Mentalno zdravlje izbeglica, tražilaca azila i migranta - izazovi i primeri dobre prakse

Most youth in detention have 1 or more psychiatric disorders (1). Posttraumatic stress disorder (PTSD) is one of the more prevalent disorders in detention, affecting at least 1 in 10 youth (2–4). One of the more debilitating aspects of PTSD is its tendency to co-occur with other psychiatric disorders (5–7). In a community sample, Giaconia and colleagues (8) found that nearly four-fifths of those with lifetime PTSD also had one or more additional disorders. Studies of detained adolescent males in Russia (9) and detained adolescent females in Australia (10) found that all of the detainees with PTSD had at least 1 comorbid disorder. It is unclear if PTSD increases the vulnerability to other disorders or if there are common genetic or environmental factors underlying the disorders (5,11). Researchers agree, however, that comorbid disorders have an adverse impact on the prognosis and treatment of individuals with PTSD. Youth with PTSD and comorbid disorders have significantly more behavioral and health problems and more impaired interpersonal relationships than those without comorbid disorders (5). Effective treatment planning for detained youth with PTSD requires epidemiologic data on patterns of prevalence and comorbidity. Yet, to our knowledge, no epidemiologic study of detainees in the US has examined PTSD and comorbid psychiatric disorders. In this paper, we administered standardized diagnostic measures to a large, stratified random sample of detained youth to: (a) compare the prevalence of psychiatric disorders among juvenile detainees with and without PTSD and (b) examine the prevalence of PTSD among youth with and without other psychiatric disorders.

Screening for Complicated Grief Among Project Liberty Service Recipients 18 Months After September 11, 2001

Few studies have explored the long-term mental health consequences of disaster losses in bereaved, either exposed to the disaster themselves or not. This study examined the prevalence and predictors of mental disorders and psychological distress in bereaved individuals either directly or not directly exposed to the 2004 tsunami disaster. A cross-sectional study of 111 bereaved Norwegians (32 directly and 79 not directly exposed) was conducted 2 years postdisaster. We used a face-to-face structured clinical interview to diagnose current posttraumatic stress disorder (PTSD) and depression (major depressive disorder, MDD) and a self-report scale to measure prolonged grief disorder (PGD). The prevalence of psychiatric disorders was twice as high among individuals directly exposed to the disaster compared to individuals who were not directly exposed (46.9 vs. 22.8 per 100). The prevalence of disorders among the directly exposed was PTSD (34.4%), MDD (25%), and PGD (23.3%), whereas the prevalence among the not directly exposed was PGD (14.3%), MDD (10.1%), and PTSD (5.2%). The co-occurrence of disorders was higher among the directly exposed (21.9 vs. 5.2%). Low education and loss of a child predicted PGD, whereas direct exposure to the disaster predicted PTSD. All three disorders were independently associated with functional impairment. The dual burden of direct trauma and loss can inflict a complex set of long-term reactions and mental health problems in bereaved individuals. The relationship between PGD and impaired functioning actualizes the incorporation of PGD in future diagnostic manuals of psychiatric disorders.

This study identified recent changes in the prevalence of psychiatric disorders among Department of Veterans Affairs (VA) nursing home residents. Psychiatric diagnoses in administrative databases were summarized for nursing home residents in 1998, 2002, and 2006. Census prevalence rates were compared with findings from earlier VA nursing home surveys. Prevalence rates were compared for age groups and birth cohorts of VA nursing home admissions in 1998 (N=27,734) and 2006 (N=32,543). Among residents in the census samples, prevalence rates for dementia and schizophrenia fluctuated moderately from 1990 to 2006, depression prevalence increased sharply, alcohol use disorder prevalence declined, and drug use disorder prevalence increased. Among 1998 and 2006 admissions, dementia prevalence increased for most birth cohorts but declined for most age groups (35% to 32% overall). Depression prevalence increased for all age groups and birth cohorts (27% to 37% overall), as did posttraumatic stress disorder prevalence (5% to 12% overall). Serious mental illness prevalence increased among the oldest residents and birth cohorts (19% to 22% overall). Alcohol use disorder prevalence declined for all birth cohorts and most age groups (18% to 16% overall), but drug use disorder prevalence increased substantially for younger age groups (6% to 9% overall). Examining differences in prevalence between birth cohorts and age groups can clarify trends in nursing home resident characteristics and improve projections of their future needs.

Reintegration Problems and Treatment Interests Among Iraq and Afghanistan Combat Veterans Receiving VA Medical Care

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country. The objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints. A population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively). General health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25. More asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms. Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.

Deployment of personnel to military operations: impact on mental health and social functioning.

Suicide Among Refugees--A Mockery of Humanity.

This Campbell systematic review examines the impacts of on health, including mental health (PTSD, anxiety and depression), physical health and social functioning, of confining asylum seekers in detention centres. The review includes nine studies from the UK, Japan, Canada, and Australia. Detention has a negative impact on the mental health of asylum seekers. Levels of post‐traumatic stress disorder (PTSD), depression, and anxiety both before and after release were found to be higher among asylum seekers who were detained compared to those who were not detained. The size of the effects were clinically important. All the studies assessed the mental health of the participants but none reported outcomes related to physical or social functioning. Executive summary/Abstract BACKGROUND The last decades of the twentieth century were accompanied by an upsurge in the number of persons fleeing persecution and regional wars. Western countries have applied increasingly stringent measures to discourage those seeking asylum from entering their country. The most controversial of the measures to discourage people from seeking asylum is the decision by some Western countries to confine asylum seekers in detention facilities. In most countries, the detention of asylum seekers is an administrative procedure that is undertaken to verify the identity of individuals, process asylum claims, and/or ensure that a deportation order is carried out. A number of clinicians have expressed concern that detention increases mental health difficulties in asylum seekers, who is already a highly traumatized population, and have called for an end to such practices. This is clearly in conflict with government policies aimed at reducing the numbers of asylum seekers. OBJECTIVES The main objective of this review is to assess evidence about the effects of detention on the mental and physical health and social functioning of asylum seekers. SEARCH STRATEGY Relevant studies were identified through electronic searches of bibliographic databases, internet search engines and hand searching of core journals. Searches were carried out to November 2013. We searched to identify both published and unpublished literature. The searches were international in scope. Reference lists of included studies and relevant reviews were also searched. SELECTION CRITERIA All study designs that used a well‐defined control group were eligible for inclusion. Studies that utilized qualitative approaches were not included. DATA COLLECTION AND ANALYSIS The total number of potential relevant studies constituted 11,376 hits. A total of nine studies, consisting of 12 papers, met the inclusion criteria and were critically appraised by the review authors. The final selection comprised nine studies from four different countries. Two studies reported on the same sample of asylum seekers in Australia at different time points after release. The nine studies thus analysed eight different asylum populations. Six studies (all analysing asylum seekers in Australia) could not be used in the data synthesis as they were judged to have too high risk of bias on the confounding item. Three studies were therefore included in the data synthesis. Meta‐analysis was used to examine the effects of detention on post‐traumatic stress disorder (PTSD), depression and anxiety while the asylum seekers were still detained. Random effects models were used to pool data across the studies using the standardised mean difference. Pooled estimates were weighted using inverse variance methods, and 95% confidence intervals were estimated. It was not possible to perform a meta‐analysis after release as only one study providing data after release was included in the data synthesis. RESULTS Two studies provided data while the asylum seekers were still detained, and one study provided data less than a year after release. The total number of participants in these three studies was 359. We performed analyses separately for these time points. All outcomes were measured such that a negative effect size favours the detained asylum seekers, i.e. when an effect size is negative the detained asylum seekers are better off than comparison groups of non‐detained asylum seekers. The three studies used in the data synthesis were all non randomised studies and only one of them was judged to be of some concern on the confounding item of the risk of bias tool. Primary study effect sizes for PTSD, depression and anxiety while the asylum seekers were still detained lies in the range 0.35 to 0.99, all favouring the non‐detained asylum group. The weighted average effect sizes for PTSD and anxiety are of a magnitude which may be characterised as being of clinical importance: 0.45 [95% CI 0.19, 0.71] and 0.42 [95% CI 0.18, 0.66]. The weighted average effect size for depression is of an even higher magnitude: 0.68 [95% CI 0.10, 1.26]. All effects favour the non‐detained; i.e. there is an adverse effect of detention on mental health. The magnitude of the pooled estimates should however be interpreted with caution as they are based on two studies, and for depression there is some inconsistency in the magnitude of effect sizes between the two studies. One study reported outcomes (PTSD, depression and anxiety) after release and the magnitude of the effect sizes were all of clinical importance: 0.59 [95% CI 0.02, 1.17], 0.60 [95% CI 0.02, 1.17] and 0.76 [95% CI 0.17, 1.34]; all favouring the non‐detained asylum seekers. AUTHORS' CONCLUSIONS There is some evidence to suggest an independent adverse effect of detention on the mental health of asylum seekers. All studies used in the data synthesis reported adverse effects on the detained asylum seekers' mental health, measured as PTSD, depression and anxiety. The magnitude of the effect sizes lay in a clinical important range despite the fact that the comparison groups used in the primary studies faced a range of similar post‐migration adversities and had a more or less similar experience of prior traumatic events as the detained asylum seekers. Thus, the current evidence suggests an independent deterioration of the mental health due to detention of a group of people who are already highly traumatised. Adverse effects on the mental health were found not only while the asylum seekers were detained, but also after release suggesting that the adverse mental health effect of detention may be prolonged, extending well beyond the point of release into the community. The conclusions should however be interpreted with caution as they are based on only three studies. More research is needed in order to fully investigate the effect of detention on mental health. While additional research is needed, the review does, however, offer support to the view that the detention of already traumatised asylum seekers may have adverse effects on their mental health.

The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes. The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale. Mental and physical health outcomes were assessed by self-report and interviewer evaluation. Survival analysis and linear and logistic regressions were used to determine the risk for adverse mental and physical health outcomes posed by traumatic grief. Survival and regression analyses indicated that the presence of traumatic grief symptoms approximately 6 months after the death of the spouse predicted such negative health outcomes as cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits at 13- or 25-month follow-up. The results suggest that it may not be the stress of bereavement, per se, that puts individuals at risk for long-term mental and physical health impairments and adverse health behaviors. Rather, it appears that psychiatric sequelae such as traumatic grief are of critical importance in determining which bereaved individuals will be at risk for long-term dysfunction.

Project Liberty provided brief crisis counseling to 753,015 residents of New York City and surrounding counties after the attacks on the World Trade Center. Most regained predisaster functioning after counseling. For those who did not, Project Liberty provided enhanced services by specially trained, licensed mental health professionals. Individuals receiving crisis counseling and enhanced services responded to confidential telephone interviews about 18 and 24 months, respectively, after the attacks. Impairment was compared between groups to determine whether enhanced services recipients reported improved functioning and fewer symptoms of depression, posttraumatic stress, and complicated grief. Crisis counseling recipients (N=153) were interviewed once and enhanced services recipients (N=76) were interviewed twice about symptomatology and daily functioning. The samples did not differ in age or gender. Significantly greater proportions of enhanced services recipients reported knowing someone who died as a result of the attacks, having been involved in rescue efforts, or having lost their job because of the attacks. Compared with crisis counseling respondents, enhanced services recipients at their first interview reported significantly more symptoms of depression, grief, and traumatic stress and significantly poorer daily functioning in five life areas. At follow-up, enhanced services respondents reported significant improvement in three of five functioning domains, significantly fewer symptoms of depression and grief, and marginally less traumatic stress. Recipients of enhanced services were more impaired than people who received only crisis counseling. On the basis of reports from service recipients, meaningful improvements in functioning and symptoms may be associated with the receipt of enhanced services.

This study sought to determine whether a set of symptoms interpreted as complicated grief could be identified and distinguished from bereavement-related depression and whether the presence of complicated grief would predict enduring functional impairments. Data were derived from a study group of 82 recently widowed elderly individuals recruited for an investigation of physiological changes in bereaved persons. Baseline data were collected 3-6 months after the deaths of the subjects' spouses, and follow-up data were collected from 56 of the subjects 18 months after the baseline assessments. Candidate items for assessing complicated grief came from a variety of scales used to evaluate emotional functioning (e.g., the Hamilton Depression Rating Scale, the Brief Symptom Inventory). The outcome variables measured were global functioning, medical illness burden, sleep, mood, self-esteem, and anxiety. A principal-components analysis conducted on intake data (N = 82) revealed a complicated grief factor and a bereavement-depression factor. Seven symptoms constituted complicated grief: searching, yearning, preoccupation with thoughts of the deceased, crying, disbelief regarding the death, feeling stunned by the death, and lack of acceptance of the death. Baseline complicated grief scores were significantly associated with impairments in global functioning, mood, sleep, and self-esteem in the 56 subjects available for follow-up. The symptoms of complicated grief may be distinct from depressive symptoms and appear to be associated with enduring functional impairments. The symptoms of complicated grief, therefore, appear to define a unique disorder deserving of specialized treatment.

Clinical Characteristics and Health Service Use of Veterans With Comorbid Bipolar Disorder and PTSD

To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder. Prospective cohort study. Survey study, 1 year after discharge from a medical-surgical ICU in the Netherlands. One-year ICU survivors of an ICU admission lasting more than 48 hours, without a neurologic disorder or other condition that would impede delirium assessment during ICU stay. None. One year after discharge, ICU survivors received a survey containing the Hospital Anxiety and Depression Scale with a subscale for symptoms of depression and a subscale for symptoms of anxiety, and the Impact of Event Scale 15 item measuring symptoms of posttraumatic stress disorder. Participants were classified as having experienced no delirium (n = 270; 48%), a single day of delirium (n = 86; 15%), or multiple days of delirium (n = 211; 37%) during ICU stay. Log-binomial regression was used to assess the association between delirium and symptoms of anxiety, depression, and posttraumatic stress disorder. The study population consisted of 567 subjects; of whom 246 subjects (43%) reported symptoms of anxiety (Hospital Anxiety and Depression Scale with a subscale for anxiety, ≥ 8), and 254 (45%) symptoms of depression (Hospital Anxiety and Depression Scale with a subscale for depression, ≥ 8). In 220 patients (39%), the Impact of Event Scale 15 item was greater than or equal to 35, indicating a high probability of posttraumatic stress disorder. There was substantial overlap between these mental health problems-63% of the subjects who scored positive for the presence of any three of the mental health problems, scored positive for all three. No association was observed between either a single day or multiple days of delirium and symptoms of anxiety, depression, or posttraumatic stress disorder. Although symptoms of anxiety, depression, and posttraumatic stress disorder were found to be common 1 year after critical illness, the occurrence of delirium during ICU stay did not increase the risk of these long-term mental health problems.