Ilse Derluyn

Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents

The objective of this study is to make comparisons of the severity of the psychological distress, behavioral problems and traumatic stress reactions, and experiences of unaccompanied refugee minors (URMs) with immigrant/refugee (I/R) and Dutch (native) adolescents with parental caregivers (N = 3273). Self-report questionnaires were administered. Most assessments took place at school. URMs consistently reported significantly higher scores for internalizing problems, traumatic stress reactions, and stressful life events than all other groups. Gender appears to play an important role in the native and I/R samples in reporting psychological distress, behavioral problems, and traumatic stress reactions. Older age was significantly related to higher scores only in the URM group. Natives scored higher on externalizing problems than the other groups. URMs reported to have experienced twice as many stressful life events than I/Rs and natives. URMs appear to be at significantly higher risk for the development of psychopathology than refugee adolescents living with a family member, immigrants, or Dutch adolescents.

Different perspectives on emotional and behavioural problems in unaccompanied refugee children and adolescents.

Objective. This study aims, firstly, to investigate the prevalence of emotional and behavioural problems in unaccompanied refugee children and adolescents living in Belgium. Secondly, this study compares the perspectives of the adolescents with those of social workers on the adolescents’ emotional well-being. Design. A total of 166 unaccompanied refugee children and adolescents, living in different large- and small-scale centres, in foster care or alone, participated in the study. Of them, 142 completed self-report questionnaires on emotional and behavioural problems (HSCL-37A, SDQ-self and RATS) and traumatic experiences (SLE), and for 124 refugee youths, social workers filled in two questionnaires on emotional and behavioural problems (CBCL/6-18 and SDQ-parent). Results. Between 37 and 47% of the unaccompanied refugee youths have severe or very severe symptoms of anxiety, depression and post-traumatic stress. Girls and those having experienced many traumatic events are at even higher risk for the development of these emotional problems. Social workers also report a high prevalence of internalising problems in this population and they also report important externalising problems in unaccompanied refugee youths. Conclusion. Being unaccompanied is an important risk factor for the emotional well-being of refugee children and adolescents. Therefore, appropriate measures on reception and care should be taken in order to support these youths.

Emotional and behavioural problems in migrant adolescents in Belgium

Refugee and migrant adolsescents may be at increased risk for the development of emotional and behavioural problems. Since studies on this topic are rather scarce and results inconsistent, this large-scale screening study aims at investigating the prevalence of emotional and behavioural problems in recently arrived migrant adolescents in Belgium, compared to Belgian peers. About 1,249 migrant adolescents and 602 Belgian adolescents filled in four self-report questionnaires on the prevalence of emotional and behavioural problems, traumatic experiences and symptoms of post-traumatic stress. Migrant adolescents experienced more traumatic events than their Belgian peers, and show higher levels of peer problems and avoidance symptoms. On the contrary, non-migrant adolescents reveal more symptoms of anxiety, externalising problems and hyperactivity. Factors influencing the prevalence of emotional and behavioural problems are the number of traumatic events experienced, gender and the living situation. Although migrant and non-migrant adolescents don’t differ much in the prevalence of emotional and behavioural symptoms, attention should be given to the screening and support of risk groups within the population of migrant adolescents, such as girls, those who experienced a lot of traumatic events and unaccompanied refugee children and adolescents.

The psychological impact of forced displacement and related risk factors on Eastern Congolese adolescents affected by war

BACKGROUND While the current knowledge base on the mental health effects of displacement is mainly limited to refugees residing in industrialised countries, this paper examines the impact of war-induced displacement and related risk factors on the mental health of Eastern Congolese adolescents, and compares currently internally displaced adolescents to returnees and non-displaced peers. METHODS Data were collected from a community sample of 819 adolescents aged 13 to 21 years, attending one of 10 selected schools across the Ituri district in the Democratic Republic of Congo. Respondents completed culturally adapted self-report measures of posttraumatic stress symptoms (using the Impact of Event Scale - Revised) and internalising and externalising behaviour problems (by means of the Hopkins Symptoms Checklist - 37 for Adolescents). Associated factors studied were age, sex, parental death, exposure to war-related violence and daily stressors. RESULTS Internally displaced persons (IDPs) reported highest mean scores for the IES-R and the HSCL-37A internalising scale, followed by returnees, while non-displaced adolescents scored significantly lower. However, ANCOVA tests showed that posttraumatic stress and internalising symptoms were mainly associated with traumatic exposure and daily stressors and not with displacement status. Externalising problem scores were associated with traumatic exposure, daily stressors and displacement. Remarkably, death of father was associated with fewer externalising problems. Sex was differently associated with internalising and externalising problems through traumatic and daily stressors. CONCLUSIONS As IDPs are highly exposed to violence and daily stressors, they report most psychological distress, when compared to returnees and non-displaced peers. The distinct mental health outcomes for returned youngsters illustrate how enhancing current socio-economic living conditions of war-affected adolescents could stimulate resilient outcomes, despite former trauma or displacement.

Forced conscription of children during armed conflict: experiences of former child soldiers in northern Uganda.

OBJECTIVE Child soldiering can be considered as one of the worst practices of institutionalized child abuse. However, little is known about the scope and nature of this abuse and the consequent experiences of children enrolled in an armed faction. This research aims at enriching the knowledge on the experiences of child soldiers in the Lords Resistance Army (LRA) in northern Uganda. METHODS The databases of 4 former Interim Care Centres for returned child soldiers in northern Uganda, comprising socio-demographic information of 8,790 returnees, and additional data from the Rachele Rehabilitation Centre on war-related experiences of 1,995 former child soldiers, are analyzed using descriptive statistics, analysis of covariance and regression analysis. RESULTS During on average 1.5 years in captivity, nearly all participants had various war-related experiences, whereby 88% witnessed and 76% forcibly participated in atrocities. Variations in exposure to warfare appear to be mainly associated with age of abduction, duration of captivity, location of captivity, being military trained, and being a rebels wife. CONCLUSIONS These findings testify to the vastness of abuse lived through by the child soldiers in this study. They fulfilled a multifaceted position in the LRA, which delivers a range of potential direct and indirect consequences. The variables decisive in differential experiences unveil trends in the strategic abduction by the LRA and in differential exposure to warfare among child soldiers. IMPLICATIONS The variation in exposure to warfare urges for an individualized approach and monitoring of returning child soldiers. In order to address the potential indirect impact of child soldiering, support also needs to be oriented towards the childs network, based on a socio-ecological approach.

Screening for traumatic exposure and posttraumatic stress symptoms in adolescents in the war-affected eastern democratic republic of congo

OBJECTIVE To explore adolescent mental health in the eastern Democratic Republic of Congo, scene of a complex emergency since 1996. DESIGN Community cross-sectional data obtained using a cluster sample approach. SETTING From November 5, 2007, through February 5, 2008, we assessed 13 secondary schools in 4 selected health zones in the Ituri district. PARTICIPANTS One thousand forty-six adolescents and young adults aged 13 to 21 years completed a self-report questionnaire. MAIN EXPOSURES War-related traumatic events, posttraumatic stress symptoms, and sociodemographic variables. MAIN OUTCOMES MEASURES The Adolescent Complex Emergency Exposure Scale, specifically designed for this region, screened for exposure to potentially traumatic events, and the Impact of Event Scale-Revised measured symptoms of posttraumatic stress consistent with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. RESULTS Among the 477 girls (45.6%) and 569 boys (54.4%) in the study, 95.0% reported at least 1 traumatic event. On average, adolescents were exposed to 4.71 traumatic events, with higher exposure rates reported in boys, older groups, rural and urban areas, and respondents whose mother or father was dead. Of 990 respondents, 52.2% met symptom criteria for posttraumatic stress disorder. Symptom scores were strongly related to cumulative trauma exposure; however, the strength of this relationship differed slightly across living area groups for girls. CONCLUSION Adolescents in the eastern Democratic Republic of Congo are highly exposed to political violence, putting them at a considerable risk--mediated by living area and sex--to develop posttraumatic stress symptoms.

War-related trauma exposure and multiple risk behaviors among school-going adolescents in Northern Uganda: The mediating role of depression symptoms

BACKGROUND The relationship between war-related trauma exposure, depressive symptoms and multiple risk behaviors among adolescents is less clear in sub-Saharan Africa. METHODS We analyzed data collected from a sample of school-going adolescents four years postwar. Participants completed interviews assessing various risk behaviors defined by the Youth Self Report (YSR) and a sexual risk behavior survey, and were screened for post-traumatic stress, anxiety and depression symptoms based on the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Multivariate logistic regression was used to assess factors independently associated with multiple risk behaviors. The logistic regression model of Baron and Kenny (1986) was used to evaluate the mediating role of depression in the relationship between stressful war events and multiple risk behaviors. RESULTS Of 551 participants, 139 (25%) reported multiple (three or more) risk behaviors in the past year. In the multivariate analyses, depression symptoms remained uniquely associated with multiple risk behavior after adjusting for potential confounders including socio-demographic characteristics, war-related trauma exposure variables, anxiety and post-traumatic stress symptoms. In mediation analysis, depression symptoms mediated the associations between stressful war events and multiple risk behaviors. LIMITATIONS The psychometric properties of the questionnaires used in this study are not well established in war affected African samples thus ethno cultural variation may decrease the validity of our measures. CONCLUSIONS Adolescents with depression may be at a greater risk of increased engagement in multiple risk behaviors. Culturally sensitive and integrated interventions to treat and prevent depression among adolescents in post-conflict settings are urgently needed.

Toward a Relational Understanding of the Reintegration and Rehabilitation Processes of Former Child Soldiers

Worldwide, about 250,000 children are employed in armed factions. Their time in the army or rebel group charges them with a range of difficult and possibly traumatizing experiences. Moreover, when returning from the armed group, they often encounter difficulties reintegrating into their community and familial context, in particular social processes of stigmatization, discrimination, and expulsion. This article frames these difficulties within the broader social context, where organized violence induces deeply rooted processes of collective trauma on entire communities. Elaborating on diverse initiatives supporting the rehabilitation and reintegration processes of former child soldiers, a relational approach is put forward to address possible gaps in current humanitarian approaches. Additionally, current gaps and possible ways forward in research studying this group, starting from a relational approach, are discussed.

Social support in unaccompanied asylum‐seeking boys: a case study

BACKGROUND The situation of unaccompanied asylum-seeking children (UASC) is characterized by a substantial disruption of the social network and loss of parental support, seriously jeopardizing their psychological well-being. However, little is known about the role of social support in the lives of UASC. METHODS Twelve UASC completed a social support instrument and interview exploring perceived social support and what this implies for both buffering and main effects of social support. RESULTS Asylum centre staff and the ethnic community were the most important resources of support. High importance was ascribed to social companionship as a way of coping. Despite pro-social efforts towards Belgian peers, this group provided hardly any social support. CONCLUSIONS The provision of social support could enhance UASCs well-being through buffering effects (e.g. social companionship as avoidant/distractive coping) and main effects (acceptance by Belgian peers enhancing self-esteem). The asylum centre shows a great potential to stimulate UASCs psychological well-being by expanding the psychosocial function of staff members and community treatment.

Mental health of victims of sexual violence in eastern Congo: associations with daily stressors, stigma, and labeling

BackgroundThe conflict-ridden context of eastern Congo has set the scene for grueling human rights violations, with sexual violence as one of the ‘weapons of war’. Currently, sexual violence continues, with a considerable increase in civilian perpetrators. However, little is known regarding the particular impact of different experiences of sexual violence on adolescents’ mental health. This study therefore investigates the impact of sexual violence on eastern Congolese adolescents’ mental health and its differing associations with daily stressors, stigma, and the labeling of sexual violence (as ‘rape’ or ‘non-consensual sexual experience’).MethodsA cross-sectional, population-based survey design was implemented in 22 secondary schools, randomly selected from a stratified sample, in Bunia, eastern Congo, a region extensively affected by war. A total of 1,305 school-going adolescent girls aged 11 to 23 participated. Self-report measures of mental health symptoms, war-related traumatic events, experiences of sexual violence, daily stressors, and stigmatization were administered. Differences in sociodemographic characteristics, traumatic experiences and daily and social stressors between types of sexual violence (rape, non-consensual sexual violence, no sexual violence) were explored through statistical analysis. ANCOVA analyses investigated associations between those risk factors and adolescents’ mental health.ResultsMore than one third of eastern Congolese adolescent girls reported experiences of sexual violence. Elevated levels of daily stressors, experiences of stigmatization, and stressful war-related events were found amongst girl victims of sexual violence, with the highest levels for girls who labeled the sexual violence as rape. Daily stressors, stigmatization, and war-related events showed a large impact on the girls’ mental health. Last, girls who labeled the sexual violence as non-consensual sexual experiences reported more post-traumatic hyper-arousal and intrusion symptoms compared to those labeling the sexual violence as rape.ConclusionsThese findings point to the important association between how war-affected adolescent girls label sexual violence (rape or non-consensual sexual experiences) and their mental health. This study also documents the large impact of sexual violence on other stressors (daily stressors, stigmatization, and stressful war events) and the impact of these stressors on girl victims’ mental health. It discusses important implications for addressing sexual violence and its consequences in war-affected contexts.