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Psychosocial Health in Displaced Iraqi Care-Seekers in Non-Governmental Organization Clinics in Amman, Jordan: An Unmet Need

Published online by Cambridge University Press:  28 June 2012

Farah Bader
Affiliation:
1Johns Hopkins School of Public Health
Rakhi Sinha
Affiliation:
1Johns Hopkins School of Public Health
Jennifer Leigh
Affiliation:
1Johns Hopkins School of Public Health
Neerav Goyal
Affiliation:
1Johns Hopkins School of Public Health
Allen Andrews
Affiliation:
1Johns Hopkins School of Public Health
Natalia Valeeva
Affiliation:
2International Medical Corps
Adam Sirois
Affiliation:
2International Medical Corps
Shannon Doocy*
Affiliation:
2International Medical Corps
*
Department of International HealthJohns Hopkins Bloomberg School of Public HealthSuite E8132615 N. Wolfe St.Baltimore, Maryland 21205 USA E-mail: [email protected]

Abstract

Introduction:

Populations displaced by conflict face numerous threats to their psychological well-being; consequently, the prevalence of mental health problems, including anxiety, depression, and post-traumatic stress disorder can be elevated as compared to populations who have not experienced forced displacement.

Problem:

Little is known about the mental health needs of displaced Iraqis. The factors associated with a need for psychological services among patients at seven clinics served by two NGOs that are known sources of care for the displaced Iraqi population in Amman, Jordan were explored.

Methods:

The survey was conducted in January and February 2008 and included a random sample of care seekers from seven clinics selected using interval sampling. Interviews on the health needs of displaced Iraqis and their access to services, including mental health services lasting approximately 20 minutes were conducted.

Results:

Of the 664 survey participants, 49% (95% CI = 45–53%) of respondents reported needing mental health services and 5% (95% CI = 3–8%) of those in need had access to services. The length of time spent in Jordan (adjusted OR = 1.08; 95% CI = 1.00–1.11) was associated with the need for mental health services and the adjusted odds of requiring psychological services was 39% less for individuals from outside of Baghdad as compared to Baghdad residents (OR = 0.61; 95% CI = 0.38–0.98). Responders citing violence as a factor were twice as likely to be from Baghdad (OR = 2.28; 95% CI = 1.03–6.91), while interviewees reporting displacement as a cause for needing mental health services were twice as likely to be female (OR = 2.14; 95% CI = 1.12–4.18). In individuals 35–44 years of age (OR = 0.36; 95% CI = 0.14–0.87) the need for mental health services due to displacement decreased by 64%, while being a part of a female-headed household decreased the need by 81% (OR = 0.19; 95% CI = 0.06–0.57%).

Conclusions:

More attention should be given to expanding the local Jordanian health system capacity for the provision of mental service. Targeted social and psychiatric interventions that are culturally sensitive and aligned with Inter-Agency Standing Committee recommendations should be developed to compliment and expand the existing mental health service capacity in Jordan.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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References

1Sphere: Humanitarian Charter and Minimum Standards in Disaster Response: Mental and Social Aspects. Sphere Handbook. The Sphere Project. Available at http://www.sphereproject.org/component/option.comfrontpage/Itemid,200/lang,English. Accessed 07 May 2008.Google Scholar
2Inter-Agency Standing Committee: IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Available at http://www.who.int/mental_health/emergencies/guidelines_iasc_mentalhealth_psychosocial_june_2007.pdf Accessed 07 May 2007.Google Scholar
3Jones, L, Asare, J, Elmasri, M, Mohanraj, A: Mental health in disaster settings: New humanitarian guidelines include the needs of people with severe mental disorders. BMJ 2007;335:679680.CrossRefGoogle Scholar
4Carbello, M: The challenge of migration and health. World Hosp Health Serv 2006;42(4):1819.Google Scholar
5Savin, D, Seymour, DJ, Littleford, LN, Bettridge, J, Giese, A: Findings from mental health screening of newly arrived refugees in Colorado. Pub Health Rep 2005;120(3):224229.CrossRefGoogle ScholarPubMed
6Hinton, D, Safren, S, Pollack, M, Tran, M: Cognitive behavioral therapy for Vietnamese refugees with PTSD and comorbid panic attacks. Cog Beh Prac 2006;13(4):271281.CrossRefGoogle Scholar
7Keller, A, Lhewa, D, Rosenfield, B, Sachs, E, Aladjem, A, Cohen, I, Smith, H, Porterfield, K:Traumatic experiences and psychological distress in an urban refugee population seeking treatment services. J Nerv Ment Dis 2006:194(3):188194.CrossRefGoogle Scholar
8Marshall, GN, Schell, TL, Elliott, MN, Berthold, SM, Chun, CA: Mental health of Cambodian refugees 2 decades after resettlement in the united states. JAMA;2005; 294(5):571579.CrossRefGoogle ScholarPubMed
9Vaage, AB,Garlov, I,Hauff, E,Thomsen, PH: Psychiatric symptoms and service utilization among refugee children referred to a child psychiatry department: A retrospective comparative case note study. Transcult Psychiatry 2007;44(3):440458.CrossRefGoogle ScholarPubMed
10Mollica, RF, Cardozo, BL, Osofsky, HJ, Raphael, B, Ager, A, Salama, P: Mental health in complex emergencies. Lancet 2004;364(9450):20582067.CrossRefGoogle ScholarPubMed
11Lindencrona, F, Ekblad, S, Hauff, E: Mental health of recently resettled refugees from the Middle East in Sweden: The impact of pre-resettlement trauma, resettlement stress and capacity to handle stress. Soc Psychiatry Psychiatr Epidemiol 2008;43(2):121131.CrossRefGoogle ScholarPubMed
12Porter, M, Haslam, N: Predisplacement and post displacement factors associated with mental health of refugees and internally displaced persons: A metaanalysis. JAMA 2005;294(5):602612.CrossRefGoogle Scholar
13Fazel, M, Wheeler, J, Danesh, J: Prevalence of serious mental disorder in 7000 refugees resettled in western countries:A systematic review.Lancet 2005;365(9467): 13091314.CrossRefGoogle ScholarPubMed
14Favaro, A, Maiorami, M, Colombo, G, Santonastaso, P: Traumatic experiences, post-traumatic stress disorder and dissociative symptoms in a group of refugees from former Yugoslavia. J Nerv Ment Dis 1999;187(5):306308.CrossRefGoogle Scholar
15de Jong, J, Komproe, I, Van Ommeren, M, Mustafa, M: Araya, M, Khaled, N, Van de put, W, Somasundaram, D: Lifetime events and posttraumatic stress disorder in 4 postconflict setttings. JAMA 2001;286:555562.CrossRefGoogle Scholar
16Eytan, A, Durlieux-Palliard, S, Whitaker-Cinch, B, Loutan, L, Bovier, P: Transcultural validity of a structured diagnostic interview to screen for major depression and post-traumatic stress disorder among refugees. J Nerv Ment Health Disorders 2007;195:723728.CrossRefGoogle ScholarPubMed
17Jamil, H, Nasser-McMillan, S, Lambert, R: Immigration and attendant psychosocial sequelae: A comparison of three waves of Iraqi immigrants. Am J Orthopsychiatry 2007;77(2):199205.CrossRefGoogle Scholar
18United Nations High Commissioner for Refugees: Iraq. Available at http://www.unhcr.org/iraq.html. Accessed 07 May 2007.Google Scholar
19International Organization for Migration (IOM).Assessment on Physchosocial Needs of Iraqis Displaced in Jordan and Lebanon. Amman, Jordan and Beirut, Lebanon. Available at http://www.iom.int/jahia/webday/shared/shared/mainsite/published_docs/brochures_and_info_sheets/report_psy_assessment.pdf. Accessed 07 May 2008.Google Scholar
20Lindert, J, Brahler, E,Wittig, U, Mielek, A, Priebe, S: [Depression, anxiety, and post-traumatic stress disorder in labor migrants, asylum seekers, and refugees: A systemic overview]. Psychother Psychosom Med Psychol 2008;58(3–4):109122.(in German).CrossRefGoogle Scholar
21Shoeb, M, Weinstein, H, Mollica, R: The Harvard Trauma Questionnaire: Adapting a cross-cultural instrument for measuring torture, trauma, and PTSD among Iraqi refugees. Int J Soc Psychiatry 2007;53(5):447463.CrossRefGoogle ScholarPubMed
22FAFO: Iraqis in Jordan: Their number and characteristics. Oslo, 2007. Available at http://www.fafo.no. Accessed 05 June 2008.Google Scholar
23Burnham, G, Lafta, R, Doocy, S, Roberts, L: Mortality after the 2003 Invasion of Iraq: A cross-sectional sample survey. Lancet 2006;368:14211428.CrossRefGoogle Scholar
24Rutz, W,Wallinder, J, Eberhard, G, Holmberg, A: An educational program on depressive disorders for GPs on Gotland: Background and evaluation. Acta Psychiatrica Scandinavica 1989;79:1926.CrossRefGoogle Scholar