Clinical and screening tools for psychic illness in asylum seekers and refugees: a narrative review.
Background: According to UNHCR, at the end of June 2024 there were 8 million asylum seekers and 43.7 million refugees worldwide, a 16% increase versus year end 2023 for both categories; these rapidly growing numbers are posing significant political, humanitarian, and healthcare challenges. These are persons who have been displaced due to wars, persecution, political and economic instability, climate change, and other disasters. Trauma, an inevitable consequence of forced displacement, is a crucial factor in the development of psychiatric diseases, causing short and long-term synaptic alterations. Post-traumatic stress disorder (PTSD), anxiety, depression, and impulse control disorders are prevalent in this sub-population; providing efficient mental health services is a global challenge that requires developing early mental health screening and treatment programs.
Objective: The main purpose of this study is to examine the available scientific literature regarding the scales used for evaluating psychiatric impairment in asylum seekers and refugees. We are particularly interested in analysing these psychometric scales from a culturally unbiased perspective, in which the psychiatric evaluation is devoid of cultural features that could influence the outcome of the interview.
Methods: We carried out a search on PubMed for articles published between inception and September 30, 2024 containing references to clinical and screening tools that evaluate mental illness among asylum seekers and refugees. Various scales are used to screen for PTSD (11), anxiety (12) and depression (11) with a significant heterogeneity in the number of items and how the scales are administered, but only one for identifying psychosis. Two tools were used to screen specifically for substance use disorders. In various studies, general scales were used for screening for mental illness. We found that in general there was little information regarding when and how the tools are administered, and if they are used for follow-up interviews.
Conclusions: This review highlights the need to create a specific, easy-to-use tool that avoids cultural biases to screen for mental illness, including PTSD, anxiety, psychosis, substance abuse and suicidal tendences, among asylum seekers and refugees.