The socio-ecological factors affecting the mental health of unaccompanied and separated refugee and asylum-seeking children

Abstract

We conducted a systematic review of existing empirical evidence on the socioecological risk and protective factors affecting the mental health of internally displaced, and unaccompanied and separated refugee and asylum-seeking children (UASC) by searching Medline, PsycInfo, ERIC, GLOBAL HEALTH DATABASE, and Web of Science for original research studies published up until May 2020. 68 studies qualified for the final sample, compromising 15,671 children excluding overlapping study populations. Cumulative exposure to violence and adversities, including post-migration stressors, were the most robust and widely examined predictors for psychological distress in UASC, supporting a strong dose-response relationship. Uncertainty and legal precarity of asylum-seeking youth were significant variables in growing mental health problems in UASC, which became particularly evident when UASC transition into institutional adulthood and subsequent loss of access to services, educational opportunities, and protection. A thorough social embedding through affectionate care, supportive relationships, an adequate child-rearing environment had a positive effect. Education and learning were key normalizing experiences that re-establish order and predictability and nurture the ability to develop a projected self. Evidence on the intersecting relation of psychopathology and intra-individual personality dimensions in UASC underscores the importance of an elaborate clinical assessment upon arrival, given the complexity of individual adaptive functioning aside regular, long-term follow-up care. Effective mental health programming must involve a tailored, culturally sensitive, multi-layered, and cross-sectorial approach engaging diverse sectors including education, child protection, legal and political participation. Addressing daily hassles and providing support with engagement coping strategies are important factors for UASC's successful adjustment and acculturation to the receiving country. Considering UASC's specific vulnerability and formative age, efforts to prompt and fair asylum processes must be the utmost priority. A sustainable humanitarian approach providing a continuum of care across national boundaries, including transit and return countries, should be prioritized. Future scholarship may expand its processual and agentic perspective on UASC's mental health by contextualizing socioecological factors along a developmental sphere of the maturing child through longitudinal studies. Realities of forcibly displaced children aside the context of receiving countries like those displaced internally or in countries of the Global South, UASC post-return, or those stuck in transit countries require further attention.