Mental health and cardiovascular disease risk in refugees

Abstract

In 2013 there were 51.2 million persons worldwide who had been forcibly displaced as a result of persecution, conflict, generalized violence, or human rights violations. 16.7 million persons, half of whom were children, were refugees. More than 80 % were living in refugee camps and other generally temporary although often long-lasting arrangements, in developing countries. From this massive population, only 98,000 were resettled in refugee-receiving countries. The prevalence of mental disorders, particularly post-traumatic stress disorder, depression, and anxiety, is greater in refugees than in non-refugees, although prevalence estimates vary greatly. As well as having poorer mental health, refugees are also more likely than non-refugee immigrants or host populations to experience poorer physical health, higher all-cause mortality, and higher cardiovascular mortality. Although the severe and persistent stress that is a central element of refugee experience is probably an independent risk factor for cardiovascular disease, it seems likely that the higher cardiovascular risk is mediated by mental disorders, such as post-traumatic stress disorder and depression, which are common in refugees and are clearly associated with increased cardiovascular risk. In addition, refugees are less likely to have access to effective mental health and general health services, resulting in further avoidable risk of cardiovascular morbidity and mortality.