The effect of post-traumatic stress disorder on refugees' parenting and their children's mental health: a cohort study (original) (raw)
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Journal of the American Academy of Child and Adolescent Psychiatry, 2018
yrian children have been exposed to war trauma, limited access to clean water, sanitation, and good nutrition, and for many, stresses of forced migration. 1 Despite these exposures by the children and their families, information on the mental health of Syrian refugees is limited. Recent studies have reported the high prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in adult Syrian refugees resettling in Middle East and the United States (US), where we found a high prevalence of possible depression (32.2%), anxiety (40.3%), and PTSD (47.7%) in adult Syrian refugees soon after arrival (A. Javanbakht et al., unpublished, 2018). Data are more limited for Syrian refugee children. One study of 96 Syrian children in a German camp found 33% had PTSD. 2 Two studies of Yazidi (a religious minority) children relocated to Turkey (38 3 and 55 4 children) reported high level of PTSD (10.5% and 36.4%) and anxiety (10.5% and 7.3%). A review on refugee children in Western countries reported an overall PTSD prevalence of 10% to 46.8% after 1 year. 5 To our knowledge, there is no previous report on Syrian refugee children resettled in the US. In this study, we examined the prevalence of possible anxiety and PTSD and potential risk factors among Syrian refugee children and their families newly resettled in southeast Michigan. This cross-sectional study (June 2016-May 2017) was a collaboration between the Wayne State University Department of Psychiatry, Stress, Trauma, and Anxiety Research Clinic (Detroit, MI) and the Arab-American and Chaldean Council (Detroit), the nonprofit agency conducting mandatory local primary care screening in the Detroit metropolitan area within 1 month of refugees arriving in the US. The refugees had been in a refugee camp for 2 years before entry to the US. All participants provided written informed consent, and children at least 13 years old provided written assent. At the end of the mandatory primary health screening, children who agreed to participate and whose parents consented were guided to a private room for an explanation of the study, further consent process, and survey administration for 10 to 20 minutes before their transportation arrived (94.8% of refugees agreed to participate). The survey included demographics, self-reported health status, previously diagnosed psychiatric or physical health problems, and selfrated fluency in English. The UCLA Posttraumatic Stress Reaction Index for the DSM-5 was added later in the study and used for PTSD diagnosis and symptom severity assessment. The Screen for Child Anxiety Related Disorders (SCARED) was used to screen for anxiety. We screened parents for PTSD, anxiety, and depression using the PTSD Checklist Civilian (PCL-C) DSM-IV version and the 25-item Hopkins Symptom Checklist (HSCL-25). More details on the instruments and statistical analysis are described in the supplementary material. The sample consisted of 131 children (40.5% girls) 6 to 17 years old (mean age 11.02, standard deviation 3.32) from 53 families, mostly
THE IMPACT OF WAR-TRAUMA ON THE MENTAL HEALTH OF REFUGEE CHILDREN
University of Debrecen, 2019
The acts of war and violence are increasingly prevalent in contemporary society. Within the last decade, the use of weapons has become more efficient and powerful resulting in devastation and loss of human life. Globally, people in affected regions usually exhibit residual effects, these effects however tend to be more pronounced in children and young adults. This paper presents concrete research on the effects of war-trauma, migration-trauma and, parental (family) distress of refugee children (RC) with the aim of understanding the deviant behavior of refugee children in reported trauma cases reviewed. This paper established the impact of war-trauma on refugee children. Children with prolonged exposure to war or violence related events stand a higher risk of developing post-traumatic stress disorder (PTSD) which could result in violent behavior throughout their life time if proper intervention is not administered. Aggravated mental stress disorder could also be experienced due to migration trauma as the RC traverse several regions enroute their new environments; which in turn leads to family distress as separation occurs as well as acculturation issues.
2012
There is an increasing need to deliver effective mental health services to refugee children and adolescents across the United States; however, the evidence base needed to guide the design and delivery of services is nascent. We investigated the trauma history profiles, psychopathology, and associated behavioral and functional indicators among war-affected refugee children presenting for psychological treatment. From the National Child Traumatic Stress Network’s Core Data Set, 60 war-affected refugee children were identified (51.7% males, mean age = 13.1 years, SD = 4.13). Clinical assessments indicated high rates of probable posttraumatic stress disorder (30.4%), generalized anxiety (26.8%), somatization (26.8%), traumatic grief (21.4%), and general behavioral problems (21.4%). Exposure to war or political violence frequently co-occurred with forced displacement; traumatic loss; bereavement or separation; exposure to community violence; and exposure to domestic violence. Academic problems and behavioral difficulties were prevalent (53.6% and 44.6%, respectively); however, criminal activity, alcohol/drug use, and self-harm were rare (all < 5.45%). These findings highlight the complex trauma profiles, comorbid conditions, and functional problems that are important to consider in providing mental health interventions for refugee children and adolescents. Given the difficulties associated with access to mental health services for refugees, both preventive and community-based interventions within family, school, and peer systems hold particular promise.
Background: The psychological effects of trauma are well-documented among refugee adults and children alone, yet less research has attended to the intergenerational transmission of trauma within refugee families. Additionally, there is considerable diversity between refugee populations as well as within-group variation in the experiences and effects of refugee trauma. Objective: The current study examines the longitudinal effects of maternal traumatic distress on family functioning and child mental health outcomes among Southeast Asian refugee women and their adolescent children. Given the potential for variation in these effects, we also explore group differences in these relationships by ethnicity and child nativity. Methods: Longitudinal data were collected from a random sample of 327 Southeast Asian refugee mothers and their children in the United States. We employed structural equation modeling to examine associations between latent variables representing maternal traumatic distress, family functioning, and child mental health outcomes (i.e., depressive symptoms, antisocial and delinquent behavior, and school problems). We then tested for group differences in these associations by ethnicity (Cambodian and Vietnamese subgroups) and child nativity (U.S.-born and foreign-born children). Results: We found maternal traumatic distress was indirectly linked to child mental health outcomes, and that child nativity was associated with these paths while ethnicity was not. For foreign-born children , maternal traumatic distress was associated with diminished family functioning a year later, which was associated with increased school problems at the two-year mark. Maternal traumatic distress was indirectly associated with depressive symptoms and antisocial and delinquent behavior, respectively, after accounting for family functioning. For all children, weaker family functioning was significantly associated with poorer mental health. Conclusions: Findings suggest that refugee parents' trauma can adversely affect family relationships and the mental health of children. Interventions that address parental trauma and support intergenerational relationships may enhance mental health within refugee communities for future generations.
2017
Historically, research with refugee populations has generally characterised the impact of the refugee experience in psychopathological terms, that is, by examining how particular aspects of people's experiences as refugees lead to specific psychiatric outcomes. Particular emphasis has been devoted to the examination of posttraumatic stress disorder (PTSD), with prevalence studies consistently finding that a small but significant proportion of refugees develop the disorder. Though the PTSD syndrome has been shown to be valid in ethnically diverse refugee populations, the emphasis on examining PTSD specifically, and psychopathology generally, has come under increased debate in recent years. Critics argue that research into PTSD has been reductive in focus, in its failure to examine how interrelationships between pre-migration, resettlement and psychosocial variables act in the aetiology of the disorder. Further critique has been directed toward the emphasis on examining PTSD and p...
Mental health status of refugee children
European Journal of Public Health, 2020
Background A number of refugees and asylum seekers have increased dramatically in recent years. More than 250 million people worldwide are considered as refugees (United Nations High Commission for Refugees, 2018), among whom more than 50% are children. General health and especially psychological health of the refugee and asylum seeking children are an emerging, however, not well explored issues. In this study, we aimed to review the literature on the psychological health of refugee children. Methods We performed a literature search and descriptive analysis of studies published until July 2019, through MEDLINE and Science Direct databases. We identified literature on psychological health state of refugee and asylum seeking children. We analysed results of 16 studies. Results The study found that refugee children are facing severe psychological health issues, such as Post-traumatic stress disorder (PTSD), depression, anxiety, sleep disorders, behavioural problems. We identified 3 pha...
Journal of Chilld Psychology and Psychiatry, 2021
Background: This paper revisits the themes of an influential 1993 review regarding the factors shaping the mental health and psychosocial well-being of refugees to take stock of developments in the evidence base and conceptualisation of issues for refugee children over the last 25 years. Methods: The study deployed a systematic search strategy. This initially identified 784 papers, which was reduced to 65 studies following application of inclusion and exclusion criteria. We used a later iteration of Bronfenbrenner's bioecological model of human development-the PPCT model-to consolidate evidence. Results: We identify a range of risk and protective factors operating at individual, familial, community and institutional and policy levels that influence outcomes for refugee children. The dynamics shaping the interaction of these influences are linked to the life course principles of socio-historical time and developmental age, proximal processes and child agency. Conclusions: Actions at individual, familial, community, school, institutional and policy levels all have potential traction on mental health and psychosocial well-being of refugee children. However, evidence suggests that greatest impact will be secured by multilevel interventions addressing synergies between ecological systems, approaches engaging proximal processes (including parenting programmes) and interventions facilitating the agency of the developing refugee child.