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PubMed1994

Some correlates of child mortality in the refugee populated regions in Tanzania.

Data from the 1988 Tanzania census were used to examine child mortality in three regions populated with Burundi refugees. Logistic and least squares analyses show that for both Tanzanian nationals and refugees low levels of maternal education are associated with high child mortality levels. Children born to mothers who are housewives are associated with low levels of mortality compared to those born to employed mothers, though the results were not statistically significant for the refugees. Maternal demographic status, computed from age and parity, has a strong effect on child survival. Unexpectedly, child mortality was lower where the water source was a well outside the village. Tanzanian mothers who are at highest risk of childbearing are roughly 6.4 times more likely to have a child death than those at lowest risk; the corresponding figure for the refugees is 36.8. This emphasises the need to intensify family planning programmes in these regions.

Adolescent↗
PubMed1993

Unemployment, underemployment and depressive affect among Southeast Asian refugees.

This study of 1348 adult Southeast Asian refugees resettling in Vancouver, British Columbia and a comparison sample of 319 permanent residents of the city demonstrates a reciprocal relationship between unemployment and depressive affect. Increased risk of depression accompanied job loss and depression made it more difficult to stay employed. Although the association between unemployment and depression was common to both refugee and host society samples, links between these phenomena proved different in the two groups. In contrast to the refugees for whom income loss was the over-riding stress resulting from job loss, loss of esteem and loss of social contact also proved to be salient stressors for resident Canadians. Although a threat to the mental health of resident Canadians, underemployment--working at a level which considering one's education and previous occupation, is lower than might be expected--did not jeopardize the mental health of refugees.

Adult↗
PubMed2001

Neuropsychological issues in the assessment of refugees and victims of mass violence.

Brain injury, stressor severity, depression, premorbid vulnerabilities, and PTSD are frequently intertwined in trauma populations. This interaction is further complicated when the neuropsychologist evaluates refugees from other cultures. In addition, the observed psychiatric symptoms reported in refugees and victims of mass violence may in fact not be the primary features of PTSD and depression but psychiatric symptoms secondary to the effects of traumatic brain injury. This paper reviews the occurrence of starvation, torture, beatings, imprisonment, and other head injury experiences in refugee and POW populations to alert treators to the presence of chronic and persistent neuropsychiatric morbidity, with implications for psychosocial adjustment. The concept of fixed neural loss may also interact with environmental and emotional stresses, and a model of neuropsychological abnormalities triggered by traumatic events and influenced by subsequent stress will also be considered. Neuropsychologists working with refugees play an important role in assessing the possibility of traumatic brain injury with tools that are relatively culture-fair.

Adaptation, Psychological↗
PubMed2003

A survey of refugee health assessments in the United States.

We conducted a survey among nine geographically dispersed, large metropolitan refugee health programs to estimate the number of U.S. refugee arrivals during 1997 and 1998, the number receiving health assessments, and the percentage of sites offering health services. The nine sites received an estimated 40% of all U.S. refugee arrivals during the study period. Of these refugees, 76% received a health assessment. The completeness of health assessments, including services offered, varied by site; some services were provided by the private sector. Most sites offered services for infectious diseases and vaccinations. While 78% of the sites offered mental health care, but only 33% actually performed mental status examinations. These statistics show that such health services need to be provided on a broader basis and possibly reflect a need to address cultural and language barriers that might be preventing their delivery to this diverse population.

Centers for Disease Control and Prevention, U.S.↗
PubMed1999

Screening for posttraumatic stress disorder symptoms among Bosnian refugees.

To assess the level of posttraumatic stress disorder (PTSD) symptoms among Bosnian war refugees, a consecutive cohort of 206 Bosnian refugees, arriving in Sweden in 1993, was screened for PTSD using a modified version of the self-report instrument PTSS-10. A comparison group of 387 visitors to seven Swedish health centers was recruited. Prevalence of possible PTSD, using two estimates, was 18 to 33% among the Bosnian refugees, and .3 to 1% in the comparison group. The PTSS-10 showed high internal consistency reliability (Cronbach's alpha = .92) and stability (test-retest reliability r = .89). Thus, Bosnian war refugees showed high levels of PTSD symptoms compared to a nonrefugee comparison group.

Adult↗
PubMed2002

Depression and parasuicide in refugee and Slovenian adolescents.

The association between depression and traumatic experiences, stress, loss, and bereavement is well known. It was expected that Bosnian refugee adolescents who had fled from war zones to Slovenia would develop higher levels of depression than their Slovenian peers without war traumatic experiences. Two years after the beginning of the war in Bosnia, 265 8th-grade refugee students aged 14 to 15 years were assessed with the Children's Depression Inventory (CDI) and compared with a sample of 195 Slovenian students of the same age. The Bosnian refugees showed significantly lower rates of depressive symptomatology despite very high rates of posttraumatic stress symptoms. Slovenian adolescents showed significantly lower self-esteem and greater feelings of inadequacy in the academic field; they were more likely to have feelings of not being loved and more often expressed the wish to kill themselves. Refugees described more sadness, worried about the future and about physical pains, but they do not show lower school achievement or more behavioral problems. The results indicate that the association between traumatic experiences and depressive symptoms is not inevitable, and that other factors including culture and context influences must be taken into account.

Adolescent↗
PubMed2004

A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement.

Little is known about the usefulness of psychotherapeutic approaches for traumatized refugees who continue to live in dangerous conditions. Narrative exposure therapy (NET) is a short-term approach based on cognitive-behavioral therapy and testimony therapy. The efficacy of narrative exposure therapy was evaluated in a randomized controlled trial. Sudanese refugees living in a Ugandan refugee settlement (N = 43) who were diagnosed as suffering from posttraumatic stress disorder (PTSD) either received 4 sessions of NET, 4 sessions of supportive counseling (SC), or psychoeducation (PE) completed in 1 session. One year after treatment, only 29% of the NET participants but 79% of the SC group and 80% of the PE group still fulfilled PTSD criteria. These results indicate that NET is a promising approach for the treatment of PTSD for refugees living in unsafe conditions.

Adult↗
PubMed2003

The long-term impact of torture on the mental health of war-wounded refugees: findings and implications for nursing programmes.

Today, nurses from many disciplines are expected to provide nursing care to refugees severely traumatized in war and conflict. The general aim of this study was to explore the long-term impact of torture on the mental health of war-wounded refugees. The study group consisted of 22 tortured and 22 nontortured male refugees who had been injured in war. Standardized interview schedules, exploring different background characteristics, and three instruments for assessment of mental health were used: the Hopkins Symptom Checklist, the Post Traumatic Symptom Scale and a well-being scale. The prevalence of psychiatric symptoms was high in both groups. However, there were no significant differences in mental health between the tortured and the nontortured refugees. The patterns of associations between background characteristics and mental health were different in the two groups. The strongest associations with lower level of mental health were higher education in the tortured group and unemployment in the nontortured group. Methodological difficulties in research on sequelae of prolonged traumatization remain. Further studies within the caring sciences can broaden the present understanding of the impact of torture and other war traumas.

Adult↗
PubMed1996

Impact of a mass vaccination campaign against a meningitis epidemic in a refugee camp.

Serogroup A meningococcus epidemics occurred in refugee populations in Zaire in August 1994. The paper analyses the public health impact of a mass vaccination campaign implemented in a large refugee camp. We compared meningitis incidence rates from 2 similar camps. In Kibumba camp, vaccination was implemented early in the course of the epidemic whilst in the control camp (Katale), vaccination was delayed. At a threshold of 15 cases per 100 000 population per week an immunization campaign was implemented. Attack rates were 94 and 134 per 100,000 in Kibumba and Katale respectively over 2 months. In Kibumba, one week after crossing the threshold, 121,588 doses of vaccine were administered covering 76% of all refugees. Vaccination may have prevented 68 cases (30% of the expected cases). Despite its rapid institution and the high coverage achieved, the vaccination campaign had a limited impact on morbidity due to meningitis. In the early phase in refugee camps, the relative priorities of meningitis vaccination and case management need to be better defined.

Democratic Republic of the Congo↗
PubMed1986

UNRWA and the health of Palestinian refugees. United Nations Relief and Works Agency.

The United Nations Relief and Works Agency for Palestine refugees (UNRWA) has provided health, education, and welfare services since 1949. A team of physicians from Georgetown University visited UNRWA Health Centers and refugee camps in Jordan, Lebanon, the West Bank, and the Gaza Strip, as well as some affiliated hospitals. Living conditions of refugees vary widely. In Jordan and the West Bank, fewer than one third live in camps, whereas in the Gaza Strip and Lebanon, conditions are more crowded. Effective programs for health education, maternal and child health, and immunization have markedly improved the health of the refugees over the years of UNRWA's operation. The general health of the population is good, primarily as a result of wise emphasis on public health and preventive medicine measures.

Child↗
PubMed1989

Hepatitis B virus infection among children born in the United States to Southeast Asian refugees.

Since 1975 nearly 1 million persons have entered the United States from Southeast Asia, where infection with hepatitis B virus (HBV) is hyperendemic. To evaluate the prevalence and patterns of transmission of HBV infection among the children of refugees from Southeast Asia, we studied 196 refugee families with 257 children born in the United States. Of 31 children born in the United States to mothers with infectious disease, 17 (55 percent) had been infected with HBV. Of 226 children whose mothers did not have infectious disease, 15 had HBV infection--a prevalence of 6.6 percent (95 percent confidence interval, 4.1 to 10.7). The risk of infection was greatest (26 percent) among children living in households with children with infectious disease (relative risk, 5.5; confidence interval, 2.3 to 13.4). Exposure to fathers or other adults with infectious disease was not significantly associated with infection. Of children from households with no persons with infectious disease, 3.9 percent (confidence interval, 1.7 to 8.8) were infected. Nearly half (46 percent) the cases of HBV infection among the U.S.-born children of refugees were not attributable to perinatal transmission from a mother with infectious disease. We conclude that child-to-child transmission may be occurring within and between households. Current recommendations to immunize the newborns of mothers with infectious disease are not sufficient to protect all U.S.-born children of Southeast Asian refugees from HBV infection early in life, when the risk of chronic sequelae and premature death is highest. We recommend that the HBV vaccination policy be expanded to include all newborns of Southeast Asian immigrants.

Asia, Southeastern↗
PubMed2004

A systematic review of questionnaires measuring the health of resettling refugee women.

Because many ethnically diverse refugee women resettle in industrialized countries, several biopsychosocial factors need to be considered in caring for them. This systematic review of studies conducted with female refugees, asylum-seekers, or "unspecified" immigrants based on six electronic databases was conducted to determine which questionnaires best measure relevant variables. Questionnaires were reviewed for measurement properties, application of translation theory, and quality of representation. Studies must have included > or = 1 measure of the following: general health; torture, abuse, sex-and-gender-based violence (SGBV); depression; stress; posttraumatic stress disorder (PTSD); anxiety; somatization; migration history; social support; socioeconomic status; discrimination; or mother-child interactions. Fifty-six studies using 47 questionnaires were identified; only five had strong evidence for use with resettling refugee women. Thus, few high-quality tools are available to measure concepts relevant to resettling refugee women's health.

Battered Women↗
PubMed2003

Refugee families during asylum seeking.

The mental health of refugee families with children during the asylum period is a neglected research area in psychiatry. The present paper describes the situation of 10 refugee families residing at an asylum centre in Finland. Case vignettes are presented to illustrate the situations of these families. The study shows a high rate of depressive and post-traumatic stress disorder-related symptoms among adult refugees. The case vignettes suggest that during the asylum period, many children and adult members of the family are not in a post-traumatic situation, but they live constantly in a distressing situation. The foremost distress amongst the asylum seekers appeared to be fear of deportation and separation from family members. Most of the adults and all children had not received any psychiatric or psychotherapeutic assessment or treatment. It is likely that current procedures for dealing with the asylum seekers contributes to the level of stress, family confusion and psychiatric problems in already traumatized refugee families.

Acculturation↗
PubMedDate not supplied

The health of Bosnian refugees in Canada.

UNLABELLED: Many investigators of refugee health have assumed that due to the stresses associated with trauma and forced resettlement, refugees experience more pathology and resulting poor health than their host populations. However, because contradictory findings have emerged from some of these studies, a clear connection between the experiences of trauma, resettlement and health remain ambiguous. OBJECTIVES: The goal of this descriptive study was to put aside initial assumptions pertaining to the health of Bosnian refugees in the study. Rather, health was defined primarily by participants, through personal descriptions and perceptions of their experiences and associated health over time. DESIGN: Ten Bosnian refugees were selected according to age, gender, ability to speak English, and period of time in Canada. Each participant was interviewed on three occasions over a 3-month period in order to gather information pertaining to their experiences and health. Qualitative and quantitative methods were triangulated, that is, an informal, unstructured interview was augmented by investigator observations and structured health and demographic questions. RESULTS: The findings have shown that while war trauma and forced resettlement indeed posed serious risks to participants' health, on balance, they verbalized and were observed to be experiencing positive health and function. CONCLUSIONS: The ability of experience positive health and function in varying degrees following exposure to war trauma and forced resettlement appeared to be largely due to interactions between life events and cumulative personal, psychosocial, and cultural characteristics over time that modified the health risks associated with war trauma and forced resettlement.

Adaptation, Psychological↗
PubMedDate not supplied

War-wounded refugees: the types of injury and influence of disability on well-being and social integration.

The aim of this study is to describe the war injuries and investigate the influence of physical disability on well-being and social integration in a group of war-wounded refugees after two years in Sweden. A culturally heterogenous sample of 54 war-wounded refugees was investigated during hospitalization shortly after arrival, and after two years. Quantitative data were covered by physical examinations, interviews and questionnaires. In addition, qualitative data were collected within semi-structured interviews on both occasions. The major types of war injuries were: fractures (22%), traumatic amputations (17%), spinal cord injuries (17%), nerve injuries (11%), combinations of fractures and nerve injuries (9%), bilateral eye injuries (9%), brain injuries (7%), other injuries (7%). Regarding the type of injuries and medical complications, the group studied was representative of small unit operations of war with low access to early medical care. The degree of physical disability was not a salient factor for well-being and social integration after two years in Sweden. The losses and desires to be repatriated were apparent from the qualitative findings, as exemplified by three case reports. The findings of this study are in accordance with previous research on refugees and war-injured ex-combatants, but further multidisciplinary research is needed. The results also imply that resettlement countries should pay continuous attention to the broad needs of their war-wounded refugees.

Humans↗
PubMedDate not supplied

The trauma of being a refugee.

This article attempts to convey a human 'feel' for the refugee and the helper, without being oppressively expert or conveying pity. It explores differences and similarities between post-traumatic stress disorder and surviving and coping capacities, leading to an argument against biased use of western forms of psychological help and a plea for fitting in with local cultural patterns for coping with disaster. The difference between 'victim' and 'survivor' is emphasized and the problems of gratitude and envy in both helped and helper considered. In FYR Macedonia deskilled professionals became their own 'experts' as they responded imaginatively to the refugees on their doorstep. They wanted professional support, literature, supervision, consultancy and friendship, but not to be told 'how to do it'. The concept of 'resilience' is examined. Some children survive the disaster others do not. The latter suffer as refugees, whilst those initially terrified benefit from the security and predictability of camp life. An attempt is made to acknowledge normal coping capacities and allow for cultural differences in ways of coping, and so to emphasize survival rather than collapse or victimisation, while not denying the pain, terror, boredom, and frustration of being a refugee. This may lead to mental breakdown, PTSD, pathological grieving, but it does not automatically do so. There is no panacea of 'treatment', but it is essential to support and enable survivors.

Adaptation, Psychological↗
PubMed2004

The psychological and social situation of repatriated and exiled refugees: a longitudinal, comparative study.

AIMS: The aim of this study was to explore possible differences in the longitudinal course of psychological symptoms and somatic symptoms between one group of Bosnian refugees returning to their home country (B) and one group remaining in the host country (N). The aim was also to look for possible differences in pre-flight traumatic experiences and psychological symptom load within the groups. In addition the experiences of returning home after a period in exile were studied, based on quantitative and qualitative data. METHODS: The study is a follow-up study of 21 Bosnian refugees returning to Bosnia compared with 175 refugees remaining in exile in Norway. Quantitative results are supplemented with qualitative information. RESULTS: Both groups demonstrated persistence of psychological symptoms, indicating severity and chronicity of the problems. The main findings were that refugees with a former history of traumatic experiences of a physical character were less willing to return. A decrease over time in all symptom parameters was found in the repatriated group with a statistically significant decline for the PTSS-16 and HTQ scores (p<0.05). CONCLUSIONS: Chronicity of psychological symptom load was found in both groups. The decision to return home seems to be closely connected to pre-flight traumatic experiences. An early decision to return home seems to be persistent over time.

Adolescent↗
PubMed1998

Refugee children from the Middle East.

OBJECTIVE: To map the frequency (prevalence) of torture victims among parents in asylum seeking Middle Eastern refugee families, to map the occurrence (prevalence) of experiences of war and other forms of organised violence among the children in these families, to map the occurrence (prevalence) of emotional symptoms and behavioural problems among the children, and to identify risk indicators and modifying factors for anxiety symptoms among the children. DESIGN: Interview with parents using a structured interview questionnaire developed for this study. Validated through a blinded semi-structured interview conducted with approximately 1/3 of the families. AUSPICES: The study has been carried out by the Rehabilitation and Research Centre for Torture Victims (RCT) in cooperation with the Danish Red Cross. MATERIAL: Structured interviews with parents regarding 311 children aged 3-15 from 149 families, all registered as asylum seekers from the Middle East between February 1, 1992 and April 30, 1993. The response was 90.4%. PRINCIPAL VARIABLES: Background (past-past)--social and demographic data; trauma complex (past)--war-related life circumstances (conditions) and experiences of war and other forms of organized violence such as loss, separation, direct exposure to violence and witnessing acts of violence (specific events and changes of life conditions); present life context (past-present)--family circumstances upon arrival in Denmark; effect (present)--the child's current psychological state. RESULTS: 28% of the parents (44% of the fathers and 13% of the mothers) had been tortured, to the effect that 51% of the children were part of a family including a survivor of torture. The most frequent specific types of violence-related events or circumstances were 'lived in a refugee camp outside the home country' (92%), 'lived under conditions of war' (89%) and 'been on the run with parents' (89%). Twenty percent of the children had lost one parent, and another 60% had been separated from one parent for more than a month. The highest prevalence of emotional symptoms were found within the anxiety dimension, as 67% of the children were assessed as being clinically anxious. The most important risk indicators for anxiety were 'lived in a refugee camp outside the home country', 'part of a torture surviving family', 'lack of opportunities for play with other children', 'beaten/kicked by an official', and 'loss of father'. Current parental behaviour was also an important risk indicator for anxiety, if the mother or father hit or punished the child more than was the case prior to arrival in Denmark. The most important anxiety-modifying factor was arrival in Denmark in the company of both parents. CONCLUSIONS: Asylum seeking refugee children from the Middle East have had many experiences of war and other forms of organised violence. The children frequently reacted with anxiety and with other symptoms of emotional instability. Prevalent anxiety symptoms correlated both with previous living conditions and present family situation. Living under prolonged conditions influenced by war and other forms of organised violence (prevalence) were found to a higher degree to be risk indicators for anxiety than were specific events or changes of life conditions (incidence).

Adolescent↗