Table 3.
Overview of selected studies (n = 12)
| Citation | Year | Study site | Country of origin | Number of participants | Male/ female | Age years (M) | Months since arrival | Measurements | Summary descriptive outcomes | Summary confirmatory outcomes |
|---|---|---|---|---|---|---|---|---|---|---|
| Unaccompanied children | ||||||||||
| Jakobsen et al.a | 2014 | Norway | Afghanistan (122); Somalia (35); Iran (3) | 160 | 160 (100 %)/0 (0 %) | 14–20 (16.23) | 4 | HSCL-25 HTQ SLE Diagnostic interviews (CIDI) |
Experiences
96.3 %: at least one stressful life event; mean: 6.2 (range: 0–12) 81.7 %: life-threatening events; 77.9 %: physical abuse; 77.9 %: loss of close relative; 63.3 %: drastic changes in family during the last year; 57.2 %: witnessing violence against others; 54.7 %: separated from family against will Mental health 41.9 %: psychiatric disorder; 30.6: PTSD; 9.4 %: depression |
|
| Vervliet et al.a | 2014a, b, c | Belgium (103); Norway (204) | Afghanistan (202); Somalia (47); Guinea (20); various (38) | 307 | 291 (95 %)/16 (5 %) | 15–18 (16.13) | 2–5 | HSCL-37A SLE RATS HTQ |
Experiences
Mean stressful life events: 6.4 (range: 0–12). 78.9 %: death of loved one; 72.5 %: physical maltreatment’; 81.8 %: experience ‘I’m in danger’; 64.0 %: drastic family changes Mental health 38.3 %: anxiety; 44.1 %: depression; 52,7 %: PTSD |
Significant risk factors
The more traumatic experiences the children reported, the more symptoms they had of anxiety, depression, and PTSD Non-significant Age Parents still alive |
| Jensen et al. | 2013 | Norway | Afghanistan (43); Eritrea (14); Somalia (14); Sri Lanka (11); various (11) | 93 | 75 (81 %)/18 (19 %) | 10–16 (13.8) | 6 | HSCL-37 SLE CPSS |
Experiences
Mean stressful life events: 5.5 (range: 0–12); 67.7 %: death of a close person; 63.4 %: witnessing violence; 62.4 %: witnessing war Mental health 30 %: anxiety; 20 %: depression; 54 % PTSD |
Significant risk factors
The number of stressful life events correlated with PTSD and internalizing symptoms Girls scored higher on the avoidance subscale (CPSS) Non-significant Age |
| Sourander | 1998 | Finland | Somalia (37); various (9) | 46 | 34 (74 %)/12 (26 %) | 6–17 (14.1) | 5 | CBCL + interviews + Clinical + legal information |
Experiences
17 %: father disappeared; 22 %: father died; 22 %: mother disappeared; 9 % mother died; 83 %: persecution: 15 %: personal violence, 28 %: eye witnessed violence towards family members Mental health 48 %: clinical or borderline (related to mood, anxiety, PTSD) |
Significant risk factors
Younger children (6–14) had more severe externalizing, social and attention problems than older children (15–17) Non-significant Duration of the flight Experience of violence Gender Practically relevant Children coming from two-parents families were doing better that the other children |
| Accompanied children | ||||||||||
| Sampsom and Gifford | 2010 | Australia | Sudan (62); Iraq (18); Ethiopia (15); various (25) | 120 | 65 (54 %)/55 (46 %) | 11–19 | <12 | Neighbour-hood maps, photo-novella’s + narrative data |
Well-being
The most important places: are associated with being able to pursue potentials largely absent in the places of their past |
|
| Rothe et al. | 2002 | USA | Cuba | 87 | 50 (57 %)/37 (43 %) | 6–17 (14.9) | 4–6 | PTSDRI CBCL-TRF |
Experiences
21 %: separation of father; 13 % separation of mother; 24 %: separation of sibling; 69 %: separation of grandparent(s) Mental health 57 %: PTSD; 67 %: avoidance; 60 % re-experiences; 52 %: somatic symptoms; 51 %: hyper-arousal |
Significant risk factors
Significant relationship between number of stressors and severity of self-reported PTSD symptoms Modest relationship between feelings that child would die at sea and witnessing violence in refugee camps with withdrawn behaviour Moderate relationship between (older) age and witnessing violence with PTSD Non-significant Gender |
| Abdallah and Elklit | 2001 | Denmark | Kosovo | 1224 | 52 %/48 % (8 % missing data) | 0–18 (8.2) | <1 (1 week) | TSF |
Experiences
54 %: separated from one of more grandparent(s); 35 %: separated from father; 7 %: from mother; 30 %: loss close relative; 40 %: witnessing violence Mental health 20 %: emotional symptoms; 24 %: psychosomatic disturbances |
Significant risk factors
Increasing age was related to increasing occurrence of PTSD Duration of the flight was associated with depression, aggression and nervousness and psychosomatic problems The number of separations, number of losses and experience of torture, were associated with higher prevalence of anxiety, PTSD, depression, regressive traits and behavioural problems Extreme poverty and hunger were associated with an increasing frequency of all symptoms Non-significant Gender |
| Goldin et al. | 2001 | Sweden | Bosnia | 90 | 46 (51 %)/44 (49 %) | 0–20 | 6–10 | Semi- structured interviews with the family + individual interviews children |
Experiences
69 %: life was ‘good’ prior to the war; 83 %: no safe place during war; 44 % severe war experiences; 29 % direct exposure to violence; 60 %: separation from a parent Mental health 30 %: multiple trauma stress |
Significant risk factors
Ethnic background significantly affected the trauma stress exposure during the war. Lower social class was related to a higher intensity of child war exposure. Older children were more affected than preschool children |
| Geltman | 2000 | USA | Bosnia | 31 | 19 (61 %)/12 (39 %) | 2–17 (10.7) | <3 | Bosnia War Trauma Question-naire |
Experiences
68 %: separation from a parent; 81 %: direct exposure to armed combat; 71 %: death friend/relative; 52 %: economic deprivation Mental health 77 %: behavioural symptoms; 72 %: repetitive talking about violence, 52 %: nightmares; 40 % acting out; 40 % avoidance of exposure to memories |
Significant risk factors
Experiencing the death of a close relative or friend and witnessing violence to strangers were associated with re-experiencing symptoms Experiencing or witnessing interpersonal violence directed to a close relative or friend was associated with symptoms of numbing |
| Montgomery | 1998 | Denmark | Middle East: Iran (32); Iraq (168) Lebanon (22) Syria (13); stateless Palestinians (75); Turkey (1) | 311 | 160 (51 %)/151 (49 %) | 3–15 (7.5) |
<1 (m 7 days) | Structured interview with parent-(s) |
Experiences
92 %: lived in a refugee camp outside the home country; 89 %: lived under conditions of war; 89 %: been on the run with parents; 20 %: lost one parent; 60 %: separated from one parent Mental health 67 %: clinically anxious |
Significant risk factors
Significant predicting factors for anxiety were: lived in a refugee camp outside the home country; part of a torture surviving family; lack of opportunities for play with other children; beaten/kicked by an official; loss of father; parent hit or punished the child more than prior to arrival Significant protective factor Being accompanied by both parents was a modifying factor for anxiety Non-significant Age (except for separation anxiety young children after loss of father) Gender |
| Almqvist and Brandell-Forsberg | 1997 | Sweden | Iran | 50 | 36 (72 %)/14 (28 %) | 3–8 (5.10) | 12 | Parental interviews + children’s assessment: observa-tions, structured tasks and questions Lowenfeld World Technique |
Experiences
84 %: exposure to violence; 32 %: eye witnessing acts of organized violence Mental health 68 %: behavioural symptoms (81 % of 42 who were exposed to violence); 48 %: over-dependency and anxiety (57 % of 42); 44 %: re-experiencing (52 % of 42); 18 %: PTSD (21 % of 42); 26 %: post-traumatic stress symptoms (31 % of 42) |
Practically relevant
The intensity of traumatic exposure was strongly related to the prevalence of PTSD |
| Ekblad | 1993 | Sweden | Former Yugoslavia | 66 | 33 (50 %)/33 (50 %) | 5–15 | 5 (m) | Structured interviews with children + parents |
Experiences
22 %: separation of one parent; 90 % separation of a relative: ≈ 100 % experienced violence; 37 %: personal exposure to violence Mental health 58 %: home sick; 45 %: depression; 41 % somatic symptoms; 39 % nightmares; 28 %: fear |
Practically relevant
Experience of direct violence; apathetic or unstable mother; higher education level father; lack of proper information before flight seemed to be associated with poorer mental health |
CBCL-TRF Child Behavioural Checklist—teacher report form, CIDI Composite International Diagnostic Instrument, developed by the WHO, CPSS Child Posttraumatic Stress Disorder Symptom Scale, HSCL-37A Hopkins Symptoms Checklist-37 for adolescents, HTQ Harvard Trauma Questionnaire, PTSDRI Post-Traumatic Stress Disorder Reactive Index, RATS Reactions of Adolescents to Traumatic Stress, SLE Stressful Life Events, TSF Trauma and Symptom Form (Danish Red Cross)
aThe samples from Norway in the studies of Jacobsen et al. (2014) and Vervliet et al. (2014a, b, c) partly overlap. Jacobsen et al. (2014) added a diagnostic interview to the measurements, which provided more results on the sample. For this reason, both studies were included