During the last 20 years, there has been a substantial influx of immigrants and refugees to Europe (Eurostat, 2002). This has led to many more schools in Dutch and Belgian metropolitan areas providing education for children and adolescents who do not speak the language of the host country fluently. The transition from one country to another implies changes and difficulties such as the loss of social networks, changes in work status as well as encountering discrimination that can be very distressing (Vinokurov, Trickett, & Birman, 2002).
The traditional higher-order latent structure of internalizing (overcontrolling) and externalizing (undercontrolling) problems have for many years been a useful framework for emotional distress and maladaptive behaviors of children and adolescents (e.g., Achenbach & Edelbrock, 1978; Southam-Gerow & Kendall, 2002). In recent years, Krueger and colleagues (2001) confirmed the usefulness of this dichotomy in explaining the covariance among adult mental health and personality disorders. Moreover, Miller and colleagues (2003) have put forward an internalizing/externalizing model to explain the reactions of traumatic stress among adult combat veterans. The internalizing/ externalizing model seems to provide an adequate framework in which traumatic stress reactions and/or (comorbid) psychopathology can be understood.
The literature on the mental health of refugee adolescents depicts a high prevalence of psychosocial symptoms reported by refugee adolescents (Felsman, Leong, Johnson, & Felsman, 1990; Sack et al., 1993; Sourander, 1998; Smith, Perrin, Yule, Hacam, & Stuvland, 2002). The most frequently reported symptoms are somatic complaints, anxiety, depression, and (post)traumatic stress reactions. Unaccompanied refugee minors (URM) run an especially high risk for developing psychopathology due to separation from primary caregivers, exposure to sequential stressful events, limited educational opportunities, and conditions in asylum centers during a very vulnerable developmental period (Felsman et al., 1990; Sourander, 1998). High comorbidity has been documented between reactions to traumatic stress and other disorders such as depression (Sack et al., 1993) and anxiety (Warshaw et al., 1993). Significant adults in the lives of adolescents (i.e., caregivers, teachers) often report a lower prevalence of internalizing problems than do the adolescents themselves since they have difficulty determining the extent to which the adolescents suffer from psychological distress.
On the other hand, perceiving the disturbing nature of externalizing problems is not difficult. Adolescents with conduct problems have been found to be referred much sooner and more often to professional mental healthcare services than adolescents with internalizing problems (Wu et al., 1999). The literature on conduct problems of refugee adolescents is very limited. Allwood, Bell-Dolan, & Husain (2002) found a strong association between witnessing of organized violence and exhibiting aggressive behavior. Jensen and Shaw (1993) suggest that adolescents who have witnessed or taken part in a war are more likely to show delinquent or anti-social behavior. This opinion is, however, not supported in four studies which evaluated the delinquent and aggressive behaviors of refugee adolescents (Raboteg-Saric, Zuzul, & Kerestes, 1994; Mollica et al., 1997; Rousseau, Drapeau, & Corin, 1998; Sourander, 1998). Different authors (i.e., Pynoos & Nader, 1993) report that adolescents may temporarily show increased risk behavior following the witnessing/experiencing of a traumatic event. Moreover, several studies have found high levels of comorbidity between externalizing behavior and experiencing traumatic stress reactions among American adolescents (Deykin & Buka, 1997; Wozniak et al., 1999).
The "pathway" to professional mental healthcare for refugee adolescents has more barriers than for native adolescents in host countries (e. …