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      The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway

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          Abstract

          Objectives

          To examine the mental health of unaccompanied refugee minors prospectively during the asylum-seeking process, with a focus on specific stages in the asylum process, such as age assessment, placement in a supportive or non-supportive facility and final decision on the asylum applications.

          Design

          This was a2½ year follow-up study of unaccompanied minors (UM) seeking asylum in Norway. 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.

          Setting

          Initially in an observation and orientation centre for unaccompanied asylum-seeking adolescents, and subsequently wherever the UM were located in other refugee facilities in Norway.

          Participants

          Male UM from Afghanistan, Somalia, Algeria and Iran.

          Main outcome measures

          Mental health symptoms assessed by Hopkins Symptom Checklist-25 and Harvard Trauma Questionnaire.

          Results

          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. According to age-assessment procedures, 56% of the population were not recognised as minors. Subsequent placement in a low-support facility was associated with higher levels of psychological distress in the follow-up period. Those who were placed in a reception centre for adults had higher levels of psychological distress symptoms both after 15 months and 26 months compared with the remaining participants who were placed in reception centres for youth. Refusal of asylum was highly associated with higher levels of psychological distress.

          Conclusion

          Mental health trajectory of young asylum seekers appears to be negatively affected by low support and refusal of asylum.

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          Most cited references22

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          Measuring trauma and health status in refugees: a critical review.

          Refugees experience multiple traumatic events and have significant associated health problems, but data about refugee trauma and health status are often conflicting and difficult to interpret. To assess the characteristics of the literature on refugee trauma and health, to identify and evaluate instruments used to measure refugee trauma and health status, and to recommend improvements. MEDLINE, PsychInfo, Health and PsychoSocial Instruments, CINAHL, and Cochrane Systematic Reviews (searched through OVID from the inception of each database to October 2001), and the New Mexico Refugee Project database. Key terms and combination operators were applied to identify English-language publications evaluating measurement of refugee trauma and/or health status. Information extracted for each article included author; year of publication; primary focus; type (empirical, review, or descriptive); and type/name and properties of instrument(s) included. Articles were excluded from further analyses if they were review or descriptive, were not primarily about refugee health status or trauma, or were only about infectious diseases. Instruments were then evaluated according to 5 criteria (purpose, construct definition, design, developmental process, reliability and validity) as described in the published literature. Of 394 publications identified, 183 were included for further analyses of their characteristics; 91 (49.7%) included quantitative data but did not evaluate measurement properties of instruments used in refugee research, 78 (42.6%) reported on statistical relationships between measures (presuming validity), and 14 (7.7%) were only about statistical properties of instruments. In these 183 publications, 125 different instruments were used; of these, 12 were developed in refugee research. None of these instruments fully met all 5 evaluation criteria, 3 met 4 criteria, and 5 met only 1 of the criteria. Another 8 standard instruments were designed and developed in nonrefugee populations but adapted for use in refugee research; of these, 2 met all 5 criteria and 6 met 4 criteria. The majority of articles about refugee trauma or health are either descriptive or include quantitative data from instruments that have limited or untested validity and reliability in refugees. Primary limitations to accurate measurement in refugee research are the lack of theoretical bases to instruments and inattention to using and reporting sound measurement principles.
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            Longitudinal follow-up of the mental health of unaccompanied refugee minors.

            Despite growing numbers of unaccompanied refugee minors (UMs) in Europe, and evidence that this group is at risk of developing mental health problems, there still remain important knowledge gaps regarding the development of UMs' mental health during their trajectories in the host country and, in particular, the possible influencing role of traumatic experiences and daily stressors therein. This study therefore followed 103 UMs from the moment they arrived in Belgium until 18 months later. Traumatic experiences (SLE), mental health symptoms (HSCL-37A, RATS) and daily stressors (DSSYR) were measured at arrival in Belgium, after 6 and 18 months. UMs reported generally high scores on anxiety, depression and post-traumatic stress disorder (PTSD). Linear mixed model analysis showed no significant differences in mental health scores over time, pointing towards the possible long-term persistence of mental health problems in this population. The number of traumatic experiences and the number of daily stressors leaded to a significant higher symptom level of depression (daily stressors), anxiety and PTSD (traumatic experiences and daily stressors). European migration policies need to reduce the impact of daily stressors on UMs' mental health by ameliorating the reception and care facilities for this group. Moreover, regular mental health screenings are needed, in combination with, if needed, adapted psychosocial and therapeutic care.
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              Trauma and resilience in young refugees: a 9-year follow-up study.

              The aim of the present study was to assess and understand the long-term trajectory of psychological problems among young Middle Eastern refugees in Denmark. Participants were 131 young refugees from the Middle East (76 girls, 55 boys; mean age = 15.3 years) from 67 families. They were assessed first on arrival in Denmark in 1992-1993 and again 8-9 years later. The high prevalence of psychological problems at arrival was considerably reduced by the time of follow-up, but it was still somewhat higher than what has been found in most community studies using the same assessment tools. Groups of children differed in showing low levels of symptoms at arrival that were stable (spared) or increased (reacting) and high levels at arrival that persisted (traumatized) or decreased (adapted). The number of types of traumatic experiences before arrival distinguished the spared and the traumatized young refugees and the number of types of stressful events after arrival the adapted and the traumatized, also after corrections for age, sex, specific traumatic events, parents' education and health, and the social situation of the young refugees. The study emphasizes the importance of environmental factors for healthy long-term adaptation after traumatic experiences related to war and other organized violence.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Open (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                21 June 2017
                : 7
                : 6
                : e015157
                Affiliations
                [1 ] Norwegian Centre for Violence and Traumatic Stress Studies , Oslo, Norway
                [2 ] Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway , Oslo, Norway
                [3 ] departmentFaculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo, Norway
                Author notes
                [Correspondence to ] Dr Marianne Jakobsen; marianne.jakobsen@ 123456nkvts.no
                Article
                bmjopen-2016-015157
                10.1136/bmjopen-2016-015157
                5734358
                28637731
                77851e33-0e17-4616-8fc2-79cb287521d6
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 17 November 2016
                : 08 May 2017
                : 16 May 2017
                Funding
                Funded by: The Norwegian Directorate of Immigration;
                Categories
                Public Health
                Research
                1506
                1724
                1712
                Custom metadata
                unlocked

                Medicine
                refugee,adolescent,unaccompanied minor,follow-up study,norway
                Medicine
                refugee, adolescent, unaccompanied minor, follow-up study, norway

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