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.
Highlights
Trauma is defined as the exposure to actual or threatened death, serious violence/injury, disaster, or actual or threatened sexual violence via direct experience, witnessing, or learning about the event [1].Approximately 70% of the general population has been exposed to trauma [2]
Post-migration difficulties, and wait time to receive clinical services were significantly associated with higher rate of mental health symptoms
Most individuals are in their 30s and ~60% of individuals are male
Summary
Trauma is defined as the exposure to actual or threatened death, serious violence/injury, disaster, or actual or threatened sexual violence via direct experience, witnessing, or learning about the event [1].Approximately 70% of the general population has been exposed to trauma [2]. Trauma is defined as the exposure to actual or threatened death, serious violence/injury, disaster, or actual or threatened sexual violence via direct experience, witnessing, or learning about the event [1]. For refugees (someone who has been forced to flee his or her country because of persecution, war, or violence [3]) repeated exposure to civilian war trauma and stress of forced migration is common. Traumatic war experiences include detention in concentration camps, separation from family, displacement, witnessing violence, and physical torture. Such events may put one at a greater risk for a wide range of physical and psychological impairment and disability [4,5]. According to the United Nations High Commission on Refugees (UNHCR), there are 65.6 million ‘persons of concern’ worldwide, including 22.5 million refugees and several million asylum seekers (someone who flees his or her own country and seeks sanctuary in another country), internally displaced persons (someone who has been forced to flee his or her home but never crossed an international border), and stateless persons
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