Pauline Anderson

May 16, 2016

ATLANTA ― Mental health problems occur after any major disaster, and the ongoing Syrian refugee crisis is no exception.

However, in contrast to Hurricane Katrina or the earthquake in Haiti, which involved a "static population" and in which the injuring event came to an end, the Syrian situation involves "a transient population where the crisis isn't over" and in which refugees have a "migration mentality," said Nicole Nguyen Perras, MD, who is in fourth-year psychiatry residency at George Washington University Hospital, Washington, DC.

For this kind of crisis, "traditional psychiatric intervention is unlikely to be helpful," Dr Perras said at a press briefing here at the American Psychiatric Association (APA) 2016 Annual Meeting.

Along with her colleagues, Dr Perras spent November and December 2015 on a fact-finding mission among Syrian refugees. In the first 9 months of 2015, an estimated 500,000 refugees passed through Greece in an attempt to reach Western Europe.

Dr Nicole Nguyen Perras

The team concentrated on two islands with the largest number of refugees – Lesbos, which at the time was getting 5000 to 7000 refugees a day, and Chios, which was receiving about 1000 a day.

Information Gathering

Despite a language barrier, Dr Perras and her colleagues talked to as many people and amassed as much information as possible about psychological and social problems, as well as practical issues, such as how people were coming to the camps, how much it cost to get across the Aegean Sea, and what exactly the refugees were leaving behind.

She described the refugees as having a "migration mentality," characterized as being in a kind of psychological limbo. Their symptoms, she said, would likely only emerge later, when the refugees were settled at their final destination.

"Migration mentality means everyone was focused on getting to the next place. There was no stopping. There was no trying to kind of figure things out. It was all about, 'All right, now we're here. What's the next move?' "

The refugee experience is "incredibly traumatizing," Dr Perras stated. This, she said, became apparent in little "bits." For example, a refugee would present to a physician for some minor physical problem, and after speaking for just a minute, would "crumble into a puddle."

"This is definitely something that, when they are able to, and when they have any reserve to start dealing with some of this, will be difficult."

There were a lot of "breakdown panic attacks," reflecting just how "really worried" these people were, she said.

What was absent, she said, were primary psychiatric illnesses or use of psychiatric medications. She noted that there was "a lot of somatization of stress, as one would imagine."

Leaky Boats

The biggest medical problem was hypothermia, resulting from refugees coming across on leaky and crowded boats. Other medical disorders included burns and war injuries, both physical and mental.

Social problems included child marriages, families "marrying their daughters off to older men," unaccompanied minors (parents having sent their children away in the hopes they would find a better life), and domestic violence, said Dr Perras.

The group offered some recommendations, one of the most important being to address Maslow's Hierarchy of Needs.

"If they're wet and cold, get them warm and dry. Do not debrief them on the beach. Do not try to talk about their trauma," said Dr Perras.

Perhaps the best thing for the refugees "was to support their migration mindset," she said.

"Trying to help them though the trauma and process it in the traditional way was not going to serve them at this time because they had to keep moving, and so we tried to do anything we could to support that."

This included making sure that the refugees had the information they needed, that they knew where to go, and that their families were kept together.

Another important recommendation, said Dr Perras, was not to "overpathologize" the refugees' cathartic panic attacks and to "try to keep them as resilient as possible" until they reached their destination, at which point "traditional psychiatry would probably be more helpful."

Recommendations for volunteers included training in "psychological first aid" and in "hop-mobilization techniques."

Asked how she herself coped with the unique Syrian refugee crisis, Dr Perras said, "It definitely was a challenge."

The last day of her work there was the day of the terrorist attacks in Paris. "It had a huge impact on me," she said.

Press briefing moderator Jeffrey Bernstein, MD, editor-in-chief, Psychiatric News, and president and CEO of the Brain and Behavior Research Foundation, thanked Dr Perras and her team for their "heroic humanitarian effort."

"I think we all applaud your willingness to go so far to help people."

No relevant financial relationships have been disclosed.

American Psychiatric Association (APA) 2016 Annual Meeting: Abstract 40, presented May 14, 2016.

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