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PubMed2006

Screening for PTSD among Somali adolescent refugees: psychometric properties of the UCLA PTSD Index.

This study presents the psychometric properties for the UCLA Posttraumatic Stress Disorder Index among a sample of Somali adolescents. Data were derived from a sample of English-speaking Somali adolescent refugees between the ages of 12 and 19 years (n=76). The UCLA PTSD Index showed good reliability (Cronbach's alpha=.85). Convergent validity was assessed through bivariate correlations with the Depression Self Rating Scale (r=.72, p<.001) and the War Trauma Screening Scale (r=59, p<.001). Results suggest that the UCLA PTSD Index may be a reliable and valid screening tool for PTSD symptoms for use with Somali adolescent refugees.

Adolescent↗
PubMed2006

Inconsistencies in the self-report of traumatic experiences by unaccompanied refugee minors.

The authors investigated the consistency with which stressful life events are reported by unaccompanied refugee minors during a 12-month follow-up period and analyzed to what extent demographic and psychopathology variables affected memory consistency. From a population-based sample of 920 unaccompanied refugee minors aged 12 to 18 years old, 63% completed the follow-up measurements. Younger participants and those with lower levels of internalizing behavior and posttraumatic stress at follow-up were more prone to memory inconsistencies. Moreover, younger participants and those with fewer inconsistencies were more likely to have obtained a temporary residence permit. Given the difference between accuracy and consistency, it is not warranted to interpret memory inconsistencies as an indication of lack of credibility when assessing traumatic life events in minors applying for asylum.

Adolescent↗
PubMed1988

An outbreak of cholera in a refugee camp in Africa.

A total of 541 cases of cholera were observed between May 7 and July 19, 1985 among the 9,929 displaced persons present in a refugee camp in Africa. In spite of malnutrition and other diseases affecting this population, only 12 deaths occurred. Antiepidemic measures consisted of preparation of isolation-wards, treatment of contaminated materials, training of refugees and patient care. Mass prophylaxis, initially considered, was dropped before the end of the epidemic.

Adolescent↗
PubMed1986

[Does selective intervention affect other areas of primary health care? Evaluation of a vaccination program in Somali refugee camps].

The discussion, whether poor countries of the third world should work towards comprehensive or selective primary health care has been based on political and economical arguments. The present study examines how far a selective strategy with one target problem influences other areas of primary health care. The study is based on the experiences with a vaccination program in the Somalia refugee camps. The program produced for the first time a reliable census of the refugee population which produced much smaller figures than had been reported previously. Data on the nutritional status of all children under 5 was collected at the vaccination places. These data provided a new basis for the general food distribution. At the same time the data served to evaluate the supplementary feeding program for vulnerable groups. The study also showed that general food distribution was more important for the reduction of malnutrition than other interventions, such as curative health care, community water supplies, sanitation, supplementary feeding program and vaccination program. Furthermore it illustrates the conditions in which sectorial actions can become a useful asset to community oriented health programmes.

Child, Preschool↗
PubMed1994

Cross-cultural response to trauma: a study of traumatic experiences and posttraumatic symptoms in Cambodian refugees.

Despite a growing literature of cross-cultural research on mental illness, little is known about the universality of most psychiatric disorders. This study was designed to determine whether people from a very different culture have the same symptoms in response to traumatic experiences as do trauma survivors in the United States. We were also interested to find out if the severity of the current symptoms is related to the amount of trauma experienced. Furthermore, we gathered information about the perceived severity of traumatic experiences among refugees. Fifty Cambodian refugees living in the U.S. were asked about their traumatic experiences and their current symptoms of posttraumatic stress, dissociation, depression, and anxiety. High levels of all symptoms were found along with statistically significant relationships between each symptom measure and the amount of trauma experienced. We conclude that the basic symptom picture in this group was similar to that observed in U.S. trauma survivors.

Acculturation↗
PubMed2006

[Long-term effects of traumatic experiences on somatic and psychic complaints of German World War Two refugees].

The effects of expulsion from German territories following World War Two have not been studied systematically, and little is known about long-term effects of this potentially traumatic experience. Via mail, 600 refugees from former German territories due to World War Two were asked to complete questionnaires about biographic data, somatic and psychic health (SCL-90-R questionnaire), and specific aspects related to traumatic experiences (post-traumatic stress disorder questionnaire). Of those contacted, 25% participated in the investigation. Of them, 9.8% fulfilled diagnostic criteria of post-traumatic stress disorder according to DSM IV. Only 1.8% of an age-matched control group met these criteria. Analysis of the SCL-90-R questionnaire showed higher scores for former refugees in somatic and psychic complaints than the control group. We show that expulsion following war may lead to symptoms of post-traumatic stress disorder and somatic and psychic complaints after more than 50 years. Our investigation supports the necessity of adequate care for subjects expelled from their home countries and the psychologically traumatised.

Aged↗
PubMed2003

Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees--preliminary communication.

BACKGROUND: Each refugee group experiences specific migration and resettlement experiences. There are no epidemiological data on risk factors for psychiatric symptoms among adult Somalis in the UK. METHODS: We interviewed a community sample of 180 Somalis. We assessed the relationship between symptoms of psychosis (BPRS), anxiety and depression (SCL-90) and suicidal thinking (BDI) and migration-related experiences such as traumatic events, immigration difficulties, employment and income. RESULTS: Anxiety and depression was incrementally more common with each pre-migration traumatic event (OR per trauma event = 1.31, 1.06-1.62, p = 0.01). Shortages of food, being lost in a war situation, and being close to death and suffering serious injury were each related to specific psychiatric symptoms. Suicidal thinking was more common among Somalis who were unemployed before migration and those using qat in the UK. CONCLUSIONS: War-related experiences, occupational status before migration and current Qat use are risk factors for psychiatric symptoms among Somali refugees.

Adult↗
PubMed2004

PTSD and depression in refugee children: associations with pre-migration trauma and post-migration stress.

This paper describes the effect of pre-migration and post-migration experiences on the mental health of a sample of 40 refugee children aged 8-16 who lived in London with at least one parent or a refugee relative. Children's post-traumatic stress disorder (PTSD) and depression symptoms were assessed with standardised self-report measures (Impact of Event Scale and Depression Self-Rating Scale for Children, respectively). Information regarding past and present experiences were gathered during an interview with parents. There was a significant correlation between the number of pre-migration traumas experienced by the families and the children's PTSD scores. There was also a significant correlation between the families' number of post-migration stresses and children's depression scores. Higher PTSD scores were significantly associated with the pre-migration experience of violent death of family members and the post-migration experience of an insecure asylum status. Higher depression scores were significantly associated with insecure asylum status and severe financial difficulties. The clinical implications of these findings are discussed.

Adolescent↗
PubMed2005

Effectiveness of a community-based advocacy and learning program for hmong refugees.

The effectiveness of a community-based advocacy and learning intervention for Hmong refugees was assessed using a comprehensive, multi-method strategy, which included a within-group longitudinal design with four data collection points and in-depth qualitative recruitment and post-intervention interviews. The intervention's impact on five aspects of refugee well-being was examined: Participants' psychological well-being, quality of life, access to resources, English proficiency, and knowledge for the U.S. citizenship exam. Twenty-eight Hmong adults and 27 undergraduate students participated together in the intervention, which had two major components: (1) Learning Circles, which involved cultural exchange and one-on-one learning opportunities for Hmong adults, and (2) an advocacy component that involved undergraduates advocating for and transferring advocacy skills to Hmong families to increase their access to resources in their communities. Undergraduate paraprofessionals and Hmong participants worked together for 6-8 hr per week for 6 months. Growth trajectory analysis revealed promising quantitative findings. Participants' quality of life, satisfaction with resources, English proficiency, and knowledge for the U.S. citizenship test increased and their levels of distress decreased over the course of the intervention. Mediating analyses suggested that participants' increased quality of life could be explained by their improved satisfaction with resources. Qualitative data helped to support and explain the quantitative data, as well as providing insight into other outcomes and processes of the intervention. Policy, practice, and research implications are discussed.

Adolescent↗
PubMed1985

Depression among Vietnamese refugees in a primary care clinic.

Refugees are at high risk for mental disorders and manifest cultural influences in their health behavior. The Vietnamese Depression Scale was administered to Vietnamese patients at a community clinic to assess the underlying prevalence of depression. The rate of accurate diagnosis and the manifestations of depression were also examined. A high prevalence of depression (52 percent) and a high level of underdiagnosis (56 percent) by primary care physicians were found. Ninety-five percent of these patients presented with physical symptoms. Compared with patients who had negative depression scores, those who had positive depression scores were more likely to be older and sought care at the clinic more frequently. These findings underscore the importance of depression as an urgent health problem among Vietnamese refugees in primary care. Accuracy in diagnosis can be improved by using the Vietnamese Depression Scale and constitutes the first step toward effective treatment.

Adult↗
PubMed1986

Two self-rating scales for depression in Hmong refugees: assessment in clinical and nonclinical samples.

An exploratory cross-cultural study was undertaken of two widely used self-rating scales: the Zung and the Depression Scale on the 90 Item Symptom Checklist, or SCL-Depression. Both scales were translated into Hmong and tested in two samples of Hmong refugees in the U.S.A. One sample (n = 86) consisted of a field survey of all Hmong people living in Minnesota. Of the 86, 15 sought treatment and were diagnosed as having major depression during the year following their self rating, so that a comparison of patients' scores with nonpatients' scores was possible. The other sample consisted of another 51 Hmong psychiatric patients with major depression. This second group was also assessed by four psychiatric rating scales (i.e. Hamilton Depression Scale, brief Psychiatric Rating Scale, Inpatient Multidimensional Rating Scale, and Nurse's Observation Scale for Inpatient Evaluation) and two measures of treatment intensity (i.e. number of visits, duration of treatment). In the general Hmong population (n = 86), both self-rating scales were highly intercorrelated, and strongly associated with patient status. In the patient sample (n = 51), only the SCL-Depression showed any correlations with psychiatric rating scales or with treatment variables. This is contrary to the anticipated outcome, as it had been expected that the Zung would perform better than the SCL-Depression. In addition, duration of treatment was inversely correlated with the SCL-Depression, also opposite to our prediction. Probable causes for these unexpected results are presented. An item analysis was undertaken, comparing 71 Hmong survey subjects who were not treated for depression with 51 Hmong psychiatric patients who were treated for depression. Most Zung and SCL-Depression items showed significantly higher symptom levels in the depressed patients. However, non-depressed controls unexpectedly reported significantly higher symptom levels on certain items. No significant differences were observed on several Zung and SCL items. These unexpected findings are discussed in light of the refugee's adjustment and experience.

Cross-Cultural Comparison↗
PubMed1984

Tuberculosis control in Somali refugee camps.

By mid-1981 an estimated 500 000 refugees were living in camps in Somalia. As the temporary camps have become permanent, crowded settlements, tuberculosis has become an increasing health problem. Initial treatment programmes were started in most of the camps, which had no microscopy facilities or active case finding. This paper describes the subsequent evaluation of the tuberculosis programme in one of the camps in the N.W. of Somalia, with a population of 25 000, and the recommendations proposed to improve its effectiveness. Fifty per cent of patients started on treatment were lost to the programme in the first year: many had left the camp, others defaulted while remaining there. As microscopy facilities became available it was possible to concentrate the limited resources on sputum positive patients and to attempt active case finding. Evaluation of the programme has indicated particular problems in the managements of tuberculosis in refugee camps.

Humans↗
PubMed1989

Tuberculosis control in refugee settlements.

Tuberculosis and its management in refugees and other displaced persons in temporary settlements poses a challenge to organisations coordinating and providing care in refugee emergencies. This paper offers a consensus of the co-sponsoring agencies on practical recommendations for implementing measures aimed at both interrupting transmission of tuberculosis and treatment of individual patients.

Humans↗
PubMed1994

Psychological and endocrine abnormalities in refugees from East Germany: Part I. Prolonged stress, psychopathology, and hypothalamic-pituitary-thyroid axis activity.

The influence of prolonged psychological stress on hormonal secretion was investigated in 84 East Germany refugees suffering from psychiatric disorders within 6 weeks of their arrival in West Berlin shortly before or after the fall of the Berlin Wall. Before leaving the German Democratic Republic, these patients had already experienced prolonged stress, which continued after migration. In most cases, the diagnosis was anxious-depressive syndrome with vegetative complaints and symptoms of increased arousal. Their formal DSM-III-R diagnoses (American Psychiatric Association, 1987) included adjustment disorders, depressive disorders, and anxiety disorders (the latter including posttraumatic stress disorder). Serum levels of thyroid stimulating hormone (TSH) and thyroid hormones (thyroxine, free thyroxine, triiodothyronine, and reverse triiodothyronine) were measured and compared with those of 20 healthy control subjects. TSH and all thyroid hormone concentrations were significantly reduced in the patient group. Fifty-two of the patients (62%) were in the hypothyroid range but did not show any clinical signs of hypothyroidism. These disturbances in hormonal secretion were not correlated to any psychiatric diagnosis or to the severity of acute or chronic stress. The marked abnormalities in the hypothalamic-pituitary-thyroid axis seen in these refugees differ from those reported in depression and would seem to reflect severe chronic stress rather than specific psychiatric disorders. The underlying neurochemical mechanisms remain to be investigated.

Adjustment Disorders↗
PubMed1986

Vietnamese refugee children in camps in Hong Kong.

Vietnamese refugee children staying in an open camp in Hong Kong were interviewed to find out the nature of their war experience. The effects of war and refugee experience on their fears about being hurt or killed were assessed. Most of the Vietnamese children in the present sample travelled to Hong Kong with their family and had little experience of separation, death or injury of close family members. However, about two-thirds of them had witnessed violence and one-third reported experience of being assaulted. Children exposed to unpleasant war experience were more likely to report a fear of being hurt than those not exposed to similar negative events. However, there was no consistent finding relating other types of fear to war experience. The family and the cohesiveness of the community in which they lived may have protected them against adverse psychological reactions.

Adolescent↗
PubMed1990

Estimates of psychological distress among Vietnamese refugees: adolescents, unaccompanied minors and young adults.

This study focuses on the assessment of psychological distress among three subgroups of Vietnamese refugee youth: adolescents, unaccompanied minors, and young adults. Using translated and backtranslated instruments, data was gathered in refugee camps in the Philippines in order to provide baseline measurement for future comparisons, as well as to begin to develop normative standards for these populations. A rationale for the choice of instruments (Vietnamese Depression Scale, Hopkins Symptom Checklist-25 and General Health Questionnaire) is offered and mean scores and percentages scoring above established clinical cut-offs are presented. Results indicate relatively high levels of depression and anxiety for the young adult group, although anxiety appeared high across all three groups. All three groups also scored poorly on self-reports of general health, with the young adults and unaccompanied minors being especially overrepresented in the clinical range. Significant method problems were noted regarding construct validity in the assessment of depression, and instructional set differences that may account for the relatively low intercorrelations between seemingly similar measures.

Adolescent↗
PubMed1992

Child health outcomes among Central American refugees and immigrants in Belize.

The purpose of this study was to investigate the effect of international migration, including refugee status, upon child health outcomes. Data were drawn from a survey conducted in 1989 in three settlements in Belize, Central America, that have a high proportion of refugees and economic immigrants living side-by-side with the local population. In two of the settlements, the entire population of mothers with children under 6 was interviewed; in the third settlement a two-thirds random sample was interviewed. Health history data were obtained for 255 children of 134 mothers, from whom sociodemographic data were also collected. The majority of children were born to Salvadoran or Guatemalan mothers, but native and naturalized Belizeans in the survey communities were included for comparison purposes. Migration, the exposure variable, was characterized by mother's residency/refugee legal status, nationality, and duration of time in country. Socioeconomic and proximate control variables were included as suggested by the Mosley-Chen framework. Despite normal birthweight averaging 3374 g, a large proportion of children are at the lowest percentiles of the weight-for-age curves (44% below the tenth percentile for the international reference population). A high incidence of diarrheal and respiratory illnesses (30% and 47% of children, respectively, having frequent episodes), and 50% of children with measles vaccination appropriate for age, indicate a population with high potential morbidity. Logistic regression was used to model the effects of migration on weight-for-age and frequency of diarrheal and respiratory tract episodes independent of socioeconomic and proximate factors, as suggested by the Mosley-Chen framework.(ABSTRACT TRUNCATED AT 250 WORDS)

Belize↗
PubMed1992

10-year assessment of treatment outcome among Cambodian refugees with sputum smear-positive tuberculosis in Khao-I-Dang, Thailand.

Tuberculosis control among displaced persons is fraught with difficulties to ensure adherence of patients to treatment for a prolonged period of time. In the Khao-I-Dang camp for Cambodian refugees an approach with daily, directly observed treatment throughout the course of 6 months duration was chosen to address the problem. Of a total 929 patients with sputum smear-positive tuberculosis who were enrolled from 1981 to 1990, 5.0% died, 75.5% completed treatment and were bacteriologically cured with a day-to-day adherence of more than 98%, none failed bacteriologically, 19.2% were transferred to another camp where continuation of treatment was guaranteed, and only 0.4% absconded from treatment. These data suggest that the approach to tuberculosis control in this refugee camp was very effective in cutting the chain of transmission of tuberculosis in a highly mobile population and in reducing substantially unnecessary morbidity and mortality.

Adolescent↗