Indicators likely to contribute to clinical and functional improvement among survivors of politically-sanctioned torture
DOI:
https://doi.org/10.7146/torture.v29i3.115202Palabras clave:
torture treatment, holistic, trauma, evaluation, asylum seekersResumen
Introduction: Heartland Alliance Marjorie Kovler Center (Kovler Center) is a torture treatment program located in Chicago, Illinois. Established in 1987, Kovler Center provides medical, mental health, and social services, as well as coordination with legal services, to a diverse population of survivors. Historically, Kovler Center used clinical measurement instruments to assess depression, anxiety and posttraumatic stress, but staff was challenged with finding the best way to assess and ultimately measure changes in functional domains. The purpose of this paper is to describe (1) the Kovler Center framework, philosophical pillars, and model of treatment; (2) the comprehensive outcome evaluation program, including the Marjorie Kovler Center Well-Being Questionnaire (MKC WBQ); and (3) the results and implications to date. Methods: Kovler Center measured outcome data utilizing three instruments including a well-being tool and supplemented the data with a satisfaction survey. These instruments were administered at intake and re-administered at six-month intervals up to 24 months. Results/Discussion: With nine years of data, Kovler Center can now provide valid and reliable findings in diagnostic and functional changes, with 86.6% of its clients reporting fewer symptoms of anxiety and depression, 83.1% reporting fewer symptoms of trauma, and significant improvement in employment status, housing status, and physical health after receiving services for 24 months. Indicators
significantly correlated with clinical improvement at 24 months include stable housing, stable employment, region from where survivors came, number of days between initial assessment and program admittance, number of services (medical, psychological, social) received while in the program, number of medical problems diagnosed with while in the program, and number of psychological problems diagnosed with while in the program. From the Generalized Linear Mixed Models (GLMM) analysis, the total number of psychological problems and whether or not the participant had a secure legal status while in the program were demonstrated to explain the variance in anxiety, depression, and PTSD. Females were more likely to experience depression while in the program compared to males, and participants from the Middle East were more likely to experience symptoms of depression and PTSD compared to participants from Africa. Conclusions: Since, medical, psychological, and social indicators are demonstrated to correlate with or predict clinical outcomes, this highlights the need for comprehensive and holistic treatment programs for survivors of torture.
Citas
American Psychiatric Association, Committee on Nomenclature and Statistics. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association.
Amnesty International. Amnesty International Annual Report. 2016.
Birck, A. (2001). Torture victims after psychotherapy: A two year follow-up. Torture, 11(2), 55-58.
Black, M. (2011). From kites to kitchens: Collaborative community-based occupational therapy with refugee survivors of torture. In Kronenberg, F, Pollard, N, & Sakellariou, D, (Eds.), Occupational Therapies Without Borders: Towards an Ecology of Occupation-Based Practices (2), 217-224.
Bronfenbrenner, U. (1979). The ecology of human development. Cambridge: Harvard University Press.
Carlsson, J. M., Mortensen, E. L., & Kastrup, M. (2006a). Predictors of mental health and quality of life in male tortured refugees. Nordic Journal of Psychiatry, 60(1), 51-57. doi/full/10.1080/08039480500504982
Carlsson, J. M., Olsen, D. R., Mortensen, E. L., & Kastrup, M. (2006b). Mental health and health related quality of life: A 10-year follow-up of tortured refugees. Journal of Nervous and Mental Disease, 194(10),725-731. doi:10.1097/01.nmd.0000243079.52138
Connor, Ross F. (1980). Ethical issues in the use of control groups. New Directions for Program Evaluation, 7,63-75. doi.org/10.1002/ev.1253
Ekblad, S. (2000). A survey of somatic, psychological, and social needs of mass displaced refugees from the Kosovo province while in Sweden. Stress Research Reports, 293, Stockholm.
Ekblad, S., Prochazka, H., & Roth, G. (2002). Psychological impact of torture: A 3-month follow-up of mass-evacuated Kosovan adults in Sweden: Lessons learnt for prevention. Acta Psychiatrica Scandinavica, 106(412), 30-36. doi. org/10.1034/j.1600-0447.106.s412.7.x
Fabri, M. (2001). Reconstructing safety: Adjustments to the therapeutic frame in the treatment of survivors of political torture. Professional Psychology: Research and Practice, 32(5), 452-457.doi/10.1037/0735-7028.32.5.452
Fabri, M., Joyce, M., Black, M., & Gonzalez M. (2009). Caring for torture survivors: The Marjorie Kovler Center. In Stout, C. (Ed.) The New Humanitarians. Westport, Connecticut, London: Praeger, 157-187.
Gorman, W. (2001). Refugee survivors of torture: trauma and treatment. Professional Psychology: Research and Practice, 32(5), 443-451. doi/10.1037/0735-7028.32.5.443
Harvard Trauma Questionnaire, 2018. [Internet] Available from: http://hprt-cambridge.org/ screening/harvard-trauma-questionnaire/
Haskell, S.G., Gordon, K.S., Mattocks, K., Duggal, M., Erdos, J., Justice, A. & Brandt, C.A. (2010). Gender differences in rates of depression, PTSD, pain, obesity, and military sexual trauma among Connecticut war veterans or Iraq and Afghanistan. Journal of Women’s Health, 19(2), 267-271. doi: 10.1089/jwh.2008.1262
Heim, C., & Nemeroff, C. B. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies. Biological Psychiatry, 49(12), 1023-1039. https://doi.org/10.1016/S0006-3223(01)01157-X
Herman, J. L. (1992). Trauma and Recovery. New York: Basic Books.
Hesbacher P. T., Rickels K., Morris R. J., Newman, H., & Rosenfeld, H. (1980). Psychiatric illness in family practice. Journal of Clinical Psychiatry, 41, 6-10. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/7351399
Higson-Smith, C. (2015). Updating the estimate of refugees resettled in the United States. St. Paul, MN: Center for Victims of Torture.
Hill, M., & Everson, M. L. (2016a). The healing impact: Heartland Alliance Marjorie Kovler Center services for survivors of politically-sanctioned torture. Chicago, IL: Heartland Alliance International.
Hill, M., & Everson, M. L. (2016b). Efficacy of rehabilitation and treatment approaches: Indicators likely to contribute to treatment success among survivors of torture. Paper presented at the International Rehabilitation Council for Torture Victims (IRCT), Mexico City, Mexico, December 5-7.
Jaranson, J. M., & Quiroga, J. (2011). Evaluating the services of torture rehabilitation programmes: History and recommendations. Torture, 21(2), 98-140. Retrieved from irct.org/assets/uploads/1018-8185_2011-2_98-140.pdf
Kibler, J. L., Joshi, K., & Ma, M. (2009). Hypertension in relation to posttraumatic stress disorder and depression in the U.S. national comorbidity survey. Behavioral Medicine, 34, 125-132. doi/abs/10.3200/BMED.34.4.125-132
Kinzie, J., Riley, C., McFarland, B., Hayes, M.,Boehnlein, J., Leung, P., & Adams, G., (2008). High prevalence rates of diabetes and hypertension among refugee psychiatric patients. Journal of Nervous and Mental Disease, 196(2),108-112. doi: 10.1097/NMD.0b013e318162aa51
Kira, I. (2002). Torture assessment and treatment: The wraparound approach. Traumatology, 8, 23-51. doi.org/10.1177/153476560200800203
Kivling-Boden, G., & Sundbom, E. (2001). Life situation and posttraumatic symptoms: A follow-up study of refugees from the former Yugoslavia living in Sweden. Nordic Journal of Psychiatry, 55, 401-408. doi.org/10.1080/08039480152693291
Kivling-Boden, G., & Sundbom, E. (2002). The relationship between post-traumatic symptoms and life in exile in a clinical group of refugees from the former Yugoslavia. Acta Psychiatrica Scandinavica, 105, 461-468. doi.org/10.1034/j.1600-0447.2002.02247.x
Lambert, M.J., & Barley, D.E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training. 38(4), 357-361. doi:10.1037%2F0033-3204.38.4.357
Lie, B. (2002). A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatrica Scandinavica, 106, 415-425. doi.org/10.1034/j.1600-0447.2002.01436.x
McFarlane, C. A., & Kaplan, I. (2012). Evidence based psychological interventions for adult survivors of torture and trauma: A 30-year review. Transcultural Psychiatry, 49(3-4), 539-567. doi.org/10.1177%2F1363461512447608
Member Centers of the National Consortium of Torture Treatment Programs (NCTTP). (2015). Descriptive, inferential, functional outcome data on 9,025 torture survivors over six years in the United States. Torture, 25(2), 34-60. Retrieved from irct.org/assets/uploads/1018-8185_2015-2_34-60.pdf
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 post-traumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180(2), 111-116. doi/10.1097/00005053-199202000-00008
Montgomery, E., & Patel, N. (2011). Torture rehabilitation: Reflections on treatment outcome studies. Torture, 21(2), 141- 145. Retrieved from irct.org/assets/uploads/1018-8185_2011-2_141-145.pdf
Piwowarczyk, L. (2005). Torture and spirituality: Engaging the sacred in treatment. Torture, 15(1), 1-8. Retrieved from irct.org/assets/uploads/Engaging%20the%20sacred.pdf
Raghavan, S., Rasmussen, A., Rosenfeld, B., & Keller, A. S. (2013). Correlates of symptom reduction in treatment-seeking survivors of torture.
Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 377–383. doi/10.1037/a0028118
Salo, C., & Bray, E. (2016). Empirically-tested interventions for torture survivors: A systematic review through an ecological lens. [Special Issue: Trauma] Translational Issues in Psychological Science, 2(4), 449–463. doi/10.1037/tps0000097
Schwartz, C. E. Chesney, M. A., Irvine, M. J, & Keefe, F. J. (1997). The control group dilemma in clinical research: Applications for psychosocial and behavioral medicine trials. Psychosomatic Medicine, 59, 362-371. doi=10.1.1.482.4005&rep=rep1&type=pdf
Spiric, Z., Opacic, G., Jovic, V., Samardzic, G.,Knezevic, G., Mandic-Gajic, G., & Todorovic, M. (2010). Gender differences in victims of war torture: Types of torture and psychological consequences. Vojnosanit Pregl, 67(5), 411-418. doi=10.2298/vsp1005411s
Stammel, N., Knaevelsrud, C., Schock, K., Walther, L. C. S., Wenk-Ansohn, M., & Bottche, M. (2017). Multidisciplinary treatment for traumatized refugees in a naturalistic setting: Symptom courses and predictors. European Journal of Psychotraumatology, 8(2), 1-13. doi.org/ 10.1080/20008198.2017.1377552
Vieweg, W. V. R., Julius, D. A., Bates, J., Quinn III, J. F., Fernandez, A., Hasnain, M., & Pandurangi, A. K. (2007). Posttraumatic stress disorder as a risk factor for obesity among male military veterans. Acta Psychiatrica Scandinavica, 116(6), 483-487. doi/abs/10.1111/j.1600-0447.2007.01071.x
Winokur A., Winokur D. F., Rickels K., & Cox, S. S. (1984). Symptoms of emotional distress in a family planning service: Stability over a fourweek period. British Journal of Psychiatry,144, 395-399. doi: 10.1192/bjp.144.4.395
World Health Organization (WHO). (2001). The international classification of functioning, disability, and health (ICF). Geneva: WHO.
Publicado
Cómo citar
Número
Sección
Licencia
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.
