Table 3.

Review over risk and protective factors for mental and physical health, respectively, among children in the Nordic countries with a refugee background

	Authors and publication year	Title	Excluded risk and protective factors	Risk and protective factors	Health outcomes
1	Abdalla and Elklit [1]	A nationwide screening of refugee children from Kosovo		Higher age	More symptoms of PTSD,anxiety, nervousness, headache Less enuresis, eating problems
				Sex	No association
				Time since displacement	Longer time as refugee: more symptoms of depression, aggression, nervousness and psychosomatic problems Short or long time: more eating difficulties
				Exposure to violence	More symptoms of anxiety, depression, psychosomatic symptoms, nervousness, PTSD, regression and behavioral problems. For eating problems and headache the symptoms declined for those with the most exposure to violence
				Exposure to torture	More symptoms of depression, psychosomatic symptoms, regressive symptoms, PTSD, school- and conduct problems More symptoms of aggression, anxiety, nervousness and hearing problems (except for children most exposed to torture)
				Loss	More behavioral problems, anxiety, depression, aggressiveness, nervousness, PTSD, psychosomatic-symptoms, regression and PTSD. For behavioral problems the curve declines for the most affected
				Separation	More symptoms of depression, PTSD, regressive symptoms and conduct problems. More symptoms of anxiety, nervousness and aggression (except children exposed to the highest number of separations)
				Extreme poverty	More symptoms of depression, psychosomatic symptoms, regressive symptoms, PTSD, conduct problems, aggression, anxiety, nervousness and enuresis and headache
				Starvation	More symptoms of depression, PTSD, conduct problems, aggression, anxiety, nervousness
2	Almqvist and Brandell-Forsberg [2]	Refugee children in Sweden: post-traumatic stress disorder in Iranian preschool children exposed to organized violence	None	Exposure to organized violence	More symptoms of PTSD
3	Almqvist et al. [3]	Mental health and social adjustment in young refugee children 3.5 years after their arrival in Sweden	Marital discord, decreased well-being in mother, decreased well-being in father, no peer to play with, exposed to bullying	Traumatic stress exposure	More symptoms of mental ill-health
				Age	No association
				No vulnerability before exposure	More symptoms of well-being
				Parents exposure to war and persecution	Worse social adjustment
				Male sex	Worse general adaptation
				Longer time since arrival	Better social adjustment
4	Angel et al. [4]	Effects of war and organized violence on children: a study of Bosnian refugees in Sweden	Parent in need of psychiatric treatment, talking about the war, social networks	The amount of traumatic exposure	More symptoms of general anxiety, phobic and depressive symptoms, war-preoccupation (if higher traumatic exposure)
				Length of stay	No association
				Age	No association
				Sex	No association
				Being from Sarajevo	Less symptoms of behavior problems and war preoccupation (if from other city than Sarajevo)
5	Back Nielsen et al. [6]	Risk of childhood psychiatric disorders in children of refugee parents with post-traumatic stress disorder: a nationwide, register-based, cohort study	No parental psychiatric diagnosis, geographical origin of parents	Parental PTSD	More likely to have symptoms of PTSD
				Female sex	No association
				Disposable income	No association
				Geographical origin	More likely to have symptoms of PTSD if geographical origin was Middle East and central Europé, Sub-Saharan Africa or other compared to Eastern Europe and Asia
6	Berg et al. [7]	Underutilisation of psychiatric care among refugee adolescents in Stockholm	None	Residency status	More PTSD among asylum seekers than family reunification
					More use of care among asylum seekers than family reunification
				Duration in Sweden	More visits to child psychiatric services with more time in Sweden
				Income level of country of origin	More visits for high-income countries
7	Eiset et al. [14]	The health status of newly arrived asylum-seeking minors in Denmark: a nationwide register-based study	None	Sex	No association for anxiety More depression for males
				Separations	More depression and anxiety
				Loss of family member	More depression and anxiety
				Poverty and starvation	More depression and anxiety
				Exposure to violence	More depression and anxiety
8	Ekblad [15]	Psychosocial adaptation of children while housed in a Swedish refugee camp: Aftermath of the collapse of Yugoslavia	Parents who stated that they coped well with the asylum and made their own meals, apathetic or unstable mother, social support, being of pre-school age, exposure to violence, geographical origin, longer time since arrival, higher education level amongst fathers, lack of proper information about flight.1	Female sex	Less total symptoms of mental and somatic ill-health
				Age	More symptoms of mental and somatic ill-health with higher age
9	Gusic et al. [23]	Dissociative experiences and trauma exposure among newly arrived and settled young war refugees	None	Being poor	For newly arrived less symptoms of dissociation For settled students more symptoms of dissociation
				Accompanied	No association
				Child labor	No association
				Sex	No association
				Age	No association
				Higher socioeconomic status	For newly arrived less symptoms of dissociation For settled students more symptoms of dissociation No association to PTSD
				PTE exposure	For settled students more symptoms of PTSD For settled students more symptoms of dissociation No association for newly arrived
10	Hjern et al. [28]	Persecution and behavior: a report on refugee children from Chile	None	Persecution	More symptoms of dependency More symptoms of sleep disturbances
				Age	Dependency more common in preschool children and concentration difficulties more common in school children
11	Hjern et al. [29]	Political violence, family stress and mental health of refugee children in exile	Divorce, parent in psychiatric care, family stress, social network	Experiences of violence	More symptoms of mental ill-health
				Separations	More symptoms of mental ill-health
				Female sex	More symptoms at the first measurement but no association at second
				Age	No association
				Nationality (chilean)	No association
12	Hjern and Angel [27]	Organized violence and mental health of refugee children in exile: a 6-year follow-up	Recent family stress	Male sex	No association
				Born in Chile	No association
				Age (above 12)	No association
				Experiences of organized violence	More symptoms of mental ill-health
13	Jensen et al. [33]	Stressful life experiences and mental health problems among unaccompanied asylum-seeking children	None	Female sex	Girls scored higher on the CPSS avoidance subscale
				Region of origin (Asia vs. Africa)	No association
				Age	No association
				Time since arrival	No association
				Stressful events	More symptoms of PTSD, anxiety, depression, internalization and total symptom (HSCL total) No association to externalizing symptoms
14	Jensen et al. [33]	Development of mental health problems—a follow-up study of unaccompanied refugee minors	None	Sex	No association
				Length of stay	No association
				Length of education	No association
				Change in stressful life events	More symptoms of PTSD. No association with internalizing or externalizing problems
15	Montgomery and Foldspang [50]	Traumatic experience and sleep disturbance in refugee children from the Middle East	Fathers scolds the child more than previously	Grandparent’s violent death before the child was born	More sleep disturbances
				Mother tortured	More sleep disturbances
				Being accompanied by both parents	Less sleep disturbances
				Kurdish etnicity	More sleep disturbances
				Longer length of fathers education	More sleep disturbances
				One or both parents tortured	More sleep disturbances
16	Montgomery and Foldspang [51]	Seeking asylum in Denmark: refugee children’s mental health and exposure to violence	None	Previous refugee camp residence	More symptoms of anxiety for children without residence permit. No association for those with permit
				Having witnessed violent events	More symptoms of anxiety for children without residence permit. No association for those with permit
				Exposure to war	More symptoms of anxiety
				Having a tortured parent	More symptoms of anxiety. No association for those without permit
17	Montgomery [48]	Long-term effects of organized violence on young Middle Eastern refugees’ mental health	Having witnessed attack on others in Denmark, attending school or work, number of stressful experiences in Denmark, number of types of discriminating experiences, number of Danish friends, spelling competency, number of schools attended in Denmark	Greater duration of mother's education in the home country	Less symptoms of externalizing & internalizing behaviors
				Number of types of experiences before arrival in Denmark	More symptoms of internalizing behavior
				Higher age	Less symptoms of externalizing behavior
				Religious affiliation (both muslim and christian)	Less symptoms of internalizing behavior
				Male sex	Less symptoms of internalizing behaviour
18	Montgomery [49]	Trauma and resilience in young refugees—a 9-year follow-up study	Stressful events after the arrival, communication, attending school or work, speaks frequently to mother about problems	Number of traumatic experiences before arrival	More likely to have symptoms of mental health problems at both initial and follow-up examination (if higher number of traumatic experiences)
				Length of fathers education in the home country	More likely to not have symptoms of mental health problems at follow-up (if longer education)
19	Montgomery and Foldspang [50]	Discrimination, mental problems, and social adaption in young refugees	Parents social situation	Age	More symptoms of internalizing problems with higher age
				Nationality	No association
				Etnicity	No association
				Religion	No association
20	Nielsen et al. [53]	Mental health among children seeking asylum in Denmark—the effect of length of stay and number of relocations: cross-sectional study	Number of relocations	Longer length of stay	More mental health difficulties
				Sex	No association on the total symptom score but girls had more emotional problems and males more behavioral problems on subscale level
21	Salari et al. [58]	Using CRIES to screen for post-traumatic stress disorder in unaccompanied refugee minors	None	Type of housing in Sweden	No association
				Length of migration journey	No association
				Time spent in Sweden	No association
				Age	No association
				Country of origin (Afghanistan vs other)	No association
22	Sarkadi et al. [59]	Is the Refugee Health Screener a Useful Tool when Screening 14–18-Year-Old Refugee Adolescents for Emotional Distress?	None	Asylum status	More symptoms of emotional distress among those awaiting decision compared to those with residence permit No difference in PTSD-symptoms
				Being unaccompanied	More symptoms of distress among the unaccompanied No difference in PTSD-symptoms
23	Solberg et al. [66]	Children at risk: a nation-wide, cross-sectional study examining post-traumatic stress symptoms in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden between 2014 and 2018	None	Age	No association
				Country of origin	Refugee minors from Afghanistan higher prevalence than those from Syria and Iraq
				Being unaccompanied	In the total sample unaccompanied minors has higher incidence of PTSD. When looking at different countries this was only statistically significant for Afghanistan
				Sex	No difference in PTSD-symptoms
24	Solberg et al. [65]	Health-related quality of life in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden: a nation-wide, cross-sectional study	Living with parents/residential home	Age	Higher age associated with worse wellbeing
				Being unaccompanied	Unaccompanied has worse wellbeing
				Country of origin	Being from Afghanistan associated with worse well-being compared to Syria and Iraq
				Socioeconomic status	Those with good economy had better wellbeing compared to children with average or poor economy
				Sex	Girls had worse wellbeing
25	Sourander [66]	Behavior problems and traumatic events of unaccompanied refugee minors	None	Higher age	Less behavioral problems
				Sex	No association
				Nationality	No association
				Duration of flight	No association
				Persecution or death of parents	No association
26	Vervliet et al. [76]	The mental health of unaccompanied refugee minors on arrival in the host country	None	Parents still alive	No association
				Number of traumatic events	More symptoms of anxiety, depression and PTSD in males
				Age	No association

₁Excluded because of lack of numerical data

CPSS child PTSD symptom scale, CRIES children´s revised impact of event Scale, HSCL Hopkins symptom checklist, PTE possible traumatic event, PTSD post-traumatic stress disorder, vs versus