Several reviews have found that psychological trauma affects access to health care services, including mental health care, in the general population. People from refugee and asylum seeker backgrounds are more likely to have a mental illness than the general population, and experience a broad range of barriers and facilitators to service access. However, to date there has been no comprehensive consideration of the potential effect of psychological trauma on access to primary health care within this population. This paper provides a mixed-methods systematic review of literature which included any consideration of the relationship between psychological trauma and access to primary health care. A systematic search of Medline, PsychInfo, Scopus, Web of Science, Embase, CINAHL and Cochrane Library was conducted. Study eligibility criteria were empirical, peer-reviewed studies that considered the relationship between psychological trauma and access to, or use of, primary healthcare in resettlement countries for refugees (including asylum seekers). Papers were required to be written in English and published between 1998 and August 2019. Quality was assessed using the Multi-Methods Appraisal Tool. The search identified a total of 14 eligible studies (11 quantitative and 3 qualitative) which had explored this relationship in refugee and asylum seeker populations. Overall, synthesis of findings indicated variable results with respect to the impact of psychological trauma on service access. Specifically, the review found that while rates of psychological trauma were high. Key themes were that while general health care access was comparable or greater than the general population, rates of mental healthcare specifically were low. In addition, included papers identified a range of barriers to service access—particularly somatisation, stigma and healthcare provide knowledge about psychological trauma. While there is a critical need for more research in this area, the study points to several key recommendations including training of general practitioners in relation to psychological trauma, ensuring culturally responsive services, and the use of interpreters. Finally, due to the levels of somatisation found in some studies, ensuring general practitioners understand the somatic element of psychological trauma—particularly within some groups of people from refugee backgrounds—is important.

中文翻译：

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来自难民和寻求庇护者背景的人的心理创伤和获得初级保健的机会：混合方法系统评价。

几项评论发现，心理创伤会影响普通人群获得医疗保健服务的机会，包括心理保健服务。来自难民和寻求庇护者背景的人比一般人群更有可能患有精神疾病，并且在获得服务方面遇到广泛的障碍和促进因素。然而，迄今为止，还没有全面考虑心理创伤对该人群获得初级卫生保健的潜在影响。本文提供了对文献的混合方法系统回顾，其中包括对心理创伤与获得初级卫生保健之间关系的任何考虑。对 Medline、PsychInfo、Scopus、Web of Science、Embase、CINAHL 和 Cochrane Library 进行了系统检索。研究资格标准是经验性的，同行评议的研究考虑了心理创伤与难民（包括寻求庇护者）在重新安置国获得或使用初级保健之间的关系。论文必须用英文撰写，并在 1998 年至 2019 年 8 月期间发表。使用多方法评估工具评估质量。搜索共确定了 14 项符合条件的研究（11 项定量研究和 3 项定性研究），这些研究探讨了难民和寻求庇护者群体中的这种关系。总体而言，研究结果的综合表明，心理创伤对服务获取的影响存在可变结果。具体来说，审查发现，虽然心理创伤的发生率很高。关键主题是，虽然一般医疗保健的可及性与一般人群相当或更高，特别是精神保健的比率很低。此外，纳入的论文确定了一系列服务获取障碍——特别是躯体化、污名化和医疗保健提供了有关心理创伤的知识。虽然迫切需要在该领域进行更多研究，但该研究指出了几项关键建议，包括对全科医生进行心理创伤培训、确保提供符合文化要求的服务以及使用口译员。最后，由于在一些研究中发现的躯体化水平，确保全科医生了解心理创伤的躯体因素——尤其是在某些难民背景人群中——是很重要的。污名和医疗保健提供有关心理创伤的知识。虽然迫切需要在该领域进行更多研究，但该研究指出了几项关键建议，包括对全科医生进行心理创伤培训、确保提供符合文化要求的服务以及使用口译员。最后，由于在一些研究中发现的躯体化水平，确保全科医生了解心理创伤的躯体因素——尤其是在某些难民背景人群中——是很重要的。污名和医疗保健提供有关心理创伤的知识。虽然迫切需要在该领域进行更多研究，但该研究指出了几项关键建议，包括对全科医生进行心理创伤培训、确保提供符合文化要求的服务以及使用口译员。最后，由于在一些研究中发现的躯体化水平，确保全科医生了解心理创伤的躯体因素——尤其是在某些难民背景人群中——是很重要的。以及口译员的使用。最后，由于在一些研究中发现的躯体化水平，确保全科医生了解心理创伤的躯体因素——尤其是在某些难民背景人群中——是很重要的。以及口译员的使用。最后，由于在一些研究中发现的躯体化水平，确保全科医生了解心理创伤的躯体因素——尤其是在某些难民背景人群中——是很重要的。