Promoting Mental Health in Unaccompanied Refugee Minors: Recommendations for Primary Support Programs

Comparative Evaluation of Health Status of Syrian Refugee and Tur CCH_70042 kish Children, Alongside the Factors Influencing Sociocultural Adaptation of Syrian Children in Türkiye

BACKGROUND

The objective of this study encompasses two distinct facets. First, it aims to provide a comprehensive analysis of the comparative assessment of psychosocial wellbeing and oral health status among Syrian and Turkish children in Türkiye. Secondly, it aims to elucidate the factors that play a role in shaping the sociocultural adaptation of Syrian children.

METHODS

A cross-sectional survey assessing self-esteem, social anxiety and resilience and clinical examination were conducted on a convenience sample of Syrian refugee and Turkish children. The sample consisted of 396 participants (55.7% male and 44.3% female), including 173 Syrian individuals (43.7%) with a mean age of 14.12 years (SD = 2.24), and 223 Turkish individuals (56.3%) with a mean age of 12.44 years (SD = 2.47). Sociocultural adaptation and perceived discrimination scales were also taken by refugee children.

RESULTS

Overall, psychosocial wellbeing, academic success and oral health outcomes of refugee participants were lower than those of the Turkish general population. Specifically, independent samples t-test revealed that Syrian refugee children exhibited higher levels of social anxiety (t(384) = 3.138, p < 0.005), higher resilience (t(384) = 3.866, p < 0.001), lower self-esteem (t(389) = 4.614, p < 0.001) and poorer academic performance (t(370.981) = -8.441, p < 0.001) compared to Turkish children. In terms of oral health, Syrian children exhibited significantly higher levels of dental health problems, including DMFT (t(394) = 4.203, p < 0.001), DMFS (t(394) = 4.858, p < 0.001) and PPD (t(394) = 15.09, p < 0.001) than their Turkish counterparts. A one-way ANOVA showed that socio-economic status was an important factor in psychosocial and oral health outcomes, except for psychological resilience (F(2,378) = 0.029, p = 0.971). Children from low socioeconomic backgrounds showed higher levels of social anxiety (F (2,376) = 10.704, p = 0.00), lower academic performance (F(2,365) = 33.119, p = 0.00) and poorer oral health outcomes including DMFT (F(2,381) = 7.230, p = 0.001), DMFS (F(2,381) = 4.983, p = 0.007) and PPD (F(2,381) = 22.463, p = 0.00). Pearson correlation analyses indicated that sociocultural adaptation of refugees was positively associated with their resilience (r = 0.45, p < 0.01), and negatively associated with perceived discrimination (r = -0.34, p < 0.01).

CONCLUSION

The findings underscore the need for integrated healthcare interventions that address the multifaceted health needs of vulnerable populations in diverse societies.

Goal-oriented practices in youth mental health and wellbeing settings: A scoping review and thematic analysis of empirical evidence

INTRODUCTION

Goal-oriented practices involve practitioners working collaboratively with clients to identify, develop and focus on objectives for the therapeutic work. It has been suggested that the key mechanism underpinning goal-oriented practices with young people is the development of epistemic trust via the foundation of open communication, along with shared decision-making: including young people in decisions about their care. However, goal-oriented work in practice is variable in scope and content, with no research consensus on what it entails, the mechanisms of change and reported outcomes.

METHOD

This research aims to map the extent, range and nature of the evidence-base for goal-oriented practices, including gaps, through a synthesis of the available empirical evidence from the past 20 years. A scoping review of 9783 studies published from 2003 onwards was conducted.

RESULTS

In total, 116 studies were identified for inclusion in the review, focusing on goal-oriented practices specifically related to the mental health and wellbeing of children and young people aged 0-18 (including caregivers as relevant). Alongside presentation of the key elements of the included studies, three themes were developed relating to the features of mental health and wellbeing goal-oriented practice in the contexts of the studies: Conceptual and Empirical Constructs of Goal-Oriented Practices, Quality and Making 'Good' Goals, and The Socio-Cultural Contexts of Goal-Oriented Practice.

CONCLUSION

Several areas for future research are identified that will build on this evidence, and further understanding in this area. Work towards the development of best practice principles will move practice towards transparency in the understanding and delivery of goal-oriented practices.

Associations of stressful life events with stress symptoms and well-being of adolescent refugees: mediation by post-migration stressors and protective resources?

OBJECTIVE

This paper focuses on the relationship between stressful life events experienced by young refugees and their reports of psychological and somatic stress symptoms and well-being. It examines whether this relationship is mediated by personal and social resources and by acculturation hassles experienced in the host country.

METHODS

Path analyses were calculated based on data from 147 adolescents aged 11 to 18 years from the Middle East after their flight to Germany to test the proposed mediation model.

RESULTS

The number of experienced stressful life event types was directly linked to current psychological and somatic stress symptoms. The association with psychological stress symptoms was partially mediated by acculturation hassles experienced in the host culture. Well-being was not related to stressful life events but showed significant associations with available social resources. A closer inspection of the mediation by acculturation hassles showed that discrimination hassles and socio-cultural adaptation hassles are important mediators in the relationship between stressful life events and the included outcome variables.

CONCLUSION

The results indicate that stressful life events as well as resources and acculturation hassles should be considered in measures to improve the adjustment of young refugees.

Post-Traumatic Stress Disorder in Unaccompanied Refugee Minors: Prevalence, Contributing and Protective Factors, and Effective Interventions: A Scoping Review

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.

Evaluating a Social-Emotional Training Program for Refugee Families and Service Providers: Pilot Study

BACKGROUND

Refugee children are often exposed to adversities that present a threat to their healthy development. Promoting refugee children's social-emotional capacities may be an opportune, strengths-based avenue to nurture their resilience, coping strategies, and mental health outcomes amid these risks. Furthermore, supporting caregivers' and service providers' capacities to provide strengths-based care may result in more sustainable, caring environments for refugee children. However, culturally adapted initiatives that aim to promote social-emotional capacities and mental health in refugee children, caregivers, and service providers are limited.

OBJECTIVE

In this pilot study, we aimed to assess the feasibility and efficacy of a brief, 3-week social-emotional training program for refugee caregivers of children aged between 2 and 12 years and service providers who support refugees. This study had 3 central objectives. First, we examined whether refugee caregivers' and service providers' knowledge of core social-emotional concepts increased from pre- to posttraining, whether these increases were maintained 2 months later, and whether caregivers and service providers reported a high use of training-based strategies after the training. Second, we assessed if refugee caregivers reported any improvements in their children's social-emotional capacities and mental health from pre- to posttraining and 2 months later. Finally, we evaluated whether caregivers and service providers experienced any improvements in their own mental health symptoms from pre- to posttraining and 2 months later.

METHODS

A total of 50 Middle Eastern refugee caregivers of children (n=26) aged between 2 and 12 years and service providers (n=24) were recruited using convenience sampling and participated in a 3-week training program. Training sessions were delivered via a web-based learning management system and involved a combination of asynchronous (video-based) and synchronous (web-based live group) sessions. The training was evaluated using an uncontrolled pre-, post-, and 2-month follow-up design. Caregivers and service providers reported their understanding of social-emotional concepts and mental health at pre-, post-, and 2 months after training and reported their use of training strategies after training. Caregivers reported their children's social-emotional capacities and mental health through a presurvey, a series of postsurveys (after each module session and 1 week after the training), and a 2-month follow-up survey. The participants also reported their demographic information.

RESULTS

Caregivers' and service providers' knowledge of social-emotional concepts increased significantly from pre- to posttraining, and the service providers' knowledge increase was sustained at the 2-month follow-up. Both caregivers and service providers reported high levels of strategy use. Furthermore, 2 markers of children's social-emotional development (ie, emotion regulation and sadness over wrongdoing) improved after training.

CONCLUSIONS

The findings highlight the potential of strengths-based, culturally adapted social-emotional initiatives to support refugee caregivers' and service providers' abilities to provide high-quality social-emotional care to refugee children.

Age and environmental factors predict psychological symptoms in adolescent refugees during the initial post-resettlement phase

BACKGROUND

Adolescent refugees are at high risk of developing mental disorders but are often not recognised early. This pilot study aimed to identify early putative risk factors associated with psychological symptoms in newly resettled refugee youth at potential risk of subsequently developing mental disorders.

METHODS

Newly resettled adolescent refugees were recruited through English language schools in Melbourne, Australia. Participants were assessed with the MINI-Kid, Achenbach Youth Self-Report and Reaction of Adolescents to Traumatic Stress scale. Parents completed a mental health screening separately. Linear regression models were used to identify predictive factors associated with symptom ratings.

RESULTS

Seventy-eight, ostensibly well, refugee adolescents (mean age = 15.0 ± 1.6 years) resettled in Australia for 6.1 ± 4.2 months were assessed. Levels of anxiety, depression and post-traumatic stress symptoms were considerably lower than in mainstream population data. Prior displacement was a key determinant of symptomatology. Transitory displacement, irrespective of duration, was associated with elevated scores for depression (t (47) = -4.05, p < 0.0001), avoidance/numbing (U = 466, p < .05) and total trauma (U = 506, p < .05) symptoms. Older age was a unique predictor of depression (F (1,74) = 8.98, p < .01), internalising (F(1,74) = 6.28, p < .05) and total (F(1,74) = 4.10, p < .05) symptoms, whilst parental depression symptoms (t = 2.01, p < 0.05), displacement (t = 3.35, p < 0.01) and, expectedly, trauma exposure (t = 3.94, p < 0.001) were unique predictors of post-traumatic stress symptoms.

CONCLUSIONS

Displaced status, older age, and parental symptoms predicted psychological symptoms in adolescent refugees in an initial relatively asymptomatic post-resettlement phase. The early recognition of at-risk refugee youth may provide an opportunity for preventative mental health interventions.

The Development of a Mental Health Program for Unaccompanied Minors in the United States

The unique needs of unaccompanied children (UC) and unaccompanied refugee minors (URM) often make it challenging for them to engage in traditional mental health services. This paper describes the development and implementation of a mental health program for UC and URM using a collaborative approach with key stakeholders. In the Exploration phase, we conducted an assessment of youths' mental health needs, barriers to, and recommendations for care through discussions with community partners. Next, we describe the Preparation phase in which we designed the program around three major domains: 1) training and consultation, 2) cross-sector collaboration, and 3) direct services. Discussion of the Implementation phase includes a description of youth served and program materials. Finally, the Sustainment phase focuses on recommendations for best practice informed by successes and challenges of program implementation. Findings have implications for future mental health programming for UC/URM.

Different Relations of Religion and Mental Health

Abstract. Background: Religiosity can foster mental health after traumatic experiences. Yet, religiosity among Muslim immigrants has also been linked to separation-oriented acculturation, which is linked to reduced mental health. Therefore, the function of religiosity for resilience in Middle Eastern refugee and immigrant adolescents might differ as their migration contexts differ in terms of traumatic experiences and the nature of cultural interactions . Aims: This study examined whether religiosity is associated with better mental health after traumatic experiences, particularly among young refugees. In addition, it was explored whether religiosity is associated with better mental health among refugees through less marginalization and whether religious immigrant peers show worse mental health through stronger separation. Method: 135 adolescents ( MAge = 18.25 years, SD = 1.73; nrefugees = 75, nimmigrants = 60) completed self-reports on religiosity, mental health, trauma, and acculturation orientations. Regression analyses were calculated examining group-specific differences in potential moderating effects of religiosity on the relationship between trauma exposures and internalizing symptoms. Furthermore, potential indirect effects of religiosity on internalizing symptoms via acculturation orientations were investigated. Results: Stronger religiosity was associated with better mental health following trauma exposure. No group-specific differences were observed. While religious refugee adolescents reported less marginalization associated with fewer internalizing symptoms, religious immigrant peers reported more separation and internalizing symptoms. Limitations: Results are limited to male Muslim adolescents in Germany. The cross-sectional nature prohibits any implications for causal dynamics in the associations. Conclusion: Religiosity is generally protective against post-traumatic consequences, but associations with acculturation differ across migration contexts.

Health-related quality of life in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden: a nation-wide, cross-sectional study

PURPOSE

To examine health-related quality of life (HRQoL) in refugee minors resettled in Sweden and compare results to a European reference population, while exploring associations between sociodemographic factors and HRQoL dimensions.

METHODS

A cross-sectional, nation-wide study was conducted with a stratified sample of refugee minors ages 12-15 and 16-18 from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018. HRQoL was measured using KIDSCREEN-27. HRQoL dimension scores of the sample were compared to mean scores of European age and gender-matched reference population. Associations between sociodemographic factors and HRQoL dimensions were investigated with independent t tests and ANOVA. A multivariable regression analysis was performed to identify the sociodemographic factors associated with HRQoL.

RESULTS

The questionnaire was sent to 10,000 potential respondents. The response rate was 26%, yielding n = 2559 refugee minors (boys 55%, girls 45%) in the study sample. Compared to European references, minors in the present study had significantly lower scores of HRQoL within psychological wellbeing and peers and social support, whereas levels for autonomy and parent/guardian relations and school environment were higher. Several sociodemographic factors were significantly associated with all HRQoL dimensions, with those 16-18 years old, having average or poor family economy, and living with an unrelated adult or family reporting lower levels of HRQoL. Minors from Afghanistan had significantly lower scores of HRQoL for all dimensions compared to those from Iraq and Syria.

CONCLUSION

Refugee minors had significantly lower levels of HRQoL for psychological wellbeing and peers and social support compared to European references. Future research should further investigate this potential HRQoL gap further.

Refugee Children's Social-Emotional Capacities: Links to Mental Health upon Resettlement and Buffering Effects on Pre-Migratory Adversity

Refugee children who experience severe pre-migratory adversity often show varying levels of mental health upon resettlement. Thus, it is critical to identify the factors that explain which refugee children experience more vs. less healthy outcomes. The present study assessed child social-emotional capacities (i.e., emotion regulation, sympathy, optimism, and trust) as potential moderators of associations between child, parental, and familial pre-migratory adversities and child mental health (i.e., internalizing and externalizing symptoms) upon resettlement. Participants were N = 123 five- to 12-year-old Syrian refugee children and their mothers living in Canada. Children and mothers reported their pre-migratory adverse life experiences, and mothers reported their children's current social-emotional capacities, internalizing symptoms, and externalizing symptoms. Greater familial (i.e., the sum of children's and their mother's) pre-migratory adversity was associated with higher child internalizing and externalizing symptoms upon resettlement. Higher emotion regulation and optimism were associated with lower internalizing and externalizing symptoms, and higher sympathy was associated with lower externalizing symptoms. In contrast, higher trust was associated with higher internalizing symptoms. Finally, higher child optimism buffered against the positive association between familial pre-migratory adversity and child internalizing symptoms. In sum, select social-emotional capacities may serve as potential protective factors that support mental health and buffer against the deleterious effects of pre-migratory adversity in refugee children.

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

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.

Accumulated environmental risk in young refugees - A prospective evaluation

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.

The Role of Emotional Intelligence and Sociocultural Adjustment on Migrants' Self-reported Mental Well-Being in Spain: A 14 Month Follow-Up Study

The analysis of mental and psychological health is a relevant public issue in modern societies. Migration is a process that may have a lasting impact on a person's mental well-being. In this study, perceived health, emotional intelligence, sociocultural adjustment and the participants' perceived general situation, not only economical, were analyzed to attest their impact on psychological distress as a measure of mental well-being. Sixty-three migrants from Romania and Ecuador were contacted twice during a 14 month period in a middle-sized Spanish city. Attrition analyses show no significant differences in perceived psychological distress between those who participated only one time or who participated in both waves. Less psychological distress is related to less attention to one's feelings and higher mood repair in both data waves. Stronger behavioral adjustment is also linked to less distress. Less distress in time 1 led to better perceived health, sociocultural adjustment and a perception of a better general situation in Spain in comparison to their home country in time 2. In general, more attention to negative feelings triggered more perceived psychological distress, whereas mood repair elicited less psychological distress, in time 2. The relevance of understanding the impact of emotional intelligence to health promotion programs with migrants is discussed.

Clinical profile and care pathways among unaccompanied minor asylum seekers in Vaud, Switzerland

Objectives The objectives of this study were to describe the overall clinical profile (somatic and psychological health) and the care pathways of unaccompanied minor asylum seekers (UMAS) who arrived in the Swiss canton of Vaud in 2015. Methods This was a retrospective study based on information extracted from the medical files of 109 patients over 1 year of follow-up. All the reasons for consultation and referrals as well as the diagnoses made were noted and coded using ICD-10. The healthcare providers for all diagnoses and referrals were also noted. Results Our sample was predominantly male (87.2%) and hailed primarily from Eritrea (39.4%) and Afghanistan (32.1%). Gatekeeping nurses at a specialized migrant care facility (MCF) referred 67.7% of the UMAS to other providers for further medical care, including 45.4% to the Interdisciplinary Division for Adolescent Health (DISA). However, 46.8% of the 109 UMAS also sought care at other structures without any referral by MCF or DISA as intended. Of the patients 39.4% were found to have at least one mental health problem, mainly functional disorders (21.1%), symptoms and episodes of depression (17.4%), symptoms of post-traumatic stress disorder (PTSD) (13.8%) and sleeping disorders (12.8%). The most common diagnoses of infectious diseases included community-acquired respiratory infections (43.1%), scabies (20.2%) and cases of skin abscesses and furuncles (13.8%). In fewer instances, cases of active tuberculosis (3.7%), chronic hepatitis B (2.8%), intestinal parasites (1.8%) and gastritis caused by Helicobacter pylori (1.8%) were also diagnosed. A significant proportion of UMAS presented traumatological (30.3%) and ophthalmological (25.7%) problems. Among the female UMAS (12.8% of the sample), evidence of genital mutilation (21.4%), pregnancy (21.4%) and abortion (14.3%) was common. Conclusions An integrated approach involving efficient coordination between different providers is necessary in order to respond adequately to the major healthcare needs of UMAS. Special attention should be paid to mental health.

Practitioner Review: Mental health problems of refugee children and adolescents and their management

BACKGROUND

Since 2010, the numbers of refugees have increased and around half are under 18 years of age. It is known that experience of organised violence, displacement and resettlement increases the risk for psychiatric disorders and psychosocial impairment. This review integrates recent research into the risk and protective factors for psychopathology with service and treatment issues.

METHODS

We draw on and critically evaluate key systematic reviews in the selected areas, innovative robust studies and relevant government reports.

RESULTS

Many refugee children show resilience and function well, even in the face of substantial adversities. The most robust findings for psychopathology are that PTSD, and posttraumatic and depressive symptoms are found at higher prevalence in those who have been exposed to war experiences. Their severity may decrease over time with resettlement, but PTSD in the most exposed may show higher continuity. More severe psychiatric disorders including psychosis may also occur. Service delivery needs to take into account socioeconomic and cultural influences but, given the high level of unmet need even in high-income countries, stepped care delivery is required. The evaluation of psychological interventions, often delivered in group settings, suggests that they can be effective for many distressed children; however, for the more impaired, a greater range of disorder-specific therapies will be required.

CONCLUSIONS

Child and adolescent mental health clinicians and service providers need to be aware of the specific needs of this population and systems for service delivery. There are significant knowledge gaps in understanding risk and vulnerability, service delivery and treatment effectiveness.

A Brief Introduction to the Multidimensional Intercultural Training Acculturation Model (MITA) for Middle Eastern Adolescent Refugees

The large number of adolescent refugees around the world constitutes a great challenge for societies. However, current models of acculturation have been developed for migrants, but not specifically for adolescent refugees. Crucial factors to describe adolescent refugee acculturation, such as intentions to return to their homeland, especially with respect to adolescent refugees with temporary residency and experiences of potentially traumatic events, are missing. Hence, the Multidimensional Intercultural Training Acculturation (MITA) model is introduced. The model proposes that two major concerns for adolescent refugees, which are socio-cultural adjustment and mental health, are predicted by intercultural and social–emotional competence, intentions to return to their homeland, and experiences of traumatic events. Moreover, the effects of three modes of acculturation are also proposed in the model. It is expected that these variables mediate the effects of intercultural competence, social–emotional competence, intentions to return to the homeland, and experiences of traumatic events on socio-cultural adjustment as well as mental health. Finally, it is also expected that in-group social support and out-group social support moderate the direct connection between the experiences of traumatic events and mental health.