Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile.

BACKGROUND: Refugees who have suffered traumatic events present complex therapeutic challenges to health professionals. There is little research into post-exile factors that may be amenable to change, and therefore reduce morbidity. We examined the importance of social factors in exile and of trauma factors in producing the different elements of psychological sequelae of severe trauma. METHOD: Eighty-four male Iraqi refugees were interviewed. Adverse events and level of social support were measured. Various measures of psychological morbidity were applied, all of which have been used in previous trauma research. RESULTS: Social factors in exile, particularly the level of "affective" social support, proved important in determining the severity of both post-traumatic stress disorder and depressive reactions, particularly when combined with a severe level of trauma/torture. Poor social support is a stronger predictor of depressive morbidity than trauma factors. CONCLUSIONS: Some of the most important factors in producing psychological morbidity in refugees may be alleviated by planned, integrated rehabilitation programmes and attention to social support and family reunion.

Survivors of torture and organized violence: demography and diagnosis.

Sixty patients, with a history of torture or other repressive state violence, newly referred to two psychiatrists, were assessed using a standard instrument. Thirty one met the diagnostic criteria for posttraumatic stress disorder (PTSD) and 21 met the criteria for MDD. Relationships between these diagnoses and history of trauma, loss of health, and social losses were investigated. Sexual torture is associated with an avoidance reaction.

Psychiatric morbidity in survivors of organised state violence including torture. A retrospective series.

The case notes documenting the psychological well-being of 100 survivors of torture and other forms of organised state violence were analysed retrospectively. The most common diagnoses were post-traumatic stress disorder (PTSD), major depression, and somatoform disorders. Of these, PTSD showed the strongest association with experience of torture. It is possible that PTSD has a dimensional nature, and that reactions to different stressors are heterogeneous.

Adaptation after torture: some thoughts on the long-term effects of surviving a repressive regime.

The long-term problems of refugee survivors of organized violence are considered. A case example is described in order to illustrate the complexity of factors that contribute to the psychological well-being and social adaptation of such a survivor. The limitations of the classic diagnostic approaches are discussed. It is suggested that measures of social function can be more helpful than a description of symptoms, and should be included in the concept of PTSD, in order to increase the usefulness of this diagnosis in relation to severe and chronic trauma.