A Secondary Analysis of Mental Health Disability and Treatment Implications in Recently-resettled Refugees 公开
Egner, Rebecca Lee (2011)
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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