BMC Public Health 2009, 9:214 http://www.biomedcentral.com/1471-2458/9/214 Table 4: Utilisation of health services and medication use according to residence status Health Care Services (contact with service in previous period stated) Refugees Asylum Seekers Unadjusted OR(95%CI) P Value (n = 28) (n = 60) (%) (%) G.P. (2 months) Hospitalisation (12 months) Specialist (2 months) Mental Health (12 months) Dentist Medications (in last 14 days) Any medication Analgesics & antipyretics Sedatives & sleeping tablets Antidepressants Other medications (Table 4), with asylum seekers utilising GP services more than refugees. A recent study from the Netherlands [24], reported on health service use of Iraqi asylum seekers and found the same unmet health need, with a high percent- age of those with psychiatric disorders not utilising men- tal health services. Another study from the Netherlands on refugees and asylum seekers reported no differences in these two groups in terms of self reported use of health care services. They also reported that both these groups may experience problems with accessing mental health care due to cultural and/or language barriers [25]. Overall it is still unclear if asylum seekers are not being offered adequate mental health services (due to lack of availability or communication problems) or if they are unwilling to use them for cultural or personal reasons. What is clear is that there is an issue of unmet health need within this population that ought to be clarified and addressed. A recent study from the UK on refugees' mental health needs suggested that refugees have a relatively high level of mental health services need but a low level of serv- ice utilisation, with GP services being the most utilized service [26]. Shortcomings of present study The size of our study was relatively small and confined to a geographic area in the North West of Ireland. This region of Ireland has a relatively small population compared to 14 (50.0) 4 (14.3) 6 (21.4) 2 (7.1) 8 (28.6) 17 (60.7) 13 (46.4) 3 (10.7) 3 (10.7) 11 (39.3) 44 (73.3) 12 (20.0) 17 (28.3) 9 (15.0) 13 (21.7) 43 (71.7) 32 (53.3) 11 (18.3) 13 (21.7) 31 (51.7) 2.8 (1.1–7.0) 1.5 (0.4–5.2) 1.5 (0.5–4.2) 2.3 (0.5–11.4) 0.7 (0.3–1.9) 1.6 (0.6–4.2) 1.3 (0.5–3.2) 1.8 (0.5–7.3) 2.3 (0.6–8.9) 1.7 (0.7–4.1) 0.03 0.52 0.49 0.31 0.48 0.31 0.55 0.37 0.22 0.28 the capital city, Dublin (90,000 compared to 1.2 million in 2006 [27]) and would not be ethnically diverse. It is therefore possible that refugees or asylum seekers in this region undergo a different level or type of post migration stress compared to those who remain in a large city such as Dublin. However, there is a lack of studies comparing the health status of asylum seekers and refugees especially in the Irish context. Other explanatory variables could have been included in our analysis. For example unem- ployment is known to have a detrimental effect on a per- sons mental health [28], and therefore this could have been explored in the refugee group. One of the strengths of this study is the use of validated instruments, which have been developed or adapted for cross cultural studies [5,6]. We chose cut-off scores for these instruments that are commonly used so our results would be directly comparable to other studies. However, we acknowledge that the instruments and the cut-points used have not been validated in our population, which was community based and contained a wide range of nationalities. Future studies Our study suggests that more research is needed on the effect of the asylum process on mental health and that interventions are needed that reduce post migration stres- sors or introduce coping strategies. Page 8 of 10 (page number not for citation purposes)