The Quebec Adolescent Refugee Project: Psychopathology and Family Variables in a Sample From 35 Nations MICHEL TOUSIGNANT, PH.D., EMMANUEL HABIMANA, PH.D., COLETTE BIRON, PH.D., CLAIRE MALO, PH.D., ESTHER SIDOLI-LEBLANC, PH.D., AND NAIMA BENDFUS, M.A. zy ABSTRACT Objective: zyxwvutsrqp This study presents the results of a psychiatric epidemiological survey using a sample of adolescents from refugee families. Method: The sample included 203 adolescents, aged 13 to 19 years, coming from 35 countries. Psychopathology was assessed with the Diagnostic Interview Schedule for Children Version 2.25 and general functioning with the Children’s Global Assessment Scale (CGAS). Results: The total rate of psychopathology excluding simple phobia was 21 zyx Yo compared with 1 1 Yo in a province-wide survey of young adolescents. Overanxious disorder had a high prevalence of 13%. The rates of major depression and conduct disorders were also high, at 5% and 6%. The rate of 3% of attempted suicide was similar to the rate found in Montreal high schools. Girls had a higher rate of psychopathologythan boys, with a gender ratio similar to the one found in the provincial survey. Father’s long-term unemployment in the first year of settlement was associated with psychopa- thology for the whole sample, and family structure was associated with psychopathology for boys only. Conclusions: The high rate of psychopathology in this group confirmed results from other surveys with similar samples. On the other hand, the CGAS scores indicated that many of the adolescents with a diagnosis had good social adaptation. zyxw J. zyxw Am. Acad. Child Adolesc. zyx Psychiafrl: 1999, 38( 1 1):14261432. Key Words: refugees, adolescents, psychiatric epidemiology, resettlement. This research grew from concerns voiced by community groups across Canada regarding the mental health and adaptation of adolescents from refugee families (Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees, 1988). This Task Force also raised some questions concerning the facilitation of adaptation of refugees in nonmetropolitan communities and the impact Accepted June 29, 1999. Dr. Tousignant is Profssor zyxwvutsrq of Psychology, Reiearch Laboratory in Human and Social Ecology, Univenity of Quebec in Montreal. Dr. Habimana ii Profssor of Psycholoa, University of Quebec in Troii-Rivi2rei. Dr. Biron is Researcher at the University of Montreal. Dr. Malo ii Researcher at the Research Institute for Youth Social Development, Montreal. Dr. Sidoli-LeBlznc is a psychologist at the Dough Hospital, Montreal. Ms. Bendris is Program Director, Center of Arab Studies for Development, Montreal. grant 498-89-0030fiom the Social Sciences and Humanities Research Council of Canad?, the FCAR (Quebec Miniihy of Educa- tion), and the University zyxwvutsrq of Quebec FODARprogram. The final writing was done while the jnt author was an associate visitingprofssor at the National Inititute of Advanced Studies, Bangalore, India. The authors thank Bkreng2re Den& Francine Pmault, DominiquePar4 and Elem Alvarado for their invaluable assistance and the panic+ating adolescents and the school authorities for their collzboration. Correspondence to Dr. Tousignant, U R E H S , University of Quebec in Montreal, Box 8888, Succ. Centre- Vile, Montreal, Quebec, Canada H3C 3P8; e-mail: tousignant. michel@uqam. ca. 0890-8567/99/3811-142601977 by the American Academy of Child and Adolescent Psychiatry. Thii work was supported of the age of arrival in the new country. Canada has also received refugees from a large number of nations, and this context provided an opportunity to complete an epidemi- ological survey on a sample of refugees from 35 nations. The second part of this article examines the family vari- ables associated with psychopathology on the assumption that conditions of life after arrival in a new country have more influence on mental health than those encountered before arrival (Beiser, 1987). Some studies have reported a decrease in prevalence of various diagnoses with the length of stay. zy A study of a Southeast Asian sample in the western United States has shown that after a 6-year follow-up, there was still a high rate of posttraumatic stress disorder (PTSD) but a sharp decrease of depressive and anxiety states (Sack et al., 1993, 1994). In the earlier survey, more than two thirds of the sample had a diagnosis; PTSD, major depressive disorder, and generalized anxiety disorder were the most prevalent (Kinzie et al., 1986; Sack et al., 1986). In an Australian longitudinal study, the symptoms of Vietnamese refugee children decreased to the level of local children only 2 years after arrival, repeating the results of a Canadian study on Southeast Asian adults (Krupinsky and Burrows, 1986). zyxwv 1426 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 38:11, NOVEMBER 1999