title: Mental health and trauma in asylum seekers landing in Sicily in 2015: a descriptive study of neglected invisible wounds.
abstract: BACKGROUND
  In 2015, Italy was the second most common point of entry for asylum seekers into Europe after Greece. The vast majority embarked from war-torn Libya; 80,000 people claimed asylum that year. Their medical conditions were assessed on arrival but their mental health needs were not addressed in any way, despite the likelihood of serious trauma before and during migration. Médecins sans Frontières (MSF), in agreement with the Italian Ministry of Health, provided mental health (MH) assessment and care for recently-landed asylum seekers in Sicily. This study documents mental health conditions, potentially traumatic events and post-migratory living difficulties experienced by asylum seekers in the MSF programme in 2014-15.
  
  
  METHODS
  All asylum seekers transiting the 15 MSF-supported centres were invited to a psycho-educational session. A team of psychologists and cultural mediators then provided assessment and care for those identified with MH conditions. Potentially traumatic events experienced before and during the journey, as well as post-migratory living difficulties, were recorded. All those diagnosed with MH conditions from October 2014 to December 2015 were included in the study.
  
  
  RESULTS
  Among 385 individuals who presented themselves for a MH screening during the study period, 193 (50%) were identified and diagnosed with MH conditions. Most were young, West African males who had left their home-countries more than a year prior to arrival. The most common MH conditions were post traumatic stress disorder (31%) and depression (20%). Potentially traumatic events were experienced frequently in the home country (60%) and during migration (89%). Being in a combat situation or at risk of death, having witnessed violence or death and having been in detention were the main traumas. Lack of activities, worries about home, loneliness and fear of being sent home were the main difficulties at the AS centres.
  
  
  CONCLUSIONS
  MH conditions, potentially traumatic events and post-migratory living difficulties are commonly experienced by recently-arrived ASs, this study suggests that mental health and psychosocial support and improved living circumstances should be integrated into European medical and social services provided by authorities in order to fulfil their humanitarian responsibility and reduce the burden of assimilation on receiving countries.
authors.affiliation: Medici Senza Frontiere Missione Italia, via Cavour 147/6, 00185 Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Crepet
authors.affiliation: Medici Senza Frontiere Missione Italia, via Cavour 147/6, 00185 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Rita
authors.affiliation: Médecins Sans Frontières Bruxelles, Operational Research Unit Luxembourg, 68 rue de Gasperich L-1617, Luxembourg City, Luxembourg.
authors.forename: Anthony
authors.initials: A
authors.lastname: Reid
authors.affiliation: Médecins Sans Frontières Bruxelles, Operational Research Unit Luxembourg, 68 rue de Gasperich L-1617, Luxembourg City, Luxembourg.
authors.forename: Wilma
authors.initials: W
authors.lastname: Van den Boogaard
authors.affiliation: Medici Senza Frontiere Missione Italia, via Cavour 147/6, 00185 Rome, Italy.
authors.forename: Pina
authors.initials: P
authors.lastname: Deiana
authors.affiliation: Medici Senza Frontiere Missione Italia, via Cavour 147/6, 00185 Rome, Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Quaranta
authors.affiliation: Medici Senza Frontiere Missione Italia, via Cavour 147/6, 00185 Rome, Italy.
authors.forename: Aurelia
authors.initials: A
authors.lastname: Barbieri
authors.affiliation: Assessorato alla Salute Regione Sicilia (Local Ministry of Health), Piazza Ottavio Ziino 24, Palermo, 90145 Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bongiorno
authors.affiliation: Medici Senza Frontiere Missione Italia, via Cavour 147/6, 00185 Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Carlo
keywords: Asylum seekers; Europe; Immigration; Italy; Mental health; Operational research; Refugee; Traumatic event