A file study of refugee children referred to specialized mental health care: from an individual diagnostic to an ecological perspective


The past years have been characterized by a large refugee crisis across the globe. The exposure to preflight, flight, and resettlement stressors puts refugee children and their families at risk of developing emotional and behavioral disorders. A unique Western-based approach of mental health problems seems to be insufficient to address the complexity of interactions between individual vulnerabilities and more ecological surrounding systems. We looked into (1) the reasons for referral; and (2) the process diagnostic outcomes after ethnopsychiatric and psychological assessment. We conducted a thematic content analysis on 93 files of refugee children. The findings suggest that mental health care professionals need to hold into account the multiplicity and intertwining of ongoing challenges to the well-being of refugee children. The integration of a Western-based psychiatric assessment with a more ecologically based view can lead to a more culturally sensitive approach in refugee children and their families. This way, both under- and overdiagnosis of psychiatric disorders could be avoided to further optimalise mental health care in this population.

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  1. 1.

    UNHCR The UN refugee agency (2016) Global trends. Forced displacement in 2015. Retrieved from http://www.unhcr.org/576408cd7.pdf. Accessed 7 March 2017

  2. 2.

    Commissariaat-Generaal voor de vluchtelingen en staatlozen (2017) Asielstatistieken. Overzicht 2016. Retrieved from http://www.cgvs.be/sites/default/files/asielstatistieken_2016_nl.pdf. Accessed 7 March 2017

  3. 3.

    Silove D, Steel Z, McGorry P, Mohan P (1998) Psychiatric symptoms and living difficulties in Tamil asylum seekers: comparisons with refugees and immigrants. Acta Psychiatr Scand 97:175–181

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Laban CJ, Gernaat H, Komproe IH, van der Tweel I, Jong De (2005) Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 193(12):825–832

    Article  PubMed  Google Scholar 

  5. 5.

    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

    CAS  Article  Google Scholar 

  6. 6.

    Fazel M, Wheeler J, Danesh J (2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365(9467):1309–1314

    Article  PubMed  Google Scholar 

  7. 7.

    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(1):7–16

    Article  PubMed  Google Scholar 

  8. 8.

    Domnich A, Panatto D, Gasparini R, Amicizia D (2012) The “Healthy Immigrant” effect: does it exist in Europe today? Ital J Public Health 9:3

    Google Scholar 

  9. 9.

    Stevens G, Walsh SD, Huijts T, Maes M, Madsen KR, Cavallo F, Molcho M (2015) An internationally comparative study of immigration and adolescent emotional behavioural problems: effects of generation and gender. J Adolesc Health 57(6):587–594

    Article  PubMed  Google Scholar 

  10. 10.

    Laban CJ, Gernaat H, Komproe IH, Schreuders BA, De Jong J (2004) Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands. J Nerv Ment Dis 2004(192):843–851

    Article  Google Scholar 

  11. 11.

    Betancourt TS, Khan KT (2008) The mental health of children affected by armed conflict: protective processes and pathways to resilience. Int Rev Psychiatry 20(3):317–328

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Daud A, Klinteberg B, Rydelius P-A (2008) Resilience and vulnerability among refugees of traumatized and non-traumatized parents. Child Adolesc Psychiatry Ment Health 2:7

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Locke CJ, Southwick K, McCloskey LA, Fernández-Esquer ME (1996) The psychological and medical sequelae of war in central American refugee mothers and children. Arch Pediatr Adolesc Med J 150(8):822–828. doi:10.1001/archpedi.1996.02170330048008

    CAS  Article  Google Scholar 

  14. 14.

    Bevaert F (2013) Ethnic differences in pathways in care for young children with problem behaviour: road work in progress. University Medical Center, Rotterdam

    Google Scholar 

  15. 15.

    Bhui K, Stansfeld S, Hull S, Priebe S, Mole F, Feder G (2014) Ethnic variations in pathways to and use of specialist mental health services in the UK: systematic review ethnic variations in pathways to and use of specialist mental health services in the UK Systematic review. Most 182(2):105–116

    Google Scholar 

  16. 16.

    Derr AS (2015) Mental health service use among immigrants in the United States: a systematic review. Psychiatr Serv 67(3):265–274

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    van Dijk R, Beijers H, Groen S (2012) Het culturele interview. Pharos, Utrecht

    Google Scholar 

  18. 18.

    Serneels G, Villanueva O’Driscoll J, Imeraj L, Vanfraussen K, Lampo A An intervention supporting the mental health of children with a refugee background. Issues in mental health nursing (In press)

  19. 19.

    American Psychiatric Association (APA) (2013) Diagnostic and statistical manual of mental disorders, 5th edn. APA, DSM-V

    Google Scholar 

  20. 20.

    Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  21. 21.

    Neuendorf KA (2016) The content analysis guidebook. Sage, London

    Google Scholar 

  22. 22.

    Lustig SL, Kia-Keating M, Grant Knight W, Geltman P, Ellis H, Kinzie D, Keane T, Saxe GN (2004) Review of child and adolescent refugee mental health. J Am Acad Child Adolesc Psychiatry 31(1):24–36

    Article  Google Scholar 

  23. 23.

    Christopher M (2004) A broader view of trauma: a biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth. Clin Psychol Rev 24:75–98

    Article  PubMed  Google Scholar 

  24. 24.

    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(9812):266–282

    Article  PubMed  Google Scholar 

  25. 25.

    Stevens G, Vollebregh W (2007) Mental health in migrant children. J Child Psychol Psychiatry 49(3):276–294

    Article  PubMed  Google Scholar 

  26. 26.

    Gadeberg AK, Norredam M (2016) Urgent need for validated trauma and mental health screening tools for refugee children and youth. Eur Child Adolesc Psychiatry 25:929–931. doi:10.1007/s00787-016-0837-2

    Article  PubMed  Google Scholar 

  27. 27.

    Stöfsel M, Mooren T (2010) Complex trauma: diagnostiek en behandeling. Bohn Stafleu van Loghem, Houten

    Google Scholar 

  28. 28.

    Söndergaard HP, Ekblad S, Theorell T (2003) Screening for post-traumatic stress disorder among refugees in Stockholm. Nord J Psychiatry 57:185–189

    Article  PubMed  Google Scholar 

  29. 29.

    Ghorashi H, van de Vijver FJR (2010) Culturele erkenning, persoonlijke ontwikkeling en etnische identiteit. In: de Jong J, Colijn S (eds) Handboek culturele psychiatrie en psychotherapie. de Tijdstroom, Utrecht, pp 57–74

    Google Scholar 

  30. 30.

    Bronfenbrenner U (1977) Toward an experimental ecology of human development. Am Psychol 32:513–531

    Article  Google Scholar 

  31. 31.

    Serdarevic M, Chronister KM (2005) Research with immigrant populations: the application of an ecological framework to mental health research with immigrant populations. Int J Ment Health Promot 7:24–34

    Article  Google Scholar 

  32. 32.

    Kagitcibasi C (2007) Family, self and human development across cultures. Theory and applications. Lawrence Erlbaun Associates Inc, New Jersey

    Google Scholar 

  33. 33.

    Lewig K, Arney F, Salveron M (2010) Challenges to parenting in a new culture: implications for child and family welfare. Eval Program Plan 33(3):324–332

    Article  Google Scholar 

  34. 34.

    Ward C, Geeraert N (2016) Advancing acculturation theory and research: the acculturation process in its ecological context. Curr Opin Psychol 8:98–104

    Article  Google Scholar 

  35. 35.

    Stuart J, Ward C (2011) A question of balance: exploring the acculturation, integration and adaptation of muslim immigrant youth. Psychosoc Interv 20(3):255–267

    Article  Google Scholar 

  36. 36.

    Fresnoza-Flot A (2009) Migration status and transnational mothering: the case of Filipino migrants in France. Glob Netw 9(2):252–270

    Article  Google Scholar 

  37. 37.

    Miller KE, Rasco LM (eds) (2004) The mental health of refugees: ecological approaches to healing and adaptation. Lawrence Erlbaum Associates, New Jersey

    Google Scholar 

  38. 38.

    Rumberger RW (2003) The causes and consequences of student mobility. J Negro Educ 72(1):6–21

    Article  Google Scholar 

  39. 39.

    Stark L, DeCormier Plosky W, Horn R, Canavera M (2015) ‘He always thinks he is nothing’: the psychosocial impact of discrimination on adolescent refugees in urban Uganda. Soc Sci Med 146:173–181

    Article  PubMed  Google Scholar 

  40. 40.

    Cristini F, Scacchi L, Perkins D, Santinello M, Vieno A (2011) The influence of discrimination on immigrant adoloscents’ depressive symptoms: what buffers detrimental effects ? Psychosoc Interv 20(3):243–253

    Article  Google Scholar 

  41. 41.

    Söndergaard HP, Solvig E, Töres T (2001) Self-reported life event patterns and their relation to health among recently resettled Iraqi and Kurdish refugees in Sweden. J Nerv Ment Dis 189(12):838–845

    Article  PubMed  Google Scholar 

  42. 42.

    Selten JP, Cantor-Graae E (2007) Hypothesis: social defeat is a risk factor for schizophrenia? Br J Psychiatry 51:9

    Article  Google Scholar 

  43. 43.

    Kubiak S (2005) Trauma and cumulative adversity in women of a disadvantaged social location. Am J Orthopsychiatry 75:451–465

    Article  PubMed  Google Scholar 

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Correspondence to Julia Villanueva O’Driscoll.

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European Refugee Fund.

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Villanueva O’Driscoll, J., Serneels, G. & Imeraj, L. A file study of refugee children referred to specialized mental health care: from an individual diagnostic to an ecological perspective. Eur Child Adolesc Psychiatry 26, 1331–1341 (2017). https://doi.org/10.1007/s00787-017-0981-3

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  • Refugees
  • Refugee children
  • Ecological framework
  • Culturally sensitive approach
  • File study
  • Mental health care