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Ryom K, Simonsen CB, Rau SR, Maindal HT, Agergaard S. Newly arrived refugees’ perception of health and physical activity in Denmark. J Migr Health 2022; 6:100111. [PMID: 35601392 PMCID: PMC9118909 DOI: 10.1016/j.jmh.2022.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 12/01/2022] Open
Abstract
The newly arrived refugees spoke of a broad and holistic perspective on health, where health is understood as a part of life and therefore more than just the absence of illness. Physical activity was by the male newly arrived refugees explained as important instrument to ensure that they could provide for their family (e.g. economy and demands). Female newly arrived refugees were more explicit on the compromises they had to make with being physical active, in order to be the “expected” caretaker of their family. Refugees experienced several barriers for doing physical activity and living healthy lives. Time, pain, low income, job insecurity, mental strain, discourse of health and physical activity, external expectations and demands (municipality and government), precariat living conditions and general worrying, were amongst the most explicit barriers.
Refugees health status after receiving asylum in their new country is often poor, both physical and mentally. Despite that, European countries rarely offer programmes specifically targeted health and health behaviour for newly arrived refugees. This study investigated newly arrived refugees’ perspective on health and in particularly physical activity (PA) upon granted asylum in Denmark. A transnational migration perspective provides the theoretical framework in this study. Semi-structured interviews with twenty newly arrived refugees provide data for the interpretative phenomenological analysis (IPA). Health manifests itself in varied ways to the newly arrived refugees and a broad and holistic perspective on health, was evident. Overall PA had important benefits, such as pain relief, better physical fitness, lose weight, a stronger body, to stay active, cater to mental health and in general something of interest to the newly arrived refugees. However, the informants experienced several barriers for doing PA and living healthy lives. Time, pain, low income, job insecurity, mental strain, discourse of health and PA (health promotion), external expectations and demands (municipality and government in Denmark), precariat living conditions and general worrying were amongst the most explicit barriers. In addition, the question of how the newly arrived refugees are positioned in their families seems vital, as patriarchal family structures seem to prevent some from doing PA. Based on the results, we underline the importance of involving refugees in developing health promotion activities while considering of their unique experiences and transnational background.
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Affiliation(s)
- Knud Ryom
- Department of Public Health, Section for Health Promotion and Population Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
- Corresponding author.
| | | | - Stefan Runge Rau
- Department of Public Health, Section for Health Promotion and Population Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Population Health, Aarhus University, Bartholins Allé 2, Aarhus 8000, Denmark
- Steno Diabetes Centre Copenhagen, Health Promotion, Copenhagen, Denmark
| | - Sine Agergaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Salama E, Castaneda AE, Suvisaari J, Rask S, Laatikainen T, Niemelä S. Substance use, affective symptoms, and suicidal ideation among Russian, Somali, and Kurdish migrants in Finland. Transcult Psychiatry 2022; 59:37-51. [PMID: 32164497 PMCID: PMC8859688 DOI: 10.1177/1363461520906028] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Comorbidity of substance use with affective symptoms and suicidality has been well documented in the general population. However, population-based migrant studies about this association are scarce. We examined the association of affective symptoms and suicidal ideation with binge drinking, daily smoking, and lifetime cannabis use among Russian, Somali, and Kurdish migrants in comparison with the Finnish general population. Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu, n = 1307) and comparison group data of the general Finnish population (n = 860) from the Health 2011 Survey were used. Substance use included self-reported current binge drinking, daily smoking, and lifetime cannabis use. Affective symptoms and suicidal ideation were measured using the Hopkins Symptom Checklist-25 (HSCL-25). We performed multivariate logistic regression analyses, including age, gender, and additional socio-demographic and migration-related factors. Suicidal ideation (OR 2.4 95% CI 1.3-4.3) was associated with binge drinking among Kurds and lifetime cannabis use among Russians (OR 5.6, 95% CI 1.9-17.0) and Kurds (OR 5.5, 95% CI 1.9-15.6). Affective symptoms were associated with daily smoking (OR 1.6, 95% CI 1.02-2.6) and lifetime cannabis use (OR 6.1, 95% CI 2.6-14.5) among Kurdish migrants. Our results draw attention to the co-occurrence of suicidal ideation, affective symptoms, and substance use, especially among Kurdish migrants. These results highlight the variation of comorbidity of substance use and affective symptoms between the different populations. This implies that screening for substance use in mental healthcare cannot be neglected based on presumed habits of substance use.
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Affiliation(s)
- Essi Salama
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Turku, Finland.,Child Psychiatry, Turku University Hospital, Finland
| | - Anu E Castaneda
- National Institute for Health and Welfare (THL), Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | | | - Shadia Rask
- National Institute for Health and Welfare (THL), Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL), Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.,Joint municipal authority for North Karelia social and health services (Siun sote), Finland
| | - Solja Niemelä
- Department of Psychiatry, University of Turku, Finland.,Addiction Psychiatry Unit, Turku University Hospital, Finland
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Pluck F, Ettema R, Vermetten E. Threats and Interventions on Wellbeing in Asylum Seekers in the Netherlands: A Scoping Review. Front Psychiatry 2022; 13:829522. [PMID: 35432018 PMCID: PMC9010677 DOI: 10.3389/fpsyt.2022.829522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most asylum seekers experience stress, not only due to the reason for fleeing and their travel but also due to their compulsory stay in the asylum seeker center in the Netherlands and the asylum procedure. This often leads to self-medication and addiction which causes lower self-esteem and lower quality of life. Adverse life events, forced migration, and prolonged asylum procedures, in addition to the complexity of the acculturation process, can all contribute to higher levels of psychopathology. OBJECTIVE What are the threats to wellbeing in terms of mental health, psychosocial, and addiction problems, and what are the effective interventions for wellbeing for asylum seekers in asylum seeker centers in the Netherlands, reported in the literature? METHOD Following the descriptive nature of the research question and the need for identifying knowledge gaps, an overview of existing knowledge was created by executing a scoping review on influencing factors on the mental health of asylum seekers. The Neuman system model was used as a guiding framework to understand the complexity of the issues this population experience and to identify the stressors and the factors which cause the imbalance and also the disease. RESULTS The literature review resulted in 26 articles that met the criteria for inclusion. The threats included the influence of staying in the environment of an asylum seekers center, drug abuse among asylum seekers, health-care professionals and employees who do not detect or underestimate the underlying suffering of asylum seekers, and frequent relocations of asylum seekers. The two assessment instruments used were the Rapid-Assessment-Response method (RAR method) and the Health Information Assessment Tool Asylum Seeker tool (HIATUS tool). Finally, the five interventions were identified: therapy for asylum seekers diagnosed with post-traumatic stress disorder (PSTD), art therapy, education focused on prevention as intervention, cultural interview, and mindspring. CONCLUSION The knowledge on identifying and reducing threats, assessment, and treatment interventions for asylum seekers living in an asylum seekers center found in the literature provided perspectives on improving their wellbeing. The great diversity of cultural aspects and continuous changes in the number and origin of refugees in the Dutch asylum seekers centers disrupted the continuity of care.
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Affiliation(s)
- Ferdy Pluck
- Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands.,Research Group Personalized Integrated Care, University of Applied Science Utrecht, Utrecht, Netherlands.,Amethist Addiction Care, Almere, Netherlands
| | - Roelof Ettema
- Research Group Personalized Integrated Care, University of Applied Science Utrecht, Utrecht, Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands.,Arq Psychotrauma Expert Group, Diemen, Netherlands.,Department of Military Mental Health Care (MGGZ), Ministry of Defense, Utrecht, Netherlands
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4
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Führer A, Niedermaier A, Kalfa V, Mikolajczyk R, Wienke A. Serious shortcomings in assessment and treatment of asylum seekers' mental health needs. PLoS One 2020; 15:e0239211. [PMID: 33027307 PMCID: PMC7540848 DOI: 10.1371/journal.pone.0239211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of psychological complaints is known to be very high in populations of asylum seekers. Despite this, data on the health care system's ability to adequately meet these high-risk populations' mental health needs are scarce. This article investigates how well the German outpatient health care system is able to detect and adequately treat them. METHODS To this end, we combined data from a cross-sectional survey with billing data from the local social welfare office from the year 2015. Using descriptive statistics, the data of the cross-sectional study are used to quantify the psychological health care needs of asylum seekers while the secondary data analysis indicates the actual access to and extent of psychological treatment. RESULTS In the cross-sectional study, 54% of patients were screened positive for symptoms of depression, 41% for symptoms of anxiety disorder and 18% for symptoms of Posttraumatic Stress Disorder. In total, 59% were screened positive for at least one of these three disorders. However, when contrasting these screening-based prevalences with the prevalences based on data from the health care system, a mismatch becomes apparent: According to the social welfare office's billing data, only 2.6% of asylum seekers received the diagnosis of depression, 1.4% were diagnosed with anxiety disorder and 2.9% with Posttraumatic Stress Disorder (PTSD). In combination, 4.9% were diagnosed with at least one of these three disorders. Overall, less than one tenth of asylum seekers with symptoms of depression, anxiety or PTSD received the corresponding diagnosis by the health care system. Among those who were diagnosed, about 45% received no treatment at all, while 38% were treated with drugs alone. Only 1% of all patients received psychotherapy. CONCLUSIONS Psychological complaints are very common among asylum seekers, yet only a small proportion of this population receives the corresponding diagnoses and treatment. While various factors can contribute to these shortcomings, there is an urgent need to systematically address this deficit and introduce measures to improve mental health care for this high-risk population.
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Affiliation(s)
- Amand Führer
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Niedermaier
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Vivian Kalfa
- Psychosocial Centre for Refugees and Victims of Torture (PSZ), Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Salama ES, Castaneda AE, Lilja E, Suvisaari J, Rask S, Laatikainen T, Niemelä S. Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study. Addiction 2020; 115:1160-1171. [PMID: 31797477 PMCID: PMC7317749 DOI: 10.1111/add.14904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/01/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds. DESIGN Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language. SETTING Population-based data were collected from six cities in Finland during 2010-12. PARTICIPANTS The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%). MEASUREMENTS The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for. FINDINGS Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18). CONCLUSIONS In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.
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Affiliation(s)
- Essi S. Salama
- Faculty of MedicineUniversity of TurkuTurkuFinland
- Child PsychiatryTurku University HospitalTurkuFinland
| | - Anu E. Castaneda
- National Institute for Health and Welfare (THL)HelsinkiFinland
- Faculty of Medicine, Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Eero Lilja
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Jaana Suvisaari
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Shadia Rask
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL)HelsinkiFinland
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun sote)JoensuuFinland
| | - Solja Niemelä
- Department of PsychiatryUniversity of TurkuTurkuFinland
- Addiction Psychiatry UnitTurku University HospitalTurkuFinland
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Cramm JM, Nieboer AP. Acculturation is associated with older Turkish immigrants' self-management abilities. BMC Public Health 2019; 19:1228. [PMID: 31488086 PMCID: PMC6727562 DOI: 10.1186/s12889-019-7471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The few previous studies investigating acculturation and self-management have suggested that increased participation in (or adaptation to) the host culture is associated with better health and disease management. However, research on the relationship between acculturation strategies (attachment to the Dutch and Turkish cultures) and broader self-management abilities among older Turkish immigrants in the Netherlands is lacking. This study aimed to investigate this relationship in this population. METHODS Turkish immigrants aged > 65 years and residing in Rotterdam, the Netherlands (n = 2350), were identified using the municipal register. In total, 680 respondents completed the questionnaire (32% response rate). RESULTS The average age of the respondents was 72.90 (standard deviation, 5.02; range, 66-95) years and 47.6% of respondents were women. The majority (80.3%) of respondents reported having low educational levels. Women, single individuals, less-educated respondents, and those with multimorbidity experienced lower levels of attachment to the Dutch culture and reported poorer self-management abilities. Slightly stronger relationships were found between self-management and attachment to the Dutch culture than attachment to the Turkish culture. Multimorbidity negatively affected the self-management abilities of older Turkish people living in the Netherlands. CONCLUSIONS The study findings indicate that especially attachment to the Dutch culture matters for the self-management abilities of older Turkish immigrants in the Netherlands. Given the high prevalence of multimorbidity in this population, investment in their self-management abilities is expected to be beneficial. Special attention is needed for women, single individuals, less-educated people, and those with multimorbidity. Interventions aiming to better integrate these groups into Dutch society are also expected to be beneficial for their self-management abilities.
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Affiliation(s)
- Jane M Cramm
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands.
| | - Anna P Nieboer
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands
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Nordin L, Perrin S. Pain and posttraumatic stress disorder in refugees who survived torture: The role of pain catastrophizing and trauma-related beliefs. Eur J Pain 2019; 23:1497-1506. [PMID: 31095807 DOI: 10.1002/ejp.1415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Traumatized refugees with comorbid pain report more severe posttraumatic stress disorder (PTSD), respond less well to PTSD-focused treatments and exhibit greater disability. A mutually maintaining relationship may exist between pain and PTSD, that may be partly accounted for by depression, but no prior studies have tested this assumption in traumatized refugees. METHOD Self-report measures of pain, PTSD, depression, disability, pain catastrophizing (PC) and trauma-related beliefs (TRBs) were administered to 197 refugees referred to the Danish Institute Against Torture (DIGNITY) prior to treatment. The contribution of pain, depression, PC, and TRBs to the overall variance in PTSD severity was examined. We also examined whether the relationship between pain and PTSD was mediated by PC and TRBs, after controlling for depression. RESULTS Depression, pain severity, PC and TRBs together accounted for 66% of the overall variance in PTSD, with depression being the primary contributor (57%). In univariate tests, both PC and TRBs significantly mediated the relationship between pain interference/severity and PTSD. However, after controlling for depression only PC mediated this relationship. CONCLUSIONS Negative beliefs about pain and the trauma made small, but additive contributions to the relationship between pain and PTSD severity, after controlling for depression. Longitudinal studies with refugees, involving tests of more complex mutual maintenance models, are warranted. SIGNIFICANCE After controlling for symptoms of depression, pain catastrophizing and negative trauma-related beliefs partly mediated the relationship between pain and PTSD in tortured refugees. The results suggest that all three variables are important in a mutual mediation model of pain and PTSD, and as targets for treatment, in traumatized refugees.
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Affiliation(s)
- Linda Nordin
- DIGNITY: Danish Institute Against Torture, Copenhagen, Denmark.,Department of Psychology, Lund University, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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8
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Nordin L, Perrin S. Pre-treatment pain predicts outcomes in multimodal treatment for tortured and traumatized refugees: a pilot investigation. Eur J Psychotraumatol 2019; 10:1686807. [PMID: 31762955 PMCID: PMC6853218 DOI: 10.1080/20008198.2019.1686807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/19/2019] [Accepted: 10/20/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Chronic pain is a common comorbid complaint in traumatized refugees seeking treatment for posttraumatic stress disorder (PTSD) and depression. However, the effect of comorbid pain on treatment remains under investigated. Objective: To investigate whether pre-treatment pain (severity/interference) predicts outcomes in a multimodal treatment targeting PTSD, depression, anxiety, somatic complaints, and health-related disability in refugees exposed to torture and organized violence. Additional predictors were gender, age, and number of treatment sessions. Method: Participants were active cases at a specialist outpatient clinic for tortured refugees (n = 276; 170 men, 106 women) who were either on a treatment waitlist (mean length = 7.4 months, SD = 4.5), in treatment (mean length = 12.2 months, SD = 6.5), or who completed treatment and had (or were waiting for) a follow-up assessment. Participants completed symptom measures at referral, pre- and post-treatment, and 9-month follow-up. Multi-level mixed modelling was used to assess whether outcomes at post-treatment and 9-months were predicted by pain, gender, age, or the number of treatment sessions. Results: Treatment yielded significant pre-to-post-treatment reductions in PTSD, depression, anxiety, and number of pain locations, but no reductions in pain severity/interference, or health-related disability, except for societal participation. Gains for PTSD, depression, and societal participation were maintained at the 9-month follow-up. Higher levels of pain interference (but not severity) predicted poorer outcomes (PTSD, depression, and anxiety). Age, gender and number of treatment sessions did not predict outcomes, except for a small negative effect of (older) age on PTSD. Conclusions: A growing body of literature suggests that pain and PTSD symptoms interact in ways to increase the severity and impact of both disorders in refugee and non-refugee populations alike. The present study suggests interference from pain can lessen the effectiveness of standard multi-modal treatments for refugees.
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Affiliation(s)
- Linda Nordin
- Rehabilitation Department, DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark.,Department of Psychology, Lund University, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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9
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Murphy JE, Smock L, Hunter-Adams J, Xuan Z, Cochran J, Paasche-Orlow MK, Geltman PL. Relationships Between English Language Proficiency, Health Literacy, and Health Outcomes in Somali Refugees. J Immigr Minor Health 2018; 21:451-460. [DOI: 10.1007/s10903-018-0765-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Yaser A, Slewa-Younan S, Smith CA, Olson RE, Guajardo MGU, Mond J. Beliefs and knowledge about post-traumatic stress disorder amongst resettled Afghan refugees in Australia. Int J Ment Health Syst 2016; 10:31. [PMID: 27073412 PMCID: PMC4828823 DOI: 10.1186/s13033-016-0065-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/31/2016] [Indexed: 11/11/2022] Open
Abstract
Background Resettled refugees are at high risk of trauma-related mental health problems, yet there is low uptake of mental health care in this population. Evidence suggests poor ‘mental health literacy’ (MHL) may be a major factor influencing help-seeking behaviour among individuals with mental health problems. This study sought to examine the MHL of resettled Afghan refugees in Adelaide, South Australia. Methods Interviews were completed with 150 (74 males; mean age 32.8 years, SD = 12.2) resettled Afghan refugees living in Adelaide, South Australia. A convenience sampling method was employed and participants were comprised of volunteers from the Afghan community residing in the northern suburbs of Adelaide. Following informed consent participants were presented a culturally appropriate vignette describing a fictional person suffering from posttraumatic stress disorder (PTSD). This was followed by a series of questions addressing participants’ knowledge and understanding of the nature and treatment of the problem described. Self-report measures of PTSD symptoms and co-morbid psychopathology were also administered. Results Thirty-one per cent of the respondents identified the problem depicted in the vignette as being PTSD, while 26 per cent believed that the main problem was ‘fear’. Eighteen per cent of participants believed that ‘getting out and about more/finding some new hobbies’ would be the most helpful form of treatment for the problem described, followed by ‘improving their diet’ and ‘getting more exercise’ (16 %). Conclusion The results of this study demonstrate aspects of MHL that appear to be specific to Afghan refugees who have resettled in Australia. They indicate the need for health promotion and early intervention programs, and mental health services, to recognise that variation in MHL may be a function of both the cultural origin of a refugee population and their resettlement country. Such recognition is needed in order to bridge the gap between Western, biomedical models for mental health care and the knowledge and beliefs of resettled refugee populations. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0065-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anisa Yaser
- Mental Health, Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
| | - Shameran Slewa-Younan
- Mental Health, Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
| | - Caroline A Smith
- National Institute of Complementary Medicine, Western Sydney University, Sydney, Australia
| | - Rebecca E Olson
- School of Social Science, Faculty of Humanities and Social Sciences, University of Queensland, Brisbane, Australia
| | | | - Jonathan Mond
- Department of Psychology, Macquarie University, Sydney, Australia
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11
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Lamkaddem M, Essink-Bot ML, Devillé W, Gerritsen A, Stronks K. Health changes of refugees from Afghanistan, Iran and Somalia: the role of residence status and experienced living difficulties in the resettlement process. Eur J Public Health 2015; 25:917-22. [PMID: 25863280 DOI: 10.1093/eurpub/ckv061] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Worldwide, refugees show a poorer mental and physical health than the populations among which they resettle. Little is known about the factors influencing health after resettlement. We examined the development of mental and physical health of refugees. As experienced living difficulties might decrease with obtaining a residence permit, we expected this to play a central role in health improvement after resettlement. METHODS A two-wave study conducted in the Netherlands among a cohort of 172 recent (n = 68) and longstanding (n = 104) permit holders from Afghanistan, Iran and Somalia between 2003 and 2011. Multivariate mediation analyses were conducted for the effect of changes in living difficulties on the association between change in status and changes in health. Health outcomes were self-reported general health, number of chronic conditions, PTSD and anxiety/depression. RESULTS Recent permit holders had larger decreases in PTSD score (-0.402, CI -0.612; -0.192) and anxiety/depression score (-0.298, CI -0.464; -0.132), and larger improvements in self-rated general health between T1 and T2 (0.566, CI 0.183; 0.949) than longstanding permit holders. This association was not significant for changes in number of chronic conditions. Mediation analyses showed that the effect of getting a residence permit on health improvements transited through an improvement in living conditions, in particular employment and the presence of family/social support. CONCLUSION These results suggest that change in residence permit is beneficial for health mainly because of the change in living difficulties. These results add up to the evidence on the role of social circumstances for refugees upon resettlement, and point at labour participation and social support as key mechanisms for health improvements.
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Affiliation(s)
- Majda Lamkaddem
- 1 Department of Public Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie-Louise Essink-Bot
- 1 Department of Public Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Walter Devillé
- 2 NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands 3 Medical Anthropology and Sociology Unit, Faculty of Social and Behavioural Sciences, University of Amsterdam, The Netherlands 4 Pharos, Utrecht, The Netherlands
| | | | - Karien Stronks
- 1 Department of Public Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
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12
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Shawyer F, Enticott JC, Doherty AR, Block AA, Cheng IH, Wahidi S, Meadows GN. A cross-sectional survey of the mental health needs of refugees and asylum seekers attending a refugee health clinic: a study protocol for using research to inform local service delivery. BMC Psychiatry 2014; 14:356. [PMID: 25539842 PMCID: PMC4296526 DOI: 10.1186/s12888-014-0356-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/10/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers have high rates of risk factors for mental disorders. In recent years, Australia has experienced a rapid increase in asylum seeker arrivals, creating new challenges for services in areas with high settlement numbers. This paper describes the design, including analytic framework, of a project set in a refugee health service in the state of Victoria, Australia, as part of their response to meeting the mental health needs of their burgeoning local population of refugees and asylum seekers. In order to assist service planning, the primary aim of this study is to determine: 1) an overall estimate of the prevalence of psychiatric disorders; 2) the specific prevalence of post-traumatic stress disorder 3) the perceived need and unmet need for mental health treatment. The secondary aim of the study is to establish matched risk ratios based on an Australian-born matched comparison group from the 2007 National Survey of Mental Health and Well-Being. METHODS/DESIGN A cross-sectional survey is used to estimate the prevalence of psychiatric disorders in refugees and asylum seekers attending a local refugee health service. Measures include the Kessler Psychological Distress Scale-10, the Post-Traumatic Stress Disorder-8, the General-practice User's Perceived-need Inventory together with service utilisation questions from the National Survey of Mental Health and Well-Being. Data collected from refugees and asylum seekers (n = 130) is matched to existing data from Australian-born residents drawn from the 2007 National Survey of Mental Health and Well-Being (n = 520) to produce estimates of the risk ratio. DISCUSSION The paper describes a prototype for what is possible within regular services seeking to plan for and deliver high quality mental health care to refugees and asylum seekers. A novel project output will be the development and dissemination of an epidemiological methodology to reliably compare mental health status in a relatively small target sample with a matched comparator group.
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Affiliation(s)
- Frances Shawyer
- Department of Psychiatry, Monash University, Clayton, VIC, 3800, Australia.
| | - Joanne C Enticott
- Department of Psychiatry, Monash University, Clayton, VIC, 3800, Australia. .,Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, VIC, 3800, Australia.
| | - Anne R Doherty
- Mental Health Program, Monash Health, Dandenong, VIC, 3075, Australia.
| | - Andrew A Block
- General Medicine Program and Refugee Health, Monash Health, Dandenong, VIC, 3175, Australia. .,Department of Medicine, Monash University, Clayton, VIC, 3800, Australia.
| | - I-Hao Cheng
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, VIC, 3800, Australia.
| | - Sayed Wahidi
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, VIC, 3800, Australia.
| | - Graham N Meadows
- Department of Psychiatry, Monash University, Clayton, VIC, 3800, Australia. .,Mental Health Program, Monash Health, Dandenong, VIC, 3075, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia.
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Alemi Q, James S, Cruz R, Zepeda V, Racadio M. Psychological distress in afghan refugees: a mixed-method systematic review. J Immigr Minor Health 2014; 16:1247-61. [PMID: 23784146 PMCID: PMC3912229 DOI: 10.1007/s10903-013-9861-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mental health problems disproportionately affect Afghan refugees and asylum seekers who continue to seek international protection with prolonged exposure to war. We performed a systematic review aimed at synthesizing peer-reviewed literature pertaining to mental health problems among Afghans resettled in industrialized nations. We used five databases to identify studies published between 1979 and 2013 that provided data on distress levels, and subjective experiences with distress. Seventeen studies met our inclusion criteria consisting of 1 mixed-method, 7 qualitative, and 9 quantitative studies. Themes from our qualitative synthesis described antecedents for distress being rooted in cultural conflicts and loss, and also described unique coping mechanisms. Quantitative findings indicated moderate to high prevalence of depressive and posttraumatic symptomatology. These findings support the need for continued mental health research with Afghans that accounts for: distress among newly resettled groups, professional help-seeking utilization patterns, and also culturally relevant strategies for mitigating distress and engaging Afghans in research.
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Affiliation(s)
- Qais Alemi
- Department of Social Work and Social Ecology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA,
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van Melle MA, Lamkaddem M, Stuiver MM, Gerritsen AAM, Devillé WLJM, Essink-Bot ML. Quality of primary care for resettled refugees in the Netherlands with chronic mental and physical health problems: a cross-sectional analysis of medical records and interview data. BMC FAMILY PRACTICE 2014; 15:160. [PMID: 25249345 PMCID: PMC4262989 DOI: 10.1186/1471-2296-15-160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/19/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND A high prevalence of mental and physical ill health among refugees resettled in the Netherlands has been reported. With this study we aim to assess the quality of primary healthcare for resettled refugees in the Netherlands with chronic mental and non-communicable health problems, we examined: a) general practitioners' (GP) recognition of common mental disorders (CMD) (depression and anxiety, and post-traumatic stress disorder (PTSD) symptoms); b) patients' awareness of diabetes type II (DMII) and hypertension (HT); and c) GPs' adherence to guidelines for CMD, DMII and HT. METHODS From 172 refugees resettled in the Netherlands, interview data (2010-2011) and medical records (n = 106), were examined. Inclusion was based on medical record diagnoses for DMII and HT, and on questionnaire-based CMD measures (Hopkins Symptom Checklist for depression and anxiety; Harvard Trauma Questionnaire for PTSD). GP recognition of CMD was calculated as the number of CMD cases registered in the medical record compared with those found in interviews. Patient awareness of HT and DMII was scored as the percentage of subjects diagnosed by the GP who reported their condition during the interview. GPs' adherence to guidelines for CMD, DMII and HT was measured using established indicators. RESULTS We identified 37 resettled refugees with CMD of which 18 (49%) had been recognised by the GP. We identified 16 refugees with DMII and 14 with HT from the medical record; 24 (80%) were aware of their condition. Thirty-five out of these 53 (66%) resettled refugees with chronic mental and non-communicable disorders received guideline-adherent treatment. CONCLUSION This study shows that awareness in resettled refugees of GP diagnosed DMII and HT is high, whereas GP recognition of CMD and overall guideline adherence are moderate.
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Affiliation(s)
- Marije A van Melle
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Lamkaddem M, Stronks K, Devillé WD, Olff M, Gerritsen AAM, Essink-Bot ML. Course of post-traumatic stress disorder and health care utilisation among resettled refugees in the Netherlands. BMC Psychiatry 2014; 14:90. [PMID: 24670251 PMCID: PMC3986925 DOI: 10.1186/1471-244x-14-90] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 03/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a major health problem among refugees worldwide. After resettlement, the prevalence of PTSD remains high despite the fact that various PTSD treatments are known to be effective. METHODS We examined the course of PTSD and the role of mental health care utilisation at a 7-year interval (2003-2010) among a cohort of refugees from Iran, Afghanistan, and Somalia after resettlement in the Netherlands. RESULTS The unchanged high prevalence of PTSD (16.3% in 2003 and 15.2% in 2010) was attributable in part to late onset of PTSD symptoms (half of the respondents with PTSD at T2 were new cases for whom PTSD developed after 2003). The second reason concerned the low use of mental health care services at T1. Whereas the multivariate analyses showed the effectiveness of mental health care, only 21% of respondents with PTSD at T1 had had contact with a mental health care provider at that time. Use of mental health care during the first wave increased the odds of improvement in PTSD symptoms between both measurements (OR 7.58, 95% CI 1.01; 56.85). CONCLUSIONS The findings of this study suggest there are two possible explanations for the persistently high prevalence of PTSD among refugees. One is the late onset of PTSD and the other is the low utilisation of mental health care. Health care professionals should be aware of these issues, especially given the effectiveness of mental health care for this condition.
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Affiliation(s)
- Majda Lamkaddem
- Department of Public Health, Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands.
| | - Karien Stronks
- Department of Public Health, Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Walter D Devillé
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands,Medical Anthropology and Sociology Unit, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands,Pharos, Utrecht, the Netherlands
| | - Miranda Olff
- Center for Psychological Trauma, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands & Arq Psychotrauma Expert Group, Diemen, the Netherlands
| | | | - Marie-Louise Essink-Bot
- Department of Public Health, Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
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Higginbottom GMA, Rivers K, Story R. Health and social care needs of Somali refugees with visual impairment (VIP) living in the United Kingdom: a focused ethnography with Somali people with VIP, their caregivers, service providers, and members of the Horn of Africa Blind Society. J Transcult Nurs 2014; 25:192-201. [PMID: 24504070 DOI: 10.1177/1043659613515715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To explore the health and social care needs of Somali refugees with visual impairment (VIP). DESIGN We conducted a three-phased focused ethnography in collaboration with the Horn of Africa Blind Society (HABS) through all stages from research design to findings dissemination. METHOD Engaging in participatory research, HABS members (n = 26), service providers (n = 10), and two Somali community groups (n = 8 and n = 7) whose members were sighted (Phase 1) took part in four focus group interviews. Phases 2 and 3 consisted of interviews with Somali refugees with VIP (n = 32) and their informal carers (n = 5). We used framework data analysis methodology. FINDINGS Four major themes emerged: (1) sociocultural perceptions of blindness and visual impairment, (2) access to services, (3) isolation and insecurity, and (4) mobility. CONCLUSION Somali people with VIP experience profound unmet social and health care needs related largely to social support, awareness of mobility options, and the stigmatization of visual impairment. Appropriate community outreach may improve access to services and quality of life for Somali people with VIP. Tailored information is needed to increase awareness of mobility and security services. Significant considerations exist when planning discharge from acute care settings to ensure continuity of support.
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Jensen NK, Norredam M, Priebe S, Krasnik A. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark. BMC FAMILY PRACTICE 2013; 14:17. [PMID: 23356401 PMCID: PMC3568406 DOI: 10.1186/1471-2296-14-17] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022]
Abstract
Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.
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Affiliation(s)
- Natasja Koitzsch Jensen
- The Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
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Colucci E, Szwarc J, Minas H, Paxton G, Guerra C. The utilisation of mental health services by children and young people from a refugee background: a systematic literature review. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/17542863.2012.713371] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kim HH, Lee YJ, Kim HK, Kim JE, Kim SJ, Bae SM, Cho SJ. Prevalence and correlates of psychiatric symptoms in north korean defectors. Psychiatry Investig 2011; 8:179-85. [PMID: 21994503 PMCID: PMC3182381 DOI: 10.4306/pi.2011.8.3.179] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 03/03/2011] [Accepted: 03/11/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of the present study is to assess the prevalence of psychiatric symptoms and associated factors in North Korean Defectors (NKDs). METHODS One hundred forty-four NKDs (male: 20; female: 124; average age: 40.4±11.7 yrs.) completed the Symptom Checklist-90-Revised (SCL-90-R) and the Center for Epidemiologic Studies Depression scale (CES-D). A stepwise logistic regression analysis was conducted to evaluate factors associated with the psychiatric symptoms of the participants. RESULTS NKDs mainly reported somatization (42.4%) and depressive symptoms (38.9%). Female NKDs showed higher prevalence of somatization (p=0.001), anxiety (p=0.020), hostility (p=0.026) and psychoticism (p=0.022) than males. The presence of physical illness was strongly related to most psychiatric symptoms on the SCL-90-R including somatization (p<0.001), obsessive-compulsive symptoms (p=0.020), interpersonal sensitivity (p=0.031), depression (p<0.001), anxiety (p<0.001), hostility (p=0.011), paranoid ideation (p=0.015) and psychoticism (p<0.001). Younger age, unemployment, lower income, and longer duration of defection were found to be the risk factors of psychiatric symptoms. In regard to mental health service utilization, we found that most (83.3%) of the participants had not received any form of psychiatric help. CONCLUSION Somatization and depression were the most prevalent psychiatric symptoms in NKDs. Our results suggest that psychiatric symptoms accompany certain sociodemographic and clinical characteristics that are associated with susceptibility to acculturation stressors. An understanding of these factors will be helpful providing appropriate mental health services to NKDs.
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Affiliation(s)
- Hyo Hyun Kim
- Gachon University of Medicine and Science, Incheon, Korea
| | - Yu Jin Lee
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, Korea
- Incheon Metropolitan Mental Health Center, Incheon, Korea
| | - Ha Kyoung Kim
- Department of Mental Health, Seoul National Hospital, Seoul, Korea
| | - Jung Eun Kim
- Incheon Metropolitan Mental Health Center, Incheon, Korea
| | - Seog Ju Kim
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, Korea
| | - Seung-Min Bae
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, Korea
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Pfeiffer A, Elbert T. PTSD, depression and anxiety among former abductees in Northern Uganda. Confl Health 2011; 5:14. [PMID: 21871069 PMCID: PMC3171296 DOI: 10.1186/1752-1505-5-14] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 08/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The population in Northern Uganda has been exposed to extreme levels of traumatic stress and thousands abducted forcibly became rebel combatants. METHODS Using structured interviews, the prevalence and severity of posttraumatic stress disorder (PTSD), depression and anxiety was assessed in 72 former abducted adults, 62 of them being former child soldiers. RESULTS As retrospective reports of exposure to traumatic stress increased, anxiety and PTSD occurrence increased (r = .45). 49% of respondents were diagnosed with PTSD, 70% presented with symptoms of depression, and 59% with those of anxiety. In a multiple linear regression analysis four factors could best explain the development of PTSD symptoms: male respondents (sex) living in an IDP-Camp (location) with a kinship murdered in the war (family members killed in the war) and having experienced a high number of traumatic events (number of traumatic events) were more likely to develop symptoms of PTSD than others. In disagreement to a simple dose-response-effect though, we also observed a negative correlation between the time spent with the rebels and the PTSD symptom level. CONCLUSIONS Former abductees continue to suffer from severe mental ill-health. Adaptation to the living condition of rebels, however, may lower trauma-related mental suffering.
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Affiliation(s)
- Anett Pfeiffer
- Department of Psychology, University of Konstanz, Box D23, 78457 Konstanz, Germany.
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Correa-Velez I, Barnett AG, Gifford SM, Sackey D. Health status and use of health services among recently arrived men with refugee backgrounds: a comparative analysis of urban and regional settlement in South-east Queensland. Aust J Prim Health 2011; 17:66-71. [DOI: 10.1071/py10051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 12/14/2010] [Indexed: 11/23/2022]
Abstract
Approximately one-third of refugee and humanitarian entrants to Australia are adult men. Many of these men and their families settle in regional areas. Little is known about the health status of refugee men and the use of health services, and whether or not there are differences between those living in urban and regional areas. This paper reports on the cross-sectional differences in health status and use of health services among a group of 233 recently arrived refugee men living in urban and regional areas of South-east Queensland. Overall, participants reported good levels of subjective health status, moderate to good levels of well-being, and low prevalence of mental illness. Men living in urban areas were more likely to have a long-standing illness and report poorer health status than those settled in regional areas. In contrast, men living in regional areas reported poorer levels of well-being in the environment domain and were more likely to visit hospital emergency departments. Targeted health promotion programs will ensure that refugee men remain healthy and develop their full potential as members of the Australian community. Programs that facilitate refugees’ access to primary health care in regional areas may promote more appropriate use of hospital emergency departments by these communities.
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Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cogn Behav Ther 2010; 39:81-91. [PMID: 19816834 DOI: 10.1080/16506070903121042] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Rates of posttraumatic stress disorder (PTSD) are exceptionally high among asylum-seekers. Reportedly, stressors caused by the asylum procedure and psychological consequences of torture contribute to the maintenance of symptoms and interfere with treatment. In a pilot randomized controlled trial, the authors examined the efficacy of trauma-focused treatment in 32 asylum-seekers with PTSD resulting from state-sponsored violence and other traumatic events. Narrative exposure therapy (NET) was compared with treatment as usual (TAU), with a focus on stabilization and psychoactive medication. Six months after treatment, a significant reduction of posttraumatic stress symptoms was found in the NET participants but not in the TAU group. Although treatment gains were moderate, these results indicate that NET is a promising approach for the treatment of PTSD in asylum-seekers living in unstable conditions.
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Fassaert T, Hesselink AE, Verhoeff AP. Acculturation and use of health care services by Turkish and Moroccan migrants: a cross-sectional population-based study. BMC Public Health 2009; 9:332. [PMID: 19744326 PMCID: PMC2749828 DOI: 10.1186/1471-2458-9-332] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 09/10/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is insufficient empirical evidence which shows if and how there is an interrelation between acculturation and health care utilisation. The present study seeks to establish this evidence within first generation Turkish and Moroccan migrants, two of the largest migrant groups in present-day Western Europe. METHODS Data were derived from the Amsterdam Health Monitor 2004, and were complete for 358 Turkish and 288 Moroccan foreign-born migrants. Use of health services (general practitioner, outpatient specialist and health care for mental health problems) was measured by means of self-report. Acculturation was measured by a structured questionnaire grading (i) ethnic self-identification, (ii) social interaction with ethnic Dutch, (iii) communication in Dutch within one's private social network, (iv) emancipation, and (v) cultural orientation towards the public domain. RESULTS Acculturation was hardly associated with the use of general practitioner care. However, in case of higher adaptation to the host culture there was less uptake of outpatient specialist care among Turkish respondents (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.82-0.99) and Moroccan male respondents (OR = 0.81, 95% CI = 0.71-0.93). Conversely, there was a higher uptake of mental health care among Turkish men (OR = 0.81, 95% CI = 0.71-0.93) and women (OR = 0.81, 95% CI = 0.71-0.93). Uptake of mental health care among Moroccan respondents again appeared lower (OR = 0.74, 95% CI = 0.55-0.99). Language ability appeared to play a central role in the uptake of health care. CONCLUSION Some results were in accordance with the popular view that an increased participation in the host society is concomitant to an increased use of health services. However, there was heterogeneity across ethnic and gender groups, and across the domains of acculturation. Language ability appeared to play a central role. Further research needs to explore this heterogeneity into more detail. Also, other cultural and/or contextual aspects that influence the use of health services require further identification.
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Affiliation(s)
- Thijs Fassaert
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
- Department of Social Medicine, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Arlette E Hesselink
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
| | - Arnoud P Verhoeff
- Department of Epidemiology, Documentation and Health Promotion, Amsterdam Municipal Health Service, Amsterdam, the Netherlands
- Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, the Netherlands
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Toar M, O'Brien KK, Fahey T. Comparison of self-reported health & healthcare utilisation between asylum seekers and refugees: an observational study. BMC Public Health 2009; 9:214. [PMID: 19566954 PMCID: PMC2711949 DOI: 10.1186/1471-2458-9-214] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 06/30/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD), depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. METHODS Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60) and refugees (n = 28) from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36), presence of PTSD symptoms and anxiety/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. RESULTS Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2-17.9) and depression/anxiety (OR 5.8, 95% CI: 2.2-15.4), while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3-12.7; OR 3.4, 95% CI: 1.2-10.1), high levels of pre migration stressors (OR 3.6, 95% CI: 1.1-11.9; OR 3.3, 95% CI: 1.0-10.4) or post migration stressors (OR 17.3, 95% CI: 4.9-60.8; OR 3.9, 95% CI: 1.2-12.3) were independent predictors of self reported PTSD or depression/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (chi2 = 19.74, df = 1, P < 0.001).In terms of health care utilisation, asylum seekers use GP services more often than refugees, while no significant difference was found between these groups for use of dentists, medication, hospitalisation or mental health services. CONCLUSION Asylum seekers have a higher level of self reported PTSD and depression/anxiety symptoms compared to refugees. However, residence status appears to act as a marker for post migration stressors. Compared to refugees, asylum seekers utilise GP services more often, but not mental health services.
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Affiliation(s)
- Magzoub Toar
- Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin 2, Ireland.
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The "lost boys" of Sudan: use of health services and functional health outcomes of unaccompanied refugee minors resettled in the U.S. J Immigr Minor Health 2008; 10:389-96. [PMID: 18071901 DOI: 10.1007/s10903-007-9110-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To assess whether mental health counseling and other health services were associated with functional health outcomes of unaccompanied Sudanese refugee minors in the U.S., this study was a descriptive survey of 304 Sudanese refugee minors in foster care through the U.S. Unaccompanied Refugee Minors Program (URMP). Functional health outcomes included scores of Child Health Questionnaire (CHQ) scales and questions regarding care for symptoms or problems associated with behavioral disorders, i.e. somatization. Posttraumatic stress disorder (PTSD) was assessed using the Harvard Trauma Questionnaire (HTQ). Health services questions derived from the National Health Interview Survey. Minors reported high rates of counseling (45%); however no differences were noted in counseling use by those with PTSD compared with others. Counseling was not associated with health outcomes. The majority (76%) reported seeking medical care for symptoms or problems often associated with behavioral and emotional problems; however such care-seeking was more common among those with PTSD (OR = 2.5, 95% CI = 1.004-6.26). Through the efforts of the URMP, the Sudanese unaccompanied minors received high levels of psychosocial support despite the absence of their biological parents. Those with worse functional health were no more likely than others to have received mental health counseling while being more likely to seek care from any health professional. This was also the case for those with PTSD compared to those without it. In linear regression analyses, reported receipt of mental health counseling did not impact either positively or negatively on the score of any CHQ scale.
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Gerritsen AAM, Bramsen I, Devillé W, van Willigen LHM, Hovens JE, van der Ploeg HM. Use of health care services by Afghan, Iranian, and Somali refugees and asylum seekers living in The Netherlands. Eur J Public Health 2006; 16:394-9. [PMID: 16672251 DOI: 10.1093/eurpub/ckl046] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although asylum seekers have been coming to The Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants, or on the refugees who have resettled in this country. The objective of this study is to estimate the use of health care services by refugees and asylum seekers and to identify determinants for this utilisation. METHODS A population-based study was conducted in The Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran, and Somalia. A total of 178 refugees and 232 asylum seekers, living in 3 municipalities and 14 reception centres, participated. RESULTS This study showed that there are no differences between refugees and asylum seekers in the self-reported use of health care services. Respondents from Somalia reported less contacts with a general practitioner, less use of mental health services, and less medication use than respondents from Afghanistan and Iran. Both female gender and older age were related to more contacts with a general practitioner and a medical specialist, and with higher medication use. Poor general health was related to more contacts with a medical specialist and mental health services, and with higher medication use. CONCLUSION Asylum seekers and refugees seem to have equal access to the Dutch health care system in general. However, there are differences in the self-reported use of health care services by the different ethnic groups.
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Affiliation(s)
- Annette A M Gerritsen
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands.
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Gerritsen AAM, Bramsen I, Devillé W, van Willigen LHM, Hovens JE, van der Ploeg HM. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 2006; 41:18-26. [PMID: 16341619 DOI: 10.1007/s00127-005-0003-5] [Citation(s) in RCA: 239] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2005] [Indexed: 11/29/2022]
Abstract
CONTEXT Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country. OBJECTIVES The objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints. DESIGN, SETTING, AND PARTICIPANTS A population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively). MAIN OUTCOME MEASURES General health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25. RESULTS More asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms. CONCLUSIONS Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.
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Affiliation(s)
- Annette A M Gerritsen
- Dept. of Medical Psychology, VU University Medical Centre, Van der Boechorststraat 7, Room D433, 1081 BT, Amsterdam, The Netherlands.
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