Review of child and adolescent refugee mental health

OBJECTIVE: To review stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. Highlighted are special refugee populations such as unaccompanied minors, asylum seekers, and former child soldiers. Pertinent medical findings are summarized. METHOD: The authors reviewed articles from 1990 to 2003 addressing the topics above. Literature was gathered from databases including PsycINFO, Medline, and SocioFile. Pertinent earlier papers and those from other disciplines cited in database-identified articles were also included. RESULTS: Child and adolescent refugees suffer from significant conflict-related exposures. Reactions to stress may be mediated by coping strategies, belief systems, and social relations. CONCLUSIONS: More research is needed on interventions, specifically on efficacy and cultural relevance. Interventions that have an impact on multiple ecological levels need further development and evaluation.     

Meta-analysis reveals no association of the Val66Met polymorphism of brain-derived neurotrophic factor with either schizophrenia or bipolar disorder

BACKGROUND: A long-term controversy exists on whether or not major psychotic disorders can be discretely divided into two groups, for example, schizophrenia and bipolar disorder. Many genes and polymorphisms have been studied for a role in both disorders, including the Val66Met (also known as rs 6265 or G196A) variant of brain-derived neurotrophic factor (BDNF). Many case-control association studies have been performed to see if BDNF could serve as a useful clinical diagnostic biomarker for schizophrenia or bipolar disorder, but results have been equivocal. OBJECTIVE: To determine, by meta-analysis, if the Val66Met polymorphism of BDNF influences risk for either schizophrenia, bipolar disorder, or both. METHODS: We searched Pubmed, Medline, and PsycInfo using keywords including Val66Met, Rs6265, G196A, BDNF, schizophrenia, and bipolar disorder. A total of 13 studies for schizophrenia and 11 studies for bipolar disorder were combined by random-effects meta-analysis. MAIN RESULTS: The pooled results from the schizophrenia sample (2955 patients; 4035 controls) and the bipolar disorder sample (3143 patients; 6347 controls) indicated lack of significance with either of the two psychoses, with pooled odds ratios of 1.00 (P=0.944) and 0.95 (P=0.161), respectively. CONCLUSION: Although there are some limitations on the study, our results indicate there is a lack of association between the Val66Met polymorphism and either of the two psychoses. A larger sample size, and evaluation of more single-nucleotide polymorphisms are needed to obtain more robust and conclusive findings regarding the relationship between the BDNF gene and psychosis.     

Influencing Adolescent Social Perceptions of Alcohol Use to Facilitate Change through a School-Based Intervention

The current study examines the effectiveness of a voluntary high school-based alcohol intervention by investigating one proposed mechanism of change in adolescent alcohol involvement: perception of peer use. High school students reporting lifetime drinking (N = 2055) completed fall and spring surveys that assessed demographic information, substance use, risk factors, and intervention attendance (N = 327). The motivational enhancement-based intervention used school and grade-specific normative data to facilitate change in adolescent perceptions regarding the frequency and quantity of peer alcohol use. Results indicate that intervention participants were more likely to increase the accuracy of their peer frequency estimates over the course of the year in comparison to the general student body. Furthermore, students demonstrating decreases in peer perceptions of alcohol use exhibited a greater reduction in number of binge episodes, lower maximum number of drinks consumed per episode, and average number of drinks consumed per drinking occasion (ps < .05); teens with the greatest alcohol use history demonstrated the largest reductions. Although we found no significant main effect for intervention attendance, findings support the role of reduced peer drinking estimates in decreasing alcohol involvement among teen drinkers.     

Patterns of Family,School, and Community Promotive Factors and Health Disparities Among Youth: Implications for Prevention Science

Prevention Science - Increasing knowledge of factors that promote health among youth from diverse backgrounds is an important step towards addressing health disparities. Although many promotive...     

Ethical research in refugee communities and the use of community participatory methods

This article describes the distinct challenges associated with conducting ethical research with refugees. A case example of an ongoing study of stigma and access to mental health treatment among Somali refugee adolescents resettled in the USA is presented. In developing the study, standard research paradigms were critically examined in order to take account of the unique aspects of Somali culture and experience. Community participatory methods were adopted to uphold both ethical and methodological rigor in the research. A participatory approach for developing ethical protocols within different refugee communities is recommended.     

Protecting and Promoting: An Integrative Conceptual Model for Healthy Development of Adolescents

Resilience and positive youth development have substantial overlap and offer complementary perspectives on fostering healthy youth development. However, these two areas have not yet been fully integrated into a unified approach, one that has the potential to build on the interconnectedness of risk, protection, and assets within the ecological systems affecting adolescent development. This article draws on extant research to delineate linkages between the risk and resilience and positive youth development literatures. School-related outcomes are examined within an integrative conceptual model delineating eight developmental domains useful for future research on underlying mechanisms associated with healthy outcomes, as well as prevention and intervention efforts.     

Belonging and connection to school in resettlement: young refugees, school belonging, and psychosocial adjustment

Schools are one of the first and most influential service systems for young refugees. There is a burgeoning interest in developing school-based refugee mental health services, in part to reduce stigma and increase treatment access for this population. Despite the relevance of gaining a better understanding of how refugee students experience schools in resettlement and how this relates to psychosocial adjustment, belonging and connection to school have not been previously investigated among a population of resettled refugees. This study examines school belonging and psychosocial adjustment among a sample of 76 Somali adolescents resettled in the United States. A greater sense of school belonging was associated with lower depression and higher self-efficacy, regardless of the level of past exposure to adversities. Notably, more than one-quarter of the variation in self-efficacy was explained uniquely by a sense of school belonging. School belonging was not significantly associated with posttraumatic stress symptom severity and did not moderate the effect of exposure to adversities on psychological adjustment. These results suggest that investigating ways of improving school experiences would be particularly useful in the effort towards continued development of school-based mental health programs for young refugees.     

Adolescent Satisfaction with Brief Motivational Enhancement for Alcohol Abuse

Although many investigations point to the importance of treatment satisfaction and working alliance as predictors of treatment engagement and outcome, few studies have closely examined these issues among adolescents. This study investigates satisfaction among a nonclinical adolescent sample participating in a school-based alcohol-prevention program. Adolescents self-selected to one of three formats: individual, group, and website. Three hundred nineteen satisfaction measures completed at the time of each participant’s final session were used for analyses. Hierarchical regression analyses examined predictors of consumer satisfaction. In general, greater participation in the program was significantly related to satisfaction. Students who participated in the group and individual formats reported greater satisfaction than students who participated in the website format. Current alcohol users were less satisfied with the session focusing on how experimental use can lead to problem use; lifetime abstainers were more satisfied with the session focusing on stress and coping. These analyses have implications for informing future adolescent school-based interventions for alcohol problems.     

A gale force wind: meaning making by male survivors of childhood sexual abuse

This in-depth qualitative study explores how 16 resilient male survivors of serious childhood sexual abuse, representing a range of racial, ethnic, and socioeconomic backgrounds, made meaning from their abuse experiences. Three main types of meaning making styles were identified in the narratives: meaning making through action, using cognitive strategies, and engaging spirituality. Meaning making through action included helping others and using creative expression to describe and process the abuse. Reasoning systems that helped survivors to understand why the abuse happened included developing a psychological framework for understanding the abuser or the role of the self in the abuse, using a sociocultural explanation, or developing a philosophical view. A few men made meaning through their spirituality. Meaning making styles seem to be related to experiences with therapy; the more experience these men had had with specialized trauma therapy, the more likely they were to make meaning by attempting to understand their perpetrators. In this study, men of color, regardless of socioeconomic class, were less likely than Caucasian men to have received specialized trauma therapy.