Topic: Forced migration and refugee health

A longitudinal study of mental health in unaccompanied refugee minors during the asylum process and early intervention with expressive arts therapy (EXIT) for newly arrived unaccompanied minor refugee boys in transit centers

Most studies investigating UM mental health have a cross-sectional design with a selection of youths with different levels of legal recognition and different durations of time in exile. These studies show consistently that individual factors such as exposure to violence and other traumatic events prior to migration, correspond to elevated symptoms of psychological distress. In some studies the negative effects of exile related stressors are also described, yet they study youths with varying time in exile. There are different asylum-procedures within the different countries, and most UM endure some uncertainty before their legal status is defined. Most countries provide some form of shelter for UM while they are waiting for their case to be processed, but conditions vary greatly.  In teh present study we want to examine the impact of different types of caregiving during the asylum seeking process. The intervention (EXIT) is a manual intervention based on well-known and accepted principles from expressive arts therapy that is resource enhancing and brief. The model builds on resilience through mainly non-verbal techniques (in that several participants in the same group are from different countries). The intervention is initiated as soon as possible; days/weeks after arriving in Norway.  EXIT activates all sensory modalities, and encourages being present in the body and accessing pleasant memories and resources from the country of origin, and thinking about one’s future and accepting responsibility for it. Good relations are facilitated in the group, in order to counteract a tendency towards withdrawal and depression. Traumatic events are not focused on, in that, the unaccompanied minors have not yet been placed or established themselves at the long term reception center and there is no regular school or health care provided and hence no possibility for follow-up.

2008 This project has been completed 2020

Project Members

  • Heir, Trond
  • Meyer, Melinda Ashley
  • Strandmoen, John-Filip
  • Løken, Liv Berit Nyblin
  • Jakobsen, Marianne

Main objective


Research topics

1. To examine UM`s mental health during the asylum-seeking process. Are the official age assessed, level of support, and the outcome of the asylum application associated with mental health.

2. Will early intervention, using expressive arts in a group setting, give measurable change in psychological symptoms for UM (unaccompanied minors) boys?


The longitudinal follow-up study of mental Health is an observational cohort study.  Participants are unaccompanied refugee minors arriving in Norway in the period 2009-2011. Over 200 participants will be recruited. Using computer based self-screening participants will be assessed 1-2 weeks after arrival, and at 4 months, 12 months and 24 months after arrival,

Data from Hopkins Symptom Checklist-25, and Harvard Trauma Questionnaire part IV will be collected

The study design of the intervention study is a randomized control trail study. The intervention will last 5 weeks. The subjects will be randomized into two groups: one group that receives EXIT (Expressive Arts in Transition) and the other group that will receive the usual health services and participate in the usual activities offered at the transit center. The intervention model that will be tested is: Expressive Arts in Transition (EXIT) for un-accompanied minor refugee boys (UM) in the transit center.

To test refugee boys where a high proportion of them are likely to have limited reading and writing-skills a Multilingual Computer-Assisted-Self-Interview (MultiCASI) is used. This is software that has been developed by ”Behandlungszentrum fur Folteropfer Berlin.” It uses a touch screen PC, where self-report instruments can be installed in different languages. All items can be answered by directly touching the screen and the written and audio versions appear simultaneously. Questions and answers can be repeated as many times as necessary through touch. The greatest advantage for this project is that we can test all participants in the same way, no matter their reading abilities. The un-accompanied minor refugee boys who participate will be evaluated at the start of the intervention, at the end, after- three months, one year and two years. 

This method for testing has not been validated in relation to psychiatric diagnostics. To test this, a separate diagnostic interviews (CIDI) with (n=160) participants that is done simultaneously with the 3 month self-report test.

Further information

EXIT is a therapy method that uses movement, drawing, music, dance and drama and verbally expressing oneself. This therapy has shown to be a suitable treatment for un- accompanied minors. The model was developed by Meyer DeMott and was first used at Brinken Asylum Seeker Center in 1991 and since then has been further developed by Fossnes Asylum Seeker Center in 1992-1994 (Meyer og Nygård, 1993, Meyer 1995; 1997; 2007).

Some possible benefits of art oriented therapy forms in comparison to pure verbal therapy forms, is that for some it is easier to get in contact with and express suppressed feelings.

This project involves the putting into practice methods for a group of asylum seekers where there is great challenges associated both to the content of the method and as to how many refugees will be involved, and simultaneously carrying out a scientific evaluation of the effects of this method. These results will provide useful knowledge in how to implement early interventions during the transit stage to prevent isolation, anxiety and depression in UM, and it will form the foundation of scientifically-based preventative measures that can reduce psychological problems for unaccompanied minors.

This study will be the first of its kind in both Norway and Europe.


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

Jakobsen, M., Meyer DeMott, M. A., & Heir, T. (2017). Validity of screening for psychiatric disorders in unaccompanied minor asylum seekers: Use of computer-based assessment. Transcultural Psychiatry, 54(5-6), 611-625. doi:10.1177/1363461517722868

Jakobsen, M., Meyer DeMott, M. A., Wentzel-Larsen, T., & Heir, T. (2017). The impact of the asylum process on mental health: A longitudinal study of unaccompanied refugee minors in Norway. BMJ Open, 7(6). doi:10.1136/bmjopen-2016-015157

Meyer DeMott, M. A., Jakobsen, M., Wentzel-Larsen, T., & Heir, T. (2017). A controlled early group intervention study for unaccompanied minors: Can Expressive Arts alleviate symptoms of trauma and enhance life satisfaction. Scandinavian Journal of Psychology, 58(6), 510-518. doi:10.1111/sjop.12395

Jakobsen, M., Meyer, M., & Heir, T. (2014). Prevalence of psychiatric disorders among unaccompanied asylumseeking adolescents in Norway. Clinical Practice and Epidemiology in Mental Health, 10(1), 53-58. doi:10.2174%2F1745017901410010053

Meyer DeMott, M. A. (2014). Chapter 6:Breaking the Silence:Expressive Arts as Testimony. In E. Guribye, B. Lie & G. Øverland (Eds.) Nordic work with traumatised refugees: Do we really care (pp. 192-201). Cambridge Scholars Publishing.

Meyer DeMott, M. A. (2014). Gjennomføringsrapport av prosjektet: Kunst- og uttrykksterapi (KUT) for nyankomne enslige mindreårige gutter 15 – 18 år ved ankomst/transittmottak.(2008 – 2014)Expressive Arts in Transition(EXIT).

Vervliet, M., Meyer, M., Jakobsen, M., Broekaert, E., Heir, T., & Derluyn, I. (2014). The mental health of unaccompanied refugee minors on arrival in the host country. Scandinavian Journal of Psychology, 55(1), 33-37. doi:10.1111/sjop.12094