Background: There are concerns about negative effects of relocations between asylum-seeker centres on the mental health of asylum-seeking children. However, empirical evidence comes from cross-sectional studies only. In this longitudinal medical record study, we aimed to assess: (i) whether relocations during the asylum process are associated with the incidence of newly recorded mental distress in asylum-seeking children; and (ii) whether this association is stronger among vulnerable children. Methods: Data were extracted from the electronic medical records database of the Community Health Services for Asylum Seekers in The Netherlands (study period: 1 January 2000-31 December 2008). Included were 8047 children aged 4 to 17 years. Case attribution was done using International Classification of Primary Care codes for mental, behavioural or psychosocial problems. The association between annual relocation rate and incidence of mental distress was measured using relative risks (RR) estimated with multivariate Cox regression models. Results: A high annual relocation rate (>1 relocation/year) was associated with increased incidence of mental distress [RR=2.70; 95% confidence interval (CI) 2.30-3.17]. The relative risk associated with a high annual relocation rate was larger in children who had experienced violence (RR=3.87; 95% CI 2.79-5.37) and in children whose mothers had been diagnosed with post-traumatic stress disorder or depression (RR=3.40; 95% CI 2.50-4.63). Conclusions: The risk of mental distress was greater in asylum-seeking children who had undergone a high annual relocation rate. This risk increase was stronger in vulnerable children. These findings contribute to the appeal for policies that minimize the relocation of asylum seekers.© The Author 2013; all rights reserved.

Longitudinal studies Asylum seekers Children Relocations Refugees Mental distress

Community Mental Health Centers mental distress Netherlands numerical model longitudinal study proportional hazards model refugee Proportional Hazards Models community care patient transport mental health human epidemiology Refugees Longitudinal Studies violence statistics and numerical data priority journal psychosocial disorder length of stay relocation ethnology Mental Disorders Cross-Sectional Studies mental disease school child cross-sectional study psychology Humans Adolescent Medical Records male community mental health center preschool child female Infant risk factor Child, Preschool Multivariate Analysis medical record questionnaire child health vulnerability Incidence Article help seeking behavior Questionnaires major clinical study posttraumatic stress disorder distress syndrome Stress Disorders, Post-Traumatic utilization assessment method asylum seeking children mental health center Child