BMC Public Health 2009, 9:214 http://www.biomedcentral.com/1471-2458/9/214 Table 3: Final regression model showing factors associated with PTSD and depression/anxiety symptoms Characteristics PTSD Symptoms Depression/Anxiety Symptoms Residence Status Refugees compared to Asylum Seekers Pre migration Stressors 0–7 compared to = 8 Post migration Stressors <2.5 compared to = 2.5 Chronic Conditions 0–1 compared to >1 Adjusted OR(95%CI) P Value Adjusted OR(95%CI) P Value 2.5 (0.6 – 10.0)a 3.6 (1.1 – 11.9)b 17.3 (4.9 – 60.8)b 4.0 (1.3 – 12.7)b 0.19 0.04 P < 0.01 0.02 3.0 (0.9 – 9.8) 3.3 (1.0 – 10.4) 3.9 (1.2 – 12.3) 3.4 (1.2–10.1) 0.08 0.04 0.02 0.03 a is the adjusted OR for the model containing residence status. b is the adjusted OR after removal of residence status from the model. For both regression models; residence status, post migration stressors, pre migration stressors and the presence of >1 chronic condition was entered into the model. In the PTSD model, the final regression model retained post migration stressors, pre migration stressors and chronic conditions, while the depression/anxiety regression model retained all three explanatory variables. OR Odds ratio, CI confidence interval, PTSD post traumatic stress disorder lower level of education compared to refugees (Table 1). In terms of health outcomes, asylum seekers appear to have a similar level of general health to refugees but they are more likely to suffer from symptoms of PTSD and depression/anxiety (Table 2). Higher levels of pre and post migration stressors and the presence of more than one chronic disease are independently associated with PTSD and anxiety/depression (Table 3). After adjusting for pre and post migration stressors and the presence of chronic conditions, residence status is no longer associ- ated with PTSD or depression/anxiety, suggesting that res- idence status acts as a marker for other explanatory variables. As there is a strong relationship between resi- dence status and post migration stressors (Table 1), it is likely that residence status acts as a marker for levels of post migration stressors. In terms of health care utilisation, asylum seekers were found to use GP services more often than refugees. There was no statistically significant difference between these groups for use of dentists, medication, hospitalisation or mental health services. Context of other studies The association between pre and post migration stressors and self reported mental health shown in this study (Table 2 and 3) supports the findings of other studies [13,16-20] and implies that mental health problems often develop and/or increase after arrival in Ireland. Factors such as social isolation, lack of work, cultural shock, lan- guage barriers, asylum procedure stress, fear of deporta- tion and separation from children, have been suggested to be the major causes of post migration stress [16,17,20]. The association between residence status and mental health status (PTSD, depression/anxiety) in this study (Table 2) has also been shown in other countries [7,13], with asylum seekers having a higher level of self reported mental health problems. A long asylum procedure has also been associated with an increase in psychiatric disor- ders [21,22]. This association could be due to a number of factors including refugees feeling more a part of the com- munity and more in control of their daily lives and subse- quently suffering from lower levels of post migration stressors. A review on the prevalence of mental disorders in refugees reported the prevalence of PTSD ranging from 2% in Viet- namese/Chinese refugees to 45% in Cambodian refugees [1], in this study the prevalence was 21.4% (Table 2). The high variability in prevalence rates may be due to differ- ences between countries in their treatment of refugees or it could be due to the use of different tools to assess the presence of PTSD and depression/anxiety symptoms in the different studies. The prevalence was relatively high in this study compared to studies carried out in other Euro- pean countries [2,7,13]. A recent study from Ireland reported that asylum seekers were five times more likely to be diagnosed with psychiatric illness than Irish Citizens [23]. Considering the higher level of self reported mental health problems among asylum seekers, it might be expected that this group would utilise mental health serv- ices more often. However, that was not the case in this study and health service utilisation only differed between refugees and asylum seekers in the use of GP services Page 7 of 10 (page number not for citation purposes)