Translational Psychiatry
Volume 9, Issue 1, 2019

Functional impairment as a proxy measure indicating high rates of trauma exposure, post-migration living difficulties, common mental disorders, and poor health amongst Rohingya refugees in Malaysia (Article) (Open Access)

Tay A.K.* , Rees S. , Miah M.A.A. , Khan S. , Badrudduza M. , Morgan K. , Fadil Azim D. , Balasundaram S. , Silove D.
  • a Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
  • b Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
  • c Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
  • d Department of Psychology, Jagannath University, Dhaka, Bangladesh
  • e Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
  • f School of Medicine, Perdana University-Royal College of Surgeons in Ireland (PU-RCSI), Selangor, Malaysia
  • g School of Medicine, Perdana University-Royal College of Surgeons in Ireland (PU-RCSI), Selangor, Malaysia
  • h Health Unit, United Nations High Commissioner for Refugees (UNHCR), Kuala Lumpur, Malaysia
  • i Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia

Abstract

A major challenge in the refugee field is to ensure that scarce mental health resources are directed to those in greatest need. Based on data from an epidemiological survey of 959 adult Rohingya refugees in Malaysia (response rate: 83%), we examine whether a brief screening instrument of functional impairment, the WHO Disability Assessment Schedule (WHODAS), prove useful as a proxy measure to identify refugees who typically attend community mental health services. Based on estimates of mental disorder requiring interventions from analyses of epidemiological studies conducted worldwide, we selected a WHODAS cutoff that identified the top one-fifth of refugees according to severity of functional impairment, the remainder being distributed to moderate and lower impairment groupings, respectively. Compared to the lower impairment grouping, the severe impairment category comprised more boat arrivals (AOR: 5.96 [95% CI 1.34–26.43); stateless persons (A20·11 [95% CI 7.14–10); those with high exposure to pre-migration traumas (AOR: 4.76 [95% CI 1.64–13.73), peri-migration stressors (AOR: 1.26 [95% CI 1.14–1.39]) and postmigration living difficulties (AOR: 1.43 [95% CI 1.32–1.55); persons with single (AOR: 7.48 [95% CI 4.25–13.17]) and comorbid (AOR: 13.54 [95% CI 6.22–29.45]) common mental disorders; and those reporting poorer general health (AOR: 2.23 [95% CI 1–5.02]). In addition, half of the severe impairment grouping (50.6%) expressed suicidal ideas compared to one in six (16.2 percent) of the lower impairment grouping (OR: 2.39 [95% CI 1.94–2.93]). Differences between the severe and moderate impairment groups were similar but less extreme. In settings where large-scale epidemiological studies are not feasible, the WHODAS may serve as readily administered and brief public health screening tool that assists in stratifying the population according to urgency of mental health needs. © 2019, The Author(s).

Author Keywords

[No Keywords available]

Index Keywords

refugee mental health service mass screening WHO Disability Assessment Schedule complicated grief human comorbidity mental disease epidemiological data male female Malaysia prevalence scoring system Article functional disease suicidal behavior major clinical study adult posttraumatic stress disorder population exposure generalized anxiety disorder disease severity Rohingya (people) psychotrauma major depression population migration health care need
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85071778743&doi=10.1038%2fs41398-019-0537-z&partnerID=40&md5=f994b296d80bbfa83a5d19389def856c
DOI: 10.1038/s41398-019-0537-z
ISSN: 21583188
Original Language: English