Overrepresentation of unaccompanied refugee minors in inpatient psychiatric care

Abstract

BackgroundUnaccompanied refugee minors (URMs) have high levels of psychiatric symptoms, and concerns for their access to mental health services have been raised. From the mid-2000s, an increasing number of asylum-seeking URMs, mainly adolescent boys from Afghanistan, have been referred to the Child & Adolescent Psychiatry emergency unit in Malmö, Sweden. The aim of the study was to compare inpatient psychiatric care between URMs and non-URMs.FindingsAll admissions in 2011 at the emergency unit were identified and divided into URMs (n = 56) and non-URMs (n = 205). On the basis of unique patients’ first treatment occasion, a group level analysis was performed on gender, age, treatment duration, additional treatment occasions/patient, involuntary care, involuntary care by gender, and ICD-10 principal diagnosis. To retrieve further sample characteristics, a questionnaire was administered to the physicians responsible for admitting patients in 2011.More URMs than non-URMs exhibited self-harm or suicidal behaviour in conjunction with referral. 86% of URMs were admitted with symptoms relating to stress in the asylum process. In the catchment area, 3.40% of the URM population received inpatient care and 0.67% inpatient involuntary care, compared to 0.26% and 0.02% respectively of the non-URM population, both comparisons p < 0.001. There were more boys in the URM group (95%) compared to the non-URM group (29%). A difference in use of involuntary care disappeared after adjusting for gender. No differences were found in diagnoses except for neurotic disorders (F40-48), which were more common in the URM group.ConclusionFrom an epidemiological perspective, URMs were overrepresented in inpatient psychiatric care.

The use of psychiatric services by young adults who came to Sweden as teenage refugees: a national cohort study

“…Over the last decade, Europe, and in particular Sweden, has received increasing numbers of unaccompanied refugee children, mostly male teenagers from the Horn of Africa, Afghanistan, Iraq and Syria (Hjern, 2012;Eide & Hjern, 2013;Migrationsverket, 2015). High levels of depressive symptoms have been reported by different European studies on this population (Bean et al 2007a;Derluyn et al 2009;Seglem et al 2011;Ramel et al 2015), suggesting that unaccompanied refugees are at a particularly high risk of mental health problems, especially introverted symptoms.…”

A first assessment of the needs of young refugees arriving in Europe: what mental health professionals need to know

“…In Malmö, Sweden, unaccompanied minors, most of them males from Afghanistan, were shown to be overrepresented in psychiatric inpatient care [22]: 3.4 % of unaccompanied minors in contrast to 0.26 % of other minors of the catchment area received inpatient treatment. A large percentage (86 % out of n = 52) was admitted with symptoms related to stress in the asylum process.…”

Practitioner Review: Mental health problems of refugee children and adolescents and their management

“…As with other vulnerable groups, lack of needs‐led care pathways in the community often leads to crisis‐driven responses through tertiary health services. For example, in Sweden, Ramel, Taljemark, Lindgren, and Johansson () found that unaccompanied minors were over‐represented on an adolescent in‐patient psychiatric unit, predominantly presented with deliberate self‐harm, and were more likely to be admitted involuntarily; this, despite 86% of their presenting problems being reported to be linked to stressors in the asylum process. Similar findings from community services studies reflect lack of coordinated pathways, access and engagement, with refugee children attending fewer appointments and being more likely to drop‐out of psychological therapies, than the average client population (Michelson & Sclare, ).…”