Psychological Distress in Refugee Children: A Systematic Review

Article

Abstract

Nearly one-quarter of the refugees worldwide are children. There have been numerous studies reporting their levels of psychological distress. The aim of this paper is to review systematically and synthesize the epidemiological research concerning the mental health of refugee children residing in Western countries. A Cochrane Collaboration style review was conducted searching nine major databases, bibliographies, and grey literature from 2003 to 2008. Included studies had to meet the reporting standards of STROBE and investigate mental health in non-clinical samples of asylum seeking and refugee children residing in OECD countries. A total of twenty-two studies were identified of 4,807 retrieved citations, covering 3,003 children from over 40 countries. Studies varied in definition and measurement of problems, which included levels of post-traumatic stress disorder from 19 to 54%, depression from 3 to 30%, and varying degrees of emotional and behavioral problems. Significant factors influencing levels of distress appear to include demographic variables, cumulative traumatic pre-migration experiences, and post-migration stressors. Importantly, the research base demands greater contextual and methodological refining such that future research would have greater generalizability and clinical implications.

Keywords

Refugee Asylum-seekers Mental health Children Systematic review 

Notes

Acknowledgments

This research was made possible with a grant from the John Fell OUP Research Fund to the Unaccompanied Asylum-seeking Project at the Centre for Evidence Based Intervention. We would like to thank all the authors of the various studies for their time and patience in answering our queries concerning their work.

References

  1. Achenbach, T. M. (1991). Manual for the youth self-report and 1991 profile. University of Vermont, Department of Psychiatry. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
  2. Ahearn, F. L. (2000). Psychosocial wellness: Methodological approaches to the study of refugees. In F. L. Ahearn Jr (Ed.), Psychosocial wellness of refugees (Vol. 7). Oxford: Berghan.Google Scholar
  3. Bean, T., Derluyn, I., Eurelings-Bontekoe, E., Broekaert, E., & Spinhoven, P. (2007a). Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. Journal of Nervous and Mental Disease, 195(4), 288–297.PubMedCrossRefGoogle Scholar
  4. Bean, T., Eurelings-Bontekoe, E., Derluyn, I., & Spinhoven, P. (2004a). Hopkins symptom checklist-37 for adolescents (HSCL-37A). User’s Manual (pp. 1–46).Google Scholar
  5. Bean, T., Eurelings-Bontekoe, E., Derluyn, I., & Spinhoven, P. (2004b). Reactions of adolescents to traumatic stress questionnaire (RATS) user’s manual. Centrum ‘45 (pp. 1–40).Google Scholar
  6. Bean, T., Eurelings-Bontekoe, E., & Spinhoven, P. (2007b). Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: One year follow-up. Social Science & Medicine, 64(6), 1204–1215.CrossRefGoogle Scholar
  7. Berman, H. (2001). Children and war: Current understandings and future directions. Public Health Nursing, 18(4), 243–252.PubMedCrossRefGoogle Scholar
  8. Bowling, A. (1995). Measuring disease. Buckingham: Open University Press.Google Scholar
  9. Bowling, A. (2002). Research methods in health: Investigating health and health services. Maidenhead: Open University Press.Google Scholar
  10. Briere, J. (1996). Trauma symptom checklist for children (TSCC) professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  11. Bryne, O. (2008). Unaccompanied children in the United States: A literature review. New York: VERA Institute of Justice.Google Scholar
  12. Castles, S., Loughna, S., & Crawley, H. (2004). States of conflict: The causes of forced migration to the EU. London: Institute for Public Policy Research.Google Scholar
  13. Chase, E., Knight, A., & Statham, J. (2008). The emotional well-being of young people seeking asylum in the UK. London: British Association for Adoption and Fostering.Google Scholar
  14. Costello, E. J., Erkanli, A., & Angold, A. (2006). Is there an epidemic of child and adolescent depression? Journal of Child Psychology and Psychiatry, 47(12), 1263–1271.Google Scholar
  15. Crisp, J. (2003). A new asylum paradigm? Globalization, migration and the uncertain future of the international refugee regime. New Issues in Refugee Research, Working Paper 100.Google Scholar
  16. Danish Immigration Service. (2008). New To Denmark: Unaccompanied children. http://www.nyidanmark.dk/en-us/coming_to_dk/asylum/unaccompanied_children.htm.
  17. de Boer, J. B., Korfker, D. G., & Reijneveld, S. A. (2004). Effects of reception centres on health and care for AMAs. PG/JGD 2004.010), 75.Google Scholar
  18. Department of Health. (1995). Unaccompanied asylum seeking children: A practice guide. London: Department of Health.Google Scholar
  19. Department of Health. (2003). Guidance on accommodating children in need and their families. LAC (2003) 13. London: Department of Health.Google Scholar
  20. Derluyn, I., & Broekaert, E. (2005). Unaccompanied refugee children and adolescents in Belgium. Socialno Delo, 44(4–5), 313–323.Google Scholar
  21. Dyregrov, A., & Yule, W. (2006). A review of PTSD in children. Child and Adolescent Mental Health, 11(4), 176–184.CrossRefGoogle Scholar
  22. Eisenbruch, M. (1991). From posttraumatic stress disorder to cultural bereavement: Diagnosis of Southeast Asian refugees. Social Science & Medicine, 33, 673–680.CrossRefGoogle Scholar
  23. Ellis, H., MacDonald, H. Z., Lincoln, A. K., & Cabral, H. J. (2008). Mental health of Somali adolescent refugees: The role of trauma, stress, and perceived discrimination. Journal of Consulting and Clinical Psychology, 76(2), 184–193.PubMedCrossRefGoogle Scholar
  24. European Commission. (2008). Freedom, Security, and Justice. http://ec.europa.eu/justice_home/fsj/asylum/fsj_asylum_intro_en.htm.
  25. European Commission. (2010). European website on integration. Retrieved 10 May 2010, from ec.europa.eu/ewsi/en/info_sheet.cfm.Google Scholar
  26. Fazel, M., & Stein, A. (2003). Mental health of refugee children: comparative study. British Medical Journal, 327(7407), 134.Google Scholar
  27. Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. Lancet, 365, 1309–1314.PubMedCrossRefGoogle Scholar
  28. Feder, M. A. (2005). Mental health and academic skills of Sierra Leonean children from refugee families. Dissertation Abstracts International: Section B: The Sciences and Engineering.Google Scholar
  29. Fell, P., & Hayes, D. (2007). What are they doing here? A critical guide to asylum and immigration. Birmingham: Venture Press.Google Scholar
  30. Fernando, S., & Campling, J. (2002). Mental health, race and culture (2nd ed.). Basingstoke: Palgrave.Google Scholar
  31. Fischer, J., & Corcoran, K. (2007). Measures for clinical practice and research (1st ed.). Oxford: Oxford University Press.Google Scholar
  32. Fox, P. G., Cowell, M. J., & Montgomery, A. C. (1994). The effects of violence on health and adjustment of Southeast Asian refugee children: An integrative review. Public Health Nursing, 11, 195–201.PubMedCrossRefGoogle Scholar
  33. Gabbay, V., Oatis, M., Silva, R. R., & Hirsch, G. S. (2004). Epidemiological aspects of PTSD in children and adolescents. In R. R. Silva (Ed.), Posttraumatic stress disorders in children, adolescents: Handbook (1st ed.). New York: WW Norton & Company.Google Scholar
  34. Garmezy, N. (1988). Stressors of childhood. In M. Rutter & N. Garmezy (Eds.), Stress, coping, development in children (2nd ed.). Baltimore, MD: Johns Hopkins University Press.Google Scholar
  35. Geltman, P. L., Grant-Knight, W., Mehta, S. D., Lloyd-Travaglini, C., Lustig, S., Landgraf, J. M., et al. (2005). The “lost boys of Sudan”: Functional and behavioral health of unaccompanied refugee minors re-settled in the United States. Archives of Pediatrics and Adolescent Medicine, 159(6), 585–591.PubMedCrossRefGoogle Scholar
  36. Goldberg, D. P. (1978). Manual of the General Health Questionnaire. Windsor: NFER-Nelson.Google Scholar
  37. Goldberg, D. P., & Williams, P. (1988). A user’s guide to the general health questionnaire. Windsor: NFER-Nelson.Google Scholar
  38. Goldin, S., Hagglof, B., Levin, L., & Persson, L. A. (2008). Mental health of bosnian refugee children: A comparison of clinician appraisal with parent, child and teacher reports. Nordic Journal of Psychiatry, 62(3), 204–216.PubMedCrossRefGoogle Scholar
  39. Goodman, R. (1994). The strengths and difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586.CrossRefGoogle Scholar
  40. Great Britain. (2008). Children and Young Persons Act 2008: Chapter 23. London: The Stationary Office.Google Scholar
  41. Grimes, D. A., & Schulz, K. F. (2002). Descriptive studies: What they can and cannot do. Lancet, 359(9301), 145–149.PubMedCrossRefGoogle Scholar
  42. Halcón, L. L., Robertson, C. L., Savik, K., Johnson, D. R., Spring, M. A., Butcher, J. N., et al. (2004). Trauma and coping in Somali and Oromo refugee youth. Journal of Adolescent Health, 35(1), 17–25.PubMedGoogle Scholar
  43. Hart, J. (2008). Introduction. In Years of conflict (Vol. 25). Oxford: Berghahn Books.Google Scholar
  44. Hathaway, J. C. (2007). Forced migration studies: Could we agree just to ‘date’? Journal of Refugee Studies, 20(3), 349–369.CrossRefGoogle Scholar
  45. Heptinstall, E., Sethna, V., & Taylor, E. (2003). The mental health needs of refugee children in the SLAM area (Funders reports ed.). London: South London and Maudsley NHS.Google Scholar
  46. Heptinstall, E., Sethna, V., & Taylor, E. (2004). PTSD and depression in refugee children: Associations with pre-migration trauma and post-migration stress. European Child and Adolescent Psychiatry, 13(6), 373–380.PubMedCrossRefGoogle Scholar
  47. Hodes, M. (2000). Psychologically distressed refugee children in the United Kingdom. Child Psychology and Psychiatry Review, 5(2), 57–68.CrossRefGoogle Scholar
  48. Hodes, M., Jagdev, D., Chandra, N., & Cunniff, A. (2008). Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. Journal of Child Psychology & Psychiatry, Online.Google Scholar
  49. Hollifield, M., Warner, T. D., Nityamo, L., Krakow, B., Jenkins, J. H., Kesler, J., et al. (2002). Measuring trauma and health status: A critical review. Journal of the American Medical Association, 288(5), 611–621.PubMedCrossRefGoogle Scholar
  50. 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. Diversity in Health and Social Care, 4, 277–285.Google Scholar
  51. Hollins, K., Heydari, H., & Leavey, G. (2003). Refugee adolescents without parents. Barnet, Enfield and Haringey NHS.Google Scholar
  52. Home Office. (2007). Asylum statistics United Kingdom 2006. Statistical Bulletin.Google Scholar
  53. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–219.PubMedGoogle Scholar
  54. Kia-Keating, M., & Ellis, B. H. (2007). Belonging and connection to school in resettlement: Young refugees, school belonging, and psychosocial adjustment. Clinical Child Psychology & Psychiatry, 12(1), 29–43.CrossRefGoogle Scholar
  55. Landgraf, J. M., Abetz, L., & Ware, J. E. (1996). The Child Health Questionnaire user’s manual. Boston: The Health Institute, New England Medical Center.Google Scholar
  56. Lustig, S. L., Kia-Keating, M., Knight, W. G., Geltman, P., Ellis, H., Kinzie, J. D., et al. (2004). Review of child and adolescent refugee mental health. Journal of the American Academy of Child & Adolescent Psychiatry, 43(1), 24–36.CrossRefGoogle Scholar
  57. McCrone, P., Bhui, K., Craig, T., Mohamud, S., Warfa, N., Stansfeld, S. A., et al. (2005). Mental health needs, service use and costs among Somali refugees in the UK. Acta Psychiatrica Scandinavica, 111(5), 351–357.PubMedCrossRefGoogle Scholar
  58. Miller, K. E., & Rasco, L. M. (2004). An ecological framework for addressing the mental health needs of refugee communities. In K. E. Miller & L. M. Rasco (Eds.), The mental health of refugees: Ecological approaches to healing and adaptation. London: Lawrence Erlbaum Associates, Publishers.Google Scholar
  59. Mollica, R. F., Caspi-Yavin, M. A. R., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indo-Chinese refugees. Journal of Nervous Mental Disease, 180, 111–116.CrossRefGoogle Scholar
  60. Momartin, S., Steel, Z., Coello, M., Aroche, J., Silove, D. M., & Brooks, R. (2006). A comparison of the mental health of refugees with temporary versus permanent protection visas. Medical Journal of Australia, 185(7), 357–361.PubMedGoogle Scholar
  61. Montgomery, E. (1998). Refugee children from the Middle East. Scandinavian Journal of Public Health, 26(1), 1–152.Google Scholar
  62. Montgomery, E., & Foldspang, A. (2005). Seeking asylum in Denmark: refugee children's mental health and exposure to violence. European Journal of Public Health, 15, 233–237.PubMedCrossRefGoogle Scholar
  63. Nielsen, S. S., Norredam, M., Christensen, K. L., Obel, C., & Krasnik, A. (2007). The mental health of asylum-seeking children in Denmark. Ugeskrift for Laeger, 169(43), 3660–3665.PubMedGoogle Scholar
  64. Nielsen, S. S., Norredam, M., Christiansen, K. L., Obel, C., Hilden, J., & Krasnik, A. (2008). Organisational factors influencing asylum-seeking children’s mental health. BMC Public Health, 8, 293.PubMedCrossRefGoogle Scholar
  65. Porter, M. (2007). Global evidence for a biopsychosocial understanding of refugee adaptation. Transcultural Psychiatry, 44(3), 418–439.PubMedCrossRefGoogle Scholar
  66. Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons. Journal of the American Medical Association, 294(5), 602–612.PubMedCrossRefGoogle Scholar
  67. Reijneveld, S. A., de Boer, J. B., Bean, T., & Korfker, D. G. (2005). Unaccompanied adolescents seeking asylum: Poorer mental health under a restrictive reception. Journal of Nervous and Mental Disease, 193(11), 759–761.PubMedCrossRefGoogle Scholar
  68. Rodriguez, N., Steinberg, A. M., & Pynoos, R. S. (1999). UCLA PTSD Index for DSM-IV. Los Angeles, CA: University of California Los Angeles Trauma Psychiatry Service.Google Scholar
  69. Rousseau, C. (1995). The mental health of refugee children. Transcultural Psychiatry Research Review, 32, 299–331.CrossRefGoogle Scholar
  70. Rousseau, C., & Drapeau, A. (2003). Are refugee children an at-risk group? A longitudinal study of Cambodian adolescents. Journal of Refugee Studies, 16(1), 67–81.CrossRefGoogle Scholar
  71. Rousseau, C., Drapeau, A., & Platt, R. (2004). Family environment and emotional and behavioral symptoms in adolescent Cambodian Refugees: Influence of time, gender, and acculturation. Medicine, Conflict & Survival, 20(2), 151–165.CrossRefGoogle Scholar
  72. Rousseau, C., Drapeau, A., & Rahimi, S. (2003). The complexity of trauma response: A 4-year follow-up of adolescent Cambodian refugees. Child Abuse and Neglect, 27(11), 1277–1290.PubMedCrossRefGoogle Scholar
  73. Rushton, J. L., Forcier, M., & Schectman, R. M. (2002). Epidemiology of depressive symptoms in the national longitudinal study of adolescent health. Journal of the American Academy of Child & Adolescent Psychiatry, 41(2), 199–205.CrossRefGoogle Scholar
  74. Rutter, M. (1985). Resilience in the face of adversity: Protective factors and the resistance to psychiatric disorder. British Journal of Psychiatry, 147, 598–611.PubMedCrossRefGoogle Scholar
  75. Rutter, M. (1988). Stress, coping, and development: Some issues and some questions. In M. Rutter & N. Garmezy (Eds.), Stress, coping, and development in children (2nd ed.). Baltimore, MD: Johns Hopkins University Press.Google Scholar
  76. Separated Children in Europe Programme. (2008). Statistics on arrivals of separated children seeking asylum in Europe in 2006. http://www.separated-children-europe-programme.org/separated_children/about_us/scep_programme.html.
  77. Silove, D., Sinnerbrink, I., Field, A., Manicavasagar, V., & Steel, Z. (1997). Anxiety, depression and PTSD in asylum-seekers: Associations with pre- migration trauma and post-migration stressors. The British Journal of Psychiatry, 170(4), 351–357.PubMedCrossRefGoogle Scholar
  78. STROBE Statement. (2008). STROBE Statement: STrengthening the Reporting of OBservational studies in Epidemiology. Retrieved 25 February 2008.Google Scholar
  79. Summerfield, D. (2000). War and mental health: A brief overview. BMJ, 321(7255), 232–235.PubMedCrossRefGoogle Scholar
  80. Thienkrua, W., Cardozo, B. L., Chakkraband, M. L. S., Guadamuz, T. E., Pengjuntr, W., Tantipiwatanaskul, P., et al. (2006). Symptoms of posttraumatic stress disorder and depression among children in tsunami-affected areas in Southern Thailand. Journal of the American Medical Association, 296(5), 549–559.PubMedCrossRefGoogle Scholar
  81. UNHCR. (1951). Convention relating to the status of refugees. Geneva: United Nations.Google Scholar
  82. UNHCR. (2007). 2006 UNHCR statistical yearbook. Geneva: UNHCR.Google Scholar
  83. UNHCR. (2008). 2007 Global trends: Refugees, asylum-seekers, returnees, internally displaced and stateless persons. Geneva: UNHCR.Google Scholar
  84. von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gotzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Epidemiology, 18(6), 800–804.CrossRefGoogle Scholar
  85. Waters, C. (2008). Refugee children: Towards the next horizon. London: Routledge.Google Scholar
  86. Weathers, F. W., Lits, B. T., Derman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Annual meeting of International Society for Traumatic Stress Studies.Google Scholar
  87. Zetter, R. (2007). More Labels, fewer refugees: Remaking the refugee label in an era of globalization. Journal of Refugee Studies, 20(2), 172.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Centre for Evidence Based Intervention, Department of Social Policy & Social WorkUniversity of OxfordOxfordUK

Personalised recommendations