Disorders in Child and Adolescent Population

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Children form one of the most vulnerable groups among refugees. Often they are the neglected lot. Psychiatric problems among refugee children are more prevalent than among the normal population of the same age. Although it has been argued that children are able to cope much better than adults, the fact remains that a large number of children among the refugee population suffer from mental disorders. Studies reveal that children, like adults, suffer an increasing number of psychiatric problems, among which PTSD, depression, anxiety and conduct disorders are the commonest ones.

In Finland, Sourander [51] found that 48% of the surveyed refugee children had symptoms of PTSD, depression or anxiety. Fox et al. [52] found depression in 51% of the South East Asian refugee children surveyed by him in the USA. Sack et al. [53] conducted a long-term study using standardized instruments to assess the prevalence of PTSD and depression in a group of Cambodian children. They found that over a 12-year period the point prevalence for PTSD decreased from 50% to 35%, and that for depression dropped from 48% to 14%. Psychosocial problems were more prevalent than mental disorders in a group of refugee children studied in the UK [54].

Numerous children become innocent victims of war. Some lose their parents and relatives, some lose friends, schooling is disrupted and childhood is lost. In many areas, children are inducted as soldiers. According to the Machel Report [55], nearly a quarter of a million child soldiers saw armed conflict in the late 1980s. Children are often forced to work as messengers, porters, and cooks or even to provide sexual gratification to older soldiers. They are often picked up from the streets or forcibly taken from their poor and frightened families by the leaders or chosen from the unaccompanied children. Unfortunately, all this leads to an increase in the prevalence rate of mental disorders among children caught in conflict areas.

In this context, Schwarzwald et al. [56] conducted a survey among Israeli children from areas hit by missiles and compared them with children from areas not hit by missiles. The prevalence for PTSD was 24.9% in the former area and 12.9% in the latter. However, social functioning was found to be relatively preserved. Mollica et al. [57] surveyed 182 Khmer children settled in Thai refugee camps and found that 53.8% had psychiatric symptoms as per parent report on the Child Behaviour Checklist [58] and 26.4% on the Youth Self-Report [59]. PTSD was found in 945 of internally displaced Bosnian children in another survey [60]. In the Gaza Strip, Thabet and Vostanis [61, 62] found that out of the 959 children surveyed by them 44% showed "caseness" on the Rutter B2 scale [63], and 26.8% in the parent rating scale [64], with a cut-off score of 9. PTSD was again found to be an important disorder.

Sack et al. [53] found almost half of the surveyed Khmer adolescents to be suffering from PTSD and depression in their initial assessment. The rates decreased to 35% for PTSD and 14% for depression after 12 years of follow-up. Servan-Schreiber et al. [65] found both PTSD and depression in 11.5% of the Tibetan children. Rates as high as 95% and 90% for PTSD and anxiety, respectively, have been found in displaced Bosnian children by Stein et al. [66]. However, all diagnoses of PTSD have to be judged carefully, keeping in mind the huge cultural difference across communities and the meaning and manifestations of trauma across different cultures.

Children end up as refugees with or without their families. They are either willing or unwilling participants in a war and often have experienced death and destruction. At times they have been the cause of death, as soldiers, or have been tortured physically or sexually. Once in a foreign land, children express some coping behaviour that is culturally determined and some other that they gradually develop. Children are quicker to absorb the new culture, make friends and learn the new language. Often their ability to assimilate faster into a new community leads to a change of role in their home, and adults tend to depend on them more for help in resolving social issues. Although there are studies showing very high prevalence rates for mental disorders, especially PTSD, there are others [40] that have criticized the overdiagnosis of PTSD by Western assessors, including the international organizations. Studies related to mental health problems among children and adolescents are summarized in Table 8.4.

Table 8.4 Studies on children and adolescents

Country

Subjects and methods

Prevalence (%)

Reference

Israel

Thailand

Former Yugoslavia

Finland

Former Yugoslavia

India

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