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Nguyen TP, Slewa-Younan S, Rioseco P. Trajectories of psychological distress and social integration in newly resettled refugees: findings from the Building a New Life in Australia longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1425-1435. [PMID: 37393205 PMCID: PMC11291576 DOI: 10.1007/s00127-023-02528-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Refugees are at greater risk of mental illness due to stressors encountered post-resettlement. However, few longitudinal studies have examined the within-person effects of these stressors, especially with respect to social integration. This study aims to examine what factors are associated with psychological distress in a longitudinal sample of refugees resettled in Australia. METHODS This study used data from three Waves of the Building a New Life in Australia study, collected between 2013 and 2018. The eligible sample included 1881 adult respondents, clustered in 1175 households. We conducted multilevel mixed-effects growth modelling incorporating time-variant and time-invariant covariates with psychological distress, using the Kessler Psychological Distress Scale (K6). RESULTS Rates of high psychological distress increased across the 5-year follow-up period. Social integration stressors (e.g. discrimination, lower sense of belonging, loneliness, lower English proficiency) were associated with higher levels of psychological distress over time. Refugees reporting loneliness not only had a greater risk of elevated psychological distress at each time point, but the difference in risk increased over each time point. Refugees who were exposed to traumatic events, older, female and of Middle Eastern background were also more likely to report higher levels of psychological distress over time. CONCLUSIONS These findings highlight the importance of identifying refugees who may encounter difficulties with social integration in the early years of resettlement. Newly arrived refugees may benefit from longer-term resettlement programmes that address post-migratory stressors, particularly with regards to loneliness, to reduce the prevalence of elevated psychological distress during the early years of resettlement.
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Affiliation(s)
- Thomas P Nguyen
- Mental Health, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South DC, Sydney, NSW, 1797, Australia.
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
- School of Psychiatry, Academic Unit of Child Psychiatry South West Sydney, University of New South Wales, Sydney, NSW, Australia.
| | - Shameran Slewa-Younan
- Mental Health, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South DC, Sydney, NSW, 1797, Australia
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Pilar Rioseco
- Australian Institute of Family Studies, Melbourne, VIC, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
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2
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Power E, McCarthy N, Kelly I, Cannon M, Cotter D. Climate change and mental health: time for action and advocacy. Ir J Psychol Med 2023; 40:6-8. [PMID: 35067251 DOI: 10.1017/ipm.2021.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Climate change poses an existential threat to our planet and our health. We explore the intersections of climate change and mental health which has been under-recognised to date. Climate change can affect mental health directly through the effects of extreme weather events such as heat, drought and flooding, and indirectly through increasing rates of migration and inequality. Vulnerable individuals with neuropsychiatric disorders will be particularly at risk. Emerging evidence is also showing effects of air pollution on brain development. Mitigation efforts related to reducing carbon emissions will have both direct and indirect effects on mental health. A further consideration demonstrated by the COVID-19 pandemic is that the spread of infectious disease can have substantial effects on the mental health of the population. With climate change and biodiversity loss, pandemics could recur in the future with increasing frequency. It is now essential that mental health professionals be equipped as agents for climate action.
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Affiliation(s)
- Emmet Power
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh McCarthy
- Psychiatry of Later Life Services, St. Camillus Hospital, Limerick, Ireland
| | - Ina Kelly
- Department of Public Health, HSE Midlands, Central Office, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - David Cotter
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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3
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Potter F, Dohrmann K, Rockstroh B, Schauer M, Crombach A. The impact of experiencing severe physical abuse in childhood on adolescent refugees' emotional distress and integration during the COVID-19 pandemic. Front Psychol 2022; 13:1023252. [PMID: 36506980 PMCID: PMC9729708 DOI: 10.3389/fpsyg.2022.1023252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Accumulating evidence highlights the importance of pre- and post- migration stressors on refugees' mental health and integration. In addition to migration-associated stressors, experiences earlier in life such as physical abuse in childhood as well as current life stress as produced by the COVID-19-pandemic may impair mental health and successful integration - yet evidence on these further risks is still limited. The present study explicitly focused on the impact of severe physical abuse in childhood during the COVID-19 pandemic and evaluated the impact of these additional stressors on emotional distress and integration of refugees in Germany. Methods The sample included 80 refugees, 88.8% male, mean age 19.7 years. In a semi-structured interview, trained psychologists screened for emotional distress, using the Refugee Health Screener, and integration status, using the Integration Index. The experience of severe physical abuse in childhood was quantified as a yes/no response to the question: "Have you been hit so badly before the age of 15 that you had to go to hospital or needed medical attention?" Multiple hierarchical regression analyses further included gender, age, residence status, months since the start of the COVID-19 pandemic and length of stay in Germany to predict emotional distress and integration. Results Two regression analyses determined significant predictors of (1) emotional distress (adjusted R 2 = 0.23): duration of being in the pandemic (ß = 0.38, p < 0.001) and severe physical abuse in childhood (ß = 0.31, p = 0.005), and significant predictors of (2) integration (adjusted R 2 = 0.53): length of stay in Germany (ß = 0.62, p < 0.001), severe physical abuse in childhood (ß = 0.21, p = 0.019) and emotional distress (ß = -0.28, p = 0.002). Conclusion In addition to migration-associated stressors, severe physical abuse in childhood constitutes a pre-migration risk, which crucially affects the well-being, emotional distress and integration of refugees in Germany.
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Affiliation(s)
- Flurina Potter
- Department of Psychology, University of Konstanz, Konstanz, Germany,*Correspondence: Flurina Potter,
| | - Katalin Dohrmann
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | - Maggie Schauer
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Anselm Crombach
- Department of Psychology, University of Konstanz, Konstanz, Germany,Department of Psychology, University of Saarbrücken, Saarbrücken, Germany
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Bird C, Bowers G, Piwowarczyk L, Ng LC. Demographic characteristics, torture experiences, and posttraumatic stress disorder symptoms among asylum seekers and refugees persecuted for same-sex behaviors. J Trauma Stress 2022; 35:1167-1176. [PMID: 35315140 DOI: 10.1002/jts.22827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/30/2021] [Accepted: 01/29/2022] [Indexed: 11/07/2022]
Abstract
Increasingly, lesbian, gay, and bisexual (LGB) individuals are fleeing the 67 countries that criminalize consensual same-sex intimate relationships, seeking asylum in countries such as the United States. Minority stress theory posits that compared with non-LGB refugees and asylum seekers (RAS), LGB RAS are likely to face persecution, rejection, and discrimination and have a higher risk of experiencing posttraumatic stress disorder (PTSD) symptoms. This study assessed differences in sociodemographic characteristics, persecution experiences, and mental health outcomes among 959 RAS persecuted for same-sex behavior (pLGB RAS) who presented for care and social services at the Boston Center for Refugee Health and Human Rights. Data were derived from intake interviews with RAS clients that elicited torture experiences and assessed PTSD symptoms using the Short Screening Scale for PTSD. Over 11% of the total sample were pLGB RAS. Compared with non-pLGB RAS, pLGB RAS reported higher PTSD symptom levels, β = .08, p = .031; more difficulty loving others, d = 0.13, p < .001; and feeling more isolated, d = 0.10, p = .005. pLGB RAS reported more persecution, d = 0.31, p = .002; physical assaults, d = 0.22, p = .029; and psychological assaults, d = 0.20, p = .047; and were more likely to be asylum seekers, d = 0.11, p = .001, and have experienced persecution in Uganda, d = 0.39, p < .001, and other countries that criminalize same-sex acts, d = 0.26, p < .001. More research is needed to understand clinical outcomes and implications of treatment for this population.
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Affiliation(s)
- Christine Bird
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Gray Bowers
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Lin Piwowarczyk
- Department of Psychiatry, Boston Center for Refugee Health and Human Rights, Boston Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren C Ng
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
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Ahmadinia H, Eriksson-Backa K, Nikou S. Health information seeking behaviour during exceptional times: A case study of Persian-speaking minorities in Finland. LIBRARY & INFORMATION SCIENCE RESEARCH 2022. [DOI: 10.1016/j.lisr.2022.101156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nowak AC, Namer Y, Hornberg C. Health Care for Refugees in Europe: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031278. [PMID: 35162300 PMCID: PMC8834962 DOI: 10.3390/ijerph19031278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 12/31/2022]
Abstract
Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. Methods: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. Results: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. Conclusions: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.
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Affiliation(s)
- Anna Christina Nowak
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
- Correspondence:
| | - Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany;
| | - Claudia Hornberg
- Department of Sustainable Environmental Health Sciences, Faculty of Medicine, Bielefeld University, 33615 Bielefeld, Germany;
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Nguyen TP, Guajardo MGU, Sahle BW, Renzaho AMN, Slewa-Younan S. Prevalence of common mental disorders in adult Syrian refugees resettled in high income Western countries: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:15. [PMID: 34986827 PMCID: PMC8729124 DOI: 10.1186/s12888-021-03664-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. METHODS Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. RESULTS Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. CONCLUSIONS Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population.
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Affiliation(s)
- Thomas P Nguyen
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Berhe W Sahle
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, Victoria, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andre M N Renzaho
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Shameran Slewa-Younan
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia.
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
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Abstract
This present study concerns refugees and asylum seekers who have been referred to a Mobile Mental Health Unit (MMHU-Ch) in rural Greece on a Northeast Aegean Island during the refugee crisis in 2015. Our objective is the examination and recording of psychopathology characteristics’, the presentation of the therapeutic interventions provided, and the difficulties. The sample is composed of 418 requests made by refugees, asylum seekers, adults, and children. The clinical and demographic data have been gathered from the MMHU-Ch’s charts. The study is retrospective, descriptive with quantitative and categorical variables. The data has been analyzed with the utilization of SPSS. The dominant diagnosis in children involves anxiety disorders, developmental disorders, and PTSD. One noteworthy finding is the high percentage of suicide behavior regardless of psychiatric diagnosis, which should be further examined. As far as interventions are concerned, the conclusions which have arisen are the gradually stronger commitment of the referents, but also the high percentage of requests that dropped out. Further examination of the interventions and their efficiency is recommended as well as probing the features of psychopathology in the long term with a view to clarifying the patronizing and aggravating factors.
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Nyanchoga MM, Lee P, Barbery G. Exploring electronic health records to estimate the extent of catch-up immunisation and factors associated with under-immunisation among refugees and asylum seekers in south east Queensland. Vaccine 2021; 39:6238-6244. [PMID: 34556368 DOI: 10.1016/j.vaccine.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/21/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Australia is one of the leading countries resettling people from refugee-like backgrounds. Catch-up immunisation is a key priority in this cohort. However, few studies have included asylum seekers and the adult age group in their study sample. In addition, Electronic Health Records (EHR) has recently been recognised as a vital tool in big data analysis with the capacity to contribute to informed strategic decision making. As such, the main aim of this study is to explore EHR routinely used in a specialised refugee clinic in South East Queensland to estimate the extent of catch-up immunisation and assess the factors associated with under-immunisation among refugees and asylum seekers. METHODS A quantitative study involving a secondary data analysis on a pre-existing dataset was undertaken. Relevant data was extracted from the EHR in the clinic. SPSS was used to perform Statistical data analysis. RESULTS The majority of clients originated from Papua New Guinea, followed by Iran and Afghanistan. When assessing the uptake of catch-up immunisations among refugees and asylum seekers, MMR (Measles-Mumps-Rubella), Polio and DTP (Diphtheria-Tetanus-Pertussis) had the highest uptake, while HPV (Human Papilloma Virus), Pneumococcal and Hib (Haemophilus influenza type b) immunisations had the lowest uptake. Binary logistic regression revealed that the younger patients, the refugees (compared to asylum seekers) and those with a longer residential duration in Australia are at a higher risk of being under-immunised. CONCLUSION This study indicates that the broader group of immigrants, and in particular refugees and asylum seekers, do not represent a homogenous group in terms of immunisation coverage, and that each cohort should be carefully considered during immunisation interventions and strategies. This will be particularly important during targeted health promotions and future immunisation programs in this cohort.
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Affiliation(s)
| | - Patricia Lee
- Senior Lecturer, School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Gaery Barbery
- Lecturer, Health Services Management, School of Medicine, Griffith University, South Bank, QLD 4101, Australia.
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Pudpong N, Kosiyaporn H, Phaiyarom M, Kunpeuk W, Sinam P, Julchoo S, Suphanchaimat R. Situation of Self-Reported Anxiety and Depression among Urban Refugees and Asylum Seekers in Thailand, 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7269. [PMID: 34299727 PMCID: PMC8307443 DOI: 10.3390/ijerph18147269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Abstract
Academic evidence on the health of urban refugees and asylum seekers (URAS) in Thailand is extremely sparse, especially for neglected problems such as mental health disorders. This study aimed to investigate the prevalence of anxiety and depression and factors associated with these problems among URAS in Bangkok. A cross-sectional study was conducted in 2019. The URAS were randomly selected from the roster of the Bangkok Refugee Centre (BRC). A self-administered questionnaire was used and 180 samples were recruited. Descriptive statistics and multivariable logistic regression were used for the analysis. We found a prevalence of 70.0% for anxiety and 39.5% for depression. Compared to Southeast Asia and China, URAS from other regions were 3.4 times (95% CI 1.5-7.5, p < 0.05) and 4.0 times (95% CI 1.1-14.0, p < 0.05) more likely to experience anxiety and depression, respectively. URAS with chronic co-morbidities (OR = 3.4, 95% CI 1.2-9.4, p < 0.05) and being divorced or widowed (OR = 11.1, 95% CI 2.1-57.2, p < 0.05) faced greater odds of depression than those without co-morbidities and being single. Related health authorities should play a proactive role in providing mental healthcare services for URAS, with greater consideration for those of certain nationalities and with chronic diseases.
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Affiliation(s)
- Nareerut Pudpong
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
- Sirindron College of Public Health, Chonburi 20000, Thailand
| | - Hathairat Kosiyaporn
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Mathudara Phaiyarom
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Watinee Kunpeuk
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Pigunkaew Sinam
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Sataporn Julchoo
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
| | - Rapeepong Suphanchaimat
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (H.K.); (M.P.); (W.K.); (P.S.); (S.J.); (R.S.)
- Division of Epidemiology, Department of Disease Control, Nonthaburi 11000, Thailand
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Tortelli A, Simon P, Lehouelleur S, Skurnik N, Richard JR, Baudin G, Ferchiou A, Leboyer M, Schürhoff F, Szöke A. Characteristics associated with the risk of psychosis among immigrants and their descendants in France. Brain Behav 2021; 11:e02096. [PMID: 33835727 PMCID: PMC8119809 DOI: 10.1002/brb3.2096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/11/2021] [Accepted: 02/15/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To explore the sociodemographic characteristics that might explain the increased incidence of psychosis among immigrants and their descendants in France. METHODS Data were collected for all subjects with first contact for psychosis aged between 18 and 64 years, in two catchment areas in the Paris region. Incidence rates (IR) and incidence rate ratios (IRR) were adjusted for gender and age. RESULTS During 805,396 persons-year at risk, we identified 321 cases of first-episode psychosis, of which 129 were immigrants and 78 descendants of immigrants. We found that the geographic origin was associated with the risk of psychosis although generation has little impact. Sub-Saharan African immigrants and their descendants showed the highest risk (IRR = 3.1 and IRR = 2.9, respectively). We observed that living in deprived areas increased the incidence of psychosis (IRR = 1.3, 95CI%: 1.0-1.6), particularly among immigrants (IRR = 1.6; 95% CI: 1.1-2.5). Finally, our study showed that subjects having unstable housing (a proxy for "hard to count population") could inflate the incidence rates among immigrants. CONCLUSION The current study shows that the increased risk of psychosis in groups with an immigration background in France is associated with their origin and highlights the importance of socioeconomic factors in modulating this risk.
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Affiliation(s)
- Andrea Tortelli
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,Pôle GHU Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Paris, France.,Institut Convergences Migrations, Aubervilliers, France
| | - Patrick Simon
- Institut Convergences Migrations, Aubervilliers, France.,Institut National d'Etudes Démographiques, Aubervilliers, France
| | | | - Norbert Skurnik
- Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, Paris, France
| | | | - Grégoire Baudin
- Laboratoire de Psychopathologie et Processus de Santé, Université de Paris, EA 4057, Boulogne-Billancourt, France
| | - Aziz Ferchiou
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,AP-HP, DMU IMPACT, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Marion Leboyer
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,AP-HP, DMU IMPACT, Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Fondation FondaMental, Créteil, France.,UPEC, University Paris-Est, Créteil, France
| | - Franck Schürhoff
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,AP-HP, DMU IMPACT, Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Fondation FondaMental, Créteil, France.,UPEC, University Paris-Est, Créteil, France
| | - Andrei Szöke
- INSERM U955 Translational Neuropsychiatry, Créteil, France.,AP-HP, DMU IMPACT, Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Fondation FondaMental, Créteil, France
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Tengilimoğlu D, Zekioğlu A, Budak F, Eriş H, Younis M. Refugees' Opinions about Healthcare Services: A Case of Turkey. Healthcare (Basel) 2021; 9:healthcare9050490. [PMID: 33919316 PMCID: PMC8143307 DOI: 10.3390/healthcare9050490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Migration is one of the most important social events in human history. In recent years, Turkey hosted a high number of asylum seekers and refugees, primarily because of continuing wars and radical social changes in the Middle East. Methods: Using a random sampling method, Syrian refugees aged 18 and over, who can communicate in Turkish, were reached via personal contact and a total of 714 refugees participated in the study voluntarily. Results: Turkey has mounted with some success and to point out that even though participating refugees in both provinces are young and healthy, almost 50% have bad or worse health status, 61% have chronic diseases, and 55% need regular medication. Participating refugees living in Şanlıurfa stated that ‘Hospitals are very clean and tidy.’ (3.80 ± 0.80). The answers given to the following statements had the highest mean for the participating refugees living in Kilis; ‘Hospitals are clean and tidy.’ (3.22 ± 1.25). Conclusion: Due to financial and human resource deficiencies, there are problems in providing preventive and therapeutic health services, especially to refugees living outside the refugee camps in bad conditions. It is important that refugees are encouraged to apply to family health and community health centers in this context.
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Affiliation(s)
- Dilaver Tengilimoğlu
- Management Department, Faculty of Management, Atilim University, 06530 Ankara, Turkey;
| | - Aysu Zekioğlu
- Health Management Department, Faculty of Health Sciences, Trakya University, 22100 Edirne, Turkey
- Correspondence:
| | - Fatih Budak
- Health Management Department, Faculty of Health Sciences, Kilis 7 Aralık University, 79000 Kilis, Turkey;
| | - Hüseyin Eriş
- Medical Documentation, Vocational School of Health, Harran University, 63000 Şanlıurfa, Turkey;
| | - Mustafa Younis
- College of Health Sciences, Jackson State University, Jackson, MS 39217, USA;
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Saadi A, Hampton K, de Assis MV, Mishori R, Habbach H, Haar RJ. Associations between memory loss and trauma in US asylum seekers: A retrospective review of medico-legal affidavits. PLoS One 2021; 16:e0247033. [PMID: 33755695 PMCID: PMC7987192 DOI: 10.1371/journal.pone.0247033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The U.S. immigration system mandates that persons seeking asylum prove their persecution claim is credible and their fear of returning home is well-founded. However, this population represents a highly trauma-exposed group, with neuropsychiatric symptoms consequent to prior torture or maltreatment that may interfere with cognitive function and their ability to recall their trauma. These memory lapses may be incorrectly perceived by asylum adjudicators as indicators of dishonesty and jeopardize the person's credibility and asylum claim. Our retrospective mixed methods study seeks to present associations between trauma and memory loss in a sample of persons seeking asylum to the U.S. and describe how memory impairments manifest in this trauma-exposed population. METHODS We randomly selected 200 medico-legal affidavits from 1346 affidavits collected in the past 30 years, as part of the Physicians for Human Rights Asylum Network connecting clinicians with legal providers for medical and/or psychiatric affidavits of U.S. asylum seekers and persons seeking other forms of humanitarian relief (hereafter, "asylum seekers"). Data was extracted from these affidavits using a coding manual informed by the Istanbul Protocol, the global standard for torture documentation. Seven affidavits were excluded due to missing age. We used multiple logistic regression to assess the association of memory loss with neuropsychiatric diagnoses: head trauma, post-traumatic stress disorder (PTSD), and depression. We supplemented these findings with a qualitative content analysis of the affidavits documenting memory loss. Memory loss presented among the asylum seekers' affidavits in several ways: memory gaps of the traumatic event; challenges with presenting a clear chronology of the trauma, avoidance of traumatic memories, and persistent short-term memory loss interfering with daily activity. RESULTS A majority of the sample received a neuropsychiatric diagnosis: 69% (n = 132) of asylum-seekers received a diagnosis of PTSD and 55% (n = 106) of depression. Head trauma was reported among 30% (n = 58) of affidavits. Further, 68% (n = 131) reported being subject to physical violence and 20% (n = 39) were documented as being at risk of suicide. Memory loss was documented among 21% (n = 40) asylum-seekers. In adjusted models, both PTSD and depression, but not head trauma, were associated with memory loss (p<0.05). CONCLUSION Stakeholders in the asylum process, spanning the medical, legal and immigration enforcement sectors, must be aware of the interplay of trauma and memory loss and how they might impact immigration proceedings for this vulnerable population.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Kathryn Hampton
- Physicians for Human Rights, New York, New York, United States of America
| | - Maria Vassimon de Assis
- Master of Development Practice Program, University of California at Berkeley, Berkeley, California, United States of America
| | - Ranit Mishori
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, United States of America
| | - Hajar Habbach
- Physicians for Human Rights, New York, New York, United States of America
| | - Rohini J. Haar
- Division of Epidemiology and Biostatistics, School of Public Health, University of California at Berkeley, Berkeley, California, United States of America
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The Effect of Traumatic Experiences of North Korean Adolescent Refugees upon Their Negative Health Perception: Focusing on Multiple Moderating Effect of Problem-Focused versus Social Support-Focused Coping Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249484. [PMID: 33352861 PMCID: PMC7766628 DOI: 10.3390/ijerph17249484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/21/2022]
Abstract
The health problems of North Korean (NK) refugees living a new life after surviving the dangers of life and death traumas is an issue that must be taken very seriously. Adolescent refugees may be particularly vulnerable to adverse physical and mental health issues because of major physical, cognitive, and psychosocial developmental changes during adolescence. This study examines the positive roles two active coping strategies—problem-focused coping and social support-focused coping—can play in NK refugee adolescents’ health self-awareness. The analysis found that “social support-focused coping” alleviates the negative relationship between traumatic experience and health perception, acting as a protective factor. Contrary to our prediction, the protective effect of adopting “problem-focused coping” in this study was not verified. The findings suggest that providing interventions for developing appropriate coping strategies help them live healthier, both physically and mentally, in South Korean society.
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Gleeson C, Frost R, Sherwood L, Shevlin M, Hyland P, Halpin R, Murphy J, Silove D. Post-migration factors and mental health outcomes in asylum-seeking and refugee populations: a systematic review. Eur J Psychotraumatol 2020; 11:1793567. [PMID: 33312450 PMCID: PMC7717836 DOI: 10.1080/20008198.2020.1793567] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/24/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
The present systematic review examined post-migration variables impacting upon mental health outcomes among asylum-seeking and refugee populations in Europe. It focuses on the effects of post-settlement stressors (including length of asylum process and duration of stay, residency status and social integration) and their impact upon post-traumatic stress disorder, anxiety and depression. Twenty-two studies were reviewed in this study. Length of asylum process and duration of stay was found to be the most frequently cited factor for mental health difficulties in 9 out of 22 studies. Contrary to expectation, residency or legal status was posited as a marker for other explanatory variables, including loneliness, discrimination and communication or language problems, rather than being an explanatory variable itself. However, in line with previous findings and as hypothesised in this review, there were statistically significant correlations found between family life, family separation and mental health outcomes.
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Affiliation(s)
- Christina Gleeson
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
| | - Rachel Frost
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
| | - Larissa Sherwood
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
- Centre for Global Health, Trinity College, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
| | - Philip Hyland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Rory Halpin
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
- Department of Rehabilitation, Spiritan Asylum, Services Initiative, Dublin, Ireland
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Collaborative Network for Training and Excellence in Psychotraumatology (CONTEXT), Trinity College, Dublin, Ireland
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Cañardo G, Gálvez J, Jiménez J, Serre N, Molina I, Bocanegra C. Health status of rescued people by the NGO Open Arms in response to the refugee crisis in the Mediterranean Sea. Confl Health 2020; 14:21. [PMID: 32377233 PMCID: PMC7195729 DOI: 10.1186/s13031-020-00275-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background The migration over the Mediterranean has become one of the deadliest sea voyages in last few years. The NGO Open Arms works in the area since 2015, with the objectives of protecting and reporting human rights at sea. This paper aims to give an overview on characteristics and health conditions of rescued people by the NGO in the Central Mediterranean. Methods A descriptive retrospective population study was conducted, including people who were rescued from distress at sea by the NGO Open Arms from 1st July 2016 to 31st December 2018. Results In this period of time 22,234 people were rescued from sea. Among them 2234 (22.7%) were minors, and 177 (0.8%) pregnant women. The most frequent countries of origin were Nigeria (1278-13.1%), Eritrea (1215-12.3%) and Bangladesh (981-9.9%). Among all people rescued, 4516 (20.3%) reported symptoms. Scabies was the most frequent pathology, being suspected in 1817 (8.2%) people. Other infectious diseases were diagnosed in 91 (0.4%). Thirty-five (0.16%) patients suffered some complication from their chronic diseases. Acute injuries due to trauma, burns, aggressions, and bullet or bladed weapon wound were reported in 135 (0.6%) cases. Seventy-four corpses were recovered. Conclusions Main diagnoses on board were directly related to the precarious living conditions through migratory route, violence and complications of chronic diseases due to lack of care. The large number of people rescued highlights the catastrophic effect on migrants' health of European policies, which overlap the desire to restrict migratory movements on the humanitarian and health issues. An integrated information system and a coordinated response are basic to improve the situation in the area.
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Affiliation(s)
| | | | | | - Núria Serre
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes, Barcelona, PROSICS Barcelona Spain
| | - Israel Molina
- 3Infectious Diseases Department, University Hospital Vall d'Hebron, Barcelona, PROSICS Barcelona Spain
| | - Cristina Bocanegra
- Open Arms NGO, Barcelona, Spain.,Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes, Barcelona, PROSICS Barcelona Spain
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Freiberg A, Wienke A, Bauer L, Niedermaier A, Führer A. Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082672. [PMID: 32295091 PMCID: PMC7215588 DOI: 10.3390/ijerph17082672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022]
Abstract
Background: The growing immigration to Germany led to more patients whose medical needs are divergent from those of the domestic population. In the field of dental health care there is a debate about how well the German health system is able to meet the resulting challenges. Data on asylum-seekers' dental health is scarce. This work is intended to reduce this data gap. Methods: We conducted this retrospective observational study in Halle (Saale), Germany. We included all persons who were registered with the social welfare office (SWO) in 2015 and received dental treatments. From the medical records, we derived information such as complaints, diagnoses, and treatments. Results: Out of 4107 asylum-seekers, the SWO received a bill for 568 people. On average, there were 1.44 treatment cases (95%-CI: 1.34-1.55) and 2.53 contacts with the dentist per patient (95%-CI: 2.33-2.74). Among those, the majority went to the dentist because of localized (43.2%, 95%-CI: 38.7-47.7) and non-localized pain (32.0%, 95%-CI: 27.8-36.2). The most widespread diagnosis was caries (n = 469, 98.7%, 95%-CI: 97.7-99.7). Conclusion: The utilization of dental care is lower among asylum-seekers than among regularly insured patients. We assume that the low prevalence rates in our data indicate existing access barriers to the German health care system.
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Hou WK, Liu H, Liang L, Ho J, Kim H, Seong E, Bonanno GA, Hobfoll SE, Hall BJ. Everyday life experiences and mental health among conflict-affected forced migrants: A meta-analysis. J Affect Disord 2020; 264:50-68. [PMID: 31846902 PMCID: PMC7064367 DOI: 10.1016/j.jad.2019.11.165] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/29/2019] [Accepted: 11/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are a growing number of forced migrants worldwide. Early detection of poor adjustment and interventions to facilitate positive adaptation within these communities is a critical global public health priority. A growing literature points to challenges within the post-migration context as key determents of poor mental health. AIMS The current meta-analysis evaluated the association between daily stressors and poor mental health among these populations. METHOD A systematic search in PsycINFO, PubMed, and Web of Science identified relevant studies from inception until the end of 2018. Effect sizes (correlation coefficients) were pooled using Fisher's Z transformation and reported with 95% confidence intervals. Moderator and mediator analyses were conducted. The protocol is available in PROSPERO [CRD42018081207]. RESULTS Analysis of 59 eligible studies (n = 17,763) revealed that daily stressors were associated with higher psychiatric symptoms (Zr=0.126-0.199, 95% CI=0.084-0.168, 0.151-0.247, p<0.001) and general distress (Zr=0.542, 95% CI=0.332-0.752, p<0.001). Stronger effect sizes were observed for mixed daily stressors relative to subjective, interpersonal, and material daily stressors, and for general distress relative to posttraumatic stress symptoms and general well-being. Effect sizes were also stronger for children and adolescents relative to adults. Daily stressors fully mediated the associations of prior trauma with post-migration anxiety, depressive, and post-traumatic stress disorder symptoms. CONCLUSIONS This meta-analysis provides a synthesis of existing research on the role of unfavorable everyday life experiences and their associations with poor mental health among conflict-affected forced migrants. Routine assessment and intervention to reduce daily stressors can prevent and reduce psychiatric morbidity in these populations.
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Affiliation(s)
- Wai Kai Hou
- Laboratory of Psychology and Ecology of Stress (LoPES), Department of Psychology, Centre for Psychosocial Health, The Education University of Hong Kong, Tai Po, NT, Hong Kong, China.
| | - Huinan Liu
- Laboratory of Psychology and Ecology of Stress (LoPES), Department of Psychology, Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Li Liang
- Laboratory of Psychology and Ecology of Stress (LoPES), Department of Psychology, Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Jeffery Ho
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hyojin Kim
- Teachers College, Columbia University, New York NY, USA
| | - Eunice Seong
- Teachers College, Columbia University, New York NY, USA
| | | | | | - Brian J. Hall
- Department of Psychology, University of Macau, Macau SAR, China
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19
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Combes SJB, Simonnot N, Azzedine F, Aznague A, Chauvin P. Self-Perceived Health among Migrants Seen in Médecins du Monde Free Clinics in Europe: Impact of Length of Stay and Wealth of Country of Origin on Migrants' Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244878. [PMID: 31817068 PMCID: PMC6950051 DOI: 10.3390/ijerph16244878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022]
Abstract
Health of migrants is a widely studied topic. It has been argued that migrant health may deteriorate over time. Though migrants are a “hard to reach” population in survey data, this paper builds on a unique dataset provided by Médecins du Monde from five countries. We study self-perceived health (SPH) in connection with socio-economic and demographic factors and length of stay. Results differ for men and women. Compared to other documented migrants, asylum seekers have a 50–70% greater chance of having worse health. Migrants with better living conditions have a 57–78% chance of being in better health. Male migrants with a job have between a 82–116% chance of being in good health. The probability for women from poorer countries to have a better physical SPH after three months of residing in the host country is six-fold that of women from richer countries. This paper contributes widely to the knowledge of health of migrants. Contrary to other evidence, health of women migrants from poorer countries tends to improve with length of stay.
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Affiliation(s)
- Simon Jean-Baptiste Combes
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
- French Collaborative Institute on Migration, 93322 Aubervilliers, France
- Correspondence:
| | - Nathalie Simonnot
- Médecins du Monde–Doctors of the World, International Network, 75018 Paris, France;
| | - Fabienne Azzedine
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
- French Collaborative Institute on Migration, 93322 Aubervilliers, France
| | - Abdessamad Aznague
- Univ Rennes, EHESP, CNRS, ARENES–UMR 6051, 35000 Rennes, France; (F.A.); (A.A.)
| | - Pierre Chauvin
- Department of Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), 75012 Paris, France;
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Bennouna C, Khauli N, Basir M, Allaf C, Wessells M, Stark L. School-based programs for Supporting the mental health and psychosocial wellbeing of adolescent forced migrants in high-income countries: A scoping review. Soc Sci Med 2019; 239:112558. [PMID: 31539785 DOI: 10.1016/j.socscimed.2019.112558] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022]
Abstract
As communities around the world continue to receive record-setting numbers of newcomers fleeing armed conflict, schools play a central role in supporting these families through the challenges of adjustment. Policymakers and educators in several high-income countries have begun to invest in efforts to support these young forced migrants not only academically, but also socially and emotionally. This study reviews the published and grey literature on 20 school-based programs aimed at improving the mental health and psychosocial wellbeing of adolescent forced migrants in high-income countries from 2000 to 2019. This review seeks to inform a more comprehensive and detailed understanding of the types of program options available to schools, while also identifying gaps in the current literature related to factors influencing program implementation. We find several common approaches and challenges to supporting adolescent forced migrants, as well as their families, communities, schools, and service providers. The reviewed programs faced recurring challenges related to intercultural exchange, gaining access to communities, promoting care-seeking, school capacity limitations, and sustainability. The lessons learned from these programs indicate that several steps can be taken to mitigate these challenges, including adapting services to individuals and their contexts, taking a multi-layered approach that addresses multiple levels of young people's social ecologies, and building trusting, collaborative partnerships with schools, communities, and students.
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Affiliation(s)
| | - Nicole Khauli
- Department of Psychiatry, Columbia University Medical Center, USA
| | - Mashal Basir
- Mailman School of Public Health, Columbia University, USA
| | | | | | - Lindsay Stark
- Brown School at Washington University in St. Louis, USA.
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21
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Santos G, Soares C, Rebelo R, Ferreira P. Mental health and undocumented migrants in Portugal. JOURNAL OF PUBLIC MENTAL HEALTH 2018. [DOI: 10.1108/jpmh-11-2017-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Gustavo Santos
- North Delegation, Doctors of the World, Porto, Portugal
- Psychiatry Department, Hospital de Magalhaes Lemos EPE, Porto, Portugal
| | - Célia Soares
- North Delegation, Doctors of the World, Porto, Portugal
- Psychiatry Department, Hospital de Braga, Braga, Portugal
| | - Raquel Rebelo
- North Delegation, Doctors of the World, Porto, Portugal
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Schoretsanitis G, Bhugra D, Eisenhardt S, Ricklin ME, Srivastava DS, Exadaktylos A, Walther S. Upon Rejection: Psychiatric Emergencies of Failed Asylum Seekers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071498. [PMID: 30012985 PMCID: PMC6069106 DOI: 10.3390/ijerph15071498] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/06/2018] [Accepted: 07/14/2018] [Indexed: 11/16/2022]
Abstract
Background: The status of a refugee or asylum seeker is only recognised after legal processes. The uncertainty of these procedures or the rejection itself may severely impact mental well-being. Methods: We surveyed the patterns of psychiatric services used by patients whose applications for asylum had been rejected. In a retrospective investigation of admissions to the University Emergency Department in Bern, Switzerland between 1 March 2012 and 28 February 2017, we studied patients receiving a psychiatric consultation after their applications had been rejected. The primary endpoint was based on the comparison of these individuals with controls who were asylum seekers with pending asylum applications using the Mann-Whitney U test and the chi-square test (χ2) with a significance level of 0.05. Results: Thirty-eight cases were identified. There were more men than women and the mean age was 30.08 ± 9.62 years. Patients predominantly presented as walk-in patients (n = 16, 42.1%), most frequently due to suicidal ideation (n = 16, 42.1%). Stress-related disorders were the most common diagnosis (n = 29, 76.3%) and patients were mainly referred to inpatient treatment (n = 28, 73.7%). Patients with rejected applications were less likely to be living in reception centres than patients with a pending application (χ2 = 17.98, p < 0.001). Conclusion: The profile of asylum seekers whose applications had been rejected reflects individuals with high-stress levels, potentially aggravated by the negative asylum decision.
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Affiliation(s)
- Georgios Schoretsanitis
- University Hospital of Psychiatry, 3008 Bern, Switzerland.
- Department of Psychiatry, Psychotherapy and Psychosomatics, and JARA-Translational Brain Medicine, RWTH Aachen University, 52074 Aachen, Germany.
| | - Dinesh Bhugra
- Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
| | | | - Meret E Ricklin
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - David S Srivastava
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
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Schoretsanitis G, Eisenhardt S, Ricklin ME, Srivastava DS, Walther S, Exadaktylos A. Psychiatric Emergencies of Asylum Seekers; Descriptive Analysis and Comparison with Immigrants of Warranted Residence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1300. [PMID: 29933607 PMCID: PMC6068840 DOI: 10.3390/ijerph15071300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022]
Abstract
Background: The aim of our study was to assess utilization patterns of psychiatric services by asylum seekers. Methods: We included 119 adults who presented themselves at the University Emergency Department between 1 March 2012 and 1 January 2017 for psychiatric consultation. Descriptive data were compared with a control group of non-Swiss individuals with warranted residence permits using Mann-Whitney-U and chi square (χ²) tests. Results: Patients were mainly single, male, residing in reception centers, and presented themselves most frequently due to suicidal ideation. Almost 60% of the patients were assigned to inpatient treatments, with 28 involuntary cases. Compared to the control group, asylum seekers were younger and more often men (p < 0.001 for both). Further, they less often had family in Switzerland (χ² = 9.91, p = 0.007). The proportion of patients coming in as walk-ins was significantly higher in the control group than in asylum seekers (χ² = 37.0, p < 0.001). Asylum seekers were more frequently referred due to suicidal ideation and aggressive behavior than participants in the control group (χ² = 80.07, p < 0.001). Diagnoses for asylum seekers infrequently included mood, as they often reported stress-related disorders (χ² = 19.6, p = 0.021) and they were infrequently released home (χ² = 9.19, p = 0.027). Conclusion: Asylum seekers more frequently demonstrated severe symptoms such as suicidal ideation and aggressive behavior and they were mainly treated as inpatients, potentially due to minimal social resources.
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Affiliation(s)
- Georgios Schoretsanitis
- University Hospital of Psychiatry, 3008 Bern, Switzerland.
- Department of Psychiatry, Psychotherapy and Psychosomatics, and JARA⁻Translational Brain Medicine, RWTH Aachen University, 52074 Aachen, Germany.
| | | | - Meret E Ricklin
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - David S Srivastava
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | | | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
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24
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Giacco D, Priebe S. Mental health care for adult refugees in high-income countries. Epidemiol Psychiatr Sci 2018; 27:109-116. [PMID: 29067899 PMCID: PMC6998959 DOI: 10.1017/s2045796017000609] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/24/2017] [Indexed: 01/18/2023] Open
Abstract
Approximately one-third of people who have obtained refugee status live in high-income countries. Over recent years, the number of refugees has been increasing, and there are questions on how many of them need mental health care and which type of interventions are beneficial. Meta-analyses showed highly variable rates of mental disorders in adult refugees. This variability is likely to reflect both real differences between groups and contexts, and methodological inconsistencies across studies. Overall prevalence rates after resettlement are similar to those in host populations. Only post-traumatic stress disorder (PTSD) is more prevalent in refugees. In long-term resettled refugees, rates of anxiety and depressive disorders are higher and linked to poor social integration. Research on mental health care for refugees in high-income countries has been extensive, but often of limited methodological quality and with very context-specific findings. The existing evidence suggests several general principles of good practice: promoting social integration, overcoming barriers to care, facilitating engagement with treatment and, when required, providing specific psychological treatments to deal with traumatic memories. With respect to the treatment of defined disorders, only for the treatment of PTSD there has been substantial refugee-specific research. For other diagnostic categories, the same treatment guidelines apply as to other groups. More systematic research is required to explore how precisely the general principles can be specified and implemented for different groups of refugees and in different societal contexts in host countries, and which specific interventions are beneficial and cost-effective. Such interventions may utilise new communication technologies. Of particular importance are long-term studies to identify when mental health interventions are appropriate and to assess outcomes over several years. Such research would benefit from sufficient funding, wide international collaboration and continuous learning over time and across different refugee groups.
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Affiliation(s)
- D. Giacco
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - S. Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
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25
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Hocking DC, Mancuso SG, Sundram S. Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH. BMC Psychiatry 2018; 18:69. [PMID: 29548315 PMCID: PMC5857116 DOI: 10.1186/s12888-018-1660-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is no screening tool for major depressive disorder (MDD) or post-traumatic stress disorder (PTSD) in asylum-seekers or refugees (ASR) that can be readily administered by non-mental health workers. Hence, we aimed to develop a brief, sensitive and rapidly administrable tool for non-mental health workers to screen for MDD and PTSD in ASR. METHODS The screening tool was developed from an extant dataset (n = 121) of multiply screened ASR and tested prospectively (N = 192) against the M.I.N.I. (Mini International Neuropsychiatric Interview) structured psychiatric interview. Rasch, Differential Item Functioning and ROC analyses evaluated the psychometric properties and tool utility. RESULTS A 9-item tool with a median administration time of six minutes was generated, comprising two 'immediate screen-in' items, and a 7-item scale. The prevalence of PTSD &/or MDD using the M.I.N.I. was 32%, whilst 99% of other diagnosed mental disorders were comorbid with one or both of these. Using a cut-score of ≥2, the tool provided a sensitivity of 0.93, specificity of 0.75 and predictive accuracy of 80.7%. CONCLUSIONS A brief sensitive screening tool with robust psychometric properties that was easy to administer at the agency of first presentation was developed to facilitate mental health referrals for asylum-seekers and new refugees.
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Affiliation(s)
- Debbie C. Hocking
- Cabrini Institute, 154 Wattletree Road, Malvern, VIC 3144 Australia ,0000 0004 0606 5526grid.418025.aFlorey Institute of Neuroscience and Mental Health, 30 Royal Parade (Cnr Genetics Lane), Parkville, VIC 3052 Australia ,0000 0004 1936 7857grid.1002.3Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC 3168 Australia
| | - Serafino G. Mancuso
- 0000 0001 2179 088Xgrid.1008.9Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia
| | - Suresh Sundram
- 0000 0004 0606 5526grid.418025.aFlorey Institute of Neuroscience and Mental Health, 30 Royal Parade (Cnr Genetics Lane), Parkville, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia ,0000 0004 1936 7857grid.1002.3Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC 3168 Australia ,0000 0004 0390 1496grid.416060.5Adult Psychiatry, Monash Medical Centre, Clayton, VIC 3168 Australia
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Cantekin D, Gençöz T. Mental Health of Syrian Asylum Seekers in Turkey: The Role of Pre-Migration and Post-Migration Risk Factors. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2017. [DOI: 10.1521/jscp.2017.36.10.835] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Giacco D, Laxhman N, Priebe S. Prevalence of and risk factors for mental disorders in refugees. Semin Cell Dev Biol 2017; 77:144-152. [PMID: 29174456 DOI: 10.1016/j.semcdb.2017.11.030] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/03/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
Given the increasing numbers of refugees worldwide, the prevalence of their mental disorders is relevant for public health. Prevalence studies show that, in the first years of resettlement, only post-traumatic stress disorder (PTSD) rates are clearly higher in refugees than in host countries' populations. Five years after resettlement rates of depressive and anxiety disorders are also increased. Exposure to traumatic events before or during migration may explain high rates of PTSD. Evidence suggests that poor social integration and difficulties in accessing care contribute to higher rates of mental disorders in the long-term. Policy and research implications are discussed.
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Affiliation(s)
- Domenico Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom.
| | - Neelam Laxhman
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
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The Absent Interpreter in Administrative Detention Center Medical Units. HEALTH CARE ANALYSIS 2017; 25:34-51. [PMID: 25189317 DOI: 10.1007/s10728-014-0285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The particular situation of the French administrative detention center (ADC) medical units appears to be an exemplary case to study the difficulties facing medical practice. Indeed, the starting point of our inquiry was an amazing observation that needed to be addressed and understood: why are professional interpreters so seldom requested in ADC medical units, where one would expect that they would be "naturally" present? Aiming to fully explore the meanings of the "absent interpreter", this article takes into account the possible meanings of this situation: the recourse to professional interpreters in France is far from expected given cumulative evidence of its benefits; perceptions of illegal immigrants and medical habitus itself may both hamper the use of a third party; the ADCs are a very stressful place for healthcare professionals, with conflicting missions, political issues enmeshed with medical goals, and heavy affective burden that may lead to self-protection. Silencing voices of suffering others might be seen as the hidden indecent truth of the "absent interpreter". These reflections open a window to a larger issue with regard to the full range of medicine: what are the place, the role and the function of patient's words and narratives in contemporary medicine? The highly invested somatic perspective and its political corollary giving primacy to bare life harbor potential risks of obscuring speeches and undervaluing narratives.
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Chase LE, Cleveland J, Beatson J, Rousseau C. The gap between entitlement and access to healthcare: An analysis of “candidacy” in the help-seeking trajectories of asylum seekers in Montreal. Soc Sci Med 2017; 182:52-59. [DOI: 10.1016/j.socscimed.2017.03.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
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Tribe RH, Sendt KV, Tracy DK. A systematic review of psychosocial interventions for adult refugees and asylum seekers. J Ment Health 2017; 28:662-676. [PMID: 28485636 DOI: 10.1080/09638237.2017.1322182] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Europe is in the midst of the largest refugee migration since the Second World War; there is an urgent need to provide an updated systematic review of the current best evidence for managing mental distress in refugee populations.Aims: The aim of this review is to provide an exhaustive summary of the current literature on psychosocial interventions, both trauma- and non-trauma-focused, for refugee populations experiencing post-traumatic stress disorder (PTSD), depressive or anxiety symptoms. To produce recommendations for future research and current clinical practice.Method: Searches were conducted in PubMed, PsychINFO (Hosted by Ovid), PILOTS and Social Services Abstracts; 5305 articles were screened and 40 were included.Results: This review found medium to high quality evidence supporting the use of narrative exposure therapy (NET). A lack of culturally adapted treatments was apparent and there was less evidence to support standard cognitive behavioural therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR) and multidisciplinary treatments.Conclusion: NET produced positive outcomes in refugees from a diverse range of backgrounds and trauma types. There is a general dearth of research in all intervention types: further research should include more "real-world" multidisciplinary interventions that better model clinical practice. Recommendations for evaluating local need, and creating a culturally sensitive workforce are discussed.
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Affiliation(s)
- Rachel H Tribe
- Division of Psychology and Language Sciences, University College London, London, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK and
| | - Kyra-Verena Sendt
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK and
| | - Derek K Tracy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK and.,Oxleas NHS Foundation Trust, London, UK
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Impact of Postmigration Living Difficulties on the Mental Health of Afghan Migrants Residing in Istanbul. ACTA ACUST UNITED AC 2016. [DOI: 10.1155/2016/7690697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The sociopolitical situation in Afghanistan continually pushes Afghans to seek safety and better socioeconomic prospects in neighboring and foreign countries. In this paper we examine the mental health of Afghan migrants residing in Istanbul, Turkey, an understudied population at high risk of psychopathology. Methods. We surveyed 158 Afghan migrants to assess psychological distress using a culturally grounded measure of mental health, the Afghan Symptom Checklist [ASCL], and used hierarchical regression analysis to examine the impact of postmigration living difficulties (PMLDs) on mental health. Results. We found that depressive, somatoform, anxiety-like symptoms occurred often, as did a number of culturally salient idioms of distress. Regression analyses showed that while socioeconomic variables and poor physical health status significantly predicted psychological distress, PMLDs exerted the strongest negative effect. The most pressing PMLDs for Afghans in Turkey are poverty, unemployment, lack of treatment for health problems, fears of being deported and related legal challenges, and family-related stressors. Conclusion. Our results point to the importance of the critical need to create culturally sensitive interventions to remediate high levels of psychological distress by addressing related PMLD stressors in a highly vulnerable Afghan migrant population residing in Turkey.
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Heudorf U, Albert-Braun S, Hunfeld KP, Birne FU, Schulze J, Strobel K, Petscheleit K, Kempf VAJ, Brandt C. Multidrug-resistant organisms in refugees: prevalences and impact on infection control in hospitals. GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc16. [PMID: 27579250 PMCID: PMC4987489 DOI: 10.3205/dgkh000276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The refugee crisis is a great challenge to the social and healthcare system in European countries, especially in Germany. An abundance of data has been published on the refugees’ health problems (infections as well as physical diseases and psychiatric problems) and their prevention (i.e., sanitary and vaccination programs). However, data on prevalences of multidrug-resistant organisms (MDRO) in refugees are scarce, although it is known that most refugees are from or travelled through countries with high prevalences of MDRO. This paper presents current data on MDRO colonization of refugees admitted to hospitals, and the impact of screening upon admission and infection control in hospitals is discussed. Methods: Anonymous data obtained by screening upon hospital admission were reported by hospitals in the Rhine-Main region of Germany to the local public health department. Screening and microbiological analyses were performed from December 2015 to March 2016 according to standardized and validated methods. Results: 9.8% of the refugees screened (32/325) exhibited colonization with methicillin-resistant Staphylococcus aureus (MRSA), and 23.3% of the refugees (67/290) were colonized with Gram-negative bacteria with extended spectrum beta-lactamases, and/or enterobacteria with resistance against 3 or 4 groups of antibacterials, so-called 3MRGN (multidrug-resistant Gram-negative bacteria with resistance against penicillins, cephalosporins and quinolones) and 4MRGN (with additional resistance against carbapenems). Carbapenem-resistant Gram-negative bacteria (CRGN) were detected in 2.1% (6/290) of the refugees. Conclusion: The data confirms the studies published between 2014 and 2016, encompassing refugees tested in Germany, the Netherlands and Israel, with prevalences of MRSA and CRGN up to 13.5% and 5.6%. The MDRO prevalences are higher than those of “risk groups” for MRSA, such as hemodialysis patients and patients depending on outpatient home-nursing care or residing in nursing homes. Therefore, screening and special infection control in hospitals is strongly suggested when refugees are admitted to hospitals, in order to ensure best medical practice and safety for all hospital patients regardless of their country of origin.
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Affiliation(s)
- Ursel Heudorf
- Public Health Department, Division of Infectious Diseases and Hygiene, Frankfurt am Main, Germany
| | - Sabine Albert-Braun
- Institute for Laboratory Medicine, Klinikum Frankfurt Höchst, Frankfurt/Main, Germany
| | - Klaus-Peter Hunfeld
- Institute for Laboratory Medicine, Microbiology and Infection Control, Northwest Medical Centre, Frankfurt/Main, Germany
| | | | | | | | | | - Volkhard A J Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Christian Brandt
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany
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Kulla M, Josse F, Stierholz M, Hossfeld B, Lampl L, Helm M. Initial assessment and treatment of refugees in the Mediterranean Sea (a secondary data analysis concerning the initial assessment and treatment of 2656 refugees rescued from distress at sea in support of the EUNAVFOR MED relief mission of the EU). Scand J Trauma Resusc Emerg Med 2016; 24:75. [PMID: 27206483 PMCID: PMC4873997 DOI: 10.1186/s13049-016-0270-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/13/2016] [Indexed: 12/01/2022] Open
Abstract
Background As a part of the European Union Naval Force – Mediterranean Operation Sophia (EUNAVFOR Med), the Federal Republic of Germany is contributing to avoid further loss of lives at sea by supplying two naval vessels. In the study presented here we analyse the medical requirements of such rescue missions, as well as the potential benefits of various additional monitoring devices in identifying sick/injured refugees within the primary onboard medical assessment process. Methods Retrospective analysis of the data collected between May – September 2015 from a German Naval Force frigate. Initial data collection focused on the primary medical assessment and treatment process of refugees rescued from distress at sea. Descriptive statistics, uni- and multivariate analysis were performed. The study has received a positive vote from the Ethics Commission of the University of Ulm, Germany (request no. 284/15) and has been registered in the German Register of Clinical Studies (no. DRKS00009535). Results A total of 2656 refugees had been rescued. 16.9 % of them were classified as “medical treatment required” within the initial onboard medical assessment process. In addition to the clinical assessment by an emergency physician, pulse rate (PR), core body temperature (CBT) and oxygen saturation (SpO2) were evaluated. Sick/injured refugees displayed a statistically significant higher PR (114/min vs. 107/min; p < .001) and CBT (37.1 °C vs. 36.7 °C; p < .001). There was no statistically significant difference in SpO2-values. The same results were found for the subgroup of patients classified as “treatment at emergency hospital required”. However, a much larger difference of the mean PR and CBT (35/min resp. 1.8 °C) was found when examining the subgroups of the corresponding refugee boats. A cut-off value of clinical importance could not be found. Predominant diagnoses have been dermatological diseases (55.4), followed by internal diseases (27.7) and trauma (12.1 %). None of the refugees classified as “healthy” within the primary medical assessment process changed to “medical treatment required” during further observation. Conclusions The initial medical assessment by an emergency physician has proved successful. PR, CBT and SpO2 didn’t have any clinical impact to improve the identification of sick/injured refugees within the primary onboard assessment process. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0270-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Kulla
- Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany.
| | - F Josse
- Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - M Stierholz
- Frigate Schleswig-Holstein, Ship Medical Officer, Endraßstrasse, 26382, Wilhelmshaven, Germany
| | - B Hossfeld
- Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - L Lampl
- Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - M Helm
- Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital Ulm, Section Emergency Medicine, Oberer Eselsberg 40, 89081, Ulm, Germany
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O'Connell M, Duffy R, Crumlish N. Refugees, the asylum system and mental healthcare in Ireland. BJPsych Int 2016; 13:35-37. [PMID: 29093895 PMCID: PMC5619618 DOI: 10.1192/s2056474000001082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The number of people seeking refugee status in Ireland is increasing year on year and the burden of mental illness experienced by refugees and asylum seekers is high. The College of Psychiatrists of Ireland has recommended the establishment of a number of specialist refugee mental health teams. In this paper we discuss the Irish asylum system, the Irish evidence regarding mental illness in this population, and current health service policy regarding refugee mental health. We propose a model of specialist refugee mental healthcare delivery.
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Affiliation(s)
- Molly O'Connell
- Psychiatry Registrar, Jonathan Swift Clinic, St James's Hospital, Dublin, Republic of Ireland
| | - Richard Duffy
- Senior Registrar, Cluain Mhuire Community Mental Health Services, Blackrock, Co. Dublin, Republic of Ireland
| | - Niall Crumlish
- Consultant Psychiatrist, Jonathan Swift Clinic, St James's Hospital, Dublin, and Clinical Lecturer, Department of Psychiatry, Trinity College, Dublin, Republic of Ireland, email
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Morbidity of asylum seekers in a medium-sized German city. Eur J Epidemiol 2016; 31:703-6. [DOI: 10.1007/s10654-016-0148-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/06/2016] [Indexed: 10/22/2022]
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Hocking DC, Kennedy GA, Sundram S. Social factors ameliorate psychiatric disorders in community-based asylum seekers independent of visa status. Psychiatry Res 2015; 230:628-36. [PMID: 26518226 DOI: 10.1016/j.psychres.2015.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/05/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Abstract
The impact of industrialised host nations' deterrent immigration policies on the mental health of forced migrants has not been well characterised. The present study investigated the impact of Australia's refugee determination process (RDP) on psychiatric morbidity in community-based asylum-seekers (AS) and refugees. Psychiatric morbidity was predicted to be greater in AS than refugees, and to persist or increase as a function of time in the RDP. The effect on mental health of demographic and socio-political factors such as health cover and work rights were also investigated. Psychiatric morbidity was measured prospectively on five mental health indices at baseline (T1, n=131) and an average of 15.7 months later (T2, n=56). Psychiatric morbidity in AS significantly decreased between time points such that it was no longer greater than that of refugees at T2. Caseness of PTSD and demoralisation reduced in AS who gained protection; however, those who maintained asylum-seeker status at T2 also had a significant reduction in PTS and depression symptom severity. Reduced PTS and demoralisation symptoms were associated with securing work rights and health cover. Living in the community with work rights and access to health cover significantly improves psychiatric symptoms in forced migrants irrespective of their protection status.
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Affiliation(s)
- Debbie C Hocking
- Department of Psychiatry and Neuropsychology, Florey Institute of Neuroscience and Mental Health, 30 Royal Parade (Cnr Genetics Lane), Parkville, Victoria 3052, Australia; School of Psychology, Victoria University, St. Albans, Victoria 3021, Australia
| | - Gerard A Kennedy
- School of Psychology, Cairnmillar Institute, Camberwell, Victoria 3124, Australia
| | - Suresh Sundram
- Unit Head, Adult Psychiatry, Monash Medical Centre, Monash Health Department of Psychiatry, Monash University, Level 3, P-Block, 246 Clayton Road, Clayton, Victoria 3168, Australia; Department of Psychiatry, Monash University, Clayton, Victoria 3168, Australia
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Bozorgmehr K, Schneider C, Joos S. Equity in access to health care among asylum seekers in Germany: evidence from an exploratory population-based cross-sectional study. BMC Health Serv Res 2015; 15:502. [PMID: 26552375 PMCID: PMC4640386 DOI: 10.1186/s12913-015-1156-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022] Open
Abstract
Background Research on inequities in access to health care among asylum-seekers has focused on disparities between asylum-seekers and resident populations, but little attention has been paid to potential inequities in access to care within the group of asylum-seekers. We aimed to analyse the principles of horizontal equity (i.e., equal access for equal need irrespective of socioeconomic status, SES) and vertical equity (higher allocation of resources to those with higher need) among asylum-seekers in Germany. Methods We performed a secondary exploratory analysis on cross-sectional data obtained from a population-based questionnaire survey among all asylum-seekers (aged 18 or above) registered in three administrative districts in Germany during the three-month study period (N = 1017). Data were collected on health care access (health care utilisation of four types of services and unmet medical need), health care need (approximated by sex, age and self-rated health status), and SES (highest educational attainment and subjective social status, SSS). We calculated odds ratios and 95 % confidence intervals (CI) in multiple logistic regression models to analyse associations between SES indicators and access to health care under control of need. Results We contacted 60.4 % (614) of the total asylum-seekers population, of which 25.4 % (N = 156) participated in the study. Educational attainment showed no significant effect on health care access in crude models, but was positively associated with utilisation of psychotherapists and hospital admissions in adjusted models. Higher SSS was positively associated with health care utilisation of all types of services. The odds of hospitals admissions for asylum-seekers in the medium and highest SSS category were 3.18 times [1.06, 9.59] and 1.6 times [0.49, 5.23] the odds of those in the lowest SSS category. After controlling for need variables none of the SES indicators were significantly associated with measures of access to care, but a positive association remained, indicating higher utilisation of health care among asylum-seekers with higher SES. Age, sex or general health status were the only significant predictors of health care utilisation in fully adjusted models. The adjusted odds of reporting unmet medical needs among asylum-seekers with “fair/bad/very bad” health status were 2.16 times [0.84, 5.59] the odds of those with “good/very good” health status. Conclusion Our findings revealed that utilisation of health services among asylum-seekers is associated with higher need (vertical equity met). Horizontal equity was met with respect to educational attainment for most outcomes, but a social gradient in health care utilisation was observed across SSS. Further confirmatory research is needed, especially on potential inequities in unmet medical need and on measurements of SES among asylum-seekers. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1156-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Voßstr.2, Geb. 37, 69115, Heidelberg, Germany.
| | - Christine Schneider
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Voßstr.2, Geb. 37, 69115, Heidelberg, Germany. .,Institute of General Practice and Interprofessional Care, University of Tuebingen, Tuebingen, Germany.
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University of Tuebingen, Tuebingen, Germany.
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Assessment and treatment of asylum seekers after a suicide attempt: a comparative study of people registered at mental health services in a Swedish location. BMC Psychiatry 2015; 15:235. [PMID: 26446409 PMCID: PMC4597378 DOI: 10.1186/s12888-015-0613-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though asylum seekers are considered vulnerable to mental ill-health, knowledge of their suicidal behaviour is limited. The aim of this study was to improve our understanding of factors that influence the clinical assessment of asylum seekers who have attempted suicide compared to the assessment of non-asylum seekers. METHODS The study focused on 88 asylum seekers registered for suicide attempts in mental health services 2005-2009, who were matched for age and gender and compared with 88 suicide attempters with Swedish personal identity numbers. The medical records were analysed with a quantitative protocol, focusing on social risk and protective factors, health history, current clinical picture as well as the assessment procedure, diagnostics, patterns of treatment and follow-up in this clinical group. Data was analysed using the chi-square test, Fisher's exact probability test, and the Mann-Whitney U test. RESULTS As in earlier studies, asylum seekers were more traumatized, had different social risk factors and received different diagnoses than the controls. Asylum seekers were referred to less specialized follow-up after treatment, in spite of their health history and of previous and current clinical pictures indicating a similar or--in the case of the female asylum seekers--more serious mental health condition. Female asylum seekers also received more intense and prolonged in-patient treatment than female controls. Asylum seekers appeared to have social networks more often than the control group. However, there was less documentation of the social context, previous suicidal behaviour, and on suicide in the family and close environment of the asylum-seeking men. Information on suicidal intent was lacking in a majority of both groups. The time relation of the suicide attempt and the asylum process suggested the importance of the asylum decision, as well as the possible role of earlier mental health problems and premigration stress, for the suicidal behaviour. CONCLUSIONS The groups had different sets of risk factors and clinical pictures. There was a lack of early and thorough exploration of suicide intent for both groups, and of contextual and subjective factors for the asylum seekers. Differences in follow-up indicate unequal access to care.
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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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Schneider C, Mohsenpour A, Joos S, Bozorgmehr K. Health status of and health-care provision to asylum seekers in Germany: protocol for a systematic review and evidence mapping of empirical studies. Syst Rev 2014; 3:139. [PMID: 25433520 PMCID: PMC4259011 DOI: 10.1186/2046-4053-3-139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/17/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are more than 100,000 asylum seekers registered in Germany, who are granted limited access to health services. This study aims to provide a systematic overview of the empirical literature on the health status of and health-care provision to asylum seekers in Germany in order to consolidate knowledge, avoid scientific redundance, and identify research gaps. METHODS/DESIGN A systematic review and evidence mapping of empirical literature on the health status of and health-care provision to asylum seekers in Germany will be performed. We will apply a three-tiered search strategy: 1. search in databases (PubMed/MEDLINE, Web of Science, IBSS, Sociological Abstracts, Worldwide Political Science Abstracts, CINAHL, Sowiport, Social Sciences Citation Index, ASSIA, MedPilot, DNB), dissertation and theses databases, and the internet (Google); 2. screening references of included studies; 3. contacting authors and civil society organizations for grey literature. Included will be studies which report quantitative and/or qualitative data or review articles on asylum seekers in Germany, published in German or English language. Outcome measures will include physical, mental, or social well-being, and all aspects of health-care provision (access, availability, affordability, and quality). Search results will be screened for eligibility by screening titles, abstracts and full texts. Data extraction comprises information on study characteristics, research aims, and domains of health or health-care services analyzed. The quality of studies will be appraised and documented by appropriate assessment tools. A descriptive evidence map will be drawn by categorizing all included articles by research design and the health conditions and/or domains of health-care provision analyzed. The body of evidence will be evaluated, and a narrative evidence synthesis will be performed by means of a multi-level approach, whereby quantitative and qualitative evidence are analyzed as separate streams and the product of each stream is configured in a final summary. DISCUSSION This systematic review will provide an evidence map and synthesis of available research findings on the health status of and health-care provision to asylum seekers in Germany. In anticipation of identifying areas which are amenable to health-care interventions, deserve immediate action, or further exploration, this review will be of major importance for policy-makers, health-care providers, as well as researchers. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014: CRD42014013043.
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Affiliation(s)
- Christine Schneider
- Department of General Practice and Health Services Research, University Heidelberg, Voßstraße 2, Gebäude 37, D-69115 Heidelberg, Germany.
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Teunissen E, Sherally J, van den Muijsenbergh M, Dowrick C, van Weel-Baumgarten E, van Weel C. Mental health problems of undocumented migrants (UMs) in The Netherlands: a qualitative exploration of help-seeking behaviour and experiences with primary care. BMJ Open 2014; 4:e005738. [PMID: 25416057 PMCID: PMC4244440 DOI: 10.1136/bmjopen-2014-005738] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems. DESIGN Qualitative study using semistructured interviews and thematic analysis. PARTICIPANTS 15 UMs in The Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached. SETTING 4 cities in The Netherlands. RESULTS UMs consider mental health problems to be directly related to their precarious living conditions. For support, they refer to friends and religion first, the general practitioner (GP) is their last resort. Barriers for seeking help include taboo on mental health problems, lack of knowledge of and trust in GPs competencies regarding mental health and general barriers in accessing healthcare as an UM (lack of knowledge of the right to access healthcare, fear of prosecution, financial constraints and practical difficulties). Once access has been gained, satisfaction with care is high. This is primarily due to the attitude of the GPs and the effectiveness of the treatment. Reasons for dissatisfaction with GP care are an experienced lack of time, lack of personal attention and absence of physical examination. Expectations of the GP vary, medication for mental health problems is not necessarily seen as a good practice. CONCLUSIONS UMs often see their precarious living conditions as an important determinant of their mental health; they do not easily seek help for mental health problems and various barriers hamper access to healthcare for them. Rather than for medication, UMs are looking for encouragement and support from their GP. We recommend that barriers experienced in seeking professional care are tackled at an institutional level as well as at the level of GP.
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Affiliation(s)
- Erik Teunissen
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jamilah Sherally
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands Centre of Expertise on Health Disparities, Pharos Utrecht, Utrecht, The Netherlands
| | - Chris Dowrick
- Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, UK
| | - Evelyn van Weel-Baumgarten
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care (Radboudumc), Radboud University Medical Center, Nijmegen, The Netherlands Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia
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Mölsä M, Punamäki RL, Saarni SI, Tiilikainen M, Kuittinen S, Honkasalo ML. Mental and somatic health and pre- and post-migration factors among older Somali refugees in Finland. Transcult Psychiatry 2014; 51:499-525. [PMID: 24648488 DOI: 10.1177/1363461514526630] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mental and somatic health was compared between older Somali refugees and their pair-matched Finnish natives, and the role of pre-migration trauma and post-migration stressors among the refugees. One hundred and twenty-eight Somalis between 50-80 years of age were selected from the Somali older adult population living in the Helsinki area (N = 307). Participants were matched with native Finns by gender, age, education, and civic status. The BDI-21 was used for depressive symptoms, the GHQ-12 for psychological distress, and the HRQoL was used for health-related quality of life. Standard instruments were used for sleeping difficulties, somatic symptoms and somatization, hypochondria, and self-rated health. Clinically significant differences in psychological distress, depressive symptoms, sleeping difficulties, self-rated health status, subjective quality of life, and functional capacity were found between the Somali and Finnish groups. In each case, the Somalis fared worse than the Finns. No significant differences in somatization were found between the two groups. Exposure to traumatic events prior to immigrating to Finland was associated with higher levels of mental distress, as well as poorer health status, health-related quality of life, and subjective quality of life among Somalis. Refugee-related traumatic experiences may constitute a long lasting mental health burden among older adults. Health care professionals in host countries must take into account these realities while planning for the care of refugee populations.
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Hadgkiss EJ, Renzaho AMN. The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature. AUST HEALTH REV 2014; 38:142-59. [PMID: 24679338 DOI: 10.1071/ah13113] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 12/29/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To document physical health problems that asylum seekers experience on settlement in the community and to assess their utilisation of healthcare services and barriers to care, in an international context. METHODS A systematic review of quantitative and qualitative studies was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, PsycINFO, Embase and CINAHL databases were searched from 2002 to October 2012, focusing on adult asylum seekers residing in the community in high-income countries. RESULTS The search yielded 1499 articles, of which 32 studies met the inclusion criteria - 23 quantitative and nine qualitative. Asylum seekers had complex health profiles spanning a range of infectious diseases, chronic non-communicable conditions, and reproductive-health issues. They appeared to utilise health services at a higher rate than the host population, yet faced significant barriers to care. CONCLUSION The findings of this study highlight the health inequities faced by asylum seekers residing in the communities of host countries, internationally. National data on asylum seekers' health profiles, service utilisation and barriers to care, as well as cross-country policy comparisons, are urgently required for the development of effective Australian health programs and evidence-based policy. What is known about the topic? The clinical and political focus of asylum seekers' health has largely been on the higher incidence of mental disorders and the impact of immigration detention. Since policy changes made in late 2011, an increasing number of asylum seekers have been permitted to live in the community while their claims are processed. There is a paucity of research exploring the physical health needs of asylum seekers residing in the community. What does this paper add? The international literature highlights the complexity of asylum seekers' health profiles. Although they appear to utilise health services at a higher rate than the host population, they continue to face many barriers to care. What are the implications for practitioners? Studies that explore policy options, including cross-country comparisons of health policy and guidelines that improve health outcomes, to foster equity of access and reduce health inequalities between asylum seekers and the host population are urgently required.
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Affiliation(s)
- Emily J Hadgkiss
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, Vic. 3065, Australia
| | - Andre M N Renzaho
- Migration, Social Disadvantage, and Health Programs, Global Health and Society Unit, School of Public Health and Preventive Medicine, Monash University, Level 3, Burnet Building, 89 Commercial Road, Melbourne, Vic. 3004, Australia
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Ogbu HU, Brady B, Kinlen L. Parenting in Direct Provision: Parents' Perspectives Regarding Stresses and Supports. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/13575279.2013.875462] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stenmark H, Catani C, Neuner F, Elbert T, Holen A. Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study. Behav Res Ther 2013; 51:641-7. [PMID: 23916633 DOI: 10.1016/j.brat.2013.07.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/20/2013] [Accepted: 07/01/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression. METHOD Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion. RESULTS Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers. CONCLUSIONS The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.
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Affiliation(s)
- Håkon Stenmark
- Dept. of Neuroscience, Norwegian University of Science and Technology, 7489 Trondheim, Norway; Centre on Violence, Traumatic Stress and Suicide Prevention, Mid-Norway, St. Olav University Hospital, Schwacks Gt. 1, 7030 Trondheim, Norway.
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Ekblad S, Linander A, Asplund M. An exploration of the connection between two meaning perspectives: an evidence-based approach to health information delivery to vulnerable groups of Arabic- and Somali-speaking asylum seekers in a Swedish context. Glob Health Promot 2012; 19:21-31. [DOI: 10.1177/1757975912453182] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The right to health care is significant for asylum seekers, particularly as many of them have experienced traumatic life events in their home country, during flight or in their host country. Post-migration living conditions have more impact than pre-migration conditions on ill health among asylum seekers, which underscores the importance of health care-related refugee reception policies. The purpose of this article is to explore the perceived meaning of comprehensive health information provided by a nurse to Arabic- and Somali-speaking adult asylum seekers, in a Swedish context, during its introduction at the Migration Board. In our study, the endpoint was whether asylum seekers found such health information relevant, understandable and respectful. Following an oral presentation, participants filled in a questionnaire consisting of three close-ended questions. A total of 39 groups of presentation attendees included 626 asylum seekers (415 Arabic- and 211 Somali-speaking). Data were analysed with descriptive statistics. Comments underwent content analysis. We also present some socio-demographic data on these asylum seekers. Independently of gender and language, the participants expressed their gratitude for and the meaningfulness of receiving professional, fact-based information, as well as being treated with concern and respect. They indicated a great need for this and felt relieved by being listened to. They liked the pedagogic group method, the opportunity for dialogue and to practice exercising their rights. These promising results indicate that exercising the asylum-seekers’ right to receive such health information would improve future reception policies not only in Sweden, but throughout the EU. A renewed focus on communication and pedagogic skills, instead of just cultural training, should be considered for health care professionals assisting asylum seekers.
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Affiliation(s)
- Solvig Ekblad
- Department LIME (learning, informatics, management and ethics), Karolinska Institutet, Stockholm, Sweden
| | - Andrea Linander
- Department LIME (learning, informatics, management and ethics), Karolinska Institutet, Stockholm, Sweden
- Umea University, Umea, Sweden
| | - Maria Asplund
- Department LIME (learning, informatics, management and ethics), Karolinska Institutet, Stockholm, Sweden
- Primary Health Care Wasa-Carema Health Centre, Södertälje, Sweden
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Bernardes D, Wright J, Edwards C, Tomkins H, Dlfoz D, Livingstone A. Asylum Seekers' Perspectives on their Mental Health and Views on Health and Social Services: Contributions for Service Provision Using a Mixed‐Methods Approach. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2011. [DOI: 10.5042/ijmhsc.2011.0150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pieper HO, Clerkin P, MacFarlane A. The impact of direct provision accommodation for asylum seekers on organisation and delivery of local primary care and social care services: a case study. BMC FAMILY PRACTICE 2011; 12:32. [PMID: 21575159 PMCID: PMC3123194 DOI: 10.1186/1471-2296-12-32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 05/15/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Many western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue. METHODS In 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied. RESULTS There was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for. CONCLUSIONS Direct provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency, inter-professional dialogue to manage this. Primary care and social care professionals working with asylum seekers should have access to training to enhance their skills for working in cross-cultural consultations.
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Affiliation(s)
- Hans-Olaf Pieper
- Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland
| | - Pauline Clerkin
- Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland
| | - Anne MacFarlane
- Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland
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Kurth E, Jaeger FN, Zemp E, Tschudin S, Bischoff A. Reproductive health care for asylum-seeking women - a challenge for health professionals. BMC Public Health 2010; 10:659. [PMID: 21040588 PMCID: PMC2988736 DOI: 10.1186/1471-2458-10-659] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 11/01/2010] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dealing with pregnancy, childbirth and the care of newborn babies is a challenge for female asylum seekers and their health care providers. The aim of our study was to identify reproductive health issues in a population of women seeking asylum in Switzerland, and to examine the care they received. The women were insured through a special Health Maintenance Organisation (HMO) and were attending the Women's Clinic of the University Hospital in Basel. We also investigated how the health professionals involved perceived the experience of providing health care for these patients. METHODS A mixed methods approach combined the analysis of quantitative descriptive data and qualitative data obtained from semi-structured interviews with health care providers and from patients' files. We analysed the records of 80 asylum-seeking patients attending the Women's Clinic insured through an HMO. We conducted semi-structured interviews with 10 care providers from different professional groups. Quantitative data were analysed descriptively. Qualitative data analysis was guided by Grounded Theory. RESULTS The principal health problems among the asylum seekers were a high rate of induced abortions (2.5 times higher than in the local population), due to inadequate contraception, and psychosocial stress due to the experience of forced migration and their current difficult life situation. The language barriers were identified as a major difficulty for health professionals in providing care. Health care providers also faced major emotional challenges when taking care of asylum seekers. Additional problems for physicians were that they were often required to act in an official capacity on behalf of the authorities in charge of the asylum process, and they also had to make decisions about controlling expenditure to fulfil the requirements of the HMO. They felt that these decisions sometimes conflicted with their duty towards the patient. CONCLUSION Health policies for asylum seekers need to be designed to assure access to adequate contraception, and to provide psychological care for this vulnerable group of patients. Care for asylum seekers may be emotionally very challenging for health professionals.
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Affiliation(s)
- Elisabeth Kurth
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute (Swiss TPH), University of Basel, Basel, Switzerland
| | | | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute (Swiss TPH), University of Basel, Basel, Switzerland
| | - Sibil Tschudin
- University Women's Hospital of Basel, Basel, Switzerland
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