Adaptative Skills and Global Functioning of Unaccompanied Migrant Minors in Europe: A Systematised Review.

Objectives: This systematised review aimed to examine European literature reporting data about adaptative skills and global external functioning of unaccompanied minors (UAMs). Methods: We conducted a systematised screening of four databases (APA PsycINFO Ovid, Medline Ovid ALL, Embase.com and Web Of Science Core Collection) using a research strategy including social, scholarly and behavioural abilities as well as externalising problems associated with the target population of UAMs. Thirty articles were included using pre-defined inclusion and exclusion criteria. Results: Our review showed that despite high levels of internalising disorders, socio-behavioural and educational adjustment of UAMs remained positive. It demonstrated how this population displays a strong desire for academic success and prosocial behaviours instead of aggressivity in everyday life. Nevertheless, our review drew attention to the strong tendency of UAMs to internalise their disorders and display chronic distress and problematic behaviours which increased with time spent in the host country. Conclusion: Our study draws attention to the risk of underestimating the real mental health needs of refugees, due to preserved external functioning combined with significant settlement pressures.

Trauma and mental health in young adults who arrived in France as unaccompanied and separated migrant children.

OBJECTIVES: The mental health of unaccompanied and separated minors (UASC) has been widely studied but not their first years of adulthood, often characterised by uncertainty after leaving child protection. The aim of this study was to estimate the prevalence of psychiatric disorders using standardised and validated research instruments and examine the effect of exposure to trauma. METHODS: One hundred and ten youth (92.7% male, median age 19.7 [18.1-22.8]) from Chambery, Montpellier and La Rochelle were recruited to a cross-sectional exploratory study. During a face-to-face interview, somatoform disorder, anxiety, and depression were assessed using the Patient Health Questionnaire (score≥10) and post-traumatic stress disorder (PTSD) with the PTSD Checklist for DSM-5 (score≥33). Traumatic life events were assessed using the Life Events Checklist. RESULTS: Of the youth, 19.3% had a probable somatoform disorder, 17.6% anxiety, 28.7% depression, and 20% PTSD. The number of traumatic life events increased the risk of depression (multi-adjusted OR (95%CI): 1.56 (1.25-1.96)), PTSD (1.60 (1.23-2.08)), somatoform disorder (1.41 (1.10-1.82), and anxiety (1.33 (1.02-1.72)). Physical assault was the type of event positively associated with the most disorders (P≤0.01, except for anxiety), followed by witnessing sudden and violent death (P≤0.01 for depression and PTSD) and sexual assault (P=0.002 for PTSD). CONCLUSION: Our study highlights the high prevalence of psychiatric disorders in young adults who arrived as UASC and the impact on their mental health of cumulative trauma and exposure to interpersonal and violent traumatic life events. A greater focus on their mental health with regular assessments is needed in order to provide rapid and adapted care.

[Assessment of families in situations of forced migration: Transcultural approaches to identifying and supporting psychological suffering]. / Évaluation des familles en situation de migration forcée: Approches transculturelles pour repérer et accompagner la souffrance psychologique.

With current migratory movements, the population is becoming increasingly mixed, and consultations are receiving more migrants. The paediatrician or general practitioner is often the front-line health professional who has to assess how to welcome a newcomer family, investigate their life history, discuss mental health with them and sometimes overcome the negative prejudices that some cultures and people may have about psychiatry. Identifying worrying symptoms is an important first step in the overall assessment. It is then essential to support these families while working on protective factors and offering support for parenthood. Finally, working with the network will be key to ensuring continuity of care and the most appropriate support for the migrant's needs.

Avec les mouvements migratoires actuels, la population devient de plus en plus métissée et les consultations accueillent davantage de migrants. Le pédiatre ou le généraliste est souvent le professionnel de santé en première ligne qui doit évaluer la façon d'accueillir une famille primo-arrivante, d'investiguer leur histoire de vie, de parler de santé mentale avec eux et parfois de contourner les préjugés négatifs que certaines cultures et personnes pourraient avoir sur la psychiatrie. Le repérage des symptômes inquiétants est une première étape importante lors de l'évaluation globale. Il est fondamental ensuite d'accompagner ces familles tout en travaillant sur les facteurs protecteurs et en proposant un soutien à la parentalité. Enfin, le travail avec le réseau sera déterminant pour assurer la continuité des soins et un accompagnement le plus adapté au besoin du migrant.

Association between uncertainty regarding right-to-stay and mental health in unaccompanied and separated migrant children (UASC) reaching adulthood: findings from France.

PURPOSE: There is substantial evidence suggesting high levels of mental health problems in unaccompanied and separated children (UASC). However, there is less focus on the first years of adulthood characterised by increased vulnerability and fear of expulsion. We aimed to describe the mental health of UASC on reaching adulthood, and how this was affected by uncertainty regarding their right-to-stay in France. METHODS: One hundred and ten youth aged 18-22 were recruited via child protection reception centres. We administered the Patient Health Questionnaire somatic (PHQ-15), anxiety (GAD-7) and depression (PHQ-9) modules, the Post-Traumatic Stress Disorder Checklist (PCL-5) and Connor-Davidson Resilience Scale (CD-RISC-10). Logistic regression analysis was performed with the dependent variable, a secure (versus uncertain) situation, defined as (1) detaining a residence permit and being in school, an apprenticeship or a salaried job, or (2) waiting for residence permit whilst occupying a salaried job. RESULTS: Of the sample, 19.3% reached criteria for a probable somatic disorder, 17.6% for anxiety and 28.7% for depression (score  ≥ 10); 41.8% were in an uncertain situation regarding their right-to-stay. Uncertainty was associated with higher anxiety ((OR per Interquartile range (95% CI), 1.77 (1.05-2.98)) and post-traumatic stress symptoms (2.05 (1.06-4.00)), lower resilience (0.50 (0.27-0.91)), and participants rating their anxiety (p = 0.02) and depressive symptoms (p = 0.003) as more severe since reaching adulthood. CONCLUSIONS: Our findings suggest uncertainty regarding right-to-stay is associated with increased mental health symptoms, specifically anxiety and trauma-induced stress, thereby highlighting the vulnerability of UASC in their first years of adulthood. This calls for greater support during this transition period with regular symptom monitoring for timely psychological interventions.

Dealing with difference: a scoping review of psychotherapeutic interventions with unaccompanied refugee minors.

Unaccompanied refugee minors (URMs) are a population at risk for developing mental problems, post-traumatic stress disorder, anxiety, and/or depression. Therapists working with URMs often have to overcome language and cultural barriers, while taking into account these young people's specific needs. A growing literature describes a wide range of interventions designed to reduce psychopathologies and improve well-being. We summarized the different interventions used with URMs to get an overview of techniques used for reducing psychopathologies and difficulties of URMs and to give recommendations to help professionals. We searched eight databases for articles and books, imposing no restrictions on publication date or geographical region, and using English and French keywords. We included all studies (RCTs, case series, case study) that assessed an intervention with one or more URMs. Seventeen studies, reported in papers or book chapters, met the criteria for inclusion in our analysis. Only one RCT has been conducted with URMs but because of small sample size we cannot conclude on its efficacy. Other studies are case series or case studies and because of their study design, we cannot conclude whether one intervention is superior to others. Further research, with higher level of evidence, is needed to determine which types of intervention are most effective when working with URMs.