The mental health and help-seeking behaviour of resettled Afghan refugees in Australia
Tóm tắt
Psychological trauma, in particular, posttraumatic stress disorder (PTSD) and depression, are highly prevalent among resettled refugees. However, little is known regarding the mental health status and associated help-seeking behaviour of resettled Afghan refugees in Australia. A sample of 150 resettled Afghan refugees (74 males; mean age 32.8 years, SD = 12.2) living in Adelaide, South Australia were recruited. Self-reported measures of PTSD, depression, exposure to traumatic events, functional impairment, self-recognition of PTSD symptomatology and help-seeking behaviours were completed. Multivariate analysis of variables associated with help-seeking was conducted. Forty-four percent of participants met criteria for clinically significant PTSD symptoms and all but one participant reported being exposed to 1 or more traumatic and/or conflict related events, such as ‘losing your property and wealth’. Moreover, 14.7% of participants had symptoms suggestive of clinically significant depression. General practitioners were the most common source of help in relation to mental health problems, with very few participants (4.6%) seeking help from specialist trauma and torture mental health services. Self-recognition of having a PTSD related mental health problem and functional impairment levels were both found to be independent predictors of help-seeking (p ≤ .05). The findings provide further evidence for high rates of PTSD symptomatology and low uptake of mental care among resettled refugees. Poor self-recognition of the presence and/or adverse impact of PTSD symptoms may need to be targeted in mental health promotion programs designed to improve “mental health literacy” and thereby promote early and appropriate help-seeking where this is needed.
Tài liệu tham khảo
United Nations High Commissioner for Refugees. Global trends forced displacement in 2015; 2015. http://www.unhcr.org/576408cd7.pdf. Accessed 18 Aug 2016.
United Nations High Commissioner for Refugees: convention and protocol relating to the status of refugees; 2010. http://www.unhcr.org/3b66c2aa10.pdf. Accessed 15 Aug 2016.
Sarabi A. Politics and modern history of Hazara Sectarian politics in Afghanistan; 2006. https://fletcher.tufts.edu. Accessed 20 Mar 2016.
Refugee Council of Australia: resources; 2014.http://www.refugeecouncil.org.au/resources/statistics/australias-refugee-and-humanitarian-program. Accessed 20 Apr 2016.
Department of Immigration and Border Protection. Fact Sheet 60-Australia’s Refugee and Humanitarian Programme. Australian Government; 2014. https://www.immi.gov.au/media/fact-sheets/60refugee.htm. Accessed 24 Aug 2016.
Australian Government. Settlement reports top 25 Countries of birth by migration stream; 2014.https://www.dss.gov.au/sites/default/files/documents/05_2015/country_of_birth_by_migration_stream_-_april_2010_to_march_2015.pdf. Accessed 8 Sept 2016.
Steel Z, Chey T, Silove D, Marnane C, Bryant R, Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009. doi:10.1001/jama.1132.
Mollica R, Wyshak G, Lavelle J. The psychosocial impact of war trauma and torture on Southeast Asian refugees. Am J Psychiatry. 1987;144:1567–72.
Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons. JAMA. 2005. doi:10.1001/jama.294.5.602.
Steel Z, Momartin S, Coello M, Aroche J, Tay W. Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Soc Sci Med. 2011. doi:10.1016/j.socscimed.2011.02.007.
Gernaat B, Malwand D, Laban CJ, Komproe I, de Jong JT. Many psychiatric disorders in Afghan refugees with residential status in Drenthe, especially depressive disorder and post-traumatic stress disorder. Ned Tijdschr Geneeskd. 2002;146(Suppl 24):1127–31.
Gerritsen A, Bramsen I, Deville W, Willigen L, Hovens J, Ploeg H. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2006. doi:10.1007/s00127-005-0003-5.
Alemi Q, James S, Cruz R, Zepeda V, Racadio M. Psychological distress in Afghan refugees: a mixed-method systematic review. J Immigr Minor Health. 2014. doi:10.1007/s10903-013-9861-1.
Gourash N. Help-seeking: a review of the literature. Am J Community Psychol. 1978. doi:10.1007/BF00941418.
Rickwood D, Thomas K, Bradford S. Review of help-seeking measures in mental health: an evidence check rapid review brokered by the Sax Institute for beyondblue. Ultimo: Sax Institute; 2012. https://www.saxinstitute.org.au/wp-content/uploads/02_Help-seeking-measures-in-mental-health.pdf. Accessed 7 Aug 2016.
Correa-Velez I, Sundararajan V, Brown K, et al. Hospital utilisation and outcomes amongst Victorian residents born in refugee source countries. An analysis of hospital admissions between 1998/99 and 2003/04 from the Victorian Admitted Episodes Dataset. http://docs.health.vic.gov.au/docs/doc/7593C20C60BE2D00CA257867008323D4/$FILE/vaed_refugees_report.pdf.
Correa-Velez I, Vijaya S, Brown K, et al. Hospital utilisation among people born in refugee-source countries: an analysis of hospital admissions, Victoria, 1998–2004. Med J Aust. 2007;186(Suppl 11):577–80.
Kayrouz R, Dear BF, Johnston L, Keyrouz L, Nehme E, Laube R, Titov N. Intergenerational and cross-cultural differences in emotional wellbeing, mental health service utilisation, treatment-seeking preferences and acceptability of psychological treatments for Arab Australians. Int J Soc Psychiatry. 2015. doi:10.1177/0020764014553004.
Slewa-Younan S, Mond J, Bussion E, Melkonian M, Mohammad Y, Dover H, Smith M, Milosevic D, Jorm AF. Psychological trauma and help-seeking behaviour amongst resettled Iraqi refugees in attending english tuition classes in Australia. Int J Ment Health Syst. 2015. doi:10.1007/s12134-015-0441-1.
Jorm AF, Korten A, Jacomb P, Christensen H, Rodgers B, Pollitt P. “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust. 1997;166:182–6.
Jorm AF. Mental health literacy: empowering the community to take action for better mental health. Am Psychol. 2012;67(Suppl 3):231–43.
Slewa-Younan S, Mond J, Bussion E, Mohammad Y, Uribe Guajardo MG, Smith M, et al. Mental health literacy of resettled Iraqi refugees in Australia: knowledge about posttraumatic stress disorder and beliefs about helpfulness of interventions. BMC Psychiatry. 2014. doi:10.1186/s12888-014-0320-x.
Yaser A, Slewa-Younan S, Smith C, Olsen R, Uribe Guajardo MG, Mond J. Beliefs and knowledge about post-traumatic stress disorder amongst resettled Afghan refugees in Australia. Int J Ment Health Syst. 2016. doi:10.1186/s13033-016-0065-7.
Slewa-Younan S, Uribe Guajardo G, Yaser A, Mond J, Smith M, Milosevic D, et al. Causes of and risk factors for posttraumatic stress disorder: the beliefs of Iraqi and Afghan refugees resettled in Australia. Int J Ment Health Syst. 2017. doi:10.1186/s13033-016-0109-z.
Gratwick-Sarll K, Bentley C, Harrison C, Mond J. Poor self-recognition of disordered eating among girls with bulimic-type eating disorders: cause for concern? Early Interv Psychiatry. 2016. doi:10.1111/eip.12168.
Gratwick-Sarll K, Mond J, Hay P. Self-recognition of eating-disordered behavior in college women: further evidence of poor eating disorders mental health literacy. Eat Disord. 2013. doi:10.1080/10640266.2013.797321.
Mond J, Hay P, Rodgers B, Owen C. Self-recognition of disordered eating among women with bulimic-type eating disorders: a community-based study. Int J Eat Disord. 2006;39(Suppl 8):747–53.
Mond JM, Hay PJ, Darby A, et al. Women with bulimic eating disorders: when do they receive treatment for an eating problem? J Consult Clin Psychol. 2009. doi:10.1037/a0015336.
Mollica R. Wyshak G, de-Marneffe D, Khuon F, Lavelle J. Indochinese version of the Hopkins Symptoms Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144:497–500.
Thapa SB, Van Ommeren M, Sharma B, de Jong JT, Hauff E. Psychiatric disability among tortured Bhutanese refugees in Nepal. Am J Psychiatry. 2003;160(Suppl 11):2032–7.
Cardozo BL, Bilukha O, Crawford G, Shaikh I, Wolfe MI, Gerber ML, et al. Mental health, social functioning, and disability in post-war Afghanistan. JAMA. 2004;292(Suppl 5):575–84.
Scholte WF, Olff M, Ventevogel P, de Vries G, Jansveld E, Cardozo BL, et al. Mental health symptoms following war and repression in eastern Afghanistan. JAMA. 2004;292(Suppl 5):585–93.
Miller K, Omidian P, Samad A, Quraishy N, Nader M, Nasiry S, et al. The Afghan symptom checklist: a culturally grounded approach to mental health assessment in a conflict zone. Am J Orthopsychiatr. 2006. doi:10.1037/0002-9432.76.4.423.
Weiss D, Marmar C. The impact of event scale—revised. In: Wilson JP, Keane TM, editors. Assessing psychological trauma and PTSD: a handbook for Practitioners. New York: Guilford Press; 1997. p. 399–411.
Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale—revised. Behav Res Ther. 2003;41(Suppl 12):1489–96.
Morina N, Ehring T, Priebe S. Diagnostic utility of the impact of event scale-revised in two samples of survivors of war. PLoS ONE. 2013. doi:10.1371/journal.pone.0083916.
World Health Organisation (WHO). Measuring health and disability manual for WHO disability assessment schedule WHODAS 2.0. 2010. http://apps.who.int/iris/bitstream/10665/43974/1/9789241547598_eng.pdf?ua=1&ua=1. Accessed 15 Mar 2016.
SAS Institute Inc. Language reference concepts. 6th ed. Cary: SAS Institute Inc.; 2016.
Firth D. Bias reduction of maximum likelihood estimates. Biometrika. 1993;80(Suppl 1):27–38.
Allison P. Logistic Regression Using SAS: Theory and Application. 2nd ed. North Carolina: SAS Institute Inc; 2012.
McFadden D. Conditional logit analysis of qualitative choice behavior. Front Econom. 1974:105–42.
Kvalseth T. Cautionary note about R2. Am Stat. 1985;39:279–85.
Allison P. Measures of fit for logistic regression. Paper 1485–2014: statistical horizons LLC and the University of Pennsylvania. 2013. https://support.sas.com/resources/papers/proceedings14/1485-2014.pdf. Accessed 3 Apr 2017.
Australia Bureau of Statistics. National Survey of Mental Health and Wellbeing. Australian Bureau of Statistics (ABS); 2007. http://www.abs.gov.au/ausstats/[email protected]/mf/4326.0. Accessed 20 Jan 2017.
Kirmayer L, Narasiah L, Munoz M, Rashid M, Ryder R, Guzder J, et al. Common mental health problems in immigrants and refugees: general approach in primary care. CMAJ. 2011. doi:10.1503/cmaj.090292.
Andrews G. Meeting the unmet need with disease management. In: Andrews G, Henderson S, editors. Unmet need in psychiatry. Cambridge: Cambridge University Press; 2000. p. 11–36.
Uribe Guajardo MG, Slewa-Younan S, Santalucia Y, Jorm AF. Important considerations when providing mental health first aid to Iraqi refugees in Australia: a Delphi study. Int J Ment Health Syst. 2016. doi:10.1186/s13033-016-0087-1.
Sulaiman-Hill CM, Thomson SC. Sampling challenges in a study examining refugee resettlement. BMC Int Health Hum Rights. 2011. doi:10.1186/1472-698X-11-2.