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Walg M, Khatib A, Laufer A, Böttche M, Maoz-Dotan C, Hassan H, Hapfelmeier G, Finkelstein M. Post-migration stress, quality of life, and mental health among accompanied and unaccompanied young refugees in Germany: How do adolescents feel after fleeing? Stress Health 2024; 40:e3378. [PMID: 38279696 DOI: 10.1002/smi.3378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
This study examines the impact of post-migration living difficulties (PMLDs) and quality of life (QoL) on the mental health of 55 young refugees who arrived in Germany either accompanied or unaccompanied. The results reveal that nearly 62% of the participants exhibited clinically significant symptoms of depression or post-traumatic stress disorder. Regression analyses indicate that psychopathology was associated with being unaccompanied and experiencing lower QoL, while QoL was associated with higher economic status and lower PMLDs. Mediation analysis further demonstrates that higher economic status and reduced PMLDs were associated with higher QoL, which, in turn, correlated with lower levels of psychopathology. These findings emphasise the importance of considering PMLDs and QoL, as well as economic status and being accompanied/unaccompanied, in the assessment and treatment of young refugees in the host country.
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Affiliation(s)
- Marco Walg
- Department of Child and Adolescent Psychiatry, SANA-Klinikum, Remscheid, Germany
| | - Anwar Khatib
- Department of Social Work, Zefat Academic College, Zefat, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Avital Laufer
- Behavioral Science, Netanya Academic College, Netanya, Israel
| | - Maria Böttche
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | | | - Hiam Hassan
- Department of Social Work, Zefat Academic College, Zefat, Israel
| | - Gerhard Hapfelmeier
- Department of Child and Adolescent Psychiatry, SANA-Klinikum, Remscheid, Germany
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Yetim O, Çakır R, Bülbül E, Alleil İS. Peer relationships, adolescent anxiety, and life satisfaction: a moderated mediation model in Turkish and syrian samples. Eur Child Adolesc Psychiatry 2024; 33:2831-2845. [PMID: 38300342 PMCID: PMC11272711 DOI: 10.1007/s00787-023-02366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
Prior studies comparing Syrian refugee adolescents to their native peers in the same region have found higher anxiety and lower life satisfaction. Therefore, identifying regulatory variables is crucial for implementing support programs. This study examined the mediating effect of peer relationships and the moderating effect of being a refugee or native adolescent on the relationship between adolescent anxiety and life satisfaction across different samples. Participants and setting: The study included 2,336 adolescents aged 11-19 (M = 14.79, SD = 1.04). Participants completed the Screen for Child Anxiety Related Disorders, Satisfaction with Life Scale, and Strengths and Difficulties Questionnaire. The mediation and moderation effects were analyzed with the path analysis codes written on Mplus 8.3. SPSS 26 was used for descriptive statistics and group comparisons. The findings showed that peer relationships mediate adolescent anxiety and life satisfaction, and this relationship is moderated according to whether the participants are native adolescents or refugee adolescents. This study highlights the significant associations between peer relationships, adolescent anxiety, and life satisfaction and the moderating role of the participant identity. The findings may inform psychological interventions to improve Syrian refugee adolescents' mental health and well-being. These findings may also have implications for policies and programs aimed at supporting the integration of Syrian refugee adolescents in host communities.
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Affiliation(s)
- Onat Yetim
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey.
| | - Resul Çakır
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey
| | - Ece Bülbül
- Psychology Department, Toros University, Bahçelievler District, Mersin, Turkey
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Durbeej N, Salari R, Sarkadi A, Kankaanpä R, Derluyn I, Verelst A, Osman F. Evaluation of the Teaching Recovery Techniques intervention among newcomer students in Swedish schools: a randomised controlled trial turned into a feasibility study. BMC Public Health 2024; 24:1921. [PMID: 39026230 PMCID: PMC11256645 DOI: 10.1186/s12889-024-19412-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND During recent years, Europe has faced the arrival of migrants whereof a considerable group of youth present mental health problems, such as symptoms of post-traumatic stress disorder (PTSD). Schools offer a safe environment for mental health interventions to these groups, yet there is limited research on the impact of school-based interventions addressing mental health problems in newcomer youths, especially in the Swedish context. This cluster randomized controlled trial (RCT) aimed to explore the effectiveness of the Teaching Recovery Techniques (TRT) intervention among newcomer students with PTSD symptoms in Swedish secondary schools. METHODS Nine schools were randomly assigned to TRT or a wait list control group prior to the baseline assessment. Follow-up data were collected immediately following the intervention and three months post-intervention. In total, 531 students were approached, of which 61 gave consent and were eligible to be included in the study: 55 in TRT and 6 in the control condition. Given the low number of participants in the control condition, we merely analyzed students who had received TRT. RESULTS We report on feasibility of recruitment, data collection, intervention delivery and intervention effectiveness. In terms of intervention effectiveness, within subjects ANOVAs revealed significant reductions in PTSD symptoms and general mental health problems from baseline to the three months-follow-up (p < 0.001). CONCLUSIONS Our results indicate that TRT is a promising school-based intervention for newcomer students with PTSD symptoms. For a successful implementation of TRT in the school context, schools need to be engaged and the implementation should be managed by a local coordinator. TRIAL REGISTRATION ISRCTN, ISRCTN48178969, Retrospectively registered 20/12/2019.
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Affiliation(s)
- Natalie Durbeej
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Raziye Salari
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Reeta Kankaanpä
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Ilse Derluyn
- Centre for the Social Study of Migration and Refugees, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
| | - An Verelst
- Centre for the Social Study of Migration and Refugees, Department of Social Work and Social Pedagogy, Ghent University, Ghent, Belgium
| | - Fatumo Osman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Norton J, Gandubert C, Pellissier S, Chaudieu I, Gaultier S. Trauma and mental health in young adults who arrived in France as unaccompanied and separated migrant children. L'ENCEPHALE 2024; 50:154-161. [PMID: 37121807 DOI: 10.1016/j.encep.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES The mental health of unaccompanied and separated minors (UASC) has been widely studied but not their first years of adulthood, often characterised by uncertainty after leaving child protection. The aim of this study was to estimate the prevalence of psychiatric disorders using standardised and validated research instruments and examine the effect of exposure to trauma. METHODS One hundred and ten youth (92.7% male, median age 19.7 [18.1-22.8]) from Chambery, Montpellier and La Rochelle were recruited to a cross-sectional exploratory study. During a face-to-face interview, somatoform disorder, anxiety, and depression were assessed using the Patient Health Questionnaire (score≥10) and post-traumatic stress disorder (PTSD) with the PTSD Checklist for DSM-5 (score≥33). Traumatic life events were assessed using the Life Events Checklist. RESULTS Of the youth, 19.3% had a probable somatoform disorder, 17.6% anxiety, 28.7% depression, and 20% PTSD. The number of traumatic life events increased the risk of depression (multi-adjusted OR (95%CI): 1.56 (1.25-1.96)), PTSD (1.60 (1.23-2.08)), somatoform disorder (1.41 (1.10-1.82), and anxiety (1.33 (1.02-1.72)). Physical assault was the type of event positively associated with the most disorders (P≤0.01, except for anxiety), followed by witnessing sudden and violent death (P≤0.01 for depression and PTSD) and sexual assault (P=0.002 for PTSD). CONCLUSION Our study highlights the high prevalence of psychiatric disorders in young adults who arrived as UASC and the impact on their mental health of cumulative trauma and exposure to interpersonal and violent traumatic life events. A greater focus on their mental health with regular assessments is needed in order to provide rapid and adapted care.
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Affiliation(s)
- Joanna Norton
- University of Montpellier, Inserm U1298, 34295 Montpellier Cedex 5, France.
| | | | - Sonia Pellissier
- Interuniversity Laboratory of Psychology (LIP/PC2S), University Savoie Mont-Blanc, University Grenoble Alpes, 38040 Grenoble Cedex 9, France
| | - Isabelle Chaudieu
- University of Montpellier, Inserm U1298, 34295 Montpellier Cedex 5, France
| | - Sydney Gaultier
- Interuniversity Laboratory of Psychology (LIP/PC2S), University Savoie Mont-Blanc, University Grenoble Alpes, 38040 Grenoble Cedex 9, France; Department of Psychiatry, Lausanne University Hospital, 1004 Lausanne, Switzerland
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Fortuna LR, Martinez W, Porche MV. Integrating Spirituality and Religious Beliefs in a Mindfulness Based Cognitive Behavioral Therapy for PTSD with Latinx Unaccompanied Immigrant Children. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:481-494. [PMID: 37593049 PMCID: PMC10427566 DOI: 10.1007/s40653-023-00541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 08/19/2023]
Abstract
Purpose: Unaccompanied immigrant children (UIC) experience significant mental health concerns, particularly posttraumatic stress. This is a vulnerable population, yet little systematic research has examined the effectiveness of evidence-based models such as cognitive behavioral therapy (CBT) to meet their needs. Integrating religious beliefs and spirituality into therapy could elucidate better understandings of traumatic stress, and posttraumatic cognitions when working with UIC with strong faith traditions/beliefs. Methods: We report on modifications made to a pre-existing treatment, consisting of integrating religious and spiritual themes, to engage and work with UIC participants in a pilot study of Mindfulness-Based CBT. Thematic analysis of therapy notes evaluated the implementation process for integrating religious and spiritual themes. Three composite vignettes illustrate how religiosity and spirituality were salient for UIC participants in this pilot study, and how these were integrated into therapy to address posttraumatic cognitions and symptoms. We assessed changes in PTSD symptom severity and posttraumatic cognitions for UIC and in comparison, to non-UIC participants using the Child PTSD Symptom Scale and the Posttraumatic Cognitions Inventory. Results: Religiosity and spirituality were important for coping and conceptualizations of trauma, served as facilitators for engaging UIC in therapy, and related to improving posttraumatic cognitions and symptoms. Conclusion: Religious identity and spirituality can be important for meaning making, trauma cognitions and symptoms, and can be important to explore in therapy with unaccompanied immigrant children and adolescents. Clinical Trial Registration: Not applicable.
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Affiliation(s)
- Lisa R. Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110 USA
| | - William Martinez
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110 USA
| | - Michelle V. Porche
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110 USA
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Oberg C, Sharma H. Post-Traumatic Stress Disorder in Unaccompanied Refugee Minors: Prevalence, Contributing and Protective Factors, and Effective Interventions: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:941. [PMID: 37371174 DOI: 10.3390/children10060941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
In 2021, there were close to 37 million children displaced worldwide. There were 13.7 million refugees and an additional 22.8 million internally displaced. In Europe, this included 23,255 unaccompanied minors seeking asylum, up 72% compared with 2020 (13,550). The objective was to review the current literature regarding PTSD in unaccompanied refugee minors (URM). The authors searched Ovid Medline, Embase, and Cochrane Library from 1 January 2008 through 15 January 2019. Thirty full texts were chosen that specifically studied unaccompanied refugee minors (URM). The results showed that URM had a prevalence of post-traumatic stress disorder (PTSD of 17-85% across the studies reviewed. There were numerous factors that contributed to PTSD, including cumulative stress and trauma, guilt, shame, and uncertainty about legal status. Protective factors included resilience, a trusted mentor, belonging to a social network, religion, having an adult mentor, and having a family (even if far away). Immigrant youth can thrive most easily in multiculturally affirming countries. Five interventions demonstrated effectiveness, comprising trauma-focused cognitive behavioral therapy (TF-CBT); "Mein Weg", a TF-CBT combined with a group-processing mixed therapy approach; teaching recovery techniques (TRT), narrative exposure therapy for children (KIDNET), and expressive arts intervention (EXIT). The significant mental health conditions include depression, anxiety, internalizing and externalizing behaviors, and frequently PTSD. It is fair to conclude that the high levels of mental health problems experienced in URM are due to exposure to traumatic experiences, separation from parents, and lack of social support.
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Affiliation(s)
- Charles Oberg
- Global Pediatrics Program, Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Hayley Sharma
- Department of Internal Medicine and Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Solhaug AK, Røysamb E, Oppedal B. Changes in life satisfaction among unaccompanied asylum-seeking and refugee minors who participated in teaching recovery techniques (TRT). Child Adolesc Psychiatry Ment Health 2023; 17:50. [PMID: 37072831 PMCID: PMC10114353 DOI: 10.1186/s13034-023-00595-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Unaccompanied asylum-seeking and refugee minors report low life satisfaction and high levels of mental health problems, nevertheless they often do not seek or receive help for their problems. Teaching Recovery Techniques (TRT) is a low-threshold, five sessions intervention developed to reduce distressing war- and disaster-related trauma reactions among children and youth. In this study, we investigate if TRT can contribute to increased life satisfaction among unaccompanied asylum-seeking and refugee minors. METHODS Asylum-seeking and resettled unaccompanied minors participated in TRT carried out in 15 locations throughout Norway, n = 147, mean age = 16.61 (SD = 1.80), 88% boys, and 67% from Afghanistan. Life satisfaction was measured by the Cantril Ladder before the intervention, and two- and eight weeks post-intervention. We also included indices of intervention compliance and contextual variables, such as asylum status. We applied a pre- and post-intervention design with linear mixed model analyses to investigate change in life satisfaction. RESULTS Life satisfaction significantly increased from pre- to post- intervention, but not for youth whose asylum application had been rejected or who were still awaiting a decision. Indices of intervention compliance were associated with an increase in life satisfaction. CONCLUSIONS TRT is a potential useful intervention to enhance life satisfaction among unaccompanied asylum-seeking and refugee minors and can be a measure to support positive development among youth at risk for mental health problems. However, TRT initiatives should consider the participant's stage of asylum process, because harsh immigration policies may overburden the coping capacity. Without further adaptation, TRT seems most useful for youth granted residence. The manual has been revised to include asylum-related stressors. TRIAL REGISTRATION ClinicalTrials.gov (16/54,571, registered 30.01.2019).
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Affiliation(s)
- Anne Kristine Solhaug
- Department of Childhood and Families, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway.
| | - Espen Røysamb
- Department of Childhood and Families, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Brit Oppedal
- Department of Childhood and Families, Norwegian Institute of Public Health, PO Box 222, Skøyen, Oslo, 0213, Norway
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Sanchez-Clemente N, Eisen S, Harkensee C, Longley N, O'Grady R, Ward A. Beyond arrival: safeguarding unaccompanied asylum-seeking children in the UK. Arch Dis Child 2023; 108:160-165. [PMID: 35728940 DOI: 10.1136/archdischild-2021-323648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/23/2022] [Indexed: 11/04/2022]
Abstract
Unaccompanied children (also called unaccompanied minors) are children who have been separated from both parents and other relatives and are not being cared for by an adult who, by law or custom, is responsible for doing so. From 2010 to 2020, unaccompanied minors accounted on average for 15.4% of the total number of first-time asylum applicants aged less than 18 years in the UK. These young people risk their lives and undergo traumatic journeys in search of a better life. However, when they arrive in the UK, they are vulnerable to significant ongoing traumatic experiences.In this review, we look at the reasons young people are forced to flee their countries, how they make their journey, and the risks and dangers they face along the way. We examine safety and victimisation risks faced by children and young people after arrival in the UK, which mechanisms and processes exist to safeguard these individuals, and examine the data available on outcomes of unaccompanied asylum-seeking child (UASC. Finally, we share two case examples that represent both the strengths and weaknesses of existing processes for UASC.
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Affiliation(s)
| | - Sarah Eisen
- Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Nicky Longley
- Infection, Hospital for Tropical Diseases, London, UK.,CRD, London School of Hygiene and Tropical Medicine, London, UK
| | - Rob O'Grady
- Looked After Children Service, Camden Local Authority, London, UK
| | - Allison Ward
- Camden Integrated Services for Children, Central and North West London NHS Foundation Trust, London, UK
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Kvestad I, Bøe T, Sayyad N, Skogen JC, Randal S, Lehmann S. Potential traumatic events and symptoms of post-traumatic stress in unaccompanied refugee minors-a comparison with youth in foster care. Eur Child Adolesc Psychiatry 2023; 32:439-449. [PMID: 34537879 PMCID: PMC10038941 DOI: 10.1007/s00787-021-01876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
Building knowledge on how child welfare services (CWS) should tailor services for unaccompanied refugee minors (URMs) is important. URMs and youth in foster care are high-risk groups taken care of by the CWS in Norway. Little is known on whether knowledge gained from youth in foster care can inform services for URMs, and if these groups are comparable in terms of experiences of potential traumatic events (PTEs) and post-traumatic stress disorder (PTSD) symptom load. Eighty-one URMs reported PTEs and PTSD-symptoms using an adapted version of the Child and Adolescent Trauma Screen (CATS). Responses were described and compared with a sample of 303 youth in foster care in linear regression models. We present relative risks (RR) and standardized mean differences (SMD) for the PTEs and the PTSD subscale and total score between the groups in forest plots. URMs had experienced a mean (standard deviation) of 6.4 (3.4) PTEs and 43.9% reported to have PTSD-symptoms at or above the clinical cut off. Compared to the foster youth, URMs reported more exposures of interpersonal violence outside of the family (RRs ranging from 66.4 [95%CI 18.1; 243.5) to 1.3 (1.0, 1.5)], and more PTSD-symptoms in the re-experiencing subscale [SMD = 0.3 (95% CI 0.1, 0.6)]. The frequency and types of PTEs and the PTSD-symptom load and profile among URMs and youth in foster care differed. Findings underscore the importance of qualified and targeted care for URMs, and that this care should differ to that of other high-risk groups in the CWS.
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Affiliation(s)
- Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Nawar Sayyad
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - Sølve Randal
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Bergen, Norway
| | - Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health Promotion and development, Faculty of Psychology, University of Bergen, Bergen, Norway
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Norton J, Gandubert C, Chaudieu I, Pellissier S, Gaultier S. Association between uncertainty regarding right-to-stay and mental health in unaccompanied and separated migrant children (UASC) reaching adulthood: findings from France. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02442-y. [PMID: 36806952 DOI: 10.1007/s00127-023-02442-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE There is substantial evidence suggesting high levels of mental health problems in unaccompanied and separated children (UASC). However, there is less focus on the first years of adulthood characterised by increased vulnerability and fear of expulsion. We aimed to describe the mental health of UASC on reaching adulthood, and how this was affected by uncertainty regarding their right-to-stay in France. METHODS One hundred and ten youth aged 18-22 were recruited via child protection reception centres. We administered the Patient Health Questionnaire somatic (PHQ-15), anxiety (GAD-7) and depression (PHQ-9) modules, the Post-Traumatic Stress Disorder Checklist (PCL-5) and Connor-Davidson Resilience Scale (CD-RISC-10). Logistic regression analysis was performed with the dependent variable, a secure (versus uncertain) situation, defined as (1) detaining a residence permit and being in school, an apprenticeship or a salaried job, or (2) waiting for residence permit whilst occupying a salaried job. RESULTS Of the sample, 19.3% reached criteria for a probable somatic disorder, 17.6% for anxiety and 28.7% for depression (score ≥ 10); 41.8% were in an uncertain situation regarding their right-to-stay. Uncertainty was associated with higher anxiety ((OR per Interquartile range (95% CI), 1.77 (1.05-2.98)) and post-traumatic stress symptoms (2.05 (1.06-4.00)), lower resilience (0.50 (0.27-0.91)), and participants rating their anxiety (p = 0.02) and depressive symptoms (p = 0.003) as more severe since reaching adulthood. CONCLUSIONS Our findings suggest uncertainty regarding right-to-stay is associated with increased mental health symptoms, specifically anxiety and trauma-induced stress, thereby highlighting the vulnerability of UASC in their first years of adulthood. This calls for greater support during this transition period with regular symptom monitoring for timely psychological interventions.
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Affiliation(s)
- Joanna Norton
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France.
| | - Catherine Gandubert
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France
| | - Isabelle Chaudieu
- INM, University of Montpellier, INSERM, 80 rue Auguste Fliche, 34000, Montpellier, France
| | - Sonia Pellissier
- LIP/PC2S, University Savoie Mont-Blanc, University Grenoble Alpes, Chambery, France
| | - Sydney Gaultier
- LIP/PC2S, University Savoie Mont-Blanc, University Grenoble Alpes, Chambery, France
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Massag J, Diexer S, Klee B, Costa D, Gottschick C, Broda A, Purschke O, Opel N, Binder M, Sedding D, Frese T, Girndt M, Hoell J, Moor I, Rosendahl J, Gekle M, Mikolajczyk R. Anxiety, depressive symptoms, and distress over the course of the war in Ukraine in three federal states in Germany. Front Psychiatry 2023; 14:1167615. [PMID: 37181901 PMCID: PMC10172594 DOI: 10.3389/fpsyt.2023.1167615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The Russian invasion of Ukraine and the resulting consequences are in the center of political discussions, media, and likely individual thinking of the population in Germany. Yet, the impact of this prolonged exposure on mental health is not known hitherto. Methods Using the population based cohort study DigiHero from three federal states (Saxony-Anhalt, Saxony, and Bavaria), we assessed anxiety levels (GAD-7), depressive symptoms (PHQ-9), and distress (modified PDI) in the first weeks of war and 6 months later. Results Of those 19,432, who responded in the first weeks of war, 13,934 (71.1%) responded also 6 months later. While anxiety and emotional distress decreased during the 6 months, their average scores were still elevated, and a substantial fraction of respondents displayed clinically relevant sequelae. Persons from low-income households were especially affected, specifically by fears related to the personal financial situation. Those who reacted with a particularly strong fear in the beginning of war were more likely to have persistent clinically relevant symptoms of depression and anxiety also 6 months later. Discussion The Russian invasion of Ukraine is accompanied by continuing impairment of mental health in the German population. Fears surrounding the personal financial situation are a strong determinant.
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Affiliation(s)
- Janka Massag
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sophie Diexer
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniela Costa
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Cornelia Gottschick
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Broda
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Oliver Purschke
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Nils Opel
- Department for Psychiatry and Psychotherapy, University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health, Site Jena-Magdeburg-Halle, Jena, Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Haematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Sedding
- Department of Cardiology and Intensive Care Medicine, Mid-German Heart Centre, University Hospital, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jessica Hoell
- Paediatric Haematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Irene Moor
- Institute for Medical Sociology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Gekle
- Julius-Bernstein-Institute of Physiology, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- German Center for Mental Health, Site Jena-Magdeburg-Halle, Jena, Germany
- *Correspondence: Rafael Mikolajczyk,
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12
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Moe G, Ytterhus B. Health and meaning through "doings": A qualitative study with young unaccompanied refugees in Norway. Soc Sci Med 2022; 315:115542. [PMID: 36434891 DOI: 10.1016/j.socscimed.2022.115542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/21/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Young unaccompanied refugees who settle in a new country are at substantial risk of developing health problems while striving to uphold a meaningful, new life. We lack knowledge about how they use their personal agency to self-care in the context of their local communities. This article examines how young unaccompanied refugees create healthy identities and looks into the social structures that promote health in their everyday life. METHODS Nineteen in-depth interviews were conducted with young unaccompanied refugees settled in Norway, originating from Afghanistan, Eritrea, and Syria. Interpretive phenomenological analysis was used. Our theoretical framework combined Antonovsky's (1987) theory of health, Honneth's (2005) philosophy of recognition, and Prilleltensky's (2020) social psychological concept of mattering. RESULTS Young unaccompanied refugees create healthy identities through "doings", i.e. meaningful activities that provide recognition and the feeling of adding value. They confirm health as a relational phenomenon, including horizontal relations at, for example, school, work, gym, and other leisure activities in the local community. Vertical relations involving legal status, residence permits, and community values, were also highly important. The participants' relation to parents/families in their country of origin was often complex, associated both with burdensome obligations to provide and a potential to care and matter. CONCLUSION Young unaccompanied refugees are dependent on inclusive, supportive policies and structures which enable them to develop healthy identities. These findings should encourage policymakers and society to strengthen and expand arenas for "doings" and meaning for young unaccompanied refugees.
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Affiliation(s)
- Gjertrud Moe
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Faculty of Medicine and Health Science.Haakon, Jarls Gt. 11, N- 7491, Trondheim, Norway.
| | - Borgunn Ytterhus
- General Practice Research Unit, Department of Public Health and Nursing, NTNU, Faculty of Medicine and Health Science.Haakon, Jarls Gt. 11, N- 7491, Trondheim, Norway.
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13
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Guessoum SB, Minassian S, de Staël P, Touhami F, DiGiovanni M, Radjack R, Moro MR, Benoit L. Multimodal co-therapy for unaccompanied minors: a qualitative study. Child Adolesc Psychiatry Ment Health 2022; 16:81. [PMID: 36344979 PMCID: PMC9641960 DOI: 10.1186/s13034-022-00518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Unaccompanied refugee minors-or unaccompanied minors-are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients' experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care. METHODS MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). RESULTS Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one's story can "set us free" if guided carefully by care providers. CONCLUSION This study suggests that MUCTUM therapy may efficiently support unaccompanied minors' mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.
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Affiliation(s)
- Sélim Benjamin Guessoum
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014, Paris, France.
- Université Paris Cité, PCPP, Paris, France.
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France.
| | | | - Pauline de Staël
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014, Paris, France
| | | | | | - Rahmeth Radjack
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014, Paris, France
- Université Paris Cité, PCPP, Paris, France
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014, Paris, France
- Université Paris Cité, PCPP, Paris, France
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Laelia Benoit
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014, Paris, France
- Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
- Child Study Center, Yale School of Medicine, New Haven, USA
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14
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Daniel-Calveras A, Baldaquí N, Baeza I. Mental health of unaccompanied refugee minors in Europe: A systematic review. CHILD ABUSE & NEGLECT 2022; 133:105865. [PMID: 36095862 DOI: 10.1016/j.chiabu.2022.105865] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
| | - Nuria Baldaquí
- Psychiatry and Psychology Department, Hospital Clínic de Barcelona, SGR-881 Barcelona, Spain
| | - Inmaculada Baeza
- Universitat de Barcelona, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, ISCIII, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (CERCA-IDIBAPS), Barcelona, Spain.
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15
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Nilsen SA, Kvestad I, Randal SB, Hysing M, Sayyad N, Bøe T. Mental health among unaccompanied refugee minors after settling in Norway: A matched cross-sectional study. Scand J Public Health 2022:14034948221100103. [PMID: 35684945 DOI: 10.1177/14034948221100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: To describe the mental health of unaccompanied refugee minors (URMs) settled in Norway and compare their responses to an age- and sex-matched sample of Norwegian young people. Methods: The data were from the Pathways to Independence study of URMs aged 15-20 years (n = 81; 82.7% male; response rate 80%) conducted in 2018-2019 in the Bergen municipality, Norway. The data from the URMs were linked to an age- and sex-matched group of young people from the Norwegian youth@hordaland study conducted in 2012 (n = 324). Mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ). Results: URMs were more likely to agree with most items pertaining to emotional problems, peer problems and prosocial subscales than Norwegian young people. Few differences were found for items on the conduct problems and hyperactivity-inattention problems scales. Poor psychometric properties, including weak factor loadings and low internal consistency, were detected for the SDQ subscales among URMs, except for the emotional problems subscale, indicating that the originally proposed five-factor model fitted the data poorly. Conclusions: URMs appear to have moderately more emotional problems than Norwegian young people. They are more likely to report being alone, getting along better with adults than with their peers and being bullied, but also report being more helpful and sharing with others. Studies with larger samples of URMs should determine the most appropriate factor structure of the SDQ when administered to URM samples.
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Affiliation(s)
- Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway
| | - Sølve Bjørn Randal
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Norway
| | - Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway.,Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | - Nawar Sayyad
- Child Welfare Services for Unaccompanied Refugee Minors, Bergen Municipality, Norway
| | - Tormod Bøe
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Norway.,Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
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16
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Oldroyd JC, Kabir A, Dzakpasu FQS, Mahmud H, Rana J, Islam RM. The experiences of children and adolescents undergoing forced separation from their parents during migration: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:888-898. [PMID: 34622499 DOI: 10.1111/hsc.13595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/19/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
Globally, the migration of unaccompanied minors is increasing, however, the experiences of these children have not been examined. We systematically synthesised the existing qualitative literature to examine the experiences of children undergoing forced separation from their parents during migration. The review was structured based on the PRISMA statement. A systematic search of Ovid MEDLINE, EMBASE, PsychINFO and Scopus databases from inception to November 23, 2020 was conducted to retrieve eligible studies. Only qualitative studies of children aged ≤18 years were reviewed. The data analysis and synthesis were informed by the intersectionality framework. The search yielded 10,956 studies of which eight were included in this review. Thematic analysis identified the following themes: unaccompanied minors experience a deep sense of loss; anxiety over the uncertainty of the migration process; difficulty adjusting to their new life in the host country and adverse health effects. These experiences were heightened by children's exposure to violence during migration. The intersectionality framework suggests that unaccompanied minors experience separation from their parents during migration in ways that marginalise them and widen inequalities. Migration processes need to be streamlined to provide integrated health, emotional, legal and educational supports for unaccompanied children with particular attention given to treating the trauma of past violence. More research is needed to explore how to facilitate the integration of unaccompanied children into host communities in ways that are healing and empowering.
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Affiliation(s)
- John C Oldroyd
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Ashraful Kabir
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Francis Q S Dzakpasu
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Juwel Rana
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, Montreal, Canada
| | - Rakibul M Islam
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh
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17
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Gabrielsson S, Karim H, Looi GME. Learning your limits: Nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care. Int J Ment Health Nurs 2022; 31:369-378. [PMID: 34913549 DOI: 10.1111/inm.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/13/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Young unaccompanied refugees come in contact with acute psychiatric care due to pre-existing mental health conditions as well as stressful and traumatic experiences before, during, and after migration. Previous research on nurses' experiences of caring for refugees has primarily reported on difficulties related to cultural differences and communication and how nurses might distrust refugees. This study aimed to describe registered nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care. Semi-structured interviews with ten nurses were analysed using a method for qualitative content analysis. Data were collected in Sweden during 2019 and 2020. Results describe nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care in one theme: learning your limits and three sub-themes: feeling powerless but doing what you can; taking a stance in a politicized environment; and being frustrated and in need of support. Findings highlight the potential and limitations of mental health nursing, the importance of reflection and peer support, and the importance of viewing the roles and responsibilities of mental health nurses and nursing in a societal context. These findings suggest that nurses can make a difference for young unaccompanied refugees in acute psychiatric care. However, in doing so, nurses need support in realizing what they can and cannot achieve. The study is reported in accordance with the COREQ guidelines.
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Affiliation(s)
- Sebastian Gabrielsson
- Department of Health, Education and Technology, Luleå University of Technology, Lulea, Sweden
| | - Hannan Karim
- Department of Psychiatry, Sunderby Hospital, Region Norrbotten, Lulea, Sweden
| | - Git-Marie Ejneborn Looi
- Department of Health, Education and Technology, Luleå University of Technology, Lulea, Sweden
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18
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Geirsdottir G, Mittendorfer-Rutz E, Björkenstam E, Chen L, Dorner TE, Amin R. Differences in labour market marginalisation between refugees, non-refugee immigrants and Swedish-born youth: Role of age at arrival and residency duration. Scand J Public Health 2022:14034948221079060. [PMID: 35343330 DOI: 10.1177/14034948221079060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS We investigated if the risk of long-term unemployment (LTU) and disability pension (DP) differs between young refugees and non-refuge immigrants compared to the Swedish-born. The role of age at arrival, duration of residency and morbidity in this association was also investigated. METHODS All 19- to 25-year-olds residing in Sweden on 31 December 2004 (1691 refugees who were unaccompanied by a parent at arrival, 24,697 accompanied refugees, 18,762 non-refugee immigrants and 621,455 Swedish-born individuals) were followed from 2005 to 2016 regarding LTU (>180 days annually) and DP using nationwide register data. Cox regression models were used to estimate crude and multivariate-adjusted (adjusted for several socio-demographic, labour market and health-related covariates) hazard ratios (aHRs) with 95% confidence intervals. RESULTS Compared to the Swedish-born, all migrant groups had around a 1.8-fold higher risk of LTU (range aHR=1.71-1.83) and around a 30% lower risk of DP (range aHR=0.66-0.76). Older age at arrival was associated with a higher risk of LTU only for non-refugee immigrants. Both older age at arrival and a shorter duration of residency were associated with a lower risk of DP for all migrant groups. Psychiatric morbidity had the strongest effect on subsequent DP, with no significant differences between migrant groups and the Swedish-born (range aHR=5.1-6.1). CONCLUSIONS Young immigrants had a higher risk of LTU and a lower risk of DP than their Swedish-born peers. No differences between the different immigrant groups were found. Age at arrival, psychiatric morbidity and duration of residency are strong determinants of being granted DP.
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Affiliation(s)
- Gerdur Geirsdottir
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | | | - Emma Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Lingjing Chen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Thomas E Dorner
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.,Karl-Landsteiner Institute for Health Promotion Research, Austria
| | - Ridwanul Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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19
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Rondung E, Leiler A, Sarkadi A, Bjärtå A, Lampa E, Löfving SG, Calam R, Oppedal B, Keeshin B, Warner G. Feasibility of a randomised trial of Teaching Recovery Techniques (TRT) with refugee youth: results from a pilot of the Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT). Pilot Feasibility Stud 2022; 8:40. [PMID: 35164865 PMCID: PMC8843024 DOI: 10.1186/s40814-022-00998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Although post-traumatic stress is prevalent among unaccompanied refugee minors (URM), there are few evidence-based psychological interventions for this group. Teaching Recovery Techniques (TRT) is a brief, manualised intervention for trauma-exposed youth, which has shown promising results in exploratory studies. The aim of the present study was to assess the feasibility of conducting a randomised controlled trial (RCT) evaluating the use of TRT among URM by investigating key uncertainties relating to recruitment, randomisation, intervention delivery and data collection. Methods A 3-month long non-blinded internal randomised pilot trial with a parallel-group design assessed the feasibility of a planned nationwide multi-site RCT. URM with or without granted asylum were eligible if they were 14 to 20 years old, had arrived in Sweden within the last 5 years and had screened positive for symptoms of post-traumatic stress disorder (PTSD). Quantitative data were collected pre- and post-intervention, and 18 weeks after randomisation. On-site individual randomisation (1:1) followed directly after pre-intervention assessment. Participants allocated to the intervention were offered seven weekly group-based TRT sessions. Quantitative pilot outcomes were analysed using descriptive statistics. Qualitative information was gathered through on-site observations and follow-up dialogue with group facilitators. A process for Decision-making after Pilot and feasibility Trials (ADePT) was used to support systematic decision-making in moving forward with the trial. Results Fifteen URM (mean age 17.73 years) with PTSD symptoms were recruited at two sites. Three of the youths were successfully randomised to either TRT or waitlist control (TRT n = 2, waitlist n = 1). Fourteen participants were offered TRT for ethical reasons, despite not being randomised. Six (43%) attended ≥ 4 of the seven sessions. Seventy-three percent of the participants completed at least two assessments, with a response rate of 53% at both post-intervention and follow-up. Conclusions The findings demonstrated a need for amendments to the protocol, especially with regard to the procedures for recruitment and randomisation. Upon refinement of the study protocol and strategies, an adequately powered RCT was pursued, with data from this pilot study excluded. Trial registration ISRCTN47820795, prospectively registered on 20 December 2018
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20
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Abstract
This present study concerns refugees and asylum seekers who have been referred to a Mobile Mental Health Unit (MMHU-Ch) in rural Greece on a Northeast Aegean Island during the refugee crisis in 2015. Our objective is the examination and recording of psychopathology characteristics’, the presentation of the therapeutic interventions provided, and the difficulties. The sample is composed of 418 requests made by refugees, asylum seekers, adults, and children. The clinical and demographic data have been gathered from the MMHU-Ch’s charts. The study is retrospective, descriptive with quantitative and categorical variables. The data has been analyzed with the utilization of SPSS. The dominant diagnosis in children involves anxiety disorders, developmental disorders, and PTSD. One noteworthy finding is the high percentage of suicide behavior regardless of psychiatric diagnosis, which should be further examined. As far as interventions are concerned, the conclusions which have arisen are the gradually stronger commitment of the referents, but also the high percentage of requests that dropped out. Further examination of the interventions and their efficiency is recommended as well as probing the features of psychopathology in the long term with a view to clarifying the patronizing and aggravating factors.
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21
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Mental health implications on Afghan children: an impending catastrophe. Glob Ment Health (Camb) 2022; 9:397-400. [PMID: 36618720 PMCID: PMC9806975 DOI: 10.1017/gmh.2022.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023] Open
Abstract
Afghan children have suffered for decades because of chronic socioeconomic health crises. The current state of Afghanistan has deprived the basic human needs of children. The lack of freedom leaves their voices unheard, causing detrimental effects on their mental health. Mental illnesses such as post-traumatic stress disorder, anxiety, and depression are prevalent in Afghanistan, causing severe negative outcomes among children. Promotion of mental health services, psychological training, awareness campaigns, acceptance of Afghan refugees, and initiatives to support re-connecting with loved ones, are among the many recommended measures needed to manage this alarming situation. This requires an immediate action plan from government and public health officials to mitigate this impending catastrophe.
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22
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Ünver H, Perdahlı Fiş N. An Analysis of Admissions to a Refugee Child Mental Health Unit in the Context of the COVID-19 Pandemic. Clin Child Psychol Psychiatry 2022; 27:136-144. [PMID: 34823386 PMCID: PMC8818475 DOI: 10.1177/13591045211058337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To examine the admissions to a refugee child outpatient mental health unit in the COVID-19 pandemic and to compare them with the pre-pandemic period. METHODS This retrospective observational study, planned through the hospital information system and patient files, included the 1-year number of outpatient unit admissions, sociodemographic, and clinical data. RESULTS Before the COVID-19 pandemic (March 2019-February 2020), a total of 2322 patients (local and refugee) applied to the same unit, and 236 (10.1%) of these patients were refugees. Since the commencement of the COVID-19 pandemic in Turkey (March 2020-February 2021), 1209 patients applied, and 10.4% (n = 126) of them were refugees. While 19.66 ± 6.31 refugees applied per month in the pre-pandemic period, this number decreased to 10.50 ± 5.31 during the pandemic period (p = 0.01). During the pandemic period, there was a significant decrease in the number of female refugee patient admissions. In addition, while admissions for external disorders increased significantly during the pandemic period (x2 = 13.99, p = 0.001), admissions for internal disorders decreased significantly (x2 = 4.54, p = 0.03). CONCLUSIONS The decrease in the mental health unit demands with the pandemic may lead to negative consequences in the long term. To determine mental health and psychological needs of patients during the outbreak will greatly contribute to the pandemic management process.
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Affiliation(s)
- Hatice Ünver
- Child and Adolescent Psychiatry Clinic, 64051Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - Neşe Perdahlı Fiş
- Department of Child and Adolescent Psychiatry, 64050Marmara University Medical Faculty, Istanbul, Turkey
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23
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Inofuentes RA, Fuente LDL, Ortega E, García-García J. Victimización y Problemas de Conducta Externalizante y Antisocial en Menores Extranjeros no Acompañados en Europa: Revisión Sistemática. ANUARIO DE PSICOLOGÍA JURÍDICA 2021. [DOI: 10.5093/apj2021a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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24
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Inofuentes RA, Fuente LDL, Ortega E, García-García J. Victimización y Problemas de Conducta Externalizante y Antisocial en Menores Extranjeros no Acompañados en Europa: Revisión Sistemática. ANUARIO DE PSICOLOGÍA JURÍDICA 2021. [DOI: 10.5093/apj2021a27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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25
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Rodriguez IM, Dobler V. Survivors of Hell: Resilience Amongst Unaccompanied Minor Refugees and Implications for Treatment- a Narrative Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:559-569. [PMID: 34820043 PMCID: PMC8586295 DOI: 10.1007/s40653-021-00385-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Approximately half of the world's displaced population are children and a significant proportion of these are unaccompanied asylum-seeking children (UASC). UASC are the most vulnerable of all refugee populations. Up to 90% of UASC have been subjected to exploitation, including trafficking or being drafted into military groups. Having survived the perils of flight, UASC are confronted with continued challenges, including the uncertainties regarding their residential rights in host counties. Unsurprisingly, the prevalence of mental health problems is higher amongst UASC than in any other refugee group. Yet, Mental Health and Psychosocial Support (MHPSS) appears to neither reach nor engage UASC. This begs for re-examination of what and how MHPSS is offered. Despite high levels of adversity, UASC often have considerable resilience, and make remarkable recoveries. However, literature exploring their resources or their own views of what helps or hinders recovery is scarce. In this narrative review, we explore individual and systemic factors promoting recovery in UASC. We consider theoretical understanding of resilience, emerging data and user perspectives. From these we deduct four areas of resilience in UASC: Individual factors - prosocial behaviour, problem-solving skills; Lifetime relationships - positive early family relationships, connection with family and country of origin, positive peer and adult relationships in host country; Acculturation - integration of own and new culture, positive relationships with prosocial institutions; Care arrangements - supported but less restrictive living arrangements. We suggest, MHPSS may need to focus on enhancing social networks, including connectedness with positive relationships in the home-country, life-history work with a focus on resource-building experiences in addition to trauma, and promoting integration of old and new cultural values. We also conclude that despite growing data, there is a gap in both eliciting user perspectives and understanding adaptive resources, especially those emerging during early development and within their cultural setting. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00385-7.
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Affiliation(s)
| | - Veronika Dobler
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Corona Maioli S, Bhabha J, Wickramage K, Wood LCN, Erragne L, Ortega García O, Burgess R, Digidiki V, Aldridge RW, Devakumar D. International migration of unaccompanied minors: trends, health risks, and legal protection. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:882-895. [PMID: 34416189 PMCID: PMC7615140 DOI: 10.1016/s2352-4642(21)00194-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022]
Abstract
The global population of unaccompanied minors-children and adolescents younger than 18 years who migrate without their legal guardians-is increasing. However, as data are not systematically collected in any region, if collected at all, little is known about this diverse group of young people. Compared with adult migrants, unaccompanied minors are at greater risk of harm to their health and integrity because they do not have the protection provided by a family, which can affect their short-term and long-term health. This Review summarises evidence regarding the international migration and health of unaccompanied minors. Unaccompanied minors are entitled to protection that should follow their best interests as a primary consideration; however, detention, sometimes under the guise of protection, is a widespread practice. If these minors are provided with appropriate forms of protection, including health and psychosocial care, they can thrive and have good long-term outcomes. Instead, hostile immigration practices persist, which are not in the best interests of the child.
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Affiliation(s)
| | - Jacqueline Bhabha
- Harvard FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | - Kolitha Wickramage
- Migration Health Division, Global Migration Health Research and Epidemiology Unit, International Organization for Migration, Manila, Philippines
| | - Laura C N Wood
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, UK
| | | | | | | | - Vasileia Digidiki
- Harvard FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA
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Song SJ. Mental health of unaccompanied children: effects of U.S. immigration policies. BJPsych Open 2021; 7:e200. [PMID: 34725023 PMCID: PMC8570101 DOI: 10.1192/bjo.2021.1016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is an unprecedented surge of forcibly displaced people globally, with a crisis of unaccompanied minors seeking haven across the US border. AIMS This paper aims to provide an understanding of the intersection between mental health and immigration policies. METHOD Examples of contemporary policies that focus on the deterrence, detention and deportation of unaccompanied minors in the USA, will be discussed, as well as the mental health effects of such 'iron triangle' immigration policies. RESULTS In the ideal circumstances, systems and policies for migrant children would uphold international humanitarian law, hasten the shift from enforcement to protection, adhere to a 'do no (further) harm' model that uses a trauma-informed, culturally responsive approach to engaging with migrant children, engage the community as stakeholders to end detention and advocate to share the burden of responsibility. CONCLUSIONS Building a humanitarian response that protects both country and migrant interest is possible through commitment and policy change that addresses mental, physical and legal protection needs.
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Affiliation(s)
- Suzan J. Song
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
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Tietze FA, Orzechowski M, Nowak M, Steger F. Access to Healthcare for Minors: An Ethical Analysis of Judgments of the European Court of Human Rights. Healthcare (Basel) 2021; 9:healthcare9101361. [PMID: 34683040 PMCID: PMC8544556 DOI: 10.3390/healthcare9101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
The right to non-discriminatory access to healthcare is anchored in the European Convention on Human Rights and other international treaties or guidelines. Since its ratification, the European Convention on Human Rights was made binding in all Member States of the Council of Europe and is interpreted by the European Court of Human Rights (ECtHR). Despite its legal recognition, discrimination in healthcare provision has repeatedly been an issue of medicoethical and political consideration. In this context, minors are particularly in danger of being deprived of this fundamental right. The aim of this study is to analyze the current state of the ECtHR jurisdiction on challenges in accessing healthcare for minor patients. We conducted a systematic search of judgments by the ECtHR using the keywords "healthcare" and "child". We performed descriptive statistics and qualitative thematic analysis. Our search resulted in n = 66 judgments, which were all screened. Access to healthcare for minors played a role in n = 21 judgments, which involved applications against n = 13 countries. We formed five, partially overlapping categories, which represent recurring themes regarding the research topic. These themes are governance failure (n = 11), the status of refugee, asylum seeker or migrant (n = 5), parental home (n = 5), maternity and birth (n = 4) and others (n = 2). The normative framework of the ECtHR's jurisprudence illustrates intersections between social, legal and medicoethical aspects of minors' discrimination in the healthcare system. It emphasizes the particular vulnerability of children, who require exceptional protection. Inadequate access to healthcare manifests itself in specific situations, such as in the context of migration or staying in public institutions. Healthcare professionals need to be sensitized for such discrimination mechanisms, as they are often at the forefront of encountering structural discrimination in the healthcare system.
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Harkensee C, Andrew R. Health needs of accompanied refugee and asylum-seeking children in a UK specialist clinic. Acta Paediatr 2021; 110:2396-2404. [PMID: 33783882 DOI: 10.1111/apa.15861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 01/24/2023]
Abstract
AIM To identify health needs and healthcare access barriers of accompanied refugee and asylum-seeking (RAS) children in the North East of England, and pilot a new service model to address these. METHODS Mixed-methods study (retrospective analysis of routinely collected service data, qualitative data from focus groups) of children who attended a hospital-based specialist clinic. RESULTS Over two years, 80 children were referred to this service. Most frequent diagnoses (total n = 104) were anaemia (n = 17), neurodevelopmental (n = 12), respiratory (n = 12) and mental health (n = 9) conditions. Mild-moderate stunting (23%), overweight and obesity (41%), stunting with obesity (9%) and micronutrient deficiencies (vitamin D (66%), vitamin A (40%) and manifest (14%) or latent (25%) iron deficiency anaemia) were highly prevalent. 62% of children had experienced psychological trauma, and 39% had abnormal results in psychosocial wellbeing screening. 21% of children required secondary or tertiary care, 8% mental health referrals, and 47% were followed up in this specialist clinic. Focus groups with families and the community report unaddressed health needs and substantial barriers of access to health care. CONCLUSION Refugee and asylum-seeking children have substantial health needs and healthcare access barriers that are not routinely addressed. The authors propose a service model for healthcare provision.
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Affiliation(s)
| | - Rachel Andrew
- Paediatric Department Queen Elizabeth Hospital Gateshead UK
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Screening for Posttraumatic Stress Symptoms in Young Refugees: Comparison of Questionnaire Data with and without Involvement of an Interpreter. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136803. [PMID: 34202802 PMCID: PMC8297356 DOI: 10.3390/ijerph18136803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
Background: The substantial number of young refugees who have arrived in Europe since 2015 requires rapid screening to identify those in need of treatment. However, translated versions of screening measures are not always available, necessitating the support of interpreters. The Child and Adolescent Trauma Screen (CATS) is a validated questionnaire for posttraumatic stress symptoms. Here, we report on the psychometric properties of the CATS in a sample of young refugees as a function of interpreter involvement. Methods: A total of N = 145 (Mage = 16.8, SD = 1.54; 93% male) were assessed with the CATS, with half of the screenings conducted with and half without interpreters. Post hoc analyses included calculating internal consistency using Cronbach’s α. We used confirmative factor analysis to investigate the factor structure. Results: The CATS total scale showed good reliability (α = 0.84). Differences in psychometric properties between the interpreter vs. the no interpreter group were minor and tended to be in favor of the interpreter group. Results of a confirmatory factor analysis were acceptable after the exclusion of items with low item-scale correlations. Conclusions: The sample and the administration of the assessment represent the situation of young refugees in Germany, where resources are low and translated versions not always available. The CATS may be a helpful screening tool for clinicians working with young refugees, even when administered with an interpreter. Limitations include the post hoc design of the analysis without randomization of participants and the lack of a third comparison group using translated questionnaire versions.
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Impact of the COVID-19 Pandemic on Habilitating Residential Communities for Unaccompanied Minors during the First Lockdown in Italy: The Educators' Relational Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116166. [PMID: 34200324 PMCID: PMC8201084 DOI: 10.3390/ijerph18116166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
Abstract
(1) Background: Italian residential communities for unaccompanied minors suffered a long period of closure during the SARS-COV2 lockdown. Professional educators who work inside these institutions with the aim to habilitate children toward life-span achievements faced a great challenge and responsibility during this period. In this context, the psychological well-being and development of unaccompanied children were at high risk. The aim of this study was to investigate the impact of the lockdown on children living in residential communities from the educators’ perspective and to explore whether the educators’ relational lens was related to their perception and sense-making. (2) Methods: We conducted a mix-method study enrolling 21 educators in 10 residential communities who completed an interview and a self-construal scale. (3) Results: The interview was analyzed by a qualitative content method revealing 10 themes (social relationships, stand-by, emotions, new activities, new norms acceptance, end of lockdown, time, space, resilience, and achievements). Moreover, correlation analyses were performed to test the possible association between RISC and themes that emerged from the interviews, showing significant associations with four interview themes. (4) Conclusions: Our study highlights considerable lockdown effects on residential communities and the importance of educators’ relational approach, a tool for habilitating children and a protective factor against emotional overwhelming.
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Vizard E, Gray J, Bentovim A. The impact of child maltreatment on the mental and physical health of child victims: a review of the evidence. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThis article gives a general overview of the current situation in relation to a range of widely recognised and also newly identified types of child maltreatment. The academic and clinical evidence relating to the impact of child maltreatment on the mental and physical health of child victims is substantial and steadily increasing in volume. New types of abuse are being identified, and changing environmental circumstances, which exacerbate the possibility of widely recognised types of child maltreatment occurring, are also being described. These include multi-type maltreatment, female genital mutilation and online child maltreatment. Serious questions may arise regarding neglect of the moral and social development of children and young people who become addicted to online gaming and pornography. Multiple national and local definitions of each of these existing and new forms of maltreatment have been created, some of which are covered here. The impact of these abuses on the physical and mental health and development of child victims in families or settings where abuse or neglect has occurred is discussed.
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Sangmo L, DiRisio AC, D'Andrea MR, Singer-Pomerantz S, Baranowski KA. The Experiences of Minors Seeking Asylum in the United States: A Modified Consensual Qualitative Research Analysis. J Trauma Stress 2020; 33:882-893. [PMID: 33219578 DOI: 10.1002/jts.22627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/08/2022]
Abstract
Minors fleeing violence in their countries of origin constitute a significant portion of asylum seekers in the United States. Medical and mental health professionals provide continuity care services and offer pro bono forensic evaluations for this population to document evidence of human rights abuses and torture. The present study included a retrospective, qualitative chart review of deidentified personal declarations and clinician medico-legal affidavits associated with 36 asylum seekers under 21 years of age. Data were analyzed through a modified consensual qualified research (CQR-M) approach to identify patterns in these individuals' reports of persecution and assess health outcomes. Among the cases studied, violence by organized criminal groups (47.2%), family-based violence (44.4%), and gender-based violence (44.4%) were the most commonly cited reasons minors sought asylum. Evaluators documented a wide range of psychological sequelae: 80.5% of minors presented with clinically significant symptoms associated with trauma- and stressor-related disorders, depression, and/or anxiety at the time of their applications for asylum. Of note, almost three-quarters of the minors reported current enrollment in school and two-thirds reported factors related to adaptive functioning. Despite reported exposure to premigratory and migratory trauma, postmigratory stressors, and psychological sequelae related to their experiences of violence, these young asylum seekers exhibited signs of resilience and a range of health-promoting strengths.
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Affiliation(s)
- Lodoe Sangmo
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aislyn C DiRisio
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Megan R D'Andrea
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Kim A Baranowski
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Walg M, Angern JS, Michalak J, Hapfelmeier G. [Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:369-379. [PMID: 32880227 DOI: 10.1024/1422-4917/a000749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial Abstract. Unaccompanied minor refugees (UMR) are a group particularly vulnerable to mental illness. They pose a great challenge not only for child and youth psychiatric and psychotherapeutic care, but also for youth-welfare institutions. The study examines the effectiveness of Stabilization Training for Adolescent Refugees with Trauma Induced Disorders in inpatient youth-welfare facilities. Methods: We conducted a randomized controlled trial with pre-post design in a naturalistic setting, randomly assigning 9 housing groups for UMRs to the intervention or waiting control condition. The mental stress of 46 UMRs was assessed by both self-report and educational staff-report. Two educational staff members conducted the Stabilization Training for Adolescent Refugees with Trauma Induced Disorders as an intervention in each of the respective residential groups. Results: Participation in training led to a reduction in subjective general psychological stress. At the end of the training, psychological stress in self-judgment was significantly lower in the intervention group than in the waiting control condition. The effectiveness of the training is apparently not reflected by educational staff assessments. Conclusions: Stabilization training is a suitable instrument for the preclinical care of UMR and thus an essential basis for further psychotherapy.
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Affiliation(s)
- Marco Walg
- Zentrum für seelische Gesundheit des Kindes- und Jugendalters, Sana-Klinikum Remscheid
| | - Johanna Sophie Angern
- Zentrum für seelische Gesundheit des Kindes- und Jugendalters, Sana-Klinikum Remscheid
| | - Johannes Michalak
- Department für Psychologie und Psychotherapie, Universität Witten/Herdecke
| | - Gerhard Hapfelmeier
- Zentrum für seelische Gesundheit des Kindes- und Jugendalters, Sana-Klinikum Remscheid
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Distorted Time Perspective in Adolescent Afghan and Syrian Refugees Is Associated With Psychological Distress. J Nerv Ment Dis 2020; 208:729-735. [PMID: 32541396 DOI: 10.1097/nmd.0000000000001194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Young refugees are a high-risk group for mental disorders, particularly for posttraumatic stress disorder (PTSD). Individuals with PTSD suffer from an altered time perspective with a focus on negative experiences in the past and a disregard for positive life events and the future. This study investigates time perspectives and psychological distress in 30 adolescent refugees from Syria and Afghanistan in Germany. Time perspective was assessed using the Zimbardo Time Perspective Inventory. The refugees exhibited a distorted time perspective that is common for individuals with PTSD: a high orientation toward the negative past and a low orientation toward the positive past and future. A high orientation toward the negative past was associated with high levels of general psychological distress, PTSD symptoms, and depression. A low orientation toward the future was related to high levels of anxiety. Taking time perspective and corresponding beliefs into consideration may be advantageous when treating refugees with trauma-related disorders.
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A System Model of Post-Migration Risk Factors Affecting the Mental Health of Unaccompanied Minor Refugees in Austria-A Multi-Step Modeling Process Involving Expert Knowledge from Science and Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145058. [PMID: 32674357 PMCID: PMC7400142 DOI: 10.3390/ijerph17145058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 11/24/2022]
Abstract
Various studies have indicated that unaccompanied minor refugees (UMRs) have a higher risk of suffering from mental health problems than do accompanied minor refugees and general population norm. However, only a few studies provide data on UMRs regarding post-migration risk factors, their interrelations, and their influence on mental health. In this study, system models of post-migration risk factors for mental health and their interactions were developed in the case of Austria. In three consecutive interactive workshops with scientists and practitioners, fuzzy-logic cognitive mapping techniques were used to integrate the experts’ knowledge. The resulting final system model consists of 11 risk factors (e.g., social contacts in the host country, housing situation, or professional health care services). The model provides a deeper insight into the complexity of interrelated direct, indirect, and reciprocal relations, as well as self-reinforcing triads. This systemic approach provides a sound basis for further investigations, taking into account the inherent complex multifactorial dependencies in this topic.
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Fegert JM, Vitiello B, Plener PL, Clemens V. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health 2020; 14:20. [PMID: 32419840 PMCID: PMC7216870 DOI: 10.1186/s13034-020-00329-3] [Citation(s) in RCA: 854] [Impact Index Per Article: 213.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including-but not restricted to-child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. CONCLUSION There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.
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Affiliation(s)
- Jörg M. Fegert
- grid.6582.90000 0004 1936 9748Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany
| | - Benedetto Vitiello
- grid.7605.40000 0001 2336 6580Division of Child Neurology and Psychiatry, Regina Margherita Pediatric Hospital, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Paul L. Plener
- grid.6582.90000 0004 1936 9748Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany ,grid.22937.3d0000 0000 9259 8492Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Vera Clemens
- grid.6582.90000 0004 1936 9748Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany
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Begemann M, Seidel J, Poustka L, Ehrenreich H. Accumulated environmental risk in young refugees - A prospective evaluation. EClinicalMedicine 2020; 22:100345. [PMID: 32510048 PMCID: PMC7264975 DOI: 10.1016/j.eclinm.2020.100345] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Recently, we reported a strong, disease-independent relationship between accumulated preadult environmental risks and violent aggression later in life. Risk factors were interchangeable, and migration was among the explored risks. Alarmed by these data, we assessed collected risk load in young 'healthy' refugees as a specific subgroup of current migration streams and evaluated first signals of behavioral abnormalities. METHODS In 9 German refugee centers, n = 133 young refugees, not previously in contact with the health system, were recruited, many of them unaccompanied minors. Risk factors experienced apart from migration/refuge were carefully assessed: Traumatic experiences before/during/after flight (including war, genocide, human trafficking, torture, murder, slavery, terrorist attacks), urbanicity, physical and sexual abuse, problematic alcohol and cannabis use (lifetime). Evaluation comprised physical exam and psychopathology screening. FINDINGS Refugees arrived in Germany via Eastern Mediterranean/Balkan route (34.6%), from Africa via Central Mediterranean route (39.1%), by plane (17.3%) or other routes, such as Western Mediterranean or Atlantic (9.0%). Flight reasons were war/expulsion (25.6%), persecution/threats to life (51.9%), economical/others (22.5%). On top of migration/refuge, 42.8% of subjects had ≥3 risk factors; only 4.5% of refugees had no additional risks. Global level of functioning and severity of psychopathology were strongly associated with number of accumulated risks (Jonckheere-Terpstra trend-test: p = 7.61 × 10-7 and p = 3.62 × 10-7, respectively). INTERPRETATION Young refugees, arriving in hosting countries with alarming 'risk burden', should be considered as highly vulnerable towards development of global functional deficits, behavioral abnormalities, and neuropsychiatric disorders. Rapid proactive integration or sustainable support of those who will return to rebuild their countries are mandatory. FUNDING The Max Planck Society supported this work.
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Affiliation(s)
- Martin Begemann
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
- Department of Psychiatry & Psychotherapy, University Medical Center, Göttingen, Germany
| | - Jan Seidel
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Luise Poustka
- Department of Child & Adolescent Psychiatry & Psychotherapy, University Medical Center Göttingen, Germany
| | - Hannelore Ehrenreich
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
- Corresponding author.
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Bauer JM, Brand T, Zeeb H. Pre-migration socioeconomic status and post-migration health satisfaction among Syrian refugees in Germany: A cross-sectional analysis. PLoS Med 2020; 17:e1003093. [PMID: 32231355 PMCID: PMC7108713 DOI: 10.1371/journal.pmed.1003093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The large increase in numbers of refugees and asylum seekers in Germany and most of Europe has put the issue of migration itself, the integration of migrants, and also their health at the top of the political agenda. However, the dynamics of refugee health are not yet well understood. From a life-course perspective, migration experience is associated with various risks and changes, which might differ depending on the socioeconomic status (SES) of refugees in their home country. The aim of this paper was to analyze the relationship between pre-migration SES and self-reported health indicators after migration among Syrian refugees. Specifically, we wanted to find out how their SES affects the change in health satisfaction from pre- to post-migration. METHODS AND FINDINGS We used data from the 2016 refugee survey, which was part of the German Socio-Economic Panel (GSOEP). Although cross-sectional by design, this survey collected information referring to the current situation as a refugee in Germany as well as to their situation before migration. Using a sample of 2,209 adult Syrian refugees who had entered Germany between 2013 and 2016, we conducted a cross-sectional and a quasi-longitudinal (retrospective) analysis. The mean ± SD age was 35 ± 11 years, with 64% of the participants being male. Our results showed a positive association between pre-migration self-reported SES and several subjective health indicators (e.g., health satisfaction, self-reported health, mental health) in the cross-sectional analysis. However, the quasi-longitudinal analysis revealed that the socioeconomic gradient in health satisfaction before migration was strongly attenuated after migration (SES-by-time interaction: -0.48, 95% CI -0.61 to -0.35, p < 0.001; unstandardized regression coefficients, 5-point SES scale and 11-point health outcome scale). Similar results were produced after controlling for sociodemographic characteristics, experiences during the migration passage, and the current situation in Germany. A sex-stratified analysis showed that while there was some improvement in health satisfaction among men from the lowest SES over time, no improvement was found among women. A limitation of this study is that it considers only the first months or years after migration. Thus, we cannot preclude that the socioeconomic gradient regains importance in the longer run. CONCLUSIONS Our findings suggest that the pre-migration socioeconomic gradient in health satisfaction is strongly attenuated in the first years after migration among Syrian refugees. Hence, a high SES before crisis and migration provides limited protection against the adverse health effects of migration passage.
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Affiliation(s)
- Jan Michael Bauer
- Department of Management, Society and Communication, Copenhagen Business School, Copenhagen, Denmark
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- * E-mail:
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