Correlates of symptom reduction in treatment-seeking survivors of torture.

Abstract

While a growing body of literature addresses the psychological consequences of torture and war trauma, there are few empirical examinations of treatment for survivors of torture. This study offers a program evaluation of a comprehensive torture treatment program in New York City. We present literature surrounding the interdisciplinary "wraparound" approach to treating survivors of torture, and examine the relationship between clinical services and symptom reduction in a multinational sample of refugees (N ϭ 172) receiving treatment over a 6-month period. Clients were administered the Brief Symptom Inventory (BSI) and the Harvard Trauma Questionnaire (HTQ) during their intake interview and six months later. We found that approximately 45% (n ϭ 77) of treated clients displayed clinically significant improvement on either the HTQ, or the BSI subscales of Depression, Anxiety, or Somatization, over the six months following their intake evaluation. Generalized linear models revealed that gaining secure immigration status was the strongest correlate of clinical improvement. However, psychotherapy and attendance at educational sessions predicted improvement in symptoms beyond adjusting to a more secure immigration status. While this study's correlational design does not establish that treatment caused the observed improvement, results point to the pivotal role of both clinical and "nonclinical" services and provide preliminary support for the value of an interdisciplinary approach. More research is needed to understand mechanisms of change and improvement in this sensitive population.

Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature

“…Primary coding was done by the first author, a clinical psychologist from the U.S. with a decade of research and practice working with refugees, torture survivors, and other survivors of political violence in home countries (Rasmussen, Rosenfeld, et al, 2007), refugee camps (Rasmussen, Katoni, Keller, & Wilkinson, 2011; Rasmussen et al, 2010), and resettlement contexts in the U.S. (Raghavan, Rasmussen, Rosenfeld, & Keller, 2012; Rasmussen, Smith, et al, 2007). A randomly selected 15 CCDs were also coded by the third author, i an Australian clinical psychologist with graduate and postdoctoral experience in posttrauma settings in Southeast Asia and clinical experience with PTSD and complicated grief.…”

Predicting post‐traumatic stress disorder treatment response in refugees: Multilevel analysis

“…Only a small number of studies however directly examined predictors of treatment response in refugees. One demographic variable (male gender; Stenmark et al ., ), one migration‐related variable (lack of refugee status; Raghavan, Rasmussen, Rosenfeld, & Keller, ), two trauma‐related variables (abduction history, Betancourt et al ., ; offender status, Stenmark, Catani, Neuner, Elbert, & Holen, ), one coping variable (lack of a firm belief system; Brune et al ., ), one treatment variable (the number of trauma‐focused treatment sessions; Lambert & Alhassoon, ), and two clinical variables (comorbid depression, Silove, Manicavasagar, Coello, & Aroche, ; poorer pre‐intervention mental health, Van Wyk, Schweitzer, Brough, Vromans, & Murray, ) have been found to predict poor treatment response.…”

Can disability predict treatment outcome among traumatized refugees?

“…Items were scored on a 4-point Likert scale. The cut-off score of 2.5 was used in accordance with similar studies on refugee populations (Buhmann, 2014;Palic & Elkit, 2009;Raghavan, Rasmussen, Rosenfeld, & Keller, 2013). The reliability estimates in the current study were high with a Cronbach alpha coefficient of .90 at baseline and .96 post-treatment.…”

“…Lavelle, Truong, Tor, & Yang, 1990), while others found statistically significant symptom reductions following multidisciplinary treatment (Brune, Haasen, Krausz, Yagdiran, Bustos, & Eisenman, 2002;Carlsson et al, 2005;Raghavan et al, 2013). There may be several reasons for these non-significant findings.…”