Systematic Review: Child and Adolescent Refugees and Asylum-Seekers' Contact With Specialist Mental Health Services

To investigate the utilization of specialist child and adolescent mental health services (CAMHS) among refugee and asylum-seeking children (<18 years old) globally compared with nonrefugee peers, specifically looking at differences in diagnostic and therapeutic profiles, service use referral pathways and barriers to access, and hospitalization.

A systematic search of MEDLINE, Embase, PsycINFO, and CINAHL was conducted from inception until August 8, 2025. Observational studies with quantitative outcomes comparing CAMHS use between refugee/asylum-seeking and nonrefugee/non-asylum-seeking children were included. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale, and data were presented in a narrative synthesis due to heterogeneity.

This review included 25 studies, mainly from high-income settings and of high quality. Refugee/asylum-seeking youth exhibited higher rates of posttraumatic stress disorder, anxiety, and depression, but lower outpatient CAMHS utilization, compared with nonrefugee/non-asylum-seeking peers. Refugees/asylum-seekers received fewer guideline-concordant treatments, particularly for attention-deficit/hyperactivity disorder and mood disorders. Compared with nonrefugees, refugees were more likely to be referred by nonmedical agencies. Barriers included language, stigma, fragmented primary care registration, and crisis-driven entry into services through emergency departments or social services rather than primary care. Findings on inpatient admissions yielded a mixed picture, with unaccompanied minors overrepresented in involuntary care.

Results imply inequity in CAMHS contact among refugee youth, in the context of high need and despite lack of economic barriers. More timely and culturally sensitive access is needed, as well as effective training for nonmedical agencies and responsive public policies that reduce structural barriers to psychiatric care and address the complex circumstances and needs of displaced youth.

Systematic Review: Child and Adolescent Refugees and Asylum-Seekers' Contact With Specialist Mental Health Services; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022310239.