Systematic review of depression and suicidality in child and adolescent (CAP) refugees

Sociodemographic factors associated with trajectories of depression among urban refugee youth in Kampala, Uganda: A longitudinal cohort study

Background

There is a high prevalence of depression among refugee youth in low- and middle-income countries, yet depression trajectories are understudied. This study examined depression trajectories, and factors associated with trajectories, among urban refugee youth in Kampala, Uganda.

Methods

We conducted a longitudinal cohort study with refugee youth aged 16-24 in Kampala, Uganda. We assessed depression using the Patient Health Questionnaire-9 and conducted latent class growth analysis (LCGA) to identify depression trajectories. Sociodemographic and socioecological factors were examined as predictors of trajectory clusters using multivariable logistic regression.

Results

Data were collected from n = 164 participants (n = 89 cisgender women, n = 73 cisgender men, n = 2 transgender persons; mean age: 19.9, standard deviation: 2.5 at seven timepoints; n = 1,116 observations). Two distinct trajectory clusters were identified: "sustained low depression level" (n = 803, 71.9%) and "sustained high depression level" (n = 313, 28.1%). Sociodemographic (older age, gender [cisgender women vs. cisgender men], longer time in Uganda), and socioecological (structural: unemployment, food insecurity; interpersonal: parenthood, recent intimate partner violence) factors were significantly associated with the sustained high trajectory of depression.

Conclusions

The chronicity of depression highlights the critical need for early depression screening with urban refugee youth in Kampala. Addressing multilevel depression drivers prompts age and gender-tailored strategies and considering social determinants of health.

Risk of suicide and suicidal behavior in refugees. A meta-review of current systematic reviews and meta-analyses

BACKGROUND

Despite the exposure to a wide combination of risk factors, evidence concerning risk of suicide among refugees is mixed.

AIMS

We aimed to establish more precise estimates of suicide and suicidal behavior in refugees and asylum seekers, investigate the role of somatic and psychiatric comorbidities, and the effectiveness of preventative interventions.

METHODS

We searched PubMed/Medline, EMBASE, CINAHL, and PsycInfo without time limitations from inception until June 5, 2024. Studies were included if systematic reviews or meta-analyses reporting data on suicide or suicidal behavior in refugees or asylum seekers, or detailing the results of preventive interventions. Quality was assessed using the National Institutes of Health Quality Assessment Tool for Systematic Reviews and Meta-Analyses.

RESULTS

Out of 49 papers, 10 systematic reviews and meta-analyses were included. Refugees showed significantly higher suicide death rates and suicidal ideation, suicide plan and suicide attempt prevalence compared to people living in the host countries. Refugees who arrived in low-income and lower-middle-income countries displayed lower suicidal ideation, but higher suicide death rates and suicide attempt prevalence compared to refugees who arrived in high-income and upper-middle-income countries. However, no review provided data regarding somatic comorbidity, psychiatric comorbidity, or the effectiveness of treatments, and evidence on specific categories of refugees is scarce.

CONCLUSION

Refugees have been proven to be at risk for suicide and suicidal behavior. More research is required to identify the targets and procedures of intervention.

Suicide among migrants: a comprehensive narrative review of literature

Suicidality among migrants represents a multifaceted and complex issue with significant implications and challenges for public mental health and policies. This narrative review aims to explore the factors contributing to suicidality within the migrant groups, consequently highlighting the need for tailored interventions and supporting strategies. Firstly, we reviewed the evidences on the prevalence of suicidal ideation, attempted suicides, and deaths by suicide among migrants. The results were extremely heterogeneous, mostly depending on the different migrant group considered. Significant differences in suicide risk have been found depending on the legal status of migrants and their country of origin/migration. The second section explored the protective and risk factors for suicidal ideation and behaviours in different migrant groups. The analysis concluded that a set of factors may interact in various ways, contributing to a heterogeneous and complex framework underpinning the phenomenon of suicide. Migration itself may be a challenging and traumatizing experience, characterized by social isolation, cultural dislocation and adjustment, as well as economic and financial distress, all of which may exacerbate pre-existing mental health vulnerabilities or trigger new mental disorders. Acculturative stress, discrimination, and language barriers further compound these challenges, often hindering access to mental health services.

Social determinants of mental health in major depressive disorder: Umbrella review of 26 meta-analyses and systematic reviews

There is a growing recognition of the impact of social determinants of mental health (SDoMHs) on people with, or at risk of, developing serious mental illnesses. Yet it is not known how associations of individual SDoMHs with risk for major depressive disorder (MDD) vary and roughly compare with one another. Following PRISMA guidelines, this umbrella review included 26 meta-analyses and systematic reviews that reported odds ratios, effect sizes, and/or pooled prevalence rates of MDD in samples with versus without specified SDoMHs. Childhood emotional, physical, or sexual abuse and neglect; intimate partner violence in females; and food insecurity were significantly associated with increased risk of MDD, with medium effect sizes. Natural disasters, terrorist acts, and military combat during deployment had small-size adverse effects, and homelessness, incarceration, and migration were associated with significantly elevated prevalence of MDD. Conversely, higher levels of parental care were significantly associated with reduced risk of MDD with medium effect sizes. Evidence supports the use of certain interventions at the individual and community level that can reduce the impact of these factors and promote health, although much more research is warranted in this area along with meaningful healthcare and societal policies to accomplish this goal.

Translating Suicide Safety Planning Components Into the Design of mHealth App Features: Systematic Review

BACKGROUND

Suicide safety planning is an evidence-based approach used to help individuals identify strategies to keep themselves safe during a mental health crisis. This study systematically reviewed the literature focused on mobile health (mHealth) suicide safety planning apps.

OBJECTIVE

This study aims to evaluate the extent to which apps integrated components of the safety planning intervention (SPI), and if so, how these safety planning components were integrated into the design-based features of the apps.

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically analyzed 14 peer-reviewed studies specific to mHealth apps for suicide safety planning. We conducted an analysis of the literature to evaluate how the apps incorporated SPI components and examined similarities and differences among the apps by conducting a comparative analysis of app features. An independent review of SPI components and app features was conducted by downloading the available apps.

RESULTS

Most of the mHealth apps (5/7, 71%) integrated SPI components and provided customizable features that expanded upon traditional paper-based safety planning processes. App design features were categorized into 5 themes, including interactive features, individualized user experiences, interface design, guidance and training, and privacy and sharing. All apps included access to community supports and revisable safety plans. Fewer mHealth apps (3/7, 43%) included interactive features, such as associating coping strategies with specific stressors. Most studies (10/14, 71%) examined the usability, feasibility, and acceptability of the safety planning mHealth apps. Usability findings were generally positive, as users often found these apps easy to use and visually appealing. In terms of feasibility, users preferred using mHealth apps during times of crisis, but the continuous use of the apps outside of crisis situations received less support. Few studies (4/14, 29%) examined the effectiveness of mHealth apps for suicide-related outcomes. Positive shifts in attitudes and desire to live, improved coping strategies, enhanced emotional stability, and a decrease in suicidal thoughts or self-harm behaviors were examined in these studies.

CONCLUSIONS

Our study highlights the need for researchers, clinicians, and app designers to continue to work together to align evidence-based research on mHealth suicide safety planning apps with lessons learned for how to best deliver these technologies to end users. Our review brings to light mHealth suicide safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and the opportunity to embed more interactive features that leverage the advanced capabilities of technology to improve client outcomes as well as foster sustained user engagement beyond a crisis. Although preliminary evidence shows that these apps may help to mitigate suicide risk, clinical trials with larger sample sizes and more robust research designs are needed to validate their efficacy before the widespread adoption and use.

Development and evaluation of psychoeducational resources for adult carers to emotionally support young people impacted by wars: A community case study

Wars and armed conflicts have a devastating impact at the economic, social, and individual level. Millions of children and adolescents are forced to bear their disastrous consequences, also in terms of mental health. Their effects are even more complicated when intertwined with those of other disasters such as the current COVID-19 pandemic. To help them face such adverse events, lay adults can be supported by psychoeducational interventions involving simple tools to assist children and adolescents emotionally. Hence, we planned and implemented two public communication campaigns concerning wars to support adult carers such as parents, teachers, educators, psychologists, first responders, and others interested in young people's wellbeing. We developed psychoeducational materials to help children and adolescents cope with negative emotions related to indirect and direct exposure to wars. This study had the objective to identify the content for two pamphlets, testing their comprehensibility, usability, and utility, and monitoring their dissemination. First, based on classifications of coping strategies and on a previous campaign about COVID-19 pandemic, we decided to include in the psychoeducational materials basic information on news about wars and common reactions to wars, respectively; on emotions that might be experienced; and on coping strategies for dealing with negative emotions. For the first pamphlet, we identified the strategies involving 141 adults. They completed an online survey with open-ended questions concerning ways to help children and adolescents cope with negative emotions associated with the Russia-Ukraine war. For the second pamphlet, we selected the contents based on Psychological First Aid manuals. Through content analyses, we chose 24 strategies. Second, data gathered with 108 adults who had consulted the psychoeducational materials supported their comprehensibility, usability, and utility. Third, we monitored the visibility of the campaigns after the release of the pamphlets, using Google Analytics™ data from the HEMOT^® website through which we disseminated them. To conclude, our findings supported the comprehensibility, the usability, and the utility of the two pamphlets, to be disseminated as psychoeducational materials in the early phase of a disaster.

The mental health consequences on children of the war in Ukraine: A commentary

The news from Ukraine is currently full of heart-wrenching stories accompanied by graphic images of civilian casualties and massacres that are telecast world-wide on a daily basis. It is hard to fathom the magnitude of the devastation and disruption to regular lives and everyday routines that war brings with it, the witnessing of countless deaths, the associated trauma of living in perpetual fear, and the daily experience of many families and orphans who are crowded into basement bomb shelters now for months on end. These issues make us contemplate the mental health consequences, among other lasting effects, of this costly war in Ukraine, and wars in other countries not so widely featured in Western news. Despite people of all ages being affected by war, children are especially vulnerable. This commentary outlines some of the epidemiology of the consequences of war, the mental health sequelae specifically, and the complexity of providing culturally and contextually relevant interventions that meet the needs of children.