BackgroundFirst generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population.MethodsScientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed.ResultsOne thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8–12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1–2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country.ConclusionFirst generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-016-0187-3) contains supplementary material, which is available to authorized users.

The review reports evidence of an overall ethnic density dose effect for ethnic minorities, but with more mixed results for individual ethnic groups. The possible mechanisms behind this effect are explored, including exposure to racism, social capital and social cohesion hypotheses. The wide-ranging implications of the review are discussed along with recommendations for future research to continue to inform public health policy.

Despite increasing research and clinical interest in delivering psychosocial interventions for children affected by war, little research has been conducted on the underlying mechanisms of change associated with these interventions. This review aimed to identify these processes in order to inform existing interventions and highlight research gaps. A systematic review of reviews was conducted drawing from academic databases (PubMed, PILOTS, Cochrane Library for Systematic Reviews) and field resources (e.g. Médecins Sans Frontières and the Psychosocial Centre of the International Federation of Red Cross and Red Crescent Societies), with extracted data analysed using Thematic Content Analysis. Thirteen reviews of psychosocial or psychological interventions for children and adolescents (< 25 years old) affected by war, armed conflict or political violence were identified, covering over 30 countries worldwide. Qualitative analysis identified 16 mechanisms of change, one of which was an adverse mechanism. Themes included protection from harm, play, community and family capacity building, strengthening relationships with caregivers, improved emotional regulation, therapeutic rapport, trauma processing, and cognitive restructuring; with the adverse mechanism relating to the pathologising of normal reactions. However, only 4 mechanisms were supported by strong empirical evidence, with only moderate or poor quality evidence supporting the other mechanisms. The poor quality of supporting evidence limits what can be inferred from this review’s findings, but serves to highlight clinically informed mechanisms of change for existing and widely used non-specialist interventions in the field, which urgently need rigorous scientific testing to inform their continued practice.Electronic supplementary materialThe online version of this article (10.1186/s13031-018-0153-1) contains supplementary material, which is available to authorized users.

BackgroundChild maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.ObjectivesTo synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.Study designFor effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.ParticipantsChildren and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.InterventionsAny psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.Main outcome measuresPsychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.MethodsYoung Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.ResultsWe identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.ConclusionsIt is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.LimitationsStudies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.Future workStudies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.Study registrationThis study is registered as PROSPERO CRD42013003889.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Syrian children affected by the civil war are at increased risk of mental health problems, including depression, anxiety, post-traumatic stress disorder (PTSD), and externalizing behaviour problems. Screening questionnaires are designed to identify individual children who require further assessment and treatment, and also estimate the need for mental health services in a population. However, few questionnaires have been rigorously tested in this population. This study examined the reliability and validity of questionnaires for depression (Center for Epidemiological Studies Depression Scale for Children, CES-DC, self-report, 10-item version), anxiety (Screen for Child Anxiety Related Emotional Disorders, SCARED, self-report, 18-item version), PTSD (Child PTSD Symptom Scale, CPSS, self-report), and internalizing and externalizing behavior problems (Strengths and Difficulties Questionnaire, SDQ, parent-report version) in a population sample of 8-17 year old Syrian children living in Informal Tented Settlements (ITS) in the Beqaa region of Lebanon. In addition, several ways of measuring functional impairment due to mental health problems were compared. These included self- and parent-report questionnaires (World Health Organization Disability Assessment Schedule, WHODAS-Child; SDQ Impact supplement, parent-report only) and an interviewer rating of severity (Clinical Global Impression–severity, CGI-s). Questionnaires were translated into Arabic and modified based on pilot testing with Syrian children. Responses from N=1006 children and caregivers were used for analysis, a subset of whom had additional clinical interview data (MINI KID + clinical judgement; N=119). The self-report questionnaires showed good internal consistency reliability with alpha&gt;.80, though the parent-report SDQ and WHODAS-Child fell below this level. In terms of validity, the SDQ externalizing scale performed well in differentiating children with conduct problems from those without and it was possible to achieve a fair balance between sensitivity (82%) and specificity (71%). The CES-DC, CPSS, SDQ total difficulties, and WHODAS-Child (selfreport) achieved an acceptable level of validity, though it was harder to achieve a good balance between sensitivity and specificity. In most cases, at least 50% of those screening positive were false positives, meaning that a more in-depth follow up assessment would be required if these tools were used as screeners in a clinical setting. Furthermore, correctionwould be needed if used to estimate prevalence rates for mental disorders in this population. There was moderate convergent validity between measures of functional impairment, with self-report WHODAS-Child showing greater agreement with interviewer ratings when compared to parent-report measures (WHODAS and SDQ Impact). Measuring functional impairment and distress due to mental health problems should help to differentiate children with clinically significant mental health problems from those with subthreshold problems; however, more work will be required to establish how helpful the tools used here are in achieving that aim.

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PurposeThere is a recent and growing migrant population in Northern Ireland. However, rigorous research is absent regarding access to mental health care by different migrant groups. In order to address this knowledge gap, this study aimed to identify the relative use of psychotropic medication between the largest first generation migrant groups in Northern Ireland and the majority population.MethodsCensus (2011) data was linked to psychotropic prescriptions for the entire enumerated population of Northern Ireland using data linkage methodology through the Administrative Data Research Centre Northern Ireland (ADRC-NI).ResultsLower prescription dispensation for all psychotropic medication types, particularly antidepressants (OR = 0.35, CI 95% 0.33–0.36) and anxiolytics (OR = 0.42, CI 95% 0.40–0.44), was observed for all migrant groups with the exception of migrants from Germany.ConclusionsIt is likely that the results reflect poorer access to services and indicate a need to improve access and the match between resources, services and the health and social care needs of migrants. Further research is required to identify barriers to accessing primary care and mental health services.