BackgroundRefugee minors are considered particularly vulnerable to negative health consequences from war, flight and resettlement. Offering health assessments after arrival in a host country could uncover unmet health needs and provide access to treatment. In Norway, a national guide describes these assessments, but little is known about its implementation especially for refugee minors. Thus, the aim of this study was first to explore how health assessments of refugee minors are carried out, second how health professionals perceive the needs of refugee minors and third, the competencies they perceive as necessary to meet the needs of refugee minors.MethodA modified Delphi study in three rounds was conducted using online surveys and one focus group to collect data on the needs and resources of refugee minors, essential factors for a good and health assessment practice. Participants were 54 health professionals responsible for early health assessments of refugee minors, throughout the Norwegian municipalities, working in primary care settings. Quantitative data was analysed descriptively, and qualitative data with content analysis.ResultsHealth assessments of refugee minors were predominantly conducted by public health nurses, but the organisational structures surrounding assessments varied greatly according to the size of the municipalities and to how much resources were allocated. The feeling of safety was found to be paramount to ensure a good start in a new country for refugee minors. The top four competences professionals should have, were 'general communication skills', a 'health professional background', 'expertise in children's health' and 'knowledge about the national guide'. To ensure good health services for refugee minors, improved, more comprehensive, and mandatory directives for children and young individuals was highlighted.ConclusionAlthough most refugee minors were invited and attend health assessments, one third of participating municipalities did not offer health assessments to all newcomers and the organisation and content of the assessments were diverse. Several topics, especially mental health, were postponed or not routinely addressed, contrasting with current knowledge of unmet health needs for this group. Missing documentation, practical barriers and providing general health information took time away from doing the actual assessments. The perceived needs of refugee minors were safety and stability, combined with meaningful activities, thus a coordinated effort from several services is necessary. Suggestions for improvements were more time given to assessments, better organisation and co-operation, improved competence and guidelines adjusted for age.

BackgroundSexual harassment is common in most countries and cultures. Less is known about sexual harassment, its risk factors, and psychosocial outcomes among young adolescents. The aim of the study was to examine the 12-month prevalence of sexual harassment exposure, and sociodemographic and psychosocial factors associated with exposure among junior high school students in Norway.MethodsA comprehensive cross-sectional study was completed by 83,297 Norwegian adolescents in junior high school in 2021. Data on exposure to sexual harassment were used in combination with sociodemographic measures and psychosocial outcomes: depressive symptoms, loneliness, self-esteem, and well-being. Group differences were analyzed with Chi Square tests, and sociodemographic risk factors were analyzed with logistic regression. Psychosocial outcomes were assessed with multivariate and univariate ANOVAs, and dose–response relationships were assessed with linear regression.ResultsAmong the adolescents, 32.6% had experienced sexual harassment during the past year. Girls had higher odds of exposure (OR: 1.90, 95% CI: 1.84–1.96), whereas adolescents whose parents had higher education had lower odds (OR: 0.95, 95% CI: 0.90–0.99). Exposure was associated with higher levels of depressive symptoms (partial η2 [ES] = 0.11) and loneliness (ES = 0.07), and with lower self-esteem (ES = 0.06) and well-being (ES = 0.06). Among exposed adolescents, more frequent exposure was associated with poorer outcomes.ConclusionExposure to sexual harassment affects one third of junior high school students in Norway. Those who are exposed have poorer psychosocial outcomes, and there is a dose–response relationship between exposure and outcomes. Awareness of sexual harassment among young adolescents, and interventions to prevent and reduce it, are needed.

Objective: To explore emerging adults’ descriptions of important resilience factors when growing up with ADHD. Method: Individual interviews with 10 emerging adults (21–24 years) who participated in a 10-year follow-up study, analyzed using thematic analysis. Results: The main theme was that “life gets better.” Resilience factors contributing to this positive development were strategies to regulate ADHD, valuable relationships, acceptance, seeing positive attributes of ADHD, receiving tailored, non-stigmatizing support, and participating in meaningful activities. Conclusion: Growing up with ADHD was associated with both challenges and positives, but the main resilience theme was that life gets better. A variety of resilience factors contributed to this, but relational and environmental factors seemed particularly important. Acceptance, both from society and self-acceptance, were related to all resilience factors in various ways indicating that better knowledge of ADHD might foster better understanding and acceptance of children and adolescents with ADHD.

Abstract Background The recent invasion of Ukraine has forced millions of civilians, especially women and children, to leave their country. Although the European Union offers guidance on individual health assessment of refugees fleeing the war in Ukraine, assessment practice varies across host countries and even on national basis. Thus, the aim of this project was to identify and prioritize procedures for mental health assessment of Ukrainian refugee minors in Norway. Methods This project applied a modified three-round-Delphi method. In a first step, the leading public health nurse and community physician in 40 municipalities across Norway were contacted via e-mail and asked to state who is in charge of health assessment, what is current assessing practice and what are the problems and needs. Answers were analysed and condensed and will be presented for rating in a second and third round. Results Preliminary results from the first round suggest that most municipalities are currently in a planning phase with uncertainties surrounding who and how future assessments will be done. Public health nurses or general practitioners are often in charge of health assessments, but it is unclear if this includes age-adjusted mental health assessments. Conclusions Preliminary results show that current practice in assessing mental health and psychosocial support for Ukranian refugee minors in Norway is very diverse. There is a need to evaluate and prioritize current procedures to assure an equal and age-adjusted procedures for all refugee minors, regardless of where they have resettled. Key messages

Almost half of the world's forcibly displaced population are children, most commonly originating from Syria, Iraq, and Afghanistan. Health disparities are well documented, especially for mental health, but not consistent across groups, time or context. Despite high exposure to trauma and stress, refugee children also show remarkable resilience. An ecological model of refugee health including both risk and resilience factors is therefore recommended. The model also includes the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the disruptions of basic systems affecting both the individual and families as a whole, offering a framework to better understand the health disparities and appropriate interventions for refugee children.

Abstract Background The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms on both negative and positive mental health outcomes. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect. Methods Cross-sectional study with 160 Syrian youth aged 13-24 years, who recently resettled in Norway. A multi-dimensional measure for resilience was used to explore the potential impact of resilience factors on pathways between potentially traumatic events from war and flight (PTE), post-migration stress, mental distress and health-related quality of life (HRQoL). Analyses included regression, moderation and moderated mediation using the PROCESS macro for SPSS. Results A direct main effect of resilience factors (promotive resilience mechanism) was found for HRQoL and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of resilience factors (protective resilience mechanism) were found. Post-migration stressors mediated the effects of PTE, and this indirect effect was present at all levels of resilience. Relational and environmental level resilience factors and combined amounts had more impact than individual level factors. Conclusions Despite high risk exposure and mental distress, resilience was also high. The direct main effect of resilience factors and less impact on PTSD, suggests universal resilience building interventions may be beneficial, compared to exclusively targeting groups with high symptom levels. These interventions should target relational and environmental resilience factors as well as individual coping techniques. Additionally, reducing current stress and symptoms could increase the efficacy of resilience factors already present. Key messages • Refugee youth may have both high levels of risk and high resilience. • Universal resilience interventions should focus on relational and environmental support, as well as individual resilience.

PURPOSE:The aim of this study is to explore how potentially traumatic events (PTEs) from war and flight influence health-related quality of life (HRQoL) in young refugees after recent resettlement. In a model based on earlier theory, we tested if post-migration stressors and mental distress mediated the effect of PTEs on HRQoL, individually and in serial. We also explored how different types of post-migration stressors influenced different dimensions of HRQoL.METHODS:This study used a cross-sectional design where 160 Syrian youth recently resettled in Norway completed questionnaires at school between May and December 2018. Correlations between types of post-migration stressors and dimensions of HRQoL were explored and a serial multiple mediator model was tested. Models were adjusted for age and gender, using two types of mental distress; post-traumatic stress disorder (PTSD) and general mental distress.RESULTS:Higher levels of PTEs reduced experienced HRQoL, but this direct effect was mediated by post-migration stressors alone and in serial with mental distress. Despite high levels of mental distress, this did not affect HRQoL independently, only in serial mediation with increased post-migration stressors. Economic concerns and discrimination were types of post-migration stressors affecting several dimensions of HRQoL.CONCLUSION:Quality of life in refugee is affected by past events from war, stressors in current resettlement and elevated mental distress through complex interrelations. The study reiterates the importance of considering structural and everyday post-migration stressors in policy and intervention to improve the health and wellbeing of refugee youth.

Background: The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms to inform future interventions and policy. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect. Methods: This was a cross-sectional study of Syrian youth recently resettled in Norway, aged 13-24 years. Regression and moderation analyses were used to explore different interactions, including moderated mediation using the PROCESS macro for SPSS. Result: A direct main effect of promotive resilience was found for health-related quality of life (HRQoL) and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of protective resilience were found. Post-migration stressors mediated the effects of potentially traumatic events (PTE) from war and flight, and this indirect effect was present at all levels of resilience. Conclusion: Despite high risk exposure and mental distress, resilience was also high. Broad resilience interventions targeting multiple factors would likely benefit the group, but these should include both individual assets and building supportive environments. Additionally, reducing current stress and providing treatment for those in need could enable recovery and increase the efficacy of resilience factors already present.

Aims: Millions have fled from the civil unrest in Syria, and half of these are children and youth. Although they are a population with an elevated risk of health problems due to adverse pre-migratory and post-migratory experiences, few studies have explored their health-related quality of life (HRQoL). This is considered a fundamental construct in public health and might provide complementary descriptions of their health and well-being after resettling in a new country. Methods: This was a cross-sectional study of 160 Syrian youth aged 13–24 years. Using KIDSCREEN-27, the results for five dimensions of HRQoL was compared to population norm data. Demographic factors and war-related adverse events were used to predict HRQoL in hierarchical regression. Results: For most participants, the overall HRQoL was good, but it was lower in the dimensions for friends, physical well-being and psychological well-being compared to population norms. Scores in the dimensions for autonomy/parental relation and the school environment were high and were the main contributors to a positive HRQoL. Age and number of reported stressful events (SE) had the greatest impact on HRQoL, but the final regression model only accounted for 21% of the total variance. Conclusions: HRQoL is a relevant and non-invasive measure for refugee youth. Contributors to lower scores in physical and psychological well-being should be explored further and indicate the potential for future interventions focussing on general psychological well-being and networks, regardless of the SE that have been experienced. These interventions could potentially be based in schools or in families in order to benefit from these being seemingly safe environments for the majority of the group.

Abstract Aim Millions have fled from the Civil unrest in Syria and half of these are children and youth. Although they are a population with elevated risk for health problems due to adverse pre-migratory and post-migratory experiences, few studies have explored their Health-Related Quality of Life (HRQoL). This is considered a fundamental construct in public health and might provide complementary descriptions of their health and wellbeing after resettling in a new country. Methods A cross-sectional survey of 160 Syrian youth aged 13-24 years recently resettled in Norway, was carried out in 23 schools. Using KIDSCREEN-27, results from five dimensions of HRQoL (physical and psychological wellbeing, parental relations, school environment and friends) was compared to norm populations and analysed with associated sociodemographic factors and war related adverse events. Results Preliminary results indicate that for most participants the overall HRQoL was good, but lower in the dimensions for physical and psychological wellbeing and friends than in norm populations. Satisfaction with parental relations and the school environment was high and the main contributors to a positive HRQoL in the participants. Age and number of reported Stressful Events had the greatest impact of all the the included variables, but all correlations were small to moderate and therefore accounted for little of the total variance. Conclusions The findings suggest that HRQoL is a relevant and non-invasive measure for refugee youth. Interventions focussing on general psychological wellbeing and networks could be beneficial for the group, and need to be explored. These interventions could potentially be based in schools or in family work, to benefit from these being seemingly safe environments for the majority of the group. Key messages Health Related Quality of life in young Syrian refugees was good, but lower in the dimensions for friends and psychological wellbeing than for norm populations. Satisfaction with parental relations and school environment was high among the Syrian youth and the main areas that contribute to a positive Health Related Quality of Life.