Immigrant children: psychiatric disorder, school performance, and service utilization

Social Disparities in Mental Health Service Use Among Children and Youth in Ontario: Evidence From a General, Population-Based Survey

OBJECTIVES

To examine differences in mental health-related service contacts between immigrant, refugee, racial and ethnic minoritized children and youth, and the extent to which social, and economic characteristics account for group differences.

METHODS

The sample for analyses includes 10,441 children and youth aged 4-17 years participating in the 2014 Ontario Child Health Study. The primary caregiver completed assessments of their child's mental health symptoms, perceptions of need for professional help, mental health-related service contacts, experiences of discrimination and sociodemographic and economic characteristics.

RESULTS

Adjusting for mental health symptoms and perceptions of need for professional help, children and youth from immigrant, refugee and racial and ethnic minoritized backgrounds were less likely to have mental health-related service contacts (adjusted odds ratios ranged from 0.54 to 0.79), compared to their non-immigrant peers and those who identified as White. Group differences generally remained the same or widened after adjusting for social and economic characteristics. Large differences in levels of perceived need were evident across non-migrant and migrant children and youth.

CONCLUSION

Lower estimates of mental health-related service contacts among immigrant, refugee and racial and ethnic minoritized children and youth underscore the importance and urgency of addressing barriers to recognition and treatment of mental ill-health among children and youth from minoritized backgrounds.

Acculturation and selected birth defects among non-Hispanic Blacks in a population-based case-control study

BACKGROUND

There are noted birth defects prevalence differences between race/ethnicity groups. For instance, non-Hispanic (NH) Black mothers are more likely to have an infant with encephalocele, although less likely to have an infant with anotia/microtia compared to NH Whites. When stratifying by nativity and years lived within the United States, additional variations become apparent.

METHODS

Data from the National Birth Defects Prevention Study were used to calculate descriptive statistics and estimate crude/adjusted odds ratios (aORs) and 95% confidence intervals (95%CIs) among NH Blacks with one of 30 major defects and non-malformed controls. Total case/controls were as follows: U.S.- (2,773/1101); Foreign- (343/151); African-born (161/64). Study participants were also examined by number of years lived in the U.S. (≤5 vs. 6+ years).

RESULTS

Compared to U.S.-born, foreign-born NH Black controls tended to be older, had more years of education, and were more likely to have a higher household income. They also had fewer previous livebirths and were less likely to be obese. In the adjusted analyses, two defect groups were significantly attenuated: limb deficiencies, aORs/95%CIs = (0.44 [0.20-0.97]) and septal defects (0.69 [0.48-0.99]). After stratifying by years lived in the United States, the risk for hydrocephaly (2.43 [1.03-5.74]) became apparent among those having lived 6+ years in the United States. When restricting to African-born mothers, none of the findings were statistically significant.

CONCLUSIONS

Foreign-born NH Blacks were at a reduced risk for a few selected defects. Results were consistent after restricting to African-born mothers and did not change considerably when stratifying by years lived in the United States.

Changes in the Prevalence of Child and Youth Mental Disorders and Perceived Need for Professional Help between 1983 and 2014: Evidence from the Ontario Child Health Study

OBJECTIVES

To examine: 1) changes in the prevalence of mental disorders and perceived need for professional help among children (ages 4 to 11) and youth (ages 12 to 16) between 1983 and 2014 in Ontario and 2) whether these changes vary by age and sex, urban-rural residency, poverty, lone-parent status, and immigrant background.

METHODS

The 1983 ( n = 2836) and 2014 ( n = 5785) Ontario Child Health Studies are provincially representative cross-sectional surveys with identical self-report checklist measures of conduct disorder, hyperactivity, and emotional disorder, as well as perceived need for professional help, assessed by integrating parent and teacher responses (ages 4 to 11) and parent and youth responses (ages 12 to 16).

RESULTS

The overall prevalence of perceived need for professional help increased from 6.8% to 18.9% among 4- to 16-year-olds. An increase in any disorder among children (15.4% to 19.6%) was attributable to increases in hyperactivity among males (8.9% to 15.7%). Although the prevalence of any disorder did not change among youth, conduct disorder decreased (7.2% to 2.5%) while emotional disorder increased (9.2% to 13.2%). The prevalence of any disorder increased more in rural and small to medium urban areas versus large urban areas. The prevalence of any disorder decreased for children and youth in immigrant but not nonimmigrant families.

CONCLUSIONS

Although there have been decreases in the prevalence of conduct disorder, increases in other mental disorders and perceived need for professional help underscore the continued need for effective prevention and intervention programs.

Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study

OBJECTIVES

To present the 6-month prevalence and sociodemographic correlates of mental disorders and mental health-related service contacts in a sample of children (4 to 11 years) and youth (12 to 17 years) in Ontario.

METHODS

The 2014 Ontario Child Health Study is a provincially representative survey of 6537 families with children aged 4 to 17 years in Ontario. DSM-IV-TR mental disorders were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and included mood (major depressive episode), anxiety (generalized anxiety, separation anxiety, social phobia, specific phobia), and behaviour disorders (attention-deficit/hyperactivity disorder, oppositional-defiant disorder, conduct disorder).The MINI-KID was administered independently to the primary caregiver and youth aged 12 to 17 years in the family's home.

RESULTS

Past 6-month prevalence of any mental disorder ranged from 18.2% to 21.8% depending on age and informant. Behaviour disorders were the most common among children, and anxiety disorders were the most common among youth. Among children and youth with a parent-identified mental disorder, 25.6% of children and 33.7% of youth had contact with a mental health provider. However, 60% had contact with one or more of the providers or service settings assessed, most often through schools.

CONCLUSIONS

Between 18% and 22% of children and youth in Ontario met criteria for a mental disorder but less than one-third had contact with a mental health provider. These findings provide support for strengthening prevention and early intervention efforts and enhancing service capacity to meet the mental health needs of children and youth in Ontario.

Risk factors for child mental health problems in Lithuania: The role of parental nationality

BACKGROUND

We compare the mental health status of children who reside in Lithuania with parents who are either Lithuanian nationals or non-Lithuanian nationals.

METHOD

Data were drawn from the School Child Mental Health Europe survey (SCMHE), a cross-sectional survey of school children aged 6-11years. A total of 1152 Lithuanian children participated, among them 11.7% from a non-Lithuanian family. Child mental health was assessed using the Dominique Interactive (DI) and the parent- and teacher Strength and Difficulties Questionnaire (SDQ). Parental attitudes were evaluated, and socio-demographics were collected.

RESULTS

Overall 26.7% of non-Lithuanian versus 17.2% of Lithuanian children reported having an internalizing disorder (p=0.01) mainly due to separation anxiety (16.4% versus 10.2%, p=0.04). Odds ratio (OR) for child-reported internalizing disorders was 1.86 (95% CI=1.17-2.96) once adjusted for other factors including being a girl, to be younger, parental unemployment and low caring and low autonomy parental attitudes which were associated with greater odds of internalizing disorders. In addition, 31.9% of non-Lithuanian reported suicidal thoughts versus 22.0% of Lithuanian children p=.02); OR=1.60 (95% CI=1.04-2.46) once adjusted for single parent, parental unemployment, parental alcohol problems and overreactivity attitude.

CONCLUSIONS

Being a non-national minority in Lithuania is a risk factor for child mental health. These findings suggest that further studies are needed to inform local policy-makers on targeted prevention and intervention programs in these children.

Social Support and the Significance of Shared Experience in Refugee Migration and Resettlement

This article examines the role of social support as a determinant of refugee well-being and migration patterns during early resettlement. Analysis is based on qualitative in-depth inter-views with 47 government-assisted refugees in Canada and 38 key informants (settlement service providers and immigration officials) in Canada and overseas. The study describes refugees' decision making during stages of migration and resettlement, from whom they seek social sup-port in particular situations, what sources are appraised as most important, and what is significant about the support. The authors suggest that a goal of refugees support-seeking strategies is affirmation through shared experience.

Internalising and externalising problems in middle childhood: A study of Indian (ethnic minority) and English (ethnic majority) children living in Britain

The psychological adjustment of ethnic minority children has received little research attention, particularly in Britain. The present study set out to investigate the adjustment of Indian children living in Britain as well as the adjustment of their English peers. The sample consisted of 125 children (66 Indian and 59 English) between the ages of 7 and 9 years ( M = 8.51, SD = 0.62) and their parents and teachers. Mothers, fathers, and teachers reported about the children’s problem behaviour, and parents also reported on their acculturation strategy and use of their Indian language. Analyses revealed that overall Indian children seem to be well adjusted in Britain. Nevertheless, according to parental reports, they exhibited more internalising problems than did their English peers. No significant differences, however, were found for externalising or total problem behaviour. Furthermore, within the Indian group, it was found that children whose mothers and fathers were more traditional in their acculturation style displayed lower levels of externalising, internalising and total problem behaviour, according to their teachers. In addition, children whose mothers and fathers utilised their Indian language to a greater extent displayed lower levels of externalising and total problem behaviour (teachers’ reports). These findings highlight the importance of examining the adjustment of ethnic minority children in multiple contexts.

Why do ethnic minority (Indian) children living in Britain display more internalizing problems than their English peers? The role of social support and parental style as mediators

The purpose of this paper was to examine explanatory mechanisms of differences in children's internalizing problems between ethnic minority (i.e., Indian) and ethnic majority (i.e., English) children living in Britain. Fifty-nine English children (31 girls) and 66 Indian children (30 girls), and their parents constituted the sample of this study. Both mothers and fathers reported on the children's internalizing problems, and provided reports of their own parenting style and social support. Analysis showed that maternal positivity, paternal negativity, and both parents’ reports of social support mediated the link between ethnicity and internalizing problems. Furthermore, according to the best-fitting structural equation model, ethnicity did not have a direct influence on children's internalizing problems, nor on parental style. Ethnicity instead predicted parental reports of social support. Social support, in turn, contributed to children's internalizing problems directly as well as indirectly through parenting style. Finally, although parenting style significantly influenced children's internalizing problems, social support was a much stronger contributor. The role of the distal as well as the proximal environments on children's adjustment is discussed.

Mental health of intermarried immigrant women and their children in South Korea

This study was aimed to examine the mental health status of immigrant women through international marriages and its effects on emotional and behavioral problems of children. Seventy-four intermarried immigrant women and 86 native Korean women were enrolled from the same district of Seoul metropolitan area. The mental health problems of study participants and their children were examined. Increased risks of having a higher level of anxiety were observed in immigrant women compared to native Korean women. Children of the immigrant group were likely to have more internalizing and externalizing behavioral symptoms than those of the native group. This pattern was more apparent in children of mothers with higher levels of anxiety. The present study found a higher risk for mild anxiety in intermarried immigrants than in native Korean women. Furthermore, considering that immigrant children seemed to have more emotional and behavioral problems relative to native children if their mothers have higher levels of anxiety, special attention should be paid to prevention and early intervention for mental health problems of intermarried immigrant women.

Predictors of immigrant children's mental health in Canada: selection, settlement contingencies, culture, or all of the above?

BACKGROUND AND STUDY AIMS

A previous publication from the New Canadian Children and Youth Study, a national study of immigrant children and youth in Canada, showed a gradient of levels of emotional distress with children from Hong Kong (HK) at the most severe end, Filipino children at the least severe, and children from the People's Republic of China (PRC) in between. Based on the premise that country of origin can be regarded as an index for differing immigration trajectories, the current study examines the extent to which arrival characteristics, resettlement contingencies and cultural factors account for country of origin variations in immigrant children's mental health. Arrival characteristics included child's age at arrival, parental education, parental fluency in English or French, and assistance from family at arrival. Resettlement contingencies included parental mental health, intra-familial conflict, settlement stress, separations from parents and child's age when mother started working outside the home. Cultural factors included one-child family composition and parenting styles.

METHODS

A national survey of 2,031 families with at least one child between the ages of 4 and 6 or 11 and 13 from HK, the PRC and the Philippines was conducted with the Person Most Knowledgeable (PMK) in snowball-generated samples in 6 different cities across Canada. Predictors of the dependent variable, emotional problems (EP), were examined in a hierarchical block regression analysis. EP was regressed on ethnic and country of origin group in model 1; arrival characteristics were added in model 2; resettlement contingencies in model 3 and cultural factors in model 4.

RESULTS

The final set of predictor variables accounted for 19.3 % of the variance in EP scores among the younger cohort and 23.2 % in the older. Parental human and social capital variables accounted for only a small amount of the overall variance in EP, but there were statistically significant inverse relationships between EP and PMK fluency in English or French. Settlement contingencies accounted for a significant increase in the explanatory power of the regression equation, net of the effects of country of origin and selection characteristics. This block of variables also accounted for the Filipino mental health advantage. Levels of parent's depression and somatization, harsh parenting, intrafamilial conflict, and resettlement stress each varied directly with levels of children's EP. Cultural variables made a significant contribution to explaining the variance in EP scores. Harsh parenting was significantly associated with increased levels of EP in both age groups, and supportive parenting was a mental health protective factor for younger children.

CONCLUSIONS

Immigrant family human and social capital, according to which immigrants are selected for admission to Canada, play a relatively small role in determining children's mental health. These effects are overshadowed by resettlement contingencies and cultural influences. Concentrating on trying to find a formula to select the "right" immigrants while neglecting settlement and culture is likely to pay limited dividends for ensuring the mental health of children.

Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States

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.

A comparison of levels and predictors of emotional problems among preadolescent Ethiopians in Addis Ababa, Ethiopia, and Toronto, Canada

According to a literature of theory and advocacy, immigration and resettlement jeopardize the mental health of children and youth, largely because of factors such as intergenerational tensions arising from conflicts about the retention of traditional values, and experiences of prejudice and discrimination. The current study examines the specificity of these putative mental health risks to the immigration experience. The level and predictors of emotional problems among preadolescent Ethiopians living in immigrant families in Toronto, Canada, were compared with a matched sample of Ethiopian youngsters in Addis Ababa, Ethiopia. Data came from structured interviews with the person most knowledgeable about the family (usually a parent), as well as from the children themselves. Youth reported higher levels of emotional problems (EP) than their parents. Predictors differed for parent and child ratings. In both the Toronto and Addis Ababa samples, parental mental health predicted parent-rated, but not self-rated EP. Contrary to immigration stress theory, parental perceptions of prejudice predicted EP in Addis Ababa, but not Toronto, and parent-child discordance regarding ethnic adherence were predictors of self-rated emotional problems in Ethiopia, but not in Canada. Perceived discrimination was a significant predictor of self-rated emotional problems in both settings. Implications for theory and further research are discussed.

Autism spectrum disorders and developmental disabilities in children from immigrant families in the United States

OBJECTIVES

Recent census data show that nearly one-quarter of US children have at least 1 immigrant parent; moreover, there has been a dramatic increase in children diagnosed with autism spectrum disorders (ASDs) and select developmental disabilities (DDs). However, little is known about access to medical home and adequacy of insurance coverage for children with ASDs and select DDs from immigrant families.

METHODS

By using the 2007 National Survey of Children's Health, we compared children with ASDs and select DDs from immigrant (n = 413, foreign born or reside with at least 1 immigrant parent) and nonimmigrant (n = 5411) families on various measures of medical home and insurance coverage. We used weighted logistic regression to examine the association between immigrant family and selected outcome measures while controlling for confounding factors.

RESULTS

Compared with nonimmigrant families, children with ASD and select DD from immigrant families were more than twice as likely to lack usual source of care and report physicians not spending enough time with family. Furthermore, multivariable analyses indicate that insurance coverage is an important factor in mitigating health care barriers for immigrant families.

CONCLUSIONS

The study demonstrates important areas of deficits in the health care experiences of children with ASD and select DD from immigrant households. Public policy implications include increasing access to existing insurance programs, augmenting public awareness resources for ASD and select DD, and offering assistance to immigrant families that are struggling with the medical needs of their children.

Differences in methylphenidate use between immigrants and spaniards in the child population of aragon, Spain: a retrospective study

The aim of this research is to study the differences in methylphenidate use in children from different ethnic groups in the region of Aragon, Spain. Differences in the use of methylphenidate between both groups of children, immigrants and Spanish nationals, were assessed based on the total number of methylphenidate prescriptions made out for all children in Aragon in 2008 (N = 98 837). We have used defined daily doses and the defined daily doses per 1000 inhabitants per day. Defined daily doses per 1000 inhabitants per day of methylphenidate use was 18.49 in Spanish boys compared with 2.70 in immigrant boys, and 5.48 in Spanish girls versus 0.83 in immigrant girls. All differences between groups were statistically significant (P < .001). This study confirms that methylphenidate use is higher in a local population than in an immigrant population. Western European and North American children show the highest use, followed by Latin Americans and Eastern Europeans.

Mental health service utilization of Somali adolescents: religion, community, and school as gateways to healing

This mixed-method study examines the utility of the Gateway Provider Model (GPM) in understanding service utilization and pathways to help for Somali refugee adolescents. Somali adolescents living in the Northeastern United States, and their caregivers, were interviewed. Results revealed low rates of use of mental health services. However other sources of help, such as religious and school personnel, were accessed more frequently. The GPM provides a helpful model for understanding refugee youth access to services, and an elaborated model is presented showing how existing pathways to help could be built upon to improve refugee youth access to services.

Internalizing and Externalizing Problems in Early Childhood

The present study set out to investigate the adjustment of Former Soviet Union (FSU) children living in Israel as well as their veteran-Israeli peers. The sample consisted of 145 children (70 veteran-Israelis and 75 FSU) between the ages of 4.0 and 6.5 years old ( M = 5.54, SD = .48) and their parents. Mothers and fathers reported about the children’s problem behavior and on their own parenting behavior. Analyses revealed that FSU children exhibited more externalizing and peer problems than did their veteran-Israeli peers. No significant differences, however, were found for internalizing problems. Furthermore, FSU mothers and fathers reported significantly lower levels of authoritarian parenting behavior than did their veteran-Israeli counterparts. Finally, ethnicity was found to moderate links between parenting and children’s problem behavior for mothers but not for fathers. Specifically, for the veteran-Israeli group, the more authoritarian mothers were, the more externalizing and peer problems their children exhibited. However, for the FSU families, the more authoritarian mothers were, the more internalizing problems suffered by their children. These findings suggest that authoritarian parenting may be reflected differently in distinct cultures and cultural conditions, and they highlight the importance of considering both mothers and fathers, as they may go through different acculturation processes.

Depression and post-traumatic stress disorder among Haitian immigrant students: implications for access to mental health services and educational programming

BACKGROUND

Previous studies of Haitian immigrant and refugee youth have emphasized "externalizing" behaviors, such as substance use, high risk sexual behavior, and delinquency, with very little information available on "internalizing" symptoms, such as depression and anxiety. Analyzing stressors and "internalizing" symptoms offers a more balanced picture of the type of social and mental health services that may be needed for this population. The present study aims to: 1) estimate the prevalence of depression and post-traumatic stress disorder (PTSD) among Haitian immigrant students; and 2) examine factors associated with depression and PTSD to identify potential areas of intervention that may enhance psychosocial health outcomes among immigrant youth from Haiti in the U.S.

METHODS

A stratified random sample of Haitian immigrant students enrolled in Boston public high schools was selected for participation; 84% agreed to be interviewed with a standardized questionnaire. Diagnosis of depression and PTSD was ascertained using the best estimate diagnosis method.

RESULTS

The prevalence estimates of depression and PTSD were 14.0% and 11.6%; 7.9% suffered from comorbid PTSD and depression. Multivariate logistic regression demonstrated factors most strongly associated with depression (history of father's death, self-report of schoolwork not going well, not spending time with friends) and PTSD (concern for physical safety, having many arguments with parents, history of physical abuse, and lack of safety of neighborhood).

CONCLUSIONS

A significant level of depression and PTSD was observed. Stressors subsequent to immigration, such as living in an unsafe neighborhood and concern for physical safety, were associated with an increased risk of PTSD and should be considered when developing programs to assist this population. Reducing exposure to these stressors and enhancing access to social support and appropriate school-based and mental health services may improve educational attainment and psychosocial health outcomes among Haitian immigrant youth.

Health status in immigrants and native early adolescents in Italy

The aim of the study was to compare health status between native and immigrant early adolescents in Italy and to analyze related psychosocial factors. Data were taken from "Health Behavior in School Aged Children", a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. A representative sample of 6,744 (50.4% males) Italian students (11, 13 and 15-years-old) completed a questionnaire. Students were assessed for demographics characteristics, socio-economic conditions, social support and bullying victimization, and, as dependent variables, for health complaints, self-reported health, life satisfaction and happiness. It turned out that immigrant adolescents, as compared to natives, are more often affected by psychosomatic symptoms, less satisfied about their health and about life, and less happy. A multiple regression model showed that migration itself is related to life satisfaction and happiness. Socio-economic inequalities, lack of social integration and victimization determine the differences between immigrants and natives in terms of health symptoms and self-reported health. Immigrant adolescents demonstrated worse health status then their native classmates. However, the differences in terms of subjective well-being are not explained by socio-economic differences, lack of social integration and discrimination.

Satellite babies in transnational families: A study of parents' decision to separate from their infants

This study examines a practice which is characteristic of an era of intensifying globalization: As part of a transnational lifestyle, an increasing number of immigrants to North America send infants thousands of miles back to their country of origin to be raised by members of their extended families-a culturally sanctioned tradition. After several years of separation, the children return to the biological parents to attend school in the adopted country, a custom which, according to Western mental health models, could have significant sequelae for attachment relationships and other facets of development. This practice is particularly prevalent among immigrants from the People's Republic of China, but a modified version of it can be found in other groups as well. The work described here is the first phase of a longitudinal project that explores the advantages and potential repercussions, for both infants and parents, of a transnational lifestyle. The current study reviews the decision-making process of a group of Chinese Canadian immigrant parents who are considering a separation from their infants. Preliminary findings show that the expected concerns about disrupting attachment relationships are embedded in more salient considerations of economic need and cultural perspective. These exploratory data exemplify an emergent field of culture-focused research and practice in infant mental health, and support the call for innovative models to situate infant developmental pathways in global and transcultural contexts.

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.

Epidemiology of attention problems among Turkish children and adolescents: a national study

OBJECTIVE

To evaluate the epidemiology of attention problems using parent, teacher, and youth informants among a nationally representative Turkish sample.

METHOD

The children and adolescents, 4 to 18 years old, were selected from a random household survey. Attention problems derived from the Child Behavior Checklist (CBCL) (N = 4,488), Teacher Report Form (TRF) (N = 2,360), and the Youth Self Report (YSR) (N = 2,206) were examined.

RESULTS

The CBCL and TRF attention problems scores were higher among young male children, whereas the YSR reported scores were higher among older adolescents without a gender effect. The CBCL and YSR scores were also higher by urban residence.

CONCLUSION

Compared with other European samples, our national sample had higher mean attention problems scores than the Scandinavian but lower mean scores than the former Soviet Union samples. In addition to elucidating the profile of attention problems in Turkey, our results also contribute to understanding the comparative global epidemiology of attention problems.

Emotional and behavioural problems in migrant adolescents in Belgium

Refugee and migrant adolescents may be at increased risk for the development of emotional and behavioural problems. Since studies on this topic are rather scarce and results inconsistent, this large-scale screening study aims at investigating the prevalence of emotional and behavioural problems in recently arrived migrant adolescents in Belgium, compared to Belgian peers. About 1,249 migrant adolescents and 602 Belgian adolescents filled in four self-report questionnaires on the prevalence of emotional and behavioural problems, traumatic experiences and symptoms of post-traumatic stress. Migrant adolescents experienced more traumatic events than their Belgian peers, and show higher levels of peer problems and avoidance symptoms. On the contrary, non-migrant adolescents reveal more symptoms of anxiety, externalizing problems and hyperactivity. Factors influencing the prevalence of emotional and behavioural problems are the number of traumatic events experienced, gender and the living situation. Although migrant and non-migrant adolescents don't differ much in the prevalence of emotional and behavioural symptoms, attention should be given to the screening and support of risk groups within the population of migrant adolescents, such as girls, those who experienced a lot of traumatic events and unaccompanied refugee children and adolescents.

Ethnic Norwegian and ethnic minority adolescents in Oslo, Norway. A longitudinal study comparing changes in mental health

BACKGROUND

Little is known about ethnic disparities in mental health during late teens. The aim of this study was to compare changes in self reported mental health between adolescents with ethnic Norwegian and ethnic minority background aged 15-16 years followed for three years.

METHODS

The youth part of the Oslo Health Study constituted the baseline of this self-reported longitudinal study, carried out in schools in 2001 (n = 3811). The follow-up in 2004 was conducted partly in school and partly through mail. A total of 2489 (1112 boys and 1377 girls) participated in the follow-up. Twenty percent of the participants had an ethnic minority background. Mental health was measured by the Strengths and Difficulties Questionnaire (SDQ) and The Hopkins Symptom Checklist (HSCL-10).

RESULTS

Ethnic minority boys and girls reported poorer mental health than ethnic Norwegians of the same sex, both at baseline and follow-up. Exceptions were hyperactivity-inattention problems and prosocial behaviours where no differences were found. Consistent changes from baseline to follow-up were; an increase in mental distress and prosocial behaviour. No ethnic disparities were found for changes in mental health from ages 15 to 18 between the two groups. There was no different effect of perceived family economy, parents' marital status and socioeconomic region of residence in Oslo on change in mental health between ethnic Norwegian and ethnic minority boys and girls from age 15 to 18 years.

CONCLUSIONS

Ethnic disparities in mental health remained the same from age 15-16 and throughout teenage years. Demographic factors adjusted for had no different impact on changes in mental health between host and immigrant adolescents.

Neighborhood and Family Influences on Educational Attainment: Results from the Ontario Child Health Study Follow-Up 2001

This study uses multilevel models to examine longitudinal associations between contextual influences (neighborhood and family) assessed in 1983 in a cohort of 2,355 children, 4-16 years of age, and educational attainment in 2001. Variation in educational attainment in 2001 attributable to between-neighborhood and between-family differences was 8.17% and 36.88%, respectively. The final model explained 33.64% of the variance in educational attainment, with unique variances of 14.53% for neighborhood and family-level variables combined versus 10.94% for child-level variables. Among the neighborhood and family-level variables, indicators of status (5.29%) versus parental capacity/family process (4.03%) made comparable predictions to attainment while children from economically disadvantaged families did not benefit educationally from living in more affluent areas.

Tobacco use among immigrant and nonimmigrant adolescents: individual and family level influences

PURPOSE

To identify individual and family level characteristics that might explain differences in rates of tobacco use among immigrant and nonimmigrant adolescents.

METHODS

Data for analysis come from a probability sample of 5401 adolescents aged 12-18 years participating in the Ontario Health Survey (OHS). Three groups were compared: (a) adolescents born in Canada to Canadian-born parents (n = 3886), (b) adolescents born in Canada to immigrant parents (n = 1233), and (c) adolescents born outside of Canada (n = 282). Discrete, multilevel logistic regression was used in the analysis.

RESULTS

Adolescents born outside of Canada report the lowest rates of tobacco use, despite greater economic hardship. A negative association emerges between family socioeconomic status and tobacco use among adolescents born in Canada but not among adolescents born outside of Canada. Immigrant youth are less likely to affiliate with peers who smoke and are more likely to come from families where parents do not smoke: these differences partially explain the decreased rates of tobacco use among immigrant adolescents.

CONCLUSIONS

Although subject to greater economic hardship, immigrant youth are less likely to engage in tobacco use. Protective factors associated with immigrant family life, such as lower rates of parental tobacco use and less exposure among immigrant adolescents to peers who smoke, may counteract some of the negative effects of poverty and social hardship. Future research should begin to address the processes that lead to adaptive outcomes among adolescents from immigrant families, despite greater exposure to social disadvantage.

Caring for migrant and refugee children: challenges associated with mental health care in pediatrics

This article reviews aspects of the mental health care of migrant and refugee children. It highlights the challenges of access to care for these children and of considering the role of pediatricians in their mental health care. It also looks at the sources of differences in presentation of mental health issues of migrant youth when compared with dominant culture youth, examining the contributions of culture, context, and the families' own views. Models of care will be described that have tried to elicit a better understanding of the difficulties migrant and refugee children may encounter. Some avenues through which we may expand our current psychiatric models of care will also be addressed. These avenues include the use of interpreters and cultural brokers, addressing the debate around ethnic matching between therapists and patients, promoting a sensitivity to otherness and mediation, and looking at the importance of time issues.

Profile of a metropolitan North American immigrant suicidal adolescent population

OBJECTIVE

Canadian immigrant adolescents have a lower suicide rate than their nonimmigrant peers. We conducted a hypothesis-generating analysis to determine whether this lower rate correlated with level of drug use and (or) with diagnostic and demographic characteristics of Canadian immigrant adolescents presenting to an emergency room for crisis assessment.

METHOD

Known risk factors for suicide were compared among immigrant youth, North American youth, and a culturally mixed group of youth at baseline and at 6-month follow-up.

RESULTS

The immigrant group was only differentiated by a lower rate of reported drug use.

CONCLUSION

The lower rate of reported drug use at the time of crisis may contribute to the lower suicide rate among immigrants.

Children's experience of loss by parental migration in inner-city Jamaica

Migratory separation, when parents migrate and leave their children behind, was investigated in a case-control sample of 9- to 10-year-olds living in inner-city communities in Kingston and St Andrew, Jamaica (N = 54). Data analyses using descriptive statistics and bivariate correlations showed that children's reactions to their parents' migration were directly related to poor school performance and psychological difficulties. Additionally, being currently exposed to violence in the home and/or community was significantly associated with high scores on a measure of grief intensity. "Protective" factors included having someone to talk to about the migration and living in a supportive family. Migratory separation needs detailed investigation like that devoted to other childhood family disruptions, such as parental divorce or death.

The health of immigrants and refugees in Canada

Canada admits between more than 200,000 immigrants every year. National policy emphasizes rigorous selection to ensure that Canada admits healthy immigrants. However, remarkably little policy is directed to ensuring that they stay healthy. This neglect is wrong-headed: keeping new settlers healthy is just, humane, and consistent with national self-interest. By identifying personal vulnerabilities, salient resettlement stressors that act alone or interact with predisposition in order to create health risk, and the personal and social resources that reduce risk and promote well-being, health research can enlighten policy and practice. However, the paradigms that have dominated immigrant health research over the past 100 years--the "sick" and "healthy immigrant," respectively--have been inadequate. Part of the problem is that socio-political controversy has influenced the questions asked about immigrant health, and the manner of their investigation. Beginning with a review of studies that point out the shortcomings of the sick immigrant and healthy immigrant paradigms, this article argues that an interaction model that takes into account both predisposition and socio-environmental factors, provides the best explanatory framework for extant findings, and the best guide for future research. Finally, the article argues that forging stronger links between research, policy and the delivery of services will not only help make resettlement a more humane process, it will help ensure that Canada benefits from the human capital that its newest settlers bring with them.

Effects of internal displacement and resettlement on the mental health of Turkish children and adolescents

AIMS

To evaluate the effects of internal displacement and resettlement within Turkey on the emotional and behavioral profile of children, age 5-18 after controlling for possible confounding and demographic variables.

METHOD

We conducted a national population survey using a self-weighted, equal probability sample. We compared the CBCL, TRF and YSR responses regarding children with (n = 1644) and without (n = 1855) experience of internal displacement. We examined the effects of gender, age, paternal employment, resettlement, urban residence and physical illness.

RESULTS

The children and adolescents with internal displacement had significantly higher internalizing, externalizing and total problem scores on the CBCL and YSR, and higher internalizing scores on the TRF. The effect of displacement was related to higher internalizing problems when factors like physical illness, child age, child gender and urban residence were accounted. The overall effect was small explaining only 0.1-1.5% of the total variance by parent reports, and not evident by teacher reports.

DISCUSSION

To our knowledge the present study is the first to examine Turkish children and adolescents with and without experience of internal displacement. The results are consistent with previous immigration studies: child age, gender, presence of physical illness and urban residence were more important predictors of internalization and externalization problem scores irrespective of informant source.

Psychopathology and mental health service utilization by immigrants' children and their families

To investigate the psychopathology of immigrants' children and psychiatric service utilization by the immigrant families, data were collected from the files of all 35 immigrant children seen over a 3-year period at the Community Mental Health Centre of the Athens University Psychiatric Department. Immigrant children were matched by age, gender and intake date with 70 Greek children. Data concerned information about the child's place of birth, current living conditions, parents' country of origin, social and economic situation, occupations and educational status, social insurance, psychiatric history, referral source, diagnostic and therapeutic services rendered, number of sessions and outcome. Utilization of services was assessed 6 months after intake. No significant differences were found regarding family's structure and parents' psychopathology. However, immigrant families had significantly worse economic situations, lower status jobs, worse housing and were usually uninsured. No significant differences were observed regarding service utilization parameters, except concerning 'cooperation with other services' No differences were found regarding frequency or type of psychiatric diagnosis. However, 91% of the immigrant group received a psychosocial diagnosis as opposed to 49% of the Greek group. Immigrant children did not present more serious or diverse psychopathology than did Greek children. Immigrant families had equal levels of service utilization as Greek families. However, it was apparent that immigrant families did not apply for help as readily as their Greek counterparts.

Do risk factors for problem behaviour act in a cumulative manner? An examination of ethnic minority and majority children through an ecological perspective

BACKGROUND

Extensive research has identified risk factors for problem behaviour in childhood. However, most of this research has focused on isolated variables, ignoring possible additive influences. The purpose of this study was to examine whether risk factors for problem behaviour act in a cumulative manner, and to investigate whether cumulative risk stemming from distinct ecological levels (Bronfenbrenner, 1979) differentially influences the manifestation of problem behaviours in middle childhood. In addition, ethnic differences between minority (i.e., Indian) and majority (i.e., English) families were examined.

METHODS

The sample consisted of 125 children (59 English and 66 of Indian origin) between the ages of 7 and 9.6 (M = 8.51, SD = 0.62) and their parents. Both mothers and fathers completed questionnaires regarding the children's problem behaviour and provided reports of the children's characteristics and environment. Children were also assessed and provided reports about themselves and their relationships. Finally, parent-child mutuality and parenting behaviour were coded from a videotaped parent-child interaction task.

RESULTS

Risk factors acted in a cumulative manner - the more risk children experienced, the more problem behaviour they exhibited. Total problem behaviour was predicted by all three levels: individual, microsystem and exosystem. However, externalising problems were mainly predicted by microsystem-level cumulative risk, whereas internalising problems were predicted by both individual-level cumulative risk and exosystem-level cumulative risk. These results were similar for both ethnic groups.

CONCLUSIONS

The support for the cumulative hypothesis highlights the importance of having a broad picture of children's characteristics and environmental components when analysing children's adjustment. The distinct influence of risk stemming from the different ecological levels suggests that the trajectories of internalising, externalising and total problem behaviour may be different.

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.

Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren

OBJECTIVE

Many recent immigrant children are at risk for violence exposure and related psychological distress resulting from experiences before, during, and after immigration. This study examines the rates of violence exposure and associated symptoms among recent immigrant children in Los Angeles.

METHOD

1,004 recent immigrant schoolchildren (aged 8-15 years) were surveyed about their prior exposure to violence and symptoms of posttraumatic stress disorder (PTSD) and depression. Participants included children whose native language was Spanish, Korean, Russian, or Western Armenian.

RESULTS

Participants reported high levels of violence exposure, both personal victimization and witnessing violence, in the previous year and in their lifetimes. Thirty-two percent of children reported PTSD symptoms in the clinical range, and 16% reported depressive symptoms in the clinical range. Although boys and older children were more likely to have experienced violence, girls reported more PTSD and depressive symptoms. Linear multiple regressions revealed that PTSD symptoms were predicted by both recent and lifetime violence exposure (p values < .001 and p < .05, respectively), when depressive symptoms and gender were controlled. On the other hand, depressive symptoms were predicted by recent victimization only (p < .001) when PTSD and gender were controlled.

CONCLUSION

These findings document the need for interventions addressing the psychological sequelae of violence exposure in immigrant children.

Theoretical basis and program design of a school-based mental health intervention for traumatized immigrant children: a collaborative research partnership

This article describes a collaborative research model for school-based mental health services that targets children who are recent immigrants with violence-related mental health symptoms. The model describes a conceptual framework used in the establishment of an academic-community partnership during the development, evaluation, and implementation of the Mental Health for Immigrants Program (MHIP), a school-based mental health intervention. The article discusses the challenges that occurred and provides specific examples of how a participatory research partnership may work together through all program phases--design through implementation and program evaluation--to meet a specific community's needs and produce generalizable knowledge. The challenges and limitations of collaborative research approaches also are discussed, with particular emphasis on the role of participatory research in the development and evaluation of school-based mental health programs.

Poverty, family process, and the mental health of immigrant children in Canada

OBJECTIVES

This study examined the differential effects of poverty on the mental health of foreign-born children, Canadian-born children of immigrant parents, and children of non-immigrant parents.

METHODS

Secondary analysis of data from a national Canadian study of children between 4 and 11 years of age was conducted.

RESULTS

Compared with their receiving-society counterparts, foreign-born children were more than twice as likely to live in poor families, but they had lower levels of emotional and behavioral problems. The effect of poverty on children's mental health among long-term immigrant and receiving-society families was indirect and primarily mediated by single-parent status, ineffective parenting, parental depression, and family dysfunction. In comparison, the mental health effect of poverty among foreign-born children could not be explained by the disadvantages that poor families often suffer.

CONCLUSIONS

Poverty may represent a transient and inevitable part of the resettlement process for new immigrant families. For long-stay immigrant and receiving-society families, however, poverty probably is not part of an unfolding process; instead, it is the nadir of a cycle of disadvantage.

Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study

The current study examines the risk-inducing effects of unemployment and the protective effects of language facility on the mental health of Southeast Asian refugees resettling in Canada. Rates of depression and of unemployment declined dramatically during the first decade after arrival. Although language fluency also improved during this period, approximately 8% of the sample spoke no English even after 10 years in the country. Initial depression was a strong predictor of subsequent depression. For males, job experience in Canada was the strongest predictor of subsequent employment whereas, for women, depression proved an important predictor of employability. For men in particular, unemployment was a potent risk factor for depression. During the initial period of resettlement, English-speaking ability had no effect on depression or on employment. However, by the end of the first decade in Canada. English language fluency was a significant predictor of depression and employment, particularly among refugee women and among people who did not become engaged in the labor market during the earliest years of resettlement. Study results demonstrate that the mental health salience of risk and protective factors changes according to the phase of resettlement.

Hospital Admissions among Returning Migrant Children and Adolescents

The purpose of the present study was to explore the morbidity, especially psychiatric and psychosomatic morbidity, of Finnish remigrant children and adolescents who have lived part of their lives in Sweden. The study subjects consisted of 287 remigrants and 305 controls. Hospital admissions in these two groups were analyzed over an eleven year period after the study subjects' remigration to Finland. We found psychiatric morbidity, frequent hospitalizations and infectious diseases to be more common among the remigrants. These findings were consistent with the previous studies on Finnish remigrants from Sweden.

Living conditions and emotional profiles of Cambodian, Central American, and Québécois youth

OBJECTIVE

To compare Cambodian and Central American adolescent refugees to Quebec with their Quebec-born peers in regard to emotional and behavioural problems, feelings of competence, and risk-behaviour profiles, and to examine relations between emotional variables and living conditions in the 3 groups.

METHOD

The sample consisted of 76 Cambodian, 82 Central American and 67 Québécois youth living in the Montreal area. The teenagers' internalization and externalization symptoms were assessed using the Child Behaviour Checklist (CBCL) and the Youth Self-Report (YSR); the YSR also provided a measure of their feelings of competence. Risk behaviour was reported by the teenagers. The socioeconomic status of the teenagers' households was taken into account in multiple regression analyses conducted for each group.

RESULTS

The level of emotional and behavioural problems reported by teenagers was lowest in Central Americans and highest in Québécois; the latter group also reported more risk behaviours than did either refugee group. The socioeconomic status of the Cambodian and Central American refugee households was lower than that of the Québécois. Living conditions were not a major determinant of emotional distress in young Cambodians, but low annual income was associated with internalizing symptoms among Central American youth. The most powerful predictor of externalizing symptoms among the Québécois youth was having a single-parent household.

CONCLUSION

This study underscores the contrast between the living conditions of young Cambodian and Central American refugees to Quebec and those of Quebec-born youth. These refugees' precarious socioeconomic status is not accompanied by an increase in adolescents' emotional and behavioural problems.

Emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents

OBJECTIVE

The aim of this study was to compare levels of emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents, and to determine factors that may contribute to any differences reported.

METHOD

Subjects were selected randomly from students aged 12-16 years attending a high school with a high proportion of immigrants in Perth, Western Australia. Parents completed the Child Behaviour Checklist (CBCL), and students completed the Youth Self-Report (YSR) and a Personal History Questionnaire.

RESULTS

On univariate analyses, non-immigrant adolescents had significantly higher CBCL and YSR scores than immigrant adolescents. Multivariate analyses suggested that CBCL scores were predicted by a number of variables other than immigration, including family intactness, socioeconomic status (SES) and gender. Higher YSR scores were predicted by non-intact families, school setting and non-immigrant status, and higher competencies scores were predicted by higher SES and parents not being immigrants.

CONCLUSIONS

In assessing the effects of immigration on adolescent mental health, it is important to control for factors associated with adolescent behavioural and emotional problems and to use multiple informants. Overall, immigrant adolescents report fewer total and externalizing problems and fewer competencies than native-born adolescents. This finding may reflect strict immigration policies or cultural differences in definitions of psychopathology and the social expectations for adolescents' behaviour.

Association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents

OBJECTIVES

The purpose of this study was to determine the association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents.

METHODS

A cross-sectional survey of adolescents at a New York City high school was conducted. Multivariate modeling methods were used to adjust for demographic and socioeconomic covariates.

RESULTS

Duration of residence was strongly and directly associated with access to ambulatory care after adjustment for ethnicity.

CONCLUSIONS

Caribbean immigrant adolescents, particularly recent immigrants, have reduced access to ambulatory care.

Immigrant and refugee children in Canada

In view of Canada's commitment to immigration, understanding the sources of successful adaptation by immigrant and refugee children is vital. This paper reviews the literature on the mental health of migrant children and suggests an agenda for future research.