Measuring the Optimal Time Interval Between Arrival and First Mental Health Evaluation's for Refugees in Québec: A Scoping Review.

To map the state of the existing literature to identify the optimal time frame between the arrival of refugees in a host country and psychosocial assessments. We conducted scoping review using the method of Arksey and O'Malley (2005). A systematic search of 5 databases including PubMed, Psycinfo (OVID), PsycINFO BD APA, Scopus and Web of Sciences) and grey literature identified 2698 references. Thirteen studies published between 2010 and 2021 were considered eligible. A data extraction grid was designed and tested by the research team. It is not so ease to identify the most appropriate time interval to assess the mental health of newly settled refugees. All the studies selected agree on the need to carry out an initial assessment when refugees arrive in their host country. Several authors agree on the need to carry out screening at least twice during the resettlement period. However, what is less clear is the best time to perform the second screening. This scoping review mainly helped in highlighting the lack of probing data on the mental health indicators focused on during the assessment and on the optimal timeline for the assessment of refugees. Further research is needed to determine whether developmental and psychological screening is beneficial, the right time to perform the screening, and the most appropriate collection instruments and interventions.

[Coming from Afar and Rediscovering Oneself: Group Intervention for Immigrant and Refugee Women Having Experienced Violence]. / Venir de loin et se retrouver : intervention de groupe pour femmes immigrantes et réfugiées ayant vécu la violence.

Objectives This paper has a clinical perspective and presents an innovative intervention that could be offered in different institutions and practice environments. The object here is a group intervention addressed specifically to immigrant and refugee women having experienced different forms of violence. The consequences of being exposed to intentional and dehumanizing violence, paired with the challenges associated with migration and forced exile, can fragilize the individuals and challenge their capacity to adapt. Even though psychological and psychosocial support in the years following their arrival could be beneficial, immigrants and refugees rarely use institutional services, and experts point out that the services are not tailored to them. In that respect stems the importance of promoting the development of more meaningful interventions for immigrants and refugees, in accordance with the principle of equity and equality of chances to have access to appropriate services, but also to better equip the specialists by giving them access to safe and culturally sensitive interventions. Following that perspective, a group intervention for immigrants and refugees having experienced violence was created in 2010 with the collaboration of researchers from l'IUPLSSS and social workers from CIUSSS de l'Estrie-Chus. Method Firstly, this article aims to present this group intervention. Innovative features of the proposed program will be highlighted, followed by an overview of the clinical and empirical supports that recommend the use of groups and art to intervene with immigrants and refugees. A more detailed description of the intervention will follow, describing the objectives of the intervention as well as the intervention framework, including some necessary components to assure the therapeutic reach of the groups and the establishment of a safe space. Secondly, the article presents a brief summary of the preliminary results of a current study aiming to evaluate the impacts of the intervention. During this study, qualitative and quantitative data was collected from 3 groups (n = 17) and analyzed with content analysis and non-parametric analyses to measure the changes between pre and post intervention. Results The results of the qualitative and quantitative analyses show that women report positive changes at the end of the group, namely in regard to post-traumatic stress symptoms and different dimensions of their well-being. Conclusion To conclude, the advantages and limits of this intervention will be discussed, but also its relevance for the practice environments. Even if it isn't the only answer for the intervention in a post-violence context, it consists of a good option for providing adapted services to the reality and needs of immigrants and refugees.

Emotion regulation strategies as mediators of the association between level of attachment security and PTSD symptoms following trauma in adulthood.

Although, a link between attachment and posttraumatic stress disorder (PTSD) symptoms has been established, the mechanisms involved in this link have not yet been identified. Furthermore, attachment has been systematically measured by self-report questionnaires, which are prone to perceptual bias. The first goal of this study was to examine the link between PTSD symptoms and attachment security level, as measured with a security index created from the Adult Attachment Projective interview. The second goal was to test emotion regulation strategies as mediators of this link. Participants were recruited in hospital emergency rooms following trauma exposure in adulthood. The results showed that a higher level of attachment security was associated with fewer PTSD symptoms at one and three months post-trauma. The results also showed that substance use and emotion-focused strategies mediated the association between attachment and PTSD symptoms. Theoretical and clinical considerations that follow from these outcomes are discussed.

Evaluation of a sandplay program for preschoolers in a multiethnic neighborhood.

BACKGROUND: This evaluative study assesses the efficacy of a school-based secondary prevention program consisting of creative expression workshops for immigrant and refugee preschoolers in a predominantly South Asian multiethnic neighborhood. Coincidentally, the program began in the wake of the tsunami. METHOD: Pretest and posttest data were collected from the parents and teachers of 105 preschoolers in 10 classes randomly assigned to an experimental or control status. The parents' and teachers' versions of the Strengths and Difficulties Questionnaire were used to assess the children's mental health. The family's ethnic origins and premigration experiences of organized violence were considered in the analysis. RESULTS: According to both the teachers' and parents' reports, the children in the experimental group benefited moderately from the program, which appeared to reduce the SDQ global score of children whose families had experienced violence in their homelands (t(21) = 3.83, p = .001 (MT(1) = 12.81, MT(2) = 9.59)), in particular those from South Asia. CONCLUSION: This study provides some evidence that immigrant preschoolers whose families have experienced adversity before migration can benefit from the creative expression workshops. Further studies are needed to determine if this program can help address the effects of mass media exposure to a disaster or traumatic event on vulnerable communities.

Classroom drama therapy program for immigrant and refugee adolescents: a pilot study.

This evaluative study assesses the effects of a school drama therapy program for immigrant and refugee adolescents designed to prevent emotional and behavioral problems and to enhance school performance. The 9-week program involved 136 newcomers, aged 12 to 18, attending integration classes in a multiethnic school. Pretest and posttest data were collected from the students and their teachers. The self-report and teacher's forms of the Strengths and Difficulties Questionnaire were used to assess emotional and behavioral symptoms. At the end of the program, although there were no reported improvement in self-esteem or emotional and behavioral symptoms, the adolescents in the experimental group reported lower mean levels of impairment by symptoms than those in the control group, when baseline data were controlled for. Their performance in mathematics also increased significantly compared to that of their control peers. The findings suggest that the workshops may have an impact on social adjustment of recently arrived immigrants and refugees. This drama therapy program appears to be a promising way of working preventively and in a nonstigmatizing manner with adolescents who have been exposed to diverse forms of adversity, among which are war and violence.

[Playing with identities, transforming shared realities: school theatre workshop for immigrant and refugee adolescents]. / Du jeu des identités à la transformation de réalités partagées: un programme d'ateliers d'expression théâtrale pour adolescents immigrants et réfugiés.

Migration during adolescence represents a challenge for the youth who need to simultaneously work through the multiple losses associated with the migratory journey and adapt to a young adult status. The drama workshop program described here was designed to facilitate the adjustment of newly arrived immigrant teens. The aim of the program is to make it easier for adolescents to adjust to their new environment through creative group work around identity issues. The program also seeks to improve intergroup relations in multiethnic schools. The workshops are inspired both from playback theater and from Boal's form theater which emphasizes the collective transformation of the singular experience. The qualitative assessment of the program effects on the adolescents suggests that the workshops constitute a safe space of expression, in which the team and the ritual nature of the play hold the participants. The workshops facilitate the representation of the multiplicity of values in the adolescent world and invite them to reconsider the way in which they interact, with their environment, without splitting between "us" and "them," but rather creating solidarities around issues of social justice. The workshops also address the life transformation associated both with adolescence and migration and help the elaboration of the losses linked to the migratory journey and the construction of a hybrid identity.

Validation of the Peritraumatic Dissociative Experiences Questionnaire self-report version in two samples of French-speaking individuals exposed to trauma.

OBJECTIVE: Peritraumatic dissociation is a risk factor for developing PTSD. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a self-report inventory used to assess dissociation that occurred at the time of a trauma. The aim of this study was the validation the PDEQ in French. METHOD: Ninety French speaking traumatized victims presenting to the emergency department were recruited. They were administered the PDEQ shortly after exposure and others trauma-related measures 2 weeks and 1 month posttrauma. RESULTS: Principal components factor analyses suggested a single factor solution for the PDEQ. Significant correlations between the PDEQ and acute and posttraumatic stress symptoms indicated moderate to strong convergent validity. The PDEQ also showed satisfactory test-retest reliability and internal consistency. CONCLUSION: This study is the first one to investigate such detailed psychometric findings on the PDEQ. This confirms the unity of the concept of peritraumatic dissociation and the value of the PDEQ-French Version to assess it.

Creative expression workshops in school: prevention programs for immigrant and refugee children.

INTRODUCTION: Immigrant and refugee families underutilize mental health services and schools are in a good position to develop prevention programs to help children adapt to their new environment. METHOD: The transcultural psychiatry team at the Montreal Children's Hospital, in partnership with schools, has implemented creative expression workshops for kindergarten, elementary schools, and high school to help the children bridge the gap between past and present, culture of origin and host society. RESULTS: The workshops provide a safe space for expression, acknowledge and value diversity, allow the establishment of continuity, and facilitate the transformation of adversity. CONCLUSION: Refugee and immigrant children's needs should be addressed through intersectoral programs that target exclusion and support a sense of agency.

Basal and dexamethasone suppressed salivary cortisol concentrations in a community sample of patients with posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) has been associated with lower concentrations of cortisol and enhanced suppression of cortisol by dexamethasone, although discrepancies exist among reports. The objective of the study was to determine the pattern of cortisol responses in patients seeking treatment for PTSD resulting from a variety of traumatic experiences and to test whether cortisol responses are significantly related to childhood trauma, severity of symptoms, or length of time since trauma. METHODS: Salivary cortisol was measured at 8 AM, 4 PM, and 10 PM on 2 consecutive days before and after a 10 PM dose of .5 mg dexamethasone in 17 psychotropic medication and substance-free subjects with PTSD and 17 matched control subjects. RESULTS: Repeated-measures analysis of variance (ANOVA) of the baseline salivary cortisol concentrations demonstrated a significant effect for group with higher concentrations in the PTSD group but no significant differences in responses to dexamethasone. The presence of childhood abuse did not significantly affect salivary cortisol concentrations, and there was no correlation between predexamethasone cortisol and either the severity of PTSD symptoms or the time since the index trauma. CONCLUSIONS: Neither low basal concentrations nor enhanced suppression of cortisol are consistent markers of a PTSD diagnosis.