Unaccompanied refugee minors (URMs) seeking asylum show high rates of posttraumatic stress disorder (PTSD), depression and anxiety. In addition, they experience post-migration stressors like an uncertain residence status. Therefore, psychotherapeutic interventions for URMs are urgently needed but have scarcely been investigated up to now. This study aimed to examine manualized individual trauma-focused cognitive behavioural therapy (TF-CBT) for URMs with PTSD involving their professional caregivers (i.e. social workers in child and adolescent welfare facilities). We conducted an uncontrolled pilot study with three follow-up assessments (post-intervention, 6 weeks, and 6 months). Participants who met the PTSD diagnostic criteria were treated in a university psychotherapeutic outpatient clinic in Germany with a mean of 15 sessions of TF-CBT. All participants (n = 26) were male UM (Mage = 17.1, SD = 1.0), predominately from Afghanistan (n = 19, 73.1%) and did not have a residence permit. The sample was severely traumatized according to the number of traumatic event types reported (M = 11.3, SD = 2.8). The primary outcome was PTSD measured with the Child and Adolescent Trauma Screen (CATS) and the Diagnostic Interview for Mental Disorders in Childhood and Adolescence (Kinder-DIPS). Secondary outcomes were depression, behavioural and somatic symptoms. All but the somatic symptoms were assessed in both self-report and proxy report. At post-intervention the completer sample (n = 19) showed significantly decreased PTSD symptoms, F(1, 18) = 11.41, p = .003, with a large effect size (d = 1.08). Improvements remained stable after 6 weeks and 6 months. In addition to PTSD symptoms, their caregivers reported significantly decreased depressive and behavioural symptoms in participants. According to the clinical interview, 84% of PTSD cases recovered after TF-CBT treatment. After 6 months, youths whose asylum request had been rejected showed increased PTSD symptoms according to individual trajectories in the Kinder-DIPS. The effect was, however, non-significant. Intervention studies are feasible with URMs. This pilot study presents preliminary evidence for the efficacy of an evidence-based intervention like TF-CBT in reducing PTSD symptoms in URMs. Stressors related to asylum proceedings after the end of therapy have the potential to negatively influence psychotherapy outcomes.

中文翻译：

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为居住状况不确定的无人陪伴的未成年难民提供手动化的以创伤为重点的 CBT：一项试点研究

寻求庇护的无人陪伴的未成年难民 (URM) 患有创伤后应激障碍 (PTSD)、抑郁和焦虑的比例很高。此外，他们还面临着移民后的压力，例如不确定的居住身份。因此，迫切需要对 URM 进行心理治疗干预，但迄今为止几乎没有进行过研究。本研究旨在检验针对患有 PTSD 的 URM 的手动个体创伤聚焦认知行为疗法 (TF-CBT)，涉及其专业护理人员（即儿童和青少年福利机构的社会工作者）。我们进行了一项非对照试点研究，并进行了三次后续评估（干预后、6 周和 6 个月）。符合 PTSD 诊断标准的参与者在德国的一所大学心理治疗门诊接受平均 15 次 TF-CBT 治疗。所有参与者（n = 26）均为男性 UM（Mage = 17.1，SD = 1.0），主要来自阿富汗（n = 19，73.1%），没有居留证。根据报告的创伤事件类型数量，样本受到严重创伤（M = 11.3，SD = 2.8）。主要结局是通过儿童和青少年创伤筛查 (CATS) 以及儿童和青少年精神障碍诊断访谈 (Kinder-DIPS) 测量的 PTSD。次要结果是抑郁、行为和躯体症状。除躯体症状外，所有症状均在自我报告和代理报告中进行评估。干预后，完成者样本 (n = 19) 显示 PTSD 症状显着减少，F(1, 18) = 11.41，p = .003，效应量较大 (d = 1.08)。6 周和 6 个月后，改善保持稳定。除了创伤后应激障碍（PTSD）症状外，他们的照顾者还报告说，参与者的抑郁和行为症状显着减少。根据临床访谈，84%的PTSD病例在TF-CBT治疗后康复。6 个月后，根据 Kinder-DIPS 中的个人轨迹，庇护申请被拒绝的青少年表现出 PTSD 症状加重。然而，效果并不显着。URM 的干预研究是可行的。这项试点研究提供了初步证据，证明 TF-CBT 等循证干预措施在减少 URM 中 PTSD 症状方面的有效性。治疗结束后与庇护程序相关的压力源可能会对心理治疗结果产生负面影响。