Article

Prevalence of Torture Survivors Among Foreign‐Born Patients Presenting to an Urban Ambulatory Care Practice

Department of Psychiatry, Boston University, Boston, Massachusetts, United States
Journal of General Internal Medicine (Impact Factor: 3.42). 08/2006; 21(7):764-8. DOI: 10.1111/j.1525-1497.2006.00488.x
Source: PubMed

ABSTRACT The prevalence of torture among foreign-born patients presenting to urban medical clinics is not well documented.
To determine the prevalence of torture among foreign-born patients presenting to an urban primary care practice.
A survey of foreign-born patients.
Foreign-born patients, age > or = 18, presenting to the Primary Care Clinic at Boston Medical Center.
Self-reported history of torture as defined by the UN, and history of prior disclosure of torture.
Of the 308 eligible patients, 88 (29%) declined participation, and 78 (25%) were not included owing to lack of a translator. Participants had a mean age of 47 years (range 19 to 76), were mostly female (82/142, 58%), had been in the United States for an average of 14 years (range 1 month to 53 years), and came from 35 countries. Fully, 11% (16/142, 95 percent confidence interval 7% to 18%) of participants reported a history of torture that was consistent with the UN definition of torture. Thirty-nine percent (9/23) of patients reported that their health care provider asked them about torture. While most patients (15/23, 67%) reported discussing their experience of torture with someone in the United States, 8 of 23 (33%) reported that this survey was their first disclosure to anyone in the United States.
Among foreign-born patients presenting to an urban primary care center, approximately 1 in 9 met the definition established by the UN Convention Against Torture. As survivors of torture may have significant psychological and physical sequelae, these data underscore the necessity for primary care physicians to screen for a torture history among foreign-born patients.

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    • "However, it has previously been found that general practitioners are unaware of the implications of patients having a refugee background and that they often refrain from enquiring further about the refugee situation [24]. In addition, there is also evidence that indicates that torture and other traumatic incidents experienced by the patients may be missed by the general practitioners [22,23]. Contrary to these findings, some of the health professionals in our study expressed that they are aware of the importance of considering a traumatic background in regards to their refugee patients. "
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    ABSTRACT: Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.
    BMC Family Practice 01/2013; 14(1):17. DOI:10.1186/1471-2296-14-17 · 1.74 Impact Factor
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    • "These estimates arise from studies of torture survivors , mainly in specialised documentation and/or treatment centres. In primary or secondary care, however, many go unrecognised [13]: estimates of up to 41% in the UK and USA [8] [9]. A community study – not patients – found up to 45% in Ethiopian and Somali settlers in the USA [15]. "
    Pain 01/2008; 133(1-3):5-8. DOI:10.1016/j.pain.2007.10.001 · 5.84 Impact Factor
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    ABSTRACT: Background: Seven to 12% of foreign-born patients in the United States has experienced torture. We aimed to teach medical students to identify and care for asylum seekers/torture survivors. Description: One hundred twenty-five students participated in a program consisting of a workshop covering sequelae of torture, asylum law, and an approach to patient evaluation; twice-monthly clinical sessions; and mentored preparation of medical affidavits. We observed clinical encounters; evaluated medical affidavits; and assessed students' knowledge, attitudes, and skills pre- and postcurriculum. Evaluation: Students successfully performed physical and psychological evaluations and prepared affidavits resulting in 89% asylum application approval. We observed improvement in student attitudes toward working with survivors (p < .05), knowledge of sequelae of torture (p < .001), and self-efficacy in clinical evaluation (p < .001). Conclusions: Medical students learned necessary skills to provide services for survivors, which will also serve them in caring for other vulnerable populations. As an advocacy, cultural competency, and domestic global health opportunity, this training was feasible and achieved its educational goals.
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