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

Harvard University, Cambridge, Massachusetts, United States
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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    • "Older Vietnamese have limited personal resources, including the lowest levels of educational attainment, household income, and English language proficiency (Kim et al., 2010). Experiences of war trauma, posttraumatic stress disorder (PTSD), and resettlement challenges may contribute to depression with prevalences as high as 49% in the Vietnamese population (Mollica et al., 1998). "
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    ABSTRACT: The goal of this qualitative study was to describe the beliefs and experiences of Vietnamese caregivers caring for a family member with dementia and to elicit their ideas about promising interventions. We recruited 10 caregivers from support groups, the Alzheimer's Association, and local community-based organizations in Northern California. We conducted semistructured in-depth interviews with all caregivers, as well as a focus group to obtain ideas about supportive strategies. Several themes emerged from the data: (a) Filial piety was influential in caregiving; (b) A sense of loss/grief or trauma was pervasive; and (c) Caregivers had clear sources of stress and sources of support. An overarching theme underlying these 3 topics was that cultural beliefs, values, and expectations impacted the caregiving experience. Suggestions for promising interventions included education, language-congruent and/or telephone support groups, case management, inclusion of the care recipient in the intervention, and importance of credibility of the intervention. It also may be valuable to include an understanding of cultural values and promotion of spirituality and religion as key components. Findings highlight targets for dementia caregiver interventions to reduce burden and distress in an understudied population.
    No preview · Article · Sep 2015 · Asian American Journal of Psychology
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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.
    Full-text · Article · Apr 2015 · European Journal of Psychotraumatology
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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.
    Full-text · Article · Nov 2014 · Journal of Affective Disorders
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