Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia.
Perdana University-Centre for Global Health and Social Change (PU-GHSC), Kuala Lumpur, Malaysia.
Psychol Med. 2022 May;52(7):1306-1320. doi: 10.1017/S0033291720003104. Epub 2020 Sep 11.
Large variations in prevalence rates of common mental disorder (CMD) amongst refugees and forcibly displaced populations have raised questions about the accuracy and value of epidemiological surveys in these cross-cultural settings. We examined the associations of sociodemographic indices, premigration traumatic events (TEs), postmigration living difficulties (PMLDs), and psychosocial disruptions based on the Adaptive Stress Index (ASI) in relation to CMD prevalence amongst the Rohingya, Chin and Kachin refugees originating from Myanmar and relocated to Malaysia.
Parallel epidemiological studies were conducted in areas where the three groups were concentrated in and around Malaysia (response rates: 80-83%).
TE exposure, PMLDs and ASI were significantly associated with CMD prevalence in each group but the Rohingya recorded the highest exposure to all three of these former indices relative to Chin and Kachin (TE: mean = 11.1 v. 8.2 v. 11; PMLD: mean = 13.5 v. 7.4 v. 8.7; ASI: mean = 128.9 v. 32.1 v. 35.5). Multiple logistic regression analyses based on the pooled sample (n = 2058) controlling for gender and age, found that ethnic group membership, premigration TEs (16 or more TEs: OR, 2.00; 95% CI, 1.39-2.88; p < 0.001), PMLDs (10-15 PMLDs: OR, 4.19; 95% CI, 3.17-5.54; 16 or more PMLDs: OR, 7.23; 95% CI, 5.24-9.98; p < 0.001) and ASI score (ASI score 100 or greater: OR, 2.19; 95% CI, 1.46-3.30; p < 0.001) contributed to CMD.
Factors specific to each ethnic group and differences in the quantum of exposure to TEs, PMLDs and psychosocial disruptions appeared to account in large part for differences in prevalence rates of CMDs observed across these three groups.
常见精神障碍(CMD)在难民和被迫流离失所人群中的流行率存在很大差异,这引发了人们对这些跨文化环境中流行病学调查的准确性和价值的质疑。我们研究了社会人口指数、前迁移创伤事件(TEs)、后迁移生活困难(PMLDs)和基于适应应激指数(ASI)的心理社会扰乱与源自缅甸并迁移到马来西亚的罗兴亚人、钦人和克钦人的 CMD 流行率之间的关联。
在这三个群体集中的马来西亚各地进行了平行的流行病学研究(应答率:80-83%)。
TE 暴露、PMLDs 和 ASI 与每组的 CMD 患病率显著相关,但罗兴亚人相对于钦人和克钦人记录到所有这三个前指数的最高暴露率(TE:均值=11.1 v. 8.2 v. 11;PMLD:均值=13.5 v. 7.4 v. 8.7;ASI:均值=128.9 v. 32.1 v. 35.5)。基于汇总样本(n=2058)进行的多元逻辑回归分析,控制性别和年龄,发现族群归属、前迁移 TEs(16 个或更多 TEs:OR,2.00;95%CI,1.39-2.88;p<0.001)、PMLDs(10-15 个 PMLDs:OR,4.19;95%CI,3.17-5.54;16 个或更多 PMLDs:OR,7.23;95%CI,5.24-9.98;p<0.001)和 ASI 评分(ASI 评分 100 或更高:OR,2.19;95%CI,1.46-3.30;p<0.001)导致 CMD。
每个族群特有的因素以及 TEs、PMLDs 和心理社会扰乱暴露量的差异似乎在很大程度上解释了这三个族群中观察到的 CMD 流行率的差异。