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.Case reports in psychiatry. 01/2012; 2012:937217.
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ABSTRACT: African immigrant and refugee communities remain medically underserved in the United States. Formative efforts are being directed to address the local needs of communities by researchers, community agencies, and local populations. However, there is a paucity of data and sparse documentation regarding these efforts. The objectives for this pilot study were to identify the health priorities of the Kansas City Somali community and to establish a working relationship between an academic medical university and the local Somali community. Our team used community-based participatory research principles and interviewed Somali community members (n = 11). Participants stated that chronic and mental health conditions were of primary concern. Medical system navigation and literacy struggles were identified as barriers. Participants offered possible solutions to some health issues, e.g., using community health workers and Qur'anic readers. Preliminary findings will help guide future research and inform strategies to improve the health and well-being of this community.Journal of Immigrant and Minority Health 11/2012; · 1.16 Impact Factor
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ABSTRACT: BACKGROUND: Over the last two decades, the total number of applications from Africans for asylum in the countries of the European Union has increased from 578,000 to more than 2.9 million. About 20 % (7,196/36,100) of the asylum seekers in Switzerland originate from Africa. The disease profile of African asylum seekers is remarkably different from that of the native population in the country of application. We have therefore conducted an analysis of African asylum seekers presenting themselves to our emergency department. METHODS: In a retrospective analysis, the central patient registry database was searched for patients originating from Africa admitted from 1 January 2000 to 30 November 2011 and labelled as "Asylbewerber" (asylum seeker) or "Flüchtling" (refugee). RESULTS: Three thousand six hundred and seventy-five African asylum seekers were admitted to our emergency department between 2000 and 2010. Thirty-four percent (n = 1,247) were female and 66 % (n = 2,426) male. Eighty percent (n = 1,940) of the men and 70 % (n = 823) of the women were younger than 40 years. Most of our patients originated from Algeria (n = 612). Forty-five percent (n = 1,628) of all patients presented with internal medical problems, 40 % (n = 1,487) with injuries. 3.5 % (n = 130) of all patients presented with psychiatric problems. Admission for psychiatric problems increased steadily from 2 % (n = 4) in 2001 to 10 % (n = 35) in 2011. CONCLUSION: The causes of presentation are manifold, including internal medical problems and injuries. Admissions for psychiatric problems are increasing. Establishing simple screening scores for somatization should be a key priority in providing more focused treatment in emergency departments.Wiener klinische Wochenschrift 08/2012; 124(17-18):647-652. · 0.81 Impact Factor