Mental health issues in unaccompanied refugee minors.
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ABSTRACT:
SUBMITTER: Huemer J
PROVIDER: S-EPMC2682790 | biostudies-literature | 2009 Apr
REPOSITORIES: biostudies-literature
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Mental health issues in unaccompanied refugee minors.
Huemer Julia J Karnik Niranjan S NS Voelkl-Kernstock Sabine S Granditsch Elisabeth E Dervic Kanita K Friedrich Max H MH Steiner Hans H
Child and adolescent psychiatry and mental health 20090402 1
Previous studies about unaccompanied refugee minors (URMs) showed that they are a highly vulnerable group who have greater psychiatric morbidity than the general population. This review focuses on mental health issues among URMs. Articles in databases PsycINFO, Medline and PubMed from 1998 to 2008 addressing this topic were reviewed. The literature had a considerable emphasis on the assessment of PTSD symptoms. Results revealed higher levels of PTSD symptoms in comparison to the norm populations ...[more]
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Project description:ObjectivesOur aim was to summarise the current evidence regarding gender differences in the mental health of unaccompanied refugee minors (URM) and to identify gaps in research.SettingWe focused on quantitative studies presenting primary data from Organisation for Economic Co-Operation and Development(OECD)countries. Language was restricted to English or German.ParticipantsTo be eligible, a study had to involve (former) URM who immigrated to an OECD country.DesignWe conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases MEDLINE, CINAHL, LIVIVO, PSYNDEX and PsycINFO were searched from 1990 to 2017. Studies were judged for eligibility by two independent reviewers each. We narratively summarised our results.Results9 primary studies, all from Europe, examined gender differences in the mental health of URM. The majority of the included studies found female URM to be more often affected by post-traumatic or depressive symptoms than their male counterparts. There is only weak evidence regarding other mental health outcomes. Two studies each conducted gender-specific analyses on anxiety and externalising behaviour, but no statistically significant differences between female and male URM were detected.ConclusionsFemale gender is associated with a higher vulnerability towards certain mental health problems among URM residing in Europe. However, the lack of representative studies using reliable diagnostic methods indicates that the findings so far should be treated with caution. Further research is needed to clarify the role of gender for mental health in URM and to examine underlying mechanisms.
| S-EPMC6067370 | biostudies-literature
Project description:Unaccompanied refugee minors (URM) represent one of the most vulnerable refugee groups due to their young age, developmental status, and insufficient coping strategies. Clinical observations indicate that the frequency of mental health problems varies between different URM subgroups. In the present research project, clinical interviews as a source of qualitative data were combined with quantitative psychometric information in a mixed-method approach in order to study the patterns of mental health problems in 561 URM from four different language groups (Arabic, Farsi, Somali, and Tigrinya) immediately after arrival in the host country (Germany). Qualitative analysis obtained as differentiating categories "language, countries of origin, age, and gender"; quantitatively, the Refugee Health Screener (RHS-15) was applied. According to the positive screening results, the highest number of mental complaints was returned by children and adolescents speaking Farsi (65.9%) and Somali (65.8%). They were followed by URM speaking Arabic (49.4%) and Tigrinya (43.3%). The results were influenced not only by origin, but also by age (with higher burden among older Farsi-speaking URM) and gender (with higher burden among male URM). Although the prevalences in URM subgroups differ, the observed high rates of positive screening results in our sample of URM from Germany substantiate the need for early detection of mental complaints and appropriate mental health care for at least every second URM.
| S-EPMC7198874 | biostudies-literature
Project description:ObjectivesTo examine the mental health of unaccompanied refugee minors prospectively during the asylum-seeking process, with a focus on specific stages in the asylum process, such as age assessment, placement in a supportive or non-supportive facility and final decision on the asylum applications.DesignThis was a2½ year follow-up study of unaccompanied minors (UM) seeking asylum in Norway. Data were collected within three weeks (n=138) and at 4 months (n=101), 15 months (n=84) and 26 months (n=69) after arrival.SettingInitially in an observation and orientation centre for unaccompanied asylum-seeking adolescents, and subsequently wherever the UM were located in other refugee facilities in Norway.ParticipantsMale UM from Afghanistan, Somalia, Algeria and Iran.Main outcome measuresMental health symptoms assessed by Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire.ResultsAt the group level, the young asylum seekers reported high levels of psychological distress on arrival and symptom levels that stayed relatively unchanged over time. According to age-assessment procedures, 56% of the population were not recognised as minors. Subsequent placement in a low-support facility was associated with higher levels of psychological distress in the follow-up period. Those who were placed in a reception centre for adults had higher levels of psychological distress symptoms both after 15 months and 26 months compared with the remaining participants who were placed in reception centres for youth. Refusal of asylum was highly associated with higher levels of psychological distress.ConclusionMental health trajectory of young asylum seekers appears to be negatively affected by low support and refusal of asylum.
| S-EPMC5734358 | biostudies-literature
Project description:Unaccompanied refugee minors (URMs) are a group who are vulnerable to developing posttraumatic stress symptoms (PTSS). However, they rarely receive the treatment that is indicated and there are no treatment studies focusing exclusively on this group of adolescents. This case study evaluates the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for URMs with PTSS.A health care utilization sample of N = 6 was assessed prior to and after treatment with TF-CBT. Therapists were asked to report differences in treatment application and content in comparison to TF-CBT standard protocol.We found moderate to high levels of PTSS at baseline and a clinically significant decrease in symptoms at posttest. Some modifications to the TF-CBT protocol were made with regard to affective modulation which required more sessions than usual whereas fewer caregiver sessions were conducted.TF-CBT is feasible in reducing PTSS in severely traumatized URMs. Further research with controlled trials is necessary.The trial registration: ClinicalTrials.gov Identifier NCT01516827. Registered 13 December 2011.
| S-EPMC4619299 | biostudies-literature
Project description:IntroductionAsylum seekers and refugees are at an elevated risk of self-harm, with younger age and traumatic experiences found to further increase such risk. Despite this, evidence regarding self-harm among unaccompanied asylum seekers and refugee minors has not been synthesised. As self-harm among minors is a risk factor for a range of adverse clinical and social outcomes, including suicide, such information may help to inform evidence-based prevention strategies among these vulnerable populations. This systematic review will synthesise findings from the literature regarding the prevalence, methods and characteristics of self-harm, including risk and protective factors, among unaccompanied asylum seekers and refugee minors internationally.Methods and analysisWe searched key electronic databases (PsycINFO, Scopus, PubMed and Ovid MEDLINE) and grey literature for relevant studies published in English from database inception to 10 February 2023. Our primary outcome is self-harm among unaccompanied asylum seekers and/or refugee minors. With the exception of single-case studies, clinical trials and case-control studies, we will include all types of study design that examine the prevalence of self-harm in unaccompanied asylum seekers and/or refugee minors. We will exclude dissertations, conference abstracts, letters, book chapters, editorials, study registrations, registered protocols and qualitative studies. Only studies reporting on participants aged <18 years will be eligible for inclusion. The Methodological Standard for Epidemiological Research Scale will be used to assess the quality of included studies. If there are sufficient studies and homogeneity between them, we will conduct meta-analyses to calculate pooled estimates of self-harm rates, as well as comparisons between subgroups of relevance. If the studies do not report sufficient data, or there is substantial heterogeneity, we will provide a narrative synthesis of the findings.Ethics and disseminationThis review is exempt from ethics approval. Our findings will be disseminated through peer-reviewed publications and conference presentations.Prospero registration numberCRD42021292709.
| S-EPMC10255047 | biostudies-literature
Project description:Background: Given the unprecedented number of traumatized refugee minors in Europe and the increased prevalence of mental disorders such as PTSD in this vulnerable population, new methodologies that help us to better understand their symptomatology are crucial. Network analysis might help clinicians to both understand which symptoms might trigger other symptoms, and to identify relevant targets for treatment. However, to date only two studies have applied the network analysis approach to an (adult) refugee population and only three studies examined this approach in children and adolescents. Objective: The aim of this study is to explore the network structure and centrality of DSM-5 PTSD symptoms in a cross-sectional sample of severely traumatized refugee minors. Method: A total of N = 419 (M age = 16.3; 90.7% male) unaccompanied (79.9%) and accompanied (20.1%) refugee minors were recruited in five studies in southern Germany. PTSD symptoms were assessed using the Child and Adolescent Trauma Screen (CATS). The network was estimated using state-of-the-art regularized partial correlation models using the R-package qgraph. Results: The most central symptoms were nightmares, physiological and psychological reactivity, and concentration problems. The strongest connections between symptoms were established for psychological and physiological reactivity, irritability/anger and self-destructive/reckless behaviour, intrusions and nightmares, nightmares and sleep disturbance, and between concentrations problems and sleep disturbance. Conclusion: This study furnishes information relevant to research and the clinical management of PTSD in refugee minors, and also in terms of comparisons with trauma-exposed children and adolescents without a migration background. Re-experiencing symptoms seem to be central in the refugee minor PTSD profile and thus merit special consideration in the diagnostic and treatment evaluation process. Investigating the PTSD network longitudinally and complementing between-subject analyses with within-subject ones might provide further insight into the symptomatology of refugee minors and how to treat them successfully.
| S-EPMC6807914 | biostudies-literature
Project description:BackgroundInformation regarding the prevalence of infectious diseases (IDs) in child and adolescent refugees in Europe is scarce. Here, we evaluate a standardized ID screening protocol in a cohort of unaccompanied refugee minors (URMs) in a municipal region of southwest Germany.Methods and findingsFrom January 2016 to December 2017, we employed a structured questionnaire to screen a cohort of 890 URMs. Collecting sociodemographic information and medical history, we also performed a standardized diagnostics panel, including complete blood count, urine status, microbial stool testing, tuberculosis (TB) screening, and serologies for hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The mean age was 16.2 years; 94.0% were male, and 93.6% originated from an African country. The most common health complaints were dental problems (66.0%). The single most frequent ID was scabies (14.2%). Of the 776 URMs originating from high-prevalence countries, 7.7% and 0.4% tested positive for HBV and HIV, respectively. Nineteen pathogens were detected in a total of 119 stool samples (16.0% positivity), with intestinal schistosomiasis being the most frequent pathogen (6.7%). Blood eosinophilia proved to be a nonspecific criterion for the detection of parasitic infections. Active pulmonary TB was identified in 1.7% of URMs screened. Of note, clinical warning symptoms (fever, cough >2 weeks, and weight loss) were insensitive parameters for the identification of patients with active TB. Study limitations include the possibility of an incomplete eosinophilia workup (as no parasite serologies or malaria diagnostics were performed), as well as the inherent selection bias in our cohort because refugee populations differ across Europe.ConclusionsOur study found that standardized ID screening in a URM cohort was practicable and helped collection of relevant patient data in a thorough and time-effective manner. However, screening practices need to be ameliorated, especially in relation to testing for parasitic infections. Most importantly, we found that only a minority of infections were able to be detected clinically. This underscores the importance of active surveillance of IDs among refugees.
| S-EPMC7108686 | biostudies-literature
Project description:BackgroundUnaccompanied 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.MethodsMUCTUM 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).ResultsQualitative 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.ConclusionThis 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.
| S-EPMC9641960 | biostudies-literature
Project description:Unaccompanied minors (UAMs) are considered a particularly vulnerable population, facing severe threats regarding their physical and mental health. As their number has increased in recent years worldwide, research on mental health interventions has become necessary. The implementation of psychotherapeutic interventions has been documented, but psychosocial interventions seem to not have been consistently studied. In this review, we summarize the psychotherapeutic and psychosocial interventions with UAMs that have been studied up to now. Following the PRISMA guidelines for scoping reviews, we searched four databases and included studies and practice papers; there were no restrictions on publication date, geographical region, language, or method. We identified 46 studies on psychotherapeutic interventions and 16 studies on psychosocial interventions that met the inclusion criteria. Psychotherapeutic interventions were mainly based on cognitive behavioural, psychodynamic, narrative, art and transcultural approaches and aimed at improving UAMs’ trauma, mental health and wellbeing, as well as professionals’ skills and therapeutic protocols. Several studies showed promising results, with the cognitive behavioural approaches being the most researched. However, more research is needed in order to draw conclusions in terms of effectiveness. Psychosocial interventions followed various approaches and aimed at UAMs’ empowerment, wellbeing, support and integration, as well as at improving caregivers’ skills. Nonetheless, they seem not only very heterogeneous but also understudied, and we believe that a focus on them would be very useful. Methodological limitations and their implications for future research are discussed.
| S-EPMC10048295 | biostudies-literature
Project description:BackgroundPrior to the COVID-19 pandemic, crowded and unsanitary living conditions lacking medical expertise made U.S. detention centers hotbeds for infectious disease outbreaks. There have been 30,000 COVID-19 cases, positivity rates exceeding 50%, and nine deaths in Immigration and Customs Enforcement (ICE) custody, but the extent of disease among children under the care of the Office of Refugee Resettlement (ORR) has not been well-documented. We sought to evaluate the burden of COVID-19 among unaccompanied minors under the ORR's responsibility.MethodsWe analyzed SARS-CoV-2 testing results of refugees and asylum seekers in facilities associated with the ORR from 02/01/2020 to 11/18/2020, courtesy of a Freedom of Information Act request.ResultsORR facilities performed 7,132 SARS-CoV-2 tests from 3/13/2020 to 11/18/2020. Overall, the SARS-CoV-2 positivity rate was 13.4%. Factors associated with higher positivity rates were age group (16 to 17 years old); identifying as male; undergoing testing in April, August, or September; staying in a for-profit versus a non-profit facility, and detention in certain facilities. The mean detention time with a positive test was 14.8 ± 3.2 days. Greater than 10 percent of positive tests were in long-term detainees.ConclusionsThe high SARS-CoV-2 test positivity rate raises concerns about an inability to limit the spread of SARS-CoV-2 within detention facilities housing unaccompanied migrant children, particularly those run by for-profit companies. Mandated measures for social distancing and vaccination among detainees and detention facility employees are needed to limit the spread of the virus.
| S-EPMC9384626 | biostudies-literature