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COVID-19 and immigration detention in the USA: time to act

Keller, Allen S; Wagner, Benjamin D
PMID: 32243775
ISSN: 2468-2667
CID: 4371612

Mothers' reports of behavioral symptoms among children detained at family detention centers in the U.S

Min, Moonkyung; Rosenfeld, Barry; Keller, Allen
Few studies have empirically examined children's symptoms during immigration detention. This study investigated the behavioral problems of detained children through their mothers' reports by interviewing 42 female immigrants from Honduras, El Salvador, and Guatemala who had been in family detention centers in Texas, using the Strengths and Difficulties Questionnaire (SDQ). Results revealed that a majority of children (59.5%) displayed significant behavioral symptoms, with 78.6% exhibiting Emotional Problems, 50% exhibiting Conduct Problems, 45.2% exhibiting Hyperactivity, and 57.1% displaying Peer Problems. Significant correlations were observed between the child's Total Difficulties score and the mother's experience of fear for one's life during the journey to the U.S. (r = .32), and between the child's Conduct Problems and the mother's experience of violence during the same stage (r = .39). Also, the child's Emotional Problems were associated with the mother's PTSD symptoms (r = .42), and Peer Problems were associated with the mother's depression symptoms (r = .39). The high prevalence of behavioral problems in the children indicates the need for special attention in the detention process. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
PSYCH:2020-97908-001
ISSN: 2690-4594
CID: 4840292

Primary Care Screening Methods and Outcomes for Asylum Seekers in New York City

Bertelsen, Nathan S; Selden, Elizabeth; Krass, Polina; Keatley, Eva S; Keller, Allen
Effective screening in primary care among asylum-seekers in the US is critical as this population grows. This study aimed to evaluate disease prevalence and screening methods in this high-risk group. Two hundred ten new clients from 51 countries, plus Tibet, who were accepted into a program for asylum seekers from 2012 to 2014 were included. Screening rates and outcomes for infectious, non-communicable, and mental illnesses were evaluated. Screening rates were highest for PTSD, depression, hepatitis B, and latent tuberculosis. Seventy-one percent of clients screened positive for depression and 55 % for PTSD, followed by latent tuberculosis (41 %), hypertension (10 %), hepatitis B (9.4 %), and HIV (0.8 %). Overall screening rates were high. Point of care testing was more effective than testing that required a repeat visit. A large psychiatric and infectious disease burden was identified. These findings can inform future primary care screening efforts for asylum seekers in the US.
PMID: 27704388
ISSN: 1557-1920
CID: 2274112

Pre-Migration Trauma Exposure and Mental Health Functioning among Central American Migrants Arriving at the US Border

Keller, Allen; Joscelyne, Amy; Granski, Megan; Rosenfeld, Barry
In recent years, increasing numbers of families and individuals have arrived at the U.S. border from Central America, in particular, from Honduras, El Salvador, and Guatemala. This study sought to examine pre-migration trauma exposure and current mental health functioning of migrant families arriving at the U.S. border from the Northern Triangle region, with specific attention to the reasons offered for leaving their home country and the frequency with which migrant families appear to satisfy legal criteria for asylum We interviewed 234 adults in McAllen, Texas, using a structured interview and standardized questionnaires to assess exposure to trauma prior to migration, reasons for leaving their home country and symptoms of posttraumatic stress and depression. We found that 191 participants (83%) cited violence as a reason for fleeing their country, 119 individuals (69%) did not report the events to the police out of fear of gang-related retaliation or police corruption, and 90% (n = 204) reported being afraid to return to their native country. Based on self-report symptom checklists, 32% of the sample met diagnostic criteria for PTSD (n = 51), 24% for depression (n = 36), and 17% for both disorders (n = 25). Examining these data against the criteria for asylum in the U.S., we found that 70% of the overall sample (n = 159) met criteria for asylum, including 80% of those from El Salvador, 74% from Honduras, and 41% from Guatemala. These findings suggest that the majority of Central American migrants arriving at the U.S. border have significant mental health symptoms in response to violence and persecution, and warrant careful consideration for asylum status.
PMCID:5224987
PMID: 28072836
ISSN: 1932-6203
CID: 2400692

Predictors of suicidal ideation in treatment-seeking survivors of torture

Lerner, Emilie; Bonanno, George A; Keatley, Eva; Joscelyne, Amy; Keller, Allen S
In this study, we examined sociodemographic, persecutor identity, torture, and postmigration variables associated with suicidal ideation in a clinical sample of 267 immigrant survivors of torture who have resettled in New York City. The purpose of this study was to identify variables associated with increased risk for suicidal ideation in survivors of torture before they receive legal, psychological, or medical services for torture-related needs. Results from a binary logistic regression model identified a combination of 3 variables associated with current suicidal ideation at intake into the program. Being female, having not submitted an application for asylum, and a history of rape or sexual assault were significantly associated with suicidal ideation at intake, when also controlling for several other important variables. The final model explained 21.4% of variation in reported suicidal ideation at intake. The discussion will focus on the importance of conducting a thorough assessment of suicidal ideation in refugees and survivors of torture. (PsycINFO Database Record
PMID: 25915645
ISSN: 1942-969x
CID: 2019642

Gynecologic needs among a population of survivors of torture in New York City [Meeting Abstract]

Pham, A; Ryan, N; Joscelyne, A; Keller, A S; Ades, V
Background: The United States has an estimated 400,000 residing survivors of torture. The Program for Survivors of Torture (PSOT) at Bellevue Hospital is the only comprehensive torture treatment center in New York City. PSOT offers both medical and mental health treatment to its clients, who are ethnically diverse. There has to date been no comprehensive assessment of the gynecological needs of this population. This study affords a novel opportunity to investigate reproductive health needs of women who have experienced torture. Methods: This is a cross-sectional descriptive study conducted through structured interviews. All women enrolling in PSOT were eligible for inclusion. Data was collected in a REDCap database and analyzed using Stata v14. Outcomes were evaluated using descriptive statistics. Outcomes of interest include obstetric history, contraceptive knowledge and use, and prevalence of prior gender based violence (GBV) and female genital cutting (FGC). Findings: The majority (71.4%) were French-speaking West Africans. All participants reported prior experience of GBV; perpetrators were more likely to be from outside the family (64.3%), but violence from an intimate partner (35.0%) or family member (33.3%) was also common. Prior sexual violence and history of FGC was reported in 66.7% and 25.0% of subjects, respectively. The mean gravidity was 2.1 pregnancies (SD = 1.1) and, of those who have been pregnant (64.3%), 77.8% reported having received antenatal care at some point in pregnancy. While 85.7% reported any prior pregnancy-related complications, 57.1% of them reported seeking medical attention. Current contraception use was only reported in 15.4%, even though over half of women expressed a desire to delay pregnancy (spacers). Moreover, among all spacers, current use of contraception (28.6%) is lower than past use (78.6%). Participants had a better basic knowledge of traditional contraceptive methods (77.5%) compared to modern ones (56.1%). Interpretation: This is the first comprehensive review of gynecologic needs of survivors of torture in NYC. Prior history of GBV is common. It appears that while many have had prenatal care, overall knowledge and use of contraception in this population is very low compared to the general population
EMBASE:614044843
ISSN: 2214-9996
CID: 2415802

Death Rates among Detained Immigrants in the United States

Granski, Megan; Keller, Allen; Venters, Homer
The United States system of immigrant detention centers has been the subject of considerable scrutiny with respect to health care of detainees. We sought to characterize the rates and types of deaths that have occurred within this system between the years 2003-2015. We analyzed a file of detainee deaths released by the U.S. Department of Homeland Security as part of a freedom of information request. Between 2003 and 2015, 150 deaths were recorded. During this time period, the annual rate of death among detainees dropped dramatically, whether measured by annual admissions or by person years of exposure. The most common causes of death were cardiovascular, cancer and suicide. More research is needed to adequately account for the contributors to these declining rates of death in immigration detention settings.
PMCID:4661656
PMID: 26569284
ISSN: 1660-4601
CID: 1856182

Health Outcomes of Traumatic Brain Injury Among Refugee Survivors of Torture

Keatley, Eva; d'Alfonso, Alana; Abeare, Christopher; Keller, Allen; Bertelsen, Nathan S
OBJECTIVE:: To compare spontaneous reporting of health complaints in a sample of refugee survivors of torture with a history of moderate/severe traumatic brain injury (TBI) with survivors of torture without TBI and analyze the contribution of posttraumatic stress disorder symptoms to health outcomes. PARTICIPANTS:: Treatment-seeking refugee survivors of torture with a moderate/severe TBI (n = 85) and a control group (n = 72) of survivors who suffered a physical injury during their persecution but had no history of a head injury. MEASURES:: Health outcomes included a self-report of general physical health (scale 1-5), number of medical visits, and a scaled score of the number of health complaints. The Harvard Trauma Questionnaire (HTQ) was used to measure posttraumatic stress disorder. RESULTS:: Moderate/severe TBI was associated with more health complaints but not higher HTQ scores. TBI and HTQ scores are independently associated with a greater number of health complaints, and an interaction between TBI and HTQ scores suggests that the relationship between moderate/severe TBI and the number of health complaints strengthened with increased posttraumatic stress disorder symptom severity. CONCLUSIONS:: Health complaints may be a common expression of psychological trauma, and service providers should be certain to explore both medical and psychological contributors when assessing refugee survivors of torture.
PMID: 25629258
ISSN: 0885-9701
CID: 1447812

Lessons in health and human rights: providing dental care to torture survivors [Case Report]

Keller, Allen S; Weiss, June; Resnick, Steve; Berkowitz, Leonard; Soeprono, Aaron; Sullivan, Melba J Nicholson; Granski, Megan; Cere, Eva; Wolff, Mark
New York City has a large number of individuals seeking asylem who are victims of torture. In addition to dental needs, which include cases of severe trauma to the mouth, these individuasl require special support because of their fear of contact by those they do not know. A cooperative program between the New York University College of Dentistry and Bellevue NYU, known as the Program for Survivors of Torture, is described.
PMID: 25080669
ISSN: 0002-7979
CID: 1411932

Effects of Post-migration Factors on PTSD Outcomes Among Immigrant Survivors of Political Violence

Chu, Tracy; Keller, Allen S; Rasmussen, Andrew
This study examined the predictors of posttraumatic stress disorder (PTSD) in a clinical sample of 875 immigrant survivors of political violence resettled in the United States, with a specific aim of comparing the relative predictive power of pre-migration and post-migration experiences. Results from a hierarchical OLS regression indicated that pre-migration experiences such as rape/sexual assault were significantly associated with worse PTSD outcomes, as were post-migration factors such as measures of financial and legal insecurity. Post-migration variables, which included immigration status in the US, explained significantly more variance in PTSD outcomes than premigration variables alone. Discussion focused on the importance of looking at postmigration living conditions when treating trauma in this population.
PMID: 22976794
ISSN: 1557-1912
CID: 557322