ObjectiveChildren and young adults comprise a significant proportion of the world´s refugee population and are disproportionately negatively affected by the social determinants of health. This heterogeneous group faces high rates of poor mental health, yet research investigating within-group inequalities in mental health remains limited. We performed a latent profile analysis to explore classes of mental health based on posttraumatic stress symptoms (PTSS), general functioning, and well-being. This study aimed to improve the understanding of mental health differences, thereby providing better guidance for assessment and tailored interventions.MethodThis study involved 131 children and 127 young adults with refugee backgrounds (mean age 18.21 years, 44.6% female, 23.6% unaccompanied) recruited nationwide in Sweden (2019-2022). To examine classes and their predictors, latent profile analysis was conducted, followed by multinomial logistic regression analysis.ResultsLatent profile analysis identified four distinct classes: Good Mental Health (58.1%; low PTSS, good functioning and well-being), Severe Mental Distress (13.6%; high PTSS, low functioning and well-being), Moderate Mental Strain (12.4%; low PTSS, moderate functioning, low well-being), and Resilient (15.9%, high PTSS, good functioning, moderate well-being). Social determinants of health, such as being unaccompanied, asylum status, exposure to multiple types of violence, sexual victimization, and child maltreatment, distinguished the classes.ConclusionChildren and young adults with refugee backgrounds can be categorized into classes based on clinically relevant mental health indicators. Focusing solely on those at the highest risk for poor mental health may overlook many who are mentally healthy and those who need more targeted support. Future research should aim to replicate findings and evaluate additional predictive factors at the family and societal levels.

Research on complex posttraumatic stress disorder (CPTSD) among individuals with refugee backgrounds is limited, and its validity within this group remains underexplored. This study aimed to assess the prevalence and discriminant validity of posttraumatic stress disorder (PTSD) and CPTSD, as well as the risk factors for CPTSD, in a community sample of adolescents with refugee backgrounds residing in Sweden. This study involved 296 adolescents. Probable diagnoses were evaluated according to DSM-5 and ICD-11 criteria. Latent class analysis was employed to examine the discriminant validity of PTSD and CPTSD, while logistic regression analysis was used to explore risk factors for CPTSD. The findings indicated that 24.1% had a probable diagnosis of PTSD according to the DSM-5. For ICD-11, the equivalent proportions were 7.1% for PTSD and 10.8% for CPTSD. Latent class analysis identified three distinct classes: Low symptoms (46.9%), PTSD (29.6%), and CPTSD (23.6%). Compared to the PTSD class, membership in the CPTSD class was predicted by exposure to more types of violence and child maltreatment. It was also associated with higher posttraumatic stress symptoms, worse general functioning, poorer mental well-being, increased suicidal thoughts, more treatment-seeking behavior, and greater comorbidity. This study found a high prevalence of PTSD and CPTSD among adolescents with refugee backgrounds living in Sweden. Distinct classes aligned with the ICD-11 formulation of PTSD and CPTSD were identified, with exposure to violence and child maltreatment emerging as key risk factors for CPTSD. Results underscore the importance of identifying and addressing posttraumatic stress in adolescents with refugee backgrounds. Future research should aim to further validate the CPTSD diagnosis in larger samples of adolescents with refugee backgrounds.

Objectives: Research on complex posttraumatic stress disorder (CPTSD) among individuals with refugee backgrounds is limited, particularly in adolescents, and its validity in this group remains underexplored. The aim of this study was to assess the prevalence and discriminant validity of posttraumatic stress disorder (PTSD) and CPTSD, as well as the risk factors for CPTSD, in a community sample of adolescents with refugee backgrounds residing in Sweden.

Methods: The study included 296 adolescents with refugee backgrounds recruited nationwide in Sweden. Participants were aged 12-25 years, 45.3% were female, and 23.7% had unaccompanied status. Probable diagnoses were evaluated according to DSM-5 and ICD-11 criteria using questionnaires. Latent class analysis was employed to examine the discriminant validity of PTSD and CPTSD, while logistic regression analysis was used to explore risk factors for CPTSD.

Results: The findings indicated that 24.1% had a probable diagnosis of PTSD according to the DSM-5. For ICD-11, the equivalent proportions were 7.1% for PTSD and 10.8% for CPTSD. The probable diagnostic rates for DSM-5 PTSD were significantly higher than ICD-11 PTSD and CPTSD. Latent class analysis identified three distinct classes: Low symptoms (46.9%), PTSD (29.6%), and CPTSD (23.6%). Compared to the PTSD class, membership in the CPTSD class was predicted by exposure to more types of violence and child maltreatment. It was also associated with higher posttraumatic stress symptoms, worse general functioning, poorer mental well-being, increased suicidal ideation, more treatment-seeking behavior and greater comorbidity.

Conclusions: This study found a high prevalence of PTSD and CPTSD among adolescents with refugee backgrounds living in Sweden. Distinct classes aligned with the ICD-11 formulation of PTSD and CPTSD were identified, with exposure to more types of violence and child maltreatment emerging as key risk factors for CPTSD. Key messages • Adolescents with refugee backgrounds living in Sweden may be highly affected by PTSD and CPTSD. • The ICD-11 distinction between PTSD and CPTSD is likely valid for adolescents with refugee backgrounds. Exposure to more types of violence and child maltreatment may be risk factors for CPTSD.

Background Programs for mental health promotion and prevention of nonsuicidal self-injury (NSSI) in schools have gained increased focus during the last decades, but less is known about adolescents’ experiences of such interventions.

Methods A whole-school preventive intervention targeting mental health and NSSI was delivered to six secondary schools. Adolescents participated in the Youth Aware of Mental Health program combined with an NSSI-focused psychoeducation module. Caregivers and teachers were given online psychoeducation on NSSI, and school health care staff were given a workshop on self-injury. Eleven group interviews (n = 65 participants) were conducted with adolescents (ages 13–15 years, 65% females) exploring participant experiences. Interviews were analyzed using thematic analysis and interpreted in light of a biopsychosocial understanding of adolescence.

Results The analysis generated two main themes. The first theme, Mental health in the context of adolescence, centered around adolescents’ conception of mental health, after having taken part in the intervention, framed in a context of coping with external stressors. The dilemma of autonomy versus help-seeking was also identified as part of the first main theme. The second theme, The who, when, what, and how of the intervention, described adolescents’ experiences of the intervention. This theme included increased awareness and knowledge of mental ill-health. The participants generally agreed that the topics included are important to adolescents and emphasized that the content needs to be relatable. Several factors that influence how a school-based program is received by adolescents were identified, such as who should be targeted and when. Adolescents also identified challenges and gave recommendations for future similar projects.

Conclusions Adolescents generally perceived addressing mental health and NSSI in schools as important. Help-seeking initiatives need to be balanced against adolescents’ need for autonomy when planning mental health prevention and intervention.

Background: Child and young adult refugees are a heterogeneous group comprising both vulnerable and resilient individuals. Person-centered statistical methods could help disentangle this heterogeneity, enabling tailored interventions. This systematic review examined person-centered studies on adversity, mental health, and resilience in children and young adults with refugee backgrounds to identify subgroups and assess their theoretical and practical relevance. Methods: The strategy included three search blocks: 1) refugee, 2) child and/or youth, and 3) person-centered method. Studies were identified through searches of PubMed, Academic Search Complete, Scopus, PsycINFO, CINAHL, ERIC, and Cochrane. The search included all published studies until December 2023. Studies were eligible for review if they used adversity, mental health or resilience variables as indicators in a person-centered analysis. The study population needed to have a refugee background with a mean age of <= 25. The reporting quality of the studies was assessed using the adapted version of the Guidelines for Reporting on Latent Trajectory Studies (GRoLTS) checklist. The results were analyzed in a narrative format and using summary tables. Results: A total of 6706 studies were initially identified, of which seven were eligible for review. The studies included 2409 individuals and were conducted in refugee camps, communities, and institutional and clinical settings across Africa, the Middle East, Europe, Asia, and North America. Five of the seven studies included adversity as an indicator, and three articles mental ill-health. Only one article specifically investigated resilience. All studies identified subgroups, but the findings regarding predictors of group membership were inconclusive. Risks for adverse outcomes, such as mental health problems, also varied across subgroups. The studies generally displayed inadequate reporting of important methodological aspects of the data analysis, a lack of theoretical consideration, and an absence of reliability testing. Conclusions: The use of person-centered approaches in research on children and young adults with refugee backgrounds, focusing on adversity, mental health, and resilience, is currently limited. Nevertheless, the reviewed studies provided valuable insights into subgroups within this population, indicating that personcentered approaches can be employed when studying this group. Future research should consider theory and prior knowledge in the selection of the final number of groups, thoroughly report quality criteria, and rigorously test the reliability of classes.

Swedish society has systematically worked to improve children's health and well-being since the early twentieth century and is considered a leading figure globally in battling violence against children. Awareness of violence against children and its detrimental effects on development and health is generally high in Sweden. Violence is also broadly recognised as a violation of human rights. A ban on corporal punishment was enacted in 1948 in social childcare institutions, in 1958 in schools, and in 1979 at home. The more recent landmark was the United Nations Convention on the Rights of the Child, established as law on 1 January 2020. In line with convention's Article 12, stating that a child has the right to express their views in all matters affecting them, more attention to child participation has been paid since 2020. This chapter provides several recent examples of strategic measures that have been used to enhance child participation in governmental assignments and enquiries and state-funded research. We discuss the examples considering the United Nations convention and child participation methods and pinpoint opportunities and obstacles to further develop and consolidate child participation as a norm in publicly funded societal activities.