1
|
D'Andrea W, Aboagye A, Lee KA, Freed S, Joachim B, Khedari-DePierro V, Yates EH, Wilmes A, Krohner S, Madhoun S, Hennawi A, Bergholz L. Growing Up on the Edge: A Community-Based Mental Health Intervention for Children in Gaza. Res Child Adolesc Psychopathol 2024; 52:833-848. [PMID: 37966687 DOI: 10.1007/s10802-023-01124-2] [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] [Accepted: 09/06/2023] [Indexed: 11/16/2023]
Abstract
The Gaza Strip is a notoriously high-conflict area, but few large-scale studies have examined the rates of psychiatric distress and emotional/behavioral problems among Gaza youth, and there are few trauma-informed, scaleable intervention options. Studies in existence have used smaller samples or have examined focal problems such as posttraumatic stress disorder (PTSD) or aggression. Here, we examine the mental health burden of young individuals (ages 8-13) in Gaza across a broad range of symptoms, and demonstrate the impact of a community-based, trauma-informed program, Eye to the Future. At the outset of this supportive youth program, over 2000 children and adolescent youth and their parents reported on child well-being using standardized measures with established global norms (the Child Behavior Checklist and Youth Self Report). These measures examine symptoms broadly (e.g. anxiety, depression, social problems, attention problems, aggression, etc.). Relative to U.S. population estimates, children in Gaza had between 2.5- and 17-times higher point prevalence of clinical mental health problems. The most significant clinical concern was anxiety, but overall, their symptoms were not confined to posttraumatic stress as a disorder and were instead broadly dispersed. However, these concerns were responsive to intervention: over the course of a six-month community psychosocial program, symptoms ameliorated, with approximately 50-70% showing reliable improvement at post-program (varying by measure). These gains were maintained in a 9-month follow-up. Future work should consider the broader mental health impact, beyond PTSD and aggression, and incorporate community supports into addressing mental health among children in the region.
Collapse
Affiliation(s)
- Wendy D'Andrea
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA.
| | - Adjoa Aboagye
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA
| | - Kellie Ann Lee
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA
| | - Steven Freed
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA
| | - Brandon Joachim
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA
| | - Vivian Khedari-DePierro
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA
| | - Ellen H Yates
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA
| | - Annedore Wilmes
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA
| | - Shoshana Krohner
- The New School, Department of Psychology, 80 Fifth Avenue, Floor 6, New York, NY, 10011, USA
| | - Saaed Madhoun
- CARE Palestine (West Bank/Gaza), 6 AlJozeh St., Bet Hanina, Jerusalem, P.O.Box 54258, Jerusalem, 91541, Israel
| | - Ahmed Hennawi
- CARE Palestine (West Bank/Gaza), 6 AlJozeh St., Bet Hanina, Jerusalem, P.O.Box 54258, Jerusalem, 91541, Israel
- Save the Children International, Middle East, North Africa, and Eastern Europe Regional Office, PO Box 941878, Amman, 11194, Jordan
| | - Lou Bergholz
- Edgework Consulting, 114 State St, 4th Floor, Boston, MA 02109, USA
| |
Collapse
|
2
|
Shank LM, Grace V, Delgado J, Batchelor P, de Raadt St James A, Sundaresan A, Bouchedid L. The impact of a guided paced breathing audiovisual intervention on anxiety symptoms in Palestinian children: a pilot randomized controlled trial. Child Adolesc Ment Health 2023; 28:473-480. [PMID: 36575823 DOI: 10.1111/camh.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Children in Palestine may be at high risk for anxiety symptoms. However, access to mental health services is limited. Therefore, the objective of this study was to conduct a pilot randomized controlled trial to examine whether a guided audiovisual paced breathing intervention was feasible, acceptable, and improved anxiety symptoms in Palestinian children. METHODS Students (6-10 years old) in an after-school program in Palestine were randomly assigned to the intervention or control condition. All participants completed a pre- and post-intervention measure of anxiety using the Revised Children's Manifest Anxiety Scale. Participants in the intervention completed 24 sessions over 8 weeks and rated breathing ease as well as pre- and post-session relaxation on a 5-point Likert scale. To examine condition differences in post-intervention anxiety, four analyses of covariance were conducted, adjusting for age, sex, and pre-intervention anxiety. RESULTS A total of 144 participants (65.3% girls; Mage = 7.5 ± 1.2; 50% per condition) enrolled in the study. There were no differences in demographics or baseline anxiety between the two conditions (ps > .05). Participants reported that it was easy to breathe during the sessions (Ms = 4.1-4.7, SDs = 0.5-1.1). For all but the first session, participants reported being more relaxed after the breathing session than before (ps < .003). Post-intervention, participants in the intervention reported fewer anxiety symptoms compared to participants in the control condition (ps < .01). CONCLUSION A guided paced breathing audiovisual intervention was feasible and had a significant positive impact on anxiety symptoms in Palestinian children compared to a control condition. Future research should examine whether the audiovisual guided breathing intervention significantly improves long-term outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Lara Bouchedid
- The Middle East Children's Institute, Deir Ghassaneh Women's Society Building, Bani Zeid al-Gharbia, Ramallah, Palestine
| |
Collapse
|
3
|
Diab M, Veronese G, Abu Jamei Y, Hamam R, Saleh S, Zeyada H, Kagee A. Psychosocial concerns in a context of prolonged political oppression: Gaza mental health providers' perceptions. Transcult Psychiatry 2023; 60:577-590. [PMID: 34986045 DOI: 10.1177/13634615211062968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this qualitative exploratory study, we investigated the perspectives of mental health providers in Gaza, Palestine, regarding the primary concerns of their clients who are exposed to low-intensity warfare and structural violence. We conducted qualitative interviews with 30 psychologists, social workers, psychiatric nurses, and psychiatrists providing services to communities in Gaza. Participants were asked to discuss their clients' most commonly occurring mental health problems, diagnoses, and psychosocial conditions. Thematic analysis identified one superordinate theme (Impact of the Blockade on Mental Health and Quality of Life) and four second-order themes (Concerns about Social Problems, General Concerns about Quality of Life, Concerns about the Mental Health of the Community, and Concerns Related to Children's Mental Health). Participants indicated that the social and political dimensions of mental health and the economic, educational, and health-related consequences of the ongoing blockade of Gaza were the main determinants of psychological burden among their clients. Findings demonstrated the importance of adopting an approach to mental health that includes understanding psychological indicators in a broader framework informed by human rights and social justice. Implications for research and clinical work are discussed, including the role of investments in social capital that may provide individuals with access to resources such as social support, which may in turn promote overall mental health.
Collapse
Affiliation(s)
- Marwan Diab
- Gaza Community Mental Health Programme
- Stellenbosch University
| | | | | | - Rawia Hamam
- Gaza Community Mental Health Programme
- Stellenbosch University
| | - Sally Saleh
- Gaza Community Mental Health Programme
- Stellenbosch University
| | - Hasan Zeyada
- Gaza Community Mental Health Programme
- Stellenbosch University
| | | |
Collapse
|
4
|
Smeeth D, McEwen FS, Popham CM, Karam EG, Fayyad J, Saab D, Rieder MJ, Elzagallaai AA, van Uum S, Pluess M. War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children. Mol Psychiatry 2023; 28:647-656. [PMID: 36385169 PMCID: PMC9908541 DOI: 10.1038/s41380-022-01859-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
Altered secretion of cortisol, the primary effector of the hypothalamus-pituitary-adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents. Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6-18 years) and their caregiver. This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon. The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of war-related events experienced. This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.
Collapse
Affiliation(s)
- Demelza Smeeth
- grid.4868.20000 0001 2171 1133Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Fiona S. McEwen
- grid.4868.20000 0001 2171 1133Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Cassandra M. Popham
- grid.4868.20000 0001 2171 1133Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Elie G. Karam
- grid.429040.bDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - John Fayyad
- grid.429040.bDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Dahlia Saab
- grid.429040.bDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Michael J. Rieder
- grid.39381.300000 0004 1936 8884Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada
| | - Abdelbaset A. Elzagallaai
- grid.39381.300000 0004 1936 8884Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada
| | - Stan van Uum
- grid.39381.300000 0004 1936 8884Division of Endocrinology and Metabolism, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON Canada
| | - Michael Pluess
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.
| |
Collapse
|
5
|
Measuring Traumatic Reactions in Palestinian Children: A Psychometric Assessment of the Children Revised Impact of Event Scale-Arabic Version (CRIES-13A). Child Psychiatry Hum Dev 2022; 53:16-26. [PMID: 33385256 DOI: 10.1007/s10578-020-01113-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
The aim of the present study was to test the measurement model and measurement invariance of the Impact of Event Scale (Arabic version) in a large sample of Palestinian children. We estimated (Study 1; n = 610) the measurement model using confirmatory factor analysis. In Study 2 (n = 864), we conducted multigroup (girls and boys) tests of measurement invariance. We pooled the data collected from the participants in the first two studies (Study 3, N = 1474) to assess overall score reliability, as well as the IES' convergent and divergent validity vis-à-vis other measures of child wellbeing and mental health. The outcomes of the statistical analyses supported an invariant 13-item measurement model (intrusion, avoidance, and hyperarousal) for CRIES-13A. Intrusion and hyper-arousal together made up a first-order domain of symptoms (re-experiencing). The combined findings of these studies suggest that the CRIES-13A displays robust psychometric properties and may be used in contexts of military violence.
Collapse
|
6
|
Simancas-Fernández MR, Celedón-Rivero JC, Salas-Picón WM, Salgado-Ruiz DE, Echeverry-Londoño MC, Vásquez-Campos JH, Guarch-Rubio M, Manzanero AL. Trauma, Reparation, and Quality of Life in Victims of Armed Conflict after Peace Agreements. ANUARIO DE PSICOLOGÍA JURÍDICA 2021. [DOI: 10.5093/apj2021a21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
7
|
Veronese G, Pepe A, Diab M, Abu Jamei Y, Kagee A. Social support, resilience, and mental health in a low-intensity warfare context: the effects of siege on university students in Gaza. J Ment Health 2021; 31:383-391. [PMID: 34607522 DOI: 10.1080/09638237.2021.1979486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gaza has long been enduring a quasi-total siege that significantly undermines quality of life in the region. Gazan youth are particularly affected by the ongoing economic recession, a disrupted environment, and health and food insecurity. These critical circumstances are worsened by the ongoing conflict between Palestine and Israel, which is a cause of death and destruction. AIMS This cross-sectional study investigated the effects of living under protracted siege conditions on mental distress, resilience, and social support among a sample of Palestinian university students living on the Gaza Strip. METHODS Five hundred fifty Palestinian university students were recruited at four universities in Gaza. They completed a battery of instruments, including the Gaza Siege Checklist, Depression, Anxiety and Stress Scale (DASS), Resilience Scale (RS), and Berlin Social Support Scales (BSSS). We used structural equation modelling (SEM) to test a conceptual model of social support and resilience as protective factors against the impact on mental distress of living under siege. RESULTS Our findings indicate that living under siege has direct adverse effects, leading to increased mental distress in the form of anxiety, depression, and acute stress. Enduring siege conditions compromises resilience and sources of social support, thereby increasing subjects' risk of developing psychological distress.
Collapse
Affiliation(s)
- Guido Veronese
- Department of Human Sciences and Education, University of Milano-Bicocca, Milan, Italy.,Department of Psychology, Stellenbosch University, Matieland, Stellenbosch, South Africa
| | - Alessandro Pepe
- Department of Human Sciences and Education, University of Milano-Bicocca, Milan, Italy
| | - Marwan Diab
- Department of Psychology, Stellenbosch University, Matieland, Stellenbosch, South Africa.,Gaza Community Mental Health Program, Gaza, Palestine
| | - Yasser Abu Jamei
- Department of Psychology, Stellenbosch University, Matieland, Stellenbosch, South Africa.,Gaza Community Mental Health Program, Gaza, Palestine
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Matieland, Stellenbosch, South Africa
| |
Collapse
|
8
|
Agbaria N, Petzold S, Deckert A, Henschke N, Veronese G, Dambach P, Jaenisch T, Horstick O, Winkler V. Prevalence of post-traumatic stress disorder among Palestinian children and adolescents exposed to political violence: A systematic review and meta-analysis. PLoS One 2021; 16:e0256426. [PMID: 34437595 PMCID: PMC8389374 DOI: 10.1371/journal.pone.0256426] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
Objective We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population. Methods PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted. Results The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I2 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures. Conclusion We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine.
Collapse
Affiliation(s)
- Nisreen Agbaria
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Stephanie Petzold
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Andreas Deckert
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Guido Veronese
- Department of Human Sciences & Education, University of Milano-Bicocca, Milan, Italy
| | - Peter Dambach
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Thomas Jaenisch
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Centre for Global Health, Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Olaf Horstick
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Volker Winkler
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
9
|
Harb GC, Schultz JH. The nature of posttraumatic nightmares and school functioning in war-affected youth. PLoS One 2020; 15:e0242414. [PMID: 33237929 PMCID: PMC7688112 DOI: 10.1371/journal.pone.0242414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students’ nightmares demonstrated frightening themes of being under attack and loss of self-efficacy/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students’ nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students’ nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.
Collapse
Affiliation(s)
- Gerlinde C. Harb
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America
- Arctic University of Norway, Tromsø, Norway
- * E-mail:
| | | |
Collapse
|
10
|
Manzanero AL, Palomo R. Dissociative Amnesia beyond the Evidence about the Functioning of Memory. ANUARIO DE PSICOLOGÍA JURÍDICA 2020. [DOI: 10.5093/apj2019a14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
11
|
Hodes M. New developments in the mental health of refugee children and adolescents. EVIDENCE-BASED MENTAL HEALTH 2019; 22:72-76. [PMID: 30944095 PMCID: PMC10270370 DOI: 10.1136/ebmental-2018-300065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 12/22/2022]
Abstract
The increase in refugees globally since 2010 and the arrival of many into Europe since 2015, around 50% of whom are under 18 years, have been the stimulus to greater investigation and publications regarding their mental health. This clinical review summarises selected themes in the field as described in the published literature since 2016. The themes include refugee statistics, premigration and postmigration experiences, psychopathology focusing on parent-child relationships, unaccompanied refugee minors and associations between resettlement, acculturation and mental health. Some important reviews and studies are discussed that address service and treatment provision. While there has been a recent increase in research in this field, more is needed into the course of psychopathology, protective factors and the promotion of integration into resettlement countries, as well as models of service delivery and treatment effectiveness.
Collapse
Affiliation(s)
- Matthew Hodes
- Department of Medicine, Centre for Psychiatry, Imperial College London, London, UK
- Westminster Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, UK
| |
Collapse
|