1. Department of General Practice RCSI Medical School Comparison of Self-Reported Health & Healthcare Utilization Between Asylum Seekers and Refugees: an Observational Study A dissertation submitted in Part fulfillment of Master of Science in PHC, RCSI, Dublin, 2006/7 M. Toar, K. O’Brien, T. Fahey

2. Contents of Presentation Introduction Methods Results Recommendations Summary

3. Introduction Refugees and asylum seekers experience high prevalence of mental health problems, especially:  Post traumatic stress disorder (PTSD)  Depression  Anxiety

4. Process of seeking asylum can take a long time in Ireland,  32% of asylum seekers residing in direct-provision centers for over two years Aim of the Study  This study compares and contrasts the prevalence of health problems, and potential risk factors

5. Methods Study Design Cross sectional study Validated self reported health status questionnaires Adult asylum seekers n=60 Adult refugees n=28 Participants from 30 countries Participants all residing in Sligo, Ireland

6. Health Status Outcome Measures General health status (SF-36) PTSD symptoms (HTQ) Anxiety/depression symptoms (HSCL-25)

7. Health Status Explanatory Measures Residence status Pre-migration stressors Post-migration stressors Presence of chronic diseases Analysis: Univariable analysis Multivariate analysis

8. Results Univariate Analysis When compared to refugees, asylum seekers reported, Significantly higher levels of PTSD (OR 6.3, 95% CI: 2.2-17.9) Significantly higher levels of anxiety/depression (OR 5.8, 95% CI: 2.2- 15.4) no difference in general health

9. Multivariable Analysis Regression model included all significant explanatory variables from univariate analysis: –Residence status –Pre-migration stressors –Post-migration stressors –Chronic conditions

10. Multivariable Regression a is the adjusted OR for the model containing residence status. b is the adjusted OR after removal of residence status from the model.

11. Conclusions on the Prevalence of Health Problems Higher levels of pre and post migration stressors and presence of more than one chronic disease are independently associated with PTSD and anxiety/depression Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (  2 = 19.74, df=1, P <0.001)

12. Health Care Utilization Asylum seekers were found to use GP services more often than refugees No difference was found between these groups for use of dentists, medication, hospitalization or mental health services

13. Context of Other Studies The association between pre and post migration stressors and self reported mental health shown in this study supports the findings of other studies and implies that mental health problems often develop and/or increase after arrival

14. Recommendations Our results suggest that living within direct provision centers adversely affects mental health and limits their integration in the society they wish to join Preventing asylum seekers from working is known to lead to mental health problems and issues of self esteem

15. Recommendations Considering the higher level of self reported mental health problems among asylum seekers, it might be expected that this group would utilize mental services more often. However, that was not the case in this study (unmet health need)

16. Summary Asylum seekers have a higher level of self reported PTSD and depression/anxiety symptoms compared to refugees Residence status appears to act as a marker for post migration stressors Compared to refugees, asylum seekers utilize GP services more often