The Dose-Effect Relationships between Torture and Psychiatric Symptoms in Vietnamese Ex-Political Detainees and a Comparison Group

Harvard Program in Refugee Trauma, Harvard School of Public Health, Cambridge, Massachusetts 02138, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 10/1998; 186(9):543-53. DOI: 10.1097/00005053-199809000-00005
Source: PubMed


The purpose of this study was to determine in Vietnamese ex-political detainees newly arrived into the United States a) the prevalence of torture and psychiatric symptoms and b) the dose-effect relationships between cumulative torture experience and the psychiatric symptoms of posttraumatic stress disorder (PTSD) and major depression. The study population included Vietnamese ex-political detainees (N = 51) and a comparison group (N = 22). All respondents received culturally validated instruments with known psychometric properties including Vietnamese versions of the Hopkins Symptom Checklist-25 and the Harvard Trauma Questionnaire. The ex-political detainees, in contrast to the comparison group, had experienced more torture events (12.2 SD = 4.2 vs. 2.6 SD = 3.1) and had higher rates of PTSD (90% vs. 79%) and depression (49% vs. 15%). Dose-effect relationships between cumulative torture experience and psychiatric symptoms were positive with the PTSD subcategory of "increased arousal" revealing the strongest association. These findings provide evidence that torture is associated with psychiatric morbidity in Vietnamese refugees. The demonstration of significant dose-effect responses supports the hypothesis that torture is a major risk factor in the etiology of major depression and PTSD. The generalizability of these results to other torture survivor groups is unknown. The interaction between torture and other pre- and post-migration risk factors over time in different cultural settings still needs to be examined.

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    • "They are likely to have been exposed to a number of traumatic events such as the threat of death; torture; starving or serious injury; and the injury, death, or disappearance of family members. The difficulties of living in a conflict area, problems during the journey, the experience of torture (Mollica et al., 1998), separation from family (Rousseau, Mekki-Berrada, & Moreau, 2001), and having a prior trauma (Trautman et al., 2002) are all found to be related to mental health problems among refugees. One of the priorities in emergencies is to protect and improve people's mental health and psychosocial wellbeing (Inter-Agency Standing Committee [IASC], 2007). "
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    ABSTRACT: The most common mental health problems among refugees are depression and posttraumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD. However, no previous randomized controlled trial (RCT) has been published on treating PTSD symptoms in a refugee camp population. Examining the effect of EMDR to reduce the PTSD and depression symptoms compared to a wait-list condition among Syrian refugees. Twenty-nine adult participants with PTSD symptoms were randomly allocated to either EMDR sessions (n=15) or wait-list control (n=14). The main outcome measures were Impact of Event Scale-Revised (IES-R) and Beck Depression Inventory (BDI-II) at posttreatment and 4-week follow-up. Analysis of covariance showed that the EMDR group had significantly lower trauma scores at posttreatment as compared with the wait-list group (d=1.78, 95% CI: 0.92-2.64). The EMDR group also had a lower depression score after treatment as compared with the wait-list group (d=1.14, 95% CI: 0.35-1.92). The pilot RCT indicated that EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees located in a camp. Larger RCTs to verify the (cost-) effectiveness of EMDR in similar populations are needed.
    European Journal of Psychotraumatology 04/2015; 6. DOI:10.3402/ejpt.v6.27414 · 2.40 Impact Factor
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    • "There is also emerging evidence that individuals exposed to conflict and persecution report high rates of other disorders, such as intermittent explosive disorder (IED; Brooks et al., 2011; Silove et al., 2009), which is characterized by spontaneous anger attacks that are out of proportion to triggering events, and may result in violence and the destruction of property (American Psychiatric Association, 2013). Research conducted over the past three decades has documented a dose– response relationship between trauma exposure and psychological distress in refugees (Mollica et al., 1998a, 1998b; Steel et al., 2009). Findings from these studies suggested that the greater the number of types of trauma participants were exposed to, the greater PTSD, anxiety, and depression symptoms they exhibited, after controlling for demographics. "
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    ABSTRACT: While emotion dysregulation represents an important mechanism underpinning psychological responses to trauma, little research has investigated this in refugees. In the current study, we examined the mediating role of emotion dysregulation in the relationship between refugee experiences (trauma and living difficulties) and psychological outcomes. Participants were 134 traumatized treatment-seeking refugees who completed measures indexing trauma exposure, post-migration living difficulties, difficulties in emotion regulation, posttraumatic stress disorder, depression, and explosive anger. Findings revealed distinctive patterns of emotion dysregulation associated with each of these psychological disorders. Results also indicated that emotion regulation difficulties mediated the association between both trauma and psychological symptoms, and living difficulties and psychological symptoms. Limitations include a cross-sectional design and the use of measures that had not been validated across all cultural groups in this study. These findings underscore the key role of emotion dysregulation in psychological responses of refugees, and highlight potential directions for treatment interventions for traumatized refugees. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 11/2014; 173C:185-192. DOI:10.1016/j.jad.2014.10.043 · 3.38 Impact Factor
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    • "The survey instrument was expanded and adapted from our pilot study [19] to construct a valid Vietnamese version of the final questionnaire using standard methods of crosscultural research [24] [25]. Data on risk factors, including personal history, military and wartime work experience, reeducation camp experience, migration and resettlement experience, stressful life events, trauma, torture, and head injury were collected. "
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    ABSTRACT: Little is known about the relationship between traumatic head injury (THI) and psychiatric morbidity in torture survivors. We examine the relationship between THI and depression, PTSD, post-concussive syndrome (PCS), disability and poor health status in Vietnamese ex-political detainees who survived incarceration in Vietnamese re-education camps. A community sample of ex-political detainees (n=337) and a non-THI, non-ex-detainee comparison group (n=82) were surveyed. Seventy-eight percent of the ex-political detainees had experienced THI; 90.6% of the ex-political detainees and 3.6% of the comparison group had experienced 7 or more trauma events. Depression and PTSD were greater in ex-detainees than in the comparison group (40.9% vs 23.2% and 13.4% vs 0%). Dose-effect relationships for THI and trauma/torture in the ex-political detainee group were significant. Logistic regression in the pooled sample of ex-detainees and the comparison group confirmed the independent impact of THI from trauma/torture on psychiatric morbidity (OR for PTSD=22.4; 95% CI: 3.0-165.8). These results demonstrate important effects of THI on depression and PTSD in Vietnamese ex-detainees who have survived torture.
    Comprehensive Psychiatry 04/2014; 55(7). DOI:10.1016/j.comppsych.2014.04.014 · 2.25 Impact Factor
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