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“You cannot just stop life for just that”: a qualitative study on children’s experiences on refugee journey to Sweden
Linköping University, Department of Biomedical and Clinical Sciences, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Save the Children, Stockholm, Sweden.ORCID iD: 0000-0002-0796-3921
Linköping University, Department of Biomedical and Clinical Sciences, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0002-1768-415x
Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Department of Child and Adolescent Psychiatry in Linköping. Linköping University, Department of Biomedical and Clinical Sciences, Barnafrid.ORCID iD: 0000-0002-1837-5930
2024 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Children with refugee backgrounds are often exposed to violence and other adverse experiences with well-known detrimental consequences on mental health. However, the current group of approximately 40 million child refugees is heterogeneous, stressing the importance of first-person perspectives in understanding children's unique experiences and needs related to the migration process. Identifying contextual factors promoting health and resilience is also essential. For instance, the roles children play as active agents in constructing their own lives and adapting to different environments are poorly described in contemporary research on child refugees and their mental health. To address these knowledge gaps, we conducted qualitative interviews with a reflexive thematic analysis with eighteen children with refugee backgrounds in Sweden. This resulted in two main themes: Longing for a good life that cannot be taken for granted and Challenged agency and changing rights. The narratives indicate that children, although exposed to different challenges in different migration phases and based on gender and asylum status, have experiences of ordinary childhood with a desire for a good life with prospects. The results also show that children execute active and adaptable agency that is impacted by various factors. Reaching the full age appears to be a confusing and ambivalent transition due to changes in rights. The results pinpoint several possibilities to address factors that pose a risk to health and restrictions of rights among child refugees.

Place, publisher, year, edition, pages
SPRINGER , 2024.
Keywords [en]
Refugee; Adversity; Resilience; Agency; Human rights; Thematic analysis
National Category
Social Work
Identifiers
URN: urn:nbn:se:liu:diva-200906DOI: 10.1007/s00787-024-02387-wISI: 001162118900001PubMedID: 38360923OAI: oai:DiVA.org:liu-200906DiVA, id: diva2:1838632
Funder
Linköpings universitet
Note

Funding: Linkoping University; Swedish Research Council for Health, Working Life and Welfare (FORTE) [Dnr 2019-12-01, Dnr 2022-01059]; Cocozza Foundation [Dnr LIU-2022-02135]

Available from: 2024-02-17 Created: 2024-02-17 Last updated: 2024-03-01
In thesis
1. Resilience, mental health, and exposure to violence among individuals with former or current experiences of being a refugee in Sweden: quantitative and qualitative studies
Open this publication in new window or tab >>Resilience, mental health, and exposure to violence among individuals with former or current experiences of being a refugee in Sweden: quantitative and qualitative studies
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Studies indicate that individuals with current or former experiences of being a refugee are more likely to have experienced adverse events, like violence, and face mental health challenges in their host countries. After arrival in host countries, people with refugee experiences often confront various post-migration adversities like discrimination. However, research in this area has been hampered by limitations and a lack of child perspective. This thesis aims to examine both pre-, peri- and post-migration factors that impact the health, well-being, and experiences of children and adults who have migrated to Sweden as refugees.

Article I is a systematic review of Nordic studies on resilience, risk and protective factors for health in refugee children. We found that adversity was consistently identified as a risk factor for poorer health, but otherwise, findings were inconsistent. No study explicitly examined resilience. Article II examined the relationship between refugee experiences in childhood and health in adulthood in a nationally representative sample. The study found no clear link between childhood refugee experiences and worse health in adulthood. Article III investigated differences in health and health-related behaviours between sexual and gender minority refugees, migrants, and Swedish/Western-born individuals and their heterosexual peers. We found higher rates of mental and general ill-health and worse health-related behaviours in sexualand gender-minority individuals regardless of whether they were refugees, migrants, or Swedish and Western-born. Surprisingly, our study revealed no indications of inferior health outcomes among refugee or migrant sexual and gender minorities in comparison to Swedish/Western-born individuals. Article IV investigated mental health and functioning of refugee children and young adults in Sweden. We found lower rates of mental ill-health than previously reported in other studies on refugee children and young adults. Unaccompanied refugee children had worse outcomes than those accompanied. Article V explored the experiences of refugee children and their agency in constructing their own lives during migration. We found that child refugees express a longing for a good life and demonstrate active agency despite facing diverse challenges.

Overall, the prevalence rates for mental ill-health were lower than in many previously published studies even though the prevalence rates are higher than in many studies published on the general population of children in Sweden. Further, the results suggest that these effects are transient. The studies highlight the need to focus on the heterogeneity of the population, for example, by addressing factors that pose a risk to health and rights in refugee children and adults. Moreover, the research emphasizes the importance of adopting a perspective that simultaneously acknowledges both the strengths and vulnerabilities of refugee children. Additionally, this perspective should recognize individual differences, rights, and goals.

Abstract [sv]

Tidigare forskning har visat att personer med nuvarande eller tidigare erfarenheter av flykt löper större risk att erfara negativa händelser och att drabbas av psykisk ohälsa. Efter flykten kan även motgångarna fortsätta i det nya landet exempelvis i form av diskriminering. Forskningen inom detta område har dock begränsats av metodologiska brister och en avsaknad av barnperspektiv. Denna avhandling syftar till att belysa både pre- , peri- och postmigratoriska faktorer som påverkar hälsa, välbefinnande och upplevelser hos barn och vuxna som har flytt till Sverige.

Artikel I är en systematisk översikt av studier om resiliens och riskoch skyddsfaktorer för fysisk och psykisk hälsa hos barn på flykt i de nordiska länderna. Vi fann att olika typer av negativa livshändelser genomgående identifierades som en riskfaktor för försämrad hälsa, medan resultaten för andra faktorer var inkonsekventa. Ingen studie undersökte uttryckligen resiliens. I artikel II undersöktes sambandet mellan att ha flytt i barndomen och senare hälsoutfall som vuxen i ett nationellt representativt urval. Studien fann ingen tydlig koppling mellan erfarenhet av flykt i barndomen och negativa hälsoutfall i vuxen ålder när man kontrollerade för störvariabler. Artikel III undersökte hälsa och hälsorelaterade beteenden hos flyktingar och migranter i jämförelse med de som är födda i Sverige eller annat land i väst som identifierar sig som homosexuella, bisexuella, transpersoner, personer med queera uttryck och identiteter. Vi fann högre nivåer av ohälsa och hälsorelaterade beteenden för sexuella och könsminoriteter oavsett om man var flykting, migrant eller född i Sverige eller annat land i väst. Vi fann dock inga bevis för sämre hälsa hos flyktingar- eller migranter jämfört med de födda i Sverige eller annat land i väst. Artikel IV undersökte förekomst av psykisk ohälsa och funktionsförmåga hos barn på flykt och unga vuxna på flykt i Sverige. Vi fann lägre förekomst av psykisk ohälsa än vad som tidigare rapporterats i andra studier av barn och unga vuxna på flykt. Ensamkommande barn hade sämre hälsa än barn som anlänt i familj. Artikel V utforskade barns upplevelse och deras förmåga att forma sina egna liv under flykten. Vi fann att barn som befinner sig på flykt, trots att de står inför olika utmaningar, uttrycker en längtan efter ett gott liv och visar aktiv handlingskraft.

Sammantaget var prevalensen av psykisk ohälsa lägre än vad som observerats i många tidigare publicerade studier, även om den fortfarande var högre än många studier om barn födda i Sverige. Vidare tyder resultaten på att dessa effekter kanske inte är permanenta. Studierna belyser behovet av att uppmärksamma gruppens heterogenitet avseende psykisk ohälsa, exempelvis genom att hantera faktorer som utgör risker för ohälsa och rättigheter hos både barn och vuxna på flykt. Slutligen betonar forskningen vikten av ett nyanserat perspektiv som erkänner både sårbarhet och motståndskraft, och som också respekterar dessa barns rättigheter, kompetenser, mål och styrkor.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2024. p. 77
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1893
Keywords
Refugee, Migrant, Mental health, Adversity, Resilience
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-201262 (URN)10.3384/9789180755078 (DOI)9789180755061 (ISBN)9789180755078 (ISBN)
Public defence
2024-04-12, Belladonna, Building 511, Campus US, Linköping, 13:00
Opponent
Supervisors
Available from: 2024-03-01 Created: 2024-03-01 Last updated: 2024-03-01Bibliographically approved

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Mattelin, EricaSöderlind, NatalieKorhonen, Laura

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