Stressful life events as predictors of refugee adolescents’ subjective mental health need

Abstract Background Asylum seeking and refugee (ASR) adolescents fleeing armed conflict have lived through stressful events. Although not all stressful life events are experienced as post-traumatic stress, they may still lead to subjective need for mental health support. In this study, we assessed which stressful events predicted subjective need. Methods We collected and analysed cross-sectional data (February 2019-November 2020) from ASR adolescents aged 11-18, coming from Syria, Afghanistan and Iraq (n = 216). Subjective mental health need was measured with the question “Do you think you have emotional difficulties that you need help with?” and stressful life events (SLE) by the SLE Checklist, a self-report screening tool that asks if participants experienced stressful events in three categories: separation from family, witnessing armed conflict, experiencing violence. Binary logistic regression was run to assess the relative contribution of stressful life events to subjective need. Results 30.1% of participants reported subjective need for mental health support. Most commonly encountered events were witnessing armed conflict (53.2%) and experiencing the death of a loved one (51.9%). Only one stressful event significantly predicted subjective need for mental health support: separation from family or relatives against one's will (e.g., by police or military) [OR = 6.32, 95%CI(1.79,22.31)]. Conclusions ASR adolescents who have been separated from their family by force report subjective need for mental health support. It is important to supplement diagnostic tools with subjective report of needing mental health care. ASR adolescents who have experienced separation from famil by force should be given spaces to talk about their need for mental health support. Public health interventions could focus on creating or utilising such spaces where mental health support is available. Crucially, bureaucratic and legal burdens that impede speedy family reunification should be reduced. Key messages • ASR adolescents who have been separated from their families by force are more likely to report subjective need for mental health support. • The higher reported need highlights the importance of reducing bureaucratic and legal burdens that impede fast family reunification.


Background:
Asylum seeking and refugee (ASR) adolescents fleeing armed conflict have lived through stressful events. Although not all stressful life events are experienced as post-traumatic stress, they may still lead to subjective need for mental health support. In this study, we assessed which stressful events predicted subjective need.

Methods:
We collected and analysed cross-sectional data (February 2019-November 2020) from ASR adolescents aged 11-18, coming from Syria, Afghanistan and Iraq (n = 216). Subjective mental health need was measured with the question ''Do you think you have emotional difficulties that you need help with?'' and stressful life events (SLE) by the SLE Checklist, a self-report screening tool that asks if participants experienced stressful events in three categories: separation from family, witnessing armed conflict, experiencing violence. Binary logistic regression was run to assess the relative contribution of stressful life events to subjective need. Results: 30.1% of participants reported subjective need for mental health support. Most commonly encountered events were witnessing armed conflict (53.2%) and experiencing the death of a loved one (51.9%). Only one stressful event significantly predicted subjective need for mental health support: separation from family or relatives against one's will (e.g., by police or military) [OR = 6.32, 95%CI(1.79,22.31)]. Conclusions: ASR adolescents who have been separated from their family by force report subjective need for mental health support. It is important to supplement diagnostic tools with subjective report of needing mental health care. ASR adolescents who have experienced separation from famil by force should be given spaces to talk about their need for mental health support. Public health interventions could focus on creating or utilising such spaces where mental health support is available. Crucially, bureaucratic and legal burdens that impede speedy family reunification should be reduced. Key messages: ASR adolescents who have been separated from their families by force are more likely to report subjective need for mental health support. The higher reported need highlights the importance of reducing bureaucratic and legal burdens that impede fast family reunification. For many affected by ongoing coloniality, research is not neutral or objective, but is part of the colonial violence inflicted through disciplines as diverse as medicine and ethnography. Against this background, choosing Community-based Participatory Research (CBPR) as research strategy for researching racism in health care can be seen as a way of challenging existing epistemologies of ignorance by embracing diversity of knowledge production. 'Community Perspectives on Racism in Health Care' is a participatory research project carried out in the frame of the National Discrimination and Racism Monitor which aims to improve the involvement of people affected by racial injustice in the research process, collect data on and generate theory about healthcare-related racism. It is conducted by DeZIM-Institut in collaboration with different racialized communities. Community members were trained as peer researchers and supported to conduct CBPR-projects. Two CBPR-projects were conducted: 1) digital focus groups with people marked as Muslims 2) digital focus groups with Black people. 'Racial' health disparities were identified on three levels: differential access to health care, differential care within the system and differences in exposures. The theory was built inductively, while drawing on existing theoretical concepts from the disciplines of public health, postcolonial and decolonial studies. Racialized people used the opportunity to be trained as peer researchers. They conducted CBPR projects tailored to the needs of their communities and conceptualized racism in the broader context of health care. Suggestions were made for improving health care services. Including those most impacted by racial injustice as peer researchers enables us to widen the ''we'' who constitute the researchers and to harvest the wisdom of situated knowledges. However ongoing challenges have been faced raising the question of the (im)possibilities of democratic knowledge production in German academia.

Key messages:
Including those most impacted by racial injustice as peer researchers enables us to harvest the wisdom of situated knowledges.
Ongoing challenges have been faced by trying to establish democratic knowledge production in German academia.
iii248 European Journal of Public Health, Volume 32 Supplement 3, 2022