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Refugees Have High Burden of Mental Health Problems

June 19, 2019

By Megan Brooks

NEW YORK—Refugees and asylum seekers fleeing conflict in their homeland often have high levels of psychological distress and should undergo routine mental health screening at arrival to a new country, researchers said at the North American Refugee Health Conference held June 14 to 16 in Toronto, Canada.

In 2015, Sweden received 156,400 new asylum seekers, making Sweden one of the high-income countries in the world receiving most refugees per inhabitant, Anna Leiler, a doctoral student at Mid Sweden University in Oestersund, noted in an oral presentation.

Refugees and especially asylum seekers show high levels of mental health problems due to difficult experiences before, during and after leaving their countries, she told attendees. For some individuals, these experiences make life intolerable and there are reports showing that at least male asylum seekers are at increased risk of death by suicide.

Leiler and colleagues assessed mental-health symptom severity and suicidal ideation among 510 adult refugees seeking asylum in Sweden who completed the Refugee Health Screener (RHS).

They found that more than a third of the total sample (173 individuals, 33.9%) admitted having suicidal thoughts in the past two weeks. The risk of suicidal ideation was significantly elevated among individuals with moderate (odds ratio, 3.12) and severe psychological distress (OR, 8.09).

"Suicidal ideation is highly prevalent among asylum seekers. These findings call for an increased awareness of the suicide risk among refugees with moderate to severe levels of psychological distress," Leiler told Reuters Health by email.

A related study from the conference found a high prevalence of depression among refugees to Canada. The researchers analyzed data on 307 refugees and 29,365 non-refugees from the Canadian Longitudinal Study on Aging.

The prevalence of depression was significantly higher among refugees than non-refugees (22.1% vs. 15.2%), Lin Shen Lamson of the University of Toronto and colleagues report in their conference abstract.

The age-sex-adjusted odds of depression for refugees (odds ratio, 1.70) was not attenuated when several relevant factors were taken into account, including education, income, marital status, comorbid physical health conditions and chronic pain, binge drinking and physical activity, and social isolation and online social networking.

However, in the model only adjusting for social support, the odds of depression for refugees was reduced to non-significance (OR, 1.30).

According to the Pew Research Center, in 2017, the number of asylum applicants in Canada reached the highest levels in decades, with 50,420 asylum applications received by the government. Most people seeking asylum came from Haiti, followed by Nigeria and Turkey (

"Targeted interventions to decrease isolation and improve refugees' social support warrant greater attention," Lamson and colleagues conclude in their abstract. Lamson did not respond to a request for comment.

In another study from the conference, researchers from Utah found a high prevalence of health and mental health conditions among refugee arriving in that state from 2012 to 2017. Among 6,842 refugees, 64% had a diagnosis for physical and/or mental health issues, reported Dr. Lisa Gren of the University of Utah, in Salt Lake City, and colleagues.

"Notable" physical health concerns were elevated blood pressure, thyroid disorders, gastroenterology complaints, anemia, tuberculosis, headaches, decreased visual acuity and urinary tract infection. For mental health issues, women had higher rates of depression and had higher screening scores for PTSD and distress.

"Refugees often face health-related challenges upon resettlement and arrive with pre-existing conditions. Service providers need to be aware of these issues to prioritize services and focus on issues of greatest need," Dr. Gren and colleagues write in their abstract.

"While visual acuity may be relatively easy issue to address with prescription lenses, other health issues may require more concerted discussion and coordinated, focused treatment. As an example, mental health issues such as depression may be linked to both somatic and physical symptoms," they add. Dr. Gren did not respond to a request for comment.


North American Refugee Health Conference 2019.

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