The role of parental factors in the mental health problems experienced by refugee children

Refugee children have high rates of complex mental health needs and a range of associated risk factors. There has been, however, limited research on the role of family-related factors and the impact of family-oriented interventions. This thesis comprises two interlinked studies to address this knowledge gap. Study I aimed to establish the role of parental factors in the development of mental health problems among Syrian refugee children residing in Turkey. A cross-sectional design involved 322 children aged 8-18 years and 263 parents in Istanbul. Children completed questionnaires on traumatic experiences (SLE), mental health problems (CRIES-8; SDQ), perceived attachment relationships (SS) and parenting styles (EMBU-C); whilst parents reported on their psychopathology (GHQ-12). The results revealed that parenting variables increased the risk of children having PTSD and general mental health problems (GMHP) after the controlling for the effects of pre-migratory trauma. The perceived lower availability of, and higher dependency on, the attachment figure uniquely explained both PTSD and GMHP. Lack of perceived warm and rejecting parenting styles predicted PTSD, whereas parental psychopathology explained GMHP. Study II aimed to evaluate the feasibility of an attachment-focussed intervention, Group Theraplay. Thirty children with possible reactive attachment disorder (RAD) and their mothers were randomly allocated to Group Theraplay or a control group. Five feasibility criteria were assessed using the same measures as in Study I at the pre- and post-intervention stages. In addition, parenting style was assessed by parents and children (PPI), RAD symptoms by parents (RPQ), and feasibility by all participants through open-ended questions. Group Theraplay was, overall, found to be feasible for application with refugee children, showing significant improvement in RPQ scores, although there was limited parental engagement. The findings have implications for practice and service development, in engaging refugee families and integrating child- and parent-focussed interventions. Future research should actively involve parents before designing a substantive evaluation

Mental health problems of Syrian refugee children: The role of parental factors

War-torn children are particularly vulnerable through direct trauma exposure as well through their parents’ responses. This study thus investigated the association between trauma exposure and children’s mental health, and the contribution of parent-related factors in this association. A cross-sectional study with 263 Syrian refugee children-parent dyads was conducted in Turkey. The Stressful Life Events Questionnaire (SLE), General Health Questionnaire (GHQ-12), Parenting Stress Inventory (PSI-SF), Impact of Events Scale for Children (CRIES-8) and Strengths and Difficulties Questionnaire (SDQ) were used to measure trauma exposure, parental psychopathology, parenting-related stress, children’s post-traumatic stress symptoms (PTSS) and mental health problems, respectively. Trauma exposure significantly accounted for unique variance in children’s PTSS scores. Parental psychopathology significantly contributed in predicting children’s general mental health, as well as emotional and conduct problems, after controlling for trauma variables. Interventions need to be tailored to refugee families’ mental health needs. Trauma-focused interventions should be applied with children with PTSD; whilst family-based approaches targeting parents’ mental health and parenting-related stress should be used in conjunction with individual interventions to improve children’s comorbid emotional and behavioural problems

How child mental health training is conceptualized in four low- and middle-income countries

The objective was to establish how stakeholders in low- and middle-income countries (LMIC) conceptualize child mental health impact. Semi-structured interviews were conducted with 18 stakeholders from disadvantaged urban communities in Kenya, South Africa, Turkey and Brazil. Participants represented education, welfare and health care agencies; as well as community and religious groups. Data were analysed through a thematic approach and three related themes were identified. Impact was defined as a process of change, with child-centred outcomes and measures that were broader than mental health symptoms improvement. Beneficiaries were identified at child, family, community and service level. Participants wished to see strategies that ensured sustainability of impact, namely child mental health policy, stakeholder engagement, interdisciplinary working, and capacity-building for all stakeholder groups. Child mental health service transformation in LMIC, especially in areas of deprivation, needs to build on existing resources and strengths by co-producing psychosocial outcomes with a range of professional and community stakeholders. Impact on children’s mental wellbeing can be achieved through a co-ordinated strategy that involves designated policy, capacity-building, and interdisciplinary networks with meaningful community involvement

Responsiveness of support systems to address refugee young people’s mental health needs: Stakeholder perspectives from Turkey and the UK

Refugee young people have high rates of unmet mental health needs. Established barriers to accessing mental health care may be contextual to the host country and its support systems. The aim of this study was to establish the perspectives of refugee young people, parents, and service providers on service responses across one middle-income and one high-income country, Turkey and the UK, respectively. In Turkey, eight professionals (social work, psychology, and education), ten parents and ten young people took part. In the UK, stakeholders included four professionals (health, educational psychology, and non-statutory), seven parents and seven young people. Data were analyzed using a codebook thematic approach. Despite structural differences between the two systems, several commonalities were identified in responses. Conceptualization of mental health, stigma, shame, and parents’ language acquisition acted as barriers to help-seeking in both countries, whilst schools were viewed as central to the initiation of interventions. Contextual barriers in Turkey included child marriage and labor, whilst reliance on non-governmental organizations (NGOs) facilitated joint care pathways. In the UK, providers aimed to adapt and extend care pathways through primary health care. Recommendations included designated policy, joint working, schools acting as service hubs, awareness, and training professionals on contextual knowledge. </p

Benefits and challenges of engaging Majority World children in interdisciplinary, multi-qualitative-method, mental health research

The qualitative community embraces transparent dialogue through sharing knowledge to improve rigour and develop new initiatives. In this paper, we recognise there are many complexities within qualitative research, leading to important debates. We explore the benefits and challenges, as well as the practicalities and technicalities, of conducting research that 1) employs multiple methods within the qualitative paradigm, 2) is interdisciplinary, and 3) examines a sensitive research topic 4) with a vulnerable group of participants. Specifically, when research is also 5) cross-cultural and 6) utilises participatory techniques. Through our discussion, we draw upon an existing project and examine the complexity of designing and completing intra-paradigmatic mixed methods research with children from different sociocultural contexts, underpinned by interdisciplinary perspectives, in a complex area like mental health.</p

Risk factors for mental health and wellness: children’s perspectives from five Majority World Countries

Several risk factors for children’s mental health and wellness have been established. These are compounded by inequalities, especially in Majority World Countries (MWC). As evidence is largely based on adult reports, we aimed to capture children’s experiences of risk across five MWC resource-constrained settings (Brazil, Pakistan, Turkey, Kenya, and South Africa) during the height of COVID-19 pandemic. Participants included 36 children aged 8–10 years and 37 young people aged 14–16 years. We employed a thematic design using a participatory methodological approach in collecting data through diary entries, drawings, posters, focus groups discussions, and child-led interviews with elders. Two researchers integrated and analysed the data set through a thematic codebook framework. Three identified themes related to exacerbation of existing risks, disruption or loss of protective factors, and lack of access to structural supports. Children linked risk factors along their socioecology. The findings have implications in actively involving children as social actors in determining and addressing risk for mental health and wellness through child-centred and multi-sectoral policy and interventions.</p

Is social media bad for mental health and wellbeing? Exploring the perspectives of adolescents

Despite growing evidence of the effects of social media on the mental health of adolescents, there is still a dearth of empirical research into how adolescents themselves perceive social media, especially as knowledge resource or how they draw upon the wider social and media discourses to express a viewpoint. Accordingly, this paper contributes to this scarce literature. Six focus groups took place over three months with 54 adolescents aged 11–18 years, recruited from schools in Leicester and London (UK). Thematic analysis suggested that adolescents perceived social media as a threat to mental wellbeing and three themes were identified; 1) it was believed to cause mood and anxiety disorders for some adolescents, (2) it was viewed as a platform for cyberbullying, and (3) the use of social media itself was often framed as a kind of ‘addiction’. Future research should focus on targeting and utilising social media for promoting mental wellbeing among adolescents and educating youth to manage the possible deleterious effects

Learning from Older adults’ Trauma Exposure and Resilience: Children’s Perspectives from Five Majority World Countries

There is limited evidence on how intergenerational trauma and resilience are perceived by children, especially in Majority World Countries (MWC). We established such perspectives among 73 children and youth in Brazil, Kenya, South Africa, Pakistan and Turkey. Children interviewed older adults, kept diary fieldnotes, and shared learning in focus groups. Data were integrated through a thematic codebook. Four themes reflected deprivation of safety needs and family challenges, especially for girls, which shaped older adults’ resilience. Children related accounts to their experiences, to generate intergenerational learning. Implications of the findings are considered in the context of intercultural shared trauma and resilience. Contributions to the intergenerational field Children can draw strength from intergenerational narratives to build their resilience in the face of future adversity. The emotional impact of intergenerational narratives can have more impact on children than conveying information or advice. A multi-method approach can be adapted for different age groups to elicit intergenerational perspectives. Children can make an important contribution as co-researchers in intergenerational research.</p