Emotional Distress in a Cohort of Unaccompanied Minors from the Northern Triangle of Central America

Background: Unaccompanied minors (UM) are children under 18 years without legal immigration status in the US and without a parent or legal guardian at the time of apprehension. Since 2013 almost a half million UM were apprehended at the US-Mexico border; over 70% come from the Northern Triangle of Central America, i.e. Guatemala, Honduras, and El Salvador. Upon release from detention, UM resettle in communities throughout the US. UM are exposed to multiple potentially traumatic experiences in their home country, during their journey, in immigration detention, and after resettlement. However, little is known about the degree and persistence of emotional distress.

This retrospective chart review study was conducted to quantify the degree of emotional distress experienced by UM living in the US using the Refugee Health Screener (RHS). The RHS was developed to screen for emotional distress in diverse cultural and linguistic populations and has been administered in multiple countries. Although investigations of UM in Europe have described factors related to the severity and persistence of emotional distress, no analysis has been done for UM from the Northern Triangle living in the US. Our research questions were: 1) What percentage of UM score positive on the RHS? 2) What factors are associated with elevated scores? 3) How do scores on the RHS change over time?

Methods: To be included in this study UM had to have completed at least one RHS between 2015 and 2020 as part of their care at a medical-legal partnership in a South Bronx community health center. Data on UM demographics and RHS scores were abstracted from the medical chart. The RHS-15 screener has a sum score ranging from 0-56 for items 1-14 (higher score indicates more distress). A separate item (15), asks patients to rate their level of distress from 0 to 10. A positive score is ≥12 out of 56 for the first 14 items, and/or a score of ≥5 on item 15.

Results: Between 2015 and early 2020, 185 UM completed at least one RHS and 69 UM completed two RHS. At first screen, 58.2% were positive. Factors associated with elevated scores on the RHS include female sex (mean score of 18.9 versus 12.8 for males) and older age (mean of 19.0 versus 11.6 for younger UM), p <0.05. Of those who screened positive on their first RHS, 75.0% (30/40) remained positive at the second RHS administration.

Conclusion: Higher distress scores on the RHS in children of older age and female sex are consistent with studies of UM in Europe. Importantly, positive RHS scores do not decline over time. This indicates that UM from the Northern Triangle require ongoing support after arrival in the US.