Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country.
The objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints.
Design, Setting, and Participants
A population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively).
Main Outcome Measures
General health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25.
More asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms.
Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
US Committee for Refugees and Immigrants (2005) World refugee survey 2005. http://www.refugees.org/article.aspx?id=1342
Fazel M, Wheeler J, Danesh J (2005) Prevalence of serious mental disorder in 7000 refugees resettled in Western countries: a systematic review. Lancet 365:1309–1314
Gernaat HB, Malwand AD, Laban CJ, Komproe I, de Jong JT (2002) Many psychiatric disorders in Afghan refugees with residential status in Drenthe, especially depressive disorder and post-traumatic stress disorder. Ned Tijdschr Geneeskd 146:1127–1131
Hondius AJ, van Willigen LH, Kleijn WC, van der Ploeg HM (2000) Health problems among Latin-American and middle-eastern refugees in the Netherlands: relations with violence exposure and ongoing sociopsychological strain. J Trauma Stress 13:619–634
van den Heuvel WJ (1998) Health status of refugees from former Yugoslavia: descriptive study of the refugees in the Netherlands. Croat Med J 39:356–360
Roodenrijs TC, Scherpenzeel RP, de Jong JTVM (1998) Traumatic experiences and psychopathology among Somalian refugees in the Netherlands. Tijdschrift voor Psychiatrie 40:132–142
Gerritsen AA, Bramsen I, Deville W, van Willigen LH, Hovens JE, van der Ploeg HM (2004) Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study. BMC Public Health 4:7
Redwood-Campbell L, Fowler N, Kaczorowski J, Molinaro E, Robinson S, Howard M, Jafarpour M (2003) How are new refugees doing in Canada? Comparison of the health and settlement of the Kosovars and Czech Roma. Can J Public Health 94:381–385
Weine SM, Razzano L, Brkic N, Ramic A, Miller K, Smajkic A, Bijedic Z, Boskailo E, Mermelstein R, Pavkovic I (2000) Profiling the trauma related symptoms of Bosnian refugees who have not sought mental health services. J Nerv Ment Dis 188:416–421
Cheung P, Spears G (1995) Illness aetiology constructs, health status and use of health services among Cambodians in New Zealand. Aust NZ J Psychiatry 29:257–265
van Willigen LH, Hondius AJ, van der Ploeg HM (1995) Health problems of refugees in the Netherlands. Trop Geogr Med 47:118–124
Sinnerbrink I, Silove DM, Manicavasagar VL, Steel Z, Field A (1996) Asylum seekers: general health status and problems with access to health care. Med J Aust 165:634–637
McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247–263
Mollica RF, Caspi-Yavin Y, Lavelle J, Tor S, Yang T, Chan S, Pham T, Ryan A, de Marneffe D (1996) Harvard Trauma Questionnaire (HTQ): manual Cambodian, Laotian and Vietnamese versions. Torture 6(Suppl 1):19–33
Mollica RF, Wyshak G, de Marneffe D, Tu B, Yang T, Khuon F, Coelho RC, Lavelle J (1996) Hopkins Symptoms Checklist 25 (HSCL-25): manual Cambodian, Laotian and Vietnamese versions. Torture 6(Suppl 1):35–42
Waziri R (1973) Symptomatology of depressive illness in Afghanistan. Am J Psychiatry 130:213–217
Good BJ, DelVecchio Good MJ, Moradi R (1985) The interpretation of Iranian depressive illness and dysphoric affect. In: Kleinman A, Good B (eds) Culture and depression. University of California Press, Berkeley, pp 369–428
Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25:3186–3191
Bullinger M, Alonso J, Apolone G, Leplege A, Sullivan M, Wood-Dauphinee S, Gandek B, Wagner A, Aaronson N, Bech P, Fukuhara S, Kaasa S, Ware JE Jr (1998) Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol 51:913–923
Westert GP, Schellevis FG, de Bakker DH, Groenewegen PP, Bensing JM, van der Zee J (2005) Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice. Eur J Public Health 15:59–65
Laban CJ, Gernaat HB, Komproe IH, Schreuders BA, de Jong JT (2004) Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 192:843–851
Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J (2002) Measuring trauma and health status in refugees: a critical review. JAMA 288:611–621
Smith Fawzi MC, Murphy E, Pham T, Lin L, Poole C, Mollica RF (1997) The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners. Acta Psychiatr Scand 95:87–93
Turner SW, Bowie C, Dunn G, Shapo L, Yule W (2003) Mental health of Kosovan Albanian refugees in the UK. Br J Psychiatry 182:444–448
Mollica RF, Sarajlic N, Chernoff M, Lavelle J, Vukovic IS, Massagli MP (2001) Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. JAMA 286:546–554
Lie B (2002) A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatr Scand 106:415–425
Beiser M, Hou F (2001) Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study. Soc Sci Med 53:1321–1334
Hinton WL, Tiet Q, Tran CG, Chesney M (1997) Predictors of depression among refugees from Vietnam: a longitudinal study of new arrivals. J Nerv Ment Dis 185:39–45
Hauff E, Vaglum P (1995) Organised violence and the stress of exile. Predictors of mental health in a community cohort of Vietnamese refugees three years after resettlement. Br J Psychiatry 166:360–367
Westermeyer J, Neider J, Callies A (1989) Psychosocial adjustment of Hmong refugees during their first decade in the United States. A longitudinal study. J Nerv Ment Dis 177:132–139
Weine SM, Vojvoda D, Becker DF, McGlashan TH, Hodzic E, Laub D, Hyman L, Sawyer M, Lazrove S (1998) PTSD symptoms in Bosnian refugees 1 year after resettlement in the United States. Am J Psychiatry 155:562–564
Herlihy J, Scragg P, Turner S (2002) Discrepancies in autobiographical memories-implications for the assessment of asylum seekers: repeated interviews study. BMJ 324:324–327
Krinsley KE, Gallagher JG, Weathers FW, Kutter CJ, Kaloupek DG (2003) Consistency of retrospective reporting about exposure to traumatic events. J Trauma Stress 16:399–409
Bhui K, Abdi A, Abdi M, Pereira S, Dualeh M, Robertson D, Sathyamoorthy G, Ismail H (2003) Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees—preliminary communication. Soc Psychiatry Psychiatr Epidemiol 38:35–43
Scholte WF, Olff M, Ventevogel P, de Vries GJ, Jansveld E, Cardozo BL, Crawford CA (2004) Mental health symptoms following war and repression in eastern Afghanistan. JAMA 292:585–593
Noorbala AA, Bagheri Yazdi SA, Yasamy MT, Mohammad K (2004) Mental health survey of the adult population in Iran. Br J Psychiatry 184:70–73
Steel Z, Silove D, Phan T, Bauman A (2002) Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. Lancet 360:1056–1062
Sondergaard HP, Ekblad S, Theorell T (2001) Self-reported life event patterns and their relation to health among recently resettled Iraqi and Kurdish refugees in Sweden. J Nerv Ment Dis 189:838–845
Blair RG (2000) Risk factors associated with PTSD and major depression among Cambodian refugees in Utah. Health Soc Work 25:23–30
Favaro A, Maiorani M, Colombo G, Santonastaso P (1999) Traumatic experiences, posttraumatic stress disorder, and dissociative symptoms in a group of refugees from former Yugoslavia. J Nerv Ment Dis 187:306–308
Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z (1997) Anxiety, depression and PTSD in asylum-seekers: associations with pre-migration trauma and post-migration stressors. Br J Psychiatry 170:351–357
Cheung P (1994) Posttraumatic stress disorder among Cambodian refugees in New Zealand. Int J Soc Psychiatry 40:17–26
Fenta H, Hyman I, Noh S (2004) Determinants of depression among Ethiopian immigrants and refugees in Toronto. J Nerv Ment Dis 192:363–372
Ai AL, Peterson C, Ubelhor D (2002) War-related trauma and symptoms of posttraumatic stress disorder among adult Kosovar refugees. J Trauma Stress 15:157–160
The research for this article was funded by the Netherlands Organization for Health Research and Development (project number 2100.0097), who also advised the investigators with regard to the design and execution of the study.
About this article
Cite this article
Gerritsen, A.A.M., Bramsen, I., Devillé, W. et al. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiat Epidemiol 41, 18–26 (2006). https://doi.org/10.1007/s00127-005-0003-5
- mental health
- post-traumatic stress disorder
- prevalence study