Examining psychological flexibility in unaccompanied refugee minors: A network analysis

Background: Refugees, particularly unaccompanied refugee minors (URM), often report poor mental health. Psychological Flexibility (PF), derived from Acceptance and Commitment Therapy (ACT), appears to positively impact mental health in various populations, including adolescents and refugees. Objectives: This study aimed to examine the structure of the PF model and the connections among its core processes, as well as the structure and connections between mental health constructs (i.e., post-traumatic stress, depression, anxiety, stress, quality of life) and PF in URM. Methods: 100 URM aged 13–18 years living in shelters in the Republic of Cyprus completed four self-reports, assessing depression, anxiety, and stress (DASS-21), PF (Psy-Flex), PTSD (CRIES-13), and HRQL (KIDSCREEN-10). Network Analysis was used to examine the structure and connections of the constructs. Results: Most core PF processes showed positive connections amongst each other, with the strongest edge between committed action and values. Together with self as context, these core processes exhibited the highest expected influence. The strongest positive connections in the mental health network were found among stress, anxiety, and depression. Stress had the highest expected influence, whereas PF had the lowest. A post hoc Johnson-Neyman analysis suggested a buffering effect of PF on the impact of PTSD on anxiety and stress. Conclusions: Proposed areas of focus for clinicians working with URM include incorporating strategies that address stress symptoms and facilitate individuals in pursuing value-based behavior. It is equally important to encourage critical reflection on values and the conceptualized self in the context of culture.