Topic: Forced migration and refugee health

Mental health of unaccompanied refugee minors: A longitudinal study from arrival in Norway to outcome of the asylum procedure

Jakobsen, M. (2018). Mental health of unaccompanied refugee minors: A longitudinal study from arrival in Norway to outcome of the asylum procedure. (Doktorgradsavhandling).

The dissertation is available for download at DUO.

Literature that deals with mental health adversities in unaccompanied minor asylum-seekers (UM), is usually based on self-report questionnaires, rarely on clinical interviews. The results indicate high levels of psychological distress in the form of emotional and behavioral problems. Self-report questionnaires may be easy to administer, and less costly than clinical interviews, but the method is limited by the subjects varying ability to read and understand the items. Researchers often have limited time and resources needed to properly translate and validate psychometric instruments into a new cultural setting.

The present study sample was recruited from UM that arrived in Norway during a period of two years. They were young men, 15-18 years old, from Afghanistan, Somalia, Algeria and Iran, and were included in the study shortly after arrival.

Mental health symptoms were assessed by Hopkins Symptom Checklist-25 (HSCL-25), and Harvard Trauma Questionnaire (HTQ). Serious Life Events checklist (SLE) was used to indicate the amount and types of traumatic events they might have experienced. Unlike previous research we administered the instruments by the use of computer-based audiotranslations and touch-screen technology. In this manner we also wanted to address some methodological challenges that often arise in connection with mental health assessments, especially with participants that have limited reading and writing skills.

A central part of the study was to estimate the prevalence of psychiatric morbidity based on structured clinical interviews (CIDI), and 160 unaccompanied minor asylum-seekers consented to be interviewed. The most prevalent diagnosis in this sample was Posttraumatic Stress Disorder (PTSD) that was present in 48 (30.6%) of the cases. Depression was diagnosed in 26 (16.3%), and Anxiety Disorder in 13 (8.1%) of the cases. Most of the youth included in this study had experienced a high number of potentially traumatic events. In order to determine how the self-report instruments could be used to screen subjects according to specific psychiatric illnesses, the psychometric properties were evaluated against the CIDI- interviews. Agreement between diagnoses (CIDI) and screening results for PTSD, Anxiety and Depression showed the same main pattern of high sensitivity, and low specificity.

The results were similar to other studies, but this is the first time cut-off values for a sample of unaccompanied refugee minors has been calculated. In order to explore the trajectories of unaccompanied refugee minors prospectively during the asylum-seeking process, the mental health data were collected within three weeks (n=138), and at 4 months (n=101), 15 months (n=84) and 26 months (n=69) after arrival. In this longitudinal part of the study, the impact of potential stressors such as age-assessments, achieving or not achieving legal recognition as a refugee, and living-conditions during the waiting-period were examined. At the group level the young asylum seekers reported high levels of psychological distress on arrival, and symptom levels that stayed relatively unchanged over time.

The official age assessments, based on x-ray examinations of hands and teeth, decided on a mean age of 18.4 years (SD 2.4), range 15-28, which meant that 72 (56%) participants were considered to be adults. About half of them (one third of the total number of participants) were placed in a reception centre for adults, and they had higher levels of psychological distress symptoms both at 15 months and 26 months compared to the remaining participants who were placed in reception centres for youth. Refusal of asylum was highly associated with higher levels of psychological distress, and refusal was also related to the official determined age of the asylum seeker. 

The number of asylum applicants considered to be unaccompanied minors has been increasing in the EU-region. Young people leaving their home countries without a parent, or other caring adults frequently encounter serious risk factors such as exploitation, violence and multiple losses. It is also well documented that the asylum process, with long periods of uncertainty, can be stressful for these youngsters. Placement in a low support facility and refusal of asylum were the main factors associated with higher levels of psychological distress in our study. These findings highlight the importance of support in the post-migration environment.