Entering exile: trauma, mental health, and coping among Tibetan refugees arriving in Dharamsala, India.

Each year thousands of Tibetans escape Chinese-controlled Tibet. The authors present findings on the experiences, coping strategies, and psychological distress (depression, anxiety, somatization, and posttraumatic stress disorder) of 769 Tibetan refugees arriving in Dharamsala, India (2003-2004). Distress increased significantly with greater trauma exposure. However, despite a high prevalence of potentially traumatizing events, levels of psychological distress were extremely low. Coping activity (primarily religious) and subjective appraisals of trauma severity appeared to mediate the psychological effects of trauma exposure. The potential impact of other variables, including culturally determined attitudes about trauma and timing of assessment, are discussed.

Validation of a Tibetan translation of the Hopkins Symptom Checklist 25 and the Harvard Trauma Questionnaire.

This study sought to translate and validate the Hopkins Symptom Checklist-25 (HSCL) and the Harvard Trauma Questionnaire (HTQ) in a Tibetan population. Translated questionnaires were administered to 57 Tibetan survivors of torture/human rights abuses living in the United States and receiving services in a torture treatment program. Participants were evaluated to determine if they met criteria for major depressive episode, generalized anxiety disorder, or posttraumatic stress disorder (PTSD). Coefficient alpha for the HSCL Anxiety subscale (.89), Depression subscale (.92), and the HTQ (.89) were high. Diagnostic accuracy using receiver operating characteristic curve analysis generated good classification accuracy for anxiety (.89), depression (.92), and PTSD (.83). However, although sensitivity and specificity for HSCL subscales were quite high, the HTQ generated low sensitivity (.33), partly because of a low rate of PTSD. Results support the reliability and validity of the HSCL but suggest further study of the HTQ with this population is required.

Classifying the torture experiences of refugees living in the United States.

Few research studies have systematically categorized the types of torture experienced around the world. The purpose of this study is to categorize the diverse traumatic events that are defined as torture, and determine how these torture types relate to demographics and symptom presentation. Data for 325 individuals were obtained through a retrospective review of records from the Bellevue/NYU for Survivors of Torture. A factor analysis generated a model with five factors corresponding to witnessing torture of others, torture of family members, physical beating, rape/sexual assault, and deprivation/passive torture. These factors were significantly correlated with a number of demographic variables (sex, education, and region of origin). Post Traumatic Stress Disorder, anxiety, and depression symptoms were significantly correlated with the rape factor but no other factors were uniquely associated with psychological distress. The results offer insight into the nature of torture and differences in responses.

Screening for PTSD among Somali adolescent refugees: psychometric properties of the UCLA PTSD Index.

This study presents the psychometric properties for the UCLA Posttraumatic Stress Disorder Index among a sample of Somali adolescents. Data were derived from a sample of English-speaking Somali adolescent refugees between the ages of 12 and 19 years (n=76). The UCLA PTSD Index showed good reliability (Cronbach's alpha=.85). Convergent validity was assessed through bivariate correlations with the Depression Self Rating Scale (r=.72, p<.001) and the War Trauma Screening Scale (r=59, p<.001). Results suggest that the UCLA PTSD Index may be a reliable and valid screening tool for PTSD symptoms for use with Somali adolescent refugees.

Traumatic experiences and psychological distress in an urban refugee population seeking treatment services.

While a growing literature has addressed the psychological consequences of torture and refugee trauma, most studies have focused on homogeneous samples drawn from a single region. Thus, relatively little research has attempted to identify demographic or experiential factors that might help explain different levels of distress in these individuals. We measured depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in a convenience sample of refugees and survivors of torture seeking treatment in a torture treatment program (N = 325). We found 81.1% of patients had clinically significant anxiety, 84.5% had clinically significant depressive symptoms, and 45.7% had significant PTSD symptoms. Regression analyses revealed that anxiety and depressive symptom were significant higher among women (beta = .08, p = 0.02 and beta = .22, p = 0.0001 for anxiety and depression respectively) and those who reported death threats as part of their traumatic experiences (beta = .10, p = 0.033 and beta = .12, p = 0.036 respectively). Symptoms of PTSD were also predicted by death threats (beta = .22, p = 0.03), but were also influenced by the experience of rape (beta = .33, p < 0.001), family torture experiences (beta = .23, p = 0.022), religion (beta = .21, p = 0.03), and age (beta = -.18, p = 0.004). The clinical implications of these results are discussed.