The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis

English version

Autoři: Rebecca Blackmore ^aff001; Jacqueline A. Boyle ^aff001; Mina Fazel ^aff002; Sanjeeva Ranasinha ^aff001; Kylie M. Gray ^aff003; Grace Fitzgerald ^aff001; Marie Misso ^aff001; Melanie Gibson-Helm ^aff001
Působiště autorů: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia ^aff001; Department of Psychiatry, Oxford University, Oxford, United Kingdom ^aff002; Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia ^aff003; Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, United Kingdom ^aff004
Vyšlo v časopise: The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis. PLoS Med 17(9): e32767. doi:10.1371/journal.pmed.1003337
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003337

Souhrn

Background

Globally, the number of refugees and asylum seekers has reached record highs. Past research in refugee mental health has reported wide variation in mental illness prevalence data, partially attributable to methodological limitations. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies.

Methods and findings

A comprehensive search of electronic databases was undertaken from 1 January 2003 to 4 February 2020 (MEDLINE, MEDLINE In-Process, EBM Reviews, Embase, PsycINFO, CINAHL, PILOTS, Web of Science). Quantitative studies were included if diagnosis of mental illness involved a clinical interview and use of a validated assessment measure and reported at least 50 participants. Study quality was assessed using a descriptive approach based on a template according to study design (modified Newcastle-Ottawa Scale). Random-effects models, based on inverse variance weights, were conducted. Subgroup analyses were performed for sex, sample size, displacement duration, visa status, country of origin, current residence, type of interview (interpreter-assisted or native language), and diagnostic measure. The systematic review was registered with PROSPERO (CRD) 42016046349. The search yielded a result of 21,842 records. Twenty-six studies, which included one randomised controlled trial and 25 observational studies, provided results for 5,143 adult refugees and asylum seekers. Studies were undertaken across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406). The prevalence of posttraumatic stress disorder (PTSD) was 31.46% (95% CI 24.43–38.5), the prevalence of depression was 31.5% (95% CI 22.64–40.38), the prevalence of anxiety disorders was 11% (95% CI 6.75–15.43), and the prevalence of psychosis was 1.51% (95% CI 0.63–2.40). A limitation of the study is that substantial heterogeneity was present in the prevalence estimates of PTSD, depression, and anxiety, and limited covariates were reported in the included studies.

Conclusions

This comprehensive review generates current prevalence estimates for not only PTSD but also depression, anxiety, and psychosis. Refugees and asylum seekers have high and persistent rates of PTSD and depression, and the results of this review highlight the need for ongoing, long-term mental health care beyond the initial period of resettlement.

Klíčová slova:

Anxiety disorders – Depression – Diagnostic medicine – Medical risk factors – Mental health and psychiatry – Post-traumatic stress disorder – Refugees – Systematic reviews

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