P0271 - Post-Traumatic Stress Disorder in Unaccompanied Refugee and Asylum-Seeking Minors: A Scoping Review

Background: Worldwide, up to 50 million children have migrated across borders or been forcibly displaced, with 300,000 unaccompanied or separated. The prevalence and negative effects of post-traumatic stress disorder (PTSD) have been thoroughly studied in accompanied refugee and asylum-seeking minors, but fewer studies have focused on PTSD in unaccompanied minors (UAMs).

Objective: Review literature regarding PTSD in unaccompanied refugee and asylum-seeking minors; define what factors separate this group in PTSD prevalence; identify effective interventions; and introduce the Budapest Declaration as a quality advocacy policy.

Methods: Databases searched included Ovid Medline, Embase, and Cochrane Library, from January 1, 2008, through January 15, 2019. 3,678 abstracts were screened, with inclusion factors as followed: Abstracts that were in English, mentioned PTSD, and studied unaccompanied refugee and/or asylum-seeking minors. From this, 40 full texts were read, with 30 chosen, 10 excluded due to being reviews, in German or Italian, and/or focused on Central America.

Results: UAMs have a greater prevalence of PTSD as high as 85% in comparison to accompanied minors, whose prevalence reaches 54%. There are numerous exacerbating factors: Cumulative trauma, post-migration trauma, organized/family violence, no parents, gender, increasing age, semi-independent living, refusal of asylum, and accompanying depression and anxiety. Protective factors include resiliency, social networks, religion, adult mentors, family even if far away, and secured refugee status. The most repeated non-significant factor was time living in the host country. Three interventions proved effective: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Teaching Recovery Techniques (TRT), and TF-CBT and group-processing mixed therapy (“Mein Weg” My Way).

Conclusions: PTSD is a major health crisis among refugee and asylum-seeking minors, with UAMs at a greater risk. Specific interventions have been found to be effective in treating PTSD in this population, although more research is needed regarding country-of-origin-specific factors that may play into prevalence and treatment. All refugee and asylum-seeking minors should have access to both evaluation and effective treatment if indicated by trained child mental health professionals. The Budapest Declaration, when implemented, will champion full legal rights and a holistic response to the mental and physical healthcare needs of these children, ensuring that protocols and evaluations are evidence-based and that care is both trauma-informed and culturally-sensitive.