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Published in: Social Psychiatry and Psychiatric Epidemiology 4/2015

01-04-2015 | Original Paper

Psychological distress in torture survivors: pre- and post-migration risk factors in a US sample

Authors: Suzan J. Song, Charles Kaplan, Wietse A. Tol, Andrew Subica, Joop de Jong

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 4/2015

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Abstract

Purpose

To investigate the relationships between sociodemographic, pre- and post-migration variables with prevalence of psychological distress and global functioning in a heterogeneous sample of torture survivors.

Methods

Clients referred from resettlement agencies via the Office of Refugee Resettlement (ORR) to a community clinic in the United States (N = 278) were interviewed with structured, translated questionnaires. Univariate and multivariate logistic regression analyses determined the associations of sociodemographic, pre-, and post-migration risk factors with posttraumatic stress disorder (PTSD), depression, anxiety, and global functioning.

Results

Regression data indicate that length of time between arrival in US and clinical services was significantly associated with PTSD and depression; participants receiving services after 1 year of resettlement were more likely to experience PTSD (adjusted OR = 3.29) and depression (adjusted OR = 4.50) than participants receiving services within 1 year. Anxiety was predicted by female gender (adjusted OR = 3.43), age over 40 years (adjusted OR = 3.12), Muslim religion (adjusted OR = 2.64), and receiving medical services (AOR 3.1). Severely impaired global functioning was associated with female gender (adjusted OR = 2.75) and unstable housing status (adjusted OR = 2.21).

Conclusion

Findings highlight the importance of examining post-migration variables such as length of time in country prior to receiving services in addition to pre-migration torture history upon relocated torture survivors. Clinicians and policy-makers should be aware of the importance of early mental health screening and intervention on reducing the psychiatric burden associated with torture and forced relocation.
Literature
1.
go back to reference Convention against torture and other cruel, inhuman or degrading treatment or punishment, GA res. 39/46, Annex, 10 Dec. 1984 Convention against torture and other cruel, inhuman or degrading treatment or punishment, GA res. 39/46, Annex, 10 Dec. 1984
3.
go back to reference Fazel MW (2005) Prevalence of serious mental disorders in 7000 refugees resettled in western countries: a systematic review. Lancet 365(9467):9–15CrossRef Fazel MW (2005) Prevalence of serious mental disorders in 7000 refugees resettled in western countries: a systematic review. Lancet 365(9467):9–15CrossRef
4.
go back to reference Llosa A, Ghantous Z, Souza R, Forgione F, Bastin P, Jones A et al (2014) Mental disorders, disability and treatment gap in a protracted refugee setting. BJP 204:208–213CrossRef Llosa A, Ghantous Z, Souza R, Forgione F, Bastin P, Jones A et al (2014) Mental disorders, disability and treatment gap in a protracted refugee setting. BJP 204:208–213CrossRef
5.
go back to reference Nickerson A, Liddell B, Maccallum F, Steel Z, Silove D, Bryant R (2014) Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss. BMC Psychiatry 14:106–117CrossRefPubMedCentralPubMed Nickerson A, Liddell B, Maccallum F, Steel Z, Silove D, Bryant R (2014) Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss. BMC Psychiatry 14:106–117CrossRefPubMedCentralPubMed
6.
go back to reference Silove D (1999) The psychosocial effects of torture, mass human rights violations and refugee trauma: Toward an integrated conceptual framework. J Nerv Mental Dis 187:200–207CrossRef Silove D (1999) The psychosocial effects of torture, mass human rights violations and refugee trauma: Toward an integrated conceptual framework. J Nerv Mental Dis 187:200–207CrossRef
7.
go back to reference Mollica RF, Sarajlic N, Chernott M, Lavelle J (2001) Longitudinal study of psychiatric symptoms, disability, mortality and emigration among Bosnian refugees. JAMA 286:546–554CrossRefPubMed Mollica RF, Sarajlic N, Chernott M, Lavelle J (2001) Longitudinal study of psychiatric symptoms, disability, mortality and emigration among Bosnian refugees. JAMA 286:546–554CrossRefPubMed
8.
go back to reference Mollica RF, Cui X, Massagli MP (2002) Science-based policy for psychosocial interventions in refugee camps. J Nerv Mental Dis 190:158–166CrossRef Mollica RF, Cui X, Massagli MP (2002) Science-based policy for psychosocial interventions in refugee camps. J Nerv Mental Dis 190:158–166CrossRef
9.
go back to reference Ezard N (2012) Substance use among populations displaced by conflict: a literature review. Disasters 36(3):533–557CrossRefPubMed Ezard N (2012) Substance use among populations displaced by conflict: a literature review. Disasters 36(3):533–557CrossRefPubMed
10.
go back to reference de Jong J (2002) Public mental health, traumatic stress and human rights violations in low-income countries. In: de Jong J (ed) Trauma, war, and violence: public mental health in socio-cultural context. Kluwer, New York, pp 1–91CrossRef de Jong J (2002) Public mental health, traumatic stress and human rights violations in low-income countries. In: de Jong J (ed) Trauma, war, and violence: public mental health in socio-cultural context. Kluwer, New York, pp 1–91CrossRef
11.
go back to reference Jaranson JM, Butcher J, Halcon L, Johnson DR, Robertson C, Savik K et al (2004) Somali and Oromos refugees: correlates of torture and trauma history. Am J Pub Health 94:591–598CrossRef Jaranson JM, Butcher J, Halcon L, Johnson DR, Robertson C, Savik K et al (2004) Somali and Oromos refugees: correlates of torture and trauma history. Am J Pub Health 94:591–598CrossRef
12.
go back to reference Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302(5):537–549CrossRefPubMed Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302(5):537–549CrossRefPubMed
13.
go back to reference Mollica RF, Shoeb M, Weinstein H (2007) The Harvard trauma questionnaire: adapting a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Iraqi refugees. Int J Soc Psychiatry 53(5):447–463CrossRefPubMed Mollica RF, Shoeb M, Weinstein H (2007) The Harvard trauma questionnaire: adapting a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Iraqi refugees. Int J Soc Psychiatry 53(5):447–463CrossRefPubMed
14.
go back to reference Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik I (2006) Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry 188:58–64CrossRefPubMed Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Susljik I (2006) Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry 188:58–64CrossRefPubMed
15.
go back to reference Weine SM, Henderson SW (2005) Rethinking the role of posttraumatic stress disorder in refugee mental health services. In: Corales TA (ed) Trends in posttraumatic stress disorder research. Nova Science Publishers, Hauppaguge, New York Weine SM, Henderson SW (2005) Rethinking the role of posttraumatic stress disorder in refugee mental health services. In: Corales TA (ed) Trends in posttraumatic stress disorder research. Nova Science Publishers, Hauppaguge, New York
16.
go back to reference Quiroga B (2004) Health challenges of refugees and immigrants. Refugee Reports 25(2) Quiroga B (2004) Health challenges of refugees and immigrants. Refugee Reports 25(2)
17.
go back to reference Miller R, Rasmussen A (2010) War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med 70:7–16CrossRefPubMed Miller R, Rasmussen A (2010) War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med 70:7–16CrossRefPubMed
18.
go back to reference Ellis BH, MacDonald H, Lincoln A, Cabral H (2008) Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. J Consult Clin Psychology 76(2):184–193CrossRef Ellis BH, MacDonald H, Lincoln A, Cabral H (2008) Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. J Consult Clin Psychology 76(2):184–193CrossRef
19.
go back to reference Miller KE, Weine S, Ramic A, Brkic N, Djuric Bjedic Z, Smajkic A et al (2002) The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. J Trauma Stress 15:377–387CrossRefPubMed Miller KE, Weine S, Ramic A, Brkic N, Djuric Bjedic Z, Smajkic A et al (2002) The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees. J Trauma Stress 15:377–387CrossRefPubMed
20.
go back to reference Montgomery E (2008) Long-term effects of organized violence on young Middle Eastern refugees’ mental health. Soc Sci Med 67:1596–1603CrossRefPubMed Montgomery E (2008) Long-term effects of organized violence on young Middle Eastern refugees’ mental health. Soc Sci Med 67:1596–1603CrossRefPubMed
21.
go back to reference Porter M, Haslam N (2005) Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons. JAMA 294(5):602–612CrossRefPubMed Porter M, Haslam N (2005) Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons. JAMA 294(5):602–612CrossRefPubMed
22.
go back to reference Silove D, Steel Z, McGorry P, Miles V et al (2002) The impact of torture on post-traumatic stress symptoms in war-affected Tamil refugees and immigrants. Comp Psych 43(1):49–55CrossRef Silove D, Steel Z, McGorry P, Miles V et al (2002) The impact of torture on post-traumatic stress symptoms in war-affected Tamil refugees and immigrants. Comp Psych 43(1):49–55CrossRef
23.
go back to reference Thabet A, Vostanis P (2000) Post-traumatic stress disorder reactions in children of war: a longitudinal study. Child Abuse Neg 24:291–298CrossRef Thabet A, Vostanis P (2000) Post-traumatic stress disorder reactions in children of war: a longitudinal study. Child Abuse Neg 24:291–298CrossRef
24.
go back to reference Steel Z, Silove D, Phan T, Bauman A (2002) Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population based study. Lancet 360:1056–1062CrossRefPubMed Steel Z, Silove D, Phan T, Bauman A (2002) Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population based study. Lancet 360:1056–1062CrossRefPubMed
25.
go back to reference Kubiak S (2005) Trauma and cumulative adversity in women of a disadvantaged social location. Am J Orthopsychiatry 75:451–465CrossRefPubMed Kubiak S (2005) Trauma and cumulative adversity in women of a disadvantaged social location. Am J Orthopsychiatry 75:451–465CrossRefPubMed
26.
go back to reference Laban CJ, Gernaat HB, Komproe IH, Schreuders BA, DeJong JT (2004) Impact of a long asylum procedure on the prevalence of psychiatric disorders in the Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 192:843–851CrossRefPubMed Laban CJ, Gernaat HB, Komproe IH, Schreuders BA, DeJong JT (2004) Impact of a long asylum procedure on the prevalence of psychiatric disorders in the Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 192:843–851CrossRefPubMed
27.
go back to reference Rutter M (2012) Resilience: casual pathways and social ecology. In: Ungar M (ed) The social ecology of resilience: a handbook of theory and practice. Springer, New York, pp 33–42CrossRef Rutter M (2012) Resilience: casual pathways and social ecology. In: Ungar M (ed) The social ecology of resilience: a handbook of theory and practice. Springer, New York, pp 33–42CrossRef
28.
go back to reference Tol WA, Song S, Jordans M (2013) Annual Research Review: resilience and mental health in children and adolescents living in areas of armed conflict—a systematic review of findings in low- and middle-income countries. J Child Psychology Psych 54(4):445–460CrossRef Tol WA, Song S, Jordans M (2013) Annual Research Review: resilience and mental health in children and adolescents living in areas of armed conflict—a systematic review of findings in low- and middle-income countries. J Child Psychology Psych 54(4):445–460CrossRef
29.
go back to reference Almedom AM, Tumwine JK (2008) Resilience to disasters: a paradigm shift from vulnerability to strength. Af Health Sci 8(2):1–4 Almedom AM, Tumwine JK (2008) Resilience to disasters: a paradigm shift from vulnerability to strength. Af Health Sci 8(2):1–4
30.
go back to reference Weathers FW, Litz B, Herman D, Huska J, Keane T (1993) The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In: Paper presented at the 9th annual conference of the ISTSS, San Antonio, TX Weathers FW, Litz B, Herman D, Huska J, Keane T (1993) The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. In: Paper presented at the 9th annual conference of the ISTSS, San Antonio, TX
31.
go back to reference Winokur A, Winokur D, Rickels K, Cox D (1984) Symptoms of emotional distress in family planning service: stability over a four-week period. Brit J Psych 144:395–399CrossRef Winokur A, Winokur D, Rickels K, Cox D (1984) Symptoms of emotional distress in family planning service: stability over a four-week period. Brit J Psych 144:395–399CrossRef
32.
go back to reference Derogatis L, Lipman R, Rickels K, Uhlenhuth E, Covi L (1974) The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci 19(1):1–15CrossRefPubMed Derogatis L, Lipman R, Rickels K, Uhlenhuth E, Covi L (1974) The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci 19(1):1–15CrossRefPubMed
34.
go back to reference Laban CJ, Gernaat HB, Komproe IH, De Jong JT (2007) Prevalence and predictors of health service use among Iraqi asylum seekers in the Netherlands. Soc Psy Psych Epi 42:837–844CrossRef Laban CJ, Gernaat HB, Komproe IH, De Jong JT (2007) Prevalence and predictors of health service use among Iraqi asylum seekers in the Netherlands. Soc Psy Psych Epi 42:837–844CrossRef
35.
go back to reference Hobfoll S (1989) Conservation of resources: a new attempt at conceptualizing stress. Am Psychol 44:513–524CrossRefPubMed Hobfoll S (1989) Conservation of resources: a new attempt at conceptualizing stress. Am Psychol 44:513–524CrossRefPubMed
36.
go back to reference Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z (1997) Anxiety, depression, and PTSD in asylum-seekers: associations with pre-migration trauma and post-migration stressors. Brit J Psych 170:351–357CrossRef Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z (1997) Anxiety, depression, and PTSD in asylum-seekers: associations with pre-migration trauma and post-migration stressors. Brit J Psych 170:351–357CrossRef
37.
go back to reference McGorry P, van Os J (2013) Redeeming diagnosis in psychiatry: timing versus specificity. Lancet 381:343–345CrossRefPubMed McGorry P, van Os J (2013) Redeeming diagnosis in psychiatry: timing versus specificity. Lancet 381:343–345CrossRefPubMed
38.
go back to reference Hollifield M, Warner TD, Lian N et al (2002) Measuring trauma and health status in refugees: a critical review. JAMA 288(5):611–621CrossRefPubMed Hollifield M, Warner TD, Lian N et al (2002) Measuring trauma and health status in refugees: a critical review. JAMA 288(5):611–621CrossRefPubMed
Metadata
Title
Psychological distress in torture survivors: pre- and post-migration risk factors in a US sample
Authors
Suzan J. Song
Charles Kaplan
Wietse A. Tol
Andrew Subica
Joop de Jong
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 4/2015
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-014-0982-1

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