Personality and psychopathology in African unaccompanied refugee minors: repression, resilience and vulnerability

Adaptative Skills and Global Functioning of Unaccompanied Migrant Minors in Europe: A Systematised Review

Objectives

This systematised review aimed to examine European literature reporting data about adaptative skills and global external functioning of unaccompanied minors (UAMs).

Methods

We conducted a systematised screening of four databases (APA PsycINFO Ovid, Medline Ovid ALL, Embase.com and Web Of Science Core Collection) using a research strategy including social, scholarly and behavioural abilities as well as externalising problems associated with the target population of UAMs. Thirty articles were included using pre-defined inclusion and exclusion criteria.

Results

Our review showed that despite high levels of internalising disorders, socio-behavioural and educational adjustment of UAMs remained positive. It demonstrated how this population displays a strong desire for academic success and prosocial behaviours instead of aggressivity in everyday life. Nevertheless, our review drew attention to the strong tendency of UAMs to internalise their disorders and display chronic distress and problematic behaviours which increased with time spent in the host country.

Conclusion

Our study draws attention to the risk of underestimating the real mental health needs of refugees, due to preserved external functioning combined with significant settlement pressures.

Prevalence, predictors, and economic burden of mental health disorders among asylum seekers, refugees and migrants from African countries: A scoping review

BACKGROUND

Asylum seekers, migrants, and refugees from African countries may have significant health needs, resulting in economic implications for receiving countries around the world. The risk of mental illness is higher in these communities because of factors like violence, deprivation, and post-immigration challenges.

OBJECTIVE

The purpose of this study was to examine the literature to determine the prevalence, predictors, and economic impacts of mental health (MH) disorders among asylum seekers, migrants, and refugees from African countries.

DESIGN AND METHODS

In this scoping review, we followed the guidelines from PRISMA and CoCoPop. A modified version of the Appraisal Tool for Cross-Sectional Studies (AXIS) was used to assess study quality for cross-sectional studies, while an appraisal list was used for qualitative studies based on the Critical Appraisal Skills Programme (CASP). Inclusion criteria included peer-reviewed articles published in English, and articles based on official reports from credible institutions and organizations. Among the exclusion criteria were publications that were not peer reviewed or had not been sourced by credible sources, publications that did not meet the study topic or language criteria, mixed populations (including Africans and non-Africans), and research abstracts, reviews, news articles, commentary on study protocols, case reports, letters, and guidelines.

DATA SOURCES

A systematic search was carried out in Medline (via PubMed), EMBASE, APA PsycINFO, Web of Science and EBSCO, to identify relevant articles that were published between 1 January 2000 and 31 January 2024.

RESULTS

A total of 38 studies met the inclusion criteria, including 22 from African countries and three qualitative studies. In terms of number of countries contributing, Uganda was the largest (n = 7), followed by Italy (n = 4). The most studied conditions, using multiple diagnostic tools, were Post-Traumatic Stress Disorder (PTSD, n = 19) and depression (n = 17). These studies all revealed elevated rates of mental health disorders among these groups, and these were related to migration, refugee-related factors, and traumatic events. Most of these groups are dominated by young males. There is, however, a prominent presence of minors and women who have suffered a variety of forms of violence, in particular sexual violence. Furthermore, mental illnesses, such as PTSD and depression, are not only persistent, but can also be transmitted to children. In accordance with our inclusion criteria, our review found only one study that examined the economic impact of MH disorders in these groups, leaving a significant knowledge gap. According to this randomized controlled trial, intervention to reduce psychological impairment can help young people stay in school, improve their quality-adjusted life year (QALY), and earn an incremental cost-effectiveness ratio (ICER) of $7260 for each QALY gained.

CONCLUSION

Asylum seekers, migrants, and refugees from African countries are likely to experience MH needs, according to this scoping review. As well as posing persistent challenges, these disorders can also be transmissible to offspring. In addition to longitudinal studies of these groups, economic impact studies of mental illnesses are necessary.

Cognitive evaluation in unaccompanied refugee children: a systematic review

OBJECTIVE

This study aims to identify what existing literature has shown about possible cognitive alterations in unaccompanied refugee children.

DATA SOURCES

The search was performed in the Web of Science, PsycInfo, Scopus, and PubMed databases, including articles published in any year and in any language. The research was submitted to the Prospero protocol (ID: CRD42021257858), and the quality of the included articles was evaluated using the Mixed Methods Appraisal Tool.

DATA SYNTHESIS

Memory and attention are the main topics identified, largely because they are related to symptoms of post-traumatic stress disorder. However, low specificity was observed in the conduction of cognitive assessments, leading to relevant inconsistencies in the collected data.

CONCLUSIONS

The use of psychological assessment instruments that are either poorly adapted or not adapted at all to the populations studied casts doubt on the validity of the data produced so far.

Quality of Life, Depressive Symptoms, and Personality Traits in Syrian Refugee Adolescents

PURPOSE

Refugee adolescents' quality of life (Qol) was not investigated during the Covid-19 pandemic which have a potential impact on refugee adolescents' Qol. In this study, it is planned to investigate refugee adolescents' Qol and its association with depression and quality of life.

METHODS

301 refugee adolescents aged between 14 and 18 who immigrated from Syria was included in the study. Personality Inventory for DSM-5 Brief Form (PID-5 BF), Beck Depression Scale, and Life Quality Scale was used as assessment tools. The data were tested using structural equation modeling.

RESULTS

Both depressive symptoms and personality traits are associated with low Qol. Also, depression mediated the relationship between personality disorder and Qol.

CONCLUSION

This is the first study that investigates Qol in Syrian refugee adolescents during the pandemic. This study draws attention to the importance of depressive symptoms and personality traits management for improvement of Qol in Syrian refugee adolescent population.

HIGHLIGHTS

• Depressive symptoms are associated with low Qol in refugee adolescents.• Personality traits are associated with low Qol in refugee adolescents.• Depressive symptoms have a mediator role between personality traits and Qol.

A systematic review of risk and protective factors of mental health in unaccompanied minor refugees

In recent years, there has been a rising interest in the mental health of unaccompanied minor refugees (UMR), who are a high-risk group for mental disorders. Especially the investigation of predictive factors of the mental health of young refugees has received increasing attention. However, there has been no review on this current issue for the specific group of UMR so far. We aimed to summarize and evaluate the existing findings of specific risk and protective factors to identify the most verified influences on the mental health of UMR. Therefore, we conducted a systematic literature search. Study designs were limited to quantitative cross-sectional and longitudinal designs. Eight databases were searched in four different languages and article reference lists of relevant papers were screened. 27 studies were included (N = 4753). Qualitative synthesis revealed the number of stressful life events to be the most evaluated and verified risk factor for mental health of UMR. A stable environment and social support, on the other hand, can protect UMR from developing poor mental health. Besides that, several other influencing factors could be pointed out, such as type of accommodation, family contact, gender and cultural competences. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible. This review helps to improve our understanding of determinants of UMRs mental health and thus to provide more targeted treatment. Furthermore, it provides information on how to prevent the development of mental health problems by specifying factors that can be modified by different health and immigration sectors in advance. Further research is needed focusing on the interaction between the various predictive factors.

Health of African Refugee Children Outside Africa: A Scoping Review

PROBLEM

Africa is the largest source continent of refugee children. However, we found no published synthesis of the literature on the health of African refugee children outside Africa. Conducting a review of the literature on this particular population will help illuminate the particular contextual health issues faced by African child refugees who live outside Africa. The purpose of this review is to synthesize what is known from the existing literature regarding the health of sub-Saharan African refugee children who live outside Africa.

METHODS

We completed a scoping review of the published literature. We included articles published in English with a focus on the health of sub-Saharan African refugee children living outside Africa. We excluded studies of refugees in Africa as the living conditions of these refugees, most of whom reside in camps, are very different from those outside Africa. Using relevant keywords, we searched 10 databases to identify and screen 6602 articles after duplicates were eliminated.

SAMPLE

A total of 20 studies were included in this review.

FINDINGS

Published research articles on sub-Saharan African child refugees living outside Africa focus on infectious diseases, mental health and neurodevelopmental disorders, food insecurity and psychosocial adjustment, physical health (including obesity), and health promotion strategies. This population is characterized by a high rate of infectious diseases (e.g., malaria), obesity, and mental health problems, especially post-traumatic stress disorder (PTSD).

CONCLUSIONS AND IMPLICATIONS

To attend to the health needs of sub-Saharan African refugee children who live outside Africa, interventions should address pre-migration factors as well as post-migration factors (including income and community belonging) while employing a strengths-based perspective.

Resilience in adolescent refugees living in Malaysia: The association with religiosity and religious coping

BACKGROUND

Until now, there is scarcity of information regarding resilience, religiosity and religious coping among adolescent refugees. Currently, most researches emphasize on the physical, psychological and social distresses experienced by refugees while overlooking these crucial aspects, that is, resilience and coping.

AIM

The study aimed to examine resilience and its association with religiosity and religious coping among adolescent refugees living in Malaysia.

METHODS

This is a cross-sectional study conducted in five community-based learning centres in Malaysia from July 2019 till December 2019. A total of 152 refugees, aged 13 to 19-years-old, were recruited. The study gauged resilience using the 14-Item Resilience Scale (RS-14), the Duke University Religion Index (DUREL) for religiosity and the Brief Religious Coping Scale (Brief RCOPE) for religious coping.

RESULTS

The majority of adolescent refugees portrayed moderate levels of resilience (43.5%). The study highlighted the interconnectedness between resilience and intrinsic religiosity (IR) (p < .001), as well as, positive (p < .001) and negative (p = .010) religious coping. Additionally, the results demonstrated that certain sociodemographic factors could potentially confound resilience, namely, countries of origin (p < .001), religion (p < .001), education centre (p < .001) and refugee status (p = .018).

CONCLUSION

With knowledge from this study, mental health professionals can initiate or improve liaison with religious-based services in working together to provide resources for adolescent refugees. Incorporating information regarding mental health with religious teachings may help increase resilience in young refugees and, in turn, alleviate their psychological distress.

Associations between defense mechanisms and life satisfaction among North Korean refugees

BACKGROUND

The present study investigated associations between defense mechanisms and life satisfaction among North Korean refugees living in South Korea.

METHODS

A total of 178 North Korean refugees completed the Korean version of the Defense Style Questionnaire, a revised version of the Ways of Thinking of North Korean Defectors scale, the Center for Epidemiologic Studies-Depression Scale, and the State-Trait Anxiety Inventory. Multiple stepwise regression analysis was performed to investigate the defense mechanisms associated with North Korean refugees' life satisfaction in South Korea.

RESULTS

Among defense mechanisms, denial most strongly predicted higher overall and economic satisfaction among North Korean refugees living in South Korea (β = 0.145, p < 0.01; β = 0.137, p = 0.03, respectively) after controlling for age, gender, anxiety, depression, and number of traumatic events experienced. Furthermore, resignation predicted lower overall (β = -0.206, p < 0.001) and economic satisfaction (β = -0.134, p = 0.02). However, the association between resignation and life satisfaction was not significant after controlling for depression, anxiety, and number of traumatic events experienced.

CONCLUSIONS

Specific defense mechanisms such as high denial and low resignation were associated with life satisfaction in South Korea among North Korean refugees. Our findings suggest that refugees' psychological defense mechanisms may affect their satisfactory resettlement.

[Assessment and health needs of unaccompanied minors]

Unaccompanied minors are particularly vulnerable due to their pathway marked with multiple bereavements and constant uprooting. They find themselves confronted with the ordeal of mistrust due to administrative contradictions between the need to protect and immigration control. They are particularly at risk of developing psychiatric pathologies. Care must be multidisciplinary and in continuity with the educational support, taking into account the young person's original culture.

Prevalence of mental disorders in young refugees and asylum seekers in European Countries: a systematic review

The European Union member states received about 385,000 asylum applications from children and adolescents below 18 years in 2015, and 398,000 in 2016. The latest political crises and war have led to an upsurge in refugee movements into European countries, giving rise to a re-evaluation of the epidemiology of psychiatric disorders and mental health problems among young refugees and asylum seekers. We systematically searched five electronic databases and reference lists of pertinent review articles. We then screened the results of forward citation tracking of key articles for relevant studies in the field for the period from January 1990 to October 2017. We dually reviewed citations and assessed risk of bias. We reported the results narratively, as meta-analyses were impeded due to high heterogeneity. We included 47 studies covered in 53 articles. Overall, the point prevalence of the investigated psychiatric disorders and mental health problems varied widely among studies (presenting interquartile ranges): for posttraumatic stress disorder between 19.0 and 52.7%, for depression between 10.3 and 32.8%, for anxiety disorders between 8.7 and 31.6%, and for emotional and behavioural problems between 19.8 and 35.0%. The highly heterogeneous evidence base could be improved by international, methodologically comparable studies with sufficiently large sample sizes drawn randomly among specific refugee populations. The prevalence estimates suggest, nevertheless, that specialized mental health care services for the most vulnerable refugee and asylum-seeking populations are needed. REGISTRATION: The systematic review protocol was registered in PROSPERO on October 19th, 2017 with the number: CRD42017080039 and is available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=80039.

Knowledge of the Unknown Child: A Systematic Review of the Elements of the Best Interests of the Child Assessment for Recently Arrived Refugee Children

Decision-making regarding an asylum request of a minor requires decision-makers to determine the best interests of the child when the minor is relatively unknown. This article presents a systematic review of the existing knowledge of the situation of recently arrived refugee children in the host country. This research is based on the General Comment No. 14 of UN Committee on the Rights of the Child. It shows the importance of knowing the type and number of stressful life events a refugee child has experienced before arrival, as well as the duration and severity of these events. The most common mental health problems children face upon arrival in the host country are PTSD, depression and various anxiety disorders. The results identify the relevant elements of the best interests of the child assessment, including implications for procedural safeguards, which should promote a child rights-based decision in the asylum procedure.

Verhaltensauffälligkeiten und Lebensqualität bei männlichen unbegleiteten minderjährigen Flüchtlingen in Jugendhilfe einrichtungen in Deutschland

Zusammenfassung. Unbegleitete minderjährige Flüchtlinge (UMF) gelten als Hochrisikogruppe für die Entwicklung psychischer Erkrankungen. Hinsichtlich Häufigkeit und Art psychischer Störungen sowie gesundheitsbezogener Lebensqualität (LQ) fehlen für Deutschland bislang Originalarbeiten. Anhand der Daten von 191 männlichen UMF, erhoben in Jugendhilfeeinrichtungen in Deutschland, wurden emotionale und Verhaltensauffälligkeiten (SDQ) sowie gesundheitsbezogene LQ (ILK) untersucht und Vergleiche zur Normstichprobe durchgeführt. Internalisierende Verhaltensauffälligkeiten zeigten sich laut Selbst- und Fremdbeurteilung bei 35 bis 61 % der Jugendlichen signifikant häufiger als in der Normstichprobe (20 %). Hyperaktivitätssymptome waren dagegen sehr selten (4 bis 7 %). Externalisierende Verhaltensprobleme wurden von Betreuungspersonen häufiger (20 %) berichtet als von den Jugendlichen (8 %). Gesundheitsbezogene LQ wurde niedrig eingeschätzt, als Ressource konnte prosoziales Verhalten identifiziert werden.

The epidemiology of PTSD and depression in refugee minors who have resettled in developed countries

BACKGROUND

With an increasing number of refugees migrating across continents, the crisis is very apparent.

AIM

A literature review of patterns, risk factors and effects of post-traumatic stress disorder (PTSD) and depression in refugee minors was carried out involving those who have resettled in different developed countries.

METHODS

Papers were narrowed down by reading the abstracts and methods to ascertain whether the refugee children had resettled in developed countries and to ensure that they had not just been internally displaced.

RESULTS

High incidences of PTSD and depression were found in refugee minors and poorer mental health was correlated with increased exposure to violence. Factors such as social support and family security were important in reducing the rates of PTSD and depression, whereas the implications of age and gender were unclear. Long-term effects from these mental illnesses indicated scholastic issues, but no further worsening of symptoms.

CONCLUSIONS

Further research is needed regarding the follow-up of refugee minors with PTSD and depression to allow the establishment of more effective support systems, as long-term outcomes become more clearly understood. Few papers discuss the influence of religion, which may be an interesting line of future research as refugees move to more secular societies.

Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors

OBJECTIVE

The aim of this study was to examine a cohort of unaccompanied refugee minors (URMs) by means of psycholinguistic methods in order to obtain a more subtle picture of their degree of traumatization.

METHODS

Twenty-eight participants were included in the Stress-Inducing Speech Task (SIST) consisting of a free association (FA) and a stress (STR) condition. Narratives were examined by means of (1) quantitative parameters (word count); (2) psycholinguistic variables (temporal junctures, TJs), narrative structure, referential activity (RA)-a measure of emotional expressivity; and (3) content analysis ratings.

RESULTS

Word count was significantly lower than in age-matched norms. In the FA condition, TJs were lower, but in the STR condition, rates were comparable. RA was significantly higher in both conditions. Content analysis ratings showed that the experiences described by these youths were potentially traumatic in nature.

CONCLUSIONS

This pattern of narrative shows a mixture of fulfilling the task demand, while containing an emotionally charged narrative. Narrative structure was absent in the FA condition, but preserved in the STR condition, as URMs struggled with the description of non-normative events. This indicates that these youths have not yet emotionally dealt with and fully integrated their trauma experiences.

Hilfebedarf und Hilfsangebote in der Versorgung von unbegleiteten minderjährigen Flüchtlingen

Zusammenfassung. In den letzten Jahren kommt es zu einer deutlichen Zunahme der Zahl unbegleiteter minderjähriger Flüchtlinge (UMF) in Deutschland. Dies stellt nicht zuletzt die klinische Versorgung vor neue Fragestellungen, da es sich um eine hoch vulnerable Gruppe handelt. In der vorliegenden Übersichtsarbeit sollen die psychischen Auffälligkeiten und deren längerfristiger Verlauf beschrieben werden, um den Hilfebedarf darzustellen. In einem weiteren Schritt werden die Hilfsangebote anhand der Rückmeldungen von UMF erfasst. Das klinische Bild wurde vorrangig von einer posttraumatischen Stresssymptomatik geprägt, wobei sich im Langzeitverlauf eine hohe Stabilität psychischer Belastungen zeigte. Daneben existiert jedoch auch ein erheblicher Anteil resilienter UMF. Mehrfach wurde von den UMF der Wunsch nach Schulbildung und rascher sprachlicher Integration geäußert.

Instruments measuring externalizing mental health problems in immigrant ethnic minority youths: a systematic review of measurement properties

BACKGROUND

Little is known about reliability and validity of instruments measuring externalizing mental health problems in immigrant ethnic minority youths.

AIMS

To provide an overview of studies on measurement properties of instruments measuring these problems in immigrant ethnic minority youths, their methodological quality and results.

METHODS

A systematic review of the literature in MEDLINE, EMbase, PsycINFO and Cochrane Library was performed. Evaluation of methodological quality of studies found was done by using the 'COSMIN-checklist'. Full text, original articles, published in English after 1990 were included. Articles had to concern the development or evaluation of the measurement properties of self-reported, parent-reported and/or teacher- or clinician-reported questionnaires assessing or screening externalizing mental health problems in immigrant ethnic minority youths. Specific results of analyses on (an) immigrant ethnic minority group had to be given.

RESULTS

Twenty-nine studies evaluating 18 instruments met our criteria. Most studies concerned instruments with known validity in Western populations, tested mainly in African Americans. Considering methodological quality, inequivalences between ethnicities were found, self-reports seemed to perform better, and administration of an instrument influenced reliability and validity.

CONCLUSION

It seems that the majority of instruments for assessing externalizing problems in immigrant ethnic minority youths is currently not sufficiently validated. Further evaluating existing instruments is crucial to accurately assess and interpreted externalizing problems in immigrant ethnic minority youths.