Abstract
Individuals who seek asylum are frequently fleeing violent persecution and may experience head injury (HI). However, little is known about the prevalence of HI in asylum seekers and refugees (ASR) despite the potential for HI to significantly affect cognitive and emotional functioning and to compromise asylum outcomes. This preliminary study investigates the prevalence of HI in ASR referred to a complex psychological trauma service. Participants were 115 adult ASR referred to a community psychological trauma service with moderate to severe mental health problems associated with psychological trauma. They were screened for a history of HI using a questionnaire developed for the study. Interpreters were used when required. The overall prevalence of HI was 51%. At least 38% of those with HI had a moderate-severe HI that could cause persisting disability. In 53% of those with HI, the cause was torture, human trafficking or domestic violence. Repeat HI can have cumulative effects on function; it was common, and was reported in 68% of those with HI. An injury to the head was not known to mental health clinicians prior to screening in 64% of cases. The emotional and cognitive consequences of HI in ASR may increase the vulnerability of this disadvantaged group, and can be associated with neurobehavioural problems affecting daily life and may compromise asylum outcomes. Routine screening for HI in ASR is needed, as are links to neuropsychology and brain injury services for advice, assessment and intervention.
Highlights
Asylum seekers and refugees (ASR) are by definition, more likely than the general population to have experienced physical assault and injury in their country of origin (United Nations, 2004), and to be victims of torture, including blows to the head and asphyxiation that can result in brain damage (Moreno & Grodin, 2002; Keatley et al 2013). Mollica et al (2014) reported that a high proportion (78%) of Vietnamese ex-political detainees resettled in Boston reported a history of head injury (HI)
In addition to cognitive impairment, HI can cause emotional problems that can lead to the breakup of relationships, social isolation and unemployment that is associated with psychological distress and that can complicate effects of psychological trauma (McMillan et al 2003)
Retrospective diagnosis of HI may be especially challenging in the case of ASR, where there may be no objective information about the occurrence or severity of the HI and where comorbidity and overlap between HI and mental health complaints (e.g. depression, post-traumatic stress disorder (PTSD)) is common (McMillan et al 2003)
Summary
Asylum seekers and refugees (ASR) are by definition, more likely than the general population to have experienced physical assault and injury in their country of origin (United Nations, 2004), and to be victims of torture, including blows to the head and asphyxiation that can result in brain damage (Moreno & Grodin, 2002; Keatley et al 2013). Mollica et al (2014) reported that a high proportion (78%) of Vietnamese ex-political detainees resettled in Boston reported a history of head injury (HI). More generally there has been little empirical investigation into the prevalence of HI in the ASR population and as a consequence there is little informed guidance for service providers. ASR often present to health services with complex needs including mental and physical health problems, social or housing problems and involvement in legal proceedings (Burnett & Peel, 2001) where cognitive impairment and emotional problems can be a disadvantage. Clinicians may not be alert to the possibility of HI when recording symptom complaints in a client group where there is already an expectation of a high prevalence of mental health problems including PTSD and depression (Fazel et al 2005). A better understanding of the prevalence of HI in this population is potentially crucial if an adequate humanitarian and clinical response to the needs of this vulnerable group is to be provided
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