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      Assessing asylum seekers, refugees and undocumented migrants

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          Summary

          Identifying the causes of psychiatric and physical symptoms in asylum seekers, refugees and other migrants and making definitive diagnoses can be challenging. Ethical and legal challenges in the UK include the likely deterrent effects of upfront charging for National Health Service (NHS) services. This paper focuses on the fictitious case of an asylum seeker presenting to a mental health service in England, highlighting some of the difficulties in assessing and treating this patient group and providing advice to clinicians on clinical and practical management. Current NHS entitlements for migrants are summarised and a list is presented in the online supplement of non-governmental organisations that can provide further support.

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          Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands.

          Cornelis Laban, Hajo B. P. E. Gernaat, Ivan H Komproe … (2004)
          Clinically, a long asylum procedure seems to be associated with psychiatric disorders. However, data on this issue are lacking. In a national community-based study, using random sampling, we compared two groups of Iraqi asylum seekers, who had resided less than 6 months (N = 143) and more than 2 years (N= 151), respectively, in The Netherlands. Respondents were interviewed with fully structured, culturally validated, translated questionnaires. Psychiatric (DSM-IV) disorders were measured with the Composite International Diagnostic Interview 2.1 and evaluated in relation with premigration and postmigration adverse life events. Overall prevalence of psychiatric disorders was 42% in the first group and 66.2% in the second. The prevalence rates of anxiety, depressive, and somatoform disorders were significantly higher in the second group. Posttraumatic stress disorder was high in both groups but did not differ (p > .05). On logistic regression of all relevant risk factors, a long asylum procedure showed an odds ratio of 2.16 (confidence interval = 1.15-4.08) for psychopathology. The conclusion is that, indeed, the duration of the asylum procedure is an important risk factor for psychiatric problems. Both politicians and mental health workers should take note of this finding.
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            Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis

            Michela Nosè, Francesca Ballette, Irene Bighelli … (2017)
            Treatment of post-traumatic stress disorder (PTSD) in refugees and asylum seekers resettled in high-income countries presents specific challenges. This systematic review examined the effectiveness of psychosocial interventions for this group. We searched the Cochrane Central Register of randomised trials, CINAHL, EMBASE, PILOTS, PsycINFO, PubMed and Web of Science up to July 2016. Studies included randomised and controlled clinical trials comparing psychosocial interventions with waiting list or treatment as usual in adult refugees and asylum seekers with PTSD resettled in high-income countries. PTSD symptoms post-intervention was the primary outcome. We computed standardized mean differences (SMD) with 95% confidence intervals (CI). This study is registered with PROSPERO: CRD42015027843. Twelve studies were included in the meta-analysis. Psychosocial interventions were effective in decreasing PTSD symptoms relative to control groups (SMD -1·03, 95% CI -1·55 to -0·51; number needed to treat 4·4; I2 86%; 95% CI 77 to 91). Narrative exposure therapy, a manualized short-term variant of cognitive behavioural therapy with a trauma focus, was the best-supported intervention (5 RCTs, 187 participants, SMD -0·78, 95% CI -1·18 to -0·38, I 2 37%; 95% CI 0 to 77). Methodological quality of the included studies was limited. Overall, psychosocial interventions for asylum seekers and refugees with PTSD resettled in high-income countries were found to provide significant benefits in reducing PTSD symptoms. Yet, the number of studies is small and their methodological quality limited, so that more rigorous trials should be conducted in the future.
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              Comparative efficacy and acceptability of pharmacological treatments for post-traumatic stress disorder in adults: a network meta-analysis

              Andrea Cipriani, Taryn Williams, Adriani Nikolakopoulou … (2018)
              Guidelines about post-traumatic stress disorder (PTSD) recommend broad categories of drugs, but uncertainty remains about what pharmacological treatment to select among all available compounds. Cochrane Central Register of Controlled Trials register, MEDLINE, PsycINFO, National PTSD Center Pilots database, PubMed, trial registries, and databases of pharmaceutical companies were searched until February 2016 for double-blind randomised trials comparing any pharmacological intervention or placebo as oral therapy in adults with PTSD. Initially, we performed standard pairwise meta-analyses using a random effects model. We then carried out a network meta-analysis. The main outcome measures were mean change on a standardised scale and all-cause dropout rate. Acute treatment was defined as 8-week follow up. Desipramine, fluoxetine, paroxetine, phenelzine, risperidone, sertraline, and venlafaxine were more effective than placebo; phenelzine was better than many other active treatments and was the only drug, which was significantly better than placebo in terms of dropouts (odds ratio 7.50, 95% CI 1.72–32.80). Mirtazapine yielded a relatively high rank for efficacy, but the respective value for acceptability was not among the best treatments. Divalproex had overall the worst ranking. The efficacy and acceptability hierarchies generated by our study were robust against many sources of bias. The differences between drugs and placebo were small, with the only exception of phenelzine. Considering the small amount of available data, these results are probably not robust enough to suggest phenelzine as a drug of choice. However, findings from this review reinforce the idea that phenelzine should be prioritised in future trials in PTSD.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BJPsych Bull
                Journal ID (iso-abbrev): BJPsych Bull
                Journal ID (publisher-id): BJB
                Title: BJPsych Bulletin
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 2056-4694
                ISSN (Electronic): 2056-4708
                Publication date (Print, pub): April 2020
                Publication date (Electronic, pub): 12 November 2019
                Volume: 44
                Issue: 2
                Pages: 75-80
                Affiliations
                [1 ]South London and Maudsley NHS Foundation Trust , UK
                [2 ]Camden and Islington Mental Health NHS Trust , UK
                [3 ]Helen Bamber Foundation , UK
                Author notes

                Declaration of interest: None.

                Correspondence to Lauren Z. Waterman ( laurenzwaterman@ 123456doctors.net.uk )
                Author information
                https://orcid.org/0000-0002-9963-4008
                Article
                Publisher Item ID: S2056469419000676
                DOI: 10.1192/bjb.2019.67
                PMC ID: 7283125
                SO-VID: bbe0ca02-13ea-412b-92da-3d6515b7d217
                Copyright © © The Authors 2019
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 March 2019
                Date revision received : 07 September 2019
                Date accepted : 25 September 2019
                Page count
                References: 28, Pages: 6
                Categories
                Subject: Praxis

                Keywords: education and training,refugee,migrant,ptsd,health inequalities
                Data availability:
                Keywords: education and training, refugee, migrant, ptsd, health inequalities

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