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PubMed1994

General health assessment in refugees claiming to have been tortured.

General health assessment of refugees claiming to have been previously exposed to torture takes place in a psychological atmosphere affected by the difficult situation of the refugee. Thirty-one refugees, mainly from the Middle East and Africa, were assessed as regards their physical and mental health. Assessment took place with the help of professional interpreters and was, during each interview, performed by two medical doctors using double-blind techniques. Based on a number of highly significant (P < 0.001) correlation coefficients and Kappa values, observers agreed frequently on gradients of symptom intensity and less frequently on absolute symptom levels. However, agreement was almost complete when assessing the presence of intense symptoms and the absolute absence of a symptom. Symptom patterns were demonstrated to be consistent, clinically interpretable and, furthermore, closely associated (P < 0.0001) with self-reported global (general) health. Reliability was moderate with respect to clinical observation during interview.

Adult↗
PubMed2004

Trauma and coping in Somali and Oromo refugee youth.

PURPOSE: To describe war-related trauma history, immigration factors, problems, and coping of Somali and Oromo refugee youth. METHODS: Analysis of a subset of participants (N = 338) aged 18-25 years from a population-based survey of Somali and Oromo refugees conducted in 2000-2002. Data included trauma history, life situation, and scales for physical (Cronbach alpha =.69), psychological (alpha =.56), and social problems (alpha =.69). Data were analyzed using Chi-square and Mann-Whitney U tests. RESULTS: Average emigration age was 14.8 years, with 4.2 years in transit and 2.0 years in the United States; 60% reported plans to return home to live. Two-thirds (66%) had less than a high school education, 49% had English language problems, 49% were employed (38% female vs. 57% male); 70% were single, with Somali females more likely than Oromo to be partnered and mothers (39% vs. 19%). There were significant ethnicity/gender differences for all problem scales. More females reported feeling alone (24% vs. 61%, p <.001). Youth with symptoms of posttraumatic stress syndrome reported more traumatic events (mean number of events: 28 vs.16). Trauma history was strongly associated with physical, psychological, and social problems. Most frequent strategies to combat sadness were praying (55.3%), sleeping (39.9%), reading (32.3%), and talking to friends (27.8%). CONCLUSIONS: Many young Somali and Oromo immigrants to the United States experience life problems associated with war trauma and torture, but many others are coping well. The findings suggest a need to develop age-appropriate strategies to promote the health of refugee youth to facilitate their successful adaptation to adult life in the United States.

Adaptation, Psychological↗
PubMed2005

Selective numbing and hyperarousal in male and female Bosnian refugees with PTSD.

Emotional numbing is an important symptom of PTSD, but it is not clear whether it affects both positive and negative affect equally or not. To address this question we administered Lang's Looking at Pictures test, in which a series of pictures are rated for valence (pleasant-unpleasant) and arousal (high-low), to 10 male and 11 female Bosnian refugees suffering from PTSD (DSM-IV criteria) and to control groups of 11 male and 10 female Bosnian refugees with similar trauma exposure but without PTSD or any other major mental illness. The mean valence ratings for unpleasant, neutral, and pleasant pictures of both PTSD and control males and females were similar to normal ratings. Likewise, the mean arousal ratings for unpleasant, neutral, and pleasant pictures of both male and female controls were similar to normals, with both unpleasant and pleasant pictures rated more arousing than neutral pictures. In contrast, in both males and females with PTSD pleasant pictures were rated as almost completely non-arousing. Thus, in Bosnian refugees affective numbing is seen primarily with pleasant or positive stimuli.

Adult↗
PubMed2005

Comparing refugees and nonrefugees: the Bosnian experience.

The Bosnian War (1992-1995) led to millions of Bosnians being either internally displaced or seeking refuge in other countries. The present study compares the mental health status of refugees with people who were internally displaced. Questionnaires examining wartime experiences, traumatic symptoms and personality were administered to 190 Bosnians (69 refugees and 121 internally displaced). Refugees scored significantly higher on traumatic symptoms. Traumatic symptoms are related to harm avoidant personality traits. Certain war experiences were also associated with greater symptomatology. The findings show that there may be more serious longer-term psychological problems in people who are forced to leave their country during wartime. This may be linked to personality. There are social, political, and treatment implications of these findings.

Adolescent↗
PubMed2006

Primary health care for refugees and asylum seekers: a review of the literature and a framework for services.

OBJECTIVES: This paper aims to provide a framework for primary health care services to meet the recognized health needs of refugees and asylum seekers that can be used in planning and evaluating services for this group. REVIEW: Primary care services for refugees and asylum seekers are reviewed and presented in terms of a tripartite framework of gateway, core and ancillary services. Gateway services facilitate entry into primary care by identifying unregistered patients and carrying out health assessments. They are typically undertaken by nurse-led outreach services and specialist health visitors. Core services provide full registration and may be provided by dedicated practices or by mainstream practices, with or without additional support. Ancillary services are those that supplement and support core services' ability to meet the additional health needs of this group. They include language and information services, close links with community-based organizations, specialist mental health services and services for survivors of torture and organized violence, as well as targeted health promotion and training of health workers. CONCLUSIONS: The framework can be used for education and training, planning and commissioning, and to provide criteria for comparison and evaluation. The paper suggests that a lack of published evaluations and reports about interventions for refugees and asylum seekers constrains further policy development that could build on the strengths of such interventions. It also stresses the importance of ancillary services to successful mainstream provision.

Community Health Nursing↗
PubMed1989

Delusions of fatal contagion among refugee patients.

Delusions of fatal contagion were encountered in about 10% of refugee psychiatric patients from Southeast Asia belonging to one ethnic group, the Hmong. Psychotic depression was the most common diagnosis among the Hmong patients with delusions of contagion, whereas paranoid and schizophrenic diagnoses predominate in patients with similar delusions from other refugee groups. Some cases also occurred as a shared delusional disorder. Associated findings included isolation from the community, intrafamilial conflict, failure to acculturate, and sexual frustration or conflict. Most patients responded to tricyclic medication, later supplemented in about half of the cases with a neuroleptic. This syndrome, which does not appear to have been described previously, should be considered in cases of somatizing refugees who present repeatedly to medical facilities.

Adolescent↗
PubMed1989

Somatization among refugees: an epidemiologic study.

Somatization has been widely reported among refugee psychiatric patients since World War II, and some psychological theorists have viewed somatization as an alternative to depression. These and other theories were tested in a population survey of 97 Hmong refugees who had lived in the U.S. for several years. Four different measures of somatization were employed, including a 12-item self-rating scale, a single-item global rating based on the total interview, and somatic subscales of the two Hamilton interview-rating scales. These data demonstrate that somatization accompanies certain demographic characteristics that are associated with failure to acculturate. Somatization in this non-patient, refugee population was associated with treatment seeking and self-identified "medical problems" and with psychiatric symptoms and disorders, but not with objective evidence of medical disorder.

Acculturation↗
PubMed1988

Cultural factors in working with Southeast Asian refugee adolescents.

The purpose of this paper is to present some of the unique socio-political-cultural factors that impact upon the psychological development of Southeast Asian refugee adolescents. As a special group of youngsters, they are confronted with the developmental crisis as adolescents, adjustment problems as refugees, and intercultural conflicts caused by the immense value differences between Eastern and Western cultures. In working with this population, clinicians are urged to take into account the special stressors resulting from the refugee and cultural experiences. Three areas of assessment are recommended: (1) assessment of major stresses (migration stress, acculturation stress, life cycle stress, and family stress); (2) assessment of strengths; and (3) assessment of culturally specific responses to mental health problems. Different treatment modalities are also discussed. It is hoped that the practical suggestions presented in this paper can lead to more culturally relevant care for this group of youths.

Acculturation↗
PubMed2004

Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia.

BACKGROUND: Posttraumatic stress disorder (PTSD) is common in refugees but its association with longer-term psychosocial dysfunction remains unclear. We examined whether a subgroup of refugees with comorbid PTSD and depression were at particularly high risk of disability. We also investigated whether specific trauma experiences were linked to this comorbid pattern. METHODS: Consecutive Bosnians (and one or two compatriots nominated by them) were recruited from a community centre, yielding a total sample of 126 participants (response rate 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS) (Blake et al., 1995) and the depression module of the Structured Clinical Interview (SCID) (First et al., 1997). RESULTS: Three diagnostic groupings emerged: normals (n=39), pure PTSD (n=29), and comorbid PTSD and depression (n=58). Of four trauma dimensions derived from principle components analysis (human rights violations, dispossession and eviction, life threat and traumatic loss), life threat alone was associated with pure PTSD, with life threat and traumatic loss both being associated with comorbidity. Compared to normals and those with pure PTSD, the comorbid group manifested more severe PTSD symptoms as well as higher levels of disability on all indices (global dysfunction: odds ratio=5.0, P<0.001, distress: odds ratio=6.0, P<0.001, social impairment: odds ratio 5.9, P<0.001, and occupational disability: odds ratio 5.0, P<0.001). LIMITATIONS: Recruitment was not random, the sample size was modest, and trauma event endorsement was based on retrospective accounts. CONCLUSIONS: The combination of life threat and traumatic loss may be particularly undermining to the psychological well-being of refugees and consequent comorbidity of PTSD and depression may be associated with longer-term psychosocial dysfunction. The findings raise the question whether the comorbid pattern identified should be given more recognition as a core posttraumatic affective disorder.

Adolescent↗
PubMed1990

Size and sociodemographic characteristics of the Afghan refugee population in Pakistan.

Some recent data are presented on the size and selected sociodemographic characteristics of the Afghan refugee population in Pakistan. Although the official figures show that there were 3.27 million registered Afghan refugees in Pakistan, it is estimated that the actual number may be as high as 3.6 million. There is an excess of females over males, mainly due to war-related activities and excessive casualties particularly among males. While infant and childhood mortality rates are declining and are lower than the levels prevalent in Pakistan, as well as in Afghanistan during the pre-war period, the fertility levels among Afghan refugees seem very high indeed.

Afghanistan↗
PubMed2000

Health problems among Latin-American and middle-eastern refugees in The Netherlands: relations with violence exposure and ongoing sociopsychological strain.

In two studies (n = 480; n = 156), the health problems (somatic, psychological, and migration-related complaints) of refugees were examined, in relation to violence, demographic, and asylum variables (ongoing sociopsychological strain). High frequencies for torture events and a substantial number of medical complaints were reported, but few cases of diagnosable Posttraumatic Stress Disorder (PTSD) were identified (Study I: 6%; Study II: 11%). Not only reported violence, but also the current social situation contributed to the experiencing of ongoing health complaints. Refugees attributed their somatic and psychological complaints to illness (48%) and to torture (29%) and psychological complaints, in particular, to worries related to the postmigration situation (40%). Paying attention only to health complaints and to past violent experiences is too limited an approach in responding to the needs of refugees.

Adult↗
PubMed2001

Going home: giving voice to memory strategies of young Mayan refugees who returned to Guatemala as a community.

Around 1982, thousands of Guatemalan Mayas fled their villages and lands to escape the Rios Montt scorched-earth policy implemented in rural areas. After more than a decade of exile, many of those refugees have returned to their homeland. This paper looks at the ways in which young Mayan refugees who have returned home after extended exile in Mexico appropriate and distance themselves from the collective project of going home. Two Mayan communities of retornados (returnees), whose paths into exile and home again differ slightly, are compared. Outside support from international organizations and cohesion in the refugee camps enabled the young people of La Victoria to see disclosure of the traumatic past from a position of strength and confrontation as the key to social change. In La Esperanza, the past is rebuilt by the youth around avoidance of recent history, and tradition appears as a bridge between past and future. The way the youth of the two communities construct their homecoming demonstrates how small changes in the migration experience may result in considerable differences in the choice of strategies, and raises important questions about assistance programs that might be developed for these populations.

Adolescent↗
PubMed2001

Sertraline, paroxetine, and venlafaxine in refugee posttraumatic stress disorder with depression symptoms.

Three new antidepressants were used in treating posttraumatic stress disorder (PTSD) and symptoms of depression in Bosnian refugees. Thirty-two Bosnian refugees seeking treatment at a mental health clinic participated in a case series study. All received open trials of Sertraline (n = 15), Paroxetine (n = 12), or Venlafaxine (n = 5), with standard clinical doses. Overall, Sertraline and Paroxetine produced statistically significant improvement at 6 weeks in PTSD symptom severity in depression, and in Global Assessment of Functioning. Venlafaxine produced improvement in PTSD symptom severity and in Global Assessment of Functioning, did not yield improvement in symptoms of major depressive disorder; and had a high rate of side effects. Notwithstanding improvement of symptoms, all 32 refugees remained PTSD positive at the diagnostic level at the 6-week follow-up.

Adult↗
PubMed1991

Primary prevention of acculturative stress among refugees. Application of psychological theory and practice.

Primary prevention in refugee mental health requires information from clinical, health, and cross-cultural psychology. Primary prevention's roots are in public health, which is distinguished by a communitywide perspective for addressing mental health concerns. This article summarizes research suggesting that refugees are an at-risk population, making them especially suitable for public health interventions. Research on stress and acculturation is highlighted, given its importance to prevention in refugee mental health. The opportunities for primary prevention programs and policies at 3 levels (i.e., local community, national, and international) are illustrated with case examples from both the United States and Canada. Prevention at the international level is highlighted by a World Health Organization Mental Health Mission to camps on the Thai-Cambodian border.

Acculturation↗
PubMed2002

Bosnian refugees and the stressors of exile: a narrative study.

The authors used semistructured interviews to examine exile-related stressors affecting a sample of 28 adult Bosnian refugees in Chicago. The interviews covered 3 areas: life in prewar Bosnia, the journey of exile, and, most centrally, life in Chicago. Primary sources of exile-related distress included social isolation and the loss of community, separation from family members, the loss of important life projects, a lack of environmental mastery, poverty and related stressors such as inadequate housing, and the loss of valued social roles. The implications of these findings for mental health interventions with refugees are considered, and the value of narrative methods in research with refugee communities is discussed.

Adaptation, Psychological↗
PubMed2005

The role of interpreters in psychotherapy with refugees: an exploratory study.

Findings are presented from a narrative study that examined the use of interpreters in psychotherapy with refugees. Fifteen therapists and 15 interpreters were interviewed at 14 refugee mental health treatment centers in the United States. Core findings concerned the impact of interpreters on the therapeutic alliance, the complex emotional reactions that may arise within the therapy triad, the effects of interpreting on interpreters' own well-being, the multiple roles that interpreters play in addition to translating language, and the training and supervision needs of interpreters and of therapists who work with them. Implications of these findings for agencies that use interpreters in their clinical work with refugees are considered, and specific recommendations are made concerning the hiring, training, and support of interpreting staff.

Adult↗
PubMed2006

Trauma healing in refugee camps in Guinea: a psychosocial program for Liberian and Sierra Leonean survivors of torture and war.

From 1999 to 2005, the Minneapolis-based Center for Victims of Torture (CVT) served Liberian and Sierra Leonean survivors of torture and war living in the refugee camps of Guinea. A psychosocial program was developed with 3 main goals: (a) to provide mental health care, (b) to train local refugee counselors, and (c) to raise community awareness about war trauma and mental health. Utilizing paraprofessional counselors under the close, on-site supervision of expatriate clinicians, the treatment model blended elements of Western and indigenous healing. The core component consisted of relationship-based supportive group counseling. Clinical interventions were guided by a 3-stage model of trauma recovery (safety, mourning, reconnection), which was adapted to the realities of the refugee camp setting. Over 4,000 clients were provided with counseling, and an additional 15,000 were provided with other supportive services. Results from follow-up assessments indicated significant reductions in trauma symptoms and increases in measures of daily functioning and social support during and after participation in groups. The treatment model developed in Guinea served as the basis for CVT's ongoing work with survivors in Sierra Leone and Liberia. ((c) 2006 APA, all rights reserved).

Guinea↗
PubMed2002

The association between nutritional status and handgrip strength in older Rwandan refugees.

OBJECTIVES: To investigate the association between nutritional status and handgrip strength in older Rwandan refugees. DESIGN: Cross-sectional study. SETTING: Rwandan refugee camp located in Karagwe district in the north-west of Tanzania. The study was carried out in the post-emergency phase. The response rate was 85%. SUBJECTS: A total of 413 men and 415 women aged 50-92 y participated in the study. METHODS: Weight, height, mid-upper-arm circumference (MUAC) and triceps skinfold were obtained using standard techniques. For people with visible kyphosis, height was estimated from armspan using regression equations developed from non-kyphotic subjects within the sample. Handgrip was measured using a mechanical handgrip dynamometer. Information regarding physical activity and health status was obtained by interview and clinical screening. RESULTS: Handgrip strength (kg) was significantly higher in men than in women (30.3+/-6.7 vs 22.3+/-5.1), and significantly lower in each older age group in both sexes. Handgrip strength was positively correlated to BMI (body mass index) and AMA (arm muscle area). The relative risk of impaired handgrip strength in individuals with poor nutritional status (BMI<18.5 kg/m(2)) compared with those of adequate nutritional status was 1.75. After controlling for potential confounders (sex, age and height), BMI remained a significant contributor to the variation in handgrip strength. CONCLUSION: Poor nutritional status is associated with poor handgrip strength independent of sex, age and height, in this refugee population. This may indicate that underweight older people are likely to have more difficulties in functioning independently in the community. Research is needed to investigate if improving nutritional status can lead to better functional ability. SPONSORSHIP: Department for International Development (UK) and HelpAge International.

Aged↗