Psychiatric issues in relation to consultations conducted with unaccompanied minors at OMP



Objective

Over the last two years, the canton of Geneva has received a record number of unaccompanied minors coming from different war zones. Initially, this influx had a significant impact on the social and educational systems. Housing, guiding and schooling of these minors was the priority. After this first phase, the main concern shifted towards the health care system and as a result the system of somatic care had to be reorganised. Since one year, the psychic care system has gradually been affected and we have witnessed a substantial increase of this population’s demand.
Most of these teenagers have experienced multiple trauma. However, when they arrive at OMP, we are faced with very heterogeneous requests for care. In this presentation, we wish to assess the situation of these minors and explain the clinical adjustments we have had to make to respond to these different requests for care.

Method and results

In order to assess the current impact of this consulting population on our health care system, we will compare the number for these specific demands and the numbers of general consultations. The periods compared are two six months periods : from October 2015 until March 2016 and October 2016 until March 2017. Then, we will present a statistical analysis of the reasons for consultations and we will highlight the average time between the arrival in Geneva and the requests for psychic care. We will also detail the various psychic disorders and the current social conditions of life. Finally, we will present different measures that we have put in place to respond to these specific requests.
We will illustrate this statistical data using three clinical situations we have experienced in our consultation work.

Conclusion

With this presentation, we hope to give an overview of the psychiatric problems resulting from this wave of migration of unaccompanied minors which is currently increasing rapidly in Europe.

Objectives:
Posttraumatic psychopathology has been identified as longstanding and devastating, particularly after childhood trauma. Still, no evidence-based prevention has been identified. Crisis Intervention Program for Children and Adolescents (CIPCA) was found at the Metin Health House (MHH) in Duhok, Kurdistan Region of Iraq (KRI), to early provide cost-effective and time-saving crisis intervention to prevents posttraumatic psychopathology among the surviving children and adolescents from the war of the Islamic State in Iraq and Syria (ISIS).
Methods:
In a pilot project supported by WHO and the Directorate of Health in Duhok governorate, 37 health professionals received one-week training of trainers (ToT) in group at the MHH. Every two certified trainers provided one-week training to a group of 30 teachers inside the camps of the Internally Displaced Peoples (IDP) around the city of Duhok. Totally, 300 IDP teachers received the CIPCA group leader certificate. Every two group leaders provided a single one-hour group intervention to 30 IDP school children. Totally, 22000 school children received CIPCA intervention, 15% showed psychological distress during the group intervention, 50% of them needed treatment.
To examine the effectiveness of CIPCA in preventing posttraumatic psychopathology, informed consent was obtained from 4500 responding school children and their caregivers to participate in a 5 years follow-up study. They were class-randomized to CIPCA intervention or controls, consequently. Caregivers filled the Child Behavior Check List (CBCL) before the CIPCA intervention and annually in 5 years.
Results:
Totally, 366 completely filled CBCL were received before the intervention. Due to lack of funding, only 28 participants were traced at the first year follow-up. All the caregivers refilled the CBCL. Both girls and boys improved in problem scores after CIPCA compared with deterioration among the controls.
Conclusions:
Improvement in problem scores among CIPCA receivers at one-year follow up seems to be promising. Funding is needed for further follow-ups to improve the evidence to confirm the effectiveness of CIPCA in preventing posttraumatic psychopathology. Updating and recent data from different child populations will be presented.

PSYCHIATRIC DISORDERS AMONG YAZIDI CHİLD AND ADOLESCENT REFUGEES IN TURKEY’S CAMP
Nasıroğlu S 1, Çeri V 2, Erkorkmaz Ü 3 and Semerci B 4
1. Sakarya University Faculty of Medicine Department of Child and Adolescent Psychiatry, Sakarya, Turkey
2. Pendik Training and Research Hospital, Department of Child andAdolescent Psychiatry, Medical School of Marmara University, Istanbul, Turkey
3.Sakarya University Faculty of Medicine Department of Biostatistics, Sakarya, Turkey
4.Department of Psychiatry, Bengi Semerci Institute, Istanbul, Turkey
Objective: To report the mental health states of a sample of Yazidi refugee children and adolescents psychiatric disorders among the children and adolescents participating in the research.
Method: The participants of this research are children and adolescents between the ages of 6-17 who live in the refugee camp in Turkey. Two child and adolescent psychiatrist speaking their mother-tongue language interviewed and evaluated each participant. Data collected include socio-demographic and past and current living situation and the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL).
Results: 136 children and adolescents (76 boys, 63 girls; mean age =11.05±3.11(SD)) At the time of the assessment 43.4% had PTSD (n:59) , 27.9% depression (n=38 ), 10.3% nocturnal enuresis (n=14 ), 9.6%Behavioral Disorder (n=7), 5.1% anxiety disorder (n=13).
Conclusion: Many of the refugee children and adolescents developed psychiatric disorders, or are at risk, especially for PTSD and depression. Their lower spirit and hopelessness might be evaluated as expected consequences considering the fact that those with a psychiatric diagnosis have experienced severe war and migration traumas (loss of a loved one, friends and family left in the war zone, death directly related to war, and injuries) compared to the others.1, 2

Keywords: Child, adolescent, refugees, psychiatric disorder, risk factor
References:
1. Almqvist K, Brandell-Forsberg M. Refugee children in Sweden: Post-traumatic stress disorder in Iranian preschool children exposed to organized violence. Child abuse & neglect. 1997;21(4):351-366.
2. Steel Z, Silove D, Phan T, Bauman A. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. The Lancet. 2002;360:1056-1062.

Objectives
Children’s abuse and neglect is widely studied as a major risk factor for emotional and behavioral disorders, various somatic and psychiatric problems during adulthood. Mental health is fundamental to health. Mental illnesses are real, disabling conditions affecting all populations regardless of race or ethnicity but disparities in mental health services exist for racial and ethnic minorities, and thus, mental illnesses exact a greater toll on their overall health and productivity.
Methods
The most important bet when working with ethnic minorities is to better understand the roles of culture, race, and ethnicity, and overcome obstacles that would keep anyone with mental health problems from seeking or receiving effective treatment.
The Day Centre "THE HOUSE OF THE CHILD" is a community unit which provides customized clinical mental health services for therapeutic treatment and psychosocial rehabilitation of children victims of abuse, neglect or domestic violence. The Day Centre was founded by the non-profit voluntary Organisation “THE SMILE OF THE CHILD”. The services are based on the bio-psycho-social model approach and treatment which aims at early detection and treatment of possible mental disorders and the overall psychosocial rehabilitation of victims of abuse / neglect and the support of their carers.
Results
By identifying the many barriers to quality care faced by racial and ethnic minorities, the Day Center provides mental health services also to children who come from minority populations.
Conclusion
Different case studies highlight challenges and various levels of difficulties in this specific scheme of cooperation aiming to open an interesting dialogue on the topic.

Aim: This study aimed to assess early-onset psychiatric disorders and factors related to these disorders in a group of refugee children upon immigration due to war.
Methods: The study was conducted between January 2016- June 2016. Clinical interviews were made with 89 children and their families. Clinical interviews were carried out by native speakers of Arabic and Persian that were primarily educated with these languages and have been living in Turkey for a long time. Strengths and Difficulties Questionnaire (SDQ) that had Arabic and Persian validity and reliability were applied to both children and their families.
Results: Eighty-nine children and adolescents were interviewed within the scope of the study. Mean age of cases were 9.96±3.98 and 56.2% (n=50) were girls while 43.8% (n=39) were boys. Within these children, 47 (52,8%) has come from Syria, 27 (30,3%) from Iraq, 14 (15,7%) from Afghanistan and 1(1.1%) from Iran. Children have been living in Turkey for 22.1±13.0 months while 18.8±13.3 months, in Manisa. One psychiatric disorder was found in 44 (49,4%) of the children. Twenty-six children were diagnosed with anxiety disorders, 12 with depressive disorders, 8 with trauma and related disorders, 5 with elimination disorders, 4 with attention deficit- hyperactivity disorder, 3 with intellectual disability. It was determined that seeing a dead or an injured person during war/emigration and father’s unemployment increased the odds of psychopathology.
Discussion: Within the context of war and emigration, these children try to cope with negative circumstances they had prior to migration and the despair their parents are in. They also are not able to attend school regularly and manage to maintain their physical needs. In case of failed interventions to manage the situation, it is of no doubt that this shall have dire psychosocial consequences.