Descriptive, inferential, functional outcome data on 9,025 torture survivors over six years in the United States
DOI:
https://doi.org/10.7146/torture.v25i2.109673Keywords:
torture, PTSD, asylum seeker, refugee, United Nations Convention against Torture, Major Depressive Disorder, immigration status, treatment, demographic findingsAbstract
Background: The National Consortium of Torture Treatment Programs conducted a large voluntary research project among torture rehabilitation centers in the United States (US). Its goal is to fill the void in the literature on demographic and diagnostic data of torture survivors across a large country.
Methods: Twenty-three centers across the US collaborated over six years, utilizing training and making decisions via conference calls and webinars. A data use agreement signed by all the participating centers governed plans and the use of the data.
Findings: This study reports on torture survivors from 125 countries, 109 of which signed the United Nations Convention against Torture (UNCAT). Of the 9,025 torture survivors represented, most came from Africa and Asia and reported an average of 3.5 types of torture. Asylum seekers have different immigration experiences and show significantly higher rates of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) than refugees. Torture survivors at high risk of PTSD and MDD in this sample reported three or more types of torture, reported rape and had the immigration status of asylum seeker. At one and two years after beginning treatment, both asylum seekers and refugees reported increased rates of employment and improvements in their immigration status.
Interpretation: This longitudinal project provides basic data on a large number of torture survivors who accessed services in the US, and provides a foundation for long-term follow up on immigration status, employment status, diagnostic status, medical diagnoses, and eventually, the effectiveness of treatment for torture survivors in the US. This article shares demographic and diagnostic findings useful for informing programmatic and policy decisions. However, these findings on refugees and asylum seekers in the US may not reflect the experience in other receiving countries. Collaboration with other researchers across continents is required to provide a much needed, more complete picture of torture survivors seeking rehabilitation across the world.
References
2. Modvig J, Jaranson J. A global perspective of torture, political violence, and health. In: Wilson JP, Drozdek B, eds. Broken Spirits: The Treatment of Traumatized Asylum Seekers, Refugees, War and Torture Victims. New York, NY, Brunner-Routledge Press, 2004; 33-52.
3. Kinzie JD, Goetz RR. (1996). A century of controversy surrounding posttraumatic stress spectrum syndromes: The impact on DSM-III and DSM-IV. J Trauma Stress. Wiley-Blackwell; 1996 Apr;9(2):159–79.
4. Jaranson JM, Quiroga J. Evaluating the services of torture rehabilitation programmes: History and recommendations. Torture. 2011;21(2):98– 140.
5. IRCT. History of the IRCT [Internet]. [cited 2015 Jan 7]. Available from: http://www.irct.org/ about-us/what-is-the-irct/history.aspx
6. Reiter RB, Zunzunegui MV, Quiroga J. Guidelines for Field Reporting of Basic Human Rights Violations. Human Rights Quarterly. JSTOR; 1986 Nov;8(4):628–33.
7. Kinzie, JD, Tran, KA, Breckenridge, A, and Bloom, JD. An Indochinese refugee psychiatric clinic: culturally accepted treatment approaches Am J Psychiatry. American Psychiatric Publishing; 1980 Nov;137(11):1429–32.
8. Mollica R, Wyshak G, Lavelle J. The psychosocial impact of war trauma and torture on Southeast Asian refugees. Am J Psychiatry. American Psychiatric Publishing; 1987 Dec;144(12):1567–72.
9. Westermeyer J. Prevention of mental disorder among Hmong refugees in the U.S.: Lessons from the period 1976 – 1986. Social Science & Medicine. Elsevier BV; 1987 Jan;25(8):941–7.
10. Quiroga J, Jaranson JM. Politically-motivated torture and its survivors: A desk study review of the literature. Torture (Thematic Issue). 2005;15(23):1–111.
11. Torture Victims Relief Act 1998, P.L. 105-320, 18 U.S.C. § 2340(1).
12. Kjersem HJ. Migration medicine in Denmark: evaluation of a number of migration medicine problems among asylum seekers and refugees. Copenhagen, Denmark, Danish Red Cross; 1996.
13. Jaranson JM, Butcher J, Halcon L, Johnson DR, Robertson C, Savik K, et al. Somali and Oromo Refugees: Correlates of Torture and Trauma History. Am J Public Health. American Public Health Association; 2004 Apr;94(4):591–8.
14. Wenzel T, Kastrup MC, Eisenman DP. Survivors of Torture: A Hidden Population. Immigrant Medicine. Elsevier BV; 2004. p. 653–63.
15. Masmas TN, Moller E, Buhmannr C, et al. Asylum seekers in Denmark—a study of health status and grade of traumatization of newly arrived asylum seekers. Torture. 2008; 18(2):77-86.
16. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement. JAMA. American Medical Association (AMA); 2009 Aug 5;302(5):537–49.
17. United States Office of Refugee Resettlement [Internet]. [cited 2015 Jul 3]. Available from: http://www.acf.hhs.gov/programs/orr/about/history
18. Martin DC, Yankay JE, Annual Flow Report – Refugees and Asylees: 2013. U.S. Department of Homeland Security, Office of Immigration Statistics Policy Directorate, DHS Office of Immigration Statistics.
19. Eisenman DP, Keller AS, Kim G. Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed? Western Journal of Medicine. BMJ; 2000 May 1;172(5):301–4.
20. Crosby SS, Norredam M, Paasche-Orlow MK, Piwowarczyk L, Heeren T, Grodin MA. Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice. J Gen Intern Med. Springer Science & Business Media; 2006 Jul;21(7):764–8.
21. Willard CL, Robin M, Lawless M. The Prevalence of Torture and Associated Symptoms in United States Iraqi Refugees. J Immigr Minor Health. Springer Science & Business Media; 2013 Apr 6;16(6):1069–76.
22. Başoğlu M, Livanou M, Crnobarić C. Torture vs Other Cruel, Inhuman, and Degrading Treatment. Archives of General Psychiatry. American Medical Association (AMA); 2007 Mar 1;64(3):277.
23. Krammer S, Kleim B, Simmen-Janevska K, Maercker A. Childhood Trauma and Complex Posttraumatic Stress Disorder Symptoms in Older Adults: A Study of Direct Effects and SocialInterpersonal Factors as Potential Mediators. J Trauma Dissociation. Informa UK; 2015 May 26;1–16.
24. Sumner JA, Kubzansky LD, Elkind MSV, Roberts AL, Agnew-Blais J, Chen Q, et al. Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women Clinical Perspective. Circulation. Ovid Technologies (Wolters Kluwer Health); 2015 Jun 29;132(4):251–9.
25. Kinzie JD, Riley C, McFarland B, Hayes M, Boehnlein J, Leung P, et al. High Prevalence Rates of Diabetes and Hypertension Among Refugee Psychiatric Patients. J Nerv Ment Dis. Ovid Technologies (Wolters Kluwer Health); 2008;196(2):108–12.
26. Agyemang C, Goosen S, Anujuo K, Ogedegbe G. Relationship between post-traumatic stress disorder and diabetes among 105 180 asylum seekers in the Netherlands. Eur J Public Health. Oxford University Press (OUP); 2011 Sep 27;22(5):658– 62.
27. Wagner J, Berthold SM, Buckley T, Kong S, Kuoch T, Scully M. Diabetes Among Refugee Populations: What Newly Arriving Refugees Can Learn From Resettled Cambodians. Current Diabetes Reports. Springer Science & Business Media; 2015 Jul 5;15(8).
28. Marshall GN, Schell TL, Wong EC, Berthold SM, Hambarsoomian K, Elliott MN, et al. Diabetes and Cardiovascular Disease Risk in Cambodian Refugees. Journal of Immigrant and Minority Health. Springer Science & Business Media; 2015 Feb 5;
29. Mollica RF, Chernoff MC, Megan Berthold S, Lavelle J, Lyoo IK, Renshaw P. The mental health sequelae of traumatic head injury in South Vietnamese ex-political detainees who survived torture. Comprehensive Psychiatry. Elsevier BV; 2014 Oct;55(7):1626–38.
30. National Consortium of Torture Treatment Programs. [cited 2015 Jun 15]. Available from: http://www.ncttp.org/research.html
31. Keatley E, Ashman T, Im B, Rasmussen A. Self-Reported Head Injury Among Refugee Survivors of Torture. J Head Trauma Rehabil. Ovid Technologies (Wolters Kluwer Health); 2013;28(6):E8–13.
32. Mollica RF, Lyoo IK, Chernoff MC, Bui HX, Lavelle J, Yoon SJ, et al. Brain Structural Abnormalities and Mental Health Sequelae in South Vietnamese Ex–Political Detainees Who Survived Traumatic Head Injury and Torture. Archives of General Psychiatry. American Medical Association (AMA); 2009 Nov 1;66(11):1221.
33. Kinzie, JD, Boehnlein, JK. Post-traumatic Psychosis among Cambodian refugees. J Trauma Stress. Wiley-Blackwell; 1989 Apr;2(2):185–98.
34. Norredam M, Jensen M, Eketran M. Psychotic symptoms in refugees diagnosed with PTSD: A series of case reports. Nord J Psychiatry. Informa UK; 2011 Sep;65(4):283–8.
35. Kinzie, JD. Guidelines for psychiatric care of torture survivors. Torture 2011;21(1):18–26.
36. Kinzie JD, Jaranson JM, Kroupin GV. Diagnosis and Treatment of Mental Illness. Immigrant Medicine. Elsevier BV; 2004. p. 639–51.
37. Kinzie JD, Evaluation and Psychotherapy of Indochinese Refugee Patients. Am J Psychother. 1981 Apr;35(2):251-261.
38. Boehnlein JK, Kinzie JD. Refugee Trauma. Transcultural Psychiatric Research Review. 1995;32:223-252.
39. Kinzie JD. Cross-cultural Treatment of PTSD, In: Core Approaches for the Treatment of PTSD. Wilson J, Friedman M, Lindy J, editors. Guilford Press; 2001.
40. Raghavan S, Rasmussen A, Rosenfeld B, Keller AS. Correlates of symptom reduction in treatment-seeking survivors of torture. Psychological Trauma: Theory, Research, Practice, and Policy, 2013 Jul;5(4):377–83.
41. Marshall GN, Schell TL, Elliott MN, Berthold S, Chun C. Mental health of Cambodian refugees two decades after resettlement in the United States. JAMA. American Medical Association (AMA); 2005 Aug 3;294(5):571.
42. Immigration Court Backlog Tool: Pending Cases and Length of Wait in Immigration Courts [Internet]. [cited 2015 July 8]. Available from: http://trac.syr.edu/phptools/immigration/court_ backlog
43. Berthold SM, Kong S, Mollica RF, Kuoch T, Scully M, Franke T. Comorbid Mental and Physical Health and Health Access in Cambodian Refugees in the US. J Community Health. Springer Science & Business Media; 2014 Mar 21;39(6):1045–52.
Downloads
Published
How to Cite
Issue
Section
License
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.
