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Preventive mental health interventions for refugee children and adolescents in high-income settings
Abstract
The mental health of refugee children and adolescents is a multifaceted phenomenon that needs to be understood and addressed across multiple sectors that influence all potential determinants of health, including housing, education, economic opportunities, and the larger policy and political context including immigration. The current state of interventions to address mental health problems in refugee children is limited and even more so for prevention programmes. This Review describes interventions of note that are delivered to individuals as well as parenting and school interventions, and broader socioeconomic and cultural interventions. Few studies aim to assess impact across multiple domains of the refugee experience. The multidimensional and collective character of challenges facing refugee children and families calls for comprehensive psychosocial interventions through which healing the psychological wounds of war is complemented by restoring and supporting the social and physical environment so that it is one in which children and their families can thrive.
... These components or spheres are especially central during adolescence, where wellbeing and mental health strongly depend on the presence or absence of problems in the emotional and relational spheres and how adolescents manage to overcome them. When it comes to migrant adolescents specifically, a positive balance in the emotional and relational spheres directly affects their integration process, which is vital to creating a new life in the host country that is now their new home (Fazel and Betancourt 2018). According to Raabe (2019), belonging and social acceptance are fundamental needs of adolescent well-being, and migrant adolescents are at higher risk of not forming stable friendships. ...
... At the same time, this finding also aligns with prior research that emphasises the role of schools as primary sites for social integration and language learning (Manzoni and Rolfe 2019;Strohmeier and Dogan 2012). The proposed solutions, such as encouraging Spanish peers to engage more in conversation or creating opportunities to interact with them, point to the critical role of friendships and peer relations with the majority population for language acquisition and integration into the host culture (Fazel and Betancourt 2018). These solutions, in addition to receiving respectful treatment from different actors, are aligned with the social capital theory, which establishes that positive relationships with peers and teachers can foster emotional and relational well-being (Lee and Lam 2016). ...
Migrant adolescents face unique emotional and relational challenges that can hinder their well-being and development. While prior research has identified many of these challenges, there is limited work exploring migrant adolescents’ perspectives on their needs. This study aims to bridge that gap by adopting a participatory approach to investigate the emotional and relational needs of migrant adolescents in Spain and the solutions they propose to address them. Using Bronfenbrenner’s Ecological Systems Theory as the theoretical framework, we conducted qualitative participatory research with migrant adolescents. They identified their emotional and relational needs, which were categorised into six thematic areas distributed across the ecological levels. The themes include supporting their families, receiving recognition and emotional support from relatives, improving school and societal experiences, learning the host language, gaining empathy from the local population, and regularising their legal status. The key actors identified to help meet their needs include parents, teachers, peers, society, and policymakers. The participants proposed self-directed solutions to these challenges, such as fostering peer relationships and advocating for policy reforms. The findings suggest that migrant adolescents have valuable insights into their emotional and relational needs, emphasising the importance of involving them in shaping interventions that support their inclusion and mental health.
... Barriers to engage in mental health interventions mentioned in the literature, such as stigma, lack of trust in authorities and cultural barriers (Fazel & Betancourt, 2018;Hodes & Vostanis, 2019;Scharpf et al., 2021) were not mentioned by the refugee parents in this study, which could also be explained by lack of trust, or perhaps they were not as prevalent given the intervention was in a school setting. ...
... A review of preventive mental health interventions for refugee children (Fazel & Betancourt, 2018) concluded that the interplay between child mental health and contextual factors is complex and needs to be addressed in a wide range of sectors, with a "continuum of care and multilevel and cross sectional intervention models" and although embedding youth trauma interventions in integrated services culturally tailored to meet the needs of refugee families would facilitate parental engagement (Heidi et al., 2011), these services are not yet always available. In lieu of this, cultural adaptations within TRT implementation are recommended. ...
Scalable light-touch programs that align with the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) approach is becoming an established intervention model for refugee youth with symptoms of post-traumatic stress. Teaching Recovery Techniques (TRT) is one example and, as TF-CBT guidelines state, parent sessions are included as the model relies on parents to provide support and instigate the techniques. In addition to traumatic stress, refugee families are often subjected to acculturative, isolation and resettlement stress. This study sought to understand how refugee parental involvement in TRT functions in practice and how it is perceived by participating youth, parents, and facilitators in Sweden. Thirty semi-structured interviews (11 youth, 8 parents, and 11 TRT facilitators) were conducted by phone or videoconference, transcribed, and analyzed using Thematic Network Analysis. A global theme ‘Parental engagement in trauma recovery requires dedicated attention’ emerged. Three organizing themes sat within this global theme: (i) Shifting roles when adapting differently to a new context; (ii) Tendency to keep parents at a distance; and (iii) Parent sessions don’t just happen. Whilst the potential for refugee parent involvement was recognized, a number of factors preventing their participation were identified. Cultural adaptations within TRT facilitators’ training are recommended, including: raising awareness about contextual factors and changes in family dynamics with regard to trauma and migration; adopting culturally responsive ways to present parental involvement to youth and parents; adding positive parenting skills; addressing parental mental health and readiness; and preparing facilitators to redirect parents to adequate services, when needed.
... Refugee community organizations that provide support services for newcomers can reduce isolation and improve access to healthcare, employment, and housing. For children, home visits to strengthen families , as well as parenting interventions (Fazel & Betancourt, 2018) and community-based family interventions (Weine et al., 2006), have shown promise to alleviate psychological difficulties. Programs aiming to integrate children and their parents in their school communities as well as school-based mental health prevention programs are supported by a growing literature (Fazel & Betancourt, 2018). ...
... For children, home visits to strengthen families , as well as parenting interventions (Fazel & Betancourt, 2018) and community-based family interventions (Weine et al., 2006), have shown promise to alleviate psychological difficulties. Programs aiming to integrate children and their parents in their school communities as well as school-based mental health prevention programs are supported by a growing literature (Fazel & Betancourt, 2018). ...
... In addition, schools have been identified as an ideal setting for delivering mental health interventions to these populations [21][22][23]. More specifically, schools provide an opportunity to easily reach children who may otherwise be isolated or unable to access services [24][25][26][27]. Further, schools are central to the children's social network and a main contact point with the host society. ...
... Mental health interventions delivered in a school context may also promote positive intercultural relationships and facilitate the development of healthy behaviours [26][27][28][29]. Although the evidence base for the effectiveness of school-based interventions is rather limited, previous research has shown that such interventions are beneficial in reducing trauma-related symptoms among refugee and migrant children [24,25,30]. ...
Background
During recent years, Europe has faced the arrival of migrants whereof a considerable group of youth present mental health problems, such as symptoms of post-traumatic stress disorder (PTSD). Schools offer a safe environment for mental health interventions to these groups, yet there is limited research on the impact of school-based interventions addressing mental health problems in newcomer youths, especially in the Swedish context. This cluster randomized controlled trial (RCT) aimed to explore the effectiveness of the Teaching Recovery Techniques (TRT) intervention among newcomer students with PTSD symptoms in Swedish secondary schools.
Methods
Nine schools were randomly assigned to TRT or a wait list control group prior to the baseline assessment. Follow-up data were collected immediately following the intervention and three months post-intervention. In total, 531 students were approached, of which 61 gave consent and were eligible to be included in the study: 55 in TRT and 6 in the control condition. Given the low number of participants in the control condition, we merely analyzed students who had received TRT.
Results
We report on feasibility of recruitment, data collection, intervention delivery and intervention effectiveness. In terms of intervention effectiveness, within subjects ANOVAs revealed significant reductions in PTSD symptoms and general mental health problems from baseline to the three months-follow-up (p < 0.001).
Conclusions
Our results indicate that TRT is a promising school-based intervention for newcomer students with PTSD symptoms. For a successful implementation of TRT in the school context, schools need to be engaged and the implementation should be managed by a local coordinator.
Trial registration
ISRCTN, ISRCTN48178969, Retrospectively registered 20/12/2019.
... Cette réalité, conjuguée au fait que plusieurs familles s'installent dans des régions où les écoles ont moins l'habitude d'accueillir des familles récemment arrivées, suscitent différents défis. En effet, les enfants réfugié·e·s sont considéré·e·s comme une catégorie d'immigrant·e·s particulièrement vulnérables notamment à cause de l'importance de l'adversité pré, péri et post-migratoire qu'ils et elles subissent (Fazel et al., 2012;Fazel et Betancourt, 2017). En ce qui concerne leurs parents, plusieurs d'entre eux vivent un cumul de vulnérabilités lié à des traumatismes et à des séparations, à un isolement social et à des expériences de discrimination qui peuvent compliquer l'exercice de la parentalité et avoir un impact sur le parcours scolaire de l'élève (Hohl et Kanouté, 2011;Kronick, 2018;Papazian-Zohrabian et al., 2018) Les difficultés que vivent les personnes réfugiées sont par ailleurs souvent conjuguées à une dépression parentale (Chase-Lansdale et al., 2007;Rousseau et al., 2011). ...
... En même temps, plusieurs élèves récemment arrivé·e·s vivent les contrecoups de réalités qui ont jalonné leur parcours migratoire. Certain·e·s ont été peu ou pas scolarisé·e·s (Gahungu et al., 2011;Hos, 2016), ont été témoins ou victimes de violences, ont vécu dans des camps de personnes réfugiées ou dans des pays de transit et sont susceptibles d'être en état de stress post-traumatique (Fazel et al., 2012;Fazel et Betancourt, 2017;Papazian-Zohrabian et al., 2018), par exemple. Toutefois, malgré de grands défis, plusieurs d'entre eux et elles font preuve de résilience, un concept qui renvoie pour nous à « la capacité d'atteindre ou l'atteinte d'une adaptation fonctionnelle malgré des circonstances adverses ou menaçantes » (Terrisse et Larose, 2001, p.11). ...
Dans le cadre d’un projet de recherche-action mené auprès d’élèves réfugié·e·s au Québec, nous avons documenté l’expérience d’enseignant·e·s qui les accueillent en classe. Dans cet article, nous présentons une analyse de récits de pratique qui relatent des situations vécues mettant en scène un·e élève réfugié·e et qui, du point de vue des personnes qui les racontent, pourraient être formatrices pour de futur·e·s enseignant·e·s. Dans une perspective compréhensive du savoir-agir professionnel, l’analyse qualitative progressive des données menée nous permettra de mettre en lumière six manières dont les participant·e·s soutiennent la résilience des élèves, ce qui nous apparaît également contribuer à leur développement professionnel.
... Language diversity in education is among the pertinent elements of focus while addressing the needs of culturally and linguistically diverse populations 11 . Some of the strategies that can be used in improving inclusivity and equity in mental health education include the utilization of programs materials that are designed to accommodate different linguistic and cultural variances 11 . ...
... Language diversity in education is among the pertinent elements of focus while addressing the needs of culturally and linguistically diverse populations 11 . Some of the strategies that can be used in improving inclusivity and equity in mental health education include the utilization of programs materials that are designed to accommodate different linguistic and cultural variances 11 . It is important to ensure training materials are adaptable, multilingual, and feature language support for this reason. ...
... Approximately 40% of forcibly displaced people are under the age of 18 and are particularly vulnerable to trauma (UNHCR, 2022). The significant number of young people who have experienced forced migration highlights the need to understand how their well-being can be supported in host countries (Fazel & Betancourt, 2018). Research indicates that having a positive sense of identity as well as a supportive environment promotes resilience, psychosocial well-being, and better integration in host societies (Fazel, Reed, Panter-Brick, & Stein, 2012;Oppedal, Ramberg, & Roysamb, 2020;Renshaw, 2019;Ungar, 2013). ...
... Many young people with refugee backgrounds experience different types of traumatic events across various stages of their journey (Betancourt et al., 2012;Fazel et al., 2012;Murray, 2019). Moreover, post-settlement experiences of acculturation, language barriers, racism, and bullying, may also adversely affect the identity construction of young people with refugee backgrounds (Fazel & Betancourt, 2018;Fazel et al., 2012;Murray, 2019;Streeck-Fischer, 2019). ...
... In general, family empowerment aims to enhance parenting skills and prevent the exacerbation of emotional problems within refugee families (Van Es et al., 2019); clinical experiences indicate that the impact of stress-related adverse complaints on parenting skills can be countered by focusing on psychosocial support to help families cope after traumatic events (Fazel & Betancourt, 2017), the term "psychosocial support" or "psychosocial intervention" may include a broader range of activities that support the psychosocial well-being of families, groups and communitiesand not only for those with mental disorders (Weissbecker et al., 2019). Graves & Shelton (2007) conducted a study entitled "Family empowerment as a mediator between family-centered care systems and changes in child functioning: identifying an important mechanism for change." ...
... For refugee families to fulfill the roles expected of them, they need to provide all forms of psychological and social support they need to overcome the crises they experienced as a result of wars and the pressures they have been exposed to and to protect them from psychological pressures that affect their performance of their various functions effectively and proficiently, and this requires constant pursuit It continues to provide these families with a psychosocial support system that can and helps them acquire the necessary knowledge and skills, as psychosocial support has essential effects in alleviating the psychological pressures experienced by refugee families as a result of the events they have been exposed to (Ager et al., 2011;Fazel & Betancourt, 2017). ...
The study aimed to examine the effectiveness of a program based on psychosocial support in raising the level of family empowerment among refugees in Jordan. The study sample consisted of (32) refugees in Irbid governorate who were randomly assigned to two equal groups: the experimental group (n = 16), who participated in the psychosocial support program, and the control group (n = 16), who did not participate in any intervention program. To achieve the study's objectives, the Family Empowerment Scale was developed to collect study data in the pre and posttests for the two study groups and the follow-up test with members of the experimental group only and the psychosocial support program. The results of the study showed that there were statistically significant differences between the experimental and control groups in the mean scores on the family empowerment scale in the posttest in favor of the experimental group, and there were no statistically significant differences between the means of the post and follow-up measures in the family empowerment scale, which reflects the reliability of the program's impact.
... By contrast, simply translating interventions across cultures without incorporating changes or adaptations might reduce the effectiveness of the intervention (Chowdhary et al., 2014). For example, implementing mental health interventions for refugee children in high-income countries are often made less impactful by complex cultural differences (Fazel & Betancourt, 2018). ...
Many interventions have been developed to improve educational and developmental outcomes in Syrian refugee children. Here, we focus on one such intervention, We Love Reading, a community-led, shared book-reading program that was developed in Jordan by a Jordanian-run NGO. We conducted a grounded theory analysis of 21 semi-structured interviews with individuals who developed We Love Reading and/or were involved in its implementation. Participants indicated that attaining a balance between two main factors helped with the long-term maintenance and sustainability of the program: the informality and flexibility of the program on the one hand and creating the necessary motivation and commitment in volunteers on the other. Future programs that wish to attain long-term sustainability may benefit from creating a more engaging and incentivizing structure of motivation for their volunteers.
... Keywords cooccurrence analysis revealed that research on the mental health of refugees, asylum-seekers and displaced people is rapidly expanding and exploring new avenues. This research focuses on understanding the mental and emotional well-being of refugees, asylum-seekers and displaced people, their prevalent disorders and coping mechanisms (Khamis, 2019;Leiler et al., 2019), understanding the specific needs and characteristics of refugees, asylum-seekers and displaced people (Anderson and Ferguson, 2018;Fazel and Betancourt, 2018;Sierau et al., 2019), as well as the sociocultural and policy factors affecting them, such as migration, acculturation and integration (Betancourt et al., 2015;Goodman and Kirkwood, 2019;LeMaster et al., 2018). ...
Purpose
Bibliometric analyses of psychological research on refugees, asylum-seekers and displaced people is scarce. This study aims to evaluate the productivity and impact of publications related to the psychology of refugees, asylum seekers and displaced people.
Design/methodology/approach
Using the Scopus database, the authors searched for psychology-related publications under the subject area “Psychology” and included keywords for refugees, asylum-seeker and displaced people. Retrieved publications were analyzed and visualized using Biblioshiny and VOSviewer. Productivity and impact of related research publications were presented.
Findings
A total of 2,317 publications were identified, with an h-index of 86. An increase post-2014 was noted. The USA was the most productive country and the University of New South Wales leading institutional contributions. “Review of Child and Adolescent Refugee Mental Health” was top cited. Some keywords, like posttraumatic stress disorder, were frequently used. Research on migration and Syrians from refugee backgrounds is notably advancing.
Research limitations/implications
This study analyzed many publications related to psychology concerning refugees, asylum seekers and displaced people over the past 23 years. Advanced analysis was facilitated using software tools, including Microsoft Excel and Biblioshiny for the Bibliometrix R package and VOSviewer software. These advanced bibliometric and scientometric tools enable us to depict in depth the evolving trends and international collaborations between authors and countries, and analysis tending topic. This study has some limitations. First, the authors restricted our analysis to the Scopus database; thus, some publications available in other databases like Web of Science or Google Scholar may have been overlooked. Second, the keywords used in this study were “refugee,” “asylum-seeker” and “displaced people”. As a result, some relevant publications might have been missed, and future research could use a more comprehensive set of keywords related to refugees, asylum and displacement. For future research, keywords such as humanitarian immigrants, queue jumpers, boaties and stateless, among other terms, should be considered across the field to label people from displaced backgrounds. Our study focused on titles to directly capture the most explicitly relevant articles. In future studies, it is important to include the abstracts and keywords to identify additional pertinent studies. In our study, the authors did not use the asterisk. Thus, the asterisk may allow for the inclusion of all possible endings of a root word.
Originality/value
The study indicates a significant increase in research publications over time. The findings are significant for establishing a research agenda and network in this area, assisting international health agencies and governments in understanding the psychological challenges among this vulnerable group.
... Clearly, there is a paucity of research on social and material factors of displacement (13). This is a missed opportunity as post-migration factors including structural challenges such as education and employment, two factors that are potentially critical to the mental health of this vulnerable group must be addressed (12,14). Importantly, there is evidence to suggest that education and employment have the potential to moderate the ability of refugees to recover from pre-migration trauma. ...
Background
The Syrian civil war is considered as the greatest humanitarian crisis in modern history, which has resulted in a major refugee crisis. A significant concern is the high prevalence of mental disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) among Syrian refugees. While the focus of most refugee mental health research has been pre-migration trauma, post-migration challenges and stressors, which can also be significant determinants of mental health, are often ignored. The purpose of this study was to assess mental health of Syrian refugees as compared to local Jordanians, and to examine sociodemographic factors and perceived stressors that are associated with mental distress among participants.
Methods
This was a cross sectional study conducted in northern region of Jordan among Syrian refugee and Jordanian adults. We used the validated Arabic version of Afghan Symptoms Checklist (ASC) to assess mental distress among participants.
Results
A total of 929 subjects (43% Syrian refugees, 56% females) participated in this study. Disparities in education, monthly income, and health insurance were significant between Syrian refugees and Jordanians, p < 0.001. The mean score in ASC was significantly higher among Syrian refugees, particularly among refugee females (mean ASC score ± standard deviation: Syrian refugee females: 58.22 ± 1.13; Syrian refugee males: 45.31 ± 1.28; Jordanian females: 51.06 ± 0.91; Jordanian males: 46.45 ± 1.08, p = 0.002). Multivariable linear regression showed that the estimated difference in the mean of ASC score between males and females is 7.42 (p < 0.001), and the estimated mean difference between Syrian refugees and Jordanians is 2.76 (p = 0.019). Interestingly, the estimated mean of ASC scores for individuals with high education level is decreased by 4.18 as compared to individuals with lower education level (high school or less), p < 0.001.
Conclusion
Education level was highly predictable of mental distress of Syrian refugees, particularly female refugees. Enhancing higher educational opportunities is proposed for improving socioeconomic status of refugees which might serve as a buffering strategy for mental distress among this vulnerable population.
... Children facing multiple types of victimization and traumatic experiences have been found to be more at risk of internalizing issues such as depression, anxiety, post-traumatic stress disorder (PTSD), as well as externalizing issues such as delinquency (Curran et al., 2016;Dierkhising et al., 2019;Finkelhor et al., 2007;Fleckman et al., 2016). Some studies have also suggested that the postmigration environment can sometimes be more predictive of psychological distress, due to discrimination and resettlement challenges for example, than traumatic events experienced before migration (Fazel & Betancourt, 2018;Gorst-Unsworth & Goldenberg, 1998). Furthermore, trauma can increase over time in host societies and cause lifelong medical and psychological problems (Dye, 2018;Lie, 2002). ...
Migrant and refugee children are at risk of experiencing various forms of violence before, during, or after migration. This study systematically identifies, reviews, and synthesizes evidence on protective and promotive factors that contribute to the resilience of migrant and refugee children facing violence. Of the 3,663 articles identified through search in five electronic databases and snowball technique, 31 quantitative or qualitative research studies met the inclusion criteria. To be included in the review, studies had to (1) have been published after 2013; (2) have been published in English; (3) include migrant or refugee children and/or adolescents aged 18 or below at the time of interview or migration; (4) mention some types of maltreatment, peer violence, or community violence faced by the children or adolescents; (5) examine the association between the hypothesized protective or promotive factors and indicators of adaptive functioning; and (6) include outcome measures that assessed adaptive functioning such as well-being or absence or low-levels of internalizing and externalizing problems. Quality assessment did not lead to the exclusion of any studies. Five levels of protective and promotive factors were identified: individual, family, school and peers, community, and spatial dimension, which converged to highlight the importance of regulatory, interpersonal, and meaning-making strengths for these children. Understanding and addressing these protective and promotive factors is crucial for promoting well-being and improving mental health outcomes in migrant and refugee children facing violence. The findings of this review have significant implications for designing intervention programs and public policies that support these children effectively.
... In behavioral health, prevention primarily centers on averting the occurrence or progression of behavioral health conditions, emphasizing actions to eliminate or reduce risks (APA, 2014). There is consistent evidence demonstrating the positive impact of preventive interventions for behavioral health concerns in immigrants (e.g., Fazel & Betancourt, 2018;Martinez et al., in press). These services encompass a range of interventions aimed at mitigating stressors associated with migration, acculturation, and adjustment to a new environment. ...
The report emphasizes the importance of culturally competent mental health services and explores the impact of anti-immigration policies on mental wellbeing. In today’s climate in which immigration is often met with hostility, it is crucial that we, as researchers and mental health professionals, understand the unique challenges faced by immigrants and use this understanding to foster positive change. Together, we can better support the wellbeing and resilience of our immigrant communities by using psychological research to inform and advance practice and policy.
https://www.apa.org/pubs/reports/psychological-science-and-immigration-today.pdf
... On the other hand, re-framing 'daily stressors' as 'macro-stressors' may J o u r n a l P r e -p r o o f Journal Pre-proof enrich the current approach to 'refugee parenting' interventions by emphasising the need to not only target parental mental health and parenting practices, but also the macro-stressors that negatively impact both--potentially ushering in a new 'third wave' of parenting interventions targeting refugee families that, for example, integrate advocacy and legal actions to solve documentation issues. Such an approach of incorporating policy-level interventions to refugee problems not only aligns with calls-to-action suggested by prominent scholars in the field [164], but is also supported by preliminary evidence from our systematic review highlighting the impact of progressive refugee policies in enhancing refugee parental mental health and parenting. Specifically, our review identified a study indicating higher instances of household violence related to parental substance abuse among Congolese refugees in Rwanda, as opposed to their South Sudanese counterparts in Uganda [100]. ...
... The gap in synthesising this evidence exists, despite studies such as that by Mailey et al. (2022) reporting that it may be difficult for some service users (SUs), especially those with depression, to leave their safe space to receive care in the green or blue spaces. Beyond the reported benefits, it is equally important to understand the opportunities, challenges, and constraints that influence participation in MH therapy (Fazel and Betancourt, 2018). We address this gap with a systematic review that examines how natural environments facilitate or hinder mental healthcare. ...
... Studies conducted with refugee students show that refugee children are even below the performance level of students in the lowest grades and that the dropout rate among these students is significantly higher (Andriessen & Phalet, 2002). Physical activity is an effective way to improve the academic engagement and social life of disadvantaged children with poor academic performance (Fazel & Betancourt, 2018). ...
The aim of this study was to show the relationship between the quality of life and physical activity of refugee children who came to Turkey as a result of forced migration from their home countries. The study was conducted with the voluntary participation of 100 children between the ages of 14 and 17 living in the center of Çorum province in Turkey who were admitted as refugees. The data was collected by means of a questionnaire. The "Personal Information Form" created by the researchers was used in the first part and the "High School Quality of Life Scale (HSQOLS)" was used in the second part. For the selection of statistical tests, two independent group comparisons were made using the Mann Whitney U-test, as the data were not normally distributed. Comparisons between three independent groups were carried out using the Kruskal-Wallis test, as the data were not normally distributed. To determine the different groups after the Kruskal-Wallis test, the Mann Whitney U post hoc pairwise comparison test with Bonferroni correction was used. The statistical significance level was assumed to be p0.005. Statistically significant differences were found between participants' athletic status in Turkey, athletic branch in Turkey, athletic branch in their country of origin, athletic branch in their country of origin, and athletic age and the total scale and all sub-dimensions of the LISCEC (p0.05). It is therefore hypothesized that physical activity and sport positively influence the quality of life of refugee children from different cultures in the countries where they settle and that this interaction is due to the integrative function of sport.
... The gap in synthesising this evidence exists, despite studies such as that by Mailey et al. (2022) reporting that it may be di cult for some service users (SUs), especially those with depression, to leave their safe space to receive care in the green or blue spaces. Beyond the reported bene ts, it is equally important to understand the opportunities, challenges, and constraints that in uence participation in MH therapy (Fazel & Betancourt, 2018). We address this gap with a systematic review that examines how natural environments facilitate or hinder mental healthcare. ...
This systematic review explored how nature-based care settings influence engagement in mental health therapy. We relied on Joanna Briggs Institute's guidelines for systematic reviews to synthesise data from nine articles selected from an initial pool of 649 records retrieved from PubMed, CINAHL, Science Direct, SocINDEX, and JBI EPB. Synthesis revealed six analytical themes: nature as a therapeutic tool, therapeutic relationships, nature’s impact on power balance, nature as a safe space, risk of nature and patient-centered care. The findings shed light on the benefits while highlighting some of the challenges that influence participation in mental health interventions. The findings suggest that integrating nature into mental health care could be an alternative or complementary approach to enhancing patient engagement. However, the specific types of mental health care of this impact vary. Robust clinical trials that examine the effectiveness of the reported benefits is recommended. Such studies must target specific patient groups, such as the young and the elderly. Longitudinal studies that examine the long-term effects and moderating factors are needed to strengthen the evidence base and enhance patient-centered care.
... Drawing from recent studies, including those by Steel et al. (2017), Fazel and Betancourt (2021), which underscore the prevalence of mental health disorders among migrant populations, our work aims to provide a nuanced understanding of the psychosocial burdens endured by individuals embarking on migration journeys. By examining the pre-migration factors such as socioeconomic disparities, political instability, and exposure to violence or trauma, we aim to elucidate the initial stressors that may set the stage for subsequent psychological challenges. ...
This qualitative exploratory research delves into the intricate life narratives of forcibly displaced individuals residing within the Emergency Transit Mechanism in Niger, employing a methodology grounded in life narrative analysis. The primary objective is to gain a comprehensive understanding of the potential stressors and traumatic experiences encountered by these individuals, encompassing both psychological and physiological dimensions, while also examining the dynamics of resilience and elements contributing to their overall well-being. The findings, derived through thematic content analysis, underscore the cumulative nature of traumatic events experienced by migrants throughout their lifetimes and across various stages of the migration continuum. The study, in alignment with extant scholarly literature, identifies thematic categories such as "A scenario of conflict and mourning, " everyday experience of violence and discrimination," "health at risk", and " Seeking security." Refugees recount enduring multiple traumas, including familial bereavements and losses resulting from conflicts and militarized violence. Furthermore, the analysis elucidates a profound interplay between traumatic occurrences , subjective well-being, and resilience among the studied population. Despite confronting adverse living circumstances, refugees demonstrate indicators of subjective well-being, hinting at the potential for resilience and recovery. This challenges conventional diagnostic frameworks such as Post-Traumatic Stress Disorder (PTSD) and underscores the necessity for a nuanced understanding of trauma's multifaceted impacts. Nevertheless , the study underscores the urgent need for a more robust and contextually attuned mental health support infrastructure, advocating for a deeper exploration of the socio-political determinants underpinning forced migration. By comprehending the root causes of displacement through a socio-political lens, policymakers and practitioners can devise comprehensive strategies and interventions aimed at both prevention and mitigation of factors precipitating forced migration. This approach seeks to foster a global landscape wherein compassionate and well-informed interventions proactively address the underlying drivers of displacement.
... Drawing from recent studies, including those by Steel et al. (2017), Fazel and Betancourt (2021), which underscore the prevalence of mental health disorders among migrant populations, our work aims to provide a nuanced understanding of the psychosocial burdens endured by individuals embarking on migration journeys. By examining the pre-migration factors such as socioeconomic disparities, political instability, and exposure to violence or trauma, we aim to elucidate the initial stressors that may set the stage for subsequent psychological challenges. ...
... The heightened risk to violence in humanitarian settings (Meyer, Hermosilla, & Stark, 2017) calls for prioritising screening and treatment of poor mental health outcomes among refugee children (Gadeberg, Montgomery, Frederiksen, & Norredam, 2017). The results reported in this study call for alternative approaches that mostly target children in school, including counselling, peer education, that can be employed to manage violence, particularly sexual violence, and poor mental health outcomes among refugee children (Fazel & Betancourt, 2018;Henley & Robinson, 2011;Hjern & Angel, 2000;Miller & Rasmussen, 2017). ...
... Further, practices in the transparency of policy documents may vary in different countries and schools, which may indicate country-specific institutionalized ideas, rationales, and discursive practices, not only on school evaluation, but also on school accountability or public information [24]. School-based interventions to hear student voices, have also been criticized for their limited ability to target the full range of multi-faceted problems especially in youth refugees [25]. The absence of student voices in public health approaches at schools has also been recognised [26]. ...
Background
For students to feel happy and supported in school, it is important that their views are taken seriously and integrated into school policies. However, limited information is available how the voices of immigrant students are considered in European school contexts. This study generated evidence from written documents to ascertain how student voice practices are described at school websites.
Methods
Between 2 March and 8 April 2021, we reviewed the policy documents publicly available on school websites. The schools located in areas of high immigration in six European countries: Austria, England, Finland, Germany, Romania, and Switzerland. The READ approach was used to guide the steps in the document analysis in the context of policy studies (1) ready the materials, 2) data extraction, 3) data analysis, 4) distil the findings). A combination of qualitative and quantitative approaches with descriptive statistics (n, %, Mean, SD, range) was used for analysis.
Results
A total of 412 documents (305 schools) were extracted. Based on reviewing school websites, reviewers’strongly agreed’ in seven documents (2%) that information related to seeking student voices could be easily found. On the contrary, in 247 documents (60%), reviewers strongly indicated that information related to seeking student voices was missing. No clear characteristics could be specified to identify those schools were hearing students’ voices is well documented. The most common documents including statements related to student voice were anti-bullying or violence prevention strategies (75/412) and mission statements (72/412).
Conclusions
Our document analysis based on publicly accessible school websites suggest that student voices are less frequently described in school written policy documents. Our findings provide a baseline to further monitor activities, not only at school level but also to any governmental and local authorities whose intention is to serve the public and openly share their values and practices with community members. A deeper understanding is further needed about how listening to student voices is realized in daily school practices.
... Children and adults from refugee backgrounds are at greater risk of mental distress and disorder than people who have not experienced forced displacement, because of a range of pre and postmigration factors (Arakelyan & Ager, 2021;Fazel et al., 2012;Fazel & Betancourt, 2018;Gleeson et al., 2020;Hanes et al., 2019;Li et al., 2016). Unaccompanied children are particularly vulnerable (Hodes et al., 2008;von Werthern et al., 2019). ...
Objective: This paper identifies the multiple adversities and trauma experienced by children who are detained after seeking asylum. A conceptual framework identifies the specific impact of immigration detention on the psychosocial development and mental health of refugee children that can inform policy and prevent additional migration-related trauma. Method: The paper draws on international evidence about the impact of childhood adversity, challenges faced by all displaced children, and the additional negative consequences of immigration detention. It integrates socioecological, temporal, and relational approaches to identify the pathways through which detention of forcibly displaced children causes preventable harm. The public health and human rights implications are identified. Conceptual framework: The framework draws on Bronfenbrenner’s socioecological model and has the child, their development, and experience at the center. Refugee children are exposed to cumulative adversity during displacement, flight, and resettlement. Immigration detention is associated with multiple additional adversities and human rights violations. International and national contexts and the detention environment impact on family functioning and directly on the child’s well-being. Conclusions: Immigration detention is a preventable and profoundly negative reception experience for already vulnerable children. It is unavoidably associated with multiple additional adverse exposures with significant health and public health consequences. The proposed framework demonstrates adversity in each socioecological sphere of the detained child’s life and across time. The framework can inform migration, child protection, and public health policy. Advocacy and political action to end this practice are urgently required to prevent further harm.
... While existing literature (Betancourt & Khan, 2008;Dangmann, 2022;Fazel & Betancourt, 2018) offers valuable insights into coping mechanisms among refugee children, research specifically focused on the Rohingya children is limited. One significant coping mechanism observed among the Rohingya children in the refugee camps in Cox's Bazar is their resilience and resourcefulness in forming social networks and support systems. ...
The Rohingyas are an ethnic minority community of Myanmar. Despite their long history in Rakhine State, Myanmar, they were made stateless by the government of Myanmar in 1982 enacting the Burma Citizenship Act of 1982 . They have endured communal violence, resulting in death, forced displacement and migration, experiencing ongoing traumatic events, particularlyamong women and children. They have become victims of torture and persecution, with females enduring rape and many witnessing their loved ones brutally killed before their eyes. These life events have a profound impact on their physical and mentalwell-being, even now while they are living as refugees in camps in neighbouring Bangladesh. Due to numerous associated issues, recent history has witnessed a complex emergency involving internal and external displacements of individuals from this ethnic minority group, rendering them refugees in various countries, including Bangladesh. This study is focusing on the Rohingya children's physical and mental well-being, who are almost 52% of the total Rohingya refugee population living in the camps in Bangladesh. This study, drawing on secondary data, presents evidence of the well-being of the Rohingya children in Bangladeshi refugee camps and investigates the challenges they face and their coping mechanisms in these situations. This article sheds light on current conditions and outlines future directions for support and research.
... Immigration is a stressful process that can be a source of adversity for refugee children, who often experience pre-and post-migratory hardships and may be exposed to traumatic events before their departure and during the trip to the country of asylum (Bennouna et al., 2020;Fazel & Betancourt, 2017). During their resettlement, refugees and especially asylum seekers can experience insecurity due to their uncertain migratory status (Fazel et al., 2012). ...
... Adolescence is a crucial stage marked by significant cognitive and physical changes. The challenges inherent in this period are further intensified when adolescents undergo stressful life events, such as relocating to a new country or experiencing the impact of war [41,47]. These adolescents have been exposed to traumatic experiences, challenging living conditions, separation from family members, and the loss of loved ones [86]. ...
Prior studies comparing Syrian refugee adolescents to their native peers in the same region have found higher anxiety and lower life satisfaction. Therefore, identifying regulatory variables is crucial for implementing support programs. This study examined the mediating effect of peer relationships and the moderating effect of being a refugee or native adolescent on the relationship between adolescent anxiety and life satisfaction across different samples. Participants and setting: The study included 2,336 adolescents aged 11–19 (M = 14.79, SD = 1.04). Participants completed the Screen for Child Anxiety Related Disorders, Satisfaction with Life Scale, and Strengths and Difficulties Questionnaire. The mediation and moderation effects were analyzed with the path analysis codes written on Mplus 8.3. SPSS 26 was used for descriptive statistics and group comparisons. The findings showed that peer relationships mediate adolescent anxiety and life satisfaction, and this relationship is moderated according to whether the participants are native adolescents or refugee adolescents. This study highlights the significant associations between peer relationships, adolescent anxiety, and life satisfaction and the moderating role of the participant identity. The findings may inform psychological interventions to improve Syrian refugee adolescents' mental health and well-being. These findings may also have implications for policies and programs aimed at supporting the integration of Syrian refugee adolescents in host communities.
... Providing these services within the school can be particularly beneficial as families and children may be hesitant to attend external mental health services, but may feel more comfortable accessing them at school. Furthermore, incorporating social and emotional skills into school curricula can enhance the resilience of migrant and refugee children and positively impact their well-being (Fazel & Betancourt, 2018;Heidi et al., 2011). ...
The increasing trend of children's migration, whether forced or voluntary, presents a challenge to policies that aim to ensure social cohesion and protect children's rights. Therefore, adopting a child-centred approach to the socio-educational inclusion of migrant and refugee children can aid in the creation of cohesive and inclusive societies. Inclusive educational environments are collaborative settings that promote participation among children, educators, the community, and other local institutions. Educational communities can play a leading role in implementing public policies that promote social inclusion and intercultural dialogue. Schools play a crucial role in integrating migrant and refugee children. Child-centred practices can be implemented to promote intercultural and linguistic competences, capacity building, and children's agency. This can help to develop a sense of belonging and inclusion for all students. To unlock the potential of inclusive education, reduce inequalities, and achieve more equitable societies, it is essential to integrate a child-centred approach that promotes access to fundamental rights, participation, recognition of cultural diversity, and children's socio-emotional well-being. This review discusses the challenges of adopting a child-centred approach to education for migrant and refugee children. It proposes inclusive interculturalism as a child-centred approach to address the socio-educational deficits of these children in educational settings in Europe.
... Interventions aiming to prevent and promote the mental health in high-risk populations, such as RAS children and adolescents, is crucial for reducing the risk of developing common mental disorders, promoting social inclusion and improving mental health and well-being (M. Fazel & Betancourt, 2018;Onoja et al., 2020;Pejušković & Vukčević-Marković, 2020;Peterson et al., 2020;Turrini et al., 2019). The majority of the interventions provided, although highly heterogeneous in format and content, have shown significant improvement in various psychopathological dimensions (trauma-related symptoms, psychological stress, anxiety, depression, cognitive symptoms and PTSD), also in the long term. ...
Background
According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children.
Methods
The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using (“immigrants” OR “migration” OR “asylum seekers” OR “refugees”) AND (“promotion” OR “prevention”) AND (“mental health” OR “mental disorders” OR “psych*”) AND (“children” OR “adolescents” OR “young adults”) as search string. Fourteen articles qualified for the detailed review.
Results and Conclusions
The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed.
... Relatedly, we spoke only to English-or Spanish-speaking adults to maintain the study's feasibility, which likely further narrowed the perspectives offered. Immigrants and refugees often have greater unmet mental health needs (Fazel & Betancourt, 2018), and although respondents from Central and South America were represented, other regions were not. As FQHCs often provide services germane to migrant populations (e.g., immigration medical examinations), they can serve as a useful entry point for mental health support for this population. ...
Although depression is common in primary care, challenges to timely intervention exist, particularly for communities of color and lower socioeconomic status. Our objective was to understand barriers and facilitators to mental healthcare access among a sample of patients receiving care at a federally qualified health center (FQHC) in Minnesota, United States. We qualitatively interviewed 34 patients of an urban FQHC, purposively sampled on race/ethnicity, insurance status, language, and depression symptom status (based on Patient Health Questionnaire‐9 responses). We inductively and deductively analyzed interview data, leveraging theory in both the codebook development and analysis processes. Participants, who were predominantly English‐speaking, female, not privately insured, and people of color, shared numerous barriers and facilitators to accessing mental healthcare. Prominent barriers primarily concerned healthcare providers, including perceived dismissal of mental health concerns and challenges with provider continuity. Additional barriers included the costs of mental health care, communication breakdowns, the patient portal, and community‐specific perceptions of mental health. Prominent facilitators included clinic organizational factors (internal and external) and staff friendliness and warmth. Other factors including consideration of patients' financial situation, integrated management of behavioral and physical health conditions, language concordant staff, the telehealth visit modality, and the clinic's social mission were also raised as facilitating access. Patient voices from a single FQHC illustrate the challenges and possibilities of providing mental healthcare in safety net settings. Clinical, strategy, and policy solutions can be tailored to minimize barriers and optimize facilitators documented herein.
... Peers can provide positive (or negative) influences on the social and emotional development and psychosocial well-being of children from early childhood (Hartup, 1996;Almqvist & Broberg, 1999). Relationships with peers can pro mote resilience and a sense of self-worth and belonging (Fazel & Betancourt, 2018). For young children who are displaced due to a humanitarian emergency, peers can play an important role in helping them adjust to their new sur roundings and life (Schwartz et al., 2021;Almqvist & Broberg, 1999). ...
Due to prolonged ethnic and religious persecution, the Karen have endured numerous traumatic experiences including systematic violence and mistreatment, resulting in long-term psychological sequelae. This study examines the prevalence of depression among Karen refugees from Burma ( N = 37) using a culturally grounded mental health screening tool within a primary health care community clinic in the southern United States. A total of 48.60% met the clinical cutoff for depression. The researchers identified three themes: (a) manifestations of depression, (b) depression linked to post-migration stressors, and (c) importance of support and education about depression. Family service organizations and resettlement agencies can assist Karen refugees by connecting them with social and tangible support, as well as providing education about depression. Future research should include Karen refugees from various parts of the United States to improve generalizability.
The global refugee crisis, driven by persecution, conflict, and environmental disasters, has led to an unprecedented rise in forcibly displaced individuals, exceeding 110 million in recent years. A significant portion of this population consists of children and adolescents, who represent 41% of refugees and are highly susceptible to trauma and mental health challenges. This chapter addresses the intricate mental health needs of refugee youth, structured around three key objectives: understanding the refugee journey and psychosocial adaptation, evaluating treatment methods for this demographic, and offering guidelines for applying evidence-based trauma therapy. Refugee experiences are categorized into preflight, flight, and resettlement phases, each presenting unique stressors. Mental health outcomes among refugee youth vary widely, influenced by preflight trauma, resettlement difficulties, and social integration challenges. Evidence-based interventions, including universal approaches like Psychological First Aid and targeted therapies, such as Trauma-Focused Cognitive Behavioral Therapy, are essential. However, there is a need for more research to address the complex, dynamic interrelationships between individual mental health and broader systemic factors. This chapter aims to equip mental health professionals with practical tools and insights for supporting refugee youth effectively.
The increasing trend of child migration, whether forced or voluntary, poses a challenge to policies aimed at ensuring social cohesion and protecting children's rights. Inclusive educational environments play a crucial role in the integration of migrant and refugee children by promoting intercultural dialogue and participation. This study aims to explore the potential of a child-centred approach to the socio-educational inclusion of migrant and refugee children in Europe, proposing a framework of inclusive interculturalism to address the specific challenges these children face in educational settings. A narrative review was conducted, examining a wide range of peer-reviewed sources to synthesise current knowledge on child-centred education and its applicability to migrant and refugee children. The review identifies key challenges in adopting a child-centred approach, including socio-cultural, linguistic and psychological barriers that hinder migrant and refugee children's full participation in education. It highlights the importance of promoting agency, cultural competence and emotional well-being through inclusive and intercultural educational practices. Implementing a child-centred, inclusive intercultural approach can promote social cohesion and reduce inequalities by ensuring that all children, regardless of their background, have access to quality education and opportunities for personal development. However, more empirical research is needed to translate these theoretical frameworks into practical interventions.
Moving from one’s home country to a foreign country due to unforeseen circumstances such as war and unrest is a distressing life event. For minors, such an experience can impact their perception of the past and present alongside future goals and desires. With this background, a pilot study was done to assess the life transition reflected in the Bridge Drawing Test (BDT) of refugee minors who have moved from either Ukraine or Eritrea and are currently living in Israel, with a control group. A mixed-methods design involving BDT and the Children’s Hope Scale (CHS) was administered to a sample (N = 35, 20 girls and 15 boys) consisting of 16 refugee minors and 19 controls aged 4 to 14 years (M = 8.3 years, SD = 2.8). The BDT was assessed using indicators from the original bridge drawing directive and the Formal Elements Art Therapy Scale (FEATS) by two Art Therapists (Cohen’s Kappa ranged from 0.6 to 1). Results showed significant group differences in indicators: Prominence of colour, details of objects and environment, obviousness of Solidarity of bridge attachments and high versus low hope from the BDT (Medium effect size & p < .05). Associations between Pathway and Agency with BDT indicator and FEATS were seen. Refugee status also moderated the relationship between the CHS Total score and the subscale of Pathway and BDT indicator, namely Directionality (p = .01 & p = .02). Bridge drawings of refugee minors have differences that can aid in understanding their hope and goals, offering benefits as a diagnostic and therapeutic intervention tool. Future studies with larger samples, and diverse cultural groups are warranted to explore the same.
The article reports on a qualitative study of how schools in Estonia were incorporating Ukrainian
war refugee students in the spring of 2023. Observations and interviews were conducted in 7
schools with teachers, school administrators, psychological support staff, refugee students in
grades 7–12, and their parents. The study found that schools were balancing three overlapping
goals: (1) to ensure psychological adjustment of the refugee students by creating a safe, supportive,
and welcoming school environment; (2) to provide students with opportunities to learn
and be academically successful, and (3) to facilitate acculturation of refugees into Estonian culture
and language. These three “A’s”: adjustment, academics, and acculturation were important
in all schools in the study. As schools engaged in implementing the three goals, they found that at
times they were in conflict with one another, requiring them to prioritize some and de-emphasize
others. The Ukrainian secondary school was created specifically for these students and prioritized
adjustment but faced challenges motivating students to engage academically and learn the
Estonian language. Russian-medium schools provided the easiest access to the academic curriculum
in Russian, without the need to acculturate; but students experienced some anti-Ukraine
attitudes from peers and teachers. In Estonian-medium schools, students had the best opportunity
to learn Estonian but felt socially isolated and were unable to engage with the Estonianlanguage
curriculum. The study highlights the need for schools to balance these different goals
and work to resolve contradictions as they arise in their unique context.
This study examines the challenges and chances of local integration of the stranded Rohingya refugees who were rescued by the Acehnese of Sumatra, Indonesia. Since 2009, there have been waves of the arrival of Rohingya in Aceh, totaling thousands in number. In contrast to many places where refugees have been rejected, the Rohingya were warmly welcome in “a rare place” (Jones and Walden 2020) Aceh. Although Indonesia has not ratified the 1951 Refugee Convention, the country has a long tradition of welcoming refugees. Using the framework of three dimensions of local integration namely legal, economic and social, this study seeks to explore whether Aceh is a temporary sanctuary or there is a possibility for medium or long-term integration. The findings reveal that although there are challenges on the local integration particularly from the legal perspective, opportunities in economic and social dimensions also exist. Therefore, there is a great chance of de facto local integration, instead of de jure, to be happening. The Acehnese cultural capital, in the forms of local wisdoms i.e. Sea Customary law, the culture of welcoming guests, Islamic solidarity, shared feeling as victims of conflict, and wise expressions on helping others, can be used as a reference for policymakers. Soft policy toward refugees and comprehensive strategies are needed to ensure that refugees are not left behind and there would be no potential conflict between the local host and Rohingya refugees. This research uses a qualitative approach which involved semi-structured interviews, observation at refugee camp and desk study.
Although there has been a lot of research focused on the effect of war on child refugees, along with those impacted directly, there are no recent studies comparing these two groups side-by-side. In this paper, we review psychiatric comorbidities associated with children (defined as 17-year-olds and younger) exposed to war, with an additional emphasis on approaches to treatment. In addition, we aim to understand these children's thoughts and insights into their situation(s). We will do so by presenting narratives given by close relatives of (1) two children currently in Ukraine in the midst of the war, (2) another young Ukrainian child war refugee who was able to recently leave the country, and (3) an adult and his experiences of being a war refugee and then resettling in the United States as a child. We never know when or where a war will begin. It is important that we have mental health professionals that can help children through the current and unexpected adversities that arise with war and displacement. These children need assistance with their uncertainties about the future and the risk of disruption of peace or comfort. Moreover, mental health disparities are substantial amongst children exposed to the traumas associated with war, and treatment is limited. We share this research to encourage mental health professionals to seek understanding of the impact the current war is having on Ukrainian youth. It is our hope that, with presenting these narrative accounts, mental health providers will gain a deeper understanding of what these children are encountering and will become prepared to support them and their mental health.
Background
Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations.
Methods
English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456).
Results
Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified—social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions.
Conclusion
Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.
Medical Care for Displaced PersonsThe United Nations High Commissioner for Refugees reports that more than 100 million people have been forcibly displaced from their homes due to persecution, conflict, violence, and human rights violations. Displacement has profound health impacts. Here, Jain and colleagues review medical care for newly displaced persons.
Purpose
Three years after the COVID epidemic and the measures put in place by governments, the authors still cannot measure the full impact of them on the well-being and mental health of adolescents. This population was particularly impacted by this crisis, and some subgroups of young people, such as those from migration backgrounds, have been confronted with additional challenges. This paper aims to explore and describe the perspective and experience of migrant adolescents during the lockdown period
Design/methodology/approach
The authors performed 13 semi-structured interviews with migrant adolescents (nine females, median age 16) at the pediatric policlinic of Lausanne University Hospital in Switzerland between November 2020 and January 2021. Participants had been living in Switzerland for an average of 2.3 years. Three of them were staying in a refugee reception centre. A thematic content analysis was carried out to extract themes and topics.
Findings
Participants had difficulty understanding information about COVID-19 in general. Remote learning was described as stressful due to various factors and lockdown had an impact on their future plans, such as finding an apprenticeship. Some young people were already socially isolated, but families were generally supportive. They expressed particular concerns, such as the family’s financial situation and the difficulty of living in refugee reception centres.
Practical implications
In the event of further lockdown, special attention must be paid to these adolescents to ensure their proper development and integration. Comprehensive follow-up of this population during and after the pandemic is essential.
Originality/value
This study provides a better understanding of the pandemic experience of migrant adolescents and underlines their difficulties.
Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance , 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suárez‐Orozco and colleague's integrative risk and resilience model for immigrant‐origin children and youth proposed by Suárez‐Orozco et al. Finally, we discuss recommendations—moving from proximal to more distal contexts.
The aim of the study was to examine the studies published on the concept of refugee/immigrant/refugee student in terms of their bibliometric characteristics. The research was carried out in the descriptive survey model. In the study, the bibliometric method was used to examine the publication outputs and the basic structure of the field. As a result of the data from the Web of Science (WoS) database on refugee/immigrant/refugee student, 497 studies were analyzed. Within the scope of the research, descriptive statistics for the descriptive structure of the refugee/immigrant/refugee student concept, analyzes showing the distribution of publications by country, descriptive statistics of influential authors, articles and journals, co-author analyzes to reveal the social structure of the literature on the concept of refugee/immigrant/refugee student. In order to reveal the conceptual structure, trend topic analyzes, strategic diagram and word cloud analyzes were used. As a result of the research, while not much research was done between 1980 and 2008, it was determined that there was a rapid increase in the number of studies as of 2009. As a result of the research, it was concluded that the United States of America is the country that publishes the most on refugee/immigrant/asylum-seeking students. It has been concluded that the research conducted by Refugee/immigrant/asylum-seeking students in schools has the most references.
Background:
Torture survivors face multiple problems, including psychological difficulties, whether they are refugees or remain in the country where they were tortured. Provision of rehabilitation varies not only with the needs of survivors and resources available, but also with service models, service provider preferences and the local and country context. Despite increasing efforts in research on effectiveness of psychological interventions with torture survivors, results are inconclusive.
Methods:
We undertook a Cochrane systematic review of psychological, social and welfare provision, with meta-analysis to best estimate efficacy. The process raised conceptual, methodological and ethical issues of relevance to the wider field.
Findings:
We searched very widely, but rejected hundreds of papers which recommended treatment without providing evidence. We found nine randomised controlled trials, from developed and under-resourced settings. All conceptualised survivors' problems in psychiatric terms, using outcomes of post-traumatic stress symptoms, distress, and quality of life, by self-report, with or without translation or unstandardised interpretation, and with little mention of cultural or language issues. None used social or welfare interventions. Four related studies used narrative exposure therapy (NET) in a brief form, and without ensuring a safe setting as recommended. Five used mixed methods, including exposure, cognitive behavioural therapy, and eye movement desensitisation. Combined, the studies showed no immediate improvement in PTSD, distress, or quality of life; at six months follow-up, a minority showed some improvement in PTSD and distress, although participants remained severely affected.
Conclusions:
While applauding researchers' commitment in running these trials, we raise ethical issues about exposure in particular, and about the effects of shortcomings in methodology, particularly around assessment using unfamiliar cultural frameworks and language, and the lack of concern about dropout which may indicate harm. The issues addressed aid interpretation of existing research, and guide clinical practice as well as future studies evaluating its effectiveness.
Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre-post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.
Objectives:
Unemployment and temporary employment are known to impact psychological health. However, the extent to which the effect is altered by migration-related and sociodemographic determinants is less clear. The purpose of this study was to investigate whether the association between employment status and psychological distress differs between immigrants and Swedish-born and to what extent, the association is modified by gender and reason for immigration.
Design:
Cross-sectional survey study.
Participants and setting:
Data from public health surveys undertaken in 2002, 2006 and 2010 from random samples of Stockholm County residents, Sweden, were used to analyse a weighted sample of 51 118 individuals aged 18-64 (43 444 Swedish-born, 4055 non-refugees, 3619 refugees). According to their activity in the labour market, the participants were categorised into permanently/self-employed, temporarily employed and unemployed.
Outcomes measures:
Associations between self-reported employment and psychological distress measured by a 12-item version of the General Health Questionnaire were explored across individuals with different migration status and reasons for immigration using logistic regression and pairwise comparisons. The analyses were stratified by gender and adjusted for age, socioeconomic characteristics and survey year.
Results:
Unemployment was associated with elevated likelihood of psychological distress across the study population, regardless of migration status and gender. Fully adjusted models revealed nearly a 3-fold higher odds of distress in unemployed Swedish-born (OR 3.05, 95% CI 2.66 to 3.51), non-refugees (OR 3.51, 95% CI 2.44 to 5.05) and refugees (OR 2.91, 95% CI 2.20 to 3.85) when compared with permanently/self-employed. Temporary employment also increased the likelihood of distress, particularly among refugees and Swedish-born.
Conclusions:
The effect of unemployment on increased likelihood of poor psychological well-being overcomes gender-specific and migration-specific differences and is equally pronounced for Swedish-born, non-refugees and refugees. Exclusion from the labour market appears to be a major determinant of psychological health inequalities in contemporary Sweden.
Objective
To conduct a randomized controlled trial assessing the impact of a family-based intervention delivered to Burmese migrant families displaced in Thailand on parenting and family functioning.
Participants and procedures
Participants included 479 Burmese migrant families from 20 communities in Thailand. Families, including 513 caregivers and 479 children aged 7 to 15 years, were randomized to treatment and waitlist control groups. The treatment group received a 12-session family-based intervention delivered to groups of families by lay facilitators. Adapted standardized and locally derived measures were administered before and after the intervention to assess parent-child relationship quality, discipline practices, and family functioning.
Results
Compared with controls, intervention families demonstrated improved quality of parent-child interactions on scales of parental warmth and affection (Effect size (ES) = 0.25 caregivers; 0.26 children, both p < 0.05) and negative relationship quality (ES = -0.37, p < 0.001 caregivers; -0.22 children, p < 0.05). Both children and caregivers also reported an effect on relationship quality based on a locally derived measure (ES = 0.40 caregivers, p < .001; 0.43 children, p < .05). Family functioning was improved, including family cohesion (ES = 0.46 caregivers; 0.36 children; both p < 0.001) and decreased negative interactions (ES = -0.30 caregivers, p < 0.01; -0.24 children, p < 0.05). Family communication also improved according to children only (ES = 0.29, p < 0.01). Caregivers, but not children, reported decreased harsh discipline (ES = -0.39, p < 0.001), and no effects were observed on use of positive discipline strategies. Treatment attendance was high, with participants attending a mean of 9.7 out of 12 sessions.
Conclusion
The intervention increased protective aspects of family well-being for migrant children and caregivers in a middle-income country. The strongest effects were on parent-child relationship quality and family functioning, while results were mixed on changes in discipline practices. Results suggest that a behavioral family-based approach implemented by lay providers in community settings is a promising intervention approach for strengthening families in highly stressed contexts.
Trial registration
Clinicaltrials.gov: NCT01668992
Refugees frequently experience symptoms of posttraumatic stress and depression, which impede their acculturation in the new host country where they are resettling. There are few longitudinal studies investigating predictors of mental health and acculturation during the early postmigration period. We conducted a longitudinal study of 298 Iraqi refugees, assessing them upon arrival to the U.S. and 1 year after migration. Premigration trauma was associated with increased PTSD and depressive symptoms at baseline, and with decreased acculturation 1 year later. Resilience was associated with depressive symptoms at 1-year follow-up, but not with other resettlement outcomes (PTSD symptoms, English-language skills, or acculturation). PTSD and depressive symptoms at baseline predicted the same symptoms at 1-year follow-up, but not any other resettlement outcomes. The number of chronic diseases at baseline predicted worse PTSD and depressive symptoms, acculturation, and English language skills at 1-year follow up. Postmigratory exposure to daily stressors and less social support predicted worse 1-year outcomes. Results suggest that interventions that aim to improve mental health and promote acculturation among refugees should assess their history of trauma, chronic disorders, and psychological symptoms soon after migration, and promptly provide opportunities for social support.
The last decade has been marked by increasing attention to rigor in the evaluation of interventions that seek to promote the mental health and psychosocial well-being of children in crisis contexts. One of the key markers of such rigor has been the increased adoption of strong quasi-experimental designs, where children receiving an intervention are compared to children not receiving the intervention. Although usually not randomly assigned to such conditions, children in the ‘intervention’ and ‘comparison’ groups are generally assumed to have had similar experiences other than in relation to exposure to the intervention. The use of such designs—when planned and implemented on a sound ethical basis—can significantly strengthen the capacity to make appropriate attribution of any changes observed by exploring the counterfactual case: what happens when there is no intervention? This question is usually supplementary to questions about the outcomes observed in children receiving the services being evaluated and crucial to inference regarding such outcomes. However, this paper argues that data from comparison groups has major value in its own right. Indeed, it represents a major untapped source of reflection on processes of resilience in humanitarian contexts. We use as a foundation for our analysis 3 studies completed over the last decade which examined the impact of protective and psychosocial interventions for war-affected children in Sierra Leone and Uganda. The interventions considered include programs fostering reintegration of formerly abducted children, prompting structured activities in schools, and establishing child-friendly spaces in refugee settlements. In each case, however, our focus is not on the group that received greatest attention in the original reports—the children receiving the intervention—but on those that did not. Analysis indicates the powerful forces which promote recovery in situations of conflict and the need for interventions to be more mindful that their core function is to bolster such engagement and not seek to drive recovery.
Treatment of post-traumatic stress disorder (PTSD) in refugees and asylum seekers resettled in high-income countries presents specific challenges. This systematic review examined the effectiveness of psychosocial interventions for this group. We searched the Cochrane Central Register of randomised trials, CINAHL, EMBASE, PILOTS, PsycINFO, PubMed and Web of Science up to July 2016. Studies included randomised and controlled clinical trials comparing psychosocial interventions with waiting list or treatment as usual in adult refugees and asylum seekers with PTSD resettled in high-income countries. PTSD symptoms post-intervention was the primary outcome. We computed standardized mean differences (SMD) with 95% confidence intervals (CI). This study is registered with PROSPERO: CRD42015027843. Twelve studies were included in the meta-analysis. Psychosocial interventions were effective in decreasing PTSD symptoms relative to control groups (SMD -1·03, 95% CI -1·55 to -0·51; number needed to treat 4·4; I² 86%; 95% CI 77 to 91). Narrative exposure therapy, a manualized short-term variant of cognitive behavioural therapy with a trauma focus, was the best-supported intervention (5 RCTs, 187 participants, SMD -0·78, 95% CI -1·18 to -0·38, I² 37%; 95% CI 0 to 77). Methodological quality of the included studies was limited. Overall, psychosocial interventions for asylum seekers and refugees with PTSD resettled in high-income countries were found to provide significant benefits in reducing PTSD symptoms. Yet, the number of studies is small and their methodological quality limited, so that more rigorous trials should be conducted in the future.
Background The majority of survivors of mass violence live in low- and middle-income countries (LMICs).
Aims To synthesise empirical findings for psychological interventions for children and adolescents with post-traumatic stress disorder (PTSD) and/or depression in LMICs affected by mass violence.
Methods Randomized controlled trials with children and adolescents with symptoms of PTSD and/or depression in LMICs were identified. Overall, 21812 hits were found through July 2016 in Medline, PsycInfo, and Pilots databases, 21 met the inclusion criteria and were reviewed according to PRISMA guidelines.
Findings Twenty-one studies were included. Active treatments for PTSD yielded large pre-treatment to post-treatment changes (g=1.15) and a medium controlled effect size (g=0.57), respectively. Effect sizes were similar at follow-up. Active treatments for depression produced small to medium effect sizes. Finally, after adjustment for publication bias, the imputed uncontrolled and controlled effect sizes for PTSD were medium and small, respectively.
Interpretation Psychological interventions may be effective in treating pediatric PTSD in LMICs. It appears that more targeted approaches are needed for depressive responses.
Objective:
There is a dearth of empirical studies aimed at examining the impact of differential cultural adaptation of evidence-based clinical and prevention interventions. This prevention study consisted of a randomized controlled trial aimed at comparing the impact of 2 differentially culturally adapted versions of the evidence-based parenting intervention known as Parent Management Training, the Oregon Model (PMTOR).
Method:
The sample consisted of 103 Latina/o immigrant families (190 individual parents). Each family was allocated to 1 of 3 conditions: (a) a culturally adapted PMTO (CA), (b) culturally adapted and enhanced PMTO (CE), and (c) a wait-list control. Measurements were implemented at baseline (T1), treatment completion (T2) and 6-month follow up (T3).
Results:
Multilevel growth modeling analyses indicated statistically significant improvements on parenting skills for fathers and mothers (main effect) at 6-month follow-up in both adapted interventions, when compared with the control condition. With regard to parent-reported child behaviors, child internalizing behaviors were significantly lower for both parents in the CE intervention (main effect), compared with control at 6-month follow-up. No main effect was found for child externalizing behaviors. However, a Parent × Condition effect was found indicating a significant reduction of child externalizing behaviors for CE fathers compared with CA and control fathers at posttest and 6-month follow-up.
Conclusion:
Present findings indicate the value of differential cultural adaptation research designs and the importance of examining effects for both mothers and fathers, particularly when culturally focused and gender variables are considered for intervention design and implementation. (PsycINFO Database Record
Background: Preventative and treatment programs for people at risk of developing psychological problems after exposure to war trauma have mushroomed in the last decade. However, there is still much contention about evidence-based and culturally sensitive interventions for children. The aim of this study was to examine the efficacy of the Teaching Recovery Techniques in improving the emotional and behavioral outcomes of war-affected children resettled in Australia.
Methods and Findings: A cluster randomized controlled trial with pre-test, post-test, and 3-month follow-up design was employed. A total of 82 participants (aged 10–17 years) were randomized by school into the 8-week intervention (n = 45) or the waiting list (WL) control condition (n = 37). Study outcomes included symptoms of post-traumatic stress disorder, depression, internalizing and externalizing problems, as well as psychosocial functioning. A medium intervention effect was found for depression symptoms. Participants in the intervention condition experienced a greater symptom reduction than participants in the WL control condition, F(1, 155) = 5.20, p = 0.024, partial η² = 0.07. This improvement was maintained at the 3-month follow-up, F(2, 122) = 7.24, p = 0.001, partial η² = 0.20.
Conclusions: These findings suggest the potential benefit of the school and group-based intervention on depression symptoms but not on other outcomes, when compared to a waiting list control group.
Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12611000 948998.
Over the past several decades, an increasing number of refugee children and families have involuntarily migrated to countries around the world to seek safety and refuge. As the refugee population increases, it is becoming more important to understand factors that promote and foster resilience among refugee youth. The present review examines the past 20 years of resilience research with refugee children to identify individual, family, school, community, and societal factors fostering resilience. This review highlights various factors that promote resilience among refugee children, including social support (from friends and community), a sense of belonging, valuing education, having a positive outlook, family connectedness, and connections to home culture. Recommendations for interventions and programs to promote resilience as well as future directions for resilience research are discussed.
Decision-making regarding an asylum request of a minor requires decision-makers to determine the best interests of the child when the minor is relatively unknown. This article presents a systematic review of the existing knowledge of the situation of recently arrived refugee children in the host country. This research is based on the General Comment No. 14 of UN Committee on the Rights of the Child. It shows the importance of knowing the type and number of stressful life events a refugee child has experienced before arrival, as well as the duration and severity of these events. The most common mental health problems children face upon arrival in the host country are PTSD, depression and various anxiety disorders. The results identify the relevant elements of the best interests of the child assessment, including implications for procedural safeguards, which should promote a child rights-based decision in the asylum procedure.
Purpose
Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country.
Methods
This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice.
Results
Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40–0.45) among refugee boys and 0.35 (95 % CI 0.33–0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services.
Conclusions
Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.
This study examined mental health problems among children of Iraqi refugees, most of whom were Christian. Exposure to potentially traumatic events was hypothesized to predict more symptoms of depression and traumatic stress. Moreover, youth reports of supportive relationships with parents and positive feelings about school were examined in relation to mental health problems. These promotive factors were expected to mitigate the hypothesized association between traumatic event exposure and mental health problems. Participants were 211 youth recruited from agencies and programs serving Iraqi refugees in a large metropolitan area in the United States. The hypotheses were partially supported. Youth who reported experiencing more potentially traumatic events endorsed more traumatic stress and depression symptoms. After accounting for exposure to potentially traumatic events and other covariates, youth who reported more positive feelings about school endorsed fewer symptoms of traumatic stress, and youth who reported more supportive relationships with parents endorsed fewer symptoms of depression. In addition, there was an interaction between potentially traumatic events and relationships with parents when predicting depression symptoms. Youth endorsed higher levels of depression symptoms when they reported less supportive relationships, regardless of the amount of traumatic event exposure, whereas youth endorsed lower levels of depression symptoms when they reported more supportive relationships with parents, but only at low levels of traumatic event exposure. Otherwise, the main effects were not qualified by interactions between potentially traumatic event exposure and the promotive factors. The findings from this study have implications for future research, policy, and practice with children of refugees.
Background:
Gender based violence (GBV) remains one of the most serious threats to the health and safety of women and girls worldwide. The problem is even more pronounced in refugee populations where women and girls are at increased risk of violence. In 2015, UNHCR reported the highest number of forcibly displaced people in recorded history. Despite growing need, there have been few rigorous evaluations of interventions aimed at primary GBV prevention and no systematic reviews of GBV prevention efforts specifically focused on refugee populations; reviews to date have primarily examined prevention of conflict related sexual violence, with very limited focus on other forms of GBV such as intimate partner violence Methods: This study reviewed the scientific literature addressing strategies for primary prevention of GBV and their effectiveness among refugee populations over the past ten years (2006 to 2015). Narrative content analysis methods were used to extract findings related to prevention activities/programs recommended by the global humanitarian community, such as sociocultural norms change, rebuilding family and community support structures, improving accountability systems, designing effective services and facilities, working with formal and traditional legal systems, monitoring and documenting GBV, and/or engaging men and boys in GBV prevention and response.
Results:
Study findings indicate that a range of GBV prevention activities recommended by the global humanitarian community are currently being applied in a variety of settings. However, there remains a limited body of evidence on the effectiveness of GBV prevention programs, interventions, and strategies, especially among refugee populations.
Conclusion:
Commonly agreed upon standards or guidelines for evaluation of GBV prevention programming, and publication of evaluations conducted using these guidelines, could assist humanitarian stakeholders to build and disseminate an evidence base of effective GBV prevention interventions, programs and strategies. Evaluation of GBV prevention efforts, especially among refugee populations, must be given higher priority to justify continuation or revision of recommended GBV activities/programs being implemented in diverse humanitarian settings.
Objective:
Becoming a refugee is a potent risk factor for indicators of psychological distress such as depression, generalized stress, and posttraumatic stress disorder (PTSD), though research into this vulnerable population has been scant, with even less work focusing on interventions. The current study applied principles from self-determination theory (SDT; Ryan & Deci, 2000) to develop and test an intervention aimed at increasing need-satisfying experiences in refugees of Syrian civil unrest.
Method:
Forty-one refugees who fled Syria during the past 24 months and resettled in Jordan participated in the study and were randomly assigned to receive the intervention or a neutral comparison.
Results:
The 1-week-long intervention alleviated some of the need frustration likely associated with refugee status, a major aim of the intervention, and also lowered refugees' self-reported symptoms of depression and generalized stress as compared to the comparison condition, though it did not reduce symptoms of PTSD.
Conclusions:
Discussion focuses on how these findings speak to the universal importance of need satisfaction for mental health, and how need-satisfying experiences can help buffer against the profound stress of being a refugee. Avenues for longer-term or more intensive interventions that may target more severe outcomes of refugee experiences, such as PTSD symptoms, are also discussed. (PsycINFO Database Record
The purpose of the present research review is to identify effective, high quality school-based interventions for immigrant students with disabilities or academic and behavioral problems. A systematic review of the literature was conducted to synthesize international research studies. Initial and criteria-based selection processes yielded six intervention studies published between 1975 and 2010. Two of the studies are academic interventions while four are behavioral interventions. Three studies were conducted in the United States while the remaining three in Israel, Canada, and Norway. The identified studies were evaluated against the quality indicators of special education research. Three experimental studies met the minimum criteria for acceptable methodological rigor. The results show an urgent need for methodologically robust intervention studies in the field of special education for immigrant students. Implications for research and practice are discussed.
Objectives:
Study results on child maltreatment based on general population samples cannot be extrapolated with confidence to vulnerable immigrant or refugee families because of the specific characteristics and needs of these families. The aims of this paper are 1) to conduct an evidence review of the prevalence, risk factors and protective factors for child maltreatment in immigrant and refugee populations, and 2) to integrate the evidence in an analytical ecosystemic framework that would guide future research.
Methods:
We used a 14-step process based on guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Canadian Collaboration for Immigrant and Refugee Health. We searched major databases from "the oldest date available to July 2014". The eligibility criteria for paper selection included qualitative or quantitative methodologies; papers written in English or French; papers that describe, assess or review prevalence, risk and protection factors for child maltreatment; and a studied population of immigrants or refugees.
Synthesis:
Twenty-four articles met the criteria for eligibility. The results do not provide evidence that immigrant or refugee children are at higher risk of child maltreatment. However, recently settled immigrants and refugees experience specific risk factors related to their immigration status and to the challenges of settlement in a new country, which may result in high risk of maltreatment.
Conclusion:
Future research must incorporate more immigrant and refugee samples as well as examine, within an ecosystemic framework, the interaction between migratory and cultural factors with regard to the prevalence, consequences and treatment of child maltreatment for the targeted groups.
Purpose
– The term “parenting” has come to assume a specific sociological meaning: it defines parents’ role and agency not only with regard to their children, but also to the state, medical doctors, psychologists and educators. How normative stances toward parenting affect the lives of parents has started to be analyzed in the social sciences, however less is known about how the “culture of parenting” impacts on the way migrant families take care of their children. The purpose of this paper is to untangle the conceptual and disciplinary roots of parenting studies stemming from early anthropological studies of kinship and ethno-psychological theories, through to the anthropology of childhood and child rearing and the current socio-anthropological studies of parenting. This review offers conceptual tools for the creation of a critical perspective on migration and parenting.
Design/methodology/approach
– The paper acknowledges the theoretical and empirical gap in the study of migration and parenting by illustrating the sparse and interdisciplinary literature which has dealt with migration and parenting.
Findings
– The paper discusses the presented literature’s limits and potentialities in light of the new culture of parenting.
Originality/value
– The paper addresses future paths for ethnographic work.
Access to needed mental health services can be particularly difficult for newly arrived refugee and asylum-seeking adolescents, although many attend school. This study examined young refugees' impressions and experience of mental health services integrated within the school system. Semi-structured interviews were conducted with 40 adolescent refugees discharged by three school-based mental health services across the United Kingdom. Two-thirds preferred to be seen at school. Rumination and worry about insecurity in the asylum process had a negative impact particularly on the adolescents' social functioning and ability to focus at school. The important role played by teachers in supporting and mediating contact with mental health services was valued by those interviewed. The study confirms that schools offer an important location for mental health services for adolescent refugees and provide an important portal for integration of services.
Aims.
This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.
Methods.
We conducted a systematic literature search designed to capture clinical, social science and general literature examining the mental health of the Syrian population. The main medical, psychological and social sciences databases (e.g. Medline, PubMed, PsycInfo) were searched (until July 2015) in Arabic, English and French language sources. This search was supplemented with web-based searches in Arabic, English and French media, and in assessment reports and evaluations, by nongovernmental organisations, intergovernmental organisations and agencies of the United Nations. This search strategy should not be taken as a comprehensive review of all issues related to MHPSS of Syrians as some unpublished reports and evaluations were not reviewed.
Results.
Conflict affected Syrians may experience a wide range of mental health problems including (1) exacerbations of pre-existing mental disorders; (2) new problems caused by conflict related violence, displacement and multiple losses; as well as (3) issues related to adaptation to the post-emergency context, for example living conditions in the countries of refuge. Some populations are particularly vulnerable such as men and women survivors of sexual or gender based violence, children who have experienced violence and exploitation and Syrians who are lesbian, gay, bisexual, transgender or intersex. Several factors influence access to MHPSS services including language barriers, stigma associated with seeking mental health care and the power dynamics of the helping relationship. Trust and collaboration can be maximised by ensuring a culturally safe environment, respectful of diversity and based on mutual respect, in which the perspectives of clients and their families can be carefully explored.
Conclusions.
Sociocultural knowledge and cultural competency can improve the design and delivery of interventions to promote mental health and psychosocial wellbeing of Syrians affected by armed conflict and displacement, both within Syria and in countries hosting refugees from Syria.
To operationalize the theory of Trauma and the Continuity of Self: A Multidimensional, Multidisciplinary, Integrative Framework (Danieli, 1998), we created a testable model using factors in Holocaust survivors' lives that may have affected their offspring's adaptation. A web-based sample of 422 adult children of survivors completed a 3-part inventory assessing multigenerational legacies of trauma. To explain the severity of the child's reparative adaptational impacts, we conducted hierarchical regression analyses (Phase 1) and path analyses (Phase 2). We hypothesized that these impacts followed largely from the (child-reported) intensities of parents' victim, numb, and fighter posttrauma adaptational styles. These styles, in turn, followed from family history and post-Holocaust family milieu. With all effects of family history and milieu on offspring specified as indirect (through parents' victim styles), the initial path model fit the data well with one exception: Broken generational linkages had direct as well as indirect effects. While survivors' Holocaust experiences-especially internment-had significant indirect effects on their children, each component of post-Holocaust family milieu had one or more associations with mothers' and fathers' victim, numb, and/or fighter styles. The strongest relationships emerged for broken generational linkages-a risk factor for negative effects-and sociocultural setting (living in Israel rather than North America)-a protective factor. Because the healing processes that underlie observed effects of family milieu are malleable, survivors' and offspring's suffering might be reduced through efforts to recapture meaning, purpose, identity, connectedness of past, present and future, and attachments to community and place. (PsycINFO Database Record
Refugee agencies noticed a high number of suicides among Bhutanese refugees resettled in the United States between 2009 and 2012. We aimed to estimate prevalence of mental health conditions and identify factors associated with suicidal ideation among Bhutanese refugees. We conducted a stratified random cross-sectional survey and collected information on demographics, mental health conditions, suicidal ideation, and post-migration difficulties. Bivariate logistic regressions were performed to identify factors associated with suicidal ideation. Prevalence of mental health conditions were: depression (21 %), symptoms of anxiety (19 %), post-traumatic stress disorder (4.5 %), and suicidal ideation (3 %), significant risk factors for suicidal ideation included: not being a provider of the family; perceiving low social support; and having symptoms of anxiety and depression. These findings suggest that Bhutanese refugees in the United States may have a higher burden of mental illness relative to the US population and may benefit from mental health screening and treatment. Refugee communities and service providers may benefit from additional suicide awareness training to identify those at highest risk.
Refugee studies have examined both resilience and adverse outcomes, but no research has examined how different outcomes co-occur or are distinct, and the social-contextual factors that give rise to these diverse outcomes. The current study begins to address this gap by using latent profile analysis to examine the ways in which delinquency, gang involvement, civic engagement, political engagement, and openness to violent extremism cluster among Somali refugees. We then use multivariable regression analyses to examine how adversity (e.g., discrimination, trauma, and marginalization) is associated with the identified latent classes. Data were collected from 374 Somali refugee young adults (Mage = 21.30 years, SD = 2.90, range 18–30, 38% female) from 4 different North American communities. Participants completed a structured survey assessing their experiences of adversity, delinquent and/or violent attitudes and behaviors (e.g., attitudes toward violent extremism, participation in delinquent behaviors, involvement in gangs), and positive outcomes (e.g., civic and political engagement). Our findings indicate that participants fall into 5 distinct groups, and that social-contextual and individual factors are uniquely related to those groups. Specifically, strong social bonds seem to be associated with positive outcomes. These findings point to the need to further examine both positive and negative outcomes, paying special attention to social–contextual factors.
Despite the high health and mental health care needs, resettled refugees often face cultural and linguistic challenges that hinder the access to appropriate and timely interventions and services. Additionally, such concepts as preventive health or mental health treatment are foreign to this population, which creates additional burdens to the refugee community that already have difficulty navigating a complex health care system in the U.S. To address multiple and complex gaps in health and mental health support for the refugee community, requested is an innovative approach that can convey culturally responsive and effective interventions for health promotion, such as peer-based health education. Few studies have been conducted on the effectiveness of peer-led community health interventions with refugee populations in the U.S. resettlement context. However, peer-led interventions have been shown to be effective when working with cultural minorities and interventions in an international context. Adopting a social capital framework, the current study conducted qualitative evaluation on the impact of a pilot peer-led community health workshop (CHW) in the Bhutanese refugee community. A hybrid thematic analysis of focus group discussion data revealed the improvement in health promotion outcomes and health practice, as well as perceived emotional health. The results also showed that the peer-led CHW provided a platform of community building and participation, while increasing a sense of community, sense of belonging and unity. The findings posit that a peer-led intervention model provides culturally responsive and effective tools for building social capital and promoting community health in the refugee community.
Increasing numbers of migrant youth around the world mean growing numbers of heterogeneous school environments in many countries. Contradictory findings regarding the relationship between immigrant school composition (the percentage of immigrant versus non-immigrant students in a school) and adolescent peer violence necessitate further consideration. The current study examined the relationship between immigrant school composition and peer violence, considering classmate support as a potential moderator among 51,636 adolescents (50.1 % female) from 11 countries. The findings showed that a higher percentage of immigrant adolescents in a school was related to higher levels of physical fighting and bullying perpetration for both immigrant and non-immigrant adolescents and lower levels of victimization for immigrants. In environments of low classmate support, the positive relationship between immigrant school composition and fighting was stronger for non-immigrants than in environments with high classmate support. In environments of low classmate support, the negative relationship between immigrant school composition and fighting and bullying victimization was stronger for immigrant adolescents than in environments with high classmate support. In general, the contribution of immigrant school composition was modest in comparison to the contribution of classmate support. The findings emphasize that it is not just the number of immigrants in a class per se, but rather the environment in the classroom which influences levels of peer violence. The results highlight a need for school intervention programs encouraging positive relations in schools with immigrant populations.
This study is designed to provide an empirical conceptualization of daily hassles among unaccompanied refugees, and whether they might affect mental health of young refugees after resettlement. First, we examined the underlying structure of daily hassles conceptualized as measuring general and acculturation-specific hassles. Second, we examined whether these two distinct categories of daily hassles significantly contribute to depression above and beyond the impact of premigration trauma.
The study was based on self-report questionnaire data collected from 895 unaccompanied refugees who had been granted residence in Norway.
Using structural equation modeling, the results confirmed the grouping of hassles in two general categories, which explained 43% of the variance in depression.
The findings underscore the importance of current life conditions for unaccompanied refugees' mental health.
The importance of the family as a unit in the aftermath of trauma necessitates the use of family interventions among immigrants and refugees. While abundant clinical material suggests that family-based trauma interventions are applicable across cultures, very little is known about the extent to which family treatment modalities are effective for immigrants and refugees. We conducted a systematic review of intervention studies that have been designed or modified specifically for traumatized immigrant and refugee families. The terms "trauma," "family," and "immigrants/refugees/culture" were used along with different terms for "intervention." Studies with no research methodology were excluded. Only 6 experimental studies met our inclusion criteria; 4 of them describe school-based interventions and 2 present multifamily support groups. The shortage of research in this area does not allow clear conclusions about the effectiveness of family interventions for traumatized immigrants or refugees. The complexity of employing methodologically rigorous research in small communities is discussed. Future trials should go beyond the individualistic approach and focus on posttraumatic stress disorder to address family-level processes, such as family relationship, communication, and resilience.
© The Author(s) 2015.
In this study, we examined whether a booster parent training, offered after a cognitive behavioural child intervention, is effective in reduction of aggressive behaviour and changes in parenting. A second aim was to identify parent and child characteristics that influence parental participation. Children (73% boys, 40% immigrants, mean age = 10.1 (.53)) were randomly assigned to the child (n = 97 children) or child and parent intervention (n = 94 children) condition. Results of both intention-to-treat and completers only analyses indicated no extra effects of the parent intervention for the total group. Parents who participated (47%) did not differ from non-participants in demographic characteristics. However, mother's perceived level of child's aggression at the end of the child intervention was of significant meaning for the decision to participate in the parent intervention. Participation seemed to interrupt the development of more aggressive behaviour and less appropriate parenting skills for those children in highest need and resulted in increased maternal involvement.
H. Keilson (1979) coined the term “sequential traumatization” for the accumulation of traumatic stresses confronting the Holocaust survivors before, during, and after the war. A central question is whether survivors were able to raise their children without transmitting the traumas of their past. Through a series of meta‐analyses on 32 samples involving 4,418 participatns, we tested the hypothesis of secondary traumatization in Holocaust survivor families. In the set of adequately designed nonclinical studies, no evidence for the influence of the parents' traumatic Holocaust experiences on their children was found. Secondary traumatization emerged only in studies on clinical participants, who were stressed for other reasons. A stress‐diathesis model is used to interpret the absence of secondary traumatization in nonclinical offspring of Holocaust survivors.
The psychological effects of war represent a growing public health concern as more refugees and asylum seekers migrate across borders. This study investigates whether sociodemographic, premigration and postmigration, and psychosocial factors predict adverse psychiatric symptoms in refugees and asylum seekers exposed to torture (N = 278). Hierarchical linear regressions revealed that female sex, older age, and unstable housing predicted greater severity of anxiety, posttraumatic stress disorder (PTSD), and depression. Cumulative exposure to multiple torture types predicted anxiety and PTSD, while mental health, basic resources (access to food, shelter, medical care), and external risks (risk of being victimized at home, community, work, school) were the strongest psychosocial predictors of anxiety, PTSD, and depression. Also, time spent in the United States before presenting for services significantly predicted anxiety, PTSD, and depression. Consequently, public-sector services should seek to engage this high-risk population immediately upon resettlement into the host country using a mental health stepped care approach.