Psychological flexibility in unaccompanied refugee minors in Cyprus - a network analysis

Background: Refugee populations, particularly Unaccompanied Refugee Minors (URM), often report poor levels of mental health. The construct of Psychological Flexibility (PF), derived from Acceptance and Commitment Therapy (ACT), appears to positively impact relevant aspects of mental health in various populations, including adolescents and refugees. Objectives: The present study aims to examine the structure of the PF model and the connections among its core processes, alongside the structure and connections between mental health constructs and PF in URM. Methods: Mental health and PF in URM (N = 101) aged 13-18 years living in different shelters in the Republic of Cyprus were assessed using the self-report measures DASS-21, Psy-Flex, CRIES-13, and KIDSCREEN-10. A Network Analysis (NA) approach was used to examine the structure and connections of the constructs. Results: The PF network showed an overall positive connectedness between the core PF processes, with the strongest edge between committed action and values. These core processes also showed the highest expected influence. The strongest positive connections in the mental health network were found between stress, anxiety, and depression. Stress showed the highest expected influence while PF had the lowest. A post hoc analysis using the Johnson-Neyman method suggested that increased PF decreases the rate of change in anxiety, depression, and stress levels concerning Post-traumatic stress disorder (PTSD) scores. This implies the presence of a buffering effect attributable to PF. Conclusions: The present study has significant implications for future clinical practice and research with URM, particularly when using ACT. Promising approaches include addressing stress symptoms and emphasizing the importance of value clarification.