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Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway.

https://arctichealth.org/en/permalink/ahliterature124184
Source
Scand J Psychol. 2012 Aug;53(4):316-32
Publication Type
Article
Date
Aug-2012
Author
Dinu-Stefan Teodorescu
Trond Heir
Edvard Hauff
Tore Wentzel-Larsen
Lars Lien
Author Affiliation
Innlandet Hospital Trust, Brumunddal, Norway. d.s.teodorescu@medisin.uio.no
Source
Scand J Psychol. 2012 Aug;53(4):316-32
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Acculturation
Adult
Comorbidity
Cross-Sectional Studies
Depressive Disorder, Major - epidemiology
Emigration and Immigration
Female
Humans
Male
Mental Disorders - epidemiology
Middle Aged
Norway - epidemiology
Outpatients - psychology
Prevalence
Refugees - psychology
Social Support
Stress Disorders, Post-Traumatic - epidemiology
Stress, Psychological
Unemployment
Abstract
Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.
PubMed ID
22612589 View in PubMed
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Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway.

https://arctichealth.org/en/permalink/ahliterature122369
Source
Health Qual Life Outcomes. 2012;10:84
Publication Type
Article
Date
2012
Author
Dinu-Stefan Teodorescu
Johan Siqveland
Trond Heir
Edvard Hauff
Tore Wentzel-Larsen
Lars Lien
Author Affiliation
Innlandet Hospital Trust, PO Box 104, Brumunddal, N-2381, Norway. d.s.teodorescu@medisin.uio.no
Source
Health Qual Life Outcomes. 2012;10:84
Date
2012
Language
English
Publication Type
Article
Keywords
Acculturation
Adult
Cross-Sectional Studies
Depression - diagnosis - epidemiology
Diagnostic and Statistical Manual of Mental Disorders
Emigration and Immigration - statistics & numerical data
Female
Health Status Indicators
Humans
Life Change Events
Male
Middle Aged
Norway
Outpatients - psychology - statistics & numerical data
Predictive value of tests
Psychometrics
Quality of Life
Questionnaires
Refugees - psychology - statistics & numerical data
Regression Analysis
Socialization
Socioeconomic Factors
Stress Disorders, Post-Traumatic - diagnosis - epidemiology
Abstract
Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway.
Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status.
All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the'life satisfaction' standard proposed by Cummins. A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively correlated with psychopathological symptoms. Sixty percent of the outpatients were unemployed.
Multi-traumatized refugees in outpatient clinics reported both symptoms of psychopathology and posttraumatic growth after exposure to multiple traumatic events. Symptoms of psychopathology were negatively related to the quality of life, and positively related to post-migration stressors such as unemployment, weak social network and poor social integration. Posttraumatic growth was positively associated with quality of life, and negatively associated with post-migration stressors. Hierarchical regression modeling showed that posttraumatic growth explained more of the variance in quality of life than did posttraumatic stress symptoms, depressive symptoms or unemployment. It may therefore be necessary to address both positive changes and psychopathological symptoms when assessing and treating multi-traumatized outpatients with a refugee background.
Notes
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PubMed ID
22824521 View in PubMed
Less detail