The Danish Trauma Database for Refugees (DTD): A Multicenter Database Collaboration-Overcoming the Challenges and Enhancing Mental Health Treatment and Research for Refugees.

Mental health of trauma-affected refugees is an understudied area, resulting in inadequate and poorer treatment outcomes. To address this, more high-quality treatment studies that include predictive analyses, long-term evaluations, cultural adaptations, and take account for comorbidities, are needed. Moreover, given the complex intertwining of refugees' health with post-migration stressors and other social factors, it is crucial to examine the social determinants of refugee mental health. The Danish Trauma Database for Refugees (DTD) is a multicenter research database uniting six national centers that provide outpatient treatment for trauma-affected refugees. Through the database, we collect clinical and sociodemographic data from approximately 1200 refugees annually and will merge the database with Danish population register data. The purpose of the DTD is two-fold; clinical and research. The DTD offers data-driven guidance for routine clinical treatment planning of the individual patient, as well as exceptional research opportunities for testing treatment interventions in clinical settings, with larger sample sizes, and more representative heterogeneity of the population. Complex analyses of risk and protective factors, barriers, access to treatment, and societal and transgenerational aspects of trauma are possible with the DTD. This conceptual paper introduces the DTD, the historical background, the development process and implementation strategy, and the associated challenges with developing and running a multicenter database. Most importantly, it highlights the clinical and research potential of the DTD for advancing the understanding and treatment of trauma-affected refugees.

Relations between PTSD symptom clusters and pain in three trauma-exposed samples with pain.

OBJECTIVES: Little is known about how the individual PTSD symptom clusters relate to intensity and interference of pain and whether these relationships differ across clinical groups. The present study examines relations between PTSD symptom clusters and pain in three trauma-exposed, unique clinical groups: 1) adults seeking treatment for chronic pain with current symptoms of PTSD, 2) trauma affected refugees seeking treatment for PTSD and chronic pain; and 3) individuals identified at admission to the emergency ward after whiplash injury. METHODS: Network analysis was used to assess unique relations between pain intensity, pain interference, re-experiencing, avoidance, numbing, hyperarousal, depression, and anxiety separately in each sample. Links between PTSD clusters and pain were then compared within and between samples. RESULTS: No within-group differences were identified for the links between pain and any of PTSD clusters in the chronic pain and refugee groups. In the whiplash group, hyperarousal was more strongly related to pain than re-experiencing, avoidance, and numbing. Between group comparisons revealed a more pronounced relationship between hyperarousal and pain in the whiplash group, with no between-group differences between the chronic pain and refugee groups. CONCLUSIONS: The findings suggest that when depression and anxiety are accounted for, few unique associations are found between pain and the PTSD symptom clusters in trauma-exposed samples with pain, with the exception of a link between pain and hyperarousal in individuals with whiplash-related PTSD symptoms.

Twenty seven years of treating survivors of torture and organized violence - associations between torture, gender and ethnic minority status among refugees referred for treatment of PTSD.

Background: Victims of torture and organized violence are among the most vulnerable refugees. The nature of torture promotes shame, secrecy and silencing of the survivors, and there is a need for studies to provide a testimony to the experiences of survivors. Objective: To contribute to the global knowledge base by exploring the nature and frequency of different types of torture as reported by survivors and to explore potential associations between basic sociodemographic variables and the likelihood of reporting different kinds of torture and of attending treatment for PTSD. Method: This study is based on archival data from 27 years of clinical practice treating survivors of torture and organized violence (N = 1249) in a specialist outpatient clinic. Data was coded from patient files by two research assistants. Statistical analysis included independent samples t-tests, Pearson Chi Square tests and regression. Results: The study found strong associations between gender of survivors and the reporting of different kinds of torture, most strongly with respect to sexual torture. Furthermore, the study found significant differences between survivors belonging to an ethnic minority and survivors who belonged to the majority populations within their countries of origin with regards to the extent of the torture, they report being subjected to. Patients who received treatment reported more torture experiences than those who did not. Conclusions: Findings from the present study document the experiences of different torture methods as reported by survivors, and suggest that belonging to an ethnic minority population is associated with an increased risk of being subjected to more severe torture, which has implications for both research and interventions aimed at treating survivors of torture.

Antecedentes: Las víctimas de la tortura y de la violencia organizada se encuentran entre los refugiados más vulnerables. La tortura por naturaleza promueve la vergüenza, el secretismo y el silenciamiento de los sobrevivientes, existiendo la necesidad de estudios que sirvan como un testimonio de las experiencias de los sobrevivientes.Objetivo: Contribuir a la base del conocimiento global explorando la naturaleza y la frecuencia de los diferentes tipos de tortura reportados por los sobrevivientes; así como, explorar las asociaciones potenciales entre las variables sociodemográficas básicas y la probabilidad de reportar diferentes tipos de tortura y de acudir a tratamiento para el trastorno de estrés postraumático (TEPT).Métodos: Este estudio se basó sobre la información de los archivos de 27 años de práctica clínica en el tratamiento de los sobrevivientes a la tortura y a la violencia organizada (N = 1249) en la atención ambulatoria de una clínica especializada. La información fue codificada de los archivos de los pacientes por dos asistentes de investigación. Los análisis estadísticos incluyeron pruebas t para muestras independientes, pruebas Chi cuadrado de Pearson, así como de regresión.Resultados: El estudio encontró asociaciones fuertes entre el género de los sobrevivientes y el reportar los diferentes tipos de tortura, con más fuerza en relación con la tortura sexual. Asimismo, el estudio encontró diferencias significativas entre los sobrevivientes que pertenecían a una minoría étnica y aquellos sobrevivientes que pertenecían a las poblaciones mayoritarias dentro de sus países de origen en relación con la extensión de la tortura que refirieron padecer. Los pacientes que recibieron tratamiento reportaron mayores experiencias de tortura que aquellos que no.Conclusiones: Los hallazgos del presente estudio documentan las experiencias de diferentes métodos de tortura reportadas por los sobrevivientes y sugieren que el pertenecer a una minoría étnica está asociado a un riesgo mayor de padecer una tortura de mayor severidad, lo que tiene implicaciones tanto para la investigación como para las intervenciones que tienen por objetivo el tratar a los sobrevivientes de tortura.

Perceptions of coercion in the community: a qualitative study of patients in a Danish assertive community treatment team.

Assertive community treatment (ACT) has been claimed to be paternalistic and coercive, yet little is known about how patients experience the assertive aspects of ACT. To explore views on--and perceptions of--coercion of patients in Danish assertive community teams. In-depth interviews were conducted with six purposefully selected patients and analysed using thematic analysis. Patients reported lack of influence on treatment process and a poor alliance with case-mangers, not being recognised as an autonomous person, and experiences of staff crossing the line and intruding privacy, as most central to perceptions of coercion. A collaborative and mutually trusting relationship, commitment, persistence and availability of staff, and recognition of the need for social support and help with everyday activities, were most important for counteracting such experiences. Perceptions of coercion were not emphasised in patients' account of their engagement with ACT, and generally only related to patients' initial contact with ACT staff. The study suggests that developing mental health practices that enhance the formation of a therapeutic relationship with patients will minimize circumstances that induce perceptions of coercion. ACT, with its engaged and committed staff with sufficient time, focusing on social and practical issues, is successful in facilitating such a contact, as experienced by patients.