Common Conditions

International studies of mental health disorders in young Asian, migrant and refugee populations show trends in common conditions for children and adolescents compared with western populations. For example, a Singaporean study of children aged 6–12 years shows the prevalence of emotional and behavioural problems are comparable to European and Australian studies at 12.5 percent of the population (Woo et al., 2007; Barkman et al., 2005; Sawyer et al., 2001). The same study also found the prevalence of internalising disorders (depressive disorders; anxiety disorders and somatic pain) to be more than twice that of externalising disorders (attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD)), in contrast to studies in the general population in the West which showed externalising disorders to be either as common as or in excess of internalising disorders (Costello et al., 2003; Ford et al., 2003; Woo et al., 2007; Sawyer, et al., 2001). Similarly, Thai and African children were also found to exhibit more over-controlled or internalising behavior (Woo et al., 2014). A Singaporean community study that validated a depression scale for adolescents estimated the prevalence of depression to be between 2 and 2.5 percent which is comparable with rates in western countries (Woo et al., 2004).

In the Singapore burden of disease and injury study, among those below the age of 14 years, autism spectrum disorder was the top cause of disease burden while attention deficit hyperactivity disorder (ADHD) and anxiety/depressive disorders ranked as the third and fifth leading causes respectively (Phua, 2009). For those in the age group 15 to 34 years, anxiety/depressive disorders and schizophrenia were the top two leading causes (Phua, 2009). Primary and secondary school students in a Singapore study have a prevalence of pathological gaming of 8.7 percent (Choo et al., 2010), which is much higher than that reported in European adolescents but lower than for Hong Kong youth (Mülle et al., 2014; Wang et al., 2014). When followed up longitudinally, pathological gamers appeared more likely to develop depression, anxiety, social phobia, and to have poorer school performance (Gentile, 2011).

The suicide rate is one of the surrogate indicators to measure the mental well-being of a population. In New Zealand, suicide is the third highest Potentially Avoidable Mortality (PAM) cause for Asian populations 0-74 years in the Auckland region, representing 11.7 percent (45) of deaths between 2008 and 2010 (Walker, 2014). In New Zealand, as in Asian countries (Chia et al., 2010; Lim et al., 2015), despite suicides in those under 20 years being less frequent compared to older people, there is an increasing trend towards suicide in young populations (10 – 24 years) (Au & Ho, 2014), and unlike other populations the ratio of female to male suicides is higher among Asian than non-Asian populations.

Studies in refugee resettlement countries find high levels of distress and depression among young refugees (Fazel et al., 2005; Kinzie et al., 1986; Lustig et al., 2004; Stein et al., 1999). During the premigration period, refugee children and their families face trauma and loss, social upheaval and disruption to their social and educational development. During refugee flight, many youth are separated from their parents and no longer have the emotional, physical and financial support of their relatives. Unaccompanied minors and children with unstable living situations are at particularly high risk for mental health problems (Bean et al., 2007; Michelson & Sclare, 2009; Nielsen et al., 2008; Weise & Burhorst, 2007). In new countries, youth often face acculturative stress and family poverty (Simich et al., 2006). Refugee children and adolescents must learn a new language, renegotiate their cultural identity, and deal with social isolation, racism, prejudice and discrimination (Montgomery & Foldspang, 2008). As youth acculturate, many come into conflict with parents and relatives who hold ideals and values different from those being adopted by their children.

Among the common presentations to CAMHs of children and adolescents from Asian, Middle Eastern and African (Asian/MEA) backgrounds are: mood disorders (depression, bipolar disorders, self-harm, suicidality); anxiety disorders; obsessive compulsive disorders; psychosomatic disorders; stress-related and adjustment disorders; posttraumatic stress disorder; attention deficit hyperactivity disorder (ADHD), developmental disorders, autism spectrum disorder (ASD), psychotic disorders, eating disorders; sexual identity issues; Internet Addiction Disorders (IAD) and drug, alcohol and gambling addictions (Kirmayer et al., 2011). Some of these presentations are explored in the following sections.