Twenty years ago, an estimated 200,000 Mayan refugees fled to Mexico from Guatemala. By 1984, 46,000 of them were under the protection of the United Nations High Commissioner for Refugees (UNHCR) in Chiapas. By 2000, 12,500 refugees and their Mexican-born children remained in 60 UNHCR refugee camps there.
In November and December 2000, researchers conducted a cross-sectional survey of 183 households in five of these Mayan refugee camps representing an estimated 1,546 residents to estimate the prevalence of mental illness and assess the need for mental health services. Interviews were conducted in Spanish and native languages where required using the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 (HSCL-25).
"Twenty years after a devastating war for the Maya people, the negative effects of trauma and living in refugee camps appear to be pervasive," said Miriam Sabin, UGA School of Social Work professor and principal investigator. "The UNHCR is in the process of phasing out programs in Chiapas since the refugees have been granted Mexican citizenship, so this study coincides with a new era for the Guatemalan refugees. It also calls attention to the need for mental health assistance to the millions of refugees worldwide who have been exposed to life-altering events."
Respondents reported experiencing a variety of 19 different traumatic events. All respondents reported experiencing at least one traumatic event personally with a mean of 8.3 traumatic events per respondent. The most frequently reported events were lack of food (94.7 percent), lack of water (85.9 percent) and lack of refuge or housing (85.3 percent). Overall, 55.9 percent also reported being close to death, 43.5 percent reported a family member or friend massacred, 45.9 percent reported experiencing the disappearance of others and 14 percent indicated being tortured.
"The atrocities of war affect all of us," said Larry Nackerud, interim dean at UGA's School of Social Work and co-author of the study. "There are 40 million refugees and displaced persons worldwide. The effects of their experience require attention whether outside our borders or inside."
Most prevalent were symptoms of anxiety. Fifty-four percent of respondents had elevated anxiety symptom scores, and 54 percent of those were female. Anxiety symptoms were associated with having experienced high numbers of traumatic events, specifically being wounded, imprisoned, sexually abused or raped, enduring forced separation from family or friends, or witnessing the disappearance of others, torture or massacre.
Nearly 12 percent of respondents qualified clinically as suffering from PTSD, and 65 percent of those were women. An additional 11.8 percent of respondents had all but one of the PTSD symptom criteria. Sufferers were more likely to have been close to death, to have witnessed an assassination, the disappearance of others, a massacre, or having been sexually abused or raped than those who did not have PTSD. They were also more likely to be living with 9 or more people and to have lived in 3 or more camps.
"People cope as well as they can," noted Sabin. "In our conversations, we found that refugees who witnessed other family members or community members being kidnapped appear to have poor mental health, despite the years since these events. Kidnappings, or disappearances as they are called in Latin America, were commonly used to eliminate enemies of governments and intimidate whole villages."
Thirty-nine percent of those surveyed had elevated symptoms of depression, and 68 percent of those respondents were female. Symptoms for depression were associated with being a woman, being a widow, witnessing the disappearance of others, experiencing torture or mutilation or experiencing between 13 and 19 traumatic events.
"The results of this survey are particularly important now since the UNHCR is phasing out programs," said Nackerud. "We do not know of any mental health programs available to the Guatemalan refugees, and it is painfully clear that they are still suffering from the wounds incurred in Guatemala 20 years ago or as a result of refugee camp life. Either way, a poor mental health status is making it more difficult for them to become productive members of the Mexican society."
Journal
JAMA