It is estimated that about 1% of the world's population has been displaced
either from their home or from their home country. In addition to physical
injury, these persons are at high risk for chronic mental health disorders
because of the multiple stressors they experience before, during, and after
their flight. They are at particularly high risk for posttraumatic
stress disorder (persisting recurrent and disturbing memories and flashbacks
of a witnessed or experienced trauma, along with other symptoms such as difficulty
sleeping, feeling detached from people and current experiences, and exaggerated
startle responses), depression, and somatization (emotional
trauma or stress experienced as physical symptoms).
Refugees are persons who flee their home country
to a different country to escape conflict. The term refugee includes asylum-seekers (individuals who are forced to leave their
country to avoid persecution often due to political or religious beliefs). Internally displaced persons are persons who are forced
to leave their home and move to a new site within their home country. The
August 3, 2005, issue of JAMA is a theme issue devoted
to articles on violence and human rights and includes articles about mental
health problems in refugee populations.
Experiencing or witnessing traumatic events is a major risk factor for
mental health problems.
The presence of the following factors before flight
may be associated with poorer mental health outcomes:
Being unprepared for trauma and refugee status
Older age
Higher socioeconomic status
Higher level of education
Female sex
Living in a rural area
The presence of the following factors after flight
may be associated with poorer mental health outcomes:
Unstable living arrangements
Lack of economic opportunity in the new living
situation
Internal displacement
Return to the country from which the refugees fled
Lack of resolution of the conflict from which they
fled
In addition to treating any medical conditions that may have developed
prior to or during flight from conflict, doctors treating refugees will ask
about the presence of physical symptoms including pain, loss of appetite,
and difficulty sleeping and also about the presence of emotional symptoms.
Because these mental health conditions may be severe and long-lasting, specialized
treatment may be required and can be located through the organizations listed
in the sidebar.
To find this and previous JAMA Patient Pages, go to the Patient Page
link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on posttraumatic
stress disorder was published in the August 1, 2002, issue.
Source: United Nations High Commissioner for Refugees
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate
in most instances, but they are not a substitute for medical diagnosis. For
specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied
noncommercially by physicians and other health care professionals to share
with patients. To purchase bulk reprints, call 718/946-7424.
TOPIC: MENTAL HEALTH