J Immigrant Minority Health DOI 10.1007/s10903-014-0039-2

ORIGINAL PAPER

Emotional and Behavioral Problems in Migrant Children and Adolescents in American Countries: A Systematic Review Esmahan Belhadj Kouider • Ute Koglin Franz Petermann

•

 Springer Science+Business Media New York 2014

Abstract The present review postulates the current mental health status in migrant children and adolescents in the North American continent. 35 studies published from 2009 to 2013 chosen from a systematic literature research were included. Almost all studies were conducted in the United States and Canada. From the perspective of selection effect, migration as a risk factor was not proven. The migration process perspective could have underestimated a higher danger of problem behavior in second-generation migrant children. Comparing native and migrant children, balanced results in problem behavior were reported, but the Asian migrant group was at higher risk of developing mental disorders. Family-based risk factors were offered: high acculturation stress, low English language competence, language brokering, discrepancies in children’s and parent’s cultural orientation, the non-Western cultural orientation, e.g., collectivistic, acceptance feelings of parents, or harsh parenting. However, the importance to support migrant families in the acculturation process becomes apparent. Keywords Emotional and behavioral problems
Migration
Children
Adolescents
Review

E. Belhadj Kouider (&)
F. Petermann Center for Clinical Psychology and Rehabilitation, Grazer Str. 6, 28359 Bremen, Germany e-mail: [email protected] F. Petermann e-mail: [email protected] U. Koglin Institutes for Special Education and Rehabilitation, Psychology Group for Special Education and Rehabilitation, University Oldenburg, Oldenburg, Germany e-mail: [email protected]

Introduction An immigrant population has rapidly increased in the US and in Canada. The conventional distinction between the immigrated ethnic groups in the US is usually white, black, Asian or Latino origin [1, 2]. Even if the immigrated ethnic groups differ partially from migrant groups in other regions in the world, analyses about migrant children’s mental health is globally important to understand their development. Irrespective of the kind of host country, living conditions as being in minority, speaking another origin language, having a different skin color or having another religious orientation are often worldwide similar challenges for all migrant children and adolescents. However, for quite some time research on migrant’s mental health has been based more in the American continent than in others. Due to this, in addition to a systematic review analyzing the emotional and behavioral condition of migrant children and adolescents in Europe [3], this review will present the current state of migrant children’s and adolescents’ mental health in the North American continent. The North American continent includes Greenland, Canada, US, Mexico, Guatemala, Honduras, Nicaragua, Belize, Costa Rica, El Salvador, Panama and several pacific Island countries. However, due to a long immigration tradition, especially in the US and Canada, a large number of migrant studies were conducted with a high focus on much more influential factors in mental health than in other regions of the world. Therefore, this overview of actual migrant children American studies shall apply particularly to factors which influence migrant children’s mental health. Furthermore, it should be filtered out if there are ethnic differences in the mental health status of migrant children in American countries.

123

J Immigrant Minority Health

Understanding the Migration Background in the North American Continent In general, an immigrant background is defined if national frontiers were crossed. Leaving the origin country may be defined as ‘emigration’; in turn someone who came from afar and lives in a new host country may be defined as an ‘immigrant’. The first migrant generation, which experienced the migration firsthand, is usually separated from following generations (second and higher). Thus, for example, the third generation may be defined if children themselves and their parents are born in host country, but their grandparents immigrated from abroad. The classical definition understands the term ‘immigrant’ as the description of someone who is ‘foreign born’ [3, 4]. About 14 % (40 million) of the total population in 2011 are in these part foreign-born citizens in the US. Furthermore, each affiliation to an ethnic group is in independence to the country of birth registered by US offices [4]. In Canada, as one of the worlds’ largest economies, an increasing population of migrant people was reported in 2010: 21 % (6.8 million) of the total population were foreign born [2]. In contrast to the US and Canadian migrant situation, in other North American countries only a small population had a foreign born root, e.g., in 2010 only 0.9 % of the total Mexican population were foreign born [5]. These comparisons show that the migrant situation in the North American continent differs largely.

Mental Disorders in Childhood Defining and understanding mental disorders is fundamental for the description of mental conditions in migrant children. In general, a membership to a majority, living without mental problems, having compliance with daily hassles and sufficient adaption in society are defined as mental health. Mental disorders are understood as deviation from the norm [6]. The ‘Diagnostical and Statistical Manual of Mental disorders’ (DSM-5) [7] describes the presence of specific symptoms, usually a clinical significance, specific exclusion criteria and the onset and development of diseases as mental disorders. Mental disorders are defined in this context as syndromes with disturbances in different capabilities as emotion regulation, individual cognition or behavior. Cultural stressors or social conflicts are not understood as mental disorders [8]. The present review reports two clusters of mental disorders, externalizing and internalizing mental problems based on the definition of Achenbach [9]: conduct disorders and hyperactivity as externalizing disorders and depression or anxiety as internalizing problems. Reasoned by their high specificity, further mental disorders such as schizophrenia,

123

personality disorders or eating disorders are not included in the present analysis. The present review will show the current prevalence rate in migrant children’s internalizing and externalizing of problem behavior. On the one hand migrant and native children will be compared; on the other hand ethnic differences in the migrant groups will be determined. Additionally, special factors influencing migrant children’s and adolescents mental health status shall be filtered out. For these descriptions and comparisons, however, specified inclusion and exclusion criteria were defined to identify suitable studies. The following section describes the inclusion criteria of the present review more precisely.

Methods Literature Search Based on manual searches and systematic literature research in databases such as Pubmed, PsychInfo and Web of Science (September 2012–August 2013) this review detected original studies comparing children’s problems in the North American continent with and without foreign roots and their behavioral. This present study uses the methodic standards for the conception of systematic reviews [10]. To filter out all relevant studies and integrate all definitions of mental disorders/behavioral problems or a migration background, the following keywords were used in the search: •

• •

Mental disorders (emotional and behavioral problems): [mental disorders OR mental health OR behavior disorders OR behavio(u)r(al) problems OR problem behavior OR internalizing OR externalizing OR emotional problems OR psychopathology OR psychiatric problems OR affective disorders OR depression OR anxiety disorders OR attention-deficit-disorder OR hyperactivity OR chronic-mental-illness OR conductdisorder OR impulse-control-disorders OR neuroses] AND Childhood: [children OR adolescents OR youths OR childhood] AND Immigrant background: [migration background OR immigrant background OR migrant OR culturally and linguistically diverse populations OR linguistic and cultural diverse background OR ethnic minority population OR foreign born].

Study Selection The following criteria were defined as a restriction for the present review:

J Immigrant Minority Health

• •

•

•

•

•

•

•

Studies with children and adolescents aged up to 20 years are included. Due to increased interest in migrant studies in the last decade, an overview of the last 5 years should be given. Peer reviewed publications in English since January 2009 up to August 2013 are included. All studies show children and adolescents with and without foreign roots or general different immigrated ethnic groups. Analyses of one ethnic group exclusively are also accepted in the present study. This inclusion might show more intensively further aspects influencing migrant children’s mental condition. An immigrant background is defined if national frontiers were crossed. The children or adolescents or at least one parent/grandparent is foreign born. Children and adolescents with immigrant background represent in this case the first, second or third generation. All other generations are not taken into consideration. To filter out all migrant children or adolescents, the kind of migrant generation has to be reported. Ethnic analyses without migration aspects were excluded. Differences between groups have to be statistically safeguarded; the sample size amounts at least N = 40 and differences are tested for statistical significance. The studies analyze prevalence of mental disorders or emotional or behavioral problems of children and adolescents. Studies with pervasive or circumscribed developmental disorders such as autism or language development disorders are excluded. These kind of mental disorders are due to genetic etiology [11, 12], and not caused by migration or developmental reasons. Given their high specificity, analyses about eating disorders, psychoses, personality disorder or suicide are also excluded. The mental disorders have to be classified in a valid form: with expert diagnosis based on DSM-5 [7] or with validated questionnaires as measure instruments, e.g., CBCL [8] or SDQ [11]. Studies with self-devised questionnaires or structured clinical interviews have to be required as large-scale studies with a sample size of at least N = 500. Furthermore, studies especially on asylum seekers/ refugees in the context of migrant children or adolescent are excluded since these issues are very specific. Suffering from traumatic experiences, these populations often undergo certain psychological crises which differ from labor migrants.

Based on analyses about migrant children’s mental health of Stevens and Vollebergh [12], different perspective designs are considered in the present study. 1.

Selection effects of migration: Comparison of random samples comprised of children and adolescents with an

2.

3.

immigrant background in the host country with random population samples in the original country. Migration process effects: Comparison of samples comprised of children and adolescents with an immigrant background in the host country with matched groups in the original/host country. In this perspective, the generation of migration (first or second) is included as factor. Ethnic minority effects: Comparison of samples comprised of migrant children and adolescents in the host country with native samples in the host country. Studies comparing different immigrated ethnic groups in the host country are also included in this category. Detailed analyses about one ethnic group are additionally integrated in this category.

Stevens and Vollebergh [12] additionally reported a cross-cultural perspective, which is excluded in the actual analyses. This perspective defines cultural differences in general (such as different parenting or different temperament), but not the comparison between different emotional or behavioral problems caused by migration. Results The systematic literature research identified 973 potential studies. Taking due account of all listed criteria, 35 studies were finally integrated (Fig. 1). Almost all studies (27) were conducted in the United States, six studies in Canada, one study in Puerto Rico and the US and one international study comprised migrant children in the US, Canada, Australia, and the UK. However, English published studies which fulfill the inclusion criteria of the Latin American countries or the Caribbean were not found in the literature research. Just one of included studies analyzed the selective perspective (the Puerto Rican and US study), four studies especially deal with the migration process (US and Canadian studies), two studies include a combination of migration process and ethnic minority perspective (US studies) and three US studies analyze the migration process of the Latino migrant children or adolescents. Thirteen of the included studies report the differences between native and migrant children or the comparison of different ethnic groups exclusively in the ethnic minority perspective (nine US studies, one international study and three Canadian studies). The majority of the studies, 15, take a closer look at the mental health of one ethnic group, especially the Latino (8 studies) and Chinese (6 studies) migrant groups. The age of the children and adolescents analyzed varied: one study observed children aged from one to nine, one study analyzed early childhood problem behavior at age 9, 24 and 48 months, seven studies report mental health of preschoolers (age 3–6), no study especially examines elementary school children (age 6–10), the majority of 18

123

J Immigrant Minority Health

Fig. 1 Flow on study selection

studies analyzed adolescents (age 11–20) and seven studies comprised another or greater spectrum from age three up to 20. Information about the mental development of the children was obtained from different sources, depending on the age of the children: In total one study is a report from professionals’ diagnostics, 12 studies are parent reports, in two studies, parents and teachers described mental health of children, one study is a teacher-report, one study is a teacher- and self-report, nine analyses are parents- and selfreports and nine studies are self-reports of adolescents. All studies in the following result descriptions are listed in the tables (Tables 1, 2 and 3). Based on findings of Stevens and Vollebergh [12], these study results describe first concentrations in selection perspective studies, then in migrations process analyses and at least in ethnic minority perspectives (comparing migrant and natives or different ethnic groups).

process effect. Only one study focused on the selection effect, here in focusing the ethnic minority group of Puerto Rican. This study of Merinkangas et al. [15] analyzed prevalence of substance abuse and behavior disorders in a clinical sample of adolescents. One analyzed group came from San Juan in Puerto Rico and the other group was composed of in first generation immigrated Puerto Rican of the general community of New Haven in the United States. All adolescents had mental problems and showed disturbed behavior. Puerto Rican adolescents who immigrated to the US do not have a significant higher prevalence rate in psychiatric disorders. Furthermore, the alcohol use of the Puerto Rican non-immigrant adolescents was greater than that of their migrant counterparts. Only the use of cannabis was higher in the US migrant group. Migration Process Effect

Description of Included Studies with the Selective and Migration Process Perspective Combination of Selection and Ethnic Minority Effect Table 1 reports studies describing the combination of selection and ethnic minority effect and the migration

123

Studies analyzing the migration process supplied very different results. Two US studies [13, 14] and three Canadian studies [16–18] exclusively show the migration process perspective in emotional and behavioral problems in migrant adolescents in relation to time of migration. With regard to the generation of migration, the youth of the second and first generation do not differ in mental health in

159 fist generation (FG); 173 s generation (SG)

(2) Sirin et al. [14]

128 first generation immigrant Chinese (Ch), 228 Canadian born Chinese (CCh), 605 with European, South American and Non-Chinese background (CE)

(6) Chen and Tse [18]

9–14

9–16

[12

12–17

Mean age 16.20 (10th, 11th, 12th grade)

9, 24 and 48 months

Age

First and second generation

First and second generation

First and second generation

First generation

First and second generation

Second generation

Migrant generationa

SPPC; CSAS

CBCL

CES-D; SDQ‘

DISC

SAFEShort; YSR

PKBS, SSRS

Measure

Teacherand selfreport

Parent- and selfreport

Self-report

Self-report

Self-report

Parentreport

Problem behaviour report

c

(ext): Ch [ CCh/ CE

(int): Ch [ CCh

(ext): FG = SG (int): FG \ SG

(int): SG 2 [ SG 1/FG

PR = PRM

(int): FG = SG; high as [ low as

C \ M/oH/oA/ OG/\B

US/M1/ M2 \ M3

Prevalence problem behaviourb,

First Generation: child born abroad; Second Generation: parent born abroad and child born in host country; Third Generation: grandparent born abroad, parent and child born in host country

Migration process

Migration process

Migration process

Selection effect; Ethnic minority group

Migration process

Migration process; Ethnic minority

Comparison

c

For studies which assessed many problem scales (e. g. personal, prosocial or schizotypical traits) only internalizing and externalizing scales are reported

Questionnaires: CES-D = Center for Epidemiologic Scale [19]; CSAS = Cultural and Social Acculturation Scale [20]; DISC = Diagnostic Interview Schedule [21]; PKBS = Preschool and Kindergarten Behavior Scale [22]; SAFE-Short = Societal, Attudinal, Familial, and Environmental-Revised-Short Form [23]; SDQ’ = Self Description Questionnaire [24]; SPPC = SelfPerception Profile for Children [25]; SSRS = Social Skills Rating System [26]; YSR = Youth Self Report [27]

b

a

Sample of the Toronto study of intact families in Canada between 1993 and 1996

233 First generation (FG), 283 s generation (SG)

(5) Montazer and Wheaton [17] Sample of pupils in grade 4–8 to analyze social and psychological adjustment

Longitudinal study in Canada analyzing impact factors in depression in adolescence

Clinic sample of Puerto Rico and Puerto Rican with psychiatric diagnosis living in New Haven in the US analyzing prevalence of behavior disorders

89 first generation migrants (FG), 354 s generation two parents born outside (SG 2), 617 s generation one parent born outside (SG 1)

115 Puerto Rican of San Juan (PR), 137 Puerto Rican migrants of New Haven (PRM)

Sample of the New York City academic and social engagement (NYCASES) analyzing acculturative stress (as), somatic or internalizing symptoms

Sample of the Early Childhood Longitudinal Study Birth Cohort (ECLS-B) in US analyzing problem behavior

Sampling characteristics

(4) Nguyen et al. [16]

Canadian studies

(3) Merikangas et al. [15]

US and Puerto Rico study

6,400 children: US born mothers (US), Migrant mothers age arrived in US at 0-12 (M1), at 13–21 (M2), over 21 (M3) and in detail Black (B), Mexican (M), other Hispanic (oH), Chinese, other Asian (oA) and other groups (OG)

Population

(1) Glick et al. [13]

US studies

Authors

Table 1 Study characteristics in analyzing selection and migration process effects

J Immigrant Minority Health

123

123

2,598 US (US), 844 migrants in the US (MUS), 14,171 UK (UK), 1,637 migrants in the UK (MUK)

286 European American (EA), 399 African American (AA), 164 Hispanic American (HA)

6,880 white US (wUS), 280 white migrants (wM), 1,160 black US (bUS), 90 black migrants (bM), 620 Hispanic US (hUS), 850 Hispanic migrants (hM), 80 Asian US (aUS), 450 Asian migrants (aM)

11,060 Non-Hispanic white US-born (US), 1,520 Asian origin (A)

36 Latinos, 51 black American, 23 EastEuropean, 20 Asian

1,586 Asian American (AA), thereof 141 US-born Asian (US-A), 101 East Asian (EA), 263 Southeast Asian (SEA), 113 South Asian (SA), 130 Mixed Asian (MA), 6,140 white US-born (US)

764 white US (US), thereof 10 foreign born (USfb), 198 Asian American (AA), thereof 43 foreign born (AAfb)

(8) WhitesideMansell et al. [29]

(9) Turney and Kao [30]

(10) Han and Huang [31]

(11) Calzada et al. [32]

(12) Huang et al. [33]

(13) Song et al. [34]

Population

(7) Jackson et al. [28]

US studies

Authors

Sample from local youth risk behavior surveys in the US analyzing risk factors for depression

Sample of preschoolers in the early childhood longitudinal study-Kindergarten (ECLS-K) in US analyzing mental health disparities

Community sample of urban families with preschoolers in the US, analyzing behavioral problems in connection with parents ethnic identity

Sample of preschoolers in the early childhood longitudinal study (ECLS) in US, behavioral problems dependent on language: monolingual (m) and bilingual (b)

Sample of the early childhood longitudinal study-Kindergarten cohort (ECLS-K) in the US

Sample of a national evaluation ‘Starting early, starting smart’ with Spanish as primary language

Ethnic minority

Ethnic minority

Ethnic minority

Ethnic minority

Ethnic minority

Ethnic minority

Ethnic minority

Perspective

Sample of the fragile families and child wellbeing study (FFS) in the US and of the millenium cohort study (MCS) in the UK

Sampling/study characteristics

Table 2 Study characteristics in analyzing ethnic differences between different ethnic groups

14–18 (9th to 12th grade)

5

3–5

3–6

Mean age 5.71

3–5

1–9

Age

First and second generation

First and second generation

First, second and third generation

First and second generation

First and second generation

First and second generation

Second generation

Migrant generationa

Self-devised questionnaire

SSRS

AMAS

Self-devised questionnaire

Self-devised questionnaire

PKBS

SDQ, CBCL

Measure

Self-report

Parent-report

Teacher- and parent-report

Teacher-report

Parent-report

Parent- (PR) and teacher-report (TR)

Parent-report

Problem behaviour report c

(depr): US/USfb/ AA \ AAfb

(int): AA [ US; US-A, US/ MA \ EA/SA

(ext): AA [ US; US-A/MA/ US \ EA/SA

high USidentitiy \ low US-identity

(ext) and (int):

US (m) [ US (b)/A (m,b)

(int) und (ext):

(ext): wUS/wM/ bM/hUS/aUS/ aM \ bUS/hM

(int): wUS/wM/ bM/hUS/ aUS \ bUS/hM/ aM

(int): EA [ AA/ HA

(ext): EA [ AA [ HA

(int): US \ MUS; UK \ MUK

(ext): US [ MUS; UK = MUK

Prevalence problem behaviourb,

J Immigrant Minority Health

10 795, Hispanic (HA), African (AA) and Asian American (AsA)

351 African American (AA), 237 Haitian American (HA), 3,754 white American (WA)

(15) Hao and Woo [36]

(16) Carson et al. [37]

2,931 Australian (A), 1,955 migrants to Australia (MA), 4,943 Canadian (C), 2,058 migrants to Canada (MC), 10,012 of United Kingdom (UK), 5,449 migrants to UK (MUK), 5,250 US (US), 3,700 migrants to US

(18) Beiser et al. [39]

361 (4–6 y.) and 387 (11–13 y.) Mainland Chinese (MCh); 274 (4–6 J.), 321 (11–13 J.) HongkongChinese (HCh); 343 (4–6 J.) and 345 (11–13 J.) Philippines (Ph)

Canadian studies

(17) Washbrook et al. [38]

US and Canadian studies

6,360 white migrants (WM), 1,644 black migrants (BM), 2,458 Hispanic migrants (HM), 21 815 non-migrant (US)

Population

(14) Degboe et al. [35]

Authors

Table 2 continued

Sample of the New Canadian children and youth study (NCCYS) examine emotional problems (EP) and physical aggression (PA)

Sample of the longitudinal study of the early childhood longitudinal study-birth cohort (ECLS-B) in the US, Australian children (LSAC), the national longitudinal survey of children and youth (NSCLY) in Canada and the millenium cohort study (MCS) in UK

Sample of administrative data from 68 clinics in the Boston area health system (US)

See previous and Health Academic Achievement (AHAA) analyzing depression (depr)

Ethnic minority

Ethnic minority

Ethnic minority

Ethnic minority

Ethnic minority

Perspective

Adolescent sample from 2,007 of the national Center for Health statistic of US children (NSCH)

Sampling/study characteristics

4–6 and 11–13

4–5

3–20

13-17

12–17

Age

First and second generation

First and second generation

First and second generation (the Haitian group)

First and second generation

First and second generation

Migrant generationa

Self-devised questionnaire

SDQ

Diagnosis of mental disorder

Structured interviews

Self-devised questionnaire

Measure

Parent-report

Parent-report

Professionals diagnostics

Parent- and self-report

Parent-report

Prevalence problem behaviourb, c

PA: MCh \ Ph \ HCh

EP: Ph \ MCh \ HCh

(ext): MA/MC/ MUK/MUS = A/C/UK/US

Anxiety (and most other diagnosis e. g. substance abuse/ bipolar disorder): WA \ HA/AA

ADHD: AA = HA = WA (depr): (HA = WA) \ AA

(depr): AsA [ HA/ AA

(int): HM [ WM/ BM/US

(ext): WM/BM/ HM [ US

Problem behaviour report

J Immigrant Minority Health

123

123 Age

Ethnic minority

Ethnic minority

Perspective

4–7

4–6 and 11–13

First and second generation

First and second generation

Migrant generationa

CBCL

Self-devised questionnaire

Measure

Motherreport

Parentreport

Problem behaviour report

EC = AsM; if p less lax/inconsistent: EC \ AsM

low parental school perception, years in Canada, English fluency were influence factors PA: HKC [ F/MC low parental school perception, years in Canada, English fluency and worse living conditions influence factors

EP: HKC = F = MC

Prevalence problem behaviourb, c

c For studies which assessed many problem scales in general (e. g. personal, prosocial or schizotypical traits) only internalizing and externalizing scales are reported; the differences are significant if nothing else is noticed

Questionnaires: AMAS = Abbreviated Multidimensional Acculturation Scale [42]; CBCL = Child Behavior Checklist/4–18 [7]; PKBS = Preschool and Kindergarten Behavior Scale [22]; SDQ = Strengths and Difficulties Questionnaire [11]; SSRS = Social Skills Rating System [26]

b

Sample of mothers and sons of Vancouver, Canada analyzing parenting (p) and behavior problems (total problems)

See previous

Sampling/study characteristics

First Generation: child born abroad; Second Generation: parent born abroad and child born in host country; Third Generation: grandparent born abroad, parent and child born in host country

23 Euro-Canadian (EC) and 23 East Asian Migrants (AsM)

(20) Chan et al. [41]

a

137 Hong Kong Chinese (HKC), 165 Filipino (F), 231 Mainland Chinese (MC)

Population

(19) Hamilton et al. [40]

Authors

Table 2 continued

J Immigrant Minority Health

444 Chinese American

444 Chinese American

444 Chinese American

316 Chinese American

311 Chinese American

444 Chinese American families, thereof 388 father– adolescent dyads (FA), 399 mother– adolescent dyads (MA)

(22) Kim et al. [44]

(23) Liu et al. [45]

(24) Juang and Cookston [46]

(25) Deng et al. [47]

(26) Kim et al. [48]

Population

(21) Liu et al. [43]

Chinese

Authors

Sample from Northern California in the US analyzing parent–child acculturation (ac), parenting (p) and adolescent depressive symptoms

Sample from a longitudinal study in Northern California with 7th or 8th grade students and four years later analyzing cultural orientation (co), discriminatory experience (de) and delinquent behavior (db)

Sample of two high schools in the US analyzing family obligation (fo) and depressive symptoms

Sample of seven middle schools of metropolitan in Northern California analyzing maternal acculturation, neighborhood and parenting in context to conduct problems (cp)

Sample of Chinese American families in the US analyzing discrimination (de) or foreigner stereotypes (fse) experiences and accent (ac) in context to depression (depr)

Short-term-longitudinal study analyzing depressive symptoms (depr) in connection to mother and adolescent language proficiency (lp)

Sampling characteristics

Table 3 Study characteristics in analyzing one ethnic migrant group

Ethnic minority group

Ethnic minority group

Ethnic minority group

Ethnic minority group

Ethnic minority group

Ethnic minority group

Comparison

12–15

12–19

13–17 (9th and 10th grade)

12–15

Time 2: 16–19

Time 1: 12–15

Mean age 13.0

Age

First and second generation

CES-D

Acculturation: VIA, Parenting: IYFP

CBCL (Delinquency scale)

CES-D

First and second generation

First and second generation

CBCL (Delinquency scale), Acculturation: VIA, Parenting: IYFP

CES-D

CES-D

Measure

First and second generation

First and second generation

First and second generation

Migrant Generationa

Parentand selfreport

Parentand Selfreport

Selfreport

Parentand Selfreport

Selfreport

Motherand selfreport

Problem behaviour report

(depr): FA: high discrepance of American or Chinese orientation between child and father influence unsupportive p practice; MA: ao (high discrepance) influence p warmth

(db): high Chinese co impact high de [ high Western co

(depr): high fo \ low fo

High neighborhood disadvantage ? low levels of monitoring

(cp): high maternal harsh discipline/ monitoring [ low maternal harsh discipline/ monitoring

(depr): low de/ac/ fse \ high de/ac/fse; for boys stronger than for girls: ac influence significantly fse and fse influence significantly de

(depr): low mother lp [ high mother lp; low adolescent lp = high adolescent lp

Prevalence problem behaviourb, c

J Immigrant Minority Health

123

123

131 foreign-born Latino American (FG), 72 USborn Latino American (SG)

250 first generation (FG), 611 s generation (SG) and 179 third generation (TG) Latino American

217 Latino American

(29) LaraCinisomo et al. [51]

(30) Martinez et al. [52]

166 Korean American

Population

(28) Bridges et al. [50]

Latino

(27) Park et al. [49]

Korean

Authors

Table 3 continued

Sample of the adolescent Latino acculturation study in the US analyzing emotional and behavioral adjustment

Sample of the profect on human development in Chicago neighbourhoods (n) analyzing internalizing behaviors

Sample of the Hispanic family study analyzing trauma exposure and mental health rates among Hispanic youths

Sample of a large cross-sectional study in the US analyzing culture orientation (co), family processes (fp) and anger regulation (ar)

Sampling characteristics

Ethnic minority group; migration process

Ethnic minority group; migration process

Ethnic minority group; migration process

Ethnic minority group

Comparison

Mean age 13.4

9–17

9–17

11–15

Age

First generation

First, second or third generation

First and second generation

First and second generation

Migrant Generationa

HIS,CES-D, CBCL

CBCL

Structured Interviews based on DSM-IV

STAXI, SCS, CDI, YSR

Measure

Parentreport

Parentreport

Selfreport

Parentand selfreport

Problem behaviour report

(ext): 2nd–4th year tr [ 10th–12th year tr

(int): time in residency (tr) not significant

Parent and youth acculturation, differential anglo orientation, discrimination, marital, immigration and total stress are risk factors;

FG/SG more likely to live in high immigrantconcentrated n; FG in residentially unstable n

(int): FG/SG [ TG

FG = SG

(ext): co (high collectivistism), fp (conflict) and ar (anger expression) high influence factors

(depr): co no effect; fp (conflict) and ar (angry feelings experiences, not expressed) high influence factors

Prevalence problem behaviourb, c

J Immigrant Minority Health

349 Latino American

288 Latino American

73 Latino American

205 Mexican– American

(32) Smokowski et al. [54]

(33) Smokowski et al. [55]

(34) Martinez et al. [56]

(35) de Leon Siantz et al. [57]

Ethnic minority group

Ethnic minority group

Ethnic minority group

Ethnic minority group

Ethnic minority group

Comparison

3–6

Mean age 12.74

Mean age 15

High school students

12–19

Age

First, second and third generation

First and second generation

First and second generation

First, second and third generation

First generation

Migrant Generationa

CBCL

CBCL, CDI

BIQ, CBQ-20, YSR

BIQ, CBQ-20, CBCL, YSR

CDI, MASC-10

Measure

Motherreport

Parentand selfreport

Selfreport

Parentand selfreport

Selfreport

Problem behaviour report

(int): mothers parenting stress and depression influence factor; boys [ girls

(ext): mothers parenting stress and acceptance feelings influence factor; boys \ girls

(ext): hlb = llb (int): hlb [ llb

(int): influenced significant by as and parentadolescent-conflict and time in US

(int) high pac [ low pac; the other risk factors were mediated by pac (pac the highest influence factor)

(int) high, if US cultural involvement, familism, higher parent income

Excluding pac:

(depr and anx): high ms [ low ms

Prevalence problem behaviourb, c

Questionnaires: BIQ = Bicultural Involvement Questionnaire [58]; CBCL = Child Behavior Checklist/4-18 [7]; CBQ-20 = Conflict Behavior Questionnaire [59]; CES-D = Center for Epidemiologic Scale [19]; CDI = Children’s Depression Inventory [60]; HIS = Hispanic Stress Inventory [61]; IYFP = Iowa Youth and Families Project [62]; MASC-10 = Multidimensional Anxiety Scale for Children [63]; SCS = Self-Construal Scale [64]; STAXI = State-Trait Anger Expression Inventory [65]; VIA = Vancouver Index of Acculturation [66]; YSR = Youth Self Report [27] c For studies which assessed many problem scales (e. g. personal, prosocial or schizotypical traits) only internalizing and externalizing scales are reported

b

Sample of the Texas migrant council in the US analyzing predictors of child behavioral problems

Sample of the Latino youth and family empowerment (LYFE) in the US, analyzing behavioral problems in connection with high and low language brokering (hlb, llb)

Sample of the Latino acculturation and health project in North Carolina (US) analyzing acculturation stress (as)

Sample of the Latino acculturation and health project analyzing risk factors as parent-adolescent-conflict (pac) influencing self-esteem (se) and internalizing symptoms

Sample of the Latino adolescent migration, health and adaption study (LAMHA) analyzing migration stressors/supports (ms) in context with depression (depr)/anxiety (anx)

Sampling characteristics

First Generation: child born abroad; Second Generation: parent born abroad and child born in host country; Third Generation: grandparent born abroad, parent and child born in host country

281 Latino American

(31) Potochnick and Perreira [53]

a

Population

Authors

Table 3 continued

J Immigrant Minority Health

123

J Immigrant Minority Health

the US study of Sirin et al. [14]. But in acculturation stress is proven a significant influence in mental health: the adolescents with higher acculturation stress had higher internalizing symptoms. Furthermore, no generation effect in migration was evident in externalizing behavior problems in the Canadian study of Montazer and Weaton [17]. Though, these authors showed in internalizing behavior problems a higher rate in second generation migrant children and adolescents than in first generation or non-migrant children. Underpinning these results, Nguyen et al. [16] differentiate that especially the adolescent group in second generation with two parents born outside had the most internalizing symptoms. In contrast to these aforementioned results, Chen and Tse [18] could demonstrate that the first immigrant Chinese group evolved more internalizing and externalizing problem behavior than the second generation Chinese and other Non-Chinese migrant groups. However, within the framework of the Early Childhood Longitudinal Study in the US Glick et al. [13] take a closer look to child development in dependence of their mother’s time of immigration. In comparison to US born mothers and to mothers arrived in the US at the ages 0–21, the children whose mothers arrived at the age of 22 and older showed lower sociability and higher levels of behavior problems (Table 1). In summary, the selection comparison of one ethnic group in the origin and host country jointly referred that migration itself cannot be defined generally as a risk factor. The migration process for children could not be described as consistent, but more studies showed surprisingly higher prevalence in second-generation migrant children or in children whose mothers immigrated in older age.

Description of the Ethnic Minority Perspective Ethnic Minority Perspective: Native and Migrant Children in Comparison Table 2 shows all studies analyzing different ethnic groups. Nine studies analyzed the comparison of children’s problem behavior of native and migrant children (study 7–10, 12–14, 16, 17) of which four studies (10, 12, 13 and 20) comprise native and especially Asian migrant groups. Furthermore, four studies (11, 15, 18, 19) reported only in different ethnic migrant groups the emotional and behavioral problem prevalence rate. Two of these studies (18, 19) explore exclusively Asian migrant groups. Migrants Without Ethnic Differentiation Comprising migrants in general with native children Washbrook et al. [38] showed in an international study in Australia, Europe and America that the prevalence rate in migrant children’s

123

externalizing problem behavior is equal to their native counterparts. Additionally, Jackson et al. [28] proved higher externalizing behavior of native US children in comparison to migrants. In turn to previous results this study describes higher internalizing problems in migrant children than of their native counterparts. Migrants Differed in Ethnic Groups: Asian American Studies with ethnic group differentiation have inconsistent results. Some studies could show in Asian American a high prevalence rate, in internalizing as externalizing problems, e.g. Whiteside-Mansell et al. [29], Huang et al. [33], Hao and Woo [36] and Chan et al. [41]. In contrast to these results Han and Huang [31] reported that the Asian migrant (monolingual as bilingual) and the US-born bilingual children groups have lower prevalence rates in behavioral problems than their US-born monolingual counterparts. In particular to previously reported findings Chan et al. [41] differ in a Canadian study that the Asian migrant 4–7 years aged boys had a higher total problem score compared with their native Euro-Canadian counterparts in dependence to parenting. If parenting was less lax or inconsistent the Asian group showed more problem behavior. Migrants Differed in Ethnic Groups: Several Groups In analyzing several ethnic groups Turney and Kao [30] reported in the Hispanic migrant group as well as in the black US-born Non-migrant group higher externalizing problems comprised with Asian, white, black US-born or other migrant groups. In the category of internalizing problems demonstrate these authors in addition to these conspicuous Hispanic migrant and black US-born groups a high prevalence of the Asian migrant children in comparison to all other native groups. Quite striking in the black children groups is that the black migrant children had lower internalizing problem behavior than their black native counterparts. In contrast to these results Degboe et al. [35] could prove a lower risk in problem behavior of the USborn group. In these analyses the Hispanic group had the highest prevalence rate in externalizing rather than internalizing problems. The migration effect could be filtered out in this study in externalizing problems as a risk factor because the migrant children showed higher symptoms. Similar to these results are analyses in a clinical sample of the Boston area health system [37]. The diagnosis being made most frequently, e.g., anxiety disorders, substance abuse or bipolar disorders, had a higher prevalence rate in the Haitian migrant or African group. Carson et al. [37] reported solely in ADHD equal prevalence rates comprised with white Americans. Depressive symptoms are in this clinical sample significantly higher represented in the African American group (Table 2).

J Immigrant Minority Health

In summary, migrants as a heterogeneous group tended to show not higher prevalence in externalizing, but in internalizing problem behavior. Asian migrant children showed in several studies more problem behavior, but not in general, because these results were not consistent. The problem behavior in Asian children depends inter alia on parenting practice. Several studies show that also the Hispanic children group may be filtered out as more highly prevalent in mental disorders than other ethnic migrant groups. Black ethnicity appears even in natives as an impacting factor in children’s mental health. Nevertheless, reasoned by these study results there is an overall impression that migrant children tend to be more vulnerable in mental disorders than natives, with the exception of black native children. Ethnic Minority Perspective: Only Migrant Children in Comparison Hao and Woo [36] compared Asian with Hispanic and African migrant adolescents. The Asian migrant group had the highest prevalence rate in depressive symptoms. However, Beiser et al. [39] and Hamilton et al. [40] took a closer look to the Asian migrant groups and filtered out the Hongkong Chinese group as the most conspicuous. Additionally, in independence to the ethnic group Calzada et al. [32] could demonstrate a dependence of child mental disorder and their parent’s ethnic identity: those parents with a high US identity had children with less externalizing rather than internalizing problem behavior (Table 2). Regarding only migrant groups, it may be summarized that Asian migrant children, and here highly intensive Hongkong Chinese, showed a high prevalence in mental disorders. As one impact in children’s mental condition could be filtered out by their parent’s cultural identity. Description of the Ethnic Minority Perspective in One Ethnic group Ethnic Minority Perspective of One Ethnic Group: Language as an Influencing Factor Many of the included studies looked deeper at the mental health of one ethnic migrant group. These studies were all carried out in the US and are listed in Table 3. Most studies about one ethnic group inspect exclusively internalizing symptoms (study 21, 22, 24–27, 29, 31–33). Two studies (study 21 and 34) analyzed the influence of English language competence. The study of Liu et al. [43] indicates that even mother language proficiency influences adolescent mental health in a negative way: if the Chinese American mother had low English language proficiency the risk of depressive symptoms of their children is higher

whereas the adolescent’s language proficiency’s influence was not significant. Martinez et al. [56] analyzed migrant Latino adolescent’s behavioral problems in context with language brokering. Children who interpret the cultural practices and translate the English language for their Latino parents are in this context understood as language brokers. The authors of this study filtered out that a high language brokering of adolescents backed up with higher internalizing symptoms. Additionally, Kim et al. [48] showed that low language competence and strong accent in English language of Latino adolescents increase discrimination experiences and consequently depressive symptoms. However, these study results [48] are stronger in boys: in comparison to their female counterparts boys were associated with higher foreigner stereotypes and higher danger in discrimination experiences in the US (Table 3). Ethnic Minority Perspective of One Ethnic Group: Parenting as an Influencing Factor Six studies showed the kind of parenting as an influencing factor in children’s mental health. Four of these analyzed Chinese American families. If in parent practices a high Chinese orientation is evident and if a low family obligation exists, the youths showed stronger depressive symptoms [46]. Additionally, if a high discrepancy between the child’s and parent’s cultural orientation (Chinese or American orientation) could be filtered out, a lower father unsupportive parenting practice and a lower mother warmth parenting could be observed [48]. Both factors, low parenting warmth and unsupportive behavior in parenting, increase depressive symptoms of migrant Chinese American adolescents. However, if Chinese American adolescents are living in families with low family obligation they showed even higher delinquent behavior. A high prevalence rate in conduct problems was also demonstrated in 12–15 years aged Chinese migrant adolescents who are living in family conditions with maternal harsh discipline or harsh monitoring and a high neighborhood disadvantage [43]. In further analyses about Latino migrant children, de Leon Siantz et al. [47] proved mothers parenting stress and mothers acceptance feelings in US society as risk factors influencing children’s externalizing problem behavior. Furthermore, beyond the parenting stress, depression of mothers may increase internalizing symptoms of their children. Another study shows that Latino adolescents in high conflicts with their parents are more vulnerable for internalizing problem behavior [54]. If the parent-adolescent conflict was excluded in these statistical analyses, a low US cultural involvement, low familism (e.g. trusting and confiding in each other) and low parent income could be filtered out as further predictors for internalizing problem behavior. At the same time, the authors of this study showed that parent-adolescent conflicts were related to acculturation stress of Latino parents (Table 3).

123

J Immigrant Minority Health

Ethnic Minority Perspective of One Ethnic Group: Acculturation as an Influencing Factor Although, as reviewed in the previous section, the kind of acculturation process of parents or adolescents/children in US society plays an important role for mental health in migrant childhood, Park et al. [49] took a closer look at Korean migrant adolescents in the US and proved a high prevalence rate in externalizing problem behavior if youths had a high collectivistic cultural orientation. Further aspects increasing the externalizing problems were high family conflicts and high anger expression in a youth’s temperament. The cultural orientation did not influence the internalizing symptoms of Korean adolescents. Underpinning these results showed Deng et al. [47] in Chinese migrant youths with a high Chinese cultural orientation high delinquent behavior. In particular, Chinese orientation impacts more discrimination experiences in this adolescent group. Latino adolescents reported a high level of acculturation stress in relation to internalizing problems [55]. Furthermore, the time of residence in the US influenced the belief of acculturation stress (Table 3). In summary, the ethnic minority perspective clarified that mother or adolescent’s language competence in English (low/high accent), children’s function as language brokers, and discrimination experiences strengthened by language problems (and herewith especially in boys) are particularly stressful factors in migrant childhood. Asian children’s mental health in the US or Canada is highly impacted by parent’s cultural orientation or parenting practice, e.g., low parenting warmth or low family obligation. If migrant adolescents were themselves culturally more collectivistic or Asian oriented, it was not the internalizing symptoms, but the externalizing problem behavior that increased. Latino migrant children were more stressed by mothers’ parenting stress, mothers’ acceptance feelings in US society, mothers’ mental constitution, high conflict between parents and adolescents, and additionally by low US cultural involvement, low familism or low family income. Description of Migration Process and Ethnic Minority Perspective in Combination Three studies describe the migration process of Latino migrant children and adolescents (study 28–30; Table 3). Similar to previous results (e.g. study 33) Martinez et al. [52] could determine that the time in residency in the US influences significantly mental health in childhood. If children have only spent a short period (as in 2–4 years) in the United States they show more externalizing symptoms than children who have spent a longer time in the US. In this study further influencing factors could be proven: parent and youth acculturation, differential Anglo orientation,

123

discrimination experiences, marital status of parents, total stress in general, and the migration itself were risk factors increasing migrant children’s mental disorders. However, in turn, Bridges et al. [50] and Lara-Cinisomo et al. [51] showed no differences in mental health in first and second generation immigrated children. Only the difference to the third generation was significant: the third generation Latino children had less internalizing symptoms. To sum up, a longer period in the host country may protect Latino children’s mental health, whereas a short time in the US is often accompanied with higher acculturation stress and more discrimination experiences.

Discussion The aim of the present study was to show the current mental health status of migrant children and adolescents in American countries. Studies fulfilling the inclusion criteria were only found in the United States and Canada, with the exception of one study in Puerto Rico and the US. In the selection perspective was found the study of Merinkangas et al. [15], which could not prove migration as a general risk factor: the prevalence of mental problems of migrated Puerto Ricans to the US was comparable to their nonmigrant Puerto Rican counterparts. Analyzing the present results in the migration perspective, it could be noted that the personal migration in first generation is sometimes, but not always, a risk for developing internalizing or externalizing symptoms. Surprisingly, some studies proved a higher prevalence in mental disorders of migrant children in the second generation, especially if both parents are foreign born. These results demonstrate that in the US and Canadian societies the cultural orientation or the development in general for non-foreign born children with a migrant background may be difficult. The ethnic minority perspective showed many different results. In comparison to native children it is not possible to notice a clearly higher risk in migrant children developing more mental disorders. Nevertheless, most comparisons of ethnic groups filtered out a high risk increasing internalizing rather than externalizing symptoms in Asian migrant children. But moreover, the number of included studies with analyses in the Asian group was particularly high. Additionally, it should be noted that it is not only the ethnic origin which leads to high difficulties in host societies for migrant children, but the different cultural orientations. Acculturation stress, which consequences in parenting stress or family problems, does also burden migrant children in the US and Canada. Particularly noticeable is the fact that the migrant mothers’ or fathers’ constitution, e.g., parents acceptance feelings, their language competence and their cultural orientation profoundly affects the mental health

J Immigrant Minority Health

status of their children. Furthermore, Turney and Kao [30] showed that the skin color may influence the mental condition of children and adolescents in US society, even in the non-foreign born group. Research Process The present review reveals many factors which influence the mental condition in migrant children in a negative way. The aim of this study was to investigate migrant children’s mental health status in North American countries. It might be surprising that many studies were potential at first, but only 35 studies were definitively included. Many studies in North America analyzed ethnic differences in general, but they did not explicitly define the migration aspect. These circumstances resulted in the consequence that many studies had to be excluded in the present analyses. Based on high numbered and really varying results in migrant children, these studies are difficult to summarize, e.g., several studies had contradictory findings. Nevertheless, all findings in this research offered many impacts in the context of migrant children’s mental health in the North American countries. Development Tasks as Special Challenge in Migrant Children and Adolescents Nevertheless, based on these study results it appears that the development in migrant childhood is more vulnerable than for natives. For example, finding personal identity in adolescence is generally a great challenge. But with a migrant background, and especially if both parents are foreign born, this development task is much more difficult. Rodriguez et al. [67] underlined also that the ethnic-racial socialization process of adolescents in the US is related to their ethnic-racial identity as well as their self-esteem. Furthermore, ethnic identity or enculturation may be predicted by the generation status of adolescents [68]. This present research in migrant studies could underline that the cultural identity in adolescents, as in their parents, highly influences their mental condition, in particular if the cultural orientation differs from host society. Possible language difficulties may result in migrant children being less or uncertainly oriented in the host society and, additionally, experience more discrimination. These facts emphasize that migrant children were in different cases more burdened than native children. Advantage in Developing Internalizing Symptoms in Migrant Childhood An actual overview of European migrant studies [5] observed a high advantage of migrant children in developing

more internalizing problems. In tendency, even though not as high as in Europe, developing more internalizing symptoms in migrant children or adolescents could also be remarked in American countries (Table 2): Five studies that analyzed internalizing symptoms showed higher symptoms of migrants (study 7, 9, 12, 14, 15), three studies (study 8, 9 and 10) reported in turn a higher prevalence rate of native children, but one of these filtered out only the black US native group as vulnerable (study 9) and one other study offered that the US monolingual native group (study 10) had a higher risk in internalizing problems. The closer look to the native and migrant comparisons (Table 2) in externalizing symptoms reveal a balanced state in prevalence rate: four studies showed higher externalizing problem behavior of native children, two studies reported equal prevalences of native and migrants and three studies proved higher externalizing symptoms of migrant children or adolescents. Thus, as a conclusion of the present study it may be stated that migrant children and adolescents in America have a tendency for a higher risk to develop internalizing problem behavior in comparison to externalizing problems. Is One Ethnic Group More Vulnerable? The actual American overview of migrant studies showed a high concentration in acculturation aspects or in migrant children’s mental condition with dependence on parenting. However, especially in the United States, there is high interest in the mental health status of various ethnic migrant groups. Almost all studies comparing different ethnic groups in detail, showed a higher prevalence rate in mental disorders in Asian migrant children. A noticeable feature for Asian children’s mental condition is the high influence of their family situation in combination with acculturation stress. Song et al. [34] reported in the first generation immigrated Asian children a particularly high level of depressive symptoms. Studies which take solely a closer look at the Chinese migrant group could be filtering out that the acculturation stress is a great challenge for these children, especially the collectivistic orientation. A high maternal harsh discipline or harsh monitoring in parenting, a low family obligation of the children and a high discrepancy of adolescent and parent cultural orientation are burning factors for this group of children. As a conclusion of these results it has to be anticipated that these aspects may increase their mental illness. The statements about the mental health status in migrant Latino children differ a little more from the status of the Asian group, but even in Latino children and adolescents there were risk factors such as parent-adolescent-conflicts, mothers parenting stress and their acceptance feelings, migration stress and further the role as language broker. Additionally, beyond these two ethnic groups, the black skin color

123

J Immigrant Minority Health

became also apparent as a predominant complaint in mental development. A surprising finding in this context is that Turney and Kao [50] showed higher internalizing symptoms in the black native US group in comparison to the migrant black group. It raises the question whether perhaps immigrated black youths live much more unabashedly with their skin color than children who were born in the US. Possibly these black native groups experienced since the early childhood more separation or discrimination reasoned by their skin color. However, it could not be postulated that generally one ethnic group is at a higher risk than other ethnic groups. The dependence of many influence factors in migrant children’s mental condition, especially the acculturation stress and in this context the family situation (parenting, conflicts, cultural orientation) are necessary to emphasize. Limitations of the Study The present results offered only the migrant children’s health situation in Canada and the US. On the one side the migration situation in these countries is much more a society interested object due to the high immigration in the US and Canada. On the other side, it is possible that there are analyses in Middle America published in Spanish. The literature research for the present review was exclusively in the English language, which may declare beyond the migrant situation why almost no other countries are represented in the current results. Furthermore, the inclusion criteria focused in internalizing and externalizing problems and did not include all mental disorders. Due to this, it cannot be postulated in the present results the complete mental health status in migrant children in the North American continent. Whether there are other mental disorder concentrations in other categories of mental symptoms such as psychoses, substance abuse or personality disorders has to left open. The studies had to have been published in the last 5 years to meet the inclusion criteria, longer periods should offer more influencing factors, but even older results are comparable with findings in this actual overview, e.g., studies from Umana-Taylor and Updegraff [69] or Ying and Han [70]. However, the present study does not take a closer look at all criteria of how and why the migrant children immigrated to the US or Canada. To assess mental health completely may be important to integrate these aspects, for instance if there was a refugee situation. Ying and Han could show in this context that refugee children were even less acculturated, and more negatively impacted by familial aspects than other migrant children [71]. Furthermore, the understanding of the questionnaires, the same understanding of mental illness, and the language competence is in most included studies assumed in the assessment of mental disorders. It sometimes remains unclear if these conditions

123

had been fulfilled. For instance, analyses about the SDQ [31] showed that the interpretations of the subscales are often not sufficient in the cross-cultural context [72]. The authors of this cross-cultural SDQ-study propose that it would be better to interpret only the total problem score in studies with different ethnic groups. Particularly, the measurement of acculturation process is often difficult. More individually-based information should be assessed in the acculturation measures. Ridley et al. [73] stress the danger of analyses in immigrants without an overview of the variability in the minority population. The risk is high to cover individual differences, misleading results or misleading interpretations. Attempts were made, to include in the present review only studies which measured the mental disorder and the acculturation process with valid and mostly quantitative instruments. Whether in the studies all necessary information were assessed, has to left open, e.g. the personal cultural orientation for an adequate acculturation status or discrimination experiences. Possibly, there are further non-assessed influence factors to the mental health or acculturation status of parents or their children. Main Results and Conclusions After the overview of Stevens and Vollebergh [12], this is the first study which demonstrates the mental health status of migrant children and adolescents in American countries. Due to the fact that immigration increased in many Western Countries, such as the US, Canada, and Europe, the interest in migrant children’s’ or adolescents’ mental health became particularly prominent. Therefore, all current studies on this topic are from high relevance in psychological practice and research, not only in America, but also worldwide. Based on all findings of the present study, general important points in context to the current mental health status in migrant children and adolescents in North America should be appointed: •

•

•

•

There is a tendency of migration to function as a risk factor for mental health problems in children or adolescents. Cultural orientation in children or their parents impact significantly on mental health in migrant children or adolescents. The personal collectivistic orientation burdens the mental constitution in individualistic societies such as the US or Canada, especially children or adolescents with Asian backgrounds are affected by this problem. Low language competence or the role of language brokering presents a difficult challenge in migrant childhood. The kind of ethnic origin, e.g., skin color, affects discrimination experiences and influence thereby the

J Immigrant Minority Health

•

•

mental constitution in migrant children and adolescents. The time period (of children or even their mothers) in the host country influences the mental well-being and social orientation or social competence in migrant childhood. Family obligation or conflicts are influenced by migration tasks and increase significantly the risk in developing mental problems in migrant children or adolescents.

Finally, the present review stresses the importance to support migrant families, children and even their parents, in the acculturation process in the US or Canadian host society. Even the low English language competence of parents may have an adverse impact on their children’s mental health. Particularly, it should be noted that this overview proved a danger in developing mental problems in second generation immigrated children. This fact shows that it is not even the migration itself, but the migration background which may increase problem behavior in migrant children or adolescents. Therefore, the risk to develop mental disorders is for migrant children often in combination with special family problems (e.g., acceptance feelings or acculturation problems of parents). Furthermore, it should be kept in mind that migrant children in ethnic minorities do not mainly externalize their problems, but they have a risk to develop internalizing problems. Internalizing symptoms, as such, may lead to social isolation. It should not be underestimated that many migrant children or adolescents with mental problems are possibly overlooked in the US or Canadian societies, and further not professionally accompanied, because anxiety or depressive symptoms are inner-experienced problems which are often not communicated by concerned persons. In combination with possible discrimination experiences this danger of internalizing problems may represent a special and high challenge for migrant children and adolescents.

Conflict of interest of interest.

The authors declare that they have no conflict

4.

5.

6.

7.

8.

9. 10. 11. 12. 13.

14.

15.

16.

17.

18. 19.

20.

21.

References 1. Cunningham SA, Ruben JD, Narayan KMV. Health of foreignborn people in the United States: a review. Health Place. 2008;14:623–35. 2. National Household Survey. 2011. Immigration and Ethnocultural Diversity in Canada. http://www12.statcan.gc.ca/nhs-enm/ 2011/as-sa/99-010-x/99-010-x2011001-eng.pdf. Assessed 22 March 2014. 3. Belhadj Kouider E, Koglin U, Petermann F. Emotional and behavioral problems in migrant children and adolescents in

22.

23.

24.

25.

Europe: a systematic review. Eur Child Adolesc Psychiatry; 2013 (in press; published online: http://link.springer.com/article/10. 1007/s00787-013-0485-8). United States Census Bureau. Homeownership among the Foreign-Born Population. 2011. http://www.census.gov/prod/ 2013pubs/acsbr11-15.pdf. Assessed 22 Feb 2014. OECD (2014). Country statistical profiles: Mexico. http://www. oecd-ilibrary.org/economics/country-statistical-profile-mexico_ 20752288-table-mex. Assessed 23 March 2014. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): American Psychiatric Association; 2013. Achenbach TM. Manual for the child behavior checklist/4-18 and 1991 profiles. Burlington: University of Vermont Department of Psychiatry; 1991. Centre for Reviews and Dissemination Systematic Reviews. CRD’s guidance for undertaking reviews in health care. York: University of York; 2009. Hahn A, Neubauer BA. Autism and metabolic disorders—a rational approach. Z Kinder- Jugendpsych. 2005;33:259–71. Schulte-Ko¨rne G, Warnke A, Remschmidt H. Genetics of dyslexia. Z Kinder-Jug Psych. 2006;34:435–44. Goodman R. The strengths and difficulties Questionnaire: a research note. J Child Psychol Psyc. 1997;38:581–6. Stevens GWJM, Vollebergh WAM. Mental health in migrant children. J Child Psychol Psychiatry. 2008;49:276–94. Glick JE, Hanish LD, Yakibu ST, Bradley RH. Migration timing and parenting practices: contributions to social development in preschoolers with foreign-born and native-born mothers. Child Dev. 2012;83:1527–42. Sirin SR, Ryce P, Gupta T, Rogers-Sirin L. The role of acculturative stress on mental health symptoms for immigrant adolescents: a longitudinal investigation. Dev Psychol. 2013;49:736–48. Merinkangas KR, Conway CP, Swendsen J, Febo V, Dierker L, Brunetto W, Stolar M, Canino G. Substance use and behaviour disorders in Puerto Rican youth: a migrant family study. J Epidemiol Commun H. 2009;63:310–6. Nguyen H, Rawana JS, Flora DB. Risk and protective predictors of trajectories of depressive symptoms among adolescents from immigrant backgrounds. J Youth Adolesc. 2011;40:1544–88. Montazer S, Wheaton B. The impact of generation and country of origin on the mental health of children of immigrants. J Health Soc Behav. 2011;52:23–42. Chen X. Tse HCH: social and psychological adjustment of Chinese Canadian children. Int J Beh Dev. 2010;34:330–8. Offord DR, Boyle MH, Szatmari P, Rae-Grant NI, Links PS, Cadman DT, et al. Ontario Child Health Study. II. Six-month prevalence of disorder and rates of service utilization. Arch Gen Psychiatry. 1997;44:832–6. Chen X, Lee B. The cultural and social acculturation scale (child and adult version). London: Department of Psychology, University of Western Ontario; 1996. Helzer JE. The diagnostic interview schedule: its development, evolution, and use. Soc Psych Psych Epid. 1988;23:6–16. Merrell KW. Assessment of behavioral, social, and emotional problems: direct and objective methods for use with children and adolescents. White Plains: Longman; 1994. Mena FJ, Padilla AM, Maldonado M. Acculturative stress and specific coping strategies among immigrant and later generation college students. Hispanic J Behav Sci. 1997;9:207–25. Marsh HW, Gouvernet PJ. Multidimensional self-concepts and perceptions of control: construct validation of responses by children. J Educ Psychol. 1989;81:57–69. Harter S. Manual for the self-perception profile for children. Denver: University of Denver; 1985.

123

J Immigrant Minority Health 26. Gresham FM, Elliott SN. Social skills rating system manual. Circle Pines: AGS; 1990. 27. Achenbach TM. Manual for the youth self report and 1991 profiles. Burlington: University of Vermont Department of Psychiatry; 1991. 28. Jackson M, Kiernan K, McLanahan S. Immigrant-native differences in child health: does maternal education narrow or widen the gap?. Mimeo: Princeton University; 2011. 29. Whiteside-Mansell L, Bradley RH, McKelvey L. Parenting and preschool child development: examination of three low-income US cultural groups. J Child Fam Stud. 2009;18:48–60. 30. Turney K, Kao G. Pre-kindergarten child care and behavioral outcomes among children of immigrants. Early Child Res Q. 2009;24:432–44. 31. Han WJ, Huang CC. The forgotten treasure: bilingualism and Asian children’s emotional and behavioral health. Am J Public Health. 2012;100:831–8. 32. Calzada EJ, Brotman LM, Huang KY, Bat-Chava Y, Kingston S. Parent cultural adaptation and child functioning in culturally diverse, urban families of preschoolers. J Appl Dev Psychol. 2009;30:515–24. 33. Huang KY, Calzada E, Cheng S, Brotman LM. Physical and mental health disparities among young children of Asian immigrants. Journal Pediatr. 2012;160:331–6. 34. Song SJ, Ziegler R, Arsenault L, Fried LE, Hacker K. Asian student depression in American high schools: differences in risk factors. J School Nursing. 2011;27:455–62. 35. Degboe A, BeLue R, Hillemeier M. Parental immigrant status and adolescent mental health in the United States: do racial/ethnic differences exist? Child Adolesc Mental Health. 2012;17:209–15. 36. Hao L, Woo HS. Distinct trajectories in the transition to adulthood: are children of immigrants advantaged? Child Dev. 2012;83:1623–39. 37. Carson N, Cook B, Alegria M. Social determinants of mental health treatment among Haitian, African American and white youth in community health centers. J Health Care Poor Underserved. 2010;2:32–48. 38. Washbrook E, Waldfogel J, Bradbury B, Corak M, Ghangro AA. The development of young children of immigrants in Australia, Canada, the United Kingdom, and the United States. Child Dev. 2012;83:1591–607. 39. Beiser M, Hamilton H, Rummens JA, Oxman-Martinez J, Ogilvie L, Humphrey C, Armstrong R. Predictors of emotional problems and physical aggression among children of Hong Kong Chinese, Mainland Chinese and Filipino immigrants to Canada. Social Psychiatry Psychiatr Epidemiol. 2010;45:1011–21. 40. Hamilton HA, Marshall L, Rummens JA, Fenta H, Simich L. Immigrant parents’perception of school environment and children’s mental health and behavior. J School Health. 2011;81:313–9. 41. Chan K, Penner K, Mah JWT, Johnston C. Assessing parenting behaviors in Euro-Canadian and East Asian immigrant mothers: limitations to observations of responsiveness. Child Fam Behav Ther. 2010;32:85–102. 42. Zea MC, Asner-Self KK, Birman D, Buki LP. The abbreviated multidimensional acculturation scale: empirical validation with two Latino/Latina samples. Cult Divers Ethnic Minor. 2013;9:107–26. 43. Liu L, Benner AD, Lau AS, Kim SY. Mother-adolescent language proficiency and adolescent academy and emotional adjustment among Chinese American families. J Youth Adolesc. 2009;38:572–86. 44. Kim SY, Wang Y, Deng S, Alvarez R, Li J. Accent, perceptual foreigner stereotype, and perceived discrimination as indirect links between English proficiency and depressive symptoms in Chinese American adolescents. Dev Psychol. 2011;47:289–301.

123

45. Liu LL, Lau AS, Chia-Chen Chen A, Dinh KT, Kim SY. The influence of maternal acculturation, neighborhood disadvantage, and parenting on Chinese American adolescents’ conduct problems: testing the segmented assimilation hypothesis. J Youth Adolesc. 2009;38:691–702. 46. Juang LP, Cookston JT. A longitudinal study of family obligation and depressive symptoms among Chinese American adolescents. J Fam Psychol. 2009;23:396–404. 47. Deng S, Kim SY, Vaughan PW, Li J. Cultural orientation as a moderator of the relationship between Chinese American adolescents’ discrimination experiences and delinquent behaviors. J Youth Adolesc. 2010;39:1027–40. 48. Kim SY, Chen Q, Li J, Huang X, Moon UJ. Parent-child acculturation, parenting, and adolescent depressive symptoms in Chinese immigrant families. J Fam Psychol. 2010;23:426–37. 49. Park IJK, Kim PY, Cheung RYM, Kim M. The role of culture, family processes, and anger regulation in Korean American adolescents’ adjustment problems. Am J Orthopsychiat. 2010;80:258–66. 50. Bridges AJ, de Arellano MA, Rheingold AA, Danielson CK, Silcott L. Trauma exposure, mental health, and service utilization rates among immigrant and United States-born Hispanic youth: results from the Hispanic family study. Psychol Trauma. 2010;2:40–8. 51. Lara-Cinisomo S, Xue Y, Brooks-Gunn J. Latino youth’s internalizing behaviours: links to immigrant status and neighbourhood characteristics. Ethnicity Health 2013;18:315–35. 52. Martinez CR, McClure HH, Eddy JM, Wilson DM. Time in US residency and the social, behavioral and emotional adjustment of Latino immigrant families. Hispanic J Behav Sci. 2011;33: 323–49. 53. Potochnik SR, Pereirra KM. Depression and anxiety among firstgeneration immigrant Latino youth: key correlates and implicates for future research. J Nerv Ment Dis. 2010;198:470–7. 54. Smokowski PR, Rose RA, Bacallao M. Influence of risk factors and cultural assets on Latino adolescents’ trajectories of selfesteem and internalizing symptoms. Child Psychiatr Hum D. 2010;41:133–55. 55. Smokowski PR, Bacallao M, Buchanan RL. Interpersonal mediators linking acculturation stressors to subsequent internalizing symptoms and self-esteem in Latino adolescents. J Commun Psychol. 2009;37:1024–45. 56. Martinez CR, McClure HH, Eddy M. Language brokering contexts and behavioral and emotional adjustment among Latino parents and adolescents. J Early Adolescence 2009;29: 71–98 57. de Leon Siantz ML, Coronado N, Dovydaitis T. Maternal predictors of behavioral problems among Mexican migrant farmworker children. J Fam Nurs. 2010;16:322–43. 58. Szapocznik J, Kurtines W, Fernandez T. Biculturalism involvement and adjustment in Hispanic American youths. Inter J Intercult Rel. 1980;4:353–65. 59. Robin AL, Foster SL. Negotiating parent-adolescent conflict: a behavioral-family systems approach. New York: Guilford; 1989. 60. Kovacs M. Children’s depression inventory (CDI): technical manual update. New York: Multi-Health Systems; 2003. 61. Cervantes RC, Padilla AM, Saldago de Snyder N. The hispanic stress inventory: a culturally relevant approach to psychosocial assessment. Psychol Assess. 1991;3:438–47. 62. Ge X, Best KM, Conger RD, Simons RL. Parenting behaviors and the occurrence of adolescent depressive symptoms and conduct problems. Dev Psychol. 1996;32:717–31. 63. March JS, Parker JDA, Sullivan K, Stallings P, Conners CK. The multidimensional anxiety scale for children (MASC): factor structure, reliability, and validity. J Am Acad Chil Adolesc Psychiatry. 1997;36:554–65.

J Immigrant Minority Health 64. Singelis TM. The measurement of independent and interdependent self-construals. Pers Soc Psychol B. 1994;20:580–91. 65. Spielberger CD. State-trait anger expression inventory-2. Odessa: Psychological Assessment Resource; 1999. 66. Ryder AG, Alden LE, Paulhus DL. Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality, self-identity, and adjustment. J Pers Soc Psychol. 2000;79:49–65. 67. Rodriguez J, Uman˜a-Taylor AJ, Smith EP, Johnson D. Cultural processes in parenting and youth outcomes: examining a model of racial-ethnic socialization and identity in diverse populations. Cultur Divers Ethnic Minor Psychol. 2009;15:106–11. 68. Uman˜a-Taylor AJ, Alfaro EC, Ba´maca MY, Guimond AB. The central role of familial ethnic socialization in Latino adolescents’ cultural orientation. J Marriage Fam. 2009;71:46–60. 69. Uman˜a-Taylor AJ, Updegraff K. Latino adolescents’ mental health: exploring the role of discrimination, ethnic identity, acculturation, and self-esteem. J Adolesc. 2007;30:549–67.

70. Ying Y, Han M. A longitudinal effect of intergenerational gap in acculturation on conflict and mental health in Southeast Asian American adolescents. Am J Orthopsych. 2007;77:61–6. 71. Ying Y, Han M. Familism and mental health: variation between Asian American children of refugees and immigrants. Int J Appl Psychoanal Stud. 2007;4:333–48. 72. Richter J, Sagatun A, Heyerdahl S, Oppedal B, Roysamb E. The strengths and difficulties Questionnaire (SDQ)—self report. An analysis of its structure in a multiethnic urban adolescent sample. J Child Psychol Psychiatry. 2011;52:1002–11. 73. Ridley CR, Li LC, Hill CL. Multicultural assessment: reexamination, reconceptualization, and practical application. Couns Psychol. 1998;26:827–911.

123