There is increasing evidence that immigrants and traumatized individuals have elevated prevalence of medical disease. This study focuses on 459 Vietnamese, Cambodian, Somali, and Bosnian refugee psychiatric patients to determine the prevalence of hypertension and diabetes. The prevalence of hypertension was 42% and of diabetes was 15.5%. This was significantly higher than the US norms, especially in the groups younger than 65. Diabetes and hypertension were higher in the high-trauma versus low-trauma groups. However, in the subsample with body mass index (BMI) measurements subjected to logistic regression, only BMI was related to diabetes, and BMI and age were related to hypertension. Immigrant status, presence of psychiatric disorder, history of psychological trauma, and obesity probably all contributed to the high prevalence rate. With 2.5 million refugees in the country, there is a strong public health concern for cardiovascular disease in this group.

Secondary traumatization from the tragic events of September 11, 2001 was studied among an ethnically diverse group of refugees who had been previously traumatized in their native war torn countries. A brief clinically oriented questionnaire was developed and administered to a clinic population of Vietnamese, Cambodian, Laotian, Bosnian and Somalian refugees in the Intercultural Psychiatric Program at Oregon Health & Science University. Traumatic symptoms and responses to the widely televised images from September 11 were assessed among the five ethnic groups, and the differential responses among patients with posttraumatic stress disorder (PTSD), depression, and schizophrenia also were assessed. The strongest responses were among Bosnian and Somalian patients with PTSD, and the Somalis had the greatest deterioration in their subjective sense of safety and security. Regardless of ethnic group, PTSD patients reacted most intensely, and patients with schizophrenia the least. Although patients largely returned to their baseline clinical status after two to three months, this study shows that cross-cultural reactivation of trauma has a significant clinical impact. It is essential that clinicians anticipate PTSD symptom reactivation among refugees when they are reexposed to significant traumatic stimuli.

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Imagery rehearsal therapy (IRT) may help reduce residual nightmares and posttraumatic stress disorder (PTSD) symptoms in veterans after trauma-focused PTSD treatment. Fifteen male U.S. veterans with PTSD and trauma-related nightmares, who had not previously completed trauma-focused PTSD treatment, attended 6 IRT group sessions. No benefits were observed immediately posttreatment. At 3- and 6-month follow-up, however, trauma-related nightmare frequency (nights/week) decreased (p < .01). The number of trauma-related nightmares/week (p < .01), number of total nightmares/week (p < .05), and PTSD symptoms (p < .05) also decreased at 3 months. The overall F test for time was significant (p < .05) for nightmare severity and fear of sleep. No effects were found on measures of the impact of nightmares, sleep quality, or depression. Clinical and research implications are discussed.