142nd APHA Annual Meeting and Exposition

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307661
Treatment of mental, neurological, and substance use problems in refugee camp primary care settings

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 3:18 PM - 3:30 PM

Jeremy Kane, MPH , Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Peter Ventevogel, MD , United Nations High Commissioner for Refugees, Geneva, Switzerland
Paul Spiegel, MD, MPH , United Nations High Commissioner for Refugees, Geneva, Switzerland
Judith K. Bass, PhD, MPH , Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Mark van Ommeren, PhD , World Health Organization, Geneva, Switzerland
Wietse Tol, PhD , Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background Population-based epidemiological research has established that refugee populations have an increased risk of mental, neurological, and substance use (MNS) disorders. However, such studies typically do not provide insight into the types of problems actually treated in refugee camp primary care settings, which is vital information for resource allocation and planning.

Method Data were collected from 90 refugee camps in 15 countries from January 2009-April 2013 utilizing the Health Information System (HIS) of the United Nations High Commissioner for Refugees (UNHCR). The HIS database includes the raw number of visits to primary care settings for 7 MNS categories stratified by sex and age: epilepsy/seizure; alcohol/substance use disorder; mental retardation/ intellectual disability; psychotic disorder; emotional disorder; other psychological complaint; and medically unexplained somatic complaint.

Results A total of 211,728 new and revisit cases were reported. The greatest proportion of MNS visits was attributable to epilepsy/seizures (46.9% of male visits; 35.1% of female visits) and psychotic disorders (25.9% of male visits; 20.0% of female visits).

Conclusion Our finding that epilepsy/seizures and psychotic disorders accounted for the highest proportion of all MNS visits in refugee camp clinics underscores the necessity for refugee health systems to be able to manage severe neuropsychiatric disorders in addition to common (trauma-related) mental disorders such as PTSD and depression. The relatively low rates of identified emotional and substance use problems – compared to high population-based rates - suggest that many MNS problems among refugees remain unattended.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Epidemiology
Provision of health care to the public

Learning Objectives:
Describe the types and number of mental, neurological, and substance use (MNS) disorders that are prevalent in primary care treatment facilities in refugee camp settings. Discuss the possible reasons for differences across geographic regions in the number and type of MNS disorders that are prevalent in refugee camp settings. Analyze the proportion of all MNS disorders in refugee camp settings that are attributable to each of 7 primary MNS disorder types: 1) epilepsy/seizure; 2) alcohol/substance use; 3) mental retardation/intellectual disability; 4) emotional disorder; 5) psychotic disorder; 6) other psychological complaint; and 7) medically unexplained somatic complaint.

Keyword(s): Mental Health, Refugees

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have assisted and led several global health studies concerning the mental health and well-being of refugee populations as well as populations affected by trauma. I have received extensive training in biostatistical and epidemiological methods which qualifies me to conduct the research described in this abstract and explain those methods during the presentation. My field experience, along with the extensive experience of the co-authors, will provide the presentation with the necessary context of refugee health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.