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Article

A Mental Health Profile of 900 Newly Arrived Refugees in Denmark Using ICD-10 Diagnoses

by
Anne Mette Fløe Hvass
1,2,3,4,*,
Lene Nyboe
5,
Kamilla Lanng
4,
Claus Vinther Nielsen
2,3 and
Christian Wejse
4
1
Department of Social Medicine, Aarhus University, 8000 Aarhus, Denmark
2
Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
3
DEFACTUM, Region Hospital West Jutland, Central Denmark Region, 7400 Herning, Denmark
4
Centre for Global Health, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
5
Clinic for PTSD and Anxiety, Aarhus University Hospital Aarhus, 8200 Aarhus, Denmark
*
Author to whom correspondence should be addressed.
Sustainability 2022, 14(1), 418; https://doi.org/10.3390/su14010418
Submission received: 20 September 2021 / Revised: 9 December 2021 / Accepted: 20 December 2021 / Published: 31 December 2021
(This article belongs to the Special Issue Migrant Health and Quality of Life)
Browse Figures
Review Reports Versions Notes

Abstract

:
(1) Background: Recognizing mental health problems in newly arrived refugees poses a challenge. Little is known of the mental health profile of refugees currently arriving in Northern Europe. (2) Method: In total, we included 900 adult (≥18 years old) refugees arriving in Aarhus, Denmark, between 1 January 2014 and 1 January 2020. All participants accepted an offer of a voluntary systematic health assessment from the municipality in Aarhus, including a mental health screening. (3) Results: Within this cohort, 26% (237/900) of the participants were referred to the Department of Psychiatry, Aarhus University Hospital, 24% (212/900) were in contact with the department and 21% (185/900) received ≥1 psychiatric diagnosis. Within the subpopulation referred (n = 237), 64% (152/237) were diagnosed with post-traumatic stress disorder (PTSD) (DF431), 14% (34/237) with neurotic, stress-related and somatoform disorders (F40–F48) and 13% (30/237) with major mood disorders (F30–F39). Among the participants referred to the Department of Psychiatry and participants receiving a diagnosis, we found an overrepresentation of participants originating from the Southern Asian region (Pakistan, Afghanistan and Iran) and with an age above 44 years. (4) Conclusion: We found a high prevalence of both referrals and psychiatric diagnoses in newly arrived refugees. Attention to psychiatric conditions in refugees and systematic health assessments during resettlement are needed.

1. Introduction

In 2020, the United Nations High Commissioner for Refugees (UNHCR) estimated that the number of forcibly displaced people surpassed 80 million globally. Of these, 26.3 million are refugees displaced across international boundaries [1]. The 1951 convention related to refugees’ status defines refugees as people who have a well-founded fear of persecution due to their religion, race, political beliefs, nationality, membership of a social group or sexual identity and cannot rely on their home country to protect them [2]. Refugees are at increased risk of mental health conditions, and studies have found that these conditions are often overlooked [3]. Differences in health reception for refugees settling in a new home country are vast, and health programmes typically do not include screening for mental health issues [4].
Several studies comparing refugees with the native population of the receiving country find that refugees have considerably higher risks for specific psychiatric disorders related to war, violence, torture and forced migration. The rate of post-traumatic stress syndrome (PTSD) is up to 10 times higher in this group than in the native born population, and elevated rates of depression, chronic pain and somatic complaints are reported [5,6,7,8]. Furthermore, a review of reviews regarding first-generation migrants identified important factors possibly contributing to the overrepresentation of mental health problems in this group. These factors encompassed (i) socio-demographic factors (including gender), (ii) geographical factors (including country of origin, host country and urbanisation) and (iii) economic factors (including downward social mobility and the size of the host country’s gross national product (GNP)) [9].
Even though refugees’ mental health problems are well documented, the estimated prevalence of specific diagnoses varies considerably. Studies have found that the prevalence of depression ranges from 2.3% to 80%; for PTSD, from 4.4% to 86% [10,11,12]. The wide intervals also reflect that the prevalence of mental disorders varies between different refugee subgroups [3]. One subgroup comprises torture victims where studies have found that 88% have PTSD [13]. However, we lack knowledge of other vulnerable subgroups within the overall refugee population.
Mental health screening is rarely a part of systematic screening programmes for newly arrived refugees [4,13]. However, when screening does include mental health, it commonly reveals a large number of mental health issues [14,15,16,17,18] as well as other comorbidities associated with a higher prevalence of mental health issues. [19]. The vulnerability to psychiatric symptoms and disorders experienced by many refugees may by associated with their exposure to multiple risk factors including torture, war, violence, oppression, loss of family members and prolonged separation, low socioeconomic status, unemployment and displacement to a new country [16].
In addition, the lack of screening programmes and the high prevalence of mental health conditions among refugees, cultural and pragmatic factors also constitute barriers to mental health treatment [20,21,22,23]. In some cultures, the treatment of mental health issues include religious and traditional healers and in many cultures high degrees of stigma are seen [3]. Furthermore, other factors affecting migrant health include language barriers, social determinants, economic strain, lack of professional interpreters, lack of knowledge of legal entitlements and transportation, all of which can affect their utilization of healthcare services [10,24,25,26,27,28,29,30,31]. Adding to this, studies on healthcare utilization have shown that immigrants and refugees are less likely than their native-born counterparts to seek out and be referred to mental health services, even when they experience comparable levels of distress [23,32,33,34,35,36].
Legal entitlement is another important factor determining access to healthcare. The Danish healthcare system is universal. Therefore, most healthcare services are free of charge to refugees and immigrants once they have received a residence permit. This includes referral to and treatment for psychiatric conditions [37]. However, due to new Danish legislation, expenses for interpreters after three years of residence are covered only in specific circumstances; this constitutes an additional barrier to accessing to treatment [38]. Some barriers may be reduced by systematic health screening programmes, including mental health issues during resettlement. A systematic screening of mental health issues is performed in the second largest Danish city, Aarhus, where the present study was conducted [39]. The cohort analysed in the present study is fairly representative for European refugees, as refugees are distributed to Danish municipalities via a quota system to ensure an even geographical distribution [40] and because the constitution of refugees in Denmark is relatively equal to that of the European refugee population [41] (Denmark receives around 7000 refugees and family reunified to refugees annually; range 1487–18,875 persons in the period 2013–2020 [42]).
In summary, refugees are (i) rarely screened for mental health problems, (ii) have higher prevalence of mental health disorders than the native-born population and (iii) have problems accessing mental healthcare. Attention in this field is needed. To our knowledge, this is the first study profiling mental health in recently resettled refugees including family reunited refuges.
The present study aimed to explore (i) which mental health problems are present among refugees upon resettlement, (ii) which subgroups are overrepresented in psychiatric diagnoses and (iii) the association between attendance rates and gender, age, route of arrival and region of origin.

2. Materials and Methods

The study was conducted in Aarhus, Denmark, with 340,000 inhabitants. Refugees receiving a residence permit in Aarhus are offered a voluntary general health assessment at the municipal Department of Social Medicine. Refugees arrive in Aarhus through three channels: the UNHCR, asylum centres and as family reunited refugees. These channels are hereafter referred to as ‘route of arrival’.

2.1. Research Design

This cross-sectional study included all refugees who accepted the offer of a health assessment between 1 January 2014 and 1 January 2020 and were ≥18 years of age at the time of assessment. Data from the health assessments were matched with diagnoses from the Department of Psychiatry (DOP), Aarhus University, which handles all psychiatric referrals in this geographical area.

2.2. Measurement

Health assessments were conducted by a medical doctor, assisted by an interpreter in the refugee’s mother tongue, and included elements of physical health, social medicine and mental health. The assessments were conducted systematically using the same template for all participants including screening questions for PTSD symptoms. The questions covered arousal, avoidance, intrusion symptoms, negative alterations in cognition and mood as well as traumatic events during migration or pre-departure. If PTSD symptoms were severe, the refugee was referred directly to a formalised PTSD assessment at a specialized PTSD clinic at Aarhus University Hospital, DOP, or the participant’s general practitioner was notified to make the referral. If other mental health problems were suspected, the participant’s general practitioner was informed and advised to make a referral, when relevant.
The option of direct referral was assessed according to severity of symptoms using the ICD-10 criteria for PTSD (Figure 1) combined with impact on level of functioning using the ICF model from the WHO [43,44]. Attendance was measured as any contact with DOP, including telephone consultations, home visits, visits to the outpatient clinic and admittances.

2.3. Data Collection

From DOP, we have data on all participants with a referral and all diagnoses given to study participants (using ICD-10 standards). These data were collected in July 2020. For each participant, diagnoses were counted once per category based on the ICD-10 [43]. Participants were divided into age groups according to the UN age classification for international migration with age groups 15–24, 25–44, 45–64 and 65+ [44,45]. Data were stored using the RedCAP (Vanderbilt, United States of America) system. The statistical analyses were performed using Stata version 14 (StataCorp, College Station, TX, USA)). Binomial proportions were reported as exact numbers and percentages, and binomial proportions were compared using Pearson’s chi-square test or Fischer’s exact test when groups were <5. The chi-square test was primarily used to establish differences based on referral/diagnoses and region/country of origin, gender and age. Most polytomous results were dichotomised for the interpretability of model results. Logistic regression was used to determine if the odds of PTSD diagnosis were related to age. The analytical strategy was to perform descriptive statistics and perform association analysis on selected demographic data in order to create a mental health profile of newly arrived refugees.
The database contained information from the health assessments including age, gender, length of education, country of origin and route of arrival. The interview also obtained information regarding familiar dispositions, family status, number of children, employment history, religion and ethnicity, but these data were missing for some participants and were therefore not yet entered into the database.
We used the United Nations Geoscheme to group and stratify results by region of origin. This system was used to classify countries into regional groups and follows the M49 coding classification [46]. Furthermore, all results were stratified by nation, as results could vary considerably between countries of origin. p-values below 0.05 (two-tailed) were considered statistically significant.
The Danish Data Protection Agency authorised the project (file number 2015-55-0586). The project was also authorised by the Danish Patient Safety Authority (file number 3-3013-1926/1). The Central Denmark Region Committee on Health Ethics assessed the project and determined that approval was not required.

3. Results

In total, 900 adult refugees participated in the health assessment during the study period (1 January 2014–1 January 2020). In total, 46.8% (CI 43%;50%) were female, and the median age was 31.5 years. The majority of refugees originated from Syria (Table 1).
Data on age and gender were available for all participants. Data on years of education were missing for 20 participants, and the route of arrival was missing for 6 participants.
We found that 26% (237/900) (confidence interval (CI): 23%; 29%) of the newly arrived refugees were referred to the DOP, as depicted in Figure 2. Furthermore, we found that 23% (211/900) (CI: 21%;26%) of the total population were diagnosed at the DOP. Within this group, 185 were given a psychiatric diagnosis (mental, behavioural or neurodevelopmental) (F10–F99) and 26 were given an observational diagnosis only (DZ diagnosis), as shown in Figure 2. An observational diagnosis is provided if a psychiatric diagnosis has not yet been given and a patient is observed and evaluated for a suspected disease or condition [43]. Thus, 87% (185/212) of the participants who attended care at the DOP were given a psychiatric diagnosis, leaving 13% who attended care but were not diagnosed with a specific psychiatric condition.

3.1. Diagnoses and Regions

In total, 95 different diagnoses were given to participants seen at the DOP. Within the referred population, we found significantly more participants originating from Southern Asia (SAS) (p = 0.001) and Western Asia (WAS) (p = 0.03) and significantly fewer originating from Eastern Africa (EAF) (p < 0.001), as shown in Table 2 and Figure 3a.
In total, 237 participants were referred to the DOP and 212 (89%) were registered as attending care at the DOP. In total, 185 participants received a psychiatric diagnosis. The overrepresentation of participants originating from the Southern Asian region and underrepresentation of participants originating from Eritrea, Ethiopia, Somalia and Zambia (EAF) were also seen here. The pattern of overrepresentation and underrepresentation in these two regions was seen in all stages of the study (symptoms, referral, attendance and diagnosis), as shown in Table 2.
The most common individual diagnosis given at the DOP was PTSD. In total, 152 were diagnosed by the DOP, and some participants had more than one diagnosis (Table 3).
Using a chi2 test, we found that participants from Afghanistan, Pakistan and Iran (SAS) and Syria, Lebanon, Iraq and Palestine (WAS) were significantly more likely to receive a PTSD diagnosis (p = 0.02/0.01), and participants from EAF were significantly less likely to receive this diagnosis (p < 0.001).
Although only four participants had diagnoses within the spectrum of schizophrenia and psychosis, we found a statistically significant overweight of participants from EAF, as three of the diagnosed individuals originated from this region (p > 0.001).
For affective disorders and substance abuse, we found no regional differences.

3.2. Non-Attendance

We found that 3% (25/900) (CI: 2%;4%) were referred but did not show up for consultations at DOP. We found no statistically significant demographic differences between subgroups compared with the total population (median age 29.7 years, 68% originated in Syria, 76% arrived through asylum centres, 48% were female). However, participants in the age group 24–44 years were significantly more likely to attend their appointments (p = 0.017) (Table 4).

3.3. Age, Gender and Participation

With regard to age, we found participants in the age group of 44–65 years to be significantly more likely to have symptoms of PTSD at screening (p < 0.001), to be referred to the DOP (p < 0.001), to attend appointments (p ≤ 0.001) at the DOP and to receive a diagnosis (p > 0.001). Furthermore, the age group of 44–65 years had a significantly higher prevalence of non-attendance (p = 0.034). The 65+ age group showed the same, yet statistically non-significant tendencies. This age group included very few individuals and was therefore pooled with the age group 44–65 years in Table 4 and Figure 3b. The data for the two pooled age groups showed the same trends as data for the age group of 44–65 years alone.
With respect to gender, we found no significant differences between male and female gender when looking at symptoms at screening (p = 0.095), referral (p = 0.809) or any psychiatric diagnosis (p = 0.896)—neither overall nor when analysing the individual diagnoses.
Using logistic regression, we found the odds for obtaining a psychiatric diagnosis to increase with age, with a 2% increase in odds per year. (Coef 0.02 (CI 0.01;0.03), p = 0.001). We also found a small association between the length of education and the risk of obtaining a psychiatric diagnosis, with a decrease of 2% in the odds per year of education (Coef −0.02 (−0.05;0.01) p < 0.0001).

3.4. Route of Arrival and Route to Diagnosis

The proportion of participants receiving a psychiatric diagnosis did not differ statistically regarding route of arrival: 21% arrived through an asylum centre (136/637) (CI:18;25), 19% were family reunified (41/214) (CI:14%;25%) and 18% arrived through the UNHCR (8/43) (CI:8%;33%). (p = 0.211).
As far as the route to diagnosis was concerned, we found that 84% (198/235) (CI: 79%;89%) were referred by a general practitioner, 22% (52/235) (CI: 17%;28%) were referred in connection with the health assessments and 2% (4/235) (CI: 0.5%:4) were referred from a somatic hospital department. Some participants were referred more than once.

4. Discussion

This study showed that systematic health screening including mental health can quickly and efficiently identify mental health problems and ensure referral to specialist treatment in a cohort of newly arrived refugees.
Previous studies have highlighted the need for more longitudinal studies showing what happens after an initial mental health screening of newly arrived refugees [16]. The present study showed that within the first years after resettlement, 21% (185/900) of refugees received a psychiatric diagnosis. More specifically, 17% with PTSD, 4% with anxiety related disorders, 3% with major mood disorders and other less frequent conditions (Table 1). our results showed that refugees above 44 years had a significantly increased risk of PTSD symptoms and of being referred to the DOP but also an increased risk of not attending after having been referred. This could create a vulnerable subpopulation of middle-aged and older refugees with untreated mental health problems. Other studies have shown how higher age in newly arrived refugees can be associated with worse mental health outcomes and increased psychological distress—especially in those who have lower educational attainment, are females, are unemployed, have poor self-rated health and chronic diseases and lack social support [28,47,48]. Furthermore, studies have shown how refugees arriving at an older age may be at a disadvantage because of slower language learning rates, fewer meaningful work and productivity opportunities, decreased social support and increased isolation because of separation from extended family and loss of the position as a respected elder [48,49].
Immigrant status is associated with lower use of mental health care, even when universal health care is provided [23]. An American study by Savin et al. with health assessments including the assessment of mental health of 1580 participants found that 10% were offered referral to mental health services. In the present study, this percentage was twice as high as 22% were referred directly, though in a very different refugee population regarding countries of origin. In the study by Savin et al., 37% of the referred refugees attended mental health services after having been referred [16], whereas in the present study, this was 89%. This could in part be due to different structures in health systems, where universal health care in Denmark is free once a residence permit has been obtained. We were still surprised to find that only 25 (11%) of the referred participants did not have contact with the DOP. Another explanation for the high attendance rate could be the direct referral from the health assessment to the DOP and the close cooperation with the general practitioners when an immediate referral was not possible. This timely linkage to psychiatric care reduces the time without a diagnosis and thereby improves the opportunities for timely and correct treatment.
During the entire study, i.e., from symptom screening to referral including attendance monitoring and receiving a diagnosis, we found an overrepresentation of participants from the SAS region and an underrepresentation of participants from the EAF region, as seen in Table 2 and Table 3. The tables show that participants from the SAS region had a higher prevalence and participants from the EAF region had a lower prevalence of symptom screening, referral, attendance and diagnoses. The overrepresentation of participants from the SAS region has also been reported in other studies: An Australian study found that 44% of Afghan refugees had PTSD symptoms and 15% had depression [50]. A study of asylum seekers and refugees from the Netherlands found that participants from Afghanistan and Iran had the highest rates of depression/anxiety and PTSD symptoms [51]. While participants from the EAF region were underrepresented in terms of symptom screening, referral, attendance and overall diagnoses, they were overrepresented with the diagnoses of schizophrenia/psychosis. Participants with this diagnosis category included only few persons, but the finding was statistically significant. Within this region, we also found statistically significantly fewer participants with diagnoses of both PTSD and the unspecific DZ diagnoses. The overrepresentation of diagnoses of schizophrenia/psychosis along with a relatively low prevalence of PTSD among refugees from the EAF region could suggest the presence of a particular disease pattern of mental health conditions in this part of the world, or it could reflect cultural conditions or particular ways of handling mental health problems. Studies have found cultural variation in the clinical presentation of anxiety and depression and that, e.g., somatic symptoms can serve as cultural expressions of distress in some ethnic groups [22]. This should be explored in future studies.
In the analysis, we found no association between the route of arrival and obtaining a psychiatric diagnosis. This shows that being family reunified to a refugee poses a risk similar to that of refugees arriving through an asylum centre or the UNHCR. Family reunified refugees are often overlooked and left out of refugee health programmes in other countries. Our results suggest that this group should receive the same attention regarding mental health as refugees arriving directly to their new home countries.
In the subpopulation of participants with contact to DOP (n = 212), we have no information about the quality of this contact. We do not know if the participants finished a planned treatment regimen or dropped out. Further studies are needed to shed light on this issue.
A review of mental health reviews in first-generation refugees found that the prevalence of PTSD was 9–36% among first-generation refugees and only 1–2% in the native population. This is in line with the results of the present study, in which 17% (12/900) of refugees had a PTSD diagnosis [9].
Aarhus is one of the few municipalities in Denmark offering systematic health assessments [4]. We have no reason to believe that our study population has a different mental health profile than that of refugee populations from other countries where most of the refugees come from the Middle East. When health systems choose not to screen newly arrived refugees for mental health problems, they risk missing psychiatric diagnoses in 21% of adults, a diagnosis that would ensure early treatment and support and be a foundation for the new life as a resettled refugee.
To ensure timely diagnoses, systematic health assessments during resettlement should thus be mandatory.

Limitations

Once resettlement in a new country is completed, a phase of hope and optimism may follow. This phase is often referred to as “the honeymoon period” [52]. “The honeymoon period” may initially have a positive effect on mental health; in our study, this could have caused us to underestimate psychiatric disorders. However, disillusionment, demoralization and depression may also occur early as a result of migration-associated trauma or because hopes and expectations are not met in the country of resettlement. This could, in turn, have caused us to overestimate the prevalence of psychiatric disorders [53,54,55]. Furthermore, a study found that referrals for mental disorders increased with the length of stay among asylum centres in Denmark, even if the prevalence of mental disorders was only 1.3% [56].
No validated mental health screening tool was used in the initial health assessment. Instead, questions based on the ICD-10 criteria for PTSD and selected general mental health questions were used. The present study found that all participants who were referred directly from the health assessment received a diagnosis, which is therefore in part a validation of the method used. On the other hand, the results raise a concern that some refugees with mental health issues were missed and that more refugees should have been referred directly. There are currently several relevant, validated instruments that could be used for this purpose, e.g., the Harvard Trauma Questionnaire (HTQ) parts I and IV, the War Trauma Scale (WTS), the Hopkins Symptom Checklist-25 (HSCL-25), the Beck Depression Inventory (BDI) [57,58] and the Refugee Health Screener RHS-15 [59,60]. Further studies should explore if the implementation of a validated tool could further improve the health assessments.
Follow-up time varied among the participants. The first health assessments completed in 2014 had a follow-up period of 6.5 years, and the last health assessments at the end of the study period had a follow-up period of only 6 months between health assessment and data retrieval from the DOP. This means that the prevalence of mental health conditions in this population could be underestimated.
A family history of mental illness is a potential confounder in some of the observed associations. Unfortunately, this parameter was not available in the database, but it should be included in future studies.
Furthermore, only 88% of refugees arriving in Aarhus accepted the offer to participate in the health assessment, and we do not know how the inclusion of the remaining 12% would have affected the results. However, with the high participation rate we did achieve in the present study, we do believe that our results provide a valid description of mental health problems in resettling refugees.

5. Conclusions

In conclusion, we found that 26% of all newly arrived refugees were referred to the DOP. The most common diagnosis was PTSD (17%). Furthermore, 25 participants did not show up for their appointment at the DOP, but among the 212 participants who attended, 87% were given a diagnosis. We identified vulnerable subgroups among those aged > 44 years and among refugees from the SAS region.
Though they are often overlooked in both clinical work and research, family reunified to refugees have a prevalence of psychiatric diagnoses similar to those of refugees per se, indicating that this subgroup needs access to the same health care services as refugees arriving through asylum centres or the UNHCR.
Refugees exhibit a high prevalence of psychiatric disorders that may be amenable to early treatment and support. Early detection and timely care may ease the strains of resettlement and accelerate the process of mental health recovery inflicted by a traumatic past. When recovery begins early, refugees are less likely to become marginalized and more capable of contributing to their families and society.
We recommend that systematic mental health screening and mental health referral be made mandatory for all newly arrived refugees as part of a general systematic health assessment upon the resettlement of refugees in Europe.

Author Contributions

A.M.F.H. and L.N. came up with the original idea for the project. The method was discussed with all authors. Data handling was conducted by K.L. and A.M.F.H. Data analysis was performed by A.M.F.H., C.W. and C.V.N. supervised all stages of the process. The original draft for the manuscript was made by A.M.F.H. and all authors contributed to the text. All authors have read and agreed to the published version of the manuscript.

Funding

The research was funded by the Folkesundhed I Midten foundation (grant number 948), The Kerrn-Jespersen foundation, Aarhus University Ph.D. grant (grant number 18947168), Defactum and the Department of Clinical Social Medicine, Central Denmark Region.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and the Central Denmark Region Committee on Health Ethics assessed the project and determined that approval was not required.

Informed Consent Statement

Informed consent was obtained from subjects involved in the study for the data collected prospectively. For the data collected retrospectively approval for data collection was obtained from the Danish Patient Safety Authority (file number 3-3013-1926/1) in accordance with Danish health legislation.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript or in the decision to publish the results.

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Figure 1. Diagnostic criteria for F43.1 post-traumatic stress disorder using the ICD-10.
Figure 1. Diagnostic criteria for F43.1 post-traumatic stress disorder using the ICD-10.
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Figure 2. Flow chart of study population from 1 January 2014 to 1 January 2020.
Figure 2. Flow chart of study population from 1 January 2014 to 1 January 2020.
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Figure 3. Referral and diagnosis by geographical region: (a) All participants who attended the health assessment (brown), participants with a referral (orange) and participants with a psychiatric diagnosis (yellow) according to geographical regions. The light blue line shows percentage of participants with a psychiatric diagnosis in each geographical region. Referral and psychiatric diagnosis by age groups. (b) All participants who attended the health assessment (brown), participants with a referral (orange) and participants with a psychiatric diagnosis (yellow) according to age group. The light blue line shows percentage of participants with a psychiatric diagnosis in each age group with a psychiatric diagnosis.
Figure 3. Referral and diagnosis by geographical region: (a) All participants who attended the health assessment (brown), participants with a referral (orange) and participants with a psychiatric diagnosis (yellow) according to geographical regions. The light blue line shows percentage of participants with a psychiatric diagnosis in each geographical region. Referral and psychiatric diagnosis by age groups. (b) All participants who attended the health assessment (brown), participants with a referral (orange) and participants with a psychiatric diagnosis (yellow) according to age group. The light blue line shows percentage of participants with a psychiatric diagnosis in each age group with a psychiatric diagnosis.
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Table
Table 1. Demographics of the study population stratified by country of origin.
Table 1. Demographics of the study population stratified by country of origin.
Country of OriginParticipants/n (%)Median Age/Years (Range)% FemaleMedian Lenght of Education/YearsRoute of Arrival/n (Asylum Centre/Family Reunification/UNHCR)
Syria565 (63%)32.3 (18; 76)45.912(414/146/6)
Lebanon14 (2%)44.5 (21.8; 60.9)71.412(7/4/2)
Iraq15 (2%)24.9(18.4; 32.2)60.010(8/3/1)
Eritrea85 (9%)26.8 (18; 65.6)37.710(70/15/0)
Ethiopia12 (1%)27.4 (23.7; 36.9)58.37(10/2/0)
Somalia27 (3%)24.9 (18; 69.7)59.31.5(16/11/0)
Afghanistan32 (4%)27.5 (18.4; 75.6)46.97(22/10/0)
Iran82 (9%)32.6 (18,2; 63.7)39.010(78/7/0)
Congo19 (2%)36.1 (19.1; 75)68.47(0/0/19)
Central African Republic6 (1%)43.2 (22.3; 74.5)66.74(0/0/6)
Columbia6 (1%)28.3 (18.4; 49)66.710(0/0/6)
Others *19 (2%)37.8 (19.4; 71.7)42.112(9/8/2)
Unknown18 (2%)38.0 (18.4; 69.4)66.77(5/6/1)
Total900 (100%)31.5 (18; 76)46.810(639/212/43)
* Others includes countries with ≤5 participants: Palestine, Jordan, Kuweit, Zambia, Morocco, Libya, Egypt, Myanmar, Algeria and Russia.
Table
Table 2. Screening, referral, attendance, diagnosis by regions.
Table 2. Screening, referral, attendance, diagnosis by regions.
Region of OriginTotal Participants n (%)PTSD Symptoms at Screening n/(% **)Referal n/(% **)Attendance n/(% **)Psychiatric Diagnosis n/(% **)Referral, without Attendance n/(% ***)
Western Asia (WAS)603 (67%)171/(28%)172*/(29%)153/(25%)135/(22%)19/(11%)
Eastern Africa (EAF)125 (14%)23 */(18%)12 */(10%)10 */(8%)9 */(7%)2/(17%)
Southern Asia (SAS)114 (12%)51 */(44%)45 */(39%)41 */(36%)34 */(29%)4/(9%)
Middle Africa (MAF)25 (3%)8/(32%)3/(12%)3/(12%)3/(12%)
Other ^15 (2%)4/(26%)1/(6%)1/(6%)1/(6%)
Unknown18 (2%)1/(5%)4/(22%)4/(22%)3/(16%)
Total900 (100%)258/(29%)237/(26%)212/(23%)185/(21%)25/(11%)
WAS: Syria, Lebanon, Iraq, Palestine. EAF: Eritrea, Ethiopia, Somalia, Zambia. SAS: Afghanistan, Pakistan, Iran. ^ Other: Regions with <10 participants: NAF (Morocco, Libya, Egypt, Algeria) SAM (Columbia), SEA (Myanmar) EUR (Russia). * Statistically significant results using Chi2 /Fischers exact test with p-values <0.05. ** % of all participants in geographical region *** % of referred.
Table
Table 3. Region of origin and psychiatric diagnoses. In total, 211 participants were given a diagnosis of whom 152 were diagnosed with PTSD.
Table 3. Region of origin and psychiatric diagnoses. In total, 211 participants were given a diagnosis of whom 152 were diagnosed with PTSD.
Total participants/n (%)PTSD n/(%) (F43.1)Axiety and stress-Related Disorders n/(% **) (F40–F49—Excluding PTSD F43.1)Major Mood Disorders n/(% **) (F30–F39)Schizophrenia and Related Psychotic Disorders n/(% **) (F20–F29)Substance Use-Related Disorders n/(% **) (F10–F19)DZ Diagnoses n/(% **) (DZ)
WAS603 (67%)115 * (19%)20 (3%)22 (4%)1 (0.2%)2 (0.3%)56 (0.1%)
EAF and MAF ^150 (17%)6 * (4%)2 (1%)3 (2%)3 * (2%)1 (0.7%)6 * (4%)
SAS114 (13%)28 * (25%)10 * (8%)3 (3%) 1 (0.9%)15 (13%)
Other ^^33 (4%)3 (0.1%)2 (6%)2 (6%) 2 (6%)
Total900 (100%)152 (17%)34 (4%)30 (3%)4 (0.4%)4 (0.4%)79 (8%)
WAS: Syria, Lebanon, Iraq, Palestine. EAF: Eritrea, Ethiopia, Somalia, Zambia. SAS: Afghanistan, Pakistan, Iran. ^ Due to very few participants in the MAF region, this was pooled with the other African group EAF in accordance with GDPR regulations. ^^ Other: Regions with <10 participants: NAF (Morocco, Libya, Egypt) SAM (Columbia), SEA (Myanmar) EUR (Russia) and Unknown. * Statistically significant results using Chi2 test/Fishers exact test with p-values < 0.05. ** % of all participants from the geographical region.
Table
Table 4. Referral, participation, diagnoses and attendance by age groups.
Table 4. Referral, participation, diagnoses and attendance by age groups.
Age GroupTotal Participants/n (%)PTSD Symptoms at Screening n(% **)Referral n/(% **)Attentance n/(% *)Psychiatric Diagnosis n/(% **)Referral without Attendance n/ (% ***)
<24 years177 (20%)38 */(21%)41/(23%)34/(19%)25 */(14%)7/(17%)
≥24 < 44 years533 (59%)141/(26%)123 */(22%)114/(21%)106/(20%)9 */(6%)
≥44 <65 years & ≥65 years *190 (21%)79 */(42%)73 */(38%)64 */(34%)54 */(28%)9/(12%)
Total900 (100%)258/(29%)237/(26%)212/(24%)185/(21%)25/(11%)
* Due to few participants in the age group above 65, this group was added to the previous age group in accordance to GDPR regulations. ** % of all participants in age groups. *** % of referred.
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Hvass, A.M.F.; Nyboe, L.; Lanng, K.; Nielsen, C.V.; Wejse, C. A Mental Health Profile of 900 Newly Arrived Refugees in Denmark Using ICD-10 Diagnoses. Sustainability 2022, 14, 418. https://doi.org/10.3390/su14010418

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Hvass AMF, Nyboe L, Lanng K, Nielsen CV, Wejse C. A Mental Health Profile of 900 Newly Arrived Refugees in Denmark Using ICD-10 Diagnoses. Sustainability. 2022; 14(1):418. https://doi.org/10.3390/su14010418

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Hvass, Anne Mette Fløe, Lene Nyboe, Kamilla Lanng, Claus Vinther Nielsen, and Christian Wejse. 2022. "A Mental Health Profile of 900 Newly Arrived Refugees in Denmark Using ICD-10 Diagnoses" Sustainability 14, no. 1: 418. https://doi.org/10.3390/su14010418

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