Head injury and neuropsychiatric sequelae in asylum seekers

McMurry, Hannah Stowe; Tsang, Darren C.; Lin, Nicole; Symes, Stephen; Dong, Chuanhui; Monteith, Teshamae

doi:10.1212/wnl.0000000000010929

Cited by 13 publications

(12 citation statements)

References 7 publications

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“…In our study, severe headache was more common among those who experienced head injury with loss of consciousness. A study of asylum seekers in the US showed that almost half (42.5%) reported a history of head injury, which is similar to our finding of 40.2% for HSCL (39).…”

Section: Severe Headache Comorbid With Ptsdsupporting

confidence: 89%

Headache comorbidity in refugees and migrants with post-traumatic stress disorder

Westergaard¹,

Jensen

Carlsson

2023

Cephalalgia

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Background Headache is often comorbid with post-traumatic stress disorder yet overlooked in health assessments of refugees. Objectives To describe prevalence of severe headache among refugees with post-traumatic stress disorder and compare severity of post-traumatic stress disorder symptoms and treatment outcomes among those with and without severe headache. Methods This follow-up study used data from the Danish Database on Refugees with Trauma. Participants were recruited from 2009 to 2015 at a specialized psychiatric clinic. Prevalence of severe headache was computed by age, sex, and history of head injury or torture. Severe headache was defined as maximum headache scores on the Hopkins Symptom Checklist, Symptom Checklist-90 or the Visual Analogue Scale. Groups with and without severe headache were described according to validated questionnaires before and after 12–18 months of multidisciplinary treatment for post-traumatic stress disorder. Regression analyses were used to analyze associations between headache at start of treatment and symptom burden post-treatment, controlled for pre-treatment scores and possible confounders. Results Among 403 female and 489 male participants, nearly all (97.5%) complained of headaches. Severe headache prevalence was 31.4% to 50.0% (depending on which questionnaire was used) and was significantly more common among females and those aged 30–49 years. There was no clear relationship between headache and head injury or torture. Participants with severe headache had heavier symptom burdens compared to those without severe headache. Post-treatment, headache prevalence by age and sex did not change significantly. Those without severe headache showed a tendency toward improvement in outcome measures; this was not seen among those with severe headache. Pre-treatment headache scores were correlated with all outcome measures. Regression analyses controlled for pre-treatment scores of the outcome variables showed associations between pre-treatment headache scores (Hopkins Symptom Checklist or Symptom Checklist-90) and post-treatment scores for intrusion, numbing, hyperarousal, anxiety, disability, and quality of life (all p < 0.02). Conclusion Headache is a prevalent comorbid condition among refugees with post-traumatic stress disorder. Measures of pre-treatment headache severity appear to predict post-traumatic stress disorder treatment outcomes. Severe headache adversely affects post-traumatic stress disorder prognosis. Assessment and treatment options should be studied further.

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Section: Severe Headache Comorbid With Ptsdsupporting

confidence: 89%

Headache comorbidity in refugees and migrants with post-traumatic stress disorder

Westergaard¹,

Jensen

Carlsson

2023

Cephalalgia

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“…Another recent study of U.S. asylum-seekers found a higher prevalence of head injury than in our sample, in addition to clients with head trauma more likely to have depression. Differences from our study could be potentially explained by sample composition, differences in clinician background, and inconsistent use of validated instruments leading to an underestimate of PLOS ONE head trauma which we outline as limitations [33]. Further, we did not capture acquired head injury from strangulation in our sample, which future studies could consider prospectively evaluating for since this type of head injury can occur above and beyond traumatic head injury and incur neurocognitive sequelae as well.…”

Section: Discussionmentioning

confidence: 94%

Associations between memory loss and trauma in US asylum seekers: A retrospective review of medico-legal affidavits

et al. 2021

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Background The U.S. immigration system mandates that persons seeking asylum prove their persecution claim is credible and their fear of returning home is well-founded. However, this population represents a highly trauma-exposed group, with neuropsychiatric symptoms consequent to prior torture or maltreatment that may interfere with cognitive function and their ability to recall their trauma. These memory lapses may be incorrectly perceived by asylum adjudicators as indicators of dishonesty and jeopardize the person’s credibility and asylum claim. Our retrospective mixed methods study seeks to present associations between trauma and memory loss in a sample of persons seeking asylum to the U.S. and describe how memory impairments manifest in this trauma-exposed population. Methods We randomly selected 200 medico-legal affidavits from 1346 affidavits collected in the past 30 years, as part of the Physicians for Human Rights Asylum Network connecting clinicians with legal providers for medical and/or psychiatric affidavits of U.S. asylum seekers and persons seeking other forms of humanitarian relief (hereafter, “asylum seekers”). Data was extracted from these affidavits using a coding manual informed by the Istanbul Protocol, the global standard for torture documentation. Seven affidavits were excluded due to missing age. We used multiple logistic regression to assess the association of memory loss with neuropsychiatric diagnoses: head trauma, post-traumatic stress disorder (PTSD), and depression. We supplemented these findings with a qualitative content analysis of the affidavits documenting memory loss. Memory loss presented among the asylum seekers’ affidavits in several ways: memory gaps of the traumatic event; challenges with presenting a clear chronology of the trauma, avoidance of traumatic memories, and persistent short-term memory loss interfering with daily activity. Results A majority of the sample received a neuropsychiatric diagnosis: 69% (n = 132) of asylum-seekers received a diagnosis of PTSD and 55% (n = 106) of depression. Head trauma was reported among 30% (n = 58) of affidavits. Further, 68% (n = 131) reported being subject to physical violence and 20% (n = 39) were documented as being at risk of suicide. Memory loss was documented among 21% (n = 40) asylum-seekers. In adjusted models, both PTSD and depression, but not head trauma, were associated with memory loss (p<0.05). Conclusion Stakeholders in the asylum process, spanning the medical, legal and immigration enforcement sectors, must be aware of the interplay of trauma and memory loss and how they might impact immigration proceedings for this vulnerable population.

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“…Head trauma was comorbid with a range of physical and mental health conditions, although more studies documented mental health comorbidities (n = 12, 55%) than physical ones (n = 9, 41%). Among mental health conditions, depression (n = 9) 13,16,17,25,27,28,30,31,33 and PTSD (n = 9) 13,16,17,19,26,27,31,33,34 were cited most frequently, followed by anxiety disorder (n = 4) 25,27,30,34 and suicidal ideation (n = 4). 25,26,28,30 Physical health conditions cited included the following: headaches (n = 6), 18,24,25,27,28,30 dizziness (n = 3), 25,28,30 sleep disturbance (n = 2), 18,34 impaired memory (n = 2), spinal injuries (n = 2), 24,34 and chronic pain (n = 1).…”

Section: Resultsmentioning

confidence: 99%

“…The most documented mechanism of injury was direct impact or head strike through a beating or blow against the head (n = 9, 41%). 13,18,20,[25][26][27][28][29][30] Three additional studies reported that blunt trauma was the leading mechanism of head trauma in their sample but did not specify the percentage that this represented. 16,19,31 Two studies cited blast-induced head trauma as the predominant mechanism of injury in their study population.…”

Section: Head Trauma Characteristicsmentioning

confidence: 99%

Head Trauma in Refugees and Asylum Seekers

et al. 2023

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Background and Objectives:Refugees and asylum-seekers are at risk for head trauma. They endure blows to the head due to exigent circumstances necessitating resettlement (e.g., torture, war, interpersonal violence), as well as during their dangerous journeys to refuge. Our objective was to assess the global prevalence of head trauma in refugees and asylum-seekers and describe its clinical characteristics in this population.Methods:The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD42020173534). PubMed/MEDLINE, PsycInfo, Web of Science, Embase, and Google Scholar databases were searched for relevant studies. We included all studies in English that comprised refugees or asylum-seekers of any age and examined prevalence or characteristics of head trauma. We excluded studies that were not peer-reviewed original research. Information was recorded on the prevalence of head trauma, method of ascertaining head trauma, severity, mechanism of injury, other trauma exposures and comorbidities. Descriptive analyses and narrative syntheses were performed.ResultsA total of 22 studies were included, of which 13 with 6,038 refugees and asylum-seekers reported head trauma prevalence. Prevalence estimates ranged from 9% to 78%. Heterogeneity among studies precluded meta-analysis. Most studies were U.S.-based (n=9, 41%), followed by the Middle East (n=5, 23%). Most refugees or asylum-seekers were from the Middle East (n=9, 41%), with those from Latin America least represented (n=3, 14%). Studies disproportionately involved younger (pooled mean age=29 years), adult samples comprised of men. Recruitment settings were predominantly hospitals/clinics (n=14, 64%), followed by refugee camps (n=3, 14%). The most common mechanism of injury was direct impact via a beating or blow to the head. Studies varied greatly in how head trauma was defined and ascertained; no study used a validated traumatic brain injury (TBI)-specific screening tool. Similarly, TBI severity was not uniformly assessed, although hospital-based samples captured more moderate-to-severe head injuries. Mental health comorbidities were more frequently documented rather than physical health ones. Only two studies included a comparison to local populations.Conclusionand Relevance Refugees and asylum-seekers are vulnerable to head trauma but studies using systematic approaches to screening are lacking. Increased attention to head trauma in displaced populations will allow for optimizing equitable care for this growing, vulnerable population.

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Head injury and neuropsychiatric sequelae in asylum seekers

Cited by 13 publications

References 7 publications

Headache comorbidity in refugees and migrants with post-traumatic stress disorder

Headache comorbidity in refugees and migrants with post-traumatic stress disorder

Associations between memory loss and trauma in US asylum seekers: A retrospective review of medico-legal affidavits

Head Trauma in Refugees and Asylum Seekers

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