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Popham CM, McEwen FS, Karam E, Pluess M. The important role of mothers during displacement: Direct and indirect effects of the refugee context on Syrian refugee children's mental health. Child Dev 2024; 95:e206-e223. [PMID: 38108194 PMCID: PMC11023757 DOI: 10.1111/cdev.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Refugee children are at increased risk for mental health problems, including post-traumatic stress, depression, and externalizing problems. The refugee environment, maternal mental health, and parenting may reduce or exacerbate that risk. This study investigated their direct and indirect associations with child mental health cross-sectionally in a sample of Syrian refugee child-mother dyads in Lebanon in 2017-19. Mediating pathways were tested using structural equation modeling with 1446 dyads (child: Mage = 11.39, 52.1% females) and again 1 year later with 872 (child: Mage = 12.17, 53.1% females) of the original sample. Mediating pathways from the refugee environment through maternal mental health and parenting to child outcomes were detected, emphasizing the importance of a holistic approach to refugee mental health.
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Affiliation(s)
- Cassandra M. Popham
- Department of Biological and Experimental Psychology, Queen Mary University of London, UK
| | - Fiona S. McEwen
- Department of Biological and Experimental Psychology, Queen Mary University of London, UK
- Department of War Studies, King’s College London, London, UK
| | - Elie Karam
- Institute for Development, Research, Advocacy and Applied Care, Lebanon
- Saint George Hospital University Medical Center, Lebanon
- St Georges University of Beirut, Lebanon
| | - Michael Pluess
- Department of Biological and Experimental Psychology, Queen Mary University of London, UK
- School of Psychology, University of Surrey, Guildford, UK
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Norton J, Gandubert C, Pellissier S, Chaudieu I, Gaultier S. Trauma and mental health in young adults who arrived in France as unaccompanied and separated migrant children. L'ENCEPHALE 2024; 50:154-161. [PMID: 37121807 DOI: 10.1016/j.encep.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES The mental health of unaccompanied and separated minors (UASC) has been widely studied but not their first years of adulthood, often characterised by uncertainty after leaving child protection. The aim of this study was to estimate the prevalence of psychiatric disorders using standardised and validated research instruments and examine the effect of exposure to trauma. METHODS One hundred and ten youth (92.7% male, median age 19.7 [18.1-22.8]) from Chambery, Montpellier and La Rochelle were recruited to a cross-sectional exploratory study. During a face-to-face interview, somatoform disorder, anxiety, and depression were assessed using the Patient Health Questionnaire (score≥10) and post-traumatic stress disorder (PTSD) with the PTSD Checklist for DSM-5 (score≥33). Traumatic life events were assessed using the Life Events Checklist. RESULTS Of the youth, 19.3% had a probable somatoform disorder, 17.6% anxiety, 28.7% depression, and 20% PTSD. The number of traumatic life events increased the risk of depression (multi-adjusted OR (95%CI): 1.56 (1.25-1.96)), PTSD (1.60 (1.23-2.08)), somatoform disorder (1.41 (1.10-1.82), and anxiety (1.33 (1.02-1.72)). Physical assault was the type of event positively associated with the most disorders (P≤0.01, except for anxiety), followed by witnessing sudden and violent death (P≤0.01 for depression and PTSD) and sexual assault (P=0.002 for PTSD). CONCLUSION Our study highlights the high prevalence of psychiatric disorders in young adults who arrived as UASC and the impact on their mental health of cumulative trauma and exposure to interpersonal and violent traumatic life events. A greater focus on their mental health with regular assessments is needed in order to provide rapid and adapted care.
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Affiliation(s)
- Joanna Norton
- University of Montpellier, Inserm U1298, 34295 Montpellier Cedex 5, France.
| | | | - Sonia Pellissier
- Interuniversity Laboratory of Psychology (LIP/PC2S), University Savoie Mont-Blanc, University Grenoble Alpes, 38040 Grenoble Cedex 9, France
| | - Isabelle Chaudieu
- University of Montpellier, Inserm U1298, 34295 Montpellier Cedex 5, France
| | - Sydney Gaultier
- Interuniversity Laboratory of Psychology (LIP/PC2S), University Savoie Mont-Blanc, University Grenoble Alpes, 38040 Grenoble Cedex 9, France; Department of Psychiatry, Lausanne University Hospital, 1004 Lausanne, Switzerland
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Behrendt M, Vervliet M, Rota M, Adeyinka S, Uzureau O, Rasmussen A, Glaesmer H, Lietaert I, Derluyn I. A conceptual study on the relationship between daily stressors, stressful life events, and mental health in refugees using network analysis. Front Psychol 2023; 14:1134667. [PMID: 37599778 PMCID: PMC10438848 DOI: 10.3389/fpsyg.2023.1134667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction There is growing recognition that daily stressors, such as social and material deficiencies, can be highly detrimental to the mental health of refugees. These stressors are in addition to stressful life events, which have been widely studied in the context of migration and forced displacement. Despite increasing evidence for an ecological model, there is still no consensus regarding the conceptualization of these highly influential factors. In particular, the demarcation of daily stressors from stressful life events and the categorization of daily stressors require further examination in order to develop usable and accurate tools for researchers, design effective interventions for practitioners and assist politicians in designing meaningful policies. Methods To address these challenges, we used data from a sample of 392 unaccompanied young refugees from diverse backgrounds and employed network analysis to examine the relationships between daily stressors, stressful life events, and symptoms of depression, anxiety, and post-traumatic stress. Results Our findings highlight the significant relationship between daily stressors and mental health, particularly depression. Meaningful clusters of daily stressors include material stressors, social stressors, and social exclusion stressors. Conclusion Our results demonstrate the importance of considering daily stressors in the mental health of refugees and suggest that using a network approach offers a viable way to study these complex interrelationships. These findings have implications for researchers, practitioners, and policymakers in understanding and addressing the mental health needs of refugees.
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Affiliation(s)
- Malte Behrendt
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Marianne Vervliet
- Department of People and Well-Being, Thomas More University of Applied Sciences, Mechelen, Belgium
| | - Marina Rota
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Sarah Adeyinka
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Océane Uzureau
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
| | - Andrew Rasmussen
- Culture, Migration, and Community, Department of Psychology, Fordham University, New York, NY, United States
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Medical Faculty, The University of Leipzig Medical Center, Leipzig, Germany
| | - Ine Lietaert
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
- Institute on Comparative Regional Integration Studies, United Nations University, Bruges, Belgium
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Centre for the Social Study of Migration and Refugees, Ghent University, Ghent, Belgium
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Hornfeck F, Eglinsky J, Garbade M, Rosner R, Kindler H, Pfeiffer E, Sachser C. Mental health problems in unaccompanied young refugees and the impact of post-flight factors on PTSS, depression and anxiety-A secondary analysis of the Better Care study. Front Psychol 2023; 14:1149634. [PMID: 37408964 PMCID: PMC10318408 DOI: 10.3389/fpsyg.2023.1149634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
Background Unaccompanied young refugees (UYRs) show elevated levels of mental distress such as post-traumatic stress symptoms (PTSS), depression, and anxiety. The individual post-arrival situation in the host country plays an important role in increasing or reducing mental health risks for these vulnerable children and youth. The study aims at examining the impact of pre- and post-migration factors on the mental health of UYRs. Methods A cross-sectional survey of N = 131 young refugees (81.7% male, M = 16.9 years old) was conducted in 22 children and youth welfare service (CYWS) facilities in Germany. The participants provided information about pre- and post-flight experiences. Standardized measures were used to assess post-traumatic stress symptoms (CATS-2), symptoms of depression (PHQ-9), and anxiety (GAD-7). Daily stressors were assessed with the Daily Stressors Scale for Young Refugees (DSSYR), sociocultural adaptation with the Brief Sociocultural Adaptation Scale (BSAS), satisfaction with social support with the Social Support Questionnaire (SSQ6-G). Results Our results demonstrated clinical levels of PTSS in 42.0% of the participants, depression in 29.0%, and anxiety in 21.4%. Hierarchical regression analyses revealed that a higher number of traumatic events and social daily stressors predicted higher levels in all three domains of mental health problems. PTSS and anxiety were also predicted by the distress related to the residence status, depressive symptoms were additionally predicted by sociocultural adaptation, less family contact and length of stay. The satisfaction with social support was not a significant predictor in the regression models. Conclusion Unaccompanied young refugees in CYWS facilities are a highly vulnerable population. As traumatic events, daily stressors and level of contact to family directly impacted UYRs mental health, interventions should be trauma-focused, but also contain modules on how to cope with daily stressors. On the policy and practical level, stakeholders in host countries are called for establishing measures to reduce post-migration stressors and enhance support for UYRs on all levels.
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Affiliation(s)
| | - Jenny Eglinsky
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Maike Garbade
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | | | - Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
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Vega Potler NJ, Zhang J, Hackley B, Choi J, Xie X, Punsky B, Pineda L, Shapiro A. Persistence of Emotional Distress in Unaccompanied Migrant Children and Adolescents Primarily From the Northern Triangle of Central America. JAMA Netw Open 2023; 6:e2318977. [PMID: 37338902 PMCID: PMC10282890 DOI: 10.1001/jamanetworkopen.2023.18977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/03/2023] [Indexed: 06/21/2023] Open
Abstract
Importance In the US, unaccompanied migrant children and adolescents (hereinafter referred to as children) are predominantly from Central America's Northern Triangle. While unaccompanied migrant children are at high risk for psychiatric sequelae due to complex traumatic exposures, longitudinal investigations of psychiatric distress after resettlement are lacking. Objective To identify factors associated with emotional distress and longitudinal changes in emotional distress among unaccompanied migrant children in the US. Design, Setting, and Participants For this retrospective cohort study, the 15-item Refugee Health Screener (RHS-15) was administered between January 1, 2015, and December 31, 2019, to unaccompanied migrant children as part of their medical care to detect emotional distress. Follow-up RHS-15 results were included if they were completed before February 29, 2020. Median follow-up interval was 203 days (IQR, 113-375 days). The study was conducted in a federally qualified health center that provides medical, mental health, and legal services. Unaccompanied migrant children who completed the initial RHS-15 were eligible for analysis. Data were analyzed from April 18, 2022, to April 23, 2023. Exposures Traumatic events before migration, during migration, during detention, and after resettlement in the US. Main Outcomes and Measures Emotional distress, including symptoms of posttraumatic stress disorder, anxiety, and depressive symptoms, as indicated by the RHS-15 (ie, score ≥12 on items 1-14 or ≥5 on item 15). Results In total, 176 unaccompanied migrant children completed an initial RHS-15. They were primarily from Central America's Northern Triangle (153 [86.9%]), were mostly male (126 [71.6%]), and had a mean (SD) age of 16.9 (2.1) years. Of the 176 unaccompanied migrant children, 101 (57.4%) had screen results above the positive cutoff. Girls were more likely to have positive screen results than boys (odds ratio, 2.48 [95% CI, 1.15-5.34]; P = .02). Follow-up scores were available for 68 unaccompanied migrant children (38.6%). On the follow-up RHS-15, most scored above the positive cutoff (44 [64.7%]). Three-quarters of unaccompanied migrant children who scored above the positive cutoff initially continued to have positive scores at follow-up (30 of 40), and half of those with negative screen scores initially had positive scores at follow-up (14 of 28). Female vs male unaccompanied migrant children (unstandardized β = 5.14 [95% CI, 0.23-10.06]; P = .04) and initial total score (unstandardized β = 0.41 [95% CI, 0.18-0.64]; P = .001) were independently associated with increased follow-up RHS-15 total score. Conclusions and Relevance The findings suggest that unaccompanied migrant children are at high risk for emotional distress, including symptoms of depression, anxiety, and posttraumatic stress. The persistence of emotional distress suggests that unaccompanied migrant children would benefit from ongoing psychosocial and material support after resettlement.
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Affiliation(s)
- Natan J. Vega Potler
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Jessica Zhang
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Barbara Hackley
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Xianhong Xie
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Brenda Punsky
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Lisa Pineda
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Alan Shapiro
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
- Department of Pediatrics, Montefiore Medical Center, Bronx, New York
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Frick U, Sipar D, Bücheler L, Haug F, Haug J, Almeqbaali KM, Pryss R, Rosner R, Comtesse H. A Mobile-Based Preventive Program for Young, Arabic-Speaking Asylum Seekers during the COVID-19 Pandemic in Germany: Design, Feasibility, and Implementation. JMIR Form Res 2023. [PMID: 37134019 DOI: 10.2196/44551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND A majority of individuals seeking asylum in Germany are living in collective housings and thus exposed to a higher risk of contagion during the COVID-19 pandemic. OBJECTIVE To test feasibility and efficacy of a culture-sensitive approach combining mobile app-based interventions and a face-to-face group intervention to improve knowledge about COVID-19 and promote vaccination readiness among collectively accommodated Arabic-speaking adolescents and young adults. METHODS We developed a mobile app that was composed of short video clips to explain the biological basis of COVID-19, demonstrate behavior to prevent transmission, and combat misconceptions and myths about vaccination. Explanations were given in a YouTube-like interview setting by a native Arabic-speaking physician. Elements of gamification (quizzes, rewards for solving test items) were also used. Consecutive videos and quizzes were presented over an intervention period of six weeks, the group intervention was scheduled as an add-on for half of participants in week 6. The manual of the group intervention was designed to provide actual behavior planning on the basis of the health action process approach. Sociodemographic information, mental health status, and knowledge about Covid-19 and available vaccines were assessed with questionnaire-based interviews at baseline and after six weeks. Interpreters assisted with the interviews in all cases. RESULTS Enrollment in the study proved to be very challenging as among other things, the housing facilities allowed contact with potentially eligible participants only during certain periods because of the pandemic situation. Also due to tightened contact restrictions, the face-to-face group interventions could not be held as planned. A total of 88 participants from 8 collective housing institutions were included in the study. 61 participants completed the full intake interview. Most participants had already been vaccinated at study enrollment (76.5%). They also yet claimed to comply with preventive measures to a very high extent (e.g., "always wearing masks" was indicated by 66% of participants), but practicing behavior that was not considered as effective against Covid-19 transmission was also frequently reported as a preventive measure (e.g., mouth rinsing). On the other hand, factual disease knowledge for COVID-19 was limited. Preoccupation with the information materials presented in the app steeply declined after study enrollment (e.g., 19% of participants watched the videos scheduled for week 3). Only 18 participants could be reached for the follow-up interview. Their COVID-19 disease knowledge did not shown to have increased after the intervention period (p=0.558). CONCLUSIONS The results indicate that vaccine uptake was high and seemed to be depending on organizational determinants for the target group. The current mobile app-based intervention demonstrated low feasibility, which might have been related to various obstacles faced during the delivery: Learning from mobile phone content based on short videos requires a basic understanding of biological and IT-aspects as well as sufficient literacy and a living situation enabling the practical application of the learned behavioral prevention strategies. Therefore, in case of future pandemics, transmission prevention in the specific target group should rely more on structural aspects instead on sophisticated psychological interventions. CLINICALTRIAL https://www.drks.de, identifier: DRKS00028825.
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Affiliation(s)
- Ulrich Frick
- Research Center, HSD University of Applied Sciences, Cologne, DE
| | - Dilan Sipar
- Catholic University Eichstätt-Ingolstadt, Ostenstraße 26, Eichstätt, DE
| | - Leonie Bücheler
- Catholic University Eichstätt-Ingolstadt, Ostenstraße 26, Eichstätt, DE
| | - Fabian Haug
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, DE
| | - Julian Haug
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, DE
| | | | - Rüdiger Pryss
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, Würzburg, DE
| | - Rita Rosner
- Catholic University Eichstätt-Ingolstadt, Ostenstraße 26, Eichstätt, DE
| | - Hannah Comtesse
- Catholic University Eichstätt-Ingolstadt, Ostenstraße 26, Eichstätt, DE
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Kvestad I, Bøe T, Sayyad N, Skogen JC, Randal S, Lehmann S. Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors-a comparison with youth in foster care. Eur Child Adolesc Psychiatry 2023; 32:439-449. [PMID: 34537879 PMCID: PMC10038941 DOI: 10.1007/s00787-021-01876-6] [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: 03/17/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.
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Affiliation(s)
- Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Nawar Sayyad
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Sølve Randal
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Bergen, Norway
| | - Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health Promotion and development, Faculty of Psychology, University of Bergen, Bergen, Norway
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Norton J, Gandubert C, Chaudieu I, Pellissier S, Gaultier S. Association between uncertainty regarding right-to-stay and mental health in unaccompanied and separated migrant children (UASC) reaching adulthood: findings from France. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02442-y. [PMID: 36806952 DOI: 10.1007/s00127-023-02442-y] [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: 06/13/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE There is substantial evidence suggesting high levels of mental health problems in unaccompanied and separated children (UASC). However, there is less focus on the first years of adulthood characterised by increased vulnerability and fear of expulsion. We aimed to describe the mental health of UASC on reaching adulthood, and how this was affected by uncertainty regarding their right-to-stay in France. METHODS One hundred and ten youth aged 18-22 were recruited via child protection reception centres. We administered the Patient Health Questionnaire somatic (PHQ-15), anxiety (GAD-7) and depression (PHQ-9) modules, the Post-Traumatic Stress Disorder Checklist (PCL-5) and Connor-Davidson Resilience Scale (CD-RISC-10). Logistic regression analysis was performed with the dependent variable, a secure (versus uncertain) situation, defined as (1) detaining a residence permit and being in school, an apprenticeship or a salaried job, or (2) waiting for residence permit whilst occupying a salaried job. RESULTS Of the sample, 19.3% reached criteria for a probable somatic disorder, 17.6% for anxiety and 28.7% for depression (score ≥ 10); 41.8% were in an uncertain situation regarding their right-to-stay. Uncertainty was associated with higher anxiety ((OR per Interquartile range (95% CI), 1.77 (1.05-2.98)) and post-traumatic stress symptoms (2.05 (1.06-4.00)), lower resilience (0.50 (0.27-0.91)), and participants rating their anxiety (p = 0.02) and depressive symptoms (p = 0.003) as more severe since reaching adulthood. CONCLUSIONS Our findings suggest uncertainty regarding right-to-stay is associated with increased mental health symptoms, specifically anxiety and trauma-induced stress, thereby highlighting the vulnerability of UASC in their first years of adulthood. This calls for greater support during this transition period with regular symptom monitoring for timely psychological interventions.
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Affiliation(s)
- Joanna Norton
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France.
| | - Catherine Gandubert
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France
| | - Isabelle Chaudieu
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France
| | - Sonia Pellissier
- LIP/PC2S, University Savoie Mont-Blanc, University Grenoble Alpes, Chambery, France
| | - Sydney Gaultier
- LIP/PC2S, University Savoie Mont-Blanc, University Grenoble Alpes, Chambery, France
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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9
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Cardoso Pinto AM, Seery P, Foster C. Infectious disease screening outcomes and reducing barriers to care for unaccompanied asylum-seeking children: a single-centre retrospective clinical analysis. BMJ Paediatr Open 2022; 6:e001664. [PMID: 37737254 PMCID: PMC9809216 DOI: 10.1136/bmjpo-2022-001664] [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] [Received: 09/04/2022] [Accepted: 11/07/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Evaluate the Unity Clinic's infectious disease screening programme for unaccompanied asylum-seeking children (UASC), calculate rates of infection and identify further health needs. DESIGN Retrospective audit of electronic patient data. SETTING AND PATIENTS UASC who attended the Unity Clinic between 1 November 2019 and 22 March 2022. MAIN OUTCOME MEASURES Baseline demographics, social, mental health and journey details, infection screening and investigation results. RESULTS 155 UASC were reviewed: 89% (138 of 155) male, median age 17 years (IQR 16-17). Most frequent countries of origin were Sudan, Eritrea and Afghanistan. Median duration of travel to the UK (n=79) was 2 years (IQR 0.5-4); 35.6% (47 of 132) arrived by boat and 54.5% (72 of 132) by road. 44.8% (69 of 154) had one or more positive infection screening results: 22.7% (35 of 154) and 1.3% (2 of 154) positive for latent and active tuberculosis, respectively; 4.6% (7 of 152) chronic active hepatitis B and 17.1% (26 of 152) for past infection; 1.3% (2 of 154) for HIV; 13.0% (19 of 146) for Strongyloides. There were three cases of syphilis (n=152; 2.0%) and one chlamydia (n=148; 0.7%)-none of whom disclosed prior sexual activity during screening. 39.6% (61 of 154) and 27.9% (43/154) reported disturbances to mood or sleep, respectively. 55.2% (85 of 154) disclosed traumatic incidents during and/or prior to their journey, including physical and sexual assault. CONCLUSIONS The Unity Clinic provides a thorough infectious disease screening service for UASC following national guidance. Results highlight the need for universal, non-judgemental screening for sexually transmitted infections, as targeted screening would not identify positive cases. High rates of well-being issues and previous abuse emphasise the need for multidisciplinary, collaborative approaches to care.
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Affiliation(s)
| | - Paula Seery
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - Caroline Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
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10
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Mental health in refugee children. Curr Opin Psychol 2022; 48:101460. [PMID: 36130437 DOI: 10.1016/j.copsyc.2022.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 01/28/2023]
Abstract
Almost half of the world's forcibly displaced population are children, most commonly originating from Syria, Iraq, and Afghanistan. Health disparities are well documented, especially for mental health, but not consistent across groups, time or context. Despite high exposure to trauma and stress, refugee children also show remarkable resilience. An ecological model of refugee health including both risk and resilience factors is therefore recommended. The model also includes the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the disruptions of basic systems affecting both the individual and families as a whole, offering a framework to better understand the health disparities and appropriate interventions for refugee children.
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Namer Y, Freţian A, Podar D, Razum O. Asylum seeking and refugee adolescents' mental health service use and help-seeking patterns: a mixed-methods study. NPJ MENTAL HEALTH RESEARCH 2022; 1:18. [PMID: 37521499 PMCID: PMC9628352 DOI: 10.1038/s44184-022-00019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
Almost a third of all people who entered Germany to seek protection since 2010 were under the age of 18. Asylum-seeking and refugee (ASR) adolescents in Germany face reduced entitlements to healthcare and experience barriers in accessing mental healthcare, despite documented mental health needs. This mixed-methods study aims to describe the mental health needs and service use of ASR adolescents in Germany and identify the predictors of their help-seeking patterns. Here we report findings of cross-sectional data collected between February 2019 and November 2020 in schools and refugee accommodations in three German federal states. Our subsample consists of ASR between the ages of 11 and 18, coming from Syria, Afghanistan, and Iraq (N = 216). Cross-sectional data are supplemented by semi-structured interviews with nine mental health professionals in one region of the study. Our findings reveal an underutilization of mental health services relative to the emotional difficulties reported. Perceived and experienced access barriers, age, and externalizing and internalizing symptoms predict different help-seeking patterns. Psychotherapy-related social resources, as well as reporting of emotional difficulties, are predictors of actual or intended psychotherapeutic service utilization. Based on our quantitative and qualitative findings, we highlight the need for widespread, accessible, and low-threshold mental health initiatives designed to work with ASR adolescents, for additional assistance in navigating the mental healthcare system, as well as for support to important people in ASR adolescents' lives who fill the gap between mental health needs and accessible mental healthcare services.
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Affiliation(s)
- Yudit Namer
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Alexandra Freţian
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Diana Podar
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
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Daniel-Calveras A, Baldaquí N, Baeza I. Mental health of unaccompanied refugee minors in Europe: A systematic review. CHILD ABUSE & NEGLECT 2022; 133:105865. [PMID: 36095862 DOI: 10.1016/j.chiabu.2022.105865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nearly half of the refugee and asylum seeking population in Europe is under the age of 18, and many of these individuals are unaccompanied children and adolescents. OBJECTIVE The aim of this systematic review is both to summarize findings regarding the prevalence of mental health disorders among unaccompanied refugee minors (URM) in European countries since the last available systematic review (October 2017), and to describe associated risk factors. METHODS Five databases were systematically searched for articles published between October 1, 2017 and May 1, 2022. RESULTS The findings from 23 studies conducted in 9 countries which examined 80,651 child and adolescent URM are explained. Afghanistan was the most common country of origin in the majority of studies and >75 % of the subjects were boys. Most of the studies (N = 13, 56.5 %) assessed posttraumatic stress disorder (PTSD) prevalence. We found a high prevalence of mental health disorders among URM children and adolescents, which varied considerably between studies, ranging from 4.6 % to 43 % for (PTSD), 2.9 % to 61.6 % for depression, 32.6 % to 38.2 % for anxiety and 4 to14.3 % for behavioral problems. Two studies looking at suicide attempts and deaths, also observed higher rates in URM compared to the host population of the same age. The studies looking at mental health risk factors suggest that levels of social support in the host country, rearing environment, and other factors are associated with psychopathology. Moreover, a meta-analysis of four studies regarding PTSD in URM and accompanied refugee minors (ARM) showed a lower prevalence among ARM: -1.14 (95%CI:-1.56-0.72). CONCLUSIONS PTSD, depression and anxiety are the most prevalent problems among the URM population in Europe. Early intervention in host countries is needed in order to improve mental health outcomes for this vulnerable population and avoid possible neglect.
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Affiliation(s)
| | - Nuria Baldaquí
- Psychiatry and Psychology Department, Hospital Clínic de Barcelona, SGR-881 Barcelona, Spain
| | - Inmaculada Baeza
- Universitat de Barcelona, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, ISCIII, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (CERCA-IDIBAPS), Barcelona, Spain.
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Lange AMC, Visser MM, Scholte RHJ, Finkenauer C. Parental Conflicts and Posttraumatic Stress of Children in High-Conflict Divorce Families. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:615-625. [PMID: 35958703 PMCID: PMC9360253 DOI: 10.1007/s40653-021-00410-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 06/15/2023]
Abstract
UNLABELLED Parental conflicts consistently predict negative outcomes for children. Research suggests that children from high-conflict divorces (HCD) may also experience post-traumatic stress symptoms (PTSS), yet little is known about the association between parental conflicts in HCD families and child PTSS. We investigated this association, hypothesizing that parental conflicts would predict child PTSS. We also tested the moderating role of interparental contact frequency, hypothesizing that frequent contact would intensify the association between parental conflicts and child PTSS. This study was part of an observational study on the outcomes of No Kids in the Middle (NKM), a multi-family group intervention for HCD families. A total of 107 children from 68 families participated in the study with at least one parent. We used pre- (T1) and post-intervention (T2) data. Research questions were addressed cross-sectionally, using regression analyses to predict PTSS at T1, and longitudinally, using a correlated change (T1 to T2) model. The cross-sectional findings suggested that mother- and child-reported conflicts, but not father-reported conflicts, were related to the severity of child PTSS. Longitudinally, we found that change in father-reported conflicts, but not change in child- or mother-reported conflicts, were related to change in child PTSS. The estimated associations for the different informants were not significantly different from one another. The frequency of contact between ex-partners did not moderate the relationship between parental conflicts and child PTSS. We conclude that there is a positive association between parental conflicts and child PTSS in HCD families independent of who reports on the conflicts. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00410-9.
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Affiliation(s)
- Aurelie M. C. Lange
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus Medical Center, Rotterdam, Netherlands
- Viersprong Institute for Studies On Personality Disorders, Halsteren, Netherlands
| | | | - Ron H. J. Scholte
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Tranzo Tilburg University, Tilburg, Netherlands
| | - Catrin Finkenauer
- Department of Interdisciplinary Social Science: Youth Studies, Utrecht University, Utrecht, Netherlands
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Abstract
AIMS Children's responses to war and displacement are varied; many struggle, while others appear resilient. However, research into these outcomes disproportionately focuses on cross-sectional data in high-income countries. We aimed to (1) investigate change in resilience across two timepoints in a highly vulnerable sample of Syrian refugee children in Lebanon, and (2) explore predictors of their mental health problems across time. METHODS In total, 982 Syrian child-caregiver dyads living in refugee settlements in Lebanon completed questionnaires via interview at baseline and follow-up one year later. We categorised children into groups based on their risk for mental health problems across both timepoints (stable high risk/SHR, deteriorating, improving, stable low risk) according to locally validated cut-offs on measures of post-traumatic stress disorder (PTSD), depression and behavioural problems. Analyses of covariance identified how the groups differed on a range of individual and socio-environmental predictors, followed up by cross-lagged panel models (CLPMs) to investigate the directionality of the relationships between significantly related predictors and symptoms. RESULTS The sample showed a meaningful amount of change in mental health symptoms from baseline to follow-up. Over half (56.3%) of children met SHR criteria and 10.3% deteriorated over time, but almost one-quarter (24.2%) showed meaningful improvement, and 9.2% were consistently at low risk for mental health problems at both timepoints. Several predictors differentiated the groups, particularly social measures. According to CLPMs, maternal acceptance (β = -0.07) predicted child mental health symptoms over time. Self-esteem (β = -0.08), maternal psychological control (β = 0.10), child maltreatment (β = 0.09) and caregiver depression (β = 0.08) predicted child symptoms and vice versa (βse = -0.11, βb = 0.07, βmpc = 0.08, βcm = 0.1, βcd = 0.11). Finally, child symptoms predicted loneliness (β = 0.12), bullying (β = 0.07), perceived social support (β = -0.12), parent-child conflict (β = 0.13), caregiver PTSD (β = 0.07), caregiver anxiety (β = 0.08) and the perceived refugee environment (β = -0.09). CONCLUSIONS Our results show risk and resilience are dynamic, and the family environment plays a key role in children's response to war and displacement. Conversely, children also have a significant impact on the family environment and caregiver's own mental health. Interventions to promote resilience in refugee children should therefore consider family-wide mechanisms.
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Nilsen SA, Kvestad I, Randal SB, Hysing M, Sayyad N, Bøe T. Mental health among unaccompanied refugee minors after settling in Norway: A matched cross-sectional study. Scand J Public Health 2022:14034948221100103. [PMID: 35684945 DOI: 10.1177/14034948221100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: To describe the mental health of unaccompanied refugee minors (URMs) settled in Norway and compare their responses to an age- and sex-matched sample of Norwegian young people. Methods: The data were from the Pathways to Independence study of URMs aged 15-20 years (n = 81; 82.7% male; response rate 80%) conducted in 2018-2019 in the Bergen municipality, Norway. The data from the URMs were linked to an age- and sex-matched group of young people from the Norwegian youth@hordaland study conducted in 2012 (n = 324). Mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ). Results: URMs were more likely to agree with most items pertaining to emotional problems, peer problems and prosocial subscales than Norwegian young people. Few differences were found for items on the conduct problems and hyperactivity-inattention problems scales. Poor psychometric properties, including weak factor loadings and low internal consistency, were detected for the SDQ subscales among URMs, except for the emotional problems subscale, indicating that the originally proposed five-factor model fitted the data poorly. Conclusions: URMs appear to have moderately more emotional problems than Norwegian young people. They are more likely to report being alone, getting along better with adults than with their peers and being bullied, but also report being more helpful and sharing with others. Studies with larger samples of URMs should determine the most appropriate factor structure of the SDQ when administered to URM samples.
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Affiliation(s)
- Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway
| | - Sølve Bjørn Randal
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Norway
| | - Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway.,Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | - Nawar Sayyad
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Norway
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway.,Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
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Barghadouch A, Skovdal M, Norredam M, Vitus K. 'This is not what I want for my children': agency and parenting in Danish asylum centres. Eur J Public Health 2022; 32:379-383. [PMID: 35468188 PMCID: PMC9159312 DOI: 10.1093/eurpub/ckac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Children of asylum-seeking families constitute a particularly vulnerable group, and there is growing interest in understanding how asylum-seeking parents can be supported to safeguard the health, wellbeing and growth of their children. In this study, we examine the capabilities of asylum-seeking parents to act on the support and advice provided by child health nurses in Danish asylum centres. Methods We draw on semi-structured qualitative interviews with 11 asylum-seeking families (corresponding to 15 parents) living in two asylum centres run by the Danish Red Cross. Results The findings illustrate that asylum-seeking parents’ agentic capabilities to take care of their children are tightly constrained by their housing constrictions and living conditions, insufficient money allowances, regular relocations and juridical status as asylum-seekers. These physical and organizational structures and the pervasive uncertainty related to being asylum-seekers inhibited parents from acting on advice from child health nurses, and from providing their children with a safe, healthy and stable environment. Conclusions Asylum-seeking parents face the task of taking care of their children within particular physical, organizational and juridical structures, which tightly constrain their ability to parent their children well, or to follow advice provided by child health nurses.
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Affiliation(s)
- Amina Barghadouch
- Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Skovdal
- Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Norredam
- Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Vitus
- Department of Sociology and Social Work, The Faculty of Social Sciences, Aalborg University, Copenhagen, Denmark
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Schmees P, Braig J, Nilles H, Kerkhoff D, Demir Z, Rueth JE, Lohaus A, Eschenbeck H. Well-Being and Resources of Minors With Refugee Background in Comparison to Minors With Migration or Native Background. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2022. [DOI: 10.1027/2512-8442/a000099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Studies on the health of minors with refugee background (RM) often focus on symptoms and risks. In contrast to these deficit-oriented approaches, the present study examined well-being and resources of RM. Aims: The aim was to get an overview of the extent to which RM differ from both minors with migration (MM) as well as native (NM) background regarding well-being and resources. In addition, the study sought to identify resources of RM that are significant for well-being. General personal and social resources, religious identity and practice as well as multicultural resources (bilingualism, ethnic identity) were examined. Method: The study was conducted in Germany with minors aged 8–16 years. RM ( n = 209), MM ( n = 535) and NM ( n = 858) completed questionnaires. Comparative analyses and multiple regression analyses were computed. Results: RM showed lower well-being and fewer social resources than MM and NM. For personal resources, the group differences were less consistent. Personal and social resources predicted the well-being of minors. While multicultural resources were not significant, especially the resources sense of coherence, integration into peer group, and religious identity positively predicted the well-being of RM. Limitations: The group of MM is very heterogeneous. Further studies should differentiate the group of MM more precisely. Conclusion: The differences in well-being among RM, MM and NM can largely be explained by differences in resources. Religious identity is an important available resource for RM. Sense of coherence and integration into peer groups should be given special attention in health promotion for RM.
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Affiliation(s)
- Pia Schmees
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Germany
| | - Johanna Braig
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Germany
| | - Hannah Nilles
- Department of Developmental Psychology, Bielefeld University, Germany
| | - Denise Kerkhoff
- Department of Developmental Psychology, Bielefeld University, Germany
- Department of Psychology, University of Konstanz, Germany
| | - Zeynep Demir
- Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, Germany
| | - Jana-Elisa Rueth
- Department of Developmental Psychology, Bielefeld University, Germany
| | - Arnold Lohaus
- Department of Developmental Psychology, Bielefeld University, Germany
| | - Heike Eschenbeck
- Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Germany
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18
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Purgato M, Tedeschi F, Turrini G, Acartürk C, Anttila M, Augustinavicious J, Baumgartner J, Bryant R, Churchill R, Ilkkursun Z, Karyotaki E, Klein T, Koesters M, Lantta T, Leku MR, Nosè M, Ostuzzi G, Popa M, Prina E, Sijbrandij M, Uygun E, Välimäki M, Walker L, Wancata J, White RG, Cuijpers P, Tol W, Barbui C. Trajectories of psychosocial symptoms and wellbeing in asylum seekers and refugees exposed to traumatic events and resettled in Western Europe, Turkey, and Uganda. Eur J Psychotraumatol 2022; 13:2128270. [PMID: 36237827 PMCID: PMC9553137 DOI: 10.1080/20008066.2022.2128270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Longitudinal studies examining mental health trajectories in refugees and asylum seekers are scarce. Objectives: To investigate trajectories of psychological symptoms and wellbeing in refugees and asylum seekers, and identify factors associated with these trajectories. Method: 912 asylum seekers and refugees from the control arm of three trials in Europe (n = 229), Turkey (n = 320), and Uganda (n = 363) were included. We described trajectories of psychological symptoms and wellbeing, and used trauma exposure, age, marital status, education, and individual trial as predictors. Then, we assessed the bidirectional interactions between wellbeing and psychological symptoms, and the effect of each predictor on each outcome controlling for baseline values. Results: Symptom improvement was identified in all trials, and for wellbeing in 64.7% of participants in Europe and Turkey, versus 31.5% in Uganda. In Europe and Turkey domestic violence predicted increased symptoms at post-intervention (ß = 1.36, 95% CI 0.17-2.56), whilst murder of family members at 6-month follow-up (ß = 1.23, 95% CI 0.27-2.19). Lower wellbeing was predicted by murder of family member (ß = -1.69, 95% CI -3.06 to -0.32), having been kidnapped (ß = -1.67, 95% CI -3.19 to -0.15), close to death (ß = -1.38, 95% CI -2.70 to -0.06), and being in the host country ≥2 years (ß = -1.60, 95% CI -3.05 to -0.14). In Uganda at post-intervention, having been kidnapped predicted increased symptoms (ß = 2.11, 95% CI 0.58-3.65), and lack of shelter (ß = -2.51, 95% CI -4.44 to -0.58) and domestic violence predicted lower wellbeing (ß = -1.36, 95% CI -2.67 to -0.05). Conclusion: Many participants adapt to adversity, but contextual factors play a critical role in determining mental health trajectories.
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Affiliation(s)
- Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Federico Tedeschi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
| | - Giulia Turrini
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Ceren Acartürk
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Minna Anttila
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Josef Baumgartner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Eirini Karyotaki
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thomas Klein
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Markus Koesters
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Tella Lantta
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Michela Nosè
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Mariana Popa
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Eleonora Prina
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy
| | - Marit Sijbrandij
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ersin Uygun
- Trauma and Disaster, Mental Health, Bilgi University, Istanbul, Turkey
| | - Maritta Välimäki
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland.,Central South University, Changsha, People's Republic of China
| | - Lauren Walker
- Department of Health Sciences, University of York, York, UK
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ross G White
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wietse Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, University of Verona, Verona, Italy.,Cochrane Global Mental Health, University of Verona, Verona, Italy
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Inofuentes RA, Fuente LDL, Ortega E, García-García J. Victimización y Problemas de Conducta Externalizante y Antisocial en Menores Extranjeros no Acompañados en Europa: Revisión Sistemática. ANUARIO DE PSICOLOGÍA JURÍDICA 2021. [DOI: 10.5093/apj2021a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Inofuentes RA, Fuente LDL, Ortega E, García-García J. Victimización y Problemas de Conducta Externalizante y Antisocial en Menores Extranjeros no Acompañados en Europa: Revisión Sistemática. ANUARIO DE PSICOLOGÍA JURÍDICA 2021. [DOI: 10.5093/apj2021a27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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21
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Elgar FJ, Sen A, Gariépy G, Pickett W, Davison C, Georgiades K, Hammami N, Da Silva MA, Gordon D, Melgar-Quiñonez HR. Food insecurity, state fragility and youth mental health: A global perspective. SSM Popul Health 2021; 14:100764. [PMID: 33732866 PMCID: PMC7944102 DOI: 10.1016/j.ssmph.2021.100764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
Youth in fragile settings face disproportionate risks of experiencing food insecurity and poor mental health. Cross-national evidence is lacking on the association between food insecurity and mental health in youth populations, and on state fragility as a social determinant of these experiences. We analysed data from six cycles of the Gallup World Poll (2014–2019), an annual survey that contains multi-item scales of food insecurity, mental health problems and positive wellbeing. The analytic sample included 164,118 youth aged 15–24 years in 160 states. We linked individual responses to state-level data from the Fragile States Index—an aggregate measure of state vulnerability to collapse or conflict (coded: sustainable, stable, warning, or alert) and estimated adjusted relative risk (RR) of food insecurity as a function of state fragility. We then used linear regression to examine associations of state fragility and food insecurity with mental health and wellbeing. The prevalence of moderate or severe food insecurity rose from 22.93% in 2014 to 37.34% in 2019. State fragility (alert vs. sustainable) was related to an increased risk of food insecurity (RR = 2.28 [95% CI 1.30 to 4.01]), more mental health symptoms (b = 6.36 [95% CI 1.79 to 10.93]), and lower wellbeing (b = −4.49 [95% CI -8.28 to −0.70]) after controlling for state wealth and household income. Increased food insecurity (severe vs. none or mild) was uniquely related to more mental health symptoms (b = 18.44 [95% CI 17.24 to 19.64]) and reduced wellbeing (b = −9.85 [95% CI -10.88 to −8.83]) after state fragility was also controlled. Globally, youth experience better mental health where states are more robust and food access is more secure. The findings underscore the importance of strong governance and coordinated policy actions that may improve youth mental health. More than 2 billion people lack reliable access to sufficient and nutritious food. Globally, food security is foundational to youth mental health and well-being. Youth in more fragile states are less food secure and have worse mental health.
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Affiliation(s)
- Frank J Elgar
- Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, Quebec, H3A 1A3, Canada
| | - Akankasha Sen
- Margaret A. Gilliam Institute for Global Food Security, McGill University, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada.,School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Geneviève Gariépy
- Department of Social and Preventive Medicine, University of Montreal, 7101 Ave du Parc, Montreal, Quebec, H3N 1X9, Canada.,Montreal Mental Health University Institute, 7401 rue Hochelaga, Montreal, Quebec, H1L 2K4, Canada
| | - William Pickett
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3L3, Canada.,Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, L2S 3A1, Canada
| | - Colleen Davison
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3L3, Canada
| | - Kathy Georgiades
- Offord Centre for Child Studies, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Nour Hammami
- Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, Quebec, H3A 1A3, Canada
| | - Marine Azevedo Da Silva
- Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montreal, Quebec, H3A 1A3, Canada
| | - David Gordon
- Bristol Poverty Institute, University of Bristol, 10 Woodland Road, Bristol, BS8 1TN, UK
| | - Hugo Ramiro Melgar-Quiñonez
- Margaret A. Gilliam Institute for Global Food Security, McGill University, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada.,School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
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Müller LRF, Gossmann K, Schmid RF, Rosner R, Unterhitzenberger J. A pilot study on ecological momentary assessment in asylum-seeking children and adolescents resettled to Germany: Investigating compliance, post-migration factors, and the relation between daily mood, sleep patterns, and mental health. PLoS One 2021; 16:e0246069. [PMID: 33524043 PMCID: PMC7850498 DOI: 10.1371/journal.pone.0246069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background Asylum-seeking children and adolescents (ASCs) resettled to western countries show elevated levels of psychological distress. While research on the mental health of ASCs is increasing, less is known about their day-to-day living experiences such as their daily mood, sleep patterns, and post-migration factors. Moreover, no examination in situ, using smartphone-assisted ecological momentary assessment (EMA), has been conducted up to now among ASCs. Furthermore, we do not know if screening measures succeed in reflecting the daily mood of ASCs experienced in everyday life. Methods We undertook a smartphone-assisted EMA study over a two-week period with 3 measurements a day. Participants were N = 40 ASCs from 10 different countries who had resettled to Germany. They completed standardized questionnaires screening for history of trauma and clinical symptoms (post-traumatic stress symptoms, depression, and anxiety) that were carried out in interview-like settings, and they participated in the subsequent EMA where they rated mood, sleep parameters, and post-migration factors on a daily basis. Multilevel models of clinical symptoms, daily mood, and sleep parameters were computed based on a total of 680 measurements. Results The multiply traumatized and highly distressed participants reported different levels of discrimination, and various social activities and contacts in the EMA. The overall compliance rate was shown to be 40.5%. Higher PTSS and anxiety scores were associated with lower levels of daily mood and poorer outcomes of some sleep parameters. Depression scores were not associated with any of the variables assessed in the EMA. Conclusions Smartphone-assisted EMA among ASCs resettled to Germany proved to be implementable despite a rather low compliance rate. Not only do ASCs show high symptom levels, they are also affected by these symptoms in their daily lives. The results emphasize the need for concise screenings and psychological treatment for this high-risk population. Limitations include the convenient nature of the sample and the lack of a comparison group.
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Affiliation(s)
| | - Katharina Gossmann
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Regina F. Schmid
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
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23
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Hollifield M, Toolson EC, Verbillis-Kolp S, Farmer B, Yamazaki J, Woldehaimanot T, Holland A. Distress and Resilience in Resettled Refugees of War: Implications for Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031238. [PMID: 33573131 PMCID: PMC7908567 DOI: 10.3390/ijerph18031238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about distress (Refugee Health Screener—15 (RHS-15)) and possible predictors of distress were collected at the domestic medical examination (T1) within 90 days of arrival and the civil surgeon examination (T2) 11–16 months after T1 for refugee groups from three countries (COU). Descriptive, correlative, analyses of variance, and regression techniques were used to determine trajectory type and their predictors. A higher percentage (7.3%) were distressed at T2 than at T1. By group, the Bhutanese became more distressed, the Burmese became less distressed, and Iraqi’s continued to have high distress. A regression model showed gender, loss, post-migration stress, and self-efficacy to be significant predictors of trajectory type (R2 = 0.46). When the T1 RHS-15 score was added to the model, observed variance increased (R2 = 0.53) and T1 RHS score accounted for the majority of variance (r = 0.64, p < 0.001), with post-migration stress accounting for markedly less (β = 0.19, p = 0.03). Loss and self-efficacy became less significant. Loss was, however, a strong predictor of delayed and chronic distress trajectory type. These data suggest that screening for distress should occur at least twice during resettlement to detect those with initial distress and those with delayed distress. Screening should be coupled with identifying other social determinants of health and a comprehensive assessment to determine the need for intervention for secondary prevention (i.e., reducing delayed distress) and treatment (reducing chronic distress).
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Affiliation(s)
- Michael Hollifield
- VA Long Beach Healthcare System, Long Beach, CA 90822, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine, Washington, DC 20052, USA
- War Survivors Institute, 5318 2nd Street, #703, Long Beach, CA, 90803, USA
- Correspondence:
| | - Eric C. Toolson
- Department of Biology, The University of New Mexico, Albuquerque, NM 87131, USA;
| | - Sasha Verbillis-Kolp
- Consultant, 3630 N. Winchell St., Portland, OR 97217, USA;
- Portland State University School of Social Work, Academic Student Recreation Center, Ste. 600, 1800 SW 6th Ave., Portland, OR 97201, USA
| | - Beth Farmer
- International Rescue Committee, 1200 S. 192nd St., SeaTac, WA 98148, USA;
| | - Junko Yamazaki
- Asian Counseling and Referral Service, Seattle, WA 98144, USA; (J.Y.); (T.W.)
| | | | - Annette Holland
- Public Health Seattle & King County, Seattle, WA 98121, USA;
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24
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Bamford J, Fletcher M, Leavey G. Mental Health Outcomes of Unaccompanied Refugee Minors: a Rapid Review of Recent Research. Curr Psychiatry Rep 2021; 23:46. [PMID: 34196826 PMCID: PMC8249279 DOI: 10.1007/s11920-021-01262-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE To examine mental health outcomes of unaccompanied refugee minors during global policy shift. Additionally, to consider mental health service delivery and placement type for this group. METHODS A rapid systematic search of research published since 2018 which related to mental health outcomes of unaccompanied refugee minors. Data extracted, risk of bias assessed and outcomes reviewed qualitatively. RESEARCH FINDINGS We found 181 papers, of which 14 met inclusion criteria. This review found consistently high levels of PTSD and PTSS among URMs in various contexts. Exposure to trauma, being unaccompanied (compared to accompanied), being female and being older are associated with poor outcomes. Depression and anxiety were consistently high among URMs and associated with discrimination, limited language attainment and daily hassles. High rates of mental illness and symptoms among unaccompanied refugee minors were consistent across national and settlement contexts but the quality of the evidence is variable with significant heterogeneity of assessment. We relate persistence of poor mental health outcomes with problems accessing mental health services and discuss the role of key post-migration factors influencing outcomes-in particular placement type and the use of detention centres.
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Affiliation(s)
- Jordan Bamford
- grid.4777.30000 0004 0374 7521Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Mark Fletcher
- grid.4777.30000 0004 0374 7521Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland, UK.
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25
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Rosner R, Sachser C, Hornfeck F, Kilian R, Kindler H, Muche R, Müller LRF, Thielemann J, Waldmann T, Ziegenhain U, Unterhitzenberger J, Pfeiffer E. Improving mental health care for unaccompanied young refugees through a stepped-care approach versus usual care+: study protocol of a cluster randomized controlled hybrid effectiveness implementation trial. Trials 2020; 21:1013. [PMID: 33298126 PMCID: PMC7724616 DOI: 10.1186/s13063-020-04922-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/19/2020] [Indexed: 11/11/2022] Open
Abstract
Background More than half of the unaccompanied young refugees (UYRs) resettled in Europe report elevated levels of posttraumatic stress symptoms (PTSS) and comorbid symptoms. Earlier studies have highlighted the effectiveness of the trauma-focused preventive group intervention “Mein Weg” (English “My Way”), and the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for UYRs. Both interventions are deemed to be empirically supported treatments (ESTs). However, UYRs seldom receive ESTs or, in fact, any treatment at all. In view of the high need and the limited treatment resources available, a stepped-care approach is indicated but has not been evaluated so far. The purpose of this trial is to compare the stepped-care approach BETTER CARE with usual care enhanced with screening and indication (usual care+). Methods In a cluster randomized controlled trial involving N = 540 UYRs living in up to N = 54 child and youth welfare service (CYWS) facilities, BETTER CARE will be compared with usual care+. We will randomize clusters comprising a CYWS facility with at least one eligible psychotherapist. BETTER CARE consists of step (1) screening and indication and either step (2) preventive trauma-focused group intervention “Mein Weg” delivered by trained CYWS staff or step (3) TF-CBT delivered by trained community therapists and supported by trained translators if necessary. Participants will be assessed 6 and 12 months after randomization. The primary outcome is the severity of PTSS after 12 months. Secondary outcomes are depressive and anxiety symptoms, quality of life, and proxy reported PTSS. Furthermore, drug use, health costs, benefits, and long-term effects on integration/acculturation will be assessed. Discussion The trial will directly integrate a stepped-care approach into existing structures of the German child welfare and (mental) health system. It could, therefore, serve as a blueprint for how to implement ESTs for UYRs. If successful, screening, prevention, and intervention will be sustainably implemented in CYWS in southern Germany. Trial registration German Clinical Trials Register DRKS00017453. Registered on 11 December 2019. Supplementary information The online version contains supplementary material available at 10.1186/s13063-020-04922-x.
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Affiliation(s)
- Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071, Eichstätt, Germany
| | - Cedric Sachser
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhövelstr. 1, 89075, Ulm, Germany
| | | | - Reinhold Kilian
- Clinic for Psychiatry and Psychotherapy II, Ulm University, Ludwig-Heilmeyer-Str., 89312, Günzburg, Germany
| | - Heinz Kindler
- German Youth Institute, Nockherstr. 2, 81541, Munich, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstr. 13, 89075, Ulm, Germany
| | | | - Jonathan Thielemann
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071, Eichstätt, Germany
| | - Tamara Waldmann
- Clinic for Psychiatry and Psychotherapy II, Ulm University, Ludwig-Heilmeyer-Str., 89312, Günzburg, Germany
| | - Ute Ziegenhain
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhövelstr. 1, 89075, Ulm, Germany
| | - Johanna Unterhitzenberger
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 26, 85071, Eichstätt, Germany
| | - Elisa Pfeiffer
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhövelstr. 1, 89075, Ulm, Germany.
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26
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A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents. Clin Psychol Rev 2020; 83:101930. [PMID: 33186775 DOI: 10.1016/j.cpr.2020.101930] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 10/13/2020] [Indexed: 12/22/2022]
Abstract
In the past decade, millions of children and adolescents have been forced to flee from protracted or newly erupted violent conflicts. Forcibly displaced children are particularly vulnerable for developing mental health problems. However, a timely and systematic review of the current evidence is lacking. We conducted a systematic review of factors contributing to the mental health of refugee children across different socio-ecological levels (individual, family, community, sociocultural). We systematically searched the databases Medline, PsycINFO, Web of Science, and Cochrane for English studies published in peer-reviewed journals between August 2010 and May 2020. Of the 2413 identified studies, 63 were included in the analyses. Only 24 studies were considered to be of high quality. Pre-migration individual (risk: exposure to war-related trauma, female gender) and post-migration family factors (risk: parental mental health problems and impaired parenting, protective: family cohesion) currently have the best evidence base. Post-migration community (protective: school connectedness, support by peers) and sociocultural factors (risk: discrimination and acculturative stress, protective: integrative acculturation) have gained some support in high-income settings. Prevention and intervention approaches should integrate factors across different socio-ecological levels. More longitudinal studies and research in low- and middle-income countries are needed to advance our knowledge on causal mechanisms behind factors contributing to refugee youth's mental health.
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27
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Buchmüller T, Lembcke H, Busch J, Kumsta R, Wolf OT, Leyendecker B. Exploring hair steroid concentrations in asylum seekers, internally displaced refugees, and immigrants. Stress 2020; 23:538-545. [PMID: 32116089 DOI: 10.1080/10253890.2020.1737008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The study of physiology in response to war and forced displacement can yield insight into the origin of stress-related mental health disorders. Previous studies found alterations in hair cortisol concentrations (HCC) in refugees. However, the direction of this alteration in HCC, as well as the association between HCC and psychological stress, remain unclear. Mixed findings can potentially be explained by the lack of contextual factors that have been taken into account. In this explorative study, we investigated HCCs in three female refugee samples (N = 89) in different contexts. Samples were i) asylum seekers from Syria, who sought protection in Germany two years ago (n = 37), ii) internally displaced persons (IDPs), who fled a genocide and lived in conditions of onging insecurity in Iraq (n = 14), and iii) Kurdish immigrants and former asylum seekers, who resettled to Germany 18 years ago and were used as reference group (n = 38). HCC was assessed in the scalp-nearest 6 cm of hair (2*3 cm segments). Data on mental and physical health, exposure to traumatic events, and time between immigration and HCC assessments were collected. Syrian asylum seekers had lower HCC than immigrant controls (η2 = .06). PTSD symptoms and perceived stress were associated with elevated cortisol levels in IDPs (r = .66 and r = .56), while time since immigration was associated with cortisol levels only in immigrant controls (r = .38). We discuss our findings with regard to the importance of contextual factors, particularly time since displacement and on-going insecurity, when studying physiological reactions in refugees.Lay summaryFemale Syrian asylum seekers had lower levels of hair cortisol concentration than Kurdish immigrants in Germany. Hair cortisol concentration was associated with post-traumatic stress symptoms only in internally displaced women who were exposed to ongoing stress and insecurity in Iraq.
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Affiliation(s)
- Thimo Buchmüller
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Hanna Lembcke
- Department for Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Julian Busch
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Robert Kumsta
- Department for Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Oliver T Wolf
- Department for Cognitive Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Birgit Leyendecker
- Center for Child and Family Research, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Strømme EM, Haj-Younes J, Hasha W, Fadnes LT, Kumar B, Igland J, Diaz E. Changes in health among Syrian refugees along their migration trajectories from Lebanon to Norway: a prospective cohort study. Public Health 2020; 186:240-245. [PMID: 32861924 DOI: 10.1016/j.puhe.2020.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Conflict-driven displacement is an indisputable social determinant of health. Yet, data on changes in health along the migration trajectories of refugees are scarce. This study aims to assess the longitudinal changes in somatic and mental health and use of medication among Syrian refugees relocating from a conflict-near transit setting in the Middle East to a resettlement setting in Europe. Further, we examine different health status trajectories and factors that predict health in the early postmigration period. STUDY DESIGN This is a prospective cohort study. METHODS Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were non-communicable disease (NCD), chronic impairment, chronic pain, anxiety/depression, post-traumatic stress symptoms, and daily use of drugs. We estimated longitudinal changes in prevalence proportions using generalized estimating equations and evaluated effect modification of health outcomes. RESULTS Altogether, 353 Syrians participated. NCDs declined (12%-9%), while the prevalence of chronic impairment, chronic pain, and use of drugs remained nearly unchanged (29%-28%, 30%-28%, and 20%-18%) between baseline and follow-up. Conversely, mental health outcomes improved (anxiety/depression 33%-11%, post-traumatic stress disorder 5%-2%). Effect modifiers for improvement over time included younger age, short length of stay, and non-legal status in the transit country before resettlement in Europe. CONCLUSIONS We find that mental health outcomes improve from a conflict-near transit setting in Lebanon to an early resettlement setting in Norway, while somatic health outcomes remain stable. Temporal changes in health among moving populations warrant attention, and long-term changes need further scrutiny.
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Affiliation(s)
- E M Strømme
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - J Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - W Hasha
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - L T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
| | - B Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway.
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway.
| | - E Diaz
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020, Bergen, Norway; Unit for Migration and Health, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway.
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29
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Björkenstam E, Helgesson M, Norredam M, Sijbrandij M, de Montgomery CJ, Mittendorfer-Rutz E. Common mental disorders among young refugees in Sweden: The role of education and duration of residency. J Affect Disord 2020; 266:563-571. [PMID: 32056927 DOI: 10.1016/j.jad.2020.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies investigating risks of common mental disorders (CMDs) in refugee youth are sparse. The current study examined health care use due to CMDs in unaccompanied and accompanied refugee youth and Swedish-born, and the role of education and residency duration. METHODS This longitudinal cohort study included 746,517 individuals (whereof 36,347 refugees) between 19 and 25 years, residing in Sweden in 2009. Refugees were classified as unaccompanied/accompanied. Risk estimates of CMDs, measured as health care use and antidepressant treatment, between 2010-2016 were calculated as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Highest attained education in 2009, and residency duration were examined as potential modifiers. RESULTS Compared to Swedish-born youth, refugees had a lower risk of treated major depressive and anxiety disorders (aHR): 0.67 (95% CI 0.63-0.72) and 0.67 (95% CI 0.63-0.71) respectively), but a higher risk for posttraumatic stress disorders (PTSD). Compared to Swedish-born, unaccompanied had a nearly 6-fold elevated risk for PTSD (aHR: 5.82, 95% CI 4.60-7.34) and accompanied refugees had a 3-fold risk of PTSD (aHR: 3.08, 95% CI 2.54-3.74). Rates of PTSD decreased with years spent in Sweden. The risk of CMDs decreased with increasing education. LIMITATIONS The study lacked information on pre-migration factors. There may further be a potential misclassification of untreated CMDs. CONCLUSION Refugees had a lower risk of treated depressive and anxiety disorders but a higher risk for PTSD. In refugees, the rates of anxiety disorders increased slightly over time whereas the rates of PTSD decreased. Last, low education was an important predictor for CMDs.
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Affiliation(s)
- Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Christopher Jamil de Montgomery
- Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
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