Characteristics of study population
For three months (Feb 2007 to April 2007) a total of 66 asylum seekers were invited to participate in this study, of these 60 asylum seekers agreed to be interviewed (response rate of 91%). A total of 33 refugees living in the community were invited to participate, and 28 were interviewed (response rate of 85%). The respondents were from 30 different countries.
Table compares the characteristics of refugees and asylum seekers. Refugees had a significantly higher level of educational attainment (χ2= 8.68, df = 2, P = 0.01), a lower level of post migration stressors (χ2= 19.74, df = 1, P < 0.01), and had spent more time in Ireland when compared to asylum seekers. The most common post migration stressors among asylum seekers were 'dissatisfaction regarding the length of the asylum procedure', 'uncertainty about residence status' and language difficulties. There was also a borderline significant difference between refugees and asylum seekers for levels of pre migration stressors (χ2= 3.96, df = 1, P = 0.05).
Characteristics of study population
Univariable associations between residence status and general health, PTSD symptoms and anxiety/depression
In this analysis (Table ), the association between residence status (refugees vs. asylum seekers) and poor general health failed to reach statistical significance (P > 0.05). However, asylum seekers had a significantly higher risk of PTSD and depression/anxiety symptoms (OR 6.3, 95% CI: 2.2–17.9; OR 5.8, 95% CI: 2.2–15.4 respectively).
Univariable association between the characteristics of the study population and health outcomes
Respondents with a high level of post migration stressors had a higher risk of poor general health status (OR 2.4, 95%CI: 1.0–5.8), PTSD (OR 18.6, 95% CI: 5.9–57.8) and depression/anxiety symptoms (OR 7.5 95% CI: 2.9–19.5). Pre migration stressors had no significant association with general health, but they had a significant positive association with the occurrence of PTSD symptoms (OR 2.7, 95% CI: 1.1–6.8) and depression/anxiety symptoms (OR 3.6, 95% CI: 1.3–9.6).
Respondents suffering from more than one chronic condition had an increased risk of PTSD (OR 5.3, 95% CI: 2.1–13.2) and depression/anxiety symptoms (OR 4.4, 95% CI 1.8–11.0), but no significant association was found with self reported poor general health.
Gender, length of time in Ireland and education level (Primary or less compared to secondary or above) were also explored in univariable analysis but had no significant effect on the outcomes for PTSD or depression/anxiety (data not shown).
Multivariable associations between residence status and symptoms of PTSD and anxiety/depression
All variables that were significantly associated with PTSD and depression/anxiety from univariable analysis were included in multivariable logistic regression (Table ). General health status was not explored in regression analysis as no significant association was found upon univariable analysis.
Final regression model showing factors associated with PTSD and depression/anxiety symptoms
After adjusting for chronic conditions and pre and post migration stressors (Table ), residence status was no longer significantly associated with symptoms of PTSD (OR 2.5, 95% CI: 0.6–10.0). After removal of residence status from the model, the association between pre migration stressors, post migration stressors and chronic conditions with PTSD remained. Residence status, pre migration stressors, post migration stressors and chronic conditions were retained in the regression model for depression/anxiety symptoms, however residence status was no longer a significant explanatory factor (OR 3.0, 95% CI: 0.9–9.8, Table ).
Post migration stressors were the most significant risk factor for self reported PTSD and depression/anxiety symptoms (OR 17.3, 95% CI: 4.9–60.8; OR 3.9, 95% CI: 1.2–12.3 respectively). High levels of pre migration stressors and chronic conditions also had a significant positive association with the occurrence of these health outcomes. In contrast, residence status was not independently associated with the presence of PTSD or depression/anxiety symptoms, but appeared to act as a marker for other explanatory variables. Table showed a strong relationship between residential status and levels of post migration stressors, and to a lesser degree, residential status and pre migration stressors, suggesting that residential status most likely acts as a marker for the presence of migration stressors.
Utilisation of Health Care Services and use of Medication
Table summarises and compares the use of health care services and medication between asylum seekers and refugees. The only statistically significant difference between asylum seekers and refugees in terms of health care services and medication use was in their use of general practice services (P = 0.03), with half of the refugees contacting their GP in last two months, compared to 73.3% of asylum seekers. No significant differences were found for hospital admissions, use of specialist services or the use of medications in the last 14 days.
Utilisation of health services and medication use according to residence status