Prevalences of mental distress and its associated factors in unaccompanied refugee minors in Germany

Prevalences for mental disorders within minor refugees are comparatively high and heterogeneous. To reduce heterogeneity and identify high-risk subgroups, we compared unaccompanied refugee minors (URM) to accompanied refugee minors (ARM) regarding depressive symptoms and mental distress. Furthermore, we examined associative factors of mental distress in URM on a broad scale. We conducted a survey with a cross-sectional design in four German University hospitals. The sample consisted of n = 172 URM and n = 52 ARM aged 14-21. Depressive symptoms were assessed via the Patient Health Questionnaire (PHQ-9). Mental distress was assessed by the Refugee Health Screener (RHS-15). Mann-Whitney test was used to examine differences between URM and ARM. Associated factors of mental distress were evaluated via a stepwise multiple regression analysis. URM showed significantly higher mean scores for PHQ-9 (p < .001) and RHS-15 (p < .001) compared to ARM indicating medium effect sizes. Furthermore, URM were significantly more likely to surpass the cut-off for depression (61.6% vs. 30.8%) and overall mental distress (81.4% vs. 53.8%) compared to ARM. The factors Number of stressful life events (SLE), Female gender, and Fear of deportation were found to be associated with an increased mental distress in URM, whereas Weekly contact to a family member, School attendance, and German language skills were accompanied with lower distress scores. All six factors accounted for 32% of the variance of mental distress in URM (p < .001). Within minor refugees, URM are a highly vulnerable subgroup, which should receive particular attention and more targeted measures by health authorities. Our results indicate that these measures should comprise a rapid promotion of family contact, school attendance, language acquisition, and the fast processing of asylum applications. However, the cross-sectional design limits the interpretability of the results

Trauma-Focused Cognitive Behavioral Therapy with Unaccompanied Refugee Minors : A Case Series

Background: Unaccompanied refugee minors (URMs) are a group who are vulnerable to developing posttraumatic stress symptoms (PTSS). However, they rarely receive the treatment that is indicated and there are no treatment studies focusing exclusively on this group of adolescents. This case study evaluates the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for URMs with PTSS. Method: A health care utilization sample of N = 6 was assessed prior to and after treatment with TF-CBT. Therapists were asked to report differences in treatment application and content in comparison to TF-CBT standard protocol. Results: We found moderate to high levels of PTSS at baseline and a clinically significant decrease in symptoms at posttest. Some modifications to the TF-CBT protocol were made with regard to affective modulation which required more sessions than usual whereas fewer caregiver sessions were conducted. Conclusion: TF-CBT is feasible in reducing PTSS in severely traumatized URMs. Further research with controlled trials is necessary

Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches

The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength-and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences

Survival states as indicators of learning performance and biological stress in refugee children: a cross-sectional study with a comparison group

Background: Our goal was to accurately detect young children at risk for long-term psychiatric disturbances after potentially traumatic experiences in the course of relocation. In addition to detailed assessment of parent-rated parent and child symptomatology, we focused on disruptive behaviors in the education environment summarized as survival states, as these frequently lead to clinical referral. Methods: We screened 52 refugee children aged 3-7 (M = 5.14 years, SD = 1.17) for symptoms of Posttraumatic Stress Disorder (PTSD) with the Child and Adolescent Trauma Screening (CATS) in parent rating. The parents' mental health was assessed using the Refugee Health Screener (RHS-15). Furthermore, the child's educators were asked to evaluate the pathological survival states of the child and we made a general assessment of the children's symptoms with the Strengths and Difficulties Questionnaire (SDQ) rated by parents and educators. Children in the refugee sample completed a working memory learning task (Subtest Atlantis from the Kaufmann Assessment Battery for Children, KABC-II) and delivered saliva samples for testing of the cortisol level. Results: The parental rating of their child's PTSD symptoms was significantly related to their own mental well-being (r = .50, p < .001). Children with survival states in educator ratings exhibited weaker learning performance (F = 3.49, p < .05) and higher evening cortisol levels (U = 113, z = ? 1.7, p < .05, one-tailed). Conclusions: Survival states are promising indicators for children's learning performance and distress level complementary to parent rating of child PTSD, which is highly intercorrelated with the parents' own symptom load. Trial registration number: DRKS00021150 on DRKS Date of registration: 04.08.2020 retrospectively registere

Non-verbal cognitive development, learning, and symptoms of PTSD in 3- to 6-year-old refugee children

As IQ tests are commonly used as key assessment method, we address the question whether our commonly used standardized IQ tests are appropriate for children from families of diverse cultures and different educational levels in a refugee population. We examined 109 refugee children aged 3-7 years (M = 5.10 years, SD = 1.25) with the 'Kaufman Assessment Battery for Children ' (KABC-II; Kaufmann & Kaufmann, 2015) on a language-free scale (Scale of Intellectual Functioning, SIF) and learning performance (subtest Atlantis). With a non-verbal IQ of 81.5 (SD = 18.01), the population mean of the refugee children is more than one standard deviation lower than the mean of the German norm population. Standardized scores follow the normal distribution and are not correlated to any of the assessed markers of adversity (flight duration, time spent in Germany, child PTSD in parent rating, parental symptom load, and parental education level).Conclusion: The interpretation of IQ test results for refugee children should be done cautiously as results may underestimate their cognitive capacity. Environmental factors, such as high illiteracy among parents in this study, the lack of institutional education of children and high lifetime stress, may explain our findings.Trial registration: DRKS00021150. What is Known: • There is a high pervasiveness for the use of standardized IQ tests in the German health and education system to determine eligibility for special education and social services. What is New: • Refugee children score significantly lower than German children in a language-free IQ test. As results are normally distributed and not correlated to any of the assessed markers of adversity, the low scores in the refugee group might be due to missing formal education

European intercomparison workshop on air quality monitoring. Vol. 5 Measuring of NO, NO_2, SO_2 and O_3

This report presents the results of a WHO Europen Intercomparison Workshop on Air Quality Monitoring (NO, NO_2, SO_2 and O_3) conducted in May 2002 by the WHO Collaborating Centre for Air Quality Management and Air Pollution Control in co-operation with the national reference laboratory of UBA Pilotstation in Langen, Germany. The Workshop was a contribution to on-going quality assurance and control activities on air quality measurements for Member States of the WHO Europen Region. Eleven laboratories mainly from Central and Eastern Europe used the opportunity to compare their measurement methods (14 manual methods and 20 monitors) and standards. (orig.)Available from TIB Hannover: RR 838(15) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

European intercomparison workshops on air quality monitoring. Vol. 4 Measuring NO, NO_2, O_3 and SO_2

This report presents the results of two European Intercomparison Workshops on Air Quality Monitoring (NO, NO_2, O_3, and SO_2). The Workshops were a contribution to continuing quality assurance and quality control activities on air quality monitoring for Member States of the WHO European Region. Fourteen institutes mainly from Central and Eastern Europe used the opportunity to compare their measurement methods (15 manual methods and 24 monitors) and standards. (orig.)Available from TIB Hannover: RR 838(13) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

European intercomparisation workshops on air quality monitoring. Vol. 3 Measuring of CO, NO, NO_2, and BTX

This report presents the results of two European Intercomparison Workshops on Air Quality Monitoring (CO, NO, NO_2 and BTX) conducted in May 1998 by the WHO Collaborating Centre for Air Quality Management and Air Pollution Control in co-operation with the national reference laboratory of UBA Pilotstation in Offenbach/Main, Germany. The Workshops were to be a contribution to continuing quality assurance and control activities on air quality monitoring in the WHO European Region. Fourteen institutes used the opportunity to compare their measurement methods (12 manual methods and 31 monitors) and standards for ambient air monitoring of carbon monoxide, oxides of nitrogen, benzene, toluene, and xylene. Summing up the laboratory measurements (automatic and manual methods) of NO, NO_2 and CO during both intercomparison Workshops more than 80% of all results agrees with the target value within a tolerance of #+-#10%, and 60 to 80% of all results were within a tolerance of #+-#5%. Best results were obtained for CO measurements (measured by monitors only): 92% agreed with a tolerance of #+-#10% and 76% agreed within #+-#5%. For the comparisons of different analytical methods during the measurements of nitrogen oxides the results showed very good agreement for NO_2. On the other hand, the results for NO were not as good and they indicated some problems with manual methods. Summing up the BTX laboratory measurements (automatic and manual methods) of both intercomparison Workshops, 44 to 60% of all results were within a tolerance of #+-#10%, and between 23 and 35% of all results were within tolerance of #+-#5% from the target value. The comparisons of calibration standards showed very good agreement between the primary calibration standard of UBA Pilotstation and the national transfer standards of the participating laboratories. Some unsystematical differences were identified for manual methods at low NO and NO_2 concentrations in ambient air. Furthermore, some measurement phenomena were identified of automatic and manual methods. Thus, there seems to be a need for further intercomparisons to check and to veryify the causes. Most of the applied methods are reliable and suitable for obtaining air quality data appropriate to evaluate and estimate environmental health risks in the WHO European Region. (orig.)Available from TIB Hannover: RR 838(11) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman