Mental Distress and Behavioral Problems in Unaccompanied Minors During the Initial 18 Months in Two European Host Countries

doi:10.21203/rs.3.rs-1191698/v1

Large numbers of unaccompanied minors (UMs) have been migrating from low-income countries to European countries in recent years. Still, knowledge about risk behaviour and conduct problems in these populations is scarce. There is also a lack of knowledge about how mental health and behavioural problems in these populations change over time and whether this varies between host countries with different asylum procedures, care routines and reception facilities. Thus, our aim was to compare trajectories of mental health and behavioural problems in populations of UMs arriving in two European host countries with different practices for handling and care of UMs.

We examined mental health and behavioural problems of UMs shortly after their arrival in Norway (n = 204) and Belgium (n = 103) using self-report questionnaires (HSCL‐37A, SLE, RATS, HTQ). The same procedure was repeated after 18 months in both Norway (n=127) and Belgium (n=76).

There was a significant increase in externalizing behaviour among UMs in Belgium, but not among UMs in Norway. The changes were due to an increase in substance abuse more than other maladaptive externalizing behaviours. Internalizing symptoms and posttraumatic stress reactions stayed relatively unchanged for UMs in both countries.

We postulate that different care and reception facilities for UMs may explain differences in substance abuse between the two countries. Apart from substance use, there were insignificant changes in mental health and externalizing behaviours among UMs in the first 18 months after arriving in their host countries.

Unaccompanied minors

asylum

mental health

behavioural problems

Norway

Belgium

Unusually large numbers of unaccompanied children and adolescents have been migrating from low-income countries to European countries in recent years. According to UNHCR [1], these young refugees have a special need for protection due to their precarious situation. The literature on the mental health of unaccompanied minors (UMs) shows that they suffer from more psychological distress than adolescents that live in their home country, or young refugees staying with a family member [2]. However, our knowledge about risk behaviour and conduct problems in UM-populations is scarce. The few studies available show lower levels of problematic behaviours compared to other groups within the same country [3,4]. However, longer time spent in the new host country can lead to an accumulation of difficulties, and among them, greater behavioural problems [5,6].

Behavioural problems in adolescence are assessed and classified differently in different studies, but a common meta-framework for describing problematic conduct has been to use the term externalizing symptoms [7]. This term is also related to the concept of “acting-out”, and to a lack of control regarding the consequences of behaviour [8]. The rather wide term “externalizing” has been used to describe a variety of conduct problems, from hyperactivity to delinquent or anti-social behaviour, and different kinds of risk-taking, including substance abuse [9]. The manifestation of externalizing behaviour can often represent more visible concerns to professional helpers and brings adolescents in contact with mental health services more often than internalizing symptoms like anxiety or depression [10]. Despite this, the presence of possible problematic behaviours in UMs has received less attention than internalizing symptoms and posttraumatic stress in the research literature. There are also very few studies focusing on the externalizing symptoms represented by alcohol and substance abuse.

We wanted to conduct a comparative longitudinal study with UMs after their arrival in two European countries, Belgium and Norway. These countries have many similarities in the way asylum-seeking young refugees are handled, but also some important differences. For instance, asylum procedures, care and reception facilities, and type and duration of protective measures for UM differ between the two countries. In 2014, we published a comparison of the mental health problems of UM within a few weeks after arrival in these two European host countries [11]. The result was high symptom scores connected to anxiety, depression and PTSD, but no significant difference between the two host countries.

In the present study, we expand on this previous study with a follow-up of the two populations of UMs. We wanted to investigate possible changes in general psychological distress, posttraumatic stress, and behavioural problems. The aim was to compare trajectories of mental health and behavioural problems in populations of UMs arriving in two European host countries with different practices for handling and care of UMs.

Procedure

Participants were unaccompanied minors that were recruited during comparable time periods in Norway and Belgium. An unaccompanied minor (UM) is any child under the age of 18 years that arrives to the host country without being accompanied by an adult caretaker. The first assessments were performed in the first weeks after their arrival, when the minors were still residing in refugee centres for newly arrived unaccompanied minors. In Belgium, unaccompanied minors resided in specific reception centres (Observation and Orientation Centres of Steenokkerzeel and Neder-Over-Heembeek, near Brussels) during the first weeks after arrival. The psychologists of these two centres asked all minors arriving between September 2010 and January 2011 and who were over fourteen years of age to participate, except for three minors who immediately at arrival told they intended to leave the centre soon and two minors who left before they could be asked to participate. Eight UMs did not consent to participate, and 103 UMs agreed to take part. The researcher firstly gave a general description of the research aims, stressing the freedom not to participate, confidentiality and anonymity, and the independence of the study from migration authorities. An informed consent, including the researcher’s contact information was signed, and the participants completed the self-report questionnaires, available in 19 different languages. Interpreters were available to ensure a good understanding of the study aims and questionnaires, and to render participants the opportunity to provide additional information in their mother-tongue.

In Norway, all UM between ages 15 and 18 years were placed in a ‘transit centre’ (Hvalstad Arival Centre near Oslo) shortly after arrival. A research assistant, who worked part-time at this centre, invited all minors who arrived during certain periods (12 weeks in the fall of 2009, 8 weeks in the fall of 2010 and 21 weeks in 2011) to participate. For practical reasons, only male UM were invited, and only the six largest language groups were selected (Arabic, Dari, Farsi, Somali, Sorani and Pashto); these groups represented approximately 50% of the total number of recently arrived unaccompanied asylum-seeking minors in Norway at the time of the study. Thirteen UM did not consent to participate, and 204 UM decided to take part in the study. All participants returned the informed consent and completed the screening questionnaires. The instruments were completed by the participants in their native languages, using laptops with touch-screen function and the computer program ‘Multilingual Computer Assisted Interview’ (MultiCASI) [12]. All text had a connected sound-file that could be activated by touch, allowing participants with weaker reading abilities to answer questions without support of an interpreter. Details about gender and countries of origin are described in a previous paper [11].

At follow-up (after 18 months), the researchers from each country visited the participants, and the same questionnaires were completed. There was loss of participants between the two waves of assessments in both countries. In Belgium, 27 participants (26.2%) dropped out, mostly because they found participating too emotionally demanding at that time. Others disappeared, were unreachable for other reasons or were forcibly deported, reducing the initial 103 into 76 participants that were re-questioned after 18 months.

In Norway, the population was reduced with 80 (38.6%) from 207 to 127 at the last assessment, mainly because many of the informants were transported out of the country or had disappeared from the different living facilities. The participants who were deported were mostly individuals who had been registered as asylum-seekers in another European country before coming to Norway, or individuals suspected of having some connection to illegal activities. The ones who deflected were typically those who feared deportation after their asylum-applications were turned down. Exact numbers and reasons for the attrition are lacking.

Questionnaires

First, a socio-demographic questionnaire asked about participants’ age, gender, country of origin, whether parents were still alive, date of departure from the home country and date of arrival in the host country. Sociodemographic characteristics of all participants included in the first wave of assessments are previously reported [13].

Second, three self-report questionnaires assessed participants’ behaviour, mental health, and exposure to difficult life events. Symptoms of anxiety, depression and externalizing problems were measured with the ‘Hopkins Symptom Checklist-37A’ (HSCL-37A), a questionnaire modified by the research group Centrum 45 based on the HSCL-25 version from the Harvard Refugee Program [14]. The Dutch research centre decided to extend the scope of the instrument by inserting 12 items of externalizing behaviour for use with young refugee populations [15-19]. The five items about bullying, stealing things, intentionally hurting someone, starting fights, and destroying others` property, correspond to criteria from the DSMIV-diagnosis Conduct Disorder. The items easily angered and argues often correspond to Oppositional Defiant Disorder. Another five items are related to substance use: use of alcohol in the weekend, use of alcohol during the week, smoking cigarettes, use of sedatives and use of illegal drugs. Participants score the 37 items (anxiety: 10 items, depression: 15, externalizing problems: 12) on a 4-point Likert scale, ranging from ‘not at all’ (1) to ‘very much’ (4). Using a confirmatory factor analysis, the two-factor structure internalizing vs. externalizing has been verified. The HSCL-37A is available in nineteen different languages and validated for use with young refugee populations [20,21]. In this study, the item “loss of sexual interest” (depression scale) was left out because this item was often not completed in previous studies [11].

Potentially traumatic experiences were registered with the ‘Stressful Life Events’ (SLE) [20,22], a self-report questionnaire available in 19 languages which asks whether the participant has experienced twelve different kinds of traumatic events, such as separation from family, natural disaster, war and physical or sexual abuse.

In the two study settings, different questionnaires were used to investigate symptoms of posttraumatic stress.

In Belgium, the ‘Reactions of Adolescents to Traumatic Stress questionnaire’ (RATS) [20] was used, including 22 items parallel to the DSM-IV criteria for post-traumatic stress disorder (PTSD). Items need to be scored on a 4-point Likert scale, ranging from ‘not at all’ (1) to ‘very much’ (4), and comprise three subscales: intrusion, avoidance and hyper-arousal. The RATS, also available in 19 languages, has good validity for use with young refugee population [20,21]. Cronbach’s alpha for total PTSD-score in this study was 0.81.

In Norway, the PTSS16 of the Harvard Trauma Questionnaire (HTQ) was used [23] (Mollica et al., 1992), consisting of the first 16 items of Part IV of the questionnaire, and equally measuring PTSD symptoms according to the DSM-IV. Items are also measured on a 4-point Likert scale, ranging from ‘not at all’ (1) to ‘extremely’ (4). The HTQ was validated for use in refugee populations in different studies [23,24]. Cronbach’s alpha for the PTSS16 in this study was 0.86.

Because of the high similarity between both questionnaires, one overall measure of posttraumatic stress for both countries was calculated: Twelve of the 16 items of the PTSS16 are identical to items of the RATS. The other four PTSS16 items are similar to the combination of two RATS items for each PTSS16 item. Mean of the two RATS items was used to transfer RATS to 16 items corresponding to PTSS16. Two RATS items did not match PTSS16 and were left out (item 13: I have trouble expressing my feelings, and item 5: I find myself sometimes acting like I did at the time of the events). A Cronbach alpha value of 0.83 was found for the final instrument.

We used independent sample t-test to compare symptom-scores in the two samples. When examining change across time, we used dependent sample t-tests.

Table 1 shows sociodemographic variables of UMs who participated in both the first and second wave of assessments. Both countries had UM from Asia and Africa. There were more participants of African origin in the Belgian group compared with the Norwegian. The Belgian participants lived in many different arrangements while most of the Norwegian participants lived in specialized youth centres for UM.

Table 2 shows internalizing problems, posttraumatic stress, and externalising problems in UMs in Belgium and Norway at arrival and after 18 months in the host country. UMs in Norway reported higher levels of internalizing symptom levels of general psychological distress than UMs in Belgium both at arrival and after 18 months. There was no significant change in internalizing symptom levels across time in either country.

UMs in Norway and Belgium did not differ significantly in posttraumatic stress either at arrival or after 18 months. There was no significant change in symptom levels of posttraumatic stress across time in either country.

Externalizing behaviour problem scores were higher among UMs in Norway than Belgium at arrival, but not after 18 months. There was a significant increase in externalizing behaviour scores across time among UMs in Belgium, but not among UMs in Norway.

When dividing externalizing behaviour into the underlying categories of substance abuse, conduct disorder behaviour, and oppositional defiant behaviour, significant differences between Belgium and Norway, as well as changes across time were found for substance abuse, but not for the other maladaptive externalizing behaviours. Substance abuse was higher among UMs in Norway (1.32) than in Belgium (1.25) at arrival (p=0.03) and higher among UMs in Belgium (1.41) than in Norway (1.28) after 18 months (p=0.03). During these 18 months, reports of substance abuse increased among UMs in Belgium (0.16, 95% CI: 0.08-0.24, p<0.001), but not among UMs in Norway (-0.05, 95% CI: -0.12-0.04, p=0.29).

In this longitudinal study of UMs in their first 18 months after arriving in two European countries, there was a significant increase in externalizing behaviour among UMs in Belgium, but not among UMs in Norway. The changes across time were due to an increase in substance abuse, and not in the other maladaptive externalizing behaviours. Internalizing symptoms and posttraumatic stress reactions stayed relatively unchanged for UMs in both countries over the period.

The legal environments of Belgium and Norway are quite similar, but there may be some differences related to specific social structures, and the policies that are adopted in relation to the European Union, of which Belgium is a member, and Norway is not. The most important difference, in our opinion, is a result of travel routes and geography. Norway`s localisation at the far north of Europe makes it more likely that UM that arrive at the border, are fewer in number, and come because they wish to stay in the country. The countries localised in central Europe will usually receive more UM who wish to travel on to other destinations.

The difference in trajectories of externalizing behaviour in the two countries may be due to different practices for support and care of UMs. Both in Belgium and in Norway, there are a few large centres where all newly arrived UM are received and registered. After 3-5 weeks, UMs in Norway are moved to smaller care and reception facilities. The levels of material and social support offered at this stage differed between the two countries.

In Norway, all UM applied for asylum, and if they were considered to be under the age of 18, they were placed in a reception centre that provided a package of care including the provision of living arrangements, education, access to health professionals, and counselling by social workers.

In Belgium, all UM who applied for asylum had the right to be cared for as asylum applicants, but at the time of the study, only a small part of the UMs applied for asylum. The other UMs were referred to services within the regionally organized youth care. In the asylum reception facilities, the quality of care (e.g., number of staff members, number of UMs living together, the housing facilities) were rather limited. The Belgian youth care services actually had higher quality criteria, but there were fewer places available, and usually too few for the number of UMs who needed these special care facilities [25,26].

In the Belgian group, problems directly connected with life during the asylum process, such as lack of material resources, uncertainty about the future, and difficulties with obtaining legal residence were registered as components in a list of post-migration stressors: a high number of post-migration daily stressors were associated with increased symptom levels [27], and the total burden of these daily material and social stressors increased during the observation period.

At the time of the second assessment (18 months), only a small number of participants in both countries had been granted a residence permit. Concerns about the future were probably present for all UMs waiting for decisions on their asylum applications. The lack of recovery from mental distress that was observed in both countries over the longitudinal follow-up may question the general level of help and support offered to UMs, many of them traumatized in their country of origin and during their flight to safety.

The increase in externalizing behaviour that was observed in the Belgian group draws attention to the exposed life situation of children separated from their caregivers. A variety of difficult circumstances are leading UMs to separate from their parent or primary caregiver [28]. Research has highlighted the burden of adversities, from war-related experiences to the breakdown of civil society, and connected them with internalizing, externalizing and posttraumatic symptoms. As refugee adolescents in a new country, their psycho-social recovery is influenced by several factors that are difficult to influence. Yet, one factor that can certainly be facilitated is the living conditions in the host countries. Improved care may play an important role in the lives of young refugees and may affect mental health and well-being in the transition period [13,29].

Benefits of higher care levels have also been demonstrated by Bean et al [16] showing that UMs who were guided and supervised daily, such as those living in foster care or residential children`s home, had less psychological distress and behavioural problems than UMs living in “small living units” or in reception centres for asylum seekers. Similar benefits of high-support housing and supervision has also been shown by others [5,30].

Methodological considerations

Some limitations should be addressed, including some differences in assessment procedures in the two countries. The assessment in Belgium was based on written self-reports, conducted with interpreters present to ensure a better understanding of the questionnaires. In Norway, the testing was computer-based, with touch screen and sound files, with some aid of interpreters in the introduction of the first wave of assessments. However, an accurate understanding of the languages used for assessment was attempted in both countries. Also, all instruments were evidence-based and validated for young refugees [21].

It would be desirable to study externalizing problems considering differences in the age of the participants, which was not possible due to small study samples and uncertain age estimates. Many participants seemed unsure about when they were born. Some participants stated a different age in the research project than they had done to the authorities, and some had been categorized as UM by the authorities, even though they stated the age to be over 18 years in the research project. This has not been corrected for in the analyses. Larger sample sizes with the opportunity to study subgroups are desirable in similar studies in the future.

Unlike the sample from Norway, the sample from Belgium also included some girls. Girls may have fewer externalizing symptoms than boys. However, Achenbach [7] argue that gender differences in problematic behaviour that are present in younger children decline steadily and are almost negligible when children reach 15-16 years of age.

Differences in access and acceptance of alcohol may have affected our results. For example, the alcohol consumption in youth with a Muslim background may be expected to be low. Also, the availability of alcohol and drugs may be different in Belgium and Norway.

UMs leave their homeland at a young age and must face challenges in a transcultural life situation without the support and protection of their parents. The complexity of factors that may contribute to an increased health risk in young refugees makes it difficult to determine to what extent problems are caused by adverse experiences before or during the flight, or by the post-arrival stress of adapting to a new life situation in a host country. Our follow-up of two populations of UMs with a baseline starting point close to arrival to the host country offered the opportunity to study mental health and behaviour related to post-migration stressors such as an insecure legal status in the waiting-period in-between, dependency on others for survival, life in a refugee reception centre, or sometimes no shelter at all. The observed increase in substance use among UMs arriving in Belgium, but not in Norway, may be due to a higher level of care in Norwegian asylum receptions for young people, including the provision of living arrangements, education, access to health professionals, and counselling by social workers. Rather than using large-scale asylum centres for adults, independent living accommodation or hotel rooms that offer less care and leave the adolescents to themselves, UMs should be accommodated in small-scale centres with appropriate support.

Funding: In Belgium, this study was carried out with support from the Special Research Fund of Ghent University and the European Refugee Fund (EVF), and in Norway with support from the Norwegian Directorate of Immigration.

Conflicts of interest/Competing interests: The authors declare no conflicts of interest.

Availability of data and material: The data presented in this study are available upon request to the project managers Melinda A. Meyer Demott, [email protected] and Ilse Derluyn, [email protected], pending ethical approval from the ethics committees. The data are not publicly available due to local restrictions and the sensitivity of the data.

Authors' contributions: Conceptualization: MJ, MV, MAMD, ID, TH; methodology: MJ, MV, MAMD, ID, TH; validation: ID, TH; formal analysis: MJ, MV, ID, TH; writing original draft: MJ; review and editing: MJ, MV, MAMD, ID, TH. All authors have read and agreed to the published version of the manuscript.

Ethics approval: The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and has been approved by the Regional Committee for Medical and Health Research Ethics, South-East Norway (approval no 2011/1734) and the Ethics Committee of the Faculty of Psychology and Educational Sciences of Ghent University, Belgium.

Consent to participate: Informed consent about participation was obtained from all participants.

Consent for publication: Informed consent about publication of results was obtained from all participants. Each participant was made aware of the right to withdraw from participation or publication at any time.

Evans R, Forte CL, Fraser EM. UNHCR`s engagement with displaced youth: a global review. Geneva: United Nations High Commissioner for Refugees (UNHCR); 2013.
Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P. Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. J Nerv Ment Dis. 2007;195:288–97.
Oppedal B, Idsoe T. Conduct Problems and Depression among Unaccompanied Refugees: The Association with Pre-Migration Trauma and Acculturation. Anales de psicologia. 2012;28:683–94.
Thommessen S, Laghi F, Cerrone C, Baiocco R, Todd BK. Internalizing and externalizing symptoms among unaccompanied refugee and Italian adolescents. Child Youth Serv Rev. 2013;35:7–10.
Hodes M, Jagdev D, Chandra N, Cunniff A. Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry. 2008;49:723–32.
Bronstein I, Montgomery P, Ott E. Emotional and behavioural problems amongst Afghan unaccompanied asylum-seeking children: results from a large-scale cross-sectional study. Eur Child Adolesc Psychiatry. 2013;22:285–94.
Achenbach TM. Multicultural Evidence-Based Assessment of Child and Adolescent Psychopathology. Transcultural Psychiatry 2010:47: 707–26.
Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P. Validation of the multiple language versions of the Hopkins Symptom Checklist-37 for refugee adolescents. Adolescence. 2007;42:51–71.
Stevens GWJM, Pels T, Bengi-Arslan L, Verhulst FC, Vollebergh WAM, Crijnen AAM. Parent, teacher and self-reported problem behavior in The Netherlands. Soc Psychiatry Psych Epidemiol. 2003;38:576–85.
Wu P, Hoven CW, Bird HR, Moore RE, Cohen P, Alegria M, Dulcan MK, Goodman SH, McCue-Horwitz M, Lichtman JH, Narrow WE, Rae DS, Regier DA, Roper MT. Depressive and disruptive disorders and mental health service utilization in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1999;38:1081–90.
Vervliet M, Meyer Demott MA, Jakobsen M, Broekaert E, Heir T, Derluyn I. The mental health of unaccompanied refugee minors on arrival in the host country. Scand J Psychol. 2014;55:33–7.
Knaevelsrud C, Müller J. MultiCASI (Multilingual Computer Assisted Self Interview). Berlin: Springer; 2008.
Jakobsen M, Meyer-DeMott MA, Wentzel-Larsen T, Heir T. The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway. BMJ Open. 2017;7:e015157.
Mollica RF, McDonald LS, Massagli MP, Silove DM. Instructions and guidance on the utilization of the Harvard Program in Refugee Trauma’s versions of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Cambridge: Harvard Program in Refugee Trauma; 2004.
Derluyn I. Different perspectives on emotional and behavioural problems in unaccompanied refugee children and adolescents. Ethnicity Health. 2007;12:141–62.
Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P. Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. J Nerv Ment Dis. 2007;195:288–97.
Derluyn I, Broekaert E, Schuyten G. Emotional and behavioural problems in migrant adolescents in Belgium. European Child Adolescent Psychiatry. 2008;17:54–62.
Derluyn I, Mels C, Broekaert E. Mental Health Problems in Separated Refugee Adolescents. J Adolesc Health. 2009;44:291–7.
Mels C, Derluyn I, Broekaert E, Rosseel Y. The psychological impact of forced displacement and related risk factors on Eastern Congolese adolescents affected by war. J Child Psychol Psychiatry. 2010;51:1096–104.
Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P. Validation of the multiple language versions of the Reactions of Adolescents to Traumatic Stress questionnaire. J Trauma Stress. 2006;19:241–55.
Bean T, Derluyn I, Eurelings-Bontekoe E, Broekaert E, Spinhoven P. Validation of the multiple language versions of the Hopkins Symptom Checklist-37 for refugee adolescents. Adolescence. 2007;42:51–71.
Bean T, Eurelings-Bontekoe E, Derluyn I, Spinhoven P. Stressful life events (SLE): User’s Manual. Centrum’45. Oegstgeest 2004.
Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard trauma questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180:111–6.
Silove DM, Manicavasagar V, Mollica RF, Thai M, Khiek D, Lavelle J, Tor S. Screening for Depression and PTSD in a Cambodian Population Unaffected by War: Comparing the Hopkins Symptom Checklist and Harvard Trauma Questionnaire with the Structured Clinical Interview. J Nerv Ment Dis. 2007;195:152–7.
Derluyn I, Broekaert E. Unaccompanied refugee children and adolescents: The glaring contrast between a legal and a psychological perspective. Int J Law Psychiatry. 2008;31:319–30.
Derluyn I. A critical analysis of the creation of separated care structures for unaccompanied refugee minors. Child Youth Serv Rev. 2018;92:22–9.
Vervliet M, Lammertyn J, Broekaert E, Derluyn I. Longitudinal follow-up of the mental health of unaccompanied refugee minors. European Child Adolescent Psychiatry. 2014;23:337–46.
UNHCR Global trends 2019. United Nations High Commissioner for Refugees (UNHCR), Copenhagen, Denmark 2020.
Vervliet M. The trajectories of unaccompanied refugee minors: Aspirations, agency and psychosocial well-being. Doctoral dissertation, Faculty of Psychology and Educational Sciences, Ghent University 2013.
Reijneveld SA, Boer JBD, Bean T, Korfker DG. Unaccompanied adolescents seeking asylum: poorer mental health under a restrictive reception. J Nerv Ment Dis. 2005;193:759–61.

Table 1. Sociodemographic characteristics of unaccompanied refugee minors who receded in Belgium and Norway, and who participated in both measurement moments.

	Belgium (n=77)	Norway (n=127)
Males	67 (87 %)	127 (100%)
Age (mean, range) (in years)	16.0 (14–17)	16.2 (14-20)
Continent of origin Asia Africa	43 (55.8%) 33 (42.9%)	103 (81.1%) 24 (18.9%)
Legal status In procedure/appeal Definitive residence documents Temporary residence documents No legal documents	35 (45.5%) 16 (20.8%) 19 (24.7%) 7 (9.1%)	43 (33.9%) 35 (27.6%) 47 (37.0%) 2 (1.6%)
Housing Large scale center for asylum seekers Local residence for asylum seekers Private house/apartment Specialized youth care Homeless	23 (29.9%) 21 (27.3%) 27 (35.1%) 4 (5.2%) 2 (2.6%)	31 (24.4%) 0 0 96 (75.6%) 0

Table 2. Internalizing problems ¹, posttraumatic stress ², and externalizing symptom scores ³ in unaccompanied refugee minors at arrival and after 18 months of residence in Belgium and Norway.

Arrival

Mean

(Belgium: n=103

Norway; n=204)

18 months

Mean

(Belgium: n=76

Norway; n=127)

Change⁴

Mean diff. (95%CI)

(Belgium: n=76

Norway; n=124)

p-values

(across time)

Internalizing symptoms

Belgium

Norway

1.75

2.02

p<0.001

1.84

2.10

p=0.002

0.10 (-0.03 - 0.22)

0.09 (-0.03 - 0.22)

p=0.96

0.13

0.14

Posttraumatic stress

Belgium

Norway

2.08

2.19

p=0.073

2.17

2.22

p=0.51

0.10 (-0.01-0.22)

0.06 (-0.08-0.20)

p=0.64

0.09

0.40

Externalizing problems

Belgium

Norway

1.20

1.29

p=0.001

1.30

1.31

p=0.81

0.13 (0.06-0.20)

0.01 (-0.06-0.08)

p=0.028

<0.001

0.70

¹Hopkins Symptom Check List (HSCL-25), 25 items

²Posttraumatic Stress Scale, Harvard Trauma Questionnaire (PTSS-16), 16 items (Norway) or Reactions of Adolescents to Traumatic Stress Questionnaire (RATS), 16 items corresponding to PTSS-16 (Belgium).

³12 items of externalizing behavior from Hopkins Symptom Check List-37A (HSCL-37A)

⁴Change refers to those refugees that participated in both assessments (76 in Belgium and 124 in Norway)

Table 3. Externalizing behavior¹ categorized as substance use, conduct disorder symptoms, and oppositional defiance in unaccompanied refugee minors at arrival and after 18 months of residence in Belgium and Norway.

Arrival

Mean

(Belgium: n=103

Norway; n=204)

18 months

Mean

(Belgium: n=76

Norway; n=127)

Change²

Mean diff. (95%CI)

(Belgium: n=76

Norway; n=124)

p-value

Substance abuse

Belgium

Norway

1.25

1.32

p=0.032

1.41

1.28

p=0.031

0.16 (0.08-0.24)

-0.05 (-0.13-0.04)

p=0.001

<0.001

0.29

Conduct disorder symptoms

Belgium

Norway

1.06

1.09

p=0.41

1.09

1.12

p=0.51

0.06 (-0.02-0.14)

0.02 (-0.06-0.10)

p=0.50

0.15

0.62

Oppositional defiance

Belgium

Norway

1.11

1.13

p=0.53

1.18

1.21

p=0.61

0.09 (-0.03-0.19)

0.07 (-0.01-0.15)

p=0.80

0.13

0.09

¹Externalizing behavior from 12 items of Hopkins Symptom Check List-37A (HSCL-37A)

² Change refers to those refugees that participated in both assessments (76 in Belgium and 124 in Norway)

Mental Distress and Behavioral Problems in Unaccompanied Minors During the Initial 18 Months in Two European Host Countries

Status:

Version 1

Abstract

Introduction

Method

Results

Discussion

Conclusions

Declarations

References

Tables

Status:

Version 1