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The “Lost Boys” of Sudan: Use of Health Services and Functional Health Outcomes of Unaccompanied Refugee Minors Resettled in the U.S.

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Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

To assess whether mental health counseling and other health services were associated with functional health outcomes of unaccompanied Sudanese refugee minors in the U.S., this study was a descriptive survey of 304 Sudanese refugee minors in foster care through the U.S. Unaccompanied Refugee Minors Program (URMP). Functional health outcomes included scores of Child Health Questionnaire (CHQ) scales and questions regarding care for symptoms or problems associated with behavioral disorders, i.e. somatization. Posttraumatic stress disorder (PTSD) was assessed using the Harvard Trauma Questionnaire (HTQ). Health services questions derived from the National Health Interview Survey. Minors reported high rates of counseling (45%); however no differences were noted in counseling use by those with PTSD compared with others. Counseling was not associated with health outcomes. The majority (76%) reported seeking medical care for symptoms or problems often associated with behavioral and emotional problems; however such care-seeking was more common among those with PTSD (OR = 2.5, 95% CI = 1.004–6.26). Through the efforts of the URMP, the Sudanese unaccompanied minors received high levels of psychosocial support despite the absence of their biological parents. Those with worse functional health were no more likely than others to have received mental health counseling while being more likely to seek care from any health professional. This was also the case for those with PTSD compared to those without it. In linear regression analyses, reported receipt of mental health counseling did not impact either positively or negatively on the score of any CHQ scale.

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References

  1. Duncan J. Overview of mental health findings for UAM and separated children. Kakuma, Kenya: United Nations High Commissioner for Refugees; 2000.

    Google Scholar 

  2. Paardekooper B. The pychological impact of war and the refugee situation on South Sudanese children in refugee camps in Northern Uganda: an exploratory study. J Child Psychol Psychiat. 1999;40:529–36.

    Article  PubMed  CAS  Google Scholar 

  3. Sourander A. Behavior problems and traumatic events of unaccompanied refugee minors. Child Abuse Neglect. 1998;22:719–27.

    Article  PubMed  CAS  Google Scholar 

  4. Rousseau C, Said TM, Gagne MH, Bibeau G. Resilience in unaccompanied minors from the North of Somalia. Psychoanal Rev. 1998;85:615–37.

    PubMed  CAS  Google Scholar 

  5. Loughry M, Flouri E. The behavioral and emotional problems of former unaccompanied refugee children 3–4 years after their return to Vietnam. Child Abuse Negl. 2001;25:249–63.

    Article  PubMed  CAS  Google Scholar 

  6. Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. J Consult Clin Psychol. 2004;72:579–87.

    Article  PubMed  Google Scholar 

  7. Lustig SL, Weine SM, Saxe GN, Beardslee WR. Testimonial psychotherapy for adolescent refugees: a case series. Transcult Psychiatry. 2004;41:31–45.

    Article  PubMed  Google Scholar 

  8. Willis MS, Nkwocha O. Health and related factors for Sudanese refugees in Nebraska. J Immigr Minor Health. 2006;8:19–33.

    Article  PubMed  Google Scholar 

  9. Stiffman AR, Pescosolido B, Cabassa LJ. Building a model to understand youth service access: the gateway provider model. Ment Health Serv Res. 2004;6:189–98.

    Article  PubMed  Google Scholar 

  10. Geltman PL, Grant-Knight W, Mehta SD, et al. The “Lost Boys of Sudan:” functional and behavioral health of unaccompanied refugee minors resettled in the United States. Arch Pediatr Adolesc Med. 2005;159:585–91.

    Article  PubMed  Google Scholar 

  11. Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and pychoeducation for treating posttraumatic stress disorder in an African refugee settlement. J Consult Clin Psychol. 2004;72:579–87.

    Article  PubMed  Google Scholar 

  12. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard trauma questionnaire: validating a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180:111–6.

    Article  PubMed  CAS  Google Scholar 

  13. Landgraf JM, Ware JE, Abetz L. CHQ Users Manual. Boston: HealthAct; 1999.

    Google Scholar 

  14. Duncan J. Sudanese unaccompanied children: best interest determination. Kakuma, Kenya: United Nations High Commissioner for Refugees; 2000.

    Google Scholar 

  15. Centers for Disease Control and Prevention. Recommendations for presumptive treatment of schistosomiasis and strongyloidiasis among the lost boys and girls of Sudan. Atlanta: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention; 2005.

  16. Coker EM. “Traveling pains:” embodied metaphors of suffering among southern Sudanese refugees in Cairo. Cult Med Psychiatry. 2004;28:15–39.

    Article  PubMed  Google Scholar 

  17. Lin EHB, Carter WB, Kleinman AM. An exploration of somatization among Asian refugees and immigrants in primary care. Am J Public Health. 1985;75:1080–4.

    Article  PubMed  CAS  Google Scholar 

  18. Jamil H, Hakim-Larson J, Farrag M, Kafaji T, Jamil LH, Hammad A. Medical complaints among Iraqi American refugees with mental disorders. J Immigr Health. 2005;7:145–52.

    Article  PubMed  Google Scholar 

  19. Perron JN, Hudelson P. How do junior doctors working in a multicultural context make sense of somatisation? Swiss Med Wkly. 2005;135:475–9.

    Google Scholar 

  20. Gerritsen AAM, Bramsen I, Deville W, van Willigen LHM, Hovens JE, van der Ploeg HM. Health and health care utilization among asylum seekers and refugees in the Netherlands: design of a study. BMC Public Health. 2004;4:7.

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was funded by the Joel and Barbara Alpert Endowment for the Children of the City, Department of Pediatrics, Boston Medical Center. This paper was presented in part at the annual meetings of the Pediatric Academic Societies on May 5, 2003, Seattle, WA and April 30, 2006, San Francisco, CA.

The authors wish to thank the following current and former staff of the Migration and Refugee Services of the U.S. Conference of Catholic Bishops, the Lutheran Immigration and Refugee Service, and the local affiliates of the U.S. Unaccompanied Refugee Minors Program, without whose support and assistance the study could not have been done: Julianne Duncan, Susan Schmidt, Marla Schmidt, Bethany Christian Services (Grand Rapids, MI), Catholic Community Services (Tacoma, WA), Catholic Family Center (Rochester, NY), Catholic Social Service (Phoenix, AZ), Commonwealth Catholic Charities (Richmond, VA), Lutheran Children and Family Services of Easter PA (Roslyn, PA), Lutheran Family Services Northwest (Seattle, WA), Lutheran Social Services of Michigan (Lansing, MI), Lutheran Social Services of New England (Newton, MA), Lutheran Social Services of North Dakota (Fargo, ND).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA

    Paul L. Geltman

  2. Department of Pediatrics, Cambridge Health Alliance, 1493 Cambridge Street—Macht 3, Cambridge, MA, 02139, USA

    Paul L. Geltman

  3. Department of Pediatrics, Rehabilitation Institute of Chicago, Chicago, IL, USA

    Wanda Grant-Knight

  4. Division of Child Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Heidi Ellis

  5. HealthActCHQ Inc, Boston, MA, USA

    Jeanne M. Landgraf

Authors
  1. Paul L. Geltman
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  2. Wanda Grant-Knight
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  3. Heidi Ellis
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  4. Jeanne M. Landgraf
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Corresponding author

Correspondence to Paul L. Geltman.

Additional information

Drs. Geltman, Grant Knight, and Ellis report no conflicts of interest. Ms Landgraf has a commercial interest in the business, HealthAct CHQ, Inc., which licenses the use of the Child Health Questionnaire and conducts its scoring for investigators. We do not believe that this presents any conflict of interest, however. The study was funded by the Joel and Barbara Alpert Endowment at Boston Medical Center. Faculty reviewers critiqued the original study proposal. The Endowment had no further input in the study or manuscript preparation. A previous paper was published in 2005 in Archives of Pediatrics and Adolescent Medicine.

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Geltman, P.L., Grant-Knight, W., Ellis, H. et al. The “Lost Boys” of Sudan: Use of Health Services and Functional Health Outcomes of Unaccompanied Refugee Minors Resettled in the U.S.. J Immigrant Minority Health 10, 389–396 (2008). https://doi.org/10.1007/s10903-007-9110-6

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  • DOI: https://doi.org/10.1007/s10903-007-9110-6

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