Mental Health of Refugees and Torture Survivors: A Critical Review of Prevalence, Predictors, and Integrated Care

Abstract

Civilian war trauma and torture rank among the most traumatic life experiences; exposure to such experiences is pervasive in nations experiencing both internal and external conflict. This has led to a high volume of refugees resettling throughout the world with mental health needs that primary care physicians may not be screening for and prepared to effectively address. In this article, we review the literature on demographics, predictors, mental health outcomes of torture, and integrated care for the mental health needs of refugees. We searched PubMed and PSYCINFO databases for original research articles on refugees and mental health published in the English language between 2010 and present. Nine percent of 720 adults in conflict areas in Nepal, with predominance of literate married males, met the threshold for Post-Traumatic Stress Disorder (PTSD), 27.5% for depression, and 22.9% for anxiety. While, PTSD rate has been documented as high as 88.3% among torture survivors from Middle East (ME), Central Africa (CA), South Asia (SA), Southeast Europe (SE). Depression was recorded as high as 94.7% among 131 African torture survivors and anxiety as high as 91% among 55 South African torture survivors. Torture severity, post-migration difficulties, and wait time to receive clinical services were significantly associated with higher rate of mental health symptoms. Mental health screening is not a standard component of initial physical exams for refugees, yet these individuals have had high trauma exposure that should inform clinical care. Integrated care models are lacking but would greatly benefit this community to prevent progression to greater severity of mental health symptoms.

Country of birth, time period of resettlement and subsequent treated common mental disorders in young refugees in Sweden

“…First, there are differences in the prevalence of CMDs in refugees originating from different countries. 37 Secondly, the differences in the risk for developing CMDs can be due to the differences in stressors related to reasons for leaving the home country, the asylum and acculturation process. 38 Social integration in the host country might differ for refugees from different countries and might be hampered by language difficulties, level of education and potential discrimination.…”

Disability, violence, and mental health among Somali refugee women in a humanitarian setting

“…Our findings are consistent with other research from non-camp settings showing that people with disabilities are at increased risk of violence and exploitation (Mirza, 2015 ; Dunkle et al ., 2018 ; Scolese et al ., 2020a ). Our research also suggests that refugee women with a disability are more likely to report poor mental health conditions (depression, anxiety, and PTSD), which is consistent with the existing literature (Steel et al ., 2009 ; Bogic et al ., 2015 ; Abu Suhaiban et al ., 2019 ). In addition, conflict-related violence and other NPV which occurred before arriving in the Dadaab refugee camps continued to have a long-term impact on women's mental health – women who reported NPV before arriving in Dadaab had higher levels of depression and PTSD.…”

Parrilla urethra: A sequalae of electric shock torture to genitals in men. A 40 case series in Kashmir (India)

“…The most frequent psychological sequelae include sleep disturbances, being uncomfortable in situations reminding of past torture experiences, stigma and social isolation, ruminations about traumatic events, emotional instability and violence towards family members and suicidal attempts (Araujo et al, 2019;Ba & Bhopal, 2017;Crescenzi et al, 2002;Cunningham & Cunningham, 1997;Masmas et al, 2008;Suhaiban et al, 2019;Tamblyn et al, 2011).…”