Daily occupations among asylum seekers- Experience, performance and perception
Sammanfattning: Asylum seekers often find themselves in a situation where the structure and content of daily occupations have been disrupted and they might have limited access to paid work and education. Studies have shown that asylum seekers experience occupational depri- vation and a change in daily occupations which might even influence their identity. Such deprivation can eventually lead to dissatisfaction with everyday life and to occupational dysfunction, i.e. a decline in ADL ability. Asylum seekers are a group who are more likely to suffer from health problems than the background population. Especially torture survivors suffer from ill health. Pain and psychological symptoms are among the most frequent health issues for both asylum seekers and torture survivors and may cause occupation-related problems. The overarching aim of this thesis was to investigate how staying in an asylum centre influenced occupations on three levels – the experience of occupational deprivation, satisfaction with daily occupations and performance of ADL tasks and whether occupational satisfaction and performance changed over a ten month period. As there are often torture survivors among asylum seekers, another aim was to assess whether torture had an influence on the occupational satisfaction and performance, and whether this had changed after ten months. Forty-three asylum seekers from Afghanistan, Iran and Syria participated at baseline and ten months later 17 were available for inclusion in follow-up studies. Study I showed that the asylum seekers experienced occupational deprivation during detention, and had trouble maintaining former occupations due to limited access to activities. The results in Studies II-IV showed a high prevalence of torture survivors, high ratings of distress and low ratings of general well-being and health, all of which had associations to occupational satisfaction, activity level and occupational performance. Torture did not appear to have an influence on satisfaction with daily occupations, but physical torture could be a predictor of decline in ADL motor skills (Study III). On arrival the participants had difficulties performing ADL tasks and expressed low satisfaction with daily occupations. Ten months later there was a statistically and clinically significant decline in ADL performance, although not in satisfaction with daily occupations and activity level. A significant decline was also seen regarding self-rated health measures. However, there was no difference between tortured and non-tortured asylum seekers regarding ADL ability and self-rated health at baseline. Due to dropout at follow-up and a prevalence of torture survivors, this analysis could not be performed at the follow-up. 13 This thesis points at a need for developing adequate occupation-focused rehabilita- tion programmes for asylum seekers and torture survivors, in order to enable occupa- tion and prevent development of ill health for this specific group.
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