OBJECTIVE: Few community studies have addressed the longitudinal course of post-traumatic stress disorder (PTSD) in traumatized refugees in early resettlement. This longitudinal study investigated changes from the first (T1) to the second interview (T2), 3 years later. The relationship between traumatic exposures and psychosocial factors/psychological symptom load were examined. METHOD: Local health professionals performed the interviews, using rating scales and a structured questionnaire. A total of 240 (52%) refugees attended. RESULTS: Unchanged Hopkins Symptom Checklist-25 and increase in Harvard Trauma Questionnaire and post-traumatic stress symptoms-16 between T1 and T2 were found, indicating the severity and chronicity of problems. Mean post-traumatic stress score was 15% above cut-off. Severe life-threatening trauma and present life in exile with unemployment and unresolved family reunion were risk factors. CONCLUSION: Early diagnostic interview should be followed by targeted approach. Pinpointing those in need of specialist services is essential. An interdisciplinary approach is necessary in this work.
Primary care clinic for refugee claimants, Montreal, Canada.
To identify factors linked to the acceptance of the tuberculin skin test (TST), and assess completion of treatment for latent tuberculosis infection (LTBI).
Asylum seekers consulting for a medical complaint or medical immigration examination between February and October 1999 were assessed for eligibility. Personal and clinical information was gathered prospectively by questionnaire. Hospital files were reviewed to assess completion of LTBI treatment.
In our study, 296 subjects (72.4% of 409 eligible) were offered TST, of whom 227 accepted (76.7%). Of these, 49 (24.9%) had a TST > or = 10 mm and 24 (49%) completed 6 months of LTBI treatment. Logistic regression models showed that patients who had never had a TST (OR 3.2, 95%CI 1.34-7.6) or had no temporary exclusion criteria (OR 4.0, 95%CI 1.6-9.9) were more likely to accept TST. Perceiving tuberculosis as a severe disease (OR 0.29, 95%CI 0.09-0.91) and consulting for an immigration examination (OR 0.42, 95%CI 0.18-0.98) was associated with refusal of TST. Increasing age was found to be independently associated with a positive TST (OR 1.06, 95%CI 1.01-1.12). Variability in the proportion of positive results was found between TST readers.
This study supports the feasibility of screening refugee claimants for LTBI during medical consultation and of developing organizational links to ensure completion of LTBI treatment.
Migrants include a broad category of individuals moving from one place to another, either forced or voluntarily. Ethnicity and migration are interacting concepts which may act as determinants for migrants' health and access to health care. This access to health care may be measured by studying utilisation patterns or clinical outcomes like morbidity and mortality. Migrants' access to health care may be affected by several factors relating to formal and informal barriers. Informal barriers include economic and legal restrictions. Formal barriers include language and psychological and sociocultural factors.
ReprintIn: Dan Med Bull. 2007 Feb;54(1):48-917349225
The aim of this study was to evaluate the extent of Activities of Daily Living (ADL) ability impairment in newly arrived Danish asylum seekers. It was hypothesized that exposure to trauma and torture would negatively influence ADL performance and that measures of ADL ability would be lower in individuals exposed to torture as compared to the non-tortured.
Forty-three newly arrived asylum seekers aged 20-50 years, from Iran, Afghanistan and Syria, were consecutively included in the study.
ADL ability was assessed with the observation-based test Assessment of Motor and Process Skills (AMPS). Interviews were based on questionnaires about torture exposure, WHO-5 Wellbeing Index, Major Depression Inventory and Pain Detect Questionnaire. All participants were interviewed and tested using a linguistic interpreter.
Thirty three (77%) participants reported exposure to torture. The tortured did not differ significantly from the nontortured on measures of ADL ability (two-sample t-tests: Motor, p= 0.36; Process, p= 0.82). ADL performance impairment was observed in the overall study sample. Twelve had motor and 15 process ability measures below age norms and 2 below both AMPS motor and process cut-offs for effortless and efficient ADL performance. There were statistically significant - weak to moderate - correlations between self-reported psychological distress, VAS average pain, pain distribution and the AMPS measures.
The study results supported significant ADL ability impairment in tortured as well as non-tortured newly arrived asylum seekers. Implementation of performance-based evaluation of ADL ability as part of the initial medical screening of this particular population should be considered.
Basic Body Awareness Therapy (BBAT) is a form of physiotherapy that is often used for psychiatric patients in Scandinavian countries. To our knowledge there has not been any studies investigating BBAT as a treatment for traumatised refugees until now.
To explore the compliance, acceptability and treatment satisfaction using group BBAT in traumatised refugees. To study changes in psychiatric and somatic symptoms as well as quality of life, level of functioning and quality of movement during treatment with BBAT.
All Arabic speaking patients that previously had received treatment at the Competence Centre for Transcultural Psychiatry in Copenhagen from April 2008 to June 2009 were invited to participate (N=29). Nine persons were included in a male (N=4) and female (N=5) group. All participants were traumatised refugees. The BBAT treatment consisted of 14 sessions over a period of 14 weeks. Before and after treatment the participants were interviewed using a semi-structured interview guide. The interviews were transcribed and analysed with a thematic approach. The participants also filled out self-administrated questionnaires and two physiotherapists tested the participants' movement harmony using the Body Awareness Rating Scale-Movement Harmony (BARS-MH) test. At the end of the study, the participants filled out anonymous questionnaires about treatment satisfaction.
The results showed that the participants had a high compliance, acceptability and treatment satisfaction with BBAT. The majority of participants showed improvements in symptoms from baseline to post-intervention on the self-administrated questionnaires and in the BARS-MH test.
Further research is needed to expand the scientific knowledge regarding the use of BBAT in traumatised refugees. If future research can confirm our positive findings it will have a considerable impact on future treatment designs and for the individual patient.
The objective of the present study was to assess alexithymia by means of the Toronto Alexithymia Scale (TAS-20) and The Emotion Protocol (EP) in a group of refugees. Eighty-six subjects were willing to participate. At last follow-up, 33 non-PTSD and 22 PTSD subjects had complete data. Subjects with PTSD had higher scores on the TAS-20 (F = 4.314, df = 77, p = 0.041), but on the subscale level, this was significant only with regard to Factor I, difficulties identifying feelings (F = 5.316, df = 77, p = 0.024). TAS Factor I and to a lower extent TAS Factor II (difficulties naming feelings) were significantly associated with the self-rated presence of dysphoric affects. At follow-up, an increase in TAS Factor I score was associated with increased prevalence of self-rated symptoms of PTSD, but not depression. Decrease in prolactin was associated with significant increase of TAS Factor I (rho = -0.396, n = 54, p = 0.003). The present study indicates that alexithymia as measured by TAS-20 is indeed associated with symptoms of PTSD. This association is almost exclusively explained by the TAS Factor I subscale and is in turn associated with a high level of self-reported dysphoric affect. The longitudinal inverse correlation with prolactin points to the possibility of an underlying disturbance in serotonergic and/or dopaminergic systems. The results thus indicate that secondary, or post-traumatic, alexithymia is a measure of suppressed or warded-off negative affects.