Unaccompanied Refugee Minors: A Systematic Review of Psychological Interventions / Unbegleitete minderjährige Flüchtlinge: Eine systematische Übersicht über psychologische Interventionen. Kindheit und Entwicklung

In 2014, 34,300 applications for asylum were placed by unaccompanied refugee minors in 82 countries. Unaccompanied refugee minors are at a very high risk for psychological disorders, since the absence of a parent is associated with developmental risks that are further increased owing to experiences made while on flight. Given the current refugee situation in Germany and the high prevalence of mental disorders in refugee populations, effective psychotherapeutic interventions are needed, especially for refugee minors. This review provides an overview of the current state of research on the effectiveness of therapeutic interventions for unaccompanied refugee minors. A comprehensive search of eight databases was conducted. The PRISMA guidelines for reporting in systematic reviews were applied, and the levels of evidence for the studies were identified. We found 12 studies examining the effectiveness of psychotherapeutic interventions for unaccompanied refugee minors reporting quantitative psychological outcomes by pre- and post-measurements. The interventions were either trauma focused with or without exposure or not trauma specific. Effect sizes based on given statistical information were calculated. Of the 12 articles, 10 showed significant results, although overall the evidence in this field is scarce and the methodological quality of the studies is often poor. Narrative exposure therapy (NET) for children (KIDNET) resulted in satisfactory effects, as did cognitive behavioral therapy (CBT), although CBT studies for refugee minors are still rare. NET/KIDNET was also effective when implemented in refugee camps and with lay persons. Overall, a critical appraisal of the studies reveals that the sample sizes are often small, power analyses are lacking, the handling of drop-outs is often not explained, and information on treatment fidelity is missing. Thus, replication of studies of high methodological quality and the exploration of other interventions, such as programs including multimodal psychosocial support and school-based programs, as well as the analyses of potential moderators and mediators are warranted. The results of interventions with lay persons suggest that schools are promising intervention settings, since all refugee minors – at least in Germany – are sent to school, and the children can be reached without stigmatizing them. Further, the refugee status as a potential moderator variable should be assessed in other therapy studies so as to shed light on potential effects. Finally, component analyses should aim at the identification of potentially shared active treatment factors that would improve the psychological health of (unaccompanied) refugee minors