Mental Health of Refugees and Nonrefugees from Wa

Authors: Melanie L Straiton Anne Reneflot Esperanza Diaz

Publish Date: 2016/06/21

Volume: 19, Issue: 3, Pages: 582-589

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Abstract

High rates of mental health problems are consistently found among immigrants from refugee generating countries While refugees and their family members may have experienced similar traumas refugees are more likely to have undergone a stressful asylum period This study aims to determine whether their mental health differs Using national registry data refugees and nonrefugees from the same countries were compared on primary healthcare service use for mental health problems and purchase of psychotropic medicine Refugees had higher odds of using primary health care services than nonrefugees Refugee women were more likely to purchase psychotropic medicine than nonrefugee women Refugee men were more likely to purchase antidepressants The findings suggest that refugees have poorer mental health than nonrefugees This may be due to a combination of greater premigration trauma and postmigration stressors such as enduring a difficult asylum periodRecent years have seen a growth in the number of people seeking asylum around the world In 2014 there were 714300 asylum applications in Europe almost 50  more than in 2013 1 Around 45  of applicants are granted asylum in the first instance 2 In 2015 Norway received over 31000 applications for asylum 3 By the end of 2014 there were 137950 refugees living in Norway and a further 50180 spouses children or parents reunited with their refugee counterparts 4 These groups make up 281  of the immigrant populationWhen permission to stay has been granted all immigrants are covered by the national health insurance scheme and entitled to the same health care as Norwegians Asylum seekers are now also entitled to this upon arrival 5 High rates of mental health problems such as posttraumatic stress depression and anxiety have been consistently found among those with a refugee background 6 7 presenting a challenge to the health service as the number of refugees grow Yet research on rates of health service use for mental health problems is limited Small scale studies often focusing on one specific ethnic group suggest a low rate of service use compared with need 8 9 10 Rates vary considerably by country of origin 11 In larger scale studies service use among immigrants from refugeegenerating countries RGCs is compared to the general population For instance in Australia immigrants from RGCs had lower rates of specialist mental health service use compared with the general population 12 while in Denmark rates were higher 13 We lack large scale studies at the primary care level where majority of mental health problems are treated 14Immigrants from RGCs may have experienced traumas such as war violence famine torture repression and loss of family These factors are related to increased risk of mental health problems 15 Those who come as refugees however are more likely to have endured a difficult and lifethreatening migration in addition to a long stressful and uncertain period in an asylum centre 16 This together with worries about the family left behind may mean that refugees have greater mental health care needs than their later arriving family members Yet few studies compare health service use for refugees and nonrefugees from the same countriesA Swedish study compared refugees and nonrefugees from RGCs on the purchase of psychotropic medicine 17 Refugee women but not men were more likely than nonrefugees to purchase psychotropic medicine The authors argued that refugee women were at higher risk of mental health problems than nonrefugee women However to purchase psychotropic medicine implies not only that one has a mental health problem but also that one has sought help and thus differences may also reflect willingness to seek help and/or access to health servicesFocusing only on those who have used primary health care services for mental health problems and thereby eliminating variation in helpseeking refugees will be more likely to use psychotropic medicine than nonrefugees even after accounting for sociodemographic factorsThe National Population Register NPR the Norwegian Health Economics Administration database HELFO and the Norwegian Prescription Database NorPD were linked together for 2008 This was done at an individual level using the personal identification number which all Norwegians at birth and all immigrants living in Norway for more than 6 months are assigned

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