Psychological trauma and access to primary healthcare for people from refugee and asylum-seeker backgrounds: a mixed methods systematic review

Clemence Due,Anna Ziersch,Erin Green

doi:10.1186/s13033-020-00404-4

Clemence Due, Anna Ziersch + Show 1 more

Open Access

https://doi.org/10.1186/s13033-020-00404-4

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Abstract

BackgroundSeveral reviews have found that psychological trauma affects access to health care services, including mental health care, in the general population. People from refugee and asylum seeker backgrounds are more likely to have a mental illness than the general population, and experience a broad range of barriers and facilitators to service access. However, to date there has been no comprehensive consideration of the potential effect of psychological trauma on access to primary health care within this population.MethodsThis paper provides a mixed-methods systematic review of literature which included any consideration of the relationship between psychological trauma and access to primary health care. A systematic search of Medline, PsychInfo, Scopus, Web of Science, Embase, CINAHL and Cochrane Library was conducted. Study eligibility criteria were empirical, peer-reviewed studies that considered the relationship between psychological trauma and access to, or use of, primary healthcare in resettlement countries for refugees (including asylum seekers). Papers were required to be written in English and published between 1998 and August 2019. Quality was assessed using the Multi-Methods Appraisal Tool. The search identified a total of 14 eligible studies (11 quantitative and 3 qualitative) which had explored this relationship in refugee and asylum seeker populations.ResultsOverall, synthesis of findings indicated variable results with respect to the impact of psychological trauma on service access. Specifically, the review found that while rates of psychological trauma were high. Key themes were that while general health care access was comparable or greater than the general population, rates of mental healthcare specifically were low. In addition, included papers identified a range of barriers to service access—particularly somatisation, stigma and healthcare provide knowledge about psychological trauma.ConclusionsWhile there is a critical need for more research in this area, the study points to several key recommendations including training of general practitioners in relation to psychological trauma, ensuring culturally responsive services, and the use of interpreters. Finally, due to the levels of somatisation found in some studies, ensuring general practitioners understand the somatic element of psychological trauma—particularly within some groups of people from refugee backgrounds—is important.

Highlights

Several reviews have found that psychological trauma affects access to health care services, including mental health care, in the general population
Evidence concerning best practice in interventions designed for psychological trauma is mixed, and this is true for interventions when working with adults and children from refugee or asylum seeker backgrounds [2]
The studies included in this review reported variable findings with respect to the impact of psychological trauma on access to primary healthcare services

Summary

Introduction

Several reviews have found that psychological trauma affects access to health care services, including mental health care, in the general population. Due et al Int J Ment Health Syst (2020) 14:71 due to a range of pre and post migration factors including experiences of war, torture, family separation, forced migration and resettlement in unfamiliar environments [1, 2] This includes psychological trauma—most commonly diagnosed as post-traumatic stress disorder (PTSD)—with research indicating that people from refugee backgrounds are approximately 10 times more likely to experience psychological trauma than the general population [1]. In this context access to primary health care—including mental healthcare—is critical for refugees and asylum seekers given its key preventative role and the fact that primary care often functions as a gateway to specialised services [3, 4]. While informal and community supports should ideally form part of holistic care, engagement with the mental health system—or with trauma trained primary care workers—is a critical part of working with psychological trauma [6]

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