Review
Systematic Review and Meta-analysis: The Prevalence of Mental Illness in Child and Adolescent Refugees and Asylum Seekers

https://doi.org/10.1016/j.jaac.2019.11.011Get rights and content

Objective

Over half of the world’s refugee population are under the age of 18 years. This systematic review aims to summarize the current body of evidence for the prevalence of mental illness in child and adolescent refugee populations.

Method

Eight electronic databases, gray literature, and Google Scholar were searched for articles from 1 January 2003 to 5 February 2018. Strict inclusion criteria regarding the diagnosis of mental illness were imposed. Study quality was assessed using a template according to study design, and study heterogeneity using the I2 statistic. Random effects meta-analyses results were presented given heterogeneity among studies. The protocol for this systematic review was registered with PROSPERO (CRD42016046349).

Results

Eight studies were eligible, involving 779 child and adolescent refugees and asylum seekers, with studies conducted in 5 countries. The overall prevalence of posttraumatic stress disorder (PTSD) was 22.71% (95% CI 12.79−32.64), depression 13.81% (95% CI 5.96−21.67), and anxiety disorders 15.77% (95% CI 8.04−23.50). Attention-deficit/hyperactivity disorder (ADHD) was 8.6% (1.08−16.12) and oppositional defiant disorder (ODD) was 1.69% (95% CI −0.78 to 4.16). Because of the high heterogeneity, further subgroup analyses were conducted.

Conclusion

Refugee and asylum seeker children have high rates of PTSD, depression, and anxiety. Without the serious commitment by health and resettlement services to provide early support to promote mental health, these findings suggest that a high proportion of refugee children are at risk for educational disadvantage and poor social integration in host communities, potentially affecting their life course.

Section snippets

Search Strategy and Selection Criteria

The protocol for this systematic review and meta-analysis was registered with PROSPERO CRD42016046349 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=46349). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).22 A PRISMA checklist is provided in Table S1 (available online). The protocol was based on that used in the earlier systematic review by Fazel et al.21 (which included adult, child, and adolescent refugee populations) but expanded

Results

The entire search, including electronic databases and other sources, yielded a total of 17,423 documents. A flowchart outlining the search results and selection of studies is provided in Figure 1. After removing duplicates, 10,419 documents were excluded based on title and abstract, and a further 965 documents were screened by full-text retrieval. Eight studies pertaining to child and adolescent populations met the inclusion criteria,29, 30, 31, 32,41, 42, 43, 44 after a final exclusion of

Discussion

This systematic review aimed to overcome some of the methodological limitations of the current body of evidence, and to establish new estimates 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. Overall, the findings have shown that refugee and asylum seeker children have high rates of PTSD

References (61)

  • Mid-year trends 2018

  • T. Bean et al.

    Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents

    J Nerv Ment Dis

    (2007)
  • R. Mitra et al.

    Prevention of psychological distress and promotion of resilience amongst unaccompanied refugee minors in resettlement countries

    Child Care Health Dev

    (2019)
  • S. Eruyar et al.

    Review: how should child mental health services respond to the refugee crisis?

    Child Adolesc Ment Health

    (2018)
  • T.S. Betancourt et al.

    Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States

    J Trauma Stress

    (2012)
  • E.G. Karam et al.

    Lifetime prevalence of mental disorders in Lebanon: first onset, treatment, and exposure to War

    PLoS Med

    (2008)
  • I. Bronstein et al.

    Psychological distress in refugee children: a systematic review

    Clin Child Fam Psychol Rev

    (2011)
  • G. Turrini et al.

    Common mental disorders in asylum seekers and refugees: umbrella review of prevalence and intervention studies

    Int J Ment Health Syst

    (2017)
  • C. Kien et al.

    Prevalence of mental disorders in young refugees and asylum seekers in European countries: a systematic review

    Eur Child Adolesc Psychiatry

    (2019)
  • G.Y. Lim et al.

    Prevalence of depression in the community from 30 countries between 1994 and 2014

    Sci Rep

    (2018)
  • L.K. Richardson et al.

    Prevalence estimates of combat-related post-traumatic stress disorder: critical review

    Aust N Z J Psychiatry

    (2010)
  • X. Fan et al.

    An exploratory study about inaccuracy and invalidity in adolescent self-report surveys

    Field Methods

    (2006)
  • R.A. Zuckerbrot et al.

    Improving recognition of adolescent depression in primary care

    JAMA Pediatr

    (2006)
  • J. Reavell et al.

    The epidemiology of PTSD and depression in refugee minors who have resettled in developed countries

    J Ment Health

    (2017)
  • D. Moher et al.

    Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement

    BMJ

    (2009)
  • Diagnostic and Statistical Manual of Mental Disorders

    (2013)
  • The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines

    (1992)
  • R.C. Kessler et al.

    The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

    Int J Methods Psychiatr Res

    (2004)
  • C. Muhtz et al.

    Long-term consequences of flight and expulsion in former refugee children

    Psychother Psychosom Med Psychol

    (2011)
  • J. Ssenyonga et al.

    Posttraumatic cognitions, avoidance coping, suicide, and posttraumatic stress disorder among adolescent refugees

  • Cited by (0)

    The authors have reported no funding for this work.

    Mr. Ranasinha served as the statistical expert for this research.

    Disclosure: Drs. Boyle and Gibson-Helm are National Health and Medical Research Council Fellows. Ms. Blackmore has received funding by scholarships from Australian Rotary Health (Ian Scott, PhD Scholarship), the Windermere Foundation, and the Monash Centre for Health Research and Implementation. Drs. Gray, Fazel, Fitzgerald, and Misso and Mr. Ranasinha have reported no biomedical financial interests or potential conflicts of interest.

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