The mental health needs of refugee children: a review of literature and implications for nurse practitioners

Refugee mothers mental health and social support needs: A systematic review of interventions for refugee mothers

Refugee mothers endure and are at risk for depression, post-traumatic stress, suicidality, and anxiety. There is a gap in the literature regarding interventions for refugee mothers’ mental health and well-being. Interventions involving refugee mothers rarely provide adequate support for refugee mothers’ specific mental health needs and challenges. This paper presents empirical evidence to contextualize the risks refugee mothers face, such as gender-based violence, mental health challenges, and language barriers. Then, the paper provides a critical systematic review of interventions conducted with refugee mothers. The critical systematic review suggests that creating and providing a safe space, being a linguistic liaison, community-building, and advocating for refugee mothers’ needs are emergent protective factors for refugee mothers. Finally, based on the review, recommendations for future interventions followed.

Empowering refugee families in transit: the development of a culturally competent and compassionate training and support package

Background

Refugee parents who fled conflicts suffered violence and traumas and face huge challenges in supporting the health and welfare of their children while in transit.

Aims

To describe the development of a culturally competent and compassionate training and support package (TSP) for nurses, social and health care workers and volunteers, with a focus on parenting needs among unsettled refugees fleeing conflict.

Methods

The multi-method approach included: a scoping review covering parenting needs of refugees fleeing conflict zones; collection of stories from refugee parents, healthcare workers and volunteers via a mobile application; discussions between team members; a piloted and evaluated curriculum.

Results

High levels of family distress and deterioration of parental identity were identified. Informed by these results, the curriculum is articulated along 20 bite-sized learning units, covering four age stages of childhood as well as targeting adults’ well-being. Pilot training was evaluated positively, confirming feasibility and usefulness of the TSP.

Conclusions

Unsettled refugee parents fleeing conflicts face psycho-social and practical difficulties negatively affecting their parenting skills. The care workforce should be trained in order to provide culturally competent and compassionate support to help these families. Open access digital platforms are promising as autodidactic and self-help tools among hard-to-reach populations.

Mental health consequences of armed conflicts in children and adolescents: An overview of literature reviews

Introduction: Armed conflicts affect the mental health of children and adolescents. Their outcomes in these populations have been documented identifying vulnerability and significant biopsychosocial damage as the most common factors. Objective: To identify and synthesize the mental health consequences of armed conflicts in children and adolescents. Materials and methods: We carried out a comprehensive and systematic search of reviews published until July 2019 in the MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, and LILACS databases, as well as in additional sources. The information was retrieved and analyzed narratively by describing the characteristics and objectives of the studies and the mental health consequences of armed conflicts in three periods of time: pre-armed conflict, during the armed conflict, and post-conflict. Results. Out of 587 potentially relevant studies, we finally selected 72. In the pre-armed conflict period, we described in detail the psychological experiences and the anticipatory somatic symptoms. During the conflict, we identified regressive, behavioral, and cognitive symptoms such as enuresis, fear, sadness, aggression, hyperactivity, and inattention, among others. Direct mental health consequences such as adjustment disorders, depression, anxiety, and post-traumatic stress were also identified. Finally, in the postconflict period, we referred to the transmission of mental health consequences and resilience processes. On the other hand, we reviewed in depth the potential consequences of armed conflicts on biopsychosocial development, morality, identity, culture, education, and society. Conclusion. The development of mental health consequences due to the exposure to armed conflicts in these populations is a complex process that depends on the stage of the exposure, the length of the conflict, and contextual factors.

A Scoping Review of the Health of African Immigrant and Refugee Children

Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.

The Strengths and Difficulties Questionnaire as a Mental Health Screening Tool for Newly Arrived Pediatric Refugees

Many refugee children have exposure to trauma prior to arrival and during resettlement. Mental health screening in primary care among resettled refugee children is needed. The Strengths and Difficulties Questionnaire (SDQ) was used to screen refugee children age 4-18 years at their Domestic Medical Examination and three other primary care visits in their first year of resettlement. We tested the association between time and SDQ score or intervention/referral, and differences based on geographic origin. SDQ scores were highest upon arrival (Ps < .0005). Referrals were most common at the six-month visit compared to arrival and one month (Ps < .01). Iraqi children had higher SDQ scores at all visits (Ps < .03). The SDQ can be used in primary care to screen newly arrived refugee children. Practitioners should screen at arrival to identify difficulties. Those with difficulties continuing at six months may need an intervention or referral.

Optimising refugee children's health/wellbeing in preparation for primary and secondary school: a qualitative inquiry

Background

Children from refugee backgrounds are less likely to access appropriate health and social care than non-refugee children. Our aim was to identify refugee children’s health/wellbeing strengths and needs, and the barriers and enablers to accessing services while preparing for primary and secondary school, in a low socio-economic multicultural community in Australia.

Method

Ten focus groups were facilitated with Arabic-speaking refugee parents of children aged 2–5 years (n = 11) or in first year secondary school (n = 22); refugee adolescents starting high school (n = 16); and key service providers to refugee families (n = 27). Vignettes about a healthy child and a child with difficulties guided the discussions. Data was thematically analysed and feedback sought from the community via the World Café method.

Results

Personal resilience and strong family systems were identified as strengths. Mental health was identified as a complex primary need; and whilst refugees were aware of available services, there were issues in knowing how to access them. Opportunities for play/socialisation were recognised as unmet adolescent needs. Adults spoke of a need to support integration of “old” and “new” cultural values. Parents identified community as facilitating health knowledge transfer for new arrivals; whilst stakeholders saw this as a barrier when systems change. Most parents had not heard of early childhood services, and reported difficulty accessing child healthcare. Preschooler parents identified the family “GP” as the main source of health support; whilst parents of adolescents valued their child’s school. Health communication in written (not spoken) English was a significant roadblock. Differences in refugee family and service provider perceptions were also evident.

Conclusions

Refugee families face challenges to accessing services, but also have strengths that enable them to optimise their children’s wellbeing. Culturally-tailored models of care embedded within GP services and school systems may assist improved healthcare for refugee families.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7183-5) contains supplementary material, which is available to authorized users.

Mental Health Impact of Hosting Disaster Refugees: Analyses from a Random Sample Survey Among Haitians Living in Miami

OBJECTIVES

Studies on the mental health of families hosting disaster refugees are lacking. This study compares participants in households that hosted 2010 Haitian earthquake disaster refugees with their nonhost counterparts.

METHODS

A random sample survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants were assessed regarding their 2010 earthquake exposure and impact on family and friends and whether they hosted earthquake refugees. Using standardized scores and thresholds, they were evaluated for symptoms of three common mental disorders (CMDs): posttraumatic stress disorder, generalized anxiety disorder, and major depressive disorder (MDD).

RESULTS

Participants who hosted refugees (n = 51) had significantly higher percentages of scores beyond thresholds for MDD than those who did not host refugees (n = 365) and for at least one CMD, after adjusting for participants' earthquake exposures and effects on family and friends.

CONCLUSIONS

Hosting refugees from a natural disaster appears to elevate the risk for MDD and possibly other CMDs, independent of risks posed by exposure to the disaster itself. Families hosting refugees deserve special attention.

Immigration-related mental health disorders in refugees 5-18 years old living in Turkey

PURPOSE

This study assessed early-onset psychiatric disorders and factors related to these disorders in a group of refugee children after immigration due to war.

MATERIALS AND METHODS

This study was conducted between January 2016 and June 2016. Clinical interviews were conducted with 89 children and their families, and were performed by native speakers of Arabic and Persian who had been primarily educated in these languages and were living in Turkey. A strengths and difficulties questionnaire (SDQ) that had Arabic and Persian validity and reliability was applied to both children and their families. Independent variables for cases with and without a psychiatric disorder were analyzed using the χ² test for categorical variables, Student's t-test for those that were normally distributed, and Mann-Whitney U-test for data that were not normally distributed. Data that showed significant differences between groups who had a psychiatric disorder and on common effects in emerging psychiatric disorders were analyzed through binary logistic regression analysis.

RESULTS

A total of 89 children and adolescents were interviewed within the scope of the study. The mean age of cases was 9.96±3.98 years, and 56.2% (n=50) were girls, while 43.8% (n=39) were boys. Among these children, 47 (52.8%) had come from Syria, 27 (30.3%) from Iraq, 14 (15.7%) from Afghanistan, and 1 (1.1%) from Iran. A psychiatric disorder was found in 44 (49.4%) of the children. A total of 26 children were diagnosed with anxiety disorders, 12 with depressive disorders, 8 with trauma and related disorders, 5 with elimination disorders, 4 with attention deficit/hyperactivity disorder, and 3 with intellectual disabilities. It was determined that seeing a dead or injured person during war/emigration and the father's unemployment increased the risk of psychopathology. The OR was 7.077 (95% CI 1.722-29.087) for having seen a dead or injured individual and 4.51 (95% GA 1.668-12.199) for father's employment status.

CONCLUSION

Within the context of war and emigration, these children try to cope with the negative circumstances they experience prior to migration, as well as the despair they see their parents experience.

Caring for Refugee Youth in the School Setting

Annually, over 80,000 refugees enter the United States as a result of political or religious persecution. Of these, approximately 35% to 40% are children and adolescents. Refugees are faced with challenges associated with living conditions, cultural and social norms, and socioeconomic status due to problems occurring in their homelands. These challenges include but are not limited to malnutrition, communicable disease, questionable immunization status, lack of formal education, sexual abuse, violence, torture, human trafficking, homelessness, poverty, and a lack of access to health care. Moreover, the psychological impact of relocation and the stress of acculturation may perpetuate many of these existing challenges, particularly for refugee youth, with limited or underdeveloped coping skills. School nurses are uniquely poised to support refugee youth in the transition process, improve overall health, and facilitate access to primary health services. The purpose of this article is to provide an overview of the unique refugee experience, examine the key health care needs of the population, and present school nurses with timely and relevant resources to assist in caring for refugee youth.

Unaccompanied Immigrant Minors: Where to Begin

The number of unaccompanied immigrant minors (UIMs) from Central America significantly increased in 2014. Nearly 50,000 children from El Salvador, Guatemala, and Honduras crossed the United States-Mexico border in 2014, compared with 3,933 in 2011. Few resources exist to guide pediatric nurse practitioners (PNPs) in their care of UIM. The multifactorial reasons behind migration and the state of children's health in Central America provide insight into the needs of UIMs. Guidelines for similar groups such as foreign-born children and refugees offer direction for the health care considerations of UIMs. This article provides demographic information on UIMs, highlights the unique and challenging medical and mental health issues facing UIMs, and discusses the role of the PNP. A UIM's initial visit with a PNP serves as an opportunity to build trust through culturally competent, trauma-informed care, provide preventive care, assess for unmet health needs, and screen for mental health conditions.

The relative impacts of uncertainty and mothers' communication on hopelessness among Palestinian refugee youth

The life of adolescent refugees has been described as uncertainty laden. Yet no quantitative data exist to elucidate that experience of uncertainty, investigate its implications in that population, or explore potential moderators. This study applies the Entropy Model of Uncertainty (Hirsh, Mar, & Peterson, 2012) and the stress-buffering hypothesis (for review, see Hegelson, 2003) to examine the experience of uncertainty among adolescent Palestinians living in refugee camps in Lebanon. It then tests the role of mothers' uncertainty-related communication for adolescent hopelessness. One hundred and sixty-two adolescents across 2 refugee camps in Lebanon participated in the study. Results support the existence of elevated levels of uncertainty about both personal and macrosecurity, show an association between uncertainty regarding personal security and levels of hopelessness, and suggest that uncertainty's negative impact may overwhelm the role of mothers' supportive communication as a buffer against hopelessness. Interestingly, the data also suggest surprisingly little hopelessness in this population.

Extreme Weather Events and Mental Health: Tackling the Psychosocial Challenge

Climate change is an emerging challenge to the mental health of entire humanity. Several studies, in recent times, have brought to light the adverse public mental health outcomes of extreme weather events for the suffering communities. The general public and the policy making bodies need to gain awareness about these impacts. Through such awareness, communities and their governments can institutionalize mechanisms to provide psychological support to the populations affected by climate change, before it becomes a massive public health challenge and starts affecting the social and vocational lives of people. There is an urgent need for addressing these impacts. The aim of this paper is to provide an overview of the deleterious effects of climate change related extreme weather events on mental health, the worldwide response of several communities to such events, and preparedness of the public and government to deal with these adverse mental health impacts. Policy imperatives to prevent and mitigate these impacts have been suggested. It is hoped that the psychologists, governments, and communities will act earnestly to prevent the impending harm to human mental health due to climate change.