Sabin Miriam, Sabin Keith, Kim Hyoung Yong, Vergara Marianela, Varese Luis
University of Georgia, School of Social Work, Athens, Georgia, USA.
Rev Panam Salud Publica. 2006 Mar;19(3):163-71. doi: 10.1590/s1020-49892006000300004.
Only one previous study had examined the epidemiology of mental health in Guatemalan refugees. The objective of this new study was to estimate the prevalence of mental illness and to assess factors associated with poor mental health among Guatemalan Mayan refugees who had been repatriated to Guatemala after spending 12-18 years in refugee camps in Mexico, and to compare the results for the repatriated Guatemalans with those for Guatemalan refugees who were continuing to live in Mexico.
In 2001 a cross-sectional survey of adults (> or = 16 years) was conducted with random household sampling proportional to the population size in each of the five repatriation villages surveyed. Posttraumatic stress disorder (PTSD), anxiety, and depression were measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25.
Together, the five repatriation villages had 565 households. Of the 565 households, 203 of them were approached to solicit study participation. A total of 179 households (one adult per household) agreed to participate, representing an overall participation rate of 88%, and one-third of all the households in the five communities. The respondents had personally experienced a mean of 5.5 trauma events and had witnessed a mean of 7.3 other trauma events. Of the respondents, 8.9% met the symptom criteria for PTSD, 17.3% for anxiety, and 47.8% for depression. PTSD was associated with being seriously wounded and with having relatives or friends mutilated. Logistic regression analyses indicated that anxiety was associated with being sexually assaulted, being female, having friends or family mutilated, being seriously wounded, and having 6-12 children (vs. having 1-5 children). Depression was associated with having 6-12 children. Anxiety was significantly more prevalent among the refugees remaining in Mexico (54.4%) than it was among the repatriated refugees (17.3%). The difference in the prevalence rates was not significant for PTSD (11.8% for refugees remaining in Mexico vs. 8.9% for those repatriated) or for depression (38.8% for refugees remaining in Mexico vs. 47.8% for those repatriated).
Psychiatric morbidity was common among the repatriated Mayans. The repatriation of refugees involves moving an already vulnerable, often traumatized population back to a place of distressing memories and still-unsettled conditions. There is a need to consider and plan for adequate mental health services for repatriating refugees.
此前仅有一项研究对危地马拉难民的心理健康流行病学情况进行了调查。这项新研究的目的是估算精神疾病的患病率，并评估在墨西哥难民营度过12至18年后被遣返回危地马拉的危地马拉玛雅难民中与心理健康不佳相关的因素，并将被遣返的危地马拉人与仍生活在墨西哥的危地马拉难民的结果进行比较。
2001年，对成年人（≥16岁）进行了一项横断面调查，采用按比例随机抽取家庭样本的方法，样本比例与所调查的五个遣返村庄中每个村庄的人口规模成比例。创伤后应激障碍（PTSD）、焦虑和抑郁通过哈佛创伤问卷和霍普金斯症状清单-25进行测量。
五个遣返村庄共有565户家庭。在这565户家庭中，有203户被邀请参与研究。共有179户家庭（每户一名成年人）同意参与，总体参与率为88%，占五个社区所有家庭的三分之一。受访者个人平均经历了5.5次创伤事件，平均目睹了7.3次其他创伤事件。在受访者中，8.9%符合PTSD症状标准，17.3%符合焦虑症状标准，47.8%符合抑郁症状标准。PTSD与受重伤以及有亲属或朋友致残有关。逻辑回归分析表明，焦虑与遭受性侵犯、女性、有朋友或家人致残、受重伤以及有6至12个孩子（与有1至5个孩子相比）有关。抑郁与有6至12个孩子有关。留在墨西哥的难民中焦虑症的患病率（54.4%）显著高于被遣返难民（17.3%）。PTSD（留在墨西哥的难民为11.8%，被遣返的难民为8.9%）和抑郁（留在墨西哥的难民为38.8%，被遣返的难民为47.8%）的患病率差异不显著。
被遣返的玛雅人中精神疾病发病率普遍较高。难民遣返涉及将一个本就脆弱且往往受过创伤的群体送回一个充满痛苦回忆且情况仍未安定的地方。有必要为遣返难民考虑并规划适当的心理健康服务。
