Perspectives from a Psychiatric outpatient Service for Immigrants and Refugees in São Paulo, Brazil in a 15 year period.

Abstract

Background Immigrants and refugees have specific mental health needs. Studies of immigrant psychiatric patients in Latin America are scarce. This article presents the profile of patients from an outpatient psychiatric service in Sao Paulo (Brazil) in order to better inform mental health service planning for immigrants and refugees.Methods Exploratory study to characterize demographic and mental health profile of refugees and immigrants attending service from 2003 to 2018. Chi-square tests and logistic regressions were used to examine the association of demographic variables, exposure to violence, and immigrant status with psychiatric diagnosis. Cluster Analysis was used to identify sub-groups within the sample. Results A total of 162 immigrants and refugees referred to the service obtained treatment, being 57·4% men, 59·8% refugees/asylum seekers, 51·9% black, 48·8% single, mean age of 35.9, 64·2% with ten years of education, 57·4% unemployed. Half of the sample (52·5%) were exposed to violence. The most common diagnosis was depression (54·2%) followed by PTSD (16·6%). Around 34% of the participants sought psychiatric care in six months upon arrival. Logistic regressions showed men were had decreased odds to present depression (OR= 0·34). Patients with PTSD were more likely to be refugees (OR= 3·9) and not having university degree (OR= 3·1). In cluster analysis, a cluster of patients with PTSD were almost all black refugee men exposed to violence. Most patients diagnosed with psychotic disorders were also black refugee men.Interpretation Data raises questions regarding sex differences and mental health care access. Refugees in Brazil are mainly black men, what might contribute to the profile found in the present study. Further investigation is needed to better understand treatment adherence and clarify the role of patient-health professional relationship in mental health outcomes.