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Ethical aspects when treating traumatized refugee children and their families
Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry.
2004 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, Vol. 58, no 3, 193-198 p.Article in journal (Refereed) Published
Abstract [en]

Basic ethical principles are worth analysing step by step when dealing with refugee children and their families. Three issues where potential ethical conflicts might arise for healthcare professionals in treating refugees with different cultural background are pointed out-traumatic life events, hierarchy and repatriation. An ethical analysis of the decision to admit a traumatized teenage refugee to a psychiatric ward is discussed with respect for the ethical principles autonomy, non-maleficence, beneficence and justice. There are both gains and losses, which are valued differently depending on the actors involved.

Place, publisher, year, edition, pages
2004. Vol. 58, no 3, 193-198 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-22021DOI: 10.1080/08039480410006223Local ID: 1049OAI: diva2:242323
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-09-10
In thesis
1. Refugee Children and Families: Psychological Health, Brief Family Intervention and Ethical Aspects
Open this publication in new window or tab >>Refugee Children and Families: Psychological Health, Brief Family Intervention and Ethical Aspects
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: There are more than 45 million refugees and displaced people in the world. Children constitute almost half of the refugee population. It is an enormous challenge and a complex situation for refugee children and families escaping from their home country, to a new system of society to which they have to adapt and where they have to recapture a sense of coherence. This thesis focuses on the psychological health of younger refugee children before and after an intervention with family therapy sessions. The experiences and perceptions of refugee families who fled to Sweden as a result of the war in Bosnia and Herzegovina from 1992 to 1995 and who have permanent residence permits were explored. The ethical aspects of treatment of traumatized refugee children and families were also analysed.

Aims: To investigate parent-child agreement on the psychological symptoms of the refugee children; to explore refugee children’s well-being before and after three sessions of family therapy; to explore, in more detail, the complexity of various family members’ experiences and perceptions of their life before the war, during the war and their escape, and in their new life in Sweden; and also to highlight ethical issues and conduct ethical analyses using basic ethical principles that take into account the varying perspectives of the actors involved with regard to the psychological treatment of refugee children and families.

Methods: Data was collected using parental interviews and psychological assessments of children aged five to twelve years. In the first study, 13 children were assessed using the Erica Method and compared with a Swedish reference group consisting of 80 children. In the second study, the Erica Method assessments from before and after an intervention with brief family therapy were compared for ten out of those 13 children, complemented by parental interviews. Family therapy sessions were videotaped, and in the third study, the verbatim transcripts of nine family therapy sessions were analysed using a qualitative method with directed content analysis. Finally, the basic ethical principles in two case studies of teenage refugee children concerning psychological treatment were analysed taking into account the varying perspectives of the actors involved in the treatment.

Results: Parents’ assessments of their children’s psychological health according to a symptom and behaviour interview did not correlate with the findings of the psychological assessments of children using the Erica Method. The majority of the parents were unaware of their children’s psychological problems, as identified in the psychological assessments. There was a higher rate of not-normal sandboxes (Erica Method) in this group of refugee children, compared to the Swedish reference group. A statistically significant number of cases had improved after a brief family therapy intervention when evaluated with Erica Method. Three main categories emerged from the analysis of the family therapy sessions: “Everyday life at home”, “Influence of war on everyday life”, and “The new life”. The three main categories were comprised of a total of ten subcategories: the family, work and school/preschool, the war, the escape, reflections, employment, health, relatives and friends, a  limited future, and transition to the new life. A structured ethical analysis concerning the principles of autonomy, beneficence, non-maleficence, and justice is feasible and valuable when dealing with refugee children and families in clinical practice as well as in research.

Conclusion: The findings from these studies show the importance of highlighting individual perspectives from the point of view of children, parents, and siblings in order to better understand the complexity of family systems. Family interventions could be beneficial for refugee children and families, even if the children do not present with overt psychological problems. Salutogenic perspectives facilitate the provision of support to refugee families. Such support helps refugee families to adapt to a new system of society and recapture a sense of coherence. In research as well as in treatment sessions, basic ethical principles, from the point of view of all actors involved, is recommended to be taken into consideration.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 100 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1373
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-97333 (URN)978-91-7519-543-8 (print) (ISBN)
Public defence
2013-10-04, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2013-09-12Bibliographically approved

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