Satisfaction of trauma-affected refugees treated with antidepressants and Cognitive Behavioural Therapy
Purpose: This study seeks to evaluate the satisfaction of trauma-affected refugees after treatment with antidepressants, psycho-education and flexible Cognitive Behavioral Therapy (CBT) including trauma exposure.
Material and methods: A treatment satisfaction questionnaire was completed by patients at the end of a randomised controlled trial (RCT) comparing treatment with CBT and antidepressants. A patient satisfaction score was developed based on the questionnaire, and predictors of satisfaction were analysed in regression models. Telephone interviews were conducted with patients dropping out of treatment before the end of the trial.
Results: In total, 193 trauma-affected refugees with PTSD were included in the study. Patients were overall satisfied with flexible CBT including exposure treatment in cases where this was part of the treatment. There was no statistically significant association between treatment outcome and satisfaction and satisfaction and treatment efficacy were independent of each other. The results showed that bi-cultural patients who had lived in Denmark for more than a decade were satisfied with the treatment based on a western psychotherapy model.
Discussion: Treatment with selective serotonin reuptake inhibitor and flexible CBT, including trauma exposure, is acceptable for trauma-affected refugees. More studies are needed to evaluate patient satisfaction with western psychotherapy models in refugee patients who have recently arrived and to compare satisfaction with alternative treatment models.
Bech, P. (2012). Clinical psychometrics. Oxford: Wiley Blackwell.
Bisson, J., Andrew, M. (2009). Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 3. https:// doi.org10.1002/14651858. CD003388.pub4
Buhman, C., Mortensen, E. L., Lundstrom, S., Ryberg, J., Nordentoft, M., & Ekstrom, M. (2014). Symptoms, quality of life and level of functioning of traumatized refugees at psychiatric trauma clinic in Copenhagen. Torture, 24(1), 25-39.
Buhmann, C., Andersen, I., Mortensen, E. L., Ryberg, J., Nordentoft, M., & Ekstrom, M. (2015). Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for refugees: description and evaluation. Torture, 25(1), 17-32.
Buhmann, C., Mortensen, E. L., Nordentoft, M., Ryberg, J., & Ekstrom, M. (2015). Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees. Torture, 25(1), 1-16.
Buhmann, C. B., Nordentoft, M., Ekstroem, M., Carlsson, J., & Mortensen, E. L. (2016). The effect of flexible cognitive-behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical trial. Br J Psychiatry, 208(3), 252- 259. https://doi:10.1192/bjp.bp.114.150961
Carlsson, J., Sonne, C., & Silove, D. (2014). From pioneers to scientists: challenges in establishing evidence-gathering models in torture and trauma mental health services for refugees. J Nerv Ment Dis, 202(9), 630-637. https://doi:10.1097/ NMD.0000000000000175
Chen, J. A., Keller, S. M., Zoellner, L. A., & Feeny, N. C. (2013). “How will it help me?” Reasons underlying treatment preferences between sertraline and prolonged exposure in posttraumatic stress disorder. J Nerv Ment Dis, 201(8), 691-697. https://doi:10.1097/NMD.0b013e31829c50a9
Crumlish, N., & O’Rourke, K. (2010). A systematic review of treatments for post-traumatic stress disorder among refugees and asylumseekers. J.Nerv.Ment.Dis., 198(4), 237-251. https://doi:10.1097/NMD.0b013e3181d61258 [doi];00005053-201004000-00001 [pii]
Derogatis, L. R. (1994). SCL-90-R: Symptom Checklist- 90-R. Administration, scoring and procedures manual (3rd ed.). Minnesota, USA: National Computer Systems.
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007) Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences, Therapist Guide. Oxford, UK: Oxford University Press.
Hamilton, M. (1959). The assessment of anxiety states by rating. Br J Med Psychol, 32(1), 50-55.
Hamilton, M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry, 23, 56-62. http:// dx.doi.org/10.1136/jnnp.23.1.56
Kehle-Forbes, S. M., Polusny, M. A., Erbes, C. R., & Gerould, H. (2014). Acceptability of prolonged exposure therapy among U.S. Iraq war veterans with PTSD symptomology. J Trauma Stress, 27(4), 483-487. https://doi:10.1002/jts.21935
Kleijn, W. C., Hovens, J. E., & Rodenburg, J. J. (2001). Posttraumatic stress symptoms in refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins symptom Checklist-25 in different languages. Psychol. Rep., 88(2), 527-532. https://doi.org/10.2466/ pr0.2001.88.2.527
Lam, R. W., Michalak, E. E., & Swinson, R. P. (2005). Assessment scales in depression, mania and anxiety. London: Taylor & Francis.
Maier, T., & Straub, M. (2011). “My head is like a bag full of rubbish”: concepts of illness and treatment expectations in traumatized migrants. Qual Health Res, 21(2), 233-248. https:// doi:10.1177/1049732310383867
Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis, 180(2), 111-116. http://psycnet.apa.org/doi/10.1097/00005053- 199202000-00008
Mollica, R. F., Wyshak, G., de Marneffe, D., Khuon, F., & Lavelle, J. (1987). Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am.J.Psychiatry, 144(4), 497-500. https://doi. org/10.1176/ajp.144.4.497
Nickerson, A., Bryant, R. A., Silove, D., & Steel, Z. (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clin Psychol Rev, 31(3), 399-417. doi:10.1016/j.cpr.2010.10.004
Noerregaard, C. (2012). Kultur og biologi ved psykofarmakologisk behandling af etniske minoriteter. [Culture and biology in psychopharmacological treatment of ethnic minorities.] Ugeskrift for laeger, 6, 337–340.
Olsen, D. R., Montgomery,E., Boejholm,S., Foldspang,A. (2007). Prevalence of pain in the head, back and feet in refugees previously exposed to torture: A ten-year follow-up study. Disability and Rehabilitation, 29(2), 163-171. https:// doi.org/10.1080/09638280600747645 Oruc, L., Kapetanovic, A., Pojskic, N., Culhane, M., Lavelle, J., Miley, K., Forstbauer, S., Mollica, RF & .Henderson, D.C. (2008). Screening for PTSD and depression in Bosnia and Herzegovina: validating the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist. Int.J.Culture Ment.Health, 1(2), 105-17-133116.
Palic, S., & Elklit, A. (2011). Psychosocial treatment of posttraumatic stress disorder in adult refugees: a systematic review of prospective treatment outcome studies and a critique. J Affect Disord, 131(1-3), 8-23. https://doi:10.1016/j. jad.2010.07.005
Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008). Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry, 71(2), 134-168. https://doi:10.1521/ psyc.2008.71.2.134
Shearing, V., Lee, D., & Clohessy, S. (2011). How do clients experience reliving as part of traumafocused cognitive behavioural therapy for posttraumatic stress disorder? Psychol Psychother, 84(4), 458-475. https://doi:10.1111/j.2044- 8341.2010.02012.x
Sheehan, K. H., & Sheehan, D. V. (2008). Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. Int.Clin.Psychopharmacol., 23(2), 70-83. https://doi:10.1097/YIC.0b013e3282f2b4d6 [doi];00004850-200803000-00002 [pii]
Shiner, B., D'Avolio L.W., Nguyen, T.M., Zayed, M.H., Young-Xu, Y., Desai, R.A., & Watts, B. (2013). Measuring use of evidence based psychotherapy for posttraumatic stress disorders. Administration and Policy in Mental Health, 40, 311- 318. https://doi: 10.1007/s10488-012-0421-0
Silove, D., Manicavasagar, V., Beltran, R., Le, G., Nguyen, H., Phan, T., & Blaszczynski, A. (1997). Satisfaction of Vietnamese patients and their families with refugee and mainstream mental health services. Psychiatr Serv, 48(8), 1064-1069. https:// doi.org/10.1176/ps.48.8.1064
Sonne, C., Carlsson, J., Bech, P., & Mortensen, E. L. (2017). Pharmacological treatment of refugees with trauma-related disorders: What do we know today? Transcult Psychiatry, 54(2):260-280. https://doi:10.1177/1363461516682180https:// doi:10.1177/1363461516682180
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van, O. M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA, 302(5), 537-549. https://doi.org/doi:10.1001/ jama.2009.1132
Stein, D. J., Ipser,J.C., Seedat,S. (2009). Pharmacotherapy for post traumatic stress disorder (PTSD) Cochrane Database of Systematic Reviews1: CD002795. https://doi. org/10.1002/14651858.CD002795.pub2
Vincent, F., Jenkins, H., Larkin, M., & Clohessy, S. (2013). Asylum-seekers’ experiences of traumafocused cognitive behaviour therapy for posttraumatic stress disorder: a qualitative study. Behav Cogn Psychother, 41(5), 579-593. https:// doi:10.1017/S1352465812000550
We accept that some authors (e.g. government employees in some countries) are unable to transfer copyright. The Creative Commons Licence Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) covers both the Torture Journal and the IRCT web site. The publisher will not put any limitation on the personal freedom of the author to use material contained in the paper in other works which may be published, provided that acknowledgement is made to the original place of publication.