1
|
Kevers R, de Smet S, Rober P, Rousseau C, De Haene L. Silencing or silent transmission? An exploratory study on trauma communication in Kurdish refugee families. FAMILY PROCESS 2024. [PMID: 38566251 DOI: 10.1111/famp.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/23/2023] [Accepted: 12/19/2023] [Indexed: 04/04/2024]
Abstract
Trauma communication in refugee families is increasingly recognized as an important relational dynamic influencing psychosocial well-being, yet studies exploring interactional dynamics and meaning making at play in intra-family trauma communication remain scarce. This article reports on a qualitative study with Kurdish refugee families including parents (N = 10) and children (N = 17) resettled in Belgium, aiming to explore practices on trauma communication within refugee family relationships. In a multiple-phased qualitative design, semi-structured family interviews and participant observation administered in the homes of the participant families are followed by parental interviews involving a tape-assisted recall procedure to investigate observed intergenerational trauma communication and parent-child interactions. Data analysis shows parents and children seldom explicitly talked about the families' lived experiences of trauma. This silence was especially related to parental wishes to avoid their children's future involvement in violence. However, findings also indicate how the intra-family transmission of memories of collective violence occurs in many subtle ways. Four modes of indirect trauma communication could be distinguished: (1) focusing on the repetition of violence in the present; (2) transmission of the collective trauma history; (3) family storytelling; and (4) interaction with meaningful objects of the past. These findings shed light onto the interwoven nature of personal-familial and collective trauma and loss and illuminate the meanings of silence and disclosure in the context of the Kurdish diaspora. In the final section, we discuss our findings and outline its clinical implications for family therapeutic practices in refugee trauma care.
Collapse
Affiliation(s)
- Ruth Kevers
- Parental and Special Education Research Unit, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- PASO, UPC KU Leuven University Psychiatric Center, Kortenberg, Belgium
| | - Sofie de Smet
- Parental and Special Education Research Unit, Faculty of Psychology and Educational Sciences and Faculty Clinical Centre PraxisP, University of Leuven, Leuven, Belgium
| | - Peter Rober
- Interfaculty Institute of Family and Sexuality Studies, University of Leuven, Leuven, Belgium
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montréal, Quebec, Canada
| | - Lucia De Haene
- Parental and Special Education Research Unit, Faculty of Psychology and Educational Sciences and Faculty Clinical Centre PraxisP, University of Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Khraisha Q, Sawalha L, Hadfield K, Al-Soleiti M, Dajani R, Panter-Brick C. Coparenting, mental health, and the pursuit of dignity: A systems-level analysis of refugee father-mother narratives. Soc Sci Med 2024; 340:116452. [PMID: 38171170 DOI: 10.1016/j.socscimed.2023.116452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
Research on coparenting is virtually absent from the refugee literature, despite its importance for family systems, children's bio-behavioural and emotional development, and intergenerational responses to social change. In 2022, we conducted 30 semi-structured interviews with Syrian refugees in Jordan and used thematic analysis to examine how fathers and mothers (n = 15 dyads) enacted parenting together. We identified four approaches characterising how couples navigated coparenting interactions, family cohesion, and intergenerational change. These were negotiation, mirroring, anchoring, and transformation. Specifically, Syrian couples negotiated how to balance responsibilities, sought emotions and behaviours that reflected calm and respect, prioritised family togetherness over education or resettlement opportunities, and, strikingly, adopted gentler parenting approaches to transform intergenerational experiences. Underpinning these four themes were efforts to uphold family dignity. Syrians described themselves as ordinary parents, eschewing the label of refugee parents and building a normal life for their families after war and displacement. Our thematic analysis offers methodological and conceptual advances in exemplifying how to capture a dyadic understanding of coparenting and why refugees strive to parent in ways that sustain mental health and dignity. This systems-level analysis of coparenting in dignity is specifically relevant to strengthening the processes of family-level communication and to designing integrated programs that support caregiving, wellness, and family unity. Our findings lay the groundwork for developing a relational, agentic model of family caregiving systems in the context of precarity and forced displacement.
Collapse
Affiliation(s)
- Qusai Khraisha
- Trinity Centre for Global Health, Trinity College Dublin, Ireland; School of Psychology, Trinity College Dublin, Ireland
| | | | - Kristin Hadfield
- Trinity Centre for Global Health, Trinity College Dublin, Ireland; School of Psychology, Trinity College Dublin, Ireland
| | - Majd Al-Soleiti
- Tahgyeer Foundation, Amman, Jordan; Department of Psychiatry, Mayo Clinic, USA
| | - Rana Dajani
- Department of Biology and Biotechnology, Faculty of Science, The Hashemite University, Jordan
| | - Catherine Panter-Brick
- Department of Anthropology, Yale University, USA; Jackson School of Global Affairs, Yale University, USA; Conflict, Resilience, and Health Program, Yale University, USA.
| |
Collapse
|
3
|
Hjern A. Psychosocial support for refugee parents in well-baby clinics. Acta Paediatr 2023; 112:2460-2461. [PMID: 37784233 DOI: 10.1111/apa.16987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet, Stockholm University, Stockholm, Sweden
- Department of Medicine, Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Xu M, Tian R, Fu C, Li J, Bi D, Wang Y. The impact of family function on post-traumatic reactions of Chinese adolescents infected with COVID-19: a latent profile study. Front Public Health 2023; 11:1153820. [PMID: 37213623 PMCID: PMC10192572 DOI: 10.3389/fpubh.2023.1153820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
Background Since the end of 2019, Corona Virus Disease 2019, also known as COVID-19, has broken out in various countries. However, the change of China's COVID-19 prevention and control policy and the sharp increase in the number of infected people are making the teenagers have post-traumatic reactions. Negative post-traumatic reactions include: post-traumatic stress disorder (PTSD), depression, anxiety. Positive post-traumatic reaction mainly refers to post-traumatic growth (PTG). The purpose of this study is to explore the post-traumatic reaction, which refers to PTSD, depression, anxiety and the co-occurrence pattern of growth after trauma and to further explore the influence of family function on different categories of Post-traumatic Reactions. Methods Latent profile analysis (LPA) was used to explore the co-occurrence of PTSD, depression, anxiety, and PTG. Multiple logistics regression was used to analyze the influence of family function on different categories of post-traumatic response. Results There were three categories of post-traumatic reactions in adolescents infected with COVID-19 adolescents infected with COVID-19, namely: growth class, struggling class, and pain class. Multivariate Logistic regression showed that the growth class and struggling class were affected by problem solving and behavior control in family function, while the growth class and pain class were affected by problem solving, roles, behavior control, and general functioning. Multiple logistic regression showed that the growth class and struggling class were affected by problem solving and roles. Conclusions The findings of this study provide evidence for the identification of high-risk individuals and the provision of effective interventions in clinical practice, as well as the influence of family functioning on the different categories of PTSD among adolescents infected with COVID-19.
Collapse
Affiliation(s)
- Mingtu Xu
- Department of Mental Health, First Affiliated Hospital of Jilin University, Changchun, China
| | - Runhui Tian
- Department of Mental Health, First Affiliated Hospital of Jilin University, Changchun, China
- *Correspondence: Runhui Tian
| | - Cong Fu
- Department of Mental Health, First Affiliated Hospital of Jilin University, Changchun, China
| | - Jingyang Li
- Department of Mental Health, First Affiliated Hospital of Jilin University, Changchun, China
| | - Dingyu Bi
- Department of Politics and Education, Jilin Experimental Middle School, Changchun, China
| | - Yan Wang
- Affiliated Middle School of Jilin University, Changchun, China
| |
Collapse
|
5
|
Risk and Protective Factors Experienced by Fathers of Refugee Background during the Early Years of Parenting: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116940. [PMID: 35682523 PMCID: PMC9180233 DOI: 10.3390/ijerph19116940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
Fathers of refugee background with young children can experience significant mental health difficulties, with the potential for intergenerational impacts. This study aimed to explore how fathers of refugee background experience risk and protective factors for their own health and wellbeing during the early years of parenting. Semi-structured interviews and one semi-structured focus group were conducted with fathers of refugee background, with young children (0–5 years), who had settled in Australia. Transcribed interviews were analysed using thematic analysis, informed by the socioecological model of health. A total of 21 fathers participated in the study. Risk factors experienced included: prior experiences of trauma, reduced access to family support in Australia, adjustments in parenting roles, and the challenges of learning a new language and securing employment. Fathers drew on a number of sources of strength, including a sense of joy from fatherhood and support from partners, families, and communities. While most fathers regularly accompanied their partners and children to healthcare appointments, they were rarely asked by healthcare professionals about their own needs. Our findings support the idea that there is a need for greater assistance for fathers, particularly for navigating issues arising from the settlement process. Healthcare services working with families of refugee background must adopt a father-inclusive, trauma-informed approach that is responsive to fathers’ needs.
Collapse
|
6
|
Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents. Eur Child Adolesc Psychiatry 2022; 31:1953-1962. [PMID: 34146175 PMCID: PMC9663346 DOI: 10.1007/s00787-021-01827-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/13/2021] [Indexed: 01/26/2023]
Abstract
Parental psychiatric morbidity related to experiences of war and trauma has been associated with adverse psychological outcomes for children. The aim of this study was to investigate parental post-traumatic stress in relation to psychiatric care utilization among children of refugees with particular attention on the child's own refugee status, sex of both child and parents, and specific psychiatric diagnoses. This was a register study in a population of 16 143 adolescents from refugee families in Stockholm County born 1995-2000 and followed between 2011 and 2017 (11-18 years old). Parental post-traumatic stress, identified in three levels of care, was analysed in relation to child and adolescent psychiatric care use. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for duration of residence and demographic and socioeconomic variables. Having a mother with post-traumatic stress was associated with higher psychiatric care utilization, with adjusted HR 2.44 (95% CI 1.90-3.14) among foreign-born refugee children and HR 1.77 (1.33-2.36) among Swedish-born children with refugee parents, with particularly high risks for children with less than five years of residence (HR 4.03; 2.29-7.10) and for diagnoses of anxiety and depression (HR 2.71; 2.11-3.48). Having a father with post-traumatic stress was not associated with increased HRs of psychiatric care utilization. Similar results were seen for boys and girls. Treatment for post-traumatic stress should be made available in refugee reception programmes. These programmes should use a family approach that targets both parents and children.
Collapse
|
7
|
Mooren T, van Ee E, Hein I, Bala J. Combatting intergenerational effects of psychotrauma with multifamily therapy. Front Psychiatry 2022; 13:867305. [PMID: 36819942 PMCID: PMC9929345 DOI: 10.3389/fpsyt.2022.867305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 12/29/2022] [Indexed: 02/04/2023] Open
Abstract
There is growing evidence that parental trauma is associated with psychosocial disorders, externalizing and internalizing problems, and higher sensitivity to posttraumatic stress disorder (PTSD) in children. Recent research findings suggest multidimensional relational, psychological, and neurobiological interrelated pathways of intergenerational influence. Moreover, the intergenerational effects of parental trauma need to be understood within a broader systemic context, as a part of family adaptation. This article explores research findings and clinical practice to enhance our understanding of intergenerational processes and presents directions for therapeutic interventions. A trauma-focused multi-family therapy, aiming to restrict the relational consequences of parental trauma and strengthen family resilience, is described. The proposition is that to facilitate and improve the quality of parent-child interaction in response to psychotrauma, fostering emotion regulation capacities and mentalization is crucial. These efforts offered through family group interventions may benefit various families coping with adversity in culturally diverse societies.
Collapse
Affiliation(s)
- Trudy Mooren
- ARQ National Psychotrauma Centre, Diemen, Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | - Elisa van Ee
- Psychotraumacentrum Zuid-Nederland, Reinier van Arkel, 's-Hertogenbosch, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Irma Hein
- Department of Child and Youth Psychiatry, Amsterdam Academic Medical Center, Amsterdam, Netherlands
| | | |
Collapse
|
8
|
Eruyar S, Haffejee S, Anderson ES, Vostanis P. Implementation of child mental health service improvement plans in four low- and middle-income countries: stakeholders' perspectives. J Interprof Care 2021:1-8. [PMID: 34657552 DOI: 10.1080/13561820.2021.1982881] [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: 06/10/2020] [Revised: 08/26/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
Children in low- and middle-income countries (LMIC) have high levels of unmet mental health needs, especially in disadvantaged communities. To address this gap, we developed a child mental health service improvement programme. This was co-facilitated using interprofessional principles and values in four countries, South Africa, Kenya, Turkey and Brazil. Eighteen stakeholders from different professions were interviewed after six months on their perspectives on enabling factors and challenges they faced in implementing service plans. Participants valued the holistic case management approach and scaled service model that underpinned the service plans. Emerging themes on participants' priorities related to service user participation, integrated care, and different levels of capacity-building. We propose that an integrated care model in LMIC contexts can maximize available resources, engage families and mobilize communities. Implementation requires concurrent actions at micro-, meso- and macro-level.
Collapse
Affiliation(s)
- Seyda Eruyar
- Department of Psychology, Necmettin Erbakan University, Konya, Turkey
| | - Sadiyya Haffejee
- Centre for Social Development in Africa, University of Johannesburg, Johannesburg, South Africa
| | - E S Anderson
- School of Medicine, University of Leicester, Leicester, UK
| | | |
Collapse
|
9
|
Arakelyan S, Ager A. Annual Research Review: A multilevel bioecological analysis of factors influencing the mental health and psychosocial well-being of refugee children. J Child Psychol Psychiatry 2021; 62:484-509. [PMID: 33277944 PMCID: PMC8246898 DOI: 10.1111/jcpp.13355] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND This paper revisits the themes of an influential 1993 review regarding the factors shaping the mental health and psychosocial well-being of refugees to take stock of developments in the evidence base and conceptualisation of issues for refugee children over the last 25 years. METHODS The study deployed a systematic search strategy. This initially identified 784 papers, which was reduced to 65 studies following application of inclusion and exclusion criteria. We used a later iteration of Bronfenbrenner's bioecological model of human development - the PPCT model - to consolidate evidence. RESULTS We identify a range of risk and protective factors operating at individual, familial, community and institutional and policy levels that influence outcomes for refugee children. The dynamics shaping the interaction of these influences are linked to the life course principles of socio-historical time and developmental age, proximal processes and child agency. CONCLUSIONS Actions at individual, familial, community, school, institutional and policy levels all have potential traction on mental health and psychosocial well-being of refugee children. However, evidence suggests that greatest impact will be secured by multilevel interventions addressing synergies between ecological systems, approaches engaging proximal processes (including parenting programmes) and interventions facilitating the agency of the developing refugee child.
Collapse
Affiliation(s)
- Stella Arakelyan
- Institute for Global Health and DevelopmentQueen Margaret UniversityEdinburghUK
| | - Alastair Ager
- Institute for Global Health and DevelopmentQueen Margaret UniversityEdinburghUK
| |
Collapse
|
10
|
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]
|
11
|
Amodia-Bidakowska A, Laverty C, Ramchandani PG. Father-child play: A systematic review of its frequency, characteristics and potential impact on children’s development. DEVELOPMENTAL REVIEW 2020. [DOI: 10.1016/j.dr.2020.100924] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Fuel to the fire: The escalating interplay of attachment and maltreatment in the transgenerational transmission of psychopathology in families living in refugee camps. Dev Psychopathol 2020; 33:1308-1321. [DOI: 10.1017/s0954579420000516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Maltreatment by parents can be conceptualized as pathogenic escalations of a disturbed parent–child relationship that have devastating consequences for children's development and mental health. Although parental psychopathology has been shown to be a risk factor both for maltreatment and insecure attachment representations, these factors` joint contribution to child psychopathology has not been investigated. In a sample of Burundian refugee families living in refugee camps in Western Tanzania, the associations between attachment representations, maltreatment, and psychopathology were examined by conducting structured interviews with 226 children aged 7 to 15 and both their parents. Structural equation modeling revealed that children's insecure attachment representations and maltreatment by mothers fully mediated the relation between maternal and child psychopathology [model fit: comparative fit index (CFI) = 0.96; root mean square error of approximation (RMSEA) = 0.05]. A direct association between paternal and child psychopathology was observed (model fit: CFI = 0.96; RMSEA = 0.05). The findings suggest a vicious cycle, wherein an insecure attachment to a mother suffering from psychopathology may be linked to children's risk to be maltreated, which may reinforce insecure representations and perpetuate the pathogenic relational experience. Interventions targeting the attachment relationship and parental mental health may prevent negative child outcomes.
Collapse
|
13
|
Drummond Johansen J, Varvin S. Negotiating identity at the intersection of family legacy and present time life conditions: A qualitative exploration of central issues connected to identity and belonging in the lives of children of refugees. J Adolesc 2020; 80:1-9. [PMID: 32044475 DOI: 10.1016/j.adolescence.2020.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Most studies on refugee populations are organized around trauma-related issues and focus on explanations of pathological factors. Few studies are anchored in general developmental psychology with the aim of exploring normal age-specific developmental tasks and how the special circumstances associated with forced migration can influence that development. METHODS Using an ecological and transactional understanding of developmental trajectories, this qualitative study explored issues connected to identity formation processes in an exile context based on interviews with 6 male and 10 female children of refugees (18-26 years) who have grown up in Norway. RESULTS The findings show that family experiences of war and conflict intersect with experiences of marginalization in exile. The interaction of these experiences influences the development of individual identity in cumulative and complex ways. Many of the participants expressed feelings of isolation, disconnectedness, and a lack of belonging. Nevertheless, though the participants described growing up facing major challenges, they also searched for ways to reframe their difficult personal and family histories into meaningful experiences. CONCLUSIONS In order to provide conditions and develop interventions that can support well-being and identity development, we need a better understanding of the different forces that influence the identity development of children of refugees. By foregrounding the participants' experiences, and perspectives, we gained insight into different ways in which participants negotiate identity issues in relation to often contradictory demands and messages from family and the wider social context.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Eidhof MB, Djelantik AAAMJ, Klaassens ER, Kantor V, Rittmansberger D, Sleijpen M, Steenbakkers A, Weindl D, Ter Heide FJJ. Complex Posttraumatic Stress Disorder in Patients Exposed to Emotional Neglect and Traumatic Events: Latent Class Analysis. J Trauma Stress 2019; 32:23-31. [PMID: 30794337 DOI: 10.1002/jts.22363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/13/2018] [Accepted: 10/24/2018] [Indexed: 11/05/2022]
Abstract
The inclusion of a complex posttraumatic stress disorder (CPTSD) diagnosis in the 11th revision of the International Classification of Diseases reflects growing evidence that a subgroup of individuals with PTSD also suffer from disturbances in emotion regulation, interpersonal skills, and self-concept, which together are termed "disturbances in self-organization" (DSO). Although CPTSD is assumed to result from exposure to complex traumatic events, emotional neglect may be an important contributor. This study investigated the presence of CPTSD, defined by endorsement of PTSD and DSO symptoms in a clinical postwar generation sample. The sample consisted of 218 patients who had been exposed to emotional neglect in childhood, a subgroup of whom had also been exposed to potentially traumatic events. Using items from the Harvard Trauma Questionnaire and the Brief Symptom Inventory, a latent class analysis revealed two classes: high endorsement of almost all CPTSD symptoms (n = 83; 38.1%) and low endorsement of all CPTSD symptoms (n = 135; 61.9%). Contrary to our hypothesis, no DSO-only class was found. The R3step method showed gender and number of traumatic events to be significant predictors of class membership. Compared to the low endorsement class, individuals in the CPTSD class were more likely to be female, p = .013, and to report a higher number of traumatic experiences, p < .001. The potential intermediary role of emotional neglect in the development of DSO and CPTSD is discussed.
Collapse
Affiliation(s)
- Marloes B Eidhof
- Reinier van Arkel Groep, Psychotrauma Centrum Zuid Nederland, 's-Hertogenbosch, the Netherlands.,Arq Psychotrauma Expert Group, Arq, Diemen, the Netherlands.,Department of Clinical Psychology, Radboud University, Nijmegen, the Netherlands
| | - A A A Manik J Djelantik
- Arq Psychotrauma Expert Group, Arq, Diemen, the Netherlands.,Foundation Center'45
- partner in Arq, Oegstgeest/Diemen, the Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Ellen R Klaassens
- Foundation Center'45
- partner in Arq, Oegstgeest/Diemen, the Netherlands
| | - Viktoria Kantor
- Department of Applied Psychology, University of Vienna, Vienna, Austria
| | | | - Marieke Sleijpen
- Arq Psychotrauma Expert Group, Arq, Diemen, the Netherlands.,Foundation Center'45
- partner in Arq, Oegstgeest/Diemen, the Netherlands
| | - Anne Steenbakkers
- Department of Special Needs Education and Youth Care, University of Groningen, Groningen, the Netherlands
| | - Dina Weindl
- Department of Applied Psychology, University of Vienna, Vienna, Austria
| | - F Jackie June Ter Heide
- Arq Psychotrauma Expert Group, Arq, Diemen, the Netherlands.,Foundation Center'45
- partner in Arq, Oegstgeest/Diemen, the Netherlands
| |
Collapse
|
17
|
Dashorst P, Mooren TM, Kleber RJ, de Jong PJ, Huntjens RJC. Intergenerational consequences of the Holocaust on offspring mental health: a systematic review of associated factors and mechanisms. Eur J Psychotraumatol 2019; 10:1654065. [PMID: 31497262 PMCID: PMC6720013 DOI: 10.1080/20008198.2019.1654065] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/14/2019] [Accepted: 07/28/2019] [Indexed: 11/24/2022] Open
Abstract
Exposure to war and violence has major consequences for society at large, detrimental impact on people's individual lives, and may also have intergenerational consequences. To gain more insight into these intergenerational consequences, research addressing the impact of the Holocaust on offspring is an important source of information. The aim of the current study was to systematically review the mechanisms of intergenerational consequences by summarizing characteristics in Holocaust survivors and their offspring suggested to impact the offspring's mental health. We focused on: 1) parental mental health problems, 2) (perceived) parenting and attachment quality, 3) family structure, especially parental Holocaust history, 4) additional stress and life events, and 5) psychophysiological processes of transmission. We identified 23 eligible studies published between 2000 and 2018. Only Holocaust survivor studies met the inclusion criteria. Various parent and child characteristics and their interaction were found to contribute to the development of psychological symptoms and biological and epigenetic variations. Parental mental health problems, perceived parenting, attachment quality, and parental gender appeared to be influential for the mental well-being of their offspring. In addition, having two survivor parents resulted in higher mental health problems compared to having one survivor parent. Also, there was evidence suggesting that Holocaust survivor offspring show a heightened vulnerability for stress, although this was only evident in the face of actual danger. Finally, the results also indicate intergenerational effects on offspring cortisol levels. Clinical and treatment implications are discussed.
Collapse
Affiliation(s)
| | - Trudy M Mooren
- Stichting Centrum'45/partner in Arq, Diemen, The Netherlands.,Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Rolf J Kleber
- Stichting Centrum'45/partner in Arq, Diemen, The Netherlands.,Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Rafaele J C Huntjens
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
18
|
Preventive mental health interventions for refugee children and adolescents in high-income settings. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:121-132. [DOI: 10.1016/s2352-4642(17)30147-5] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 11/21/2022]
|
19
|
Papadopoulos RK, Gionakis N. The neglected complexities of refugee fathers. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2018. [DOI: 10.1002/ppi.1438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Nikos Gionakis
- Babel Day Centre for the Mental Health of Migrants and Refugees; Athens Greece
| |
Collapse
|
20
|
Giallo R, Riggs E, Lynch C, Vanpraag D, Yelland J, Szwarc J, Duell-Piening P, Tyrell L, Casey S, Brown SJ. The physical and mental health problems of refugee and migrant fathers: findings from an Australian population-based study of children and their families. BMJ Open 2017; 7:e015603. [PMID: 29151045 PMCID: PMC5702027 DOI: 10.1136/bmjopen-2016-015603] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 10/06/2017] [Accepted: 10/18/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to report on the physical and mental health of migrant and refugee fathers participating in a population-based study of Australian children and their families. DESIGN Cross-sectional survey data drawn from a population-based longitudinal study when children were aged 4-5 years. SETTING Population-based study of Australian children and their families. PARTICIPANTS 8137 fathers participated in the study when their children were aged 4-5 years. There were 131 (1.6%) fathers of likely refugee background, 872 (10.7%) fathers who migrated from English-speaking countries, 1005 (12.4%) fathers who migrated from non-English-speaking countries and 6129 (75.3%) Australian-born fathers. PRIMARY OUTCOME MEASURES Fathers' psychological distress was assessed using the self-report Kessler-6. Information pertaining to physical health conditions, global or overall health, alcohol and tobacco use, and body mass index status was obtained. RESULTS Compared with Australian-born fathers, fathers of likely refugee background (adjusted OR(aOR) 3.17, 95% CI 2.13 to 4.74) and fathers from non-English-speaking countries (aOR 1.79, 95%CI 1.51 to 2.13) had higher odds of psychological distress. Refugee fathers were more likely to report fair to poor overall health (aOR 1.95, 95% CI 1.06 to 3.60) and being underweight (aOR 3.49, 95% CI 1.57 to 7.74) compared with Australian-born fathers. Refugee fathers and those from non-English-speaking countries were less likely to report light (aOR 0.25, 95% CI 0.15 to 0.43, and aOR 0.30, 95% CI 0.24 to 0.37, respectively) and moderate to harmful alcohol use (aOR 0.04, 95% CI 0.10 to 0.17, and aOR 0.14, 95% CI 0.10 to 0.19, respectively) than Australian-born fathers. Finally, fathers from non-English-speaking and English-speaking countries were less likely to be overweight (aOR 0.62, 95% CI 0.51 to 0.75, and aOR 0.84, 95% CI 0.68 to 1.03, respectively) and obese (aOR 0.43, 95% CI 0.32 to 0.58, and aOR 0.77, 95% CI 0.61 to 0.98, respectively) than Australian-born fathers. CONCLUSION Fathers of refugee background experience poorer mental health and poorer general health than Australian-born fathers. Fathers who have migrated from non-English-speaking countries also report greater psychological distress than Australian-born fathers. This underscores the need for primary healthcare services to tailor efforts to reduce disparities in health outcomes for refugee populations that may be vulnerable due to circumstances and sequelae of forced migration and to recognise the additional psychological stresses that may accompany fatherhood following migration from non-English-speaking countries. It is important to note that refugee and migrant fathers report less alcohol use and are less likely to be overweight and obese than Australian-born fathers.
Collapse
Affiliation(s)
- Rebecca Giallo
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Claire Lynch
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Jane Yelland
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Josef Szwarc
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | | | - Lauren Tyrell
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - Sue Casey
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - Stephanie Janne Brown
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| |
Collapse
|
21
|
Merry L, Pelaez S, Edwards NC. Refugees, asylum-seekers and undocumented migrants and the experience of parenthood: a synthesis of the qualitative literature. Global Health 2017; 13:75. [PMID: 28927440 PMCID: PMC5606020 DOI: 10.1186/s12992-017-0299-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To synthesize the recent qualitative literature and identify the integrative themes describing the parenthood experiences of refugees, asylum-seekers and undocumented migrants. METHODS We searched seven online databases for the period January 2006 to February 2017. We included English and French published peer-reviewed articles and graduate-level dissertations, which qualitatively examined the parenthood experiences of refugees, asylum-seekers and undocumented migrants. We summarized study characteristics and performed a thematic analysis across the studies. RESULTS One hundred thirty eight studies met inclusion criteria. All but three were conducted in high-income countries, mainly in the US. Migrants studied were mostly undocumented from Latin America and refugees from Sub-Saharan Africa. Almost all studies (93%) included mothers; about half (47%) included fathers; very few (5%) included extended family members. We identified three integrative themes: 1) experiencing hardship and/or loss in the context of precarious migration and past traumas; 2) building resilience and strength by bridging language, norms and expectations; and 3) living transnationally: obligations, challenges and resources. Each theme contributed to shaping the parenthood experience; the transnationalism theme intersected with the themes on hardship and loss and resilience and strength. CONCLUSION More research is needed with fathers, extended family members, asylum-seekers and in the LMIC context. A transnational lens needs to be applied to programs, policies and future research for refugee, asylum-seeker and undocumented migrant parents. Addressing transnational concerns (family separation and reunification), acknowledging transnational resources, fostering a transnational family identity and conducting transnational and longitudinal studies are potentially pivotal approaches for this sub-population of parents.
Collapse
Affiliation(s)
- Lisa Merry
- School of Nursing, University of Ottawa, Ottawa, Canada.
| | - Sandra Pelaez
- Faculty of Education, McGill University, Montreal, Canada
| | | |
Collapse
|
22
|
van Ee E, Jongmans MJ, van der Aa N, Kleber RJ. Attachment Representation and Sensitivity: The Moderating Role of Posttraumatic Stress Disorder in a Refugee Sample. FAMILY PROCESS 2017; 56:781-792. [PMID: 27245266 DOI: 10.1111/famp.12228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
It has been hypothesized that adult attachment representations guide caregiving behavior and influence parental sensitivity, and thus affect the child's socio-emotional development. Several studies have shown a link between posttraumatic stress disorder (PTSD) and reduced parental sensitivity, so it is possible that PTSD moderates the relationship between insecure attachment representations and insensitivity. In this study symptoms of PTSD (Harvard Trauma Questionnaire), parental sensitivity (Emotional Availability Scales), and attachment representations (Attachment Script Assessment) were assessed in 53 parents who were asylum seekers or refugees. Results showed that when parents were less able to draw on secure attachment representations, symptoms of PTSD increased the risk of insensitive parenting. These findings suggest that parental sensitivity is affected not just by attachment representations, but by a conjunction of risk factors including symptoms of PTSD and insecure attachment representations. These parents should therefore be supported to establish or confirm secure models of attachment experiences, to facilitate their ability interact sensitively and form a secure relationship with their children.
Collapse
Affiliation(s)
- Elisa van Ee
- Centrum '45, Diemen, The Netherlands
- Foundation Arq, Diemen, The Netherlands
| | | | - Niels van der Aa
- Centrum '45, Diemen, The Netherlands
- Foundation Arq, Diemen, The Netherlands
| | - Rolf J Kleber
- Foundation Arq, Diemen, The Netherlands
- Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
23
|
van Ee E, Kleber RJ, Jongmans MJ. Relational Patterns Between Caregivers With PTSD and Their Nonexposed Children: A Review. TRAUMA, VIOLENCE & ABUSE 2016; 17:186-203. [PMID: 25964276 DOI: 10.1177/1524838015584355] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The question as to whether or not children can be affected by the traumatization of their parents has been the topic of a long-standing debate. This article provides a critical review of 72 research studies on traumatized parents with symptoms of posttraumatic stress disorder (PTSD), the parent-child interaction, and the impact on their nonexposed child (0-18 years). The evidence suggests that traumatization can cause parenting limitations, and these limitations can disrupt the development of the young child. From the studies reviewed several patterns emerged: Relational patterns of traumatized parents who are observed to be emotionally less available and who perceive their children more negatively than parents without symptoms of PTSD; relational patterns of children who at a young age are easily deregulated or distressed and at an older age are reported to face more difficulties in their psychosocial development than children of parents without symptoms of PTSD; and relational patterns that show remarkable similarities to relational patterns between depressed or anxious parents and their children. Mechanisms such as mentalization, attachment, physiological factors, and the cycle of abuse offer a valuable perspective to further our understanding of the relational patterns. This article builds on previous work by discussing the emerged patterns between traumatized parents and their nonexposed children from a relational and transactional perspective.
Collapse
Affiliation(s)
- Elisa van Ee
- Reinier van Arkel, Psychotraumacentrum Zuid Nederland, Den Bosch, the Netherlands
| | - Rolf J Kleber
- Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands
| | | |
Collapse
|
24
|
van Ee E, Kleber RJ, Jongmans MJ, Mooren TT, Out D. Parental PTSD, adverse parenting and child attachment in a refugee sample. Attach Hum Dev 2016; 18:273-91. [DOI: 10.1080/14616734.2016.1148748] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
25
|
Song SJ, Tol W, de Jong J. Indero: intergenerational trauma and resilience between Burundian former child soldiers and their children. FAMILY PROCESS 2014; 53:239-251. [PMID: 24635407 DOI: 10.1111/famp.12071] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Since many former child soldiers are aging and having children of their own, this study aimed to understand how the effects of trauma are passed to the next generation. In this qualitative study, semistructured interviews, focus groups, and observations were conducted with 25 former child soldiers and 15 matched civilian parents. Analysis used a grounded-theory approach. Trauma may be transmitted from former child soldiers to their offspring via (a) the effect on indero (how to raise a child); (b) severe parental emotional distress; and (c) community effects. Incorporating themes of indero values on how to raise children, the effects of parental posttraumatic stress and depressive symptoms on offspring, and the stigma associated with the families of former child soldiers may provide key areas of intervention in mental healing.
Collapse
Affiliation(s)
- Suzan Joon Song
- Pediatric and Adult Psychiatry, Center for Survivors of Torture, San Jose, CA
| | | | | |
Collapse
|
26
|
Lebow JL. Editorial: overselling our findings. FAMILY PROCESS 2014; 53:175-178. [PMID: 24893672 DOI: 10.1111/famp.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|