title: Frequent relocations between asylum-seeker centres are associated with mental distress in asylum-seeking children: a longitudinal medical record study.
abstract: BACKGROUND
  There are concerns about negative effects of relocations between asylum-seeker centres on the mental health of asylum-seeking children. However, empirical evidence comes from cross-sectional studies only. In this longitudinal medical record study, we aimed to assess: (i) whether relocations during the asylum process are associated with the incidence of newly recorded mental distress in asylum-seeking children; and (ii) whether this association is stronger among vulnerable children.
  
  
  METHODS
  Data were extracted from the electronic medical records database of the Community Health Services for Asylum Seekers in The Netherlands (study period: 1 January 2000-31 December 2008). Included were 8047 children aged 4 to 17 years. Case attribution was done using International Classification of Primary Care codes for mental, behavioural or psychosocial problems. The association between annual relocation rate and incidence of mental distress was measured using relative risks (RR) estimated with multivariate Cox regression models.
  
  
  RESULTS
  A high annual relocation rate (>1 relocation/year) was associated with increased incidence of mental distress [RR = 2.70; 95% confidence interval (CI) 2.30-3.17]. The relative risk associated with a high annual relocation rate was larger in children who had experienced violence (RR = 3.87; 95% CI 2.79-5.37) and in children whose mothers had been diagnosed with post-traumatic stress disorder or depression (RR = 3.40; 95% CI 2.50-4.63).
  
  
  CONCLUSIONS
  The risk of mental distress was greater in asylum-seeking children who had undergone a high annual relocation rate. This risk increase was stronger in vulnerable children. These findings contribute to the appeal for policies that minimize the relocation of asylum seekers.
authors: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands and Netherlands Association for Community Health Services, Utrecht, The Netherlands.
authors: Simone
authors: S
authors: Goosen
authors: Karien
authors: K
authors: Stronks
authors: Anton E
authors: AE
authors: Kunst
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003155:Community Mental Health Centers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000208:ethnology; D008603:Mental Health; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology* / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Children; asylum seekers; longitudinal studies; mental distress; refugees; relocations