标题：Addressing Health Disparities in the Mental Health of Refugee Children and Adolescents Through Community-Based Participatory Research: A Study in 2 Communities
摘要：Objectives. We sought to understand the problems, strengths, and help-seeking behaviors of Somali Bantu and Bhutanese refugees and determine local expressions of mental health problems among youths in both communities. Methods. We used qualitative research methods to develop community needs assessments and identify local terms for child mental health problems among Somali Bantu and Bhutanese refugees in Greater Boston and Springfield, Massachusetts, between 2011 and 2014. A total of 56 Somali Bantu and 93 Bhutanese refugees participated in free list and key informant interviews. Results. Financial and language barriers impeded the abilities of families to assist youths who were struggling academically and socially. Participants identified resources both within and outside the refugee community to help with these problems. Both communities identified areas of distress corresponding to Western concepts of conduct disorders, depression, and anxiety. Conclusions. There are numerous challenges faced by Somali Bantu and Bhutanese youths, as well as strengths and resources that promote resilience. Future steps include using culturally informed methods for identifying those in need of services and developing community-based prevention programs. There are disparities in the mental health of refugee children and adolescents resettled in the United States compared with youths in the general US population. For instance, the prevalence of posttraumatic stress disorder and depression among resettled refugee children is estimated to be as high as 54% and 30%, 1 respectively, compared with an estimated 5% (posttraumatic stress disorder) and 11% (depression) of youths with these disorders in the general population. 2 In addition to specific psychiatric disorders, refugee youths experience overall greater psychological distress than those in the general population. 3 Youths in the general US population are exposed to adverse events that elevate risk of mental disorders 4 ; however, the refugee experience, including flight from country of origin, displacement in a refugee camp, and third country resettlement, increases risk of being exposed to multiple acute and chronic stressors that accumulate and lead to differential mental health outcomes. 4–6 In addition, children in the US population in general have poor access to and underutilization of mental health services, but the situation is exacerbated by refugee status and its associated acculturative and resettlement stressors. 7,8 Our study makes an original contribution to understanding the experiences of individuals and families in 2 refugee groups—Somali Bantu and Nepali-origin Bhutanese. Historically perceived as slaves in Somalia, the Somali Bantu community escaped the 1991 civil war and fled their homes to nearby Kenyan refugee camps. 9–12 In 2003, approximately 12 000 Somali Bantu refugees arrived in the United States. 13 Ethnic-Nepali citizens of Bhutan were expelled from their country of origin in the early 1990s 14 and lived in refugee camps in Nepal for almost 20 years. 15 Roughly 75 000 Bhutanese refugees have relocated to the United States since 2008.
