The Clinical-Psychological Diagnostic Process in an Outpatient Health-Care Center for Refugee Children and Adolescents: First Results of Mental Health Problems, Traumatic Events, and Treatment Goals

In the past years, numerous children and adolescents have fled from war zones and areas of conflict to Germany. Such experiences increase the probability of psychological distress enormously. Still, there are only scarce data about the prevalence of mental health problems in refugee children. The Outpatient Health-Care Center for Refugees of the University Medical Center Hamburg-Eppendorf offers psychiatric-psychotherapeutic and psychosociat treatment for refugee children and adolescents. A standardized clinical diagnosis process was developed in order to provide a grounded basis for treatment planning as well as a first overview of prevalence data regarding psychological disorders and accompanying mental health problems in refugee children and adolescents. This standardized clinical diagnostic process includes an anamnesis of the patient's social background as well as a diagnostic interview. The diagnostic interview incorporates parts of a standardized clinical interview (MINI-KID) and established standardized self-reports to asses depression. posttraumatic stress disorder (PTSD), dissociative symptoms, substance consumption, and suicidal behavior. Additionally, traumatic events in their home country, during flight, and in Germany as well as the patient's treatment goals were considered during the diagnostic process. From October 2016 to November 2017, 134 refugee children and adolescents (19.4% female) between the age of 8 and 20 years were diagnosed in the Outpatient Health-Care Center for Refugees in Hamburg. Based on a newly developed questionnaire, it was shown that 93 (90.3%) of the refugee children and adolescents experienced interpersonal violence multiple times in their home country and 88 (84.6%) during their flight. Even in Germany, 18 (19.1%) of the children and adolescents encountered interpersonal violence multiple times. Regarding psychological disorders of the refugee children, 90 (69.8%) were diagnosed with a current PTSD. Furthermore, 67 (50%) of the children were diagnosed with current moderate or severe depression. The most commonly reported treatment goal by patients was more adaptive dealing with negative emotions and thoughts. In sum, a standardized diagnostic process of the Outpatient Center for Refugee children is presented and high prevalence rates of psychological disorders and accompanying mental health problems are revealed. These findings clearly show that patients visiting the Outpatient Health-Care Center for Refugees in Hamburg represent a high-risk group and have, therefore, a great need for psychological treatment. As psychological health is an important factor for successful integration, specialized psychiatric-psychotherapeutic and psychosocial treatment should be made more accessible for refugee children. Moreover, such a treatment is indispensable since, should they return home, the psychological health of the refugees is essential for reconstruction and reconciliation processes in their home countries.