Mental Health

Mental health conditions in refugee populations can develop or become exacerbated due to issues related to acculturation and limited coping mechanisms upon resettlement. Among the 3,577 Congolese refugees examined by IOM physicians in the overseas medical screening exam from 2010–2012, 1% were found to have a mental health condition. Data in Table 2 demonstrate the most common mental health conditions found among Congolese refugees. These were mental retardation (0.39%); adjustment disorders (0.34%); schizophrenia (0.11%); mental disorder, not otherwise specified (0.08%); depression (0.06%); and specific developmental disorder of motor function (0.6%). Mental retardation includes cases ranging from mild to moderate and unspecified mental retardation. Depression includes mild, moderate, and severe episodes of depression without psychotic symptoms. The mental health component of the overseas medical screening exam is subject to limitations in the refugee setting including lack of medical history, language limitations, cultural barriers, and a lack of mental health specialists.

Table 2: Top disease conditions (ICD-10) under mental health disease group among Congolese refugees (n=3,577) screened in Burundi, Rwanda, Uganda, and Kenya, 2010–2012

Source: IOM

Although IOM data indicated low rates for some mental health disorders, other assessments have shown high rates of post-traumatic stress disorder (PTSD) among this population. The high rates of PTSD are due to the severe and widespread nature of personal violence and trauma Congolese refugees are reported to have witnessed and experienced, including Sexual Gender Based Violence. A population-based study conducted in the eastern DRC identified 41% of the adult population that met the symptom criteria for major depressive disorder (MDD), and 50% for PTSD. After extrapolation to the sampling frame population of the DRC, it is estimated that 3.25 million adults meet criteria for PTSD, 2.63 million meet criteria for MDD, and approximately 1.04 million have attempted suicide ⁹.

A recent report surveying 43 local resettlement agencies serving Congolese refugees after their arrival in the United States suggested a high degree of mental health issues, including depression, anxiety disorder, substance abuse, and domestic violence ¹¹. This report also identified at least 2 challenges in terms of increasing access to mental health services in the US for Congolese: (a) interpretation needs and (b) client’s refusal of services. However, in a controlled trial of psychotherapy among Congolese survivors of sexual violence randomly assigned to either group therapy or individual support, group psychotherapy was found to be more effective at reducing PTSD symptoms, combined depression and anxiety symptoms, and improving functioning ²⁷. This suggests that while mental health is a sensitive subject for Congolese, in settings where trust has been built between patient and caregiver, open discussion of mental health problems may be more readily achieved.

References

9. Johnson K et al. Association of Sexual Violence and Human Rights Violations with Physical and Mental Health in Territories of the Eastern Democratic Republic of the Congo. Journal of the American Medical Association 2010; Vol. 304. No. 5: 553-62. Available at: http://www.lawryresearch.com/553.full.pdf [PDF - 10 pages]
11. Fuys, Andrew, and Sandra Vines. (2013) “Increasing Congolese Refugee Arrivals: Insights for Preparation.” Executive Summary. Washington DC: Refugee Council USA. Print. February 15. Report from Associate Directors for International Programs and Resettlement and Integration, Church World Service.
27. Bass JK, Annan J, Murray S et al. Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence. N Engl J Med 2013;368:2182-91.