Department of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Psychologische Hochschule, Berlin, Germany.
Public Health. 2018 May;158:163-175. doi: 10.1016/j.puhe.2018.03.012. Epub 2018 Apr 5.
Little is known about the psychological trauma experienced by children and young adults (CYAs) following displacement after natural disasters vs migration from conflict zones. In both instances, the decision to leave is usually cast by the family, and the life of CYAs is suddenly disrupted by external circumstances.
An anonymous survey.
The same survey instrument, provided by the National Child Traumatic Stress Network (NCTSN), was used to survey self-reported health needs among CYAs during the aftermath of Hurricane Katrina (Health Survey for Children and Adolescents After Katrina) in October 2005-February 2006 and again during the peak of refugee arrivals in Berlin between October 2015 and March 2016. A weighted index to measure cumulative exposure to traumatic stresses during migration was developed along with an unweighted psychological impact score based on the 22-item NCTS psychological impact questionnaire. Spearman's correlation coefficient (rho) was used to assess the correlation between age and the two psychological impact indices. The two-tailed t-test was used to investigate differences in trauma experienced and psychological impact by gender. Logistic regression was used to investigate differences in types of traumatic stress experienced and psychological impact among CYAs displaced because of Hurricane Katrina and those seeking asylum in Berlin.
The Katrina cohort included a total of 1133 CYAs, the Berlin cohort, a total of 405 CYAs. The median age in the Katrina cohort was 6.73 years (standard deviation [SD] 5.67, range 0-24; 50.13% males) compared with 17.64 years (SD, range 0-24; 83% males) in the Berlin cohort. Comparative analyses were adjusted to age and gender and revealed significant differences between the two cohorts, both with regards to the amount of trauma experienced and the psychological impact. A statistically significant and moderate positive correlation was observed between trauma experienced and psychological impact of migration in the refugee population (rho = 0.4955, P < 0.001); the correlation was less pronounced but still significant in the Katrina cohort (rho = 0.0942, P = 0.0015). Free-text responses revealed that in addition to common concerns about health, housing and safety, refugees were also pre-occupied with language acquisition and the adaptation to a new culture.
The observed differences in the experience and the consequences of trauma in displaced CYAs warrant additional investigation. It was replicated that human-made disaster seems to show more traumatising potential than natural disaster. Stakeholders need to be aware of the potential medium and long-term consequences of migration/evacuation and allocate resources accordingly.
对于儿童和青少年（CYAs）在自然灾害后流离失所与冲突地区移民后所经历的心理创伤，人们知之甚少。在这两种情况下，离开的决定通常都是由家庭做出的，CYAs 的生活突然被外部环境打乱。
一项匿名调查。
使用由国家儿童创伤应激网络（NCTSN）提供的相同调查工具，于 2005 年 10 月至 2006 年 2 月卡特里娜飓风（卡特里娜飓风后儿童和青少年健康调查）后和 2015 年 10 月至 2016 年 3 月柏林难民潮高峰期再次调查 CYAs 自我报告的健康需求。根据 NCTS 心理影响问卷的 22 项内容，开发了一个衡量在迁移过程中累积暴露于创伤性压力的加权指数，以及一个基于未加权的心理影响评分。使用 Spearman 相关系数（rho）评估年龄与两个心理影响指数之间的相关性。使用双尾 t 检验调查性别对创伤经历和心理影响的差异。使用逻辑回归调查因卡特里娜飓风而流离失所和在柏林寻求庇护的 CYAs 所经历的创伤类型和心理影响的差异。
卡特里娜飓风队列共纳入 1133 名 CYAs，柏林队列共纳入 405 名 CYAs。在卡特里娜飓风队列中，中位数年龄为 6.73 岁（标准差[SD]5.67，范围 0-24；50.13%为男性），而在柏林队列中，中位数年龄为 17.64 岁（SD，范围 0-24；83%为男性）。比较分析调整了年龄和性别，结果显示两个队列之间在创伤经历和心理影响方面存在显著差异。在难民群体中，创伤经历和心理影响之间存在显著且中度正相关（rho=0.4955，P<0.001）；在卡特里娜飓风队列中，相关性虽然较弱但仍具有统计学意义（rho=0.0942，P=0.0015）。自由文本回复显示，除了对健康、住房和安全的常见关注外，难民还特别关注语言习得和适应新文化。
流离失所的 CYAs 所经历和承受的创伤的差异值得进一步研究。复制表明，人为灾难似乎比自然灾害更具潜在的创伤性。利益相关者需要意识到迁移/撤离的潜在中长期后果，并相应地分配资源。
