Psychological stress experienced by refugees can manifest in many ways, impacting overall health and creating a demand for more accessible healthcare. The population of young refugees migrating to Sweden is a group that is often overlooked or underrepresented in terms of adequate healthcare. From this population, individuals experiencing Resignation Syndrome are even more vulnerable and require special attention. Hundreds of young migrants are suffering from this condition and there still isn’t an appropriate understanding of how this can be treated effectively.

Resignation Syndrome is a condition that causes a state of reduced consciousness and is brought on by traumatic events. It is experienced by children of asylum seekers and can be attributed to extreme stress in the resettlement process. There are many challenges and factors that this specific population faces which all contribute to this mental and physical state. The children affected by this condition are in unstable situations, experiencing stress awaiting to be granted asylum and prior exposure to violence. Refugee children in Sweden are already more prone to mental illness and the most common being anxiety, depression, OCD, and PTSD (Axelsson, 2020).

Resignation Syndrome can be described as an extension of these illnesses and presents as a progressive development of depression symptoms and eventually leads to a state of complete apathy. Other symptoms include, “severely impaired functional capacity with apathy, lack of contact, lack of reaction to pain stimuli, incontinence, immobility and passive or active food refusal” (Randell, 2021). It is interesting to see how the Swedish healthcare system has dealt with this unique condition and how politics play a role in the improvement of this condition.

Sweden has a universal healthcare system and all children including unaccompanied and accompanied refugees are entitled to it. This still doesn’t account for the larger gaps refugees face when arriving in Sweden. Some barriers include stigma around mental health and being completely new to the Swedish healthcare system which causes hesitancy to reach out for psychiatric care (Axelsson, 2020). Lack of translators and proper social care has also proven to be big barriers to accessible care.

When it comes to Resignation Syndrome, it wasn’t recognized in the Swedish International Classification of Diseases until 2014. Prior to this, it was difficult for the follow through of clinical studies and follow-ups to study the disease further. Child and Adolescent Psychiatry (BUP) in Stockholm was given the control of treatment of the condition in 2005 and they mostly focused on outpatient approaches (Ohlis, 2022). Although there was a functional level assessment introduced to assess care needs and build communication within the care team, studies that focus on the longer symptoms and effects are lacking. New research about prolonged health concerns due to this condition and what different kinds of methods to help these children are also lacking (Ohlis, 2022).

The current approach to treatment is specialized outpatient care and treatment of symptoms. There have also been reports of antidepressants or other drugs to treat PTSD as follow-up treatment. The main thing that was believed to reverse the catatonic state is a family-oriented approach and receiving the decision that their family has been granted asylum (Sallin, 2021). It is interesting that surveys show that the number of children reported to have resignation syndrome dropped significantly in 2006 due to a change in the asylum law that relaxed restrictions that same year (Sallin, 2016). While receiving the news that their family is allowed to stay in Sweden is crucial to the recovery process, some studies and approaches reveal that family-oriented treatment may not always be the most helpful. Again, the lack of research on these individuals has caused the disparity gap to become larger.

There have been different kinds of therapy approaches that have been successful to some extent. In one study, an environmental therapy approach was applied to patients experiencing resignation syndrome and they were separated from their parents during observations. Their approach also included avoiding the topic of the asylum-seeking process in order to help the children experience a different environment. The study suggests that being away from their parents during this therapy is also a crucial factor in recovery (Sallin, 2021). It is significant to note that another preventive intervention that exists for refugee minors experiencing depression and PTSD is Teaching Recovery Techniques (TRT). This is a community driven approach, and it provides more education around recovery for the minor population (Sarkadi, 2018). It is also immersive which is the important factor in the environmental therapy as well. The studies and data from multiple studies suggest that a connection to community interactions and resources is a huge aspect of recovery.

For future health interventions, there should be an emphasis on social approaches to treatment and an emphasis on education. The families are new to the health care system in Sweden and may be unable to navigate their children’s health with confidence. There also needs to be more awareness of the disease including more research and therapy studies. Since it wasn’t recognized until 2014, there isn’t an appropriate amount of attention it needs to become more widely and internationally studied. There is a wider problem of policy and specifically policy that supports asylum seeker youth as well. Solidarity and access to adequate health and welfare services is challenged when the nation state is controlling who qualifies as a refugee or asylum seeker. This is especially exigent since the population of refugee minors has doubled between 2005 and 2015 (Bradby, 2017).

Through exploring the studies on refugee youth in Sweden and particularly those with Resignation Syndrome, it is evident that there is a lack of attention from Sweden’s healthcare system. In order for the appropriate treatment plans to be initiated, more information is required to deeply understand this condition. The current treatment of a family-oriented approach can be argued against in recent studies, and this can be communicated more. This group is an especially vulnerable population and from a healthcare perspective, Sweden hasn’t been meeting their needs in many ways. 

References

Axelsson, L., Bäärnhielm, S., Dalman, C., & Hollander, A.-C. (2020). Differences in psychiatric care utilisation among unaccompanied refugee minors, accompanied migrant minors, and Swedish-born minors. Social Psychiatry & Psychiatric Epidemiology, 55(11), 1449–1456. https://doi-org.ezproxy.depaul.edu/10.1007/s00127-020-01883-z

Bradby H, Liabo K, Ingold A, Roberts H. Visibility, resilience, vulnerability in young migrants.

Health. 2019;23(5):533-550. doi:10.1177/1363459317739441

Ohlis A, Narusyte J, Lindvall O, Dalman C, Hollander AC. [Long term outcome of children diagnosed with resignation syndrome in the Stockholm Region 2005-2012]. Lakartidningen. 2022 Jun;119:21171. PMID: 35730113.

Randell, E., & Osman, F. (2021). Living in the Shadow of Political Decisions: Former Refugees’ Experiences of Supporting Newly Arrived Refugee Minors. Journal of Refugee Studies, 34(4), 4121–4139. https://doi-org.ezproxy.depaul.edu/10.1093/jrs/feaa096

Sallin, K., Evers, K., Jarbin, H. et al. Separation and not residency permit restores function in resignation syndrome: a retrospective cohort study. Eur Child Adolesc Psychiatry (2021). https://doi.org/10.1007/s00787-021-01833-3

Sallin K, Lagercrantz H, Evers K, et al. Resignation syndrome: Catatonia? Culture-

bound? Front Behav Neurosci. 2016;10:7.

Sarkadi, A., Ådahl, K., Stenvall, E., Ssegonja, R., Batti, H., Gavra, P., Fängström, K., & Salari, R. (2018). Teaching Recovery Techniques: evaluation of a group intervention for unaccompanied refugee minors with symptoms of PTSD in Sweden. European Child & Adolescent Psychiatry, 27(4), 467–479. https://doi-org.ezproxy.depaul.edu/10.1007/s00787-017-1093-9

von Knorring, AL., Hultcrantz, E. Asylum-seeking children with resignation syndrome: catatonia or traumatic withdrawal syndrome?. Eur Child Adolesc Psychiatry 29, 1103–1109 (2020). https://doi.org/10.1007/s00787-019-01427-0