International migration of unaccompanied minors: trends, health risks, and legal protection

Approaching pediatric mental health screening and care in immigration detention

Children held in US immigration detention facilities often arrive with significant mental health conditions requiring prompt attention. Despite the abundance of literature highlighting the need for adequate mental health care in migrant children, there is a chasm between the care offered to detained migrant children in the US and the minimum standards of healthcare in the US. This discrepancy is fueled by the mandate of Immigration and Customs Enforcement (ICE), which prioritizes immigration enforcement rather than the health and well-being of detained children. The tension between the existing ICE's enforcement mandate and the internationally recognized right to health care for children results in inadequate mental health care, causing long-term harm. We highlight current pediatric mental health screening and treatment practices in immigration detention facilities, exploring the role of ICE and child protection frameworks. We conclude by providing policy recommendations to improve mental health care in US-based detention facilities.

Care Pathways for Undocumented Migrant Children Seeking Cleft Lip and Palate Care: Institutional Experience, Current State Policies, and Opportunities

Timely medical care is crucial for optimal outcomes in children with cleft lip and palate. Undocumented migrant children face significant healthcare barriers. This study assesses the demographic characteristics and unmet surgical needs of undocumented children at our institution and analyzes state-level policies affecting their care.

A retrospective review was conducted at a single institution between 2023 and 2024. Medicaid and Children's Health Insurance Program policies were reviewed as of August 2024, categorizing states by immigrant child healthcare coverage.

Multidisciplinary cleft clinic in a pediatric referral center.

Ten undocumented children were included, with clinical data and immigration status collected from social work and insurance records.

Timing of initial cleft surgery, additional surgical needs, and surgical completion were assessed.

Ten undocumented children were identified, with a mean age of 7 (range 1-10) years. Eight received primary cleft surgery in their home countries, but many had unmet surgical needs, including alveolar bone grafting (n = 4), oronasal fistula closure (n = 5), and dental care (n = 3). Twelve states provide comprehensive coverage regardless of immigration status, with 2 more expected by 2025. Twenty-three states cover only certain noncitizens without a waiting period, while 14 impose a 5-year delay. Broad coverage was concentrated in the Northeast and West (P = .002), with only one US-Mexico border state included.

This study highlights barriers undocumented migrant children face in accessing cleft care, with disparities in state-funded policies potentially delaying critical interventions. Addressing these disparities is essential for equitable healthcare access.

Growing up in transit. Personal development and resistance of migrant adolescents travelling through Mexico unaccompanied

Mexico is a major global migration corridor. The last decade has seen an increase in adolescents travelling unaccompanied from Guatemala, Honduras and El Salvador, mainly due to violence and natural disasters. This group of migrants is exposed to migration risks such as trafficking and exploitation, as well as multiple deportations and long waiting times without appropriate access to health and education services. These conditions have significant documented adverse impacts on health and mental health, but the impact on personal development has been less explored. Thus, this article aims to explore the impact of migration transit on identity and resilience of unaccompanied migrant youth, psychosocial mental health constructs that are important for wellbeing and personal development. Through 47 semi-structured interviews conducted with migrant youth and different migration workers in summer 2021 in two migrant shelters in Mexico City and Guadalajara, we found that possibilities for identity building for migrant youth were restricted in a context of curbed freedom. Violence and poverty led to loss of crucial formative years, pushing many to aspire only to work - regardless of the type of work. Resilience overlapped with resistance but was generally maintained with cultural narratives of goal achievement, faith and hope. Strong responsibility towards sending remittances to family made family one of the main goals of the migration journey. Workers highlighted how regional migration management, underlined by discriminatory policies which place profit and national security ideology before a recognition of common humanity, is a considerable barrier to funding services and advancing access to rights for youth. However, youth showed recognition of their own agency and humanity, which represents an important basis on which to build a counter-discriminatory vision and management of this migration. Results are reported according to COREQ guidelines.

Victimization, polyvictimization, and depression symptoms among immigrants and native children and youth in Chile

BACKGROUND

Migration exposes children and youth to vulnerabilities, including uprooting, lack of protection, limited access to services, and violence. Previous studies have shown that victimization experiences impact the mental health of migrant children, including depression, anxiety, and post-traumatic stress disorder. This study aims to examine the co-occurrence of multiple forms of maltreatment (polyvictimization) among migrant and Chilean children and youth and its association with depressive symptoms, addressing a research gap in Latin America.

METHODS

Secondary data from the National Polyvictimization Survey (NPS) conducted by the Chilean Ministry of the Interior were analyzed. Measures assessing polyvictimization and depressive symptoms were administered to a sample of 1362 participants, with equal group sizes for migrants and Chilean-born individuals. Data analysis included descriptive statistics, group comparisons, correlation analyses, and multiple regression analyses.

RESULTS

The study revealed marked differences in experiences of conventional crime victimization and polyvictimization between migrant and Chilean-born participants, with migrants facing slightly higher incidences. Correlational analysis indicated variable strengths of association between victimization types and depressive symptoms across groups, with Chilean-born individuals showing stronger correlations for certain victimization forms. Multiple regression analysis highlighted gender, polyvictimization, child maltreatment, internet victimization, sexual victimization, and peer/sibling victimization as significant predictors of depressive symptoms across the sample. Notably, an interaction was observed between child maltreatment and migrant status, indicating a mitigated impact of maltreatment on depressive symptoms among migrant adolescents. This suggests the potential for unique resilience or coping mechanisms in this group.

CONCLUSIONS

This study elucidates the varied victimization experiences of migrant children and youth in Chile, with a notable emphasis on the mitigating effect of migrant status on the relationship between child maltreatment and depressive symptoms. It highlights the resilience and potential adaptive strategies of migrant minors facing adversity. The findings underscore the necessity of developing support and intervention strategies that recognize the specific needs and strengths of migrant children and youth, advocating for policies that protect and empower this vulnerable demographic amidst new environmental challenges.

Understanding the Legal Rights and Mental Health Needs of Unaccompanied Immigrant Children in US Government Custody and Beyond

This article addresses the mental health rights of unaccompanied children, the ways in which the US immigration system does not sufficiently support children's mental health, and how clinicians can play a role in meeting immigrant children's mental health needs.

Friendship attachment style, intolerance of uncertainty, and psychological distress among unaccompanied immigrant minors in times of COVID-19

INTRODUCTION

This cross-sectional study used a convergent parallel mixed-method design to investigate friendship attachment style, intolerance of uncertainty, and psychological distress among unaccompanied immigrant minors (UIMs) during the second wave of the COVID-19 pandemic in Italy.

METHOD

Participants were 80 male UIMs (Mage  = 17 years, standard deviation = 0.84) hosted in residential care communities. Individual interviews comprising questionnaires and open-ended questions assessed the constructs of interest. Qualitative data were analyzed through thematic content analysis, whereas descriptive statistics and regression analysis were computed on quantitative data.

RESULTS

Several UIMs mentioned positive relationships with peers, but more than half also felt reluctant to trust others and build new friendships due to events experienced before and during migration. However, in quantitative data, 69% identified themselves with the secure friendship attachment style. Regarding intolerance of uncertainty, participants expressed feelings of worry about the pandemic, but also emphasized their resources in terms of confidence, optimism, and planning skills, as well as being accustomed to uncertainty; indeed, levels of this variable were low-to-medium. In regression analysis, insecure attachment and higher intolerance of uncertainty were each associated with greater psychological distress. Moreover, psychological distress was lower among securely attached UIMs with low (vs. high) levels of intolerance of uncertainty.

CONCLUSION

The findings suggest that, even in conditions of societal insecurity, UIMs display resilience and employ effective coping strategies; however, a lack of trust in peer relationships and the inability to tolerate uncertainty may undermine their psychological adjustment. Implications for developmental theory and practice are discussed.

Accuracy of Age Estimation Using Three Dental Age Estimation Methods in a Young, Large, and Multiethnic Patient Sample

European countries have become host countries for migrants and unaccompanied minors. However, many migrants arrive without identity documents. Many methods exist to estimate age; among them, several methods using dental age have been proposed. Our objective was to evaluate the accuracy of biological age determination in a multiethnic sample using dental age estimated using three methods: Nolla, Demirjian, and the London Atlas. Orthopantomograms collected for 324 patients of various ethnicities aged from 4 to 20 years old were included. Then, for each orthopantomogram, a blind trained examiner used the three methods of age estimation. For each method, the estimated mean age was greater than the real mean age (p < 0.0001). The accuracy after 18 years old with a 1-year margin was under 50%. Demirjian's method gave a less accurate estimated age than Nolla's method (p < 0.0001) or the London Atlas (p < 0.001). The most accurate methods were those of Nolla and the London Atlas, with average absolute deviations of 1.3 and 1.2 years, respectively. Demirjian's method was much less accurate, with a deviation of around 2 years. The evaluated methods are unable to provide reliable information to determine if an individual is a minor.

Persistence of Emotional Distress in Unaccompanied Migrant Children and Adolescents Primarily From the Northern Triangle of Central America

Importance

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.

Objective

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.

Exposures

Traumatic events before migration, during migration, during detention, and after resettlement in the US.

Main Outcomes and Measures

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).

Results

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.

Conclusions and Relevance

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.

Psychotherapeutic and Psychosocial Interventions with Unaccompanied Minors: A Scoping Review

Unaccompanied minors (UAMs) are considered a particularly vulnerable population, facing severe threats regarding their physical and mental health. As their number has increased in recent years worldwide, research on mental health interventions has become necessary. The implementation of psychotherapeutic interventions has been documented, but psychosocial interventions seem to not have been consistently studied. In this review, we summarize the psychotherapeutic and psychosocial interventions with UAMs that have been studied up to now. Following the PRISMA guidelines for scoping reviews, we searched four databases and included studies and practice papers; there were no restrictions on publication date, geographical region, language, or method. We identified 46 studies on psychotherapeutic interventions and 16 studies on psychosocial interventions that met the inclusion criteria. Psychotherapeutic interventions were mainly based on cognitive behavioural, psychodynamic, narrative, art and transcultural approaches and aimed at improving UAMs' trauma, mental health and wellbeing, as well as professionals' skills and therapeutic protocols. Several studies showed promising results, with the cognitive behavioural approaches being the most researched. However, more research is needed in order to draw conclusions in terms of effectiveness. Psychosocial interventions followed various approaches and aimed at UAMs' empowerment, wellbeing, support and integration, as well as at improving caregivers' skills. Nonetheless, they seem not only very heterogeneous but also understudied, and we believe that a focus on them would be very useful. Methodological limitations and their implications for future research are discussed.

Humanitarian crisis on the US-Mexico border: Mental health needs of refugees and asylum seekers

Families and youth from the Northern Triangle of Central America seeking asylum in the U.S. report substantial trauma exposure and post-traumatic stress symptoms. Sexual and gender minorities of this population especially present unique circumstances and thus challenges and needs. However, with immigration along the southern U.S. border at a 21-year high, health and social resources for refugees and asylum seekers are being strained. Accordingly, the primary aim of this review is to raise awareness about migration-related trauma and the mental health needs among Central American and LGBTQ + refugees and asylum seekers in the U.S.-Mexico border. The authors also discuss practical, clinical, and advocacy implications to improve the mental health of refugees and asylum seekers entering the United States.

Multimodal co-therapy for unaccompanied minors: a qualitative study

BACKGROUND

Unaccompanied refugee minors-or unaccompanied minors-are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients' experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care.

METHODS

MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis).

RESULTS

Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one's story can "set us free" if guided carefully by care providers.

CONCLUSION

This study suggests that MUCTUM therapy may efficiently support unaccompanied minors' mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.

How Do We Address and Treat the Trauma of a 16-Year-Old Girl, Unaccompanied Minor, and Her Rape-Born Son? A Case Report

BACKGROUND

The child psychiatry unit of the Cochin Hospital in Paris is specialized in a transcultural clinical approach and treatment of psychotraumatism. The clinical demands addressed to the service often combine several levels of vulnerability: recent migration, repeated and intentional traumas, isolation and breach in family bonds sometimes precarious living conditions. Mastering how to approach trauma content adapting to the person's temporality while taking into account the individual, family and collective dimensions, is a key driver to the clinical intervention (of our approach).

OBJECTIVE AND METHOD

We describe a paradigmatic clinical situation articulating its multidimensional complexity: the case of Céline, a 16-year-old Mozambique teenager, unaccompanied minor (UM), who arrived in France three years ago with her 4-year-old child born out of rape. They are both cared for by Paris Child Welfare Bureau. The authors used the CARE guidelines for a rigorous approach to clinical case writing.

RESULTS AND DISCUSSION

In the clinical discussion, we highlight the pertinence of transcultural abilities for the treatment of a complex PTSD (post-traumatic stress disorder). We describe the measures taken to adapt the clinical interview framework to the mother's psychic temporality, while negotiating what can be said in attendance of the child. The idea of tranquility is primordial-whether she decides to tell or not tell the child. Removing the pressure to have to tell is an element of treatment.

CONCLUSION

Working through a progressive narrative construction, the therapeutical process allowed for the restoration of multiple levels of continuity between times prior to the trauma and following it, as well as prior to migration and following it, to create a continuum from adolescence to adulthood. Restoring narrativity favors the process of becoming a mother and the one of negotiating this new identity. The therapeutic axes also focused on improving the well-being of the UM-mother and preventing the impacts of transgenerational trauma transmission to the child. For women with similar experiences, sharing their emotions and their stories with us makes their choice about telling their child legitimate and comfortable, regardless of the decision they make.

Learning your limits: Nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care

Young unaccompanied refugees come in contact with acute psychiatric care due to pre-existing mental health conditions as well as stressful and traumatic experiences before, during, and after migration. Previous research on nurses' experiences of caring for refugees has primarily reported on difficulties related to cultural differences and communication and how nurses might distrust refugees. This study aimed to describe registered nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care. Semi-structured interviews with ten nurses were analysed using a method for qualitative content analysis. Data were collected in Sweden during 2019 and 2020. Results describe nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care in one theme: learning your limits and three sub-themes: feeling powerless but doing what you can; taking a stance in a politicized environment; and being frustrated and in need of support. Findings highlight the potential and limitations of mental health nursing, the importance of reflection and peer support, and the importance of viewing the roles and responsibilities of mental health nurses and nursing in a societal context. These findings suggest that nurses can make a difference for young unaccompanied refugees in acute psychiatric care. However, in doing so, nurses need support in realizing what they can and cannot achieve. The study is reported in accordance with the COREQ guidelines.