Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees
DOI:
https://doi.org/10.7146/torture.v25i1.109505Keywords:
refugee, trauma, CBT, antidepressants, PTSD, treatment outcomeAbstract
Purpose: To describe change in mental health after treatment with antidepressants and trauma-focused cognitive behavioral therapy.
Methods: Patients receiving treatment at the Psychiatric Trauma Clinic for Refugees in Copenhagen completed self-ratings of level of functioning, quality of life, and symptoms of PTSD, depression, and anxiety before and after treatment. Changes in mental state and predictors of change were evaluated in a sample that all received well-described and comparable treatment.
Results: 85 patients with PTSD or depression were included in the analysis. Significant improvement and effect size were observed on all rating scales (p-value <0.01 and Cohen’s d 45-0.68). Correlation analysis showed no association between severity of symptoms at baseline and the observed change.
Conclusion: Despite methodological limitations, the finding of a significant improvement on all rating scales is important considering that previous follow-up studies of comparable patient populations have not found significant change in the patients’ condition after treatment.
References
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33. Gorst-Unsworth C, Goldenberg E. Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile. Br J Psychiatry. 1998 Jan;172:90-4.
34. Hermansson AC, Timpka T, Thyberg M. The mental health of war-wounded refugees: an 8-year follow-up. J Nerv MentDis. 2002 Jun;190(6):374-80.
35. Asmundson GJ, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002 Dec;47(10):930-7.
36. Asmundson GJ, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety. 2009;26(10):888-901.
37. Poundja J, Fikretoglu D, Brunet A. The co-occurrence of posttraumatic stress disorder symptoms and pain: is depression a mediator? J Trauma Stress. 2006 Oct;19(5):747-51.
38. Moskowitz A. Schizophrenia, trauma, dissociation, and scientific revolutions. J Trauma Dissociation. 2011;12(4):347-57.
39. Neuner F, Kurreck S, Ruf M, Odenwald M, Elbert T, Schauer M. Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cogn Behav Ther. 2010;39(2):81-91.
40. Neuner F, Onyut PL, Ertl V, Odenwald M, Schauer E, Elbert T. Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. J Consult Clin Psychol. 2008 Aug;76(4):686-94.
41. Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. JConsult ClinPsychol. 2004;72(4):579-87.
42. Hinton DE, Chhean D, Pich V, Safren SA, Hofmann SG, Pollack MH. A randomized controlled trial of cognitive-behavior therapy for Cambodian refugees with treatment-resistant PTSD and panic attacks: a cross-over design. J Trauma Stress. 2005 Dec;18(6):617-29.
43. Hinton DE, Pham T, Tran M, Safren SA, Otto MW, Pollack MH. CBT for Vietnamese refugees with treatment-resistant PTSD and panic attacks: a pilot study. J Trauma Stress. 2004 Oct;17(5):429-33.
44. Otto MW, Hinton D, Korbly NB, Chea A, Ba P, Gershuny BS, et al. Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther. 2003 Nov;41(11):1271-6.
45. Paunovic N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behav Res Ther. 2001 Oct;39(10):1183-97.
2. Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2006 Jan 25;(1).
3. Hetrick SE, Purcell R, Garner B, Parslow R. Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2010 Jul 7;(7).
4. Crumlish N, O'Rourke K. A systematic review of treatments for post-traumatic stress disorder among refugees and asylum-seekers. J Nerv Ment Dis. 2010 Apr;198(4):237-51.
5. Carlsson JM, Mortensen EL, Kastrup M. A follow-up study of mental health and healthrelated quality of life in tortured refugees in multidisciplinary treatment. J Nerv Ment Dis. 2005 Oct;193(10):651-7.
6. Carlsson JM, Olsen DR, Mortensen EL, Kastrup M. Mental health and health-related quality of life: a 10-year follow-up of tortured refugees. J Nerv Ment Dis. 2006 Oct;194(10):725-31.
7. Carlsson JM, Olsen DR, Kastrup M, Mortensen EL. Late mental health changes in tortured refugees in multidisciplinary treatment. J Nerv Ment Dis. 2010 Nov;198(11):824-8.
8. Palic S, Elklit A. An explorative outcome study of CBT-based multidisciplinary treatment in a diverse group of refugees from a Danish treatment centre for rehabilitation of traumatized refugees. Torture. 2009;19(3):248-70.
9. Palic S, Elklit A. Psychosocial treatment of posttraumatic stress disorder in adult refugees: a systematic review of prospective treatment outcome studies and a critique. J Affect Disord. 2011 Jun;131(1-3):8-23.
10. Nickerson A, Bryant RA, Silove D, Steel Z. A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clin Psychol Rev. 2011 Apr;31(3):399417.
11. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992 Feb;180(2):111-6.
12. Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987 Apr;144(4):497-500.
13. Oruc L, Kapetanovic A, Culhane M, Lavelle J, Miley K, Forstbauer S, et al. Screening for PTSD and depression in Bosnia and Herzegovina: validating the Harvard Trauma Questionnaire and the Hopkins Symptom Cheklist. Int J Culture Ment Health. 2008 Dec;1(2):105-116.
14. Kleijn WC, Hovens JE, Rodenburg JJ. Posttraumatic stress symptoms in refugees: assessments with the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 in different languages. Psychol Rep. 2001 Apr;88(2):527-32.
15. WHO. Info package; mastering depression in primary care Frederiksborg, Denmark: World Health Organisation, Regional Office for Europe, Psychiatric Research Unit; 1998 [updated 1998]. Available from: http://www.who-5.org.
16. Sheehan KH, Sheehan DV. Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. IntClinPsychopharmacol. 2008 Mar;23(2):70-83.
17. Lam RW, Michalak EE, Swinson RP. Assessment scales in depression, mania, and anxiety. London: Taylor & Francis; 2005. p. 152-3.
18. Cohen J. Statistical power analysis for the behavioural sciences. 2nd ed: Lawrence Erlbaum Associates; 1988.
19. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991 Feb;59(1):12-9.
20. Buhmann CB, Mortensen EL, Andersen I, Ryberg J, Nordentoft M, Ekstroem M. Cognitive Behavioral Psychotherapeutic treatment at a psychiatric trauma clinic for Refugees: description and evaluation. Torture. 2015;25(1):pp.
21. Basoglu M. Rehabilitation of traumatised refugees and survivors of torture. BMJ. 2006 Dec 16;333(7581):1230-1.
22. Jakobsen M, Thoresen S, Johansen,L.E.E. The validity of screening for post-traumatic stress disorder and other mental health problems among asylum seekers from different countries. Journal of Refugee Studies. 2011;24(1):171-86.
23. Buhmann C, Mortensen EL, Lundstroem S, Ryberg J, Nordentoft M, Ekstroem M. Symptoms, Quality of Life and level of functioning of traumatized refugees at Psychiatric Trauma Clinic in Copenhagen. Torture. 2014;24 (1): 25-39.
24. Sheehan DV, Kamijima K. An evidence-based review of the clinical use of sertraline in mood and anxiety disorders. Int Clin Psychopharmacol. 2009 Mar;24(2):43-60.
25. Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol. 2005 Dec;20(8):533-59.
26. Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005 Aug;294(5):571-9.
27. Lie B. A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatr Scand. 2002 Dec;106(6):415-25.
28. Blair RG. Risk factors associated with PTSD and major depression among Cambodian refugees in Utah. Health Soc Work. 2000 Feb;25(1):23-30.
29. Beiser M, Hou F. Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study. Soc Sci Med. 2001 Nov;53(10):1321-34.
30. Bhui K, Craig T, Mohamud S, Warfa N, Stansfeld SA, Thornicroft G, et al. Mental disorders among Somali refugees: developing culturally appropriate measures and assessing socio-cultural risk factors. Soc Psychiatry Psychiatr Epidemiol. 2006 May;41(5):400-8.
31. Lindencrona F, Ekblad S, Hauff E. Mental health of recently resettled refugees from the Middle East in Sweden: the impact of pre-resettlement trauma, resettlement stress and capacity to handle stress. Soc Psychiatry Psychiatr Epidemiol. 2008 Feb;43(2):121-31.
32. Carlsson JM, Mortensen EL, Kastrup M. Predictors of mental health and quality of life in male tortured refugees. Nord J Psychiatry. 2006;60(1):51-7.
33. Gorst-Unsworth C, Goldenberg E. Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile. Br J Psychiatry. 1998 Jan;172:90-4.
34. Hermansson AC, Timpka T, Thyberg M. The mental health of war-wounded refugees: an 8-year follow-up. J Nerv MentDis. 2002 Jun;190(6):374-80.
35. Asmundson GJ, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002 Dec;47(10):930-7.
36. Asmundson GJ, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety. 2009;26(10):888-901.
37. Poundja J, Fikretoglu D, Brunet A. The co-occurrence of posttraumatic stress disorder symptoms and pain: is depression a mediator? J Trauma Stress. 2006 Oct;19(5):747-51.
38. Moskowitz A. Schizophrenia, trauma, dissociation, and scientific revolutions. J Trauma Dissociation. 2011;12(4):347-57.
39. Neuner F, Kurreck S, Ruf M, Odenwald M, Elbert T, Schauer M. Can asylum-seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cogn Behav Ther. 2010;39(2):81-91.
40. Neuner F, Onyut PL, Ertl V, Odenwald M, Schauer E, Elbert T. Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. J Consult Clin Psychol. 2008 Aug;76(4):686-94.
41. Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an african refugee settlement. JConsult ClinPsychol. 2004;72(4):579-87.
42. Hinton DE, Chhean D, Pich V, Safren SA, Hofmann SG, Pollack MH. A randomized controlled trial of cognitive-behavior therapy for Cambodian refugees with treatment-resistant PTSD and panic attacks: a cross-over design. J Trauma Stress. 2005 Dec;18(6):617-29.
43. Hinton DE, Pham T, Tran M, Safren SA, Otto MW, Pollack MH. CBT for Vietnamese refugees with treatment-resistant PTSD and panic attacks: a pilot study. J Trauma Stress. 2004 Oct;17(5):429-33.
44. Otto MW, Hinton D, Korbly NB, Chea A, Ba P, Gershuny BS, et al. Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther. 2003 Nov;41(11):1271-6.
45. Paunovic N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behav Res Ther. 2001 Oct;39(10):1183-97.
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2018-09-26
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Buhmann, C., Mortensen, E. L., Nordentoft, M., Ryberg, J., & Ekstrøm, M. (2018). Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees. Torture Journal, 25(1), 16. https://doi.org/10.7146/torture.v25i1.109505
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