I. Bramsen

Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands

ContextWorldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country.ObjectivesThe objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints.Design, Setting, and ParticipantsA population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively).Main Outcome MeasuresGeneral health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25.ResultsMore asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms.ConclusionsBoth physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.

Social support, coping, life events, and posttraumatic stress symptoms among former peacekeepers: a prospective study

Abstract This study examined both cross-sectionally and longitudinally the relationship between social support, coping strategies, additional stressful life events, and symptoms of posttraumatic stress disorder (PTSD) among Dutch former peacekeeping soldiers. Two groups of peacekeepers were investigated: 311 peacekeepers who participated in the peacekeeping operation in Lebanon between 1979 and 1985, and 499 peacekeepers who were deployed after 1990. These peacekeepers completed a questionnaire in 1996 and again in 1998. The results show that more negative social contacts and fewer positive social contacts were associated with more PTSD symptom severity. More use of the coping strategies ‘wishful thinking’ and ‘accepting responsibility’ was related to more PTSD symptoms. Conversely, more planful problem solving and seeking social support was related to less PTSD symptom severity. In addition, a bilateral relationship was found between additional stressful life events and PTSD symptom severity. The results indicate that social support and coping strategies may be valuable aspects of prevention and intervention programs.

Fifty years later: the long-term psychological adjustment of ageing World War II survivors

Most studies of the long‐term after‐effects of war have focused on survivors seeking treatment or financial compensation. The present study examined the current psychological adjustment of a community sample of ageing World War II (WWII) survivors, including survivors of bombardments, persecution, resistance, combat and other violence.

Self-Rating Inventory for Posttraumatic Stress Disorder: Review of the Psychometric Properties of a New Brief Dutch Screening Instrument

The Self-rating Inventory for Posttraumatic Stress Disorder of 22 items was developed for use with populations without identified traumatic experiences. The inventory has been used extensively in survey research in The Netherlands. This paper examines the psychometric properties. In four different groups (trauma and psychiatric patients, elderly Dutch subjects, former peacekeepers, and medical students) internal consistency, test-retest reliability, concurrent and discriminant validity, and sensitivity and specificity are analyzed. The inventory showed good internal consistency, test-retest reliability, concurrent and discriminant validity, and high sensitivity and specificity. It appears to be valuable for survey research on posttraumatic stress in nonselected populations. As a screening device, high sensitivity for PTSD symptoms is evident even when the traumatic event has not been defined.

Participation in preconceptional carrier couple screening: characteristics, attitudes, and knowledge of both partners

Editor—Couples in which both partners are carriers for a particular autosomal recessive disease, such as cystic fibrosis, Tay-Sachs disease, or thalassaemia, have a 1 in 4 risk for each child to have this disorder. Population carrier screening programmes aimed at the identification of carrier couples make it possible to inform these couples about their risk and about the reproductive options that are available. Before beginning any genetic screening programme, it is important to assess community interest in screening.1 It is well known that the way in which carrier screening is offered and the timing, for example, during or outside pregnancy, determine participation in screening and the reasons for participation. Screening offered face to face with the possibility of immediate testing gives high uptake rates, whereas offers made by mailed invitation or poster announcements attract little interest.2-6 Most of the data on motives for participation have been obtained from programmes offering carrier screening during pregnancy.7-15 In these studies, a high interest in screening was reported, although it has been argued that testing during pregnancy is often accepted just because it is offered.16The decision to participate was mostly made by women, who were often initially tested without discussing it with their partner. Anxiety has been reported among those who are tested positive, while waiting for their partners results.10 17 18 It can also cause distress when the partner is not available or does not want to be tested.19 Furthermore, prenatal screening leaves limited reproductive options for a carrier couple and might impose time constraints when decisions about a prenatal diagnosis have to be made.20 Offering carrier screening outside pregnancy shows low participation rates when no pregnancy is planned, but interest is higher when there are plans for having children (preconceptional).4 7 …

A health-related quality of life questionnaire for multiple sclerosis patients

Objective ‐ The construction of a brief, valid and reliable HRQoL questionnaire for use in multiple sclerosis patients based on generic and disease‐specific HRQoL measures. Material and methods ‐ The Medical Outcomes Study 36‐item Short Form Health Survey (SF‐36), COOP/WONCA Charts, and Disability & Impact Profile (DIP) were used in a longitudinal study in 162 patients with multiple sclerosis. Results ‐ Factor analyses identified 2 underlying dimensions of HRQoL, relating to “physical functioning” and “psychological functioning”. Selection of the 3 highest loading reliable scales on each factor resulted in a final questionnaire consisting of 3 scales of the SF‐36 and 3 scales of the DIP. In total 40 items were selected; completion time is about 10 min. Conclusion ‐ The final questionnaire adequately measured 2 dimensions of HRQoL. The length of the questionnaire is acceptable for patients with MS in view of respondent burden.

Long term health complaints following the Amsterdam Air Disaster in police officers and fire‐fighters

Background: On 4 October 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, the Netherlands. Fire-fighters and police officers assisted with the rescue work. Objectives: To examine the long term health complaints in rescue workers exposed to a disaster. Methods: A historical cohort study was performed among police officers (n = 834) and fire-fighters (n = 334) who performed at least one disaster related task and reference groups of their non-exposed colleagues (n = 634 and n = 194, respectively). The main outcome measures included digestive, cardiovascular, musculoskeletal, nervous system, airway, skin, post-traumatic stress, fatigue, and general mental health complaints; haematological and biochemical laboratory values; and urinalysis outcomes. Results: Police officers and fire-fighters who were professionally exposed to a disaster reported more physical and mental health complaints, compared to the reference groups. No clinically relevant statistically significant differences in laboratory outcomes were found. Conclusions: This study is the first to examine long term health complaints in a large sample of rescue workers exposed to a disaster in comparison to reference groups of non-exposed colleagues. Findings show that even in the long term, and in the absence of laboratory abnormalities, rescue workers report more health complaints.

Preconception Cystic Fibrosis Carrier Couple Screening: Impact, Understanding, and Satisfaction

The impact, understanding of test-results, and satisfaction among participating couples in a preconception cystic fibrosis (CF) carrier screening project were assessed 6 months after testing. Questionnaire data were obtained from 17/18 identified carriers, 15 partners of carriers with negative test results, and 794 (73%) other participants. None of the carriers changed their reproductive plans because of their test results. Eight participants were worried about their results, including four carriers. Those who attended a general practitioner (GP) consultation for pretest education were less worried than those who attended an educational session. Seven carriers felt less healthy. Predictors of a correct understanding of test results (correct in 62% of participants) were: positive test results, high level of knowledge of CF, high level of education, attending an educational session, and previously heard of CF. All participants who reported that they were worried, all carriers, and 95% of the other participants said that they would make the same decision to be tested again. Although couples who were educated during a GP consultation were less worried, the results of the study suggest that understanding is more correct in couples attending an educational session. The results further suggest that since satisfaction with the screening was high, worries and feeling less healthy due to the test results are probably not a great burden.

Factors associated with posttraumatic stress among peacekeeping soldiers.

This study aimed to investigate positive and negative consequences of peacekeeping operations, help-seeking behaviour among peacekeepers, PTSD prevalence rates and factors associated with PTSD symptoms. A sample of 3,481 peacekeeping soldiers who participated in various peacekeeping operations was investigated on average 6 years following their deployment. The prevalence of PTSD was 5.6% overall, with 8.0% among peacekeepers of the former Yugoslavia and 3.7% among peacekeepers who went to Cambodia. Twelve percent received professional help during deployment. The majority reported positive consequences of the deployment as well (e.g., a broadening of their horizon [82%], increased self-confidence [52%]). The following variables were significantly associated with current PTSD symptoms: lower level of education, being single, more traumatic situations during deployment, feeling more powerless and threatened, the idea that the mission had become meaningless, having had no control over the situation, and the use of professional help during deployment.

Use of Medical and Mental Health Care by World War II Survivors in The Netherlands

This study examined the mental and medical health care utilization of World War II (WWII) survivors and the characteristics of survivors seeking professional health care. Forty seven years after the end of WW II, a random sample of 4,057 Dutch WW II survivors answered a four-page questionnaire; 1,461 persons subsequently answered an extensive follow-up questionnaire. Twenty-two percent had sought some form of health care for war-related complaints at some time since WW II. Most consultations were made in the 1940s. More consultations were made to general practioners or to medical specialists as opposed to mental health specialists. Although the level of posttraumatic stress disorder (PTSD) symptoms was most important for discriminating between help-seeking and non-help-seeking respondents, 59% of the highly-exposed respondents with PTSD had not sought professional help in the years 1990–1992. The results show the importance of primary health care in recognizing PTSD symptoms and referring survivors to the appropriate professional helper.