Objective Over half of the world’s refugee population are under the age of 18 years. This systematic review aims to summarize the current body of evidence for the prevalence of mental illness in child and adolescent refugee populations. Method Eight electronic databases, gray literature, and Google Scholar were searched for articles from 1 January 2003 to 5 February 2018. Strict inclusion criteria regarding the diagnosis of mental illness were imposed. Study quality was assessed using a template according to study design, and study heterogeneity using the I2 statistic. Random effects meta-analyses results were presented given heterogeneity among studies. The protocol for this systematic review was registered with PROSPERO (CRD42016046349). Results Eight studies were eligible, involving 779 child and adolescent refugees and asylum seekers, with studies conducted in 5 countries. The overall prevalence of posttraumatic stress disorder (PTSD) was 22.71% (95% CI 12.79−32.64), depression 13.81% (95% CI 5.96−21.67), and anxiety disorders 15.77% (95% CI 8.04−23.50). Attention-deficit/hyperactivity disorder (ADHD) was 8.6% (1.08−16.12) and oppositional defiant disorder (ODD) was 1.69% (95% CI −0.78 to 4.16). Because of the high heterogeneity, further subgroup analyses were conducted. Conclusion Refugee and asylum seeker children have high rates of PTSD, depression, and anxiety. Without the serious commitment by health and resettlement services to provide early support to promote mental health, these findings suggest that a high proportion of refugee children are at risk for educational disadvantage and poor social integration in host communities, potentially affecting their life course.

Systematic Review and Meta-analysis: The Prevalence of Mental Illness in Child and Adolescent Refugees and Asylum Seekers.

Severe life events and psychological symptoms were measured by self-report in unaccompanied asylum-seeking children 6 months after arrival in Norway.

Stressful life experiences and mental health problems among unaccompanied asylum-seeking children

Everyday life experiences and mental health among conflict-affected forced migrants: A meta-analysis

Unaccompanied refugee minors are a particularly vulnerable group. The aim of this study is to increase our knowledge about possible pathways to well-being and integration for unaccompanied refugee minors as they strive to establish new lives in a host county. The present study followed a group of youth who fled to Norway without their caregivers at three time points; 6 months (n = 95; M age = 13.8, 80% boys), 2 years (n = 78; M age = 16.5, 83% boys), and 5 years (n = 47; M age 20.0, 83% boys) after arrival. Linear mixed effects models were used to assess whether age, gender, and trauma exposure prior to arrival were associated with levels and changes in symptoms of posttraumatic stress (PTS), depression, anxiety, and externalizing symptoms over time. Regression analyses were conducted to examine whether daily hassles, perceived social support, and new trauma experiences predict PTS, internalization, externalization, and somatization. The mean levels of depression had decreased significantly at 5 years, but mean levels of anxiety, PTS, and externalizing symptoms did not. Females and severely trauma exposed had higher levels of symptoms. Higher age was associated with less change in symptoms of depression and posttraumatic stress over time. Five years after arrival, many still experienced clinical levels of mental health problems, and level of daily hassles was an important predictor. Support may be needed not only at arrival to handle mental health problems in general and posttraumatic stress in particular, but also after resettlement. Help to manage daily hassles may be especially important to ensure well-being and integration.

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Long-term mental health in unaccompanied refugee minors: pre- and post-flight predictors.

Climate change is a worldwide challenge. Its consequences do encompass severe threats not only for the existence and somatic health, but also for the mental health of children and adolescents. Mental health can be impaired by three types of consequences. Direct consequences of climate change, such as natural disasters and indirect consequences, such as loss of land, flight and migration, exposure to violence, change of social, ecological, economic or cultural environment. Moreover, the increasing awareness of the existential dimension of climate change in children and adolescents can influence their well-being or challenge their mental health. Consequences of climate change for somatic health may interact with mental health or have psychological sequelae in children and adolescents. Based on the estimates by the United Nations Intergovernmental Panel on Climate Change, we have summarized current data on these differential pathways as to how climate change affects the mental health of children worldwide through selective literature research on Pubmed. Mental health sequelae of direct and indirect consequences of climate change, increased awareness and physical health problems caused by climate change are presented. We give insights into special vulnerabilities of children and adolescents and identify high-risk groups. As the "Fridays for Future" movement has been initiated in northern Europe, we will discuss these results with a focus on children and adolescents in Europe. The results indicate that climate change is a serious threat to children and adolescent mental health. Children´s rights, mental health and climate change should not continue to be seen as separate points; instead, they need to be brought together to address this major challenge determining the future of our children and their descendants.

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Report of the intergovernmental panel on climate change: implications for the mental health policy of children and adolescents in Europe-a scoping review

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

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

Die Studie analysiert Art und Ausmas der psychischen Arbeitsplatzbelastungen und die daraus ableitbaren gesundheitlichen Folgen in Osterreich. Fast ein Drittel der unselbstandig Beschaftigten in Osterreich leiden unter gesundheitlicher Beeintrachtigung, rund 13% unter arbeitsbedingten Problemen. Ein Drittel der unselbstandig beschaftigten Manner und ein Viertel der unselbstandig beschaftigten Frauen sind psychischen Belastungsfaktoren (Zeitdruck, Uberbeanspruchung) ausgesetzt und dadurch subjektiv in ihrem Wohlbefinden beeintrachtigt. Psychische Belastungsfaktoren steigern das Krankheitsrisiko um rund 50%. Beschaftigte mit einem physischen Belastungsfaktor weisen mit durchschnittlich 2,6 Ausfallstagen pro Jahr geringere Fehlzeiten auf als Beschaftigte mit einem psychischen Belastungsfaktor (durchschnittlich 3 Ausfallstage). Die Fehlzeiten sind am hochsten, wenn beide Belastungsfaktoren gemeinsam auftreten. Die Analyse der gruppenspezifischen Unterschiede zeigt in folgenden Berufsgruppen eine erhohte Wahrscheinlichkeit fur einen subjektiv gesehen schlechten Gesundheitszustand: Verkaufs- und Dienstleistungshilfskrafte, sonstige Hilfskrafte und Beschaftigte in nichtakademischen Gesundheitsberufen. Auch Arbeitslose weisen ein stark erhohtes Krankheitsrisiko auf. Insgesamt liegt in Osterreich der Anteil der Personen mit arbeitsbedingten Beschwerden im EU-Durchschnitt (15 EU-Lander, die am European Working Condition Survey teilnehmen), der Anteil von Ruckenbeschwerden, Muskelbeschwerden und Stress etwas uber dem Wert der Vergleichslander.

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Psychische Belastungen der Arbeit und ihre Folgen

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.

https://www.mdpi.com/1660-4601/17/14/5058/pdf

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.

http://academic.oup.com/eurpub/article-pdf/28/suppl_4/cky212.455/26616211/cky212.455.pdf

Prevalence of Mental Disorders in Young Refugees and Asylum-Seekers in European Countries

Die osterreichische Bevolkerung wird aufgrund von Zuwanderung aus dem Ausland zunehmend vielfaltiger. Dies macht die Integration von Migranten/Migrantinnen zu einem zentralen gesellschaftlichen Handlungsfeld. Der vorliegende Beitrag verdeutlicht die Wechselwirkungen zwischen sozialer Integration und psychischer Gesundheit: Einerseits erschweren migrationsspezifische Gesundheitsbelastungen wie z. B. traumatisierende Erlebnisse in Zusammenhang mit Krieg, Verfolgung oder Flucht die Integration in die Aufnahmegesellschaft. Andererseits wirken sowohl das Verlassen des gewohnten sozialen Umfelds wie auch die Anforderungen in Zusammenhang mit Anpassungen an die Aufnahmegesellschaft, soziale Ausgrenzung, Verstandigungsschwierigkeiten aufgrund mangelnder Sprachkenntnisse oder unsichere aufenthaltsrechtliche Situationen als psychische Belastungsfaktoren negativ auf die Gesundheit.

Anna Faustmann

Papers

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

Psychische Belastungen der Arbeit und ihre Folgen

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.

Prevalence of Mental Disorders in Young Refugees and Asylum-Seekers in European Countries

Psychische Gesundheit im Kontext von Migration und Flucht – eine integrationswissenschaftliche Perspektive