Prevalences of mental distress and its associated factors in unaccompanied refugee minors in Germany

Prevalences for mental disorders within minor refugees are comparatively high and heterogeneous. To reduce heterogeneity and identify high-risk subgroups, we compared unaccompanied refugee minors (URM) to accompanied refugee minors (ARM) regarding depressive symptoms and mental distress. Furthermore, we examined associative factors of mental distress in URM on a broad scale. We conducted a survey with a cross-sectional design in four German University hospitals. The sample consisted of n = 172 URM and n = 52 ARM aged 14–21. Depressive symptoms were assessed via the Patient Health Questionnaire (PHQ-9). Mental distress was assessed by the Refugee Health Screener (RHS-15). Mann–Whitney test was used to examine differences between URM and ARM. Associated factors of mental distress were evaluated via a stepwise multiple regression analysis. URM showed significantly higher mean scores for PHQ-9 (p < .001) and RHS-15 (p < .001) compared to ARM indicating medium effect sizes. Furthermore, URM were significantly more likely to surpass the cut-off for depression (61.6% vs. 30.8%) and overall mental distress (81.4% vs. 53.8%) compared to ARM. The factors Number of stressful life events (SLE), Female gender, and Fear of deportation were found to be associated with an increased mental distress in URM, whereas Weekly contact to a family member, School attendance, and German language skills were accompanied with lower distress scores. All six factors accounted for 32% of the variance of mental distress in URM (p < .001). Within minor refugees, URM are a highly vulnerable subgroup, which should receive particular attention and more targeted measures by health authorities. Our results indicate that these measures should comprise a rapid promotion of family contact, school attendance, language acquisition, and the fast processing of asylum applications. However, the cross-sectional design limits the interpretability of the results.

Overcoming barriers to mental health care: multimodal trauma-focused treatment approach for unaccompanied refugee minors

Background This study evaluated the feasibility of a short-term, multimodal trauma-focused treatment approach adapted specifically for unaccompanied refugee minors (URMs) in the Netherlands. This approach aims to overcome barriers to mental health care and to reduce symptoms of posttraumatic stress disorder (PTSD) and depression. Methods An uncontrolled study was conducted, evaluating the main request for help, treatment integrity and feasibility, and the course of symptoms of PTSD (Children's Revised Impact of Event Scale-13) and depression (Patient Health Questionnaire modified for Adolescents). Results In total, 41 minors were included in the study. Most participants were male (n = 27), predominately from Eritrea (75.6%) with a mean age of 16.5 (SD = 1.5). Minors mostly reported psychological problems, such as problems sleeping, and psychosocial problems, including worries about family reunification. Deviations from the approach were made to meet the current needs of the minors. Factors limiting the feasibility of the approach were often related to continuous stressors, such as news concerning asylum status. Conclusions The results provide a first indication that this approach partly overcomes barriers to mental health care and emphasize the added value of collaborating with intercultural mediators and offering outreach care. Trial registration: The study was registered in the Netherlands Trial Register (NL8585), 10 April 2020, Retrospectively registered, https://www.trialregister.nl/trial/8585.

The Challenges of Quantitative Surveys Among Hard-to-Survey Populations – A Case for Mixed-Methods Designs Based on a Survey With Unaccompanied Refugee Minors

Surveys of specific target groups that are hard to survey are prone to errors and biases. In this paper, we use the Total Survey Error (TSE) framework and a study on unaccompanied refugee minors (URM) in Germany to discuss how a mixed-methods quantitative-dominant research design can address challenges of quantitative-only surveys of such groups. We show that unit nonresponse and measurement are two main levels of bias that can be partly supplemented by qualitative research. In addition, taking ethical considerations into account when researching URMs affects the quality of quantitative surveys. This effect cannot be avoided, but it should be classified by researchers. We conclude that surveying hard-to-survey populations benefits from a combination of quantitative surveys and semi-structured interviews.

Mental Health Outcomes of Unaccompanied Refugee Minors: a Rapid Review of Recent Research

Purpose To examine mental health outcomes of unaccompanied refugee minors during global policy shift. Additionally, to consider mental health service delivery and placement type for this group. Methods A rapid systematic search of research published since 2018 which related to mental health outcomes of unaccompanied refugee minors. Data extracted, risk of bias assessed and outcomes reviewed qualitatively. Research Findings We found 181 papers, of which 14 met inclusion criteria. This review found consistently high levels of PTSD and PTSS among URMs in various contexts. Exposure to trauma, being unaccompanied (compared to accompanied), being female and being older are associated with poor outcomes. Depression and anxiety were consistently high among URMs and associated with discrimination, limited language attainment and daily hassles. Summary High rates of mental illness and symptoms among unaccompanied refugee minors were consistent across national and settlement contexts but the quality of the evidence is variable with significant heterogeneity of assessment. We relate persistence of poor mental health outcomes with problems accessing mental health services and discuss the role of key post-migration factors influencing outcomes—in particular placement type and the use of detention centres.

Unaccompanied refugee minors: settlement experience in Toronto

This paper begins by outlining the legal rights of unaccompanied refugee minors. The paper explores the initial settlement experience of unaccompanied refugee minors who live in Toronto. Their experiences with the Immigration and Refugee Board (IRB), their refugee hearings, and their experiences as they waited to be notified of their immigration status have been examined through primary research. Research questions that frame this project include: 1) How does the asylum process, which includes such elements as their legal rights, hearing date, and waiting for status, impact unaccompanied refugee minors’ sense of belonging, their establishment/settlement experience in Toronto, and their overall well-being? 2) How does arriving to a new place challenge and modify an existing identity, and what are the challenges unaccompanied minors face in their transition to Canada that have an effect on their identity? And, 3) How does this time in their life influence their perceptions of their future?

Unaccompanied refugee minors: settlement experience in Toronto

This paper begins by outlining the legal rights of unaccompanied refugee minors. The paper explores the initial settlement experience of unaccompanied refugee minors who live in Toronto. Their experiences with the Immigration and Refugee Board (IRB), their refugee hearings, and their experiences as they waited to be notified of their immigration status have been examined through primary research. Research questions that frame this project include: 1) How does the asylum process, which includes such elements as their legal rights, hearing date, and waiting for status, impact unaccompanied refugee minors’ sense of belonging, their establishment/settlement experience in Toronto, and their overall well-being? 2) How does arriving to a new place challenge and modify an existing identity, and what are the challenges unaccompanied minors face in their transition to Canada that have an effect on their identity? And, 3) How does this time in their life influence their perceptions of their future?