Agreement for posttraumatic stress symptoms among unaccompanied young refugees and professional caregivers

<b>Background:</b> Prevalence rates for posttraumatic stress symptoms (PTSS) in unaccompanied young refugees (UYRs) are high. Research with biological parents indicates low agreement rates between self and caregiver reports for PTSS, although caregivers play an important role as gatekeepers to ensure appropriate treatment.<b>Objective:</b> This study examines youth and caregiver agreement on the endorsement of different trauma types, the PTSS severity score and symptom clusters, as well as the potential association between youth factors (age, comorbidity, and duration in facility) and disagreement.<b>Method:</b> The sample consisted of <i>N</i> = 610 UYRs, aged <i>M</i> = 16.75 (<i>SD</i> = 1.33, range: 12-20) years. Of these, 91.0% were male, and 43.4% were from Afghanistan, currently residing in German children and youth welfare facilities.<b>Results:</b> Agreement rates across trauma types were poor (accidental trauma: Cohen's <i>k</i> = .13; community violence: Cohen's <i>k</i> = .07; domestic violence: Cohen's <i>k</i> = .19; sexual abuse: Cohen's <i>k</i> = .38). Agreement rates for the PTSS severity score (ICC = .22) and symptom clusters were poor (re-experiencing: ICC = .27; avoidance: ICC = .02; negative alterations in cognitions and mood ICC = .12; hyperarousal: ICC = .25), with youth reporting significantly higher scores. Regression models showed that having comorbid symptoms and a shorter duration in the facility were associated with higher disagreement at the PTSS severity score (Adjusted -<i>R</i>² = .21) and across symptom clusters (re-experiencing: Adjusted -<i>R</i>² = .13; avoidance: Adjusted -<i>R</i>² = .07; negative alterations in cognitions and mood: Adjusted -<i>R</i>² = .16; hyperarousal: Adjusted- <i>R</i>² = .16). Age was not significantly associated with disagreement rates.<b>Conclusion:</b> It is important to enhance the awareness and comprehension of caregivers regarding recognition of mental illnesses and their symptoms as well as assessing mental health among UYRs.