HADStress: a somatic symptom screen for posttraumatic stress among Somali refugees.
ABSTRACT This study assessed whether a simple, readily implemented four-symptom somatic screen would be able to effectively identify current posttraumatic stress symptoms in victimized populations.
The sample consisted of 622 Somali community-dwelling refugees who fled widespread violence and trauma occurring in East Africa during 1990-1992. Data were collected during 2000-2003 and included demographic characteristics, number of types of torture and nontorture trauma experienced earlier in Africa, and current self-rated posttraumatic stress symptoms, as measured by the Posttraumatic Stress Disorder Checklist (PCL). The sample was also assessed with the HADStress screen, which was developed for this study, to determine whether the screen was effective in detecting current posttraumatic stress symptoms. The HADStress screen assessed for the presence of four somatic symptoms: Headaches, Appetite change, Dizziness, and Sleep problems. All items were given equal weight. Possible scores on the screen range from 0 to 4, with higher scores indicating more somatic symptoms.
Univariate analysis showed that persons who experienced more types of trauma (both torture and nontorture trauma) and persons who had higher PCL scores (indicating more current posttraumatic stress symptoms) had significantly higher HADStress scores. Negative binomial regression analysis showed that PCL scores were the most effective variable in predicting HADStress scores. On the Tukey-B post hoc analysis, a HADStress score of 0 or 1 was associated with a mean PCL score of less than 30, a score of 2 was associated with a mean PCL score of 40.28, and a score of 4 was associated with a mean PCL score of 51.07 (suggesting that over 50% of this group would have active posttraumatic stress disorder).
A score of 2 or higher on the HADStress scale among refugees warrants additional evaluation for posttraumatic stress symptoms in clinical settings. For communitywide efforts at early recognition and treatment, a cutoff score of 4 may be more practical and cost-effective.
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ABSTRACT: Hemicrania continua is a headache characterized by chronic unremitting unilateral pain associated with ipsilateral autonomic findings. This type of headache responds to high-flow oxygen and indomethacin. This case report describes a male veteran with posttraumatic stress disorder (PTSD) and major depressive disorder who suffers from comorbid hemicrania continua. The psychiatric symptoms were recalcitrant to psychopharmacological intervention. However, when the patient's hemicrania continua was treated appropriately, the patient's psychiatric symptoms also abated. This case demonstrates the need to address physical comorbidities that may exacerbate psychiatric disorders, such as PTSD.06/2012; 2012:937217. DOI:10.1155/2012/937217
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ABSTRACT: Abstract Background: Given the scarcity of mental health resources available for refugees in areas of conflict, it is imperative to investigate interventions that would be accepted by the refugees. Materials and Methods: In this study we surveyed 354 Syrian refugees using the HADStress screening tool and asked about their openness to referral to psychiatry and telepsychiatry. Results: Of the surveyed sample, 41.8% had scores on HADStress that correlate to posttraumatic stress disorder. However, only 34% of the whole sample reported a perceived need to see a psychiatrist, and of those only 45% were open to telepsychiatry. Conclusions: Women, those who were bilingual, and those with positive HADStress status were less likely to accept telepsychiatry; however, this finding did not reach statistical significance. This study reports a partial acceptance of Syrian refugees for telepsychiatric services despite the high prevalence of psychological stress.Telemedicine and e-Health 09/2014; 20(10). DOI:10.1089/tmj.2013.0373 · 1.54 Impact Factor
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ABSTRACT: Refugees are a vulnerable class of immigrants who have fled their countries, typically following war, violence, or natural disaster, and who have frequently experienced trauma. In primary care, engaging refugees to develop a positive therapeutic relationship is challenging. Relative to care of other primary care patients, there are important differences in symptom evaluation and developing treatment plans. To discuss the importance of and methods for obtaining refugee trauma histories, to recognize the psychological and physical manifestations of trauma characteristic of refugees, and to explore how cultural differences and limited English proficiency affect the refugee patient-clinician relationship and how to best use interpreters. MEDLINE and the Cochrane Library were searched from 1984 to 2012. Additional citations were obtained from lists of references from select research and review articles on this topic. Engagement with a refugee patient who has experienced trauma requires an understanding of the trauma history and the trauma-related symptoms. Mental health symptoms and chronic pain are commonly experienced by refugee patients. Successful treatment requires a multidisciplinary approach that is culturally acceptable to the refugee. Refugee patients frequently have experienced trauma requiring a directed history and physical examination, facilitated by an interpreter if necessary. Intervention should be sensitive to the refugee's cultural mores.JAMA The Journal of the American Medical Association 08/2013; 310(5):519-28. DOI:10.1001/jama.2013.8788 · 30.39 Impact Factor