This systematic review aims to establish estimates for the prevalence of mental illness in child and adolescent refugee populations. The review identified a limited number of high-quality studies measuring prevalence estimates of mental illness, despite the substantial number of children and adolescents displaced globally.
Eight studies met the strict inclusion criteria for the systematic review, covering 779 child and adolescent refugees and asylum seekers in five countries (Germany, Malaysia, Norway, Sweden and Turkey). Studies were only included if the diagnosis of mental illness was made based on a clinical interview and validated diagnostic assessment measure, and undertaken by a mental health professional (psychiatrist, psychologist, psychiatric nurse) or trained para-professional (psychology research assistant, trained researcher). Studies that based diagnoses solely on self-report questionnaires or symptomatology rating scales were excluded. To avoid selection bias, studies were only included if they recruited representative samples of refugee children; studies recruiting participants solely from medical clinics were excluded. When multiple articles used data from the same study, the article providing data that best met the search criteria was included.
Main findings:
- Refugee and asylum seeker children have high rates of PTSD, anxiety, and depression. The overall prevalence of post-traumatic stress disorder (PTSD) was 23 percent, depression 14 percent, and anxiety disorders 16 percent. Attention-deficit/hyperactivity disorder (ADHD) was 9 percent and oppositional defiant disorder (ODD) was 2 percent.
- PTSD, depression, and anxiety disorders were all higher for those displaced less than 2 years, compared to those displaced more than 2 years, while the prevalence of ADHD was higher among those displaced more than 2 years. This finding might be explained by the phenomena of spontaneous recovery, which can occur in some cases of PTSD and depression. ADHD, on the other hand, persists in childhood with some change in presentation as individuals become older.
- PTSD was higher for those with insecure visa status and temporary residence, however depression and anxiety disorders were higher for those with refugee visa status and community residence. The authors call for rigorous longitudinal research to understand the relationship between refugee experiences, different mental illnesses, visa status and resettlement experiences, and trajectories of recovery.
The authors conclude that there are immediate and detrimental effects of pre-migration trauma, forced displacement, and the postmigration environment on the mental health of child and adolescent refugee and asylum seekers. Refugee and asylum seeker children have substantial need for mental health services to address high rates of PTSD, depression, and anxiety, including youth- and refugee-appropriate, cross-culturally valid screening in refugee centers to streamline allocation to clinical assessment and treatment services. Except for ADHD, all other mental illnesses showed higher prevalence for individuals recently displaced (two years or less), indicating the need for early support when a child or adolescent refugee and asylum seeker arrives in the host/resettlement country. This support might include adequately resourced refugee centers designed to protect children from further traumatization and to ameliorate resettlement stressors that can increase the risk of poor social integration and educational disadvantage.