title: Comparison of psychiatric disability on the health of nation outcome scales (HoNOS) in resettled traumatized refugee outpatients and Danish inpatients.
abstract: BACKGROUND
  Currently, the mental health issues of traumatized refugees are mainly documented in terms of posttraumatic stress disorder, depression, and anxiety. Importantly, there are no reports of the level of psychiatric disability in treatment seeking traumatized refugees resettled in the West. Insufficient acknowledgment of the collective load of bio-psycho-social problems in this patient group hinders effective psychiatric and social service utilization outside the specialized clinics for traumatized refugees.
  
  
  METHODS
  The level of psychiatric disability in traumatized refugees from Danish specialized clinics (N = 448) is documented using routine monitoring data from pre- and post-treatment on the Health of Nation Outcome Scales (HoNOS). Furthermore, the HoNOS ratings are compared with routine monitoring data from Danish inpatients with different diagnoses (N = 10.911).
  
  
  RESULTS
  The routinely collected data indicated that despite their outpatient status, traumatized refugees had higher levels of psychiatric disability at pre-treatment compared to most inpatients. Moreover, the traumatized refugees had a HoNOS profile characterized by an overall high problem level in various psychiatric and social domains. The rate of pre- to post-treatment improvement on the HoNOS was smaller for the traumatized refugees than it was for the psychiatric inpatients.
  
  
  CONCLUSIONS
  The level, and the versatile profile, of psychiatric disability on the HoNOS point to complex bio-psycho-social problems in resettled treatment seeking traumatized refugees. Thus, a broader assessment of symptoms and better cooperation between psychiatric, health care, and social systems is necessary in order to meet the treatment needs of this group.
authors.affiliation: National Centre for Psychotraumatology, University of Southern Denmark, Odense, Denmark. spalic@health.sdu.dk.
authors.forename: Sabina
authors.initials: S
authors.lastname: Palic
authors.affiliation: Clinic for PTSD and Transcultural Psychiatry (CPTP), Aarhus University Hospital, Aarhus, Denmark. mihpde@rm.dk.
authors.forename: Michelle Lind
authors.initials: ML
authors.lastname: Kappel
authors.affiliation: Clinic for PTSD and Transcultural Psychiatry (CPTP), Aarhus University Hospital, Aarhus, Denmark. monine@rm.dk.
authors.forename: Monica Stougaard
authors.initials: MS
authors.lastname: Nielsen
authors.affiliation: Competence Center for Transcultural Psychiatry Denmark, Psychiatric Center Ballerup, The Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark. jessica.carlsson.lohmann@regionh.dk.
authors.forename: Jessica
authors.initials: J
authors.lastname: Carlsson
authors.affiliation: Psychiatric Research Unit, Psychiatric Center North Zealand, Hillerød, Denmark. per.bech@regionh.dk.
authors.forename: Per
authors.initials: P
authors.lastname: Bech
mesh_terms: D000328:Adult; D000368:Aged; D003718:Denmark / Q000453:epidemiology; D006233:Persons with Disabilities / Q000523:psychology*; D004641:Emigration and Immigration / Q000639:trends; D005260:Female; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D012036:Refugees / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D016896:Treatment Outcome