Nutritional and Mental Health Status of Afghan Refugee Children in Peshawar, Pakistan: A Descriptive Study

Age and environmental factors predict psychological symptoms in adolescent refugees during the initial post-resettlement phase

BACKGROUND

Adolescent refugees are at high risk of developing mental disorders but are often not recognised early. This pilot study aimed to identify early putative risk factors associated with psychological symptoms in newly resettled refugee youth at potential risk of subsequently developing mental disorders.

METHODS

Newly resettled adolescent refugees were recruited through English language schools in Melbourne, Australia. Participants were assessed with the MINI-Kid, Achenbach Youth Self-Report and Reaction of Adolescents to Traumatic Stress scale. Parents completed a mental health screening separately. Linear regression models were used to identify predictive factors associated with symptom ratings.

RESULTS

Seventy-eight, ostensibly well, refugee adolescents (mean age = 15.0 ± 1.6 years) resettled in Australia for 6.1 ± 4.2 months were assessed. Levels of anxiety, depression and post-traumatic stress symptoms were considerably lower than in mainstream population data. Prior displacement was a key determinant of symptomatology. Transitory displacement, irrespective of duration, was associated with elevated scores for depression (t (47) = -4.05, p < 0.0001), avoidance/numbing (U = 466, p < .05) and total trauma (U = 506, p < .05) symptoms. Older age was a unique predictor of depression (F (1,74) = 8.98, p < .01), internalising (F(1,74) = 6.28, p < .05) and total (F(1,74) = 4.10, p < .05) symptoms, whilst parental depression symptoms (t = 2.01, p < 0.05), displacement (t = 3.35, p < 0.01) and, expectedly, trauma exposure (t = 3.94, p < 0.001) were unique predictors of post-traumatic stress symptoms.

CONCLUSIONS

Displaced status, older age, and parental symptoms predicted psychological symptoms in adolescent refugees in an initial relatively asymptomatic post-resettlement phase. The early recognition of at-risk refugee youth may provide an opportunity for preventative mental health interventions.

Epidemiology of violence against children in migration: A systematic literature review

BACKGROUND

Children in migration experience various forms of violence before, on, and after their migration journey. Epidemiological research on the prevalence of violence in this highly vulnerable group is lacking, however.

METHOD

A PRISMA-guided systematic literature review with a three-tiered search strategy was conducted by searching academic literature databases and gray literature on websites of international organizations and by contacting experts. All empirical studies published within the last 15 years were eligible. Predefined search terms related to violence, children, epidemiology, and migration were used.

FINDINGS

Of 1014 records, 17 studies met the inclusion criteria. Sample sizes ranged from 100 to 8,047, with a total of 16,915 children (Mdn = 311). Lifetime prevalence of violence varied considerably: Child physical maltreatment ranged from 9 %-65 % and child sexual abuse from 5 %-20 %. For internally displaced children, violence often occurred at the hands of those who were responsible for their care. Unfortunately, data on the context and country in which the violence occurred-in the country of origin, on route, or in the country of arrival-were lacking.

CONCLUSION

The discrepancy between the importance of the topic and the dearth of data is striking. Filling the gaps requires not only more rigorous methodology but also more research in general on the epidemiology of violence against children in migration. We outline methodological challenges and draft an agenda for improved data on the topic. There is an urgent need for evidence that supports the development and adaptation of effective, tailored, and child-sensitive prevention and intervention programs for children in migration.

Mental Health Outcomes for Youth Living in Refugee Camps: A Review

Currently, there are approximately 10.8 million child refugees worldwide. Youth living in refugee camps face a wide range of difficulties placing them at risk for trauma exposure and negative mental health outcomes. However, little is known about the mental health functioning of these youth. The present review provides a systematic review of mental health outcomes for refugee/displaced youth residing in refugee camps. Twenty studies were included in the present review. Among these studies, the prevalence of mental health disorders varied greatly with some studies reporting null effects for disorders like posttraumatic stress disorder and others reporting prevalence as high as 87%. Levels of anxiety, somatic symptoms, depression, and aggression also varied across studies. The results point to the significant need for more research on the mental health of youth residing in refugee camps. Despite the wide range of measurement approaches, the evidence points to a fairly consistent finding of a range of maladjustment problems for youth living in refugee camps. Implications for improving the methodology for investigating mental health are discussed.

Impact of the Introduction of the Electronic Health Insurance Card on the Use of Medical Services by Asylum Seekers in Germany

Objectives: Asylum seekers in Germany represent a highly vulnerable group from a health perspective. Furthermore, their access to healthcare is restricted. While the introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers instead of healthcare-vouchers is discussed controversially using politico-economic reasons, there is hardly any empirical evidence regarding its actual impact on the use of medical services. The aim of the study is to examine this impact on the use of medical services by asylum seekers as measured by their consultation rate of ambulant physicians (CR). Study Design: For this purpose, a standardized survey was conducted with 260 asylum seekers in different municipalities, some of which have introduced the EHIC for asylum seekers, while others have not. Methods: The period prevalence was compared between the groups “with EHIC” and “without EHIC” using a two-sided t-test. Multivariate analysis was done using a linear OLS regression model. Results: Asylum seekers in possession of the EHIC are significantly more likely to seek ambulant medical care than those receiving healthcare-vouchers. Conclusions: The results of this study suggest that having to ask for healthcare-vouchers at the social security office could be a relevant barrier for asylum seekers.

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.

A cross-sectional study on posttraumatic impact among Qiang women in Maoxian County 1 year after the Wenchuan Earthquake, China

The authors sought to examine the posttraumatic impact among Qiang women aged 18 years or older in 2 villages of Maoxian county 1 year after the Wenchuan earthquake and determined the variables associated with mental health status and posttraumatic symptoms for further psychological interventions. They interviewed 270 Qiang women. Psychological health status was assessed using the Chinese Health Questionnaire (CHQ-12). Posttraumatic symptoms were assessed using the Impact of Event Scale-Revised (IES-R), Chinese version. The results showed that 141 (52.2%) of the participants had psychological problems. The widowed and those who witnessed casualty scored higher on the CHQ-12. Among those surveyed, 100 (37.0%) women's mean intrusion subscale scores were ≥2; for 71 (26.3%) women, the mean avoidance score was ≥2; and for 88 (32.6%), the mean hyperarousal score was ≥2. Also, 23 (8.5%) women had scores ≥2 on all the 3 subscales. Those who had no job, were injured, and had witnessed casualties scored higher on each subscale of the IES-R.

Prevalence of mental health problems in adolescent schoolchildren in Galle District, Sri Lanka: eight months after tsunami

The present study was conducted to assess the prevalence and associations of mental health problems (MHPs) among adolescent schoolchildren in Sri Lanka 8 months after the tsunami disaster. A descriptive cross-sectional study was carried out in the Galle Municipality area, Sri Lanka. The study instrument consisted of a self-administered questionnaire and the validated Sinhalese version of the Strengths and Difficulties Questionnaire. The prevalence of MHPs in the study population was 32.2% (confidence interval [CI] = 28.44% to 35.96%). Direct experience of the tidal wave (odds ratio [OR] = 2.93, P = .013), perception of being affected by tsunami (OR = 1.79, P = .0014), and impact of rumors (OR = 1.85, P < .001) were significantly associated with MHPs. Not having a close friend (OR = 1.79, P = .04), being criticized by teachers (OR = 1.66, P = .008), and adolescents being not satisfied with their academic achievements (OR = 2.42, P = .02) were also significantly associated with MHPs. Even 8 months after the tsunami, MHPs among adolescent schoolchildren in the affected areas are still very high.