Skip to main content
Top
Published in: Child and Adolescent Psychiatry and Mental Health 1/2014

Open Access 01-12-2014 | Research

Development of mental health problems - a follow-up study of unaccompanied refugee minors

Authors: Tine K Jensen, Envor M Bjørgo Skårdalsmo, Krister W Fjermestad

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2014

Login to get access

Abstract

Background

Studies have shown that unaccompanied refugee children have elevated symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and externalizing problems. Few studies have examined change in this group’s mental health symptoms after resettlement in a new country, particularly for those who arrive to a host country when being under the age of 15.

Method

The sample included 75 unaccompanied refugee children (mean age 16.5 years, SD =1.6; 83% boys) who settled in Norway. We examined change in the number of stressful life events, symptoms of PTSD (Child PTSD Symptom Scale; CPSS), and symptoms of anxiety, depression and externalizing problems (Hopkins Symptom Checklist; HSCL-37A) from 6 months after arrival (T1) to 1.9 years (SD =0.6) later (T2) using paired samples t-tests. Linear regression models were used to examine whether length of stay, level of education or change in the number of experienced stressful life events predicted symptom change.

Results

There was a small and non-significant change in the mean scores of both symptom scales between T1 and T2, although there was considerable variation among the participants. The number of children who remained above the clinical cut-off value from T1 to T2 was as follows: 28 of 47 (59.6%) on the CPSS and eight of 16 (50.0%) on the HSCL-37A. There was a significant increase in the number of reported stressful life events from T1 to T2. An increase in reported stressful life events predicted an increase in PTSS (β =1.481, 95% CI .552 to 2.411). Length of stay, increase in stressful life events and level of education did not predict changes in the HSCL-37A.

Conclusions

There was no average change in the level of PTSS, depression, anxiety, or externalizing problems in this group of unaccompanied refugee children from shortly after arrival to nearly two years later. The large variation in change scores across informants indicates a need for monitoring the development of mental health problems and securing that the youth’s primary psychosocial needs are met. The high rate of children above clinical cut-off on the symptoms scales and with suicidal ideation indicates that many may be in need of treatment.
Appendix
Available only for authorised users
Literature
1.
go back to reference Tol WA, Song S, Jordans MJ: Annual research review: resilience and mental health in children and adolescents living in areas of armed conflict–a systematic review of findings in low- and middle-income countries. J Child Psychol Psychiatry. 2013, 54 (4): 445-460. 10.1111/jcpp.12053.CrossRefPubMed Tol WA, Song S, Jordans MJ: Annual research review: resilience and mental health in children and adolescents living in areas of armed conflict–a systematic review of findings in low- and middle-income countries. J Child Psychol Psychiatry. 2013, 54 (4): 445-460. 10.1111/jcpp.12053.CrossRefPubMed
2.
go back to reference Vervliet M, Meyer Demott MA, Jakobsen M, Broekaert E, Heir T, Derluyn I: The mental health of unaccompanied refugee minors on arrival in the host country. Scand J Psychol. 2014, 55 (1): 33-37. 10.1111/sjop.12094.CrossRefPubMed Vervliet M, Meyer Demott MA, Jakobsen M, Broekaert E, Heir T, Derluyn I: The mental health of unaccompanied refugee minors on arrival in the host country. Scand J Psychol. 2014, 55 (1): 33-37. 10.1111/sjop.12094.CrossRefPubMed
3.
go back to reference Reed RV, Fazel M, Jones L, Panter-Brick C, Stein A: Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors. Lancet. 2012, 379 (9812): 250-265. 10.1016/S0140-6736(11)60050-0.CrossRefPubMed Reed RV, Fazel M, Jones L, Panter-Brick C, Stein A: Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors. Lancet. 2012, 379 (9812): 250-265. 10.1016/S0140-6736(11)60050-0.CrossRefPubMed
4.
go back to reference Fazel M, Reed RV, Panter-Brick C, Stein A: Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet. 2012, 379 (9812): 266-282. 10.1016/S0140-6736(11)60051-2.CrossRefPubMed Fazel M, Reed RV, Panter-Brick C, Stein A: Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet. 2012, 379 (9812): 266-282. 10.1016/S0140-6736(11)60051-2.CrossRefPubMed
5.
go back to reference Bean TM, Eurelings-Bontekoe E, Spinhoven P: Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: one year follow-up. Soc Sci Med. 2007, 64 (6): 1204-1215. 10.1016/j.socscimed.2006.11.010.CrossRefPubMed Bean TM, Eurelings-Bontekoe E, Spinhoven P: Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: one year follow-up. Soc Sci Med. 2007, 64 (6): 1204-1215. 10.1016/j.socscimed.2006.11.010.CrossRefPubMed
6.
go back to reference Felsman KJ, Leong FTL, Johnson MC, Felsman IC: Estimates of psychological distress among Vietnamese refugees: adolescents, unaccompanied minors and young adults. Soc Sci Med. 1990, 31 (11): 1251-1256. 10.1016/0277-9536(90)90132-C.CrossRefPubMed Felsman KJ, Leong FTL, Johnson MC, Felsman IC: Estimates of psychological distress among Vietnamese refugees: adolescents, unaccompanied minors and young adults. Soc Sci Med. 1990, 31 (11): 1251-1256. 10.1016/0277-9536(90)90132-C.CrossRefPubMed
7.
go back to reference Jensen TK, Fjermestad KW, Granly L, Wilhelmsen NH: Stressful life experiences and mental health problems among unaccompanied asylum-seeking children. Clin Child Psychol Psychiatry. 2013, [Epub ahead of print] Jensen TK, Fjermestad KW, Granly L, Wilhelmsen NH: Stressful life experiences and mental health problems among unaccompanied asylum-seeking children. Clin Child Psychol Psychiatry. 2013, [Epub ahead of print]
8.
go back to reference Lustig SL, Kia-Keating M, Knight WG, Geltman P, Ellis H, Kinzie JD, Keane T, Saxe GN: Review of child and adolescent refugee mental health. J Am Acad Child Adolesc Psychiatry. 2004, 43 (1): 24-36. 10.1097/00004583-200401000-00012.CrossRefPubMed Lustig SL, Kia-Keating M, Knight WG, Geltman P, Ellis H, Kinzie JD, Keane T, Saxe GN: Review of child and adolescent refugee mental health. J Am Acad Child Adolesc Psychiatry. 2004, 43 (1): 24-36. 10.1097/00004583-200401000-00012.CrossRefPubMed
9.
go back to reference Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P: Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. J Nerv Ment Dis. 2007, 195 (4): 288-297. 10.1097/01.nmd.0000243751.49499.93.CrossRefPubMed Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P: Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. J Nerv Ment Dis. 2007, 195 (4): 288-297. 10.1097/01.nmd.0000243751.49499.93.CrossRefPubMed
10.
go back to reference Derluyn I, Mels C, Broekaert E: Mental health problems in separated refugee adolescents. J Adolesc Health. 2009, 44 (3): 291-297. 10.1016/j.jadohealth.2008.07.016.CrossRefPubMed Derluyn I, Mels C, Broekaert E: Mental health problems in separated refugee adolescents. J Adolesc Health. 2009, 44 (3): 291-297. 10.1016/j.jadohealth.2008.07.016.CrossRefPubMed
11.
go back to reference Hodes M, Jagdev D, Chandra N, Cunniff A: Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry. 2008, 49 (7): 723-732. 10.1111/j.1469-7610.2008.01912.x.CrossRefPubMed Hodes M, Jagdev D, Chandra N, Cunniff A: Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry. 2008, 49 (7): 723-732. 10.1111/j.1469-7610.2008.01912.x.CrossRefPubMed
12.
go back to reference Berry JW: Conceptual approaches to acculturation.Acculturation: Advances in Theory, Measurement, and Applied Research. Edited by: Chun KM, Organista PB, Marín G. 2003, Washington, DC: American Psychological Association, 17-37.CrossRef Berry JW: Conceptual approaches to acculturation.Acculturation: Advances in Theory, Measurement, and Applied Research. Edited by: Chun KM, Organista PB, Marín G. 2003, Washington, DC: American Psychological Association, 17-37.CrossRef
13.
go back to reference Oppedal B: Development and acculturation.The Cambridge Handbook of Acculturation Psychology. Edited by: Sam DL, Berry JW. 2006, New York, NY: Cambridge University Press, 97-112.CrossRef Oppedal B: Development and acculturation.The Cambridge Handbook of Acculturation Psychology. Edited by: Sam DL, Berry JW. 2006, New York, NY: Cambridge University Press, 97-112.CrossRef
14.
go back to reference Seglem KB, Oppedal B, Raeder S: Predictors of depressive symptoms among resettled unaccompanied refugee minors. Scand J Psychol. 2011, 52 (5): 457-464. 10.1111/j.1467-9450.2011.00883.x.CrossRefPubMed Seglem KB, Oppedal B, Raeder S: Predictors of depressive symptoms among resettled unaccompanied refugee minors. Scand J Psychol. 2011, 52 (5): 457-464. 10.1111/j.1467-9450.2011.00883.x.CrossRefPubMed
15.
go back to reference Thommessen S, Laghi F, Cerrone C, Baiocco R, Todd BK: Internalizing and externalizing symptoms among unaccompanied refugee and Italian adolescents. Child Youth Serv Rev. 2013, 35 (1): 7-10. 10.1016/j.childyouth.2012.10.007.CrossRef Thommessen S, Laghi F, Cerrone C, Baiocco R, Todd BK: Internalizing and externalizing symptoms among unaccompanied refugee and Italian adolescents. Child Youth Serv Rev. 2013, 35 (1): 7-10. 10.1016/j.childyouth.2012.10.007.CrossRef
16.
go back to reference Vervliet M, Lammertyn J, Broekaert E, Derluyn I: Longitudinal follow-up of the mental health of unaccompanied refugee minors. Eur Child Adolesc Psychiatry. 2014, 23 (5): 337-346. 10.1007/s00787-013-0463-1.CrossRefPubMed Vervliet M, Lammertyn J, Broekaert E, Derluyn I: Longitudinal follow-up of the mental health of unaccompanied refugee minors. Eur Child Adolesc Psychiatry. 2014, 23 (5): 337-346. 10.1007/s00787-013-0463-1.CrossRefPubMed
17.
go back to reference Pynoos RS, Steinberg AM, Wraith R: Developmental psychopathology. Edited by: Cicchetti D, Cohen DJ. 1995, Oxford, England: John Wiley & Sons, 2: 72-95. A developmental model of childhood traumatic stress, Risk, disorder, and adaptation. Pynoos RS, Steinberg AM, Wraith R: Developmental psychopathology. Edited by: Cicchetti D, Cohen DJ. 1995, Oxford, England: John Wiley & Sons, 2: 72-95. A developmental model of childhood traumatic stress, Risk, disorder, and adaptation.
18.
go back to reference Coll CG, Magnuson K: The psychological experience of immigration: A developmental perspective. Immigration and the Family: Research and Policy on US Immigrants. Edited by: Booth A, Crouter AC, Landale N. 1997, Hilsdale, NJ: Lawrence Erlbaum Associates Coll CG, Magnuson K: The psychological experience of immigration: A developmental perspective. Immigration and the Family: Research and Policy on US Immigrants. Edited by: Booth A, Crouter AC, Landale N. 1997, Hilsdale, NJ: Lawrence Erlbaum Associates
19.
go back to reference Chase E: Security and subjective wellbeing: the experiences of unaccompanied young people seeking asylum in the UK. Sociol Health Illn. 2013, 35 (6): 858-872. 10.1111/j.1467-9566.2012.01541.x.CrossRefPubMed Chase E: Security and subjective wellbeing: the experiences of unaccompanied young people seeking asylum in the UK. Sociol Health Illn. 2013, 35 (6): 858-872. 10.1111/j.1467-9566.2012.01541.x.CrossRefPubMed
20.
go back to reference Eide K, Hjern A: Unaccompanied refugee children – vulnerability and agency. Acta Paediatr. 2013, 102 (7): 666-668. 10.1111/apa.12258.CrossRefPubMed Eide K, Hjern A: Unaccompanied refugee children – vulnerability and agency. Acta Paediatr. 2013, 102 (7): 666-668. 10.1111/apa.12258.CrossRefPubMed
21.
go back to reference Bronstein I, Montgomery P, Dobrowolski S: PTSD in asylum-seeking male adolescents from Afghanistan. J Trauma Stress. 2012, 25 (5): 551-557. 10.1002/jts.21740.CrossRefPubMed Bronstein I, Montgomery P, Dobrowolski S: PTSD in asylum-seeking male adolescents from Afghanistan. J Trauma Stress. 2012, 25 (5): 551-557. 10.1002/jts.21740.CrossRefPubMed
22.
go back to reference Huemer J, Karnik NS, Voelkl-Kernstock S, Granditsch E, Dervic K, Friedrich MH, Steiner H: Mental health issues in unaccompanied refugee minors. Child Adolesc Psychiatr Mental Health. 2009, 3: 13-10.1186/1753-2000-3-13.CrossRef Huemer J, Karnik NS, Voelkl-Kernstock S, Granditsch E, Dervic K, Friedrich MH, Steiner H: Mental health issues in unaccompanied refugee minors. Child Adolesc Psychiatr Mental Health. 2009, 3: 13-10.1186/1753-2000-3-13.CrossRef
23.
go back to reference Bronstein I, Montgomery P, Ott E: Emotional and behavioural problems amongst Afghan unaccompanied asylum-seeking children: results from a large-scale cross-sectional study. Eur Child Adolesc Psychiatry. 2013, 22 (5): 285-294. 10.1007/s00787-012-0344-z.CrossRefPubMed Bronstein I, Montgomery P, Ott E: Emotional and behavioural problems amongst Afghan unaccompanied asylum-seeking children: results from a large-scale cross-sectional study. Eur Child Adolesc Psychiatry. 2013, 22 (5): 285-294. 10.1007/s00787-012-0344-z.CrossRefPubMed
24.
go back to reference Derluyn I, Broekaert E: Different perspectives on emotional and behavioural problems in unaccompanied refugee children and adolescents. Ethn Health. 2007, 12 (2): 141-162. 10.1080/13557850601002296.CrossRefPubMed Derluyn I, Broekaert E: Different perspectives on emotional and behavioural problems in unaccompanied refugee children and adolescents. Ethn Health. 2007, 12 (2): 141-162. 10.1080/13557850601002296.CrossRefPubMed
25.
go back to reference Oppedal B, Idsoe T: Conduct problems and depression among unaccompanied refugees: the association with pre-migration trauma and acculturation. An Psicol. 2012, 28 (3): 683-694. Oppedal B, Idsoe T: Conduct problems and depression among unaccompanied refugees: the association with pre-migration trauma and acculturation. An Psicol. 2012, 28 (3): 683-694.
26.
go back to reference Geltman PL, Grant-Knight W, Ellis H, Landgraf JM: The “lost boys” of Sudan: Use of health services and functional health outcomes of unaccompanied refugee minors resettled in the U.S. J Immigr Minor Health. 2008, 10 (5): 389-396. 10.1007/s10903-007-9110-6.CrossRefPubMed Geltman PL, Grant-Knight W, Ellis H, Landgraf JM: The “lost boys” of Sudan: Use of health services and functional health outcomes of unaccompanied refugee minors resettled in the U.S. J Immigr Minor Health. 2008, 10 (5): 389-396. 10.1007/s10903-007-9110-6.CrossRefPubMed
27.
go back to reference Alisic E, Zalta AK, Van Wesel F, Larsen SE, Hafstad GS, Hassanpour K, Smid GE: Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Brit J Psychiat. 2014, 204 (5): 335-340. 10.1192/bjp.bp.113.131227.CrossRefPubMed Alisic E, Zalta AK, Van Wesel F, Larsen SE, Hafstad GS, Hassanpour K, Smid GE: Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Brit J Psychiat. 2014, 204 (5): 335-340. 10.1192/bjp.bp.113.131227.CrossRefPubMed
28.
go back to reference Reijneveld SA, De Boer JB, Bean T, Korfker DG: Unaccompanied adolescents seeking asylum: poorer mental health under a restrictive reception. J Nerv Ment Dis. 2005, 193 (11): 759-761. 10.1097/01.nmd.0000185870.55678.82.CrossRefPubMed Reijneveld SA, De Boer JB, Bean T, Korfker DG: Unaccompanied adolescents seeking asylum: poorer mental health under a restrictive reception. J Nerv Ment Dis. 2005, 193 (11): 759-761. 10.1097/01.nmd.0000185870.55678.82.CrossRefPubMed
29.
go back to reference Tolin DF, Foa EB: Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006, 132 (6): 959-992.CrossRefPubMed Tolin DF, Foa EB: Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006, 132 (6): 959-992.CrossRefPubMed
31.
go back to reference Bean TM, Eurelings-Bontekoe E, Derluyn I, Spinhoven P: Stressful life events (SLE): User’s Manual. Centrum '45, Oegstgeest. 2004 Bean TM, Eurelings-Bontekoe E, Derluyn I, Spinhoven P: Stressful life events (SLE): User’s Manual. Centrum '45, Oegstgeest. 2004
32.
go back to reference Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P: Validation of the multiple language versions of the Hopkins symptom checklist - 37 for refugee adolescents. Adolescence. 2007, 42 (165): 51-71.PubMed Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P: Validation of the multiple language versions of the Hopkins symptom checklist - 37 for refugee adolescents. Adolescence. 2007, 42 (165): 51-71.PubMed
33.
go back to reference Foa EB, Johnson KM, Feeny NC, Treadwell KR: The child PTSD symptom scale: a preliminary examination of its psychometric properties. J Clin Child Psychol. 2001, 30 (3): 376-384. 10.1207/S15374424JCCP3003_9.CrossRefPubMed Foa EB, Johnson KM, Feeny NC, Treadwell KR: The child PTSD symptom scale: a preliminary examination of its psychometric properties. J Clin Child Psychol. 2001, 30 (3): 376-384. 10.1207/S15374424JCCP3003_9.CrossRefPubMed
34.
go back to reference Hukkelberg S, Ormhaug SM, Holt T, Wentzel-Larsen T, Jensen TK: Diagnostic utility of CPSS vs. CAPS-CA for assessing posttraumatic stress symptoms in children and adolescents. J Anxiety Disord. 2014, 28 (1): 51-56. 10.1016/j.janxdis.2013.11.001.CrossRefPubMed Hukkelberg S, Ormhaug SM, Holt T, Wentzel-Larsen T, Jensen TK: Diagnostic utility of CPSS vs. CAPS-CA for assessing posttraumatic stress symptoms in children and adolescents. J Anxiety Disord. 2014, 28 (1): 51-56. 10.1016/j.janxdis.2013.11.001.CrossRefPubMed
36.
go back to reference Derluyn I, Broekaert E: Unaccompanied refugee children and adolescents: the glaring contrast between a legal and a psychological perspective. Int J Law Psychiat. 2008, 31 (4): 319-330. 10.1016/j.ijlp.2008.06.006.CrossRef Derluyn I, Broekaert E: Unaccompanied refugee children and adolescents: the glaring contrast between a legal and a psychological perspective. Int J Law Psychiat. 2008, 31 (4): 319-330. 10.1016/j.ijlp.2008.06.006.CrossRef
37.
go back to reference Montgomery E: Trauma and resilience in young refugees: a 9-year follow-up study. Dev Psychopathol. 2010, 22 (2): 477-489. 10.1017/S0954579410000180.CrossRefPubMed Montgomery E: Trauma and resilience in young refugees: a 9-year follow-up study. Dev Psychopathol. 2010, 22 (2): 477-489. 10.1017/S0954579410000180.CrossRefPubMed
38.
go back to reference Fivush R, Shukat JR: Content, consistency, and coherence of early autobiographical recall. Memory and Testimony in the Child Witness Applied Psychology: Individual, Social, and Community Issues. Edited by: Zaragoza MS, Graham JR. 1995, Thousand Oaks, CA: Sage Publications, Inc, 5-23. 1 Fivush R, Shukat JR: Content, consistency, and coherence of early autobiographical recall. Memory and Testimony in the Child Witness Applied Psychology: Individual, Social, and Community Issues. Edited by: Zaragoza MS, Graham JR. 1995, Thousand Oaks, CA: Sage Publications, Inc, 5-23. 1
39.
go back to reference Spinhoven P, Bean T, Eurelings-Bontekoe L: Inconsistencies in the self-report of traumatic experiences by unaccompanied refugee minors. J Trauma Stress. 2006, 19 (5): 663-673. 10.1002/jts.20152.CrossRefPubMed Spinhoven P, Bean T, Eurelings-Bontekoe L: Inconsistencies in the self-report of traumatic experiences by unaccompanied refugee minors. J Trauma Stress. 2006, 19 (5): 663-673. 10.1002/jts.20152.CrossRefPubMed
40.
go back to reference Smid GE, Lensvelt-Mulders GJLM, Knipscheer JW, Gersons BPR, Kleber RJ: Late-onset PTSD in unaccompanied refugee minors: exploring the predictive utility of depression and anxiety symptoms. J Clin Child Adolesc Psychol. 2011, 40 (5): 742-755. 10.1080/15374416.2011.597083.CrossRefPubMed Smid GE, Lensvelt-Mulders GJLM, Knipscheer JW, Gersons BPR, Kleber RJ: Late-onset PTSD in unaccompanied refugee minors: exploring the predictive utility of depression and anxiety symptoms. J Clin Child Adolesc Psychol. 2011, 40 (5): 742-755. 10.1080/15374416.2011.597083.CrossRefPubMed
41.
go back to reference Silove D: Do conflict-affected societies need psychiatrists?. Br J Psychiatry. 2012, 201 (4): 255-257. 10.1192/bjp.bp.112.108480.CrossRefPubMed Silove D: Do conflict-affected societies need psychiatrists?. Br J Psychiatry. 2012, 201 (4): 255-257. 10.1192/bjp.bp.112.108480.CrossRefPubMed
42.
go back to reference Van Ommeren M: Validity issues in transcultural epidemiology. Br J Psychiatry. 2003, 182 (5): 376-378. 10.1192/bjp.182.5.376.CrossRefPubMed Van Ommeren M: Validity issues in transcultural epidemiology. Br J Psychiatry. 2003, 182 (5): 376-378. 10.1192/bjp.182.5.376.CrossRefPubMed
Metadata
Title
Development of mental health problems - a follow-up study of unaccompanied refugee minors
Authors
Tine K Jensen
Envor M Bjørgo Skårdalsmo
Krister W Fjermestad
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Child and Adolescent Psychiatry and Mental Health / Issue 1/2014
Electronic ISSN: 1753-2000
DOI
https://doi.org/10.1186/1753-2000-8-29

Other articles of this Issue 1/2014

Child and Adolescent Psychiatry and Mental Health 1/2014 Go to the issue