A multilevel bioecological analysis of factors influencing the mental health and psychosocial wellbeing of refugee children

Abstract

Background: This paper revisits the themes of an influential 1993 review regarding the factors shaping the mental health and psychosocial well-being of refugee children to take stock of developments in the evidence base and conceptualisation of issues over the last 25 years.

Methods: The study deployed a systematic search strategy. This initially identified 784 papers, which was reduced to 65 studies following application of inclusion and exclusion criteria. We used a later iteration of Bronfenbrenner’s bioecological model of human development – the PPCT model - to consolidate evidence.

Results: We identify a range of risk and protective factors operating at individual, familial, community and institutional and policy levels that influence outcomes for refuge children. The dynamics shaping the interaction of these influences are linked to the life course principles of socio-historical time and developmental age, proximal processes, and child agency.

Conclusions: Actions at individual, familial, community, school, institutional and policy levels all have potential traction on mental health and psychosocial well-being of refuge children. However, evidence suggests that greatest impact will be secured by multilevel interventions addressing synergies between ecological systems, approaches engaging proximal processes (including parenting programmes) and interventions facilitating the agency of the developing refugee child.