News Release

Child refugee mental health compromised by a lack of research and inadequate funding

Peer-Reviewed Publication

The Lancet_DELETED

The increasingly restrictive asylum immigration policies of many high-income countries are leaving low-income and middle-income countries to cope with large numbers of displaced children without the necessary resources to prevent poor mental health outcomes. Furthermore, prolonged bureaucratic asylum processes in high-income countries are having negative effects on children's mental health. The findings of a two-part Review, published Online First in The Lancet, highlight the urgent need for high-income countries and international agencies to contribute towards the funding of interventions to tackle the significant unmet mental health needs of some of the world's most vulnerable children.

Worldwide, an estimated 18 million children are forcibly displaced as a result of conflict and persecution, and more are forced to migrate as a result of economic pressures and natural disasters. Most children remain within or near their country of origin, with just half a million seeking asylum in high-income western countries every year. Although low-income and middle-income countries take in most of the world's refugees, research has mainly focused on refugees in high-income countries. For example, despite 70% of refugees in sub-Saharan Africa and 30% of refugees worldwide living in camps, the effects of living in camps on mental health has rarely been studied.

Because resources are so limited in low-income and middle-income countries, clarification of the risk and protective factors for psychological, emotional, and behavioural disorders is vital to developing effective interventions and to ensuring that scarce resources are targeted at children most in need.

Mina Fazel from Oxford University, Oxford, UK and colleagues reviewed the evidence for the risk and protective factors that affect the mental health of children forcibly displaced to low-income, middle-income, and high-income countries. A total of 71 studies involving over 11 500 children and adolescents were included in the final analysis.

Exposure to violence was identified as the strongest risk factor for poor mental health. The authors also found worse mental health outcomes for children who were displaced internally within their own country and for those who settled in a refugee camp. In children forcibly displaced to high-income countries, being exposed to further violence after migration or having several changes of residence resulted in worse outcomes, whereas high levels of support from family and peers and a positive school experience were protective.

But according to the authors, a lack of longitudinal studies has limited the understanding of which risk and protective factors are causally associated with psychological outcomes, and the practical difficulties of doing research in dangerous conflict situations has hampered the identification of potentially modifiable family and community factors during and after displacement.

Moreover, they say: "Since so many of the world's forcibly displaced individuals are living in poorly resourced countries, high-income countries, with the help of international agencies, need to take responsibility and contribute towards the funding for the development and assessment of interventions."

The second part of the Review emphasises that the stress of adjusting to a foreign country plays an important role in the mental health status of children. Indeed, rapid and stable settlement in host countries seems to be very important for the positive psychological functioning of refugee children.

"Frequent moves, delays, and prolonged bureaucratic processes have negative effects on children's mental health. Equitable and prompt access to services for physical and psychological health, and access to good housing and schooling, are central to adaptation and positive mental health", explain the authors.

They conclude: "Since mental health problems originating in childhood and adolescence are often long-lasting, high-income countries must implement immigration, health-care, and social policies that support family units and keep deleterious consequences for child health and development to a minimum."

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Dr Mina Fazel, Oxford University, Oxford, UK. T) +44 (0)7779 638941 (mobile) E) mina.fazel@psych.ox.ac.uk


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