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%]).