**1. Introduction**

During the refugee movements in the years 2014 to 2016, European countries faced a rapidly growing number of refugees and asylum seekers, resulting in a record level of 1.3 million asylum applications in 2015 [1]. Of these, 8277 asylum applications were filed by under-age refugees [2]. Although the number of asylum-seeking applications has been decreasing since 2016, asylum seekers and refugees still represent a persistent issue and an important field of action, especially in terms of the vital matter of ensuring their mental health and well-being.

Refugees may suffer from mental disorders, as they often cope with dire situations and life events that affect their mental health. In particular, numerous studies have highlighted the special vulnerability of refugee children and adolescents to mental health problems and psychiatric disorders [2–8]. In a systematic review [3] that included 47 studies from 14 European countries and published from 1990 to 2017, covering a sample size of 24,786 refugee or asylum-seeking minors, the estimated point prevalence of diverse psychiatric disorders and mental health problems for children and adolescents was reported as follows: For posttraumatic stress disorder (PTSD), between 19.0% and 52.7%; for depression, between 10.3% and 32.8%; for anxiety disorders, between 8.7% and 31.6%; and for emotional and behavioral problems, between 19.8% and 35.0%. Despite the highly heterogeneous evidence base, it can be assumed that up to one-third of refugee and asylum-seeking children and adolescents suffer from depression, anxiety disorders, or emotional or behavioral problems, and up to one-half could be affected by PTSD [3]. Moreover, various studies showed that unaccompanied minor refugees (UMR) had a higher risk of suffering from mental health problems and psychiatric disorders than did the accompanied minor refugees and general population norm (cf., [3]). Out of this group, female UMRs appear to be exposed to a higher risk for developing mental health problems, PTSD and depression [4]. Several risk factors can influence the point of prevalence of mental health problems in minors. The literature differentiates between factors of pre-migration, e.g., traumatic exposure to poverty, violence, and war; factors of peri-migration, e.g., separation, sexual abuse, and trafficking; and factors of post-migration, e.g., access to education, social support, the asylum application process, discrimination, acculturation, insecure living conditions, and uncertainty about the future [9–13]. The latter factors are those that can be triggered by country-specific policies of the host countries through the creation of conditions that either hinder or facilitate the integration of refugee children and adolescents and, consequently, either reinforce or weaken their mental health. A comparison of approaches to the integration of UMRs established by EU Member States (MS) shows that MS generally give priority to the care of UMRs. Thereby, MS apply similar accommodation arrangements, appoint a representative (e.g., guardian), provide access to education, the labor market, social welfare assistance and health care (including emergency treatment, basic medical care, and in many cases additional specialized medical care and counseling) [5]. Despite these similarities, integration policies and processes generally depend on the country-specific environment and, hence, post-migration risk factors may be more or less subject to social, political, and economic conditions.

One of the main challenges for the integration of UMRs found in the above-mentioned comparison refers to a lack of specialized and trained staff [5]. This highlights the importance of political and practical recommendations for coping with post-migration risk factors, taking into account the specific conditions affecting the situation of UMRs in a foreign country.

Given the complex interplay between post-migration risk factors, mental health status, and country-specific integration conditions, this study focuses on Austria as a country recording a high share of (unaccompanied) minor asylum applicants [1]. However, in the case of Austria, only a few studies provide data on post-migration risk factors and their influence on the mental health of UMRs. Among others, the Institute for Empirical Social Research (IFES) carried out an exploratory study on the living conditions of UMRs in eastern Austria [14]. This study included quantitative and qualitative interviews with 66 UMRs who spoke about their living situations and future expectations. The study provides insights into essential framework conditions such as accommodation, access to education and work, the financial situation and daily routines of UMRs, and their future perspectives, even if the influence on mental health was not specifically surveyed. Other available publications on specific post-migration risk factors are mostly from non-profit-organizations (e.g., Asylkoordination Österreich, Caritas), international institutions (e.g., European Migration Network), and government institutions and ministries (e.g., Ombudsman Board, the Federal Ministry of Education, Science and Research), though they focus mainly on practical and/or legal matters.

Moreover, significant interrelationships between risk factors have not yet been sufficiently investigated. Consequently, the interactions and dynamics of risk factors of this complex domain

of research may be inadequately addressed and implemented in the development of strategies or measurements. In the case of UMRs, this could not only raise costs for secondary and tertiary professional care but also hinder their sustainable integration into society. Thus, evaluating the effectiveness of appropriate measures to ensure the mental health of UMRs requires more than the mere aggregation of parts of the interrelated and multidimensional factors contributing to vulnerabilities of UMRs.

In view of the topicality and relevance of the subject and the scarce availability of data at national and international levels, this study aims to identify post-migration factors, their interrelationships, and potential influence on mental health. An interdisciplinary and systemic approach incorporating experts' knowledge and experiences was applied to obtain different perspectives from both a scientific and a practical point of view. The final goal of this study was to develop a knowledge-based system model that integrates different knowledge and describes post-migration risk factors as a network of interacting factors. In research and practice, knowledge-based system modeling techniques are used to retrieve the knowledge and represent how individuals organize knowledge, link concepts within a knowledge domain, and understand complex problem situations [15–17]. Different types of problems can benefit from this approach of incorporating experts' knowledge, if, for instance, scientific data on a specific topic is limited or if the problem involves many parties and has no clear solution or clearly correct answers and is, therefore, complex [18–20].

In this study, we incorporated the approach of system modeling, as described in the section *Materials and Methods*. Based on our final system model developed within three workshops as described in the *Procedure* section, the research results are presented and discussed within the context of the specific legal and policy framework in Austria. The developed system model calls for a more detailed analysis and should currently only provide insights into future needs for action and further investigation as described in the *Limitations* and *Conclusions*.

#### **2. Materials and Methods**

#### *2.1. The Technique of Fuzzy-Logic Cognitive Mapping*

In this study, the technique of fuzzy-logic cognitive mapping (FCM), a commonly used form of semi-quantitative system modeling, was applied. It is an established technique for eliciting, capturing, and diagramming structured knowledge on interrelated issues of a knowledge domain held by individuals or groups [21,22]. The result of the process of system modeling is a cognitive map that takes the form of a system and provides a visual representation of a person's existing understanding on a particular subject. A cognitive map has three characteristics [23]. The first characteristic includes both the direction and nature of causality; the second characteristic reveals the strength of the connections, and the third characteristic reflects a feedback mechanism that captures the effect of a change in a node on another node that, in turn, affects other nodes along the path. In other words, these cognitive maps contain nodes, i.e., concepts that can be linked qualitatively (e.g., low, medium, high) or quantitatively (e.g., between −1 and 1) to other concepts. This connectivity allows researchers to uncover trends by measuring the degree of conceptual agreement in the cognitive maps produced by individuals [15] or by groups jointly defining, expanding, discussing, and collaborating on the concepts and structures of a system [18].

Furthermore, by applying mapping techniques in a group environment, the knowledge of the group can be extended by developing and discussing the emerging system models. That is, collaborative system modeling can act as scaffolding tools to create an environment in which diverse group members can share their knowledge [24]. Thus, by generating a representation of the problem to solve a particular situation, individual contributors can build on each other, and actions or ideas can be taken up or complemented by other group members [25].
