The present study was designed to understand differences between unaccompanied refugees who retained or achieved good mental health (healthy or resilient) and those who maintained or developed poor ...mental health (clinical and vulnerable). Using person-based analyses, the role of pre-migration traumatic exposure and acculturation-related factors in long-term trajectories of psychological adjustment among unaccompanied refugees was explored. This study included three waves of data collection in a population-based sample. The participants were 918 unaccompanied refugees who had received asylum and residence status in Norway. The pattern of change in depression symptoms over time was used to characterize subgroups displaying resilient, vulnerable, clinical or healthy trajectories. Results indicated that the extent of post-migration acculturation hassles and heritage culture competence, as well as pre-migration traumatic events and gender, distinguished the refugee groups in terms of mental health trajectories. The implications for clinical practice and immigration policy are discussed.
Unaccompanied refugee youth (URY), who as children fled their countries to seek asylum in a foreign country without the company of an adult legal caretaker are described as being in a vulnerable ...situation. Many of them struggle with mental reactions to traumatic events experienced pre-migration, and to the daily hassles they face after being granted asylum and residence. Despite continuous high levels of mental health problems URY demonstrate remarkable agency and social mobility in the years after being granted asylum in their destination countries. A sense of subjective well-being (SWB) may enable resilient outcomes in people exposed to past or ongoing adversities. To fill the gap in the research literature about positive psychological outcomes among URY, the overall aim of this study was to explore the longitudinal associations between SWB and two taxing acculturation hassles: perceived discrimination and ethnic identity crisis. Three annual waves of self-report questionnaire data were collected from a population-based sample of URY;
n
= 581,
M
age
= 20.01(
SD
= 2.40),
M
length of stay
= 4.63 (
SD
= 4.40), 82 % male, mainly from Afghanistan, Somalia, Iraq, and Sri Lanka. The longitudinal associations between SWB, perceived discrimination and ethnic identity crisis across time were analyzed using auto-regressive cross-lagged modeling. The results revealed that perceived discrimination, but not ethnic identity crisis, negatively predicted subsequent levels of SWB. More importantly, high levels of SWB at one timepoint predicted decreases in both discrimination and ethnic identity crisis at subsequent timepoints. Further, increases in SWB from one timepoint to the next was associated with significant co-occurring decreases in both discrimination and ethnic identity crisis, and vice versa. Despite the negative effect of perceived discrimination on SWB, promoting SWB in URY can protect them from future hazards of acculturation hassles in complex ways. We underscore the need for more research on SWB among URY and other refugee youth. We further discuss the potential of SWB to foster resilient outcomes in young refugees and suggest that interventions to strengthen SWB among them should consider their transnational and multicultural realities and experiences.
Over the last decades, due to high rates of immigration, many high-income countries have witnessed demographic shifts towards more cultural diversity in the population. Socio-economic deprivation and ...traumatic experiences pre-migration contribute to a high risk for mental health problems among immigrant background youth. Moreover, when adapting to the multi-cultural contexts of the resettlement countries they face several acculturation demands, which may also affect their mental health in adaptive or hazardous ways. One of these acculturation tasks involves developing the cultural competence necessary to thrive and participate socially within the heritage and the majority cultural domains. From a public mental health perspective, it is important to have thorough knowledge about acculturation-related risk and protective factors. However, this responsibility has been challenged by a lack of acculturation measures that are theoretically linked to mental health, and target the cultural competencies of immigrant background youth. Therefore, the current study aimed at examining if a construct of peer-related culture competence, operationalized in the Youth Culture Competence Scale (YCCS), captured the same competence-phenomenon across different language, age, and immigrant groups in two immigrant-receiving countries. The scale includes two dimensions: one of heritage, and one of majority peer-related culture competence.
Self-report questionnaire data were collected from 895 unaccompanied refugees and 591 immigrant background high school students in Norway, and from 321 immigrant university students in the United States. To examine if the measure assessed the same phenomenon of peer-related culture competence across these three multi-ethnic samples with an age range from 13 to 28, we examined its measurement equivalence. Additionally, we examined if the association between peer-related culture competence and depressive symptoms was similar in these groups.
Confirmatory factor analyses supported the proposed two factor structure of the YCCS across the three samples. The structural equation model assessing the effects of heritage and majority culture competence on depressive symptoms confirmed that each culture competence dimension had a unique association with depressive symptoms across the samples.
We conclude that the YCCS is a robust acculturation measure that may be included in public health studies of mental health among multi-ethnic refugee and immigrant samples of varied ages.
Unaccompanied asylum-seeking and refugee minors report low life satisfaction and high levels of mental health problems, nevertheless they often do not seek or receive help for their problems. ...Teaching Recovery Techniques (TRT) is a low-threshold, five sessions intervention developed to reduce distressing war- and disaster-related trauma reactions among children and youth. In this study, we investigate if TRT can contribute to increased life satisfaction among unaccompanied asylum-seeking and refugee minors.
Asylum-seeking and resettled unaccompanied minors participated in TRT carried out in 15 locations throughout Norway, n = 147, mean age = 16.61 (SD = 1.80), 88% boys, and 67% from Afghanistan. Life satisfaction was measured by the Cantril Ladder before the intervention, and two- and eight weeks post-intervention. We also included indices of intervention compliance and contextual variables, such as asylum status. We applied a pre- and post-intervention design with linear mixed model analyses to investigate change in life satisfaction.
Life satisfaction significantly increased from pre- to post- intervention, but not for youth whose asylum application had been rejected or who were still awaiting a decision. Indices of intervention compliance were associated with an increase in life satisfaction.
TRT is a potential useful intervention to enhance life satisfaction among unaccompanied asylum-seeking and refugee minors and can be a measure to support positive development among youth at risk for mental health problems. However, TRT initiatives should consider the participant's stage of asylum process, because harsh immigration policies may overburden the coping capacity. Without further adaptation, TRT seems most useful for youth granted residence. The manual has been revised to include asylum-related stressors.
ClinicalTrials.gov (16/54,571, registered 30.01.2019).
There is a lack of knowledge about psychosocial resources that may sustain post‐resettlement psychological adjustment among unaccompanied minor asylum‐seekers. The aim of this study is to investigate ...the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population‐based multi‐ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel.
In 2015, 162,877 persons sought asylum in Sweden, 35,369 of whom were unaccompanied refugee minors (URMs). Refugee children, especially URMs, have often experienced traumas and are at significant ...risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue years after resettlement. The Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT) aims to evaluate a community-based intervention, called Teaching Recovery Techniques (TRT), for refugee youth experiencing PTSD symptoms.
A randomised controlled trial will be conducted in which participants will be randomly allocated to one of two possible arms: the intervention arm (n = 109) will be offered the TRT programme, and the waitlist-control arm (n = 109) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; about 8 weeks after randomisation) and follow-up (T3; about 20 weeks after randomisation).
This study will provide knowledge about the effect and efficiency of a group intervention for URMs reporting symptoms of PTSD in Sweden.
ISRCTN, ISRCTN47820795. Prospectively registered on 20 December 2018.
BackgroundRefugee children have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and ...anxiety, which can continue for years after resettlement. The Accompanied refugeeS In Sweden Trial (ASsIST) aims to evaluate a community-based intervention, called ‘Teaching Recovery Techniques’ (TRT), for accompanied refugee minors experiencing PTSD symptoms.Methods/designA cluster randomised controlled trial will be conducted in which participants will be randomly allocated to one of the two possible arms: the intervention arm (n=113) will be offered the TRT programme and the waitlist-control arm (n=113) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; c.8 weeks after randomisation) and follow-up (T3; c.20 weeks after randomisation).Ethics and disseminationEthical approval was granted by the Regional Ethical Review Board in Uppsala (Ref. 2018/382) (24th February 2019). Results will be published in scientific journals.Trial registration detailsISRCTN17754931. Prospectively registered on 4th June 2019.
Although post-traumatic stress is prevalent among unaccompanied refugee minors (URM), there are few evidence-based psychological interventions for this group. Teaching Recovery Techniques (TRT) is a ...brief, manualised intervention for trauma-exposed youth, which has shown promising results in exploratory studies. The aim of the present study was to assess the feasibility of conducting a randomised controlled trial (RCT) evaluating the use of TRT among URM by investigating key uncertainties relating to recruitment, randomisation, intervention delivery and data collection.
A 3-month long non-blinded internal randomised pilot trial with a parallel-group design assessed the feasibility of a planned nationwide multi-site RCT. URM with or without granted asylum were eligible if they were 14 to 20 years old, had arrived in Sweden within the last 5 years and had screened positive for symptoms of post-traumatic stress disorder (PTSD). Quantitative data were collected pre- and post-intervention, and 18 weeks after randomisation. On-site individual randomisation (1:1) followed directly after pre-intervention assessment. Participants allocated to the intervention were offered seven weekly group-based TRT sessions. Quantitative pilot outcomes were analysed using descriptive statistics. Qualitative information was gathered through on-site observations and follow-up dialogue with group facilitators. A process for Decision-making after Pilot and feasibility Trials (ADePT) was used to support systematic decision-making in moving forward with the trial.
Fifteen URM (mean age 17.73 years) with PTSD symptoms were recruited at two sites. Three of the youths were successfully randomised to either TRT or waitlist control (TRT n = 2, waitlist n = 1). Fourteen participants were offered TRT for ethical reasons, despite not being randomised. Six (43%) attended ≥ 4 of the seven sessions. Seventy-three percent of the participants completed at least two assessments, with a response rate of 53% at both post-intervention and follow-up.
The findings demonstrated a need for amendments to the protocol, especially with regard to the procedures for recruitment and randomisation. Upon refinement of the study protocol and strategies, an adequately powered RCT was pursued, with data from this pilot study excluded.
ISRCTN47820795 , prospectively registered on 20 December 2018.
Unaccompanied refugee minors (URMs), are at high risk for mental health problems, yet there is a lack of knowledge about social anxiety among these youths. The aim of this study was to investigate ...symptoms of social anxiety among URMs resettled in Norway, and the combined effects of pre-migration traumatic events, post-migration acculturation related factors (perceived discrimination and culture competence in relation both to the heritage and majority cultures) and demographic background variables, over and above the effect of concurrent depressive symptoms.
Cross-sectional self-report questionnaire data were collected from 557 URMs from 31 different countries, mainly from Afghanistan (49,6%), Somalia (11,1%), and Iraq (7,0%). Results: The findings from structural equation model (SEM) showed that the effect of pre-migration traumatic events on social anxiety was non-significant (β = 0.001, p = .09), while perceived discrimination and majority culture competence had unique effects on social anxiety (β = 0.39, p < .001 and β = −0.12, p = .008, respectively) over and above depressive symptoms (β = 0.30, p < .001).
The findings show that factors of the current socio-cultural developmental context rather than pre-migration war-related traumatic events the youths experienced before migration accounts for variation in social anxiety. Potential practical implications of the findings for social workers, educational staff and clinicians are discussed.
•Social anxiety is associated with socio-cultural post-migration factors, rather than pre-migration traumatic events.•Perceived discrimination is directly associated with levels of social anxiety, over and above the effects of depression.•Culture competence on the majority culture is associated with lower levels of social anxiety.
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