“Lost boys of Sudan” have emotional problems

BMJ 2005; 330 doi: (Published 09 June 2005) Cite this as: BMJ 2005;330:1350
  1. Susan Mayor
  1. London

    A group of young unaccompanied Sudanese refugees settling in the United States have generally done well. But some are showing behavioural and emotional problems in their personal and home lives, a study published this week has found (Archives of Pediatrics and Adolescent Medicine 2005;159: 585-91).

    Living in an institution or being alone in a US foster family, without any of their relatives or fellow refugees, increased the risk of prolonged psychological distress.

    The study followed up the refugees, a group of unaccompanied minors from a Kenyan refugee camp, called the “lost boys of Sudan” by the media, who were resettled in the US in 2000. The mean age of the boys was 17.6 years. As very young children in the Sudan in the 1980s, they had been forced to flee their burning villages and then trekked hundreds of kilometres across desert to Ethiopia. They were then expelled in 1991 and fled to Kenya, fording rivers in which many drowned or were killed by crocodiles.

    The functional and behavioural health of a sample of 304 of the refugees was assessed about one year after resettlement in the US by using the Harvard trauma questionnaire and the child health questionnaire. Feedback was sought from foster parents, resettlement programme staff, and the children themselves, to assess their trauma, coping, and quality of life.

    Results showed that the children scored well on measures related to functioning at school and with peers. However, they tended to score less well on measures of general and mental health, family activities, and family cohesion. A fifth of the boys had a diagnosis of post-traumatic stress disorder and were more likely to have lower (worse) scores on all the subscales of the child health questionnaire. Low functional and behavioural health scores were seen mainly in functioning in the home and in subjective health ratings.

    Some factors were associated with increased risk of post-traumatic stress disorder in the youths, including separation from immediate family, direct personal injury, and head trauma. Most of the children had directly witnessed or were victims of violence related to war. Nearly all (93%) reported that their villages had been attacked; many reported witnessing close friends or family members being tortured, injured or killed; and 20% said that they had been tortured themselves.

    Experiences in the US that increased the risk of post-traumatic stress disorder included living in an institution or being in foster care alone with a US family; feeling lonely or isolated; and less participation in group activities. Feeling safe at home and at school reduced the risk of post-traumatic stress disorder.

    Paul Geltman, assistant professor of paediatrics at Boston University School of Medicine, said, “This suggests that relative levels of family and community engagement after arriving in the United States may mediate the ultimate impact of early trauma on later psychosocial functioning.

    “The Sudanese minors seemed to function well in school and activities outside the home. However, problems emerged in their home lives and emotional states, as evidenced by low scores on the child health questionnaire family and mental health subscales.”

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