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Health trajectories of international humanitarian aid workers: growth mixture modelling findings from a prospective cohort study. BJPsych Open 2023; 9:e83. [PMID: 37194550 DOI: 10.1192/bjo.2023.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Most staff stay healthy during humanitarian work, although some worsen. Mean scores on health indicators may be masking individual participants struggling with health issues. AIMS To investigate different field assignment-related health trajectories among international humanitarian aid workers (iHAWs) and explore the mechanisms used to stay healthy. METHOD Growth mixture modelling analyses for five health indicators using pre-/post-assignment and follow-up data. RESULTS Among 609 iHAWs three trajectories (profiles) were found for emotional exhaustion, work engagement, anxiety and depression. For post-traumatic stress disorder (PTSD) symptoms, four trajectories were identified. The 'healthy/normative' trajectory had the largest sample size for all health indicators (73-86%). A stable (moderate) 'ill health' trajectory was identified for all health indicators (7-17%), except anxiety. An 'improving' trajectory was found for PTSD and anxiety symptoms (5-14%). A minority of staff (4-15%) worsened on all health indicators. Deterioration continued for PTSD, depressive symptoms and work engagement 2 months post-assignment. A strong sense of coherence was associated with higher odds of belonging to the 'healthy' trajectory. Female biological sex was associated with higher odds of belonging to the 'worsening' depression and anxiety trajectories. Extended duration of field assignment was related to higher odds of belonging to the 'worsening' depressive symptoms trajectory. CONCLUSIONS Most iHAWs stayed healthy during their assignment; a stable 'ill health' trajectory was identified for most health indicators. Sense of coherence is an important mechanism for understanding the health of all iHAWs in the different health trajectories, including the 'healthy' profile. These findings give new possibilities to develop activities to prevent worsening health and help strengthen iHAWs' ability to remain healthy under stress.
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How do international humanitarian aid workers stay healthy in the face of adversity? PLoS One 2022; 17:e0276727. [PMID: 36383538 PMCID: PMC9668143 DOI: 10.1371/journal.pone.0276727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND International humanitarian aid workers (iHAWs) are motivated strongly to travel abroad to help communities affected by war, famine, disaster and disease. They expose themselves to dangers and hardships during their field assignments. Despite working under such challenging circumstances, most workers remain healthy. The objective of the present study was to unravel the mechanism that enables workers to remain healthy under the same circumstances that affect these communities. We hypothesised that the different components of the Sense of Coherence (SOC) health mechanism mediate the relationship between field stressors and post-assignment health. METHODS AND FINDINGS The stress-health model was tested among 465 international aid workers using a longitudinal pre-post assignment study design and structural equation modelling for path analyses. The (health) outcome variables were PTSD, anxiety, depression, emotional exhaustion, and work engagement. Our findings highlight the importance of being healthy before aid assignment and the negative health impact of field stressors that were not potentially traumatic. The SOC components mediated the relationship between field stress and post-assignment health, with males and females using different SOC components to alleviate stress. Males are more likely trying to understand the nature of the stressor, whereas females mobilise their resources to manage stressors. In both groups, a high level of meaningfulness of the work was an important component in maintaining health. Regarding using the SOC concept for understanding the process of maintaining health, our findings indicated that SOC is best considered context-specific and multidimensional. CONCLUSION In addition to good pre-mission health, the SOC components help prevent field assignment-related negative health effects in iHAWs. Our findings support the idea to compose gender-balanced teams of iHAWs to maintain and promote health. The findings can be used to develop or refine health conversation tools and SOC based health interventions to promote health and wellbeing and prevent ill-health among aid workers and other stress-exposed populations.
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Predictors of posttraumatic growth among conflict-related sexual violence survivors from Bosnia and Herzegovina. Confl Health 2019; 13:23. [PMID: 31171935 PMCID: PMC6549258 DOI: 10.1186/s13031-019-0201-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/30/2019] [Indexed: 09/03/2023] Open
Abstract
Background Conflict-related sexual violence (CRSV) was committed on a large scale against women across Bosnia and Herzegovina (BiH) during the 1990’s war, and research has shown both negative and positive psychosocial outcomes following such acts of interpersonal violence. We aim to determine the capacity for posttraumatic growth (PTG) among a population of women who experienced CRSV, and to what extent it is impacted by factors such as coping and optimism. Methods This study sought to examine the relationship between PTG (posttraumatic growth inventory), symptoms of posttraumatic stress disorder (PTSD; Harvard Trauma Questionnaire) and dispositional factors such as coping (COPE) and optimism (Life-Orientation Test-Revised) in a sample of n = 104 women. We first conducted bivariate correlations and then hierarchical linear regression analyses, and hypothesized that approach coping strategies and optimism will act to enhance PTG. Results Findings showed that the average total score for PTG in this study was 58.94 (SD = 23.01), and current PTSD symptomatology above a threshold of > 2.5 was detected in 92.3% (n = 96) participants (mean score 3.18, SD = .45). Bivariate correlations showed that higher levels of PTG were associated with greater optimism, greater approach coping strategies positive reinterpretation and planning, and lower avoidance strategies behavioural disengagement and substance use. When entered into a regression model, only positive reinterpretation and behavioural disengagement remained, the R-square of the total set of predictors was 0.16, thus explaining 16% of PTG total score. Conclusion Two types of coping (namely capacity of both greater positive reinterpretation and lower behavioural disengagement) most strongly predicted growth after trauma in this sample of CRSV survivors from BiH. These dimensions of coping confirm the role of coping strategies in the development of PTG. Further research would be useful in corroborating these findings in other post-conflict settings, and delving further into the possibility of a dual mechanism of growth and distress after CRSV. Electronic supplementary material The online version of this article (10.1186/s13031-019-0201-5) contains supplementary material, which is available to authorized users.
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Terrorism, human-made and natural disasters as a professional and ethical challenge to psychiatry. Int Psychiatry 2018. [DOI: 10.1192/s174936760000761x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The consequences of terrorism, wars and natural disasters are a challenge to the psychiatric profession. The large numbers of people estimated to have mental health problems surpass the capacities of existing mental health services, whether modern or traditional. The bulk of the 35 million refugees and internally displaced people worldwide reside in countries that, on average, have less than one psychiatrist or psychologist per 100 000 people (WHO, 2001). Even the 500 000 people estimated to need some form of psychological support after the attack in New York on 11 September 2001 exceeded the service capacity, despite the fact that New York has the highest density of mental health professionals in the world (Herman & Susser, this issue, pp. 2–4). Elsewhere, many survivors of various types of disaster reside in peripheral areas of countries and are not covered by modern mental health services.
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Abstract
BACKGROUND Globally, suicide is an important cause of mortality. In low- and middle income settings, it is difficult to find unequivocal data to establish suicide rates. The objective of this review is to synthesize the reporting of suicide incidence in six south Asian countries. METHODS We conducted a scoping review combining peer-reviewed studies (PubMed, PsycINFO, EMBASE) with in-country searches for grey literature in Afghanistan, Pakistan, Sri Lanka, India, Nepal and Bangladesh. The review included mapping reported suicide rates, quality appraisals of the studies, use of definitions of suicide and means of committing suicide. RESULTS In total, 114 studies and reports were included in the review, including 50 peer-reviewed publications. Reported suicide rates varied widely from 0.43/100,000 to 331.0/100,000. The average suicide rate across studies was found to be high compared to the world average, however many studies were of poor quality or not representative. The majority of studies failed to explicitly define suicide (84% of the published articles and 92% of the grey literature documents). Poisoning and hanging were consistently the most common methods of committing suicide on the sub-continent. CONCLUSIONS The reported suicide rates in South Asia are high compared to the global average, but there is a paucity of reliable data on suicide rates in South Asia. Reports are likely to diminish rather than exaggerate the magnitude of suicide rates. There is an urgent need to establish new, or evaluate existing, national suicide surveillance systems in the South Asian countries.
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Probable posttraumatic stress disorder and disability in Cambodia: associations with perceived justice, desire for revenge, and attitudes toward the Khmer Rouge trials. JAMA 2009; 302:527-36. [PMID: 19654387 DOI: 10.1001/jama.2009.1085] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Millions of Cambodians suffered profound trauma during the Khmer Rouge era (1975 to 1979). A joint United Nations-Cambodian tribunal (the "Khmer Rouge trials") was empanelled in 2006 to prosecute top Khmer Rouge leaders and began substantive hearings in March 2009. OBJECTIVES To establish the prevalence of probable posttraumatic stress disorder (PTSD) among adult Cambodians and to assess correlates of PTSD symptoms and disability with perceived justice, desire for revenge, and knowledge of and attitudes toward the trials. DESIGN, SETTING, AND PARTICIPANTS A national probability sample of 1017 Cambodians was assembled using a multistage, stratified cluster design, including 813 adults older than 35 years who had been at least 3 years old during the Khmer Rouge era and 204 adults aged 18 to 35 years who had not been exposed to the Khmer Rouge era. Face-to-face interviews were conducted between December 2006 and August 2007. MAIN OUTCOME MEASURES Prevalence of probable PTSD using the PTSD Checklist, Civilian version (cutoff score of 44), and mental and physical disability using the Medical Outcomes Study 12-item Short Form Health Survey. RESULTS The prevalence of current probable PTSD was 11.2% (95% confidence interval [CI], 8.6%-13.9%) overall and 7.9% (95% CI, 3.8%-12.0%) among the younger group and 14.2% (95% CI, 11.0%-17.3%) in the older group. Probable PTSD was significantly associated with mental disability (40.2% vs 7.9%; adjusted odds ratio [AOR], 7.80; 95% CI, 3.90-15.60) and physical disability (39.6% vs 20.1%; AOR, 2.60; 95% CI, 1.26-5.39). Although Cambodians were hopeful that the trials would promote justice, 87.2% (n = 681) of those older than 35 years believed that the trials would create painful memories for them. In multivariate analysis, respondents with high levels of perceived justice for violations during the Khmer Rouge era were less likely to have probable PTSD than those with low levels (7.4% vs 12.7%; AOR, 0.54; 95% CI, 0.34-0.86). Respondents with high levels of desire for revenge were more likely to have probable PTSD than those with low levels (12.0% vs 7.2%), but the difference was not statistically significant in the multivariate analysis (AOR, 1.76; 95% CI, 0.99-3.11). CONCLUSIONS Probable PTSD is common and associated with disability in Cambodia. Although Cambodians had positive attitudes toward the trials, most were concerned that the trials would bring back painful memories. Now that the trials have begun, longitudinal research is needed to determine the impact of the trials on Cambodians' mental health.
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Dispositional and situational coping and mental health among Palestinian political ex-prisoners. ANXIETY STRESS AND COPING 2008; 21:337-58. [DOI: 10.1080/10615800701797333] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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The deterioration and mobilization effects of trauma on social support: childhood maltreatment and adulthood military violence in a Palestinian community sample. CHILD ABUSE & NEGLECT 2005; 29:351-73. [PMID: 15917077 DOI: 10.1016/j.chiabu.2004.10.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2002] [Revised: 10/12/2004] [Accepted: 10/14/2004] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To show that exposure to childhood maltreatment deteriorates, whereas exposure to adulthood military violence mobilizes social support; second, to show that associations between traumatic events and mental health problems are mediated through social support and, subsequently, adulthood military violence is associated with low level and childhood maltreatment with high level of mental health symptoms; third, to explore whether the moderating (protecting) effect of sufficient and satisfactory social support would differ among victims of childhood maltreatment and adulthood military violence. METHOD The participants were a random-sample of Palestinian men and women (n=585) of 16-60 years of age. Exposure to military violence in adulthood was assessed by the Harvard Trauma Questionnaire (HTQ_I), and to childhood maltreatment by a 13-item questionnaire developed for the study. A Social Network Schedule was applied to assess the function, source, and satisfaction with social support, and the Revised SCL90-R Symptoms Checklist to assess mental health symptoms. RESULTS Findings supported our hypothesis that exposure to childhood maltreatment was associated with low levels of social support, whereas exposure to adulthood military violence was associated with high levels of social support. Contrary to our second hypothesis, both childhood maltreatment and adulthood military violence were associated with high levels of mental health symptoms. Finally, high level and satisfactory social support moderated the association between exposure to military violence in adulthood and mental health symptoms, but not between childhood maltreatment and mental health symptoms. CONCLUSION The findings emphasize that the nature of trauma, that is, whether familial or political, determines the availability of protective resources versus vulnerability, which should be considered when tailoring interventions to trauma victims.
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Prenatal depression, mode of delivery and perinatal dissociation as predictors of postpartum posttraumatic stress: an empirical study. Clin Psychol Psychother 2005. [DOI: 10.1002/cpp.446] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Despite efforts to promote traditional medicine, allopathic practitioners often look with distrust at traditional practices. Shamans in particular are often regarded with ambivalence and have been considered mentally ill people. We tested the hypothesis that shamanism is an expression of psychopathology. In the Bhutanese refugee community in Nepal, a community with a high number of shamans, we surveyed a representative community sample of 810 adults and assessed ICD-10 mental disorders through structured diagnostic interviews. Approximately 7% of male refugees and 0.5% of female refugees reported being shamans. After controlling for demographic differences, the shamans did not differ from the comparison group in terms of 12-month and lifetime ICD-10 severe depressive episode, specific phobia, persistent somatoform pain, posttraumatic stress, generalized anxiety, or dissociative disorders. This first-ever, community-based, psychiatric epidemiological survey among shamans indicated no evidence that shamanism is an expression of psychopathology. The study's finding may assist in rectifying shamans' reputation, which has been tainted by past speculation of psychopathology.
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Terrorism, human-made and natural disasters as a professional and ethical challenge to psychiatry. Int Psychiatry 2003; 1:8-9. [PMID: 31507651 PMCID: PMC6735229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The consequences of terrorism, wars and natural disasters are a challenge to the psychiatric profession. The large numbers of people estimated to have mental health problems surpass the capacities of existing mental health services, whether modern or traditional. The bulk of the 35 million refugees and internally displaced people worldwide reside in countries that, on average, have less than one psychiatrist or psychologist per 100 000 people (WHO, 2001). Even the 500 000 people estimated to need some form of psychological support after the attack in New York on 11 September 2001 exceeded the service capacity, despite the fact that New York has the highest density of mental health professionals in the world (Herman & Susser, this issue, pp. 2-4). Elsewhere, many survivors of various types of disaster reside in peripheral areas of countries and are not covered by modern mental health services.
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The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression. J Trauma Stress 2002; 15:415-21. [PMID: 12392230 DOI: 10.1023/a:1020141510005] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Previous research has indicated a relationship between posttraumatic stress disorder (PTSD) and somatic complaints. We examined whether this relationship is a result of shared comorbidity with anxiety and depression. Local doctors interviewed a random, community sample of 526 tortured and 526 nontortured Bhutanese refugees living in U.N. refugee camps in Nepal. The interview covered demographics, torture, somatic complaints, and PTSD, depression, and anxiety measures. Number of PTSD symptoms, independent of depression and anxiety, predicted both number of reported somatic complaints and number of organ systems involving such complaints. Physicians need to screen for PTSD when survivors of extreme stressors present nonspecific somatic complaints.
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Abstract
We sought to examine the impact of political imprisonment on anxiety, depression, and somatic symptoms reported by newly arrived Tibetan refugees in Dharamsala, India. We used the Hopkins Symptom Checklist-25 to compare 76 previously imprisoned with 74 never imprisoned recent Tibetan refugees. Previously imprisoned refugees reported more traumatic events, especially torture and deprivation. Previously imprisoned refugees reported more anxiety than nonimprisoned refugees, but the groups were similarly high in terms of depression and number of somatic complaints. According to assessment with the Harvard Trauma Questionnaire, 20% of the tortured and imprisoned refugees met criteria for posttraumatic stress disorder.
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[Many psychiatric disorders in Afghan refugees with residential status in Drenthe, especially depressive disorder and post-traumatic stress disorder]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2002; 146:1127-31. [PMID: 12092304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To assess the prevalence of psychiatric disorders and help-seeking behaviour of Afghan refugees with a residence status in the province of Drenthe, the Netherlands. DESIGN Cross-sectional prevalence study. METHOD By means of a modified multiflex snowball sampling with 3 primary informants, 55 Afghan households in 16 towns and villages in Drenthe were selected. After informed consent had been obtained, 51 adults completed a sociodemographic questionnaire and a culturally validated shortened 'Composite international diagnostic interview' (CIDI), DSM-IV version. Help-seeking behaviour was recorded. RESULTS Half of the sample had resided in the Netherlands for at least 3 years. There was a high level of education, an unemployment level of 88% and moderate to poor language skills in 92% of the respondents. The prevalence of psychiatric disorders was 65% (95% CI: 52-78); depressive disorder occurred in 57% and posttraumatic stress disorder in 35%. Psychopathological findings were related to poor language skills, a lower level of education and unemployment. A total of 56% received treatment from a general practitioner and 4% were under psychiatric treatment. CONCLUSIONS The prevalence of psychiatric disorders among adult Afghan refugees in Drenthe with a residence status was considerably higher than among the general population in the Netherlands.
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Psychiatric disorders among tortured Bhutanese refugees in Nepal. ARCHIVES OF GENERAL PSYCHIATRY 2001; 58:475-82. [PMID: 11343527 DOI: 10.1001/archpsyc.58.5.475] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND The impact of torture on the distribution of psychiatric disorders among refugees is unknown. METHODS We surveyed a population-based sample of 418 tortured and 392 nontortured Bhutanese refugees living in camps in Nepal. Trained interviewers assessed International Classification of Diseases, 10th Revision (ICD-10) disorders through structured diagnostic psychiatric interviews. RESULTS Except for male sex, history of torture was not associated with demographics. Tortured refugees, compared with nontortured refugees, were more likely to report 12-month ICD-10 posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders. In addition, tortured refugees were more likely to report lifetime posttraumatic stress disorder, persistent somatoform pain disorder, affective disorder, generalized anxiety disorder, and dissociative (amnesia and conversion) disorders. Tortured women, compared with tortured men, were more likely to report lifetime generalized anxiety disorder, persistent somatoform pain disorder, affective disorder, and dissociative (amnesia and conversion) disorders. CONCLUSIONS Among Bhutanese refugees, the survivors had higher lifetime and 12-month rates of ICD-10 psychiatric disorder. Men were more likely to report torture, but tortured women were more likely to report certain disorders. The results indicate the increased need for attention to the mental health of refugees, specifically posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders among those reporting torture.
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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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A 14-Year Retrospective-Prospective Study on the Effect of Depot Neuroleptic on a Cohort of West-African Out-Patients with a Chronic Functional Psychosis. Eur Psychiatry 1997. [DOI: 10.1016/s0924-9338(97)80313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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