Resilience and protective factors

Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents

Hodes M, Jagdev D, Chandra N, Cunniff A. (2008), Journal of Child Psychology and Psychiatry, 49(7):723-32. Full article requires paid subscription.

Summary written for www.HealTorture.org by CVT Intern Joseph Walker: 

Across the world there are significant numbers of displaced and unaccompanied refugee children. They are sent away from their families or flee from their communities out of fear of persecution, organized violence, or war. Young people who experience war events and displacement have elevated rates of psychopathology, particularly posttraumatic stress disorder. Unaccompanied asylum-seeking children and adolescents (UASC) are a group who may have experienced a high level of such trauma, and thus would appear to be at increased risk of psychiatric disorder. The specific aims of this study were threefold: first, to investigate whether UASC had experienced a higher level of past adversities and war trauma than accompanied asylum-seeking and refugee children (ARC); second, to determine whether UASC had higher levels of psychological distress than ARC; and third, to identify which factors, including living arrangements, ameliorate the effects of this distress.

UASC were recruited through the City of Westminster local authority Department of Social Services. ARC were a subgroup from a study of adolescent mental health carried out with students at a secondary school in the City of Westminster. Recruitment to the study was facilitated by the involvement of the allocated social workers for the young people, who were able to introduce the investigator or discuss the study prior to the investigator contacting the subjects. There were 78 UASC and 35 ARC, both groups having the same median age of 17 years, and no significant differences with regard to gender for the groups. The interviews and assessments took place either at their place of residence or at social work offices. The questionnaires of psychological distress were completed by the participant, or the investigator when there were literacy difficulties. Past war trauma events were assessed using the Harvard trauma questionnaire, which covers 17 types of maltreatment and traumatic events. The study found that UASC had experienced a much higher level of total traumatic events than ARC. The UASC group experienced on average 6.83 traumatic events, compared to 1.29 for the ARC group (p-value = .000). The two groups were investigated for posttraumatic stress symptoms for each gender separately using the Impact of Event Scale (IES), for which a score of 35 is the threshold for high risk of developing PTSD. Male UASC children had a mean score of 36.98, while ARC males had a mean score of 15.33 (p-value = .001). Female UASC scored 42.27 on average, with ARC females scoring 21.88 (p-value = .000). 61.5% of UASC males and 73.1% of females were determined to be at a high risk for developing PTSD.

UASC were predominantly living in foster families or semi-independent or fully independent arrangements. Posttraumatic stress symptoms were significantly higher amongst those in low-support living arrangements (living independently or semi-independently). The finding that post-traumatic stress symptoms are increased in lower-support living arrangements suggest that foster family living and high support may ameliorate posttraumatic stress, as well as provide general support. However, larger sample sizes and inclusion of interview measures of psychopathology would have strengthened the study further. There are a number of implications of this study. From the clinical perspective, it is important for those working with unaccompanied asylum-seeking adolescents to be aware of the high level of past war trauma, including injuries and sexual assault, that might affect their physical well-being. Mental health practitioners need to be aware of the high risk of posttraumatic stress disorder. Together with professionals in the child welfare agencies they should contribute to early detection for those who are highly distressed and whose difficulties appear to be persistent. 

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Sierra Leone’s Former Child Soldiers: A Longitudinal Study of Risk, Protective Factors, and Mental Health

This longitudinal study investigates adaptive behaviors among former child soldiers in Sierra Leone and whether post conflict factors contribute to adverse or resilient mental health outcomes.

Betancourt, Theresa et al (2010). Journal of the American Academy of Child & Adolescent Psychiatry, 49 (6), 606-615.

We encourage you to also review Dr. Betancourt's presentation: Studies of Adversity, Resilience, and Child Mental Health.

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The mental health of children affected by armed conflict: protective processes and pathways to resilience

Betancourt TS, Khan KT (2008), International Review of Psychiatry; 20(3):317-28.

This paper examines the concept of resilience in the context of children affected by armed conflict and presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective.
Note: Requires paid subscription - link is to abstract.

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