Emotional and behavioural problems

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					      Emotional and behavioural problems

in migrant and non-migrant adolescents in Belgium




                Ilse Derluyn, MEduc

                Eric Broekaert, PhD

               Gilberte Schuyten, PhD




                                                    1
SUMMARY



Background

Refugee and migrant adolescents may be at increased risk for the development of emotional

and behavioural problems.



Aims

This study aims to investigate the emotional and behavioural problems of newly arrived

adolescent migrants in Belgium compared to Belgian peers.



Method

1249 migrant adolescents and 602 Belgian adolescents filled in four questionnaires on

emotional and behavioural problems, traumatic experiences and post-traumatic stress.



Results

Migrants have more peer problems and avoidance symptoms than non-migrants; on the

contrary, non-migrant adolescents have more anxiety symptoms, externalising problems and

hyperactivity. Migrants experienced more traumatic events than non-migrants. Important

influencing factors in the development of emotional and behavioural problems were the

number of traumatic events, gender and living situation.



Conclusions

Migrants and non-migrant don’t differ much in the development of emotional and behavioural

symptoms. Risk groups for the development of emotional problems and post-traumatic stress




                                                                                            2
are migrants who experienced a lot of traumatic events, girls and unaccompanied migrant

adolescents.



Declaration of interest

None.

Funding detailed in Acknowledgements.




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INTRODUCTION



With the increasing number of migrants and refugees worldwide, the effect of migration and

acculturation on psychological development has become very important (Stevens, Pels,

Bengi-Arslan, et al, 2003), especially for children and adolescents. Migrating children may

face traumatic events before or during the flight (Berman, 2001), have to cope with different

losses and separations (Perez Foster, 2001), and are forced to re-establish their life in an

unfamiliar environment. Therefore, this migration process can result in the development of

emotional and behavioural problems (Lavik, Hauff, Skrondal, et al, 1996), such as post-

traumatic stress, depression, anxiety, fear of recurrence, guilt, separation fears, grief,

withdrawal, eating and sleeping problems, identity confusion, and delinquent behaviour

(Allwood, Bell-Dolan & Husain, 2002). Recent research, however, has produced

contradictory results about emotional and behavioural problems in migrant adolescents, with

some studies suggesting they are at increased risk, and others demonstrating no differences or

a lower risk among migrants than among the native-born (Davies & McKelvey, 1998; Sam,

1994). Moreover, in Belgium, research about the psychological problems of migrant

adolescents is scarce. Therefore, this study aims to investigate the emotional and behavioural

problems of newly arrived adolescent migrants in Belgium, compared to native-born peers.




                                                                                                 4
METHODOLOGY



Study setting and design



The study was conducted in intensive language classes for newly arrived, 11- to 18-years

olds, non-Dutch speaking migrant adolescents in Flanders (Belgium). From the 42 schools

organizing these classes, 34 were randomly selected to participate. After a classical

description of the study to the participants, their written informed consent was obtained and

they completed, anonymous, four self-report questionnaires under supervision of at least two

research assistants (educated to master’s level) during a 60-90 minute classroom period. As

all questionnaires were translated in different languages, the adolescents were given, as much

as possible, the questionnaires in the own mother tongue. There were 1294 migrant

adolescents who agreed to fill in the questionnaires, although not all participants completed

all items. As there is a continuous inflow of new adolescent migrants during the school year

from September until June, this is between 65% and 97% of the population in intensive

language classes for 11- to 18-years olds in Flanders. In further analyses, 45 migrants born in

western countries were excluded (43 from Western Europe, 1 from North America and 1 from

Japan), just as three migrants older than 21 years of age.

We included a control group of Belgian adolescents in the study: out of the five Flemish

provinces, 17 schools for 11- to 18-years old adolescents were randomly selected to

participate. We aimed a well-balanced sample concerning the ages of the adolescents and

their study programme. In total, 617 Belgian adolescents participated; 15 adolescents with

another than Belgian nationality were left out in further analyses. The research procedure was

similar to the one of the migrant adolescents.




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Ethics approval for the study was given by the Ethics Committee of the Faculty of Psychology

and Educational Sciences, Ghent University.



Measures



Demographic and social characteristics, such as gender, age, nationality, time in Belgium and

living situation, were measured using a series of closed questions.

The Hopkins Symptom Checklist-37 for Adolescents (HSCL-37A), an adaptation of the

Hopkins Symptom Checklist-25 (HSCL-25) (Derogatis, Lipman, Rickels, et al, 1974; Parloff,

Kelman & Frank, 1954) was used. The HSCL-25 is a self-report screening tool used to

diagnose elevated symptoms of anxiety (ten items) and depression (fifteen items). Bean,

Spinhoven, Eurelings-Bontekoe, et al (in press) adapted the HSCL-25 for use with migrant

adolescents into the HSCL-37A: to overcome language problems, item questions were

simplified and shortened, and the questionnaire was translated into nineteen different

languages. In addition, a subscale of twelve items questioning different externalising

symptoms of substance use and aggressive behaviour was added to the original questionnaire.

All items must be answered on a Likert-scale, ranging from 1 (little) to 4 (very much). The

HSCL-25 has demonstrated its usefulness as screening tool for depression and anxiety in

various cross-cultural settings and with different refugee populations (e.g., Kleijn, Hovens &

Rodenburg, 2001; Lavik, Laake, Hauff, et al, 1999; Sandanger, Moum, Ingebrigtsen, et al,

1999).



The self-report version for 11- to 16-year olds of the Strengths and Difficulties Questionnaire

(SDQ) (Goodman, Meltzer & Bailey, 1998) is a behavioural screening questionnaire that asks

about 25 attributes. The twenty-five items are divided between five subscales with five items



                                                                                                 6
each, generating scores for emotional symptoms, conduct problems, inattention-hyperactivity,

peer problems and pro-social behaviour. All scales, but the last, are summed to generate a

total difficulties score. Respondents use a 3-point Likert scale to indicate how far each

attribute applies. In this study, the extended version of the SDQ was used, which assesses also

the impact of symptoms in terms of resultant distress, social impairment or burden for others

(Goodman, 1999). This questionnaire is available in more than twenty languages. Research

shows that the SDQ has a high reliability and validity (Goodman, 2001), and is able to

discriminate between children drawn from high- and low-risk samples and to screen for child

psychiatric disorders, also in non-western populations (Goodman, Ford, Simmons, et al, 2000;

Mullick & Goodman, 2001).



To investigate the traumatic events the adolescents experienced, the Stressful Life Events

(SLE) (Bean, 2000) was used. Participants are directed to indicate whether or not they

experienced twelve different kinds of stressful events, such as war, natural disaster, separation

from family, physical or sexual abuse. The SLE is available in nineteen languages.



The Self Inventory Checklist for Adolescents (ZIL-A) is an adaptation of the Self Inventory

Checklist (ZIL) (Hovens, Bramsen & van der Ploeg, 2000), a self-report questionnaire

looking for the level of post-traumatic stress symptoms. The twenty-two item scale, parallel to

the DSM-IV criteria for post-traumatic stress disorder (PTSD), can be divided into three

subscales: intrusion (six items), avoidance (nine items) and hyper-arousal (seven items).

Participants are directed to answer the items according to the events endorsed on the SLE, and

to score the items on a Likert scale, ranging from 1 (not at all) to 4 (always). The

questionnaire was adapted into the ZIL-A (Bean, Spinhoven, Eurelings-Bontekoe, et al, in




                                                                                                7
press) to be better understandable for migrant adolescents: the items were simplified,

shortened, and translated into nineteen languages.



Statistical analyses


Descriptive statistics were used to describe main social and demographic characteristics of the

migrant and non-migrant group. Multivariate analysis of covariance (MANCOVA, SPSS

version 11.0 for Windows) was carried out to examine the effects of group (migrants and non-

migrants), gender, living situation (both parents, one parent or other), age and total number of

traumatic events (covariate) on the subscales of the HSCL-37A, the SDQ and the ZIL-A. All

second order interactions between the factors were included in the model.

Binary logistic regression analyses were executed to look for the main influencing factors on

the behavioural and emotional problems in the migrant group. Independent variables in these

analyses were age, gender, living situation (both parents, father, mother, alone, and other),

and the total number of traumatic experiences. As dependent variables, the subscales of the

different questionnaires with following thresholds were used: for the HSCL-37A, we used the

recommended threshold of 1.75 for the subscales anxiety, depression and internalising

problems (Mollica, Wyshak, de Marneffe, et al, 1986); for the subscale externalising

problems, we could not apply this threshold as this subscale is not yet validated. For the SDQ,

we used the thresholds as recommended by Goodman (1997); the borderline and clinical

groups were put together. For the ZIL-A, a total score of greater than 52 is judged to indicate

a PTSD full-symptom diagnosis (Hovens, Bramsen & van der Ploeg, 2000).

Finally, binary logistic regression was used to examine the relationship between the type of

trauma exposure (SLE-items as independent variables) and the risk for PTSD (a PTSD full

symptom diagnosis as dependent variable) for both groups of migrants and non-migrants.




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Quality of the subscales


Reliability analyses, executed on all subscales of the HSCL-37A, the SDQ and the ZIL-A,

revealed good alpha values (greater than 0.70), except for the subscales conduct problems

(0.62), hyperactivity (0.69), and peer problems (0.48). The assessment of the one-factor

model fit (AMOS 5) is given with the RMSEA goodness-of-fit measure. Following Browne &

Cudeck (1993), the fit of the one-factor model for the subscales externalising problems (0.11)

and hyperactivity (0.11) were poor, for avoidance (0.10) and hyper-arousal (0.10) mediocre,

and for the subscales anxiety (0.06), depression (0.04), emotional problems (0.03), conduct

problems (0.04), peer problems (0.06), pro-social behaviour (0.04) and intrusion (0.06) good.

Thus, although the rather low reliability values for the subscales conduct and peer problems,

these subscales show a good fit for the one-factor model.




                                                                                                9
RESULTS



Characteristics of the sample



                       Insert table 1



Some demographic characteristics of both groups are given in table 1. The Belgian

adolescents are somewhat older than the migrants (t=-10.85, d.f.=1066, P<0.001). 10% of the

migrants live in Belgium without parents, and almost 3% with only a brother or sister. Less

migrant (84.9%) than non-migrant adolescents (97.5%; ²=169.9, d.f.=8, P<0.001) live with

one or both parents.

The migrant adolescents come from 93 different countries; the most frequent countries of

origin are Morocco (179, 14.4%), Ghana (135, 10.8%), Turkey (118, 9.5%), and Angola (40,

3.2%). 508 (41%) migrants come from Africa, 433 (34.9%) from Asia, 240 (19.4%) from

Eastern Europe, and 58 (4.7%) from South and Central America. 29 (2.6%) migrants arrived

in Belgium less than one month ago, 414 (37.6%) one to six months ago, 407 (37%) are in

Belgium for six months up to one year, and 251 (22.8%) for more than one year.

178 (14.5%) migrants live in an asylum center; 103 (58%) of them are unaccompanied

refugee minors. Ten migrant adolescents (0.8%) live in another center for minors, and fifteen

(1.2%) migrants and one non-migrant (0.2%) live in a foster family.




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Traumatic experiences



                      Insert table 2



The traumatic events the migrant and non-migrant adolescents experienced during their life

time, as indicated on the Stressful Life Events, are given in table 2. Migrants experienced an

average of 3.64 (s.d. 2.74) traumatic events, which is significant more (t=8.493; d.f.=1549;

P<0.001, 95% CI 0.75-1.19) than non-migrant adolescents (mean 2.67; s.d. 2.02). Most

traumatic events were experienced more by migrant adolescents; only the life event

‘experienced a stressful life event where he/she thought that someone else was in danger’ was

experienced more by non-migrants (P<0.03). For the events ‘the death of a loved one’,

‘sexual abuse’ and ‘experienced a stressful life event where he/she thought I am in danger’,

no significant differences between the groups were found. The death of a loved one was the

most experienced traumatic event: more than 56% of the migrants and 60% non-migrants

were confronted with it. More than 44% of the migrants and almost one third of the non-

migrants experienced important changes in their family life in the last year (OR 1.64); 23.5%

migrants were once in their lifetime separated from their family against their will (5.66). More

than one quarter of the migrant group experienced an armed conflict (29.34), and 9.2%

migrants and 7.2% non-migrants were confronted with sexual abuse.




                                                                                               11
Emotional and behavioural problems



                      Insert table 3



Table 3 shows the scores of both groups on the subscales of the questionnaires on emotional

and behavioural problems. If we use the threshold of 1.75 for the subscales anxiety,

depression and internalising problems of the HSCL-37A, 434 migrants (36%) and 264

(43.9%) non-migrants score within the clinical range on the anxiety subscale. Also on the

subscale depression, a high proportion of both groups score above the threshold: 468 (39.4%)

of the migrants and 246 (40.9%) of the non-migrant group. On the subscale internalising

problems, 457 (38.8%) migrants and 264 (43.9%) non-migrants have a score within the

clinical scores. As the subscale externalising problems of the HSCL-37A is not yet validated,

we cannot apply this threshold.



On the total problem scale of the SDQ, 142 (12.4%) migrants have a score in the borderline

range (16-19) and 84 (7.3%) in the clinical range (20-40). For non-migrants, this is

respectively 101 (16.9%) and 129 (7.4%).

The subscale emotional problems of the SDQ reveals that of the migrant group, 90 (7.8%)

have a score in the borderline range (6) and 130 (11.2%) a clinical score (7-10). 49 (8.2%)

non-migrants have a borderline score on this subscale and 55 (9.2%) score within the clinical

range.

On the subscale conduct problems, 103 (8.9%) migrants score within the borderline range (4),

and 88 (7.6%) in the clinical range (5-10). For the non-migrant group, this is respectively 49

(8.2%) and 58 (9.7%).




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The scores on the hyperactivity subscale reveal that 85 (14.2%) adolescents of the non-

migrant group score in the borderline range (6) and 120 (20.1%) in the clinical range (7-10);

for the migrant group, this is respectively 70 (6.1%) and 54 (4.7%).

Concerning the subscale peer problems, 325 (28.2%) migrants have a score within the

borderline range (4-5), and 87 (7.5%) within the clinical range (6-10). 91 (15.2%) non-

migrants have a borderline score and 24 (4%) score in the clinical range.

Of the migrant group, 92 (8%) score within the borderline range (5), and 86 (7.4%) within the

clinical range (0-4) of the subscale pro-social behaviour; 39 non-migrants (6.5%) have

borderline scores, and 39 (6.5%) clinical scores.

On the impact scale, which gives an idea of the impact of the problems on the adolescents’

daily functioning, 653 (66%) migrants and 415 (70%) non-migrants state their problems have

no impact on their daily functioning; 93 (9.4%) and 72 (12.1%) adolescents of both groups

state their problems have some impact, and the problems of 244 (24.6%) migrants and 106

(17.9%) non-migrants have a great impact.



The ZIL-A scores show the levels of post-traumatic stress in both groups. For all subscales,

migrants have higher scores than their non-migrants peers. With a threshold of 52 on the total

ZIL-score, 139 (15.7%) migrants and 40 (6.9%) non-migrants score within the clinical range.



Differences between both groups, and influence of gender, age, living situation and

trauma



Using MANCOVA, significant effects are found for group (F(12,1151)=5.23, P<0.001;

²=0.05), gender (F(12,1151)=3.80, P<0.001, ²=0.04), living situation (both parents, one

parents, and other) (F(24,2302)=1.62, P<0.04, ²=0.02), and total number of traumatic events



                                                                                               13
(F(12,1151)=14.06, P<0.001, ²=0.13). Interaction effects are found for group with gender

(F(12,1151)=2.25, P<0.01, ²= 0.02), group with age (F(60,5393)=1.62, P<0.003, ²=0.017),

group with total number of traumatic events (F(12,1151)=3.34, P<0.001, ²=0.03), gender

with age (F(60, 5393)=1.51, P<0.008, ²=0.02), gender with living situation

(F(24,2302)=1.21, P<0.02, ²=0.01), and gender with total number of traumatic events

(F(12,1151)=2.29, P<0.008, ²=0.02).



Non-migrants have higher scores than migrants on the anxiety (1.77 v. 1.66; F=4.13, d.f.=1,

P<0.05) and externalising subscale (HSCL-37A) (1.56 v. 1.28; F=13.28, d.f.=1, P<0.001),

and on the hyperactivity subscale (SDQ) (4.75 v. 3.04; F=16.78, d.f.=1, P<0.04). On the

contrary, migrants have more peer problems (SDQ) (2.86 v. 2.09; F=18.35, d.f.=1, P<0.001),

and higher avoidance scores (ZIL-A) (16.44 v. 14.81; F=4.52, d.f.=1, P<0.04). No significant

differences between migrants and non-migrants are found on the other subscales.



Girls have more anxiety symptoms (HSCL-37A) (1.78 v. 1.65; F=6.52, d.f.=1, P<0.02), more

emotional problems (SDQ) (3.83 v. 2.75; F=6.72, d.f.=1, P<0.02), and higher avoidance

scores (ZIL-A) (16.10 v. 15.14, F=5.08, d.f.=1, P<0.03); boys have less pro-social behaviour

(SDQ) (7.08 v. 8.14; F=24.53, d.f.=1, P<0.001). Age only influences pro-social behaviour

(SDQ) (F=2.29, d.f.=5, P<0.05), with the lowest scores for 14-years olds.

The living situation of adolescents results in significant differences in anxiety symptoms

(HSCL-37A) (both parents: 1.66, one parent: 1.66, other: 1.83; F=6.52, d.f.=2, P<0.02),

conduct problems (SDQ) (2.10 v. 2.31 v. 2.42; F=3.45, d.f.=2, P<0.04), and pro-social

behaviour (SDQ) (7.83 v. 7.60 v. 7.41; F=6.69, d.f.=2, P<0.002). The total number of

traumatic experiences (SLE) has a significant effect on all subscales (hyperactivity and pro-

social behaviour: P<0.002, peer problems: P<0.004, other subscales: P<0.001).



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Interaction effects between group and gender on the externalising subscale (HSCL-37A)

(F=5.35, d.f.=1, P<0.03) and on pro-social behaviour (SDQ) show greater differences

between non-migrant boys and girls than between migrant boys and girls. Between group and

age, interaction effects are found on externalising (HSCL-37A) (F=2.96, d.f.=5, P<0.02) and

peer problems (SDQ) (F=2.73, d.f.=5, P<0.02): for externalising problems, we found for 15-

years olds a decrease in the migrant group and an increase in the non-migrant group; for peer

problems, 14-years old migrants show a decrease, while non-migrants show an increase.

The interaction effect between group and living situation on conduct problems (SDQ)

(F=4.87, d.f.=2, P<0.009) reveals that migrants have the lowest conduct problems scores

when living with one parent, while for non-migrants, the lowest scores are for those living

with both parents.

The interaction effect between gender and age on depression symptoms (HSCL-37A)

(F=3.18, d.f.=5, P<0.008) shows that 16-years old girls have more and boys less depression

symptoms compared to 15-years old, and 18-years old girls show a decrease and boys an

increase compared to 17-years olds. For externalising symptoms (HSCL-37A), 17-years old

girls have higher and boys lower scores compared to 16-years olds (F=2.23, d.f.=5, P<0.05).

On the emotional subscale (SDQ), for boys, the 14-years olds have the lowest scores and the

15-years olds the highest scores, whereas for girls, 15-years olds have the lowest scores and

16-years olds the highest (F=3.15, d.f.=5, P<0.009). On the impact subscale (SDQ), 16-years

old boys have much lower scores compared to 15-years olds, whereas this decrease is much

smaller for girls (F=3.04, d.f.=5, P<0.02).

The interaction effect between gender and living situation on depression symptoms (HSCL-

37A) (F=3.81, d.f.=2, P<0.03) reveals a high increase for boys who don’t live with one or

both parents, compared to a smaller increase for girls in this living situation. For emotional



                                                                                                 15
symptoms (SDQ), girls living with one parent have less emotional problems than those living

with both parents, whereas boys show an increase (F=3.07, d.f.=2, P<0.05).



Influence of trauma, gender, age, and living situation in the migrant group



                      Insert table 4



Table 4 shows the influence of different variables on the emotional and behavioural problems

in migrant adolescents. The number of traumatic events the migrant adolescents experienced

has a significant influence on the development of all emotional and behavioural problems,

except on the subscales hyper-activity and pro-social behaviour (SDQ).

Gender also influences the emotional problems: girls are more likely than boys to have

anxiety (OR 1.79) and depression (2.12) symptoms (HSCL-37A), and emotional problems

(SDQ) (2.21). On the contrary, girls have less peer problems (0.53) and problems in pro-

social behaviour (0.53).

The age of the adolescent only has small influences on behavioural and emotional problems:

16-years old migrants are more likely to have depression symptoms (HSCL-37A) (1.69), and

emotional problems (SDQ) (1.94), compared to migrants up to 13 years of age; also 15- (2.21)

and 17-years olds (1.97) may have more emotional problems (SDQ). 16- (0.52) and 17-years

olds (0.51) are less likely to have problems in pro-social behaviour (SDQ).

Finally, migrant adolescents who live alone in Belgium are a high risk group for the

development of anxiety (1.82) and depression (2.84) (HSCL-37A), and emotional problems

(SDQ) (1.95), compared to migrants living with both parents. For post-traumatic stress, they

have a relative risk of 2.94, compared to those living with both parents. On the contrary, they

have less conduct problems (SDQ) (0.29).



                                                                                             16
Relationships between type of trauma and post-traumatic stress



                       Insert table 5



The type of trauma an adolescent experienced may influence the level of post-traumatic

stress. In table 5, differences between the migrant and non-migrant adolescents concerning the

influence of the trauma type on a full symptom PTSD diagnose is shown. For migrants, there

is little difference between the trauma types in their effect on the post-traumatic stress level,

and only two types have a significant influence: changes in family life (OR 1.73) and physical

abuse (2.03). For non-migrant adolescents, differences are much greater, with physical (4.69)

and sexual abuse (5.27) as important traumatic types in the development of post-traumatic

stress, even as separation from the family (3.84).




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DISCUSSION



People fleeing from war or persecution, from poverty or disasters is a worldwide phenomenon

of all time. Also minors leave their home countries, and migrate to build a new life in an

unknown country. This experience of migration can place young people at risk for the

development of emotional and behavioural problems. Four factors might influence this: At

first, all migrating children and adolescents share the experiences of loss and separations: the

loss of one’s home and belongings, familiar environment, friends and relatives, usual patterns

of family life and education, social network and cultural context (Ajdukovic & Ajdukovic,

1993). The escape breaks up the existing family system, and refugees loose not only their

social heritage, but also their social identity, bound to their origin. And, all this happens

during adolescence, the critical transition period for identity development, which involves that

migration may complicate the basis adolescent processes, such as separation from parents,

choice of social role, and the search for an adult identity (Ajdukovic, 1998). Thirdly, refugee

and migrant adolescents may have to deal with direct or indirect traumatic experiences they

have encountered before or during the escape from their homeland (Berman, 2001). Finally,

they have to start a new life in an unknown country, often without knowing if they can stay or

not, they have to adapt to a new society, build a new social network, learn a new language and

new cultural practices, they may encounter teasing and bullying, and many migrant families

are forced into marginalized positions (Sack, 1998).



Emotional and behavioural problems



In this study, we found high rates of both migrant and Belgian adolescents having clinical

scores of anxiety and depression (HSCL-37A): 36% of the migrant group and almost 44% of



                                                                                                18
the non-migrants have serious anxiety problems, and around 40% of both groups have severe

depression symptoms. On the emotional problems subscale of the SDQ, lower percentages of

emotional problems were found, with 19% of the migrant group and 17.4% of the non-

migrants having borderline or clinical scores. A possible explanation for this difference may

be that the adult-oriented thresholds of the HSCL-37A should be adapted for the use in an

adolescent population.

Belgian adolescents have more anxiety symptoms than non-migrants; for depression and

emotional symptoms, no differences between the two groups were found. This latter finding is

in accordance with some research (Munroe-Blum, Boyle, Offord, et al, 1989; Klimidis,

Stuart, Minas, et al, 1994; Rousseau & Drapeau, 1998), while the first finding corresponds

with studies reporting migrants having fewer emotional problems than non-migrants (Davies

& McKelvey, 1998; Sam, 1994). On the contrary, some studies reported higher emotional

problems in migrant children and adolescents compared to native-born peers (Bengi-Arslan,

Verhulst, van der Ende, et al, 1997; Darwish Murad, Joung, van Lenthe, et al, 2003; Diler,

Avci & Seydaoglu, 2003). We should take into account that the problems in the migrant group

may be an underestimation of the real figures, because migrants may feel less comfortable

reporting behaviours that might be perceived as deviant out of their cultural backgrounds, and

individuals and families are taught to keep emotional and behavioural problems to themselves

(Davies & McKelvey, 1998).



Concerning behavioural problems, 16.5% of the migrants and 17.9% of the non-migrant

adolescents have important conduct problems, and non-migrants have significant more

externalising problems. This is in accordance with different studies (e.g., Darwish Murad,

Joung, van Lenthe, et al, 2003; Stevens, Pels, Bengi-Arslan, et al, 2003). Belgian adolescents

also have higher hyperactivity scores than migrants, with 34.3% Belgians and 10.8% migrants



                                                                                             19
having borderline or clinical scores. A possible explanation for these findings may be the

striving of migrants to have a better future by attempting to obtain good academic

achievements.

Further on, migrants have significant more peer problems than non-migrant adolescents

(respectively 35.7% and 19.2% have borderline or clinical scores), which is in accordance

with the research of Darwish Murad, Joung, van Lenthe, et al (2003), and migrants have more

borderline or clinical scores on the pro-social behaviour subscale compared to non-migrants

(respectively 15.4% and 13%). These findings may be due to the possible acculturation

difficulties newly arrived migrants may encounter.

9.4% migrant and 12.1% non-migrant adolescents state their problems have some impact on

their daily functioning, and one quarter of the migrant group and almost one fifth of the non-

migrants say their problems have a great impact on their daily functioning.



Traumatic experiences and post-traumatic stress



Migrant adolescents experienced significant more traumatic events than Belgians (a mean of

3.6 compared to 2.7). The death of a loved one was the most experienced traumatic event for

both groups. More than one quarter of the migrants experienced a war or armed conflict and

almost one quarter was once separated from their family. Most of the traumatic events, except

four, were experienced more by migrants; the life event ‘experienced a stressful life event

where he/she thought that someone else was in danger’ was experienced more by non-

migrants.

In this study, migrant had significant higher avoidance scores than non-migrant adolescents,

and more migrants (15.7%) than non-migrants (6.9%) had clinical PTSD scores. These

percentages are comparable to some studies (Seedat, Nyamai, Njenga, et al, 2004; Servan-



                                                                                              20
Schreiber, Le Lin & Birmaher, 1998), but lower than in other studies, where between 20 and

98% of the migrant and refugee children and adolescents met clinical PTSD levels (e.g.,

Allwood, Bell-Dolan & Husain, 2002; Goldstein, Wampler & Wise, 1997). As already stated,

this may be due to the fact that migrants may under report emotional problems.

The type of traumatic events that lead to a full symptom PTSD diagnosis was different for

migrants and non-migrants: for migrants changes in family life (OR 1.73) and physical abuse

(2.03) lead to higher risks on PTSD, while for non-migrants, this was separation from family

(3.84), physical (4.69) and sexual abuse (5.27). This important influence of sexual abuse is

also supported in other studies (Seedat, Nyamai, Njenga, et al, 2004).



Influence of number of traumatic experiences, gender, age, and living situation for both

groups



For both groups, the number of traumatic experiences is an important influencing factor in the

development of emotional and behavioural problems. This is in accordance with many other

studies (e.g., Seedat, Nyamai, Njenga, et al, 2004; Weine, Becker, McGlashan, et al, 1995).

In both groups, girls have more anxiety symptoms, emotional problems and avoidance

symptoms compared to boys. On the contrary, boys have less pro-social behaviour, although

this difference between girls and boys is greater in the non-migrant group. Moreover, in the

migrant group, girls have more depression symptoms and less peer problems than boys. All

these findings are supported in other studies (e.g., Allwood, Bell-Dolan & Husain, 2002;

Diler, Avci & Seydaoglu, 2003; Verhulst, Achenbach, van der Ende, et al, 2003). The age of

the adolescent only has small influences on the development of emotional and behavioural

problems. Also in literature, there are little consistent results about the influence of age on the

development of behavioural and emotional symptoms (Berman, 2001).



                                                                                                 21
The living situation of adolescents influences their emotional and behavioural problems.

Migrant and non-migrant adolescents who do not live with one or both parents are at risk for

the development of anxiety symptoms, conduct problems and less pro-social behaviour.

Moreover, unaccompanied migrant adolescents are a high risk group for the development of

anxiety, depression, emotional problems and post-traumatic stress. On the contrary, they have

less conduct problems than accompanied migrant adolescents. This strongly supports the

protective influence of the availability of a parent, which is also shown in many other studies

(e.g., Derluyn, Broekaert, Schuyten, et al, 2004; Sourander, 1998).



Limitations of the research



A first limitation of this study is that, although a great part of the population of the 11- to 18-

years old, non-Dutch speaking newcomers in Flanders was included, the study group remains

a diverse group, composed of adolescents of 93 different countries, and differing from the

cultural background of the Belgian control group.



Besides the impact subscale of the SDQ, we did not assess the level of functional impairment

produced by the emotional and behavioural symptoms, which might result in a over-diagnosis

of disorders (Guarnaccia & Lopez, 1998). The questionnaires do not provide a qualitative

understanding of how adolescents are affected by their experiences, and the symptoms asked

for are only one dimension of the possible reactions to migration and traumatic events

(Berman, 2001). We also did not use clinical interviews, which may be helpful to obtain a

greater richness of information from participants than self-report measures alone (Barrett,

Moore & Sonderegger, 2000), and we only questioned the adolescent’s perception on his

problems. We do not have information about the legal status of the adolescents, about family



                                                                                                  22
characteristics, and about their current economic and social living situation. We also do not

know how the reactions of the adolescents to the stressors may be mediated by the nature,

exposure and duration of traumatic stressors, by the meaning or interpretation attached to

these events by their community and family, and by individual characteristics of the

adolescent, such as intelligence, pre-migration status, and coping strategies.



Certain adolescents may have experienced difficulties to understand the questionnaires,

because they were not available in all languages, or some adolescents were illiterate. The

questionnaires are not culturally validated for the various ethnic groups in which they were

used, and the likelihood of cultural response bias to questionnaire items cannot be excluded.

As already stated, migrant adolescents might feel less comfortable reporting behaviours that

might be perceived as deviant, since mental illness is stigmatised in some cultures, and

individuals and families are thus taught to keep emotional and behavioural problems to

themselves (Davies & McKelvey, 1998). Moreover, it is important to take into account the

difficulties when using psychological concepts and assessment instruments in other cultures,

because ethno-cultural variation may decrease their validity, and the fact that symptoms and

signs can be identified with standardized questionnaires no guarantee that they mean the same

thing in those settings (Bracken, Giller & Summerfield, 1995).



Clinical implications



These study shows the possibilities of using instruments as screening tool for the assessment

of emotional and behavioural problems in migrant adolescents, although these instruments do

not lead to a full clinical diagnosis of mental disorder.




                                                                                                23
Since many studies have shown that emotional and behavioural problems reported by

adolescents may predict the onset of DSM-IV mood and anxiety disorders in adulthood

(Roza, Hofstra, van der Ende, et al, 2003), this study underscores the importance of early

detection of these problems and, if needed, early interventions. However, although we found

high rates of emotional and behavioural problems and traumatic experiences in migrant

adolescents, this does not involve that these youngsters do not continue to function well in

their daily life (Mollica, Poole, Son, et al, 1997). Therefore, we are convinced that it is very

important to avoid stigmatisation of these adolescents, and consider them as normal people

who have to live in abnormal circumstances (Papadopoulos, 1999).




ACKNOWLEDGEMENTS

We thank all participating adolescents and schools.

This study was supported by a PhD Bursary of the Special Research Fund of Ghent

University.




Clinical implications

      Unaccompanied minors are a high risk group for the development of emotional

       problems and post-traumatic stress.

      Attention should be given to early detection and, if needed, intervention to prevent the

       development of severe emotional and behavioural problems in migrant adolescents.

      Stigmatisation of migrant adolescents must be avoided, and they should be considered

       as normal minors who live in abnormal circumstances




                                                                                                   24
Limitations of the study

      The self-report questionnaires used in this study were not culturally validated and

       were not translated in all languages.

      We have limited information about the background and current living situation of the

       adolescents, and we only included the view of the adolescent himself.

      The symptoms asked for in this study are only one dimension of the possible reactions

       to migration and traumatic events of adolescents.




                                                                                             25
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                                                                                           31
Name and addresses of the authors:



Ilse Derluyn, MEduc

Department of Orthopedagogics

Ghent University

H. Dunantlaan 2

9000 Gent

Belgium



Eric Broekaert, PhD

Department of Orthopedagogics

Ghent University

H. Dunantlaan 2

9000 Gent

Belgium



Gilberte Schuyten, PhD

Department of Data-Analysis

Ghent University

H. Dunantlaan 1

9000 Gent

Belgium




                                     32
Corresponding author:



Ilse Derluyn

Department of Orthopedagogics

Ghent University

H. Dunantlaan 2

9000 Gent

Belgium

Phone: (+32) (0) 9 264 63 63

Fax: (+32) (0) 9 264 64 91

E-mail : Ilse.Derluyn@UGent.be




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