DOI: 10.5061/dryad.bvq83bk5h
title: Head injuries, traumas, and neuropsychiatric sequela in asylum seekers

description: Importance: Asylum seekers experience a high burden of physical and
 psychological trauma, yet there is a scarcity of literature regarding the
 epidemiology and sequelae of head injury (HI) in asylum seekers.
 Objective: To examine head injury prevalence and related neuropsychiatric
 comorbidities in asylum seekers. Methods: A retrospective cross-sectional
 study through review of 139 medical affidavits from an affidavit database
 was performed. Affidavits written from 2010 – 2018 were included.
 Demographic and case-related data were collected and classified based on
 the presence of head injury. Primary study outcome measurement was
 prevalence of head injury and headache. Secondary outcomes included the
 neuropsychiatric sequelae of head injury including depression, PTSD,
 anxiety, memory/concentration deficits, and the prevalence of abusive and
 traumatic history. Hypothesis and outcome measures were determined before
 data extraction. Results: One hundred and thirty-nine medical affidavits
 of asylum seekers were included in the study. The mean age was 27.4±12.1,
 56.8% identified as female, 28.1% were &lt;18 years. Almost half
 (42.5%) explicitly self-reported history of head injury. Compared to
 clients who did not report head injury, clients with head injury were
 older (31.4 vs 24.4, 7.0 year difference; 95%CI [2.9, 10.9 years]) and
 more likely to report a history of headache (62.7% vs 28.8%, 33.9%
 difference; 95%CI [20.0, 47.8%], p&lt;.001), physical abuse (91.5% vs
 65.0%, 26.5% difference; 95%CI [12.8, 38.5%];), physical trauma (96.6% vs
 66.3%, 30.4% difference; 95%CI [17.9, 41.5%]), concussion (22.0% vs 0.0%,
 22% difference; 95%CI [12.2, 34.1%]), and loss of consciousness (27.1% vs
 0.0%, 27.1% difference; 95%CI [16.4, 39.6%]). Moreover, clients with head
 injuries were more likely to suffer neuropsychological sequelae such as
 memory/concentration deficits (45.8% vs 28.8%, 17.0% difference; 95%CI
 [0.8, 33.2%]), and depression (83.1% vs 65%, 18.1% difference; 95%CI [3.0,
 33.2%]).
description: <i>Human Rights Clinic</i>
             The
 Human Rights Clinic of Miami (HRCM) provides pro bono
 clinical evaluations and medical affidavits for individuals seeking asylum
 in the United States. Medical affidavits are physician-generated, legal
 documents utilized in immigration court to provide objective clinical
 corroboration of a client’s narrative. Clients applying for asylum are
 connected to the HRCM through pro bono legal representatives and are
 interviewed for 2-3 hours by a physician and medical interpreter. To
 remain an objective entity, the organization does not provide medical
 care. <i>Data collection</i>
 In this study, consecutive
 medical affidavits written by physicians at the HRCM from January
 1<sup>st</sup>, 2010 to April 31<sup>st</sup>,
 2018 were independently reviewed by two investigators to extract relevant
 demographics and case information. Medical affidavits contained the
 results of PTSD (Primary Care PTSD Screen, DSM IV, and PCL-4), depression
 (HAMD, PHQ-9, and DSM IV criteria), and anxiety (GAD-7)
 screens.  Variables were marked as present only if they
 were explicitly reported in the affidavit and were experienced for a
 significant period. <i>Statistical
 analysis</i> Clients were classified into two
 groups based on the presence or absence of HI. Summary statistics and
 comparative analyses were performed using JMP-Pro version 14.0.0 (SAS
 Institute Inc., Cary, NC). Continuous variables were analyzed using a
 <i>t </i>test and categorical variables were analyzed using a
 Pearson’s chi-squared test. All tests were two-tailed, and a <i>P
 </i>value of &lt;0.05 was considered statistically
 significant. <i>Standard Protocol Approvals,
 Registrations, and Patient Consents</i>
 <i>            </i>All clients provided informed
 consent and were de-identified for research purposes. The University of
 Miami Institutional Review Board approved this investigation.