Prevention of psychological distress and promotion of resilience amongst unaccompanied refugee minors in resettlement countries.

As increasing numbers of Unaccompanied Refugee Minors (URM) are arriving in Europe, there is a need to investigate which factors promote psychological resilience and improve their mental health. This review aims to identify preventive post settlement influences, including living arrangements, access to mental health services and effective treatments that may improve mental health outcomes.

METHODS: A systematic literature review was conducted of published papers in any language for children (<18 years) entering a host country, unaccompanied and seeking asylum. Specific studies were eligible if they examined any treatment or non-treatment influences on mental health or psychological resilience for the URM. Thirteen published quantitative studies were identified.

RESULTS: URMs in more supportive living arrangements including foster care had lower risk of PTSD and lower depressive symptoms compared with those in semi-independent care arrangements. URM's living in reception settings that restricted freedom had more anxiety symptoms. Regarding help seeking, one study found only 30% of URM's had foster-parents or guardians who could detect a mental health need. Two papers found the URMs had low levels of contact with mental health services despite the high prevalence of psychiatric symptoms. URMs were less likely than accompanied children to receive trauma-focused interventions, cognitive therapy or even practical assistance with basic social needs. With regard to treatment evaluation, only case series were identified. Three studies found cognitive behavioural therapy improved PTSD symptoms and mental health outcomes. A less structured approach (mental health counselling alone), did not improve functional health outcomes.

CONCLUSION: Higher support living arrangements with low restrictions are associated with lower psychological distress. Most URM's are not receiving psychological interventions and there is a dearth of studies evaluating treatment effectiveness for this group. There is an urgent need for more research to investigate pathways to mental health services and treatment efficacy in this vulnerable group.