Mental health and healthcare utilisation in adult asylum seekers
We assessed a sample of unselected adult asylum seekers to determine their current mental health status and patterns of healthcare utilisation.
METHOD: We included 78 unselected adult asylum seekers after their first year of residence in the Zurich area of Switzerland. The Swiss Federal Office for Migration provided their names and addresses. The current mental health of the participants was assessed through diagnostic interviews. Their use of healthcare services and the resultant costs over a 12-month period were established by reference to the records of the responsible health insurance company.
RESULTS: Forty-one percent of participants had at least one psychiatric disorder, primarily major depression and posttraumatic stress disorder. Healthcare costs were about 1.8 times those of the average resident population. Asylum seekers sought medical advice more than twice as often as did average residents. While they presented high psychiatric morbidity, they received very little specific treatment.
CONCLUSION: Asylum seekers incur higher healthcare costs than comparable residents. Mentally ill asylum seekers are underdiagnosed and often inadequately treated.
- Harris MF, Telfer BL. The health needs of asylum seekers living in the community. Med J Aust. 2001;175(11-12):589–92.
- Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. Lancet. 2005;365:1309–14.
- Johnson H, Thompson A. The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clin Psychol Rev. 2008;28:36–47.
- Silove D, Steel Z, McGorry P, Mohan P. Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: Comparison with refugees and immigrants. Acta Psychiatr Scand. 1998;97(3):175–81.
- Gerritsen AA, Bramsen I, Devillé W, van Willigen LH, Hovens JE, van der Ploeg HM. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2006;41:18-26.
- Hollifield M, Warner TD, Nityamo L, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J. Measuring trauma and health status in refugees. JAMA. 2002;288:611–21.
- United Nations High Commissioner for Refugees (UNHCR) The refugee convention. 1951; URL: http://www.unhcr.org/3b66c2aa10.html (accessed July 24, 2009).
- United Nations High Commissioner for Refugees (UNHCR) 2008 Global Trends: Refugees, Asylum-seekers, Returnees, Internally Displaced and Stateless Persons, Country Data Sheets. 2009; URL: http://www.unhcr.org/4a375c426.html (accessed March 22, 2010).
- Swiss Federal Office for Migration. Asylstatistik 2008. 2009; URL: http://www.bfm.admin.ch/etc/medialib/data/migration/statistik/asylstatistik/jahresstatistik/kommentierte_jahresstatistik.Par.0001.File.tmp/Statistik-J-d-2008-Kommentar.pdf (accessed July 27, 2009).
- Laban CJ, Gernaat HB, Komproe IH, Schreuders BA, De Jong JT. Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis. 2004;192(12):843–51.
- Carta MG, Bernal M, Hardoy MC, Haro-Abad JM, et al. Migration and mental health in Europe (the state of the mental health in Europe working group: appendix I). Clinical Practice and Epidemiology in Mental Health. 2005;1(13):1–16.
- Gerritsen AA, Bramsen I, Devillé W, van Willigen LH, Hovens JE, van der Ploeg HM. Use of health care services by Afghan, Iranian, and Somali refugees and asylum seekers living in the Netherlands. Eur J Public Health. 2006;16(4):394–9.
- Laban CJ, Gernaat HB, Komproe IH, van der Tweel I, De Jong JT. Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis. 2005;193(12):825–32.
- Maggi J, Cattacin S. Needed basic research in “Migration and Health” 2002–2006 in Switzerland. 2003; Bern, Swiss Federal Office of Public Health.
- Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of interpreter services on delivery of health care to limited-English-proficient patients. J Gen Intern Med. 2001;16(7):493–5.
- Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255–99.
- Bontempo R. Translation fidelity of psychological scales: An item response theory analysis of an individualism – collectivism scale. Journal of Cross Cultural Psychology. 1993;24:149–66.
- Knaevelsrud C, Müller J. Multilingual Computer-Assisted Self-Interview (MultiCASI) system for psychiatric diagnostic of migrants. (Version 1.0). 2007; Heidelberg: Springer.
- Sheehan DV, Lecrubier V, Sheehan KH, Amorim P, Janvas J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl. 20):22–33.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed.). 1994; Washington, DC: American Psychiatric Association.
- Gemeinsame Einrichtung KVG. 2009; URL: http://www.kvg.org/ra/statistik/default.htm (accessed July 25, 2009)
- Swiss Federal Statistical Office. Gesundheitsstatistik 2009. 2009; Neuchâtel, BFS.
- Jäger M, Sobocki P, Rössler W. Cost of disorders of the brain in Switzerland with a focus on mental disorders. Swiss Med Wkly. 2008;12, 138(1-2):4–11.
- Eitinger L. Pathology of the concentration camp syndrome. Arch Gen Psychiatry. 1961;5:79–87.
- Eitinger L. Concentration camp survivors in Norway and Israel. 1964; London: Allan & Unwin.
- Chodoff P. Late effects of the concentration camp syndrome. Arch Gen Psychiatry. 1963;8:323–33.
- Kinzie JD. Evaluation and psychotherapy of Indochinese refugee patients. Am J Psychother. 1981;35(2):251–61.
- Kinzie JD, Fredrickson RH, Ben R, Fleck L, Karls W. Post-traumatic stress disorder among survivors of Cambodian concentration camps. Am J Psychiatry. 1983;141:645–50.
- Westermeyer J, Vang TF, Neider J. Refugees who do and do not seek psychiatric care: An analysis of premigratory and postmigratory characteristics. J Nerv Ment Dis. 1983;171(2):86–91.
- Boehnlein JK, Kinzie JD, Ben R, Fleck J. One-year follow-up study of posttraumatic stress disorder among survivors of Cambodian concentration camps. Am J Psychiatry. 1985;142(8):956–9.
- Boehnlein JK. Clinical relevance of grief and mourning among survivors of Cambodian concentration camps. Soc Sci Med.1987;25(7):765–72.
- Boehnlein JK. A review of mental health services for refugees between 1975 and 1985 and a proposal for future services. Hosp Community Psychiatry. 1987;38(7):764–8.
- Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.
- Mollica RF, Wyshak G, Lavelle J. The psychosocial impact of war trauma and torture on Southeast Asian refugees. Am J Psychiatry. 1987;144:1567–72.
- Carlson EB, Rosser-Hogan R. Trauma experiences, posttraumatic stress, dissociation, and depression in Cambodian refugees. Am J Psychiatry. 1991;148(11):1548–51.
- Hauff E, Vaglum P. Chronic posttraumatic stress disorder in Vietnamese refugees. A prospective community study of prevalence, course, psychopathology, and stressors. J Nerv Ment Dis. 1994;182(2):85–90.
- Silove D, Chang R, Manicavasagar V. Impact of recounting trauma stories on the emotional state of Cambodian refugees. Psychiatr Serv. 1995;46(12):1287–8.
- Holtz T. Refugee trauma versus torture trauma: A retrospective controlled cohort study of Tibetan refugees. J Nerv Ment Dis. 1998;186:24–34.
- Moisander PA, Edston E. Torture and its sequel: A comparison between victims from six countries. Forensic Sci Int. 2003;137(2-3):133–40.
- Thapa SB, van Ommeren M, Sharma B, de Jong JT, Hauff E. Psychiatric disability among tortured Bhutanese refugees in Nepal. Am J Psychiatry. 2003;160(11):2032–7.
- Turner SW, Gorst-Unsworth C. Psychological sequelae of torture: A descriptive model. Br J Psychiatry. 1990;157:475–80.
- Loutan L, Subilia L. Torture et violence organisée: leur conséquences sur les requérants d’asile et les refugiés. Médecine et Hygiène. 1995;49:1942–50.
- Weine SM, Vojvoda D, Becker DF, McGlashan TH, Hodzic E, Laub D, et al. PTSD symptoms in Bosnian refugees 1 year after resettlement in the United States. Am J Psychiatry. 1998;155(4):562–4.
- Favaro A, Maiorani M, Colombo G, Santonastaso P. Traumatic experiences, posttraumatic stress disorder, and dissociative symptoms in a group of refugees from former Yugoslavia. J Nerv Ment Dis. 1999;187(5):306–8.
- Mollica RF, Sarajlic N, Chernoff C, Lavelle J, Vukovic IS, Massagli MP. Longitudinal study of psychiatric symptoms, disability, mortality and emigration among Bosnian refugees. JAMA. 2001;286:546–54.
- Moser C, Nyfeler D, Verwey M. (eds) Traumatisierungen von Flüchtlingen und Asyl Suchenden. Einfluss des politischen, sozialen und medizinischen Kontextes. 2001; Zürich: Seismo-Verlag.
- Turner SW, Bowie C, Dunn G, Shapo L, Yule W. Mental health of Kosovan Albanian refugees in the UK. Br J Psychiatry. 2003;182:444–8.
- Momartin S, Silove D, Manicavasagar V, Steel Z. Comorbidity of PTSD and depression: Associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia. J Affect Disord. 2004;80(2-3):231–8.
- Westermeyer J, Neider J, Callies A. Psychosocial adjustment of Hmong refugees during their first decade in the United States: A longitudinal study. J Nerv Ment Dis. 1989;177(3):132–9.
- Steel Z, Silove D, Phan T, Bauman A. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study. Lancet. 2002;360(9339):1056–62.
- Boehnlein JK, Kinzie D, Sekiya U, Riley C, Pou K, Rosborough B. A ten-year treatment outcome study of traumatized Cambodian refugees. J Nerv Ment Dis. 2004;192:658–63.
- Silove D, Steel Z, McGorry P, Miles V, Drobny J. The impact of torture on post-traumatic stress symptoms in war-affected Tamil refugees and immigrants. Compr Psychiatry. 2002;43(1):49–55.
- Fenta H, Hyman I, Noh S. Determinants of depression among Ethiopian immigrants and refugees in Toronto. J Nerv Ment Dis. 2004;192(5):363–72.
- Maier T. Psychosocial and psychodynamic factors influencing healthcare utilization. Health Care Analysis. 2006;14(2):69–78.