Head Injury and Associated Sequelae in Individuals Seeking Asylum in the United States: A Retrospective Mixed-Methods Review of Medico-Legal Affidavits

被引:0
作者
Saadi, Altaf [1 ,2 ]
Asfour, Julia [3 ]
De Assis, Maria Vassimon [4 ]
Wilson, Tessa [5 ]
Haar, Rohini J. [6 ]
Heisler, Michele [5 ,7 ]
机构
[1] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA
[2] Harvard Med Sch, Dept Neurol, Boston, MA 02115 USA
[3] Tufts Univ, Sch Arts & Sci, Boston, MA 02155 USA
[4] Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94704 USA
[5] Phys Human Rights, New York, NY 10018 USA
[6] Univ Calif Berkeley, Sch Publ Hlth, Div Epidemiol & Biostat, Berkeley, CA 94704 USA
[7] Univ Michigan, Sch Publ Hlth, Dept Internal Med, Ann Arbor, MI 48109 USA
基金
美国国家卫生研究院;
关键词
refugee health; asylum seekers; migrant health; head injury; head trauma; forensic evaluations; BRAIN-INJURY; TBI;
D O I
10.3390/brainsci14060599
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
People seeking asylum are susceptible to head injury (HI) due to exposure to various forms of violence including war, torture, or interpersonal violence. Yet, the extents to which clinicians assess HI, and if so, what the associated characteristics are, are not well known. We analyzed 200 U.S.-based medico-legal affidavits using descriptive, multivariate regression, and thematic analysis. Head injury was documented in 38% of affidavits. Those who experienced physical violence were eight times likelier to experience HI than those who did not experience physical violence. Five themes emerged: (1) HI occurred commonly in the context of interpersonal violence (44%), followed by militarized violence (33%); (2) mechanisms of HI included direct blows to the head and asphyxiation, suggesting potential for both traumatic brain injury and brain injury from oxygen deprivation; (3) HI was often recurrent and concurrent with other physical injuries; (4) co-morbid psychiatric and post-concussive symptoms made it challenging to assess neurological and psychiatric etiologies; and (5) overall, there was a paucity of assessments and documentation of HI and sequelae. Among individuals assessed for asylum claims, HI is common, often recurrent, occurring in the context of interpersonal violence, and concurrent with psychological and other physical trauma. Physical violence is an important risk factor for HI, which should be assessed when physical violence is reported.
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页数:12
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