Ethnomedical syndromes and treatment-seeking behavior among Mayan refugees in Chiapas, Mexico.

This survey investigated the prevalence of ethnomedical syndromes and examined treatments and treatment-seeking in Mayan Guatemalans living in United Nations High Commissioner for Refugee (UNHCR) camps in Chiapas, Mexico. Methods included a rapid ethnographic assessment to refine survey methods and inform the cross-sectional survey, which also examined mental health outcomes; 183 households were approached for interview, representing an estimated 1,546 residents in five refugee camps and 93% of all households. One adult per household (N = 170) was interviewed regarding his or her health; an additional 9 adults in three surveyed households participated and were included in this analysis; of the 179 participants, 95 primary child-care providers also answered a children's health questionnaire for their children. Results indicated that ethnomedical syndromes were common in this sample, with 59% of adults and 48.4% of children having experienced susto (fright condition) and 34.1% of adults reporting ataques de nervios (nervous attacks); both conditions were significantly associated with symptoms consistent with posttraumatic stress disorder, anxiety and depression and are mental health conditions recognized by the American Psychiatric Association. Combining healthcare provider and indigenous treatments such as physician prescribed medication (65%), medicinal plants (65.7%), and limpias (spiritual cleansings) (40.6%) was reported. Most participants (86%) sought routine medical treatment from UNHCR trained health promoters in their camp. Assessing ethnomedical health is important for informing mental health programs among this population.

The mental health status of Mayan refugees after repatriation to Guatemala.

OBJECTIVE: Only one previous study had examined the epidemiology of mental health in Guatemalan refugees. The objective of this new study was to estimate the prevalence of mental illness and to assess factors associated with poor mental health among Guatemalan Mayan refugees who had been repatriated to Guatemala after spending 12-18 years in refugee camps in Mexico, and to compare the results for the repatriated Guatemalans with those for Guatemalan refugees who were continuing to live in Mexico. METHODS: In 2001 a cross-sectional survey of adults (> or = 16 years) was conducted with random household sampling proportional to the population size in each of the five repatriation villages surveyed. Posttraumatic stress disorder (PTSD), anxiety, and depression were measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. RESULTS: Together, the five repatriation villages had 565 households. Of the 565 households, 203 of them were approached to solicit study participation. A total of 179 households (one adult per household) agreed to participate, representing an overall participation rate of 88%, and one-third of all the households in the five communities. The respondents had personally experienced a mean of 5.5 trauma events and had witnessed a mean of 7.3 other trauma events. Of the respondents, 8.9% met the symptom criteria for PTSD, 17.3% for anxiety, and 47.8% for depression. PTSD was associated with being seriously wounded and with having relatives or friends mutilated. Logistic regression analyses indicated that anxiety was associated with being sexually assaulted, being female, having friends or family mutilated, being seriously wounded, and having 6-12 children (vs. having 1-5 children). Depression was associated with having 6-12 children. Anxiety was significantly more prevalent among the refugees remaining in Mexico (54.4%) than it was among the repatriated refugees (17.3%). The difference in the prevalence rates was not significant for PTSD (11.8% for refugees remaining in Mexico vs. 8.9% for those repatriated) or for depression (38.8% for refugees remaining in Mexico vs. 47.8% for those repatriated). CONCLUSIONS: Psychiatric morbidity was common among the repatriated Mayans. The repatriation of refugees involves moving an already vulnerable, often traumatized population back to a place of distressing memories and still-unsettled conditions. There is a need to consider and plan for adequate mental health services for repatriating refugees.

The mental health status of Mayan refugees after repatriation to Guatemala / La salud mental de refugiados mayas después de su repatriación a Guatemala

Objective. Only one previous study had examined the epidemiology of mental health in Guatemalan refugees. The objective of this new study was to estimate the prevalence of mental illness and to assess factors associated with poor mental health among Guatemalan Mayan refugees who had been repatriated to Guatemala after spending 12­18 years in refugee camps in Mexico, and to compare the results for the repatriated Guatemalans with those for Guatemalan refugees who were continuing to live in Mexico. Methods. In 2001 a cross-sectional survey of adults (≥ 16 years) was conducted with random household sampling proportional to the population size in each of the five repatriation villages surveyed. Posttraumatic stress disorder (PTSD), anxiety, and depression were measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. Results. Together, the five repatriation villages had 565 households. Of the 565 households, 203 of them were approached to solicit study participation. A total of 179 households (one adult per household) agreed to participate, representing an overall participation rate of 88%, and one-third of all the households in the five communities. The respondents had personally experienced a mean of 5.5 trauma events and had witnessed a mean of 7.3 other trauma events. Of the respondents, 8.9% met the symptom criteria for PTSD, 17.3% for anxiety, and 47.8% for depression. PTSD was associated with being seriously wounded and with having relatives or friends mutilated. Logistic regression analyses indicated that anxiety was associated with being sexually assaulted, being female, having friends or family mutilated, being seriously wounded, and having 6­12 children (vs. having 1­5 children). Depression was associated with having 6­12 children. Anxiety was significantly more prevalent among the refugees remaining in Mexico (54.4%) than it was among the repatriated refugees (17.3%). The difference in the prevalence rates was not significant for PTSD (11.8% for refugees remaining in Mexico vs. 8.9% for those repatriated) or for depression (38.8% for refugees remaining in Mexico vs. 47.8% for those repatriated). Conclusions. Psychiatric morbidity was common among the repatriated Mayans. The repatriation of refugees involves moving an already vulnerable, often traumatized population back to a place of distressing memories and still-unsettled conditions. There is a need to consider and plan for adequate mental health services for repatriating refugees.

Objetivo. Existe un solo estudio en el que se hayan examinado las tendencias epidemiológicas observadas en el ámbito de la salud mental en refugiados guatemaltecos. El objetivo de este nuevo estudio radica en calcular la prevalencia de enfermedades mentales y evaluar los factores asociados con el menoscabo de la salud mental en refugiados guatemaltecos de ascendencia maya que fueron repatriados a Guatemala después de pasar de 12 a 18 años en campamentos para refugiados en México, así como comparar los resultados observados en los guatemaltecos repatriados con los observados en refugiados guatemaltecos que siguieron viviendo en México. Métodos. En 2001 se llevó a cabo una encuesta transversal de adultos (≥16 años de edad) con muestras aleatorias de un tamaño que guardaba proporción con el de la población de cada una de las cinco aldeas de repatriados que se estudiaron. Se determinó la prevalencia del síndrome de estrés postraumático (SEP), de estados de ansiedad y de depresión mediante el Cuestionario de trauma de Harvard (Harvard Trauma Questionnaire) y la Lista 25 de verificación de síntomas de Hopkins (Hopkins Symptom Checklist-25). Resultados. En las cinco aldeas de repatriados había en conjunto 565 hogares, de los cuales 203 fueron abordados para solicitar su participación en el estudio. Aceptó participar un total de 179 hogares (un adulto en cada hogar), equivalente a 88% de la muestra y a una tercera parte de todos los hogares en las cinco comunidades. Las personas que respondieron a la encuesta habían tenido individualmente un promedio de 5,5 experiencias traumáticas personales y habían presenciado un promedio de 7,3 episodios ajenos de carácter traumático. De las personas que participaron en la encuesta, 8,9% satisfacían los criterios diagnósticos de SEP, 17,3% los de ansiedad y 47,8% los de depresión. El SEP mostró una asociación con haber sufrido heridas graves y con tener parientes que habían sido mutilados. Los análisis de regresión logística revelaron una asociación entre la presencia de estados de ansiedad y el haber sufrido agresión sexual, ser mujer, haber tenido amigos o parientes mutilados, haber sufrido heridas graves y tener de 6 a 12 hijos (frente a tener de 1 a 5). La depresión mostró una asociación con tener de 6 a 12 hijos. Los estados de ansiedad mostraron una prevalencia significativamente mayor entre los refugiados que se quedaron en México (54,4%) que entre los que fueron repatriados (17,3%). En cambio, no se observaron diferencias significativas entre los refugiados que permanecieron en México y los que fueron repatriados en cuanto a las tasas de prevalencia de SEP (11,8% frente a 8,9%, respectivamente) y de depresión (38,8% frente a 47,8%, respectivamente). Conclusiones. Se observaron problemas psiquiátricos frecuentes en los mayas repatriados. La repatriación de refugiados entraña movilizar a una población que de por sí es vulnerable y que ha sido víctima de muchos traumas a un lugar cargado de recuerdos dolorosos y donde siguen imperando condiciones muy precarias. Es preciso, por ende, contemplar la necesidad de planificar servicios de salud mental para refugiados repatriados.

Factors associated with poor mental health among Guatemalan refugees living in Mexico 20 years after civil conflict.

CONTEXT: From 1981 to 2001, 46 000 refugees who fled the 36-year civil conflict in Guatemala for Chiapas, Mexico were under the protection of the United Nations High Commissioner for Refugees. OBJECTIVES: To estimate the prevalence of mental illness and factors associated with poor mental health of underserved Guatemalan refugee communities located in Chiapas, Mexico, since 1981 and to assess need for mental health services. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of 183 households in 5 Mayan refugee camps in Chiapas representing an estimated 1546 residents (adults and children) conducted November-December 2000. MAIN OUTCOME MEASURES: Symptom criteria of Posttraumatic Stress Disorder (PTSD), anxiety, and depression as measured by the Harvard Trauma Questionnaire and Hopkins Symptom Checklist-25 (Hopkins-25). RESULTS: One adult (aged > or =16 years) per household (n = 170 respondents) who agreed to participate was included in the analysis, representing an estimated 93% of households. All respondents reported experiencing at least 1 traumatic event with a mean of 8.3 traumatic events per individual. Of the respondents, 20 (11.8%) had all symptom criteria for PTSD. Of the 160 who completed the Hopkins Symptom Checklist-25, 87 (54.4%) had anxiety symptoms and 62 (38.8%) had symptoms of depression. Witnessing the disappearance of family members (adjusted odds ratio [AOR], 4.58; 95% confidence interval [CI], 1.35-15.50), being close to death (AOR, 4.19, 95% CI, 1.03-17.00), or living with 9 to 15 persons in the same home (AOR, 3.69; 95% CI, 1.19-11.39) were associated with symptoms of PTSD. There was a protective factor found for lacking sufficient food (AOR, 0.08; 95% CI, 0.01-0.59). Elevated anxiety symptoms were associated with witnessing a massacre (AOR, 10.63; 95% CI, 4.31-26.22), being wounded (AOR, 3.22; 95% CI, 0.95-10.89), and experiencing 7 to 12 traumatic events (AOR, 2.67; 95% CI, 1.14-6.27) and 13 to 19 traumatic events (AOR, 2.26; 95% CI, 0.65-7.89). Elevated symptoms of depression were associated with being a woman (AOR, 3.64; 95% CI, 1.47-9.04), being widowed (AOR, 27.55; 95% CI, 2.54-299.27), being married (AOR, 1.93; 95% CI, 0.59-6.33), witnessing disappearances (AOR, 2.68; 95% CI, 1.16-6.19), experiencing 7 to 12 traumatic events (AOR, 1.57; 95% CI, 0.64-3.88), or experiencing 13 to 19 traumatic events (AOR, 7.44; 95% CI, 2.18-25.37). CONCLUSION: Psychiatric morbidity related to human rights violations, traumatic events, and refugee status was common among Guatemalan refugees surveyed 20 years after the Guatemalan civil conflict.