Resilience in Context: A Brief and Culturally Grounded Measure for Syrian Refugee and Jordanian Host-Community Adolescents

Symptoms of depression and anxiety among Ukrainian children displaced to Poland following the outbreak of the Russo-Ukrainian war: Associations with coping strategies and resilience

This study sought to discern the association of resilience, coping, and contextual factors on depression and anxiety among Ukrainian children displaced to Poland following the Russo-Ukrainian war. A cross-sectional analysis was undertaken with 284 Ukrainian children, aged 11-15 years, relocated to Poland in 2022 due to the ongoing conflict. Participants were assessed using validated tools for anxiety, depression, resilience, and coping, alongside a study-specific questionnaire. Notable associations emerged between depression and variables including age (Mage = 12.04, 49% females), emotional coping, relational resilience, and significant loss, accounting for 39% of the variance (p < .001). Anxiety was intricately linked with heightened emotional coping and diminished problem-solving capabilities, accounting for notable variances (state: 32%, trait: 45%, p < .001). Resilience, particularly in relational contexts, and the experience of bereavement stood out as paramount determinants of mental health outcomes. Children's mental health in conflict zones is shaped by a convoluted interplay of individual and environmental factors. This study accentuates the pivotal role of relational resilience, bereavement, and coping mechanisms in modulating depression and anxiety amidst war-related adversities. It underscores the imperative for targeted interventions, fostering positive relationship frameworks, and enhancing adaptive coping mechanisms.

Maternal Trauma and Psychopathology Symptoms Affect Refugee Children's Mental Health But Not Their Emotion Processing

Refugee children's development may be affected by their parents' war-related trauma exposure and psychopathology symptoms across a range of cognitive and affective domains, but the processes involved in this transmission are poorly understood. Here, we investigated the impact of refugee mothers' trauma exposure and mental health on their children's mental health and attention biases to emotional expressions. In our sample of 324 Syrian refugee mother-child dyads living in Jordan (children's Mage=6.32, SD = 1.18; 50% female), mothers reported on their symptoms of anxiety and depression, and on their children's internalising, externalising, and attention problems. A subset of mothers reported their trauma exposure (n = 133) and PTSD symptoms (n = 124). We examined emotion processing in the dyads using a standard dot-probe task measuring their attention allocation to facial expressions of anger and sadness. Maternal trauma and PTSD symptoms were linked to child internalising and attention problems, while maternal anxiety and depression symptoms were associated with child internalising, externalising, and attention problems. Mothers and children were hypervigilant towards expressions of anger, but surprisingly, mother and child biases were not correlated with each other. The attentional biases to emotional faces were also not linked to psychopathology risk in the dyads. Our findings highlight the importance of refugee mothers' trauma exposure and psychopathology on their children's wellbeing. The results also suggest a dissociation between the mechanisms underlying mental health and those involved in attention to emotional faces, and that intergenerational transmission of mental health problems might involve mechanisms other than attentional processes relating to emotional expressions.

Overcoming socioeconomic adversity: Academic resilience in mathematics achievement among children and adolescents in Ireland

Although socioeconomic disadvantage is linked with academic underachievement, many children from low-income backgrounds perform well in school. Which modifiable factors predict this academic resilience? We examine between- and within-person predictors of one important academic metric - mathematics performance - across adolescence in 1715 (796 male, 919 female) youth living in poverty in Ireland, using data from three waves (9, 13, and 17/18 years) of the Growing Up in Ireland study. Using linear mixed models, math performance was worse when adolescents had more socioemotional and behavioural difficulties, more child-parent relationship conflict, parents had lower expectations of the adolescent's educational achievement, and when primary caregivers had less education. Adolescents who had better intellectual self-concept and attended a non-disadvantaged school had greater math performance. This research adds to the growing body of work suggesting academic resilience is dynamic and multisystemic; it provides potential targets at multiple levels to promote such resilience.

The Effect of a Short-Term Mindfulness Program on Motor Skills and on Psychological and Social Behavior in Preschool Children: A Randomized Controlled Trial

We assessed the effect of a one-week mindfulness-based intervention on resilience, social behavior, and motor skills in four to five-year-old children. In this randomized controlled trial, 45 children (22 females; 23 males; M age = 4.5, SD = 0.4 years) from the same preschool were randomly assigned to three groups: (a) a mindfulness group (MG; n = 15) that participated in five 30-min mindfulness sessions; (b) a physical activity group (PAG; n = 15) that engaged in five 45-min physical exercise sessions; and a control group (CG; n = 15) that received no intervention. Training sessions were held on five consecutive days. Prior to (T0) and after the five mindfulness sessions (T1), all participants blindly completed the Movement Assessment Battery for Children-2 (to assess their motor skills), the Strength and Difficulties Questionnaire (to evaluate their behavior), and the Child and Youth Resilience Measure-28 (to measure their resilience). At baseline (T0), there were no significant differences between the groups. The mindfulness group experienced the strongest positive effects after the intervention (T1), with improvements in both motor skills and social behavior, though there was no significant effect on resilience. Our results suggest that a brief mindfulness training intervention is a promising strategy for improving motor skills and social behavior in early childhood settings.

Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises

BACKGROUND

Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health.

OBJECTIVES

To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure).

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour.

MAIN RESULTS

We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults.

AUTHORS' CONCLUSIONS

To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.

Cross-culturally adapting the GHQ-12 for use with refugee populations: Opportunities, dilemmas, and challenges

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.

Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status

There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.

The role of school functioning, physical activity, BMI, sex and age in building resilience among Ukrainian refugee children in Poland

The study aims to examine the relationship between school functioning, physical activity (PA), sex, Body Mass Index (BMI), age, and resilience in Ukrainian children who migrated to Poland due to the war. A cross-sectional study was conducted in 2022, focusing on 248 children aged 10-15 years. The findings suggest that school environment, including enjoyment of school and strong support from teachers, plays a significant role in building resilience in children. PA enhanced the resilience of girls, whereas a higher BMI negatively impacted it. A child-friendly school environment that encourages PA and provides social support could be a promising approach for the mental health of Ukrainian refugee children.

Suicidality Among Syrian Refugee Children in Jordan

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

Resilience of sub-Saharan children and adolescents: A scoping review

The population of sub-Saharan children and adolescents is substantial and growing. Even though most of this population is vulnerable, there is no comprehensive understanding of the social-ecological factors that could be leveraged by mental health practitioners to support their resilience. The present study undertakes a narrative scoping review of empirical research (quantitative, qualitative, and mixed) on the resilience of children and adolescents living in sub-Saharan Africa to determine what enables their resilience and what may be distinctive about African pathways of child and adolescent resilience. Online databases were used to identify full-text, peer-reviewed papers published 2000-2018, from which we selected 59 publications detailing the resilience of children and/or adolescents living in 18 sub-Saharan countries. Studies show that the resilience of sub-Saharan children and adolescents is a complex, social-ecological process supported by relational, personal, structural, cultural, and/or spiritual resilience-enablers, as well as disregard for values or practices that could constrain resilience. The results support two insights that have implications for how mental health practitioners facilitate the resilience of sub-Saharan children and adolescents: (i) relational and personal supports matter more-or-less equally; and (ii) the capacity for positive adjustment is complexly interwoven with African ways-of-being and -doing.

Pathways to resilience and pathways to flourishing: Examining the added-value of multisystem research and intervention in contexts of war and forced displacement

This paper examines the added-value that multisystem approaches bring to research and intervention in contexts of war and forced displacement. I highlight what is useful and truly innovative about systems-level work, aware that providing data-related evidence is only part of the story when connecting research to policy and practice. I discuss four types of added-value: these are conceptual, instrumental, capacity-building, and connectivity impacts that, respectively, aim to change current knowledge, improve implementation, build research skills, and strengthen network connectivity. Specifically, systems-based research can help transform the key frames of humanitarian work, fostering the more integrated and distributive models of professional assistance known as resilience and network humanitarianism. I argue that systems-level approaches on resilience and flourishing in war-affected and refugee populations help to articulate new mindsets, methodologies, partnerships, and ways of working relevant for humanitarian research, policy and practice. I focus attention on interdisciplinary, interventionist, prospective, transgenerational, and network-building initiatives. My specific examples cover the family context of mental health and trauma memory in Afghanistan, as well as program evaluation with Syrian refugees in Jordan, connecting stress biology to human experience, and social networks to psychological empowerment. The paper suggests future directions to support more effective and impactful systems-level work in protracted humanitarian crises.

A Qualitative Study of Risk and Protective Factors for Resilience in Survivors of Sex Trafficking

This study explored risk and protective factors for resilience in survivors of sex trafficking from the survivors' perspectives. In-depth interviews were conducted with 16 participants recruited from survivor-led advocacy agencies and social service agencies that provide trafficking-specific services. Two overarching themes emerged from data analysis: (a) deep connections to self and others facilitate resilience and (b) detrimental "help" threatens survivors' resilience. Our findings suggest that it may be important for service providers to assist survivors build healthy relationships with themselves and others to promote survivors' resilience. Further, our results highlight the importance of offering more inclusive, survivor-centered, and trauma-informed services.

Promoting positive development among refugee adolescents

Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suárez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suárez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.

A systematic review of cross-cultural measures of resilience and its promotive and protective factors

As psychological resilience has been increasingly recognized as contextually constructed, mixed methods studies that map out local ecologies of resilience have become increasingly common. However, the direct adaptation of quantitative tools for cross-cultural use based on qualitative findings has been relatively lacking. The current review aims to provide an overview of existing measures of resilience used cross-culturally and to synthesize the protective and promotive factors and processes (PPFP) of resilience identified within these measures into a single resource. A January 2021 search of PubMed for studies of the development of psychological resilience measures that excluded studies of non-psychological resilience yielded 58 unique measures. These measures contain 54 unique PPFP of resilience, ranging from individual to communal-level characteristics. This review is intended to serve as a complementary tool for adapting standardized measures for stakeholders requiring an assessment tool that is attuned to their context for mental health risk assessment and intervention evaluation.

A Three-Year Longitudinal Study of Risk Factors for Suicidality in North Korean Defectors

BACKGROUND

This longitudinal study examined risk factors for future suicidality among North Korean defectors (NKDs) living in South Korea.

METHODS

The subjects were 300 NKDs registered with a regional adaptation center (the Hana Center) in South Korea. Face-to-face interviews were conducted using the North Korean version of the World Health Organization's Composite International Diagnostic Interview to diagnose mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Subjects were also asked about sociodemographic and clinical factors at baseline. At follow-up after three years, the NKDs (n = 172 respondents) were asked to participate in an online survey, responding to self-questionnaires about suicidality. Logistic regression analyses were used to explore associations between baseline variables and future suicidality among NKDs.

RESULTS

Thirty (17.4%) of the 172 survey respondents reported suicidality at follow-up. The presence of health problems over the past year, any prior suicidality at baseline, a higher score on a trauma-related scale, and a lower score on a resilience scale at baseline were associated with greater odds of suicidality at follow-up after adjusting for age, sex, and educational level. Of all mental disorder categories, major depressive disorder, dysthymia, agoraphobia, and social phobia were also associated with significantly increased odds of suicidality at follow-up after adjusting for age, sex, educational level, and prior suicidality at baseline.

CONCLUSION

Resilience, a previous history of suicidality, and the presence of lifetime depressive disorder and anxiety disorder should be given consideration in mental health support and suicide prevention in NKDs.

The impact of family income and parental factors on children's resilience and mental well-being

Although there is robust evidence on the intergenerational transmission of trauma-related distress, much less is known about the relation of family income and parental resilience on the resilience and mental well-being of traumatized children. We aimed to determine the association between parental resilience and perceived financial stability, and the resilience and depression of their children among Syrian refugees in Jordan. We carried out a survey of 363 parent-child dyads from a refugee clinic in Northern Jordan. Measures of resilience, trauma, symptoms of mental illnesses, and demographics were reported by the mother and child. We evaluated the associations between parental resilience and their children's mental health. Resilience was highest among parents who reported that their income met their financial needs, (65.77 [standard deviation (SD) 15.96]), and lower for those who reported less income or who stated that their income met their needs only fairly well (62.77 [SD 17.56]). Resilience was lowest for those who reported that that income met their needs poorly (48.02 [SD 23.24]). Parent resilience was positively correlated with child resilience (β = 0.076 [95% confidence interval 0.035-0.12], p < 0.001). Depression and resilience of parents were most closely correlated with the depression and resilience scores of their children, among parents who reported the highest financial stability. Income plays a modifying role in the parent-child resilience and depression associations, with this association being least pronounced within those families who were financially less secure. These findings can help develop interventions to target parental transgenerational impacts according to income status.

Mental Health Risk and Protective Factors of Nigerian Male Asylum Seekers Hosted in Southern Italy: a Culturally Sensitive Quantitative Investigation

This study provides a culturally sensitive quantitative investigation aimed at assessing the post-traumatic symptomatology, post-migratory difficulties, and resilience of 36 Nigerian male asylum seekers hosted in the province of Caserta, South Italy. A survey composed by the Harvard Trauma Questionnaire-Revised (HTQ-R), the Post-Migratory Checklist (PLMD), and the Connor-Davidson Resilience Scale (CD-RISC) was administered to participants. Descriptive and correlation analyses were made in order to describe the mental health risk and protective factors and understand the relation between these. A linear regression analysis was used to evaluate the influence of post-migratory difficulties and resilience on PTSD. Stratified bivariate analyses were also computed to detect PTSD group and no-PTSD group differences about post-migration difficulties and resilience levels. Regression analysis showed that PMLD numbers significantly increased the risk of having PTSD. No significant effect emerged for the level of resilience. Statistically significant differences between the PTSD group and non-PTSD group in relation to post-migratory difficulties were also found. No differences in the resilience factors emerged. The results offer a glimpse into a specific ethnic group of asylum seekers and its mental health risks and protective factors, taking into consideration the specificities of their past and current life-story experiences. Clinical implications for professionals working in the field of forced migration will be outlined.

Psychometric properties of Persian version of child and youth resilience measure-revised in children

BACKGROUND

Resilience is both the individuals' capacity to navigate their way to the resources that sustain their well-being in the context of exposure to adversity and their capacity to negotiate for resources to be accessed. Hence, it is crucial for clinical settings and research centers to have access to a valid and reliable scale that can measure different components of resilience. This study aimed to determine the psychometric properties and cultural adaptation of the Persian version of the Child and Youth Resilience Measure-revised (CYRM-R) in Children.

MATERIALS AND METHODS

This cross-sectional study includes the standard procedure of translation of the CYRM-R and Person Most Knowledgeable-Child and Youth Resilience Measure-revised (PMK-CYRM-R), exploration of the goodness-of-fit, and confirmatory factor analysis (CFA) of a sample of 200 parents or caregivers and their children aged 5 to 9 years who were selected by convenient sampling in Tehran, Iran. CYRM-R, PMK-CYRM-R, and The Strengths and Difficulties Questionnaire (SDQ) were completed by participants. Also, internal consistency, face, content, and criterion validity were investigated.

RESULTS

A two-factor structure of CYRM-R for Iranian children was identified by CFA: Personal and Caregiver. Results indicated adequate goodness-of-fit and strong internal consistency (Cronbach's alpha = 0.88). Acceptable face, content, and criterion validity of the CYRM-R were reported by positive correlation to the PMK-CYRM-R. No significant relation was found between CYRM-R and SDQ.

CONCLUSION

Findings of the present study support the robust psychometric properties and cultural adaptation of the CYRM-R in Iranian children.

Improving adolescent mental health and protection in humanitarian settings: longitudinal findings from a multi-arm randomized controlled trial of child-friendly spaces among South Sudanese refugees in Uganda

BACKGROUND

The effects of conflict and displacement on adolescent mental health and protection are profound and can have lasting consequences. We aimed to investigate the effectiveness of two group-based psychosocial interventions on mental health and protection of South Sudanese refugee adolescents.

METHODS

A randomized controlled trial was done in four villages within the Omugo extension of Rhino Camp refugee settlement in the West Nile region of Uganda. Male and female adolescents (aged 9-14 years) were randomly assigned to attend 12 weeks of either a Standard psychosocial intervention delivered in a child-friendly space (CFS) or a more structured sequential delivery of psychosocial sessions guided by a newly developed Toolkit for Child-Friendly Spaces in Humanitarian Settings. The primary outcomes were psychological distress and resilience 12 months after baseline assessment. The trial is registered with ClinicalTrials.gov, NCT03897894.

RESULTS

Between May 28, 2019, and February 20, 2020, 1,280 eligible adolescents were recruited. With 70.2% retention at follow-up, 214 assigned to the Standard, 211 assigned to the Toolkit, and 370 assigned to the waitlist control were included in the intention-to-treat and as-treated analysis. Both the Toolkit and Standard approaches were more effective in reducing psychological distress and perceived protection risks reported by adolescents compared to no intervention. Differential intervention impacts are indicated in subgroup analyses.

CONCLUSIONS

The trial found that both psychosocial interventions when implemented in a CFS are well suited as a first-line mental health and violence prevention intervention for adolescent populations exposed to conflict and forced displacement. Where feasible, CFS should be implemented as a primary response strategy soon after displacement to improve psychological health and reduce the risk environment for adolescents.

Middle eastern refugee children and adolescents mental health: A systematic review

Psychological problems have become a substantial burden on refugee communities, with a considerable impact on refugee children's quality of life and well-being. The available studies reveal growing mental health disorders in refugee children and adolescents, particularly traumas, anxiety, and depression disorders. This review aims to examine empirical evidence relating to the mental health of refugee children and adolescents in the Middle East. Following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic literature review (2010-2020) identified 54 studies about Middle Eastern refugee children and adolescents' mental health. Eighteen studies were excluded based on their lack of relevance to the focus of the review. Of the remaining records, ten reported common mental health disorders, ten reported on Post-traumatic Stress Disorder, three reported the importance of mental health promotion in schools, while the others discussed protective factors. The results highlight a need to understand the mental health support needs of this group, add knowledge to this area of inquiry and provide baseline data regarding Middle Eastern refugee children and adolescents mental health. Differences across research designs were recorded to contextualize the quality of the study results. There is a paucity of studies investigating the causality, prevalence, risk factors, and interventions of non-traumatic-psychiatric disorders as well as the role of teacher in strengthen refugee's mental health. Limited information is available about suicidality and self-harm, protective factors, adversity, adaptation, acculturation, and social demographics in refugee children.

Predictors of Literacy and Attitudes Toward Reading Among Syrian Refugee Children in Jordan

Refugee children often face disruptions to their education before and during displacement. However, little is known about either levels or predictors of refugee children's literacy or about their attitudes toward reading in low- or middle-income countries. To address this, we conducted in-home literacy assessments using the Holistic Assessment of Learning and Development Outcomes with 322 Syrian refugee mother-child dyads who lived in Jordan (child age range 4-8 years, M = 6.32 years, 50% female). Overall, the children had quite low levels of literacy, although they indicated a strong enthusiasm for reading. Child age, maternal education, and maternal ability to read all predicted child literacy, although maternal literacy predicted it only among children enrolled in school. Among those enrolled in school (64.9% of the total sample, 88.7% of those aged ≥ 6), students attending hybrid classes had better literacy than those attending either solely in-person or solely online, although the frequency of school attendance did not predict literacy. A less consistent pattern emerged for predicting children's attitudes toward reading. Our results suggest an urgent need to improve literacy skills among refugee children in Jordan, as well as a need for validated measures of attitudes toward reading for use with Arabic-speaking youth.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13158-022-00334-x.

Development and validation of a Community Resilience Scale for Youth (CRS-Y)

The purpose of this article is to present the development and validation of a Community Resilience Scale for Youth (CRS-Y) among a Portuguese sample of nearly 4000 young people growing up in regions on the border with Spain. The scale was developed for young people to assess their perception of the resilience of regional communities in terms of positive development and purposeful experiences for young people. Resilient communities, under a social ecological approach, are those able to move forward on social change and transformation. This concept is especially remarkable in more challenging contexts such as border regions of mainland Portugal which are characterised by economic, social, educational, and cultural disadvantages while discovering possibilities of resilience through promising local dynamics. A multi-step approach was used to develop this scale of 12-item scale. Items were generated based on an in-depth literature review and research previously conducted with young people in these contexts. The overall sample was randomly divided into two subsamples of 1828 and 1735 young people each. Principal component analysis was performed with one of the subsamples and yielded a three-factor structure, explaining 61.5% of the total variance. Confirmatory factor analysis performed on the second showed good fit indexes. Furthermore, internal consistency of the three proposed components, gauged either by Cronbach’s alpha or McDonald’s omega, indicated good reliability. Given the results, the CRS-Y is a valid and reliable tool showing adequate psychometric properties. This scale will be useful for schools and policy makers at the local level. Indicators such as the promotion of opportunities to participate and be recognised, collective trust and the promotion of shared values and protection are relevant in assessing regional communities’ resilience and informing youth policies.

Validation of the Child and Youth Resilience Measure-28 (CYRM-28) in India

Background:

The Child and Youth Resilience Measure-28 (CYRM-28) is one of the few measures based on a contextually and culturally embedded understanding of resilience. However, its psychometric properties have not been examined in India which is home to the largest proportion of adolescents worldwide. The present study was conducted to address this gap.

Aims:

This study examined the psychometric properties and factor structure of the English and Hindi translated version of the CYRM-28 in the Indian context. Additionally, it investigated the role of select sociodemographic factors on the resilience levels of Indian school-going adolescents.

Method:

Using convenience sampling, data were collected from 1281 adolescents (mean = 15.28 years; SD = 1.08) enrolled in private and government schools in rural and urban parts of Northern India. Three measures were used in this study: CYRM-28, Warwick-Edinburg mental well-being scale (WEMWBS) and PERMA. Descriptive statistics, confirmatory factor analysis, reliability analysis, correlation, and multivariate analysis of variance were conducted to validate the scale and to study the effect of sociodemographic factors on resilience levels of India adolescents.

Results:

A 16-item (English and Hindi) version of the CYRM-28, with a three factor-structure was found to be the most adequate fit for the Indian context. It demonstrated good reliability and convergent validity with the WEMWBS and PERMA. Further, the multivariate results, albeit with a small effect size, showed a significant main effect for place of residence and age, with urban and older adolescents obtaining higher resilience scores than their rural and younger counterparts.

Conclusion:

The present research shows that a shorter 16-item version of the CYRM with a three-factor structure is a reliable and valid tool for use among Indian adolescents. The CYRM is a robust resilience measure being used across varied cultures—its validation in the Indian context widens the scope for resilience research in the Indian adolescent population.

How American college students understand social resilience and navigate towards the future during covid and the movement for racial justice

The COVID-19 pandemic and crisis around racial injustice have generated compounded macro-level stressors for American society that negatively impact mental health and wellbeing. We contribute to understanding the impact of these crises by examining the process of developing social resilience, which we conceptualize as a temporally-embedded process of sense-making through which actors activate a sense of dignity, agency, and hope in the face of challenges to sustain wellbeing based on available resources. We interviewed 80 college students (aged 18-23) living in the American Northeast and Midwest before (September 2019-February 2020) and during (June-July 2020) the pandemic to analyze how they make sense of crises, respond to challenges, and project themselves into the future. We compare "privileged" upper-middle class youth who have families with more resources to buffer themselves against growing uncertainty, with "less privileged" youth from lower-middle and working class families. Efforts to achieve a sense of dignity, agency, and hope amidst widespread uncertainty illuminate opportunities and constraints in the process of building social resilience, which take different temporal forms across the two class groups given their experiences and resources.

The multifaceted nature of the response to adversity in an Italian sample of refugee community leaders

The end of the last decade saw record numbers of refugee arrivals to Italy, straining the existing reception and integration systems. Although significant research attention has focused on the prevalence of posttraumatic stress disorder (PTSD), depression, and suicidal ideation in refugee populations, there are increasing calls to study the interactions between distress, resilience, and positive outcomes of adversity. To fully understand the complexity of the refugee experience, these voices must be heard in dialogue. Studies must be framed within a more nuanced view of refugees, characterizing them not exclusively as victims but also as advocates for their own well-being and the well-being of their communities. This exploratory study performed a thematic analysis of 15 interviews conducted with refugee community leaders in Italy, each a founder or leader of a community association and actively engaged in civil society. In keeping with Papadopoulos' (2007) construct of adversity-activated development, an inductive analysis identified three distinct patterns of positive adversity response: meaning, motivation, and mobilization. A deductive analysis identified the most appropriate theories of resilience to describe the sample, which included resilience as a dynamic positive adaptation and resilience as resistance to change in moral codes and personal value systems. The resulting image of refugee community leaders in Italy is that of individuals who are exposed to adversity and experiences of suffering and distress but safeguard their core values while positively adapting to a new country.

Measuring Mental Wellness of Adolescents: A Systematic Review of Instruments

Objective

Mental health is critical to the healthy development of adolescents. However, mental health encompasses more than the absence of mental illness; and should include indicators of mental wellness. A critical review of available mental wellness instruments for adolescents were conducted to identify operational definitions of mental wellness concepts for this population group.

Method

A systematic review of literature published between 2000 and 2020 was done to identify mental wellness instruments for adolescent populations. The review followed the PRISMA operational steps.

Results

We identified 2,543 articles from the search strategy and screened titles and abstracts for eligibility. After appraisal, 97 studies were included in the qualitative synthesis; of which, 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose.

Conclusion

The review reflected previous research identifying a lack of consensus around the definitions of mental health, mental wellness, and mental wellbeing. This has implications for developing instruments for adolescents that adequately measure these constructs. Most of the instruments identified in the review were predominantly English and from developed countries. This indicates a need for instrument that are explicitly conceptualised and operationalised for adolescents in all their varied contexts.

War-related trauma linked to increased sustained attention to threat in children

Experiences of war and displacement can have profound effects on children's affective development and mental health, although the mechanism(s) underlying these effects remain unknown. This study investigated the link between early adversity and attention to affective stimuli using a free-viewing eye-tracking paradigm with Syrian refugee (n = 31, M_age  = 9.55, 12 female) and Jordanian non-refugee (n = 55, M_age  = 9.98, 30 female) children living in Jordan (March 2020). Questionnaires assessed PTSD, anxiety/depression, insecurity, distress, and trauma. Refugee children showed greater initial avoidance of angry and happy faces compared to non-refugee children, and higher trauma exposure was linked to increased sustained attention to angry stimuli. These findings suggest that war-related trauma may have differential effects on the early and later stages of affective processing in refugee children.

Promotive factors associated with internalising symptoms amongst college students during the COVID-19 lockdown in Enugu metropolis, Nigeria

Background

The outbreak of the coronavirus disease 2019 (COVID-19) pandemic has caused a high burden of psychological distress amongst adolescents.

Aim

This study aimed to evaluate associations of personal strengths including resilience and social support with internalising symptoms amongst college students during the lockdown in the wake of the COVID-19 pandemic.

Setting

The study population included students from senior and junior college classes in public schools in Enugu metropolis, Nigeria.

Method

A school-based cross-sectional study design was employed for the study. A two-stage sampling technique was used to select 496 students (mean age = 16.5, s.d. = 1.9 years; 52.2% female) in six out of 33 public colleges in Enugu metropolis, Nigeria during the lockdown period occasioned by the COVID-19 pandemic. Validated questionnaires assessing anxiety, depression, resilience and social support were used to collect information.

Results

Most of the students reported depressive symptoms, whilst just over a third of the sample reported anxiety or both depressive and anxiety symptoms. Chi-square and logistic regression analyses revealed that being male and reporting higher levels of social support and the ability to bounce back from stress were associated with less anxiety. Being younger and reporting a moderate level of support were associated with more depressive symptoms, whilst the ability to bounce back was associated with fewer depressive symptoms.

Conclusions

Good social support and the ability to bounce back from stress were linked to lower levels of anxiety and depressive symptoms amongst college adolescents during the lockdown in the wake of the COVID-19 pandemic despite high prevalence rates.

Validity and reliability of resiliency measures trialled for the evaluation of a preventative Resilience-promoting social-emotional curriculum for remote Aboriginal school students

Purpose

We aimed to test the reliability and validity of two brief measures of resilience adopted for the evaluation of a preventative social-emotional curriculum implemented for Aboriginal middle school students from socially disadvantaged remote communities in Australia’s Northern Territory. The questionnaires chosen were intended to measure psychological resilience and socio-cultural resilience as complementary dimensions of the capacity to cope in circumstances of significant life stress and risk of self-harm.

Methods

Confirmatory factor analysis (CFA) was conducted to assess construct validity of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), a measure of psychological resilience, and the 12-item Child and Youth Resilience Measure (CYRM-12), a measure of socio-cultural resilience, with a sample of 520 students. Associations between resilience and psychological distress and emotional and behavioural difficulty were analysed in relation to life stressors to assess criterion validity of the scales.

Results

CFA provided support for the validity of the respective constructs. There was good fit for both scales. However, assessment of criterion validity of the scales suggested that the adapted measure of socio-cultural resilience (CYRM-12NT) showed higher reliability and a clearer indication of predictive validity than the measure of psychological resilience (CD-RISC-10).

Conclusions

The CYRM-12NT appears to be a more useful measure of resilience among Aboriginal youth exposed to significant life stress and disadvantage. However, both measures may require further development to enhance their validity and utility among potentially at-risk adolescents in socially, culturally and linguistically diverse remote Aboriginal communities.

Moderating role of moral injury in the mental health of adolescent refugees

OBJECTIVE

This study investigated whether moral injury appraisals moderated the relationships between trauma, postmigration living difficulties, resilience, and mental health outcomes in adolescent refugees.

METHOD

Eighty-five adolescent refugees from a community sample completed an online survey.

RESULTS

A significant interaction was found between moral injury and discrimination for externalizing and posttraumatic stress disorder (PTSD) symptoms; adolescents whom had experienced high levels of discrimination combined with high levels of moral injury had poorer mental health. A significant interaction was found between moral injury and resilience for internalizing symptoms: high levels of resilience appeared to buffer the association between moral injury and internalizing symptoms. Contrary to predictions, stressful life experiences and postmigration living difficulties did not interact significantly with moral injury to predict mental health.

CONCLUSIONS

Discrimination may contribute to perpetuating poor mental health in adolescent refugees with high levels of moral injury. Resilience may buffer some of the negative effects of moral injury.

Correlates of Suicide Ideation and Resilience Among Native- and Foreign-Born Adolescents in the United States

PURPOSE

Nearly 20% of U.S. adolescents have considered suicide. Yet, gaps remain in understanding correlates of resilience and suicide risk, especially among populations born outside the United States who may face unique migration- and acculturation-related stressors. This study adds to the literature by exploring correlates of suicide ideation among a diverse population.

METHODS

This study analyzes quantitative data (N = 357) from the Study of Adolescent Lives after Migration to America, in Detroit and Harrisonburg. More than 40% of the sample was born outside the United States, with the majority born in the Middle East and North Africa. Path analysis was used to model dual outcomes of resilience and suicide ideation using measures of hope, school belonging, stressful life events, and being born outside the United States.

RESULTS

Suicide ideation and resilience were negatively correlated (ß = -.236[.069]; p < .001). Adolescents with greater hope (ß = .367; p < .001) and school belonging (ß = .407; p < .001) reported higher resilience, while lower levels of school belonging correlated with higher levels of suicide ideation (ß = -.248; p = .009). More stressful life events were associated with suicide ideation (ß = .243; p < .001), while fewer were correlated with resilience (ß = -.106; p = .003). Being born outside the United States was associated with suicide ideation (ß = .186; P-.015), with this finding driven by those from the Middle East and North Africa region, who faced significantly increased risk of suicide ideation (ß = .169; p = .036).

CONCLUSIONS

Findings suggest that adolescents born in the Middle East and North Africa region may represent a vulnerable group needing targeted and culturally responsive interventions to destigmatize mental health and psychosocial well-being, boost existing sources of resilience, and encourage help-seeking behaviors.

Immigrant Youth Resilience: Theoretical Considerations, Empirical Developments, and Future Directions

Resilient adaptation among immigrant youth provides the foundation for healthy and productive adult lives. Great diversity is observed in their adaptation. This diversity has been studied during the past decade from different angles and intellectual traditions. However, the results are disconnected. In this paper, first, we present a resilience conceptual model for understanding immigrant youth adaptation. We argue that its concepts and principles allow us to best pull together what is known and discover what is still unknown. Together with narrower topic-specific conceptual models, it can guide the formulation of hypotheses regarding immigrant youth resilience. Second, we examine comparatively, through the lens of this conceptual model, results of a content analysis on the abstracts of studies on individual differences in immigrant youth adaptation, conducted during the past decade in North American and European countries. Finally, we discuss the meaning of acculturation-related terms which are often used in an inconsistent way.

Love and peace across generations: Biobehavioral systems and global partnerships

Children's environments - especially relationships with caregivers - sculpt not only developing brains but also multiple bio-behavioral systems that influence long-term cognitive and socioemotional outcomes, including the ability to empathize with others and interact in prosocial and peaceful ways. This speaks to the importance of investing resources in effective and timely programs that work to enhance early childhood development (ECD) and, by extension, reach communities at-scale. Given the limited resources currently devoted to ECD services, and the devastating impact of COVID-19 on children and communities, there is a clear need to spur government leaders and policymakers to further invest in ECD and related issues including gender and racial equity. This essay offers concrete examples of scholarly paradigms and leadership efforts that focus on child development to build a peaceful, equitable, just, and sustainable world. As scholars and practitioners, we need to continue to design, implement, assess, and revise high-quality child development programs that generate much-needed evidence for policy and programmatic changes. We must also invest in global partnerships to foster the next generation of scholars, practitioners, and advocates dedicated to advance our understanding of the bio-behavioral systems that underlie love, sociality, and peace across generations. Especially where supported by structural interventions, ECD programs can help create more peaceful, just, and socially equitable societies.

Impact of a Brief Family Skills Training Programme ("Strong Families") on Parenting Skills, Child Psychosocial Functioning, and Resilience in Iran: A Multisite Controlled Trial

Caregivers have a key role in protecting children’s wellbeing, and, with appropriate skills, can prevent a multitude of negative social outcomes, particularly in challenged or humanitarian settings. Accordingly, the Strong Families programme was designed as a light touch family skills programme, with a focus of supporting caregiving during stressful situations. To evaluate the short-term impact of the Strong Families programme, we performed a time-convenience, randomized, controlled trial in Iran. A total of 292 families (63% from Iranian decent, 39% from Afghan decent, and 1% other), with children aged eight to twelve years, were recruited through ten centers in Iran and allocated to an intervention (n = 199) or waitlist/control group (n = 93). The two groups did not differ demographically at baseline. We assessed families prospectively, through three scales, PAFAS (parenting and family adjustment scales), SDQ (strengths and difficulties questionnaire), and CYRM-R (child and youth resilience measure). Caregivers in the intervention group improved (highly) statistically significantly on all but one PAFAS subscales (parental consistency, coercive parenting, positive encouragement, parental adjustment, family relationships, and parental teamwork), which was not noted in the waitlist group. On the SDQ, there were (highly) significant positive changes in scores in the intervention group on all sub-scales and the “total difficulty scale“, whereas the waitlist/control group also improved on three (prosocial, conduct problems, and hyperactivity) of the five SDQ subscales. Children originating from Afghanistan improved significantly on the overall resilience scale of the CYRM-R in the intervention group, but not in the waitlist/control group. Overall, all our stratified results of the different scales reflect an accentuated improvement in families with higher levels of problems at baseline. Our comparative results indicated a strong alignment of the strong families programme with its intended short-term impact, per its logical frame on parenting practices and family management skills, children behaviour, caregivers and children mental health, and capacity to cope with stress. We postulate that the potential nudging or diffusion of knowledge (cross-contamination between intervention and waitlist/control group) at the community level could explain improvements in the waitlist/control group on some indicators, however, further research on this is recommend.

Syrian Refugee Youth Resettled in Norway: Mechanisms of Resilience Influencing Health-Related Quality of Life and Mental Distress

Background: The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms to inform future interventions and policy. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect.

Methods: This was a cross-sectional study of Syrian youth recently resettled in Norway, aged 13–24 years. Regression and moderation analyses were used to explore different interactions, including moderated mediation using the PROCESS macro for SPSS.

Result: A direct main effect of promotive resilience was found for health-related quality of life (HRQoL) and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of protective resilience were found. Post-migration stressors mediated the effects of potentially traumatic events (PTE) from war and flight, and this indirect effect was present at all levels of resilience.

Conclusion: Despite high risk exposure and mental distress, resilience was also high. Broad resilience interventions targeting multiple factors would likely benefit the group, but these should include both individual assets and building supportive environments. Additionally, reducing current stress and providing treatment for those in need could enable recovery and increase the efficacy of resilience factors already present.

Resilience as a communal concept: Understanding adolescent resilience in the context of the Syrian refugee crisis in Bar Elias, Lebanon

Background

The conflict in Syria has led to the displacement of 1.5 million refugees into the neighboring country of Lebanon, with a majority that have yet to return to their homeland. Syrian adolescents in the town of Bar Elias in the Bekaa Valley, Lebanon have lived and grown in the face of resource-limited environments, restricted movement, and a longing for return. Resilience is manifested in the adaptation to such circumstances through close supportive relationships, social engagement, employment, and religion. There is a communal aspect to resilience that is important to the adolescent refugee experience and to the efforts supporting these communities.

Methods

Fifteen one-to-one interviews and two focus groups, with a total of eighteen Syrian adolescents, were analyzed using an inductive thematic analysis informed by grounded theory principles. Participants were recruited through partnering non-governmental organizations (NGOs) in the area, and ethical approval was granted through UCL and the American University in Beirut (AUB).

Results

Syrian adolescents highlighted supportive relationships, communal activities and spaces, memories of home, employment, and shared environments as integral elements to their personal adaptation. Methods of resilience involved social cohesion and establishing stability for one's family and close community. Adaptation to the present is intertwined with facing the consequences of displacement in this new context and maintaining aspirations for a bright future. Engaging with the environments they share and help create is an important facet of resilience and occurs through group gatherings , hobbies, and online communication. Additionally, inner strength can be derived from religious activities and empowers individual processing.

Conclusion

This study illuminates the elements and mechanisms embodied in these adolescents' communities and relationships that allow for adaptation to life in Bar Elias. These factors strengthen their approach to overcome social barriers and practice resilience. These communal aspects of the adolescents' lives also connect to their memories of home, current environment, and future aspirations.

Resilience and Mental Health Among Syrian Refugee Children in Jordan

Refugee populations are at high risk of experiencing trauma and developing negative mental health outcomes. The resilience of Syrian refugee children is not well established as far as modifying the association between trauma and mental illness. A total of 339 Syrian refugee children aged 10 to 17 were surveyed to assess resilience, depression and history of trauma. All children reported exposure to at least one traumatic event, 48.6% reported exposure to highly salient traumatic events such as being held hostage, kidnapping or imprisonment. High rates of suicidal ideation and depression symptomatology were found. Resilience was strongly inversely related to depression. Relational support was found to be the most protective resilience factor and was the most highly correlated with less depressive symptomatology. Empowering children and families to build resilience through social support may be a viable prevention and management approach to other unaffordable or unavailable treatments for mental illnesses.

Escaping the inescapable: Risk of mental health disorder, somatic symptoms and resilience in Palestinian refugee children

Exposure to war, conflict and forced migration puts children at risk of mental health problems. The present study examined the levels of psychological distress and resilience factors among 106 Palestinian refugee children aged 11 to 17 in the West Bank. In a cross-sectional, mixed method design along with qualitative interviews, three questionnaires were administered: the Strength and Difficulties Questionnaire and Patient Health Questionnaire-15, assessed the risk of mental health disorders and psychosomatic complaints, and the Child and Youth Resilience Measure assessed the availability of resilience-enhancing factors. Palestinian refugee children were found to be at greater risk for mental disorders and psychosomatic complaints than were children living in non-conflict affected settings. In addition, resilience-enhancing resources were significantly reduced and were negatively correlated with both symptom outcomes. Risk factors identified included poverty, violence and marginalisation. Key protective factors were youth education, supportive relationships and social participation. Our findings support interventions that address the identified protective factors, which may promote the mental health of this vulnerable population.

Refugee mental health and human rights: A challenge for global mental health

This article introduces a thematic issue of Transcultural Psychiatry that presents recent work that deepens our understanding of the refugee experience-from the forces of displacement, through the trajectory of migration, to the challenges of resettlement. Mental health research on refugees and asylum seekers has burgeoned over the past two decades with epidemiological studies, accounts of the lived experience, new conceptual frameworks, and advances in understanding of effective treatment and intervention. However, there are substantial gaps in available research, and important ethical and methodological challenges. These include: the need to adopt decolonizing, participatory methods that amplify refugee voices; the further development of frameworks for studying the broad impacts of forced migration that go beyond posttraumatic stress disorder; and more translational research informed by longitudinal studies of the course of refugee adaptation. Keeping a human rights advocacy perspective front and center will allow researchers to work in collaborative ways with both refugee communities and receiving societies to develop innovative mental health policy and practice to meet the urgent need for a global response to the challenge of forced migration, which is likely to grow dramatically in the coming years as a result of the impacts of climate change.

Researching the Effectiveness of Tree of Life: an Imbeleko Approach to Counseling Refugee Youth

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.

Supporting Muslim refugee youth during displacement: Implications for international school psychologists

School psychologists around the world have an important role in advocating for refugee youth, including Muslim refugees who experience increased risk for mental health issues due to discrimination. There are few studies, however, that have examined the resiliency factors that impact Muslim refugee youth’s well-being. This qualitative research study investigated these factors through the voices of humanitarian workers who are the primary source of support for these youth during displacement. Humanitarian workers ( N = 28 ) were recruited using snowball sampling through organizations that serve refugee youth and families during displacement. Using a recursive thematic process, we identified four main themes associated with risk factors: (1) gender norm expectations, (2) challenges in help-seeking, (3) unsafe climate and limited resources, and (4) challenges in collaborating with family. We also identified two main themes of protective factors: (1) faith and culture, and (2) family, peer, and community connections. We discussed these themes in the context of school psychological practice and provided specific recommendations for international school psychologists who support Muslim refugee students.

Prevalence of common mental disorders among Syrian refugee children and adolescents in Sultanbeyli district, Istanbul: results of a population-based survey

AIMS

Research demonstrates elevated levels of common mental disorders among Syrian refugees, but the majority of studies have, to date, focused on adult populations. This study aims to estimate the prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) among Syrian children and adolescents living in Sultanbeyli district of Istanbul, Turkey.

METHODS

A population-based survey among Syrian children and adolescents aged 8-17 years living in Sultanbeyli district was conducted in 2019, as part of an all-age survey of disability. 80 clusters of 50 participants (all-ages) were selected from the local municipality's refugee registration database using probability proportionate to size sampling. Children aged 8-17 years were assessed for symptoms of common mental disorders using the Child Revised Impact of Event Scale (CRIES-8) and abbreviated versions of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) and the Screen for Child Anxiety Related Disorders (SCARED).

RESULTS

Of the 852 participants, 23.7% (95% CI 19.9-27.2) screened positive for symptomatic depression, PTSD and anxiety. The prevalence estimates for depression, PTSD and anxiety were 12.5% (95% CI 9.8-15.6), 11.5% (95% CI 9.1-14.4) and 9.2% (95% CI 6.8-12.1), respectively. Depression and PTSD were significantly more common in older adolescents, whilst anxiety and PTSD were significantly more common in girls. Depression was more common in children from poorer households and those who had received no education. Children coming from larger households were less likely to show symptoms of PTSD.

CONCLUSIONS

Syrian refugee children and adolescents are vulnerable to common mental disorders, and culturally appropriate prevention and intervention support are needed for this population.

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC's research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).

The health status of newly arrived asylum-seeking minors in Denmark: a nationwide register-based study

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.