003 to 5 February 2018. Strict inclusion criteria regarding the diagnosis of mental illness were imposed. Study quality was assessed using a template according to study design, and study heterogeneity using the I2 statistic. Random effects meta-analyses results were presented given heterogeneity among studies. The protocol for this systematic review was registered with PROSPERO (CRD42016046349). RESULTS Eight studies were eligible, involving 779 child and adolescent refugees and asylum seekers, with studies conducted in 5 countries. The overall prevalence of posttraumatic stress disorder (PTSD) was 22.71% (95% CI 12.79-32.64), depression 13.81% (95% CI 5.96-21.67), and anxiety disorders 15.77% (95% CI 8.04-23.50). Attention-deficit/hyperactivity disorder (ADHD) was 8.6% (1.08-16.12) and oppositional defiant disorder (ODD) was 1.69% (95% CI -0.78 to 4.16). Because of the high heterogeneity, further subgroup analyses were conducted. CONCLUSION Refugee and asylum seeker children have high rates of PTSD, depression, and anxiety. Without the serious commitment by health and resettlement services to provide early support to promote mental health, these findings suggest that a high proportion of refugee children are at risk for educational disadvantage and poor social integration in host communities, potentially affecting their life course.
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Affiliation(s)
- Rebecca Blackmore
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | - Kylie M Gray
- Centre for Developmental Psychiatry & Psychology, School of Clinical Sciences at Monash Health, Monash University, Monash Medical Centre, Clayton, Victoria, Australia; Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Jacqueline A Boyle
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | | | - Sanjeeva Ranasinha
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | - Grace Fitzgerald
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | - Marie Misso
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, Victoria, Australia.
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Crooks CV, Hoover S, Smith ACG. Feasibility trial of the school‐based STRONG intervention to promote resilience among newcomer youth. PSYCHOLOGY IN THE SCHOOLS 2020. [DOI: 10.1002/pits.22366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Claire V. Crooks
- Faculty of Education Centre for School Mental Health, University of Western Ontario London Ontario Canada
| | - Sharon Hoover
- National Center for School Mental Health University of Maryland School of Medicine Baltimore Maryland
| | - Alexandra C. G. Smith
- Faculty of Education Centre for School Mental Health, University of Western Ontario London Ontario Canada
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21
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Tamburrino I, Getanda E, O'Reilly M, Vostanis P. "Everybody's responsibility": Conceptualization of youth mental health in Kenya. J Child Health Care 2020; 24:5-18. [PMID: 30590955 DOI: 10.1177/1367493518814918] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is increasing interest in providing resilience-building interventions in low- and middle-income countries (LMIC), but limited evidence on how young people and their carers process mental health and related supports. The aim of this study was to establish stakeholders' conceptualization of youth mental health in a disadvantaged area of Kenya through focus groups with 7 young people aged 14-17 years and their parents, 9 teachers and 11 practitioners or community leads. The four identified themes related to definitions of both mental well-being and mental health problems; a range of contributing factors related to identity resolution, parenting, poverty and social media; attribution of responsibility at different socio-ecological levels; and required awareness, supports and interventions at these levels. Stakeholders, notably young people, are thus essential in the development and planning of user-led and culturally appropriate interventions in LMIC.
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Affiliation(s)
- Inge Tamburrino
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,Psychology Section, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elijah Getanda
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Michelle O'Reilly
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Panos Vostanis
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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22
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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 DOI: 10.1146/annurev-publhealth-040119-094230] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [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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23
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Said G, King D. Implementing Narrative Exposure Therapy for unaccompanied asylum-seeking minors with post-traumatic stress disorder: A pilot feasibility report. Clin Child Psychol Psychiatry 2020; 25:213-226. [PMID: 31315450 DOI: 10.1177/1359104519864123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are high rates of post-traumatic stress disorder (PTSD) in unaccompanied asylum-seeking minors (UAM) and there is a requirement for feasible, acceptable and evidence-based treatments. Narrative Exposure Therapy (NET) is a short-term treatment for PTSD following multiple traumatic events. This article aims to examine the applicability of NET for UAM in routine clinical practice and to provide preliminary feasibility, acceptability and effectiveness data. The participants were four UAM receiving NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted to understand the acceptability of this approach and standardised measures of PTSD were used to provide preliminary data regarding the effectiveness of NET for these clients. The clients attended NET consistently with few missed appointments. At post-treatment, two clients' symptom scores were below the clinical cut-off for PTSD and all three clients who completed NET met reliable improvement criteria. The clients reported improvements in functional outcomes and mentioned that they would encourage other young people with similar difficulties to engage in NET. This study was limited by the small sample size and naturalistic time limitations in clinicians' contracts. This article highlights that it is possible to implement NET within routine clinical practice and observed improvements in PTSD symptoms and functional outcomes for UAM.
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Affiliation(s)
- Glorianne Said
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Dorothy King
- Berkshire Traumatic Stress Service, Berkshire Healthcare NHS Foundation Trust, UK
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24
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Eruyar S, Maltby J, Vostanis P. How do Syrian refugee children in Turkey perceive relational factors in the context of their mental health? Clin Child Psychol Psychiatry 2020; 25:260-272. [PMID: 31648532 DOI: 10.1177/1359104519882758] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although there has been increasing attention on the impact of risk and resilience factors on refugee children's mental health, there has been limited evidence on the role of parental factors to inform interventions, and this predominantly relies on adult reports. The aim was to investigate the relationship between perceived parenting styles and attachment relationships and child mental health, as reported by 322 Syrian refugee minors aged between 8 and 17 years in Turkey. Child-rated scales included the Children Revised Impact of Event Scale-8 (CRIES-8), Strengths and Difficulties Questionnaire (SDQ), Security Scale and Egna Minnen Betraffande Uppfostran for Children (EMBU-C), and were used as measures of post-traumatic stress disorder (PTSD), general mental health problems, attachment relationships and perceived parenting styles, respectively. Children with secure maternal and paternal attachment perceived their parents as less rejecting, while children with secure paternal attachment also reported their parents as emotionally warmer. Attachment relationships significantly contributed in predicting PTSD after controlling for age and gender, while conduct problems were predicted by lack of emotional warmth, rejection and over-protection by both parents, in addition to insecure attachment relationships. Refugee children's views are essential in establishing their needs and planning interventions. These should address both the impact of trauma and current family relationships.
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Affiliation(s)
- Seyda Eruyar
- Faculty of Social Sciences and Humanities, Necmettin Erbakan University, Turkey
| | - John Maltby
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
| | - Panos Vostanis
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
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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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Hodes M, Vostanis P. Practitioner Review: Mental health problems of refugee children and adolescents and their management. J Child Psychol Psychiatry 2019; 60:716-731. [PMID: 30548855 DOI: 10.1111/jcpp.13002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since 2010, the numbers of refugees have increased and around half are under 18 years of age. It is known that experience of organised violence, displacement and resettlement increases the risk for psychiatric disorders and psychosocial impairment. This review integrates recent research into the risk and protective factors for psychopathology with service and treatment issues. METHODS We draw on and critically evaluate key systematic reviews in the selected areas, innovative robust studies and relevant government reports. RESULTS Many refugee children show resilience and function well, even in the face of substantial adversities. The most robust findings for psychopathology are that PTSD, and posttraumatic and depressive symptoms are found at higher prevalence in those who have been exposed to war experiences. Their severity may decrease over time with resettlement, but PTSD in the most exposed may show higher continuity. More severe psychiatric disorders including psychosis may also occur. Service delivery needs to take into account socioeconomic and cultural influences but, given the high level of unmet need even in high-income countries, stepped care delivery is required. The evaluation of psychological interventions, often delivered in group settings, suggests that they can be effective for many distressed children; however, for the more impaired, a greater range of disorder-specific therapies will be required. CONCLUSIONS Child and adolescent mental health clinicians and service providers need to be aware of the specific needs of this population and systems for service delivery. There are significant knowledge gaps in understanding risk and vulnerability, service delivery and treatment effectiveness.
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Affiliation(s)
- Matthew Hodes
- Centre for Psychiatry, Imperial College London, London, UK
| | - Panos Vostanis
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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27
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Hodes M. New developments in the mental health of refugee children and adolescents. EVIDENCE-BASED MENTAL HEALTH 2019; 22:72-76. [PMID: 30944095 PMCID: PMC10270370 DOI: 10.1136/ebmental-2018-300065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 12/22/2022]
Abstract
The increase in refugees globally since 2010 and the arrival of many into Europe since 2015, around 50% of whom are under 18 years, have been the stimulus to greater investigation and publications regarding their mental health. This clinical review summarises selected themes in the field as described in the published literature since 2016. The themes include refugee statistics, premigration and postmigration experiences, psychopathology focusing on parent-child relationships, unaccompanied refugee minors and associations between resettlement, acculturation and mental health. Some important reviews and studies are discussed that address service and treatment provision. While there has been a recent increase in research in this field, more is needed into the course of psychopathology, protective factors and the promotion of integration into resettlement countries, as well as models of service delivery and treatment effectiveness.
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Affiliation(s)
- Matthew Hodes
- Department of Medicine, Centre for Psychiatry, Imperial College London, London, UK
- Westminster Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
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Abstract
The job of an editor is exciting, fraught with difficulties, friend-making, enemy-making, time-eating, time-saving, but above all, it is exciting. I took over from Jane Barlow in November 2018. First, I would like to thank her for her work. I do not just say this: Jane has made my work easy in many ways. She has steered the journal to become a recognisable presence in our field, with an impact factor, a growing number of downloads and high aspirations of participation in PubMed Central. The job of an editor is also to extend the success of previous editors. The way I see it is that CAMH should continue to grow to become one of the leading sources for clinically relevant knowledge worldwide. I would like you, our readers, to think of CAMH whenever you need clinical advice.
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Affiliation(s)
- Dennis Ougrin
- Department of Child and Adolescent Psychiatry, Kings College London, London, UK
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Working with unaccompanied asylum-seeking young people: cultural considerations and acceptability of a cognitive behavioural group approach. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x18000260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis paper outlines a psychological skills group for unaccompanied asylum-seeking young people with a focus on cultural adaptations in the context of a UK mental health service. Unaccompanied asylum-seeking young people have typically experienced multiple losses, traumatic experiences, significant disruption and psychosocial stressors. These experiences occur during a key developmental period and outside of the context of a supportive family environment. Mental health difficulties are estimated to be present in 41–69% of this population. Prevalence rates are higher than among children seeking asylum with their families or children who are not from refugee or asylum-seeking backgrounds. Cognitive behavioural approaches were considered to be applicable and useful when working with this client group. Group approaches may offer unique benefits for this population through peer support and normalization. The group described was planned around three key themes: physical health needs, emotional wellbeing and resilience-building. A number of adaptations were made to meet the needs of this population which included engagement, considering physical health needs, sleep, language needs, issues related to power, race and status, and thinking about the needs of the group as young people. Attendance ratings, session rating scale outcomes, preliminary effectiveness data and qualitative feedback from young people identified that this is an acceptable approach for these young people. Unaccompanied asylum-seeking young people require a broad package of care; however, making adaptations to routine practice allowed access to evidence-based interventions to support mental health and wellbeing.
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Vostanis P, O'Reilly M, Duncan C, Maltby J, Anderson E. Interprofessional training on resilience-building for children who experience trauma: Stakeholders' views from six low- and middle-income countries. J Interprof Care 2018; 33:143-152. [PMID: 30358453 DOI: 10.1080/13561820.2018.1538106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Children exposed to multiple adversities are at high risk of developing complex mental health and related problems, which are more likely to be met through integrated interprofessional working. Combining the expertise of different practitioners for interprofessional care is especially pertinent in low- and middle-income countries (LMIC) in the absence of specialist resources. The aim of this study was to work with practitioners who deliver care to vulnerable children in six LMIC (Turkey, Pakistan, Indonesia, Kenya, Rwanda, and Brazil) to understand their perspectives on the content of an interprofessional training programme in building resilience for these children. Seventeen participants from different professional backgrounds, who were in contact with vulnerable children were interviewed. A thematic analytic framework was used. Four themes were identified, which were the benefits of a tiered approach to training, challenges and limitations, perceived impact, and recommendations for future training. The findings indicate the importance of co-ordinated policy, service, and training development in an interprofessional context to maximize resources; the need for cultural adaptation of skilled-based training and interventions; and the usefulness of new technologies to enhance accessibility and reduce costs in LMIC.
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Affiliation(s)
- Panos Vostanis
- a School of Neuroscience, Psychology and Behaviour , University of Leicester , Leicester , UK
| | | | - Charlie Duncan
- c Senior Research Fellow , British Association for Counselling and Psychotherapy , Lutterworth , UK
| | - John Maltby
- a School of Neuroscience, Psychology and Behaviour , University of Leicester , Leicester , UK
| | - Elizabeth Anderson
- d Department of Medical and Social Care Education , University of Leicester , Leicester , UK
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