Mental Health of Unaccompanied Children in the United States: Using the Strengths and Difficulties Questionnaire to Assess Behavioral Health

Background and Purpose: Each year, thousands of unaccompanied children (UC) migrate to the United States (US). Most UC in recent years have migrated from Guatemala, Honduras, and El Salvador. Research indicates that UC experience significant mental health challenges, although much of this research is in the context of Europe. This cross-sectional study examines mental health using the Strengths and Difficulties Questionnaire (SDQ). The SDQ consists of 25 items, measures behavioral health, and has been used in research with UC. This study is guided by social ecological theory and addresses the following research questions: (1) To what extent is country of origin associated with mental distress for UC who are resettled in the US? (2) To what extent is sponsor type associated with mental distress for UC who are resettled in the US?

Methods: The study includes a preliminary sample of n=70 UC who were receiving post-release services (PRS) in the US in 2021. PRS are case management services that help connect UC with health, education, and legal supports. The dependent variable in the study was mental distress, which was measured using the Strengths and Difficulties Questionnaire (SDQ) and calculating the clinical cut point (1=Elevated mental distress; 0=Not elevated). PRS case workers completed the SDQ with UC at the start of PRS. Independent variables include age (years), sex (0=female; 1=male), country of origin (El Salvador, Guatemala, and Honduras), and sponsor type (mother, father, and uncle). A binomial logit model was used to examine the association between mental distress and demographic variables.

Results: Of the 70 UC, 37 migrated from Honduras (52.8%), 23 UC migrated from Guatemala (32.9%), and 10 UC migrated from El Salvador (14.3%). Of the sample of UC, 31 (44.3%) are female and 39 (55.7%) are male, and the mean age is 14.8 years (SD=2.7). Most UC in the sample were placed with their mother (26.3%), followed by uncle (14.5%), and father (6.6%). Results from a binomial logit regression model indicate UC from Honduras, compared to UC from other countries, have 95% lower odds of having an SDQ score above the clinical cut point (p<.05). Results also indicate UC from Guatemala, compared to UC from other countries, have 93% lower odds of having an SDQ score above the clinical cut point (p<.05).

Conclusions and Implications: This study is among the first known empirical examinations of mental health of UC in the US using a standardized mental health measure. Results reveal that nearly 10% of the sample (9.5%) exhibited elevated SDQ scores at the beginning of receiving PRS in the US. Furthermore, results indicate UC from Guatemala and Honduras have significantly lower odds of experiencing mental distress at the beginning of PRS, suggesting cultural variations in experiences of mental health. An important area for future research is examining longitudinal trends in mental health as UC continue receiving PRS. Finally, the results of the study inform the use of standardized mental health measures as part of the assessment framework that clinicians use when working with UC in the US.