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The Psychological and Medical Sequelae of War in Central American Refugee Mothers and Children

The Psychological and Medical Sequelae of War in Central American Refugee Mothers and Children Abstract Objective: To investigate the physical and mainly psychological sequelae of exposure to war in Central American children and their mothers who immigrated to the United States on average 4 years before the study began. Design: Interview study. Participants: Twenty-two immigrant Central American women caretakers and 1 of their children aged 5 to 13 years. Main Outcome Measures: Standardized and new measures were administered to assess children's physical and mental health symptoms and exposure to political violence. Results: Eighteen of the 22 children had chronic health problems. Fifteen children and all of the adults had observed traumatic events, including bombings and homicides. Thirteen of the children showed mental health symptom profiles above established norms, although only 2 met the criteria for posttraumatic stress disorder according to their own reports. Many of the caretakers were unaware of their child's psychological distress. Four of the mothers exhibited posttraumatic stress disorder, and their symptoms predicted their child's mental health. Conclusions: Pediatricians are sometimes the first and only contacts these families have with health care providers. Caretakers' reports of children's mental health are often incomplete. It is therefore important for physicians to probe for "hidden" symptoms in refugee children. These family members may need referrals to social and psychological services, and pediatricians can open the gates to existing community networks of support. Because we found that maternal mental health influences the child's, the child's interests are well served when pediatricians also encourage the mother to contact services for herself if she confides that she is experiencing some of the severe psychological sequelae reported by the women in this study.Arch Pediatr Adolesc Med. 1996;150:822-828 References 1. US Committee for Refugees. World Refugee Survey: 1989 in Review . Washington, DC: US Committee for Refugees: 1990. 2. Arroyo W. Eth S. Children traumatized by Central American warfare . In: Eth S, Pynoos RS, eds. Post-traumatic Stress Disorder in Children . Washington, DC: American Psychiatric Press Inc; 1985. 3. Aroian KJ. A model of psychological adaptation to migration and resettlement . Nurs Rev . 1990;39:5-10. 4. Aronowitz M. The social and emotional adjustment of immigrant children: a review of the literature . Int Migration Rev . 1984;18:237-257.Crossref 5. Minde K, Minde R. Children of immigrants: the adjustment of Ugandan Asian primary-school children in Canada . Can J Psychiatry . 1976;21:371-381. 6. Cervantes RC, Salgado de Snyder VN, Padilla AM. Posttraumatic stress in immigrants from Central America and Mexico . J Hosp Community Psychiatry . 1989;40:615-619. 7. Kinzie JD, Fredrickson RH, Ben R, Reck J, Karls W. Posttraumatic stress disorder among survivors of Cambodian concentration camps . Am J Psychiatry . 1984;141:645-650. 8. Mollka RF, Wyshak G, Lavelle J. The psychological impact of war trauma and torture on Southeast Asian refugees . Am J Psychiatry . 1987;144:1567-1572. 9. Kinzie JD, Sack WH, Angell RH, Manson S, Ben R. The psychiatric effects of massive trauma on Cambodian children . J Am Acad Child Adolesc Psychiatry . 1986;25:370-383.Crossref 10. Ahearn FL, Athey JL, eds. Refugee Children: Theory, Research and Services . Baltimore, Md: The Johns Hopkins University Press; 1991. 11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition. Revised . Washington, DC: American Psychiatric Association; 1987. 12. Achenbach TM, Edelbrock CS. Manual for the Child Behavior Checklist and Revised Child Behavior Profile . Burlington, Vt: University Associates in Psychiatry; 1983. 13. Achenbach TM, McConaughy SH. Empirically Based Assessment of Child and Adolescent Psychopathology: Practical Applications . Newbury Park, Calif: Sage Publications Inc; 1987. 14. Kovacs M, Beck AT. An empirical clinical approach toward a definition of childhood depression . In: Schulterbrant JG, Raskin A, eds. Depression in Childhood: Diagnosis, Treatment, and Conceptual Models . New York, NY: Raven Press; 1977:1-26. 15. Creamer M. Post-traumatic stress disorder: some diagnostic and clinical issues . Aust N Z J Psychiatry . 1990;24:517-522. 16. Green BL, Korol M, Grace MC, et al. Children and disaster: age, gender, and parental effects of PTSD symptoms . J Am Acad Child Adolesc Psychiatry . 1991; 30:945-951.Crossref 17. Schwarz ED, Kowalski JM. Posttraumatic stress disorder after a school shooting: effects of symptom threshold selection and diagnosis by DSM-III, DSM-III-R. or proposed DSM-IV Am J Psychiatry . 1991;148:592-597. 18. Terr LC. Childhood traumas: an outline and overview . Am J Psychiatry . 1991; 148:10-20. 19. Davidson JRT, Hughes D, Blazer DG, George LK. Post-traumatic stress disorder in the community: an epidemiological study . Psychol Med . 1991;21:713-721.Crossref 20. Helzer JE, Robins LN, McEvoy L. Post-traumatic stress disorder in the general population . N Engl J Med . 1987;317:1630-1634.Crossref 21. Cohn J, Danielsen L, Holzer KIM, et al. A study of Chilean refugee children in Denmark . Lancet . 1985:2:437-438.Crossref 22. Hjern A, Angel B, Hojer B. Persecution and behavior: a report of refugee children from Chile . Child Abuse Negl . 1991;15:239-248.Crossref 23. Hodges K, Gordon Y, Lennon MP. Parent-child agreement on symptoms assessed via a clinical research interview for children: the Child Assessment Schedule (CAS) . J Child Psychol Psychiatry . 1990;31:427-436.Crossref 24. Ivens C, Rehm LP. Assessment of childhood depression: correspondence between reports by child, mother, and father . J Am Acad Child Adolesc Psychiatry . 1988;27:738-741.Crossref 25. Moretti MM, Fine S, Haley G, Marriage K. Childhood and adolescent depression: child-report versus parent-report information . J Am Acad Child Adolesc Psychiatry . 1985;24:298-302.Crossref 26. Weissman MM, Wickramaratne P, Warner V, et al. Assessing psychiatric disorders in children . Arch Gen Psychiatry . 1987;44:747-753.Crossref 27. Conrad M, Hammen C. Role of maternal depression in perceptions of child maladjustment . J Consult Clin Psychol . 1989;57:663-667.Crossref 28. Poznanski E, Mokros HB, Grossman J, Freeman LN. Diagnostic criteria in childhood depression . Am J Psychiatry . 1985;142:1168-1173. 29. Sack WH, Angell RH, Kinzie JD, Ben R. The psychiatric effects of massive trauma on Cambodian children: the family, the home, and the school . J Am Acad Child Adolesc Psychiatry . 1986;25:377-383.Crossref 30. Terr LC. Chowchilla revisited: the effects of psychic trauma four years after a school-bus kidnapping . Am J Psychiatry . 1983;140:1543-1550. 31. Saigh PA. The development of posttraumatic stress disorder following four different types of traumatization . Behav Res Ther . 1991;29:213-216.Crossref 32. Rosenheck R, Nathan P. Secondary traumatization in children of Vietnam veterans . J Hosp Community Psychiatry . 1985;36:539-539. 33. Saigh PA. Verbally mediated childhood post-traumatic stress disorder . Br J Psychiatry . 1992;161:704-706.Crossref 34. McCloskey LA, Southwick K, Fernández-Esquer ME, Locke C. Surviving political and domestic violence: comparing the psychosocial outcomes of Central American and Mexican American immigrant mothers and children . J Community Psychol . 1995;23:95-116.Crossref 35. McCloskey LA, Southwick K. Psychosocial problems in refugee children exposed to war . Pediatrics . 1996;97:394-397. 36. Costello EJ, Edelbrock CS. Detection of psychiatric disorder in pediatric primary care: a preliminary report . J Am Acad Child Adolesc Psychiatry . 1985; 24:771-774.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

The Psychological and Medical Sequelae of War in Central American Refugee Mothers and Children

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1996.02170330048008
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Abstract

Abstract Objective: To investigate the physical and mainly psychological sequelae of exposure to war in Central American children and their mothers who immigrated to the United States on average 4 years before the study began. Design: Interview study. Participants: Twenty-two immigrant Central American women caretakers and 1 of their children aged 5 to 13 years. Main Outcome Measures: Standardized and new measures were administered to assess children's physical and mental health symptoms and exposure to political violence. Results: Eighteen of the 22 children had chronic health problems. Fifteen children and all of the adults had observed traumatic events, including bombings and homicides. Thirteen of the children showed mental health symptom profiles above established norms, although only 2 met the criteria for posttraumatic stress disorder according to their own reports. Many of the caretakers were unaware of their child's psychological distress. Four of the mothers exhibited posttraumatic stress disorder, and their symptoms predicted their child's mental health. Conclusions: Pediatricians are sometimes the first and only contacts these families have with health care providers. Caretakers' reports of children's mental health are often incomplete. It is therefore important for physicians to probe for "hidden" symptoms in refugee children. These family members may need referrals to social and psychological services, and pediatricians can open the gates to existing community networks of support. Because we found that maternal mental health influences the child's, the child's interests are well served when pediatricians also encourage the mother to contact services for herself if she confides that she is experiencing some of the severe psychological sequelae reported by the women in this study.Arch Pediatr Adolesc Med. 1996;150:822-828 References 1. US Committee for Refugees. World Refugee Survey: 1989 in Review . Washington, DC: US Committee for Refugees: 1990. 2. Arroyo W. Eth S. Children traumatized by Central American warfare . In: Eth S, Pynoos RS, eds. Post-traumatic Stress Disorder in Children . Washington, DC: American Psychiatric Press Inc; 1985. 3. Aroian KJ. A model of psychological adaptation to migration and resettlement . Nurs Rev . 1990;39:5-10. 4. Aronowitz M. The social and emotional adjustment of immigrant children: a review of the literature . Int Migration Rev . 1984;18:237-257.Crossref 5. Minde K, Minde R. Children of immigrants: the adjustment of Ugandan Asian primary-school children in Canada . Can J Psychiatry . 1976;21:371-381. 6. Cervantes RC, Salgado de Snyder VN, Padilla AM. Posttraumatic stress in immigrants from Central America and Mexico . J Hosp Community Psychiatry . 1989;40:615-619. 7. Kinzie JD, Fredrickson RH, Ben R, Reck J, Karls W. Posttraumatic stress disorder among survivors of Cambodian concentration camps . Am J Psychiatry . 1984;141:645-650. 8. Mollka RF, Wyshak G, Lavelle J. The psychological impact of war trauma and torture on Southeast Asian refugees . Am J Psychiatry . 1987;144:1567-1572. 9. Kinzie JD, Sack WH, Angell RH, Manson S, Ben R. The psychiatric effects of massive trauma on Cambodian children . J Am Acad Child Adolesc Psychiatry . 1986;25:370-383.Crossref 10. Ahearn FL, Athey JL, eds. Refugee Children: Theory, Research and Services . Baltimore, Md: The Johns Hopkins University Press; 1991. 11. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition. Revised . Washington, DC: American Psychiatric Association; 1987. 12. Achenbach TM, Edelbrock CS. Manual for the Child Behavior Checklist and Revised Child Behavior Profile . Burlington, Vt: University Associates in Psychiatry; 1983. 13. Achenbach TM, McConaughy SH. Empirically Based Assessment of Child and Adolescent Psychopathology: Practical Applications . Newbury Park, Calif: Sage Publications Inc; 1987. 14. Kovacs M, Beck AT. An empirical clinical approach toward a definition of childhood depression . In: Schulterbrant JG, Raskin A, eds. Depression in Childhood: Diagnosis, Treatment, and Conceptual Models . New York, NY: Raven Press; 1977:1-26. 15. Creamer M. Post-traumatic stress disorder: some diagnostic and clinical issues . Aust N Z J Psychiatry . 1990;24:517-522. 16. Green BL, Korol M, Grace MC, et al. Children and disaster: age, gender, and parental effects of PTSD symptoms . J Am Acad Child Adolesc Psychiatry . 1991; 30:945-951.Crossref 17. Schwarz ED, Kowalski JM. Posttraumatic stress disorder after a school shooting: effects of symptom threshold selection and diagnosis by DSM-III, DSM-III-R. or proposed DSM-IV Am J Psychiatry . 1991;148:592-597. 18. Terr LC. Childhood traumas: an outline and overview . Am J Psychiatry . 1991; 148:10-20. 19. Davidson JRT, Hughes D, Blazer DG, George LK. Post-traumatic stress disorder in the community: an epidemiological study . Psychol Med . 1991;21:713-721.Crossref 20. Helzer JE, Robins LN, McEvoy L. Post-traumatic stress disorder in the general population . N Engl J Med . 1987;317:1630-1634.Crossref 21. Cohn J, Danielsen L, Holzer KIM, et al. A study of Chilean refugee children in Denmark . Lancet . 1985:2:437-438.Crossref 22. Hjern A, Angel B, Hojer B. Persecution and behavior: a report of refugee children from Chile . Child Abuse Negl . 1991;15:239-248.Crossref 23. Hodges K, Gordon Y, Lennon MP. Parent-child agreement on symptoms assessed via a clinical research interview for children: the Child Assessment Schedule (CAS) . J Child Psychol Psychiatry . 1990;31:427-436.Crossref 24. Ivens C, Rehm LP. Assessment of childhood depression: correspondence between reports by child, mother, and father . J Am Acad Child Adolesc Psychiatry . 1988;27:738-741.Crossref 25. Moretti MM, Fine S, Haley G, Marriage K. Childhood and adolescent depression: child-report versus parent-report information . J Am Acad Child Adolesc Psychiatry . 1985;24:298-302.Crossref 26. Weissman MM, Wickramaratne P, Warner V, et al. Assessing psychiatric disorders in children . Arch Gen Psychiatry . 1987;44:747-753.Crossref 27. Conrad M, Hammen C. Role of maternal depression in perceptions of child maladjustment . J Consult Clin Psychol . 1989;57:663-667.Crossref 28. Poznanski E, Mokros HB, Grossman J, Freeman LN. Diagnostic criteria in childhood depression . Am J Psychiatry . 1985;142:1168-1173. 29. Sack WH, Angell RH, Kinzie JD, Ben R. The psychiatric effects of massive trauma on Cambodian children: the family, the home, and the school . J Am Acad Child Adolesc Psychiatry . 1986;25:377-383.Crossref 30. Terr LC. Chowchilla revisited: the effects of psychic trauma four years after a school-bus kidnapping . Am J Psychiatry . 1983;140:1543-1550. 31. Saigh PA. The development of posttraumatic stress disorder following four different types of traumatization . Behav Res Ther . 1991;29:213-216.Crossref 32. Rosenheck R, Nathan P. Secondary traumatization in children of Vietnam veterans . J Hosp Community Psychiatry . 1985;36:539-539. 33. Saigh PA. Verbally mediated childhood post-traumatic stress disorder . Br J Psychiatry . 1992;161:704-706.Crossref 34. McCloskey LA, Southwick K, Fernández-Esquer ME, Locke C. Surviving political and domestic violence: comparing the psychosocial outcomes of Central American and Mexican American immigrant mothers and children . J Community Psychol . 1995;23:95-116.Crossref 35. McCloskey LA, Southwick K. Psychosocial problems in refugee children exposed to war . Pediatrics . 1996;97:394-397. 36. Costello EJ, Edelbrock CS. Detection of psychiatric disorder in pediatric primary care: a preliminary report . J Am Acad Child Adolesc Psychiatry . 1985; 24:771-774.Crossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Aug 1, 1996

References