Prevalence and predictors of health service use among Iraqi asylum seekers in the Netherlands.
BACKGROUND
A long asylum procedure is associated with higher prevalence rates of psychiatric disorders, lower quality of life, higher disability and more physical health problems. Additional knowledge about health seeking behavior is necessary to guide governments and health professionals in their policies.


OBJECTIVE
To measure service use among one of the biggest asylum seekers population in the Netherlands and to assess its relationships with predisposing and need variables (including post-migration living problems).


METHODS
Two groups were randomly selected: Group 1 (n = 143), less than 6 months and Group 2 (n = 151), more than 2 years in the Netherlands. Respondents were interviewed with fully structured, culturally validated, translated questionnaires, which contained instruments to measure psychiatric disorders, quality of life, disability, physical health and post-migration living problems. Use of preventive and curative (physical and mental) health services was measured and the relationship with predisposing and need risk factors was estimated with univariate and multivariate logistic regression analyses.


RESULTS
A long asylum procedure is not associated with higher service use, except for mental health service use and drug use. Use of mental health services is, however, low compared to the prevalence of psychiatric disorders. Low quality of perceived general health and functional disability are the most important predictors of services use. Psychopathology predicts use of a medical specialist (non-psychiatrist), but does not predict mental health service use.


CONCLUSIONS
A high percentage of asylum seekers with a psychiatric disorder is not getting adequate treatment. There is a mismatch between the type of health problem and the type of health service use. The various health services should work together in education, detection, referral and care in order to provide help to this group of patients.
Laban
Cornelis J
CJ
De Evenaar, Centre for Transcultural Psychiatry, Institute of Community Mental Health Care Drenthe, Beilen, The Netherlands. cjlaban@hetnet.nl
Gernaat
Hajo B P E
HB
Komproe
Ivan H
IH
De Jong
Joop T V M
JT
D000293:Adolescent; D000328:Adult; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007493:Iraq / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010342:Patient Acceptance of Health Care; D012036:Refugees; D011795:Surveys and Questionnaires