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Determinants of resource needs and utilization among refugees over time

Abstract

Purpose

This study examined refugees’ resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories.

Methods

Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms.

Results

Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview.

Conclusions

Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

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Acknowledgments

This research was supported by a grant from the National Institute of Mental Health (NIMH, award number R01MH085793) and National Institute of Environmental Health Sciences (P30ES020957). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIMH, nor NIEHS. The authors wish to thank Yousif Talia, M.D., Evone Barkho, M.D., MPH, and Monty Fakhouri, M.S., for their work in collecting data and Mrs. Raja Yaldo for her help with data entry. Sincere thanks to Lutheran Social Services of Michigan, The Kurdish Human Rights Watch, and the Catholic Services of Macomb County for their assistance in participant recruitment. The authors also extend their gratitude to the refugees who participated in this study. Bengt Arnetz, Judith Arnetz, and Hikmet Jamil completed this work at Wayne State University, Detroit, Michigan, but have since moved to Michigan State University, East Lansing & Grand Rapids, Michigan.

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Correspondence to A. Michelle Wright.

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Wright, A.M., Aldhalimi, A., Lumley, M.A. et al. Determinants of resource needs and utilization among refugees over time. Soc Psychiatry Psychiatr Epidemiol 51, 539–549 (2016). https://doi.org/10.1007/s00127-015-1121-3

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Keywords

  • Refugees
  • Resource need
  • Resource utilization
  • PTSD
  • Depression