Upstate medical students have teamed with residents and faculty to provide physical examinations for newly resettled refugees since 2010. The assessment of adults has included screening for emotional distress, which was present in 38 percent of adult refugee patients.
But health care providers would not have realized that if they had not asked the refugees questions designed to assess their emotional health, said Peter Cronkright, MD, a physician who advocates for refugee services and who trains medical students. Students use phone interpreters to administer the “Refugee Health Screener – 15,” a tool to sensitively detect the range of emotional distress common across refugee groups. If the test results are abnormal, the refugee likely has post-traumatic stress syndrome, anxiety and depression.
“When you screen, often you discover that they have these things,” said Cronkright. He said it’s not surprising that refugees have mental health issues, but unless a health care provider raises the question, the issues may go undiagnosed – and untreated.
Refugees may arrive at the clinic with back pain or dizziness or headache, and it’s up to the health care provider to screen for any emotional contributors. Prior to implementing the screener tool, only 11 percent of newly resettled refugee adults were noted to have a mental disorder. Once it was in place, that percentage grew to 39 percent. Among refugees from Iraq, the percentage was 60 percent.
Cronkright served on a panel at the 2014 North American Refugee Conference regarding the need to screen for emotional distress in refugees, and his students presented a poster about their participation and outcomes.
Cronkright believes people often communicate their emotional pain through physical symptoms, especially when they have difficulty communicating. That’s a common challenge among refugees who are making new homes in a new culture, surrounded by people who speak a language they often don’t understand. A physician who attempted to treat that person’s headaches, back pain or similar problems without addressing their emotional health would be dodging the real issue.
The American College of Physicians recommends screening only for issues for which a physician can make a difference. Cronkright said primary care providers can make a difference by offering an objective exam, acknowledging the patient’s suffering, and treating the patient’s emotional distress with counseling and/or medications.
He also points out that a great predictor of whether someone with acute back pain will go on to develop a chronic problem with back pain is not the results of an imaging scan but rather the presence of emotional distress.
Cronkright encourages his learners to consider the psychological and social factors contributing to the patient’s suffering, as well as the physical.
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Depending on the culture, many refugees who settle in the Syracuse area find it taboo to admit depression or emotional struggles. The Burmese don’t even have a word for depression. In caring for refugees from Burma, Cronkright is mindful to use the phrase “loss of hope” or “hopelessness.”
This article appears in the fall 2015 issue of Upstate Health magazine.