Mental health of unaccompanied young refugees : the role of institutional factors, symptom recognition, and psychotherapeutic treatment access

Kurzfassung/Abstract

Unaccompanied young refugees (UYRs) are exposed to multiple stressors before, during, and after flight, placing them at heightened risk for mental health disorders such as post-traumatic stress symptoms (PTSS), depression, and anxiety. As UYRs are usually placed in residential group homes in the Child and Youth Welfare System (CYWS) in Germany, it is important to analyze the role of the institutional environment on UYR’s mental health, as well as the symptom recognition and agreement with their caregivers concerning the symptomatology and how psychotherapeutic treatment can be facilitated. This dissertation synthesizes findings from three publications examining these research questions.

The first publication found that lower caregiver workload predicted reduced PTSS, depression, and anxiety, while UYR-specific accommodation was linked to lower PTSS after one year. Additionally, open group climate, defined as a supportive, warm, responsive, and respectful atmosphere, mediated the effect between physical facility characteristics (accommodation quality) and PTSS, depression, and anxiety, as well as between living in a UYR-specific group and PTSS and depression. The second publication showed low but statistically significant agreement between self- and caregiver reports, with self-reports consistently yielding higher scores regarding PTSS. Greater disagreement was associated with comorbid symptoms and shorter facility stays. The third publication qualitatively identified structured training programs, supportive caregivers and facilities, and skilled interpreters as key facilitators for psychotherapeutic treatment of UYRs from the perspective of psychotherapists.

Overall, this dissertation underscores the necessity of specialization across all fields. This includes trauma-informed care in UYRs-specific groups, widespread mental health screenings, training for caregivers and interpreters, and adequate staffing to ensure symptom recognition and service accessibility. Strengthening local partnerships between CYWS facilities and psychotherapists, along with implementing outreach approaches, can enhance access to mental health care. Policymakers must uphold facility standards, invest in staff resources, and support financial measures for interpreters and evidence-based interventions.