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Bernhardt K, Le Beherec S, Uppendahl JR, Fleischmann M, Klosinski M, Rivera LM, Samaras G, Kenney M, Müller R, Nehring I, Mall V, Hahnefeld A. Young children's development after forced displacement: a systematic review. Child Adolesc Psychiatry Ment Health 2024; 18:20. [PMID: 38303022 PMCID: PMC10835848 DOI: 10.1186/s13034-024-00711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES To examine the impact of displacement experiences on 0- to 6-year-old children's social-emotional and cognitive development, as well as influencing factors on reported outcomes. STUDY DESIGN We systematically searched MEDline, Psyndex, Cochrane Library, Web of Science, Elsevier, TandF, Oxford Journal of Refugee Studies, Journal of Immigrant & Refugee Studies, and Canada's Journal on Refugees for existing literature regarding social-emotional and cognitive outcomes in children directly exposed to forced displacement due to political violence. Results were synthesized in the discussion and displayed using harvest plots. RESULTS Our search generated 9,791 articles of which 32 were selected for review and evaluation according to NICE criteria. Included studies provided results for 6,878 forcibly displaced children. Measured outcomes were diverse and included areas such as peer relations, prosocial behavior, family functioning, play, intelligence, learning performance, and language development. Repeated exposure to adverse experiences, separation from parents, parental distress, as well as duration and quality of resettlement in the host country were reported as influencing factors in the reviewed studies. CONCLUSION As protective factors like secure and stable living conditions help to promote children's development, we call for policies that enhance participation in the welcoming society for refugee families. Early integration with low-threshold access to health and educational facilities can help to mitigate the wide-ranging negative consequences of forced displacement on young children's development.
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Affiliation(s)
- Katharina Bernhardt
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany.
| | - Saskia Le Beherec
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
| | - Jana R Uppendahl
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Melia Fleischmann
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Klosinski
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Luisa M Rivera
- Department of Anthropology, Emory University, Atlanta, GA, USA
| | - Georgia Samaras
- Department of Science, Technology and Society, Technical University of Munich, Munich, Germany
| | - Martha Kenney
- Department of Women and Gender Studies, San Francisco State University, San Francisco, CA, USA
| | - Ruth Müller
- Department of Science, Technology and Society, Technical University of Munich, Munich, Germany
- School of Management, Technical University of Munich, Munich, Germany
- School of Life Sciences, Technical University of Munich, Munich, Germany
| | - Ina Nehring
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Volker Mall
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
| | - Andrea Hahnefeld
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany
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Magwood O, Bellai-Dussault K, Fox G, McCutcheon C, Adams O, Saad A, Kassam A. Diagnostic test accuracy of screening tools for post-traumatic stress disorder among refugees and asylum seekers: A systematic review and meta-analysis. J Migr Health 2022; 7:100144. [PMID: 36568829 PMCID: PMC9772565 DOI: 10.1016/j.jmh.2022.100144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Refugees and asylum seekers often experience traumatic events resulting in a high prevalence of post-traumatic stress disorder (PTSD). Undiagnosed PTSD can have detrimental effects on resettlement outcomes. Immigration medical exams provide an opportunity to screen for mental health conditions in refugee and asylum seeker populations and provide links to timely mental health care. Objective To assess the diagnostic accuracy of screening tools for PTSD in refugee and asylum seeker populations. Methods We systematically searched Medline, Embase, PsycINFO, CENTRAL and CINAHL up to 29 September 2022. We included cohort-selection or cross-sectional study designs that assessed PTSD screening tools in refugee or asylum seeker populations of all ages. All reference standards were eligible for inclusion, with a clinical interview considered the gold standard. We selected studies and extracted diagnostic test accuracy data in duplicate. Risk of bias and applicability concerns were addressed using QUADAS-2. We meta-analyzed findings using a bivariate random-effects model. We partnered with a patient representative and a clinical psychiatrist to inform review development and conduct. Results Our review includes 28 studies (4,373 participants) capturing 16 different screening tools. Nine of the 16 tools were developed specifically for refugee populations. Most studies assessed PTSD in adult populations, but three included studies focused on detecting PTSD in children. Nine studies looked at the Harvard Trauma Questionnaire (HTQ) with diagnostic cut-off points ranging from 1.17 to 2.5. Meta-analyses revealed a summary point sensitivity of 86.6% (95%CI 0.791; 0.917) and specificity of 78.9% (95%CI 0.639; 0.888) for these studies. After evaluation, we found it appropriate to pool other screening tools (Posttraumatic Stress Disorder Checklist, the Impact of Event Scale, and the Posttraumatic Diagnostic Scale) with the HTQ. The area under the curve for this model was 79.4%, with a pooled sensitivity of 86.2% (95%CI 0.759; 0.925) and a specificity of 72.2% (95%CI 0.616; 0.808). Conclusions Our review identified several screening tools that perform well among refugees and asylum seekers, but no single tool was identified as being superior. The Refugee Health Screener holds promise as a practical instrument for use in immigration medical examinations because it supports the identification of PTSD, depression, and anxiety across diverse populations. Future research should consider tool characteristics beyond sensitivity and specificity to facilitate implementation in immigration medical exams. Registration Open Science Framework: 10.17605/OSF.IO/PHNJV.
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Affiliation(s)
- Olivia Magwood
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, 125 University, Ottawa, ON K1N 6N5, Canada
| | - Kara Bellai-Dussault
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Grace Fox
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Chris McCutcheon
- Interdisciplinary School of Health Sciences, University of Ottawa, 125 University, Ottawa, ON K1N 6N5, Canada
| | - Owen Adams
- Canadian Medical Association, 1410 Blair Towers Place, Suite 500, Ottawa, ON K1J 9B9, Canada
| | - Ammar Saad
- Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
- Pinecrest-Queensway Community Health Centre, 1365 Richmond Rd #2, Ottawa, ON K2B 6R7, Canada
- Ottawa Newcomer Health Centre, 291 Argyle, Ottawa, ON K2P 1B8, Canada
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Hahnefeld A, Münch K, Aberl S, Henningsen P, Mall V. Versorgung traumatisierter Vorschulkinder. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chiappedi M, Mensi MM. Recent Advances in Child and Adolescent Psychiatry. CHILDREN 2022; 9:children9040489. [PMID: 35455533 PMCID: PMC9029220 DOI: 10.3390/children9040489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
The field of child and adolescent psychiatry is receiving growing attention, although a number of local differences still exist in terms of academic curricula, board certifications and even definitions of what is to be considered part of this field or not [...]
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Magwood O, Kassam A, Mavedatnia D, Mendonca O, Saad A, Hasan H, Madana M, Ranger D, Tan Y, Pottie K. Mental Health Screening Approaches for Resettling Refugees and Asylum Seekers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3549. [PMID: 35329237 PMCID: PMC8953108 DOI: 10.3390/ijerph19063549] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
Refugees and asylum seekers often face delayed mental health diagnoses, treatment, and care. COVID-19 has exacerbated these issues. Delays in diagnosis and care can reduce the impact of resettlement services and may lead to poor long-term outcomes. This scoping review aims to characterize studies that report on mental health screening for resettling refugees and asylum seekers pre-departure and post-arrival to a resettlement state. We systematically searched six bibliographic databases for articles published between 1995 and 2020 and conducted a grey literature search. We included publications that evaluated early mental health screening approaches for refugees of all ages. Our search identified 25,862 citations and 70 met the full eligibility criteria. We included 45 publications that described mental health screening programs, 25 screening tool validation studies, and we characterized 85 mental health screening tools. Two grey literature reports described pre-departure mental health screening. Among the included publications, three reported on two programs for women, 11 reported on programs for children and adolescents, and four reported on approaches for survivors of torture. Programs most frequently screened for overall mental health, PTSD, and depression. Important considerations that emerged from the literature include cultural and psychological safety to prevent re-traumatization and digital tools to offer more private and accessible self-assessments.
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Affiliation(s)
- Olivia Magwood
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON K1N 7K4, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, 75 Laurier Ave E, Ottawa, ON K1N 6N5, Canada;
- Pinecrest-Queensway Community Health Centre, 1365 Richmond Rd #2, Ottawa, ON K2B 6R7, Canada
- Ottawa Newcomer Health Centre, 291 Argyle, Ottawa, ON K2P 1B8, Canada
| | - Dorsa Mavedatnia
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; (D.M.); (M.M.)
| | - Oreen Mendonca
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
| | - Ammar Saad
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 5B2, Canada
| | - Hafsa Hasan
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON M5T 3M6, Canada
| | - Maria Madana
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; (D.M.); (M.M.)
| | - Dominique Ranger
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
| | - Yvonne Tan
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- Faculty of Arts and Sciences, Queen’s University, 99 University Ave, Kingston, ON K7L 3N6, Canada
| | - Kevin Pottie
- C.T. Lamont Primary Care Research Center, Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON K1R 7G5, Canada; (O.M.); (O.M.); (A.S.); (H.H.); (D.R.); (Y.T.)
- Department of Family Medicine, Western University, London, ON N6A 3K7, Canada
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Verhagen IL, Noom MJ, Lindauer RJL, Daams JG, Hein IM. Mental health screening and assessment tools for forcibly displaced children: a systematic review. Eur J Psychotraumatol 2022; 13:2126468. [PMID: 36212114 PMCID: PMC9542271 DOI: 10.1080/20008066.2022.2126468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: An unprecedentedly large number of people worldwide are forcibly displaced, of which more than 40 percent are under 18 years of age. Forcibly displaced children and youth have often been exposed to stressful life events and are therefore at increased risk of developing mental health issues. Hence, early screening and assessment for mental health problems is of great importance, as is research addressing this topic. However, there is a lack of evidence regarding the reliability and validity of mental health assessment tools for this population. Objective: The aim of the present study was to synthesise the existing evidence on psychometric properties of patient reported outcome measures [PROMs] for assessing the mental health of asylum-seeking, refugee and internally displaced children and youth. Method: Systematic searches of the literature were conducted in four electronic databases: MEDLINE, PsycINFO, Embase and Web of Science. The methodological quality of the studies was examined using the COSMIN Risk of Bias checklist. Furthermore, the COSMIN criteria for good measurement properties were used to evaluate the quality of the outcome measures. Results: The search yielded 4842 articles, of which 27 met eligibility criteria. The reliability, internal consistency, structural validity, hypotheses testing and criterion validity of 28 PROMs were evaluated. Conclusion: Based on the results with regard to validity and reliability, as well as feasibility, we recommend the use of several instruments to measure emotional and behavioural problems, PTSD symptoms, anxiety and depression in forcibly displaced children and youth. However, despite a call for more research on the psychometric properties of mental health assessment tools for forcibly displaced children and youth, there is still a lack of studies conducted on this topic. More research is needed in order to establish cross-cultural validity of mental health assessment tools and to provide optimal cut-off scores for this population. HIGHLIGHTS Research on the psychometric properties of mental health screening and assessment tools for forcibly displaced children and youth is slowly increasing.However, based on the current evidence on the validity and reliability of screening and assessment tools for forcibly displaced children, we are not able to recommend a core set of instruments. Instead, we provide suggestions for best practice.More research of sufficient quality is important in order to establish crsoss-cultural validity and to provide optimal cut-off scores in mental health screening and assessment tools for different populations of forcibly displaced children and youth.
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Affiliation(s)
- Ilse L Verhagen
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marc J Noom
- Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
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