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Global Refugees Checklist
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Overview of Depression

Rates of depression are lower among new immigrants, but over time these rates rise to match the general population. The rate of depression among refugees is comparable to that in the general population, but more than half also have post-traumatic stress disorder, and this comorbidity can complicate the recognition of depression:

Key Recommendations:

Quality of Evidence: MODERATE

Balance of benefits and harms Values and preferences
  • The prevalence of depression is similar among Canadians and among immigrants and refugees (10.7%), but access to care may be limited for migrants.
  • The NNT to prevent one case of persistent depression was 18 (95% CI 10–91) in studies of 1–12 months' duration.
  • Treatment in enhanced depression-care models accounts for an additional 1%–2% reduction in depressive symptoms relative to usual care.
  • No data on harms were reported, which would include patients' out of-pocket costs and adverse effects of medication.

The committee attributed more value to:

  • screening and treating depression to improve quality of life

Attributed less value to:

  • concerns about impairing rapport in therapeutic relationships, cultural acceptability and potential stigma of diagnostic labels
  • the cost and inconvenience of additional follow-up assessments
  • the possible adverse effects or costs associated with treating patients with an incorrect diagnosis

Links to Other Learning Resources

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer L, Ueffing E, MacDonald N, Hassan G, McNally M, Kahn K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P and co-authors of the Canadian Collaboration for Immigrant and Refugee Health. Overview: Evidence-based clinical guidelines for immigrants and refugees. CMAJ 2011; 183(12):E824-E925.

Design and Production: Centre for e-Learning, Teaching and Learning Support Service (TLSS), University of Ottawa