Article1998

Impact of Torture on Refugees Displaced Within the Developing World

Nirakar Man Shrestha · Bhogendra Sharma · Mark van Ommeren · Ramesh Makaju · Ivan H. Komproe · Ganesh B. Shrestha +1 more

281 citations0/0 files storedJAMA

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Migration, Health and Trauma Posttraumatic Stress Disorder Research Torture, Ethics, and Law

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-RPTSD symptoms (P<.005) and had higher HSCL-25 anxiety and depression scores (P<.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 (P<.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.

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References

1974The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory 1997Anxiety, depression and PTSD in asylum-seekers: Assocations with pre-migration trauma and post-migration stressors 1995World Mental Health: Problems and Priorities in Low-Income Countries 1987Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees 1991Primary prevention of acculturative stress among refugees: Application of psychological theory and practice.1997Development of a criteria set and a structured interview for disorders of extreme stress (SIDES)1987The psychosocial impact of war trauma and torture on Southeast Asian refugees 1993The Effect of Trauma and Confinement on Functional Health and Mental Health Status of Cambodians Living in Thailand-Cambodia Border Camps

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2017The Global Refugee Crisis: Empirical Evidence and Policy Implications for Improving Public Attitudes and Facilitating Refugee Resettlement 2010Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma 2002A 3‐year follow‐up study of psychosocial functioning and general symptoms in settled refugees

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