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DSM-III psychiatric disorders among Hmong refugees in the United States: a point prevalence study.

The author reports on a survey of 97 Hmong adult refugees in the United States. Thirty of these refugees showed symptoms of chronic maladjustment, and 13 showed another DSM-III axis I disorder; two manifested a paranoid psychosis, and six had a major depression. There were few axis II diagnoses. Medical conditions were frequent and often psychophysiological in nature, but they were not associated with axis I disorders. Axis IV psychosocial stressors were not associated with axis I diagnoses, but subjects with an axis I disorder tended to show lower adaptive levels on axis V. The demographic condition most strongly associated with an axis I diagnosis was current status as a welfare recipient.

Acculturation↗

The prevalence of posttraumatic stress disorder and its clinical significance among Southeast Asian refugees.

All 322 patients at a psychiatric clinic for Indochinese refugees were surveyed to determine the presence of posttraumatic stress disorder (PTSD). If PTSD was not diagnosed at the time of initial evaluation, a structured reinterview was performed. Seventy percent of the patients (N = 226) met the criteria for a current diagnosis of PTSD, and an additional 5% (N = 15) met the criteria for a past diagnosis. The Mein had the highest rate of PTSD (93%) and the Vietnamese the lowest (54%). Of the patients with PTSD who were enrolled in the clinic before March 1988, 46% (N = 87) were given a diagnosis of PTSD only after the reinterview. PTSD is a common disorder among Indochinese refugees, but the diagnosis is often difficult to make.

Asia, Southeastern↗

Testimony psychotherapy in Bosnian refugees: a pilot study.

OBJECTIVE: The authors sought to describe the use of the testimony method of psychotherapy in a group of traumatized adult refugees from genocide in Bosnia-Herzegovina. METHOD: The subjects were 20 Bosnian refugees in Chicago who gave written informed consent to participate in a case series study of testimony psychotherapy. All subjects received testimony psychotherapy, averaging six sessions, approximately 90 minutes, weekly or biweekly. Subjects received standardized instruments for posttraumatic stress disorder (PTSD), depression, traumatic events, global functioning, and prior psychiatric history. The instruments were administered before treatment, at the conclusion of the treatment, and at the 2- and 6-month follow-ups. RESULTS: The posttreatment assessments demonstrated significant decreases in the rate of PTSD diagnosis, PTSD symptom severity, and the severity of reexperiencing, avoidance, and hyperarousal symptom clusters. Depressive symptoms demonstrated a significant decrease, and there was a significant increase in scores on the Global Assessment of Functioning Scale. Two-month and 6-month follow-up assessments demonstrated further significant decreases in all symptoms and an increase in scores on the Global Assessment of Functioning Scale. CONCLUSIONS: This pilot study provides preliminary evidence that testimony psychotherapy may lead to improvements in PTSD and depressive symptoms, as well as to improvement of functioning, in survivors of state-sponsored violence.

Adult↗

Psychotherapy with severely traumatized refugees.

Severely traumatized refugees often have a complicated and chronic clinical course involving a posttraumatic stress disorder. The diagnosis and therapy of such patients faces many problems. Based upon observations of chronic posttraumatic stress disorder in refugees of many countries, the authors suggest treatment approaches.

Adult↗

A mental health survey of the Vietnamese refugee in Japan.

A mental health survey was conducted using the Cornell Medical Index (CMI) on Vietnamese refugees who have resettled in Japan. 64.5% of the females and 37.2% of the males displayed emotional disturbance. The refugees with life-threatening and/or concentration camp experience had significantly higher CMI scores than those without it (t test, P less than 0.05). CMI scores of the group residing in Japan for 4-5 years are markedly lower than the group residing there for 2-3 years (F test, P less than 0.05).

Acculturation↗

Psychiatric disorders among recently-arrived Eastern Europeans seen through a US refugee counseling service.

OBJECTIVE: To describe the types and extent of psychiatric disorders found in a group of recently-arrived Eastern Europeans being treated by native-speaking mental health providers. PATIENTS: Forty seven Hungarians, Romanians, Czechoslovakians, Poles and Gypsies referred by voluntary or government agencies, other organizations or community members to a refugee counseling service in Seattle, Washington. Over 90% were refugees and 68% maintained this status at the intake evaluation. METHOD: Clinical, descriptive study of data collected retrospectively by chart review. RESULTS: The majority of clients had poor or fair English skills and less than half were employed. Twelve (26%) had a prior mental health problem and five (11%) a psychiatric hospitalization. The most common diagnoses were adjustment reaction in 21 (45%), marital/family problems in five (11%), and paranoid schizophrenia in five (11%). CONCLUSIONS: Psychiatric disorders were frequent in this clinical population of Eastern Europeans presenting for outpatient mental health care and may be associated with previous mental health problems. Our findings emphasize the need for sensitivity to the special risks of emigration.

Adjustment Disorders↗

Posttraumatic stress disorder among Cambodian refugees in New Zealand.

The author's objective was to determine the amount of trauma, prevalence and diagnostic features of posttraumatic stress disorder (PTSD), and to study the relationship between PTSD and demographic variables, trauma experiences, coping style and post-migration stresses among adult Cambodian refugees in New Zealand. Information on basic sociodemographic data, trauma experiences, posttraumatic stress symptoms, General Health Questionnaire 28-item version (GHQ-28) scores, coping style, and post-migration stresses were gathered from 223 adult Cambodian refugees living in Dunedin, New Zealand. Most subjects had experienced multiple, severe traumas. The prevalence of PTSD was 12.1%. The most frequently reported posttraumatic stress symptom was recurrent intrusive recollection of trauma. There was a significant association between PTSD and amount of trauma, coping style, and post-migration stresses.

Adaptation, Psychological↗

The psychological effects of the war in Afghanistan on young Afghan refugees from different ethnic backgrounds.

This study examined the psychological effects of the war in Afghanistan on two groups of young Afghan refugees currently residing in the United States. One group, with Tajik parents showed significantly less evidence of post-traumatic stress disorder (PTSD) and depression than the second group with Pashtun parents. These two groups of young refugees came from very different socioeconomic and cultural backgrounds. Some of these differences persist to the present. The Tajik parents are wealthier, more likely to speak English at home and less religious than the Pashtun parents. Their wartime experiences were also different. The Pashtun parents and their children spent more time in Afghanistan during the war, and experienced or witnessed more traumatic events, such as torture or combat, than the Tajik parents and their children. The possible effects of these ethnic differences on current psychopathology are described and discussed.

Acculturation↗

Nutritional and mental health status of Afghan refugee children in Peshawar, Pakistan: a descriptive study.

The study sought to ascertain and describe the physical and mental health states of Afghan refugee children after the terrorist attack on September 11, 2001 in the US and the aerial bombing of Afghanistan that followed. A cross-sectional survey was carried out in four refugee camps in Peshawar, Pakistan from February to March 2002, and comparisons among camps were made. A total of 70 males (mean age SD = 9.81 +/- 1.98 years old) and 30 females (7.94 +/- 2.07) answered a self-developed questionnaire on demographic data, traumatic events experience, living environment in the camps, and physical and mental health, through interviews. Anthropometric measures were measured and physical symptoms including anaemia and edema were assessed. Severe malnutrition was not shown and there were no significant differences in most nutritional and physical states among the camps. Nevertheless, in the newer camps more children experienced war related traumatic events. Mental symptoms were prevalent in all camps, though the characteristics of the symptoms differed among the camps.

Afghanistan↗

Beyond asylum: implications for nursing and health care delivery for Afghan refugees in Australia.

Descriptions of the refugee experience, together with an analysis of access, use, and appropriateness of mental and physical health services as perceived by members of the Afghan immigrant or refugee community living in New South Wales (NSW), Australia, are reported in this article. Using focus groups and semistructured interviews in a variety of settings, the study included 13 key informants and 25 general informants, together with health care agencies providing services to the Afghans and organizations providing resources. Analysis of interviews with Afghan people revealed a number of themes. These include emotional responses to trauma, migration, and resettlement experiences; culture-specific health maintenance strategies; barriers impeding access to and appropriateness of Australian health care services; and informant-suggested strategies to enhance accessibility and the appropriateness of health care and community services. These findings are significant and have relevance for improving the quality of culture-specific health care for the Afghan community in NSW Australia.

Adult↗

Coping with trauma and hardship among unaccompanied refugee youths from Sudan.

The purpose of this study was to explore how unaccompanied refugee youths from Sudan, who grew up amid violence and loss, coped with trauma and hardship in their lives. The author used a case-centered, comparative, narrative approach to analyze the narratives of 14 male unaccompanied refugee youths from Sudan recently resettled in the United States. She analyzed narratives for both content and form and identified four themes that reflect coping strategies used by the participants: (a) collectivity and the communal self, (b) suppression and distraction, (c) making meaning, and (d) emerging from hopelessness to hope. The findings underscore the importance of understanding the cultural variations in responses to trauma and are discussed in relation to the concept of resilience.

Adaptation, Psychological↗

Functional visual loss in Cambodian refugees: a study of cultural factors in ophthalmology.

South East (SE) Asians accounted for a disproportionate percentage of the functional visual loss (FVL) seen in our area between 1983 and 1987. Moreover, 94% of the SE Asian FVL patients were Cambodian, although Cambodians only represented 20-30% of the local SE Asian patient population. Cambodian refugees are, at present, generally from lower socio-economic classes than the Vietnamese, and a much larger percentage of them have a history of camp incarceration and previous trauma. The Cambodians presenting with FVL may have conversion hysteria influenced by their wartime experience and cultural background. This study demonstrates that the SE Asian refugees in California are not a homogenous group with respect to visual problems, and that an awareness of cultural or historical factors can be important to the management of ophthalmic symptoms in our multi-cultural societies.

Adult↗

Salmonella and Shigella carriers among refugees from the middle east and Sri Lanka in Denmark.

One per cent of ten thousand refugees were asymptomatic carriers of Salmonella and Shigella species found by a differentiated health check programme at a Danish Red Cross arrival centre in Denmark 1985 and 1986. Six patients with typhoid fever and one with S. parathyphi-A septicaemia all fell ill within the first few weeks after arrival. A child of a chronic S. typhi carrier developed typhoid fever four months after arrival. Cases of sporadic and mild diarrhoea occurred due to Salmonella and Shigella species. The carriers were instructed in prophylactic, hygienic measures and no outbreaks developed. The health check system in this period seemed to be sufficient in relation to preventing outbreaks of infections caused by non-typhoid Salmonella and Shigella species. The relative cost-effectiveness of a more intensive S. typhi screening on arrival is questionable. The organization of health check systems should be reviewed regularly, as each refugee situation is different and will change in different periods.

Carrier State↗

Dietary assessment of refugees living in camps: a case study of Mae La Camp, Thailand.

This study presents data on consumption patterns, methods of food procurement, and adequacy of dietary intake among Burmese refugee camp households living along Thailand's border with Burma. Households established for one or more years and with children under 15 years of age were sampled. A questionnaire was used to determine economic, food-consumption, and dietary intake patterns; foods consumed were weighed and measured using a 24-hour recall for the household unit; and nutritional status was determined by a Microtoise tape and digital standing scales. In total, 182 households containing 1,159 people were surveyed. The average household energy and protein intakes were 96.6% and 111.4%, respectively, of the recommended daily allowance (RDA) for healthy Thais. Twelve percent of protein was derived from animal sources. Carbohydrate, protein, and fat accounted for 84%, 9%, and 7% of total energy, respectively. The intake of vitamins A, B1, B2, and C and of calcium ranged from 24.2% to 53.1% of the RDA. Iron intake was 85.3% of the RDA, derived mainly from rice, fermented fish, mung beans, green leafy vegetables, and eggs. Ration foods supplied 60.5% to 98.18% of all nutrients consumed in the households, with the exception of vitamins A and C. Among children under five years of age, 33.7% were underweight, 36.4% were studied, and 8.7% were wasted. Although the refugees were able to procure some nonration foods by foraging, planting trees and vegetables, raising animals, and purchasing and exchanging ration foods for other items, the quantity and quality were not sufficient to compensate for the nutrients that were low or lacking in the ration. The overwhelming majority of dietary nutrients were provided by ration foods, and although the ration and the overall diet may be adequate for short-term subsistence, they do not suffice for long-term survival and optimal growth, especially for younger children.

Adolescent↗

Asthma prevalence in children living in villages, cities and refugee camps in Palestine.

Previous studies have suggested that asthma prevalence is generally lower in the Middle East than in more developed countries. The aim of this study was to investigate the prevalence and severity of asthma and asthma symptoms in schoolchildren in the Ramallah District in Palestine. In the autumn of 2000, 3,382 schoolchildren aged 6-12 yrs were surveyed in 12 schools, using the International Study for Asthma and Allergies in Childhood (ISAAC)-phase III, parents-administered translated questionnaire. The crude prevalence rates for "wheezing-ever", "wheezing in the previous 12 months", and "physician-diagnosed asthma" were 17.1, 8.8 and 9.4% respectively, with urban areas having higher prevalence rates than rural areas. Within urban areas, refugee camps had higher prevalence rates than cities. Yet, within the rural areas, the 12-month prevalence was lower in the deprived villages than other residences. Place of residence remained significant for asthma and asthma symptoms, after adjusting for sex, age, and place of birth. To conclude, children from refugee camps appear to be at higher risk of asthma than children from neighbouring villages or cities. The prevalence of asthma and asthma symptoms in Palestine appears to be close to that of Jordan, but it is much lower than Israel, and lower than some other countries in the region, such as Kuwait and Saudi Arabia, and more developed countries. This initial study is a baseline for a study on lifestyle and environmental determinants for asthma among Palestinian children.

Adolescent↗

Narrative Exposure Therapy as a treatment for child war survivors with posttraumatic stress disorder: two case reports and a pilot study in an African refugee settlement.

BACKGROUND: Little data exists on the effectiveness of psychological interventions for children with posttraumatic stress disorder (PTSD) that has resulted from exposure to war or conflict-related violence, especially in non-industrialized countries. We created and evaluated the efficacy of KIDNET, a child-friendly version of Narrative Exposure Therapy (NET), as a short-term treatment for children. METHODS: Six Somali children suffering from PTSD aged 12-17 years resident in a refugee settlement in Uganda were treated with four to six individual sessions of KIDNET by expert clinicians. Symptoms of PTSD and depression were assessed pre-treatment, post-treatment and at nine months follow-up using the CIDI Sections K and E. RESULTS: Important symptom reduction was evident immediately after treatment and treatment outcomes were sustained at the 9-month follow-up. All patients completed therapy, reported functioning gains and could be helped to reconstruct their traumatic experiences into a narrative with the use of illustrative material. CONCLUSIONS: NET may be safe and effective to treat children with war related PTSD in the setting of refugee settlements in developing countries.

Adolescent↗

Tents pre-treated with insecticide for malaria control in refugee camps: an entomological evaluation.

BACKGROUND: A refugee shelter that is treated with insecticide during manufacture would be useful for malaria control at the acute stage of an emergency, when logistic problems, poor co-ordination and insecurity limit the options for malaria control. METHODS: Tents made of untreated canvas with deltamethrin-treated polyethylene threads interwoven through the canvas during manufacture, 'pre-treated tents', were tested in Pakistan for their impact on malaria vectors. Fixed-time contact bioassays tested the insecticidal activity of the material over 3 months of outdoor weathering. Unweathered tents were erected under large trap-nets on outdoor platforms and tested using wild-caught, host-seeking mosquitoes and insectary-reared mosquitoes released during the night into the trap-nets. RESULTS: The insecticide-treated tents were effective both in killing mosquitoes and reducing blood-feeding. Mean 24 hour mortality was 25.7% on untreated tents and 50.8% on treated tents (P = 0.001) in wild anophelines and 5.2% on untreated tents and 80.9% on treated tents (P < 0.001) in insectary-reared Anopheles stephensi. Blood-feeding of wild anophelines was reduced from 46% in the presence of an untreated tent to 9.2% (P < 0.001) in the presence of treated tents and from 51.1% to 22.2% (P < 0.001) for insectary-reared An. stephensi. In contact bioassays on tents weathered for three months there was 91.3% mortality after 10-minute exposure and a 24 h holding period and 83.0% mortality after 3-minute exposure and a 24 h holding period. CONCLUSION: The results demonstrate the potential of these pre-treated canvas-polyethylene tents for malaria control. Further information on the persistence of the insecticide over an extended period of weathering should be gathered. Because the epidemiological evidence for the effectiveness of pyrethroid-treated tents for malaria control already exists, this technology could be readily adopted as an option for malaria control in refugee camps, provided the insecticidal effect is shown to be sufficiently persistent.

Animals↗