Risk and Protective Factors of Mental Health Outcomes Among Refugee Youths Who Resettled to the United States: A Scoping Review

Background: Accumulating evidence indicates a high prevalence of psychological distress in refugee youths who resettled to the United States. Although the current literature has documented the risk and protective factors of mental health outcomes among youths in the United States, it is not clear how this body of literature can be applied to refugee youths. The populations of resettled refugee youth, subjected to various stressors—including forced migration, separation from parents or caregivers, wars, and other traumatic events—encounter substantially different experiences compared to their US-born counterparts. In order to inform preventive and intervention efforts toward improved well-being, we assess the current evidence regarding risk and protective influences on refugee youths’ mental health.

Methods: A scoping review (Arksey & O’Malley, 2005) was conducted to investigate the risk and protective factors of mental health outcomes among refugee youths. Inclusion criteria required a study to (a) include primary or secondary data analysis conducted with refugee youths aged under 25 years when they resettled to the United States, (b) be published between 2000-2018 in a peer-reviewed journal in the English language, (c) be included in the following datasets: PsycINFO, CINAHL, Academic Search Complete, Sociological Abstract, or Social Work Abstract, and (d) provide evidence of risk or protective association with internalizing or externalizing mental health outcomes (e.g., PTSD, depression, anxiety, psychological distress, emotional wellbeing). All the three authors screened the studies and reached the consensus on included articles through an iterative process. Information of study objectives, sample, research design, and findings on risk and protective factors of mental health outcomes were extracted and summarized.

Results: The search yield 1,453 citations from which 85 full-texted articles were retrieved and reviewed. In total, 28 studies were included in the current review. The included studies are heterogeneous in the research designs with the majority using a quantitative analytic approach. The mental health outcomes investigated in the included studies included Posttraumatic Stress Disorder (PTSD), depression, anxiety, internalizing and externalizing behaviors, sense of belonging, sense of loneliness, self-esteem, and psychological adjustment. The risk factors identified included the number of traumatic events, history of trauma and personal injury, backlash against immigrants, and perceived discrimination. Protective factors included emotional intelligence, financial stability, English proficiency, social support network, family cohesion and bonding, cultural adherence and guidance, and faith and religious involvement. In addition, some evidence showed that psychological distress was manifested differently for boys and girls.

Conclusions: The current review adds a unique contribution by summarizing research of risk and protective factors for mental health outcomes in an understudied population—refugee youths who resettled to the United States. Findings highlight the unique contexts shaping refugee youths’ well-being and the urgency of addressing mental health issues among resettled youths. In light of the resilience framework, the findings expand the understanding of factors that elevate risk of adverse mental health outcomes and inform the social work practice in promoting positive mental health and well-being. Implications for practice and future research are discussed.