Filges Trine, Bengtsen Elizabeth, Montgomery Edith, Kildemoes Malene Wallach
VIVE Campbell VIVE - The Danish Centre of Applied Social Science Copenhagen Denmark.
Administration The Danish National Centre for Social Research Copenhagen Denmark.
Campbell Syst Rev. 2024 Jul 8;20(3):e1420. doi: 10.1002/cl2.1420. eCollection 2024 Sep.
The number of people fleeing persecution and regional conflicts is rising. Western countries have applied increasingly stringent measures to discourage those seeking asylum from entering their country, amongst them, to confine asylum seekers in detention facilities. Clinicians have expressed concerns over the mental health impact of detention on asylum seekers, a population already burdened with trauma, advocating against such practices.
The main objective of this review is to assess evidence about the effects of detention on the mental and physical health and social functioning of asylum seekers.
Relevant literature was identified through electronic searches of bibliographic databases, internet search engines, hand searching of core journals and citation tracking of included studies and relevant reviews. Searches were performed up to November 2023.
Studies comparing detained asylum-seekers with non-detained asylum seekers were included. Qualitative approaches were excluded.
Of 22,226 potential studies, 14 met the inclusion criteria. These studies, from 4 countries, involving a total of 13 asylum-seeker populations. Six studies were used in the data synthesis, all of which reported only mental health outcomes. Eight studies had a critical risk of bias. Meta-analyses, inverse variance weighted using random effects statistical models, were conducted on post-traumatic stress disorder (PTSD), depression, and anxiety.
A total of 27,797 asylum seekers were analysed. Four studies provided data while the detained asylum seekers were still detained, and two studies after release. All outcomes are reported such that a positive effect size favours better outcomes for the non-detained asylum seekers. The weighted average SMD while detained is 0.45 [95% CI 0.19, 0.71] for PTSD and after release 0.91 [95% CI 0.24, 1.57]; for anxiety 0.42 [95% CI 0.18, 0.66] and for depression 0.68 [95% CI 0.10, 1.26] both while detained. Based on single-study data, the SMD was 0.60 [95% CI 0.02, 1.17] for depression and 0.76 [95% CI 0.17, 1.34] for anxiety, both after release. Three studies (one study each) reported outcomes related to psychological distress, self-harm and social well being. Psychological distress favoured the detained but was not significant; whereas both effect sizes on self-harm and social wellbeing indicated highly negative impacts of detention; in particular, the impact on self-harm was extremely high. The OR of self-harm was reported separately for asylum seekers detained in three types of detention: Manus Island, Nauru and onshore detention. The ORs were in the range 12.18 to 74.44; all were significant.
AUTHORS' CONCLUSIONS: Despite similar post-migration adversities amongst comparison groups, findings suggest an independent adverse impact of detention on asylum seekers' mental health, with the magnitude of the effect sizes lying in an important clinical range. These effects persisted beyond release into the community. While based on limited evidence, this review supports concerns regarding the detrimental impact of detention on the mental health of already traumatised asylum seekers. Further research is warranted to comprehensively explore these effects. Detention of asylum seekers, already grappling with significant trauma, appears to exacerbate mental health challenges. Policymakers and practitioners should consider these findings in shaping immigration and asylum policies, with a focus on minimising harm to vulnerable populations.
逃离迫害和地区冲突的人数正在上升。西方国家采取了越来越严格的措施来阻止寻求庇护者进入其国家，其中包括将寻求庇护者关押在拘留设施中。临床医生对拘留对寻求庇护者心理健康的影响表示担忧，这一群体已经饱受创伤之苦，他们反对这种做法。
本综述的主要目的是评估关于拘留对寻求庇护者的身心健康和社会功能影响的证据。
通过对书目数据库进行电子检索、利用互联网搜索引擎、手工检索核心期刊以及对纳入研究和相关综述进行引文追踪来识别相关文献。检索截至2023年11月。
纳入比较被拘留的寻求庇护者和未被拘留的寻求庇护者的研究。排除定性研究方法。
在22226项潜在研究中，14项符合纳入标准。这些研究来自4个国家，共涉及13个寻求庇护者群体。6项研究用于数据综合分析，所有这些研究仅报告了心理健康结果。8项研究存在严重的偏倚风险。对创伤后应激障碍（PTSD）、抑郁症和焦虑症进行了荟萃分析，使用随机效应统计模型进行逆方差加权。
共分析了27797名寻求庇护者。4项研究在被拘留的寻求庇护者仍被拘留期间提供了数据，2项研究在其获释后提供了数据。所有结果的报告方式均使得正向效应量有利于未被拘留的寻求庇护者获得更好的结果。被拘留期间PTSD的加权平均标准化均值差（SMD）为0.45[95%置信区间0.19，0.71]，获释后为0.91[95%置信区间0.24，1.57]；被拘留期间焦虑症的SMD为0.42[95%置信区间0.18，0.66]，抑郁症的SMD为0.68[95%置信区间0.10，1.26]。根据单项研究数据，获释后抑郁症的SMD为0.60[95%置信区间0.02，1.17]，焦虑症的SMD为0.76[95%置信区间0.17，1.34]。3项研究（每项1项研究）报告了与心理困扰、自我伤害和社会福祉相关的结果。心理困扰方面有利于被拘留者，但不显著；而关于自我伤害和社会福祉的效应量均表明拘留有高度负面影响；特别是对自我伤害的影响极大。分别报告了在马努斯岛、瑙鲁和境内拘留三种类型拘留中被拘留的寻求庇护者的自我伤害比值比（OR）。OR值在12.18至74.44之间；均具有显著性。
尽管比较组在移民后面临类似的逆境，但研究结果表明拘留对寻求庇护者的心理健康有独立的不利影响，效应量的大小处于重要的临床范围内。这些影响在获释进入社区后仍然存在。尽管证据有限，但本综述支持对拘留对已经受过创伤的寻求庇护者心理健康的有害影响的担忧。有必要进行进一步研究以全面探讨这些影响。拘留已经在应对重大创伤的寻求庇护者似乎会加剧心理健康挑战。政策制定者和从业者在制定移民和庇护政策时应考虑这些研究结果，重点是尽量减少对弱势群体的伤害。
