Meb Rashid

Common mental health problems in immigrants and refugees: general approach in primary care

Background: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. Methods: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. Results: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. Interpretation: Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

Evidence-based clinical guidelines for immigrants and refugees

(see Appendix 2, available at [www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.090313/-/DC1][1] for summary of recommendations and clinical considerations) There are more than 200 million international migrants worldwide,[1][2] and this movement of people has implications for individual and

Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions

Background: Setting priorities is critical to ensure guidelines are relevant and acceptable to users, and that time, resources and expertise are used cost-effectively in their development. Stakeholder engagement and the use of an explicit procedure for developing recommendations are critical components in this process. Methods: We used a modified Delphi consensus process to select 20 high-priority conditions for guideline development. Canadian primary care practitioners who care for immigrants and refugees used criteria that emphasize inequities in health to identify clinical care gaps. Results: Nine infectious diseases were selected, as well as four mental health conditions, three maternal and child health issues, caries and periodontal disease, iron-deficiency anemia, diabetes and vision screening. Interpretation: Immigrant and refugee medicine covers the full spectrum of primary care, and although infectious disease continues to be an important area of concern, we are now seeing mental health and chronic diseases as key considerations for recently arriving immigrants and refugees.

Health Status of North Korean Refugees in Toronto: A Community Based Participatory Research Study

AbstractIncreasing numbers of North Koreans are fleeing their country due to economic insecurity and political persecution, with over 1000 North Koreans Refugee (NKR) claims in Canada in the past decade. There is little published on their health. Using a Community-Based Participatory Research (CBPR) methodology, we investigated NKR health status through a retrospective chart review of 1022 patients rostered at a Toronto refugee clinic between December 2011 and June 2014. The health status of 117 NKRs was compared to that of 905 other refugees seen during the same period. There were lower rates of chronic diseases, including obesity and elevated blood pressure, among NKRs. Conversely, some infectious diseases were more prevalent, including hepatitis B and chlamydia. Female NKRs had higher rates of abnormal cervical cytology. This study uniquely uses CBPR methodology to examine the health of NKRs, and can help guide targeted interventions in this population.

The Who, What, Why and When of Gynaecological Referrals for Refugee Women

Refugees have health needs relating to unstable living situations and poor access to care. We examined the nature of health problems requiring gynaecological referrals for refugee women in Toronto. A retrospective cohort design was used to examine gynaecologic referrals of women at a refugee clinic between December, 2011 and June, 2016. The primary outcome measure was the indications for gynaecological referral. 125 out of 1040 women received a gynaecologic referral for 131 unique concerns. The most common referrals were for abnormal uterine bleeding and cervical dysplasia. Fibroids were prevalent amongst African patients, while referrals for LARCs/sterilization were absent from Middle Eastern patients. 26% of patients referred had a sexual violence history. Refugee women exhibit gynaecologic needs similar to the broader population. Needs vary by geographic origins. As global conflicts shift, so too will this population’s needs. High rates of sexual violence history reflect the need for further understanding and intervention.

A 38-year-old man with fever and a history of malaria

A 38-year-old man presents to his family physician with a three-day history of fever and chills. He has no localizing symptoms and is worried that he has malaria, because he has had several previous infections with the parasite and now has similar symptoms. He has not been in an area endemic for

Response to Alexander

Alexander’s letter[1][1] in response to Stan-brook’s editorial[2][2] is filled with inaccuracies. Alexander states that “all genuine refugees in Canada receive primary health care coverage.” Not true. Alexander must know that refugee claimants are not initially deemed as failed claimants or

Hepatitis B virus screening and vaccination in a family from Nigeria

A 42-year-old man born in Nigeria brings his 7-year-old daughter to their family physician’s clinic for her well-child visit. The father has been living in Canada for 6 years and sponsored his daughter and wife, who arrived a year ago. Should he and his family be screened for chronic hepatitis B