Introduction In 2015, there was a high influx of refugees to Sweden, creating an extreme situation where individuals were forced to remain in large housing facilities for long periods. The present study aims to describe the mental health and quality of life of these individuals. Methods Data, based on 510 individuals, were obtained by means of a questionnaire at open screenings conducted at or nearby refugee housing facilities. Of the participating refugees, 367 were asylum seekers and 143 had received a residence permit but were still awaiting a more permanent housing solution. The questionnaire included measures of depressive symptoms (PHQ-9), symptoms of anxiety (GAD-7), risk of having post-traumatic stress disorder (PC-PTSD), and quality of life (WHOQOL-BREF). Results Of the total sample, 56-58.4% reported clinically significant levels of symptoms of depression, anxiety and risk of having PTSD. Prevalence estimates were higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated negatively with mental health outcomes. Conclusions Individuals residing in refugee housing facilities show high levels of psychological distress and rate their quality of life as low. Asylum seekers score higher than those having received a residence permit. These results are troublesome since the wait time for asylum decisions has lengthened considerably after 2015. The results of the present study calls for the urgency of societal actions to shorten the asylum process and improve conditions at the housing facilities.

The recent inflow of refugees to Sweden has put pressure on health care as well as revealing a need for methods regarding assessment of refugees' mental health status. The present study investigated the use of the Refugee Health Screener (RHS; Hollifield et al., 2013) to distinguish among severity levels of symptoms of psychological distress in refugees. Refugees residing in asylum accommodations (n = 510) were screened with RHS-13, together with screeners for depression, anxiety, and posttraumatic stress disorder (PTSD). Risk for mild, moderate, or severe levels of depression, anxiety, or/and PTSD was used as screening proxy. Receiver operating characteristic analysis rendered cutoff scores of 11, 18, and 25, for mild, moderate, and severe symptoms, respectively. Evaluated against each symptom scale separately, cutoffs performed well. Cutoff 11, previously identified by Hollifield et al. (2016), was also confirmed. However, utilization of additional cutoffs could improve refugee mental health by guiding clinical decision making.

BackgroundAlthough many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care.ObjectiveThis randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth.MethodsThis nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale.ResultsWe included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=−1.97, P=.049, Cohen d=0.28, 95% CI –0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03).ConclusionsFear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.Trial RegistrationClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat)

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Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth.