Mental Health Of Asylum Seekers Research Articles

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: A cross-sectional, population-based, multi-level analysis in a German federal state.

Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.

Mental deterioration of refugees and asylum seekers with uncertain legal status in Australia: Perceptions and responses of legal representatives.

Many developed countries have introduced strict measures designed to deter people seeking asylum. Measures such as held detention, insecure visas, restrictions work and services all impact the mental health of asylum seekers. In 2014 Australia introduced a 'fast track assessment' (FTA) system of processing refugee claims for asylum seekers who arrived by boat, those found to be refugees were only eligible for temporary residence. Legal professionals play a pivotal role in protecting the rights of asylum seekers and gain unique insight into the impact of the legal system has on clients mental health. To investigate how legal professionals in Australia perceived the impact of the FTA process on their clients. Mixed methods comprising of two phases - (i) an online survey and (ii) follow-up focus groups and interviews with legal professionals involved in assisting asylum seekers in the FTA process. An inductive thematic analysis was used to analyse the data. Survey results were obtained from 38 legal professionals. Follow up in depth qualitative focus groups and interviews were conducted with 16 survey participants. The data demonstrate that legal professionals encounter clients in complex seemingly insurmountable mental health crises including deepening mental distress and deterioration, feelings of hopelessness, defeat and entrapment. Interviewees shared compelling examples of what they believed constituted a direct connection between asylum seekers experiencing uncertainty and deteriorating mental health over time with fluctuations in hopelessness, anger, withdrawal and suicidality. These negative impacts were often compounded by separation from family. The legal framework for determining whether an asylum seeker is a refugee can have a detrimental impact on the mental health of asylum seekers. The mental distress of asylum seekers and refugees is exacerbated by uncertainty linked to both delays in processing accompanied by sustained and ongoing uncertainty of legal status.

Mental health of asylum seekers and refugees: The role of trauma and postmigration living difficulties and the moderating effect of intergroup contact

Refugees undergo traumatic events during the premigration and transit phases and also experience severe difficulties after resettlement in a new country, and they are therefore at high risk of developing mental health problems. The present studies examined if intergroup contact with members of the receiving society moderates these negative impacts on refugees’ mental health. Two studies with refugees in Switzerland (N = 262) revealed both buffering and exacerbating effects of intergroup contact. Having more Swiss friends was associated with a less negative relationship between postmigration living difficulties and mental health. Surprisingly, having more Swiss friends was also associated with a more negative relationship between traumatization and mental health. These results suggest that intergroup contact may help refugees adjust to the living conditions in the receiving society, but may pose a risk regarding trauma-related disorders.

Threats and Interventions on Wellbeing in Asylum Seekers in the Netherlands: A Scoping Review.

BackgroundMost asylum seekers experience stress, not only due to the reason for fleeing and their travel but also due to their compulsory stay in the asylum seeker center in the Netherlands and the asylum procedure. This often leads to self-medication and addiction which causes lower self-esteem and lower quality of life. Adverse life events, forced migration, and prolonged asylum procedures, in addition to the complexity of the acculturation process, can all contribute to higher levels of psychopathology.ObjectiveWhat are the threats to wellbeing in terms of mental health, psychosocial, and addiction problems, and what are the effective interventions for wellbeing for asylum seekers in asylum seeker centers in the Netherlands, reported in the literature?MethodFollowing the descriptive nature of the research question and the need for identifying knowledge gaps, an overview of existing knowledge was created by executing a scoping review on influencing factors on the mental health of asylum seekers. The Neuman system model was used as a guiding framework to understand the complexity of the issues this population experience and to identify the stressors and the factors which cause the imbalance and also the disease.ResultsThe literature review resulted in 26 articles that met the criteria for inclusion. The threats included the influence of staying in the environment of an asylum seekers center, drug abuse among asylum seekers, health-care professionals and employees who do not detect or underestimate the underlying suffering of asylum seekers, and frequent relocations of asylum seekers. The two assessment instruments used were the Rapid-Assessment-Response method (RAR method) and the Health Information Assessment Tool Asylum Seeker tool (HIATUS tool). Finally, the five interventions were identified: therapy for asylum seekers diagnosed with post-traumatic stress disorder (PSTD), art therapy, education focused on prevention as intervention, cultural interview, and mindspring.ConclusionThe knowledge on identifying and reducing threats, assessment, and treatment interventions for asylum seekers living in an asylum seekers center found in the literature provided perspectives on improving their wellbeing. The great diversity of cultural aspects and continuous changes in the number and origin of refugees in the Dutch asylum seekers centers disrupted the continuity of care.

A trauma informed response to COVID 19 and the deteriorating mental health of refugees and asylum seekers with insecure status in Australia.

COVID‐19 brings increased risk to the mental health of asylum seekers and refugees in Australia on temporary visas. Rapid government changes due to the COVID‐19 pandemic are resulting in significant and sustained hardship on this already vulnerable group. This discursive paper is both an explainer and a resource for mental health nurses and health professionals with scope of practice in primary care and emergency departments responding to this population. The aim of this paper is to alert clinicians to the drivers of mental and suicide related distress and to provide recommendations as to how to therapeutically engage and support this group. Drivers include complex intersections between legal uncertainty, economic, social and mental health stress as drivers of entrapment, acute mental distress and suicidal ideation. Information about the COVID‐19 related factors as drivers contributing to worsening states of distress may help guide clinicians to consider protective factors designed to mitigate the onset or worsening of mental distress, plus aid in the development of health policy and service‐delivery arrangements of support and therapeutic engagement.

Threats on well-being in asylum seekers in the Netherlands. A scoping review: An Integrated Personalized Care Approach

Introduction: Asylum seekers in Dutch refugee Camps are often heavenly burdened from mental health problems triggered by the reason of fleeing and the circumstances during their travel to the Netherlands. This leads frequently to self-medication for relieve and as a consequence addiction, lower quality of life and mutual displeasure. In order to create an overview of existing knowledge of why so many asylum seekers experience psychiatric problems in Dutch refugee Camps, we reviewed the literature on influencing factors on mental health of asylum seekers with regard to the experience of the asylum seekers procedure and staying in a refugee camp.Methods: We used the PRISMA ScR statement recommendations in the design, literature search, analysis, and reporting of our scoping review (Tricco et al., 2018).Results: The duration of the asylum procedure is an important risk factor for experiencing psychiatric problems. How asylum seekers perceive and cope with illness in terms of their culture of origin, is often unknown by professionals providing mental health care in refugee camps in the Netherlands. The Dutch refugee camps are typically parsimonious; meaning asylum seekers receive “bed, bath and bread”, as such they literally receive only the very basic support. An asylum seeker has limited rights in the Netherlands. They live usually in mixed groups of refugees of different cultural background in small living facilities. They can’t work, only voluntary on the asylum seekers centre and work that is mostly far below their education level, such as cleaning work while they have an academic degree. They get a small weekly allowance for groceries, clothes and all the other things they need. Only children with the age under eighteen have access to school facilities.Discussion: When an asylum seeker gets a residence permit, this person moves from the asylum seeker centre to a living space in the Dutch community. This reliefs the person from the strict regulations in the asylum seeker centre, leading by itself to a better health perception. However they face problems from the burden full experiences of living in the strict regime in the asylums seeker centre, not feeling prepared for living in the free Dutch society.Conclusions: Circumstances in Dutch refugee centres have an increasing effect on psychiatric problems of refugees. These problems are originated in the reason of fleeing and the circumstances during their travel to the Netherlands, but are accelerated by the strict regime in Dutch refugee centres.Lessons learned: Living in mixed cultural setting in sparse circumstances should be supported by healthcare providers in Dutch refugee camps which have competencies in guiding refugees in how they perceive and cope with illness in terms of their culture of origin.Limitations: There is no universal way to treat asylum seekers, and the literature is not specific in how to deliver integrated and personalized care.`Suggestions for further research: Cultural sensitive treatment possibilities and current treatment evaluation of healthcare for refugees in refugee camps.

An embodied distress: African asylum seekers' experiences of mental health difficulties while awaiting an asylum outcome in Ireland.

The mental health of asylum seekers has attracted significant interest and examination. Quantitative studies have consistently indicated that asylum seekers experience mental distress at a higher rate than both host populations and their refugee counterparts. Qualitative insight into asylum seekers' embodied experience of mental distress is limited. This qualitative narrative study aimed to explore African asylum seekers' everyday embodied experiences of mental distress. Sixteen semi-structured one-to-one interviews were conducted with African asylum seekers who had experienced mental distress and were receiving mental health care services in Ireland. Narrative data were analysed using a holistic analysis framework of narrative form and content. Participants described their everyday endurance of relentless rumination, shame, self-loathing, anger, and mistrust, and of becoming demoralised and hopeless. Study findings indicate that asylum seekers' mental distress interweaves the physical, psychological, emotional, and social realms, thus impacting on the whole of their being. Consequences for asylum seekers include feeling anaesthetised, having a severely diminished capacity to connect and interact with their external surroundings and other people, and, for some, efforts to end their life.Examinations of, and responses to, asylum seekers' mental distress must delve beyond the confines of diagnostic categorisations and codifications of symptomology. To achieve heightened understanding and efficacious interventions, we must empathetically listen and engage with asylum seekers' narratives of distress and the socio-cultural and socio-political context they inhabit.

Subjective social mobility, quality of life and mental health of asylum seekers/refugees in Germany

Abstract Background Changes in the subjective social status (SSS) of migrants, specifically between the pre- and post-migratory movement, can be a relevant determinant of their mental health condition. This study analyzed the effect of downward subjective social mobility to the mental health of asylum seekers and refugees (ASR) in Germany. Methods Through a random sampling procedure, 560 adult ASR (18+ years) were recruited across 58 collective accommodation centers in Germanys' 3rd largest state (2018). SSS was assessed with the MacArthur social ladder (10-rungs), in reference to the participants' position in the country of origin and in Germany. Quality of Life (QoL, measured with EUROHIS-QOL), anxiety (General Anxiety Disorder-2) and depressive symptoms (Patient Health Questionnaire-2), were considered as mental health outcomes. Generalized linear regression models were fitted to measure associations between changes in SSS and each outcome. Results A loss of 3 or more steps in SSS from origin to Germany (compared to no-change) was significantly associated with poorer scores in QoL (B, standardized coefficient= -2.679, standard error, se = 1.351, p = 0.047), with more symptoms of depression (B = 1.156, se = 0.389, p = 0.003) and anxiety (B = 0.971, se = 0.432, p = 0.025), in models adjusted for SSS in the country of origin. The strength and direction of associations was unaltered after further adjusting for sex, age, educational level and time since arrival, although the coefficient for QoL was non-significant for those declaring a 3-step downward mobility (B= -2.494, se = 1.351, p = 0.066 for QoL; B = 1.048, se = 0.393, p = 0.008 for depression; and B = 1.006, se = 0.438, p = 0.022 for anxiety). Discussion The results suggest that interventions should focus on those experiencing social downward mobility and not only prioritize individuals with low social status. Early integration efforts and intersectoral measures to counter social downward mobility could prevent poor mental health among ASR. Key messages We analysed the impact to the quality of life and mental health of asylum seekers and refugees, of a change in subjective social status from country of origin to Germany. Asylum seekers and refugees residing in Germany, who perceived a downward social status mobility following their migration process, are at risk for poorer mental health.

Contextual housing environment and mental health of asylum seekers – a multi-level analysis

Abstract Background Housing is an important determinant of health among asylum seekers and refugees (ASR). Little is known about the effects of contextual housing environment. We used state-wide reliable and valid data to examine these effects on ASR mental health. Methods We drew a balanced random sample of 58 shared refugee accommodation centers (SRA) from 1938 centres with 70,634 ASR in Germany's 3rd largest federal state. We measured depression (PHQ2) and anxiety (GAD2) using established instruments in nine languages. We assessed physical housing environment with a validated multi-dimensional Small-area Housing Environment Deterioration index (SHED). Linking survey- and SHED-data to GIS- and secondary data sources on accommodation size and remoteness, district urbanity and deprivation, we used multi-level logistic regression to calculate exposure effects and 95 % confidence intervals (CI), while adjusting for age, sex, relocations and chronic illness. Results Of 412 ASR living in 58 SRA, 45.0% of inhabitants and 35.7% of SRA were rated as having a high/very high degree of deterioration. The odds for reporting symptoms of generalized anxiety increased for the highest degree of deterioration (1.30; 0.37-4.55), large accommodation size (1.01; 1.00-1.03), remoteness (1.63; 0.61 - 4.36), district urbanity (1.67; 0.66-4.20) and deprivation (1.33; 0.60-2.92). The odds of depression symptoms increased in SRA with highest deterioration (1.98; 0.74-5.33) and accommodation remoteness (1.10; 0.48-2.52), decreased in SRA with district urbanity (0.63; 0.31-1.28) and district deprivation (0.66; 0.36-1.23) but not large accommodation size (1.00; 0.99-1.02). Conclusions Almost half of ASR are living in SRA with high/very high degree of deterioration. There is a general tendency of higher odds for mental illness symptoms conditional on housing environment. Future analyses with sample size calculations are needed to better understand these health associations for shared refugee accommodation. Key messages We described contextual housing environment, i.e. degree of deterioration, accommodation size, remoteness, urbanity and deprivation, of a balanced random sample of 58 shared refugee accommodations. In multi-level logistic regression, contextual housing environment tends to be associated with higher odds for reporting symptoms of mental illness.

The evolution of a healthcare interpreting service mapped against the bilingual health communication model: a historical qualitative case study

BackgroundTwenty-five years ago, the need for health care interpreting in Switzerland increased due to the sharp influx of asylum seekers from war zones and countries of political unrest. Due to complex health needs, there was a need to move away from using volunteers as interpreters towards qualified interpreter services.MethodsA historical qualitative case study design was used to describe the evolution of the language assistance programmes at Geneva University Hospitals, between 1992 and 2017. The aim was to map the evolution of the interpreter services against the Bilingual Health Communication Model with the constructs—Communicative Goals, Individual Agency, System Norms and Quality and Equality of Care—while identifying key factors to optimise interpreter service and patient care.Results and discussionFive phases were identified during the 25 years of service evolution studied: (1) Service initiation—the interpreter services were first used in a small service that cared for refugees and asylum seekers. (2) Growth and formalisation—due to the arrival of high numbers of Albanian-speaking asylum seekers, Albanian-speaking interpreters were provided to all departments of the Geneva University Hospitals. This helped roll out the use of interpreters among doctors and nurses. (3) Ensuring quality—the care for all patients, whether foreign-language speaking or not, became an issue and led to research into the quality of patient-provider communication. (4) Institutionalisation—this phase dealt with challenges including the lack of interpreter financing regulation and the clarification of interpreter roles. (5) Equity—healthcare interpreter services were put in an overall framework of equity standards. The Bilingual Health Communication Model was applied and showed that some items were not implemented: clear shifts (i) towards a culturally sensitive focus, (ii) towards community interpreting, (iii) towards triadic communication, (iv) towards spelling out the right to have an interpreter and (v) towards the involvement of insurance companies. Finally, the inclusion of healthcare interpreting as an essential ingredient in healthcare provision, including chronic disease management, is incomplete or missing.ConclusionsHealthcare interpreting at Geneva University Hospitals has evolved from a ‘muddling-through’ approach towards an institutional approach by addressing quality of care, by focussing on the mental health of asylum seekers, training of both interpreters and users of interpreters and institutional policy based on equity.

Self-harming behaviours of asylum seekers and refugees in Europe: A systematic review.

The increasing number of asylum seekers and refugees in Europe calls for even more professionals to take care of refugees' mental health. Although different studies claim that migration could be a potential risk factor for self-harming behaviours, an in-depth exploration of the presence and characteristics of self-harm in the context of asylum is needed. In accordance with PRISMA guidelines, a systematic review was conducted across the databases Scopus, PubMed, Web of Knowledge and PsycArticles, regarding the main features of self-harming behaviour among refugees in Europe. Twelve articles and 3 main trajectories were identified: (1) A context at-risk: self-harm and detention centres; (2) A target at-risk: self-harm and unaccompanied minors; (3) A comparison between the mental health of asylum seekers and natives. Research on this topic in Europe is still underdeveloped and disorganised. Studies have mainly carried out wider quantitative investigations on mental health, usually overlapping self-harm with suicide. Detention centres emerged as the most widely investigated context and the one with the highest risk for self-harming behaviours. Instead, unaccompanied minors emerged as a particularly vulnerable category. Research in this field should be improved, combining quantitative and qualitative methods for a deeper understanding of the meanings of self-harm across cultures.

Subjective social status mobility and mental health of asylum seekers and refugees: Population-based, cross-sectional study in a German federal state

BackgroundAsylum seekers and refugees (ASR) experience substantial changes in subjective social status (SSS), pre and post migration, which may affect their mental health. However, the effect of SSS mobility on mental health among ASR has been underexplored so far. MethodsPopulation-based cross-sectional study among a random sample of 560 adult ASR living in 64 collective accommodation centres in Baden-Wurttemberg, Germany. SSS in the country of origin before emigration and in Germany was assessed with a multi-lingual, adapted version of the MacArthur social ladder. Health-related quality of life (HRQoL), anxiety and depressive symptoms were measured as mental health outcomes. Generalized linear regression models were fitted to estimate associations between changes in SSS and each outcome. ResultsA perceived loss of three or more steps in SSS from origin to Germany (compared to no change) was associated with poorer scores in HRQoL (B, standardized coefficient = -2.679, standard error, se = 1.351, p = 0.047), with more depressive symptoms (B = 1.156, se = 0.389, p = 0.003) and anxiety (B = 0.971, se = 0.432, p = 0.025), in models adjusted for SSS in country of origin. The strength and direction of associations remained after adjusting for sex, age, education and time since arrival (HRQoL: B = -2.494, se = 1.351, p = 0.066; depression: B = 1.048, se = 0.393, p = 0.008; anxiety: B = 1.006, se = 0.438, p = 0.022). ConclusionASR experiencing downward SSS mobility present poorer mental health compared to those experiencing no change in SSS. Early integration efforts and intersectoral measures to counter social downward mobility could prevent poor mental health among ASR.

Deterioration of housing environment and mental health of asylum seekers – a multi-level analysis

Abstract Background Asylum seekers arriving in Germany are assigned to a local district and an accommodation centre wherein. We developed and validated a six-item questionnaire for rapid assessment of housing deterioration and investigated its association with inhabitant mental health. Methods Using cross-sectional data from a state-wide survey in Germany, we applied a random-effects modelling approach to estimate the exposure effect of housing deterioration on depression and general anxiety among a random sample of asylum seekers, using validated instruments (GAD2/PHQ2) for outcome variables. Housing deterioration was assessed on six items (windows/glass, walls/roof, garbage, graffiti, outside spaces, overall living environment) resulting in a deterioration score as exposure of interest. Additionally, we assessed the instrument’s intra- and inter-rater reliability and internal consistency. Results Of the 412 asylum seekers living in 58 accommodation centres, 45.7% reported symptoms of depression and 45.0% suffered general anxiety. Most centres (76.7%) were based in urban municipalities and 45.7% of inhabitants were living in an accommodation centre hosting ≥51 inhabitants. Preliminary adjusted odds ratio for accommodation centres with highest deterioration (Q 4) was 2.07 (0.67-6.40) for generalized anxiety, compared to 1.17 (0.45-3.08) for centres with lowest deterioration (Q 1). For depression, preliminary odds ratio was 1.92 (0.87-4.27) compared to 1.26 (0.63-2.50). The validation study confirmed inter-/intra-rater reliability (Brennan-Prediger coefficient: 0.81 and 0.92, respectively) and internal consistency (Crohnbach’s α: 0.80). Conclusions There are higher odds ratios for generalized anxiety disorder and depression among asylum seekers based on higher deterioration of housing environment. A questionnaire for rapid deterioration assessment and identification of accommodations needing further evaluation has been developed and successfully validated. Key messages Deterioration of small-scale housing environment is associated with poorer mental health for asylum seekers living in accommodation centres. A highly reliable new tool has been developed for rapid assessment of deterioration status of accommodation centres and identification of those needing further evaluation.

Identifying the critical time points for mental health of asylum seekers and refugees in high-income countries.

High heterogeneity was found in the prevalence rates of mental disorders in adult asylum seekers and refugees in high-income countries. This may be related to different problems. Among them, there is a changing exposure to risk and protective factors for mental health at different phases of these people's life before migration, and during the migratory journey and resettlement. This study aimed at identifying and distinguishing time points in which distinct risk and protective factors for the mental health of asylum seekers and refugees may occur. Systematic review and narrative synthesis. A systematic search was carried out for the period January 2017-August 2019, given the existence of systematic reviews of the evidence up to January 2017. Two hundred and fifty-two studies were identified with our search and 31 studies were included. The critical time points identified are: (a) before the travel; (b) during the travel; (c) at initial settlement in the host country; (d) when attempting to integrate in the host country; (e) when the immigration status is challenged or revoked. Some factors such as sense of belonging in the host country can be risk factors or protective factors depending on the time point. These five critical time points can guide the development and selection of well-timed preventive and treatment interventions. They could also be used to stratify samples in epidemiological studies and meta-analyses. At present, we know much more on risk factors than on protective factors. Knowing more about protective factors may inform the development of interventions to foster them.

Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration.

The mental deterioration of the so called 'legacy caseload' (asylum seekers who arrived in Australia by boat between August 2012-December 2013) has become a national concern and is garnering international attention. Prolonged uncertainty is contributing to mental deterioration and despair. There have been at least 11 deaths by suicide since June 2014. Social support services have been limited and legal assistance in short supply; this is associated with lengthy delays with visa applications. Thwarted belongingness, purpose and identity, a shortage of available services, and barriers to legal support for processes attendant upon Refugee Status Determination increase the likelihood that the mental health of asylum seekers will deteriorate further, potentially developing into worsening decline, which will lead to increased self-harm and suicide. This article summarises recent suicide deaths in Australia, positing practical assistance and support for asylum seekers living in the community. Therapeutic engagement should be trauma-informed wherever possible, helping asylum seekers to reframe their sense of lethal hopelessness.

Mental health and legal representation for asylum seekers in the ‘legacy caseload’

This article examines the legal challenges asylum seekers arriving by boat to Australia experience when seeking assistance with their claims and its impact on their mental health. The authors outline the experiences of asylum seekers in the “legacy caseload” group who have been waiting up to four years to have their protection claims assessed. The complex interplay between legal assistance to support refugee claims and the way those making claims inevitably struggle to understand, engage and participate in the process is analysed. It is argued that provision of legal assistance for this group will be essential to ensuring that the refugee status determination process is fair and allows asylum seekers to understand and participate more fully in the process. Recent changes to the assessment of claims combined with a reduction in funding for legal assistance create significant hurdles and combine to compound existing stress and emotional trauma leading to detrimental outcomes on the mental health of asylum seekers.

Mental health of traumatized refugees and asylum seekers: Experiences of a centre of transcultural psychiatry in Hannover, Germany

IntroductionGermany has always been an important host country for traumatized refugees and asylum seekers. Although, recently an increasing number of investigations about mental health of individual migrant groups have been published in Germany, there is a paucity of research concerning mental health of asylum seekers and refugees.Aims-objectivesTo investigate socio-demographic and clinical characteristics of traumatized refugees-asylum seekers who were applied to an outpatient psychiatry clinic in Germany.MethodA standardized data collection form (socio-demographics, diagnosis, suicidality, etc.) was filled by therapists for each traumatized refugee-asylum seeker who was applied to outpatient clinic of Klinikum Wahrendorff-Centre of Transcultural Psychiatry between April 2013 and October 2015.ResultsFifty-eight traumatized refugees-asylum seekers (F/M = 27/31, age: 34.7 ± 1.4) were assessed. 53 (91.4%) of them were assessed via interpreters. Thirty (51.7%) of them were staying in refugee-dormitories, 25 (43.1%) of them were living alone. They’ve been living in Germany for 19.9 ± 16 months (min: 1–max: 82). Psychiatric symptoms appeared before 29.9 ± 19 months. Time to reach to psychiatric care in Germany was 14.2 ± 11 months. Psychiatric diagnoses were posttraumatic stress disorder (PTSD): 12 (21%), depression + PTSD: 44 (76%), depression: 2 (3%). Fifty-three (91.4%) of them had suicidal ideation and 16 (27.6%) of them had at least one suicide attempt before.ConclusionsTraumatized refugees in this study have high rates of suicidal ideation and suicide attempts and it takes months to years for them to reach a psychiatric care. Therefore, strategies should be developed for early detection of PTSD symptoms in traumatized refugees and access barriers to reach a psychiatric care should be overcome.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Impact of Detention on the Health of Asylum Seekers

Objectives: This review assesses the evidence about the effects of detention on the mental and physical health and social functioning of asylum seekers. Method and Analysis: We followed Campbell Collaboration guidelines to conduct a systematic review. Meta-analytic methods were used to quantitatively synthesize the study results. Results: Primary study effect sizes for post-traumatic stress disorder, depression, and anxiety, while the asylum seekers were still detained lies in the range 0.35–0.99, all favoring the nondetained asylum group. Author’s Conclusions: There is some evidence to suggest an independent adverse effect of detention on the mental health of asylum seekers. The conclusions should however be interpreted with caution as they are based on few studies. More research is needed in order to fully investigate the effect of detention on mental health.

Mental health screening in immigration detention: A fresh look at Australian government data.

The poor mental health of asylum seekers and refugees in immigration detention has consistently been reported in peer-reviewed literature internationally; however, data on the mental health of asylum seekers and refugees detained in Australian immigration has been very limited. We re-analysed mental health screening data obtained by the Human Rights Commission. Longer time in detention was associated with higher self-reported depression scores, with female individuals being more vulnerable to time in detention than those of male gender. Approximately one-half of the refugee group who agreed to complete the Harvard Trauma Questionnaire had post-traumatic stress disorder symptoms. On clinician-rated measures, one-third of the children, adolescents and adults suffered with clinical symptoms requiring tertiary outpatient assessment. This paper consolidates the findings of the 2014 Australian Human Rights Commission report and it provides an argument for public reporting of refugee data.

‘I Feel Like a Beggar’: Asylum Seekers Living in the Australian Community Without the Right to Work

While numbers of asylum seekers received by Australia are small compared to global figures, a range of deterrence measures have been implemented in response to increasing numbers arriving by boat in recent years. One of the more recent measures was denying asylum seekers who arrived by boat after 13 August 2012 the right to work upon their release from immigration detention into the community. There are around 26,000 asylum seekers who have been subject to this policy with most still waiting for their initial interview for refugee status and none have had their refugee claims resolved. This paper examines the findings of a study that explored the implications of this policy for asylum seekers. It draws on 29 semi-structured interviews with asylum seekers and highlights the distress and fear that many are enduring, caused by the denial of the right to work and ongoing uncertainty about their refugee claims. The study’s findings provide support for the conclusions of earlier research that highlight the importance of the right to work and securing employment for the mental health of asylum seekers, as well as studies that found there were negative mental health consequences of forcing asylum seekers to live for long periods with uncertainty around their protection claims.