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Salim S. The burden of trauma in the life of a refugee. Front Public Health 2024; 12:1298544. [PMID: 39086798 PMCID: PMC11288919 DOI: 10.3389/fpubh.2024.1298544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 06/19/2024] [Indexed: 08/02/2024] Open
Affiliation(s)
- Samina Salim
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX, United States
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Kapel Lev-Ari R, Aloni R, Ari AB. Children Fleeing War-Exploring the Mental Health of Refugee Children Arriving in Israel after the Ukraine 2022 Conflict. CHILD ABUSE & NEGLECT 2024; 149:106608. [PMID: 38141479 DOI: 10.1016/j.chiabu.2023.106608] [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: 06/14/2023] [Revised: 09/18/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND In February 2022, Ukraine suffered a devastating assault by Russia, leading to destruction, casualties, and mass displacement. Among those displaced were over 1.5 million children. Forced displacement exposes children to a heightened risk of mental health issues. OBJECTIVE This study investigated the prevalence of Post-traumatic stress disorder (PTSD) and other mental health issues among child refugees shortly after their displacement from Ukraine to Israel. It aimed to identify factors influencing PTSD development and explore their associations. METHODS The study included 59 child refugees who had arrived in Israel after fleeing the war in Ukraine. Parents completed self-report questionnaires to assess their children's mental health. RESULTS Only three children met the DSM diagnostic criteria for PTSD, with higher scores in the negative cognition and re-experiencing clusters. Over half of the children exhibited general mental health problems, with approximately 40 % showing internalizing problems, and 30 % showing externalizing problems. The study also found a significant comorbidity between PTSD symptoms and internalizing problems. Additionally, internalizing problems emerged as the sole significant predictor of PTSD levels when considering factors such as age, gender, economic status, parents' work status, internalizing problems, and externalizing problems. CONCLUSIONS Child refugees frequently experience psychological distress, even if they do not meet the formal diagnostic criteria for PTSD. They often exhibit other distress symptoms, primarily internalizing problems, which can be challenging to detect. A deeper understanding of the challenges faced by refugee children can inform the development of targeted assistance programs and the recruitment and training of personnel in host countries.
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Affiliation(s)
| | - Roy Aloni
- Department of Behavioral Sciences, Ariel University, Israel
| | - Amichai Ben Ari
- Department of Behavioral Sciences, Ariel University, Israel; Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Buria L, Moisieieva N, Kapustianska A, Vakhnenko A, Zviagolska I, Vlasova O, Rumiantseva M. Evaluation of the treatment strategy for complicated allergic rhinitis. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:62-67. [PMID: 38431809 DOI: 10.36740/wlek202401109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Aim: To carry out a comprehensive evaluation of treatment modification for patients with seasonal allergic rhinitis (SAR) complicated by anxiety-neurotic disorders. PATIENTS AND METHODS Materials and Methods: Patients with SAR in the acute stage on the background of anxiety disorders were studied. Immunological studies were carried out, an assessment of the dynamics of indicators of the quality of life of patients, the level of anxiety / depression was assessed. In the clinical group, a variant of therapy modification was proposed. RESULTS Results: Significant changes in the subpopulation ratio of lymphocytes, an increase in the immunoregulatory index, which indicated the severity of the immunological process, were revealed in SAR patients in the acute stage against the background of anxiety disorders. At the same time, a significant activation of the humoral link of immunity was observed: an increase and a significant increase in IgE in the blood serum and an increase in the content of sIgA in the nasal secretion. In most patients, eosinophilia was found in the peripheral blood and in the rhinocytogram before treatment. In the study of the quality of life of patients, changes in many parameters were found. CONCLUSION Conclusions: The combination of "Nazafort Allergy Protection" and Atarax seems to be the most successful, which significantly improved the physical and psycho-emotional state of patients with SAR, complicated by anxiety and neurotic disorders. This combination led to an increase in the stress resistance of patients.
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Affiliation(s)
- Lilia Buria
- POLTAVA STATE MEDICAL UNIVERSITY, POLTAVA, UKRAINE
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Fel S, Jurek K, Lenart-Kłoś K. The relationship between socio-demographic factors and depression: a cross sectional study among civilian participants in hostilities in Ukraine. Sci Rep 2023; 13:21897. [PMID: 38082045 PMCID: PMC10713780 DOI: 10.1038/s41598-023-49289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
There is still a gap in scientific knowledge in relation to civilian participants in hostilities. This is despite the fact that there is an extensive body of literature on major depressive disorder (MDD) in individuals who have experienced armed conflict. The purpose of this article is to identify socio-demographic factors which are related to levels of depression among civilian participants in the war in Ukraine, based on a cross-sectional study that was conducted in 2019 from a convenience sample of 314 Ukrainian adults (235 males). Depression was assessed via the Beck Depression Inventory. Multiple regression analyses were conducted to identify possible predictors of depression. Significant predictors were: loss of a loved one, place of residence, age, health insurance, financial situation, and marital status (F (6, 224) = 10.515, p < 0.001, R2 = 0.21; Adjusted R2 = 0.19). They also show that symptoms of depression resulting from the loss of a loved one due to war can be reduced through participation in an educational system. Having children is associated with a risk of more severe depression. Specialists are encouraged to engage in face-to-face interviews and to maintain a supportive and safe environment for participants in hostilities, e.g., in the area of education.
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Affiliation(s)
- Stanisław Fel
- The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Krzysztof Jurek
- The John Paul II Catholic University of Lublin, Lublin, Poland.
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Khairat M, Hodge S, Duxbury A. Refugees' and asylum seekers' experiences of individual psychological therapy: A qualitative meta-synthesis. Psychol Psychother 2023; 96:811-832. [PMID: 37166267 DOI: 10.1111/papt.12470] [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: 08/16/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE The current review aimed to synthesise qualitative literature exploring adult refugees' and asylum seekers' experiences of individual psychological therapy. METHODS A comprehensive systematic search of the following databases led to the identification of eight studies for inclusion in this review: PsycINFO, PsycARTICLES, MEDLINE, EMBASE, CINAHL and Academic Search Ultimate. All selected studies used qualitative methodology to explore refugees' and asylum seekers' experiences of individual psychological therapy. Studies were appraised using an adapted version of the Critical Appraisal Skills Programme (CASP) Tool. The data from these selected studies were then synthesised using a meta-ethnographic approach. RESULTS The synthesis of selected studies resulted in the development of five themes; (i) the importance of recognition and validation within therapy, (ii) building a human connection within the therapeutic relationship and the importance of cultural competency, (iii) revisiting trauma, managing difficult emotions from therapy and regaining hope, (iv) the value of practical interventions, (v) 'one should not wake up the djinns (demons)'-cultural stigma and accessing therapy. These themes illustrated the complexities of working therapeutically with asylum seekers and refugees and the vital role of building trust and safety within the therapeutic relationship prior to engagement in therapeutic work. The results also highlighted varied responses to engaging in trauma work ranging from participants finding the experience transformative to others finding it unhelpful, some participants preferred more practical interventions. Participants' cultural backgrounds and pre-conceptions around therapy impacted on engagement and the therapist's cultural competency was a significant factor in therapeutic engagement. CONCLUSIONS Working therapeutically with asylum seekers and refugees involves a number of factors for consideration. Forced migrants' socio-political context was seen as central to their experiences of distress and recognition of these factors was imperative for positive therapeutic engagement. This review highlights a number of clinical implications to guide practitioners working therapeutically with this community.
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Affiliation(s)
- Mariam Khairat
- The Division of Health Research, Lancaster University, Lancaster, UK
| | - Suzanne Hodge
- The Division of Health Research, Lancaster University, Lancaster, UK
| | - Anna Duxbury
- Lancashire Emotional Health in Schools Service, Lancaster University, Lancaster, UK
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Śliwerski A, Kossakowska K. The mental functioning of school-age children in Poland since the outbreak of war in Ukraine and during the subsequent refugee crisis. CHILD ABUSE & NEGLECT 2023:106500. [PMID: 37833119 DOI: 10.1016/j.chiabu.2023.106500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND There is growing body of research focusing on the functioning of children who have fled from war-torn areas. However, there is currently lack of data regarding the functioning of children residing in host countries. OBJECTIVE The aim of this study is to examine the presence of emotional problems, negative attitudes, interpersonal problems, and functional difficulties among Polish children during the first month after the outbreak of war and initial phase of the current refugee crisis. PARTICIPANTS AND METHOD The study group comprised children aged 9-15 (N = 360), living in Poland. The Children's Depression Inventory 2 (CDI-2) and The Cognitive Triad Inventory for Children (CTIC) was used to measure emotional functioning. The study took place 7 to 39 days after the outbreak of the war in Ukraine. RESULTS The children reported more emotional problems (t(359) = 9.340; p < .001; d = 0.49) with a negative mood (t(359) = 6.692; p < .001; d = 0.35) and negative self-esteem (t(359) = 9.632; p < .001; d = 0.51). The severity of depression symptoms was the highest in the first week after the outbreak of the war (F(5,354) = 2.472; p < .05; η2 = 0.03). The view of the self (F(1,358) = 3.858; p = .05; R2 = 0.01) and of the world (F(1,358) = 5.359; p < .05; R2 = 0.02) improved over time; however, their vision of the future remained unchanged. CONCLUSION The results shows that children who are not directly affected by the war can also display difficulties in mental functioning. In the initial months following the outbreak of the war and during the early stage of the current refugee crisis, Polish children demonstrated significantly higher levels of emotional problems and negative self-esteem. Moreover, the perception of oneself and the world appeared to be influenced by the duration since the onset of the war.
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Affiliation(s)
- Andrzej Śliwerski
- Institute of Psychology, University of Łódź, al. Rodziny Scheiblerów 2, 90-128 Łódź, Poland.
| | - Karolina Kossakowska
- Institute of Psychology, University of Łódź, al. Rodziny Scheiblerów 2, 90-128 Łódź, Poland
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Blay Benzaken Y, Zohar S, Yuval K, Aizik-Reebs A, Gebremariam SG, Bernstein A. COVID-19 and Mental Health Among People Who Are Forcibly Displaced: The Role of Socioeconomic Insecurity. Psychiatr Serv 2023; 74:158-165. [PMID: 35833254 DOI: 10.1176/appi.ps.202200052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Forcibly displaced persons may be at elevated risk for poor mental health outcomes because of the COVID-19 pandemic. This study sought to examine associations between COVID-19-related socioeconomic insecurity and mental health outcomes among asylum seekers. METHODS The authors evaluated the association between the degree of food, housing, and income insecurity related to the pandemic and mental health outcomes among East African asylum seekers in a high-risk, postdisplacement setting in the Middle East (i.e., Israel). RESULTS Anxiety symptom severity (p=0.03) as well as the rate of suicidal ideation among women (odds ratio [OR]=2.81, p=0.016) were significantly elevated in a community sample of asylum seekers during the COVID-19 pandemic (N=66) relative to a similar sample (N=158) from the same community and context assessed before the pandemic. No differences between the two groups were observed for severity or rate of probable depression or posttraumatic stress disorders. In addition, among the sample assessed during the pandemic, socioeconomic insecurity due to the pandemic was strongly associated with elevated symptom severity and probable anxiety, depression, and posttraumatic stress disorders as well as suicidal ideation (R2 range=0.19-0.35; OR range=4.54-5.46). CONCLUSIONS Findings are consistent with growing evidence of a mental health crisis among asylum seekers that is linked to COVID-19 control policies and residential status policies. The results highlight the risk for suicidal ideation linked to intersectional marginalization among female asylum seekers. These findings may inform postdisplacement policy making, social justice advocacy, humanitarian aid, and clinical science and practice to mitigate poor mental health outcomes associated with COVID-19 among forcibly displaced persons.
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Affiliation(s)
| | - Shani Zohar
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Kim Yuval
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | | | - Amit Bernstein
- Department of Psychology, University of Haifa, Haifa, Israel
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Bürgin D, Anagnostopoulos D, Vitiello B, Sukale T, Schmid M, Fegert JM. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry 2022; 31:845-853. [PMID: 35286450 PMCID: PMC9209349 DOI: 10.1007/s00787-022-01974-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.
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Affiliation(s)
- David Bürgin
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | | | - Benedetto Vitiello
- Division of Child Neurology and Psychiatry, Department of Public Health and Pediatric Sciences, Regina Margherita Pediatric Hospital, University of Turin, Turin, Italy
| | - Thorsten Sukale
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Steinhövelstrasse 5, 89073, Ulm, Germany.
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Bernardi L, Gotlib IH, Zihnioğlu Ö. Effects of COVID-19-related life changes on mental health in Syrian refugees in Turkey. BJPsych Open 2021; 7:e182. [PMID: 34659792 PMCID: PMC8503067 DOI: 10.1192/bjo.2021.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mental disorders are currently the greatest global health burden. The coronavirus diseases 2019 (COVID-19) pandemic is having an adverse impact on people's mental health, particularly in vulnerable populations, such as refugees. AIMS The present study was designed to examine the association between COVID-19 and changes in mental health in Syrian refugees in Turkey. METHOD We conducted a two-wave panel survey of a representative sample of 302 of the estimated 500 000 Syrian refugees (ages 18 and older) living under humanitarian support in Istanbul (first wave between 9 and 15 July 2020 and the follow-up between 11 and 14 September 2020). We administered seven items from the CoRonavIruS Health Impact Survey in addition to one-context specific item about life changes because of COVID-19, and measures of depression (10-item Center for Epidemiologic Study Depression Scale, CESD-10), anxiety (6-item State-Trait Anxiety Inventory, STAI-6) and perceived stress (Perceived Stress Scale, PSS-4). RESULTS A factor analysis yielded three COVID-19 factors, labelled 'social relationships', 'stress' and 'hope.' We conducted a series of cross-lag panel analyses to test associations between the COVID-19 factors and mental health. We found associations between all COVID-19 factors and CESD-10, between COVID-19 'stress' and STAI-6, and between COVID-19 'stress' and COVID-19 'hope' and PSS-4. CONCLUSIONS Our measures of life changes because of the COVID-19 pandemic are associated with changes in the mental health of Syrian refugees living in Istanbul. It is therefore important that they are provided with services to reduce what may be particularly debilitating consequences of COVID-19.
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Júnior JG, de Sales JP, Moreira MM, Pinheiro WR, Lima CKT, Neto MLR. A crisis within the crisis: The mental health situation of refugees in the world during the 2019 coronavirus (2019-nCoV) outbreak. Psychiatry Res 2020; 288:113000. [PMID: 32353696 PMCID: PMC7156944 DOI: 10.1016/j.psychres.2020.113000] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND 68.5 million people around the world have been forced to leave their houses. Refugees have mainly to face their adaption in a host country, which involves bureaucracy, different culture, poverty, and racism. The already fragile situation of refugees becomes worrying and challenged in the face of the new coronavirus (COVID-19) epidemic. Therefore, we aimed to describe the factors that can worsen the mental health of refugees. METHOD The studies were identified in well-known international journals found in three electronic databases: PubMed, Scopus, and Embase. The data were cross-checked with information from the main international newspapers. RESULTS According to the literature, the difficulties faced by refugees with the COVID-19 pandemic are potentiated by the pandemic state. There are several risk factors common to coronavirus and psychiatric illnesses as overcrowding, disruption of sewage disposal, poor standards of hygiene, poor nutrition, negligible sanitation, lack of access to shelter, health care, public services, and safety. These associated with fear and uncertainty create a closed ground for psychological sickness and COVID-19 infection. CONCLUSIONS There should be not only a social mobilization to contain the virus, but also a collective effort on behalf of the most vulnerable populations.
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Affiliation(s)
- Jucier Gonçalves Júnior
- Department of Internal Medicine, Santa casa de Misericórdia de Fortaleza, Fortaleza, Ceará, Brazil
| | | | - Marcial Moreno Moreira
- School of Medicine, Universidade Federal do Cariri (UFCA), Barbalha, Ceará, Brazil,School of Medicine of Juazeiro do Norte (FMJ/Estácio) – Juazeiro do Norte, Ceará, Brazil
| | | | | | - Modesto Leite Rolim Neto
- School of Medicine, Universidade Federal do Cariri (UFCA), Barbalha, Ceará, Brazil; School of Medicine of Juazeiro do Norte (FMJ/Estácio) - Juazeiro do Norte, Ceará, Brazil.
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