A Secondary Analysis of Mental Health Disability and Treatment Implications in Recently-resettled Refugees Público

Egner, Rebecca Lee (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/dn39x1977?locale=es
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Abstract

Introduction

Refugees are at disproportionately high risk for mental health disability -specifically PTSD,
anxiety and depression - due to the extent and scope of the various challenges they encounter as
a population fleeing crisis and cultural obstacles in their country of resettlement. Despite the
scale of the burden, few studies have examined the specific mental health needs of this
vulnerable population. A study profiling the unique demographic and symptomatic
characteristics of refugees will provide much needed information for healthcare providers and
local organizations committed to attenuating the plight of refugees by tailoring outreach and
mental health care appropriately.

Methods
This was a secondary analysis of data collected from DeKalb County health screenings of
refugees screened between September 2008 and March 2009. The database included eight
demographic variables and 28 mental health symptomatic variables of refugees expressing
mental health distress. Analysis was completed in SAS software package version 9.3 from the
SAS Institute. Chi-square analyses were used to assess associations between demographic,
symptomatic and outcome variables. Analysis of variance assessed differences in mean
expression of general mental health disability, PTSD, and depression symptoms across groups of
country of origin. Phi correlation coefficients were collected to examine correlations between
symptomatic variables.

Results and Implications
Of an initial 1,236 records reviewed, 138 (11.2%) expressed four or more symptoms and/or had a
history of torture and were thus abstracted for further analysis. Results indicate a large mental
health burden across refugees of various ethnicities, age groups, gender, marital status, and
education levels. Refugees express, on average, seven symptoms, with a range from 1 to 25
symptoms, and most commonly expressed symptoms include excessive worry (60.9%),
difficulties sleeping (60.6%), and low energy (60.8). The highest correlated symptoms are
problems concentrating and staying away from reminders of traumatic events (φ=0.96) while
those of depression are feeling worthless and having thoughts of ending one's life (φ=0.70).
Health care providers and local organizations are encouraged to support and encourage the
development of community-based culturally-appropriate treatment approaches addressing
specific mental health symptoms and attenuating resettlement challenges contributing to mental
health disability in the refugee community.

Table of Contents

INTRODUCTION..................................................................................1
Background and Rationale......................................................................1
Purpose Statement...............................................................................2
Significance.........................................................................................2
Definition of Terms................................................................................3
LITERATURE REVIEW...........................................................................4
Mental Health in a Global and Local Context...............................................4
Refugees in Georgia- Overview................................................................6
DeKalb County Refugee Physical and Mental Health Screening Processes.........8
Mental Health Symptomatology and Perceptions in Varying Ethnicities.............9
Additional Challenges and Treatment Implications......................................11
A Call to Action...................................................................................12
METHODOLOGY.................................................................................14
Introduction.......................................................................................14
Data Collection: Study Population and Setting..........................................14
Data Collection: Procedures..................................................................15
Instruments.......................................................................................16
Statistical Analysis..............................................................................16
RESULTS...........................................................................................18
Demographic Characteristics of Study Population.......................................18
Demographics by Country of Origin..........................................................18
Missing Values.....................................................................................19
General Symptomatology.......................................................................19
Demographics and Symptomatology.........................................................20
Symptom Correlations...........................................................................21
DISCUSSION......................................................................................35
Summary of Findings.............................................................................35
Treatment Implications..........................................................................36
Suggested Treatment Approaches...........................................................37
Integrated Approach: Physical and Mental Health.......................................37
The Center for Torture and Trauma Survivors (CTTS)..................................38
Strengths and Limitations.......................................................................39
Missing Data........................................................................................39
Future Research...................................................................................40
Refugee Children and Mental Health Screening............................................40
Need for Longitudinal Research................................................................41
Conclusion...........................................................................................42
INDEX OF APPENDICES........................................................................44
Appendix A. Institutional Review Board Letter of Approval.............................45
Appendix B. Description of Data Abstraction Procedures -
DeKalb Board of Record Abstraction..........................................................46
Appendix C. Medical Record Abstraction Log
(for all records of screenings, 9/08-3/09)..................................................48
Appendix D. Needs Assessment Data Collection Log
(for those included in analysis)................................................................49
Appendix E..........................................................................................53
REFERENCES......................................................................................54

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