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PubMed2005

Evaluation of a classroom program of creative expression workshops for refugee and immigrant children.

OBJECTIVE: This evaluative study assessed the effect of a creative expression program designed to prevent emotional and behavioral problems and to enhance self-esteem in immigrant and refugee children attending multiethnic schools. METHOD: The 12-week program involved 138 children, aged 7 to 13, registered in both integration classes designed for immigrant children and regular classes at two elementary schools. Pretest and posttest data were collected from the children themselves and from their teacher. Teachers used Achenbach's Teacher's Report Form to assess the emotional and behavioral symptoms of their pupils whereas children self-reported their symptoms with the Dominic, a computerized questionnaire. Self-esteem was measured with the Piers-Harris Self-Concept Scale administered by interviewers to the children. RESULTS: At the end of the program, the children in the experimental groups reported lower mean levels of internalizing and externalizing symptoms and higher mean levels of feelings of popularity and satisfaction than the children in the control groups, when controlling for baseline data. In integration classes, the effect on self-esteem was especially notable in boys. The intervention's effect on internalizing and externalizing symptoms was not modified by gender, age or fluency in the mainstream language. CONCLUSION: The study provides some evidence that creative workshops in the classroom can have a beneficial effect on the self-esteem and symptomatology of immigrant and refugee children from various cultures and backgrounds. These quantitative results support previous qualitative analysis showing that the workshops participate in the reconstruction of a meaningful personal world while simultaneously strengthening the link of the child to the group. They also transform the teachers' perceptions of newcomers by placing an emphasis on their strength and their resilience, while not negating their vulnerabilities.

Adaptation, Psychological↗
PubMed1994

Therapy with refugee families: what is a "good" conversation?

This article addresses the question of what is a "good" conversation by analyzing "poor" conversations. During a project on family therapy with refugee families, we often experienced what we labeled as "poor" conversations. We present examples of a variety of such conversations, which we then analyze with reference to therapeutic maps and central concerns of the therapists. We describe four patterns of therapist/client relationships that emerged from this analysis. The main focus of our discussion is to clarify when "poor" conversations may be an important part of the therapeutic process, and when and how they should be avoided. We believe that the issues we raise are central to therapeutic work in general and not just to therapy with refugee families.

Acculturation↗
PubMed2001

Engaging refugee families in therapy: exploring the benefits of including referring professionals in first family interviews.

The possible benefits of including referring professionals in the first family interviews are being explored as a way to engage refugee families in therapy. Families in exile confront a number of problems related both to premigration traumatic exposures and to present adaptation processes. Refugee clients and the referring professionals in the larger system frequently see the problems and their solutions quite differently. This situation may often result in unclear working alliances in a context of therapy. We will describe first family interviews in which referring professionals are interviewed about their reasons for referrals, and where the families are invited to discuss these considerations. The conversations permit families, referrers, and therapists to reflect upon differences in positions and perspectives. Their experiences suggest that agreements or contracts based on these joint interviews are less ambiguous and more clearly formulated than contracts based on interviews with families alone. Finally, these experiences are discussed as a potentially valuable approach in a cross-cultural context.

Adult↗
PubMed2005

Mental disorders, disability and health service use amongst Vietnamese refugees and the host Australian population.

OBJECTIVE: To compare the prevalence of common mental disorders, disability and health service utilization amongst Vietnamese refugees resettled in Australia for 11 years, with data obtained from a national survey of the host population. METHOD: A stratified multistage probability household survey of 1611 Vietnamese undertaken in the state of New South Wales was compared with data from 7961 Australian-born respondents. Measures included the CIDI 2.1 and the MOS SF-12. RESULTS: The 12-month prevalence of anxiety, depression and drug and alcohol dependence amongst Vietnamese was 6.1% compared with 16.7% amongst Australians. Vietnamese with a mental illness reported higher disability but exhibited similar levels of mental health consultation. The overall service burden of mental disorders was lower for the Vietnamese. CONCLUSION: The findings suggest that refugee groups resettled for some time in Western countries may show sound mental health adaptation and do not necessarily impose a burden on general or mental health services.

Adolescent↗
PubMed1985

Periodontal conditions, remaining teeth and oral hygiene habits in a group of Vietnamese refugees in Norway.

Since 1975, about 3500 Vietnamese refugees have come to Norway. The purpose of the present study was to report on remaining teeth and periodontal conditions in a population of 200 adolescent and adult Vietnamese refugees. The mean number of remaining teeth ranged from 27.8 in the youngest age group to 24.6 in the oldest. This number of teeth is slightly lower than reported from Norwegian populations, but similar to other Asian populations. Almost all index teeth showed dental plaque, and subgingival calculus was observed in 9 of 10 teeth after the age of 20. Gingival bleeding was seen on all index sites of 26.5% of the subjects and all subjects above the age of 40 had gingivitis adjacent to one or more index teeth. There was a progression of probeable pocket depths with increasing age. In the oldest age group, 72.7% had pockets between 3.5 mm and 5.5 mm. The data indicated that if optimal conditions should be obtained, substantial resources would be required. In populations with limited resources and with relatively few subjects with severe periodontal breakdown, it is suggested that an identification of subjects "at risk" to be dentally handicapped through loss of teeth, should be a priority.

Adolescent↗
PubMed1993

Simplified preventive dentistry program for Chilean refugees: effectiveness of one versus two instructional sessions.

A simplified dental health program for newly arrived refugees was evaluated. The efficacy of presenting the program in one instructional session or two was compared. 193 Chilean refugees, granted residency in Stockholm in Spring 1981 or in Spring 1982, participated. The subjects were divided into two groups. One group received a dental health program only at the first visit, in conjunction with the baseline examination, and the other group was recalled for a further session 3 months after the baseline examination. Both groups were recalled for evaluation 6 months after the initial visit. At follow-up the groups comprised 94 and 65 subjects respectively. The mean relative reductions in gingivitis (relating GBI reduction to baseline GBI) were 33.2% (95% < I: 29.1 to 37.3%) in the single-visit group and 40.5% (95% < I: 35.9 to 45.8%) in the two-visit group. The reduction in periodontal pocket depth was mainly a reduction of shallow pockets. The maximum effect was attained after one instructional session.

Adult↗
PubMedDate not supplied

Health and nutrition in newly resettled refugee children from Chile and the Middle East.

The general health and nutritional status of 105 refugee children from Chile and the Middle East were examined shortly after the arrival in Stockholm. A chronic medical condition was present in 10% and there were clinical signs of caries in 57% of the children. Iron deficiency was found in 15% of Chileans and 6% of Middle Easterners, but no other nutritional deficiencies were discovered. Stunting and wasting was rare and a significant catch-up growth was observed in both groups in a follow-up 18 months after resettlement. Obesity was common in the Chilean group on arrival in Sweden and increased further after resettlement. We conclude that chronic medical conditions, caries and obesity were the major somatic health problems in this sample of newly resettled refugee children.

Adolescent↗
PubMed1984

Health promotion in a Cambodian refugee camp: a CHILD-to-child approach.

This paper describes a School Health Program established in Khao I Dang, a refugee camp of 80,000 Cambodians in Thailand. Originally designed to provide health screening and immunization, the program was expanded to include health promotion. The author conceptualizes the health promotion activities based on the underlying principles in the manual CHILD-to-child. Three specific projects using CHILD-to-child techniques are described. The article concludes with a discussion of the applicability of these techniques to refugee settings in general and to American schools.

Cambodia↗
PubMed1988

Food preferences, beliefs, and practices of Southeast Asian refugee adolescents.

Food preferences, beliefs, and practices were assessed among 207 Southeast Asian refugee high school students, all of whom had been in the U.S. five years or less. Questionnaires typed both in English as well as their native language of either Cambodian, Vietnamese, or Hmong, were administered to all students in a classroom setting. Results indicated Southeast Asian refugee youth have maintained strong ties to their native foods and traditional meal patterns. In the U.S., as in Southeast Asia, rice remains the staple food in their diet. High status foods in Southeast Asia such as fruits, meats, and soft drinks remain highly preferred in the U.S. While milk is well-liked, cheese remains a strongly disliked food item. Fruits and vegetables are frequently consumed. Nutritionally weak American foods such as candy bars, cake, and potato chips are not consumed frequently. However, soft drinks are consumed daily by almost one-third of the students. Breakfast was missed by almost 60% of females and 37% of males. Forty-five percent of the youth reported they had primary responsibility for evening meal preparation.

Adolescent↗
PubMedDate not supplied

Anterior dental extractions among Dinka and Nuer refugees in the United States: a case series.

Few U.S. adults today experience life without permanent anterior teeth and know little about how an incomplete anterior dentition affects adult well-being. Sudanese refugees, who had resettled in the U.S. and who had six mandibular anterior teeth ritually extracted during youth, provided an opportunity to examine the significance of the effect of this partial edentulism. The authors interviewed five adult refugees whose anterior dentition was restored using dental implants. Factors considered before and after restoration included incisal ability, food item recognition, food consumption patterns and related social factors. Before restoration of the anterior dentition, participants could not incise typical foods eaten in the U.S. and expressed embarrassment about their dental status, which limited smiling, speaking and social interaction. This case series offers insight into the bio-cultural importance of the anterior dentition for all populations living with a visible gap in the lower jaw.

Adult↗
PubMed2002

The mental health of refugee children.

The UK is facing a major increase in the number of people seeking asylum each year, of whom approximately a quarter are children. The stressors to which refugees are exposed are described in three stages: (1) while in their country of origin; (2) during their flight to safety; and (3) when having to settle in a country of refuge. The evidence concerning the impact of displacement on children's mental health is reviewed and a framework for conceptualising the risk factors is proposed. The available literature shows consistently increased levels of psychological morbidity among refugee children, especially post-traumatic stress disorder, depression, and anxiety disorders. The principles underlying the delivery of mental health care for these children are also considered. It is argued that much primary prevention can be undertaken in the school context. Some key aspects of British immigration law are examined and the tension between the law and the best interests of the child principle is discussed. There is particular concern for the plight of unaccompanied children. Attention to the mental health needs of this vulnerable group is urgently required.

Adaptation, Psychological↗
PubMed1982

Hepatitis B among Indochinese refugees in Great Britain.

Six hundred and thirty-two blood samples from 879 consecutive admissions to one resettlement camp for Indochinese refugees in Great Britain were screened for markers of hepatitis B (HB) virus infection. The overall prevalence of HB surface antigen (HBsAg) was 15%, being 16% in those aged 40 years or less, and falling to 8% in those older than 40 (P less than 0.05). No significant difference in prevalence was found between males and females. HBe antigen was detected in 56% of those with HBsAg and was demonstrable in 55-76% of those under 30 years of age. HBe antibody was found in 21% of HBsAg-positive refugees. In those under 40 years old, HB core (HBc) antibody was commoner in males (P less than 0.01). HBc antibody prevalence increased significantly with age in females (P less than 0.01) but not in males. There was no definite evidence that vertical transmission of hepatitis B was present in the group studied.

Adolescent↗
PubMedDate not supplied

Elevated blood levels of dehydroepiandrosterone sulphate vary with symptom load in posttraumatic stress disorder: findings from a longitudinal study of refugees in Sweden.

BACKGROUND: The present study is part of a longitudinal study of recently resettled refugees with the aim of learning which factors in their daily life influence health as measured by self-report and stress-responsive hormones. METHODS: In a group of recently resettled refugees with a high incidence of posttraumatic stress disorder (PTSD), diagnosed by structured interview, self-rated symptoms of PTSD were followed three times over a period of 9 months after inclusion in the study. Eighty-six individuals were included in the study and 58 subjects (67.4%) completed it. Blood samples were drawn at each examination for assessment of hormone levels. RESULTS: After adjustment for age, dehydroepiandrosterone sulphate (DHEA-s) was observed to be higher in non-depressed PTSD cases than in non-PTSD without depression. There was an interaction between PTSD and depression regarding DHEA-s levels. DHEA-s correlated significantly with changes in self-rated symptoms of PTSD at last follow-up; the greater the increase in PTSD symptoms, the greater the increase in plasma DHEA-s. The variation of DHEA-s levels in relation to changes in self-rated health in non-PTSD showed the opposite pattern, although not reaching significance. CONCLUSIONS: The finding of changes in DHEA-s should encourage further studies of the role of altered steroid metabolism in PTSD.

Adolescent↗
PubMedDate not supplied

A longitudinal study of hormonal reactions accompanying life events in recently resettled refugees.

BACKGROUND: Refugees constitute a growing section of the general population in many countries. It is therefore important to study which factors in everyday life are important to recently resettled refugees after they have been granted residence. METHODS: Life events from a checklist, as well as categories derived from written responses to open-ended questions were analysed (repeated-measures ANOVA). Changes over time in mean serum/plasma concentrations of cortisol, thyroxine, prolactin, and dehydroepiandrosterone sulphate (DHEA-S) were compared in subjects with and without the reported events. RESULTS: Distress in significant others (close friends or first-degree relatives) and a perception of excessive demands in everyday life were associated with increases in serum cortisol. Events associated with decreased levels of prolactin were typically situations of strain in relation to authorities or individuals to which the subjects were in a position of dependency. DHEA-S changed in opposite directions in post-traumatic stress disorder (PTSD) and non-PTSD subjects. DHEA-S also changed with positive events. CONCLUSIONS: Distress in significant others and a too demanding everyday life lead to significant changes in the stress-responsive hormones cortisol, prolactin and DHEA-S. Since DHEA-S behaves differently in PTSD, this condition is a potential confounder in studies of DHEA-S with an unknown proportion of PTSD among participants.

Adolescent↗
PubMed2003

Treatment of drug addiction in traumatised refugees. A case report.

The comorbidity of post-traumatic stress disorder (PTSD) and drug addiction is quite often overlooked in refugees. However, the simultaneous treatment of both disorders is of elemental importance for a positive outcome in addicted and traumatised refugees. Furthermore, mutual misinterpretations of habits, behaviours and reactions through negligence of the distinct sociocultural context of patient and clinician often leads to unfavourable developments. These observations are exemplified in this case report.

Adult↗
PubMed1984

A successful supervised outpatient short-course tuberculosis treatment program in an open refugee camp on the Thai-Cambodian border.

The operation of a tuberculosis treatment program in an open refugee camp of 45,000 refugees on the Thai-Cambodian border is described. Fifty-eight patients received 6 months of supervised daily, outpatient therapy with a protocol employing isoniazid, rifampin, streptomycin, and pyrazinamide. Patient compliance was high, with only 15 of 10,209 patient days being missed, despite a high incidence of minor side effects. Three patients died, 4 defaulted, and 1 moved to another camp for treatment. The therapies of 4 patients were extended because of the need for reduced doses of medications, the development of extrapulmonary disease, treatment failure, and slow resolution of infiltrates on radiographs. There was 1 late relapse. This report demonstrates the feasibility in integrating short-course therapies with program designs to produce high compliance under difficult field conditions.

Adolescent↗
PubMed1985

Psychiatric diagnoses of Cuban refugees in the United States: findings of medical review boards.

To assess the reproducibility of psychiatric diagnoses made in immigration proceedings, the authors examined cases of 109 Cuban refugees who had appealed psychiatric diagnoses that precluded their admission to the United States according to the Immigration and Nationality Act. Medical review boards upheld only 23 (42%) of 55 initial diagnoses of antisocial personality disorder but affirmed exclusionary certifications in 39 (72%) of the 54 other cases. Failure to sustain a high proportion of diagnoses of antisocial personality disorder may reflect interviewer biases, cross-cultural inappropriateness of diagnostic criteria, or other deficiencies in the current system of psychiatric evaluation of potential refugees.

Antisocial Personality Disorder↗
PubMed1987

Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees.

The United States is accepting the largest number of displaced persons since World War II. Over 70% are Southeast Asians; many have suffered serious war trauma and torture. Cultural differences in health-seeking behavior and lack of specialized mental health services make the recognition of psychiatric distress in Southeast Asia refugees difficult for American health care providers. The authors describe the development and validation of Cambodian, Laotian, and Vietnamese versions of the Hopkins Symptom Checklist-25. This brief, simple, and reliable instrument is well received by refugee patients, offers an effective screening method for the psychiatric symptoms of anxiety and depression, and is especially helpful for evaluating trauma victims.

Anxiety↗