Culture competence and mental health across different immigrant and refugee groups.

BACKGROUND: Over the last decades, due to high rates of immigration, many high-income countries have witnessed demographic shifts towards more cultural diversity in the population. Socio-economic deprivation and traumatic experiences pre-migration contribute to a high risk for mental health problems among immigrant background youth. Moreover, when adapting to the multi-cultural contexts of the resettlement countries they face several acculturation demands, which may also affect their mental health in adaptive or hazardous ways. One of these acculturation tasks involves developing the cultural competence necessary to thrive and participate socially within the heritage and the majority cultural domains. From a public mental health perspective, it is important to have thorough knowledge about acculturation-related risk and protective factors. However, this responsibility has been challenged by a lack of acculturation measures that are theoretically linked to mental health, and target the cultural competencies of immigrant background youth. Therefore, the current study aimed at examining if a construct of peer-related culture competence, operationalized in the Youth Culture Competence Scale (YCCS), captured the same competence-phenomenon across different language, age, and immigrant groups in two immigrant-receiving countries. The scale includes two dimensions: one of heritage, and one of majority peer-related culture competence. METHODS: Self-report questionnaire data were collected from 895 unaccompanied refugees and 591 immigrant background high school students in Norway, and from 321 immigrant university students in the United States. To examine if the measure assessed the same phenomenon of peer-related culture competence across these three multi-ethnic samples with an age range from 13 to 28, we examined its measurement equivalence. Additionally, we examined if the association between peer-related culture competence and depressive symptoms was similar in these groups. RESULTS: Confirmatory factor analyses supported the proposed two factor structure of the YCCS across the three samples. The structural equation model assessing the effects of heritage and majority culture competence on depressive symptoms confirmed that each culture competence dimension had a unique association with depressive symptoms across the samples. CONCLUSIONS: We conclude that the YCCS is a robust acculturation measure that may be included in public health studies of mental health among multi-ethnic refugee and immigrant samples of varied ages.

The asylum-process, bicultural identity and depression among unaccompanied young refugees.

INTRODUCTION: The overall aim of the present study was to expand our knowledge about depression among unaccompanied refugee minors in the years after they were granted protection in Norway. Predictors were contextual variables in terms of the asylum-process, acculturation variables in terms of bicultural identity, and demographic information such as residence-time. METHOD: Register data and cross-sectional self-report questionnaire data were collected from 895 unaccompanied young refugees (UYRs). They originated in 31 different countries, the majority was from Afghanistan, 82.4% were boys, and average residence-time was 2.5 years. RESULTS: The length of the asylum-process was not associated with depression while heritage identity and residence-time were. Moderating analyses showed that an over-time steady decrease in depression was present for UYRs with a strong heritage identity. The prevalence of depression symptoms dropped from an initial 40%-14% among youth with 10 years of residence. Majority identity had neither direct nor indirect effects on depression. CONCLUSION: To optimize the psychosocial support offered to unaccompanied refugee minors during transition to stable resettlement, we need more substantial information about the aspects of the asylum-seeking process that increase the risk for mental health problems among them. In the years following resettlement, a strong heritage, but not majority identity was associated with lower levels of depressive symptoms. The findings are discussed in relation to structural barriers to bicultural identity formation and integration embedded in the way psychosocial support and education for these youths are structured, and implication for future research.

Depression among unaccompanied minor refugees: the relative contribution of general and acculturation-specific daily hassles.

OBJECTIVES: This study is designed to provide an empirical conceptualization of daily hassles among unaccompanied refugees, and whether they might affect mental health of young refugees after resettlement. First, we examined the underlying structure of daily hassles conceptualized as measuring general and acculturation-specific hassles. Second, we examined whether these two distinct categories of daily hassles significantly contribute to depression above and beyond the impact of premigration trauma. DESIGN: The study was based on self-report questionnaire data collected from 895 unaccompanied refugees who had been granted residence in Norway. RESULTS: Using structural equation modeling, the results confirmed the grouping of hassles in two general categories, which explained 43% of the variance in depression. CONCLUSION: The findings underscore the importance of current life conditions for unaccompanied refugees' mental health.

The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers.

There is a lack of knowledge about psychosocial resources that may sustain post-resettlement psychological adjustment among unaccompanied minor asylum-seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population-based multi-ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel.

Life Satisfaction among Unaccompanied Refugee Minors: Associations with Traumatic Events and Daily Hassles.

While there is a growing literature about mental health problems among unaccompanied asylum-seeking and refugee minors (URMs), far less is known about their wellbeing. Such information is important as a subjective sense of wellbeing is associated with a variety of positive health and psychosocial outcomes. The aim of this study was to examine life satisfaction and the association with traumatic events, daily hassles, and asylum status among URMs in Norway. We collected self-report questionnaire data from URMs living in Norway (n = 173, 90.80% male, 71.1% from Afghanistan). Mean age was 16.62 (SD = 1.74) years, and they reported clinically relevant post-traumatic stress symptoms. We explored variation in life satisfaction, URM-specific daily hassles and traumatic events. We also investigated a mediation model, in which we assumed that daily hassles mediated the association between traumatic events and life satisfaction. The participants reported low life satisfaction (M = 4.28, SD = 2.90, 0-10 scale). A negative outcome of the asylum process and URM-specific daily hassles were associated with reduced life satisfaction. URM-specific daily hassles accounted for the relation between traumatic events and life satisfaction. The youth had been exposed to several traumatic events yet the effect of these on life satisfaction appeared indirect, via an increase in URM-specific daily hassles. Reducing the number of, or help URM cope with, URM-specific daily hassles may increase their life satisfaction.

Changes in life satisfaction among unaccompanied asylum-seeking and refugee minors who participated in teaching recovery techniques (TRT).

BACKGROUND: Unaccompanied asylum-seeking and refugee minors report low life satisfaction and high levels of mental health problems, nevertheless they often do not seek or receive help for their problems. Teaching Recovery Techniques (TRT) is a low-threshold, five sessions intervention developed to reduce distressing war- and disaster-related trauma reactions among children and youth. In this study, we investigate if TRT can contribute to increased life satisfaction among unaccompanied asylum-seeking and refugee minors. METHODS: Asylum-seeking and resettled unaccompanied minors participated in TRT carried out in 15 locations throughout Norway, n = 147, mean age = 16.61 (SD = 1.80), 88% boys, and 67% from Afghanistan. Life satisfaction was measured by the Cantril Ladder before the intervention, and two- and eight weeks post-intervention. We also included indices of intervention compliance and contextual variables, such as asylum status. We applied a pre- and post-intervention design with linear mixed model analyses to investigate change in life satisfaction. RESULTS: Life satisfaction significantly increased from pre- to post- intervention, but not for youth whose asylum application had been rejected or who were still awaiting a decision. Indices of intervention compliance were associated with an increase in life satisfaction. CONCLUSIONS: TRT is a potential useful intervention to enhance life satisfaction among unaccompanied asylum-seeking and refugee minors and can be a measure to support positive development among youth at risk for mental health problems. However, TRT initiatives should consider the participant's stage of asylum process, because harsh immigration policies may overburden the coping capacity. Without further adaptation, TRT seems most useful for youth granted residence. The manual has been revised to include asylum-related stressors. TRIAL REGISTRATION: ClinicalTrials.gov (16/54,571, registered 30.01.2019).

Subjective Well-Being Among Unaccompanied Refugee Youth: Longitudinal Associations With Discrimination and Ethnic Identity Crisis.

Unaccompanied refugee youth (URY), who as children fled their countries to seek asylum in a foreign country without the company of an adult legal caretaker are described as being in a vulnerable situation. Many of them struggle with mental reactions to traumatic events experienced pre-migration, and to the daily hassles they face after being granted asylum and residence. Despite continuous high levels of mental health problems URY demonstrate remarkable agency and social mobility in the years after being granted asylum in their destination countries. A sense of subjective well-being (SWB) may enable resilient outcomes in people exposed to past or ongoing adversities. To fill the gap in the research literature about positive psychological outcomes among URY, the overall aim of this study was to explore the longitudinal associations between SWB and two taxing acculturation hassles: perceived discrimination and ethnic identity crisis. Three annual waves of self-report questionnaire data were collected from a population-based sample of URY; n = 581, M age = 20.01(SD = 2.40), M length of stay = 4.63 (SD = 4.40), 82 % male, mainly from Afghanistan, Somalia, Iraq, and Sri Lanka. The longitudinal associations between SWB, perceived discrimination and ethnic identity crisis across time were analyzed using auto-regressive cross-lagged modeling. The results revealed that perceived discrimination, but not ethnic identity crisis, negatively predicted subsequent levels of SWB. More importantly, high levels of SWB at one timepoint predicted decreases in both discrimination and ethnic identity crisis at subsequent timepoints. Further, increases in SWB from one timepoint to the next was associated with significant co-occurring decreases in both discrimination and ethnic identity crisis, and vice versa. Despite the negative effect of perceived discrimination on SWB, promoting SWB in URY can protect them from future hazards of acculturation hassles in complex ways. We underscore the need for more research on SWB among URY and other refugee youth. We further discuss the potential of SWB to foster resilient outcomes in young refugees and suggest that interventions to strengthen SWB among them should consider their transnational and multicultural realities and experiences.

Feasibility of a randomised trial of Teaching Recovery Techniques (TRT) with refugee youth: results from a pilot of the Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT).

BACKGROUND: Although post-traumatic stress is prevalent among unaccompanied refugee minors (URM), there are few evidence-based psychological interventions for this group. Teaching Recovery Techniques (TRT) is a brief, manualised intervention for trauma-exposed youth, which has shown promising results in exploratory studies. The aim of the present study was to assess the feasibility of conducting a randomised controlled trial (RCT) evaluating the use of TRT among URM by investigating key uncertainties relating to recruitment, randomisation, intervention delivery and data collection. METHODS: A 3-month long non-blinded internal randomised pilot trial with a parallel-group design assessed the feasibility of a planned nationwide multi-site RCT. URM with or without granted asylum were eligible if they were 14 to 20 years old, had arrived in Sweden within the last 5 years and had screened positive for symptoms of post-traumatic stress disorder (PTSD). Quantitative data were collected pre- and post-intervention, and 18 weeks after randomisation. On-site individual randomisation (1:1) followed directly after pre-intervention assessment. Participants allocated to the intervention were offered seven weekly group-based TRT sessions. Quantitative pilot outcomes were analysed using descriptive statistics. Qualitative information was gathered through on-site observations and follow-up dialogue with group facilitators. A process for Decision-making after Pilot and feasibility Trials (ADePT) was used to support systematic decision-making in moving forward with the trial. RESULTS: Fifteen URM (mean age 17.73 years) with PTSD symptoms were recruited at two sites. Three of the youths were successfully randomised to either TRT or waitlist control (TRT n = 2, waitlist n = 1). Fourteen participants were offered TRT for ethical reasons, despite not being randomised. Six (43%) attended ≥ 4 of the seven sessions. Seventy-three percent of the participants completed at least two assessments, with a response rate of 53% at both post-intervention and follow-up. CONCLUSIONS: The findings demonstrated a need for amendments to the protocol, especially with regard to the procedures for recruitment and randomisation. Upon refinement of the study protocol and strategies, an adequately powered RCT was pursued, with data from this pilot study excluded. TRIAL REGISTRATION: ISRCTN47820795 , prospectively registered on 20 December 2018.

The role of psychologists in international migration research: Complementing other expertise and an interdisciplinary way forward.

This research note addresses the current and potential future role of psychologists in the study of international migration. We review ways in which psychologists have contributed to the study of migration, as well as ways in which psychological scholarship could be integrated with work from other social science fields. Broadly, we discuss four major contributions that psychology brings to the study of international migration-studying migrants' internal psychological experiences, incorporating a developmental perspective, conducting experimental studies, and integrating across levels of analysis. Given the position of psychology as a 'hub science' connecting more traditional social sciences with health and medical sciences, we argue for a more prominent role for psychologists within the study of international migration. Such a role is intended to complement the roles of other social scientists and to create a more interdisciplinary way forward for the field of migration studies. The research note concludes with an agenda for further scholarship on migration.

The Strengths and Difficulties Questionnaire (SDQ) - self-report. An analysis of its structure in a multiethnic urban adolescent sample.

BACKGROUND: The SDQ is currently one of the internationally most frequently used screening instruments for child and adolescent mental health purposes. However, its structure, cross-cultural equivalence, and its applicability in ethnic minority groups is still a matter of discussion. METHODS: SDQ self-report data of 5,379 ethnic Norwegian and 865 ethnic minority adolescents with a variety of national origins was analysed by means of confirmatory factor analysis (CFA). Multi-group comparisons considering equal thresholds combined with more in-depth analyses on factor loadings, residuals, composite reliability, and average amount of variance explained by indicators of respective constructs were performed. RESULTS: CFA suggested a good fit of the five-factor model of the SDQ self-report in the subsample of ethnic Norwegian adolescents and an acceptable fit in ethnic minority subsamples without substantial differences between ethnic Norwegian SDQ data and data of Pakistani or those of 'other ethnic minority' adolescents. When assuming equal thresholds between response categories of the items as well as equal factor loadings the structure in the data significantly differed between ethnic Norwegian and both ethnic minority samples. Some factor loadings and some correlations between constructs significantly differed between ethnic Norwegian and both ethnic minority samples. The correlation coefficients between the hyperactivity factor and the conduct problems factor were too high in all three subsamples in order to establish distinct constructs. Composite reliability and average explained variance of the emotional symptoms factor were good in all samples, whereas they were low for some of the other factors. CONCLUSIONS: To some extent the theoretically proposed five-factor structure of the Norwegian version of the SDQ self-report was supported in 15- to 16-year-old adolescents. However, the results of more detailed analyses raise questions about the interpretation of some subscales. When applying this screening method to Norwegian adolescents, our results suggest that the use of the total difficulty score of the SDQ in screening youth should be preferred over the subscale scores.

Predictors of depressive symptoms among resettled unaccompanied refugee minors.

This study investigated the level and predictors of depressive symptoms among unaccompanied refugee minors after resettlement in Norway. Participants (N = 414) were resettled in 26 municipalities from all regions of the country. The average length of resettlement time was 3.4 years. They originated from 33 different countries, mainly Afghanistan (n = 116), Somalia (n = 74), Sri Lanka (n = 41) and Iraq (n = 43). Participants completed a self-report questionnaire administered in groups. Findings show that unaccompanied minors are a high-risk group for mental health problems also after resettlement in a new country. A multilevel model predicting depressive symptoms from individual and contextual demographic factors indicated that, controlling for post-traumatic stress, females had more symptoms than males and Somalis had fewer symptoms than participants from other countries. Variation in symptom levels as a function of gender and ethnic background indicates that some groups may have inherent protective or vulnerability factors that need to be further studied to understand differences in psychosocial adaptation among unaccompanied minors. Further, findings imply that researchers, policy makers and mental health care workers need to expand their attention beyond the first phases of arrival of unaccompanied asylum seeking and refugee minors to the continuing experience of mental health problems after resettlement.

Social anxiety among unaccompanied minor refugees in Norway.The association with pre-migration trauma and post-migration acculturation related factors.

OBJECTIVE: Unaccompanied refugee minors (URMs), are at high risk for mental health problems, yet there is a lack of knowledge about social anxiety among these youths. The aim of this study was to investigate symptoms of social anxiety among URMs resettled in Norway, and the combined effects of pre-migration traumatic events, post-migration acculturation related factors (perceived discrimination and culture competence in relation both to the heritage and majority cultures) and demographic background variables, over and above the effect of concurrent depressive symptoms. METHODS: Cross-sectional self-report questionnaire data were collected from 557 URMs from 31 different countries, mainly from Afghanistan (49,6%), Somalia (11,1%), and Iraq (7,0%). RESULTS: The findings from structural equation model (SEM) showed that the effect of pre-migration traumatic events on social anxiety was non-significant (ß = 0.001, p = .09), while perceived discrimination and majority culture competence had unique effects on social anxiety (ß = 0.39, p < .001 and ß = -0.12, p = .008, respectively) over and above depressive symptoms (ß = 0.30, p < .001). CONCLUSIONS: The findings show that factors of the current socio-cultural developmental context rather than pre-migration war-related traumatic events the youths experienced before migration accounts for variation in social anxiety. Potential practical implications of the findings for social workers, educational staff and clinicians are discussed.

Evaluation of the teaching recovery techniques community-based intervention for accompanied refugee children experiencing post-traumatic stress symptoms (Accompanied refugeeS In Sweden Trial; ASsIST): study protocol for a cluster randomised controlled trial.

BACKGROUND: Refugee children have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue for years after resettlement. The Accompanied refugeeS In Sweden Trial (ASsIST) aims to evaluate a community-based intervention, called 'Teaching Recovery Techniques' (TRT), for accompanied refugee minors experiencing PTSD symptoms. METHODS/DESIGN: A cluster randomised controlled trial will be conducted in which participants will be randomly allocated to one of the two possible arms: the intervention arm (n=113) will be offered the TRT programme and the waitlist-control arm (n=113) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; c.8 weeks after randomisation) and follow-up (T3; c.20 weeks after randomisation). ETHICS AND DISSEMINATION: Ethical approval was granted by the Regional Ethical Review Board in Uppsala (Ref. 2018/382) (24th February 2019). Results will be published in scientific journals. TRIAL REGISTRATION DETAILS: ISRCTN17754931. Prospectively registered on 4th June 2019.

Evaluation of the Teaching Recovery Techniques community-based intervention for unaccompanied refugee youth experiencing post-traumatic stress symptoms (Swedish UnaccomPanied yOuth Refugee Trial; SUPpORT): study protocol for a randomised controlled trial.

BACKGROUND: In 2015, 162,877 persons sought asylum in Sweden, 35,369 of whom were unaccompanied refugee minors (URMs). Refugee children, especially URMs, have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue years after resettlement. The Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT) aims to evaluate a community-based intervention, called Teaching Recovery Techniques (TRT), for refugee youth experiencing PTSD symptoms. METHODS/DESIGN: A randomised controlled trial will be conducted in which participants will be randomly allocated to one of two possible arms: the intervention arm (n = 109) will be offered the TRT programme, and the waitlist-control arm (n = 109) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; about 8 weeks after randomisation) and follow-up (T3; about 20 weeks after randomisation). DISCUSSION: This study will provide knowledge about the effect and efficiency of a group intervention for URMs reporting symptoms of PTSD in Sweden. TRIAL REGISTRATION: ISRCTN, ISRCTN47820795. Prospectively registered on 20 December 2018.

The Longitudinal Relation between Daily Hassles and Depressive Symptoms among Unaccompanied Refugees in Norway.

The aim of the present longitudinal study is to understand the longitudinal relation between depressive symptoms and daily hassles (i.e., general and acculturation hassles) in a high-risk population of unaccompanied refugees. We investigated the validity of three stress-mental health models: the stress exposure model, the stress generation model, and the reciprocal model. Data were collected from 918 unaccompanied refugees in Norway in three waves. Of the initial sample, the majority (82.1%) were male (M age = 19.01 years, SD = 2.54 years). The data were analyzed with auto-regressive cross-lagged modeling and latent growth curve modeling. The results supported the stress exposure model for the relation between depressive symptoms and acculturation hassles, indicating that acculturation hassles predicted the subsequent levels of depressive symptoms rather than vice versa. On the other hand, the reciprocal model was supported for the relation between depressive symptoms and general hassles indicating a bidirectional, mutual relation. Unconditional latent growth models further showed that depression level remained unchanged over time, while levels of acculturation and general hassles decreased. The implications for clinical practice and immigration policy are discussed.

Own and parental war experience as a risk factor for mental health problems among adolescents with an immigrant background: results from a cross sectional study in Oslo, Norway.

BACKGROUND: An increasing proportion of immigrants to Western countries in the past decade are from war affected countries. The aim of this study was to estimate the prevalence of war experience among adolescents and their parents and to investigate possible differences in internalizing and externalizing mental health problems between adolescents exposed and unexposed to own and parental war experience. METHOD: The study is based on a cross-sectional population-based survey of all 10th grade pupils in Oslo for two consecutive years. A total of 1,758 adolescents were included, all with both parents born outside of Norway. Internalizing and externalizing mental health problems were measured by Hopkins Symptom Checklist-10 and subscales of the Strengths and Difficulties Questionnaire, respectively. Own and parental war experience is based on adolescent self-report. RESULTS: The proportion of adolescents with own war experience was 14% with the highest prevalence in immigrants from Eastern Europe and Sub-Saharan Africa. The proportion of parental war experience was 33% with Sub-Saharan Africa being highest. Adolescents reporting own war experience had higher scores for both internalizing and externalizing mental health problems compared to immigrants without war experience, but only externalizing problems reached statistically significant differences. For parental war experience there was a statistically significant relationship between parental war experience and internalizing mental health problems. The association remained significant after adjustment for parental educational level and adolescents' own war experience. CONCLUSION: War exposure is highly prevalent among immigrants living in Oslo, Norway, both among adolescents themselves and their parents. Among immigrants to Norway, parental war experience appears to be stronger associated with mental health problems than adolescents own exposure to war experience.

Is relatively young age within a school year a risk factor for mental health problems and poor school performance? A population-based cross-sectional study of adolescents in Oslo, Norway.

BACKGROUND: Several studies have shown that children who are relatively young within a school year are at greater risk for poorer school performance compared with their older peers. One study also reported that relative age within a school year is an independent risk factor for emotional and behavioral problems. The objective of this study was to test the hypothesis that relatively younger adolescents in the multiethnic population of Oslo have poorer school performance and more mental health problems than their relatively older classmates within the same school year. METHODS: This population-based cross-sectional study included all 10th-grade pupils enrolled in 2000 and 2001 in the city of Oslo. The participation rate was 88%. Of the 6,752 pupils in the study sample, 25% had a non-Norwegian background. Mental health problems were quantified using the abbreviated versions of Symptom Check List-25 (SCL-10) and the Strength and Difficulties Questionnaire (SDQ). Information on school performances and mental health problems were self-reported. We controlled for confounding factors including parental educational level, social support, gender, and ethnicity. RESULTS: The youngest one-third of pupils had significantly lower average school grades than the middle one-third and oldest one-third of their classmates (p < 0.001). Of the mental health problems identified in the questionnaires, the groups differed only on peer problems; the youngest one-third reported significantly more problems than the middle and oldest groups (p < 0.05). Age within a school year and gender showed significant interactions with total SDQ score, SDQ peer problems score, SDQ pro social score, and SCL-10 score. After stratifying for gender, the peer problem scores differed significantly between age groups only among boys. The SCL-10 score was significant, but only in girls and in the opposite direction to that expected, with the oldest pupils having significantly higher scores than the other two groups (p < 0.05). CONCLUSION: In adolescents from a multicultural city in Norway, relative age within a school year significantly influenced academic performance. In contrast to data from Great Britain, relative age within a school year was not an important risk factor for mental health problems in adolescents in Oslo.

Communal proactive coping strategies among Tamil refugees in Norway: A case study in a naturalistic setting.

BACKGROUND: An exclusive focus on individual or family coping strategies may be inadequate for people whose major point of concern may be collective healing on a more communal level. METHODS: To our knowledge, the current study is the first to make use of ethnographic fieldwork methods to investigate this type of coping as a process in a natural setting over time. Participant observation was employed within a Tamil NGO in Norway between August 2006 and December 2008. RESULTS: Tamil refugees in Norway co-operated to appraise their shared life situation and accumulate resources communally to improve it in culturally meaningful ways. Long term aspirations were related to both the situation in the homeland and in exile. However, unforeseen social events created considerable challenges and forced them to modify and adapt their coping strategies. CONCLUSIONS: We describe a form of coping previously not described in the scientific literature: Communal proactive coping strategies, defined as the process by which group members feel collectively responsible for their future well-being and co-operate to promote desired outcomes and prevent undesired changes. The study shows that proactive coping efforts occur in a dynamic social setting which may force people to use their accumulated proactive coping resources in reactive coping efforts. Theoretical and clinical implications are explored.

Emotional problems in preadolescents in Norway: the role of gender, ethnic minority status, and home- and school-related hassles.

BACKGROUND: "The gender gap" refers to a lifelong higher rate of emotional problems in girls, as compared to boys, that appears during adolescence. The gender gap is a well-replicated finding among older adolescents and is assumed to be a cross-cultural phenomenon. However, these cross-cultural studies have not investigated the gender gap in ethnic minorities but sampled ethnic majority adolescents in different countries. Some studies that investigated the gender gap across ethnic groups indirectly (by presenting emotional problem scores stratified by gender and ethnic group) indicate that the gender gap is less prominent or even absent among minorities. The aims of this study were to assess whether the gender gap is found in both majority and minority preadolescents, and to investigate whether a possible (gender and ethnic) group difference can be accounted for by differences in home or school hassles. METHODS: Participants were 902 preadolescent students (aged 10 to 12) from two cities in Norway. We collected self-report measures of emotional problems and home and school hassles. Using mediated moderation analysis we tested whether the interaction effect between gender and ethnic minority background on emotional problems was mediated by home or school hassles. RESULTS: The gender gap in emotional problems was restricted to ethnic majority preadolescents. School hassles but not home hassles accounted in part for this effect. CONCLUSIONS: The absence of the gender gap among minority as opposed to majority preadolescents may indicate that social circumstances may postpone or hamper the emergence and magnitude of the gender gap in ethnic minority preadolescents. In this study, school hassles partly accounted for the combined gender and ethnic group differences on emotional problems. This indicates that school hassles may play a role in the higher levels of emotional problems in preadolescent minority boys and consequently the absence of a gender gap found in our minority sample.

Ethnic group, acculturation, and psychiatric problems in young immigrants.

BACKGROUND: The goal of this study was to investigate the effects of ethnic origin and acculturation factors on psychiatric problems among immigrant adolescents. One aim was to examine variations in psychiatric problems according to gender and immigrant generation level. Another aim was to explore ethnic group differences in psychiatric problems and acculturation risk and protective factors. Finally, we examined the potential mediating effect of acculturation in the relationship between ethnic origin and psychiatric symptoms. METHOD: Questionnaire data were collected from 1275 immigrant 10th graders with 11 different ethnic origins. Psychiatric problems were measured by the Strength and Difficulty Questionnaire. Acculturation risk factors involved perceived discrimination and ethnic identity crisis. Protective factors were family values, host and ethnic culture competence. RESULTS: First-generation girls and second-generation boys were identified as particularly vulnerable to psychiatric problems. There was significant variation in psychiatric problems and acculturation between ethnic groups. There was substantial ethnic group-level correlation between emotional and conduct problems, and between discrimination and peer problems. Otherwise, a differentiated pattern of high-scoring ethnic groups emerged across the various symptom and acculturation indices. ANOVAs yielded unique effects on each symptom category of both ethnic group and the acculturation risk and protective factors, undermining the notion of a mediating effect of acculturation. CONCLUSIONS: There is a complex pattern of adaptation in cultural context and idiosyncratic relationships between distinct psychiatric symptom groups and socio-cultural factors. Information about the differentiated vulnerability of gender, generation, and ethnic groups to psychiatric morbidity is important to identify groups at special risk, and to produce interventions that are tailored to their needs. Future studies should examine how cultural factors contribute both to resilience and to an increased vulnerability to psychiatric problems.