Head injuries, traumas, and neuropsychiatric sequela in asylum seekers

Importance: Asylum seekers experience a high burden of physical and
psychological trauma, yet there is a scarcity of literature regarding the
epidemiology and sequelae of head injury (HI) in asylum seekers.
Objective: To examine head injury prevalence and related neuropsychiatric
comorbidities in asylum seekers. Methods: A retrospective cross-sectional
study through review of 139 medical affidavits from an affidavit database
was performed. Affidavits written from 2010 – 2018 were included.
Demographic and case-related data were collected and classified based on
the presence of head injury. Primary study outcome measurement was
prevalence of head injury and headache. Secondary outcomes included the
neuropsychiatric sequelae of head injury including depression, PTSD,
anxiety, memory/concentration deficits, and the prevalence of abusive and
traumatic history. Hypothesis and outcome measures were determined before
data extraction. Results: One hundred and thirty-nine medical affidavits
of asylum seekers were included in the study. The mean age was 27.4±12.1,
56.8% identified as female, 28.1% were <18 years. Almost half
(42.5%) explicitly self-reported history of head injury. Compared to
clients who did not report head injury, clients with head injury were
older (31.4 vs 24.4, 7.0 year difference; 95%CI [2.9, 10.9 years]) and
more likely to report a history of headache (62.7% vs 28.8%, 33.9%
difference; 95%CI [20.0, 47.8%], p<.001), physical abuse (91.5% vs
65.0%, 26.5% difference; 95%CI [12.8, 38.5%];), physical trauma (96.6% vs
66.3%, 30.4% difference; 95%CI [17.9, 41.5%]), concussion (22.0% vs 0.0%,
22% difference; 95%CI [12.2, 34.1%]), and loss of consciousness (27.1% vs
0.0%, 27.1% difference; 95%CI [16.4, 39.6%]). Moreover, clients with head
injuries were more likely to suffer neuropsychological sequelae such as
memory/concentration deficits (45.8% vs 28.8%, 17.0% difference; 95%CI
[0.8, 33.2%]), and depression (83.1% vs 65%, 18.1% difference; 95%CI [3.0,
33.2%]).