This article delves into six critical aspects concerning Unaccompanied Minor Migrants (UMMs) in Spain. First, it outlines the current demographic profile, offering insight into who the newly arrived UMMs in Spain are. Second, it examines the pre-migration process factors, focusing on the key reasons and conditions that drive UMMs to migrate. Third, it explores factors related to the migration process, including the type of migration and the reason for migrating. Fourth, it analysis post-migration factors, identifying the most critical elements affecting UMMs after their arrival in Spain. Fifth, it assesses their health status, looking at both general health levels and psychological distress. Finally, it investigates mental health risk factors, considering the main pre-, during and post-migration elements that influence their mental well-being.

The psychosocial well-being and social inclusion of UMMs are a significant challenge for post-covid-19 European societies. In Spain, it is estimated that there are more than 12,000 UMMs. Notably, they are a particularly vulnerable migrant group who travel alone at an early age and face numerous risks during migration, such as traumatic experiences and exploitation, and after arrival, they face difficulties in adaptation and integration.

The relationship between mental health and early-age migration is complex, and empirical evidence is far from conclusive. Several studies have found a higher prevalence of mental health problems among young migrants compared to their native peers. However, some research has reported the “healthy immigrant paradox”, indicating that young migrants have better mental health than native youth.

Research has shown how the circumstances of migrants’ lives influence their health. A critical framework for understanding this relationship is that of the social determinants of health (SDOH), which has garnered broad consensus. According to the World Health Organisation (WHO), the SDOH encompass “the circumstances in which people are born, grow, live, work, and age, including the health system. These circumstances result from distributing money, power, and resources at global, national, and local levels, depending on the policies adopted”.

In order to understand the impact of social determinants on migrants’ health, particularly in UMMs, it is crucial to consider their migratory cycle. The migration flows of UMMs are more complex than those of adults due to pre-migration, travel, and post-migration factors. One of the main mental health risk factors that these young people cope with is early separation from their family of origin. Moreover, the journey itself, which is usually long and stressful, combined with the fact that they are minors, exposes them to even more dangerous situations than adults face. After arrival, they suffer from discrimination in the host country. All these risk factors make them more vulnerable to emotional distress and mental health problems during a susceptible stage of development, adolescence, and transition to adulthood, requiring appropriate social and healthcare care focused on the person with a biopsychosocial and spiritual perspective.

Although there is evidence that UMMs are in a particularly vulnerable situation, there is practically no literature focused on this group. The lack of data at both the European and national levels presents challenges for research and intervention on the mental health of unaccompanied migrant youth in Spain.

This article collects data from the Migration Impacts on Health (MIO) project. It aims to identify risk and protective factors for UMMs’ well-being and mental health and shed light on specialised and multidisciplinary interventions.

The MIO study, conducted with 230 UMMs aged between 15 and 17, reveals key data about their backgrounds, duration of stay in Spain, resources, and educational and work status. The majority of these young migrants came from Morocco (57.4%), followed by Gambia (15.2%), Algeria (8.7%), Senegal (7.8%), Pakistan (5.2%), and other countries (5.6%). 

Notably, these young individuals had only recently arrived in Spain. Their average time since arrival was 6.39 months, indicating that most of the sample had spent less than one year in Spain. Of the total sample, 20.4% had been served by the Specialised Attention Programme for Unaccompanied Minors (SPAAI), 6.1% by emergency services, 68.3% by general reception facilities, 4.3% by the Initial Reception Program (PIL), and 0.9% by other resources.

Most of them (98.2%) had studied in their country of origin. Their educational attainment varied, with 30% having completed primary education, 63% having completed secondary education, 0.4% having completed preparatory education for university, and 6.6% having other forms of education.

Only a tiny percentage of these young immigrants had family or friends who were economically dependent on them in their country of origin, with 2.6% indicating that they had to send money home to support others. Likewise, 97.4% reported that they were not economically dependent on their families. The overwhelming majority of these young migrants identified as Muslim (99.6%), and only 0.4% reported adhering to religions other than Islam. Regarding their employment status in Spain, 5.2% had a work contract or internship, while 94.8% did not.

Assessing childhood trauma in young migrant populations is crucial due to the unique and often severe challenges these individuals face before migrating. Childhood trauma, encompassing various forms of abuse and neglect, has profound and long-lasting effects on individuals’ mental, emotional, and physical health. Surprisingly, the reported mean of childhood trauma, assessed by the Childhood Trauma Questionnaire – Short Form, was 13.1 (on a scale of 5 to 25), which is in the low range. This low average trauma score might suggest a degree of resilience within the sample population, potentially influenced by protective factors such as family stability or effective coping mechanisms. In psychological terms, resilience refers to the ability to bounce back from adversity, adapt to change, and maintain stable functioning even under challenging circumstances. The mean score on the 10-item Connor-Davidson Resilience Scale (CD-RISC) was 2.2 out of a maximum of 4 per item, suggesting a moderate level of resilience in the study sample.

Another key factor is language skills upon arrival, because language barriers present a significant challenge for these young migrants during the adaptation process in Spain. A staggering 89.2% of the UMMs reported no knowledge of Spanish upon arrival. This lack of language skills hampers their ability to integrate into the new society and affects their access to essential services and support systems. Only 10.8% had minimal knowledge of Spanish, indicating a slight advantage in navigating their new environment.

The data reveals that most of these adolescents undertook their journey with the consent and support of their families. Specifically, 83.9% of the UMMs migrated in consensus with their family, indicating a collective decision to seek better opportunities or safer environments. Meanwhile, 13.9% embarked on this journey voluntarily and individually, reflecting a personal choice driven by their circumstances. A smaller portion, 2.2%, was in consensus with friends, highlighting a much less common migration pattern among peers.  

Nearly all participants (98.7%) cited socioeconomic reasons as the primary motivation for their migration. These reasons include seeking a better standard of living, improved working conditions, and higher remuneration. A small fraction (0.9%) of the respondents indicated that their migration was motivated by family-related reasons, specifically to provide financial support or to help their family. This shows that, although less common, some young migrants are driven by a sense of duty and responsibility towards their families. Only 0.4% of the participants mentioned other unspecified reasons for their migration. This suggests that factors outside socioeconomic and family motivations are relatively rare among young migrants.

The study also explored UMMs’ expectations prior to migrating compared to their actual experiences upon arrival. The findings are stark: 87.9% of the UMMs felt their situation in Spain was worse than anticipated. This significant majority reflects the harsh realities and unforeseen challenges they encountered in the host country. Conversely, 7.2% found their circumstances to be as expected, while 4.9% felt their new life was better than anticipated.

The UMMs faced several specific post-migration challenges, particularly in documentation and employability, though they did not report significant educational difficulties.

According to the survey, most participants were either undocumented (36.1%) or in the process of obtaining their documentation (35.2%). A small percentage had temporary residency (5.7%), nationality (0.4%), or another form of residency (22.1%). This data underscores the significant number of individuals struggling with their residency status. Moreover, only 5.2% of participants had employment or internship contracts. 

Notably, all participants lived in residential centres and received educational support from centre professionals. Regarding social support, assessed using the Medical Outcomes Study Social Support Survey 6-Item, the mean score for the sample was 2.1 (on a scale from 1 to 5). This measure indicates the moderate level of perceived social support among the participants, highlighting the crucial role of social networks in their post-migration experience. 

One critical aspect to consider in examining the post-migration factors that affect UMMs is the perceived stress level. The perception of stress in the sample of the study was 6.4 out of a maximum of 40, as measured by the Perceived Stress Scale (PSS-10), indicating low stress levels. However, a specific stress impacting UMMs is acculturative stress, which reflects the psychological impact of adapting to a new culture. The data indicate that 68.7% of UMMs experienced both physical and psychological acculturative stress, 12.2% experienced either physical or psychological acculturative stress, and 19.1% did not experience any acculturative stress. This high percentage of those experiencing acculturative stress underscores the challenges these young migrants face in trying to integrate into a new cultural environment, which can be compounded by language barriers, social expectations, and the loss of familiar cultural contexts.

Information regarding stress related to covid-19 was evaluated using an adapted version of the Peri Life Events Scale. This test included various items addressing concerns about being infected, loved ones being infected, the death of loved ones due to covid-19, and job loss or income reduction caused by covid-19. The mean was 9.0, indicating a moderate stress level caused by covid-19.

Finally, another critical aspect to consider in examining the post-migration factors that affect UMMs is the level of perceived discrimination due to ethnic origin, religion, or skin colour since they arrived in Spain. The data reveals that nearly all of these minors (91.7%) had experienced some form of discrimination, whereas only a small percentage (8.3%) of participants reported that they had never experienced discrimination. This high presence of perceived discrimination can have profound implications for the mental health and overall well-being of these young individuals. In this sense, the Everyday Discrimination Scale provides a more detailed measure of the frequency of five situations of discrimination experienced. The frequency scale for each question ranges from 0 to 5, with “0” representing “never” and “5” indicating “almost every day”. This scale provides a nuanced measure of how often discrimination occurs. A score of “1” (“less than once a year”) suggests that incidents are rare, while “2” (“a few times a year”) indicates occasional but infrequent occurrences. As the scale progresses, “3” (“a few times a month”) reflects a moderate frequency, whereas “4” (“at least once a week”) signals a regular and recurring pattern. Finally, a score of “5” (“almost every day”) represents a persistent and habitual experience of discrimination. By structuring responses in this way, the scale helps quantify patterns of discrimination over a year in an interpretable manner. The average score among adolescents was 5.2, suggesting a low frequency of daily discrimination among these adolescents, likely because most of the sample had spent less than a year in Spain.

Since discrimination often arises in social, academic, or institutional settings, limited time in the country may mean fewer interactions and fewer opportunities to experience discrimination. This reduced exposure could contribute to the lower number of reported incidents. 

Concerning health, most participants perceived their overall health (including mental and physical health) as excellent (95.2%) or good (4.3%), and only 0.4% perceived their health as fair. 

Some 70.9% reported no chronic health problems in the last twelve months, whereas 29.1% reported having had at least one. These results reveal a discrepancy between the subjective perception of health status and the actual condition, reflecting why professionals often find it difficult to detect mental health issues among UMMs. In addition, it is essential to highlight the relationship between health and spirituality using the holistic and person-centred model and from a cross-cultural perspective. 

In terms of mental health, psychological distress was assessed using the Kessler Psychological Distress Scale (K-10), which has been widely used in assessing psychological distress among general and clinical populations from different cultural backgrounds. The scale identifies symptoms of psychological distress, specifically anxiety and depression. The average score in the study sample was 4.8 (on a scale from 0 to 40), indicating a low-moderate level of psychological distress.

Psychological distress among migrants is a complex phenomenon influenced by various pre- and post-migration factors. A Tobit model was utilised to analyse these main factors and their impact on psychological distress among UMMs, controlling for sociodemographic characteristics and education level prior to migration. This statistical approach provides insights into risks experienced before migration and the challenges encountered after resettlement.

Pre-migration factors encompass aspects of individuals’ lives that influence their psychological state upon arrival in the host country. Surprisingly, childhood trauma did not show a significant association with psychological distress. However, its impact could manifest differently over time, warranting further exploration. Resilience also did not show a significant association with psychological distress. Regarding the factors related to migration per se, the decision to migrate (consensus with family, friends, or individual decision) did not show any relation with psychological distress. 

While pre-migration and migration-related factors did not show an association with psychological distress, several post-migration factors showed a statistically significant positive association: duration of stay in Spain, lower self-reported health ratings, perceived stress, and perceptions of discrimination assessed. Stress related to covid-19 and degree of social support are post-migration factors not associated significantly with psychological distress.

The study provides a nuanced understanding of psychological distress among UMMs, distinguishing between factors impacting them before, during and after migration. In particular, the study’s results seem to align with the healthy immigrant paradox, which suggests that migrants who succeed in their journey tend to be more resilient and, therefore, healthier than the native population. It is possible that UMMs, due to health selectivity, are more likely to migrate and initially healthier. However, the cumulative effects of post-migration risk factors ‒ such as perceived stress and discrimination ‒ ultimately impact their mental health. The transition to adulthood has become more complex, non-linear, and extended over time for UMMs. Therefore, more longitudinal studies on this specific group are also needed to examine risk and protective factors for health over time.

Finally, to comprehensively understand the health of UMMs, it is also essential to integrate the social determinants of the health model with the life course perspective and examine the healthy immigrant paradox. The social determinants of health model offers a structural analysis of the factors affecting health. At the same time, the life course perspective adds a temporal dimension, considering how these factors interact over time. Together, these approaches provide a dynamic understanding of how various social determinants impact health at different stages of the migratory cycle, emphasising the importance of context and circumstances at each stage: before, during, and after migration. Notably, in this specific migrant group, their entire migration cycle often occurs during adolescence, a critical period for life development. This stage involves the transition to adulthood and influences the formation of adult identity, attitudes, goals, and aspirations.

Overall, the transition to adulthood for young people in European societies is filled with economic, educational, social, and mental health challenges. Young migrants face the added challenge of navigating micro-transitions (such as handling legal and administrative status changes, completing education, entering the labour market, and forming families) within the broader migration cycle. This “double transition” sets them apart from other migrants and may increase their vulnerability to mental health issues. This underscores the need for comprehensive support systems that address both pre-existing vulnerabilities and the evolving challenges migrants face in their new environments. Policy interventions and community-based initiatives can leverage these insights to enhance mental health outcomes and promote skills and competencies among young migrant populations over time.

The study highlights the impact of post-migration factors on psychological distress among newly arrived UMMs. It underscores the need for comprehensive mental health care that considers the different stages of the migratory cycle. Additionally, it advocates for promoting cross-cultural mental health care models and developing policies and services to address and mitigate the effects of post-migration factors, including discrimination against UMMs in Spain. These measures may be crucial to improving overall health outcomes and social integration.

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