The impact of a long asylum procedure on quality of life,disability and physical health in Iraqi asylum seekers in the Netherlands

BACKGROUND: Refugees in western countries often face long juridical procedures before their requests for a resident permit is granted. The, still scanty, literature shows high prevalence rates of psychopathology among asylum seekers, but there has been little interest for other impaired dimensions of health. The present study is part of a community-based mental health survey among Iraqi asylum seekers in the Netherlands, conducted between November 2000 and September 2001, on the risks of a long asylum procedure. OBJECTIVES: The objectives of this study were to explore quality of life (QoL), disability and physical health and their relationships with psychopathology and pre- and post-migration variables. METHOD: Two groups of pre-stratified (length of asylum procedure), randomly selected Iraqi asylum seekers (N = 143 and N = 151), were interviewed with fully structured, culturally validated questionnaires. Quality of life was examined with QoLWHO-Bref, functional disability with the Brief Disability Questionnaire and physical health with a newly developed questionnaire. Psychiatric (DSM IV) disorders were measured with the WHO Composite International Diagnostic Interview 2.1. Multivariate logistic regression analyses were used to estimate the relationships between the outcome measures and socio-demographics, adverse life events in Iraq, post-migration living problems (PMLP) and psychopathology. RESULTS: Respondents with a long asylum procedure reported significantly lower QoL, higher functional disability and more physical complaints. Multivariate regression shows that length of stay is the strongest predictor for a low overall QoL. In addition, lower QoL was predicted by psychopathology, higher age, adverse life events in the Netherlands and the PMLP-clusters: family issues, socio-economic living conditions and socio-religious aspects. Disability was predicted by psychopathology, higher age and the PMLP clusters: family issues and socio-religious aspects. Physical complaints were predicted by length of asylum procedure, psychopathology, female sex, adverse life events in Iraq and PMLP-family issues. CONCLUSION: A long asylum procedure has a negative impact on the overall health situation and the QoL of asylum seekers. The situation is not only harming the affected, but also interferes with the integration process in the Netherlands or elsewhere. The findings are important for health professionals, governments and human right specialists.     

Acute admissions among immigrants and asylum seekers to a psychiatric hospital in Norway

Objective: The purpose of the present study was to compare admission rates, including admission by coercion, length of hospital stay and diagnosis among immigrants, asylum seekers and Norwegian-born patients.Material: All admissions (n=3053) to Østmarka Hospital during the period 1995–2000 were examined. A sample including all immigrants (94) and asylum seekers (39) as well as a control group of 133 Norwegians was analysed.Results: Immigrants and Norwegians had the same relative risk of admission (1.07). The relative risk of admission was higher for asylum seekers compared to Norwegians (8.84). There were differences in the diagnoses given at discharge in the three groups of patients, both among men (²=22.33, df=6, p<0.001) and women (²=15.31, df=6, p<0.001). Schizophrenia was frequent among female immigrants. The number of admissions by coercion was highest among immigrants, and lowest among asylum seekers (²=12.03, df=2, p<0.005).Conclusion: Compared to Norwegians and immigrants, asylum seekers had high admission rates and low frequency of admissions by coercion. Schizophrenia was frequent among female immigrants admitted to hospital.     

Prevalence of mental disorders and mental health service use in Japan

A high disease burden of mental disorders has been noted worldwide, including Japan. It is important to monitor mental disorder prevalence trends and the use of mental health services over time using epidemiological data and to plan appropriate policies and measures that consider mental health in each country. This review outlines the prevalence trends of common mental disorders (CMD) and the use of mental health services in Japan from the 2000s to the 2010s and compares them with those in other countries. This review clarifies that the prevalence of CMD in Japan has been relatively stable in the past decade. The 12‐month prevalence of mental health service use has increased about 1.2 times to 1.6 times in the past 10–15 years. Thus, it is very likely that the rise in mental health service use contributes to increased patient numbers. Regarding cross‐national comparison, the prevalence rate of CMD in Japan is much lower compared to rates in the USA and Europe. The 12‐month prevalence of mental health service use was also lower in Japan compared to prevalence rates in other high‐income countries. Mental health epidemiology has clarified that the prevalence of CMD worldwide has remained unchanged, even though mental health service use has increased in high‐income countries. Thus, the gap in treatment quality and prevention should be addressed in the future.     

Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands

In a previous community-based, national study among Iraqi asylum seekers, a long asylum procedure was found to have a higher risk for common psychiatric disorders than adverse life events in Iraq. In the present article, the postmigration period is considered in more detail and evaluated in relationship with psychiatric disorders. Respondents were interviewed with fully structured, culturally validated, translated questionnaires. With the use of a Post- migration Living Problems questionnaire, worries about all kinds of problems were gathered. Psychiatric (DSM-IV) disorders were measured with the Composite International Diagnostic Interview 2.1. Factor analysis was done on the postmigration living problems, and in univariate and multivariate analyses, associations with psychopathology were calculated. Results show that clusters of postmigration living problems could be identified: family issues, discrimination, asylum procedure, socioeconomic living conditions, socioreligious aspects, and work-related issues. There was a significant relationship between all clustered postmigration living problems and psychopathology, except for socioreligious aspects. Multivariate logistic regression showed that lack of work, family issues, and asylum procedure stress had the highest odds ratios for psychopathology. The findings appeal to governments to shorten the asylum procedures, allow asylum seekers to work, and give preference to family reunion. Mental health workers should recognize the impact of postmigration living problems and consider focusing their treatment on coping with these problems instead of traumas from the past.     

Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands

Clinically, a long asylum procedure seems to be associated with psychiatric disorders. However, data on this issue are lacking. In a national community-based study, using random sampling, we compared two groups of Iraqi asylum seekers, who had resided less than 6 months (N = 143) and more than 2 years (N= 151), respectively, in The Netherlands. Respondents were interviewed with fully structured, culturally validated, translated questionnaires. Psychiatric (DSM-IV) disorders were measured with the Composite International Diagnostic Interview 2.1 and evaluated in relation with premigration and postmigration adverse life events. Overall prevalence of psychiatric disorders was 42% in the first group and 66.2% in the second. The prevalence rates of anxiety, depressive, and somatoform disorders were significantly higher in the second group. Posttraumatic stress disorder was high in both groups but did not differ (p > .05). On logistic regression of all relevant risk factors, a long asylum procedure showed an odds ratio of 2.16 (confidence interval = 1.15-4.08) for psychopathology. The conclusion is that, indeed, the duration of the asylum procedure is an important risk factor for psychiatric problems. Both politicians and mental health workers should take note of this finding.     

Mental health service use among older Canadians with anxiety and comorbid physical conditions

Objectives: The objective of this study was to understand the relationship between mental health service use and comorbid any anxiety and commonly occurring physical conditions (i.e., arthritis, cardiovascular disease, and gastrointestinal disease) in a national sample of older Canadians.

Methods: The sample consisted of older adults aged 55 years and older from the Canadian Community Health Survey 1.2 (N = 12,792). Trained lay interviewers assessed mental disorders based on Diagnostic and Statistical Manual of Mental Disorders – 4th Edition (DSM-IV) criteria. Physical conditions were based on self-reported diagnoses by health professionals. Past-year mental health service use was categorized into whether services were utilized in the general or specialty sectors. Crosstabulations and multiple logistic regressions examined the effects of both anxiety and physical conditions on mental health service use within the general and specialty mental health sectors.

Results: Adjusted logistic regressions indicated that there was no effect of anxiety among older adults with gastrointestinal disease on mental health service use. Conversely, in adjusted regressions, having a comorbid anxiety disorder with cardiovascular disease or arthritis was associated with increased odds of service use from the general sector in comparison to cardiovascular disease and arthritis, respectively, alone. Additionally, older adults with comorbid any anxiety disorder and gastrointestinal disease in comparison to anxiety alone had lower rates of seeking mental health services; however, these effects were no longer significant in an adjusted model.

Conclusion: Comorbidity between gastrointestinal conditions and anxiety was associated with unmet mental health service needs. This may be conceptualized in the context overlapping symptomatology in gastrointestinal conditions and anxiety.     

Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands

CONTEXT: Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country. OBJECTIVES: The objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints. DESIGN, SETTING, AND PARTICIPANTS: A population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively). MAIN OUTCOME MEASURES: General health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25. RESULTS: More asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms. CONCLUSIONS: Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.     

Asthma and mental disorders in Canada: Impact on functional impairment and mental health service use

Objective

The goal of this study is to examine the association between asthma and mental disorders and the impact of asthma and mental disorder comorbidity on functional impairment and mental health care service use among adults in the community.

Methods

Data came from the Canadian Community Health Survey Cycle 1.2 (N=36,984; age ≥15 years; response rate, 77%). Mental disorders were assessed using the Composite International Diagnostic Interview. Chronic physical health conditions, quality of life, and disability were also assessed. Asthma diagnoses were based on self-report of having been diagnosed with asthma by a health care professional.

Results

Asthma was associated with a significantly increased likelihood of a range of mental disorders among adults in Canada, with the strongest links between asthma and posttraumatic stress disorder, mania, and panic disorder. Adults with both mental disorders and asthma had significantly higher rates of functional impairment and use of mental health services, compared with those with either asthma or mental disorders but not both.

Conclusions

Our findings provide new information suggesting that adults in the community with asthma and mental disorders have higher levels of both short- and long-term health-condition-related functional disability and greater use of mental health services, compared with those with asthma without mental disorders. Results are also consistent with previous studies showing a significant link between asthma and mental disorders. Implications of these findings for efforts aimed at secondary prevention and improving treatment strategies for individuals with both asthma and mental disorders are discussed.     

Children in foster care: Mental health, service use and costs

Abstract Objective To assess the prevalence of mental health problems in children in foster care, their families’ use of services and the associated costs. Methods Information on mental health problems, service use and costs was collected, by postal questionnaires and home interviews, on 182 children, their foster carers and teachers from 17 local authorities in Central Scotland. Results Over 90% of the children had previously been abused or neglected and 60 % had evidence of mental health problems including conduct problems, emotional problems, hyperactivity and problems with peer relations. When compared with 251 children from local schools, the children in foster care had significantly higher symptom scores for Reactive Attachment Disorder. Those children with highest scores for mental health problems were attracting a high level of service support from a wide range of agencies, except Child and Adolescent Mental Health Services (CAMHS). Costs were associated with learning disability, mental health problems, and a history of residential care. Conclusions Children in “mainstream” foster care are at greater risk of mental health problems, and are attracting greatest costs, but CAMHS are not successfully targeting these problems. CAMHS may need to develop new models of service delivery.     

Associations of health insurance coverage,mental health problems,and drug use with mental health service use in US adults: an analysis of 2013 National Survey on Drug Use and Health

Objective: To estimate the prevalence of mental health service use among US adults, examine the associations of mental health service use with health insurance coverage, mental health problems and drug use, and detect health disparities.

Methods: This was a cross-sectional study with 5,434 adults receiving mental health service out of 37,424 adult respondents from the 2013 National Survey on Drug Use and Health. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors with mental health service use.

Results: The overall prevalence of mental health services use was 14.7%. Our results showed that being female, aging, having a major depressive episode, serious psychological distress, and illicit drug or alcohol abuse/dependence were positively associated with mental health service use; whereas being African American, Asian or Hispanic ethnicity, married, and having any form of insurance were negatively associated with mental health service use . Stratified analysis by insurance types showed that Medicaid/CHIP, CHAMPUS, and other insurance were positively associated with mental health service use.

Conclusions: Health insurance coverage, mental health problems, and drug abuse or dependence were associated with mental health service use in US adults. Furthermore, adults with different insurances had disparities in access of mental health service.     

Prevalence of psychiatric disorders among sentenced prisoners in a medium security prison in Ghana: Implications for mental health assessment and service

Background

Extant literature has shown that there is a higher prevalence of mental disorders among prisoners compared to the general population. These findings have, however, mostly been from high-income and westernised cultures. In Ghana, little is known about the extent of psychiatric disorders among prisoners, as is consistent with the dearth of scholarly work in low and middle-income countries.

Aims

Our aim was to determine the prevalence of common mental disorders among sentenced prisoners in the second largest prison in Ghana.

Methods

A cross-sectional survey research design was used in one prison. The Mini International Neuro-Psychiatric Interview questionnaire was used to collect data from men and women serving prison sentences who volunteered for the study. Socio-demographic characteristics and criminal history data were collected using a questionnaire designed by the researchers.

Results

Five hundred prisoners participated. Nearly half (246, 49.8%) had at least one psychiatric disorder. The most prevalent disorders were major depression and a range of anxiety disorders (145, 29%, 132, 26% respectively). A smaller proportion recorded high scores on the antisocial personality disorder scale (13%); just 50 (10%) reported using substances in the 12 months before interview, but this is a minimum estimate of such problems as many were already in prison during that time. None of these prisoners, regardless of disorder, had been screened, diagnosed, or treated in prison.

Conclusions

This study contributes to the gap in scholarly literature in low- and middle-income countries on psychiatric disorders in the prison population. It will be important to explore further the extent to which the internationally recognised screening tools used led to under-estimation of psychiatric disorders. The findings are of immediate practical importance nationally as they highlight the need to implement reforms anticipated by the new mental health legislation of 2012 and strategies for interagency working to improve health services and their uptake in the criminal justice system.

     

Prevalence and identification of alcohol use disorders among severe mental illness inpatients in Taiwan

Aims:  A higher prevalence of alcohol use disorders (AUD) among psychiatric patients has been reported previously and the identification rate is relatively low. This study was designed to investigate the prevalence and identification of AUD among acute psychiatric inpatients with severe mental illness in a psychiatric hospital in Taiwan.
Methods:  In a two-phase case identification strategy, the Alcohol Use Disorders Identification Test (AUDIT) was used as the first phase screening tool and the Structured Clinical Interview for DSM-IV-TR as the second phase diagnostic interview. The definition of identification was diagnosis of AUD on medical record at discharge.
Results:  Of 400 respondents, 42 screened positive and 358 screened negative. All screen-positive respondents and 35 screen-negative respondents entered the second phase interview. The weighted lifetime prevalence of alcohol dependence was 8.3% (95% confidence interval [CI]: 4.6–11.9%); alcohol abuse, 1.5% (95%CI: 0.2–2.8%); and AUD, 9.8% (95%CI: 5.7–13.8%). The overall identification rate of AUD by medical staff was 28.2% (0% for alcohol abuse and 33.3% for alcohol dependence). Patients with mood disorders were prone to being undetected as having AUD.
Conclusion:  AUD comorbidity was common among inpatients with severe mental illness in Taiwan and was easily neglected by medical staff. It is necessary to use a validated screening questionnaire, such as AUDIT, to detect high-risk patients and then give appropriate interventions to enhance treatment outcome.     

Psychiatric disorders among foreign-born and US-born Asian-Americans in a US national survey

Background Among Hispanics, Non-Hispanic Whites and Non-Hispanic Blacks studies have found lower risk for psychiatric disorders among the foreign-born than among the US-born. We examine the association of nativity and risk for psychiatric disorder in a national sample of the Asian-American (AA) population. Methods Data on 1,236 AAs from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) are analyzed using logistic regression and discrete time survival models to specify differences between the foreign-born and US-born in the lifetime occurrence of mood, anxiety and substance use disorders. Results Foreign-born AAs had significantly lower risk for all classes of disorder compared with US-born AAs (OR = 0.16–0.59). Risk for all classes of disorder was lowest for those foreign-born AAs who arrived in the US as adults. Among foreign-born AAs risk of first onset was lowest relative to the US-born in years prior to their arrival in the US and tended to rise to levels equal to that of the US-born with longer duration of residence in the US. Conclusions Among AAs, risk for psychiatric disorders is lower among the foreign-born than among the US-born. The pattern of change in risk over time suggests that both the developmental timing and the duration of experience in the US contribute to increases in risk.     

Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden

Social Psychiatry and Psychiatric Epidemiology - In 2015, there was a high influx of refugees to Sweden, creating an extreme situation where individuals were forced to remain in large housing...