Polytraumatization in young male refugees from the Middle East and its association with internalizing and externalizing symptoms

Usama El-Awad; Tilman Reinelt; Johanna Braig; Hannah Nilles; Denise Kerkhoff; Pia Schmees; Jana-Elisa Rueth; Atefeh Fathi; Mira Vasileva; Franz Petermann; Heike Eschenbeck; Arnold Lohaus

doi:10.1186/s13034-021-00428-9

Polytraumatization in young male refugees from the Middle East and its association with internalizing and externalizing symptoms

Child Adolesc Psychiatry Ment Health. 2021 Dec 17;15(1):75. doi: 10.1186/s13034-021-00428-9.

Authors

Usama El-Awad^{1

2}, Tilman Reinelt³, Johanna Braig⁴, Hannah Nilles⁵, Denise Kerkhoff⁵, Pia Schmees⁴, Jana-Elisa Rueth⁵, Atefeh Fathi⁶, Mira Vasileva⁷, Franz Petermann⁸, Heike Eschenbeck⁴, Arnold Lohaus⁵

Affiliations

¹ Faculty of Psychology and Sports Sciences, University of Bielefeld, P.O. Box 10 01 31, 33501, Bielefeld, Germany. usama.el-awad@uni-bielefeld.de.
² Center for Clinical Psychology and Rehabilitation, University of Bremen, Grazer Str. 6, 28359, Bremen, Germany. usama.el-awad@uni-bielefeld.de.
³ University of Zurich and University Hospital Zurich, Zurich, Switzerland.
⁴ Department of Educational Psychology and Health Psychology, University of Education Schwäbisch Gmünd, Oberbettringer Str. 200, 73525, Schwäbisch Gmünd, Germany.
⁵ Faculty of Psychology and Sports Sciences, University of Bielefeld, P.O. Box 10 01 31, 33501, Bielefeld, Germany.
⁶ Center for Psychosomatic Psychotherapeutic Rehabilitation, Luisenklinik, Paulinenstraße 21, 70178, Stuttgart, Germany.
⁷ Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC, 3053, Australia.
⁸ Center for Clinical Psychology and Rehabilitation, University of Bremen, Grazer Str. 6, 28359, Bremen, Germany.

Abstract

Background: Young Middle Eastern male refugees are currently among the most vulnerable groups in Europe. Most of them have experienced potentially traumatic events (PTEs) such as rape, torture, or violent assaults. Compared to their peers, young refugees suffer more from internalizing and externalizing symptoms, especially when unaccompanied. Little is known about the cumulative impact of experiencing different types of PTEs on mental health outcomes (polytraumatization) of young male refugees from the Middle East. We investigated (1) whether there is a dose-response relationship between multiple PTE types experienced and mental health outcomes, (2) whether individual types of PTEs are particularly important, and (3) to what extent these are differentially associated with mental health outcomes among unaccompanied or accompanied peers.

Methods: In total, 151 young Middle Eastern male refugees in Germany (M_age = 16.81 years, SD_age = 2.01) answered questionnaires on PTEs, mental health, and post-migration stress.

Results: Hierarchical regression analyses revealed, while controlling for age, duration of stay, unaccompanied status, and post-migration stress, (1) a dose-effect between PTE types on both internalizing and externalizing symptoms. Moreover, (2) regarding internalizing symptoms, violent family separation and experiencing life-threatening medical problems were particularly crucial. The latter was driven by unaccompanied refugees, who also reported higher levels of substance use.

Conclusions: The results extend findings from the literature and suggest that not only may greater polytraumatization be related to greater depression among refugees, but also to a range of other mental health outcomes from the internalizing and externalizing symptom domains. Furthermore, the results highlight the mental health risks that unaccompanied and accompanied refugee adolescents face after exposure to PTEs, and provide information for practitioners as well as researchers about event types that may be particularly relevant.

Keywords: Anxiety; Depression; Externalizing symptoms; Internalizing symptoms; Polytraumatization; Potentially traumatic events; Refugee adolescents.

Abstract

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