Utilization of Mental Health Counseling Services Among Refugees and Asylum-Seekers in Malaysia.

This paper examines the frequency of post-traumatic stress disorder (PTSD) and factors associated with mental health counseling utilization among adult refugees and asylum-seekers in Malaysia. Participants (n = 286) were recruited using venue-based random sampling from three health clinics in 2018. Framed by Andersen's model of health care utilization, we used a multilevel logistic regression and hypothesized that predisposing factors (female, older age, not married, higher education, lived longer in Malaysia, registered refugee), greater enabling factors (easy access to healthcare, larger household income, not needing interpreter, health literacy, larger household), and greater need factors (higher PTSD symptoms) would be associated with counseling attendance. We found one-third (34.3%) of participants screened positive for PTSD and most (71.9%) never attended counseling services. Our hypothesis was partially supported. Older age was associated with counseling attendance [OR:1.03 (95% CI:1.00,1.06)]. Enabling factors associated with counseling attendance include easy access to a health facility [OR:9.82 (95% CI:3.15,30.59)] and not needing interpreter services [OR:4.43 (95% CI:1.34,14.63)]. Greater need factor/PC-PTSD score [OR:0.69 (95% CI:0.52,0.91)]; however, was associated with lower counseling attendance. Other predisposing/enabling/need factors did not show significant associations. Understanding factors associated to care can benefit health clinics address gaps in counseling utilization for refugees and asylum-seekers in Malaysia.