Substance use prevalence rates among migrant and native adolescents in Europe: A systematic review.

ISSUES: Migrant adolescents show specific risk and protective factors associated with substance use, but the extent to which prevalence rates differ between migrant and native-born youth in Europe remains unclear. The present study aims to provide a comprehensive review of all available substance use prevalence studies on differences in substance use between migrant and native-born adolescents in Europe. APPROACH: In this systematic review, PubMed, Medline and Pre-Medline, EMBASE and PsycINFO were searched for articles comparing substance use prevalence rates (tobacco, alcohol, illicit drugs) between migrant and native-born adolescents or young adults aged 11 to 29 years in European countries. The Joanna Briggs Institute prevalence critical appraisal tool was used for quality assessment. KEY FINDINGS: Fifteen studies met the inclusion criteria. The findings unanimously showed lower alcohol use in migrant compared to native-born adolescents, in particular among migrant adolescents from non-European countries and/or with a Muslim background. For tobacco and illicit drug use, findings were mixed. IMPLICATIONS: The results suggest a healthier behaviour profile among migrants than among native-born adolescents regarding alcohol use. Therefore, it would be beneficial to develop interventions to support migrant communities in maintaining their healthier alcohol use practices upon arrival in the host country. CONCLUSION: Compared to native-born adolescents, migrant adolescents are less likely to use alcohol. The findings on tobacco and illicit drug use were mixed. A European standard for surveys regarding substance use among adolescents is needed to investigate fluctuations, causes, and consequences of substance use differences between migrants and natives at the European level.

Reliable and clinically significant change based on the Health of the Nation Outcome Scales.

To evaluate treatment outcomes of individual patients based on clinician-rated instruments, the assessment of reliable and clinically significant change (RCSC) is essential. In heterogeneous samples, RCSC underestimates treatment outcome. Therefore, the Reliable Change Index (RCI) was adjusted by a stratification into subsamples. This method was tested on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) ratings (n = 12,547) at admission and discharge of youths (age 6-18 years) treated in ten psychiatric institutions. Based on the test-retest reliability of a subsample (n = 397), the RCI was calculated for three severity groups ("very severe," "moderately severe," and "subclinical/mild"). Individuals who accomplished reliable change during treatment and moved to a subclinical score were classified as recovered. Using the traditional RCSC calculation, the large majority (75.1%) of the sample would be considered as unchanged, 2.9% as deteriorated, 18.9% as improved, and 3.1% as recovered. Using RCI cutoff points based on the severity ratings at admission results in a more representative distribution of outcome groups, where 54.6% of the sample was stable, 7.5% worsened, 21.6% improved, and 16.3% recovered. This methodological framework for calculating RCSC for heterogeneous populations is applicable for all HoNOS instruments, making it very useful for mental health professionals.