ARTICLES
Review of Child and Adolescent Refugee Mental Health

https://doi.org/10.1097/00004583-200401000-00012Get rights and content

ABSTRACT

Objective

To review stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. Highlighted are special refugee populations such as unaccompanied minors, asylum seekers, and former child soldiers. Pertinent medical findings are summarized.

Method

The authors reviewed articles from 1990 to 2003 addressing the topics above. Literature was gathered from databases including PsycINFO, Medline, and SocioFile. Pertinent earlier papers and those from other disciplines cited in database-identified articles were also included.

Results

Child and adolescent refugees suffer from significant conflict-related exposures. Reactions to stress may be mediated by coping strategies, belief systems, and social relations.

Conclusions

More research is needed on interventions, specifically on efficacy and cultural relevance. Interventions that have an impact on multiple ecological levels need further development and evaluation.

Section snippets

DEVELOPMENT, CULTURE, AND THEORY

A culturally relevant, developmental theoretical foundation is essential to understanding the experience of refugee youths in the context of flight and resettlement. Developmental theory (Erikson, 1950) has been applied to understanding vulnerability among refugee children (Eisenbruch, 1988), whose wartime experiences of mistrust, self-doubt, and inferiority exacerbate the psychosocial crises that occur during normal development. Psychological development mediates the impact of war and

PHASES OF REFUGEE EXPERIENCE

Among refugees, four broad responses to the stressful experiences have been described: anticipation, devastating events, survival, and adjustment (Fazel and Stein, 2002; Gonsalves, 1992; Papadopoulos, 2001). These reactions fit within the three phases of the refugee experience described below.

Preflight Stress

In Mozambique, one study found that 77% of over 500 children surveyed had witnessed murders or mass killings (Boothby, 1994; Boothby et al., 1991). Elsewhere, among a sample of 40 adolescent Cambodian refugees who had survived 4 years in a Pol Pot “work camp,” 98% endured forced labor, 90% lived in age-segregated camps, and 83% lacked sufficient food for long periods of time (Kinzie et al., 1986).

Combat Experience

Combat is common among refugee children before or during flight. An estimated 300,000 children

Preflight: Coping With War And Political Violence

Ideological commitment has preliminary empirical support as a protective factor among youths in a war zone. A study of Israeli Jewish young adolescents exposed to political violence investigated ideological commitment operationalized by attitudes toward war, peace, patriotism, and the political enemy (Punamaki, 1996). Stronger ideological commitment was associated with less anxiety, insecurity, depression, and failure among children faced with low levels of war exposure. At higher levels of war

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    Supported by SAMHSA grant U79 SM54305 (Dr. Saxe).

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