Trauma History and Psychopathology in War-Affected Refugee Children Referred for Trauma-Related Mental Health Services in the United States

Authors

  • Theresa S. Betancourt,

    Corresponding author
    1. François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, Massachusetts, USA
    • Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
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  • Elizabeth A. Newnham,

    1. François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, Massachusetts, USA
    2. School of Psychology, The University of Western Australia, Perth, Western Australia, Australia
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  • Christopher M. Layne,

    1. UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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  • Soeun Kim,

    1. University of California Los Angeles School of Public Health, Los Angeles, California, USA
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  • Alan M. Steinberg,

    1. UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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  • Heidi Ellis,

    1. Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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  • Dina Birman

    1. Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
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  • This manuscript was developed (in part) under grant numbers 3U79SM054284-10S from the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS) and Grant #1K01MH077246-01A2 from the National Institute of Mental Health (NIMH). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA/HHS or NIMH. We thank Ernestine Briggs-King, Carrie Purbeck Trunzo, Robert C. Lee, Linda Kumah, Stephanie Reading, Rebecca Vivrette, and Thomas Belin for their support in the development of this manuscript. We are grateful to the 56 sites within the NCTSN that have contributed data to the Core Data Set as well as to the children and families that have contributed to our growing understanding of child traumatic stress.

  • TSB, EAN, CML, HE, and DB designed the study. AS and CML were involved in development of the dataset and measurement. SK analyzed the data and TSB and EAN wrote the first draft. All authors contributed to the final manuscript.

Correspondence concerning this article should be addressed to Theresa S. Betancourt, Department of Global Health and Population/François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, 651 Huntington Avenue, 7th floor, Boston, MA 02115. E-mail: Theresa_Betancourt@harvard.edu

Abstract

There is an increasing need to deliver effective mental health services to refugee children and adolescents across the United States; however, the evidence base needed to guide the design and delivery of services is nascent. We investigated the trauma history profiles, psychopathology, and associated behavioral and functional indicators among war-affected refugee children presenting for psychological treatment. From the National Child Traumatic Stress Network's Core Data Set, 60 war-affected refugee children were identified (51.7% males, mean age = 13.1 years, SD = 4.13). Clinical assessments indicated high rates of probable posttraumatic stress disorder (30.4%), generalized anxiety (26.8%), somatization (26.8%), traumatic grief (21.4%), and general behavioral problems (21.4%). Exposure to war or political violence frequently co-occurred with forced displacement; traumatic loss; bereavement or separation; exposure to community violence; and exposure to domestic violence. Academic problems and behavioral difficulties were prevalent (53.6% and 44.6%, respectively); however, criminal activity, alcohol/drug use, and self-harm were rare (all < 5.45%). These findings highlight the complex trauma profiles, comorbid conditions, and functional problems that are important to consider in providing mental health interventions for refugee children and adolescents. Given the difficulties associated with access to mental health services for refugees, both preventive and community-based interventions within family, school, and peer systems hold particular promise.

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