Living conditions and emotional profiles of Cambodian, Central American, and Québécois youth

Immigrant child health in Canada: a scoping review

Introduction

Understanding the health of immigrant children from birth to 18 years of age is important given the significance of the early childhood years and complexity of factors that may influence the health status of immigrant populations. Thus, the purpose of this review was to understand the extent and nature of the literature on the health of immigrant children in Canada.

Methods

We conducted a scoping review of the literature. The review was focused on studies of first-generation and second-generation immigrant children aged 0–18 years. We completed standardised data extraction of immigration status, immigration route, age of children, data source, health or clinical focus, country of origin and major findings.

Results

In total, 250 published papers representing data from 237 studies met the inclusion criteria for this study. A total of 178 articles used quantitative methodologies (mostly survey and cross-sectional study designs), 54 used qualitative methodologies and 18 used mixed methodologies. The articles considered in this review included 147 (59%) focusing on physical health, 76 (30%) focusing on mental health and 37 (15%) focusing on the social aspects of health for refugee and first-generation and second-generation immigrant children across the provinces and territories of Canada.

Conclusions

Several literature gaps exist with respect to child immigrant health in Canada. For instance, there are no exclusive studies on immigrant boys and limited studies on children of international students.

The epidemiology of PTSD and depression in refugee minors who have resettled in developed countries

BACKGROUND

With an increasing number of refugees migrating across continents, the crisis is very apparent.

AIM

A literature review of patterns, risk factors and effects of post-traumatic stress disorder (PTSD) and depression in refugee minors was carried out involving those who have resettled in different developed countries.

METHODS

Papers were narrowed down by reading the abstracts and methods to ascertain whether the refugee children had resettled in developed countries and to ensure that they had not just been internally displaced.

RESULTS

High incidences of PTSD and depression were found in refugee minors and poorer mental health was correlated with increased exposure to violence. Factors such as social support and family security were important in reducing the rates of PTSD and depression, whereas the implications of age and gender were unclear. Long-term effects from these mental illnesses indicated scholastic issues, but no further worsening of symptoms.

CONCLUSIONS

Further research is needed regarding the follow-up of refugee minors with PTSD and depression to allow the establishment of more effective support systems, as long-term outcomes become more clearly understood. Few papers discuss the influence of religion, which may be an interesting line of future research as refugees move to more secular societies.

Learning Problems in Children of Refugee Background: A Systematic Review

CONTEXT

Learning problems are common, affecting up to 1 in 10 children. Refugee children may have cumulative risk for educational disadvantage, but there is limited information on learning in this population.

OBJECTIVE

To review the evidence on educational outcomes and learning problems in refugee children and to describe their major risk and resource factors.

DATA SOURCES

Medline, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Education Resources Information Center.

STUDY SELECTION

English-language articles addressing the prevalence and determinants of learning problems in refugee children.

DATA EXTRACTION

Data were extracted and analyzed according to Arksey and O'Malley's descriptive analytical method for scoping studies.

RESULTS

Thirty-four studies were included. Refugee youth had similar secondary school outcomes to their native-born peers; there were no data on preschool or primary school outcomes. There were limited prevalence data on learning problems, with single studies informing most estimates and no studies examining specific language disorders or autism spectrum disorders. Major risk factors for learning problems included parental misunderstandings about educational styles and expectations, teacher stereotyping and low expectations, bullying and racial discrimination, premigration and postmigration trauma, and forced detention. Major resource factors for success included high academic and life ambition, "gift-and-sacrifice" motivational narratives, parental involvement in education, family cohesion and supportive home environment, accurate educational assessment and grade placement, teacher understanding of linguistic and cultural heritage, culturally appropriate school transition, supportive peer relationships, and successful acculturation.

LIMITATIONS

Studies are not generalizable to other cohorts.

CONCLUSIONS

This review provides a summary of published prevalence estimates for learning problems in resettled refugee children, highlights key risk and resource factors, and identifies gaps in research.

A scoping review of mental health issues and concerns among immigrant and refugee youth in Canada: Looking back, moving forward

BACKGROUND

Youth comprise a significant portion of the total immigrant population in Canada. Immigrant and refugee youth often have different migration trajectories and experiences, which can result in different mental health outcomes. Research is emerging in this area, but study findings have not yet been consolidated.

RESEARCH QUESTION

What is known from the existing literature about mental health issues and concerns among immigrant and refugee youth in Canada?

METHOD

We searched Embase, Health Star, Medline, CINAHL, PsycINFO, and Social Science Abstracts databases for the period 1990-2013 for Canadian studies related to the mental health of youth born outside Canada. Seventeen studies met inclusion criteria.

RESULTS

Determinants of mental illness included pre-migration experiences, number of years since immigration to Canada, post-migration family and school environment, in- and out-group problems, discrimination, and lack of equitable access to health care. Only a few common categories of mental illness were identified, and the burden of mental illness was shared differently across gender and immigration status, with female youth experiencing more mental health problems than male youth. Some studies identified fewer emotional and behavioural problems among refugee youth; others reported higher rates of psychopathology among refugee youth compared with their Canadian-born provincial counterparts. Pre-migration experiences and the kinds of trauma experienced were important for refugee youth's mental health. Findings also indicated the importance of family involvement, school settings as points of care and services, and in terms of timing, focusing on the first year of arrival in Canada.

PRACTICE IMPLICATIONS

Professionals must work across health, social, and settlement sectors to address the various pre- and post-migration determinants of mental health and illness, and provide more timely and effective services based on how and when these determinants affect different groups of youth.

Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors

We undertook a systematic search and review of individual, family, community, and societal risk and protective factors for mental health in children and adolescents who are forcibly displaced to high-income countries. Exposure to violence has been shown to be a key risk factor, whereas stable settlement and social support in the host country have a positive effect on the child's psychological functioning. Further research is needed to identify the relevant processes, contexts, and interplay between the many predictor variables hitherto identified as affecting mental health vulnerability and resilience. Research designs are needed that enable longitudinal investigation of individual, community, and societal contexts, rather than designs restricted to investigation of the associations between adverse exposures and psychological symptoms. We emphasise the need to develop comprehensive policies to ensure a rapid resolution of asylum claims and the effective integration of internally displaced and refugee children.

Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors

Children and adolescents who are forcibly displaced represent almost half the world's internally displaced and refugee populations. We undertook a two-part systematic search and review of the evidence-base for individual, family, community, and societal risk and protective factors for the mental health outcomes of children and adolescents. Here we review data for displacement to low-income and middle-income settings. We draw together the main findings from reports to identify important issues and establish recommendations for future work. We draw attention to exposure to violence as a well established risk factor for poor mental health. We note the paucity of research into predictor variables other than those in the individual domain and the neglect of other variables for the assessment of causal associations, including potential mediators and moderators identifiable in longitudinal work. We conclude with research and policy recommendations to guide the development and assessment of effective interventions.

Self-reported mental health in 12-year-old second-generation immigrant children in Sweden

BACKGROUND

Today 29.3% of all newborns in Sweden are second-generation immigrants. Studies on mental health among these children are few, inconclusive and vary widely with regard to the informant used and the age of the immigrant. The majority of previous studies focus on study groups that cover a wide age span but since mental health varies considerably during the preadolescent and adolescent years, more age-specific studies are needed. Additional focus on the health and well-being of these children is necessary if a well-functioning society is to develop.

AIM

To investigate whether and how second-generation immigrant children in Sweden differ from non-immigrant children in their presentation of self-reported mental health at the age of 12.

METHODS

Second-generation immigrant children (n = 142) from a birth cohort in southern Sweden, subjects of the SESBiC-study (the South East Sweden Birth Cohort-study) were compared with non-immigrant children (n = 1036) from the same cohort in their presentation of self-reported mental health at the age of 12 using the Strengths and Difficulties Questionnaire. Gender, family structure and parents' educational level were controlled for.

RESULTS

Second-generation immigrant children did not differ from the non-immigrant children in their own presentation of mental health at the age of 12 in any of the categories of immigrant groups.

CONCLUSION

It is a promising sign for future integration that second-generation immigrant children's self-reported mental health at the age of 12 was quite similar to that of non-immigrant children.

Better mental health in children of Vietnamese refugees compared with their Norwegian peers--a matter of cultural difference?

BACKGROUND

There are conflicting results on whether immigrant children are at a heightened risk of mental health problems compared with native youth in the resettlement country. THE OBJECTIVE OF THE STUDY: To compare the mental health of 94 Norwegian-born children from a community cohort of Vietnamese refugees, aged 4 - 18 years, with that of a Norwegian community sample.

METHODS

The SDQ was completed by two types of informants; the children's self-reports, and the parents' reports, for comparison with Norwegian data from the Health Profiles for Children and Youth in the Akershus study.

RESULTS

The self-perceived mental health of second-generation Vietnamese in Norway was better than that of their Norwegian compatriots, as assessed by the SDQ. In the Norwegian-Vietnamese group, both children and parents reported a higher level of functioning.

CONCLUSION

This surprising finding may result from the lower prevalence of mental distress in Norwegian-Vietnamese children compared with their Norwegian peers, or from biased reports and cultural differences in reporting emotional and behavioural problems. These findings may represent the positive results of the children's bi-cultural competencies.

Traumatic Experiences and Post-traumatic Stress Symptoms in Kurdish Children in their Native Country and in Exile

BACKGROUND

  Traumatic experiences and post-traumatic stress symptoms were assessed in Kurdish children in their native country and in exile.

METHOD

  312 randomly selected school-age children at two sites completed assessments of traumatic experiences and post-traumatic symptoms.

RESULTS

  Although traumatic experiences showed more similarities than differences between the two samples, the PTSD frequencies and post-traumatic stress symptom scores were higher in Kurdistan than in exile. Living in exile showed negative correlation with PTSD frequencies and post-traumatic stress symptom scores.

CONCLUSIONS

  Living in exile seems to have trauma healing effect on children of Kurdistan.

Prevalence and correlates of conduct disorder and problem behavior in Caribbean and Filipino immigrant adolescents

This study investigates the prevalence and subtypes of conduct disorder (CD) and behavioral problems among youth in two communities characterized by prolonged parent-child separation upon immigration. CD and problem behaviors were assessed in 252 Caribbean-Canadian and Filipino-Canadian adolescents (12-19-year-old) using the DISC-C, the YSR and the CBCL cross-informant construct. Adolescents reported less problem behaviors than their host country peers, despite immigrant background or parent-child separation. The high adolescent-onset CD rate supports the hypothesis that psychosocial stressors play a role in the emergence of the disorder. Specifically, high levels of perceived racism and low collective self-esteem predicted problem behaviors in these youngsters.

Traumatic experiences and post-traumatic stress disorder in Kurdistanian children and their parents in homeland and exile: an epidemiological approach

The prevalence and correlates of post-traumatic stress disorder (PTSD) were assessed in random samples of school-aged Kurdistanian children and their parents in homeland and exile. Of the 376 eligible children at the two sites, 312 children and their parents (293 mothers and 248 fathers) completed the Harvard-Uppsala Trauma Questionnaire and Posttraumatic Stress Symptom interviews for children, and Harvard Trauma Questionnaire for parents. Unlike their children, fathers showed significantly higher PTSD frequencies in exile than in the homeland. The fathers' PTSD negatively correlated with the living standard and fathers' education, while child PTSD mostly correlated with maternal education and living in exile. Living in exile seems to have a negative impact on fathers' post-traumatic reactions, despite its positive influence on children. High drop-outs in exile limit the conclusions.

Global evidence for a biopsychosocial understanding of refugee adaptation

Early research on refugee mental health and adaptation has largely proceeded from a life-events/biomedical framework. That approach has helped elucidate the relationship between life events and psychiatric symptoms, but has been criticized as reductionistic or exclusionary. This article argues that the complexity of the social domain of refugee experience and the causal interactions among biological, psychological and social domains make individual effects difficult to study in isolation. A biopsychosocial approach could complement the more focal research to move the field forward. Evidence in support of this position is marshaled from new analyses conducted on a meta-analytic data set of five decades of the worldwide empirical literature on refugee mental health, reflecting data derived from 67,294 primary study participants (Porter & Haslam, 2005). Results demonstrate the importance of higher-order interactions between distal and proximal social variables, as well as associations among biological, psychological and community-level social functioning in refugees. Interdisciplinary research and novel analytic methods can complement more focal research. The presumed benefits of returning refugees to their country of origin are questioned in light of the important effects of social variables on refugee adaptation.

Caring for migrant and refugee children: challenges associated with mental health care in pediatrics

This article reviews aspects of the mental health care of migrant and refugee children. It highlights the challenges of access to care for these children and of considering the role of pediatricians in their mental health care. It also looks at the sources of differences in presentation of mental health issues of migrant youth when compared with dominant culture youth, examining the contributions of culture, context, and the families' own views. Models of care will be described that have tried to elicit a better understanding of the difficulties migrant and refugee children may encounter. Some avenues through which we may expand our current psychiatric models of care will also be addressed. These avenues include the use of interpreters and cultural brokers, addressing the debate around ethnic matching between therapists and patients, promoting a sensitivity to otherness and mediation, and looking at the importance of time issues.

Profile of a metropolitan North American immigrant suicidal adolescent population

OBJECTIVE

Canadian immigrant adolescents have a lower suicide rate than their nonimmigrant peers. We conducted a hypothesis-generating analysis to determine whether this lower rate correlated with level of drug use and (or) with diagnostic and demographic characteristics of Canadian immigrant adolescents presenting to an emergency room for crisis assessment.

METHOD

Known risk factors for suicide were compared among immigrant youth, North American youth, and a culturally mixed group of youth at baseline and at 6-month follow-up.

RESULTS

The immigrant group was only differentiated by a lower rate of reported drug use.

CONCLUSION

The lower rate of reported drug use at the time of crisis may contribute to the lower suicide rate among immigrants.

Trauma and coping in Somali and Oromo refugee youth

PURPOSE

To describe war-related trauma history, immigration factors, problems, and coping of Somali and Oromo refugee youth.

METHODS

Analysis of a subset of participants (N = 338) aged 18-25 years from a population-based survey of Somali and Oromo refugees conducted in 2000-2002. Data included trauma history, life situation, and scales for physical (Cronbach alpha =.69), psychological (alpha =.56), and social problems (alpha =.69). Data were analyzed using Chi-square and Mann-Whitney U tests.

RESULTS

Average emigration age was 14.8 years, with 4.2 years in transit and 2.0 years in the United States; 60% reported plans to return home to live. Two-thirds (66%) had less than a high school education, 49% had English language problems, 49% were employed (38% female vs. 57% male); 70% were single, with Somali females more likely than Oromo to be partnered and mothers (39% vs. 19%). There were significant ethnicity/gender differences for all problem scales. More females reported feeling alone (24% vs. 61%, p <.001). Youth with symptoms of posttraumatic stress syndrome reported more traumatic events (mean number of events: 28 vs.16). Trauma history was strongly associated with physical, psychological, and social problems. Most frequent strategies to combat sadness were praying (55.3%), sleeping (39.9%), reading (32.3%), and talking to friends (27.8%).

CONCLUSIONS

Many young Somali and Oromo immigrants to the United States experience life problems associated with war trauma and torture, but many others are coping well. The findings suggest a need to develop age-appropriate strategies to promote the health of refugee youth to facilitate their successful adaptation to adult life in the United States.

The complexity of trauma response: a 4-year follow-up of adolescent Cambodian refugees

OBJECTIVE

The objective of this study was to document the psychosocial adjustment of young refugees during their adolescence and its association with the war-related trauma experienced by their family before migration.

METHOD

Data were collected on 57 young Khmer resettled in Montreal and followed from early to late adolescence. The associations between premigratory exposure to political violence and postmigratory mental health and social adjustment were estimated for early, mid-, and late adolescence.

RESULTS

The associations between premigratory exposure to political violence and postmigratory psychosocial adjustment fluctuated over the adolescence period. Overall, the adolescents whose families were more highly exposed to political violence tended to report a more positive social adjustment and less mental health symptoms than those less exposed.

CONCLUSION

The high expectations of Cambodian parents towards their children and the preservation of traditional values despite the Khmer rouge attempts to eradicate them might contribute to explain the paradoxical association between the families' exposure to political violence and the adolescents' psychosocial adjustment in the host country. Although children and adult refugees seen in clinical setting are reminders of the negative effects of adversity, resilience should be more systematically explored in community samples to further our understanding of the long-term effects of trauma.

Predictors of self-reported problem behaviours in Turkish immigrant and Dutch adolescents in the Netherlands

BACKGROUND

Although many studies have compared psychopathology in different cultures, not much is known about factors that contribute to the observed differences.

METHODS

We compared self-reported emotional and behavioural problems in 363 Turkish immigrant and 1098 Dutch adolescents in the Netherlands and we evaluated the contribution of adolescent, parent, family and stress-related factors to the observed ethnic differences. Data were drawn from the Dutch version of the Youth Self-Report (YSR), as well as from Dutch and Turkish parental questionnaires.

RESULTS

Turkish girls scored higher on four of the eight YSR syndrome-scales, on the Internalising broadband scale and on total problems than Dutch girls. Turkish boys scored higher on three syndrome scales and on the Internalising scale, but scored less on Delinquent Behaviour than their Dutch peers. Ethnic differences for both sexes were most pronounced on the Withdrawn and Anxious/Depressed scales. Socio-economic measures, in particular education of the parents, contributed most to the explanation of ethnic differences on the Somatic Complaints scale for girls and Social Problem and Internalising scales for boys. On most scales, however, ethnic differences could not be explained by other factors. The distribution of some factors appeared to be more favourable (i.e., less frequent) for Turkish than for Dutch youths, such as referral of family members to mental health services.

CONCLUSIONS

Low educational levels of the parents play an important, yet not an exclusive role in explaining cross-cultural differences in emotional and behavioural problems in adolescents. In particular, differences in Withdrawn and Anxious/Depressed behaviour could not be explained by non-cultural factors. This study offers starting-points for future research on cultural-specific predictors of psychopathology in immigrants.