Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York.
Department of Psychiatry, New York University Grossman School of Medicine, New York.
JAMA Netw Open. 2023 Jun 1;6(6):e2318977. doi: 10.1001/jamanetworkopen.2023.18977.
In the US, unaccompanied migrant children and adolescents (hereinafter referred to as children) are predominantly from Central America's Northern Triangle. While unaccompanied migrant children are at high risk for psychiatric sequelae due to complex traumatic exposures, longitudinal investigations of psychiatric distress after resettlement are lacking.
To identify factors associated with emotional distress and longitudinal changes in emotional distress among unaccompanied migrant children in the US.
DESIGN, SETTING, AND PARTICIPANTS: For this retrospective cohort study, the 15-item Refugee Health Screener (RHS-15) was administered between January 1, 2015, and December 31, 2019, to unaccompanied migrant children as part of their medical care to detect emotional distress. Follow-up RHS-15 results were included if they were completed before February 29, 2020. Median follow-up interval was 203 days (IQR, 113-375 days). The study was conducted in a federally qualified health center that provides medical, mental health, and legal services. Unaccompanied migrant children who completed the initial RHS-15 were eligible for analysis. Data were analyzed from April 18, 2022, to April 23, 2023.
Traumatic events before migration, during migration, during detention, and after resettlement in the US.
Emotional distress, including symptoms of posttraumatic stress disorder, anxiety, and depressive symptoms, as indicated by the RHS-15 (ie, score ≥12 on items 1-14 or ≥5 on item 15).
In total, 176 unaccompanied migrant children completed an initial RHS-15. They were primarily from Central America's Northern Triangle (153 [86.9%]), were mostly male (126 [71.6%]), and had a mean (SD) age of 16.9 (2.1) years. Of the 176 unaccompanied migrant children, 101 (57.4%) had screen results above the positive cutoff. Girls were more likely to have positive screen results than boys (odds ratio, 2.48 [95% CI, 1.15-5.34]; P = .02). Follow-up scores were available for 68 unaccompanied migrant children (38.6%). On the follow-up RHS-15, most scored above the positive cutoff (44 [64.7%]). Three-quarters of unaccompanied migrant children who scored above the positive cutoff initially continued to have positive scores at follow-up (30 of 40), and half of those with negative screen scores initially had positive scores at follow-up (14 of 28). Female vs male unaccompanied migrant children (unstandardized β = 5.14 [95% CI, 0.23-10.06]; P = .04) and initial total score (unstandardized β = 0.41 [95% CI, 0.18-0.64]; P = .001) were independently associated with increased follow-up RHS-15 total score.
The findings suggest that unaccompanied migrant children are at high risk for emotional distress, including symptoms of depression, anxiety, and posttraumatic stress. The persistence of emotional distress suggests that unaccompanied migrant children would benefit from ongoing psychosocial and material support after resettlement.
在美国，无人陪伴的未成年移民（以下简称儿童）主要来自中美洲的“北方三角”地区。由于经历了复杂的创伤性事件，无人陪伴的未成年移民患精神后遗症的风险很高，但对他们重新安置后的精神困扰的纵向调查却很缺乏。
确定与美国无人陪伴的未成年移民情绪困扰及其纵向变化相关的因素。
设计、地点和参与者：这是一项回顾性队列研究，在 2015 年 1 月 1 日至 2019 年 12 月 31 日期间，通过难民健康筛查表（RHS-15）对无人陪伴的未成年移民进行了评估，以检测其情绪困扰。如果在 2020 年 2 月 29 日之前完成了后续 RHS-15 结果，则纳入其中。中位随访间隔为 203 天（IQR，113-375 天）。该研究在一家提供医疗、心理健康和法律服务的联邦合格健康中心进行。完成初始 RHS-15 的无人陪伴未成年移民有资格进行分析。数据于 2022 年 4 月 18 日至 2023 年 4 月 23 日进行分析。
在移民前、移民期间、拘留期间和在美国重新安置后发生的创伤性事件。
情绪困扰，包括创伤后应激障碍、焦虑和抑郁症状，由 RHS-15 表示（即，项目 1-14 的得分≥12 或项目 15 的得分≥5）。
共有 176 名无人陪伴的未成年移民完成了初始 RHS-15。他们主要来自中美洲的“北方三角”地区（153 [86.9%]），大多数是男性（126 [71.6%]），平均年龄（SD）为 16.9（2.1）岁。在 176 名无人陪伴的未成年移民中，有 101 名（57.4%）的检测结果超过阳性截断值。与男孩相比，女孩更有可能检测结果呈阳性（优势比，2.48 [95% CI，1.15-5.34]；P = .02）。有 68 名无人陪伴的未成年移民（38.6%）有后续评分。在后续的 RHS-15 中，大多数得分超过阳性截断值（44 [64.7%]）。四分之三的最初检测结果呈阳性的无人陪伴未成年移民在随访中仍呈阳性（30 名中的 40 名），一半最初检测结果呈阴性的无人陪伴未成年移民在随访中呈阳性（28 名中的 14 名）。与男性相比，女性无人陪伴的未成年移民（未标准化 β = 5.14 [95% CI，0.23-10.06]；P = .04）和初始总分（未标准化 β = 0.41 [95% CI，0.18-0.64]；P = .001）与后续 RHS-15 总分的增加独立相关。
研究结果表明，无人陪伴的未成年移民情绪困扰风险很高，包括抑郁、焦虑和创伤后应激障碍的症状。情绪困扰的持续存在表明，无人陪伴的未成年移民在重新安置后需要持续的心理社会和物质支持。
