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Fortuna LR, Porche MV. Upholding the Human Rights and Well-Being of Refugee Children Through Effective Clinical Care. Child Adolesc Psychiatr Clin N Am 2024; 33:111-124. [PMID: 38395499 PMCID: PMC10894321 DOI: 10.1016/j.chc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Refugee children are often exposed to adversities and traumatic experiences that can harm the mental health and well-being of refugee children. These include human trafficking and exploitation and dangers in detention centers and refugee camps. All these adverse events can be traumatic and contribute to poor mental health, including posttraumatic stress, anxiety, depression, and substance use disorders. Therefore, the assessment of refugee children and adolescents should include screening and identification for these experiences, provision of evidence-based trauma treatment, and social supports to promote their well-being and thriving.
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Affiliation(s)
- Lisa R Fortuna
- University of California Riverside, School of Medicine Education Building 2, 5th Floor, Psychiatry and Neurosciences, 900 University Avenue, Riverside, CA 92521, USA.
| | - Michelle V Porche
- University of California, Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, 7M10, San Francisco, CA 94110, USA
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Milano BA, Moutoussis M, Convertino L. The neurobiology of functional neurological disorders characterised by impaired awareness. Front Psychiatry 2023; 14:1122865. [PMID: 37009094 PMCID: PMC10060839 DOI: 10.3389/fpsyt.2023.1122865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
We review the neurobiology of Functional Neurological Disorders (FND), i.e., neurological disorders not explained by currently identifiable histopathological processes, in order to focus on those characterised by impaired awareness (functionally impaired awareness disorders, FIAD), and especially, on the paradigmatic case of Resignation Syndrome (RS). We thus provide an improved more integrated theory of FIAD, able to guide both research priorities and the diagnostic formulation of FIAD. We systematically address the diverse spectrum of clinical presentations of FND with impaired awareness, and offer a new framework for understanding FIAD. We find that unraveling the historical development of neurobiological theory of FIAD is of paramount importance for its current understanding. Then, we integrate contemporary clinical material in order to contextualise the neurobiology of FIAD within social, cultural, and psychological perspectives. We thus review neuro-computational insights in FND in general, to arrive at a more coherent account of FIAD. FIAD may be based on maladaptive predictive coding, shaped by stress, attention, uncertainty, and, ultimately, neurally encoded beliefs and their updates. We also critically appraise arguments in support of and against such Bayesian models. Finally, we discuss implications of our theoretical account and provide pointers towards an improved clinical diagnostic formulation of FIAD. We suggest directions for future research towards a more unified theory on which future interventions and management strategies could be based, as effective treatments and clinical trial evidence remain limited.
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Affiliation(s)
- Beatrice Annunziata Milano
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
- Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michael Moutoussis
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- National Hospital of Neurology and Neurosurgery (UCLH), London, United Kingdom
| | - Laura Convertino
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- National Hospital of Neurology and Neurosurgery (UCLH), London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- *Correspondence: Laura Convertino,
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Amarasena L, Samir N, Sealy L, Hu N, Rostami MR, Isaacs D, Gunasekera H, Young H, Agrawal R, Levitt D, Francis JR, Coleman J, Mares S, Larcombe P, Cherian S, Raman S, Lingam R, Zwi K. Offshore detention: cross-sectional analysis of the health of children and young people seeking asylum in Australia. Arch Dis Child 2023; 108:185-191. [PMID: 36549868 DOI: 10.1136/archdischild-2022-324442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia's immigration policy of indefinite mandatory detention on Nauru. DESIGN Cross-sectional analysis of a cohort of CYP seeking asylum. SETTING Australian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia. PARTICIPANTS Sixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years. MAIN MEASURES Health outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools. RESULTS Over half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01); originated from the Eastern Mediterranean region (p<0.05); witnessed trauma (p<0.05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p<0.05). Neurodevelopmental concerns were seen in eight children (13%). CONCLUSIONS This study highlights the almost universal physical and mental health difficulties in a sample of CYP who experienced forced migration and were subjected to Australia's offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.
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Affiliation(s)
- Lahiru Amarasena
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia .,Community Child Health, Sydney Children's Hospital Randwick - Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Nora Samir
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia
| | - Louise Sealy
- Community Child Health, Sydney Children's Hospital Randwick - Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Nan Hu
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia
| | - Mohammad Reza Rostami
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - David Isaacs
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,The Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hasantha Gunasekera
- The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,The Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Helen Young
- Paediatrics, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rishi Agrawal
- Paediatric Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - David Levitt
- Mater Refugee Complex Care Clinic, Mater Misericordiae Health Services, Brisbane, Queensland, Australia.,Paediatrics, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research - Charles Darwin University, Darwin, Northern Territory, Australia.,Paediatric Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jacinta Coleman
- Adolescent Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Penny Larcombe
- Paediatrics, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sarah Cherian
- Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Discipline of Paediatrics, University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia.,Community Paediatrics, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia.,Community Child Health, Sydney Children's Hospital Randwick - Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Karen Zwi
- School of Women's and Children's Health, University of New South Wales - Randwick Campus, Sydney, New South Wales, Australia.,Community Child Health, Sydney Children's Hospital Randwick - Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Samir N, Amarasena L, Sealy L, Hodgins M, Gelaw Y, Lingam R, Zwi K. Ethics and governance for a multi-site study in Australia: Navigating the snakes and ladders. J Paediatr Child Health 2022; 58:16-23. [PMID: 34529302 DOI: 10.1111/jpc.15747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/26/2021] [Accepted: 09/05/2021] [Indexed: 11/28/2022]
Abstract
Multi-site research studies are essential if we are to conduct national research across all Australian jurisdictions. There is widespread agreement among clinicians and researchers that obtaining essential approvals to conduct multi-site research studies in Australia can be complex, bureaucratic and time consuming. Although there is inherent value in the review process, resources and months of valuable research time are often expended long before the study has begun. Using our recent experience for a multi-site, longitudinal paediatric cohort study of children and adolescents who were detained in offshore immigration detention on Nauru, we describe the process of navigating the ethics and governance approval systems. We identify tips for researchers and clinicians conducting multi-site studies, including early consultation with ethics and governance committees, using their recommended templates, anticipating time delays, and commencing time consuming processes as early as permissible. Our recommendations at the systemic level include streamlined and integrated ethics and governance review processes for all Australian jurisdictions, with co-ordinated requests for further information, a standardised approach across all Research Governance Offices, a rapid system for addressing amendments and individualised study support and consultations. Above all, a nationally agreed framework whereby ethics and governance committees across jurisdictions communicate with each other, use the same electronic platform and present a unified process whilst protecting the welfare, rights, dignity and safety of research participants is required. The complexity of the current ethics and governance processes may inadvertently and unintentionally be a barrier to conducting ethical research.
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Affiliation(s)
- Nora Samir
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lahiru Amarasena
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louise Sealy
- Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Michael Hodgins
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yalemzewod Gelaw
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Zwi
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Willey S, Desmyth K, Truong M. Racism, healthcare access and health equity for people seeking asylum. Nurs Inq 2021; 29:e12440. [PMID: 34312941 DOI: 10.1111/nin.12440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023]
Abstract
People seeking asylum are at risk of receiving poorer quality healthcare due, in part, to racist and discriminatory attitudes, behaviours and policies in the health system. Despite fleeing war and conflict; exposure to torture and traumatic events and living with uncertainty; people seeking asylum are at high-risk of experiencing long-term poor physical and mental health outcomes in their host country. This article aims to raise awareness and bring attention to some common issues people seeking asylum face when seeking healthcare in high-income countries where the health system is dominated by a Western biomedical view of health. Clinical case scenarios are used to highlight instances of racist healthcare policies and practices that create and maintain ongoing health disparities; limited access to culturally and linguistically appropriate health services, and lack of trauma-informed approaches to care. Nurses and midwives can play an important role in countering racism in healthcare settings; by identifying and calling out discriminatory practice and modelling tolerance, respect and empathy in daily practice. We present recommendations for individuals, organisations and governments that can inform changes to policies and practices that will reduce racism and improve health equity for people seeking asylum.
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Affiliation(s)
- Suzanne Willey
- Monash Nursing and Midwifery, Monash University Peninsula Campus, Frankston, VIC, Australia
| | - Kath Desmyth
- Victorian Refugee Health Program, Cohealth, Footscray, VIC, Australia
| | - Mandy Truong
- Monash Nursing and Midwifery, Monash University Clayton Campus, Clayton, VIC, Australia
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