Cited by 634Migration, Health and TraumaMigration and Exile StudiesEducation and experiences of immigrants and refugees

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Psychological Distress in Refugee Children: A Systematic Review

Bronstein, Israel, Montgomery, Paul·2011·Clinical Child and Family Psychology Review

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Abstract

Nearly one-quarter of the refugees worldwide are children. There have been numerous studies reporting their levels of psychological distress. The aim of this paper is to review systematically and synthesize the epidemiological research concerning the mental health of refugee children residing in Western countries. A Cochrane Collaboration style review was conducted searching nine major databases, bibliographies, and grey literature from 2003 to 2008. Included studies had to meet the reporting standards of STROBE and investigate mental health in non-clinical samples of asylum seeking and refugee children residing in OECD countries. A total of twenty-two studies were identified of 4,807 retrieved citations, covering 3,003 children from over 40 countries. Studies varied in definition and measurement of problems, which included levels of post-traumatic stress disorder from 19 to 54%, depression from 3 to 30%, and varying degrees of emotional and behavioral problems. Significant factors influencing levels of distress appear to include demographic variables, cumulative traumatic pre-migration experiences, and post-migration stressors. Importantly, the research base demands greater contextual and methodological refining such that future research would have greater generalizability and clinical implications.

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Family-based mental health interventions for refugees across the migration continuum: A systematic review
Bunn, M., Zolman, N., Smith, C. P., Khanna, D., Hanneke, R., Betancourt, T. S., & Weine, S. M. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100153 · Cited by 78
“Several systematic reviews have identi ﬁ ed high rates of depression, anxiety and PTSD among refugee adults and children in humanitarian settings and in resettlement contexts (Bogic et al., 2015; Bronstein & Montgomery, 2011; Kien et al., 2018; Nesterko et al., 2020).”
Background
Violence Exposure and Mental Health Among Resettled Refugees: A Systematic Review
Scoglio, A. A. J., & Salhi, C. (2020) · Trauma Violence & Abuse · doi:10.1177/1524838020915584 · Cited by 73
“While there have been reviews on the effect of stress and psychological trauma on resettled refugees’ mental health (Bronstein & Montgomery, 2011; Ehntholt & Yule, 2006; Fazel et al., 2012; Lustig et al., 2004), there has been no review on the specific effects of violence to the authors’ knowledge.”
Background
Improving the provision of services to young people from refugee backgrounds with comorbid mental health and substance use problems: addressing the barriers
Posselt, M., McDonald, K., Procter, N. G., de Crespigny, C., & Galletly, C. A. (2017) · BMC Public Health · doi:10.1186/s12889-017-4186-y · Cited by 68
“Prevalence studies concerning refugee young people have reported that rates of PTSD vary from 19 to 54% and rates of depression vary from 3 to 30% [20].”
Background
Mental Health Outcomes of Unaccompanied Refugee Minors: a Rapid Review of Recent Research
Bamford, J., Fletcher, M., & Leavey, G. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01262-8 · Cited by 66
Gender differences in the mental health of unaccompanied refugee minors in Europe: a systematic review
Mohwinkel, L.-M., Nowak, A. C., Kasper, A., & Razum, O. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-022389 · Cited by 65
“However, URM are forced to cope with these stressors at a young age and mostly without parental support.(8) Their high vulnerability is further reflected in study results showing that a high number of URM experience traumatic events, such as incidents of physical and sexual violence strengths and limitations of this s…”
Result
Experiences of Discrimination and Everyday Racism Among Children and Adolescents With an Immigrant Background – Results of a Systematic Literature Review on the Impact of Discrimination on the Developmental Outcomes of Minors Worldwide
Metzner, F., Adedeji, A., Wichmann, M. L.-Y., Zaheer, Z., Schneider, L., Schlachzig, L., Richters, J., Heumann-Schoop, S., & Mays, D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.805941 · Cited by 62
“Similarly, other reviews have explored the association between perceived racial discrimination and mental health in different predefined settings (Bronstein and Montgomery, 2011; Borsch et al., 2019; Haft et al., 2021).”
Background
Treating children and adolescents with multiple traumas: A randomized clinical trial of narrative exposure therapy
Peltonen, K., & Kangaslampi, S. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1558708 · Cited by 61
“Findings on the prevalence of post-traumatic stress disorder (PTSD) among refugee children have varied between 19% and 54% (for a review, see Bornstein & Montgomery, 2011).”
The synergy of the refugee crisis and the financial crisis in Greece: Impact on mental health
Anagnostopoulos, D., Giannakopoulos, G., & Christodoulou, G. N. (2017) · International Journal of Social Psychiatry · doi:10.1177/0020764017700444 · Cited by 61
“Moreover, it has been shown that refugees experience higher rates of psychiatric disorders than other populations with post-traumatic stress disorder, depression and anxiety disorders to be the most common psychiatric disorders among war refugees (Bronstein & Montgomery, 2011; Steel et al., 2009).”
Background
The long-term financial and psychological resettlement outcomes of pre-migration trauma and post-settlement difficulties in resettled refugees
O'Donnell, A. W., Stuart, J., & O’Donnell, K. J. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113246 · Cited by 66
Resilience and Mental Health Among Syrian Refugee Children in Jordan
Dehnel, R., Dalky, H. F., Sudarsan, S., & Al‐Delaimy, W. K. (2021) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01180-0 · Cited by 74
The psychological effects of forced family separation on asylum-seeking children and parents at the US-Mexico border: A qualitative analysis of medico-legal documents
Hampton, K., Raker, E., Habbach, H., Deda, L. C., Heisler, M., & Mishori, R. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259576 · Cited by 60
“In addition, there is an increased risk of psychiatric disorders such as anxiety, depression, and psychosis, and of detrimental coping behaviors such as smoking and use of alcohol or drugs [18, 19, 31, 32].”
What is the Impact of Placement Type on Educational and Health Outcomes of Unaccompanied Refugee Minors? A Systematic Review of the Evidence
O'Higgins, A., Ott, E., & Shea, M. (2018) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-018-0256-7 · Cited by 58
“As a result, URM suffers from disproportionately higher levels of mental health problems, including post-traumatic stress disorder, depression and anxiety, than children who migrate with their parents or peers who are not migrants (Bronstein and Montgomery 2011; Fazel and Stein 2002; Fazel et al.”
BackgroundInfluential
1-year follow-up of the mental health and stress factors in asylum-seeking children and adolescents resettled in Germany
Müller, L. R. F., Gössmann, K., Hartmann, F., Büter, K. P., Rosner, R., & Unterhitzenberger, J. (2019) · BMC Public Health · doi:10.1186/s12889-019-7263-6 · Cited by 59
The family crisis migration stress framework: A framework to understand the mental health effects of crisis migration on children and families caused by disasters
Vos, S. R., Clark‐Ginsberg, A., Puente-Duran, S. A., Salas‐Wright, C. P., Duque, M., Herrera, I. C., Maldonado‐Molina, M. M., Castillo, M. N., Lee, T. K., García, M. F., et al. (2021) · New Directions for Child and Adolescent Development · doi:10.1002/cad.20397 · Cited by 62
The Efficacy of a Group Cognitive Behavioral Therapy for War-Affected Young Migrants Living in Australia: A Cluster Randomized Controlled Trial
Ooi, C. S., Rooney, R. M., Roberts, C. M., Kane, R. T., Wright, B. R., & Chatzisarantis, N. L. D. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01641 · Cited by 58
The Psychological Problems of North Korean Adolescent Refugees Living in South Korea
Lee, Y. M., Shin, O. J., & Lim, M. H. (2012) · Psychiatry Investigation · doi:10.4306/pi.2012.9.3.217 · Cited by 57
Immigration-related mental health disorders in refugees 5–18 years old living in Turkey
Sapmaz, Ş. Y., Tanrıverdi, B. Ü., Öztürk, M., Gözaçanlar, Ö., Ülker, G. Y., & Özkan, Y. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s150592 · Cited by 56
“This study showed that post-traumatic stress-disorder rates were 19%–54%, while depression was 3%–30% in refugee children; other emotional and behavioral problems also existed within the sample.(8) Learning disorders, disruptions in school functioning, addiction, defiance, aggression, hyperactivity, feeding and sleepi…”
Frequent relocations between asylum-seeker centres are associated with mental distress in asylum-seeking children: a longitudinal medical record study
Goosen, S., Stronks, K., & Kunst, A. E. (2013) · International Journal of Epidemiology · doi:10.1093/ije/dyt233 · Cited by 55
Barriers to the inclusion of refugee and asylum-seeking children in schools in England
McIntyre, J., & Hall, C. (2018) · Educational Review · doi:10.1080/00131911.2018.1544115 · Cited by 54
Establishing the feasibility of assessing the mental health of children displaced by the Syrian conflict
Cartwright, K. L., El‐Khani, A., Subryan, A., & Calam, R. M. (2015) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2015.3 · Cited by 52
“(Fazel & Stein, 2002; Quota et al. 2003; Lustig et al. 2004; Fazel et al. 2005; Attanayake et al. 2009; Bronstein & Montgomery, 2011; Dimitry, 2011) with refugee children living in camps as opposed to urban or rural areas more likely to suffer (Khamis, 2005).”
Background
Trauma and resilient functioning among Syrian refugee children
Yaylaci, F. T. (2018) · Development and Psychopathology · doi:10.1017/s0954579418001293 · Cited by 51
“These children miss a very important protective factor, presence of parents, and this renders them vulnerable to traumatic experiences, abuse, and exploitation (Bronstein & Montgomery, 2011; Derluyn & Broekaert, 2008; Missing Children Europe, 2017).”
Background
The Longitudinal Relation between Daily Hassles and Depressive Symptoms among Unaccompanied Refugees in Norway
Keleş, S., Idsøe, T., Friborg, O., Sirin, S. R., & Oppedal, B. (2016) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-016-0251-8 · Cited by 51
“In particular, the symptom levels of post-traumatic stress disorder and of depression remain high (Bronstein and Montgomery 2011; Derluyn et al. 2009).”
Internalizing and externalizing symptoms among unaccompanied refugee and Italian adolescents
Thommessen, S. A. O., Laghi, F., Cerrone, C., Baiocco, R., & Todd, B. K. (2012) · Children and Youth Services Review · doi:10.1016/j.childyouth.2012.10.007 · Cited by 50
“…were not incorporated or explored in the present study, shifting the predominant focus from symptoms only, to resilience and coping mechanisms in unaccompanied refugee children and adolescents is an important task for future research (Betancourt & Khan, 2008; Bronstein & Montgomery, 2011).”
Bibliometric analysis of medicine – related publications on refugees, asylum-seekers, and internally displaced people: 2000 – 2015
Sweileh, W. M. (2017) · BMC International Health and Human Rights · doi:10.1186/s12914-017-0116-4 · Cited by 47
Health-related quality of life in refugee youth and the mediating role of mental distress and post-migration stressors
Dangmann, C. R., Solberg, Ø., & Andersen, P. N. (2021) · Quality of Life Research · doi:10.1007/s11136-021-02811-7 · Cited by 49
A Systematic Review of Longitudinal Risk and Protective Factors and Correlates for Posttraumatic Stress and Its Natural History in Forcibly Displaced Children
Tam, S. Y., Houlihan, S., & Meléndez‐Torres, G. J. (2015) · Trauma Violence & Abuse · doi:10.1177/1524838015622437 · Cited by 49
“…small and unrepresentative samples, and a narrow focus on individual level rather than family- or community-level data (Betancourt et al., 2013; Bronstein & Montgomery, 2011; Panter-Brick, Goodman, Tol, & Eggerman, 2011; PanterBrick, Grimon, & Eggerman, 2014; Reed, Fazel, Jones, Panter-Brick,…”
Background
Constructing early childhood services as culturally credible trauma-recovery environments: participatory barriers and enablers for refugee families
Lamb, C. (2019) · European Early Childhood Education Research Journal · doi:10.1080/1350293x.2020.1707368 · Cited by 55
“Trauma inhibits child development (Kaplan et al. 2016; Zilberstein 2014), frequently leading to psychological, emotional and behavioural problems (Bronstein and Montgomery 2011).”
Background
Parent Support Programmes for Families Who are Immigrants: A Scoping Review
Hamari, L., Konttila, J., Merikukka, M., Tuomikoski, A., Kouvonen, P., & Kurki, M. (2021) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01181-z · Cited by 52
Traumatic Events Exposure and Psychological Trauma in Children Victims of War in the Gaza Strip
Manzanero, A. L., Crespo, M., Barón, S., Scott, T., El‐Astal, S., & Hemaid, F. (2017) · Journal of Interpersonal Violence · doi:10.1177/0886260517742911 · Cited by 47
“Bronstein and Montgomery (2011) showed percentages between 19% and 54% for PTSD and between 3% and 30% for depression.”
Analysis of care and education pathways of refugee and asylum‐seeking children in care in England: Implications for social work
O’Higgins, A. (2018) · International Journal of Social Welfare · doi:10.1111/ijsw.12324 · Cited by 46
Protecting Asylum Seeking Children on the Move
Kohli, R. K. S. (2014) · Revue européenne de migrations internationales · doi:10.4000/remi.6768 · Cited by 45
Trauma-Informed Psychoeducation for Somali Refugee Youth in Urban Kenya: Effects on PTSD and Psychosocial Outcomes
Im, H., Jettner, J. F., Warsame, A. H., Isse, M. M., Khoury, D. Y., & Ross, A. I. (2018) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-017-0200-x · Cited by 54
“In another systematic review based on 3,003 refugee children from over 40 countries (Bronstein and Montgomery 2011), the prevalence of CMD was 19 to 54% for PTSD and 3 to 30% for depression.”
Background
Knowledge of the Unknown Child: A Systematic Review of the Elements of the Best Interests of the Child Assessment for Recently Arrived Refugee Children
Os, E., Kalverboer, M., Zijlstra, E. A., Post, W. J., & Knorth, E. J. (2016) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-016-0209-y · Cited by 44
“In two systematic reviews of the mental health of refugee children, the following risk factors—related to the pre- or during migration period—were identified: exposure to violence, personal injury, pre-existing vulnerability (cumulative), family experience of adverse events, unaccompanied entry and separation from par…”
BackgroundResultInfluential
Epidemiology of violence against children in migration: A systematic literature review
Jud, A., Pfeiffer, E., & Jarczok, M. N. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104634 · Cited by 44
Children at risk: A nation-wide, cross-sectional study examining post-traumatic stress symptoms in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden between 2014 and 2018
Solberg, Ø., Nissen, A., Vaez, M., Cauley, P., Eriksson, A.-K., & Saboonchi, F. (2020) · Conflict and Health · doi:10.1186/s13031-020-00311-y · Cited by 44
Schools’ and teachers’ roles and challenges in supporting the mental wellbeing of refugee youths: a qualitative study with Swedish teachers
McDiarmid, S., Durbeej, N., Sarkadi, A., & Osman, F. (2021) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2021.2007568 · Cited by 59
“…depression, anxiety, and post-traumatic stress disorder have all been found to be higher among refugee youths than youths in the general population (Bronstein & Montgomery, 2011; Fazel et al., 2005; Kandemir et al., 2018; Khamis, 2019; Kien et al., 2019; Salari et al., 2017; Scherer et al., 2020)…”
Background
Making other dreams: The impact of migration on the psychosocial wellbeing of Albanian-origin children and young people upon their families’ return to Albania
Vathi, Z., & Duci, V. (2015) · Childhood · doi:10.1177/0907568214566078 · Cited by 43
“Refugee children feature prominently in this body of literature (Almqvist and Broberg, 1999; Bronstein and Montgomery, 2011).”
Background
Stronger together: Community resilience and Somali Bantu refugees.
Frounfelker, R. L., Tahir, S. A., Abdi, A., & Betancourt, T. S. (2019) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000286 · Cited by 43
“…with exposure to a wide range of traumatic events and adversities, such as economic insecurity, discrimination, and language barriers, that negatively influence psychosocial functioning (Bronstein & Montgomery, 2011; Fazel & Stein, 2002; Fazel, Wheeler & Danesh, 2005; Henley & Robinson, 2011).”
Background
Children and Adolescents in Conflict and Displacement
Bennouna, C., Stark, L., & Wessells, M. (2020) · Springer eBooks · doi:10.1007/978-3-030-45278-0_2 · Cited by 43
Family therapy sessions with refugee families; a qualitative study
Björn, G. J., Gustafsson, P. A., Sydsjö, G., & Berterö, C. (2013) · Conflict and Health · doi:10.1186/1752-1505-7-7 · Cited by 47
“A review of 22 studies of refugee children found substantial variation in the definitions used and measurements made of the children’s problems and reported levels of post-traumatic stress disorder ranging from 19 to 54% [11].”
Background
A Scoping Review of the Health of African Immigrant and Refugee Children
Salami, B. O., Sánchez, H. F., Fouché, C., Evans, C., Sibeko, L. N., Tulli-Shah, M., Bulaong, A., Kwankye, S. O., Ani–Amponsah, M., Okeke‐Ihejirika, P., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073514 · Cited by 41
“Despite the fact that these children’s health should be protected as a human right, overwhelming evidence from systematic reviews indicates refugee children experience poor mental health status, especially post-traumatic stress [17–19].”
Review of the strengths and difficulties questionnaire translated into languages spoken by children and adolescents of refugee background
Stolk, Y., Kaplan, I., & Szwarc, J. (2017) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1568 · Cited by 47
“The psychological sequelae of these cumulative traumas, combined with resettlement stressors may contribute to complex developmental and mental health needs (Bronstein & Montgomery, 2011; Henley & Robinson, 2011; Kaplan, 2013).”
Ecologies of care: mental health and psychosocial support for war-affected youth in the U.S.
Bennouna, C., Ocampo, M. G., Cohen, F., Basir, M., Allaf, C., Wessells, M., & Stark, L. (2019) · Conflict and Health · doi:10.1186/s13031-019-0233-x · Cited by 41
Mental health and drug and alcohol comorbidity in young people of refugee background: a review of the literature
Posselt, M., Galletly, C. A., de Crespigny, C., & Procter, N. G. (2013) · Mental Health and Substance Use · doi:10.1080/17523281.2013.772914 · Cited by 39
Unaccompanied minors in the Netherlands and the care facility in which they flourish best
Kalverboer, M., Zijlstra, E. A., van Os, C., Zevulun, D., ten Brummelaar, M., & Beltman, D. (2016) · Child & Family Social Work · doi:10.1111/cfs.12272 · Cited by 39

Authors: Bronstein, I., & Montgomery, P.
Affiliations: University of Oxford (GB)
Corresponding author: Bronstein, Israel
ORCID: Bronstein, Israel
Montgomery, Paul
Venue: Clinical Child and Family Psychology Review
Publisher: Springer Science and Business Media LLC
Published: 2011-03
Volume: 14
Issue: 1
Pages: 44-56
ISSN: 1096-4037 (ISSN-L)
1573-2827
DOI: 10.1007/s10567-010-0081-0
OpenAlex: W2099969597
Cited by: 634
References: 83
Citations by year: 2026: 26 · 2025: 34 · 2024: 44 · 2023: 60 · 2022: 53 · 2021: 65 · 2020: 128 · 2019: 50 · 2018: 35 · 2017: 33 · 2016: 35 · 2015: 31 · 2014: 14 · 2013: 16 · 2012: 10
FWCI: 1.21
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Clinical Child and Family Psychology Review (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Social Sciences › Sociology and Political Science › Migration and Exile Studies
Social Sciences › Education › Education and experiences of immigrants and refugees
Keywords: refugee children, psychological distress, mental health, post-traumatic stress disorder, depression, emotional and behavioral problems, asylum seekers, pre-migration trauma, post-migration stressors, Western countries
MeSH terms: Age Factors, Child, Depression, Female, Humans, Male, Psychiatric Status Rating Scales, Refugees, Sex Factors, Stress Disorders, Post-Traumatic, Stress, Psychological, Resilience, Psychological

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Psychological Distress in Refugee Children: A Systematic Review

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