ContextLittle is known about the long-term mental health of trauma-exposed
refugees years after permanent resettlement in host countries.ObjectiveTo assess the prevalence, comorbidity, and correlates of psychiatric
disorders in the US Cambodian refugee community.Design, Setting, and ParticipantsA cross-sectional, face-to-face interview conducted in Khmer language
on a random sample of households from the Cambodian community in Long Beach,
Calif, the largest such community in the United States, between October 2003
and February 2005. A total of 586 adults aged 35 to 75 years who lived in
Cambodia during the Khmer Rouge reign and immigrated to the United States
prior to 1993 were selected. One eligible individual was randomly sampled
from each household, with an overall response rate (eligibility screening
and interview) of 87% (n = 490).Main Outcome MeasuresExposure to trauma and violence before and after immigration (using
the Harvard Trauma Questionnaire and Survey of Exposure to Community Violence);
weighted past-year prevalence rates of posttraumatic stress disorder (PTSD)
and major depression (using the Composite International Diagnostic Interview
version 2.1); and alcohol use disorder (by the Alcohol Use Disorders Identification
Test).ResultsAll participants had been exposed to trauma before immigration. Ninety-nine
percent (n = 483) experienced near-death due to starvation and 90%
(n = 437) had a family member or friend murdered. Seventy percent
(n = 338) reported exposure to violence after settlement in the
United States. High rates of PTSD (62%, weighted), major depression (51%,
weighted), and low rates of alcohol use disorder were found (4%, weighted).
PTSD and major depression were highly comorbid in this population (n = 209;
42%, weighted) and each showed a strong dose-response relationship with measures
of traumatic exposure. In bivariate analyses, older age, having poor English-speaking
proficiency, unemployment, being retired or disabled, and living in poverty
were also associated with higher rates of PTSD and major depression. Following
multivariate analyses, premigration trauma remained associated with PTSD (odds
ratio [OR], 2.08; 95% CI, 1.37-3.16) and major depression (OR, 1.56; 95% CI,
1.24-1.97); postmigration trauma with PTSD (OR, 1.65; 95% CI, 1.21-2.26) and
major depression (OR, 1.45; 95% CI, 1.12-1.86); and older age with PTSD (OR,
1.76; 95% CI, 1.46-2.13) and major depression (OR, 1.47; 95% CI, 1.15-1.89).ConclusionMore than 2 decades have passed since the end of the Cambodian civil
war and the subsequent resettlement of refugees in the United States; however,
this population continues to have high rates of psychiatric disorders associated
with trauma.

/pdf/mental-health-of-cambodian-refugees-2-decades-after-l4fu039poz.pdf

Mental health of Cambodian refugees 2 decades after resettlement in the United States

In the introductory article to a six-part PLoS Medicine series on Migration & Health, series guest editors Cathy Zimmerman, Mazeda Hossain, and Ligia Kiss outline a migratory process framework that involves five phases: pre-departure, travel, destination, interception, and return.

/pdf/migration-and-health-a-framework-for-21st-century-policy-1ot2mbsux5.pdf

Migration and Health: A Framework for 21st Century Policy-Making

Background Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum.

Aims To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees.

Method Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed post-traumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to past trauma, detention and temporary protection.

Results A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release.

Conclusions Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.

/pdf/impact-of-immigration-detention-and-temporary-protection-on-20by3n50mj.pdf

Impact of immigration detention and temporary protection on the mental health of refugees

Refugees demonstrate high rates of post-traumatic stress disorder (PTSD) and other psychological disorders. The recent increase in forcible displacement internationally necessitates the understanding of factors associated with refugee mental health. While pre-migration trauma is recognized as a key predictor of mental health outcomes in refugees and asylum seekers, research has increasingly focused on the psychological effects of post-migration stressors in the settlement environment. This article reviews the research evidence linking post-migration factors and mental health outcomes in refugees and asylum seekers. Findings indicate that socioeconomic, social, and interpersonal factors, as well as factors relating to the asylum process and immigration policy affect the psychological functioning of refugees. Limitations of the existing literature and future directions for research are discussed, along with implications for treatment and policy.

The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers

A critical review of psychological treatments of posttraumatic stress disorder in refugees

Mental health of detained asylum seekers

v Objectives To measure the frequency of people reporting torture among patients in a medical outpatient clinic and to determine primary care physicians' awareness of their patients' exposure to torture. v Design Cross-sectional survey followed by selected in-depth interviews of participants report- ing a history of torture. Medical record review and interview of torture survivors' primary care physicians. v Setting The internal medicine clinic of a large, urban medical center. v Participants A convenience sample of 121 adult patients who were not born in the United States and who were attending the adult ambulatory care clinic. v Interventions All participants were interviewed using the Detection of Torture Survivors Survey, a validated instrument that asks about exposure to torture according to the World Medical Association definition of torture. Participants who reported a history of torture were interviewed in depth to confirm that they had been tortured. We reviewed the medical records of participants who reported a history of torture and interviewed their primary care physicians. v Main outcome measures Self-reported history of torture. The awareness of primary care physicians of this history. v Results Eight of 121 participants (6.6% (95% confi- dence interval: 3.1%-13.1%)) reported a history of torture. None of the survivors of torture had been identified as such by their primary care physician. v Conclusions Physicians of patients who have not been born in the United States and who attend urban general medical clinics frequently are unaware that their patients are survivors of torture. Primary care physicians can be the locus of intervention in the care of torture survivors. The first step is for physicians to recognize the possibility of torture survivors among their patients.

Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed?

Asylum seekers arriving in the United States are often imprisoned for months or years while their asylum claims are processed. Recently, Physicians for Human Rights and the Bellevue/New York University Program for Survivors of Torture released the findings of the first systematic study examining the health of detained asylum seekers. The study found that the mental health of asylum seekers interviewed was extremely poor, including high levels of symptoms for anxiety, depression, and posttraumatic stress disorder, which worsened the longer individuals were in detention. The study also raises concerns about the manner in which asylum seekers are treated upon arrival in the United States and then while in detention. These findings support assertions that detention has a harmful effect on the health and well-being of asylum seekers. Policies regarding the long-term detention of asylum seekers should be reconsidered.

Glen Kim

Papers

Mental health of detained asylum seekers

Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed?

The impact of detention on the health of asylum seekers