Youths’ Perceived Impact of Invalidation and Validation on Their Mental Health Treatment Journeys

Youths’ experiences in seeking and accessing help for mental health problems can have pervasive and lasting effects on personal and interpersonal functioning. In particular, youth who experience validating experiences presumably persevere in seeking help and generally have positive treatment outcomes, whereas youth who experience invalidation are also likely to experience, at least in the short term, ruptures in therapeutic relationships, shame, and reluctance to seek services. The goal of the current study was to expand on previous research assessing youths’ interactions with mental health providers, allied professionals, family members, and peers, with a focus on subjective experiences of validation and invalidation. The current study investigated both validating and invalidating experiences in seeking, accessing, and maintaining professional services among 31 Canadian youth (n?=?20 girls, n?=?11 boys; 12 to 21 years old [M?=?16.97, SD?=?2.01]) who were diagnosed or self-identified with at least one of five conditions: depression (n?=?26), anxiety (n?=?22), eating disorders (n?=?9), autism spectrum disorder (n?=?2), or conduct disorder or oppositional defiant disorder (n?=?2). Youth were recruited using convenience (e.g., posted advertisements in mental health clinics) and snowball sampling methods. Journey mapping methodology (i.e., participants created visual representations of milestones of their mental health journeys) was employed accompanied by semi-structured interviews to prompt youth to expand on their experiences (e.g., “Could you describe what was happening in your life when you first felt you would need support for your mental health?”). Four themes emerged using inductive thematic analysis, marked by the presence (validation) or lack (invalidation) of: feeling heard, feeling seen, feeling understood, and receiving helpful actions. Participants also reported key consequences of validation and invalidation. Findings broaden a conceptualization of validation across supportive relationships and an understanding of factors that enhance or impede the formation or maintenance of therapeutic relationships with youth. Clinical implications and limitations are discussed.

     

Mental health consequences of detaining children and families who seek asylum: a scoping review

Almost 80 million people globally are forcibly displaced. A small number reach wealthy western countries and seek asylum. Over half are children. Wealthy reception countries have increasingly adopted restrictive reception practices including immigration detention. There is an expanding literature on the mental health impacts of immigration detention for adults, but less about children. This scoping review identified 22 studies of children detained by 6 countries (Australia, Canada, Hong Kong, Netherlands, the UK and the US) through searches of Medline, PsychINFO, Emcare, CINAHL and Scopus data bases for the period January 1992–May 2019. The results are presented thematically. There is quantitative data about the mental health of children and parents who are detained and qualitative evidence includes the words and drawings of detained children. The papers are predominantly small cross-sectional studies using mixed methodologies with convenience samples. Despite weaknesses in individual studies the review provides a rich and consistent picture of the experience and impact of immigration detention on children’s wellbeing, parental mental health and parenting. Displaced children are exposed to peri-migration trauma and loss compounded by further adversity while held detained. There are high rates of distress, mental disorder, physical health and developmental problems in children aged from infancy to adolescence which persist after resettlement. Restrictive detention is a particularly adverse reception experience and children and parents should not be detained or separated for immigration purposes. The findings have implications for policy and practice. Clinicians and researchers have a role in advocacy for reception polices that support the wellbeing of accompanied and unaccompanied children who seek asylum.

     

Dissociation in Black or Black-British People of African and African-Caribbean Descent in the United Kingdom

Visibly black people of African and African-Caribbean descent (black people) are 2-5 times more likely to be diagnosed with schizophrenia and other psychoses than their counterparts from other ethnic minorities in the United Kingdom. However, the symptomology of psychotic illnesses and dissociative experiences are difficult to differentiate. Interestingly, black people detained under the Mental Health Act are more likely to give perceived racism as the cause of their emotional distress than their counterparts from other ethnic groups, but there is very little indication in the literature as to how perceived racism might exert its effect on black people's mental health. This study is designed to construct and test a theoretical model that related mental representations that might be indicative of the subjective experience of racism, with consequential racialized body image disturbance, dissociative experiences, and low global self-esteem. A Web-based questionnaire comprised of the Dissociative Experiences Scale II, Object Relations and Social Cognition Scale of Racial Identity, Racialized Body Image Disturbance Scale, and Rosenberg's Self-Esteem Scale was used to collect the data. As predicted, mental representations indicative of the subjective experience of racism were found to be directly related to racialized body image disturbance, dissociative experiences, and low self-esteem that could occur as a consequence of race-related incidents. However, the best predictors of dissociative experiences in Black people were low self-esteem, mental representations of indirect experience of racism, low academic achievement, young age, radicalized body image disturbance, and the predictors varied according gender and ethnicity.     

Development of a chatbot for depression: adolescent perceptions and recommendations

Background

Chatbots are a relatively new technology that has shown promising outcomes for mental health symptoms in adults; however, few studies have been done with adolescents or reported adolescent user experiences and recommendations for chatbot development.

Methods

Twenty three participants ages 13–18 (M_age = 14.96) engaged in user testing of a chatbot developed to psychoeducate adolescents on depression, teach behavioral activation, and change negative thoughts. Thematic analysis was conducted of participants' responses to user experience questions, impressions, and recommendations.

Results

Over half (56.5%) of the sample completed the full intervention and provided user experience feedback online. The average NPS score was 6.04 (SD = 2.18), and 64.3% (n = 9) said they would use the chatbot in the future. Of all user experience responses, 54.5% were positive. The most common impressions were related to symptom improvement (61.1%) and availability (52.8%) The most frequent recommendations were related to solving technical problems (66%).

Conclusions

Chatbots for mental health are acceptable to some adolescents, a population that tends to be reluctant to engage with traditional mental health services. Most participants reported positive experiences with the chatbot, believing that it could help with symptom improvement and is highly available. Adolescents highlighted some technical and stylistic problems that developers should consider. More pilot and user testing is needed to develop mental health chatbots that are appealing and relevant to adolescents.     

Experiences of school teachers on participation in a brief school mental health program: a qualitative inquiry

Background: School mental health programs (SMHPs) aim to strengthen school teachers’ understanding about issues related to child and adolescent mental health and their management. Many studies have looked at outcomes of such programs quantitatively. However, there is a lack of studies on the qualitative effects of SMHPs. With this in mind, the aim was to explore and evaluate the experiences of school teachers in a corporate social responsibility (CSR) project who participated in a brief SMHP in the suburbs of Bangalore City in India. Materials and methods: Twenty-two school teachers of a CSR project participated in this brief one-day SMHP. The program aimed to orient the teachers about common child and adolescent psychiatric disorders. Data were collected through a semi-structured open-ended questionnaire and by narrative inquiry. The data analysis adopted a general inductive approach. Results: From the qualitative data analysis, five overarching themes have emerged: (i) positive experience of being participants in the program; (ii) lack of knowledge on school mental health issues; (iii) enriched understanding and new learning; (iv) expansion of SMHP to other schools; (v) suggestions for prospective SMHP. Conclusion: The positive experiences and increased knowledge of the participants supports conducting similar programs with systematic methods for people working closely with school children.     

The Association Between Disaster-Related Experiences and Mental Health Outcomes Among Drug Using African American Hurricane Katrina Evacuees

This article provides a detailed examination of the relationship between disaster-related experiences and mental health outcomes among a sample of drug using African American Hurricane Katrina evacuees. Face-to-face structured interviews were administered to Hurricane Katrina evacuees (n = 350) residing in voucher assisted apartment complexes in Houston, Texas (2006–2007). We use Ordinary Least Squares and logistic regression models to examine both the relevance of disaster-related experiences and the interactive relationships between disaster-related experiences and post-disaster mental health outcomes including psychological distress, severe depression, somatic symptoms, and posttraumatic stress disorder. Results indicate that disaster-related experiences including negative life changes, disaster exposure, post-disaster stressors, and resource loss, have unique, inverse relationships with mental health. While resource loss has the strongest inverse relationship with mental health, disaster exposure has a negative interactive effect on psychological distress and anxiety. Although highly vulnerable populations report low levels of mental health nearly 2 years following a disaster experience, there is a convergence in mental health outcomes with high levels of disaster experiences and disaster exposure that suggests mental resiliency.     

Expériences dissociatives sévères relevées dans un groupe d'étudiants français : à propos de la dépersonnalisation

Objective. - The link between dissociative experiences and psychical health is not systematic, these experiences have been encountered into general population with many degrees. The authors have studied stern dissociative experiences in a french student sample (subjects which DES. score is over psychiatric level).Method. - Authors used the Dissociative Experiences Scale (DES.) in french version. After extraction of high scores (psychiatric level) from a group made of students, distribution of the components of DES (Imaginative involvement, Depersonalization-derealization, Dissociative amnesia) is studied in order to understand the nature of severe dissociative experiences in this group (34 subjects aged 18 to 25 years).Results. - Results show that Depersonalization-Derealization component appears as a good clinical indication of psychic suffering, comparatively to other dissociative disorders (particularely dissociative amnesia). DES composant ”Imaginative involvement” does not appear to be specific of dissociative disorder.Conclusion. - A reflection is suggested, in the point of view of psychopathology, about the status of depersonalization disorder: is it specific of dissociative disorders or is it an expression of various forms of psychopathology. The psychopathological register of depersonalization disorder is being debated.     

Prevalence of psychotic‐like experiences and their correlations with internalizing problems: A study of early adolescents in rural area in Karawang,Indonesia

Introduction

Adolescents who live in rural areas have been found to experience more mental health problems than those who live in urban areas. In Indonesia, adolescents who live in rural areas have limited facilities to access mental health services. On the other hand, there is still a strong belief in the rural communities that mental health problems are the consequence of demonic possession, having committed a sin, lack of faith, etc. Rural communities tend to seek traditional remedies such as advice from traditional healers or witchdoctors. Unfortunately, previous studies have indicated that the onset of most mental health problems is during adolescence, and this includes psychotic symptoms that are often manifested as psychotic‐like experiences (PLEs).

Methods

The Strength and Difficulties Questionnaire was used to examine internalizing problems. PLEs were used to examine psychotic symptoms. Data were collected in 3 junior high schools in Karawang. A total of 270 adolescents (aged between 11 and 16 years old) who live in the rural area in Karawang participated in this research.

Results

The study found that the prevalence of adolescents with at least 2 symptoms of PLEs was 7%. The result of the study indicated that there is no significant correlation between psychotic‐like experiences and internalizing problems (r = .075, P = .22).

Discussion

PLEs significantly correlated with peer‐relationship problems rather than with internalizing problems. Further investigation is needed to examine the factors that contribute to PLEs in rural settings.     

Review: Digital experiences and their impact on the lives of adolescents with pre-existing anxiety,depression, eating and nonsuicidal self-injury conditions – a systematic review

Background

Published systematic reviews provide evidence linking positive and negative digital experiences to adolescent mental health. However, these reviews focus on the general public rather than the digital experiences of adolescents with different pre-existing mental health conditions and so may be limited in their clinical relevance. We review publications relating to anxiety, depression, eating disorders and nonsuicidal self-injury to identify common and condition-specific digital experiences and how these may be implicated in the origins and maintenance of these mental health conditions.

Methods

A systematic literature search using a combination of mental health, digital experience (including social media use), and age of the target population terms was conducted on four databases. Detailed findings from the included studies were summarised using a combination of thematic and narrative methods.

Results

Five qualitative and 21 quantitative studies met the eligibility criteria for inclusion (n = 5021). Nine studies included adolescents with depression, one with eating problems, two with nonsuicidal self-injury and 14 with multiple emotional health conditions. The review identified six themes related to the target populations' digital experiences: (a) social connectivity and peer support; (b) escape and/or distraction; (c) social validation and social comparison; (d) accessing/creation of potentially harmful content; (e) cyberbullying; and (f) difficulties with self-regulation during engagement with digital media.

Conclusions

Digital practices of adolescents with pre-existing clinical vulnerabilities are complex and encompass a range of positive and negative experiences, which appear to have common elements across different clinical populations. The literature is currently too limited to identify disorder-specific practices, with too few direct or indirect comparisons between conditions.     

Traumatic experiences and dissociation in a non-clinical group of university students in Ecuador: a cross-sectional study

Background: In Ecuador, as in most Latin American countries, scientific research on trauma and dissociation is scarce. The aim of this study was to examine the prevalence of potentially traumatic experiences and dissociative symptoms in adolescents and young adults who were students at the Central University in Quito, Ecuador.

Methods: A cross-sectional study in which 144 students completed a self-administrated questionnaire consisting of Linköping Youth Life Experience Scale (LYLES), Adolescent-Dissociation Experience Scale (A-DES ) and background variables. Data collection was conducted in autumn 2012. Standard multiple regression analysis was used to analyse the data.

Results: All students reported a history of a minimum of five potentially traumatic experiences with a mean of 14.8. Eight participants (5.6%) scored above 3.7 on the Adolescent-Dissociation Experience Scale, which is considered clinically significant dissociation. No correlation was found between high scores on LYLES and A-DES.

Conclusions: The prevalence of potentially traumatic experiences in the study population is very high compared to studies conducted in high-income settings. The low prevalence of dissociation suggests high resilience in the study population but more research on morbidity is needed to draw conclusions about mental health outcomes. Further research should include study populations in less advantageous contexts.     

Developing sense of coherence in educational contexts: Making progress in promoting mental health in children

Abstract

The notion of salutogenesis was developed by Aaron Antonovsky to achieve a fundamental innovative approach to promoting mental health. Within the concept of salutogenesis, the author defined the sense of coherence (SOC) as a global life orientation, and he suggests that it emerges in the early years of childhood. In order to develop coherence and its components it is necessary to explore certain health resources. In this paper the following questions will be discussed: (1) which are the individual and social resources to keep healthy, and (2) how can these resources be activated? Selected empirical findings will be presented to respond to these research questions. The results show that resources such as self-worth and a sense of belonging are fundamental health factors. They can be developed most effectively in the early years of childhood and through the formal educational system, e.g. in kindergartens and primary schools. However, the findings show that professionals need to be trained to be able to deliver educational programmes in terms of salutogenesis. At the same time, experience shows that promoting health resources in children successfully depends on the participation of the parents and their support by the professional educators. This paper aims to present new ideas and experiences in the area of a practical realization of the concept of salutogenesis in educational systems. Particularly, health promotion programmes, for example ‘The I am I programme' (), could be implemented successfully in kindergartens with a high quota of children with an immigrant background, due to the fact that this programme includes the reflection and experience of cultural traditions, food, songs, dancing, and family rituals.     

What Can the Experiences of People With an Intellectual Disability Tell Us About the Desirable Attributes of a Mental Health Professional?

Introduction: Mental health professionals have reported that they have limited knowledge, skills, and confidence in the area of intellectual disability mental health. This article aims to learn from the experiences of people with intellectual disability about the attributes that may assist mainstream mental health professionals to provide them with a quality mental health service. Methods: Six people with intellectual disability participated in an interview or focus group. Thematic analysis was undertaken applying the Intellectual Disability Mental Health Core Competencies Framework. Results: The findings supported previous research for the need for mental health professionals to be adaptable, able to communicate, and work with a person’s support network. The study reinforced the need for professionals to undertake professional development in the area but also suggested that people with intellectual disability be included as educators and as peer workers. New attributes were identified, including the need for mental health professionals to be able to build rapport and trust through demonstrating their experience and respect for working with people with intellectual disability, and their ability to understand trauma and how it may influence mental health needs. Conclusions: The attributes identified in the study could be used to inform an intellectual disability mental health workforce development framework.     

Prevalence of depersonalization and derealization experiences in a rural population

  Background: Dissociative symptoms are common psychiatric symptoms whose prevalence in rural (agricultural) populations is unknown. The present study examines the prevalence of depersonalization and derealization experiences in a southern rural US population as well as socio-demographic and emotional factors associated with these experiences. Method: A random sample of 1008 adults in rural eastern North Carolina completed a survey by telephone, which included questions about experiences of depersonalization or derealization in the past year. Demographic information was gathered on all respondents; for those reporting these dissociative experiences, information on their frequency, duration, and whether they occurred during conditions of danger, severe stress, upsetting memories, nervousness or depression, or for no apparent reason was also elicited. Results: The reported prevalence rates were 19.1% for depersonalization, 14.4% for derealization, and 23.4% for either dissociative experience. Logistic regression showed that women reported a significantly higher rate of dissociative experiences (26.5%) than men (19.5%), (Odds Ratio=1.93, 95% CI= 1.37–2.74), particularly African-American women (29.9%). Experiencing chronic pain (OR=2.96, 95% CI= 2.05–4.28) and irregular church attendance (OR= 1.18, 95% CI=1.07–1.31) were also associated with increased frequency of dissociation. Increasing age (OR=0.73, 95% CI=0.65–0.81) and being employed (OR=0.58, 95% CI=0.39–0.86) were associated with reduced frequency of dissociation. Pain, gender, and age were related to both depersonalization and derealization experiences. Employment and church attendance were related to depersonalization experiences, while ethnic minorities experienced more derealization. Conclusions: A predominantly southern rural population reported a high 1-year prevalence of depersonalization and derealization experiences. The prevalence of dissociation experiences was common in this southern sample, as was found by Ross and colleagues (1990) in an urban population in Canada. Risk factors for depersonalization and derealization experiences had considerable overlap, but differed on several variables suggesting different underlying mechanisms. Accepted: 4 October 2000     

Bullying and discrimination experiences among Korean-American adolescents

The bullying experiences of Korean-American adolescents (N = 295) were explored in relation to discrimination and mental health outcomes. Bullying experiences were assessed by the Bully Survey (Swearer, 2005), discrimination by the Perceived Ethnic and Racial Discrimination Scale (Way, 1997) and depression by the Center for Epidemiological Studies – Depression Scale (CES-D). Those who reported being bullied (31.5%) as well as those who reported both being bullied and bullying others (15.9%) experienced a higher level of depression, which was elevated beyond the clinically significant level of CES-D. The results of a LISREL model suggest that the experiences of bullying among Korean/Asian-American adolescents and their related mental health issues need to be addressed in a comprehensive context of their discrimination experiences, acculturation, family and school environments.     

Dyadic analyses on the prospective association between birth experience and parent-child-bonding: The role of postpartum depression,anxiety, and childbirth-related posttraumatic stress disorder

ObjectiveNegative birth experiences are associated with postpartum mental health difficulties in parents. However, research considering the long-term impact of a negative birth experience on parent-child-bonding and the interdependence between parents is rare. This study aimed to investigate actor as well as partner effects for the association between parents’ birth experience and parent-child-bonding and whether this association is mediated by postpartum psychiatric symptoms.MethodA community sample of couples (N = 743) completed questionnaires during pregnancy, 2, and 14 months after birth.ResultsApplying Actor-Partner Interdependence Mediation Models, structural equation modeling showed that parents’ own negative birth experience predicted a poorer bond to their child 14 months postpartum. Compared to mothers, this association was twice as strong for partners and was mediated by symptoms of postpartum depression (mothers and partners), anxiety (partners), and childbirth-related posttraumatic stress disorder (mothers). Negative birth experiences of one parent were not related to the other parent’s bonding with the child.ConclusionResults underline the importance of parents’ positive birth experience for their postpartum mental health and secure bond to their child. The other parent’s birth experience or postpartum mental health does not seem to affect one’s own bond to the child in the long term.     

Psychotic experience subtypes, poor mental health status and help-seeking behaviour in a community sample of young adults

Background: Different subtypes of psychotic experiences (PEs) have been identified in clinical and non‐clinical samples. Researchers have considered these PEs to either be variations of personality or expressions of vulnerability to psychotic disorder. This study aimed to determine which particular subtypes of PEs were more likely to be associated with poor mental health status and help‐seeking behaviour in a non‐clinical sample of young adults. Methods: The study was conducted on a community sample of 997 young adults. The prevalence of PEs and distress was measured using the Community Assessment of Psychic Experiences (CAPE), depressive and anxiety symptoms were measured using Beck Depression Inventory‐II and Beck Anxiety Inventory, and general functioning was measured using the General Health Questionnaire‐12. Factorial analysis of the CAPE positive dimension was conducted and correlations between factors and clinical variables were analysed. Results: Four PE subtypes were identified: perceptual abnormalities, persecutory ideas (PI), bizarre experiences, and magical thinking. At least one high frequency PI was endorsed by 60.8% (n = 606) of the sample and proved to be significantly associated both with poor mental health status and help‐seeking behaviour. Conclusion: PEs subtypes are differentially associated with various markers of poor mental health status. PI seem to have stronger psychopathological significance than other subtypes of PEs. Further longitudinal studies are required to extend these findings.     

Exorcising memories of internalised stigma: The demons of lived experience

Public stigma and self-stigma impact negatively on the lives of people with mental health issues. Many people in society stereotype and discriminate against people with mental ill-health, and often this negative process of marginalisation is internalised by people with lived experiences. Thus, this negative internalisation leads to the development of self-stigma. In this article, I reflect on my own experiences of shame and self-stigma as a person with mental ill-health socially bullied by peers from my community and social groups. I present a personal narrative of both public and self-stigmatisation which I hope will enable me to exorcise memories of internalised stigma, which are encountered as my demons of lived experience. Using reflexivity, a process used widely in health and social care fields, I consider how social bullying shattered my fragile confidence, self-esteem, and self-efficacy in the early days of my recovery; the impact of associative stigma on family members is also explored. Following this, the potential to empower people who experience shame and stigma is explored alongside effective anti-stigma processes which challenge discrimination. I connect the concept of recovery with the notion of empowerment, both of which emphasise the importance of agency and self-efficacy for people with mental ill-health. Finally, I consider how the concepts of empowerment and recovery can challenge both the public stigma held by peers in the community and the self-stigma of those with lived experiences.     

Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact

OBJECTIVES: To study the attitudes and experiences of Australian clinicians with dissociative disorders and the paths to diagnosis and experiences of patients. METHOD: The attitudes of Australian clinicians to dissociative disorders and the experiences of patients were assessed by questionnaires. The clinicians were mental health specialists and a small number of general medical practitioners. The patients had all been diagnosed with a dissociative disorder. RESULTS: Of the 250 clinicians, 21% reported experience with more than six cases on average of any one of the dissociative disorders, 38% with less than six, 42% with none; 55% regarded them as valid diagnoses, 35% dubiously valid and 10% invalid. Of the 55 patients, 76% reported delays in diagnosis (57%, >3 years and 25%, >10 years) with adverse consequences in 64%; 80% had experienced sceptical or antagonistic attitudes from clinicians, rated as destructive by 48%. They were disabled (60% rated as >50% impaired) and were heavy consumers of health services (48% hospitalized, 68% >5 times). There was considerable comorbidity including moderate or severe depression (96%), self-harm (68%), suicide attempts (69%), panic disorder (53%), eating disorders (75%), substance abuse (25%), poor physical health (44%), major interpersonal (70%) and sexual problems (90%). Patients rated individual psychotherapy as the most helpful treatment (90%) but medications, such as antidepressants, were also valued (60%). CONCLUSIONS: Although over half of the responding Australian clinicians thought that dissociative disorders were valid, the rest were dubious about their validity with 10% believing them to be invalid. Only 21% had considerable experience with the disorders. These findings may relate to some of the difficulties perceived by patients, which included delays in diagnosis, suboptimal treatment and negative experiences with clinicians.     

Comorbid personality disorders and their impact on severe dissociative experiences in Mexican patients with borderline personality disorder

Abstract

Objective: To identify personality disorders comorbid with borderline personality disorder (BPD) that may confer greater risk for the presence of severe dissociative experiences.

Method: Three hundred and one outpatients with a primary diagnosis of BPD were evaluated using the Structured Clinical Interview for DSM-IV Axis II personality disorders, the Borderline Evaluation of Severity Over Time (BEST) and the Dissociative Experiences Scale (DES).

Results: The most frequent personality disorders comorbid to BPD were paranoid (83.2%, n?=?263) and depressive (81.3%, n?=?257). The mean BEST and DES total score were 43.3 (SD?=?11.4, range 15–69) and 28.6 (SD?=?19.8, range 0–98), respectively. We categorized the sample into patients with and without severe dissociative experiences (41% were positive). A logistic regression model revealed that Schizotypal, Obsessive-compulsive and Antisocial personality disorders conferred greater risk for the presence of severe dissociative experiences.

Discussion: Our results suggest that a large proportion of patients with BPD present a high rate of severe dissociative experiences and that some clinical factors such as personality comorbidity confer greater risk for severe dissociation, which is related to greater dysfunction and suffering, as well as a worse progression of the BPD.     

The impact of immigration detention on mental health: a systematic review

Background

The number of asylum seekers, refugees and internally displaced people worldwide has increased dramatically over the past 5 years. Many countries are continuing to resort to detaining asylum seekers and other migrants, despite concerns that this may be harmful. In light of the considerable body of recent research, this review aims to update and expand on a 2009 systematic review on the mental health consequences of detention on adult, adolescent and child immigration detainees, which found (on the basis on 9 studies) that there was consistent evidence that immigration detention had adverse effects on mental health.

Methods

Three databases were searched using key terms relating to immigration detention and mental health. Electronic searches were supplemented by reference screening. Studies were included if they were quantitative, included individuals detained for immigration purposes, reported on mental health problems and were published in peer-reviewed journals. Two reviewers independently screened papers for eligibility, and a further two reviewers completed quality appraisals for included studies.

Results

Twenty- six studies (21 of which were not included in the 2009 review) reporting on a total of 2099 participants were included in the review. Overall, these studies indicated that adults, adolescents and children experienced high levels of mental health problems. Anxiety, depression and post-traumatic stress disorder were most commonly reported both during and following detention. Higher symptom scores were found in detained compared to non-detained refugees. In addition (and more clearly than was evident in 2009), detention duration was positively associated with severity of mental symptoms. Greater trauma exposure prior to detention was also associated with symptom severity.

Conclusions

The literature base reviewed in this paper consistently demonstrated severe mental health consequences amongst detainees across a wide range of settings and jurisdictions. There is a pressing need for the proper consideration of mental health and consequent risk of detention-related harm in decisions surrounding detention as well as for improved care for individuals within detention facilities. Recommendations based on these findings are presented, including increased focus on the identification of vulnerability and on minimising the duration of detention.