The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis.
The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pmed.1003337
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发表时间：
2020-09
期刊：
影响因子：
15.8
通讯作者：
Gibson-Helm M
中科院分区：
文献类型：
--
作者：
Blackmore R;Boyle JA;Fazel M;Ranasinha S;Gray KM;Fitzgerald G;Misso M;Gibson-Helm M
在全球范围内，难民和寻求庇护者的人数达到了历史新高。过去在难民心理健康方面的研究报告说，精神疾病流行率数据存在很大差异，部分原因是方法上的限制。本系统综述旨在总结全球难民人群中精神疾病患病率的现有证据，并克服个体研究的方法学局限性。从2003年1月1日至2020年2月4日对电子数据库进行了全面检索（MEDLINE、MEDLINE In-Process、EBM Reviews、Embase、PsycINFO、CINAHL、PILOTS、Web of Science）。如果精神疾病的诊断涉及临床访谈和使用经验证的评估措施，并报告至少50名参与者，则纳入定量研究。根据研究设计（改良的Newcastle-Ottawa量表），使用基于模板的描述性方法评估研究质量。随机效应模型，基于反方差权重，进行。对性别、样本量、流离失所持续时间、签证状态、原籍国、目前居住地、访谈类型（翻译辅助或母语）和诊断措施进行了亚组分析。该系统综述已在PROSPERO（CRD）42016046349中注册。搜索结果为21，842条记录。26项研究，包括一项随机对照试验和25项观察性研究，提供了5，143名成年难民和寻求庇护者的结果。在15个国家进行了研究：澳大利亚（652名难民）、奥地利（150）、中国（65）、德国（1，104）、意大利（297）、黎巴嫩（646）、尼泊尔（574）、挪威（64）、韩国（200）、瑞典（86）、瑞士（164）、土耳其（238）、乌干达（77）、联合王国（420）、美国（406）创伤后应激障碍（PTSD）患病率为31.46%（95%CI 24.43-38.5），抑郁患病率为31.5%焦虑障碍患病率为11%（95% CI 6.75-15.43），精神病患病率为1.51%（95% CI 0.63-2.40）。该研究的局限性在于，在PTSD、抑郁和焦虑的患病率估计中存在实质性异质性，并且在纳入的研究中报告了有限的协变量。这一全面的审查产生了目前的患病率估计，不仅创伤后应激障碍，而且抑郁症，焦虑症和精神病。难民和寻求庇护者的创伤后应激障碍和抑郁症的发病率很高，而且持续存在，这次审查的结果强调，在重新安置的最初阶段之后，需要进行持续的长期心理健康护理。在一项系统性综述和Meta分析中，丽贝卡·布莱克摩尔（Rebecca Blackmore）及其同事在15个国家进行的研究中调查了成年难民和寻求庇护者中精神疾病的患病率。在全球范围内，难民和寻求庇护者的人数达到了历史新高。这项系统性审查旨在估计目前成年难民和寻求庇护者中精神疾病的常见程度。我们进行了一次全面的文献检索，寻找在难民和寻求庇护者人群中诊断精神疾病的研究。对于纳入的研究，诊断必须是使用经验证的诊断评估措施进行临床访谈得出的。我们发现，成年难民和寻求庇护者有很高的和持续的创伤后应激障碍（PTSD）和抑郁症的发病率。焦虑症和精神病的患病率与一般人群的调查结果更具可比性。创伤后应激障碍和抑郁症发病率的增加似乎在流离失所后持续多年。这些结果突出了早期和持续的心理保健的重要性，超过了最初的重新安置期，以促进难民和寻求庇护者的健康。
Globally, the number of refugees and asylum seekers has reached record highs. Past research in refugee mental health has reported wide variation in mental illness prevalence data, partially attributable to methodological limitations. This systematic review aims to summarise the current body of evidence for the prevalence of mental illness in global refugee populations and overcome methodological limitations of individual studies. A comprehensive search of electronic databases was undertaken from 1 January 2003 to 4 February 2020 (MEDLINE, MEDLINE In-Process, EBM Reviews, Embase, PsycINFO, CINAHL, PILOTS, Web of Science). Quantitative studies were included if diagnosis of mental illness involved a clinical interview and use of a validated assessment measure and reported at least 50 participants. Study quality was assessed using a descriptive approach based on a template according to study design (modified Newcastle-Ottawa Scale). Random-effects models, based on inverse variance weights, were conducted. Subgroup analyses were performed for sex, sample size, displacement duration, visa status, country of origin, current residence, type of interview (interpreter-assisted or native language), and diagnostic measure. The systematic review was registered with PROSPERO (CRD) 42016046349. The search yielded a result of 21,842 records. Twenty-six studies, which included one randomised controlled trial and 25 observational studies, provided results for 5,143 adult refugees and asylum seekers. Studies were undertaken across 15 countries: Australia (652 refugees), Austria (150), China (65), Germany (1,104), Italy (297), Lebanon (646), Nepal (574), Norway (64), South Korea (200), Sweden (86), Switzerland (164), Turkey (238), Uganda (77), United Kingdom (420), and the United States of America (406). The prevalence of posttraumatic stress disorder (PTSD) was 31.46% (95% CI 24.43–38.5), the prevalence of depression was 31.5% (95% CI 22.64–40.38), the prevalence of anxiety disorders was 11% (95% CI 6.75–15.43), and the prevalence of psychosis was 1.51% (95% CI 0.63–2.40). A limitation of the study is that substantial heterogeneity was present in the prevalence estimates of PTSD, depression, and anxiety, and limited covariates were reported in the included studies. This comprehensive review generates current prevalence estimates for not only PTSD but also depression, anxiety, and psychosis. Refugees and asylum seekers have high and persistent rates of PTSD and depression, and the results of this review highlight the need for ongoing, long-term mental health care beyond the initial period of resettlement. In a systematic review and meta analysis, Rebecca Blackmore and colleagues investigate the prevalence of mental illness among adult refugees and asylum seekers in studies undertaken across 15 countries. Globally, the numbers of refugees and asylum seekers have reached record highs. This systematic review aims to estimate how common mental illnesses are in current adult refugee and asylum-seeker populations. We performed a comprehensive literature search looking for studies that diagnosed mental illness in refugee and asylum-seeker populations. For studies to be included, the diagnosis must have resulted from a clinical interview using a validated diagnostic assessment measure. We found adult refugee and asylum seekers have high and persistent rates of posttraumatic stress disorder (PTSD) and depression. The prevalence of anxiety disorders and psychosis are more comparable to findings from general populations. The increased prevalence of PTSD and depression appears to persist for many years after displacement. These results highlight the importance of early and ongoing mental health care, extending beyond the period of initial resettlement, to promote the health of refugees and asylum seekers.
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