gms | German Medical Science

Introduction: Forced displacement is on the rise worldwide and 40% of all displaced people are aged between 0–17 years. Asylum seeking or refugee (ASR) minors are reported to be often affected by mental illness, with prevalences ranging between 19–53% for post-traumatic stress disorder (PTSD), 10–33% for depression and 9– 32% for anxiety disorders. However, since displacement and migration are highly dynamic it is difficult to obtain reliable data on disease incidences, which in turn is necessary for the development and provision of adequate care services for this vulnerable population. Our study analyzes the incidence of psychiatric disorders in ASR minors from 20 refugee shelters in Germany contributing to PriCareNet, a research network dedicated to medical care for asylum seekers and refugees.

Methods: Available data was obtained from October 2017 until end of June 2023 from the PriCareNet research network, comprising routine medical data extracted in an anonymized format from a standardized medical record. This includes information on the number of patients and the incidence of the selected indicators, e.g. “mental and behavioral disorders”" (ICD-10 diagnoses: F00-F99) stratified by age group (minors <18 years and adults ≥18 years). To calculate incidences, the total yearly number of newly diagnosed patients with mental conditions was used as the numerator and the total number of patients as the denominator. All observations <3 are set to 0 to maintain anonymity. The facilities’ infrastructure is currently investigated using a questionnaire but feedback is pending.

Results: During the study period 22.846 children were treated in medical facilities in PriCareNet. Of those, 842 children (4%) were diagnosed with a psychiatric or mental disorder (Table 1 [Tab. 1]). Overall, we observed high fluctuation of diagnosed individuals as well as overall patient numbers in the reporting centers.

Discussion: Our retrospective analysis of routine medical data in 20 refugee shelters showed an incidence of 4% of mental disorders among the pediatric patients. This number seems very low compared to previous prevalence studies in refugee children, and is likely an underestimation of the true burden of disease due to the use of routine medical data in primary care settings. Various confounders may explain these differences. Firstly, PriCareNet is not specifically designed to collect data on mental health (alone) but to collect routine care information. This could also explain why some centers did not report any affected children. Secondly, unaccompanied minor refugees are cared for by the youth welfare office and are not included in the data analyzed. In 2022 this group accounted for around 10% of all refugee children and is particularly vulnerable to mental illness. Thirdly, it must be taken into account that the length of stay in refugee shelters ranges from a few weeks up to six months and a visit of the health infrastructure is not mandatory in all reporting centers. Therefore, an unknown number of patients could be missed because of not showing up. Lastly, not all centers are staffed with specialist care for mental health, which could also decrease incidence numbers.

In summary, our analyses reflect the dynamic environment of ASR medical care. We advise to implement a standardized screening for mental health in refugee minors in the routine medical care in refugee shelters to provide better detection and care for mental health.