Kiely Bridget, Larkin James, Mullan Kathryn, Tuathail Maitiú Ó, Coughlan Emma, Marshall Debbie, Fitzgerald Margaret, O'Reilly Fiona
Department of General Practice, Royal College of Surgeons, Dublin 2, Ireland.
Department of Psychiatry, St Vincent's University Hospital, Dublin, Ireland.
J Migr Health. 2025 Feb 28;11:100317. doi: 10.1016/j.jmh.2025.100317. eCollection 2025.
The mental health needs of refugees and asylum seekers are often unmet. Many screening methods for mental health problems in refugees and asylum seekers have been suggested, but the optimal method for identifying those at risk has not been determined. The PROTECT questionnaire and the Patient Health Questionnaire 4 (PHQ4) are two tools currently being used to identify refugees and asylum seekers at risk of mental health problems in Ireland, but there is limited data on the prevalence of positive scores or risk factors for these to inform health service planning.
Cross sectional analysis was conducted of anonymous data of all adult asylum seekers or refugees who completed a PHQ4 and PROTECT questionnaire during their nurse conducted arrival health assessment within a one-year period. Data collected include: gender, age category, marital status, family unit, country of origin, refugee/asylum status, medical conditions, mental health conditions, exposure to violence, PROTECT score, PHQ4 score and outcome of GP mental health review. Statistical analysis was completed using R.
440 people completed a PROTECT and PHQ4 questionnaire. 198 people had a GP review based on either a positive PROTECT or PHQ4 score. Among all participants, 9.1 % ( = 40) were diagnosed with depression, 15.0 % ( = 66) were diagnosed with PTSD, 3.8 % ( = 17) had an adjustment disorder and 3.7 % had anxiety.. There was a positive correlation between PHQ-4 score and PROTECT score, (rs = 0.738, < .001) although the PROTECT score identified more cases of PTSD and depression. Being female (aOR: 2.47 95 % CI: 1.59-3.86) and country of origin Zimbabwe (aOR: 3.19 95 % CI: 1.56-6.53) was associated with a positive PROTECT score. Country of origin was negatively associated with PROTECT score for Syria (aOR: 0.32 95 % CI: 0.15-0.65). There were similar findings for PHQ4.
Rates of depression, anxiety and PTSD were similar to other studies. There was a strong correlation between PHQ4 scores and PROTECT but with PROTECT ultimately identifying more cases of depression and PTSD, suggesting it may be reasonable to use it alone. Whichever screening tool is used, adequate healthcare resources need to be available for further assessment and treatment. Participants from Syria were less likely to have a positive score compared to others and further research is required to understand the reasons for this.
难民和寻求庇护者的心理健康需求往往得不到满足。人们提出了许多针对难民和寻求庇护者心理健康问题的筛查方法，但尚未确定识别高危人群的最佳方法。PROTECT问卷和患者健康问卷4（PHQ4）是目前爱尔兰用于识别有心理健康问题风险的难民和寻求庇护者的两种工具，但关于这些工具阳性评分的患病率或风险因素的数据有限，无法为卫生服务规划提供参考。
对所有成年寻求庇护者或难民的匿名数据进行横断面分析，这些人在为期一年的护士进行的入境健康评估期间完成了PHQ4和PROTECT问卷。收集的数据包括：性别、年龄类别、婚姻状况、家庭单位、原籍国、难民/庇护身份、医疗状况、心理健康状况、暴力暴露情况、PROTECT评分、PHQ4评分以及全科医生心理健康评估结果。使用R软件完成统计分析。
440人完成了PROTECT和PHQ4问卷。198人因PROTECT或PHQ4阳性评分接受了全科医生评估。在所有参与者中，9.1%（=40）被诊断为抑郁症，15.0%（=66）被诊断为创伤后应激障碍（PTSD），3.8%（=17）患有适应障碍，3.7%患有焦虑症。PHQ-4评分与PROTECT评分之间存在正相关（rs = 0.738，P <.001），尽管PROTECT评分识别出更多的PTSD和抑郁症病例。女性（调整后比值比：2.47，95%置信区间：1.59 - 3.86）和原籍国为津巴布韦（调整后比值比：3.19，95%置信区间：1.56 - 6.53）与PROTECT阳性评分相关。原籍国叙利亚与PROTECT评分呈负相关（调整后比值比：0.32，95%置信区间：0.15 - 0.65）。PHQ4也有类似的发现。
抑郁症、焦虑症和PTSD的发病率与其他研究相似。PHQ4评分与PROTECT之间存在很强的相关性，但PROTECT最终识别出更多的抑郁症和PTSD病例，这表明单独使用它可能是合理的。无论使用哪种筛查工具，都需要有足够的医疗资源用于进一步评估和治疗。与其他参与者相比，叙利亚的参与者获得阳性评分的可能性较小，需要进一步研究以了解其原因。
