Mental health in migrant children

Many factors have been identified to explain differences in mental health problems between migrant and native children: the process of migration, the ethnic minority position of migrants, their specific cultural background and the selection of migrants. In this paper, the international literature regarding mental health of migrant children is reviewed using strict selection criteria. An extensive search was carried out to locate journal articles on the subject of mental health in migrant youth published since the 1990s. Only 20 studies met all inclusion criteria. Besides the conclusion that the studies did not unequivocally find an increased risk of mental health problems in migrant children, it proved to be very difficult to draw any sound conclusions with respect to these children's risk of mental health problems, since the impact of migration on children's mental health varied with the informants used and the characteristics of the migrant group and of the host country. The lack of univocal definitions of key terms further complicated generalised conclusions in this research field. As such, this research field is in urgent need of more research using standardised research designs, methodology and definitions. A proposition for this research design is made.     

Screening for childhood mental health problems: outcomes and early identification

Background: Many childhood psychiatric problems are transient. Consequently, screening procedures to accurately identify children with problems unlikely to remit and thus, in need of intervention, are of major public health concern. This study aimed to develop a universal school‐based screening procedure based on the answers to three questions: (1) What are the broad patterns of mental health problems from kindergarten to grade 5? (2) What are the grade 5 outcomes of these patterns? (3) How early in school can children likely to develop the most impairing patterns be identified accurately? Methods: Mothers and teachers reported on a community sample (N = 328) of children’s internalizing and externalizing symptoms in kindergarten and grades 1, 3, and 5. In grade 5, teachers reported on children’s school‐based functional impairments, physical health problems, and service use; mothers reported on children’s specialty mental health care. Results: Four patterns distinguished children who (1) never evidenced symptoms; (2) evidenced only isolated symptoms; or evidenced recurrent symptoms, either (3) without or (4) with comorbid internalizing and externalizing. By grade 5, children with recurrent comorbid symptoms had the greatest impairments, physical health problems, and service use. These children can be identified quite accurately by grade 1. Conclusions: Universal screening at school entry can effectively identify children likely to develop recurrent comorbid symptoms, and would provide a basis for developing optimal targeted intervention programs.     

Factors associated with acceptance of peers with mental health problems in childhood and adolescence

Background: Research suggests that children’s reactions to peers with mental health problems are related to the maintenance and outcomes of these problems. However, children’s perceptions of such peers, particularly those with internalising problems, are neither well researched nor understood. The present study aimed to test a series of models relating socio‐demographic and attributional variables to the acceptance of hypothetical boys and girls with attention deficit hyperactivity disorder (ADHD) and depression. Methods: A sample of 595 participants, drawn from five different age‐groups spanning early childhood to late adolescence, completed a booklet of questions in response to two vignettes describing the behaviour of hypothetical target peers with depression and ADHD. The sample was drawn from schools randomly selected in the east of Ireland. Results: The models indicated that age and gender of the participant, and the perceived responsibility of the target character for his/her condition, were the three most important predictors of acceptance in all models. However, the relationship between these variables and acceptance varied depending on the gender of the target child and the condition (depression or ADHD) in the models tested. Conclusions: The findings of the study suggest that the relationships between socio‐demographic and attributional variables and acceptance of peers with mental health problems depend on the type of mental health problem under consideration. The findings have implications for the development of information and education programmes to improve the integration of children with mental health problems.     

Childhood adversity,parental vulnerability and disorder: examining inter-generational transmission of risk

BACKGROUND: An investigation of intergenerational factors associated with psychiatric disorder in late adolescence/early adulthood was undertaken to differentiate influences from maternal disorder, maternal poor psychosocial functioning and poor parenting, on offspring. METHOD: The sample comprised an intensively studied series of 276 mother-offspring pairs in a relatively deprived inner-city London area with high rates of lone parenthood and socio-economic disadvantage. The paired sample was collected over two time periods: first a consecutively screened series of mothers and offspring in 1985-90 (n = 172 pairs) and second a 'vulnerable' series of mothers and offspring in 1995-99 (n = 104 pairs). The vulnerable mothers were selected for poor interpersonal functioning and/or low self-esteem and the consecutive series were used for comparison. Rates of childhood adversity and disorder in the offspring were examined in the two groups. Maternal characteristics including psychosocial vulnerability and depression were then examined in relation to risk transmission. RESULTS: Offspring of vulnerable mothers had a fourfold higher rate of yearly disorder than those in the comparison series (43% vs. 11%, p < .001). They were twice as likely as those in the comparison series to have experienced childhood adversity comprising either severe neglect, physical or sexual abuse before age 17. Physical abuse, in particular, perpetrated either by mother or father/surrogate father was significantly raised in the vulnerable group. Analysis of the combined series showed that maternal vulnerability and neglect/abuse of offspring provided the best model for offspring disorder. Maternal history of depression had no direct effect on offspring disorder; its effects were entirely mediated by offspring neglect/abuse. Maternal childhood adversity also had no direct effect. CONCLUSIONS: Results are discussed in relation to psychosocial models of risk transmission for disorder. Maternal poor psychosocial functioning needs to be identified as a factor requiring intervention in order to stem escalation of risk across generations.     

Explicit and implicit stigma towards peers with mental health problems in childhood and adolescence

Background: Children and adolescents with mental health problems are widely reported to have problems with peer relationships; however, few studies have explored the way in which these children are regarded by their peers. For example, little is known about the nature of peer stigmatisation, and no published research has investigated implicit attitudes thus ensuring that stigma is not well understood. To address this issue, the current study explored patterns of explicit and implicit stigmatisation of peers with depression and attention deficit hyperactivity disorder (ADHD). Methods: The sample was 385 children (M = 10.21 years) and adolescents (M = 15.36 years). Participants completed a questionnaire assessing explicit stigma towards an age‐ and gender‐matched peer with ADHD or depression and another peer with ‘normal issues’ who were described in vignettes. They also completed a modified version of the Implicit Association Test (IAT) that explored implicit attitudes towards the target peers. Results: Questionnaire data indicated that the peer with ADHD was perceived more negatively than the peer with depression on all dimensions of stigma, except perceived dangerousness and fear. In contrast, the IAT findings suggest that some participants had more negative views of the peer with depression than the peer with ADHD. Specifically, the findings demonstrate that adolescent males demonstrated significantly stronger negative implicit evaluations of depression compared with younger males and adolescent females. Conclusions: Children and adolescents demonstrate stigmatising responses to peers with common mental health problems. The nature and extent of these responses depends on the type of problem and the type of measurement used. The findings highlight the importance of using both explicit and implicit measures of stigma.     

Identifying and implementing prevention programmes for childhood mental health problems

A substantial number of children and adolescents in Australia have mental health problems. This review provides guidance to service providers for selecting prevention programmes designed to reduce mental health problems experienced by children. It addresses three issues. First, it highlights the importance of utilising programmes that focus on risk and protective factors which have a causal relationship with mental health problems. Second, it describes approaches that can be used to assess the quality of programme evaluations, and identifies common characteristics of more effective programmes. Finally, it identifies general factors which influence the uptake of innovations, such as new prevention programmes, in health services. These features include, for example, compatibility with potential providers' values, norms and perceived needs, and some flexibility which allows potential providers to adapt programmes to suit their specific needs and context. Addressing these general issues is important to maximise the uptake of effective new prevention programmes.     

Parental mental health and children's adjustment: the quality of marital interaction and parenting as mediating factors

BACKGROUND: Research has put emphasis on the process of transmission of mental-health problems from parents to children. This study examines the specificity of the interpersonal relationships mediating these symptoms. METHOD: Information about parent and child mental health, marital interaction, and parenting was received from 527 mothers and fathers. Information about child mental health was also received from their 12-year-old children (260 girls and 267 boys). RESULTS: The results confirm that parental mental-health problems can compromise a mother's and father's parenting abilities and represent a threat to their children's adjustment. The results suggest that the different types of parental mental-health problems initiate specific paths between parental and child mental-health problems. The results also reveal examples of how the mediation may depend on both the parents' and the children's gender. CONCLUSIONS: The results further suggest that opposite-sex parenting is important to children's adjustment during the years of early adolescence. Keywords: Child development, epidemiology, gender, marital relationships, mental health, parenting.     

Conduct problems, IQ, and household chaos: a longitudinal multi-informant study

Background:  We tested the hypothesis that household chaos would be associated with lower child IQ and more child conduct problems concurrently and longitudinally over two years while controlling for housing conditions, parent education/IQ, literacy environment, parental warmth/negativity, and stressful events.
Methods:  The sample included 302 families with same-sex twins (58% female) in Kindergarten/1st grade at the first assessment. Parents' and observers' ratings were gathered, with some collected over a two-year period.
Results:  Chaos varied widely. There was substantial mother–father agreement and longitudinal stability. Chaos covaried with poorer housing conditions, lower parental education/IQ, poorer home literacy environment, higher stress, higher negativity and lower warmth. Chaos statistically predicted lower IQ and more conduct problems, beyond the effects of other home environment factors.
Conclusions:  Even with other home environment factors controlled, higher levels of chaos were linked concurrently with lower child IQ, and concurrently and longitudinally with more child conduct problems. Parent self-reported chaos represents an important aspect of housing and family functioning, with respect to children's cognitive and behavioral functioning.     

A 6 year follow-up of childhood enuresis: Prevalence in adolescence and consequences for mental health

Recent studies have shown an association between enuresis and behavioural or emotional problems. The direction or causality of the association and its duration, however, remain unclear. This study followed a large group of children from ages 11 to 15 years and reported the prevalence of enuresis to age 13 years. The enuretic status of the sample at age 11 years was established relative to the history of enuresis at age 9 years. At age 11 years a significant association was found between enuresis and measures of psychopathology. This association was particularly evident for those children with secondary enuresis, and those who had a history of enuresis but had ceased to wet the bed. Current primary enuresis was not significantly associated with disorder. Similar associations were found between enuresis at age 11 and later disorder at age 13. At age 15 years no significant associations between enuresis and disorder were found. These findings have implications for parents of children with enuresis and for clinicians dealing with the disorder.     

Behavior problems and mental health contacts in adopted, foster, and nonadopted children

The implications of adoption for the emotional and behavioral adjustment of children have been an issue in child welfare for many years. Past research has suggested that adopted children are over-represented in mental health settings. In addition, some studies have suggested that adopted and nonadopted children differ on measures of social, emotional, behavioral, and cognitive functioning. The current study used data from a large, representative sample in the United States to examine whether adopted children are more likely to have had mental health contacts or emotional or behavioral problems than nonadopted children. Age of placement in the adoptive home was examined as a variable contributing to the adjustment of adopted children. Results suggest that adopted and foster children are more likely to have mental health contacts than nonadopted children. Results are mixed regarding whether adopted and foster children have more behavior problems than nonadopted children. However, significant differences between adopted, foster, and nonadopted children disappeared when a small group of influential cases were removed. This suggests that the differences seen between the groups reflect a small number of cases and are not representative of the groups of adoptees and foster children as a whole. The vast majority of adopted children showed patterns of behavior problems similar to those of nonadopted children. These results are discussed in relation to the past literature and areas for future research.     

Organized violence and mental health of refugee children in exile: a six-year follow-up

In an earlier study we described a high rate of poor mental health in 63 refugee children from Chile and the Middle East during the first 18 mo of exile. In this follow-up study the mental health of 49 of these children is described in parent, teacher and child interviews 6-7 y after settlement in Sweden. The level of poor mental health in parent interviews has improved from 47% 18 mo after settlement to 22% (p < 0.01 in paired t-test) at follow-up. CONCLUSIONs: Eighteen percent of 34 children still in primary school were judged by their teachers to show deviant behaviour in the classroom. Three children were found to suffer from either reexperience or avoidance of painful memories, whereas only one neurologically impaired child fulfilled the criteria of PTSD according to DSM-IV. Recent stress in the family sphere and exposure to acts of organized violence in the country of origin are identified as the major determinants of poor mental health.