"Little By Little, I Go": Understanding Mental Health, Resilience, and Integration for Unaccompanied Children in the United States

Background and Purpose: Unaccompanied immigrant children (UC) are a vulnerable group of immigrants who have migrated to the US in increasing numbers over the past decade, mostly from Central America. Research indicates UC experience trauma before, during, and after their migration to the US, and mental health symptoms may not align with existing assessment tools. A gap in research is limited understanding of how UC describe mental health challenges and the extent to which symptoms of mental distress align or conflict with US-based diagnostic methods. This qualitative study is guided by social ecological theory and explores the following research questions: (1) How do UC describe mental health challenges?, and (2) How do UC describe the supports they receive in resettlement communities?

Methods: This study is based on a research partnership with a non-profit organization in Providence, Rhode Island that provides social services for immigrants. Study participants (n=11) were recruited in Fall 2021. Data was collected using semi-structured in-depth interviews that lasted between 30 and 60 minutes. All interviews were conducted in Spanish, and all but one interview was audio recorded, transcribed, and translated. Thematic analysis guided the first and second cycles of coding, which included descriptive, in vivo, and initial coding. The second cycle of coding focused on code mapping to organize the data and construct themes based on the first cycle of coding.

Results: All participants migrated from Guatemala. Eight participants identified as female and three identified as male. The mean age of participants was 16.7 years old (SD=2.8). Results reveal that relationships explain mental distress and resilience experienced by UC. First, relationships are central to the trauma UC experience as they migrate to the US. Family separation is a stressor experienced by all participants, yet this separation manifests in different ways. One participant explained: “Sometimes I start crying and I go, ‘Why did I come here? I was better off in Guatemala with my parents, happy’”. Participants also reported symptoms that align with depression: “When I get sad, I start crying, that's right—that’s how I let it out a little bit—the little bit of sadness I have.” Second, while the agency provides tangible supports including food and clothing, participants described the relationships with staff members and case managers as stabilizing forces that helped UC manage mental distress and adjust to resettlement communities. One participant explained when describing the agency: “I do like it a lot, because there are times when I really need to have a conversation with someone. And they ask me, ‘How are you?’”

Conclusions and Implications: The results of this study reveal that severed relationships in the context of family separation explain the mental distress UC experience in the US. Furthermore, relationships form the foundation for healing as UC navigate challenges associated with integration. An important area of future research is understanding the relationship between mental health symptoms and integration in resettlement communities. The results of the study can guide the development of culturally-informed mental health measures, as well as inform existing assessment frameworks.