Impact of Torture on Refugees Displaced Within the Developing World

Abstract

Context.-Most of the world's refugees are displaced within the developing world. The impact of torture on such refugees is unknown. Objective.-To examine the impact of torture on Bhutanese refugees in Nepal. Design.-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. Setting.-Bhutanese refugee community in the United Nations refugee camps in the Terai in eastern Nepal. Participants.-A random sample of 526 tortured refugees and a control group of 526 nontortured refugees matched for age and sex. Main Outcome Measures.-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. Results.-The 2 groups were similar on most demographic variables. The tortured refugees, as a group, suffered more on 15 of 17 DSM-III-R PTSD symptoms (PϽ.005) and had higher HSCL-25 anxiety and depression scores (PϽ.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 (PϽ.001 for both). Conclusion.-Torture plays a significant role in the development of PTSD, depression, and anxiety symptoms among refugees from Bhutan living in the developing world.

Somatic panic-attack equivalents in a community sample of Rwandan widows who survived the 1994 genocide

“…Multiple studies have demonstrated high rates of somatic symptoms in trauma victims (Lin and Cheung, 1999;Shrestha et al, 1998;Van Ommeran et al, 2001). Results of the present study support the hypothesis that Rwandan holocaust survivors frequently experience the sudden onset of somatic symptom(s) that form part of a panic attack.…”

Western conceptualizations and eastern experience: A cross‐cultural study of traumatic stress reactions among Tibetan refugees in India

“…These differences between the studies are difficult to interpret, but may have to do with sample differences (Holtz's respondents were predominantly nuns). The study of Bhutanese refugees in Nepal (Shrestha et al, 1998) revealed a similar pattern to ours, with nearly one third of the respondents reaching the cutoff point for substantial emotional distress. The proportion of respondents that endorsed anxiety was 38%, whereas substantial symptoms of depression were reported by 20%.…”

Conceptual Problems with the DSM‐IV Criteria for Posttraumatic Stress Disorder

“…Shocking nearly everyone in the West, many African girls eagerly await traditional coming-of-age ceremonies in which their genitalia are carved up by older women (Obermeyer, 1999;Shweder, 2000). Conversely, compelling Hindus to violate religious taboos by forcing them to eat pork and beef is a common method of torture in Bhutan (Shrestha et al, 1998).…”