Article

Improving Mental Health Outcomes of Burmese Migrant and Displaced Children in Thailand: a Community-Based Randomized Controlled Trial of a Parenting and Family Skills Intervention

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The negative effects of displacement and poverty on child mental health are well-known, yet research on prevention interventions in low- and middle-income countries, especially fragile states, remains limited. We examined the effectiveness of a parenting skills intervention on mental health outcomes among Burmese migrant and displaced children living in 20 communities in Thailand. Participants were primary caregivers and children aged 7 to 15 years (n = 479 families). Families were randomly assigned to receive an adapted version of the Strengthening Families Program (n = 240) or a wait-list control condition (n = 239). Assessments were conducted at baseline and 1-month post-intervention for both conditions and at 6 months for treatment group only. One month after the program, children in the treatment condition showed significant reductions in externalizing problems (caregiver effect size (ES) -0.22, p = 0.02; child report ES -0.11, p = 0.02) and child attention problems compared with controls (caregiver report ES -0.23, p = 0.03). There was no significant treatment effect on children's internalizing problems (ES -0.06; p = 0.31). Children reported a significant increase in prosocial protective factors relative to controls (ES 0.20, p < 0.01). Results suggest that an evidence-based parenting skills intervention adapted for a displaced and migrant Burmese population facing high levels of adversity can have positive effects on children's externalizing symptoms and protective psychosocial factors. Trial registration: Clinicaltrials.gov: https://clinicaltrials.gov/show/NCT01829815.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... The majority of the studies were conducted in North America. The countries of origin are reported in Fig. 2. In two studies, the first author affiliation was in USA but the intervention was conducted in another country (Thailand and Turkey) [23,24]. ...
... Rights reserved. [23,34,36,38,44,58,64,[83][84][85][86][87][88][89][90][91][92][93]. A total of 14 of the studies lacked a clear methods section or the methods were inadequately reported [27,28,30,32,33,45,55,56,59,66,[94][95][96][97] (Fig. 4). ...
... A total of 14 interventions were studied two times or more in original studies or reports and two study protocols were designed to use the same intervention. These 14 interventions were Padres Informados/Jóvenes Preparados (PI/JP) [25,31,98], Happy Families Program (HFP) (adapted from the Strengthening Families Program) [23,88], Generation PMTO (Parent Management Training-Oregon model) [43-45, 83, 84], Supported Playgroups [57,68], Caregiver Supported Intervention (CSI) [102,103] and incredible years [58,73,74,85,95], CAPAS-Original/CAPAS-Enhanced (based on PMTO) [36,45,105], Family Communication [38,39], Connect-Programme (Ladnaan-programme = Connectprogramme + information on Swedish society) [75,86,87], Familias Unidas [40,41], Migrant Education Event Start (MEES) [47,48], Social Support Intervention [81,100], Fortalezas Familieares (FF): Family Strengths [49][50][51] and Coffee and Family Education and Support (CAFES) [93,101]. These interventions are presented (rationale of intervention, methods to reach participants, intervention procedures and materials, delivery of intervention and tailoring) in Table 2, and synthesised in the following sections. ...
Article
Full-text available
Parental support is of paramount importance in the promotion of positive parenting, strengthening parenthood and protecting children from disadvantages due to immigration experiences. The aim was to describe what is known about parent support programmes targeted to families who are immigrants. Electronic databases and the grey literature were systematically and comprehensively searched with no time/language restrictions. JBI approach and PRISMA-ScR were used to guide the review. N = 88 articles were sourced. Interventions were targeted to improve parental practices, skills and family wellbeing, usually through group-based methods. Most interventions included components of positive parenting and family communication. Identifying the needs of the target group and cultural tailoring were reported to be highly important in gaining acceptability, promoting engagement and producing benefits. Parent support programmes for families who are immigrants potentially improve positive parental practices and families’ wellbeing. There are many applicable and effective interventions to be exploited.
... A Thai program aimed at promoting positive family skills and interaction for young people showed positive results in the reduction of externalizing behavior and attention problems and a significant increase in protective psychosocial factors, however, no significant effects on their internalizing problems were reported. At the 6-months follow-up, caregivers reported maintained improvement on attention and externalizing problems, and the young people reported maintained improvement on externalizing problems and protective factors, however, young females showed significantly more internalizing problems than young males (Annan et al., 2017). A small study by Hughes and Scott (2013) assessed the usefulness of a career education intervention for refugee or humanitarian entrant students in Australia. ...
... One study scored "strong" on its quantitative and moderate on its qualitative part (Van der Gucht et al., 2019). Two studies scored "strong" on their qualitative and moderately on their quantitative part (Al-Rousan et al., 2018;Annan et al., 2017). Nathan et al. (2013) scored "strong" on their qualitative part and, while they received a "weak" overall score for their quantitative part, they did demonstrate strength in the domains of selection bias, study design, and data collection methods. ...
... The interventions varied in effectiveness. One writing for recovery therapy program, was identified as best practice (Kalantari et al., 2012), while further 15 studies were considered as promising practice (Al-Rousan et al., 2018;Annan et al., 2017;Baker & Jones, 2006;Barrett et al., 2000;Ellis et al., 2013;Marsh, 2012;Meyer DeMott et al., 2017;Millar & Warwick, 2019;Möhlen et al., 2005;Panter-Brick et al., 2018;Quinlan et al., 2016;Rousseau et al., 2017;Sarkadi et al., 2017;Stark et al., 2018;Van der Gucht et al., 2019). The remaining 12 studies are deemed emerging practice (Barrett et al., 2001(Barrett et al., , 2003Beehler et al., 2012;Ehntholt et al., 2005;Fazel et al., 2009;Garoff et al., 2019;Hughes & Scott, 2013;Nathan et al., Onyut et al., 2005;Oras et al., 2004;Schauer et al., 2004;Yankey & Biswas, 2012). ...
Article
Full-text available
Migration can affect the physical, mental, emotional, and social wellbeing of individuals and families. This study provides an overview of interventions aimed at improving the wellbeing of young migrants. It identifies knowledge gaps and provides direction for future research. The review process comprises a systematic search of six academic databases, and websites for relevant peer-reviewed and gray literature on the topic. A total of 2,911 records were identified, of which 28 studies met our eligibility criteria for inclusion. Thematic analysis comprised of the description of study characteristics and outcome themes. EPHPP and CASP tools were utilized to assess the methodological quality of studies. The review findings indicate a number of approaches with varying effectivity, however, arts, music, and sports programs showed good results for youth across all migrant groups. Our findings call for further and more high-quality evaluation research, with longitudinal designs that ideally include stakeholder collaboration.
... A Thai program aimed at promoting positive family skills and interaction for young people showed positive results in the reduction of externalizing behavior and attention problems and a significant increase in protective psychosocial factors, however, no significant effects on their internalizing problems were reported. At the 6-months follow-up, caregivers reported maintained improvement on attention and externalizing problems, and the young people reported maintained improvement on externalizing problems and protective factors, however, young females showed significantly more internalizing problems than young males (Annan et al., 2017). A small study by Hughes and Scott (2013) assessed the usefulness of a career education intervention for refugee or humanitarian entrant students in Australia. ...
... One study scored "strong" on its quantitative and moderate on its qualitative part (Van der Gucht et al., 2019). Two studies scored "strong" on their qualitative and moderately on their quantitative part (Al-Rousan et al., 2018;Annan et al., 2017). Nathan et al. (2013) scored "strong" on their qualitative part and, while they received a "weak" overall score for their quantitative part, they did demonstrate strength in the domains of selection bias, study design, and data collection methods. ...
... The interventions varied in effectiveness. One writing for recovery therapy program, was identified as best practice (Kalantari et al., 2012), while further 15 studies were considered as promising practice (Al-Rousan et al., 2018;Annan et al., 2017;Baker & Jones, 2006;Barrett et al., 2000;Ellis et al., 2013;Marsh, 2012;Meyer DeMott et al., 2017;Millar & Warwick, 2019;Möhlen et al., 2005;Panter-Brick et al., 2018;Quinlan et al., 2016;Rousseau et al., 2017;Sarkadi et al., 2017;Stark et al., 2018;Van der Gucht et al., 2019). The remaining 12 studies are deemed emerging practice (Barrett et al., 2001(Barrett et al., , 2003Beehler et al., 2012;Ehntholt et al., 2005;Fazel et al., 2009;Garoff et al., 2019;Hughes & Scott, 2013;Nathan et al., Onyut et al., 2005;Oras et al., 2004;Schauer et al., 2004;Yankey & Biswas, 2012). ...
Preprint
A systematic review of interventions targeting the wellbeing of young people of migrant and refugee backgrounds.
... Interventions consisted of eight prevention programs and two treatment interventions. All prevention interventions were provided to families and children experiencing known risk factors for poor mental health, including high HIV prevalence Bell et al., 2008), being part of a displaced or migrant population (Annan, Sim, Puffer, Salhi, & Betancourt, 2016), or living in an ongoing or post-conflict setting (O'Callaghan et al., 2014;Puffer et al., 2015). Five prevention interventions were open to all community members, while three targeted a subset of the population considered to be at increased risk. ...
... Provider characteristics.-Reasons for using NSPs included trying to develop a sustainable intervention model (Annan et al., 2016;Bhanan et al., 2014;Li et al., 2014;Jordans et al., 2013;Bell et al., 2008;Rahman et al., 2016) and provision by a NSP was less stigmatizing and therefore increased both access to the community and potentially increased efficacy (O'Callaghan et al., 2014;Bell et al., 2008). Providers included community members, lay counselors including local NGO workers, and teachers (Table 4). ...
... Acceptability was assessed by treatment attendance, structured participant report, and structured and unstructured community report. Two studies noted difficulty with inconsistent or poor attendance (Eloff et al., 2014), and four studies noted high rates of attendance (Annan et al., 2016;Bhana et al., 2014;Puffer et al., 2015;O'Callaghan et al., 2014). The one study that noted providing a structured assessment of participant perception of the program reported high levels of participant satisfaction (Jordans et al., 2013). ...
Article
Introduction: Youth in low- and middle-income countries (LMICs) are at increased risk for poor mental health due to economic and social disadvantage. Interventions that strengthen families may equip children and adolescents with the supports and resources to fulfill their potential and buffer them from future stressors and adversity. Due to human resource constraints, task-sharing-delivery of interventions by nonspecialists-may be an effective strategy to facilitate the dissemination of mental health interventions in low resource contexts. To this end, we conducted a systematic review of the literature on family-based interventions delivered in LMICs by nonspecialist providers (NSPs) targeting youth mental health and family related outcomes. Method: Cochrane and PRISMA procedures guided this review. Searches were conducted in PsychInfo, PubMed, and Web of Science, with additional articles pulled from reference lists. Results: This search yielded 10 studies. Four studies were developed specifically for the delivery context using formative qualitative research; the remaining interventions underwent adaptation for use in the context. All interventions employed a period of structured training; nine studies additionally provided ongoing supervision to counselors. Interventions noted widespread acceptance of program material and delivery by NSPs. They also noted the need for ongoing supervision of NSPs to increase treatment fidelity. Discussion: Usage of NSPs is quite consistently proving feasible, acceptable, and efficacious and is almost certainly a valuable component within approaches to scaling up mental health programs. A clear next step is to establish and evaluate sustainable models of training and supervision to further inform scalability. (PsycINFO Database Record
... Three of the interventions involved treatment arms which did not fulfil the criteria of being non-specialised or group-based in this review, and hence are only partially described (Betancourt et al., 2012;Bolton et al., 2007;Descilo et al., 2010;Thabet et al., 2005). Of the nine interventions, four were based in Uganda (Ager et al., 2011;Betancourt et al., 2012;Bolton et al., 2007;Kostelny and Wessells, 2008;Sonderegger et al., 2011), two in the occupied Palestinian Territories (Loughry et al., 2006;Thabet et al., 2005), and one each in Thailand (Annan et al., 2017;Sim et al., 2014), Sierra Leone (Gupta and Zimmer, 2008) and India (Descilo et al., 2010). Three of the researched interventions were RCTs (Ager et al., 2011;Annan et al., 2017;Betancourt et al., 2012;Bolton et al., 2007;Sim et al., 2014), five were quasi-experimental studies (Descilo et al., 2010;Kostelny and Wessells, 2008;Loughry et al., 2006;Sonderegger et al., 2011;Thabet et al., 2005) and one was a cohort study (Gupta and Zimmer, 2008). ...
... Of the nine interventions, four were based in Uganda (Ager et al., 2011;Betancourt et al., 2012;Bolton et al., 2007;Kostelny and Wessells, 2008;Sonderegger et al., 2011), two in the occupied Palestinian Territories (Loughry et al., 2006;Thabet et al., 2005), and one each in Thailand (Annan et al., 2017;Sim et al., 2014), Sierra Leone (Gupta and Zimmer, 2008) and India (Descilo et al., 2010). Three of the researched interventions were RCTs (Ager et al., 2011;Annan et al., 2017;Betancourt et al., 2012;Bolton et al., 2007;Sim et al., 2014), five were quasi-experimental studies (Descilo et al., 2010;Kostelny and Wessells, 2008;Loughry et al., 2006;Sonderegger et al., 2011;Thabet et al., 2005) and one was a cohort study (Gupta and Zimmer, 2008). Five of the interventions were camp-based (Descilo et al., 2010;Gupta and Zimmer, 2008;Kostelny and Wessells, 2008;Sonderegger et al., 2011;Thabet et al., 2005), three were school-based (Ager et al., 2011, Gupta andZimmer, 2008;Thabet et al., 2005) and three were community-based (Annan et al., 2017;Betancourt et al., 2012;Bolton et al., 2007;Loughry et al., 2006;Sim et al., 2014). ...
... Three of the researched interventions were RCTs (Ager et al., 2011;Annan et al., 2017;Betancourt et al., 2012;Bolton et al., 2007;Sim et al., 2014), five were quasi-experimental studies (Descilo et al., 2010;Kostelny and Wessells, 2008;Loughry et al., 2006;Sonderegger et al., 2011;Thabet et al., 2005) and one was a cohort study (Gupta and Zimmer, 2008). Five of the interventions were camp-based (Descilo et al., 2010;Gupta and Zimmer, 2008;Kostelny and Wessells, 2008;Sonderegger et al., 2011;Thabet et al., 2005), three were school-based (Ager et al., 2011, Gupta andZimmer, 2008;Thabet et al., 2005) and three were community-based (Annan et al., 2017;Betancourt et al., 2012;Bolton et al., 2007;Loughry et al., 2006;Sim et al., 2014). Only one intervention was not in the context of a protracted crisis, with it instead being in the context of a natural disaster (Descilo et al., 2010). ...
Article
Full-text available
Purpose The purpose of this paper is to describe non-specialised, group-based interventions in displaced populations from reviewed literature, and to explore their outcomes. Design/methodology/approach A literature review was conducted using the PubMed database, Web of Science, The Cochrane Library of Systematic Reviews, and defined “grey literature”. Characteristics of the interventions were summarised into a table under key categories such as targeted persons, study setting, level of evidence, outcome measures, assessment tools used and summary of results. Findings In total, 11 articles were identified stemming from nine separate interventions. Three of these were considered level 1 evidence as they were randomised controlled trials. The described interventions were markedly heterogeneous in nature and produced diverse findings. There were noted methodological issues in the majority of interventions reviewed. Originality/value This original research has demonstrated clear need for research that uses robust methodology accounting for the complex and challenging nature of this context.
... For example, one study (Fazel et al. 2009) titled their intervention 'mental health intervention' and focused on specific psychological needs of each client. Annan et al. (2017) used a parenting and family skills intervention called the Happy Families Program (HFP), which focused on improving some psychological skills amongst both care-givers and children. These skills included effective interpersonal interactions, behavioural modification, problem-solving and emotion regulation. ...
... Although social adjustment was not the direct focus in several of the studies used in our meta-analysis, it was nevertheless a primary focus in some of them (Baker and Jones 2006;Yankey and Biswas 2012;Annan et al. 2017). Unfortunately, however, these programmes had only limited benefit on the social adjustment of young refugees. ...
Article
Full-text available
The purpose of this study was to evaluate the effectiveness of existing psychological interventions on the social adjustment of young refugees. From 51 peer-reviewed articles identified in the literature, 11 studies with 25 therapeutic effect sizes met criteria for inclusion (N = 1,736). Hedges’ g was used to measure effect sizes and a random-effects model was conducted. The number of sessions and participant age were considered as potential moderator variables in moderator analyses through meta-regression. The effect sizes of the included studies were compared based on the type of intervention. The results showed that the aggregated effect size for all included interventions was significant, computed as g = 0.14, p < 0.01, 95% confidence interval [0.06, 0.21]. The effect size is considered small, based on Cohen's (1992) guidelines. The results of the meta-regression showed that the effectiveness of the included psychological interventions on social adjustment was not moderated by either the number of sessions (b = 0.006 p = 0.035) or age (b = –0.008, p = 0.59). Furthermore, there were no significant differences between different therapeutic approaches (Q = 7.37, df (Q) = 6; p = 0.28). This meta-analysis demonstrates that mental-health interventions in young refugees mildly improve their social adjustment. Due to the importance of social adjustment in refugees, we suggest that existing interventions place greater specific focus on improving social adjustment. The details of implications for future studies are discussed.
... For example, one study (Fazel et al. 2009) titled their intervention 'mental health intervention' and focused on specific psychological needs of each client. Annan et al. (2017) used a parenting and family skills intervention called the Happy Families Program (HFP), which focused on improving some psychological skills amongst both care-givers and children. These skills included effective interpersonal interactions, behavioural modification, problem-solving and emotion regulation. ...
... Although social adjustment was not the direct focus in several of the studies used in our meta-analysis, it was nevertheless a primary focus in some of them (Baker and Jones 2006;Yankey and Biswas 2012;Annan et al. 2017). Unfortunately, however, these programmes had only limited benefit on the social adjustment of young refugees. ...
Article
This study explored community disaster preparedness among rural subsistence communities affected by recurrent drought-induced disasters in Eswatini and Lesotho. Sixteen focus group discussions comprising 197 participants from different backgrounds were conducted. Recorded interviews were transcribed, coded and categorised. Themes and subthemes were developed and formed the basis of analysis and interpretation guided by structuration theory. Emerging themes related to community disaster preparedness included: (1) knowledgeability and systems of meaning; (2) structural responses to disaster preparedness; and (3) the dispensation of power and control. However, power and control were also impediments to effective disaster preparedness through the curtailing of collaboration, access to resources and information, and collective participation. Addressing these impediments can improve learning and contribute to developing robust disaster preparedness. There is an urgent need to streamline and integrate traditional knowledge and systems to be used in tandem with existing scientific knowledge.
... Various forms of parenting programs have been successfully adapted among Asian groups residing in the United States of America (USA). An evidence-based parenting intervention adapted for migrants with high levels of adversity had positive effects on their children's externalizing and attention-deficit symptoms (Annan et al., 2017). In recent years, similar efforts have been observed in Thailand and Indonesia. ...
... Many findings in studies of cross-cultural adaptation of evidence-based parenting programs were only relevant at the specific location only. Sumargi et al. (2015)'s adapted version of such program achieved cultural appropriateness and acceptability in an Indonesian population but this findings could not be generalized while findings by Annan, Sim, Puffer, Salhi, & Betancourt, (2017) can only be applied on Burmese immigrants in Thailand who would also have been exposed to various other psychosocial challenges other than parenting or child behavioral problems. Similarly, in Norway, program adaptability and effectiveness were consistently demonstrated by Larsson et al. (2009) but only children with high baseline severity of behavioral problems were involved, placing the risk of selection bias towards those who more likely would show parental and child improvements. ...
Article
Children with emotional and behavioral problems are often managed using medications or behavioral therapy, but in some countries, there is no structured parenting intervention to equip parents from different cultural backgrounds with adequate parenting skills to help these children. This paper aims to synthesize key findings from previous research on multicultural parenting programs and produce a comprehensive integrated view by looking into three separate themes: effective multicultural parenting programs, ethnocultural groups and cultural adaptation process. Literature search through Scopus and Google Scholar from 1999 to 2019 was conducted using the terms "effective parenting program", "effective parenting intervention", "effective multicultural parenting program", "effective multicultural parenting intervention", "multicultural parenting program", "multicultural parenting intervention", "parenting program and ethnic groups", "parenting intervention and ethnic groups", "adapted parenting program", "adapted parenting intervention", "cultural adaptation of parenting program'' and "cultural adaptation of parenting intervention". By applying the "Literature Review Synthesis Process", authors conducted cross-analysis, integrated possibilities, and prioritized the synthesized information gearing towards highly probable solutions for improving multicultural parenting programs to manage emotional and behavioral problems in children better. Development of a culturally fit parenting intervention and its implications on existing parenting programs are also discussed. The findings highlight the need 1) to engage with ethnocultural groups of parents during development of a new multicultural parenting program, and 2) to incorporate specific measures for engaging with parents during multicultural parenting program implementation. This paper contributes in acknowledging cultural components in future parenting intervention programs. Finally, recommendations are made for future directions of research.
... This is also echoed by Adams et al. (2021), whose study emphasised the low likelihood of individual transformations in resilience to climate change without social support. However, the interventions in our review were predominantly focused at the level of the individual adolescent and lacked a wider community component (with the exception of Annan et al., 2016, Bosqui et al., 2020and Wang, 2016. This is surprising given that studies have shown that distress among adolescents in humanitarian contexts is strongly related to parenting and parental wellbeing (Eltanamly et al., 2019). ...
... The intervention described by Bosqui et al. (2020) found that most families highlighted the importance of family and relationships in supporting their adolescent child's mental health. Annan et al.'s (2016) study focused on a family skills training programme designed to increase resilience, which was also found to have a small but significant positive effect on externalising behaviour and attention problems among adolescents. ...
Article
Research suggests that adolescents in humanitarian settings are particularly vulnerable to mental health challenges, but there is less attention to how mental health and psychosocial support (MHPSS) in these settings considers climate-related factors. This article aims to bridge this gap by reviewing studies on the impact of MHPSS interventions in humanitarian settings for adolescents in low- and middle-income countries. Our findings indicate there is a lack of attention to climate change; none of the 25 studies identified mentioned climate change or considered it in the intervention design. Given the urgency of the climate crisis, it is vital that MHPSS interventions for adolescents in humanitarian settings are adapted to respond to climate change-related factors. We also found that the data from such studies are rarely disaggregated by sex or disability. This is vital in order to deepen our understanding of the intersectional impacts of MHPSS on adolescents.
... Previous research is mixed as to the status of mental health among migrant children, and the value of our meta-analysis is to shed light on this controversial topic. Our systematic review and meta-analysis showed that migrant children had more mental health problems compared with counterparts.Based on Chinese version of the strengths and difficulties questionnaire, Yang et al. found that the rural-to-urban migrant children had relatively poor mental health (Annan et al., 2017;Yang et al., 2018). Our meta-analysis relies on MHT. ...
... There are many mediating or moderate variables between objective environmental variables and the mental health of migrant children, such as attachment and mutual support within the mobile family, social support from teachers and peers, sense of school belonging,and neighborhood satisfaction (Li and Jiang, 2018), which can play a protective role in the mental health of migrant children. Parenting skills intervention and Group Intervention Program are found to have positive effects on migrant children's mental health outcomes (Annan et al., 2017;Meir et al., 2014). However, our results should be considered cautiously due to a number of methodologically relevant issues in the retained studies. ...
Article
Background: Mental health has become a new focus of public health related to migrants in recent years. There are many contradictions in previous studies on the mental health status of migrant children in China. Methods: PubMed, OVID, ERIC, Web of Knowledge, CNKI, Wan Fang and Chongqing VIP were searched on August 16, 2018. The data were analyzed using SMD and random effect model in Comprehensive Meta-Analysis software. Results: We included 11 studies involving 4621 migrant children and 5076 urban children. The mental health of migrant children was worse than that of urban children, as evidenced by total score of Mental Health Test (Standardized Mean Difference, SMD = 0.36, 95% CI 0.21 to 0.59) and seven out eight sub-scales of Mental Health Test (SMD, ranging from 0.24 to 0.37). The results were robust to sensitivity analysis. Conclusion: Our study supports the notion that compared with urban counterparts, migrant children had more mental health problems with less public services. Future research should focus on how to improve mental health of migrant children.
... Studies such as those of Annan et al. (2017), Penner et al. (2021) and Veldman et al. (2014) studied the mental health of children and adolescents through problems or difficulties: (1) internalizing (IP) associated with the individual ambit (e.g. depression, anxiety), (2) externalizing (EP), referring to behavior directed exteriorly (e.g. ...
... The scale of internalizing problems evaluates internal difficulties experienced by the child or adolescent, such as desperation and sadness; the scale of externalizing problems mainly measures conflicts in social relations, such as disobeying rules and fighting with others; the scale of attention difficulties evaluates difficulty in concentration. This study used the PSC-17 to evaluate mental health, as in the studies of Annan et al., (2017), Penner et al., (2021) and Veldman et al. (2014), who analyzed the mental health of children and adolescents using internalizing, externalizing and attention problems. It is worth mentioning that this instrument has only been validated locally for children; however, ongoing studies have shown that the structure for adolescents is the same (Leiva, 2021;Leiva, Mendoza, et al., 2021). ...
Article
Full-text available
This study analyzed the relation between Subjective Well-Being, Adverse Childhood Experiences and Mental Health in Chilean children and adolescents. It evaluated the cumulative effect of adverse experienses and subjective well-being. The sample included 2699 children and adolescents from 11 municipal educational establishments of the Antofagasta Region, Chile. All were in the 6th to 12th grades; 52.1% (n = 1405) identified as female; ages ranged from 11 to 17 years (Mean = 14.35 years, SD = 1.82). We evaluated Well-Being, Adversities and Mental Health with the Kidscreen-27, Inventary of Adversities and PSC-17, respectively. We used Student t-tests for independent samples and one-way ANOVA for comparisons. Pearson product-moment coefficients were used to estimate the level of association between two or more variables. The results showed significant differences in all dimensions of subjective well-being between those who presented some adversity and those who did not. The cumulative effect of adversities was associated with poor well-being, and mental health was favored when the subjective well-being was higher. We discuss the relation between well-being, adversities and mental health in Chilean children and adolescents.
... While successful global research-practice partnerships do not always achieve a balance between knowledge generation and dissemination (Palinkas 2018), they do yield improved outcomes, improved quality of services delivered, more costeffective care, and innovative approaches to service delivery (Annan et al. 2017;McBain et al. 2015;Murray et al. 2015;Puffer et al. 2016). Partnerships may be viewed as successful if there is sustainability of the products of the partnership (i.e., an EBP). ...
... Quantitative data relating to the effect of interventions were available from 17 publications. 29 33 41 55 57 67 68 84 98 106 113 141 144 146 147 149 150 Reported outcomes included anxiety-related symptoms, depression-related symptoms, general mental health and functioning, post-traumatic stress disorder and trauma-related disorder. Nearly all interventions for which effectiveness data were reported were targeted to children and adolescents, with a majority delivered in schools and a large proportion delivered to IDPs. ...
Article
Full-text available
Background Over 240 million children live in countries affected by conflict or fragility, and such settings are known to be linked to increased psychological distress and risk of mental disorders. While guidelines are in place, high-quality evidence to inform mental health and psychosocial support (MHPSS) interventions in conflict settings is lacking. This systematic review aimed to synthesise existing information on the delivery, coverage and effectiveness of MHPSS for conflict-affected women and children in low-income and middle-income countries (LMICs). Methods We searched Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Psychological Information Database (PsycINFO)databases for indexed literature published from January 1990 to March 2018. Grey literature was searched on the websites of 10 major humanitarian organisations. Eligible publications reported on an MHPSS intervention delivered to conflict-affected women or children in LMICs. We extracted and synthesised information on intervention delivery characteristics, including delivery site and personnel involved, as well as delivery barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data. Results The search yielded 37 854 unique records, of which 157 were included in the review. Most publications were situated in Sub-Saharan Africa (n=65) and Middle East and North Africa (n=36), and many reported on observational research studies (n=57) or were non-research reports (n=53). Almost half described MHPSS interventions targeted at children and adolescents (n=68). Psychosocial support was the most frequently reported intervention delivered, followed by training interventions and screening for referral or treatment. Only 19 publications reported on MHPSS intervention coverage or effectiveness. Discussion Despite the growing literature, more efforts are needed to further establish and better document MHPSS intervention research and practice in conflict settings. Multisectoral collaboration and better use of existing social support networks are encouraged to increase reach and sustainability of MHPSS interventions. PROSPERO registration number CRD42019125221.
... As examples, parenting and family programs have shown positive impacts among caregivers in Liberia (Puffer et al. 2015), caregivers in South Africa (Cluver et al. 2016), and Burmese migrant families (Puffer et al. in press). They have also documented effects on mental health symptoms of children (Jordans et al. 2013;Annan et al. 2016). The evidence is therefore, converging to provide the foundation for combining effective parenting intervention strategies with interventions for other outcomes, such as alcohol use, that also affect the family system. ...
Article
Full-text available
Background Problem drinking accounts for 9.6% of disability-adjusted life years worldwide. It disproportionally affects men and has disabling physical, psychological, and behavioral consequences. These can lead to a cascade of negative effects on men's families, with documented ties to intimate partner violence (IPV) and child maltreatment. These multi-level problems are often exacerbated where poverty rates are high, including low and middle-income countries (LMICs). In contexts where strong patriarchal norms place men in positions of power, family-level consequences are often even more pronounced. Methods We conducted a systematic review of the literature on interventions in LMICs targeting men's problem drinking and any family-related outcomes. Cochrane and PRISMA procedures guided the review. The search was conducted in PsychInfo, PubMed, and Web of Science. Results The search yielded 1357 publications. Nine studies from four different countries met inclusion criteria. Of those, only one had the primary goal of simultaneously improving drinking and a related family-level outcome (IPV). Six of the studies documented modest improvements on both drinking and couples or family outcomes. Strategies common to these included cognitive-behavioral techniques, communication skills training, narrative therapy, and participatory learning. Gender-transformative approaches were associated with reduced IPV and more equitable gender norms, and motivational interviewing and behavioral approaches were beneficial for reducing alcohol use. Conclusions Findings highlight the scarcity of interventions addressing men's drinking and its effects on families, particularly for parent-child outcomes. However, results point to strategies that, combined with other evidence-based family interventions can guide the development and rigorous evaluation of integrated programs.
... Fino a pochi anni fa la maggior parte delle sperimentazioni scientifiche era focalizzata principalmente sulla valutazione di interventi volti a ridurre i sintomi psicologici, con poco interesse per le misure di resilienza. Oggi, invece, si sta osservando un passaggio verso una maggiore considerazione delle risorse personali dei bambini, della promozione del loro benessere, e del loro inserimento sociale, con un approccio meno medicalizzante [13,[29][30][31][32]. Questo studio mostra che i bambini riescono a mettere in campo le proprie risorse nella risposta al trauma, con un conseguente miglioramento spontaneo della sintomatologia. ...
Article
Full-text available
To compare the psychological reaction to traumatic war experiences in displaced versus non-displaced children. Methods: We report a secondary explorative analysis of four large randomized trials involving children not receiving psychosocial interventions in humanitarian settings in lowand middle-income countries. Results: We analyzed 4 randomized controlled trials. Results highlighted a similar trend in the spontaneous trajectories of psychological symptoms and resilience outcomes in displaced versus non-displaced children. Conclusions: These results highlight that being displaced is not associated with serious deterioration of mental health, compared to living in the original village. Future research should be focused on the analysis of social determinants of mental health using large samples of children.
... While family-based interventions in LMICs are promising, few studies have found significant effects on children's internalizing behaviors . For example, an intervention to improve parenting skills among migrant and displaced Burmese populations in Thailand had no effect on children's internalizing disorders, but improved externalizing behaviors and attention problems compared to control children (Annan et al., 2017). A family-based intervention led by psychologists to improve mental health among children in post-conflict Rwanda reduced depression and anxiety post-intervention and at 6-month follow-up based on caregiver reports, but not according to children self-reports (Betancourt et al., 2014). ...
Chapter
Full-text available
This chapter focuses on the state of child behavioral healthcare systems, policy, and research efforts across African countries, specifically Ghana. The investments in child behavioral health have been too minimal and there is scarce evidence of impact. The following recommendations are made: (1) There is a need for appropriate measurement and screening tools/scales that will take into account context-specific issues. This will require that some qualitative studies that explore context-specific social expectations and standards for behaviour in childhood are undertaken. (2) There is a need to incorporate behavioral health services in all regional and district hospitals by establishing behavioral health units. This will ensure that there is an equitable distribution of accessible behavioral healthcare services across all the regions. (3) There is a need for extensive and continuous research into behavioral health problems, promotion, and prevention. This will require collaboration between academics, various health institutions, and nongovernmental organizations (NGOs). Findings can be used as proven basis to inform policy and practice.
... While a review of evidencebased parenting programs found promise of transportability, only one study identified was from a LMIC . Promisingly, the International Rescue Committee has successfully replicated adapted versions of a parenting program among displaced Burmese families in Thailand (Annan et al., 2017;Sim, Annan et al., 2014) as well as in postconflict Liberia (Puffer et al., 2015;Sim, Puffer, et al., 2014), suggesting the feasibility of transferability from one humanitarian context to another. Nonetheless, further research is needed to inform whether programs developed in relatively low-conflict settings such as South Africa are transferable to a high-conflict, postwar setting such as South Sudan. ...
Article
Purpose This study investigated process and outcomes of the Parenting for Lifelong Health (PLH) for Young Children and for Adolescents programs implemented as part of routine service delivery in postconflict settings. Methods These group-based programs were delivered by trained facilitators to 97 caregivers (PLH for Young Children) and 108 caregiver–adolescent dyads (PLH for Adolescents) over 12 or 14 (respectively) weekly sessions. Routine monitoring data were collected by the implementing partners using standardized self-report measures. Reducing harsh discipline was specified as the primary outcome, with secondary outcomes including improvements in positive parenting and reductions in poor parental supervision and parental inefficacy. Results Analyses were intention to treat. Both PLH programs retained effectiveness in routine conditions in a postwar setting, with moderate to large effect sizes. The programs also had high enrollment and attendance rates, indicating high acceptability. Conclusions Findings suggest promising viability for the implementation of evidence-based parenting programs in challenging postconflict contexts.
... However, parental engagement in the training programmes is considered critical to their effectiveness (Nix, Bierman, McMahon, & The Conduct Problems Prevention Research Group, 2009;Weeland et al., 2017). Previous studies reported mixed results concerning participant attendance rates -about 39% to 81% (Annan, Sim, Puffer, Salhi, & Betancourt, 2017;Garvey, Julion, Fogg, Kratovil, & Gross, 2006;Heinrichs, Bertram, Kuschel, & Hahlweg, 2005;Shenderovich et al., 2018). Even among well-established parenting training programmes for which numerous trials show positive impacts on parenting and child outcomes, attendance rates have not always been as good as hoped -Triple P: 48.2%; ...
Article
Full-text available
Parent training programmes have significant potential to improve the quality of children's early environments and thereby their development and life-course outcomes. The aim of this study was to identify and explain the extent to which parents engaged in two group-based training programmes, offered to high-risk families enrolled in a randomized controlled trial study called PIÁ in Southern Brazil. The programmes were: 1) ACT: Raising Safe Kids, a 9-week programme aiming to reduce harsh parenting and maltreatment and improve positive parenting practices; 2) Dialogic book-sharing (DBS), an 8-week programme aiming to promote parental sensitivity and improve child cognitive development and social understanding. Of the 123 mothers randomly allocated to the ACT programme, 64.2% (n = 79) completed the course, and of 124 mothers allocated to DBS, 76.6% (n = 95) completed the course. After the interventions, mothers were very positive about the experience of both programmes but highlighted practical difficulties in attending. In adjusted regression analyses, only two variables significantly predicted ACT course completion (maternal age and distance between the intervention site and household); no significant predictor was found for DBS attendance. We conclude that although high completion rates are possible, there are important challenges to engaging parents of young children in training programmes, and practical difficulties occurring during training courses may be more important for attendance than baseline participant characteristics.
... The most common examples include group-based parenting interventions for caregivers or, less often, family strengthening interventions including both caregivers and children. Overall, these skillsbased programs have shown promising effects on child and family outcomes (Annan et al. 2016;Knerr et al. 2013;Mejia et al. 2012). One gap in family-based interventions implemented in LMICs is the lack of those focused on treatment, rather than prevention, which targets families with currently high levels of distress and/or with older children or adolescents experiencing mental health problems (Patterson, Edwards and Vakili 2017). ...
Article
Full-text available
The large burden of mental health disorders among young people worldwide calls for scalable prevention and treatment models that reach children and families in low-resource settings. This paper describes the development of an evidence-informed family therapy intervention designed for lay counselor delivery in low-resource settings and presents findings on the feasibility and acceptability of implementation in Kenya. Qualitative data guided the development of a components-based family therapy that integrates multiple strategies from solution-focused and systems-based therapies, as well as those from parenting skills training and cognitive behavioral therapies. Eight lay counselors delivered the intervention, with 10 families completing treatment. Lay counselors demonstrated adequate fidelity and clinical competency when treating families with a wide range of presenting clinical problems. Unique elements of the implementation model proved feasible and acceptable, including recruiting “natural” lay counselors from communities already engaged in informal counseling for families; participants indicated trust and respect in the counseling relationship that facilitated their participation. Both counselors and families reported positive perceptions of intervention content and strategies, including those least similar to local counseling practices. Results support the potential of this implementation strategy that aims to add evidence-based practices to local practices and routines rather than creating new cadres of lay counselors or health workers. Supervision, provided by psychology student trainees, also proved feasible and mutually beneficial, with phone-based supervision as acceptable as in-person meetings; this suggests the potential feasibility of this model for use in remote locations. Future directions include integrating these delivery approaches into existing social structures to develop and evaluate a comprehensive implementation model for scale-up.
... Intervention participants had primarily positive feedback, with most reporting improvements in their households, such as perceived reductions in violent discipline among caregivers and aggressive behaviors among children. Although high participant satisfaction was reported in interviews, attendance rates were lower than in some of the previous studies (e.g., Annan et al. 2017). Other work explores reasons for missed group sessions in Sinovuyo Teen. ...
Article
Full-text available
Objectives Previous studies of parenting programs suggest that facilitator fidelity, participant attendance and engagement often influence treatment outcomes. While the number of parenting program evaluations has been growing in low- and middle-income countries, little is known about the implementation processes and their impact on participant outcomes in these settings. Methods This study was nested within a cluster-randomised trial of a parenting program in South Africa. The paper aims to, first, describe the implementation of the intervention over 14 weeks. Second, using longitudinal multilevel analyses, the paper examines the impact of variation in observer-rated fidelity, attendance, and engagement on participant outcomes – parenting and maltreatment reported by caregivers and adolescents aged 10–18 (N = 270 pairs), 14 outcome constructs. Results Fidelity, attendance and participant engagement rates were similar to those reported in high-income country studies. However, the participation and implementation characteristics did not predict participant outcomes. This may be due to limited variation in dosage as home visits were comprehensively provided when participants could not attend group sessions, and fidelity was monitored by the implementers and researchers. One statistically significant predictor after the multiple testing correction was higher fidelity predicting an increase in adolescent-reported maltreatment at follow-up, possibly due to an increase in reporting (incidence rate ratio 1.33, 95% CI [1.19, 1.49], p < 0.01). Conclusions Our study confirms that a high quality of implementation can be achieved in a low-resource context. Suggestions for future research on parenting programs include examining therapeutic alliance alongside program fidelity and facilitator skill as well as systematically recording program adaptations.
... One example of such an intervention is the Strengthening Families Program (SFP) [54], a family skills training program designed to increase resilience and reduce risk factors for behavioral, emotional, academic, and social problems in 3-16 year-olds. Although a culturally adapted version of SFP was found to be effective in reducing externalizing problems in a randomized controlled trial with 7-15-year-old Burmese refugee youths in Thailand [55], there have been no studies to date evaluating its effectiveness in survivors of acute weather events. On the other hand, using an RCT design, the group-based, Integrated Mental Health and Disaster Preparedness intervention was tested in three earthquake-exposed and flood-prone communities in Haiti and found to significantly increase peer-based help-giving and help-seeking, as well as reduce symptoms of PTSD, depression, anxiety and functional impairment [56]. ...
Article
Full-text available
This narrative review examined strategies for preparedness and response to mental health impacts of three forms of climate change from a services perspective: (1) acute and extreme weather events such as hurricanes, floods, and wildfires, (2) sub-acute or long-term events such as droughts and heatwaves; and (3) the prospect of long-term and permanent changes, including higher temperatures, rising sea levels, and an uninhabitable physical environment. Strategies for acute events included development and implementation of programs and practices for monitoring and treating mental health problems and strengthening individual and community resilience, training of community health workers to deliver services, and conducting inventories of available resources and assessments of at-risk populations. Additional strategies for sub-acute changes included advocacy for mitigation policies and programs and adaptation of guidelines and interventions to address the secondary impacts of sub-acute events, such as threats to livelihood, health and well-being, population displacement, environmental degradation, and civil conflict. Strategies for long-lasting changes included the implementation of evidence-based risk communication interventions that address the existing and potential threat of climate change, promoting the mental health benefits of environmental conservation, and promoting psychological growth and resilience.
... Four studies included multiple components: one (4%) delivered separate interventions to children and parents ("parent-child based") (Baker-Henningham, Scott, Jones, & Walker, 2012; H. Baker-Henningham, S. P. Walker, C. Powell, & J. M. Gardner, 2009); one (4%) targeted a combinationof parents, children, and teachers with parenting strategies, social skills, and classroom management strategies, respectively ("multi-component")(Annan, Sim, Puffer, Salhi, & Betancourt, 2017); one (4%) targeted youth, a caregiver selected by the youth, and also engaged the community ("multimodal")(Ştefan & Miclea, 2013); and one (4%) provided psychosocial stimulation for parents and toddlers (jointly)) (see ...
Article
Full-text available
Background Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high‐income countries. The transferability of this evidence to culturally diverse, low‐resource settings with few mental health specialists is unknown. Methods We conducted a systematic review with random‐effects meta‐analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low‐ and middle‐income countries (LMIC). Results Twenty‐six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at‐risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non‐specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was −0.25 (95% confidence interval (CI): −0.41 to −0.09; I²: 78%) and of treatment studies was −0.56 (95% CI: −0.51 to −0.24; I²: 74%). Subgroup analyses demonstrated effectiveness for child‐focused (SMD: −0.35; 95% CI: −0.57 to −0.14) and behavioural parenting interventions (SMD: −0.43; 95% CI: −0.66 to −0.20), and that interventions were effective across age ranges. Conclusions Our meta‐analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child‐focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non‐specialists and on implementation of effective interventions in LMIC settings.
... [32][33][34][35][36][37] Recent studies have provided some evidence that psychosocial factors that operate within the household play some role in mediating the intergenerational transmission of trauma, 1 3 4 38 with the strongest evidence supporting parenting behaviors, parental mental health symptoms, and attachment. 1 3 4 Understanding the role of psychosocial factors within the family in mediating and moderating the intergenerational transmission of trauma is critical to develop household-level psychosocial interventions that prevent transmission among high-risk families. Some psychosocial interventions have been explicitly developed to prevent the intergenerational transmission of trauma or have been evaluated for this purpose; [39][40][41][42][43][44][45][46] however, these interventions are heterogeneous in their theoretical and therapeutic approaches and in evidence used to inform development. 39 In addition, few interventions have been evaluated, and those that have often evaluate their impact on parenting behaviors rather than child mental health outcomes. ...
Preprint
Full-text available
Introduction: Psychosocial factors within the family appear to play a critical role in mediating the intergenerational transmission of trauma; however, there has yet to be a review article that quantitatively synthesizes causal mechanisms across a diversity of trauma-types. This study aims to systematically consolidate the epidemiological research on family-level psychosocial mediators and moderators to ultimately produce causal diagram(s) in the intergenerational transmission of trauma. Methods and analysis: We will identify epidemiological peer-reviewed publications, dissertations, and conference abstracts that measure the impact of at least one psychosocial family-level factor mediating or moderating the relationship between parental trauma exposure and a child mental health outcome. English, French, Kinyarwanda, and Spanish articles will be eligible. We searched MEDLINE, PsycINFO, PTSDpubs, Scopus and ProQuest Dissertations and Theses and will conduct forward citation chaining of included documents. Two reviewers will perform screening and data extraction independently. We will extract reported mediators, moderators, and relevant study characteristics for included studies. Findings will be presented using narrative syntheses, descriptive analyses, mediation meta-analyses, moderating meta-analyses, and causal diagram(s), where possible. We will also perform a risk of bias assessment for studies included in meta-analyses and will construct a funnel plot to assess publication bias. Ethics and dissemination: Ethical approval is not needed for this review. Results will be presented at academic conferences and published in a peer-reviewed journal in hopes to inform the development and evaluation of resilience-building interventions.
... While family-based interventions in LMICs are promising, few studies have found significant effects on children's internalizing behaviors . For example, an intervention to improve parenting skills among migrant and displaced Burmese populations in Thailand had no effect on children's internalizing disorders, but improved externalizing behaviors and attention problems compared to control children (Annan et al., 2017). A family-based intervention led by psychologists to improve mental health among children in post-conflict Rwanda reduced depression and anxiety post-intervention and at 6-month follow-up based on caregiver reports, but not according to children self-reports (Betancourt et al., 2014). ...
Chapter
Full-text available
This chapter explores the transmission of trauma, models of transmission, intersection of PTSD in parents and parent-infant attachment, determinants of the PTSD transmission within the Rwandan context, possible pathways of child traumatization in post-genocide Rwanda, conclusions, and further perspectives.
... Esta investigación utiliza el PSC-17 para evaluar la SM, tal como ha sido efectuado en otros estudios que han abordado la SM en NNA a través de problemas internalizantes, externalizantes y de atención; asociando el primero al ámbito individual (depresión, ansiedad) y los segundos a comportamientos dirigidos hacia el exterior (agresividad, problemas conductuales; Annan et al., 2017;Penner et al., 2021;Veldman et al., 2014). ...
Article
Full-text available
This research aimed to inquire about the level of Sense of Community perceived in school contexts and its relationship with the well-being and mental health of adolescents, also considering gender as a relevant category. 2839 students from 11 municipal educational establishments in the commune of Calama (Chile) participated, between 6th grade and 12th grade, and aged between 11 and 18 years old. Sense of community, well-being and mental health difficulties were assessed through the SCI-2, Kidscreen-27 and PSC-17 scales, respectively. For the analysis, Student's t-tests, one way ANOVA and multiple linear regressions were performed. The results show that sense of community, well-being and mental health are better in elementary school students and male students. It was also found that sense of community predicts well-being and mental health in adolescents. It is concluded with the relevance of the sense of community in adolescents' well-being and mental health in school contexts.
Chapter
An unprecedented number of children and adolescents are migrating to escape war and persecution, often unaccompanied by family (UNHCR: Global trends forced displacement in 2015. The UN Refugee Agency, Geneva, 2016). These children face security and health risks in their country of origin, on the journey to safety, and sometimes in their place of resettlement. The trauma and hardships that accompany these experiences have potential to create significant mental health difficulties. This chapter aims to review the risk factors associated with mental health disorders among refugee children and adolescents exposed to war, violence and displacement, and to critically review the effectiveness of psychological interventions recently used with this population. Precipitating and maintaining factors that influence the expression of mental health difficulties and resilience among children and adolescents affected by war are discussed according to a social ecological framework. While the effectiveness of individual, group- and school-based interventions is compelling, more evidence is needed to determine optimal models of intervention delivery for this population.
Article
Full-text available
Objectives Children and youth in low-and middle-income countries (LMIC) are at greater risk for poor mental health. Adverse circumstances including poverty, violence, and lack of available psychological treatments increase their vulnerability. Given the importance of the family environment for child and youth wellbeing, family interventions are a powerful mode of treatment; however, their development and evaluation has received relatively little attention in LMIC. Methods This review presents evidence for family- and parent-focused interventions on mental health outcomes for children and youth in LMIC and identifies treatment components present in promising interventions. A systematic search was conducted using comprehensive search terms in five databases (Global Health, PubMed, PsychINFO, PILOTS, and Cochrane Library). Reporting follows PRISMA guidelines. Independent raters screened and retrieved articles for inclusion, completed quality ratings, conducted data extraction, and coded common practice elements. Results This review included 36 papers representing 32 unique studies of family or parenting interventions in LMIC. Study designs covered: RCTs (50% of studies), pre-to-post studies (38%), and other (12%). The majority of interventions showed positive outcomes for child and youth mental health and wellbeing. The two most frequently used treatment techniques were caregiver psychoeducation and caregiver coping skills; the next most common were treatment processes of providing between-session homework and accessibility promotion. Conclusions Evidence for family-focused interventions for child and youth mental health in LMIC is growing with several promising approaches that should be more rigorously evaluated. Further research into effects of specific intervention components will ensure targeted and optimally effective interventions.
Article
Full-text available
Introduction Parenting programmes are increasingly popular for reducing children’s exposure to interpersonal violence in low/middle-income countries, but there is limited evidence on their effectiveness. We investigated the incremental impact of adding a caregiver component to a life skills programme for adolescent girls, assessing girls’ exposure to violence (sexual and others) and caregivers’ gender attitudes and parenting behaviours. Methods In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 869 adolescent girls aged 10–14 and 764 caregivers in South Kivu, Democratic Republic of Congo. Following a baseline survey, participants were divided into 35 clusters based on age, language and location. Eighteen clusters were randomised to the treatment arm and 17 clusters to the wait-list control arm. Adolescent girls in both arms received 32 life skills sessions; caregivers in the treatment arm received 13 complementary caregiver sessions. The primary outcome was girls’ self-reported exposure to sexual violence in the last 12 months; secondary outcomes included self-reports of specific forms of sexual violence, physical and emotional violence, transactional sex, child marriage for girls and parenting behaviours for caregivers. Intent-to-treat and per-protocol analyses were conducted. Results At 12 months of follow-up, the intervention showed no impact on sexual violence (adjusted OR=0.95; 95% CI 0.65 to 1.37) or any secondary outcomes for girls. The intervention was associated with improved supportive parenting behaviours. Protocol adherence was also associated with improvements in these outcomes. Conclusion While the caregiver curriculum improved some parenting outcomes, additional programmatic adaptations may be needed to reduce adolescent girls’ violence exposure in humanitarian settings. Trial registration number NCT02384642 .
Preprint
Full-text available
There is evidence to suggest that simplified and lay facilitated psychological interventions could contribute to reducing human resource for mental health shortages and disparities among forcibly displaced migrants. The review aimed to identify the evidence for the effectiveness of scalable psychological interventions for this sub-populations and the barriers and facilitators to their implementation. A systematic review was conducted, using peer-reviewed evidence published up until September 2017. Quantitative and mixed methods intervention studies were screened from Medline, Embase, Scopus, PsychINFO and CINAHL. Only English-language studies in which non-specialists administered the intervention were included. Narrative synthesis was used to analyse the study findings on effectiveness and the barriers and facilitators to implementation were identified through thematic analysis. Out of 2,766 relevant citations and abstracts screened, 13 met the inclusion criteria. We found high quality evidence with mixed results on the effectiveness of Narrative Exposure Therapy in reducing PTSD symptoms in children and adults. Medium-high quality evidence was found for the effectiveness of parenting skills interventions in reducing children’s behavioural problems and for interventions with components of Cognitive Behavioural Therapy in reducing psychological distress. High-quality evidence was also found for a simplified version of IPT-G administered by lay facilitators indicating significant reductions in depression symptoms among adolescent among girls, but not boys, aged 14-17 years. We also found medium-high quality evidence showing no effect of psycho-education in reducing psychological distress. Cultural adaptation was identified as a facilitator to implementation and the training of non-specialists was described as both a barrier and facilitator. There is scarce but good quality evidence for the effectiveness of scalable psychological interventions for forcibly displaced persons. Further research on the effectiveness of these interventions on adults is urgently needed. Future studies should detail the process of adapting the training material, the supervision, and training received by non-specialists to assess fidelity, allow future replications, and facilitate scale-up.
Article
Full-text available
Background Recent political changes in Myanmar provide opportunities to expand mental health (MH) services. Given Myanmar's unique situation, we felt a need to assemble and interpret available local information on MH in Myanmar to inform service design, rather than simply drawing lessons from other countries. We reviewed academic and gray literature on the experience of MH problems in Myanmar and the suitability, availability, and effectiveness of MH and psychosocial programming. Methods We searched: (1) Google Scholar; (2) PubMed; (3) PsychInfo; (4) English-language Myanmar journals and databases; (5) the Mental Health and Psychosocial Support (MHPSS) Network resources website; (6) websites and (7) local contacts of organizations identified during 2010 and 2013 mapping exercise of MHPSS providers; (8) the Myanmar Information Management Unit (MIMU) website; (9) University libraries in Yangon and Mandalay; and (10) identified local MH professionals. Results Qualitative data suggest that MH conditions resulting from stress are similar to those experienced elsewhere. Fourteen intervention evaluations were identified: three on community-level interventions, three on adult religion-based practice (meditation), four adult psychotherapeutic interventions, and four child-focused interventions. Support for the acceptability and effectiveness of interventions is mostly anecdotal. With the exception of two rigorous, randomized control trials, most evaluations had serious methodologic limitations. Conclusions Few evaluations of psychotherapeutic or psychosocial programs for people from Myanmar have been published in the black or gray literature. Incorporating rigorous evaluations into existing and future programs is imperative for expanding the evidence base for psychotherapeutic and psychosocial programs in this context.
Article
Full-text available
Parenting programs are a promising approach to improving family well-being. For families to benefit, programs need to be able to engage families actively in the interventions. Studies in high-income countries show varying results regarding whether more disadvantaged families are equally engaged in parenting interventions. In low- and middle-income countries (LMICs), almost nothing is known about the patterns of participation in parent training. This paper examines group session attendance and engagement data from 270 high-risk families enrolled in the intervention arm of a cluster-randomized controlled trial in South Africa. The trial evaluated a 14-week parenting intervention aiming to improve parenting and reduce maltreatment by caregivers. The intervention was delivered in 20 groups, one per study cluster, with 8 to 16 families each. Overall, caregivers attended 50% of group sessions and children, 64%. Using linear multilevel models with Kenward-Roger correction, we examined child and caregiver baseline characteristics as predictors of their attendance and engagement in the group sessions. Variables examined as predictors included measures of economic, educational, and social and health barriers and resources, as well as family problems and sociodemographic characteristics. Overall, the study yielded no evidence that the level of stressors, such as poverty, was related to attendance and engagement. Notably, children from overcrowded households attended on average 1.2 more sessions than their peers. Our findings suggest it is possible to engage highly disadvantaged families that face multiple challenges in parenting interventions in LMICs. However, some barriers such as scheduling, and alcohol and substance use, remain relevant. Electronic supplementary material The online version of this article (10.1007/s11121-018-0941-2) contains supplementary material, which is available to authorized users.
Article
Recent years have seen an upsurge in parent education programmes in low and middle-income countries (LMICs) that aim to help reduce violence against children. This article draws on a narrative review that examined the impact of 42 programmes working with parents of adolescents in LMICs. Here we focus on 17 initiatives that aimed to reduce neglect of, or physical, emotional or sexual violence against adolescents, or to reduce child marriage. Programmes aiming to prevent sexual violence or child marriage generally focused more strongly on understanding and challenging prevailing norms, while those oriented to preventing physical and emotional violence emphasised sharing information and practising new communication skills. We argue that key elements of programme design (group-based participatory sessions, formative research that enabled sensitive framing and adaptation of content) have strong potential to help shift norms that underpin violence against adolescents. To fulfil their potential to change norms underpinning violence against adolescents, programmes should expand their reach, with a particular focus on embedding initiatives within institutions that can take them to scale, promoting male engagement, and support participants to maintain changes over the long-term.
Article
The effectiveness of an indigenous parent training program was examined within selected Pakistani families. For this purpose, 110 parents of adolescents with above-average levels of delinquent tendencies (challenging behaviors), who were screened and chosen from five randomly selected schools in Lahore, Punjab, Pakistan, participated in the study. The adolescents' parents were randomly placed into either an intervention group or a control group. Members of the intervention group participated in seven sessions of parent training, which aimed to increase behaviors associated with an authoritative parenting style. Findings show that participants in the parent training program displayed an increase in authoritative parenting behaviors and a decrease in authoritarian and neglectful parenting behaviors at both posttest and follow-up. In addition, their children showed reductions in parent-reported challenging behaviors. Declines in challenging behaviors were explained by increases in authoritative parenting behaviors, although not all intervention effects could be explained by such increases. We conclude that, similar to Western countries, the authoritative parenting style is the most effective parenting style for managing adolescents' challenging behaviors in Pakistan.
Article
Background: Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention). Methods: We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number. Results: 295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features. Conclusion: Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.
Article
Full-text available
Objectives Over 2.4 million people have been displaced within the Thailand-Myanmar border region since 1988. The efficacy of community-driven health models within displaced populations is largely unstudied. Here, we examined the relationship between maternal healthcare access and delivery outcomes to evaluate the impact of community-provided health services for marginalised populations. Setting Study setting was the Thailand-Myanmar border region’s single largest provider of reproductive health services to displaced mothers. Participants All women who had a delivery (n=34 240) between 2008 and 2019 at the study clinic were included in the performed retrospective analyses. Primary and secondary outcome measures Low birth weight was measured as the study outcome to understand the relationship between antenatal care access, family planning service utilisation, demographics and healthy deliveries. Results First trimester (OR=0.86; 95% CI=0.81 to 0.91) and second trimester (OR=0.86; 95% CI=0.83 to 0.90) antenatal care visits emerged as independent protective factors against low birthweight delivery, as did prior utilisation of family planning services (OR=0.82; 95% CI=0.73 to 0.92). Additionally, advanced maternal age (OR=1.36; 95% CI=1.21 to 1.52) and teenage pregnancy (OR=1.27, 95% CI=1.13 to 1.42) were notable risk factors, while maternal gravidity (OR=0.914; 95% CI=0.89 to 0.94) displayed a protective effect against low birth weight. Conclusion Access to community-delivered maternal health services is strongly associated with positive delivery outcomes among displaced mothers. This study calls for further inquiry into how to best engage migrant and refugee populations in their own reproductive healthcare, in order to develop resilient models of care for a growing displaced population globally.
Article
Introduction Armed conflict is damaging to children’s emotional and physical well-being and blunts normal development trajectories when experienced during sensitive growth periods such as early adolescence, typically defined as 10-14 years of age. Caregivers play a critical role in building and strengthening resilience in adverse events across the life course. The purpose of this article is to identify and explore the existing evidence on caregiver- and family-focused interventions to improve adolescent health and well-being. Methods A scoping review of peer-reviewed and gray literature on interventions to improve health and resiliency that engage young adolescents and parent/caregivers in low-and-middle income countries affected by conflict. Results Of the 4,698 articles screened, 14 articles detailing results from 12 interventions met the scoping inclusion criteria. Discussion Interventions have historically aimed to address psychological difficulties associated with armed conflict while measuring early adolescent internalizing and externalizing behavior outcomes and parenting quality outcomes. Future research should give additional attention to children’s regulation of behavior by their parents and to the economic and safety issues that threaten the health and well-being of early adolescents and their families. Lastly, program developers should ensure that interventions are appropriately adapted to local cultural and geopolitical contexts by collaborating closely with local communities and stakeholders.
Article
Full-text available
In humanitarian settings, mental health and psychosocial support services (MHPSS) are often delivered in group-based formats. Group interventions enable providers to reach more individuals when resources and technical expertise are limited. Group-based programs also foster social support, empathy, and collective problem-solving among the participants. To remedy the current lack of tools available to assess the group facilitation competencies of individuals delivering group-based MHPSS, we made it our objective to develop such a tool. Our approach, which focused on adults, complimented a similar initiative underway for children and adolescents. We reviewed MHPSS manuals to identify key group facilitation competencies, which include developing and reviewing group ground rules, facilitating participation among all group members, fostering empathy between members, encouraging collaborative problem-solving, addressing barriers to attendance, time management, and ensuring group confidentiality. We then developed the Group Facilitation Assessment of Competencies (GroupACT) Tool. The GroupACT is a structured observational tool for assessing these competencies during standardized role-plays with actor clients, or in vivo during the delivery of group sessions with actual clients. We conclude this article with guidance for using the GroupACT to assess facilitators' competencies in providing group-based MHPSS in the health, education, protection, and other sectors in humanitarian settings.
Article
Full-text available
Colombia has endured one of the world's longest internal displacement crises in recent history. Programs that address the practices and psychosocial wellbeing of the community of caregivers of young children in protracted crises are urgently needed. We developed and implemented a program aimed at strengthening the resilience and wellbeing of caregivers (parents, grandparents, and educators) of children enrolled in home-based and institutional centers for early childhood development in Colombia. The program, Conmigo, Contigo, Con Todos, or 3Cs, used purposive sampling across 14 municipalities disproportionately impacted by the armed conflict in Colombia. It consisted of two modules, a skills-building program (SBP) module and a psychotherapy intervention (PTI). The program content drew from cognitive behavioral therapy and mindfulness, and from inputs from local stakeholders. By applying a pragmatic evaluation strategy, we explored the pre-post intervention changes in parental resilience (the primary outcome of interest) through self-reports on the Connor-Davidson Resilience Scale (CD-RISC). The analysis of the pre-post intervention outcomes showed statistically significant improvements in CD-RISC in both intervention arms (SBP and PTI). Caregivers in the PTI group started with lower CD-RISC scores than caregivers who did not receive the PTI, and they showed the most improvement over time. Caregivers who had lower than average participation in the SBP (M=1-3 sessions out of a total of 6) did not show significant changes in CD-RISC. Additionally, caregivers who had higher than average participation in the SBP showed significantly more improvement in CD-RISC scores than caregivers who did not attend any sessions. We discuss the implications of these findings for future applications of the program and substantiate the measurable impact of interventions for caregivers in conflict settings.
Chapter
Evidence suggests that the burden of mental health problems among children and adolescents in Africa is significant, and that the treatment gap in mental health is widening. African countries have experienced considerable political and social instability and change and currently have the highest rates of HIV/AIDS and malaria in the world, which can result in neuropsychiatric sequelae. Yet, these countries have very few human and economic resources dedicated to the mental health of children and young people. This chapter reviews the state of the economic evidence base on mental health programs and interventions for children and adolescents in low-resource settings and examines the most immediate economic considerations of introducing, integrating, and scaling up these interventions to improve child and adolescent mental health and well-being in such settings.
Article
Full-text available
Background Children who have been forcibly displaced are likely to experience psychosocial challenges given they may be dealing with past trauma and challenges of adapting to their new environment. Effective psychosocial interventions are needed to promote psychosocial wellbeing. Literature identifies the ages of 6–12 years (middle childhood), as key to addressing psychosocial development. To date, systematic reviews identifying effective psychosocial interventions for children have focused on adolescents. Aim We conducted a systematic review and meta-analysis to: 1) identify psychosocial interventions conducted in middle childhood with forcibly displaced children; 2) summarize the characteristics of the included interventions; 3) identify the methodological quality of the studies; and 4) identify effectiveness of the interventions. Method A comprehensive literature search was conducted across four databases and supplementary literature. Study design was classified according to the National Health and Medical Research Council Hierarchy of Evidence. Methodological quality was assessed using the QualSyst appraisal checklist. Intervention approaches were classified into activity codes using the ‘Who is Where When doing What’ (4Ws) tool. Intervention effects were explored through meta-analysis. Results Nineteen studies with 2386 children met the eligibility criteria. A total of 19 intervention approaches were identified. The interventions found to be most promising were Narrative Exposure Therapy for children and adolescents (KidNET), Cognitive Behavioural Therapy, Child-Centred Play Therapy, Eye Movement Desensitization and Reprocessing, and creative interventions. Unstructured play or education alone did not produce a beneficial intervention effect. Conclusions Middle childhood presents a unique opportunity to address psychosocial wellbeing with forcibly displaced children. While psychological-based activities in this review demonstrated effectiveness for symptom reduction, future intervention options should expand to include strengths- and resilience-based. Further research evaluating the effectiveness of psychosocial intervention for forcibly displaced children is required using randomised control designs, greater sample sizes, and longitudinal data.
Article
Adolescence is a developmental phase where mental disorders typically manifest and where platforms for response (including schools and health services) change rapidly. However, data to inform public mental health responses are limited, including in countries like Myanmar which has a large adolescent population and where mental health has been identified as a priority of policy. In this paper we sought to systematically review the peer-reviewed and grey literature to determine (i) the prevalence of mental disorder among adolescents in Myanmar, (ii) determinants of mental disorder and (iii) interventions that have been implemented and evaluated. Nine publications met inclusion criteria (7 peer-reviewed and 2 grey literature) that included 7 publications reporting prevalence, 6 reporting correlates and one an intervention. The available data from the 2016 Global School-based Health Survey highlight that depression (27.2%) and suicidal ideation (9.4%) are prevalent in Myanmar, these rates substantially higher than regional averages. The limited available data on correlates identified violence and bullying, alcohol and substance use, and home, family and community security and cohesion as being closely related to mental health for adolescents. Only one study focussed on interventions and this found mindfulness meditation training to be an effective approach for young people whose parents were living with HIV. These findings underscore the need to address adolescent mental health in Myanmar, but also to invest in better data collection efforts.
Article
Full-text available
Southeast Asian countries host significant numbers of forcibly displaced populations, both within countries and across borders. This brief review paper provides a basic overview on recent forced migration research in Southeast Asia for the period 2013 to 2018. To this end, a keyword search with two predefined sets of search terms was carried out in the Web of Science database in September 2018. The identified research literature corpus was then analyzed regarding persons of concern, study site(s) (country/ies) as well as main drivers of migration. The results show that the major part of studies focuses on refugees and asylum seekers in the region's main host countries, namely Thailand, Malaysia, and Indonesia. This correspondence between current research trends and the distribution of refugees and asylum seekers in Southeast Asia could, however, not be identified for internally displaced persons (IDPs). Although Southeast Asian countries account for a substantial share of worldwide IDPs, only a very limited number of identified studies focus on this group of persons of concern.
Article
Full-text available
Background: The experiences of protracted conflict and displacement are clear threats to children's developmental progress. Understanding the factors that shape the trajectories of children's well-being and adjustment in such contexts is important for informing interventions. Methods: We collected data at three time points from a sample of Syrian refugee and Jordanian children (n=650) residing in Zarqa, Jordan who met eligibility criteria for humanitarian programming. We assessed primary outcomes of protection concerns, caregiver stress, mental health, and developmental assets at three time points: baseline (T1), three months later (T2), and fifteen months after baseline (T3). Results: Over the fifteen-month study period (T1-T3) child protection concerns and mental health symptoms improved, caregiver stress remained constant, and developmental assets deteriorated. School attendance was independently associated with improvements in protection concerns (β = -1.05, P=0.01), caregiver stress (β = -0.66, P =0.02), and developmental assets (β = 3.84, P =0.02). Concern over lost livelihoods significantly predicted higher protection concerns (β = 4.08, P <0.001) and caregiver stress (β = 2.32, P <0.001). Attending child-focused programming did not significantly impact primary outcomes. Conclusions: This study documents the capacity for adjustment and adaptation of children in the context of protracted displacement. The significant influences of attending school and concern over lost livelihoods on observed trajectories indicate the importance of addressing structural factors, such as education and employment, in supporting processes of resilience in these populations. Programmatic activities for children may secure valuable shorter-term impacts but here, as elsewhere, failed to impact outcomes longer-term.
Article
Introduction Studies have found that adolescents' subjective well-being (SWB) shows a downward trend with age. The improvement of adolescents' SWB is therefore an urgent problem. According to previous studies, altruism may be an effective way to improve adolescents' SWB. We conducted an Integrative Educational Intervention of Altruism (IEIA) for the first time to determine whether altruism intervention can effectively improve adolescents’ SWB. Methods We conducted an IEIA on adolescents in an experimental group for 14 weeks using pre- and post-test experimental designs with peer groups. The participants were randomly recruited from a junior high school in East China and included 280 Grade 8 students (138 boys and 142 girls; mean age: 14.53 years). Before and after the experiment, the adolescents completed measures of SWB using the Multidimensional Students’ Life Satisfaction Scale and Happiness Scale. Results From the pretest, we found no significant differences in friendship, academic, freedom, school and social satisfaction or positive emotions between the control and experimental groups. However, in the post-test, the life satisfaction and positive emotions of the experimental group were rated significantly higher than those of the control group. These results show that experimental intervention can effectively improve adolescents’ life satisfaction and positive emotions. Conclusions Altruistic intervention was identified as an effective way to improve adolescents’ SWB. It is thus necessary to cultivate altruistic environments, to enrich altruistic education programs, and to carry out voluntary services for the benefit of the public. Altruistic adolescents themselves may benefit when helping others.
Article
Although 9 of 10 of the world's children live in low- and middle-income countries (LMICs), and children constitute nearly half of the populations of these countries, far too little research has focused on child mental health in LMICs.¹ The expansion of research in global health and global mental health over the past several decades has not yet been matched by new research in child and adolescent mental health in LMICs.² It is time for that to change. New research should include a focus on social drivers and the mechanisms by which they contribute to mental illnesses.
Book
Full-text available
Rampant forms of violence increasingly take place not only in troubled areas but also in centers and metropoles. Such violence is no longer simply confined to local concerns or historical ruptures, but emerges instead in relation to modalities of power. The movement of people and expanding networks of actors and capital enables the notion of violence to transgress boundaries set by institutions, geography, state, and power. In some conditions, rather than sealing off the emergence of violence, the transition to democracy has opened the door for engineered violent confrontations to manifest out of cleavages that have been tempered by previous authoritarian rule. ASEAS 12(2) addresses violence in selected cases and on different scales. The contributions discuss how violence is practiced, how it (re)produces structures, and how it may eventually transform into non-violence. Violence is not simply an outcome of tensions but is a mechanism that actors and organizations deploy to stabilize their struggles, which eventually makes peacebuilding or democratic projects volatile. The articles in this issue feature police violence in the Philippines; intimate partner violence against women in Vietnam; Islamist online/offline mobilization strategies in Indonesia; the role of traditional actors in reconciliation processes in Timor-Leste; and gender security in the context of conflict management in Thailand’s Deep South.
Article
en Child refugees are at high risk for problems with academic achievement and psychosocial well-being. We aimed to review the literature concerning these outcomes in primary school–aged child refugees. This study was a systematic review and included studies that reported on outcomes of interest in child refugees between 5 and 12 years of age. Our search generated 3,172 articles; we selected 313 for review and included 45. Child refugees are diverse in their educational performance, and early deficits often resolve with time spent in the host country. These children are at an increased risk of emotional and behavioral difficulties, and multiple factors are associated with these outcomes. Although educational difficulties of primary school–aged child refugees in high-income countries tend to resolve, the risks for psychosocial problems persist. This review provides a deepened understanding of the diverse educational and psychosocial experiences of these children and highlights the need for developing health and educational programs to support this population. 抽象 zh 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 JOTS-20-0035.R1 Aghajafari Academic Achievement and Psychosocial Adjustment in Child Refugees: A Systematic Review Traditional Chinese 標題: 難民兒童的學業成就和心理社會調節:系統性文獻回顧 撮要: 難民兒童有高險於學業成就和心理社會健康上出現問題。我們的目標, 旨在回顧檢視難民兒童於小學階段遇上以上問題的文獻。本研究為系統性文獻回顧, 包含了檢視5至12歲難民兒童的相關問題的研究。我們搜尋出3,172篇文章, 從中選擇出313篇作回顧, 最後包含了其中的45篇。難民兒童有不同的學習表現, 而早期的缺陷, 往往會隨兒童在收容國的時間越長而得以解決。這些兒童有較高風險在情緒和行為上面對困難, 而有多種因素跟這些問題相關。雖然在高收入國家, 在小學階段的難民兒童其學業問題通常都能得以解決, 但他們仍有風險有心理社會問題。本回顧有助我們加以了解這些兒童不同的學業和心理社會體驗, 並凸顯為這群體制訂健康及教育計劃的需要。 Simplified Chinese 标题: 难民儿童的学业成就和心理社会调节:系统性文献回顾 撮要: 难民儿童有高险于学业成就和心理社会健康上出现问题。我们的目标, 旨在回顾检视难民儿童于小学阶段遇上以上问题的文献。本研究为系统性文献回顾, 包含了检视5至12岁难民儿童的相关问题的研究。我们搜寻出3,172篇文章, 从中选择出313篇作回顾, 最后包含了其中的45篇。难民儿童有不同的学习表现, 而早期的缺陷, 往往会随儿童在收容国的时间越长而得以解决。这些儿童有较高风险在情绪和行为上面对困难, 而有多种因素跟这些问题相关。虽然在高收入国家, 在小学阶段的难民儿童其学业问题通常都能得以解决, 但他们仍有风险有心理社会问题。本回顾有助我们加以了解这些儿童不同的学业和心理社会体验, 并凸显为这群体制订健康及教育计划的需要。
Article
Full-text available
Delivery of psychological and psychosocial treatments by non-specialists in low-and middle-income countries (LMIC) is a growing strategy to address the global mental health treatment gap. However, little is known about which competencies are essential for non-specialists to effectively deliver treatment. Psychotherapy research in high-income countries suggests that effective treatment requires competency in common factors. Therefore, our objective was to identify how common factors are described in evidence-supported non-specialist interventions in LMICs. To meet this objective, we identified and coded common factors by reviewing 16 evidence-supported manuals for psychological treatments delivered by non-specialists in LMICs. World Health Organization (WHO) manuals and other non-proprietary manuals, with positive randomized control outcomes, were included in the review. Fifteen common factors were identified and described in most manuals: ‘promoting hope and realistic expectancy of change’ and ‘confidentiality’ were described in 15 manuals (94%), followed by ‘giving praise’ and ‘psychoeducation’ (88% of manuals), and ‘rapport building’ (81% of manuals). Descriptions of common factors were similar across manuals, suggesting that training and competency evaluation approaches can be harmonized across interventions. Compiling these descriptions from the manuals can inform foundational training in common factors for diverse cadres of non-specialists around the world.
Article
Background Previous research has found mixed results on whether the most disadvantaged families benefit as much as less disadvantaged families from parenting interventions designed to reduce child maltreatment, and little in known in low-income settings. Objective In this study, we test the effects of child, caregiver, household, and community characteristics as treatment moderators of intervention outcomes – child maltreatment and parenting practices. We test characteristics previously examined elsewhere as well as factors relevant to the South African context. Participants and setting This analysis includes adolescents (ages 10−18) and their caregivers (N = 552 pairs) who participated in a randomised trial of a parenting programme in the Eastern Cape Province of South Africa. Methods Data from the caregiver and adolescent standardised questionnaires collected at baseline, post-test (1-month post-intervention), and follow-up (5–9 months) were analysed using longitudinal multilevel analyses. We tested seven hypothesised moderators for each of the primary outcomes through interactions of treatment effect with baseline moderators. Results No moderator effects were statistically significant after correcting for multiple comparisons testing. Hence, in line with several recent studies examining moderation effects in parenting programmes, our study suggests that parenting interventions aiming to reduce child maltreatment and promote parenting skills in low- and middle-income countries may be similarly effective for families facing various levels of economic, social, and health risk factors. Conclusions It may be useful to explicitly power trials for testing moderator effects, study different types of moderators and use person-centred analyses to further understand variations in treatment effects.
Article
Full-text available
Importance Although there is evidence that adverse childhood experiences are associated with worse mental health in adulthood, scarce evidence is available regarding an emerging concern that the next generation might also be affected. Objective To compare the risk of psychiatric hospitalization in cousins whose parents were vs were not exposed to the Finnish evacuation policy that involved a mean 2-year stay with a Swedish foster family. Design, Setting, and Participants This multigenerational, population-based cohort study of Finnish individuals and their siblings born between January 1, 1933, and December 31, 1944, analyzed the association of evacuee status as a child during World War II in the first generation with the risk of psychiatric hospitalization among offspring in the second generation. Evacuee status during World War II was determined using the Finnish National Archive’s registry of participants in the Finnish evacuation. Data on evacuee status were linked to the psychiatric diagnoses in the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012, for offspring (n = 93 391) born between January 1, 1950, and December 31, 2010. Sex-specific Cox proportional hazards regression models were used to estimate hazard ratios for risk of psychiatric hospitalization during the follow-up period. Because offspring of evacuees and their nonevacuated siblings are cousins, the Cox proportional hazards regression models included fixed effects to adjust for confounding factors in families. Data analysis was performed from June 15, 2016, to August 26, 2017. Exposures Parental participation in the evacuation during World War II (coded 1 for parents who were evacuated and placed in foster care and 0 for those not evacuated). Main Outcomes and Measures Offspring’s initial admission to the hospital for a psychiatric disorder, obtained from the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012. Results Of the 93 391 study persons, 45 955 (49.2%) were women and 47 436 (50.8) were men; mean (SD) age in 2012 among survivors was 45.4 (6.58) years. Female offspring of mothers evacuated to Sweden during childhood had an elevated risk of psychiatric hospitalization (hazard ratio for any type of psychiatric disorder: 2.04 [95% CI, 1.04-4.01]; hazard ratio for mood disorder: 4.68 [95% CI, 1.92-11.42]). There was no excess risk of being hospitalized for a psychiatric disorder among women whose fathers were exposed to the Finnish evacuation policy during World War II or among men whose mothers or fathers were exposed. Conclusions and Relevance In a prior follow-up study of the Finnish evacuees, girls evacuated to Swedish foster families during World War II were more likely to be hospitalized for a psychiatric disorder—in particular, a mood disorder—in adulthood than their nonevacuated sisters. The present study found that the offspring of these individuals were also at risk for mental health problems that required hospitalization and suggests that early-life adversities, including war-related exposures, may be associated with mental health disorders that persist across generations.
Article
Full-text available
Objective: To evaluate a family- and church-based intervention for adolescents and caregivers in rural Kenya to improve family relationships, reduce HIV risk, and promote mental health. Method: The intervention was developed using community-based participatory methods and focused on strengthening family communication. Modules addressed economic, relationship, and HIV-related topics using evidence-based behavioral strategies alongside culturally grounded content. A stepped wedge cluster randomized trial was conducted with 124 families (237 adolescents ages 10 to 16; 203 caregivers) from 4 churches. Participants completed interviewer-administered surveys over 5 rounds. Primary outcomes included family communication, HIV risk knowledge, self-efficacy, and beliefs. Secondary outcomes included parenting, social support, mental health, and adolescent sexual behavior. We estimated intent-to-treat effects via ordinary least squares regression with clustered standard errors. Results: Relative to controls, the intervention group reported better family communication across domains at 1- and 3-months postintervention and higher self-efficacy for risk reduction skills and HIV-related knowledge at 1-month postintervention. Sexually active youth in the intervention reported fewer high-risk behaviors at 1-month postintervention, including unprotected sex or multiple partners. Male caregivers in the intervention reported higher parental involvement at both time points, and youth reported more social support from male caregivers at 3-months postintervention. No effects on secondary outcomes of parenting, social support, and mental health were detected. Conclusions: This intervention holds promise for strengthening positive family processes to protect against negative future outcomes for adolescents. Implementation with religious congregations may be a promising strategy for improving sustainability and scalability of interventions in low-resource settings. (PsycINFO Database Record
Article
Full-text available
The objective of this study was to evaluate the impact of a brief parenting intervention, ‘Parents Make the Difference‘(PMD), on parenting behaviors, quality of parent-child interactions, children's cognitive, emotional, and behavioral wellbeing, and malaria prevention behaviors in rural, post-conflict Liberia. Methods. A sample of 270 caregivers of children ages 3–7 were randomized into an immediate treatment group that received a 10-session parent training intervention or a wait-list control condition (1:1 allocation). Interviewers administered baseline and 1-month post-intervention surveys and conducted child-caregiver observations. Intent-to-treat estimates of the average treatment effects were calculated using ordinary least squares regression. This study was pre-registered at ClinicalTrials.gov (NCT01829815). Results. The program led to a 55.5% reduction in caregiver-reported use of harsh punishment practices ( p < 0.001). The program also increased the use of positive behavior management strategies and improved caregiver–child interactions. The average caregiver in the treatment group reported a 4.4% increase in positive interactions ( p < 0.05), while the average child of a caregiver assigned to the treatment group reported a 17.5% increase ( p < 0.01). The program did not have a measurable impact on child wellbeing, cognitive skills, or household adoption of malaria prevention behaviors. Conclusions. PMD is a promising approach for preventing child abuse and promoting positive parent-child relationships in low-resource settings.
Article
Full-text available
Lack of reliable and valid measures of therapist competence is a barrier to dissemination and implementation of psychological treatments in global mental health. We developed the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale for training and supervision across settings varied by culture and access to mental health resources. We employed a four-step process in Nepal: (1) Item generation: We extracted 1081 items (grouped into 104 domains) from 56 existing tools; role-plays with Nepali therapists generated 11 additional domains. (2) Item relevance: From the 115 domains, Nepali therapists selected 49 domains of therapeutic importance and high comprehensibility. (3) Item utility: We piloted the ENACT scale through rating role-play videotapes, patient session transcripts, and live observations of primary care workers in trainings for psychological treatments and the Mental Health Gap Action Programme (mhGAP). (4) Inter-rater reliability was acceptable for experts (intraclass correlation coefficient, ICC(2,7) = 0.88 (95% confidence interval (CI) 0.81-0.93), N = 7) and non-specialists (ICC(1,3) = 0.67 (95% CI 0.60-0.73), N = 34). In sum, the ENACT scale is an 18-item assessment for common factors in psychological treatments, including task-sharing initiatives with non-specialists across cultural settings. Further research is needed to evaluate applications for therapy quality and association with patient outcomes. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
Article
Full-text available
There has been rapid global dissemination of parenting interventions, yet little is known about their effectiveness when transported to countries different from where they originated, or about factors influencing success. This is the first systematic attempt to address this issue, focusing on interventions for reducing child behavior problems. Stage 1 identified evidence-based parenting interventions showing robust effects in systematic reviews; Stage 2 identified trials of these interventions in a new country. Systematic review/meta-analysis of transported programs was followed by subgroup analyses by trial- and country-level cultural, resource, and policy factors. We found 17 transported trials of 4 interventions, originating in United States or Australia, tested in 10 countries in 5 regions, (n = 1,558 children). Effects on child behavior were substantial (SMD -.71) in the (14) randomized trials, but nonsignificant in the (3) nonrandomized trials. Subgroup analyses of randomized trials found no association between effect size and participant or intervention factors (e.g., program brand, staffing). Interventions transported to "western" countries showed comparable effects to trials in origin countries; however, effects were stronger when interventions were transported to culturally more distant regions. Effects were higher in countries with survival-focused family/childrearing values than those ranked more individualistic. There were no differences in effects by country-level policy or resource factors. Contrary to common belief, parenting interventions appear to be at least as effective when transported to countries that are more different culturally, and in service provision, than those in which they were developed. Extensive adaptation did not appear necessary for successful transportation.
Article
Full-text available
Migrant workers from Burma1 often experience exploitation, abuse and violations at various stages of travel to and within Thailand and in workplaces in Thailand. Guided by Zimmerman et al.'s conceptual framework, which identifies the potential risks associated with trafficking process, this article presents findings from in-depth interviews with 61 migrant workers living and working in and around Mae Sot, Thailand, on the Thailand-Burma border, to describe the broader context of irregular migration from Burma to Thailand, and trafficking-related risks in this context.Results demonstrate that use of transporters (“carries”) and brokers in order to travel to Thailand and find employment can enable trafficking. Moreover, migrant workers are exposed to a range of exploitative experiences in workplaces in Thailand, including violence, coercion, and economic exploitation. This article explores dynamics of migration that can enable trafficking in this context, as well as exploitative working conditions consistent with forced labour.
Article
Full-text available
Objective: The objective of this study is to assess the feasibility and acceptability of an intervention to reduce mental health problems and bolster resilience among children living in households affected by caregiver HIV in Rwanda. Design: Pre-post design, including 6-month follow-up. Methods: The Family Strengthening Intervention (FSI) aims to reduce mental health problems among HIV-affected children through improved child-caregiver relationships, family communication and parenting skills, HIV psychoeducation and connections to resources. Twenty families (N = 39 children) with at least one HIV-positive caregiver and one child 7-17 years old were enrolled in the FSI. Children and caregivers were administered locally adapted and validated measures of child mental health problems, as well as measures of protective processes and parenting. Assessments were administered at pre and postintervention, and 6-month follow-up. Multilevel models accounting for clustering by family tested changes in outcomes of interest. Qualitative interviews were completed to understand acceptability, feasibility and satisfaction with the FSI. Results: Families reported high satisfaction with the FSI. Caregiver-reported improvements in family connectedness, good parenting, social support and children's pro-social behaviour (P < 0.05) were sustained and strengthened from postintervention to 6-month follow-up. Additional improvements in caregiver-reported child perseverance/self-esteem, depression, anxiety and irritability were seen at follow-up (P < .05). Significant decreases in child-reported harsh punishment were observed at postintervention and follow-up, and decreases in caregiver reported harsh punishment were also recorded on follow-up (P < 0.05). Conclusion: The FSI is a feasible and acceptable intervention that shows promise for improving mental health symptoms and strengthening protective factors among children and families affected by HIV in low-resource settings.
Article
Full-text available
Background Despite robust evidence of fathers’ impact on children and mothers, engaging with fathers is one of the least well-explored and articulated aspects of parenting interventions. It is therefore critical to evaluate implicit and explicit biases manifested in current approaches to research, intervention, and policy.Methods We conducted a systematic database and a thematic hand search of the global literature on parenting interventions. Studies were selected from Medline, Psychinfo, SSCI, and Cochrane databases, and from gray literature on parenting programs, using multiple search terms for parent, father, intervention, and evaluation. We tabulated single programs and undertook systematic quality coding to review the evidence base in terms of the scope and nature of data reporting.ResultsAfter screening 786 nonduplicate records, we identified 199 publications that presented evidence on father participation and impact in parenting interventions. With some notable exceptions, few interventions disaggregate ‘father’ or ‘couple’ effects in their evaluation, being mostly driven by a focus on the mother–child dyad. We identified seven key barriers to engaging fathers in parenting programs, pertaining to cultural, institutional, professional, operational, content, resource, and policy considerations in their design and delivery.Conclusions Barriers to engaging men as parents work against father inclusion as well as father retention, and undervalue coparenting as contrasted with mothering. Robust evaluations of father participation and father impact on child or family outcomes are stymied by the ways in which parenting interventions are currently designed, delivered, and evaluated. Three key priorities are to engage fathers and coparenting couples successfully, to disaggregate process and impact data by fathers, mothers, and coparents, and to pay greater attention to issues of reach, sustainability, cost, equity, and scale-up. Clarity of purpose with respect to gender-differentiated and coparenting issues in the design, delivery, and evaluation of parenting programs will constitute a game change in this field.
Article
Full-text available
A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation—the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation—the modification of program content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension between fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that “build in” adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness.
Article
Full-text available
Objective: Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. Method: Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. Results: All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. Conclusions: CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.
Article
Full-text available
Family and youth violence are increasingly recognized as key public health issues in developing countries. Parenting interventions form an important evidence-based strategy for preventing violence, both against and by children, yet most rigorous trials of parenting interventions have been conducted in high-income countries, with far fewer in low- and middle-income countries (LMICs). This systematic review, conducted in line with Cochrane Handbook guidelines, investigated the effectiveness of parenting interventions for reducing harsh/abusive parenting, increasing positive parenting practices, and improving parent-child relationships in LMICs. Attitudes and knowledge were examined as secondary outcomes. A range of databases were systematically searched, and randomized trials included. High heterogeneity precluded meta-analysis, but characteristics of included studies were described according to type of delivery mode and outcome. Twelve studies with 1580 parents in nine countries reported results favoring intervention on a range of parenting measures. The validity of results for most studies is unclear due to substantial or unclear risks of bias. However, findings from the two largest, highest-quality trials suggest parenting interventions may be feasible and effective in improving parent-child interaction and parental knowledge in relation to child development in LMICs, and therefore may be instrumental in addressing prevention of child maltreatment in these settings. Given the well-established evidence base for parenting interventions in high-income countries, and increasingly good evidence for their applicability across cultures and countries, there is now an urgent need for more rigorously evaluated and reported studies, focusing on youth outcomes as well as parenting, adapted for contexts of considerable resource constraints.
Article
Full-text available
Purpose: Conduct problems and emotional distress have been identified as key problems among children and adolescents in post-war Burundi. This pilot study aims to evaluate the impact of a brief parenting psychoeducation intervention on children's mental health. Methods: This study employs a controlled pre and post evaluation design. The two-session psychoeducation intervention was offered to groups of parents of children (mean age 12.3 years, 60.8 % female) who had been screened for elevated psychosocial distress. Children in the intervention group (n = 58) were compared to a waitlist control group (n = 62). Outcome indicators included child-reported levels of aggression (using the Aggression Questionnaire), depression symptoms (using the Depression Self Rating Scale) and perceived family social support. Results: The intervention had a beneficial effect on reducing conduct problems compared to the control condition (Cohen d = 0.60), especially among boys, while not showing impact on depression symptoms or family social support. Parents evaluated the intervention positively, with increased awareness of positive parenting strategies and appropriate disciplinary techniques reported as the most common learning points. Conclusion: A brief parenting psychoeducation intervention conducted by lay community counselors is a promising public health strategy in dealing with widespread conduct problems in boys living in violence-affected settings and not so for social and emotional indicators and for girls. An efficacy study is warranted to confirm these preliminary findings.
Article
Full-text available
There is a growing interest in whether and how to adapt psychotherapies to take into account the cultural, linguistic, and socioeconomic context of diverse ethnocultural groups. At the root of the debate is the issue of whether evidence-based treatments (EBTs) developed within a particular linguistic and cultural context are appropriate for ethnocultural groups that do not share the same language, cultural values, or both. There is considerable evidence that culture and context influence almost every aspect of the diagnostic and treatment process. Yet, there are concerns about fidelity of interventions, and some have questioned whether tinkering with well-established EBTs is warranted. We present arguments in favor of the cultural compatibility and universalistic hypotheses. Next, we review the available published frameworks for cultural adaptations of EBTs and offer examples from the literature on the process and outcome of different approaches used. Conceptual models for adapting existing interventions and emerging evidence that adapted intervention leads to positive outcomes suggest that there are tools for engaging in evidence-based psychological practices with ethnocultural youth. Recommendations for future directions are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Chapter
Full-text available
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness of behavioural/cognitive-behavioural group-based parenting interventions for children with early onset conduct problems in improving a) child behaviour outcomes and b) parenting skills and parental mental health. To critically appraise and summarise current evidence on the incremental resource use, costs and cost-effectiveness of behavioural/cognitive-behavioural group-based parenting interventions when compared to treatment as usual.
Article
Full-text available
Many children in developing countries are at risk of emotional and behavioral difficulties, which are likely to be elevated due to the effects of poverty. Parenting programs have shown to be effective preventative strategies in high-income countries, but to date the research on their effectiveness in lower-income countries is limited. International organizations such as the World Health Organization have called for the implementation of programs to prevent behavioral difficulties through the development of stable relationships between children and their parents. The aim of the present paper was to review the literature on parenting programs in developing countries in order to identify challenges, opportunities and directions for further research. First, reports of international organizations were reviewed in order to gain a preliminary overview of the field. In a second stage, a non-systematic review was carried out. Databases were searched in order to identify empirical evaluations of parenting programs in low-income countries. Finally, a systematic review was carried out to specifically identify evaluations of programs targeting emotional or behavioral outcomes. Only one study had a strong methodology among those designed to prevent emotional and behavioral outcomes. Opportunities for further program development and research are identified.
Article
Full-text available
Children and adolescents who are forcibly displaced represent almost half the world's internally displaced and refugee populations. We undertook a two-part systematic search and review of the evidence-base for individual, family, community, and societal risk and protective factors for the mental health outcomes of children and adolescents. Here we review data for displacement to low-income and middle-income settings. We draw together the main findings from reports to identify important issues and establish recommendations for future work. We draw attention to exposure to violence as a well established risk factor for poor mental health. We note the paucity of research into predictor variables other than those in the individual domain and the neglect of other variables for the assessment of causal associations, including potential mediators and moderators identifiable in longitudinal work. We conclude with research and policy recommendations to guide the development and assessment of effective interventions.
Article
Full-text available
This article examines issues and challenges in the design of cultural adaptations that are developed from an original evidence-based intervention (EBI). Recently emerging multistep frameworks or stage models are examined, as these can systematically guide the development of culturally adapted EBIs. Critical issues are also presented regarding whether and how such adaptations may be conducted, and empirical evidence is presented regarding the effectiveness of such cultural adaptations. Recent evidence suggests that these cultural adaptations are effective when applied with certain subcultural groups, although they are less effective when applied with other subcultural groups. Generally, current evidence regarding the effectiveness of cultural adaptations is promising but mixed. Further research is needed to obtain more definitive conclusions regarding the efficacy and effectiveness of culturally adapted EBIs. Directions for future research and recommendations are presented to guide the development of a new generation of culturally adapted EBIs.
Article
Full-text available
Worldwide, millions of children are affected by armed conflict. However, data on the prevalence of mental disorders among these children is sparse. We aimed to determine the prevalence of mental disorders among children affected by war using a systematic review and meta-regression analysis. We systematically reviewed existing literature to identify studies on prevalence of post-traumatic stress disorder (PTSD), anxiety, depression and psychosis among children exposed to armed conflict. We searched electronic databases and references listed in studies to obtain eligible studies. We pooled studies using the random-effects method and explored heterogeneity using meta-regression analysis. Seventeen studies met our inclusion criteria. Studies included 7,920 children. Sample sizes ranged from 22 to 2,976. Four studies were conducted during a conflict and others during post-conflict. All the studies reported PTSD as the primary outcome ranging from 4.5 to 89.3%, with an overall pooled estimate of 47% (9% CI: 35-60%, I2 = 98%). Meta-analysis heterogeneity was attributable to study location (OR 1.33, 95% CI: 1.27-1.41), method of measurement (OR 1.36, 95% CI: 1.29-1.44) and duration since exposure to war (coefficient 0.17, 95% CI: 0.94-0.25). In addition, four studies reported elevated depression that allowed pooling (43%, 95% CI: 31-55%) and three studies reported elevated anxiety disorders allowing pooling (27%, 95% CI: 21-33%). Our systematic review suggests a higher prevalence rate of mental disorders among children exposed to conflict than among the general population. Given the number of current conflicts, there is a paucity of information regarding mental disorders among children affected by war.
Article
Full-text available
To review stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. Highlighted are special refugee populations such as unaccompanied minors, asylum seekers, and former child soldiers. Pertinent medical findings are summarized. The authors reviewed articles from 1990 to 2003 addressing the topics above. Literature was gathered from databases including PsycINFO, Medline, and SocioFile. Pertinent earlier papers and those from other disciplines cited in database-identified articles were also included. Child and adolescent refugees suffer from significant conflict-related exposures. Reactions to stress may be mediated by coping strategies, belief systems, and social relations. More research is needed on interventions, specifically on efficacy and cultural relevance. Interventions that have an impact on multiple ecological levels need further development and evaluation.
Article
Full-text available
Anxiety of childhood is a common and serious condition. The past decade has seen an increase in treatment-focussed research, with recent trials tending to give greater attention to parents in the treatment process. This review examines the efficacy of family-based cognitive behaviour therapy and attempts to delineate some of the factors that might have an impact on its efficacy. The choice and timing of outcome measure, age and gender of the child, level of parental anxiety, severity and type of child anxiety and treatment format and content are scrutinised. The main conclusions are necessarily tentative, but it seems likely that Family Cognitive Behaviour Therapy (FCBT) is superior to no treatment, and, for some outcome measures, also superior to Child Cognitive Behaviour Therapy (CCBT). Where FCBT is successful, the results are consistently maintained at follow-up. It appears that where a parent is anxious, and this is not addressed, outcomes are less good. However, for children of anxious parents, FCBT is probably more effective than CCBT. What is most clear is that large, well-designed studies, examining these factors alone and in combination, are now needed.
Article
Full-text available
Case reports of human rights violations have focused on individuals' experiences. Population-based quantification of associations between rights indicators and health outcomes is rare and has not been documented in eastern Burma. We describe the association between mortality and morbidity and the household-level experience of human rights violations among internally displaced persons in eastern Burma. Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household surveys in 2004. Workers recorded data on vital events, mid-upper arm circumference of young children, malaria parasitaemia status of respondents and household experience of various human rights violations during the previous 12 months. Under-5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost one-third of households reported forced labour (32.6%). Forced displacement (8.9% of households) was associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households) was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82), child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations (14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations. Widespread human rights violations in conflict zones in eastern Burma are associated with significantly increased morbidity and mortality. Population-level associations can be quantified using standard epidemiological methods. This approach requires further validation and refinement elsewhere.