Explaining healthcare among unaccompanied minor refugees: a realist review

Abstract Introduction Existing research on psychosocial care of unaccompanied minor refugees (UMRs) mainly focusses on socio-epidemiological accounts and qualitative evidence from the perspective of experts in the field of psychosocial care. In contrast, knowledge concerning differing context factors as well as underlying mechanisms of current healthcare barriers, which could inform policy recommendations, are rather scant. Methods To synthesize scientific evidence and gray literature dealing with the field of psychosocial healthcare of UMRs, a realist review (RR) was conducted following six methodological steps of RAMESES publication standards for realist synthesis. Based on a iterative search of keywords “UMR”, “UMF”, “UMA” and “mental health care” in electronic databases PubMed, GBV and Web of Science we gained access to 974 texts from 2005 to 2019. Screend studies and reports were systematically reviewed according rigor and relevance, which included n = 53 documents for realist synthesis with theory-informed context-mechanism-outcome configurations (CMOs). Results UMRs have a high prevalence risk for posttraumatic stress disorders and they face manifold institutional, cultural, ethical, juridical, and language-based barriers of care. A dominant and multiple CMO highlight residence status (C1), which limits access of UMRs to healthcare (M1) and produces psychosocially related mental health outcomes (O1). Residence status (C1) may also trigger mechanisms of structural or at least perceived discrimination (M2), which mediates undersupply of UMRs (O2). Conclusions The inclusion of lay perspectives and an intersectional approach could inform health services research and practitioners. The reflection of UMR’s social positions between categorical constructs of resilience and vulnerability, discriminatory discourses of othering, and restrictive health policies may guide policy recommendations to potentially reduce persistent disadvantages. Key messages The inclusion of lay perspectives and an intersectional approach could inform UMR related health services research and practitioners. The reflection of UMR’s social positions (between categories, discourses, and health policies) may guide policy recommendations to potentially reduce persistent disadvantages.