Psychological distress and mental health service contact of unaccompanied asylum-seeking children.

BACKGROUND: Evidence is emerging that psychological problems, particularly symptoms of depression and post-traumatic stress disorder, are more prevalent in unaccompanied asylum-seeking children (UASC) than their accompanied peers. However, little is known about help seeking and mental health service (MHS) utilization in this group, and how this relates to their psychological needs. This study aims to describe the level of psychological distress among a group of UASC and the pattern of MHS contact. METHOD: Socio-demographic data on 71 UASC residing in London was obtained and self-report questionnaires were completed regarding trauma events (Harvard Trauma Questionnaire), general psychological distress [Strengths and Difficulties Questionnaire (SDQ)], post-traumatic stress symptoms (Impact of Event Scale), depressive symptoms (Birleson Depression Self-Rating Scale for Children) and contact with MHS (Attitudes to Health and Services Questionnaire). RESULTS: UASC were mainly male (n = 48, 67.6%), Black African (n = 39, 54.9%) and their median age was 17 years (interquartile range = 15; 17). They had been living in the UK for a median of 18 months. Eight (11.3%) scored on the SDQ borderline/abnormal range for total symptoms, but this was 21 (29.6%) using the SDQ emotional subscale. Forty-seven (66.2%) were at high risk for post-traumatic stress disorder and nine (12.7%) at high risk for depressive disorder. Only 12 (17%) had MHS contact. Predictors of MHS contact were depressive symptoms and duration of time in the UK. CONCLUSIONS: UASC had a high level of emotional symptoms, especially post-traumatic stress symptoms. However, only a small proportion of UASC were in contact with MHS. This suggests a high level of MHS under-utilization, and reasons for this are discussed.

How effective is group intervention in the treatment for unaccompanied and accompanied refugee minors with mental health difficulties: A systematic review.

BACKGROUND: Unaccompanied refugee minors (URM) are at significantly higher risk of trauma exposure and mental illness. Research examining the most effective treatments for this population is limited. AIMS: To study the available research evidence on outcomes from various group interventions in this population. The objective is to investigate if these can be used clinically in future interventions. METHODS: Systematic review was carried out for patient outcomes where group therapy was used as treatment in URM. Studies with ARM (Accompanied refugee minors) were included because of similarities between these groups and because many studies were mixed population. RESULTS: Seventeen papers met eligibility criteria with a total of N = 1,119 participants. About 80% studies with a quantitative component reported improvements, and 69% of the studies that carried out statistical analyses reported statistically significant improvements in mental health symptoms. Every qualitative measure reported positive outcome for the participants. Studies with URM tended to show improved outcomes more often than studies exclusively with ARM. CONCLUSIONS: The evidence demonstrates the efficacy of group therapy in improving mental health outcomes, although the number of studies with robust methodology is small. Group intervention has potential to improve engagement and outcomes of URM with mental illness. Future direction for research is discussed.

Mental health of unaccompanied refugee minors in Europe: A systematic review.

BACKGROUND: Nearly half of the refugee and asylum seeking population in Europe is under the age of 18, and many of these individuals are unaccompanied children and adolescents. OBJECTIVE: The aim of this systematic review is both to summarize findings regarding the prevalence of mental health disorders among unaccompanied refugee minors (URM) in European countries since the last available systematic review (October 2017), and to describe associated risk factors. METHODS: Five databases were systematically searched for articles published between October 1, 2017 and May 1, 2022. RESULTS: The findings from 23 studies conducted in 9 countries which examined 80,651 child and adolescent URM are explained. Afghanistan was the most common country of origin in the majority of studies and >75 % of the subjects were boys. Most of the studies (N = 13, 56.5 %) assessed posttraumatic stress disorder (PTSD) prevalence. We found a high prevalence of mental health disorders among URM children and adolescents, which varied considerably between studies, ranging from 4.6 % to 43 % for (PTSD), 2.9 % to 61.6 % for depression, 32.6 % to 38.2 % for anxiety and 4 to14.3 % for behavioral problems. Two studies looking at suicide attempts and deaths, also observed higher rates in URM compared to the host population of the same age. The studies looking at mental health risk factors suggest that levels of social support in the host country, rearing environment, and other factors are associated with psychopathology. Moreover, a meta-analysis of four studies regarding PTSD in URM and accompanied refugee minors (ARM) showed a lower prevalence among ARM: -1.14 (95%CI:-1.56-0.72). CONCLUSIONS: PTSD, depression and anxiety are the most prevalent problems among the URM population in Europe. Early intervention in host countries is needed in order to improve mental health outcomes for this vulnerable population and avoid possible neglect.

Unaccompanied asylum-seeking children and young people - Understanding their journeys towards improved physical and emotional health.

In 2018, approximately 20,000 unaccompanied children and young people applied for asylum in a European Union country. Unaccompanied asylum-seeking children present with significant emotional and physical health needs. These needs are likely the result of the situation that led them to leave their home, the difficult journeys they make to reach safety and their living circumstances after arriving at their destination. Maintaining engagement with both screening and therapeutic health services is challenging. A stepwise approach to delivery of services is recommended so as not to overwhelm them. Case studies and personal practical experience are used to highlight key learning points.

A review of adolescent autobiographical memory and the implications for assessment of unaccompanied minors' refugee determinations.

The number of unaccompanied asylum-seeking children (UASC) is increasing, and unlike those who arrive with their parents, UASC are subject to interview to determine refugee status. The limited amount of objective evidence available in most asylum claims means that the UASC's account of their experiences often becomes key in deciding whether or not the young person is granted protection. Research indicates that assumptions about human memory influence decision-makers' views on asylum seekers' accounts; however, these do not necessarily appear to fit with the published research on autobiographical memory and may lead to an unfair decision. Therefore, understanding the nature and limitations of autobiographical memory is key to a fair refugee determination process. A literature review of published research on autobiographical memory among adolescents was undertaken across four databases. In total, 45 papers were identified which were thematically organised into three areas: development of autobiographical memory, contextual influences and impact of psychopathology. From this review, conclusions are drawn about what can be reasonably expected of an adolescent's autobiographical memory generally and more specifically when the unique characteristics of UASC are taken into account. We also discusss how commonly used credibility indicators in refugee status determinations for minors are problematic in light of this research. It is important that the psychological evidence on the nature of autobiographical memory in adolescents is considered in asylum processing of UASC.

Unaccompanied refugee minors' early life narratives of physical abuse from caregivers and teachers in their home countries.

The early life narratives of 34 unaccompanied refugee minors, especially their reports of interpersonal violence, were analyzed using Interpretative Phenomenological Analysis (IPA). The youth originated from eight countries, with Afghanistan, Eritrea, and Sri Lanka being the most frequent origins, and they arrived to Norway before the age of 15. Four of these youth were girls. The physical violence took place at home and/or at school and could be extremely harsh. Approximately half of the youth expressed some type of ambivalence toward the perpetrator. In analyzing how the youth understood the reasons for violence two categories of internal and three categories of external attributions were found. Several of the youth blamed their own behavior for the abuse, although such internal attributions were frequently combined with external attributions. Some different patterns of attributions emerged between home and school violence. Most of the youth placed the blame for school violence on their own behavior or that violence was part of normal school discipline. For violence at home there was a tendency to place more blame on the perpetrator (mostly fathers). Possible long-term consequences of the experiences and the different attributional styles as well as implications of the findings are discussed. Professionals should assess refugee children for interpersonal violence experiences as well as for other experiences in their home country.