What do we want to know?
This systematic literature review was undertaken to understand the nature and extent of literature on the impact of forced displacement on adolescent mental health within and between low- and middle-income countries. To achieve this, we have conducted a conceptual mapping to consider the definitions of displacement in the literature, and on the ways the research literature has conceptualized the relationship between displacement and mental health.
Who wants to know?
The findings may be helpful to a range of communities. Particularly those interested in understanding the impact of diverse displacement experiences, developing a shared understanding of displacement’s relationship with mental health issues, and the co-design of methodologies and interventions to address the mental health impacts of displacement.
What did we find?
Defining displacement
- There was variation in how displaced adolescents are referred to across studies
- None discussed displacement as a feeling of ‘un-homing’, but all of the studies focused on forced physical relocation either within a country or between countries
- Displaced adolescents were mainly referred to as ‘refugees’, even though in some cases they are not legally recognised as refugees by the host governments.
- ‘Refugee unaccompanied children’ was used interchangeably with ‘refugee’ / ‘unaccompanied children’ and the term internally displaced adolescents also featured.
CROSS CUTTING THEMES
Age and mental health outcomes
- Adolescents are sensitive to the adverse effects of exposure to highly negative social experiences, such as war (Mirabolfathi, 2020).
- Younger adolescents have stronger reactions to traumatic experiences than older children (Oppedal et al., 2018); which may be due to working memory capacity which is still developing (Mirabolfathi, 2020); as more highly developed cognitive abilities in older adolescents facilitated adaptive coping (Barenbaum 2004, Betancourt & Khan, 2008).
- However, older age was significantly associated with incidence of anxiety-related disorders (Gormez, 2018).
Gender and mental health outcomes
- Female gender was associated with all mental health problems, despite boys reporting more traumatic experiences (Eruyer, 2018, Kandemir, 2018)
- However, we note that most studies assess depression and anxiety, which are both internalising symptoms that are more typically associated with female gender.
- Environmental factors – particularly adolescents’ mobility around their neighbourhood or camp – play a moderating role, which intersects with gender: girls’ mobility is restricted and therefore less likely to build potential support networks outside of the home (Betancourt, 2012, also noted as a potential mental health factor by DeJong, 2017).
MENTAL HEALTH FACTORS
Structural determinants
This review identified 11 structural determinants of health that caused or exacerbated mental health disorders. These determinants were:
- Experience of or exposure to violence
- Inability to go to school
- Lack of food or water
- Indirect exposure to violence
- Change or loss of culture (including acculturative stress)
- No shelter/ poor living conditions
- Restriction of movement
- Exposure to unhygienic conditions
- No access to medical care
- Poverty
- Undertreatment of mental health disorders
Proximal conditions
A total of 27 studies looked at one or more factors belonging to adolescents’ proximal conditions. The factors identified under proximal conditions included:
- Difficulties adjusting to new country/society
- Being separated from family/communities
- Loss/death of family
- Loss of material possessions
- Living in a formal camp
- Feeling (un)safe
- Sexual abuse or assault
- Change in relationship with parents/parental stress
- Lack of social support
- Parental/caregiver depression (or other caregiver MH condition)
- Family conflicts
- Intimate partner violence
What are the implications?
This review has shown that there is evidence that adolescents who have been displaced are at high risk of having poor mental health. The scholarship has shown that displacement is a multidimensional event, which can be associated with different dimensions and factors that affect mental health, across the displacement trajectory. Mechanisms which connect specific experiences of displacement with worse mental health outcomes are still poorly understood. Whilst all of the papers included in this review focused on adolescents, few compared mental health outcomes between age groups. Limitations of research findings might be partially due to difficulties conducting research with adolescents who have been displaced. However, few papers discussed methodologies and research contexts in detail, and therefore it is difficult to say what factors influenced research design. Thus, as mental health research is increasingly becoming focused on mechanisms, displaced adolescents living in LMICs must be included in developing understandings of mental health.
How did we get these results?
The findings are based on a conceptual analysis of studies investigating the prevalence or impact of displacement on mental health issues.
This report should be cited as:
Sender H, Dickson K, Bangpan M, Choi C, Van Den Berghe C, Buckle N, Lakhanpaul M (2023) Adolescent mental health and displacement from and into low- and middle-income countries. London: EPPI Centre, UCL Social Research Institute, University College London.