Cognitive function and traumatic brain injury in refugees and asylum-seekers attending mental health services : a preliminary study, and Clinical Research Portfolio

• Main Author: Christie, Zara
• Published: University of Glasgow 2014
• Subjects: 616.89; BF Psychology
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.631033

Objective: Every year, an estimated 10 million people suffer a traumatic brain injury (TBI; Hyder, Wunderlich, Puvanachandra, Gururaj, & Kobusingye, 2007). Refugees and asylum-seekers fleeing persecution have often experienced war and torture and are at a greater risk of TBI (Priebe & Esmaili, 1997). Following a TBI, cognitive, behavioural and psychosocial difficulties can significantly impact on independence (Cohen, 2001). This preliminary study investigated whether cognitive function is poorer in refugees and asylum-seekers who report a severe TBI, compared to those who do not. The study also compared cognitive performance in refugees and asylum-seekers attending mental health services with Western controls from normative data. Assessing the cognitive performance of this group against Western expectations is important, to inform the clinical work as well as UK asylum law and policy. Methods: The study employed a between-subjects design, comparing 14 refugees and asylum-seekers with a self-report of one or more severe TBIs and 11 without a history of TBI. Participants attended for one assessment session and completed the Colour Trails Test (CTT; D’Elia, Satz, Uchiyama, & White, 1996) as well as other cognitive tests. Where necessary, an interpreter was present. Results: Refugees and asylum-seekers who self-reported a history of severe TBI were not more cognitively impaired on the CTT than those without TBI. The combined groups performed significantly worse on the CTT compared to normative data. Conclusions: This preliminary study suggests that refugees and asylum-seekers attending mental health services are performing much poorer cognitively than healthy Western counterparts. This highlights the value of assessing cognition in this complex group, as on a case-by-case basis, results informed the practice of mental health clinicians and GPs. Furthermore, these results raise issues about the expectations placed on cognitively impaired individuals throughout the asylum process if these expectations are based on experience of cognitive function typical of that represented by Western norms. Additional research may instigate policy-makers to make adjustments to the asylum process to better acknowledge mental health and cognitive impairment.