Mental disorders in long-settled war refugees: a study conducted in former Yugoslavian refugees resettled in Germany, Italy and the United Kingdom.

PhDWorldwide there are several million war refugees, many of whom stay in the host countries for years. However, little is known about their long-term mental health. The current thesis examined the prevalence, course, and predictors of mental disorders and subjective quality of life (SQOL) in 854 war refugees from former Yugoslavia who had resettled in Germany, Italy and the United Kingdom 9.3 years previously. 215 interviewees with Posttraumatic Stress Disorder (PTSD) at baseline were reinterviewed one-year later. The participants were additionally assessed for use of social and health care interventions during the one-year follow-up period. Prevalence rates of mental disorders in the war refugees varied substantially across countries, with between 42.1% and 67.8% of refugees having a mental disorder. Warrelated factors explained most variance in rates of PTSD whereas post-migration factors explained most variance in mood, anxiety and substance use disorder rates. Risk factors for each disorder were consistent across host countries. At the end of the one-year follow-up period, a third of the sample no longer met the criteria for PTSD. Recovery was positively associated with employment and negatively associated with severity of war exposure, baseline PTSD symptom severity and use of mental health services. Despite the high rates of mental disorders, refugees felt reasonably satisfied with SQOL. Low SQOL was associated with poor post-migration living conditions and mental illness, but not with war trauma.In conclusion, mental disorders appeared to be highly prevalent in war refugees many years after resettlement. This increased risk may result from exposure not only to wartime trauma but also to post-migration socio-economic adversity. Policies promoting community integration and employment may be more effective than existing psychiatric and psychological interventions in improving mental health and quality of life in war refugees

Recovery from Posttraumatic Stress Symptoms: A Qualitative Study of Attributions in Survivors of War

This study was funded by a grant from the European Commission, contract number INCO-CT-2004-50917

Long-Term Impact of War on Healthcare Costs: An Eight-Country Study

PMCID: PMC3251588This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

<p>Abstract</p> <p>Background</p> <p>Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.</p> <p>Methods</p> <p>Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.</p> <p>Results</p> <p>Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.</p> <p>Conclusions</p> <p>Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.</p

Providing medical care for undocumented migrants in Denmark: what are the challenges for health professionals?

<p>Abstract</p> <p>Background</p> <p>The rights of undocumented migrants are frequently overlooked. Denmark has ratified several international conventions recognizing the right to health care for all human beings, but has very scanty legislation and no existing policies for providing health care to undocumented migrants. This study focuses on how health professionals navigate and how they experience providing treatment for undocumented migrants in the Danish health care system.</p> <p>Methods</p> <p>The study was carried out as part of an EU-project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). This presentation is based on 12 semi-structured interviews with general practitioners (9) and emergency room physicians (3) in Denmark.</p> <p>Results</p> <p>The emergency room physicians express that treatment of undocumented migrants is no different from the treatment of any other person. However, care may become more complicated due to lack of previous medical records and contact persons. Contrary to this, general practitioners explain that undocumented migrants will encounter formal barriers when trying to obtain treatment. Additional problems in the treatment of undocumented migrants include language issues, financial aspects for general practitioners, concerns about how to handle the situation including possibilities of further referrals, and an uncertainty as to whether to involve the police.</p> <p>Conclusions</p> <p>The health professionals in our study describe that undocumented migrants experience an unequal access to primary care facilities and that great uncertainties exist amongst health professionals as how to respond in such situations. The lack of official policies concerning the right to health care for undocumented migrants continue to pass on the responsibility to health professionals and, thereby, leaves it up to the individual to decide whether treatment can be obtained or not.</p

Visiting with Elders—Aging, Caregiving, and Planning for Future Generations of American Indians and Alaska Natives

(1) Background: To address the importance of engaging American Indian and Alaska Native Elders in a dialogue about healthy aging and fill the gap in the scholarly literature on this topic. (2) Methods: This study conducted a listening session with Elders who attended the 2021 National Indian Council on Aging (NICOA) Annual Conference in Reno, Nevada. The listening session was audio-recorded and transcribed for thematic analysis by two analysts. (3) Results: Important insights regarding American Indian and Alaska Native Elders’ perspectives on planning for future care and aging-related diseases, such as Alzheimer’s disease. (4) Conclusions: This study is one of the first to engage American Indian and Alaska Native Elders in a conversation about health aging. Calls for intergenerational solidarity, protection of Elders, education, and relationality were found to be important themes

Mental disorders following war in the Balkans: a study in 5 countries.

CONTEXT: War experience may affect mental health. However, no community-based study has assessed mental disorders several years after war using consistent random sampling of war-affected people across several Western countries. OBJECTIVES: To assess current prevalence rates of mental disorders in an adult population who were directly exposed to war in the Balkans and who still live in the area of conflict, and to identify factors associated with the occurrence of different types of mental disorders. DESIGN, SETTING, AND PARTICIPANTS: War-affected community samples in Bosnia-Herzegovina, Croatia, Kosovo, the Republic of Macedonia, and Serbia were recruited through a random-walk technique. MAIN OUTCOME MEASURE: Prevalence rates of mood, anxiety, and substance use disorders were assessed using the Mini-International Neuropsychiatric Interview. RESULTS: Between 637 and 727 interviewees were assessed in each country (N = 3313). The prevalence rates were 15.6% to 41.8% for anxiety disorders, 12.1% to 47.6% for mood disorders, and 0.6% to 9.0% for substance use disorders. In multivariable analyses across countries, older age, female sex, having more potentially traumatic experiences during and after the war, and unemployment were associated with higher rates of mood and anxiety disorders. In addition, mood disorders were correlated with lower educational level and having more potentially traumatic experiences before the war. Male sex and not living with a partner were the only factors associated with higher rates of substance use disorders. Most of these associations did not significantly differ among countries. CONCLUSIONS: Several years after the end of the war, the prevalence rates of mental disorders among war-affected people vary across countries but are generally high. War experiences appear to be linked to anxiety and mood disorders but not substance use disorders. Long-term policies to meet the mental health needs of war-affected populations are required

Experience of human rights violations and subsequent mental disorders - A study following the war in the Balkans

War experiences are associated with substantially increased rates of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD) and Major Depression (MD). There is limited evidence on what type of war experiences have particularly strong associations with subsequent mental disorders. Our objective was to investigate the association of violations of human rights, as indicated in the 4th Geneva Convention, and other stressful war experiences with rates of PTSD and MD and symptom levels of intrusion, avoidance and hyperarousal. In 2005/6, human rights violations and other war experiences, PTSD, post-traumatic stress symptoms and MD were assessed in war affected community samples in five Balkan countries (Bosnia-Herzegovina, Croatia, Kosovo, Macedonia, and Serbia) and refugees in three Western European countries (Germany, Italy, United Kingdom). The main outcome measures were the MINI International Neuropsychiatric Interview and the Impact of Event Scale-Revised. In total 3313 participants in the Balkans and 854 refugees were assessed. Participants reported on average 2.3 rights violations and 2.3 other stressful war experiences. 22.8% of the participants were diagnosed with current PTSD and also 22.8% had MD. Most war experiences significantly increased the risk for both PTSD and MD. When the number of rights violations and other stressful experiences were considered in one model, both were significantly associated with higher risks for PTSD and were significantly associated with higher levels of intrusion, avoidance and hyperarousal. However, only the number of violations, and not of other stressful experiences, significantly increased the risk for MD. We conclude that different types of war experiences are associated with increased prevalence rates of PTSD and MD more than 5 years later. As compared to other stressful experiences, the experience of human rights violations similarly increases the risk of PTSD, but appears more important for MD.Ex-Yugoslavia Germany Italy UK War experiences and violation of human rights Post-Traumatic Stress Disorder (PTSD) Major Depression War Human rights Balkans