Mental health in newly arrived asylum seekers in Norway (In conversation)

This study explores the possibility of developing an assessment instrument based on self-report sufficiently sensitive and practically applicable to detect mental illness and need for treatment among asylum seekers. The study was conducted among relatively newly arrived asylum seekers in Norway, 85 adult asylum seekers completed a questionnaire, of these 65 underwent a diagnostic interview.
 

Two main groups were defined in the analysis: A Somalian group (n=39) and a group from Middle-East and North-Africa (n=39). Large differences with regard to educational background were found among the groups. Of the Somali group 60 % have no formal education, 30 % report primary school, and only 5 % education on high school level. In the Middle-East and North-Africa group 40 % have secondary school and 30 % higher education. A large part of the study group needed assistance from interpreter for completion of the questionnaire, even after these had been translated, because of lack of education/illiteracy.

The results from self-report questionnaire shows the following: 59 % had anxiety symptoms and 46 % had depressive symptoms that exceeded what is normally regarded as a limit for clinically relevant. Thirty three percent had a score exceeding what is considered clinically relevant when using HTQ, and thereby indicating a PTSD-diagnosis. Based on the subscales of HTQ consisting of items related to events that are considered very stressful and potentially traumatizing, 76,5 % report that they have been “close to being killed” and as many as 67 % have experienced family and/or friends being killed. As much as 31,4 % of the women reported that they had been raped, and the corresponding number among men was 13,6 % (total sample 21,5 % report rape). No significant difference between men and women with regard to torture was reported, but the total number was high,
57,3 % report torture.

In addition a major part report that basic needs have not been met. Results from CIDI-interviews show that among the 65 persons that were interviewed 46% met the criteria for a post traumatic stress disorder, 34% fulfil the criteria for a depressive disorder, 26% can be diagnosed with anxiety. Some met the criteria for more than on disorder at the same time.

No clear relation can be seen between the number or nature of traumatic events and psychiatric diagnoses in this investigation. Based on this investigation we can conclude that the translated instruments based on self-report are valid for recent asylum seekers with some education but is not helpful finding the PTSD-cases, but is somewhat better regarding anxiety and depression, although it distinguishes poorly between the disorders. This implies that one at best can identify asylum seekers that are in need of further evaluation applying HSCL-25 to this literate group.

Questionnaires filled in by asylum seekers with little or no education – assisted by interpreters – do not correspond well with the psychiatric disorders that are diagnosed in this study. At the same time we know that persons with little or no formal education constitute a relatively large part of the asylum seekers to Norway. Alternative ways of assessing health and need for therapy should be developed. This will be discussed.