BackgroundOver one million Syrian asylum seekers have travelled to Greece with the ultimate aim of reaching other countries in western Europe. Depression prevalence and associated sociodemographic and displacement characteristics have been reported for resettled migrants. However, the prevalence of major depressive disorder (MDD) and its risk factors have not been described among migrants engaged in the asylum process ensuing from the Syrian crisis. This study provides new data about the mental health status of migrants in transition in the context of protracted asylum procedures.MethodsWe conducted a cross-sectional survey in a Syrian refugee camp in the Attica region of Greece from January 16–31, 2017. Individuals ≥18 years of age with verbal Arabic or English language skills were eligible to participate. The Patient Health Questionnaire-8 (PHQ-8), an eight-item validated diagnostic and severity measure, was used to screen for MDD. We analysed the relationships between MDD and sociodemographic and displacement characteristics using multivariable logistic regression.ResultsA total of 135 surveys were completed, representing 40% of the adult population in the refugee camp. The mean age of the participants was 30 years (18–61 years); women comprised 41% of the sample; 74% of the participants had ever married; 67% had children; and 33% of participants had not attended secondary school, including 11% who had never attended school. Median time since departing the country of origin was 12 months (< 1–74 months). Median time spent in the asylum process in Greece was 10 months (< 1–49 months). MDD was detected in 44% (95% CI: 37–50) of participants. Being a woman (Adjusted Odds Ratio [AOR]: 3.23, p = 0.019), each additional child (AOR: 1.61, p = 0.006), and increased time in the asylum process in Greece (AOR: 1.15, p = 0.043) were significant risk factors for MDD. Ever being married was associated with reduced odds of MDD (AOR: 0.23, p = 0.042).ConclusionsSyrian migrants face an extraordinarily high burden of MDD as they seek asylum. Incorporation of screening and treatment into service provision within refugee camps is urgently needed, particularly as migrants spend extended periods of time in transition due to protracted asylum procedures.

Background: Despite the need for mental health surveillance in humanitarian emergencies, there is a lack of validated instruments. This study evaluated a sequential screening process for major depressive disorder (MDD) using the two-and eight-item Patient Health Questionnaires (PHQ-2 and PHQ-8, respectively). Methods: This study analyzed data collected during a cross-sectional survey in a Syrian refugee camp in Greece (n = 135). The response rate for each instrument was assessed, and response burden was calculated as the number of items completed. The sequential screening process was simulated to replicate the MDD classifications captured if the PHQ-2 was used to narrow the population receiving the full PHQ-8 assessment. All respondents were screened using the PHQ-2. Only respondents scoring ≥ 2 are considered at risk for symptoms of MDD and complete the remaining six items. The positive and negative percent agreement of this sequential screening process were evaluated. Results: The PHQ-2, PHQ-2/8 sequential screening process, and PHQ-8 were completed by 91%, 87%, and 84% of respondents, respectively. The sequential screening process had a positive percent agreement of 89% and a negative percent agreement of 100%, and eliminated the need to complete the full PHQ-8 scale for 34 (25%) respondents. Conclusions: The benefits of the sequential screening approach for the classification of MDD presented here are twofold: preserving classification accuracy relative to the PHQ-2 alone while reducing the response burden of the PHQ-8. This sequential screening approach is a pragmatic strategy for streamlining MDD surveillance in humanitarian emergencies.

Background: Extended interval dosing of natalizumab is associated with significantly lower progressive multifocal leukoencephalopathy risk compared with every-4-week (Q4W) dosing in patients with relapsing-remitting multiple sclerosis. Previous studies have suggested that natalizumab effectiveness is maintained in patients who switch from Q4W to extended interval dosing but have been limited by a lack of well-matched patient cohorts. Methods: Tysabri Observational Program (TOP) data as of November 2019 were used to identify patients with relapsing-remitting multiple sclerosis treated with natalizumab Q4W and those with a single physician-indicated dosing change from Q4W to every-6-week (Q6W) dosing after ⩾1 year of Q4W treatment. Patients were propensity score matched at the time of the switch from Q4W to Q6W dosing. Clinical outcomes (annualized relapse rate and probability of remaining relapse free or free of 24-week confirmed disability worsening) and safety outcomes were assessed for the two cohorts. Results: This study included 219 pairs of propensity score–matched Q6W and Q4W patients. Annualized relapse rates were similar for Q6W (0.150) and Q4W (0.157) patients. The probability of remaining relapse free [hazard ratio = 1.243 (95% confidence interval = 0.819–1.888); p = 0.307] and of remaining free of 24-week confirmed disability worsening [hazard ratio = 0.786 (95% confidence interval = 0.284–2.176); p = 0.644] did not differ significantly between Q6W and Q4W patients. Summarized safety results for the matched Q6W and Q4W patients are also presented. Conclusion: These real-world findings in well-matched patient cohorts from TOP demonstrate that natalizumab effectiveness is maintained in patients who switch to Q6W dosing after ⩾1 year of Q4W dosing. ClinicalTrials.gov identifier: NCT00493298