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Psychological stress, cardiovascular disease and somatic pain in asylum seekers: a retrospective cross-sectional study
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Although asylum seeking has become a major political issue in the Western world, research on its psychological impact is still in its infancy. This study examined levels and predictors of distress among a community sample of persons who have sought asylum in Ireland. A key aim was to provide a longitudinal analysis of the relationship between legal status security and psychological distress. Distress was measured by the Symptom Checklist-90-Revised at Time 1 (N ϭ 162) and its shorter version (the Brief Symptom Inventory) at Time 2 (N ϭ 70). Levels of severe distress were high at both baseline (46%) and follow-up (36%). The only persons to show a decrease in distress were those who had obtained a secure legal status (e.g., refugee status or residency) between the study phases. Distress risk factors included female gender, an insecure legal status, separation from children, discrimination, and postmigration stress. Protective factors were social support (Time 1) and the presence of a partner. The findings suggest that asylum seekers are a high-risk group for distress. This risk can be reduced by appropriate policy changes and interventions to increase social resources.
At the end of 2022, 108.4 million people around the world were forcibly displaced, the highest number ever recorded. Of these, 50% were women. Despite this situation, little is known about the mental health of female refugees. The first aim of this study was to examine the prevalence of depression and anxiety symptoms among female refugees in Germany. The second aim was to examine which sociodemographic and migration-related variables have an impact on refugees’ mental health, and the third aim was to assess the potential predictors of their mental health. A sample of 92 female refugees from East Africa and the Middle East living in Germany were interviewed. Symptoms of depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25). The experience of potentially traumatic events (PTEs) was assessed using the Posttraumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ). In our sample of female refugees, 65.2% reported symptoms of depression, and 60.9% reported symptoms of anxiety. Symptoms of depression or anxiety were associated with being from the Middle East, having a higher level of education, and reporting more PTEs. The multiple regression model for anxiety was able to explain 32.4% of the variance in anxiety symptoms. The findings highlight the high burden of mental health problems that female refugees bear. The identified predictors of depressive and anxiety symptoms should sensitize medical and refugee professionals to identify vulnerable individuals and groups, refer them to appropriate psychological treatment, and, where possible, modify the identified predictors.
Chronic pain affects many people world-wide, and this number is continuously increasing. There is a clear link between chronic pain and the development of cardiovascular disease through activation of the sympathetic nervous system. The purpose of this review is to provide evidence from the literature that highlights the direct relationship between sympathetic nervous system dysfunction and chronic pain. We hypothesize that maladaptive changes within a common neural network regulating the sympathetic nervous system and pain perception contribute to sympathetic overactivation and cardiovascular disease in the setting of chronic pain. We review clinical evidence and highlight the basic neurocircuitry linking the sympathetic and nociceptive networks and the overlap between the neural networks controlling the two.
Pre-migration trauma, a psychological risk factor for refugees, is often measured using cumulative indices. However, recent research suggests that trauma subtypes, rather than cumulative trauma, may better predict psychological outcomes. This study investigated the predictive utility of trauma subtypes in the assessment of refugee mental health. Multiple regression was used to determine whether cumulative trauma or trauma subtypes explained more variance in depression, anxiety, and post-traumatic stress disorder (PTSD) symptom scores in 70 Syrian and Iraqi refugees. Subtype models performed better than cumulative trauma models for PTSD (cumulative R² = 0.138; subtype R² = 0.32), anxiety (cumulative R² = 0.061; subtype R² = 0.246), and depression (cumulative R² = 0.041; subtype R² = 0.184). Victimization was the only subtype significantly associated with PTSD (p < 0.001; r² = 0.210), anxiety (p < 0.001; r² = 0.162), and depression (p = 0.002; r² = 0.140). Cumulative trauma was predictive of PTSD symptoms only (p = 0.003; r² = 0.125). Trauma subtypes were more informative than cumulative trauma, indicating their utility for improving predictive efforts in research and clinical contexts.
Anti-immigrant rhetoric and immigration policy enforcement in the United States over the last 2 decades has increased attention to fear of deportation as a determinant of poor health. We describe its association with mental health outcomes among Middle East and North African (MENA) residents of Michigan. Using a convenience sample of MENA residents in Michigan (n = 397), we conducted bivariate and multiple variable regression to describe the prevalence of deportation worry and examine the relationship between deportation worry and depressive symptoms (PHQ-4 scores). We found that 33% of our sample worried a loved one will be deported. Deportation worry was associated with worse mental health (p < 0.01). Immigration policies are health policies and deportation worry impacts mental and behavioral health.
Background
Limited research exists on pain and especially the co-occurrence of pain and mental ill health in general refugee populations. The present study aimed to approximate the prevalence of chronic pain (CP) among adult refugees from Syria resettled in Norway; investigate the association between CP and mental ill health; and explore how CP and mental ill health associate with both perceived general health and functional impairment. Gender as potential effect modifier in these associations was also examined.
Methods
Cross-sectional, postal survey questionnaire. Inclusion criteria: ≥ 18 years old; refugee from Syria; and arrived in Norway between 2015 and 2017. Study sample was randomly drawn from full population registries, and n = 902 participated (participation rate ≈10%). CP was measured with 10 items on pain lasting for ≥ 3 consecutive months last year. Symptoms of anxiety, depression and PTSD were measured with the HSCL and HTQ scales, respectively. Ordered and binomial logistic regressions were used in analyses. Gender was tested as effect modifier with Wald test for interaction.
Results
In the sample overall, the proportion of participants who reported severe CP was 43.1%. There was strong evidence that anxiety, depression and PTSD were associated with higher levels of CP. In fully adjusted regression models, including both CP and mental health variables, CP was strongly associated with poor perceived general health whereas mental health showed much weaker associations. The association between mental health (anxiety and PTSD) and functional impairment was highly gender specific, with strong associations in men but not in women. CP was strongly associated with functional impairment with no difference across gender.
Conclusion
The study shows a high burden of CP in a general population of adult refugees from Syria with likely substantial adverse consequences for daily functioning. The strong association between CP and mental ill health suggests personnel working with refugees’ health should be attuned to their co-occurrence as both problems may need to be addressed for either to be effectively mitigated. A clear mismatch exists between the burden on health caused by pain in general refugee populations and the amount of available evidence to guide mitigating strategies.
Trial registration
NCT03742128.
Background:
The interplay between pain of different chronicity and cardiovascular disease (CVD) is incompletely understood.
Aim:
We aimed to investigate the association between different levels of chronic or non-chronic pain and risk of CVD.
Methods:
Participants in the UK Biobank who reported pain at baseline were divided into three groups according to pain duration and widespreadness. Participants reporting no pain were controls. Multivariable Cox regression was used to investigate the association between pain and incidence of myocardial infarction, heart failure, stroke, cardiovascular mortality and composite CVD (defined as any of the before-mentioned cardiovascular events).
Results:
Of 475,171 participants, 189,289 reported no pain, 87,830 reported short-term pain, 191,716 chronic localized pain, and 6,336 chronic widespread pain (CWP). During a median of 7.0 years' follow-up, participants with CWP and chronic localized pain had, after adjustment for age, sex, established cardiovascular risk factors, physical activity, anxiety, depression, cancer, chronic inflammatory/painful disease, pain/anti-inflammatory medication, socioeconomic status, a significantly increased risk for composite CVD (hazard ratio, HR 1.14, CI 1.08-1.21, p-value < 0.001; and HR 1.48, CI 1.28-1.73, p-value < 0.001, respectively) compared to controls, with similar results when using the different specific CVDs as outcomes. Population attributable risk proportion for chronic pain as a risk factor for composite CVD was comparable to that of diabetes (8.6% vs. 7.3%, respectively).
Conclusions:
Chronic pain is associated with an increased risk for myocardial infarction, stroke, heart failure and cardiovascular death independent of established cardiovascular risk factors, socioeconomic factors, co-morbidities and medication. Our study, the largest to date, confirms and extends our understanding of chronic pain as an underestimated cardiovascular risk factor with important public health implications.
Background:
There have been a limited number of studies that have focused on factors which shape the experiences of resettlement and occupational injustice among refugee populations.
Purpose:
To explore the factors that shape the living difficulties of Syrian refugees who were lawfully admitted into the United States and ways whereby they might interfere with shaping occupational injustice.
Method:
Mixed methodologies were incorporated. The living difficulty scale for refugees (LDSR) was disseminated. Semistructured interviews were conducted, and fieldnotes were collected as sources of qualitative data.
Results:
254 participants (mean age 36.2 ± 9.6 yrs; 159 females and 95 males) completed the survey, and nine of them participated in the semistructured interviews. Age (p < 0.01), region (p < 0.001), and time in the United States (p < 0.05) had significant effects on the experiences of the participants, but not gender (p = 0.308). Occupational injustice is an outcome of an interaction between interpersonal and contextual factors. Practice Implications. Occupational therapists need to assume a vital role in maximizing opportunities of engagement in meaningful occupations for Syrian refugees to counteract occupational injustice and difficulties associated with resettlement.
Background
This is the first systematic review and meta-analysis assessing cardiovascular disease incidence and risk factors among refugees and asylum seekers.
Methods and results
PubMed, PsycINFO, CINAHL, and Embase databases were searched for studies in English from January 1, 1977, to March 8, 2020. Inclusion criteria were (1) observation of refugee history in participants; (2) diagnosis of CVD (coronary artery disease, heart failure, stroke, or CVD mortality) and risk factors (hypertension, diabetes, tobacco use, hyperlipidemia, obesity, psychosocial factors); (3) assessment of effect size and spread, (4) adjustment for sex; and (5) comparison with non-refugee migrants or natives. Data were extracted and evaluated by multiple reviewers for study quality. Of the 1158 screened articles, Participants from 7 studies (0.6%) involving 116.989 refugees living in Denmark, Sweden, and the United States were included in the systematic review, of which three studies synthesized the quantitative analyses. A fixed-effects model was created to pool the effect sizes of included studies. The pooled incidence of CVD in refugees was 1.71 (95% CI: 1.03, 2.83) compared with non-refugee counterparts. Pyschosocial factors were associated with increased risk of CVD in refugees but evidence on CVD risk factors varied by nativity and duration since resettlement.
Conclusions
Refugee experience is an independent risk factor for CVD. Robust research on CVD in displaced populations is needed to improve the quality of evidence, clinical and preventive care, and address health equity in this marginalized population globally.
The present systematic review examined post-migration variables impacting upon mental health outcomes among asylum-seeking and refugee populations in Europe. It focuses on the effects of post-settlement stressors (including length of asylum process and duration of stay, residency status and social integration) and their impact upon post-traumatic stress disorder, anxiety and depression. Twenty-two studies were reviewed in this study. Length of asylum process and duration of stay was found to be the most frequently cited factor for mental health difficulties in 9 out of 22 studies. Contrary to expectation, residency or legal status was posited as a marker for other explanatory variables, including loneliness, discrimination and communication or language problems, rather than being an explanatory variable itself. However, in line with previous findings and as hypothesised in this review, there were statistically significant correlations found between family life, family separation and mental health outcomes.
Background:
There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes.
Methods:
This review scoped 77 papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants' access to healthcare. The review aims at identifying what is known about access to healthcare as well as healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onwards.
Results:
The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is evidence of persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described.
Conclusions:
The European situation concerning migrants' and refugees' health status and access to healthcare is heterogeneous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long-term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants' health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants' own views on their health and barriers to access to healthcare is key.
Background
An estimated 87% of torture survivors experience chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation. We hypothesized that the United Nations Istanbul Protocol (UNIP) would have a sensitivity of approximately 15% for pain detection, and that the use of a validated pain screen would improve its sensitivity by at least 29%, as compared to the reference standard (pain specialist evaluation).
Methods and findings
This prospective blind-comparison-to-gold-standard study of survivors of torture, as defined by the World Medical Association, took place at Weill Cornell Medicine between February 1, 2017, and June 21, 2019. 11 women and 9 men, for a total of 20 participants, were included in the analysis. Five participants received 2 UNIP evaluations, for a total of 25 unique evaluations included in the analysis. Participants were representative of a global population, with home countries in Africa, Central America, South Asia, the Caribbean, and the Middle East. Methods of torture experienced were homogeneous, following the predictable pattern of systematic torture. Participants first received the standard evaluation protocol for torture survivors (UNIP) by a trained evaluator, and subsequently received a validated pain screen (Brief Pain Inventory–Short Form [BPISF]) followed by a noninvasive examination by a pain specialist physician (reference standard). The primary outcome was the diagnostic and treatment capability of the standard protocol (index test) versus the validated pain screen (BPISF), as compared to the reference standard. Trained evaluators performing the initial assessment with the UNIP (index test) were blinded to the study, and the pain specialist physician (reference standard) was blinded to the outcome of the initial UNIP evaluation and the BPISF; data from the initial UNIP assessment were not gathered by the principal investigator until all other study procedures were completed. Providers using only the UNIP captured pain in a maximum of 16% of evaluations, as compared to 85% of participants being diagnosed with pain by the reference standard. When employed, the validated pain screen had a sensitivity of 100% (95% CI 72%–100%) and a negative predictive value of 100%, as compared to a sensitivity of 24% (95% CI 8%–50%) and a negative predictive value of 19% (95% CI 5%–46%) for the index test. The difference in the sensitivity of the UNIP as compared to the BPISF was significant, with p < 0.001. No adverse events owing to participation in the study were reported by participants. Limitations of the study include small sample size, its single-site nature, and the exclusion of individuals who did not speak 1 of the 5 study languages.
Conclusions
These data indicate that a validated pain screen can supplement the current global standard assessment of torture survivors, the UNIP, to increase the accuracy of pain diagnosis.
Trial registration
ClinicalTrials.gov NCT03018782.
Background: The vast majority of the world’s refugees and people seeking asylum live in a state of sustained displacement. Little is known, however, about the mental health impact of prolonged insecurity.
Objective: This study aimed to investigate the association between insecure visa status and mental health, suicidality, disability and social engagement in a sample of refugees and asylum-seekers living in Australia
Method: Participants were 1,085 refugees with secure (i.e. permanent residency or Australian citizenship, n = 826, 76.1%) and insecure (i.e. asylum-seeker claim, bridging visa, temporary visa, n = 259, 23.9%) visa status who had arrived in Australia since January 2011, and were from Arabic, Farsi, Tamil or English-speaking backgrounds. Participants completed an online survey assessing pre- and post-migration experiences, mental health, disability and social engagement.
Results: Results indicated that, after controlling for background factors, refugees with insecure visas had significantly greater PTSD symptoms, depression symptoms, thoughts of being better off dead and suicidal intent compared to those with secure visas. There were no group differences in disability. Refugees with insecure visas received support from significantly more groups in the Australian community than those with secure visas. Further, refugees with insecure visa status who had low group membership showed greater depression symptoms and suicidal intent than those with secure visa status who had low group membership.
Conclusion: Findings highlight the negative mental health consequences of living in a state of protracted uncertainty for refugees and people seeking asylum, and the key role of social engagement in influencing mental health amongst insecure visa holders. Results also underscore the importance of designing and implementing policies and services that facilitate improved mental health for those with visa insecurity.
Background:
Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees.
Results:
Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores.
Conclusions:
The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.
Background
Worry about deportation has been associated with cardiovascular disease risk factors in cross‐sectional research. No research has evaluated this association longitudinally or examined the association between deportation worry and incident cardiovascular disease outcomes.
Methods and Results
We used data from an ongoing community‐based cohort of 572 women primarily of Mexican origin. We estimated associations between self‐reported deportation worry and: (1) trajectories of blood pressure, body mass index, and waist circumference with linear mixed models, and (2) incident hypertension with Cox proportional hazards models. Nearly half (48%) of women reported “a lot,” 24% reported “moderate,” and 28% reported “not too much” deportation worry. Higher worry at baseline was associated with nonlinear systolic blood pressure and mean arterial pressure trajectories. For example, compared with not too much worry, a lot of worry was associated with a faster initial increase (β, interaction with linear year term: 4.10; 95% CI , 1.17–7.03) followed by a faster decrease in systolic blood pressure (β, interaction with quadratic year term: −0.80; 95% CI , −1.55 to −0.06). There was weak evidence of an association between deportation worry and diastolic blood pressure and no association with body mass index , waist circumference , or pulse pressure trajectories. Among 408 women without baseline hypertension, reporting a lot (hazard ratio, 2.17; 95% CI , 1.15–4.10) and moderate deportation worry ( hazard ratio, 2.48; 95% CI, 1.17–4.30) were each associated with greater risk of incident hypertension compared with reporting not too much worry.
Conclusions
Deportation worry may contribute to widening disparities in some cardiovascular disease risk factors and outcomes over time.
Introduction:
Survivors of torture are for many reasons at particularly high risk for inadequate assessment and management of pain. Among the many health problems associated with torture, persistent pain is frequent, particularly pain in the musculoskeletal system. The pathophysiology underlying post-torture pain is largely unknown, but pain inflicted in torture may have profound effects on neurophysiology and pain processing.
Methods:
A narrative review of assessment and treatment studies, informed by clinical experience, was undertaken.
Results:
The clinical presentation in survivors of torture shares characteristics with other chronic primary pain syndromes, including chronic widespread pain. Unfortunately, such pain is often misunderstood and dismissed as a manifestation of psychological distress, both in specialist psychosocially oriented torture services and in mainstream health care. This means that pain is at risk of not being recognized, assessed, or managed as a problem in its own right.
Conclusions:
The available research literature on rehabilitation for torture survivors is predominantly targeted at mental health problems, and studies of effectiveness of pain management in torture survivors are lacking. Rehabilitation is identified as a right in the UN Convention on Torture, aiming to restore as far as possible torture survivors' health and capacity for full participation in society. It is therefore important that pain and its consequences are adequately addressed in rehabilitative efforts. This article summarizes the current status on assessment and management of pain problems in the torture survivor.
Aims
High heterogeneity was found in the prevalence rates of mental disorders in adult asylum seekers and refugees in high-income countries. This may be related to different problems. Among them, there is a changing exposure to risk and protective factors for mental health at different phases of these people's life before migration, and during the migratory journey and resettlement. This study aimed at identifying and distinguishing time points in which distinct risk and protective factors for the mental health of asylum seekers and refugees may occur.
Methods
Systematic review and narrative synthesis. A systematic search was carried out for the period January 2017–August 2019, given the existence of systematic reviews of the evidence up to January 2017.
Results
Two hundred and fifty-two studies were identified with our search and 31 studies were included. The critical time points identified are: (a) before the travel; (b) during the travel; (c) at initial settlement in the host country; (d) when attempting to integrate in the host country; (e) when the immigration status is challenged or revoked. Some factors such as sense of belonging in the host country can be risk factors or protective factors depending on the time point.
Conclusions
These five critical time points can guide the development and selection of well-timed preventive and treatment interventions. They could also be used to stratify samples in epidemiological studies and meta-analyses. At present, we know much more on risk factors than on protective factors. Knowing more about protective factors may inform the development of interventions to foster them.
Sociologists recognize that immigration enforcement policies are forms of institutionalized racism that can produce adverse health effects in both undocumented and documented Latinos and Mexican-origin persons in the United States. Despite this important advancement, little research examines the relationship between fear of immigration enforcement and biobehavioral health in mixed-status Mexican-origin families. This study applies an embodiment of racism approach to examine how household fear of deportation (FOD) is related to differences in salivary proinflammatory cytokines (IL-1
β
, IL-6, IL-8, and TNF
α
) in healthy Mexican-origin families with at least one immigrant, living in Phoenix, AZ. Participants were 111 individuals (n=46 adults, 72% female; n=65 children, 49% female) from 30 low-income, mixed-status families. During a home visit, anthropometric measures and saliva were collected from each family member and a household survey was administered. Saliva was assayed for salivary IL-1
β
, IL-6, IL-8, and TNF
α
. Random effects multilevel structural equation models estimated the relationship between household FOD and a salivary proinflammatory cytokine latent variable between families, while controlling for other chronic stressors (economic/occupational, immigration, parental, and family conflict). Household FOD (
β
=0.68, p=0.04) and family conflict chronic stress (
β
=1.96, p=0.03) were strongly related to elevated levels of proinflammatory cytokines between families. These results were consistent in non-mixed and mixed-status families. Future research is needed to characterize what aspects of living with an undocumented family member shape the physical health outcomes of persons with authorized status or US-citizenship.
Pain and stress share significant conceptual and physiological overlaps. Both phenomena challenge the body’s homeostasis and necessitate decision-making to help animals adapt to their environment. In addition, chronic stress and chronic pain share a common behavioral model of failure to extinguish negative memories. Yet, they also have discrepancies such that the final brain endophenotype of posttraumatic stress disorder, depression, and chronic pain appears to be different among the three conditions, and the role of the hypothalamic-pituitary-adrenal axis remains unclear in the physiology of pain. Persistence of either stress or pain is maladaptive and could lead to compromised well-being. In this brief review, we highlight the commonalities and differences between chronic stress and chronic pain, while focusing particularly on the central role of the limbic brain. We assess the current attempts in the field to conceptualize and understand chronic pain, within the context of knowledge gained from the stress literature. The limbic brain—including hippocampus, amygdala, and ventromedial prefrontal cortex—plays a critical role in learning. These brain areas integrate incoming nociceptive or stress signals with internal state, and generate learning signals necessary for decision-making. Therefore, the physiological and structural remodeling of this learning circuitry is observed in conditions such as chronic pain, depression, and posttraumatic stress disorder, and is also linked to the risk of onset of these conditions.
Objective:
With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain.
Setting:
Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM).
Methods:
As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions.
Perspective:
The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms.
Conclusions:
Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPT undertook a similar approach to organizing various acute pain conditions.
Pain care for survivors of torture and of war shows similarities and marked differences. For both, pain can be complex with unfamiliar presentations and the pains hard to assign to known disorders. For many survivors, pain and associated disability are overshadowed by psychological distress, often by post-traumatic stress symptoms that can be frightening and isolating. Pain medicine in war can exemplify best techniques and organisation, reducing suffering, but many military veterans have persistent pain that undermines their readjustment. By contrast, survivors of torture rarely have any acute health care; their risk for developing chronic pain is high. Even when settled as refugees in a well-resourced country, their access to healthcare may be restricted. Recent evidence is reviewed that informs assessment and treatment of pain in both groups, with the broader context of psychological distress addressed at the end. Clinical and research implications are briefly outlined.
Refugees demonstrate high rates of post-traumatic stress disorder (PTSD) and other psychological disorders. The recent increase in forcible displacement internationally necessitates the understanding of factors associated with refugee mental health. While pre-migration trauma is recognized as a key predictor of mental health outcomes in refugees and asylum seekers, research has increasingly focused on the psychological effects of post-migration stressors in the settlement environment. This article reviews the research evidence linking post-migration factors and mental health outcomes in refugees and asylum seekers. Findings indicate that socioeconomic, social, and interpersonal factors, as well as factors relating to the asylum process and immigration policy affect the psychological functioning of refugees. Limitations of the existing literature and future directions for research are discussed, along with implications for treatment and policy.
Unlabelled:
To determine rates of diabetes, hypertension, and hyperlipidemia in Cambodian refugees, and to assess the proportion whose conditions are satisfactorily managed in comparison to the general population. Self-report and laboratory/physical health assessment data obtained from a household probability sample of U.S.-residing Cambodian refugees (N = 331) in 2010-2011 were compared to a probability sample of the adult U.S. population (N = 6,360) from the 2009-2010 National Health and Nutrition Examination Survey. Prevalence of diabetes, hypertension and hyperlipidemia in Cambodian refugees greatly exceeded rates found in the age- and gender-adjusted U.S.
Population:
Cambodian refugees with diagnosed hypertension or hyperlipidemia were less likely than their counterparts in the general U.S. population to have blood pressure and total cholesterol within recommended levels. Increased attention should be paid to prevention and management of diabetes and cardiovascular disease risk factors in the Cambodian refugee community. Research is needed to determine whether this pattern extends to other refugee groups.
Background
Legal status and other resettlement stressors are known to impact mental health of asylum seekers and refugees. However, the ways in which they interact with treatment of posttraumatic stress disorder (PTSD) with these populations is still poorly understood. The aim of this study was to examine whether legal status and other resettlement stressors influence outcomes of a trauma-focused group PTSD treatment within a day-treatment setting with asylum seekers and refugees.
Methods
Sixty six male Iranian and Afghan patients with PTSD residing in the Netherlands were assessed with self-rated symptom checklists for PTSD, anxiety and depression, and a demographic questionnaire one week before and two weeks after the treatment. Multivariate linear regression analysis was used to examine the impact of legal status and living arrangements on the treatment outcomes per symptom domain.
Results
The results suggest that both asylum seekers and refugees can be helped with their mental health complaints with a trauma-focused group therapy for PTSD regardless of their legal status. Obtaining a refugee status in a course of the treatment appears to improve the treatment outcomes.
Conclusions
Legal status is impacting outcomes of group therapy for PTSD with male asylum seekers and refugees. Asylum seekers may benefit from group treatment regardless of unstable living conditions.
Nearly 2.7 million individuals worldwide are internally displaced (seeking refuge in secure areas of their own country) annually by armed conflict. Although the psychological impact of war has been well documented, less is known about the mental health symptoms of forced displacement among internally displaced persons.
To estimate the prevalence of the most common war-related mental health conditions, symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to assess the association between displacement status and these conditions in postwar Jaffna District, Sri Lanka.
Between July and September 2009, a cross-sectional multistage cluster sample survey was conducted among 1517 Jaffna District households including 2 internally displaced persons camps. The response rate was 92% (1448 respondents, 1409 eligible respondents). Two percent of participants (n = 80) were currently displaced, 29.5% (n = 539) were recently resettled, and 68.5% (n = 790) were long-term residents. Bivariable analyses followed by multivariable logistic regression models were performed to determine the association between displacement status and mental health.
Symptom criteria of PTSD, anxiety, and depression as measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25.
The overall prevalences of symptoms of PTSD, anxiety, and depression were 7.0% (95% confidence interval [CI], 5.1%-9.7%), 32.6% (95% CI, 28.5%-36.9%), and 22.2% (95% CI, 18.2%-26.5%), respectively. Currently displaced participants were more likely to report symptoms of PTSD (odds ratio [OR], 2.71; 95% CI, 1.28-5.73), anxiety (OR, 2.91; 95% CI, 1.89-4.48), and depression (OR, 4.55; 95% CI, 2.47-8.39) compared with long-term residents. Recently resettled residents were more likely to report symptoms of PTSD (OR, 1.96; 95% CI, 1.11-3.47) compared with long-term residents. However, displacement was no longer associated with mental health symptoms after controlling for trauma exposure.
Among residents of Jaffna District in Sri Lanka, prevalence of symptoms of war-related mental health conditions was substantial and significantly associated with displacement status and underlying trauma exposure.
Clinically, a long asylum procedure seems to be associated with psychiatric disorders. However, data on this issue are lacking. In a national community-based study, using random sampling, we compared two groups of Iraqi asylum seekers, who had resided less than 6 months (N = 143) and more than 2 years (N= 151), respectively, in The Netherlands. Respondents were interviewed with fully structured, culturally validated, translated questionnaires. Psychiatric (DSM-IV) disorders were measured with the Composite International Diagnostic Interview 2.1 and evaluated in relation with premigration and postmigration adverse life events. Overall prevalence of psychiatric disorders was 42% in the first group and 66.2% in the second. The prevalence rates of anxiety, depressive, and somatoform disorders were significantly higher in the second group. Posttraumatic stress disorder was high in both groups but did not differ (p > .05). On logistic regression of all relevant risk factors, a long asylum procedure showed an odds ratio of 2.16 (confidence interval = 1.15-4.08) for psychopathology. The conclusion is that, indeed, the duration of the asylum procedure is an important risk factor for psychiatric problems. Both politicians and mental health workers should take note of this finding.
The global refugee crisis requires that researchers, policymakers, and clinicians comprehend the magnitude of the psychological consequences of forced displacement and the factors that moderate them. To date, no empirical synthesis of research on these issues has been undertaken.
To meta-analytically establish the extent of compromised mental health among refugees (including internally displaced persons, asylum seekers, and stateless persons) using a worldwide study sample. Potential moderators of mental health outcomes were examined, including enduring contextual variables (eg, postdisplacement accommodation and economic opportunity) and refugee characteristics.
Published studies (1959-2002) were obtained using broad searches of computerized databases (PsycINFO and PILOTS), manual searches of reference lists, and interviews with prominent authors.
Studies were selected if they investigated a refugee group and at least 1 nonrefugee comparison group and reported 1 or more quantitative group comparison on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4% of identified reports), yielding 59 independent comparisons and including 67,294 participants (22,221 refugees and 45,073 nonrefugees).
Data on study and report characteristics, study participant characteristics, and statistical outcomes were extracted using a coding manual and subjected to blind recoding, which indicated high reliability. Methodological quality information was coded to assess potential sources of bias.
Effect size estimates for the refugee-nonrefugee comparisons were averaged across psychopathology measures within studies and weighted by sample size. The weighted mean effect size was 0.41 (SD, 0.02; range, -1.36 to 2.91 [SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement conditions moderated mental health outcomes. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes. Methodological differences between studies affected effect sizes.
The sociopolitical context of the refugee experience is associated with refugee mental health. Humanitarian efforts that improve these conditions are likely to have positive impacts.
To examine prospectively the trajectory of trauma-related psychiatric symptoms and disability amongst asylum seekers over the course of the refugee determination process. To identify the direct impact of the refugee decision on psychiatric symptoms by adjusting for other variables, namely sociodemographic characteristics, past trauma, and ongoing postmigration stresses.
A prospective cohort study of asylum seekers recruited from a random sample of immigration agents in Sydney, Australia.
Consecutive asylum seekers were referred for interview by immigration agents. Interviews were undertaken after the initial application and on average, 3.8 months after the refugee decision.
Measures assessed premigration trauma and postmigration stressors. Mental health status was assessed using the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. Functional impairment was assessed with the Medical Outcomes Study-Short Form 12.
Sixty-two of 73 asylum seekers were retained at follow-up. The accepted (16) and rejected (46) groups did not differ on premigration trauma or baseline psychiatric symptoms. Postdecision, the accepted group showed substantial improvements in posttraumatic stress disorder, anxiety, depression, and in mental health functioning, whereas the rejected group maintained high levels of symptoms on all psychiatric indices.
Establishing secure residency status for asylum seekers may be important to their recovery from trauma-related psychiatric symptoms. The practical and theoretical implications are discussed.
Fear-potentiated startle (FPS) can be used to measure fear and safety learning—behaviors affected by trauma thatmay map onto posttraumatic stress disorder (PTSD). Therefore, FPS could be a candidate biomarker of trauma-related psychopathology
and a potential identifier of trauma-exposed youth in need of focused treatment. We enrolled n = 71 (35 females, Mage = 12.7 years) Syrian youth exposed to civilian war trauma. Eyeblink electromyogram (EMG) data from a differential conditioning FPS
paradigm were obtained 2.5 years after resettlement. Youth provided self-report of trauma exposure (Harvard Trauma Questionnaire) and PTSD symptoms (UCLA PTSD
Reaction Index). While FPS during conditioning was not associated with symptoms, associations with psychopathology emerged in fear extinction. Probable PTSD was associated with FPS in the last block of extinction, such that FPS to threat cue was significantly greater in the PTSD+ group compared to the PTSD– group at the end
of extinction (F = 6.25, p = .015). As with adults, we observed a deficit in extinction learning but not fear conditioning in youth with PTSD. These results support the use of trauma-informed cognitive behavioral therapy based on the learning principles of extinction in youth with PTSD.
Symptoms of cardiovascular disease drive health care use and are a major contributor to quality of life. Symptoms are of fundamental significance not only to the diagnosis of cardiovascular disease and appraisal of response to medical therapy but also directly to patients’ daily lives. The primary purpose of this scientific statement is to present the state of the science and relevance of symptoms associated with cardiovascular disease. Symptoms as patient-reported outcomes are reviewed in terms of the genesis, manifestation, and similarities or differences between diagnoses. Specifically, symptoms associated with acute coronary syndrome, heart failure, valvular disorders, stroke, rhythm disorders, and peripheral vascular disease are reviewed. Secondary aims include (1) describing symptom measurement methods in research and application in clinical practice and (2) describing the importance of cardiovascular disease symptoms in terms of clinical events and other patient-reported outcomes as applicable.
Introduction:
Limited is known about prevalence and risk factors for diabetes, hypertension, and hyperlipidemia among refugees.
Methods:
At a refugee clinic in Buffalo, N.Y. (2004-2014), 1,570 adults were studied using multivariate logistic regression.
Results:
Prevalences of diabetes, hypertension, and hyperlipidemia were 7.8%, 24.1%, and 27.1%, respectively. Among refugees, 49.2% of diabetes and 46.7% of hypertension were uncontrolled. Obesity (odds ratio [OR]=2.49; 95% confidence interval [CI]=1.61-3.85) and length of stay (OR=1.25; 95%CI=1.16-1.35) were risk factors for diabetes. Eastern European origin (OR=4.09; 95%CI=2.00-8.38), obesity (OR=2.62; 95%CI=1.92-3.58), length of follow-up (OR=1.06; 95%CI=1.00-1.12), gender (OR=0.59; 95%CI=0.44-0.78) and tobacco use (OR=1.54; 95%CI=1.00-2.38) were associated with hypertension. Age (OR=1.02; 95%CI=1.01-1.04) was associated with hyperlipidemia.
Conclusions:
Refugees had comparable burden of non-communicable diseases, but a greaterleast once during the study period proportion of refugees than of the U.S. population had uncontrolled conditions. Duration of follow-up, obesity, tobacco use, gender, age, and region of origin were risk factors for diagnosis. Culturally-tailored chronic disease management strategies are needed.
Objectives
Current regional conflicts are creating a surge in forced migration, and heightened visa restrictions are increasingly being applied. The current study aimed to examine the relationship between visa insecurity and psychological outcomes within a large clinical sample of refugees and people seeking asylum in Australia.
Methods
The sample comprised 781 clients (53.9% male, 16–93 years) attending a clinic for trauma survivors. Country of birth was most frequently identified as Afghanistan (18.1%), Iraq (15.3%) and Iran (15.1%). The Hopkins Symptom Checklist was administered at admission.
Results
Latent class analyses identified four groups varying in severity of symptoms, namely very high (16.1%), high (38.1%), moderate (31.5%), and low (14.3%). People with insecure visa status were at least five times more likely to report high (OR = 5.86, p < 0.001) or very high (OR = 5.27, p < 0.01) depression and anxiety symptoms than those with permanent residency. Women were almost twice as likely to report high (OR = 1.96 p < 0.01) or very high (OR = 1.96, p < 0.05) symptoms.
Conclusions
The findings suggest that temporary visas play a significant role in psychological distress and that timely immigration processing has important implications for health outcomes.
With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency.
Background
U.S. Latinos report high levels of concern about deportation for themselves or others. No previous research has tested the link between worry about deportation and clinical measures of cardiovascular risk.
Purpose
We estimate the associations between worry about deportation and clinically measured cardiovascular risk factors.
Methods
Data come from the Center for the Health Assessment of Mothers and Children of Salinas study. The analytic sample includes 545 Mexican-origin women.
Results
In multivariable models, reporting a lot of worry about deportation was significantly associated with greater body mass index, greater risk of obesity, larger waist circumference, and higher pulse pressure. Reporting moderate deportation worry was significantly associated with greater risk of overweight and higher systolic blood pressure. Significant associations between worry about deportation and greater body mass index, waist circumference, and pulse pressure, respectively, held after correcting for multiple testing at p < .05.
Conclusions
Worry about deportation may be an important cardiovascular risk factor for ethnic minority populations in the USA.
Torture and the conditions under which it is inflicted often leave persistent painful disorders. Because there may be no lasting signs, persistent pain is often misconceived as a somatic representation of psychological distress, also common after torture. This serious failure to understand the nature of persistent pain means that pain is largely overlooked and untreated in torture survivors. We carried out a systematic review on treatments for pain from torture, but found few studies and little use of current understanding and evidence. We discuss this in the context of treating pain associated with psychological distress and of the broader problems faced by the refugee and torture survivor that may take priority over pain. We propose clinical and research implications for this neglected field.
The Stress of Immigration Survey (SOIS) is a screening tool used to assess immigration-related stress. The mixed methods approach included concept development, pretesting, field testing, and psychometric evaluation in a sample of 131 low-income women of Mexican descent. The 21-item SOIS screens for stress related to language, immigrant status, work issues, yearning for family and home country, and cultural dissonance. Mean scores ranged from 3.6 to 4.4 (a scale of 1-5, higher is more stress). Cronbach α values were more than 0.80 for all subscales. The SOIS may be a useful screening tool for detecting high levels of immigration-related stress in low-income Mexican immigrant women.
Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy. This paper describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. ACTTION-APS Pain Taxonomy will include the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment.
Perspective
The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.
Objective
This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship.Methods
Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random-effects model was used to estimate the pooled odds ratio and 95% confidence interval. Planned subgroup analyses and meta-regression examined potential moderators.ResultsIndividuals who reported exposure to trauma were 2.7 (95% confidence interval = 2.27-3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than that with sexual or physical abuse. Chronic fatigue syndrome had a larger association with reported trauma than did either irritable bowel syndrome or fibromyalgia. Studies using nonvalidated questionnaires or self-report of trauma reported larger associations than did those using validated questionnaires.Conclusions
Findings highlight the limitations of the existing literature and emphasize the importance of conducting prospective studies, further examining the potential similarities and differences of these conditions and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.
Mental health problems among Southeast Asian refugees have been documented. However, longer term health consequences of mass violence as re-settled refugees age are less well described. This study investigated relationships among trauma symptoms, self-reported health outcomes, and barriers to healthcare among Cambodian and Vietnamese persons in Connecticut. An internet phone directory was used to generate a list of names that was compared to 2000 census data to estimate the proportion of the population in each group. From these lists, 190 telephone listings were selected at random. Interviewers telephoned selected listings to screen for eligible participants and obtain an appointment for interview. Surveys were administered through face-to-face interviews during home visits conducted in Khmer or Vietnamese. The Harvard Trauma Questionnaire assessed trauma symptoms. Questions regarding the presence of physician diagnosed heart disease, hypertension, diabetes, and chronic pain were adapted as written from the Health Interview Survey. Healthcare access and occurrence were measured with questions regarding cost and access, patient-provider understanding, and interpretive services. Hierarchical modeling was used to account for respondent nesting within family. Analyses controlled for age, sex, and country of origin. Individuals who reported greater trauma symptoms were more likely to report heart disease by a factor of 1.82, hypertension by a factor of 1.41, and total count of diseases by a factor of 1.22, as well as lower levels of subjective health. Greater trauma symptoms were also associated with greater lack of understanding, cost and access problems, and the need for an interpreter. Although the majority of Southeast Asian immigrants came to the United States as refugees approximately 20-30 years ago, there continues to be high levels of trauma symptoms among this population which are associated with increased risk for disease and decreased access to healthcare services.
Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
Most of the world's refugees are displaced within the developing world. The impact of torture on such refugees is unknown.
To examine the impact of torture on Bhutanese refugees in Nepal.
Case-control survey. Interviews were conducted by local physicians and included demographics, questions related to the torture experienced, a checklist of 40 medical complaints, and measures of posttraumatic stress disorder (PTSD), anxiety, and depression.
Bhutanese refugee community in the United Nations refugee camps in the Terai in eastern Nepal.
A random sample of 526 tortured refugees and a control group of 526 nontortured refugees matched for age and sex.
The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for PTSD and the Hopkins Symptom Checklist-25 (HSCL-25) for depression and anxiety.
The 2 groups were similar on most demographic variables. The tortured refugees, as a group, suffered more on 15 of 17 DSM-III-RPTSD symptoms (P<.005) and had higher HSCL-25 anxiety and depression scores (P<.001) than nontortured refugees. Logistic regression analysis showed that history of torture predicted PTSD symptoms (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.7-8.0), depression symptoms (OR, 1.9; 95% CI, 1.4-2.6), and anxiety symptoms (OR, 1.5; 95% CI, 1.1-1.9). Torture survivors who were Buddhist were less likely to be depressed (OR, 0.5; 95% CI, 0.3-0.9) or anxious (OR, 0.7; 95% CI, 0.4-1.0). Those who were male were less likely to experience anxiety (OR, 0.66; 95% CI, 0.44-1.00). Tortured refugees also presented more musculoskeletal system- and respiratory system-related complaints (P<.001 for both).
Torture plays a significant role in the development of PTSD, depression, and anxiety symptoms among refugees from Bhutan living in the developing world.
Each year, approximately 715 000 Americans experience a heart attack, approximately 162 000 of which are fatal (Table 1).1 Of those who die, almost half die suddenly before they can get to a hospital. Although a heart attack is a frightening event, if you learn the signs of a heart attack and what steps to take, you can save a life, perhaps even your own. During a heart attack, a clot in one of the arteries of the heart suddenly blocks the flow of blood to the heart, and within minutes, heart muscle begins to die. This is technically called a myocardial infarction, meaning death of heart muscle. The more time that passes without treatment, the greater the damage. The part of the heart that dies during a heart attack cannot grow back or be repaired.
View this table:
Table 1.
Who Is at Risk
Fortunately, clot-dissolving drugs and other artery-opening treatments such as angioplasty (often followed by insertion of a stent, which helps to keep the artery open after the procedure) can stop a heart attack in its tracks. Given soon after symptoms begin, these treatments can prevent or limit damage to the heart. The quicker they are started, the more good they will do and the greater the chances are of a full recovery. These treatments are most effective if they are started in the first hour after the onset of heart attack symptoms. The benefit of opening the blocked artery decreases with each passing hour from symptom onset until treatment.
Many people think that a heart attack is sudden and intense, like the ‘“Hollywood” heart attack depicted in the movies where a person clutches his or her chest and falls over. …
Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum.
To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees.
Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed post-traumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to past trauma, detention and temporary protection.
A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release.
Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.
E motional and physical stresses have a negative impact on the heart and the vascular system. Acute stress happens all at once; chronic stress occurs over a longer time period. Stress hormones (catecholamines, including epinephrine, which is also known as adrenaline) have damaging effects if the heart is exposed to elevated catecholamine levels for a long time. Stress can cause increased oxygen demand on the body, spasm of the coronary (heart) blood vessels, and electrical instability in the heart' s conduction system. Chronic stress has been shown to increase the heart rate and blood pressure, making the heart work harder to produce the blood flow needed for bodily functions. Long-term elevations in blood pressure, also seen with essential hypertension (high blood pressure not related to stress), are harmful and can lead to myocardial infarction (heart attack), heart failure, abnormal heart rhythms, and stroke. The October 10, 2007, issue of JAMA contains an article about the effects of chronic job stress on the heart and the cardiovascular system., issue; and one on risk factors for heart disease was published in the August 20, 2003, issue.
Although asylum seeking has become a major political issue in the Western world, research on its psychological impact is still in its infancy. This study examined levels and predictors of distress among a community sample of persons who have sought asylum in Ireland. A key aim was to provide a longitudinal analysis of the relationship between legal status security and psychological distress. Distress was measured by the Symptom Checklist-90-Revised at Time 1 (N = 162) and its shorter version (the Brief Symptom Inventory) at Time 2 (N = 70). Levels of severe distress were high at both baseline (46%) and follow-up (36%). The only persons to show a decrease in distress were those who had obtained a secure legal status (e.g., refugee status or residency) between the study phases. Distress risk factors included female gender, an insecure legal status, separation from children, discrimination, and postmigration stress. Protective factors were social support (Time 1) and the presence of a partner. The findings suggest that asylum seekers are a high-risk group for distress. This risk can be reduced by appropriate policy changes and interventions to increase social resources.