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Abstract Rabia Çinar (2022)

Background
There are around 78.000 refugees who recently received a staying permit in the Netherlands of whom about 35% are under the age of 18. They are at risk for mental health problems due to traumatic experiences in the past, as well as unfavourable living circumstances in the Netherlands (poverty, discrimination etc). Timely recognition and treatment of psychosocial problems prevents the development of more severe disorders in the future. As gatekeeper to the healthcare system, General Practitioners (GPs) could play an important role in this, however evidence shows that they struggle to discuss psychosocial problems with refugees and refugees seldom mention these themselves. . The empowerment project aims to increase the person-centred cultural sensitive skills and interprofessional collaboration of GPs and Mental Health Nurses to improve timely recognition, discussion and effective guidance of mental distress in refugee youth. We hypothesised that 1) the number of General Practice consultations in which mental health is being discussed is lower in contacts with refugee minors than in contacts with other minors and 2) an intervention aimed at improving GPs discussion of and care for mental health problems in refugee minors will increase the number of GP consultations in which mental health is being discussed with refugee minors.

Methods
This quantitative, retrospective cohort study is carried out in four General Practices in the Netherlands whose caregivers were trained during the Empowerment project. To find an answer to the second research question, an extensive intake is conducted as an intervention. The intervention is performed as a stepped wedge design study. Patient records are viewed and analysed descriptive. For the primary outcome measure, a generalized linear mixed model is used.

Results
152 refugees from 21 different countries were identified in a total of 16394 patients. Refugee minors consulted the GP less often than the controls. Language and speech deficiency was diagnosed more often by refugee minors. The number of discussions about mental health problems by the GP with refugee minors before and after the intervention is compared. The number of psychological diagnoses quadrupled in the period between 2019 and 2021 compared to the period between 2014 and 2019. In the controls, this difference was 2.5 times. The discussions about mental health with refugees were doubled during the intervention period compared with the control period. However, this increase is not significant.

Conclusion
The intervention doubled the number of mental health discussions by the GP with refugee minors/their parents. This increase was not significant, but there was still a trend in the right direction. Also the number of psychological diagnoses are increased in the intervention period. So, it seems likely that the person-centred cultural sensitive intake has a positive effect on the discussion of mental health problems with refugee minors.

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