Mental Illness among Refugee Arrivals: Examining DSM-V Diagnoses Rates, Predictors, and Psychiatric Care Engagement in U.S. Resettlement Programs

Author(s): Aimee Hilado, Melissa Bond.

Purpose: This article examines the prevalence of clinically significant mental disorders among 446 newly arrived refugees receiving clinical services through a U.S. Refugee Resettlement organization’s mental health program. Of the analytic sample, a subsample of 197 refugees received onsite psychiatric services in the same resettlement program. The paper answers two questions: First, what predicts enrollment in psychiatric care among refugee arrivals identified in resettlement programs? Second, how do refugees receiving psychiatric care navigate other clinical and non-clinical resettlement services?

Methods: Using logistic regression modeling, the study examined the prevalence of schizophrenia, major depressive disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder, adjustment disorder, and other covariates that predict psychiatric care enrollment and levels of refugee engagement in clinical and resettlement services broadly.

Results: Presenting problems of PTSD (b = 1.094, t(371) = 2.94, OR = 2.985, p = .003) and schizophrenia (b = 2.932, t(371) = –2.73, OR = 18.760, p = .006) were each associated with an increased likelihood of enrollment in psychiatric services. Refugees from African nations (b = –1.076, t(371) = –2.85, OR = 0.341, p = .005) were about 66% less likely to be enrolled in psychiatric care than were refugees from the Middle East. Receiving the general adjustment presenting problem flag (b = –2.569, t(371) = –7.09, OR = 0.077, p <.001) was also associated with a decreased likelihood of psychiatric care enrollment.

Conclusion: The findings provide directions for addressing mental illness within resettlement context and considerations for providing psychiatric care to culturally-diverse refugee arrivals.