Mental health and associated stress factors in accompanied and unaccompanied refugee minors resettled in Germany: a cross-sectional study

Abstract

BackgroundStudies throughout Europe have shown that asylum-seeking children and adolescents (ASC) are at risk of developing mental disorders. The most common mental-health problems in ASC include posttraumatic stress symptoms (PTSS), internalizing symptoms such as depression and anxiety, and externalizing behaviour. Being an unaccompanied refugee minor (URM) was found to be highly predictive for higher levels of psychological distress within ASC. Nevertheless, and even though Germany is Europe’s biggest host country for ASC, studies that reliably examine the mental health of both URM and accompanied refugee minors (ARM) in Germany with psychometrically tested measures are still lacking.MethodsA cross-sectional survey in 19 facilities for minor refugees in Bavaria, Germany, screening for PTSS, depression, anxiety, externalizing behaviour, and post-migration factors was conducted. Participants were 98 ASC (URM, n = 68; ARM, n = 30) primarily from Afghanistan, Syria, and Eritrea. In 35.7% of interviews, interpreters were involved.ResultsBoth URM and ARM reported high levels of psychological distress and large numbers of potentially traumatic events, with 64.7% of URM and 36.7% of ARM scoring above the clinical cut-off for PTSS, 42.6% of URM and 30% of ARM for depression, and 38.2% of URM and 23.3% of ARM for anxiety. The total number of traumatic experiences was found to be the most robust predictor for PTSS, depression, and anxiety. Lower levels of individual resources, lower levels of social support in the host country, and poorer German language proficiency were associated with higher levels of psychological distress within both groups. URM reported significantly more traumatic events than ARM.ConclusionsASC in Germany are severely distressed and burdened by the experiences of various types of potentially traumatic events. The levels of distress found in the current study correspond with rates that have been reported in previous studies with ASC throughout Europe. Limitations of the present study include the convenience sample and the cross-sectional nature of findings.

Children at risk: A nation-wide, cross-sectional study examining post-traumatic stress symptoms in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden between 2014 and 2018

“…This also holds true when comparing our estimates to reported prevalence estimates for trauma exposed children and adolescents [41]. Still, in a recent study conducted with refugee minors in a German context, a greater proportion of participants than in the current study were deemed to present post-traumatic stress symptoms above the determined cut-off (56.1% in comparison with 42% in the present study) [42]. Notably, these findings are equivalent to those for the subset of the present study's population of minors from Afghanistan (56% prevalence for symptom-defined PTSD), a population highly represented in the German study cited.…”

Improving Mental Health Care for Unaccompanied Young Refugees through a Stepped Care Approach versus Usual Care+: Study Protocol of a Cluster Randomized Controlled Hybrid Effectiveness Implementation Trial

“…Good internal consistency (α = .75-.93) has been con rmed in the initial validation [26] and in an RCT with UYRs (α = .75) [12]. At present, the CATS is accessible in several languages and has been successfully used in previous studies with UYRs [2,19].…”

Improving Mental Health Care for Unaccompanied Young Refugees Through A Stepped Care Approach Versus Usual Care+: Study Protocol of A Cluster Randomized Controlled Hybrid Effectiveness Implementation Trial

“…However, participants can directly bene t from successful treatment and long-term symptom reduction can be achieved. Even for the control group who will not receive the stepped-care, we do not expect any harm: in two previous studies [2,8] we assessed young refugees' mental health without providing further interventions. No serious or adverse events were reported during the two studies.…”

“…The control condition will be called usual care+ as it presents the usual care that UYRs receive in the CYWS facilities and mental healthcare system enhanced with screening and indication procedures offered by study participation (see step 1 75-.93) has been con rmed in the initial validation [26] and in an RCT with UYRs (α = .75) [12]. At present, the CATS is accessible in several languages and has been successfully used in previous studies with UYRs [2,19].…”

“…However, there are reports that CYWS staff have been confronted with major challenges, for instance limited professional experience and insu cient training [1]. A recent cross-sectional study showed that UYRs in southern Germany had experienced a high number of traumatic events, and presented elevated levels of posttraumatic stress symptoms (PTSS), depression, and anxiety [2]. Symptoms, especially within the re-experiencing cluster, seem to be central in this population [3], and they differ in this respect from other traumatized children and adolescent samples [4].…”