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A controlled early group Intervention study for unaccompanied minors: Can Expressive Arts alliviate symptoms of trauma and enhance life satisfaction?
Abstract
Objective: This is the first controlled study of an expressive arts group intervention with unaccompanied minor asylum seeking children. The aim of the study was to examine whether such an intervention may alleviate symptoms of trauma and enhance life satisfaction.
Methods: 145 unaccompanied minor refugee boys with their stated age between 15 and 18 were allocated into a 10 session 5 weeks manualized expressive arts intervention (EXIT) or a life as usual (LAU) control group.
The participants were assessed on onset and 4 times over a period of 25 months with a battery of instruments measuring post-traumatic stress symptoms (PTSS), general psychological distress (HSCL-25A), current life satisfaction (CLS) and expected life satisfaction (ELS). The instruments were presented in the participants’ native languages, using touch-screen laptops and the computer program Multilingual Computer Assisted Interview (MultiCASI).
Results: There were significant time by group interactions in favor of the EXIT group for PTSS and CLS. At the end of the follow up the EXIT group had higher life satisfaction and hope for the future than the LAU group.
Conclusions: A manualized EXIT group intervention can have a beneficial effect on helping minor refugee boys to cope with symptoms of trauma, strengthen their life satisfaction and develop hope for the future. Our findings support previous studies showing that the arts may help people in reconstructing meaning and connection with others by focusing on resources and creativity.
Key words: Expressive Arts, Group intervention, Unaccompanied asylum-seeking boys, Trauma symptoms, Life satisfaction, Hope
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Methods:
The authors conducted a systematic review of scholarly journals and manuscripts. The search was limited to articles published in English that focused on group treatment with torture survivors.
Findings:
The authors identified 36 articles and chapters for review describing a variety of group interventions for survivors of torture, including: • Supportive Group Therapy • Empowerment Workshops • Group Treatment for Sleep Disorders • Den Bosch model • Wraparound approach • Stage-oriented model The literature examined varied in approach and format: present-day and past-focused groups; structured, time-limited groups; and flexible, ongoing support groups. The studies took place in diverse locations, including Denmark, Germany, Guinea, Namibia, the Netherlands, Palestine, Serbia, the U.S., the UK, and Zimbabwe, and, in conflict, post-conflict and/or humanitarian settings. The interventions were facilitated by licensed mental health professionals, paraprofessionals, and bilingual/bicultural staff - or a combination of the latter two.
Interpretations:
Group treatment is an approach which can be administered to larger groups of survivors to address a range of treatment issues. The authors examined key clinical practice issues for group treatment including group composition and content, facilitation and measurement strategies. While the literature does provide a compelling conceptual rationale for using group treatment, the empirical literature is in fact very limited at this time, and needs to be strengthened in order to build confidence in outcomes across contexts and survivor communities.
Conclusions:
This paper points to a growing interest in the topic of group treatment for survivors of torture and severe violence, providing a comprehensive picture of group-based interventions and highlighting the need for additional research and knowledge-building.
Creative arts therapy programs delivered by qualified therapy professionals have been identified as effective for adolescents affected by adversity. The current study provided a controlled trial of creative arts therapy to address the psychosocial needs of students from refugee backgrounds. Forty-two students participated in a therapy trial, comprising an creative arts group and control group. Mental health and behavioural difficulties were assessed pre and post intervention. Hopkins Symptoms Checklist-25 (HSCL-25) and the Strengths and Difficulties Questionnaire (SDQ) were used to assess well-being. Findings suggested an effect for a reduction in behavioural difficulties for the treatment group. A significant reduction in emotional symptoms was found for the treatment group. Findings provide empirical support for school-based creative arts therapy programs specific to refugee young people.
There are no valid and reliable cross-cultural instruments capable of measuring torture, trauma, and trauma-related symptoms associated with the DSM-III-R diagnosis of posttraumatic stress disorder (PTSD). Generating such standardized instruments for patients from non-Western cultures involves particular methodological challenges. This study describes the development and validation of three Indochinese versions of the Harvard Trauma Questionnaire (HTQ), a simple and reliable screening instrument that is well received by refugee patients and bicultural staff. It identifies for the first time trauma symptoms related to the Indochinese refugee experience that are associated with PTSD criteria. The HTQ's cultural sensitivity may make it useful for assessing other highly traumatized non-Western populations.
Children's adjustment to resettlement countries is vitally important to future outcomes, yet little attention is given to the role of hope in this process. This research focused on expressions of hope in 10 refugee and immigrant children during early years of resettle-ment. Using case study methods that employed arts-based data collection, categories were constructed from participants' visual images and associated narratives. Hope in newcomer children was conceptualized as a dynamic enduring trait that is intimately linked to each child's life context. Further, three hope-engendering sources were identified that facilitated an emotional connection to others, to self, and to the environment.
Survivors of sexual violence have high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Although treatment for symptoms related to sexual violence has been shown to be effective in high-income countries, evidence is lacking in low-income, conflict-affected countries.
In this trial in the Democratic Republic of Congo, we randomly assigned 16 villages to provide cognitive processing therapy (1 individual session and 11 group sessions) or individual support to female sexual-violence survivors with high levels of PTSD symptoms and combined depression and anxiety symptoms. One village was excluded owing to concern about the competency of the psychosocial assistant, resulting in 7 villages that provided therapy (157 women) and 8 villages that provided individual support (248 women). Assessments of combined depression and anxiety symptoms (average score on the Hopkins Symptom Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), PTSD symptoms (average score on the PTSD Checklist [range, 0 to 3, with higher scores indicating worse symptoms]), and functional impairment (average score across 20 tasks [range, 0 to 4, with higher scores indicating greater impairment]) were performed at baseline, at the end of treatment, and 6 months after treatment ended.
A total of 65% of participants in the therapy group and 52% of participants in the individual-support group completed all three assessments. Mean scores for combined depression and anxiety improved in the individual-support group (2.2 at baseline, 1.7 at the end of treatment, and 1.5 at 6 months after treatment), but improvements were significantly greater in the therapy group (2.0 at baseline, 0.8 at the end of treatment, and 0.7 at 6 months after treatment) (P<0.001 for all comparisons). Similar patterns were observed for PTSD and functional impairment. At 6 months after treatment, 9% of participants in the therapy group and 42% of participants in the individual-support group met criteria for probable depression or anxiety (P<0.001), with similar results for PTSD.
In this study of sexual-violence survivors in a low-income, conflict-affected country, group psychotherapy reduced PTSD symptoms and combined depression and anxiety symptoms and improved functioning. (Funded by the U.S. Agency for International Development Victims of Torture Fund and the World Bank; ClinicalTrials.gov number, NCT01385163.).
This paper illustrates how human ecological theory and hope theory were used to develop arts-based research tools and program
interventions with refugee children in a Canadian inner city context. Building on key ideas such as: the contextualized, reciprocal,
and dynamic nature of hope, the paper identifies a series of program activities. These include the use of photographs, a hope
quilt, the development of narratives, followed by opportunities for children to share their hope work with others and for
parents and other adults to undertake child-focused and hope-based discussions. Policy and program implications for refugee
children are then discussed.
This study provides a summary of the results of an expert opinion survey initiated by the International Society for Traumatic Stress Studies Complex Trauma Task Force regarding best practices for the treatment of complex posttraumatic stress disorder (PTSD). Ratings from a mail-in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase-based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma-focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles. Sustained symptom monitoring during the course of treatment and during extended follow-up would advance knowledge about both the speed and durability of treatment effects.
We undertook a systematic search and review of individual, family, community, and societal risk and protective factors for mental health in children and adolescents who are forcibly displaced to high-income countries. Exposure to violence has been shown to be a key risk factor, whereas stable settlement and social support in the host country have a positive effect on the child's psychological functioning. Further research is needed to identify the relevant processes, contexts, and interplay between the many predictor variables hitherto identified as affecting mental health vulnerability and resilience. Research designs are needed that enable longitudinal investigation of individual, community, and societal contexts, rather than designs restricted to investigation of the associations between adverse exposures and psychological symptoms. We emphasise the need to develop comprehensive policies to ensure a rapid resolution of asylum claims and the effective integration of internally displaced and refugee children.
There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.
Refugees experience multiple traumatic events and have significant associated health problems, but data about refugee trauma and health status are often conflicting and difficult to interpret.
To assess the characteristics of the literature on refugee trauma and health, to identify and evaluate instruments used to measure refugee trauma and health status, and to recommend improvements.
MEDLINE, PsychInfo, Health and PsychoSocial Instruments, CINAHL, and Cochrane Systematic Reviews (searched through OVID from the inception of each database to October 2001), and the New Mexico Refugee Project database.
Key terms and combination operators were applied to identify English-language publications evaluating measurement of refugee trauma and/or health status.
Information extracted for each article included author; year of publication; primary focus; type (empirical, review, or descriptive); and type/name and properties of instrument(s) included. Articles were excluded from further analyses if they were review or descriptive, were not primarily about refugee health status or trauma, or were only about infectious diseases. Instruments were then evaluated according to 5 criteria (purpose, construct definition, design, developmental process, reliability and validity) as described in the published literature.
Of 394 publications identified, 183 were included for further analyses of their characteristics; 91 (49.7%) included quantitative data but did not evaluate measurement properties of instruments used in refugee research, 78 (42.6%) reported on statistical relationships between measures (presuming validity), and 14 (7.7%) were only about statistical properties of instruments. In these 183 publications, 125 different instruments were used; of these, 12 were developed in refugee research. None of these instruments fully met all 5 evaluation criteria, 3 met 4 criteria, and 5 met only 1 of the criteria. Another 8 standard instruments were designed and developed in nonrefugee populations but adapted for use in refugee research; of these, 2 met all 5 criteria and 6 met 4 criteria.
The majority of articles about refugee trauma or health are either descriptive or include quantitative data from instruments that have limited or untested validity and reliability in refugees. Primary limitations to accurate measurement in refugee research are the lack of theoretical bases to instruments and inattention to using and reporting sound measurement principles.
Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.
Self-report screening is an important element of transcultural research. Problems concerning illiteracy, cultural sensitivity, and possible misunderstandings have been handled differently in different settings. The aim of this study was to evaluate the validity of two well-known instruments: the Hopkins Symptoms Check List (HSCL-25), and the Harvard Trauma Questionnaire (HTQ, Part IV), with a sample of 160 unaccompanied asylum-seeking adolescents from Afghanistan and Somalia. Assessments were performed 4 months after arrival in Norway, and the screening instruments were presented to the informants on computers with touch-screen function, using the program MultiCASI. Sound-files in the native languages of the informants appeared simultaneously with the written items and could be repeated by touch. We found that the screening procedures were well received and understood by the informants regardless of reading and writing abilities. Agreement between diagnoses (CIDI) and screening results were similar to other studies. Computer-based assessment in this setting was practical, cost effective, and can be recommended.
It is well known that infants as soon as they are born tend to use fist, fingers, thumbs in stimulation of the oral erotogenic zone, in satisfaction of the instincts at that zone, and also in quiet union. It is also well known that after a few months infants of either sex become fond of playing with dolls, and that most mothers allow their infants some special object and expect them to become, as it were, addicted to such objects. There is a relationship between these two sets of phenomena that are separated by a time interval, and a study of the development from the earlier into the later can be profitable, and can make use of important clinical material that has been somewhat neglected. Those who happen to be in close touch with mothers' interests and problems will be already aware of the very rich patterns ordinarily displayed by babies in their use of the first 'not-me' possession. These patterns, being displayed, can be subjected to direct observation. There is a wide variation to be found in a sequence of events that starts with the newborn infant's fist-in-mouth activities, and leads eventually on to an attachment to a teddy, a doll or soft toy, or to a hard toy. It is clear that something is important here other than oral excitement and satisfaction, although this may be the basis of everything else. Many other important things can be studied, and they include: 1. The nature of the object. 2. The infant's capacity to recognize the object as 'not-me'. 3. The place of the object – outside, inside, at the border. 4. The infant's capacity to create, think up, devise, originate, produce an object. 5. The initiation of an affectionate type of object-relationship.
Despite increasing numbers of unaccompanied refugee minors (UM) in Europe and heightened concerns for this group, research on their mental health has seldom included the factor “time since arrival.” As a result, our knowledge of the mental health statuses of UM at specific points in time and over periods in their resettlement trajectories in European host countries is limited. This study therefore examined the mental health of UM shortly after their arrival in Norway (n = 204) and Belgium (n = 103) through the use of self‐report questionnaires (HSCL‐37A, SLE, RATS, HTQ). High prevalence scores of anxiety, depression and posttraumatic stress disorder (PTSD) symptoms were found. In addition, particular associations were found with the number of traumatic events the UM reported. The results indicate that all UM have high support needs on arrival in the host country. Longitudinal studies following up patterns of continuity and change in their mental health during their trajectories in the host country are necessary.
Despite growing numbers of unaccompanied refugee minors (UMs) in Europe, and evidence that this group is at risk of developing mental health problems, there still remain important knowledge gaps regarding the development of UMs' mental health during their trajectories in the host country and, in particular, the possible influencing role of traumatic experiences and daily stressors therein. This study therefore followed 103 UMs from the moment they arrived in Belgium until 18 months later. Traumatic experiences (SLE), mental health symptoms (HSCL-37A, RATS) and daily stressors (DSSYR) were measured at arrival in Belgium, after 6 and 18 months. UMs reported generally high scores on anxiety, depression and post-traumatic stress disorder (PTSD). Linear mixed model analysis showed no significant differences in mental health scores over time, pointing towards the possible long-term persistence of mental health problems in this population. The number of traumatic experiences and the number of daily stressors leaded to a significant higher symptom level of depression (daily stressors), anxiety and PTSD (traumatic experiences and daily stressors). European migration policies need to reduce the impact of daily stressors on UMs' mental health by ameliorating the reception and care facilities for this group. Moreover, regular mental health screenings are needed, in combination with, if needed, adapted psychosocial and therapeutic care.
What happens in the psyche of the person who migrates? How is the balance between what is objectively perceived and what is subjectively conceived of restored? What factors impinge on this process? Can group analysis help with the transition or lack of it? Is the significance of the therapy group different from any other patient group? These are questions arising from my own personal experiences of being a foreigner in the UK, and from the experiences of running groups with immigrants. I would like to explore these issues, and perhaps speculate, on the basis of Winnicott's ideas of a transitional object and playing and reality. In the second part of the article I will relate these ideas to group analysis.
Previous research on political violence has shown an inverse relationship between overall exposure and psychological well-being. The aim of this study was to examine this relationship in more detail by exploring the impact of specific types of war-related events upon psychological well-being, as well as the role of social and political context in moderating these outcomes. The psychological well-being of 337 Bosnian adolescents living in two towns on opposite sides of the war was assessed using the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Based on the combined symptom scores, and in-depth interviews regarding life history, war experiences, and subjective experience of psychological well-being a gender-matched sub-sample of 40 adolescents was selected and completed a 45-item trauma event scale. Results from the quantitative and qualitative analyses showed that the relationship between exposure, displacement and well-being varied significantly depending on the community in which the adolescents lived. Specific meanings given to different types of war events were important in moderating their effect. Living in a neglected, isolated and depressed community, worry about school performance, missing friends and family breakdown could have as significant an effect on well-being as exposure to war-related events. The findings demonstrate the need to take social context and meaning of events into account when examining the impact of war exposure on psychological well-being.
Background
Researchers focused on mental health of conflict-affected children are increasingly interested in the concept of resilience. Knowledge on resilience may assist in developing interventions aimed at improving positive outcomes or reducing negative outcomes, termed promotive or protective interventions.Methods
We performed a systematic review of peer-reviewed qualitative and quantitative studies focused on resilience and mental health in children and adolescents affected by armed conflict in low- and middle-income countries.ResultsAltogether 53 studies were identified: 15 qualitative and mixed methods studies and 38 quantitative, mostly cross-sectional studies focused on school-aged children and adolescents. Qualitative studies identified variation across socio-cultural settings of relevant resilience outcomes, and report contextually unique processes contributing to such outcomes. Quantitative studies focused on promotive and protective factors at different socio-ecological levels (individual, family-, peer-, school-, and community-levels). Generally, promotive and protective factors showed gender-, symptom-, and phase of conflict-specific effects on mental health outcomes.Conclusions
Although limited by its predominantly cross-sectional nature and focus on protective outcomes, this body of knowledge supports a perspective of resilience as a complex dynamic process driven by time- and context-dependent variables, rather than the balance between risk- and protective factors with known impacts on mental health. Given the complexity of findings in this population, we conclude that resilience-focused interventions will need to be highly tailored to specific contexts, rather than the application of a universal model that may be expected to have similar effects on mental health across contexts.
Unaccompanied asylum-seeking children (UASC) are considered at high risk for mental health problems, yet few studies focus on single ethnic populations. This study presents results from the largest Afghan UASC mental health survey in the UK. Specifically, the study aims to estimate the prevalence of emotional and behavioural problems and to investigate the associations of these problems with demographic variables, cumulative traumatic events, and care and migration variables. A census sample of 222 Afghan UASC was interviewed using validated self-report screening measures. Emotional and behavioural problems were screened using the Hopkins Symptoms Checklist 37A (HSCL-37A). Pre-migration stressful life events were screened using the Stressful Life Events Questionnaire. Administrative data on care and asylum were provided by the local authority social services and the UK Border Agency. Approximately one-third (31.4 %) scored above cut-offs for emotional and behavioural problems, 34.6 % for anxiety and 23.4 % for depression. Ordinary least squares regression indicated a significant dose-response relationship between total pre-migration traumatic events and distress as well as between increased time in the country and greater behavioural problems. Compound traumatic events in the pre-migration stages of forced migration have a deleterious association with UASC well-being. Increased time in country suggests a possible peer effect for these children. Consistent with other studies on refugee children, it should be stressed that the majority of UASC scored below suggested cut-offs, thus displaying a marked resilience despite the experience of adverse events.
This evaluative study assessed the effect of a creative expression program designed to prevent emotional and behavioral problems and to enhance self-esteem in immigrant and refugee children attending multiethnic schools.
The 12-week program involved 138 children, aged 7 to 13, registered in both integration classes designed for immigrant children and regular classes at two elementary schools. Pretest and posttest data were collected from the children themselves and from their teacher. Teachers used Achenbach's Teacher's Report Form to assess the emotional and behavioral symptoms of their pupils whereas children self-reported their symptoms with the Dominic, a computerized questionnaire. Self-esteem was measured with the Piers-Harris Self-Concept Scale administered by interviewers to the children.
At the end of the program, the children in the experimental groups reported lower mean levels of internalizing and externalizing symptoms and higher mean levels of feelings of popularity and satisfaction than the children in the control groups, when controlling for baseline data. In integration classes, the effect on self-esteem was especially notable in boys. The intervention's effect on internalizing and externalizing symptoms was not modified by gender, age or fluency in the mainstream language.
The study provides some evidence that creative workshops in the classroom can have a beneficial effect on the self-esteem and symptomatology of immigrant and refugee children from various cultures and backgrounds. These quantitative results support previous qualitative analysis showing that the workshops participate in the reconstruction of a meaningful personal world while simultaneously strengthening the link of the child to the group. They also transform the teachers' perceptions of newcomers by placing an emphasis on their strength and their resilience, while not negating their vulnerabilities.
The objective of this study was to assess the preliminary psychometric properties of the Reaction of Adolescents to Traumatic Stress questionnaire (RATS) for refugee adolescents. Four independent heterogeneous adolescent population samples (N = 3,535) of unaccompanied refugee minors, immigrants, and native Dutch and Belgian adolescents were assessed at school. The confirmatory factor analyses, per language version, support the three-factor structure of intrusion, avoidance/numbing, and hyperarsoual. The total and subscales of the RATS show good internal consistency and good (content, construct, and criterion) validity. The RATS, in this study, was found to be a reliable and valid instrument for assessing posttraumatic stress reactions of culturally diverse adolescents.
The Hopkins Symptom Checklist depression scale (HSCL-D) and the Harvard Trauma Questionnaire (HTQ) have been used extensively in international studies, particularly among refugees and conflict-affected populations. Like many other screening measures, however, the HSCL-D and HTQ have not been subjected to extensive epidemiologic testing, particularly among communities not affected by war. The present study examined the psychometric properties of the HSCL-D and HTQ by comparing the measures with the Structured Clinical Interview for DSM-IV (SCID) among ethnic Cambodians living in Surin, Thailand, a community that was spared the long period of mass violence that affected Cambodia proper. The PTSD data of the HTQ were then contrasted with those obtained from a refugee clinic. The main finding was that in the Surin study, the screening measures showed greater agreement with the SCID in identifying noncases (negative prediction) than cases (positive prediction). In contrast, in the earlier clinic study, the HTQ showed high positive and moderately low negative prediction. The results support previous observations that clinical interviews such as the SCID may be more conservative in identifying cases. We raise the possibility, however, that structured interviews may perform differently across clinic and community populations. In particular, clinicians may be more accurate in identifying cases than noncases in highly symptomatic clinic populations, with the converse applying in low prevalence community populations. These issues warrant further investigation to specify more clearly the value of using the two approaches to case identification.
Refugee and migrant adolescents may be at increased risk for the development of emotional and behavioural problems. Since studies on this topic are rather scarce and results inconsistent, this large-scale screening study aims at investigating the prevalence of emotional and behavioural problems in recently arrived migrant adolescents in Belgium, compared to Belgian peers. About 1,249 migrant adolescents and 602 Belgian adolescents filled in four self-report questionnaires on the prevalence of emotional and behavioural problems, traumatic experiences and symptoms of post-traumatic stress. Migrant adolescents experienced more traumatic events than their Belgian peers, and show higher levels of peer problems and avoidance symptoms. On the contrary, non-migrant adolescents reveal more symptoms of anxiety, externalizing problems and hyperactivity. Factors influencing the prevalence of emotional and behavioural problems are the number of traumatic events experienced, gender and the living situation. Although migrant and non-migrant adolescents don't differ much in the prevalence of emotional and behavioural symptoms, attention should be given to the screening and support of risk groups within the population of migrant adolescents, such as girls, those who experienced a lot of traumatic events and unaccompanied refugee children and adolescents.
To investigate the level of posttraumatic stress and depressive symptoms, and background risk and protective factors that might increase or ameliorate this distress amongst unaccompanied asylum-seeking children and adolescents (UASC).
Cross-sectional survey carried out in London. Participants were 78 UASC aged 13-18 years, predominantly from the Balkans and Africa, compared with 35 accompanied refugee children. Measures included self-report questionnaires of war trauma, posttraumatic stress and depressive symptoms.
UASC had experienced high levels of losses and war trauma, and posttraumatic stress symptoms. Predictors of high posttraumatic symptoms included low-support living arrangements, female gender and trauma events, and increasing age only amongst the UASC. High depressive scores were associated with female gender, and region of origin amongst the UASC.
UASC might have less psychological distress if offered high-support living arrangements and general support as they approach the age of 18 years, but prospective studies are required to investigate the range of risk and protective factors.
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