Abstract
BackgroundPrevious studies of Haitian immigrant and refugee youth have emphasized "externalizing" behaviors, such as substance use, high risk sexual behavior, and delinquency, with very little information available on "internalizing" symptoms, such as depression and anxiety. Analyzing stressors and "internalizing" symptoms offers a more balanced picture of the type of social and mental health services that may be needed for this population. The present study aims to: 1) estimate the prevalence of depression and post-traumatic stress disorder (PTSD) among Haitian immigrant students; and 2) examine factors associated with depression and PTSD to identify potential areas of intervention that may enhance psychosocial health outcomes among immigrant youth from Haiti in the U.S.MethodsA stratified random sample of Haitian immigrant students enrolled in Boston public high schools was selected for participation; 84% agreed to be interviewed with a standardized questionnaire. Diagnosis of depression and PTSD was ascertained using the best estimate diagnosis method.ResultsThe prevalence estimates of depression and PTSD were 14.0% and 11.6%; 7.9% suffered from comorbid PTSD and depression. Multivariate logistic regression demonstrated factors most strongly associated with depression (history of father's death, self-report of schoolwork not going well, not spending time with friends) and PTSD (concern for physical safety, having many arguments with parents, history of physical abuse, and lack of safety of neighborhood).ConclusionsA significant level of depression and PTSD was observed. Stressors subsequent to immigration, such as living in an unsafe neighborhood and concern for physical safety, were associated with an increased risk of PTSD and should be considered when developing programs to assist this population. Reducing exposure to these stressors and enhancing access to social support and appropriate school-based and mental health services may improve educational attainment and psychosocial health outcomes among Haitian immigrant youth.
Highlights
Previous studies of Haitian immigrant and refugee youth have emphasized "externalizing" behaviors, such as substance use, high risk sexual behavior, and delinquency, with very little information available on "internalizing" symptoms, such as depression and anxiety
Given the high level of suicidality documented previously [22], the elevated rates of poverty [23,24], and the relative lack of knowledge of "internalizing" symptoms among Haitian immigrant and refugee youth, the primary aim of this study is to estimate the prevalence of depression and post-traumatic stress disorder (PTSD) among Haitian immigrant students enrolled in public schools in an urban center in the U.S By selecting students enrolled in school, this study offers the opportunity to inform potential interventions that can assist Haitian immigrant youth within public school systems
The Teacher's Report Form (TRF) is analogous to the Child Behavior Checklist (CBCL) developed by Achenbach that inquires about a broad range of internalizing and externalizing psychological symptoms in children; the responses for the TRF are based on teacher's report rather than child self-report [25]
Summary
Previous studies of Haitian immigrant and refugee youth have emphasized "externalizing" behaviors, such as substance use, high risk sexual behavior, and delinquency, with very little information available on "internalizing" symptoms, such as depression and anxiety. Refugee and immigrant children have a broad range of needs, including adequate housing, healthcare, food, education, and basic security [1] As part of their healthcare needs, refugee and immigrant children require adequate access to mental health services and support programming that can serve as primary and/or secondary prevention of poor psychosocial health outcomes. These outcomes can consist of depression, anxiety, post-traumatic stress disorder, conduct problems, difficulties relating to adults and/or peers, attention problems, difficulty concentrating, and poor school performance [2,3,4,5,6,7,8,9,10]. In addition to the underutilization of mental health services, immigrant and refugee youth have demonstrated a greater need for mental health services compared to the host population in the Netherlands [12], the United Kingdom [13], and Switzerland [14]
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