Matthew Hodes

Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents.

BACKGROUND To investigate the level of posttraumatic stress and depressive symptoms, and background risk and protective factors that might increase or ameliorate this distress amongst unaccompanied asylum-seeking children and adolescents (UASC). METHODS Cross-sectional survey carried out in London. Participants were 78 UASC aged 13-18 years, predominantly from the Balkans and Africa, compared with 35 accompanied refugee children. Measures included self-report questionnaires of war trauma, posttraumatic stress and depressive symptoms. RESULTS UASC had experienced high levels of losses and war trauma, and posttraumatic stress symptoms. Predictors of high posttraumatic symptoms included low-support living arrangements, female gender and trauma events, and increasing age only amongst the UASC. High depressive scores were associated with female gender, and region of origin amongst the UASC. CONCLUSION UASC might have less psychological distress if offered high-support living arrangements and general support as they approach the age of 18 years, but prospective studies are required to investigate the range of risk and protective factors.

Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis

Food allergy is a common cause of anaphylaxis, but the incidence of fatal food anaphylaxis is not known. The aim of this study was to estimate the incidence of fatal food anaphylaxis for people with food allergy and relate this to other mortality risks in the general population.

Psychopathology, adversity, and service utilization of young refugees

OBJECTIVE To investigate the psychopathology, social impairment, adversities, and service utilization of refugee families and their children seeking help at a child and adolescent psychiatry clinic in London. METHOD A retrospective case-control study of 30 refugee children and families individually matched with nonrefugee immigrant families and white British families. Case note review was carried out to obtain data on diagnosis, social adjustment, past adversity, exposure to violence, current socioeconomic circumstances, and use of the child and adolescent psychiatric service. RESULTS Refugee children tended to have disorders with a psychosocial etiology rather than neurobiological disorders. Refugees had similar levels of social impairment compared with the other groups. Refugees were much more isolated and disadvantaged and had different referral pathways but were not more likely to drop out of treatment prematurely. CONCLUSIONS Refugee children and families had been exposed to high levels of adversity. The ability of community agencies to refer families who could use treatment has significant resource implications.

Maternal Expressed Emotion and Adjustment in Children with Epilepsy

Epilepsy in childhood may alter family relationships but the relevance of these changes for the increased rates of psychopathology has been little investigated. This study uses maternal expressed emotion (EE) to examine family relationships of children with epilepsy and the association with high risk for psychiatric disorder. EE was assessed using the Camberwell Family Interview carried out with the mothers of 22 schoolchildren with chronic epilepsy who were attending a general hospital outpatient clinic. Sixteen of these children had similarly aged healthy siblings who served as controls. High risk for psychiatric disorder in the children and mothers was assessed using behavioural, mood, and self-esteem questionnaires completed by mothers, teachers, and children. It was found that mothers showed significantly more emotional overinvolvement and a trend for more hostility towards their children with epilepsy than towards sibling controls. For the 22 children with epilepsy, maternal emotional overinvolvement was not associated with child behavioural deviance. High levels of criticism and, to a lesser extent, hostility did show associations with child behavioural deviance, and the strongest links were between maternal criticism and maternal rated antisocial and overactive behaviour in the child. Fewer positive comments by mothers towards the children were associated with child emotional symptoms and lower self-esteem in a number of areas. This study suggests that further research could consider the appropriateness of psychological intervention for families in which mothers are critical and hostile and whose children show antisocial behaviour.

A School-Based Mental Health Service for Refugee Children

This article describes a school-based mental health service established to help psychologically distressed refugee pupils. The primary school involved was situated in an inner London borough and had a high proportion of refugee and immigrant children. Teachers identified refugee pupils with psychological difficulties and referred them to an outreach mental health worker who provided treatment on the school site. In addition to clinical interview the strengths and difficulties questionnaire was used as an assessment and outcome measure. In total 14 children (12 boys) were referred to the project. The children had been exposed to high levels of past violence and losses, and experienced ongoing socio-economic adversity. The children mostly had disorders related to these adversities, but a small number also appeared to have specific learning or scholastic difficulties. The difficulties mostly presented in the class as inattention and over-activity. A range of psychological and family interventions were offered, which included seeing the teachers initially, the children alone and relatives. Overall children were helped by the intervention with a reduction in SDQ scores (21.3 to 15.7) and some children showed dramatic benefit. This model seemed acceptable to the children, families and school. The implications of the project are discussed.

Mental health problems of young refugees: Duration of settlement, risk factors and community-based interventions

Little is known about the characteristics of young psychologically-distressed refugees in mental health services, and how they vary according to the duration of settlement. This study of 102 young refugees referred to a community-based mental health service describes past adversities and current circumstances, referral problems, service utilization and treatment outcomes using the Strengths and Difficulties Questionnaire (SDQ). The more recently-arrived refugees had significantly higher levels of close exposure to war and violence, were more likely to have suffered separation from immediate family and to have insecure legal status. Those refugees settled longer were significantly more likely to be referred because of conduct problems while there was a trend in recent arrivals to present with internalizing pathology. A comparison of the teachers’ and parents’ mean SDQ scores of the study’s young refugees sample and a national study representative of Great Britain as a whole showed that young refugees have higher scores in total problem and all subscales scores than the British scores. Community-based mental health services for young refugees appeared effective – significant improvement was found in SDQ scores for the sub-group (n = 24) who took up the treatments offered. The implications are discussed for service development and practitioners.

Children of Mothers with Eating Disorders: A Preliminary Study

This study investigated the extent of psychiatric disorder and abnormalities of weight and growth amongst children of mothers with eating disorders. The design was a cross-sectional study, in which mothers were identified by attendance at specialist eating disorder services. Assessments included interviews with the mothers and children, questionnaires included EAT and child behaviour questionnaires (Rutter A scale), and weight and height of mothers and children was measured. Thirteen mothers who had 26 children participated in the study. The findings were that mothers had chronic eating disorders and high rates of marital difficulties and separation. Amongst the children 50 per cent had psychiatric disorders, and 32 per cent abnormalities of weight or growth. Female offspring tended to have low body weight. Mothers underestimated their childrens dietary needs. The adjustment and growth of this group of children should be considered when mothers request help for themselves.

Patients' ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial

Previous work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices.

Anxiety and stress in mothers of food-allergic children

Previous reports suggest that parents especially mothers of food‐allergic children may have increased anxiety. Studies with an appropriate control group have not been undertaken, and the determinants of such anxiety are not known. We compared measures of anxiety and stress in mothers of food‐allergic children and atopic non‐food‐allergic children, with anxiety and stress in mothers of children with no chronic illness.

The assessment of expressed emotion in a standardised family interview.

This study compared the expressed emotion (EE) scores obtained using individual interviews with parents with the scores obtained in whole family interviews. Interviews were carried out with 31 parents of 16 adolescents referred because of an eating disorder. There was moderate correlation of scores between the two interviews regarding critical comments, emotional overinvolvement, and warmth, but it was low for positive remarks. The study suggests that the whole family interview, which is time saving, is useful in assessing expressed emotion. The levels of expressed emotion, particularly the relatively low levels of critical comments and emotional overinvolvement, are similar to those of previous studies.