Mental Health

Central American Refugee Health Profile

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It can be assumed that the vast majority of children arriving through the CAM program will have experienced some form of significant trauma in their lifetime. These children come from Central American countries with homicide rates ranking among the top five worldwide, high poverty rates, and widespread gang violence. Violence toward women, often perpetuated by gangs and armed criminal groups, has been widely documented. In a 2013 United Nations study, 400 unaccompanied children from El Salvador, Guatemala, Honduras, and Mexico were interviewed. When asked why they had decided to migrate to the United States alone, nearly half (48%) said they left their home country due to escalating violence. Additionally, 81% cited family or opportunities available, 21% reported abuse in the home, and 16% cited situations of deprivation as factors that contributed to their migration70.

Access to inpatient and outpatient mental health services is very limited. A report from the Pan American Health Organization (PAHO) found that only 363 Guatemalan patients were able to access national outpatient mental health facilities, of whom 58% were women, and 14% were children or teens. Of those treated, anxiety disorders were the most common diagnoses71. Due to limited access to outpatient and inpatient psychiatric treatment in El Salvador, Guatemala, and Honduras, it is difficult to determine the prevalence and types of mental health issues among children and adults.

Once in the United States, these refugee children must adapt to a new physical environment and culture. Leaving behind family and loved ones in their home country and adapting to life in the United States, coupled with the stress associated with being alone and potentially reuniting with unfamiliar or unknown relatives, can have severe consequences. These factors increase the risk for depression, anxiety, PTSD, substance abuse, and homelessness72. Therefore, it is important to evaluate these children for mental health issues at initial screening and on an ongoing basis through frequent visits with appropriately trained mental health and primary care providers.

  1. Cultural Orientation Resource Exchange, Backgrounder: Central American Minors. 2015.

  2. Central Intelligence Agency. Guatemala. The World Factbook  [cited 2015 March]; 
    Available from:  https://www.cia.gov/library/publications/the-world-factbook/geos/gt.htmlExternal.

  3. Central Intelligence Agency. El Salvador. The World Factbook  [cited 2015 March]; 
    Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/es.htmlExternal.

  4. Central Intelligence Agency. Honduras. The World Factbook  [cited 2015 March]; 
    Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ho.htmlExternal.

  5. United States Department of State, Guatemala, in International Religious Freedom Report for 2012. 2012.

  6. Stansifer, C.L., Guatemala, in Encyclopaedia Britannica. 2015.

  7. Moncada R, J., W. Clegern, and R. Woodward, Honduras, in Encyclopaedia Britannica. 2014.

  8. Zimmerman, L., Women in Latin America. Roger Thayer Stone Ceter for Latin American Studies, Tulane University.

  9. U.S. Customs and Border Protection. Southwest Border Unaccompanied Alien Children Statistics FY 2015. 2015  [cited 2015 November]; 
    Available from: http://www.cbp.gov/newsroom/stats/southwest-border-unaccompanied-children/fy-2015External.

  10. Centers for Disease Control and Prevention, Unaccompanied Children: Health Information for Public Health Partners.

  11. Langlois, J., Written testimony of USCIS Refugee, Asylum and International Operations Associate Director Joseph Langlois for a Senate Committee on the Judiciary, Subcommittee on Immigration and The National Interest hearing titled “Eroding the Law and Diverting Taxpayer Resources: An Examination of the Administration’s Central American Minors Refugee/Parole Program”. 2015.

  12. Article 1, Convention Relating to the Status of Refugees, Editor. 1951.

  13. U.S. Citizenship and Immigration Services. Humanitarian Parole. 2015  [cited 2015 November]; 
    Available from: http://www.uscis.gov/humanitarian/humanitarian-paroleExternal.

  14. Central Intelligence Agency. Physicians density.  [cited 2016 March 17]; 
    Available from: https://www.cia.gov/library/publications/the-world-factbook/fields/2226.htmlExternal.

  15. World Health Organization, Health workforce, infrastructure, essential medicines. 2009.

  16. World Bank, Universal Healthcare on the rise in Latin America. 2013.

  17. Pan American Health Organization, Health Systems Profile: Honduras, in Monitoring and Analyzing Health Systems Change/Reform. 2009.

  18. Brown, S. Considering Curanderismo: the place of traditional Hispanic folk healing in modern medicine. 2008  [cited 2016 September]; 
    Available from:  http://www.bc.edu/clubs/mendel/ethos/archives/2008/brown.shtmlExternal.

  19. UNICEF, Country statistics 2015.

  20. The World Bank, HealthStats 2016.

  21. UNICEF. At a glance: Guatemala. 2013  [cited 2015 November]; Available from: http://www.unicef.org/infobycountry/guatemala_statistics.htmlExternal.

  22. Geneva Declaration Secretariat, Global Burden of Armed Violence 2011: Lethal Encounters. 2011, Cambridge University Press: Cambridge.

  23. United Nations High Commissioner for Refugees, Women on the Run: First-hand accounts of refugees fleeing El Salvador, Guatemala, Honduras, and Mexico. 2015.

  24. Manjoo, R., Special Rapporteur on violence against women finalizes country mission to Honduras and calls for urgent action to address the culture of impunity for crimes against women and girls. 2014, United Nations Human Rights, Office of the High Commissioner.

  25. Marilena Adams, T., Chronic violence and non-conventional armed actors: a systematic approach. 2014.

  26. Bakrania, S., Organised violence and its impacts in Central America’s northern triangle. 2013, GSDRC Applied Knowledge Services.

  27. American Academy of Pediatrics. Immigrant Toolkit.  [cited 2015 December]; Available from: https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Council-on-Community-Pediatrics/Pages/Section-1-Clinical-Care.aspxExternal.

  28. Pan American Health Organization and World Health Organization, Chikungunya and dengue fever in the Americas, in Epidemiological Alert. 29 August 2014.

  29. Centers for Disease Control and Prevention. Chikungunya Virus. 2016  [cited 2016 March 11]; Available from: https://www.cdc.gov/chikungunya/index.html.

  30. Centers for Disease Control and Prevention. All Countries & Territories with Active Zika Virus Transmission. 2016  [cited 2016 December]; 
    Available from: https://www.cdc.gov/zika/geo/active-countries.html.

  31. Gatherer, D. and A. Kohl, Zika virus: a previously slow pandemic spreads rapidly through the Americas. J Gen Virol, 2016. 97(2): p. 269-73.

  32. European Centre for Disease Prevention and Control, Rapid risk assessment: Zika virus epidemic in the Americas: potential association with microcephaly and Guillain-Barré syndrome. 2015, ECDC: Stockholm.

  33. World Health Organization. Tuberculosis profile: El Salvador. 2015  [cited 2015 November]; 
    Available from: https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=SV&LAN=EN&outtype=htmlExternal.

  34. World Health Organization. Tuberculosis profile: Guatemala. 2015  [cited 2015 November]; 
    Available from: https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=GT&LAN=EN&outtype=htmlExternal.

  35. World Health Organization. Tuberculosis profile: Honduras. 2015  [cited 2015 November]; 
    Available from: https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=HN&LAN=EN&outtype=htmlExternal.

  36. Calvo, F.N., et al, Reunión de la Comisión Intergubernamental de la Iniciativa de los Países de Centroamérica (IPCA) para la Interrupción de la Transmisión Vectorial, Transfusional y Atención Médica de la Enfermedad de Chagas.

  37. Bern, C., et al., Trypanosoma cruzi and Chagas’ Disease in the United States. Clin Microbiol Rev, 2011. 24(4): p. 655-81.

  38. Bern, C., Chagas’ Disease. N Engl J Med, 2015. 373(19): p. 1882.

  39. Hotez, P.J., L. Woc-Colburn, and M.E. Bottazzi, Neglected tropical diseases in Central America and Panama: review of their prevalence, populations at risk and impact on regional development. Int J Parasitol, 2014. 44(9): p. 597-603.

  40. Hotez, P.J., et al., The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis, 2008. 2(9): p. e300.

  41. World Health Organization. PCT Databank. 2014  [cited December 2015]; 
    Available from: http://www.who.int/neglected_diseases/preventive_chemotherapy/databank/en/External.

  42. Schneider, M.C., et al., Elimination of neglected diseases in latin america and the Caribbean: a mapping of selected diseases. PLoS Negl Trop Dis, 2011. 5(2): p. e964.

  43. Schar, F., et al., Strongyloides stercoralis: Global Distribution and Risk Factors. PLoS Negl Trop Dis, 2013. 7(7): p. e2288.

  44. Bhattarai, R., et al., Estimating the non-monetary burden of neurocysticercosis in Mexico. PLoS Negl Trop Dis, 2012. 6(2): p. e1521.

  45. Botero, D., et al., Taeniasis and cysticercosis. Infect Dis Clin North Am, 1993. 7(3): p. 683-97.

  46. Medina, M.T., et al., Reduction in rate of epilepsy from neurocysticercosis by community interventions: the Salama, Honduras study. Epilepsia, 2011. 52(6): p. 1177-85.

  47. Cook, D.M., et al., A retrospective analysis of prevalence of gastrointestinal parasites among school children in the Palajunoj Valley of Guatemala. J Health Popul Nutr, 2009. 27(1): p. 31-40.

  48. Chero, J.C., et al., Hymenolepis nana infection: symptoms and response to nitazoxanide in field conditions. Trans R Soc Trop Med Hyg, 2007. 101(2): p. 203-5.

  49. Drugs for Parasitic Infections. 3rd ed. 2013, New Rochelle, NY: The Medical Letter.

  50. World Health Organization. Guatemala. Noncommunicable Disease Country Profiles 2014  [cited 2015 December]; 
    Available from: http://www.who.int/nmh/countries/gtm_en.pdf Cdc-pdf[PDF – 1 page]External.

  51. World Health Organization. Country Cooperation Strategy, Guatemala.  [cited 2015 December]; 
    Available from: http://apps.who.int/iris/bitstream/10665/136864/1/ccsbrief_gtm_en.pdf Cdc-pdf[PDF – 1 page]External.

  52. World Health Organization. El Salvador. Noncommunicable Disease Country Profiles 2014  [cited 2015 December]; 
    Available from: http://www.who.int/nmh/countries/slv_en.pdf Cdc-pdf[PDF – 1 page]External.

  53. World Health Organization. Country Cooperation Strategy, Honduras. 2013  [cited 2015 December]; 
    Available from: http://apps.who.int/iris/bitstream/10665/136893/1/ccsbrief_hnd_en.pdf Cdc-pdf[PDF – 2 pages]External.

  54. The World Bank. Nutrition at a Glance, El Salvador.  [cited 2015 December]; 
    Available from: http://siteresources.worldbank.org/NUTRITION/Resources/281846-1271963823772/ElSalvador91311web.pdf Cdc-pdf[PDF – 2 pages]External.

  55. The World Bank. Nutrition at a Glance, Guatemala.  [cited 2015 December]; 
    Available from: http://siteresources.worldbank.org/NUTRITION/Resources/281846-1271963823772/Guatemala.pdf Cdc-pdf[PDF – 2 pages]External.

  56. The World Bank. Nutrition at a Glance, Honduras.  [cited 2015 December]; 
    Available from: http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2013/05/10/000333037_20130510152029/Rendered/PDF/771720BRI0Box000honduras0April02011.pdf Cdc-pdf[PDF – 2 pages]External.

  57. The World Bank. Data by country.  [cited 2015 December]; Available from: http://data.worldbank.org/indicator/SP.DYN.IMRT.IN/countriesExternal.

  58. World Health Organization. The worldwide prevalence of anaemia, 1993-2005.  [cited 2015 December]; 
    Available from: http://apps.who.int/iris/bitstream/10665/43894/1/9789241596657_eng.pdf Cdc-pdf[PDF – 51 pages]External.

  59. American Academy of Pediatrics. State Medicaid Payment for Caries Prevention Services by Non-Dental Professionals. 2013; 
    Available from: http://www2.aap.org/oralhealth/docs/OHReimbursementChart.pdf Cdc-pdf[PDF – 12 pages]External.

  60. US Preventive Services Task Force. Dental caries in children from birth through age 5 years: screening. May 2014; 
    Available from: http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/dental-caries-in-children-from-birth-through-age-5-years-screeningExternal.

  61. Central Intelligence Agency. The World Factbook.  [cited 2015 December]; Available from: https://www.cia.gov/library/publications/resources/the-world-factbook/index.htmlExternal.

  62. Martin-Herz, S.P., et al. Developmental screening with recent immigrant and refugee children: a preliminary report. 2012; 
    Available from: http://ethnomed.org/clinical/pediatrics/developmental-screening-with-recent-immigrant-and-refugee-childrenExternal.

  63. Centers for Disease Control and Prevention. Developmental monitoring for health professionals.  [cited 2015 December]; 
    Available from: https://www.cdc.gov/ncbddd/childdevelopment/screening-hcp.html.

  64. American Academy of Pediatrics. Recommendations for preventative pediatric health care.  [cited 2015 December]; 
    Available from: https://www.aap.org/en-us/Documents/periodicity_schedule_oral_health.pdf Cdc-pdf[PDF – 2 pages]External.

  65. National Newborn Screening & Global Resource Center.  [cited 2015 December]; Available from: http://genes-r-us.uthscsa.edu/%3Cfront%3EExternal.

  66. World Health Organization. Lead: assessing the environmental burden of disease at national and local levels.  [cited 2015 December]; 
    Available from: http://www.who.int/quantifying_ehimpacts/publications/en/leadebd2.pdf?ua=1 Cdc-pdf[PDF – 73 pages]External.

  67. Rivera, M.F., Prevalence of lead intoxication in public schools in Tegucigalpa. Revista Medica Hondureña, 1997. 65(3).

  68. De Burgos, H., The site of lead: social poisoning in El Salvador. Anthropoligica, 2015. 57(1): p. 185-198.

  69. Vigeh, M., H. Saito, and S. Sawada, Lead exposure in female workers who are pregnant or of childbearing age. Ind Health, 2011. 49(2): p. 255-61.

  70. United Nations High Commissioner for Refugees, Children on the Run: Unaccompanied children leaving Central America and Mexico and the need for international protection.

  71. Pan American Health Organization, Guatemala, in Health in the Americas, 2012 Edition: Country Volume. 2012.

  72. Working with Immigrant-Origin Clients: An Update for Mental Health Professionals. 2013, American Psychological Association.

  73. World Food Programme. El Salvador. 2016  [cited 2016 March 15]; Available from: https://www.wfp.org/countries/el-salvador/overviewExternal.

  74. Lutter, C. and C. Chaarro, Malnutrition in infants and young children in Latin America and the Caribbean: Achieving the Millennium Development Goals. 2008, PAHO: Washington DC.

  75. UNICEF, Stunting prevalence among children under five. June 2015.

  76. World Food Programme. Guatemala. 2016  [cited 2016 March 15]; Available from: https://www.wfp.org/countries/guatemalaExternal.

  77. World Health Organization, Global prevalence of vitamin A deficiency in populations at risk 1995-2005. WHO Global Database on Vitamin A Deficiency. . 2009, World Health Organization: Geneva.

  78. World Food Programme. Honduras. 2016  [cited 2016 March 15]; Available from: https://www.wfp.org/countries/hondurasExternal.

  79. FAO, The state of food insecurity in the world: economic crises-impacts and lessons learned. 2009.

  80. Rivera, J.A., et al., Childhood and adolscent overweight and obesity in Latin America: a systematic review. Lancet Diabetes Endocrinol, 2014. 2: p. 321-32.

  81. UNICEF, W.H.O. and World Bank, Joint Child Malnutrition Estimates: Levels and Trends. 2015.

  82. Webber, L., et al., High rates of obesity and non-communicable diseases predicted across Latin America. PLoS One, 2012. 7(8): p. e39589.

  83. World Health Organization, Global Infobase. 2016.

  84. World Health Organization, Global Database on BMI. 2005.

  85. Popkin, B.M., M.K. Richards, and C.A. Montiero, Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. J Nutr, 1996. 126(12): p. 3009-16.

  86. Centers for Disease Control and Prevention. Defining childhood obesity.  [cited 2015 December]; Available from: https://www.cdc.gov/obesity/childhood/defining.html.

  87. American Academy of Pediatrics. Blood Pressure Tables for Children and Adolescents.  [cited 2015 December]; 
    Available from: http://www.nhlbi.nih.gov/health-pro/guidelines/current/hypertension-pediatric-jnc-4/blood-pressure-tablesExternal.