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Rizkalla N, Alsamman S, Bakr O, Masud H, Sbini S, Segal SP. Hidden scars: the persistent multifaceted health and psychosocial consequences for Syrian torture survivors. Eur J Psychotraumatol 2024; 15:2400833. [PMID: 39351621 PMCID: PMC11445929 DOI: 10.1080/20008066.2024.2400833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/30/2024] [Accepted: 08/05/2024] [Indexed: 10/04/2024] Open
Abstract
Background: The impact on the physical and mental health of those who survived torture and their close circles in the Syrian regime's detention facilities remains under-studied.Objective: This qualitative study explored Syrian refugees' narrations of captivity and torture, and the consequences of such extreme traumatic events on their physical and psychosocial health.Method: Thirteen audio-recorded interviews were conducted in Arabic with Syrian refugees. Study participants were at least 19 years of age, resided in diverse urban areas of Jordan, had experienced captivity and torture in Syrian detention facilities, and voluntarily agreed to participate in the study. Participation was anonymous, only oral consent was required, and no incentives were provided to participants. Interviews were transcribed and translated into English by a team of researchers, followed by analysis of repetitive themes according to the narrative paradigm.Results: Analysis of interviews elicited three major themes: extreme traumatic experiences of torture, and its physical and psychosocial health consequences. The first major theme was divided into two sub-themes: torture experienced by the participants themselves, and torture experienced by participants' close circles. The second major theme, pertaining to physical health, was divided into two sub-themes: acute and chronic health sequelae. The third major theme, related to psychosocial health, was divided into four sub-themes: mental health symptomatology, impacts on professional life, impacts on interpersonal relationships, and social consequences.Conclusions: Torture experiences of Syrian refugees had adverse consequences for the physical and psychosocial health, functioning, and the overall well-being of survivors and their close circles. Interventions may seek to improve both the acute and chronic health consequences, as well as the mental health symptoms and associated impacts on livelihood, professional, and relationship dynamics. They should span clinical, legal, and advocacy spheres, given that a holistic approach may contribute immensely to survivors' healing process.
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Affiliation(s)
- Niveen Rizkalla
- Mack Center on Mental Health & Social Conflict, School of Social Welfare, and & School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Sarah Alsamman
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Oussama Bakr
- School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Hana Masud
- Psychology Department, University of Massachusetts Boston, Boston, MA, USA
| | - Salaam Sbini
- Divinity School, Harvard University, Cambridge, MA, USA
| | - Steven P. Segal
- Professor of the Graduate Division and Chair Emeritus of the Mack Center on Mental Health & Social Conflict, School of Social Welfare, University of California, Berkeley, CA, USA
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Schippert AC, Grov EK, Dahl-Michelsen T, Silvola J, Sparboe-Nilsen B, Danielsen SO, Lie I, Aaland M, Bjørnnes AK. Preventing retraumatisation in torture survivors during surgical care: results of a guideline-development project and qualitative study exploring healthcare providers' experiences. BMJ Open 2024; 14:e083388. [PMID: 39179277 PMCID: PMC11344513 DOI: 10.1136/bmjopen-2023-083388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 08/01/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVES Insufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather healthcare professionals' experiences treating torture survivors and insights on the guideline's feasibility and acceptability. DESIGN The study was conducted in two phases. Phase 'a' involved developing guidelines based on reviews of torture survivors' encounters in somatic care and potential retraumatisation triggers, as well as a qualitative study on survivors' experiences during surgical interventions. The development process adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for methodological rigour. Phase 'b' involved focus groups and individual interviews with healthcare professionals to explore challenges in caring for torture survivors and to evaluate the guidelines. SETTING The study, conducted from May to August 2023, involved participants from surgical departments in three hospitals in southern and southeastern Norway. PARTICIPANTS Twenty-one healthcare professionals, including surgeons, anaesthesiologists, nurses and a dentist, participated in the study. Both focus group interviews and individual interviews were conducted. RESULTS Phase 'a': guidelines comprising six sections were developed: an introduction, general guidelines and four sections covering the preoperative, perioperative and postoperative surgical stages. Phase 'b': healthcare professionals struggled to understand torture's complexities and identify survivors' unique needs. They faced challenges using interpreters and assisting patients with strong reactions. While the guidelines were viewed as practical and useful for raising awareness, their length was questioned. CONCLUSIONS We provide recommendations for preventing retraumatisation in torture survivors undergoing surgical treatment. The guidelines may serve as a starting point for offering safe and individualised care to torture survivors. Teaching institutions and hospitals may incorporate the guidelines into healthcare professionals' education.
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Affiliation(s)
- Ana Carla Schippert
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Akershus University Hospital, Lorenskog, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tone Dahl-Michelsen
- Institute of Physiotherapy, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Juha Silvola
- ENT, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo Faculty of Medicine, Lorenskog, Norway
| | - Bente Sparboe-Nilsen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Hospitality, Culinary Arts and Meal Science, Örebro Universitet-Campus Grythyttan, Grythyttan, Sweden
| | - Stein Ove Danielsen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Irene Lie
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital Ullevaal, Oslo, Norway
- Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Center for Patient-Centered Heart and Lung Research, Oslo University Hospital, Oslo, Norway
| | | | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Nielsen MR, Jervelund SS. Experiences of access to healthcare among newly arrived immigrants in Denmark: Examining the role of residence permit. Scand J Public Health 2024; 52:649-659. [PMID: 37209005 DOI: 10.1177/14034948231173473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
AIMS In Denmark, all residents regardless of nationality are 'de jure' entitled to a wide range of free-of-charge healthcare services. There is, however, only scarce quantitative knowledge on immigrants' experiences of their 'de facto' access to healthcare and on how access relates to immigrants' types of residence permits. The study aims to address these gaps. METHODS Survey data on access to healthcare, employment and housing were collected among adult, newly arrived immigrants in Denmark (n=1711) at 26 publicly contracted Danish language schools in September-December 2021 by national cluster-random sampling stratified by region. Data were analysed using descriptive statistics and multivariate logistic regression. RESULTS In total, 21% reported general difficulties obtaining good healthcare. Commonly experienced barriers related to financial constraints (39%), communication (37%) and lack of knowledge about the healthcare system (37%). Refugees and their families had higher odds of reporting barriers related to finances (odds ratio (OR) 2.58; confidence interval (CI) 1.77-3.76), communication (OR 3.15; CI 2.39-4.14) and knowledge (OR 1.84; CI 1.16-2.90), while other family reunified immigrants had lower odds of reporting knowledge barriers (OR 0.71; CI 0.54-0.93) compared with immigrants with EU/EEA residence permits, adjusted for gender and residential region. These results remained significant when further adjusted for age, length of stay, education, income, rural/urban residence and household size. CONCLUSIONS Difficulties accessing healthcare are experienced by a large share of newly arrived immigrants in Denmark and are dependent on residence permit type. The findings suggest strengthened efforts to reduce barriers related to finances, communication and knowledge, while focusing on the most vulnerable immigrants.
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Affiliation(s)
- Maj R Nielsen
- Centre for Private Governance, Faculty of Law, University of Copenhagen, Denmark
| | - Signe S Jervelund
- Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Jahan N, Velasco M, Vranceanu AM, Alegría M, Saadi A. Clinician perspectives on characteristics and care of traumatic brain injury among asylum seekers and refugees. Disabil Rehabil 2024:1-10. [PMID: 38831593 DOI: 10.1080/09638288.2024.2356014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/10/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Traumatic brain injury (TBI) disproportionately affects asylum-seekers and refugees (ASR), although underdiagnosed and undertreated. Our study assesses clinicians' perspectives on characteristics and management of TBI among ASR, with the hope of improving TBI management in this population. MATERIALS AND METHODS We conducted six focus groups of 16 clinicians across two academic medical centers in Boston, Massachusetts, United States. Clinicians in our sample included primary care clinicians, nurse practitioners, social workers, psychologists, neurologists, psychiatrists, and neuropsychologists. We analyzed the qualitative data following a hybrid inductive-deductive thematic analytic approach. RESULTS Clinicians characterized TBI among ASR as mostly mild and remote, involving head strikes, perpetrated predominantly by interpersonal violence and strangulation-related brain injury, and involving symptom overlap with mental health diagnoses, challenging diagnosis. Clinicians also described inadequate screening, the importance of connecting the physical and psychological symptoms of the brain injury rather than viewing them as distinct, and addressing diagnosis-related stigma and shame. Finally, they discussed lack of TBI-specific knowledge among providers and patients alike, and resource limitations affecting the continuum of care for this population. CONCLUSION Integrating clinicians' perspectives in caring for this population allows us to best meet their needs, including in TBI recovery.
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Affiliation(s)
- Nusrath Jahan
- Tufts University School of Medicine, Boston, MA, USA
| | - Margarita Velasco
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Margarita Alegría
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Schippert ACSP, Dahl-Michelsen T, Grov EK, Sparboe-Nilsen B, Silvola J, Bjørnnes AK. Torture survivors' experiences of receiving surgical treatment indicating re- traumatization. PLoS One 2023; 18:e0287994. [PMID: 37847719 PMCID: PMC10581467 DOI: 10.1371/journal.pone.0287994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/18/2023] [Indexed: 10/19/2023] Open
Abstract
Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors' experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6-40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals' attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.
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Affiliation(s)
- Ana Carla S. P. Schippert
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Akershus University Hospital, Oslo, Norway
| | | | - Ellen Karine Grov
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Bente Sparboe-Nilsen
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Juha Silvola
- Akershus University Hospital, Oslo, Norway
- Institute of Clinical medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Norwegian University of Science and Technology, Gjøvik, Norway
| | - Ann Kristin Bjørnnes
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Smith ML, Seegulam V, Szentkúti P, Horváth-Puhó E, Galea S, Lash TL, Rosellini AJ, Schnurr PP, Sørensen HT, Gradus JL. Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1305-1316. [PMID: 36449069 DOI: 10.1007/s00127-022-02391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement. METHODS We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5 years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10 years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10 years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults). RESULTS Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth. CONCLUSION Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.
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Affiliation(s)
- Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya Seegulam
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St., Boston, MA, 02118, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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Dahl M, Søndergaard SF, Al‐Allaq RS, Diederichsen A, Lindholt JS. Arabic-speaking male immigrants' perceptions of preventive initiatives: An interview study. Health Expect 2023; 26:1618-1627. [PMID: 37095730 PMCID: PMC10349227 DOI: 10.1111/hex.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Arabic-speaking men are a sparsely investigated population in health promotion and disease prevention. This may hamper their ability to achieve the highest obtainable health due to less accessibility and acceptability of preventive measures. AIM We explored Arabic-speaking (Palestinian, Iraqi and Somali) male immigrants' perceptions of preventive initiatives in general and such initiatives for cardiovascular diseases (CVD) in particular to understand how to address inequalities in engagement in prevention. METHODS This qualitative study employed content analysis of semistructured interviews with 60-66-year-old Arabic-speaking men living in Denmark. Supplementary, structured data, for example, health data, were collected. From June to August 2020, 10 men were interviewed. FINDINGS Preventive initiatives were found ethically and culturally acceptable alongside personally and socially relevant; they were perceived as humanitarian and caring for the participants' health, respecting of their self-determination and enabling their empowerment. Thus, the participants entreated that their fellow countrymen be assisted in achieving the prerequisite coping capabilities to address inequality in access, perceived acceptance and relevance. This led us to define one main category 'Preventive initiatives - Caring and humanitarian aid empower us' with the underlying subcategories: 'We are both hampered and strengthened by our basic assumptions' and 'We need help to achieve coping capabilities enabling us to engage in preventive initiatives'. CONCLUSION Prevention was perceived as acceptable and relevant. Even so, Arabic-speaking men may be a hard-to-reach group due to their basic assumptions and impaired capabilities for engaging in prevention. Addressing inequality in accessibility, acceptability and relevance in regard to prevention may be promoted through a person-centred approach embracing invitees' preferences, needs and values; and by strengthening invitees' health literacy through efforts at the structural, health professional and individual levels. PUBLIC CONTRIBUTION This study was based on interviews. The interviewees were recruited as public representatives to assist us in building an understanding of Arabic-speaking male immigrants' perceptions of preventive initiatives in general and preventive initiatives for CVD in particular.
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Affiliation(s)
- Marie Dahl
- Vascular Research Unit, Department of Vascular SurgeryViborg Regional HospitalViborgDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Research Unit of Cardiac, Thoracic, and Vascular surgery, Department of Clinical ResearchFaculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
| | - Susanne F. Søndergaard
- Centre for Research in Clinical Nursing, Viborg Regional Hospital and School of Nursing, VIA University CollageViborgDenmark
- Department of Public Health, NursingAarhus UniversityAarhusDenmark
| | | | | | - Jes S. Lindholt
- Department of Cardiothoracic and Vascular SurgeryOdense University HospitalOdenseDenmark
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA)OdenseDenmark
- Cardiovascular Centre of Excellence in Southern Denmark (CAVAC)OdenseDenmark
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Hvidegaard M, Lanng K, Meyer K, Wejse C, Hvass AMF. What Are the Characteristics of Torture Victims in Recently Arrived Refugees? A Cross-Sectional Study of Newly Arrived Refugees in Aarhus, Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6331. [PMID: 37510564 PMCID: PMC10378834 DOI: 10.3390/ijerph20146331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
Torture victims live with complex health conditions. It is essential for the rehabilitation of torture survivors that their traumas are recognized at an early stage. The aim of this study was to investigate (i) the prevalence of reported torture exposure, (ii) the association between demographic characteristics and exposure to torture, and (iii) the association between PTSD and exposure to torture among recently arrived refugees in Aarhus, Denmark. Data were extracted from health assessments of refugees arriving in Aarhus in the years 2017-2019, and 208 cases were included in the analysis. The prevalence of reported torture was 13.9% (29/208). Most torture victims were found among refugees arriving from Iran (17.0% (9/53)), Syria (9.3% (8/86)), and Afghanistan (25.0% (5/20)). Significant associations were found between reported torture exposure and male gender, Southeast Asian origin, and a diagnosis of PTSD. In the study, 24.5% (24/98) of males and 4.5% (5/110) of females had been subjected to torture. However, it is possible that the prevalence of female torture survivors is underestimated due to the taboos surrounding sexual assaults and fear of stigmatization. Nearly half of the torture victims in the study were diagnosed with PTSD (44.8% (13/29)). The results confirm that torture victims constitute a vulnerable group living with severe consequences, including mental illness such as PTSD. Furthermore, understanding the cultural perspectives of the distress among refugees is crucial in providing appropriate healthcare services. This study highlights the importance of addressing the mental health needs of torture survivors and tailoring interventions toward vulnerable refugee populations.
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Affiliation(s)
- Mette Hvidegaard
- Center for Global Health, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Medical Diseases, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Kamilla Lanng
- Center for Global Health, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Karin Meyer
- DIGNITY-Danish Institute Against Torture, 2100 København, Denmark
| | - Christian Wejse
- Center for Global Health, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Anne Mette Fløe Hvass
- Center for Global Health, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Social Medicine, Aarhus Municipality, 8000 Aarhus, Denmark
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Re-traumatization of torture survivors during treatment in somatic healthcare services: A mapping review and appraisal of literature presenting clinical guidelines and recommendations to prevent re-traumatization. Soc Sci Med 2023; 323:115775. [PMID: 36934529 DOI: 10.1016/j.socscimed.2023.115775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 01/28/2023] [Accepted: 02/12/2023] [Indexed: 02/27/2023]
Abstract
RATIONALE The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization. OBJECTIVE Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors' physical diseases in healthcare services. METHODS A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used. RESULTS Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design. CONCLUSIONS This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors' biopsychosocial situations, demonstrate cultural sensitivity, and change theirpersonal attitudes . They must also identify tortured patients and determine when professional interpreters should be used.
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Traumatic brain injury and forensic evaluations: Three case studies of U.S. asylum-seekers. J Forensic Leg Med 2021; 79:102139. [PMID: 33740607 DOI: 10.1016/j.jflm.2021.102139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 11/20/2022]
Abstract
Traumatic brain injuries are common among refugees and asylum-seekers and can result from a range of etiologies, including intimate partner violence, gang violence, war-related trauma, and torture. Regardless of the cause, these injuries often result in a host of neuropsychiatric and other symptoms that may complicate individuals' subsequent health outcomes. For asylum-seekers, documenting prior head trauma is essential to the legal process, since traumatic brain injuries and their subsequent effects on memory and cognition may affect the ability to provide thorough testimony. Using three case vignettes, we explore how to approach the forensic evaluation of asylum-seekers with a history of traumatic brain injury, illustrating the range of etiologies and sequelae of traumatic brain injury in this complex population.
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