Hanes Gemma, Sung Lydia, Mutch Raewyn, Cherian Sarah
Refugee Health Service, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Paediatric Consultative Services, Child and Adolescent Mental Health Service, Perth, Western Australia, Australia.
J Paediatr Child Health. 2017 Sep;53(9):882-888. doi: 10.1111/jpc.13559. Epub 2017 May 10.
Cumulative adverse childhood experiences have long-term consequences and may manifest within and influence health, educational and psychosocial domains. The Princess Margaret Hospital Refugee Health Service (RHS) undertakes multidisciplinary screening of refugee children <16 years, allowing standardised identification of negative childhood experiences. Addition of the extended Strengths and Difficulties Questionnaire (SDQ) in 2014 aimed to augment psychological assessment of this cohort.
An audit of prospectively collected standardised RHS proformas, health records and initial and 6-month follow-up SDQs for new patients aged 2-16 years between August 2014 and January 2016 was undertaken. Wider refugee adverse childhood experiences (R-ACE) were also captured.
Initial SDQ data were obtained from 204 patients (mean age 9.2 ± SD 4.4 years) with 143 follow-up SDQs available. One third (37.3%) had at least one psychological symptom identified based on initial screening proforma. Multiple R-ACE were disclosed with 126 of 201 (62.7%) experiencing ≥3. African ethnicity, age >10 years, separation anxiety on initial proforma and no formal parental education were associated with higher R-ACE. Initial SDQ results varied with age/ethnicity; however, peer problem scores were consistently elevated. Total difficulty SDQ scores did not capture psychopathology at expected frequencies. Improvement in follow-up SDQ results were appreciated for children aged 4-10 years. Most patients (80.2%) disclosed improvement in health status following RHS involvement.
Refugee children have complex backgrounds with exposure to multiple traumatic events. Comprehensive standardised health and psychological screening is recommended to target intervention. Further validation of culturally age-appropriate mental health screening tools in this diverse population is required.
童年期累积的不良经历具有长期影响，可能在健康、教育和心理社会领域显现并产生影响。玛格丽特公主医院难民健康服务中心（RHS）对16岁以下难民儿童进行多学科筛查，以便对不良童年经历进行标准化识别。2014年增加了扩展版优势与困难问卷（SDQ），旨在加强对这一群体的心理评估。
对2014年8月至2016年1月期间前瞻性收集的2至16岁新患者的标准化RHS表格、健康记录以及初始和6个月随访的SDQ进行审核。还收集了更广泛的难民不良童年经历（R-ACE）。
获得了204名患者（平均年龄9.2±标准差4.4岁）的初始SDQ数据，其中143份有随访SDQ数据。根据初始筛查表格，三分之一（37.3%）的患者至少有一项心理症状。发现了多种R-ACE，201名患者中有126名（62.7%）经历了≥3次。非洲裔、年龄>10岁、初始表格显示有分离焦虑以及父母未接受正规教育与较高的R-ACE相关。初始SDQ结果因年龄/种族而异；然而，同伴问题得分一直较高。总困难SDQ得分未按预期频率反映精神病理学情况。4至10岁儿童的随访SDQ结果有所改善。大多数患者（80.2%）表示在RHS参与后健康状况有所改善。
难民儿童背景复杂，经历过多种创伤事件。建议进行全面的标准化健康和心理筛查以进行干预。需要在这一多样化人群中进一步验证适合不同文化和年龄的心理健康筛查工具。
