Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps
Open accessAbstract
BACKGROUND: Population-based epidemiological research has established that refugees in low- and middle-income countries (LMIC) are at increased risk for a range of mental, neurological and substance use (MNS) problems. Improved knowledge of rates for MNS problems that are treated in refugee camp primary care settings is needed to identify service gaps and inform resource allocation. This study estimates contact coverage of MNS services in refugee camps by presenting rates of visits to camp primary care centers for treatment of MNS problems utilizing surveillance data from the Health Information System (HIS) of the United Nations High Commissioner for Refugees. METHODS: Data were collected between January 2009 and March 2013 from 90 refugee camps across 15 LMIC. Visits to primary care settings were recorded for seven MNS categories: epilepsy/seizure; alcohol/substance use; mental retardation/intellectual disability; psychotic disorder; emotional disorder; medically unexplained somatic complaint; and other psychological complaint. The proportion of MNS visits attributable to each of the seven categories is presented by country, sex and age group. The data were combined with camp population data to generate rates of MNS visits per 1,000 persons per month, an estimate of contact coverage. RESULTS: Rates of visits for MNS problems ranged widely across countries, from 0.24 per 1,000 persons per month in Zambia to 23.69 in Liberia. Rates of visits for epilepsy were higher than any of the other MNS categories in nine of fifteen countries. The largest proportion of MNS visits overall was attributable to epilepsy/seizure (46.91% male/35.13% female) and psychotic disorders (25.88% male/19.98% female). Among children under five, epilepsy/seizure (82.74% male/82.29% female) also accounted for the largest proportion of MNS visits. CONCLUSIONS: Refugee health systems must be prepared to manage severe neuropsychiatric disorders in addition to mental conditions associated with stress. Relatively low rates of emotional and substance use visits in primary care, compared to high prevalence of such conditions in epidemiological studies suggest that many MNS problems remain unattended by refugee health services. Wide disparity in rates across countries warrants additional investigation into help seeking behaviors of refugees and the capacity of health systems to correctly identify and manage diverse MNS problems.
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Pre-existing neuropsychiatric disorders such as psychosis and epilepsy are important for mental health service planning for conflict-affected populations.
“In addition, pre-existing neuropsychiatric disorders such as psychosis and epilepsy are important for mental health service planning for conflict-affected populations [12, 13].”
From Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment (2016) · cites this paper as [12]
There may be multiple reasons for the discrepancy between help-seeking data and epidemiological estimates, including help-seeking behavior, recognizability, and treatability and quality of care.
“There may be multiple reasons for this discrepancy, including: help-seeking behavior (e.g., systematic differences in the types of problems for which refugees seek assistance for mental health concerns in health care centers); recognizability (e.g., the extent to which staff in health care centers identify different types of mental health concerns); treatability and quality of care (e.g., the”
From Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment (2016) · cites this paper as [12]
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Cites
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009) · JAMA · doi:10.1001/jama.2009.1132 · Cited by 2,246 · see citing works
Self-citationResources for mental health: scarcity, inequity, and inefficiency
Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61239-2 · Cited by 1,789 · cited 8× · see citing works
“In the case of refugee camps, however, and indeed most settings in LMIC, the estimated number of those requiring services is unknown or a very rough estimate [32].”
BackgroundInfluentialDegenhardt, L., Chiu, W.-T., Sampson, N., Kessler, R. C., Anthony, J. C., Angermeyer, M., Bruffaerts, R., de Girolamo, G., Gureje, O., Huang, Y., et al. (2008) · PLoS Medicine · doi:10.1371/journal.pmed.0050141 · Cited by 796 · see citing works
Review of Child and Adolescent Refugee Mental Health
Lustig, S. L., Kia‐Keating, M., Grant-Knight, W., Geltman, P. L., Ellis, H., Kinzie, J. D., Keane, T. M., & Saxe, G. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200401000-00012 · Cited by 790 · see citing works
Mental Health of Cambodian Refugees 2 Decades After Resettlement in the United States
Marshall, G. N. (2005) · JAMA · doi:10.1001/jama.294.5.571 · Cited by 667 · see citing works
Psychological distress in refugee children: a systematic review
Bronstein, I., & Montgomery, P. (2011) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-010-0081-0 · Cited by 634 · cited 11× · see citing works
“Meta-analysis of the most robust of these surveys (that is, those using random samples and diagnostic interviews) showed average prevalence estimates of 15.4% (30 studies) for PTSD and 17.3% (26 studies) for depression [5].”
BackgroundInfluentialMental Illness in the Community: The Pathway to Psychiatric Care.
Higgins, A. C., Goldberg, D. P., & Huxley, P. (1982) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2068429 · Cited by 627 · see citing works
MENTAL ILLNESS IN THE COMMUNITY: THE PATHWAY TO PSYCHIATRIC CARE
Hannay, D. (1981) · PubMed Central · Cited by 601 · see citing works
Reed, R. V., Fazel, M. S., JONES, L. M., Panter‐Brick, C., & Stein, A. L. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60050-0 · Cited by 551 · see citing works
Epidemiology of schizophrenia: the global burden of disease and disability
Jablensky, A. V. (2000) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s004060070002 · Cited by 465 · see citing works
Epidemiology and aetiology of epilepsy in sub-Saharan Africa
Preux, P.-M., & Druet-Cabanac, M. (2005) · The Lancet Neurology · doi:10.1016/s1474-4422(04)00963-9 · Cited by 433 · see citing works
Mental illness in the community
Goldberg, D. P., & Huxley, P. J. (1983) · International Journal of Rehabilitation Research · doi:10.1097/00004356-198303000-00021 · Cited by 399 · see citing works
Trauma, War, and Violence: Public Mental Health in Socio-Cultural Context
de Jong, J. T. V. M. (2002) · Kluwer Academic Publishers eBooks · doi:10.1007/b109606 · Cited by 348 · see citing works
Ngugi, A. K., Bottomley, C., Kleinschmidt, I., Wagner, R. G., Kakooza‐Mwesige, A., Ae-Ngibise, K. A., Owusu‐Agyei, S., Masanja, H., Kamuyu, G., Odhiambo, R., et al. (2013) · The Lancet Neurology · doi:10.1016/s1474-4422(13)70003-6 · Cited by 321 · see citing works
Explanatory models of mental illness in sub-Saharan Africa
Patel, V. (1995) · Social Science & Medicine · doi:10.1016/0277-9536(94)00231-h · Cited by 233 · see citing works
Gender and use of substance abuse treatment services.
Green, C. A. (2006) · Europe PMC (PubMed Central) · Cited by 230 · see citing works
Global Epidemiology of Mental Disorders: What Are We Missing?
Baxter, A. J., Patton, G. C., Scott, K. M., Degenhardt, L. J., & Whiteford, H. (2013) · PLoS ONE · doi:10.1371/journal.pone.0065514 · Cited by 209 · see citing works
Madness or sadness? Local concepts of mental illness in four conflict-affected African communities
Ventevogel, P., Jordans, M., Reis, R., & de Jong, J. (2013) · Conflict and Health · doi:10.1186/1752-1505-7-3 · Cited by 174 · see citing works
Self-citationThe explanatory models of depression in low income countries: listening to women in India
Pereira, B., Andrew, G., Pednekar, S., Pai, R., Pelto, P., & Patel, V. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.09.025 · Cited by 166 · see citing works
Six rapid assessments of alcohol and other substance use in populations displaced by conflict
Ezard, N., Oppenheimer, E., Burton, A., Schilperoord, M., Macdonald, D., Adelekan, M., Sakarati, A., & van Ommeren, M. (2011) · Conflict and Health · doi:10.1186/1752-1505-5-1 · Cited by 160 · see citing works
Poverty, psychological disorder and disability in primary care attenders in Goa, India
Patel, V., Pereira, J., Countinho, L., Fernandes, R., Fernandes, J., & Mann, A. (1998) · The British Journal of Psychiatry · doi:10.1192/bjp.172.6.533 · Cited by 147 · see citing works
Psychoses, PTSD, and depression in Somali refugees in Minnesota
Kroll, J., Yusuf, A., & Fujiwara, K. (2011) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-010-0216-0 · Cited by 145 · see citing works
Severe mental disorders in complex emergencies
Jones, L., Asare, J. B., El Masri, M., Mohanraj, A., Sherief, H., & van Ommeren, M. (2009) · The Lancet · doi:10.1016/s0140-6736(09)61253-8 · Cited by 145 · see citing works
Self-citationSubstance use among populations displaced by conflict: a literature review
Ezard, N. (2011) · Disasters · doi:10.1111/j.1467-7717.2011.01261.x · Cited by 124 · see citing works
Labbate, L. A., Croft, H. A., & Oleshansky, M. A. (2003) · PubMed · Cited by 113 · see citing works
Weaver, H., & Roberts, B. (2010) · Substance Use & Misuse · doi:10.3109/10826081003793920 · Cited by 111 · see citing works
Estimating the coverage of mental health programmes: a systematic review
Silva, M. J. D., Lee, L., Fuhr, D. C., Rathod, S. D., Chisholm, D., Schellenberg, J., & Patel, V. (2014) · International Journal of Epidemiology · doi:10.1093/ije/dyt191 · Cited by 107 · see citing works
Bass, J. K., Ryder, R. W., Lammers, M., Mukaba, T. N., & Bolton, P. A. (2008) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2008.02160.x · Cited by 105 · see citing works
Self-citationJenkins, R., Kiima, D., Okonji, M., Njenga, F. G., Kingora, J., & Lock, S. (2010) · PubMed Central · Cited by 103 · see citing works
Ventevogel, P., van de Put, W., Faiz, H., van Mierlo, B., Siddiqi, M., & Komproe, I. H. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001225 · Cited by 102 · see citing works
Self-citationKauye, F., Jenkins, R., & Rahman, A. (2013) · Psychological Medicine · doi:10.1017/s0033291713001141 · Cited by 102 · see citing works
Silove, D., Bateman, C. R., Brooks, R. T., Fonseca, C. A. Z., Steel, Z., Rodger, J., Soosay, I., Fox, G., Patel, V., & Bauman, A. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.10.1205 · Cited by 91 · see citing works
Hershey, C. L., Doocy, S., Anderson, J., Haskew, C., Spiegel, P., & Moss, W. J. (2011) · Conflict and Health · doi:10.1186/1752-1505-5-24 · Cited by 72 · see citing works
Self-citationLuitel, N. P., Jordans, M. J. D., Murphy, A., Roberts, B., & McCambridge, J. (2013) · Alcohol and Alcoholism · doi:10.1093/alcalc/agt009 · Cited by 61 · see citing works
Mental disorders, disability and treatment gap in a protracted refugee setting
Llosa, A. E., Ghantous, Z., de Souza, R. R., Forgione, F., Bastin, P., Jones, A., Antierens, A., Slavuckij, A., & Grais, R. F. (2013) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.120535 · Cited by 50 · see citing works
Tol, W. A., Rees, S. J., & Silove, D. M. (2013) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796013000188 · Cited by 50 · see citing works
Self-citationGender Differences in Psychological Distress among Southeast Asian Refugees
Chung, R. C., Bemak, F., & Kagawa‐Singer, M. (1998) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199802000-00007 · Cited by 46 · see citing works
The United Nations High Commissioner for Refugees (UNHCR)
Betts, A., Loescher, G., & Milner, J. (2008) · Routledge eBooks · doi:10.4324/9780203928394 · Cited by 46 · see citing works
Communal Violence and Child Psychosocial Well-being: Qualitative Findings from Poso, Indonesia
Tol, W. A., Reis, R., Susanty, D., & de Jong, J. T. V. M. (2010) · Transcultural Psychiatry · doi:10.1177/1363461510364573 · Cited by 44 · see citing works
Self-citationTol, W. A., & van Ommeren, M. (2012) · Evidence Based Mental Health · doi:10.1136/ebmental-2012-100644 · Cited by 43 · see citing works
Self-citationHaskew, C., Spiegel, P., Tomczyk, B., Cornier, N., & Hering, H. (2010) · Bulletin of the World Health Organization · doi:10.2471/blt.09.074096 · Cited by 41 · see citing works
Self-citationUnited Nations High Commissioner for Refugees (UNHCR)
de la Vega, C. (2013) · Cited by 35 · see citing works
Mbatia, J. K., & Jenkins, R. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.10.1028 · Cited by 34 · see citing works
Reportable neurologic diseases in refugee camps in 19 countries
Mateen, F. J., Carone, M., Haskew, C., et al. (2012) · Neurology · doi:10.1212/wnl.0b013e318266fcf1 · Cited by 31 · see citing works
Ezard, N., Debakre, A., & Catillon, R. (2010) · Intervention · doi:10.1097/wtf.0b013e3283413134 · Cited by 29 · see citing works
Weiss, W. M., Vu, A., Tappis, H., Meyer, S., Haskew, C., & Spiegel, P. (2011) · Conflict and Health · doi:10.1186/1752-1505-5-19 · Cited by 25 · see citing works
Self-citationPsychiatric disorders in an African refugee camp
Kamau, M., Silove, D. M., Steel, Z., Rj, C., Bateman, C. R., & Ekblad, S. (2004) · Cited by 23 · see citing works
Mental disorders and health care seeking in Bandiagara: a community survey in the Dogon Plateau
Carta, M. G., Coppo, P., Carpiniello, B., & Mounkuoro, P. P. (1997) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/bf00788242 · Cited by 19 · see citing works
Integrating mental health into primary health care settings after an emergency
Rose, N., Hughes, P. G., Ali, O., & JONES, L. M. (2011) · Intervention · doi:10.1097/wtf.0b013e32834e0061 · Cited by 15 · see citing works
Performance of UNHCR nutrition programs in post-emergency refugee camps
Doocy, S., Tappis, H., Haskew, C., Wilkinson, C., & Spiegel, P. B. (2011) · Conflict and Health · doi:10.1186/1752-1505-5-23 · Cited by 11 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Daily stressors, trauma exposure, and mental health among stateless Rohingya refugees in Bangladesh
Riley, A., Varner, A., Ventevogel, P., Taimur Hasan, M. M., & Welton-Mitchell, C. (2017) · Transcultural Psychiatry · doi:10.1177/1363461517705571 · Cited by 276 · see citing works
Self-citationCuijpers, P., Heim, E., Abi Ramia, J., Burchert, S., Carswell, K., Cornelisz, I., Knaevelsrud, C., Noun, P., van Klaveren, C., van’t Hof, E., et al. (2022) · PLoS Medicine · doi:10.1371/journal.pmed.1004025 · Cited by 118 · see citing works
Adaku, A., Okello, J., Lowry, B., Kane, J. C., Alderman, S., Musisi, S., & Tol, W. A. (2016) · Conflict and Health · doi:10.1186/s13031-016-0085-6 · Cited by 66 · see citing works
“, the extent to which people will return to a health care center when they perceive it can be treated effectively there) [12].”
BackgroundSelf-citationWeissbecker, I., Hanna, F., El Shazly, M., Gao, J., & Ventevogel, P. (2019) · An Uncertain Safety · doi:10.1007/978-3-319-72914-5_6 · Cited by 61 · see citing works
Self-citationGreene, M. C., Kane, J. C., Khoshnood, K., Ventevogel, P., & Tol, W. A. (2018) · Harm Reduction Journal · doi:10.1186/s12954-018-0267-1 · Cited by 47 · see citing works
Self-citationMurphy, A., Chikovani, I., Uchaneishvili, M., Makhashvili, N., & Roberts, B. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3113-y · Cited by 31 · see citing works
Fine, S. L., Kane, J. C., Spiegel, P. B., Tol, W. A., & Ventevogel, P. (2022) · BMC Medicine · doi:10.1186/s12916-022-02371-8 · Cited by 20 · see citing works
Self-citationOstuzzi, G., Barbui, C., Hanlon, C., Chatterjee, S., Eaton, J., Jones, L., Silove, D., & Ventevogel, P. (2017) · BMC Medicine · doi:10.1186/s12916-017-0960-z · Cited by 8 · see citing works
Self-citationTorre, C. (2023) · London School of Economics and Political Science (LSE) · doi:10.21953/lse.00004557
- Authors
- Kane, J. C., Ventevogel, P., Spiegel, P., Bass, J. K., van Ommeren, M., & Tol, W. A.
- Affiliations
- Johns Hopkins University (US)
- Office of the United Nations High Commissioner for Refugees (CH)
- Corresponding author
- Kane, Jeremy C
- Venue
- BMC Medicine
- Published
- 2014-11-24
- Volume
- 12
- Issue
- 1
- Pages
- 228-228
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC4269097
- OpenAlex
- W2131193488
- Cited by
- 141
- References
- 50
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 9 · 2023: 9 · 2022: 9 · 2021: 16 · 2020: 52 · 2019: 10 · 2018: 16 · 2017: 5 · 2016: 7 · 2015: 2
- FWCI
- 5.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- National Institute on Drug Abuse (T32DA007292)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Health › Migration, Racism, and Human Rights
- Keywords
- refugees, mental illness, neurological disorders, substance use, epilepsy, psychosis, intellectual disability, emotional disorders, refugee camps, primary care, service coverage, help-seeking, neuropsychiatric disorders, low- and middle-income countries
- MeSH terms
- Adolescent, Adult, Mental Disorders, Child, Child, Preschool, Epilepsy, Female, Health Services Accessibility, Humans, Infant, Infant, Newborn, Male, Primary Health Care, Refugees, United Nations, Prevalence, Substance-Related Disorders, Health Information Systems
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