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European Journal of Pediatrics

, Volume 177, Issue 12, pp 1767–1774 | Cite as

What can we learn from unaccompanied refugee adolescents’ perspectives on mental health care in exile?

  • Frederikke JarlbyEmail author
  • Simone Goosen
  • Ilse Derluyn
  • Kathrine Vitus
  • Signe Smith Jervelund
Original Article

Abstract

Unaccompanied refugee adolescents who have fled war and persecution often have poor mental health. Yet, little is known about their own perspectives on what can relieve their mental health problems. The aim was to explore unaccompanied refugee adolescents’ perspectives on healing and the mental healthcare offered to them when resettled. The study was based on methodical triangulation of participant observation in a Danish municipal institution for unaccompanied refugee minors, semi-structured individual interviews with experts, social workers and male refugee minors and a focus group interview with refugee minors. Results show that the refugee adolescents associated traditional conversational therapy with discussing negative and stigmatising aspects of their past and carrying risks of re-traumatisation. Instead, alternative activities were proposed, through which resources could be accumulated and they could be met without stereotype.

Conclusion: To enhance the complex mental health needs of unaccompanied minors’ mental healthcare, the perspective of the refugee adolescents should be taken into account. This calls for a holistic approach to mental healthcare in their daily lives, where they are met in a non-stigmatising manner in which their unique capabilities are the main focus. Moreover, a trusting relationship constitutes the fundament to support good mental health among refugee adolescents.

What is Known:

• Unaccompanied refugee adolescents are at risk of poor mental health outcomes, e.g., depression, anxiety, PTSD and psychosocial stress.

• Stigma, lack of social support, stressful life events and lack of intercultural competency among mental health professionals are barriers to good mental health.

What is New:

• There is a need for informal and tailored health promotion initiatives in the refugee adolescentseveryday lives.

• To treat the refugee adolescents as equal human beings through curiosity and receptiveness to their resources is important in order to build trust and address stigma.

Keywords

Exile Minors Psychosocial URM Well-being Youth perspective 

Abbreviations

CRC

Convention of the Rights of the Child

PTSD

Post-traumatic stress syndrome

WHO

The World Health Organization

Notes

Authors’ contributions

FJ and SSJ conceived the study. FJ conducted the fieldwork, performed the data analysis, wrote the first draft of the manuscript and finalised the manuscript. SSJ supervised the study design and the analysis. SG, ID, KV and SSJ contributed to critically reviewing and revising the manuscript. The final manuscript as submitted is approved by all authors.

Compliance with ethical statements

Conflict of interest

The authors declare that they have no conflict of interests.

Informed consent

Before the fieldwork, a detailed information sheet about the researcher and the aim of the study was provided to all participants. Informed consent was given by all participants in the study. For participants younger than 18 years of age, informed consent was also given by legally authorised representatives. All details which might lead to identification of the participants were changed in the presentation of the results.

Supplementary material

431_2018_3249_MOESM1_ESM.docx (32 kb)
ESM 1 (DOCX 32 kb)

References

  1. 1.
    Afifi RA, Makhoul J, El Hajj T, Nakkash RT (2011) Developing a logic model for youth mental health: participatory research with a refugee community in Beirut. Health Policy Plan 26:508–517.  https://doi.org/10.1093/heapol/czr001 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Angel B, Hjern A, Ingleby D (2001) Effects of war and organized violence on children: a study of Bosnian refugees in Sweden. Am J Orthop 71:4–15.  https://doi.org/10.1037/0002-9432.71.1.4 CrossRefGoogle Scholar
  3. 3.
    Barghadouch A, Kristiansen M, Jervelund SS, Hjern A, Montgomery E, Norredam M (2016) Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers. Soc Psychiatry Psychiatr Epidemiol 51:1125–1136.  https://doi.org/10.1007/s00127-016-1260-1 CrossRefPubMedGoogle Scholar
  4. 4.
    Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P (2007) Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. J Nerv Ment Dis 195:288–297.  https://doi.org/10.1097/01.nmd.0000243751.49499.93 CrossRefPubMedGoogle Scholar
  5. 5.
    Bourdieu P, Wacquant LJD (2009) Refleksiv sociologi: mål og midler. Hans Reitzel, KbhGoogle Scholar
  6. 6.
    Colucci E, Minas H, Szwarc J, Guerra C, Paxton G (2015) In or out? Barriers to facilitators to refugee-background young people accessing mental health services. Transcult Psychiatry 52(6):766–790.  https://doi.org/10.1177/1363461515571624 CrossRefPubMedGoogle Scholar
  7. 7.
    Derluyn I, Broekaert E, Schuyten G (2008) Emotional and behavioural problems in migrant adolescents in Belgium. Eur Child Adolesc Psychiatry 17:54–62.  https://doi.org/10.1007/s00787-007-0636-x CrossRefPubMedGoogle Scholar
  8. 8.
    Derluyn I, Mels C, Broekaert E (2009) Mental health problems in separated refugee adolescents. J Adolesc Health 44:291–297.  https://doi.org/10.1016/j.jadohealth.2008.07.016 CrossRefPubMedGoogle Scholar
  9. 9.
    Dubbin LA, Chang JS, Shim JK (2013) Cultural health capital and the interactional dynamics of patient-centered care. Soc Sci Med 93:113–120.  https://doi.org/10.1016/j.socscimed.2013.06.014 CrossRefPubMedGoogle Scholar
  10. 10.
    Fassaert T, de Wit MAS, Verhoeff AP, Tuinebreijer WC, Gorissen WHM, Beekman ATF, Dekker J (2009) Uptake of health services for common mental disorders by first-generation Turkish and Moroccan migrants in the Netherlands. BMC Public Health 9Google Scholar
  11. 11.
    Fazel M, Betancourt TS (2017) Preventive mental health interventions for refugee children and adolescents in high-income settings. Lancet Child Adolesc Health 2:121–132.  https://doi.org/10.1016/S2352-4642(17)30147-5 CrossRefPubMedGoogle Scholar
  12. 12.
    Fazel M, Garcia J, Stein A (2016) The right location? Experiences of refugee adolescents seen by school-based mental health services. Clin Child Psychol Psychiatry 21(3):368–380.  https://doi.org/10.1177/1359104516631606 CrossRefPubMedGoogle Scholar
  13. 13.
    Fazel M, Reed RV, Panter-Brick C, Stein A (2012) Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet 379:266–282.  https://doi.org/10.1016/S0140-6736(11)60051-2 CrossRefPubMedGoogle Scholar
  14. 14.
    Friedman MJ, Kos AM (eds) (2005) Promoting the psychosocial well being of children following war and terrorism, NATO security through science series. IOS Press, AmsterdamGoogle Scholar
  15. 15.
    Goffman E (2009) Stigma: om afvigerens sociale identitet. Samfundslitteratur, FrederiksbergGoogle Scholar
  16. 16.
    Goldin S, Hägglöf B, Levin L, Persson LÅ (2008) Mental health of Bosnian refugee children: a comparison of clinician appraisal with parent, child and teacher reports. Nord J Psychiatry 62:204–216.  https://doi.org/10.1080/08039480801983604 CrossRefPubMedGoogle Scholar
  17. 17.
    Hudson CC, Adams S, Lauderdale J (2016) Cultural expressions of intergenerational trauma and mental health nursing implications for US health care delivery following refugee resettlement: an integrative review of the literature. J Transcult Nurs 27(3):286–301.  https://doi.org/10.1177/1043659615587591 CrossRefPubMedGoogle Scholar
  18. 18.
    Ikram U, Stronks K (2016) Preserving and improving the mental health of refugees and asylum seekers. A literature review for the health Council of the Netherlands. Health Counc NethGoogle Scholar
  19. 19.
    Jensen TG, Weibel K, Vitus K (2017) ‘There is no racism here’: public discourses on racism, immigrants and integration in Denmark. Patterns Prejudice 51:51–68.  https://doi.org/10.1080/0031322X.2016.1270844 CrossRefGoogle Scholar
  20. 20.
    Kevers R, Rober P, Derluyn I, De Haene L (2016) Remembering collective violence: broadening the notion of traumatic memory in post-conflict rehabilitation. Cult Med Psychiatry 40:620–640.  https://doi.org/10.1007/s11013-016-9490-y CrossRefPubMedGoogle Scholar
  21. 21.
    Kvale S, Brinkmann S (2014) Interview: det kvalitative forskningsinterview som håndværk. Hans Reitzels Forlag, KøbenhavnGoogle Scholar
  22. 22.
    Livingston JD, Boyd JE (2010) Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med 71:2150–2161.  https://doi.org/10.1016/j.socscimed.2010.09.030 CrossRefPubMedGoogle Scholar
  23. 23.
    Mason J (2002) Qualitative researching, 2nd ed. Sage Publications, LondonGoogle Scholar
  24. 24.
    Métraux JC (2005) From child well-being to social reconstruction, in: promoting the psychosocial well being of children following war and terrorism. IOS Press, AmsterdamGoogle Scholar
  25. 25.
    Mirdal GM, Ryding E, Sondej ME (2012) Traumatized refugees, their therapists, and their interpreters: three perspectives on psychological treatment. Psychol Psychother Theory Res Pract 85:436–455.  https://doi.org/10.1111/j.2044-8341.2011.02036.x CrossRefGoogle Scholar
  26. 26.
    Montgomery E (2011) Trauma, exile and mental health in young refugees: mental health in young refugees. Acta Psychiatr Scand 124:124: 1–124:46.  https://doi.org/10.1111/j.1600-0447.2011.01740.x CrossRefGoogle Scholar
  27. 27.
    Nadeau L, Jaimes A, Johnson-Lafleur J, Rousseau C (2017) Perspectives of migrant youth, parents and clinicians on community-based mental health services: negotiating safe pathways. J Child Fam Stud 26(7):1936–1948.  https://doi.org/10.1007/s10826-017-0700-1 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Nettleton S (2006) The sociology of health and illness. Polity Press, CambridgeGoogle Scholar
  29. 29.
    Putnam RD (2001) Bowling alone: the collapse and revival of American community, 1. touchstone ed. Simon & Schuster, New YorkGoogle Scholar
  30. 30.
    Suurmond J, Seeleman C, Rupp I, Goosen S, Stronks K (2010) Cultural competence among nurse practitioners working with asylum seekers. Nurse Educ Today 30:821–826.  https://doi.org/10.1016/j.nedt.2010.03.006 CrossRefPubMedGoogle Scholar
  31. 31.
    UN General Assembly (1989) Convention on the Rights of the ChildGoogle Scholar
  32. 32.
    Valibhoy MC, Kaplan I, Szwarc J (2017) It comes down to just how human someone can be: a qualitative study with young people from refugee backgrounds about their experiences of Australian mental health services. Transcult Psychiatry 54(1):23–45CrossRefGoogle Scholar
  33. 33.
    Vitus K (2010) Waiting time: the de-subjectification of children in Danish asylum centres. Childhood 17:26–42.  https://doi.org/10.1177/0907568209351549 CrossRefGoogle Scholar
  34. 34.
    WHO (2014) Mental health: a state of well-being. http://www.who.int/features/factfiles/mental_health/en/ [accessed 12-08-2018]

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Public Health, Danish Research Centre for Migration, Ethnicity and HealthCopenhagen UniversityCopenhagenDenmark
  2. 2.Netherlands Association for Community Health ServicesUtrechtNetherlands
  3. 3.Department of Social Work and Social PedagogyGhent UniversityGentBelgium
  4. 4.Department of Sociology and Social WorkAalborg UniversityCopenhagenDenmark

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