Intergenerational acculturation and enculturation gaps and adolescent
depressive/anxiety symptoms in refugee families
Beatrijs Pronk
Bachelor thesis
Student number: 10819843
Mentor: Johanna Bakker
Amsterdam, January, 2016
Word count: 5399
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Contents
Abstract ... 3
Intergenerational acculturation and enculturation gaps and adolescent depressive/anxiety symptoms in refugee families ... 4
The Relation between Family Conflict and Adolescent Depression/Anxiety ... 8
The Relation between Family Cohesion and Adolescent Depression/Anxiety ... 12
Discussion ... 15
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Abstract
This literature review investigates how family conflict and family cohesion affect the relation between intergenerational acculturation gaps and adolescent depressive and anxiety symptoms. Eleven studies that used a sample of first, second, or third generation refugees, migrants or immigrants were reviewed. Only quantitative studies that were published in the period of 2002-2016 were selected. Additionally, other relevant articles were examined. Results indicate that family conflict increases the risk for adolescent depression and anxiety. Family cohesion is negatively related to adolescent depression. When adolescents are more acculturated than their fathers, fathers use less supportive parenting practices, which increases the risk for adolescent depression. Parents' and adolescents' retention of the native culture promotes family cohesion and adolescents'
enculturation is a protective factor for adolescent depression and anxiety. Intergenerational
acculturation gaps and adolescent internalizing problems is a topic that needs clarification in order to support refugee families facing these issues.
Keywords: acculturation, acculturation gaps, refugee families, refugee adolescents,
adolescent depression, adolescent anxiety, adolescent internalizing problems, family conflict, family cohesion
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Intergenerational acculturation and enculturation gaps and adolescent depressive/anxiety symptoms in refugee families
The world is confronted with an unprecedented displacement crisis (European Commission of Humanitarian Aid and Civil Protection, 2016). The United Nations Refugee Agency (UNHCR) estimated the number of refugees worldwide 21.3 million in 2015. More than half were children (UNHCR, 2016). Refugees are defined as people who have been forced to flee their country of birth and are unable or unwilling to return due to fear of persecution (European Commission of
Humanitarian Aid and Civil Protection, 2016). The term refugee is often used interchangeably with 'migrant' but these concepts are not the same. Migrants choose to move mainly to improve their lives by finding work, education, family reunion or other reasons, and not because of a direct threat of persecution or death (UNHCR, 2016). An immigrant is anyone who is alien in society, and has entered the country legally or without inspection (Association of State and Territorial Health Services, 2010). The similarity between refugees and immigrants is that both are part of ethnic minority groups.
Nevertheless, refugees will be the focus of this review; in particular refugee families, and refugee adolescents that exhibit depressive and anxiety symptoms. Specifically, depression and anxiety were selected for examination since they were predominantly assessed in the studies
analyzed. In addition, studies were included that investigated family conflict and family cohesion of refugee families. The major part of the participant target group was first generation migrants and refugees and second generation migrants and immigrants. All studies examined ethnic minority families in the United States (US).
Situations of war or political conflict can cause people to flee their home country and experiences of before, during, and after the flight can be traumatizing (Phillimore, 2011). These experiences exacerbate the challenge to adapt to the new society and culture. This process of adaptation is referred to as acculturation and it takes place when individuals from two cultures meet
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5 (Berry, 1997). Acculturation is a complex process in which individuals' behaviors, attitude, and values change, with the minority member affected the most (Berry 1997; Phinney, Horenczyk, Liebkind, & Vedder, 2001). Whereas acculturation thus concerns the socialization in the host culture, enculturation refers to socialization and maintenance of the native culture (Kim, 2007).
Inconveniently, researchers use different terms, referring to either 'acculturation in the native culture' or 'enculturation', while in fact they are equal to each other. This makes differentiating between the concepts acculturation and enculturation hazardous. However, no unambiguous construct assessing acculturation for the use of empirical research has been developed so far.
According to Berry (1997), how people acculturate depends on the strategies they choose in their maintenance of the native culture and contact and participation with the host culture group. From this perspective he developed a conceptual framework which describes the following four acculturation strategies. Assimilation refers to low maintenance of the native culture and high participation with the host culture. Separation includes high maintenance of the native culture and avoidance of participation with the host culture. Integration, that can also be referred to as
biculturalism, is the combination of high maintenance of the native culture and high participation with the host culture. Marginalisation applies to low maintenance of the native culture and low participation with the host culture. The healthiest psychological adaptation of acculturating individuals is predicted by an integration strategy and minimal cultural distance (Berry, 1997).
Berry states that variation in the course, level of difficulty, and eventual outcome of acculturation of all cultural minority groups depend on three factors: Voluntariness, mobility and permanence towards the host society. Despite these differences in theory, it appears that in practice, the basic process of adaptation is similar among the different minority groups (Berry & Sam, 1996). Therefore, many of the findings of studies that use an immigrant sample can be generalized to some extent to other kinds of acculturating groups, like refugees (Berry, 1997).
Children from ethnic minority families often acculturate earlier than their parents, resulting in differences in language competence, values, and interests (Birman, 2006; Sabatier, 2008). When
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6 parents and children are living in two seperate cultural worlds this is referred to as an acculturation gap (Szapocznik & Kurtines, 1993). In the 1970s in the US, it appeared that Cuban refugee
adolescents acculturated faster to the host culture than their more conservative parents, which increased their risk of behavioral conduct problems (Szapocznik, Scopetta, & King, 1978; Szapocznik, Scopetta, Kurtines, & Arnalde, 1978).
These observations provided the foundation for the acculturation gap-distress model, that describes the phenomenon of intergenerational acculturation gaps, which indeed causes stress in family relationships, and increases family conflict, youth problem behaviors, and maladjustment (Szacpocznik & Kurtines, 1993; Szapocznik et al., 1984). Moreover, parent-adolescent intercultural conflict exacerbates normative levels of intergenerational conflict (Szapocznik et al., 1984;
Szapocznik & Kurtines, 1993). Importantly, the articles reviewed are not consistent whether
acculturation and enculturation gaps can function independently. When there exists a gap in the host culture, it is likely that there must be one in the native culture and vice versa. Therefore, measuring one gap implies always measuring the other gap indirectly.
Adolescents go through significant biological, cognitive, and psychosocial changes; which frequently increases families' stress levels (Francisco, Loios, & Pedro, 2016). Therefore, refugee adolescents are at risk for negative consequences of acculturation or enculturation gaps. They are especially vulnerable because internalizing and externalizing psychological problems increase in adolescence (Wolff & Ollendick, 2006). Externalizing problems are related to attention, self-regulation, and noncompliance, and to antisocial and aggressive behaviors; internalizing problems encompass depression, withdrawal, and anxiety, and feelings of inferiority, self-consciousness, shyness, hypersensitivity, and somatic complaints (Achenbach, Howell, Quay, & Conners, 1991).
Refugee children and adolescents are at a significantly higher risk for developing internalizing and externalizing problems compared to their host culture-national and immigrant peers (Jeth, Niclasen, Ryding, Baroud, & Esbjorn, 2014). These risks are associated with their exposure to pre-migration and post-migration violence and traumatic experiences, perceived
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7 discrimination, several changes of residence in the host country, poor financial support, and parental psychological problems (Fazel, Reed, Panter-Brick, & Stein, 2012).
Migrant children and adolescents are at greater risk for developing internalizing rather than externalizing problems, and this might result in social isolation (Belhadj Kouider, Koglin, & Petermann, 2015). The risk for mental health problems is frequently related to problems at the family level (Belhadj Kouider, Koglin, & Petermann, 2015). These include acculturation problems of parents and intergenerational acculturation gaps.
The phenomenon acculturative family distancing (AFD) gives a more detailed description of the way family problems arising from acculturation or enculturation gaps are expressed (Hwang, 2006). This process refers to the occurrence of intergenerational distancing and communication difficulties as a result of direct parent-child disagreements in cultural beliefs and values. It is a more direct and problem-focused conception of the acculturation gap and it assumes that both adolescent and parental depression increases via family conflict (Hwang, Wood, & Fujimoto, 2010).
Certain challenges that relate to environmental or developmental circumstances, call up on family's adaptability, or adjustment, that contains the family's ability of changing its leadership, rules and roles (Olson, 2000). Research has shown that family adaptability is inversely related to adolescents' depression (Cumsville, & Epstein, 1994).
Other important protective factors for psychological difficulties of refugee adolescents at the family level include family cohesion and children's perception of high parental support (Berthold, 1999; Grgic et al. 2005; Kovacev, 2004; Rousseau, Drapeau & Platt, 2004; Sujoldzic, Peternel, Kulenovic, & Terzi, 2006). Cohesion refers to the extent to which family members are committed to the family system (Moos & Moos, 1976), and to the degree of emotional bonding between family members, family boundaries, interests and recreation, and supportiveness (Trickett & Jones, 2007).
The interpretation of emotional bonding directly related to parents and children can appear as the quality of the relationship between them. Another important aspect of cohesion is the extent to which parents use supportive parenting practices and open communication with their children.
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8 Family cohesion is part of the broad construct family environment (Moos & Moos, 1976). Another component is conflict, which contains the frequency of hostile and aggressive family interactions. In this review only conflict and cohesion will be discussed.
Current findings might indicate that among refugee families that exhibit intergenerational acculturation or enculturation gaps, adolescents show elevated levels of depression and anxiety, compared to their non-acculturating peers. However, literature does not provide a univocal answer to the question of whether intergenerational acculturation or enculturation gaps in refugee families are related to adolescent depressive and anxiety symptoms. The aim of this overview is to answer this question based on the interpretation of important current findings. In order to clarify the underlying processes that might reveal how the supposed relation between intergenerational acculturation or enculturation gaps and adolescent depression and anxiety operates, the following sub-questions will be assessed:
1) How does family conflict affect adolescent depression and anxiety? 2) How does family cohesion affect adolescent depression and anxiety?
The Relation between Family Conflict and Adolescent Depression/Anxiety
As described by the acculturation-gap distress model, acculturation gaps between parents and adolescents will trigger high levels of conflict between them, which puts adolescents at risk for developing internalizing problems. In this paragraph findings of several studies will be discussed, aiming to answer the question, How does family conflict affect adolescent depressive and anxiety symptoms? In the following order studies will be reviewed that investigated adolescent depression, anxiety, and depression and anxiety combined.
The influence of adolescent perceived intergenerational and intercultural parent-adolescent conflict on adolescent depressive symptoms from early to late adolescence was investigated in the longitudinal study by Ying and Han (2007). Participants were first (83.1 %) and second generation Southeast Asian American adolescents (N = 409) between 14 and 17 years old. Acculturation,
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9 intergenerational and intercultural conflict, and depressive symptoms were measured twice in a time period of three years. Both kinds of conflict were assessed at the second measurement with a four-item questionnaire that was designed by the authors. The standardized Center for Epidemiological Studies-Depression Scale (CES-D) was used to indicate depressive symptoms at the second measurement. The results demonstrated that intergenerational acculturation gaps in early adolescence significantly predicted both kinds of conflict in late adolescence. Importantly, both kinds of conflict in early adolescence increased depressive symptoms in late adolescence. Furthermore, the relation between intergenerational acculturation gaps in early adolescence and depressive symptoms in late adolescence was explained fully by intergenerational and intercultural conflict in late adolescence (Ying & Han, 2007). The findings of this study implicate that
intergenerational acculturation gaps have an indirect influence on adolescent depressive symptoms, whereas a direct effect exists between intergenerational conflict and adolescent depressive
symptoms.
In order to observe the kind of disagreements that arise from intergenerational acculturation gaps at a more proximal level, Hwang, Wood, and Fujimoto (2010) investigated the association between AFD and adolescent depressive symptoms. The sample consisted of 105 Chinese-American adolescents between 14 and 18 years old (M = 15.61) and their mothers. The slight majority of adolescents was second generation, and 51 (49 %) adolescents were first generation. Measurements were made of AFD, acculturation and enculturation, family conflict, and depressive symptoms of both adolescents and mothers, by using standardized questionnaires. Findings showed that greater enculturation gaps between mothers and children in which the mother was more
enculturated, were associated with higher levels of AFD-related problems for both adolescents and mothers. AFD further increased adolescent depressive symptoms and the risk of clinical depression, and this relation was partially explained by family conflict (Hwang, Wood, & Fujimoto, 2010). According to the authors, these findings indicate that adolescent's maintenance of the native culture might function as a culturally protective factor, which has the ability of improving family
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10 relationships and adolescent's well-being.
The study by Farver et al. (2002) analyzed the effect of family conflict on adolescent anxiety symptoms in Asian Indian families. One hundred and eighty second generation adolescents between 14 and 19 years old (M = 16.0) and one of their parents completed standardized questionnaires about their acculturation and enculturation, family conflict, and anxiety levels, the latter being reported by adolescents. Subsequently all participants were categorized into one of the four
acculturation styles. Acculturation gaps were observed when there was a mismatch in acculturation style between parents and adolescents. Results demonstrated that among families with
intergenerational acculturation gaps, adolescents reported higher levels of family conflict and anxiety. The lowest levels of family conflict were reported by parents and adolescents from families in which parents and adolescents matched each other's acculturation style (Farver et al., 2002).
Contrasting evidence was found bij Pasch et al. (2006). This study examined the influence of intergenerational conflict on adolescent depressive and anxiety symptoms. The sample consisted of 114 (78 %) second generation, and 32 (22 %) first generation Mexican-American adolescents between 12 and 15 years old (M = 14.0), and their parents. Standardized questionnaires were used to estimate acculturation of adolescents and parents, and anxiety and depression levels separately were reported by adolescents. Adolescents and parents were asked about the frequency of
unpleasant disagreements with each other. Findings showed that intergenerational conflict was positively related to adolescent depressive and anxiety symptoms. However, in families exhibiting acculturation gaps, no increased levels of conflict or adolescent depression and anxiety were found.
Corresponding to previous outcomes, the study of Smokowski, Rose and Bacallao (2008) did not find a positive relation between intergenerational acculturation gaps and family conflict. They examined how acculturation and enculturation gaps and acculturation conflicts of 402 first (80%) and second generation Latino parent-adolescent dyads were related to intergenerational conflict, and family cohesion and adaptability. The design was cross-sectional and measurements were made with in-depth and structured interviews separately for adolescents and parents.
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11 Standardized questionnaires were used to assess acculturation and enculturation, biculturalism, intergenerational conflict, acculturation conflict, and family cohesion and adaptability. Results revealed that intergenerational acculturation gaps were unrelated to intergenerational conflict, but acculturation conflict was positively related to intergenerational conflict. This indicates that intergenerational acculturation and enculturation gaps were less discernible than the direct assessment of acculturation conflicts (Smokowski, Rose, & Bacallao, 2008).
However, Birman (2006) did find that intergenerational acculturation gaps were positively related to intergenerational conflict. In her study, the size and direction of intergenerational
acculturation and enculturation gaps and their effect on family adjustment was investigated among 115 Jewish Russian first generation refugee adolescents and their parents. Participating adolescents were between 11 and 19 years old (M = 15 years). Adolescents and parents completed standardized questionnaires that assessed their acculturation and enculturation, and family adjustment was measured by questions about intergenerational conflicts and disagreements. Results demonstrated that greater acculturation gaps were positively related to greater intergenerational conflict and disagreement, which was associated with lower levels of family adjustment (Birman, 2006). The findings of this study, and the fact that it used a refugee sample, support the earlier discussed theory that families are particularly at risk for family adjustment problems when confronted with
environmental changes. This in turn, can lead to a greater risk for adolescents to develop internalizing problems, such as depression and anxiety.
In short, regarding depression, findings have shown that intergenerational and intercultural conflict explain the link between intergenerational acculturation gaps and adolescent depressive symptoms. Furthermore, among families exhibiting an enculturation gap between mothers and children, family conflict seems to considerably explain the relationship between AFD-related problems and adolescent depressive symptoms. Concerning anxiety exclusively, family conflict is related to adolescent anxiety symptoms in families with intergenerational acculturation gaps. Contrasting evidence shows that intergenerational acculturation gaps do not increase
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12 intergenerational conflict and are therefore unrelated to adolescent depressive and anxiety
symptoms.
The Relation between Family Cohesion and Adolescent Depression/Anxiety
Family cohesion is a protective factor for adolescent mental health problems, and therefore an important aspect of the family environment. In the next section studies and findings will be discussed, for the purpose of answering the question, How does family cohesion affect adolescent depressive an anxiety symptoms? First, findings on depression will be discussed, followed by depression and anxiety combined.
In a longitudinal study, Schwartz et al. (2015) observed 302 Hispanic parent-adolescent dyads that moved to the US between one and three years earlier. The adolescents were between 14 and 17 years old, and the participants filled out standardized questionnaires every six months over a period of two and a half years. Measures were made of acculturation and enculturation, family functioning, and adolescent depressive symptoms. The examination of family functioning consisted of five interrelated components: Parental involvement with the adolescent, positive parenting, parent-adolescent communication, and whole-family cohesion and communication. Findings indicated that acculturation gaps were not detrimental to family functioning. However, when adolescents scored lower than their parents on enculturation at the first measurement, this was related to diminished levels of family functioning and increased levels of adolescent depression. These findings imply that intergenerational enculturation differences in particular, are the most problematic for adolescent's functioning.
A study that observed a population of Chinese-American adolescents with at least one foreign born parent examined the effect of intergenerational acculturation and enculturation gaps on the quality of parent-adolescent relationships, parenting practices, and adolescent depressive
symptoms (Kim, Chen, Jing, Huang, and Moon, 2009). The sample consisted of 388
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13 13) years old. Questionnaires were used to measure acculturation and enculturation, parenting, and adolescent depressive symptoms. Outcomes revealed that greater father-adolescent acculturation gaps, in which the adolescent was more acculturated, were significantly related to higher levels of adolescent depression. Interestingly, this relationship was fully explained by the fathers'
unsupportive parenting practices. This implicates that intergenerational acculturation gaps are indirectly related to adolescent depression through unsupportive parenting practices (Kim et al., 2009).
The previous findings are in line with the longitudinal study conducted by Kim, Chen, Wang, Shen, and Orozco-Lapray (2012), in which parent-adolescent relationships and adolescent depressive symptoms were analyzed. Out of a total of 379 Chinese-American families, adolescents between 12 and 15 years old and their parents filled out questionnaires. All parents were foreign born and 72.0 % of the adolescents were born in the US. Measures were assessed twice, and the second assessment was four years after the first. The questionnaires assessed acculturation and enculturation of adolescents and parents, parenting practices, sense of alienation in parent-adolescent relationship, and parent-adolescent depressive symptoms. Findings showed that intergenerational acculturation gaps, in which the child was more acculturated at the first
measurement, were significantly related to sense of alienation and unsupportive parenting practices at both measurements among father-adolescent dyads, leading to increased levels of adolescent depression. The same pattern was observed in mother-adolescent dyads at the first measurement, also leading to increased levels of adolescent depression. In contrast, intergenerational enculturation gaps were not significantly related to unsupportive parenting practices.
Kim and Park (2011) investigated the influence of parent-adolescent communication on adolescent depressive and anxiety symptoms in Korean-American families. A considerable amount of the adolescent sample was first generation (33.8 %); however, the majority was second
generation (66.2 %). Seventy-seven mother-adolescent dyads completed questionnaires that measured their acculturation and enculturation, mother-adolescent and father-adolescent
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14 communication, and adolescent internalizing problems. The subscale that assessed depression and anxiety was the major part of the questionnaire on internalizing problems, but items about
withdrawn behavior and somatization were also included (Youth-Self Report; YSR). No significant relation between intergenerational acculturation or enculturation gaps and adolescent's internalizing problems was found. Findings did indicate, however, that among mother-adolescent dyads with greater enculturation gaps, less adolescent perceived open communication with fathers was associated with higher levels of internalizing problems. Kim and Park (2011) consider that close father-adolescent relationships may be a protective factor for internalizing problems, and promote adolescent's resilience.
Another study on family functioning that used a sample of Hispanic families was conducted by Telzer, Yuen, Gonzales, and Fuligni (2016). First (12.6 %), second (68.9 %), and third or greater (18.5 %) generation Mexican-American adolescents and their parents (N = 428) filled out
questionnaires and reported their levels of acculturation and enculturation, family functioning, and adolescent depressive and anxiety symptoms. Report of family functioning consisted of the
reflection on the negative and positive aspects of family relationships. Negative aspects were indicated by conflict and positive aspects by support. Results showed that acculturation or enculturation gaps were neither negatively related to family functioning, nor positively related to adolescent depression and anxiety. Interestingly, adolescents reported higher levels of family functioning when they maintained the behaviors, language, and values of their own culture,
regardless of the enculturation of their parents. This suggests that the retention of the native culture is important for the adaptation of minority youth (Telzer et al., 2016).
The study conducted by Smokowski, Rose, & Bacallao (2008), also investigated family adaptability and cohesion, and some interesting results were found. Adolescent enculturation and biculturalism were positively related to family cohesion and adaptability. Parents' enculturation and biculturalism were also associated with higher levels of family cohesion and adaptability. This indicates that parent- and adolescent biculturalism are important resources in the contribution to
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15 positive family dynamics (Smokowski, Rose, & Bacallao, 2008).
Based on these findings, it can be concluded that among ethnic minority families exhibiting acculturation gaps, low levels of family cohesion are associated with adolescent depressive
symptoms. The underlying mechanisms in this association are sense of alienation in the parent-adolescent relationship, and unsupportive parenting practices especially from fathers, arising from acculturation gaps in which children are more acculturated, and less open communication of fathers towards their children resulting from an enculturation gap in which adolescents are less enculturated than their fathers. Interestingly, adolescent enculturation seems to correlate directly to family
cohesion and functions as a protective factor for depression, regardless of their parents' level of enculturation or acculturation. Concerning depression and anxiety, there is not enough evidence.
Discussion
In response to the main question of this review, that investigated the relation between intergenerational acculturation or enculturation gaps and adolescent depressive and anxiety symptoms among refugee families, the following conclusion can be made. Intergenerational acculturation and enculturation gaps are related to adolescent depressive and anxiety symptoms. However, the studies reviewed indicate that two underlying mechanisms explain the relation's functioning.
In general, acculturation and enculturation gaps are associated with high levels of intergenerational conflict, which further increases adolescent's risk of depression and anxiety. It should be noted that this either occurs in families exhibiting acculturation gaps or enculturation gaps. Greater mother-adolescent enculturation gaps for instance, lead to more AFD-related problems for both adolescents and mothers, which in turn, increases adolescent depressive
symptoms. The role of family conflicts seems important in this process. The context in which these conflicts take place, the family's functioning and cohesion, provide additional evidence.
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16 acculturation or enculturation gaps, family cohesion is related to adolescent depressive and anxiety symptoms. Interestingly, among families in which adolescents are more acculturated than
particularly their fathers, acculturation gaps are associated with unsupportive parenting of fathers, which increases adolescent depressive symptoms. A possible explanation is that fathers are
generally more engaged in the socialization of their children into the outside world (Paquette, 2004). When fathers are less acculturated than their children, they might not be able to perform this task adequately and feel frustrated and alienated from their children; which indicates their use of less supportive parenting practices. A similar finding shows that fathers of adolescent children who are less enculturated their parents, use less open communication with their children. This might be explained by AFD-related challenges; because of acculturation differences fathers feel more distanced from their children and therefore use less open communication, which increases depressive symptoms of their children.
Another interesting finding is that adolescent and parent enculturation is associated with higher levels of family cohesion and adaptability, and adolescent enculturation functions as a protective factor for adolescent depression. When adolescents are less enculturated than their parents, this is associated with decreased levels of family functioning, and greater enculturation gaps in which adolescents are less enculturated than their parents are associated with higher levels of adolescent depression and anxiety. Therefore, it is suggested that adolescent's retention of the native culture is a protective factor for depression and anxiety (Telzer et al., 2016).
Four studies did not find a relation between acculturation or enculturation gaps and
adolescent depressive or anxiety symptoms. The can be interpreted with the following clarification. Four out of five studies that did find a relation, used a fairly simple way of measuring acculturation or enculturation gaps. The studies of Ying and Han (2007), Hwang, Wood, and Fujimoto (2010), and Kim et al. (2009) calculated the acculturation or enculturation difference scores between adolescents and parents to compute the gaps. Farver, Narang, and Bhadha (2002) categorized participants in the four acculturation styles and compared the intergenerational differences. Most of
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17 the studies that did not find a relation, used a more advanced method of computing the gaps. The studies of Kim and Park (2011), and Telzer et al. (2016), additionally applied an interaction analysis apart from calculating the differences in acculturation or enculturation scores. Schwartz et al. (2016) used a linear growth model and compared difference scores of acculturation at the four measurements between participants. When instead basic methods are used, it might be easier to find a relation between intergenerational acculturation gaps and adolescent depressive and anxiety symptoms.
The study of Pasch et al. (2006) did not find a relation between intergenerational acculturation gaps and adolescent depressive and anxiety symptoms, and the gaps were not associated with elevated levels of family conflict. The reason for this might be that this study only measured frequency of conflict, not the intensity or subject of conflict. In addition, varied by culture, conflict might be expressed differently. For instance, interdependence is very important in collectivistic cultures, and therefore family conflict might be expressed in a less direct way than in individualistic cultures (Triandis, 1989; Markus & Kitayama, 1991). Smokowski, Rose, and Bacallao (2008) found that acculturation and enculturation gaps are less discernible than the direct assessment of acculturation conflict, and they suggest that therefore, research should focus more on this kind of measurement.
Despite these important findings, this review has some limitations. First of all, studies that used a refugee sample were underrepresented. This is due to the fact that literature on this subject that includes refugees is extremely sparse. However, the majority of studies analyzed -seven out of nine- included first generation participants in their samples. It is unknown unfortunately, if these participants migrated by force or voluntarily. It is very important that more research is conducted in this field, and that studies will provide more information about migration history of participants.
Two out of 11 studies did not measure adolescent depressive and anxiety symptoms. However, these two studies have the following advantages over the other studies. Birman (2006) used a sample that consisted of refugees exclusively. Furthermore, based on the literature on family
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18 adjustment some inferences could be made out of this study's findings. The other study was the only one that directly measured acculturation conflict, and 80 % of the sample was first generation (Smokowski, Rose, & Bacallao, 2008).
Moreover, the samples consisted of different ethnicities and this makes it hard to make generalizing inferences. It is precarious that the materials that were used were not sufficiently culture-sensitive. Self-report of depression and anxiety for example, might be looked upon
differently in collectivistic cultures, and for some participants be associated with stigma. There is a need for the development of more culture-sensitive materials. However, many studies did analyze participant's enculturation by using scales that were designed for specific ethnic minorities, which does yield some information about their appreciation of the native culture.
Furthermore, not all studies used reports of every family member, and therefore not all individual perspectives on family issues could be captured. However, many of the studies discussed did include reports of both parents. Still, there is a need for a clearer distinction between parents' unique influence on family dynamics and adolescent depression and anxiety. Whether differences between both parents' acculturation or enculturation depend on gender, or how these differences influence each other, and how these affect their children are another subject of interest. Also, siblings were not included in the sample. Differences between siblings' acculturation or enculturation, will preferably be taken into account in research that follows.
Considering individual differences, the impact of trauma on adolescents and parents, and psychopathology of parents were not included in measures, except for mothers' depression in the study of Hwang, Wood, and Fujimoto, (2010). It might be possible that among families with acculturation or enculturation gaps, parents with severe mental health problems feel even more distanced from their adolescent children, which could put the children particularly at risk for depression and anxiety. On account of complex refugee family processes that arise from their experiences of living in a conflict or warzone, there is a need of research that targets these specific issues.
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19 As previously mentioned, the measurement of the acculturation or enculturation gaps is fairly inconsistent across studies. Assessing acculturation bidimensionally is more desirable than unidimensionally, and through bidimensional measures, it can be shown that, depending on whether they are in the host or native culture, acculturation gaps function in unique ways (Telzer, 2010). Fortunately, only two of the discussed studies measured acculturation unidimensionally (Ying & Han, 2007; Pasch et al., 2006). Discussing and measuring acculturation and enculturation and acculturation and enculturation gaps is very complex. What makes this especially challenging, is that researchers do not agree on which terms they use. Currently, there is a lack of consistent theories and frameworks from which clear and valid measures can be made, and therefore this should be prioritized in research strategies.
Also, all studies were quantitative, and most questionnaires used standardized scales. It might be possible that participants' answers were more subtle than the questionnaires could capture. Sensitive topics like family conflict or parent-child relationships might be better assessed with open-ended questions. Tardiff-Williams (2009) argues that, in order to understand the influence of individuals' acculturative experiences on the quality of their relationships with family members, acculturation should be redefined as a dialogic, continually discussed process, that is constructed in relationships. The author suggests that therefore, the optimal way of measuring acculturation is via narrative and qualitative methods.
Moreover, gender differences were not taken into account. In the general population, it has been found that girls are at higher risk for internalizing problems than boys (Achenbach et al., 1991). Interestingly, a study that focused on Cambodian refugee families, has found that, in adolescence over time, families with girls experienced increased levels of family conflict (Rousseau, Drapeau, and Platt, 2004.) For families with boys, this period was associated with decreased levels of family cohesion. There are indications that this occurs across cultures (Fuligni, 1998). These findings indicate that future research requires the analysis of gender differences among refugee families.
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20 Another important subject that was not investigated, is Culture brokering (CB). CB refers to the phenomenon that children or adolescents from ethnic minority families behave as cultural translators, or brokers, to their parents and other family members (Trickett, & Jones, 2007). In the study of Trickett and Jones (2007) the relation between CB and family functioning, and the extent to which CB was associated with parent-adolescent role reversal, was examined in a sample of 147 first and second generation Vietnamese refugee parent-adolescent dyads. Results showed that over 90 % of adolescents used CB, and it was related to acculturation levels of parents but unrelated to adolescent acculturation. Furthermore, CB was related to adolescent reported family conflict, but also to family adaptability. CB might have had a unique influence on the results that have been reviewed, and in order to investigate how this interacts with the discussed findings, future research should include this in measurement.
Finally, based on the current state of empirical research on the subject of this review, there is an urgent need for research conducted on refugee families with intergenerational acculturation and enculturation gaps and adolescent depression and anxiety. Refugee families are a vulnerable group in society, challenged by the process of adaptation to a new culture. Refugee adolescents even face additional challenges during their transition into adulthood. In order to protect them from
depression and anxiety, it is urgent that academics, policy makers, and clinical practitioners provide constructive answers and support on these issues. The most important aim of this review is to raise awareness of the need to further investigate how depression and anxiety can be prevented among refugee adolescents within the context of their families.
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