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Suicide death and hospital-treated suicidal behaviour in asylum seekers in the Netherlands: a national registry-based study
Simone Goosen, Anton E Kunst, Karien Stronks, Irene EA van Oostrum, Daan G Uitenbroek, Ad JFM Kerkhof
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-484
Abstract: We obtained data on cases of suicide and suicidal behaviour from all asylum seeker reception centres in the Netherlands (period 2002-2007, age 15+). The suicide death rates in this population and in subgroups by sex, age and region of origin were compared with the rate in the Dutch population; the rates of hospital-treated suicidal behaviour were compared with that in the population of The Hague using indirect age group standardization.The study included 35 suicide deaths and 290 cases of hospital-treated suicidal behaviour. The suicide death rate and the incidence of hospital-treated suicidal behaviour differed between subgroups by sex and region of origin. For male asylum seekers, the suicide death rate was higher than that of the Dutch population (N = 32; RR = 2.0, 95%CI 1.37-2.83). No difference was found between suicide mortality in female asylum seekers and in the female general population of the Netherlands (N = 3; RR = 0.73; 95%CI 0.15-2.07). The incidence of hospital-treated suicidal behaviour was high in comparison with the population of The Hague for males and females from Europe and the Middle East/South West Asia, and low for males and females from Africa. Health professionals knew about mental health problems prior to the suicidal behaviour for 80% of the hospital-treated suicidal behaviour cases in asylum seekers.In this study the suicide death rate was higher in male asylum seekers than in males in the reference population. The incidence of hospital-treated suicidal behaviour was higher in several subgroups of asylum seekers than that in the reference population. We conclude that measures to prevent suicide and suicidal behaviour among asylum seekers in the Netherlands are indicated.In 2008 an estimated 383 000 asylum applications were recorded in 51 Western countries, including most European countries, the USA and Canada [1]. Asylum seekers are people who have left their country of origin, applied for protection as a refugee in another country, and
Screening for tuberculosis infection among newly arrived asylum seekers: Comparison of QuantiFERON?TB Gold with tuberculin skin test
Brita Winje, Fredrik Oftung, Gro Korsvold, Turid Manns?ker, Anette Jeppesen, Ingunn Harstad, Berit Heier, Einar Heldal
BMC Infectious Diseases , 2008, DOI: 10.1186/1471-2334-8-65
Abstract: The 1000 asylum seekers (age ≥ 18 years) enrolled in the study were voluntarily recruited from 2813 consecutive asylum seekers arriving at the national reception centre from September 2005 to June 2006. Participation included a QFT test and a questionnaire in addition to the mandatory TST and chest X-ray.Among 912 asylum seekers with valid test results, 29% (264) had a positive QFT test whereas 50% (460) tested positive with TST (indurations ≥ 6 mm), indicating a high proportion of latent infection within this group. Among the TST positive participants 50% were QFT negative, whereas 7% of the TST negative participants were QFT positive. There was a significant association between increase in size of TST result and the likelihood of being QFT positive. Agreement between the tests was 71–79% depending on the chosen TST cut-off and it was higher for non-vaccinated individuals.By using QFT in routine screening, further follow-up could be avoided in 43% of the asylum seekers who would have been referred if based only on a positive TST (≥ 6 mm). The proportion of individuals referred will be the same whether QFT replaces TST or is used as a supplement to confirm a positive TST, but the number tested will vary greatly. All three screening approaches would identify the same proportion (88–89%) of asylum seekers with a positive QFT and/or a TST ≥ 15 mm, but different groups will be missed.The incidence of tuberculosis in Norway is generally low (6.3/100 000 population in 2006), but high among immigrants from countries where tuberculosis is endemic [1]. Most cases of tuberculosis are due to imported new strains rather than transmission within Norway [2,3]. WHO have estimated the global prevalence of latent tuberculosis infection in 1997 to be 35% for Africa, 44% for Southeast Asia and 15% for Europe [4]. The enormous pool of persons with latent tuberculosis challenges control of tuberculosis in low endemic countries. National guidelines for prevention and control of tuberculo
Multimorbidity in Adult Asylum Seekers: A First Overview  [PDF]
Carmen A. Pfortmueller, Manuela Stotz, Gregor Lindner, Thomas Müller, Nicolas Rodondi, Aristomenis K. Exadaktylos
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082671
Abstract: Principals Over the last two decades, the total annual number of applications for asylum in the countries of the European Union has increased from 15,000 to more than 300,000 people. The aim of this study was to give a first overview on multimorbidity of adult asylum seekers. Methods Our retrospective Swiss single center data analysis examined multimorbidity of adult asylums seekers admitted to our ED between 1 January 2000 and 31 December 2012. Results A total of 3170 patients were eligible for the study; they were predominantly male (2392 male, 75.5% versus 778 female, 24.5). The median age of the patients was 28 years (range 28–82). The most common region of origin was Africa (1544, 48.7%), followed by the Middle East (736, 23.6%). 2144 (67.6%) of all patients were not multimorbid. A total of 1183 (37.7%) of our patients were multimorbid. The mean Charlson comorbidity index was 0.25 (SD 1.1, range 0–12). 634 (20%) of all patients sufferem from psychiatric diseases, followed by chronic medical conditions (12.6%, 399) and infectious diseases (4.7%, 150). Overall, 11% (349) of our patients presented as a direct consequence of prior violence. Patients from Sri Lanka/India most often suffered from addictions problems (50/240, 20.8%, p<0.0001). Infectious diseases were most frequent in patients from Africa (6.6%), followed by the Balkans and Eastern Europe/Russia (each 3.8%). Conclusion The health care problems of asylum seekers are manifold. More than 60% of the study population assessed in our study did not suffer from more than one disease. Nevertheless a significant percentage of asylum seekers is multimorbid and exhibits underlying psychiatric, infectious or chronic medical conditions despite their young age.
The role of entry screening in case finding of tuberculosis among asylum seekers in Norway
Ingunn Harstad, Geir W Jacobsen, Einar Heldal, Brita A Winje, Saeed Vahedi, Anne-Sofie Helvik, Sigurd L Steinshamn, Helge Gar?sen
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-670
Abstract: We aimed to assess the effectiveness of entry screening of a cohort of asylum seekers. Cases detected by screening were compared with cases detected later. Further we have characterized cases with active tuberculosis.All asylum seekers who arrived at the National Reception Centre between January 2005 - June 2006 with an abnormal chest X-ray or a Mantoux test ≥ 6 mm were included in the study and followed through the health care system. They were matched with the National Tuberculosis Register by the end of May 2008.Cases reported within two months after arrival were defined as being detected by screening.Of 4643 eligible asylum seekers, 2237 were included in the study. Altogether 2077 persons had a Mantoux ≥ 6 mm and 314 had an abnormal chest X-ray. Of 28 cases with tuberculosis, 15 were detected by screening, and 13 at 4-27 months after arrival. Abnormal X-rays on arrival were more prevalent among those detected by screening. Female gender and Somalian origin increased the risk for active TB.In spite of an imperfect follow-up of screening results, a reasonable number of TB cases was identified by the programme, with a predominance of pulmonary TB.In recent years most new tuberculosis (TB) cases in Norway have occurred among immigrants from high incidence countries. Rarely, new cases are due to transmission within the country [1].Low incidence countries have diverse policies on entry screening of immigrants from high incidence countries. These range from no screening at all, to pre-immigration screening or screening after arrival [2-4]. There is an ongoing discussion about the content and effectiveness of different screening programmes to control tuberculosis [5,6]. Studies of screening of tuberculosis among immigrants have given TB prevalences that range from 0.1-1.2% [7-10], that can be due to differences in the characteristics of the populations and the screening programmes.Previous studies have shown differences between cases detected by or outside the screening
Tuberculosis screening and follow-up of asylum seekers in Norway: a cohort study
Ingunn Harstad, Einar Heldal, Sigurd L Steinshamn, Helge Gar?sen, Geir W Jacobsen
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-141
Abstract: We assessed a national programme for screening, treatment and follow-up of tuberculosis infection and disease in a cohort of asylum seekers.Asylum seekers ≥ 18 years who arrived at the National Reception Centre from January 2005 to June 2006, were included as the total cohort. Those with a Mantoux test ≥ 6 mm or positive x-ray findings were included in a study group for follow-up.Data were collected from public health authorities in the municipality to where the asylum seekers had moved, and from hospital based internists in case they had been referred to specialist care.Individual subjects included in the study group were matched with the Norwegian National Tuberculosis Register which receive reports of everybody diagnosed with active tuberculosis, or who had started treatment for latent tuberculosis.The total cohort included 4643 adult asylum seekers and 97.5% had a valid Mantoux test. At least one inclusion criterion was fulfilled by 2237 persons. By end 2007 municipal public health authorities had assessed 758 (34%) of them. Altogether 328 persons had been seen by an internist. Of 314 individuals with positive x-rays, 194 (62%) had seen an internist, while 86 of 568 with Mantoux ≥ 15, but negative x-rays (16%) were also seen by an internist. By December 31st 2006, 23 patients were diagnosed with tuberculosis (prevalence 1028/100 000) and another 11 were treated for latent infection.The coverage of screening was satisfactory, but fewer subjects than could have been expected from the national guidelines were followed up in the community and referred to an internist. To improve follow-up of screening results, a simplification of organisation and guidelines, introduction of quality assurance systems, and better coordination between authorities and between different levels of health care are all required.As tuberculosis (TB) in native populations in Western countries decreases, the relative importance of cases among immigrants increases. Latent tuberculosis is preval
Peur, mensonges et propagande : la presse britannique et les demandeurs d’asile Fear, Lies and Propaganda: The British Press and Asylum Seekers  [cached]
Pascale Villate-Compton
Revue LISA / LISA e-journal , 2009, DOI: 10.4000/lisa.511
Abstract: At a time when the integration of ethnic communities in Europe has become a burning issue, the case of Great Britain and the role played by its national press is particularly interesting. The British press, with its high circulation figures, is amongst the most virulent in Europe. For a number of years, the question of immigration and asylum seekers has been a recurring theme in its pages which are characterized by their complete lack of neutrality and an accompanying unwillingness to provide the necessary information for an informed debate on the subject. Several studies have underlined the systematically defamatory nature of the media’s coverage of the problems of immigration and asylum seekers since 1999 in which a blatantly propagandist approach has had a direct impact on both public opinion and political decisions.
Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark
Peter Hallas, Anne R Hansen, Mia A St?hr, Ebbe Munk-Andersen, Henrik L Jorgensen
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-288
Abstract: The study population was asylum seekers in Danish asylum centres run by the Danish Red Cross. General medical care was provided by Red Cross staff who could refer selected cases to medical specialists. If an asylum seeker needed more than three specialist consultations for mental illness or five consultations for physical illness the referrals had to be approved by The Danish Immigration Service. Between July 2001 – December 2002 the Red Cross prospectively registered health related data on all new applications (n = 4516) to the Immigration Service regarding referrals to medical specialists. We used these records to analyse the association between length of stay in the asylum centres and overall rate of referral for mental disorders. Data was analysed using weighted linear regression.We found that referrals for mental disorders increased with length of stay in asylum centres in a large, multiethnic population of asylum seekers. The association was found in all the categories of psychiatric illness studied and for a majority of the nationality groups studied.Length of stay in asylum centres was associated with an increase in referrals for mental disorders in a large, multiethnic group of asylum seekers. The present study supports the view that prolonged length of stay in an asylum centre is a risk factor for mental health. The risk of psychiatric illness among asylum seekers should be addressed by political and humanitarian means, giving prevention of illness the highest priority.The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers have claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders.A study from Denmark using data from 1986–1988 showed an increase in psychiatric illness with length of stay among asylum seekers [1]. No recent study, however, has focused on the effects of length of stay on the mental health on a large, multiethnic
Non-clinicians’ judgments about asylum seekers’ mental health: how do legal representatives of asylum seekers decide when to request medico-legal reports?
Lucy Wilson-Shaw,Nancy Pistrang,Jane Herlihy
European Journal of Psychotraumatology , 2012, DOI: 10.3402/ejpt.v3i0.18406
Abstract: Background : Procedures for determining refugee status across Europe are being speeded up, despite the high prevalence of mental health difficulties among asylum seekers. An assurance given is that ‘‘vulnerable applicants’’ will be identified and excluded from accelerated procedures. Although experts have recommended assessments to be undertaken by experienced clinicians, this is unlikely to happen for political and financial reasons. Understanding how non-clinically qualified personnel perform assessments of mental health issues is timely and crucial. Misrecognition of refugees due to the inappropriate use of accelerated procedures involves the risk of returning the very people who have the right to protection from further persecution. Objective : To examine the decision making of immigration lawyers, who are an example of a group of nonclinicians who decide when and whether to refer asylum-seekers for psychiatric assessment. Method : Semi-structured interviews were conducted with 12 legal representatives working with people seeking refugee or human rights protection in the United Kingdom. The resultant material was analysed using Framework Analysis. Results : Themes clustered around the legal case, the client, the representative and the systems, all with sub-themes. A mapping exercise integrated these themes to show how representatives brought together questions of (1) evidential reasons for a report, influenced by their legal, psychological and case law knowledge, and (2) perceived evidence of mental distress, influenced by professional and personal experiences and expectations. Conclusions : The legal representatives interviewed were well-informed and trained in psychological issues as well as clearly dedicated to their clients. This helped them to attempt quasi-diagnoses of common mental health problems. They nonetheless demonstrated stereotypical understanding of post-traumatic stress disorder and other possible diagnoses and the role of subjectivity. The study has implications for other groups – particularly those less trained and compassionate – who are required to make clinical judgments without the necessary expertise.
LGBTI asylum claims: the Central and Eastern European perspective
Anna ?ledzińska-Simon,Krzysztof ?miszek
Forced Migration Review , 2013,
Abstract: Recent research indicates that CEE countries still lag far behind therest of Europe in their asylum practices in relation to LGBTI asylumclaims. Low levels of awareness, lack of guidance and cultural hostility are jeopardising asylum seekers’ prospects for fair treatment.
Temporary geographies of the city: the experienced spaces of asylum seekers in the City of Turku, Finland  [cached]
P?ivi Kym?l?inen,Paulina Nordstr?m
Fennia : International Journal of Geography , 2010,
Abstract: Temporarity has a significant role in today’s urban spaces and peoples’ experiences of them. The city is often understood through stable material structures, while less attention is paid to such aspects of urban space that are there only for a limited time such as markets, events, manifestations and construction sites, for instance. Experiences of momentarity may be related to these kinds of elements of the city, but equally to personal feelings of not belonging to the city. In this paper we discuss, firstly, temporary geographies and their importance in today’s urban studies. Debates on relational spaces and moving geographies have directed attention towards the temporary aspects of urban spaces. Temporarity itself has mostly been discussed in relation to urban planning while less attention has been paid to other aspects of everyday life. Secondly, the theoretical aspects of temporary geographies in this paper will be illustrated with empirical material collected among young asylum seekers in the City of Turku in Finland in 2008–2009. The asylum seekers were interviewed and they kept photo diaries about their urban experiences. The material tells about the feelings of momentarity in urban space as the asylum seekers’ uses of the city were coloured by uncertainty while they were waiting for the decision about permission to stay in the country.
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