title: Development of mental health problems - a follow-up study of unaccompanied refugee minors.
abstract: BACKGROUND
  Studies have shown that unaccompanied refugee children have elevated symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and externalizing problems. Few studies have examined change in this group's mental health symptoms after resettlement in a new country, particularly for those who arrive to a host country when being under the age of 15.
  
  
  METHODS
  The sample included 75 unaccompanied refugee children (mean age 16.5 years, SD =1.6; 83% boys) who settled in Norway. We examined change in the number of stressful life events, symptoms of PTSD (Child PTSD Symptom Scale; CPSS), and symptoms of anxiety, depression and externalizing problems (Hopkins Symptom Checklist; HSCL-37A) from 6 months after arrival (T1) to 1.9 years (SD =0.6) later (T2) using paired samples t-tests. Linear regression models were used to examine whether length of stay, level of education or change in the number of experienced stressful life events predicted symptom change.
  
  
  RESULTS
  There was a small and non-significant change in the mean scores of both symptom scales between T1 and T2, although there was considerable variation among the participants. The number of children who remained above the clinical cut-off value from T1 to T2 was as follows: 28 of 47 (59.6%) on the CPSS and eight of 16 (50.0%) on the HSCL-37A. There was a significant increase in the number of reported stressful life events from T1 to T2. An increase in reported stressful life events predicted an increase in PTSS (β =1.481, 95% CI .552 to 2.411). Length of stay, increase in stressful life events and level of education did not predict changes in the HSCL-37A.
  
  
  CONCLUSIONS
  There was no average change in the level of PTSS, depression, anxiety, or externalizing problems in this group of unaccompanied refugee children from shortly after arrival to nearly two years later. The large variation in change scores across informants indicates a need for monitoring the development of mental health problems and securing that the youth's primary psychosocial needs are met. The high rate of children above clinical cut-off on the symptoms scales and with suicidal ideation indicates that many may be in need of treatment.
authors.affiliation: Department of Psychology, University of Oslo, Forskningsveien 3a, 0372 Oslo, Norway ; Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugveien 1-3, 0484 Oslo, Norway.
authors.forename: Tine K
authors.initials: TK
authors.lastname: Jensen
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugveien 1-3, 0484 Oslo, Norway.
authors.forename: Envor M Bjørgo
authors.initials: EM
authors.lastname: Skårdalsmo
authors.affiliation: Frambu center for rare disorders, Sandbakkveien 18, 1404 Siggerud, Norway.
authors.forename: Krister W
authors.initials: KW
authors.lastname: Fjermestad
keywords: Longitudinal; Mental health; Refugee children; Trauma; Unaccompanied