title: Mental health of Bosnian refugee children: a comparison of clinician appraisal with parent, child and teacher reports.
abstract: This study compares clinician appraisal of Bosnian refugee children with independent parent, child and teacher reports. From whom and by what means can children "at risk" be reasonably identified? Forty-eight Bosnian refugee children (aged 7-20), resettled in Sweden 1994-95, were assessed clinically by means of a semi-structured interview. Thereafter, standardized mental health questionnaires were administered to parents (Achenbach's Child Behavior Checklist), children (Achenbach's Youth Self-Report and Macksoud's Posttraumatic Stress Reaction Checklist) and teachers (clinician designed School Competence Scale and Achenbach's Teacher's Report Form). On clinician interview, nearly half of the children (48%) were identified with one or more mental health problem "demanding further attention". Depressiveness was the single most prevalent symptom (31%); followed by post-traumatic stress (23%), and anxiety-regressiveness (15%). At the same time, 75% of the children were rated by teachers as "quite competent" in school. Parent, child and clinician appraisals of primary school children showed broad similarities. Teachers reported a similar prevalence of child distress, but identified different symptoms and different children demanding attention. Evaluation of teenage youths showed greater disparity: teenagers labeled their own symptoms more often as post-traumatic stress reactions and teachers identified few youths in need of attention. Inter-relatedness among parent, child and clinician appraisals supports the robustness of our semi-structured interview. At the same time, apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment. Also, a more concrete presentation of post-traumatic stress reactions and a higher "further attention" threshold for inward emotional problems seem called for.
authors.affiliation: Division of Child and Adolescent Psychiatry, Department of Clinical Sciences, Norrlands University Hospital, S-901 87 Umeå, Sweden. stephen.goldin@psychiat.umu.se
authors.forename: Stephen
authors.initials: S
authors.lastname: Goldin
authors.forename: Bruno
authors.initials: B
authors.lastname: Hägglöf
authors.forename: Lilian
authors.initials: L
authors.lastname: Levin
authors.forename: Lars Ake
authors.initials: LA
authors.lastname: Persson
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D017522:Bosnia and Herzegovina / Q000208:ethnology; D002648:Child; D002667:Child Reactive Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015588:Observer Variation; D010552:Personality Assessment / Q000706:statistics & numerical data*; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012306:Risk; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D013548:Sweden