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Specialist Mental Health Services Required For Refugees Exposed To Extreme Trauma

September 13, 2002

A population study of Vietnamese refugees now living in Australia published on THE LANCET's website-www.thelancet.com-highlights the need for specialist mental-health services for the small proportion of refugees at high risk of mental illness related to previous exposure to severe trauma.

Little is known about the long-term adverse effects of mass trauma on the psychological wellbeing of refugees and other war-affected populations. Most previous research has focused on the short-to-medium term and suggests that posttraumatic stress reactions tend to persist. Derrick Silove and colleagues from Liverpool Hospital, Australia, retrospectively assessed the long-term effects of trauma on mental health and disability in Vietnamese refugees resettled in Australia (around 1.5 million Vietnamese people were displaced after the Communist uprising in 1975).

Around 1400 adult Vietnamese people living in Sydney, Australia, were studied. Trained interviewers assessed various factors including previous exposure to trauma, history of mental illness in the preceding year, psychiatric assessment, frequency of disability and use of medical services, and social/cultural factors.

8% of people studied had mental disorders (anxiety or depression), a low rate compared with other studies on the general population. Although the interviews took place around 14 years after the most severe traumatic event, trauma exposure was the most important predictor of mental disorder. Even in those traumatised, however, the risk of mental illness decreased consistently over time. However, people who had been exposed to more than three trauma events (199 people studied) were at four times greater risk of mental illness 10 or more years later than people who had not experienced trauma.

Derrick Silove comments: "Our findings show that most refugees are not at risk of long-term mental illness. Nevertheless, there was a close association between incremental levels of trauma and risk of mental illness, associated psychosocial dysfunction, and tendency to use both western and traditional health services. Trauma exposure seemed to remain relevant for a small subgroup of people exposed to high levels of trauma, who, even after 10 years or more, were at increased risk of mental illness and associated psychosocial disability. The study findings highlight the need for specialized services for this high-risk group."

Contact: Mr Zachary Steel, Psychiatry Research and Teaching Unit, Level 4, Health Services Building, Liverpool Hospital, Liverpool NSW 2170, Australia; T) +61 2 9828 4921; F) +61 2 9828 4910; E) z.steel@unsw.edu.au

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