Predictors of mental health and quality of life in male tortured refugees

Abstract

Some of the most frequently reported mental health problems in traumatized refugees are depression, anxiety and post-traumatic stress disorder (PTSD). The aim of this paper is to describe a group of tortured refugees referred to the Rehabilitation and Research Centre for Torture Victims (RCT) and to study the importance of past trauma/torture and post-migratory factors for the present symptoms of PTSD, depression, anxiety and for health-related quality of life. The sample comprises 63 male tortured refugees admitted to a pre-treatment assessment at RCT. Data on personal background, trauma, present situation in Denmark, symptoms of depression, anxiety (Hopkins Symptom Checklist-25, HSCL-25, and Hamilton Depression Scale, HDS), PTSD (Harvard Trauma Questionnaire, HTQ), and on health-related quality of life (WHO Quality of life-Bref, WHOQOL-Bref) were collected through self-administered questionnaires and structured and semi-structured interviews. The scores in the questionnaires measuring emotional distress were high. Previous torture and trauma, lower education, fewer social contacts, no occupation and pain were identified as significant predictors of emotional distress. Few social contacts was a significant predictor of a lower health-related quality of life. Even after many years, past torture is significantly associated with emotional distress. Post-migratory factors are also significantly associated with emotional distress and health-related quality of life, and potentially modifiable factors, such as social relations and occupation, are of special interest.

Evidence-based clinical guidelines for immigrants and refugees

“…Phases II and III should focus on the patient's priorities, which may include social integration and/or treatment of symptoms. Unemployment, isolation and discrimination may overshadow the efficacy of mental health treatment in many patients, 430 which suggests that multifaceted interventions that include primary care, community organizations and other social institutions may be effective. 432 …”

“…51 Studies of child refugees report 11% prevalence of posttraumatic stress disorder. 429,430 Symptoms may be reactivated when faced with new traumas, particularly if reminiscent of earlier traumatic experiences. 431 Torture and cumulative trauma are the strongest predictors of post-traumatic stress disorder and are associated with chronic physical and mental health problems.…”

“…431 Torture and cumulative trauma are the strongest predictors of post-traumatic stress disorder and are associated with chronic physical and mental health problems. 430 Fear of repatriation may exacerbate consequences of premigratory traumas. Do not conduct routine screening for exposure to traumatic events, because pushing for disclosure of traumatic events in well-functioning individuals may result in more harm than good.…”

Recommendations for Canadian Mental Health Practitioners Working With War-Exposed Immigrants and Refugees

“…Rather, the study found social factors to be significant contributors to the subjects' symptomatology versus the impact of torture per se. Drawing on another study with similar treatment outcomes (Miller et al, 2002), Carlsson, Mortensen, & Kastrup (2006) argue for a broader scope in treatment interventions that are more closely linked to the context in which refugees live.…”

An evaluation of combined narrative exposure therapy and physiotherapy for comorbid PTSD and chronic pain in torture survivors

“…3 A number of studies have investigated the link between pain and PTSD, including amongst torture survivors specifically. 4 Chronic pain is highly prevalent in torture survivors, 4 often co-occurs with PTSD and is associated with poorer prognosis.…”