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Behavioural disorders may be more common among younger refugee and migrant children, which are significantly more severe in younger (6-14 years) compared with older (15-17 years) age groups, according to a worldwide review of asylum seekers and refugee children.
“Children were particularly vulnerable to the effects of detention. High rates of mental health conditions among refugee children were associated with being placed in detention, and mental disorders were 10 times more likely following detention than prior to detention,” the report said.
“Prolonged stay in an asylum centre was associated with a 30-fold increase in the risk of psychopathology among children aged 11-16 years. These associations were most pronounced in UASC and in children who had experienced multiple relocations within the asylum system,” the report added.
The findings were published in a report titled Mental Health of Refugees and Migrants: Risk and Protective Factors and Access to Care, brought out by the World Health Organization on the occasion of World Mental Health Day on October 10, 2023.
It is the fifth edition of the Global Evidence Review on Health and Migration (GEHM) series launched by the WHO's Department of Health and Migration in June 2021.
The year 2021 had 258 million international migrants. However, there are three times more internal migrants than international migrants, but there is a lack of data.
“By the end of 2021, the total number of forcibly displaced people was 89.3 million, of whom 53.2 million were internally displaced people, 27.1 million were refugees and 4.6 million were asylum seekers,” the report stated.
The WHO estimates that one in five people (22.1 per cent) in conflict-affected areas may experience depression, anxiety, Post Traumatic Stress Disorder (PTSD), bipolar disorder, or schizophrenia. A recent meta-analysis showed that international migrants in Europe are at an increased risk of psychotic disorders compared with non-migrants, the review stated.
In terms of mental health, the data is mixed based on the country of origin and the conditions. For example, among refugees based in high-income countries, those originally from the Middle East and North Africa had a threefold higher risk of psychotic disorders compared with refugee groups from other geographies.
Another review of refugees — Unaccompanied or Separated Children (UASC) — found that those originating from Afghanistan and Iraq had a higher risk of mental disorders compared with their peers from other countries. More instances of relocations after migration resulted in a threefold increased chance of having poorer mental health among asylum-seeking children, the report said.
Social exclusion and discrimination in countries in which migrants choose to make their home are contributing factors. One review reported that migrants from African and Caribbean countries, where the population is categorised as Black had a much higher risk of suffering psychotic disorders.
This is in comparison to migrants from countries of origin in which most of the population is categorised as White. These findings may have underlying structural and institutional racism, the study stated.
Evidence suggests that, among refugees and migrants, girls and women have a higher risk of depression and anxiety than boys and men. Moreover, refugees and migrants who identify as LGBTQI+ were affected in terms of their mental health, including when transgender women were held in male facilities. Detainees who are torture survivors were a further vulnerable group at risk of severe, complex PTSD and suicide attempts, the study added.
Being stuck in a state of limbo, with a pending or rejected asylum application had a 1.76-fold higher risk of depressive symptoms than those whose application had been approved in Germany, the report noted.
As the needs of refugees or migrants may be complex, some professionals have expressed concerns that they are unprepared to assess or treat them.
Some mental health service providers said their colleagues complained of burnout. “It was a big shock. I felt like I almost couldn’t use anything of what I had learned during my education and that was very strange,” said one such health professional quoted in the study. Without socio-cultural training, treating migrants in distress would be difficult, the review said.
Language barriers were a factor preventing the correct dissemination of awareness and giving a diagnosis. One of the issues was translated medical jargon and a fear among refugees and migrants of being misunderstood and misdiagnosed.
“Refugees and migrants face many unique stressors and challenges. This report sets out the urgent need for robust policies and legislation, rooted within stronger health systems, to meet the mental health care needs of refugees and migrants,” said Dévora Kestel, WHO Director for Mental Health and Substance Use.