Transit Migration and Trauma: the Detrimental Effect of Interpersonal Trauma on Syrian Children in Transit in Italy
Following the humanitarian crisis caused by the Syrian war, the shortages in European Union’s reception system exposed numerous children to a prolonged period of transit within frontier countries (e.g., Italy), during which they were considered “invisible” and received no legal recognition and protection. This situation offered a unique possibility to study the psychological dimensions involved in the elaboration of trauma during a migratory journey characterized by the lack of reception services. The present study, conducted on a group of Syrian children (n = 271) in transit to Italy with their families while on their journey to Northern Europe, aimed to explore the mental health of this population, focusing on the impact of interpersonal trauma as risk factors and resilience as protection for children’s mental health outcomes. The children were assessed for dose of exposure to traumatic experiences, post-traumatic symptomatology, social impairment dimensions, and resilience. A hierarchical multiple regression analysis was performed to check for the effects of dose of exposure and specific type of interpersonal trauma on post-traumatic symptomatology. Results showed that traumatic experiences affecting interpersonal relationships (family torture, serious deprivation, and bereavement) predict higher levels of PTSD, while the protective role of resilience on PTSD outcomes turned out to be inhibited. The paper also discusses the implications for stakeholders and policy makers and defines the theoretical future developments of the research.
KeywordsResilience Migration PTSD Children Transit migration Syria Dublin regulation
Compliance with Ethical Standard
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Conflict of Interest
The authors declare that they have no conflict of interest.
- Abdeen, Z. A. M., Qasrawi, R., Nabil, S., & Shaheen, M. A. M. (2008). Psychological reactions to Israeli occupation: findings from the national study of school-based screening in Palestine. International Journal of Behavioral Development, 32(4), 290–297. https://doi.org/10.1177/0165025408092220.Google Scholar
- Alisic, E., Zalta, A. K., van Wesel, F., Larsen, S. E., Hafstad, G. S., Hassanpour, K., & Smid, G. E. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. The British Journal of Psychiatry: The Journal of Mental Science, 204, 335–340. https://doi.org/10.1192/bjp.bp.113.131227.Google Scholar
- Almaqrami, M., & Shuwail, A. (2004). Validity of the self-report version of the Strengths and Difficulties Questionnaire in Yemen. Saudi Medical Journal, 25(5), 592–601.Google Scholar
- Betancourt, T. S. (2005). Stressors, supports and the social ecology of displacement: psychosocial dimensions of an emergency education program for Chechen adolescents displaced in Ingushetia, Russia. Culture, Medicine, and Psychiatry, 29(3), 309–340. https://doi.org/10.1007/s11013-005-9170-9.Google Scholar
- Briggs-Gowan, M. J., Ford, J. D., Fraleigh, L., McCarthy, K., & Carter, A. S. (2011). Prevalence of exposure to potentially traumatic events in a healthy birth cohort of very young children in the northeastern United States. Journal of Traumatic Stress, 23, 725–733. https://doi.org/10.1002/jts.20593.Google Scholar
- Brom, D., Pat-Horenczyk, R., & Ford, J. D. (Eds.). (2009). Treating traumatized children: risk, resilience and recovery. New York, NY: Routledge/Taylor & Francis Group.Google Scholar
- Castelli, C. (2013). Tutori di resilienza. Guida orientativa per interventi psico-educativi. Milan, Italy: EDUCatt Università Cattolica.Google Scholar
- Clervil, R., Guarino, K., DeCandia, C. J., & Beach, C. A. (2013). Trauma-informed care for displaced populations: A guide for community-based service providers. Needham, MA: The National Center on Family Homelessness.Google Scholar
- Council of Europe (2017). Council of Europe Action Plan on protecting refugee and migrant children adopted. Retrieved from https://www.coe.int/en/web/children/-/council-of-europe-action-plan-on-protecting-refugee-and-migrant-children-adopted?desktop=false. Accessed 23 Jan 2019.
- D’Andrea, W., Ford, J. D., Stolbach, B., Spinazzola, J., & Van der Kolk, B. A. (2012). Understanding interpersonal trauma in children: why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82, 187–200.Google Scholar
- Damra, J. K., & Nassar, Y. H. (2014). The effect of cognitive behavioral trauma focused therapy model on sample of war children’s depression symptomatology. Zarqa, Jordan: Hashemite University, Faculty of Sciences Education, Department of Educational Psychology.Google Scholar
- Dell’Osso, L., Carmassi, C., Stratta, P., Massimetti, G., Akiskal, K. K., Akiskal, H. S., Maremmani, I., & Rossi, A. (2012). Gender differences in the relationship between maladaptive behaviors and post-traumatic stress disorder. A study on 900 L’Aquila 2009 earthquake survivors. Frontiers in Psychiatry, 3, 111. https://doi.org/10.3389/fpsyt.2012.00111].
- Dhamrah, J., & Abueita, S. (2014). The effect of trauma focused cognitive behavioral therapy and music therapy on decreasing the posttraumatic stress symptomatology among a sample of war children. Zarqa, Jordan: Hashemite University, Faculty of Sciences Education, Department of Educational Psychology.Google Scholar
- European Commission (2017a) Communication from the commission to the European Parliament and Council on the protection of children in migration, SWD (2017) 129 final, COM (2017) 211 final. Brussels.Google Scholar
- European Parliament and Council of the European Union (2013). Directive 2013/33 of the European Parliament and Council of 23 June 2013. Retrieved from https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32013L0033&from=en. Accessed 23 Jan 2019.
- Forbes, D., Fletcher, S., Parslow, R., Phelps, A., O’Donnell, M., Bryant, R., McFarlane, A., Silove, D., & Creamer, M. (2012). Trauma at the hands of another: longitudinal study of differences in the posttraumatic stress disorder symptom profile following interpersonal compared with non-interpersonal trauma. The Journal of Clinical Psychiatry, 73, 372–376. https://doi.org/10.4088/JCP.10m06640.Google Scholar
- Fullerton, M. (2016). Asylum crisis Italian style: the Dublin regulation collides with European human rights law. Harvard Human Rights Journal, 29, 57–134.Google Scholar
- Giordano, F., Castelli, C., Crocq, L., & Baubet, T. (2012). Non-sense and chaos in the drawings of children victims of the earthquake in Abruzzo [Le non-sens et le chaos dans les dessins des enfants victimes du tremblement de terre aux Abruzzes]. Annales Medico-Psychologiques, 170(5), 342–348. https://doi.org/10.1016/j.amp.2012.05.011.Google Scholar
- Giordano, F., & Ferrari, C. (2018). Resilience in children victims of violence: an intervention project with adolescents in Lithuania [Processi di resilienza in minori vittime di violenza: Un progetto di intervento con adolescenti in Lituania]. Maltrattamento e Abuso all’Infanzia, 20(2), 105–116.Google Scholar
- Giordano, F., Orenti, A., Lanzoni, M., Marano, G., Biganzoli, E., Castelli, C., & Baubet, T. (2015). Trauma and temporal discontinuity in children victims of natural disasters. the Test de trois dessins: Avant, pendant et avenir [Trauma e discontinuità temporale nei minori vittime di disastri naturali. Il Test de trois dessins: Avant, pendant et avenir]. Maltrattamento e Abuso all’Infanzia, 17(2), 87–116. https://doi.org/10.3280/MAL2015-002005.Google Scholar
- Giordano, F., Ragnoli, F., Brajda Bruno, F., & Boerchi, D. (2018). Resilience and trauma-related outcomes in children victims of violence attending the Assisted Resilience Approach Therapy (ARAT). Child and Youth Services Review, 96, 286–293. https://doi.org/10.1016/j.childyouth.2018.11.050.Google Scholar
- Goodman, R. (1997). The strengths and difficulties questionnaire: a research note. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 38(5), 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.Google Scholar
- Içduygu, A. (1995). Transit migrants and Turkey. Bogazici Journal: Review of Social, Economic and Administrative studies, 1–2, 10(142), 127.Google Scholar
- Keller, A., Lhewa, D., Rosenfeld, B., Sachs, E., Aladiem, A., Cohen, I., Smith, H., & Porterfield, K. (2006). Traumatic experiences and psychological distress in an urban refugee population seeking treatment services. The Journal of Nervous and Mental Disease, 194(3), 188–194. https://doi.org/10.1097/01.nmd.0000202494.75723.83.Google Scholar
- Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM–IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62, 617–627. https://doi.org/10.1001/archpsyc.62.6.617.Google Scholar
- Khawaja, N. G., Ibrahim, O., & Schweitzer, R. D. (2017). Mental wellbeing of students from refugee and migrant backgrounds: the mediating role of resilience. School Mental Health: A Multidisciplinary Research and Practice Journal, 9(3), 284–293. https://doi.org/10.1007/s12310-017-9215-6.Google Scholar
- Kuwabara, S. A. (2012). Conceptual and methodological considerations for studying positive adaptation in displaced youth. Baltimore, Maryland: Johns Hopkins University.Google Scholar
- Macksoud, M., & Aber, J. L. (1996). The war experiences and psychological development of children in Lebanon. Child Development, 67(1), 70–88. https://doi.org/10.1111/j.1467-8624.1996.tb01720.x.Google Scholar
- Macksoud, M., Aber, J. L., Dyregrov, A., & Raundalen, M. (1990). Post-traumatic stress disorder reaction checklist for children. New York: Columbia University, Center for the Study of Human Rights, Project on Children and War.Google Scholar
- Macksoud, M., Aber, L., Dyregrov, A., & Raundalen, M. (1990). The Post-Traumatic Stress Reaction Checklist for Children (PTSRC). New York: Columbia University, Center for the Study of Human Rights, Project on Children and War.Google Scholar
- Maragel, M., & Manachi, S. (2018). The resilience of Syrian refugee children in Lebanon. In M. Pace & S. Sen (Eds.), Syrian refugee children in the Middle East and Europe (pp. 32–45). London: Routledge.Google Scholar
- Masten, A. S. (2012). Risk and resilience in development. In P. D. Zelazo (Ed.), Oxford handbook of developmental psychology. New York, NY: Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199958450.001.0001.Google Scholar
- Masten, A. S., & Narayan, A. J. (2012). Child development in the context of disaster, war, and terrorism: pathways of risk and resilience. Annual Review of Psychology, 63, 227–257. https://doi.org/10.1146/annurev-psych-120710-100356.Google Scholar
- McLaughlin, K. A., Koenen, K. C., Hill, E. D., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Trauma exposures and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 52(8), 815–830. https://doi.org/10.1016/j.jaac.2013.05.011.Google Scholar
- Montgomery, E. (1998). Refugee children from the Middle East. Scandinavian Journal of Social Medicine Supplementum, 54, 1–152.Google Scholar
- Norris, F. H., Steven, S. P., Pfefferbaum, B., Wyche, K. F., & Pfefferbaum, R. L. (2008). Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. American Journal of Community Psychology, 41, 127–150. https://doi.org/10.1007/s10464-007-9156-6.Google Scholar
- Punamaki, R. L., Palosaari, E., Diab, M., Peltonen, K., & Qouta, S. (2015). Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: trauma, family- and child-related predictors. Journal of Affective Disorders, 172, 133–140. https://doi.org/10.1016/j.jad.2014.09.021.Google Scholar
- Schmitt-Rodermund, E., & Silbereisen, R. K. (2008). Well-adapted adolescent ethnic German immigrants in spite of adversity: the protective effects of human, social, and financial capital. European Journal of Developmental Psychology, 5(2), 186–209. https://doi.org/10.1080/17405620701557290.Google Scholar
- Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA, 302, 537–549. https://doi.org/10.1001/jama.2009.1132.Google Scholar
- Tol, W. A., Song, S., & Jordans, M. J. (2013). Annual research review: resilience and mental health in children and adolescents living in areas of armed conflict—a systematic review of findings in low- and middle-income countries. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 54(4), 445–460. https://doi.org/10.1111/jcpp.12053.Google Scholar
- Ungar, M., & Liebenberg, L. (2009). Cross-cultural consultation leading to the development of a valid measure of youth resilience: the international resilience project. Studia Psychologica, 51(2–3), 259–268.Google Scholar
- United Nations High Commissar for Refugees (2018). Situation Syria regional refugee response. Retrieved from https://data2.unhcr.org/en/situations/syria
- Vallerand, R. J. (1989). Vers une méthodologie de validation trans-culturelle de questionnaires psychologiques: Implications pour la recherche en langue française [Toward a methodology for the transcultural validation of psychological questionnaires: implications for research in the French language]. Canadian Psychology/Psychologie Canadienne, 30(4), 662–680. https://doi.org/10.1037/h0079856.Google Scholar
- Vernberg, E. (2002). Intervention approaches following disasters. In A. M. LaGreca, W. K. Silverman, E. M. Vernberg, & M. C. Roberts (Eds.), Helping children cope with disasters and terrorism (pp. 55–72). Washington, DC: American Psychological Association. https://doi.org/10.1037/10454-003.Google Scholar
- Vindevogel, S. (2017). Resilience in the context of war: a critical analysis of contemporary conceptions and interventions to promote resilience among war-affected children and their surroundings. Peace and Conflict: Journal of Peace Psychology, 23(1), 76–84. https://doi.org/10.1037/pac0000214.Google Scholar
- Weine, S. M., Ware, N., Hakizimana, I., Tugenberrg, T., Currie, M., Dahnweih, G., Wagner, M., Polutnik, C., & Wulu, J. (2014). Fostering resilience: Protective agents, resources, and mechanisms for adolescent refugees psychosocial well-being. Adolescent Psychiatry, 4, 164–176. https://doi.org/10.2174/221067660403140912162410.
- World Health Organization (2017). Migrant populations, including children, at higher risk of mental health disorders. Retrieved from http://www.euro.who.int/en/health-topics/noncommunicable-diseases/mental-health/news/news/2017/04/migrant-populations,-including-children,-at-higher-risk-of-mental-health-disorders