title: Depression and post-traumatic stress disorder among Haitian immigrant students: implications for access to mental health services and educational programming.
abstract: BACKGROUND
  Previous studies of Haitian immigrant and refugee youth have emphasized "externalizing" behaviors, such as substance use, high risk sexual behavior, and delinquency, with very little information available on "internalizing" symptoms, such as depression and anxiety. Analyzing stressors and "internalizing" symptoms offers a more balanced picture of the type of social and mental health services that may be needed for this population. The present study aims to: 1) estimate the prevalence of depression and post-traumatic stress disorder (PTSD) among Haitian immigrant students; and 2) examine factors associated with depression and PTSD to identify potential areas of intervention that may enhance psychosocial health outcomes among immigrant youth from Haiti in the U.S.
  
  
  METHODS
  A stratified random sample of Haitian immigrant students enrolled in Boston public high schools was selected for participation; 84% agreed to be interviewed with a standardized questionnaire. Diagnosis of depression and PTSD was ascertained using the best estimate diagnosis method.
  
  
  RESULTS
  The prevalence estimates of depression and PTSD were 14.0% and 11.6%; 7.9% suffered from comorbid PTSD and depression. Multivariate logistic regression demonstrated factors most strongly associated with depression (history of father's death, self-report of schoolwork not going well, not spending time with friends) and PTSD (concern for physical safety, having many arguments with parents, history of physical abuse, and lack of safety of neighborhood).
  
  
  CONCLUSIONS
  A significant level of depression and PTSD was observed. Stressors subsequent to immigration, such as living in an unsafe neighborhood and concern for physical safety, were associated with an increased risk of PTSD and should be considered when developing programs to assist this population. Reducing exposure to these stressors and enhancing access to social support and appropriate school-based and mental health services may improve educational attainment and psychosocial health outcomes among Haitian immigrant youth.
authors.affiliation: Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. mksfawzi@msn.com
authors.forename: Mary C Smith
authors.initials: MC
authors.lastname: Fawzi
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
authors.forename: Lilly
authors.initials: L
authors.lastname: Marcelin
authors.forename: Michelle
authors.initials: M
authors.lastname: Klopner
authors.forename: Kerim
authors.initials: K
authors.lastname: Munir
authors.forename: Anna C
authors.initials: AC
authors.lastname: Muriel
authors.forename: Catherine
authors.initials: C
authors.lastname: Oswald
authors.forename: Joia S
authors.initials: JS
authors.lastname: Mukherjee
mesh_terms: D000293:Adolescent; D001900:Boston / Q000453:epidemiology; D003866:Depressive Disorder / Q000208:ethnology*; D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006205:Haiti / Q000208:ethnology; D006801:Humans; D007398:Interpersonal Relations; D016015:Logistic Models; D008297:Male; D010287:Parent-Child Relations; D012111:Residence Characteristics; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology*; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult