European Child & Adolescent Psychiatry

, Volume 22, Issue 5, pp 285–294 | Cite as

Emotional and behavioural problems amongst Afghan unaccompanied asylum-seeking children: results from a large-scale cross-sectional study

  • Israel BronsteinEmail author
  • Paul Montgomery
  • Eleanor Ott
Original Contribution


Unaccompanied asylum-seeking children (UASC) are considered at high risk for mental health problems, yet few studies focus on single ethnic populations. This study presents results from the largest Afghan UASC mental health survey in the UK. Specifically, the study aims to estimate the prevalence of emotional and behavioural problems and to investigate the associations of these problems with demographic variables, cumulative traumatic events, and care and migration variables. A census sample of 222 Afghan UASC was interviewed using validated self-report screening measures. Emotional and behavioural problems were screened using the Hopkins Symptoms Checklist 37A (HSCL-37A). Pre-migration stressful life events were screened using the Stressful Life Events Questionnaire. Administrative data on care and asylum were provided by the local authority social services and the UK Border Agency. Approximately one-third (31.4 %) scored above cut-offs for emotional and behavioural problems, 34.6 % for anxiety and 23.4 % for depression. Ordinary least squares regression indicated a significant dose–response relationship between total pre-migration traumatic events and distress as well as between increased time in the country and greater behavioural problems. Compound traumatic events in the pre-migration stages of forced migration have a deleterious association with UASC well-being. Increased time in country suggests a possible peer effect for these children. Consistent with other studies on refugee children, it should be stressed that the majority of UASC scored below suggested cut-offs, thus displaying a marked resilience despite the experience of adverse events.


Refugee children Mental health Asylum Afghan 



This study was funded by the John Fell Oxford University Fund Unaccompanied Asylum-Seeking Children Project. A special debt of gratitude goes to Lindsay Shepard for all her care and assistance with the data collection, to the dedicated team of social workers and interpreters, and to all the young people.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    UNHCR (2011) Global trends 2010. United Nations High Commissioner for Refugees, GenevaGoogle Scholar
  2. 2.
    Crisp J (2003) A new asylum paradigm? Globalisation, migration and the uncertain future of the international refugee regime. New Issues in Refugee Research. Working Paper no.100, United Nations High Commissioner for Refugees Evaluation and Policy Analysis Unit, GenevaGoogle Scholar
  3. 3.
    UNHCR (2010) 2009 UNHCR statistical yearbook. United Nations High Commissioner for Refugees, GenevaGoogle Scholar
  4. 4.
    Thomas S, Thomas S, Nafees B, Bhugra D (2004) ‘I was running away from death’—the pre-flight experiences of unaccompanied asylum seeking children in the UK. Child Care Health Dev 30:113–122. doi: 0.1111/j.1365-2214.2003.00404.x PubMedCrossRefGoogle Scholar
  5. 5.
    Garmezy N (1988) Stressors of childhood. In: Rutter M, Garmezy N (eds) Stress, coping, and development in children, 2nd edn. Johns Hopkins University Press, BaltimoreGoogle Scholar
  6. 6.
    Rutter M (1999) Resilience concepts and findings: implications for family therapy. J Fam Ther 21:119–144. doi: 10.1111/1467-6427.00108 CrossRefGoogle Scholar
  7. 7.
    Appleyard K, Egeland B, van Dulmen MH, Sroufe LA (2005) When more is not better: the role of cumulative risk in child behavior outcomes. J Child Psychol Psychiatry 46:235–245. doi: 10.1111/j.1469-7610.2004.00351.x PubMedCrossRefGoogle Scholar
  8. 8.
    Bronstein I, Montgomery P (2011) Psychological distress in refugee children: a systematic review. Clin Child Fam Psychol 14:44–56. doi: 10.1007/s10567-010-0081-0 CrossRefGoogle Scholar
  9. 9.
    Miller KE, Rasmussen A (2010) War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med 70:7–16. doi: 10.1016/j.socscimed.2009.09.029 PubMedCrossRefGoogle Scholar
  10. 10.
    Van Ommeren M (2003) Validity issues in transcultural epidemiology. Brit J Psychiatry 182:376–378. doi: 10.1192/bjp.02.194 CrossRefGoogle Scholar
  11. 11.
    Fazel M, Stein A (2002) The mental health of refugee children. Arch Dis Child 87:366–370. doi: 10.1136/adc.87.5.366 PubMedCrossRefGoogle Scholar
  12. 12.
    Hodes M (2000) Psychologically distressed refugee children in the United Kingdom. Child Adolesc Ment Health 5:57–68. doi: 10.1111/camh.2000.5.issue-2 CrossRefGoogle Scholar
  13. 13.
    Lustig SL, Kia-Keating M, Knight WG, Geltman P, Ellis H, Kinzie JD, Keane T, Saxe GN (2004) Review of child and adolescent refugee mental health. J Am Acad Child Psychiatry 43:24–36. doi: 10.1097/00004583-200401000-00012 CrossRefGoogle Scholar
  14. 14.
    Miller KE, Rasco LM (2004) An ecological framework for addressing the mental health needs of refugee communities. In: Miller KE, Rasco LM (eds) The mental health of refugees: ecological approaches to healing and adaptation. Lawrence Erlbaum Associates, LondonGoogle Scholar
  15. 15.
    Pumariega AJ, Rothe E, Pumariega JAB (2005) Mental health of immigrants and refugees. Community Ment Health J 41:581–597. doi: 10.1007/s10597-005-6363-1 PubMedCrossRefGoogle Scholar
  16. 16.
    Bronfenbrenner U (1979) The ecology of human development: experiments by nature and design. Harvard University Press, CambridgeGoogle Scholar
  17. 17.
    Mougne C (2010) Trees only move in the wind: a study of unaccompanied Afghan children in Europe. United Nations High Commissioner for Refugees Policy Development and Evaluation Service, GenevaGoogle Scholar
  18. 18.
    Loyn D (2008) Butcher and Bolt. Hutchinson, LondonGoogle Scholar
  19. 19.
    Rashid A (2008) Descent into chaos: The US and the disaster in Pakistan, Afghanistan, and Central Asia. Viking, New YorkGoogle Scholar
  20. 20.
    Catani C, Schauer E, Elbert T, Missmahl I, Bette JP, Neuner F (2009) War trauma, child labor, and family violence: life adversities and PTSD in a sample of school children in Kabul. J Trauma Stress 22:163–171. doi: 10.1002/jts.20415 PubMedCrossRefGoogle Scholar
  21. 21.
    Gupta L (2005) Children exposed to war in Afghanistan. Bereavement Care 24:31–34. doi: 10.1080/02682620508657630 CrossRefGoogle Scholar
  22. 22.
    Panter-Brick C, Eggerman M, Gonzalez V, Safdar S (2009) Violence, suffering, and mental health in Afghanistan: a school-based survey. Lancet 374:807–816. doi: 10.1016/S0140-6736(09)61080-1 PubMedCrossRefGoogle Scholar
  23. 23.
    Boland K (2010) Children on the move: a report on children of Afghan origin moving to western countries. UNICEF, GenevaGoogle Scholar
  24. 24.
    Home Office (2011) Control of immigration: quarterly statistical summary, United Kingdom—fourth quarter 2010: Home OfficeGoogle Scholar
  25. 25.
    Home Office (2010) Control of immigration: Statistics United Kingdom 2009, vol 15, issue 10. Crown Copyright, LondonGoogle Scholar
  26. 26.
    Morris J (2005) Children on the edge of care. Joseph Rowntree Foundation, New YorkGoogle Scholar
  27. 27.
    Wade J, Mitchell F, Baylis G (2005) Unaccompanied asylum seeking children: the response of social work services. British Association for Adoption and Fostering, LondonGoogle Scholar
  28. 28.
    Chase E, Knight A, Statham J (2008) The emotional well-being of young people seeking asylum in the UK. British Association for Adoption and Fostering, LondonGoogle Scholar
  29. 29.
    Hodes M, Jagdev D, Chandra N, Cunniff A (2008) Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry 49:723–732. doi: 10.1111/j.1469-7610.2008.01912.x PubMedCrossRefGoogle Scholar
  30. 30.
    Wade J, Sirriyeh A, Kohli R, Simmonds J (2012) Fostering unaccompanied asylum-seeking and refugee children: a research project (Summary). British Association for Adoption and Fostering, LondonGoogle Scholar
  31. 31.
    Rice L, Poppleton S (2010) Policies on reception, return, integration arrangement for, and numbers of, unaccompanied minors, UK report of an EU comparative study. UK Border Agency, Home Office, LondonGoogle Scholar
  32. 32.
  33. 33.
    O’Higgins A (2011) The destitution of young refugees in the UK. Oxf Monit Forced Migr 1:8011Google Scholar
  34. 34.
    Hollins K, Heydari H, Grayson K, Leavey G (2007) The mental health and social circumstances of Kosovan Albanian and Albanian unaccompanied refugee adolescents living in London. Div Health Soc Care 4:277–285Google Scholar
  35. 35.
    Heptinstall E, Sethna V, Taylor E (2004) PTSD and depression in refugee children: associations with pre-migration trauma and post-migration stress. Eur Child Adolesc Psychiatry 13:373–380. doi: 10.1007/s00787-004-0422-y PubMedCrossRefGoogle Scholar
  36. 36.
    Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik I (2006) Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry 188:58–64. doi: 10.1192/bjp.bp.104.007864 PubMedCrossRefGoogle Scholar
  37. 37.
    Crawley H (2007) When is a child not a child. Immigration Law Practitioners Association, LondonGoogle Scholar
  38. 38.
    STROBE Statement (2008) STROBE Statement: strengthening the reporting of observational studies in epidemiology.
  39. 39.
    Bean T, Eurelings-Bontekoe E, Derluyn I, Spinhoven P (2004) Hopkins Symptom Checklist-37 for Adolescents (Hscl-37a): User’s Manual. Centrum’45, OegstgeestGoogle Scholar
  40. 40.
    Sandanger I, Moum T, Ingebrigtsen G, Dalgard OS, Sorensen T, Bruusgaard D (1998) Concordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I. Soc Psychiatry Psych Epidemiol 33:345–354. doi: 10.1007/s001270050064 CrossRefGoogle Scholar
  41. 41.
    Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P (2007) Validation of the multiple language versions of the Hopkins Symptom Checklist-37 for refugee adolescents. Adolescence 42:51–71PubMedGoogle Scholar
  42. 42.
    Bean T, Eurelings-Bontekoe E, Derluyn I, Spinhoven P (2004) Stressful life events (Sle): User’s Manual. Centrum’45, OegstgeestGoogle Scholar
  43. 43.
    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. doi: 10.1097/01.nmd.0000243751.49499.93 PubMedCrossRefGoogle Scholar
  44. 44.
    Field A (2006) Discovering statistics using SPSS (introducing statistical methods series). Sage Publications Ltd., LondonGoogle Scholar
  45. 45.
    Bronstein I, Montgomery P, Dobrowolski S (2012) PTSD in asylum-seeking male adolescents from Afghanistan. J Trauma Stress 25:551–557. doi: 10.1002/jts.21740 Google Scholar
  46. 46.
    Feir-Walsh BJ, Toothaker LE (1974) An empirical comparison of the Anova F-test, normal scores test and Kruskal–Wallis test under violation of assumptions. Educ Psychol Meas 34:789–799. doi: 10.1177/001316447403400406 CrossRefGoogle Scholar
  47. 47.
    Fox PG, Cowell JM, Montgomery AC (1994) The effects of violence on health and adjustment of Southeast Asian refugee children: an integrative review. Public Health Nurs 11:195–201. doi: 10.1111/j.1525-1446.1994.tb00401.x PubMedCrossRefGoogle Scholar
  48. 48.
    Huemer J, Karnik NS, Voelkl-Kernstock S, Granditsch E, Dervic K, Friedrich MH, Steiner H (2009) Mental health issues in unaccompanied refugee minors. Child Adolesc Psychiatry Ment Health 3:13. doi: 10.1186/1753-2000-3-13 PubMedCrossRefGoogle Scholar
  49. 49.
    Porter M, Haslam N (2005) Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. J Am Med Assoc 294:602–612. doi: 10.1001/jama.294.5.602 CrossRefGoogle Scholar
  50. 50.
    Bean TM, Eurelings-Bontekoe E, Spinhoven P (2007) Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: one year follow-up. Soc Sci Med 64:1204–1215. doi: 10.1016/j.socscimed.2006.11.010 PubMedCrossRefGoogle Scholar
  51. 51.
    Barnes M, Morris K (2008) Strategies for the prevention of social exclusion: an analysis of the Children’s Fund. J Soc Pol 37:251–270. doi: 10.1017/S0047279407001730 CrossRefGoogle Scholar
  52. 52.
    Birman D, Trickett EJ, Vinokurov A (2002) Acculturation and adaptation of Soviet Jewish refugee adolescents: predictors of adjustment across life domains. Am J Commun Psychol 30:585–607. doi: 10.1023/A:1016323213871 CrossRefGoogle Scholar
  53. 53.
    Stanley K (2001) Cold comfort: young separated refugees in England. Save the Children, LondonGoogle Scholar
  54. 54.
    Dishion TJ, McCord J, Poulin F (1999) When interventions harm. Peer groups and problem behaviour. Am Psychol 54:755–764. doi: 10.1037/0003-066X.54.9.755 PubMedCrossRefGoogle Scholar
  55. 55.
    McCord J (2003) Cures that harm: unanticipated outcomes of crime prevention programs. Ann Am Acad Polit Soc Sci 587:16–30. doi: 10.1177/0002716202250781 CrossRefGoogle Scholar
  56. 56.
    Groark C, Sclare I, Raval H (2011) Understanding the experiences and emotional needs of unaccompanied asylum-seeking adolescents in the UK. Clin Child Psychol Psychiatry 16:421–442. doi: 10.1177/1359104510370405 PubMedCrossRefGoogle Scholar
  57. 57.
    Turner VW (1969) The ritual process: structure and anti-structure. Aldine Publishing Company, ChicagoGoogle Scholar
  58. 58.
    de Boer JB, Korfker DG, Reijneveld SA (2004) Effects of reception centres on health and care for AMAs (report: PG/JGD 2004.010). Dutch National Medical Organisaiton for Asylum-Seekers (MOA), LeidenGoogle Scholar
  59. 59.
    Reijneveld SA, de Boer JB, Bean T, Korfker DG (2005) Unaccompanied adolescents seeking asylum: poorer mental health under a restrictive reception. J Nerv Ment Dis 193:759–761. doi: 10.1097/01.nmd.0000185870.55678.82 PubMedCrossRefGoogle Scholar
  60. 60.
    Bonita R (2007) Basic epidemiology. World Health Organisation, GenevaGoogle Scholar
  61. 61.
    Fernando S, Campling J (2002) Mental health, race and culture, 2nd edn. Palgrave, BasingstokeGoogle Scholar
  62. 62.
    Nederhof AJ (1984) Methods of coping with social desirability bias: a review. Euro J Soc Psychol 15:263–280. doi: 10.1002/ejsp.2420150303 CrossRefGoogle Scholar
  63. 63.
    Fischer J, Corcoran K (2007) Measures for clinical practice and research. Oxford University Press, OxfordGoogle Scholar
  64. 64.
    Collishaw S, Goodman R, Ford T, Rabe-Hesketh S, Pickles A (2009) How far are associations between child, family and community factors and child psychopathology informant-specific and informant-general? J Child Psychol Psychol 50:571–580. doi: 10.1111/j.1469-7610.2008.02026.x CrossRefGoogle Scholar
  65. 65.
    Riphenburg CJ (2005) Ethnicity and civil society in contemporary Afghanistan. Middle East J 59:31–51Google Scholar
  66. 66.
    Hobfoll SE (2001) The influence of culture, community, and the nested-self in the stress process: advancing conservation of resources theory. Appl Psychol Int Rev 50:337–421. doi: 10.1111/1464-0597.00062 CrossRefGoogle Scholar
  67. 67.
    Layne CM, Beck CJ, Rimmasch H, Southwisk JS, Moreno MA, Hobfoll SE (2009) Promoting “Resilient” posttraumatic adjustment in childhood and beyond. In: Brom D, Horenczyk P, Ford J (eds) Treating traumatized children. Routledge, London, pp 13–47Google Scholar
  68. 68.
    Bean T (2006) Assessing the psychological distress and mental healthcare needs of unaccompanied refugee minors in the Netherlands. Ph.D. thesis, Leiden University, LeidenGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Israel Bronstein
    • 1
    Email author
  • Paul Montgomery
    • 1
  • Eleanor Ott
    • 1
  1. 1.Department of Social Policy and Intervention, Centre for Evidence Based InterventionUniversity of OxfordOxfordUK

Personalised recommendations