Violence, social vulnerability, and mental health issues among migrants and refugees.

Objectives: To measure and characterize three interrelated phenomena identified in the findings of the Committee for the Health of Exiles (Comede): violence experienced by exiles, their conditions of social vulnerability, and the severe mental health disorders from which they suffer, as well as the links between these three phenomena. Methods: Prevalence rates of severe mental health disorders were calculated among the 16,095 individuals who underwent a health assessment at Comede between 2007 and 2016. The results regarding other indicators (violence, social vulnerability, symptoms, and syndromes) are derived from an analysis of medical and psychological consultations for 5,204 patients seen between 2012 and 2016. Results: Between 2012 and 2016, 62% of those seen reported a history of violence, 14% a history of torture, and 13% gender- and sexual orientation-related violence. Extreme violence, which is more common among women and asylum seekers, is closely linked to nationality and social status in the country of origin. All forms of violence are associated with a significantly higher likelihood of receiving psychotherapy—three times more often in cases of extreme violence—and are strongly linked to severe mental health disorders. Furthermore, these exiled individuals face multiple social vulnerability factors: limited financial resources, lack of housing and shelter, precarious residency status, lack of health coverage, language barriers, difficulties accessing food, isolation, and social distress (24% meet at least 5 vulnerability criteria). These indicators of social vulnerability are closely linked to a history of violence, particularly for individuals in situations of social distress. A history of torture and gender-based violence is strongly associated with precarious daily living conditions and housing, social isolation, and even more so with relational isolation. The overall prevalence of severe mental disorders stands at 16.6% in this population, higher among women (23.5% versus 13.8% among men). Two-thirds of these disorders consist of psychotraumatic syndromes (60%) and complex trauma (8%), clinical forms that are more common among asylum seekers and victims of intentional violence, particularly for certain nationalities. Depressive disorders (22%) are more common among exiles in situations of social distress and among those whose asylum claims have been rejected. The impact of these disorders is significant, affecting concentration, attention, and memory as well as increasing the risk of suicide. Conclusion: These findings lead us to recommend that mental health issues among exiles and their social support be given greater consideration in prevention and care initiatives. It is necessary to integrate the specific needs of these individuals throughout the entire care pathway, from voluntary health screenings to multidisciplinary care. This must be done nationwide, particularly by promoting the use of professional interpreters and other measures that facilitate access to care.

Author(s): Veïsse A, Wolmark L, Revault P, Giacopelli M, Bamberger M, Zlatanova Z

Publishing year: 2017

Pages: 405-14

Weekly Epidemiological Bulletin, 2017, n° 19-20, p. 405-14

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