Mental disorders, disability and treatment gap in a protracted refugee setting

Background Studies have shown high levels of distress and mental disorder among people living in refugee camps, yet none has confirmed diagnosis through clinical reappraisal. Aims To estimate the prevalence of mental disorders, related disability and treatment gap in adult refugees living in the Burj el-Barajneh camp. Method Randomly selected participants were screened by household representative (n = 7 48) and individual (n = 315) interviews; clinical reappraisal was performed on a subset (n = 19 4) of 326 selected participants. Weighted prevalence estimates and 95% confidence intervals were calculated. Results The prevalence of current mental disorders was 19.4% (95% CI 12.6-26.2); depression was the most common diagnosis (8.3%, 95% CI 4.4-12.2) and multiple diagnoses were common (42%) among the 88 persons with mental disorder. Lifetime prevalence of psychosis was 3.3% (95% CI 1.0-5.5). Mental disorders were associated with moderate to severe dysfunction (odds ratio=8.8, 95% CI 4.5-17.4). The treatment gap was 96% (95% CI 92-100). Conclusions A range of mental disorders and associated disability are common in this long-term refugee setting. Combined with an important treatment gap, findings support the current consensus-based policy to prioritise availability of mental health treatment in refugee camps, especially for the most severe and disabling conditions.