Head Trauma in Refugees and Asylum Seekers

Abstract

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 We excluded studies that were not peer-reviewed original research.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.

Neurological Care of Refugees and Other Forcibly Displaced Persons

“…14 Gang violence and interpersonal violence is also associated with a higher prevalence of TBI, which is reported in as many as 78% of refugees and asylum seekers, although prevalence estimates are wide-ranging. 15 Interpersonal violence encompasses intimate partner violence (IPV), which can include both TBI and hypoxic-ischemic brain injury from strangulation. In a New York-based study of IPV survivors, refugee status was associated with higher prevalence of IPV and related brain injury, 16 which is consistent with IPV providing additional grounds for survivors seeking asylum protection.…”

Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020

“…Refugees have the human right to health, and countries have obligations to provide refugees and forcibly displaced people health care services. This is delineated in the 1951 Convention Relating to the Status of Refugees and its 1967 Protocol, and is important as prior research has shown a higher prevalence of various neuropsychiatric disorders such as posttraumatic stress disorder (PTSD), depression, and head trauma as well as chronic diseases such as cardiovascular disease . Yet despite both these protections and known health needs, they experience significant health disparities .…”

“…This is delineated in the 1951 Convention Relating to the Status of Refugees and its 1967 Protocol, 4 and is important as prior research has shown a higher prevalence of various neuropsychiatric disorders such as posttraumatic stress disorder (PTSD), depression, and head trauma as well as chronic diseases such as cardiovascular disease. 5 , 6 , 7 Yet despite both these protections and known health needs, they experience significant health disparities. 8 They face health care barriers including lack of access and interrupted health care coverage, difficulty navigating complex systems, lack of culturally and linguistically concordant care, discrimination, and poor health care utilization.…”

Head Injury and Associated Sequelae in Individuals Seeking Asylum in the United States: A Retrospective Mixed-Methods Review of Medico-Legal Affidavits

“…Globally, traumatic brain injury (TBI) affects over 60 million individuals [ 14 ] and is the leading cause of disabilities worldwide in comparison with any other injury [ 8 ]. Its high prevalence among forcibly displaced populations is documented alongside the high prevalence of violence suffered and witnessed, but TBI remains under-recognized, partially due to the significant overlap of neurobehavioral post-concussive symptoms and the psychiatric symptoms that are also common in this population [ 15 ]. According to one study that included 139 U.S.-based individuals seeking asylum, nearly half self-reported head injury and were more likely to experience headaches and depression than individuals who did not report head injury [ 16 ].…”

“…According to one study that included 139 U.S.-based individuals seeking asylum, nearly half self-reported head injury and were more likely to experience headaches and depression than individuals who did not report head injury [ 16 ]. A systematic review found a prevalence of TBI of as high as 78%, although prevalence estimates were wide-ranging due to heterogeneity in the studies [ 15 ]. Fewer studies in the systematic review explored characteristics of head injury in this population, such as common mechanisms of injury, symptoms, and relationships with psychosocial factors.…”