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Mirza M, Trimboli C, Hartman J, Gamble A, Rfat M, Bentley J, Gross M, Alheresh R, Hussein Q, Markos T. Examining Barriers to Rehabilitation and Addressing Rehabilitation Needs among Persons with Forced Migration Experiences: Interdisciplinary Perspectives. Arch Phys Med Rehabil 2024:S0003-9993(24)00990-0. [PMID: 38763346 DOI: 10.1016/j.apmr.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 04/01/2024] [Accepted: 05/02/2024] [Indexed: 05/21/2024]
Abstract
Globally, human displacement is at a record high. According to the United Nations High Commissioner for Refugees, 110 million people have been forcibly displaced worldwide due to persecution, mass conflict, or human rights violations. Conflicts continue to rage in different part of the world such as Ukraine, Palestine, Sudan, and Tigray. Large-scale political upheaval is also on the rise in many countries including Haiti, Venezuela, and Iran among others. Natural disasters fueled by climate change will further contribute to large-scale forced migration. Persons with forced migration experiences (PFME) tend to have significant rehabilitation needs due to high risk of physical injuries, mental trauma, and exacerbation of pre-existing health problems during displacement. Rehabilitation practitioners in host countries must be well equipped to address the complex needs of this population. However, there is currently limited literature to guide best practice. In this paper, a group of interdisciplinary professionals examine rehabilitation needs among PFME, provide examples of established and emerging rehabilitation interventions with PFME in the context of asylum and resettlement, identify barriers to accessing rehabilitation services in host countries, and propose avenues for professional advocacy in this area.
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Affiliation(s)
- Mansha Mirza
- University of Illinois Chicago, Department of Occupational Therapy.
| | | | - Jeff Hartman
- University of Wisconsin School of Medicine and Public Health, Doctor of Physical Therapy Program
| | - April Gamble
- Wchan Organization for Victims of Human Rights Violations, Kurdistan, Iraq
| | - Mustafa Rfat
- Washington University in St. Louis, Brown School of Social Work
| | - Jacob Bentley
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | | | - Rawan Alheresh
- University of Jordan, Department of Occupational Therapy
| | - Qusay Hussein
- The University of Texas at Austin, Steve Hicks School of Social Work
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Kibet JJ, Phillips JS, Latrous MC, Khalil H, Morris LD. Translation, cultural adaptation and validation of the Swahili Pain Catastrophizing Scale among refugees who survived torture and/or war trauma in Kenya: An observational study. Health Sci Rep 2024; 7:e2095. [PMID: 38766571 PMCID: PMC11099726 DOI: 10.1002/hsr2.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/04/2024] [Accepted: 04/13/2024] [Indexed: 05/22/2024] Open
Abstract
Background and Aims Accurate assessment of any patient relies on the use of appropriate measurements which are culturally- and linguistically-applicable and valid. The following study aimed to translate, cross-culturally adapt and test the nomological validity, structural validity, internal consistency, test-retest reliability, sensitivity-to-change and feasibility of the Swahili version of the Pain Catastrophizing Scale (Swa-PCS) among refugees who survived torture/war trauma living with chronic pain in Kenya. Methods An observational study was conducted. Translation and cultural adaptation of the original PCS for the Swahili-speaking refugee population in Kenya, who survived torture or war trauma was undertaken. Following this process, a validation study was conducted on the newly-adapted instrument, to ascertain the psychometric properties (nomological validity, structural validity, internal consistency, test-retest reliability, sensitivity-to change, and ceiling and floor effects). Results Fifty participants were included in this study. Correlations between pain catastrophization and fear-avoidance behavior measures were significant (r = 0.538, p < 0.01). Ceiling effects were 42-48% with no floor effects. Standard errors of measurement values were between 0.938 and 3.38. Minimal-detectable-change values were between 2.17 and 7.82. Internal consistency was satisfactory to good, for the whole and subsections respectively (range α = 0.693-0.845). Magnification had the lowest α. Test-retest reliability was also satisfactory to good (range ICC = 0.672-0.878). Confirmatory factor analysis confirmed that the Swa-PCS had three factors which explained the majority of the variance. Root mean square error of approximation and comparative fit index were calculated for goodness-of-fit assessment, and were 0.18 and 0.83, respectively. Conclusion This study showed that the adapted Swa-PCS displayed overall satisfactory to good internal consistency, test-retest reliability and sensitivity-to-change. Furthermore, the Swa-PCS scores were related to fear-avoidance behavior scores as expected (nomological validity). Structural validation of the Swa-PCS requires further investigation. Further testing of the psychometric properties of the Swa-PCS is however warranted.
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Affiliation(s)
- Jepkemoi J. Kibet
- Department of PhysiotherapyUniversity of the Western CapeBellvilleSouth Africa
| | - Joliana S. Phillips
- Department of PhysiotherapyUniversity of the Western CapeBellvilleSouth Africa
| | - Mariem C. Latrous
- Department of Rehabilitation Sciences, College of Health Sciences, QU HealthQatar UniversityDohaQatar
| | - Hanan Khalil
- Department of Rehabilitation Sciences, College of Health Sciences, QU HealthQatar UniversityDohaQatar
| | - Linzette D. Morris
- Department of Rehabilitation Sciences, College of Health Sciences, QU HealthQatar UniversityDohaQatar
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Gammoh O, Aljabali AAA, Tambuwala MM. The crosstalk between subjective fibromyalgia, mental health symptoms and the use of over-the-counter analgesics in female Syrian refugees: a cross-sectional web-based study. Rheumatol Int 2024; 44:715-723. [PMID: 38285107 PMCID: PMC10914905 DOI: 10.1007/s00296-023-05521-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
Suboptimal fibromyalgia management with over-the-counter analgesics leads to deteriorated outcomes for pain and mental health symptoms especially in low-income countries hosting refugees. To examine the association between the over-the-counter analgesics and the severity of fibromyalgia, depression, anxiety and PTSD symptoms in a cohort of Syrian refugees. This is a cross-sectional study. Fibromyalgia was assessed using the patient self-report survey for the assessment of fibromyalgia. Depression was measured using the Patient Health Questionnaire-9, insomnia severity was measured using the insomnia severity index (ISI-A), and PTSD was assessed using the Davidson trauma scale (DTS)-DSM-IV. Data were analyzed from 291. Among them, 221 (75.9%) reported using acetaminophen, 79 (27.1%) reported using non-steroidal anti-inflammatory drugs (NSAIDs), and 56 (19.2%) reported receiving a prescription for centrally acting medications (CAMs). Fibromyalgia screening was significantly associated with using NSAIDs (OR 3.03, 95% CI 1.58-5.80, p = 0.001). Severe depression was significantly associated with using NSAIDs (OR 2.07, 95% CI 2.18-3.81, p = 0.02) and CAMs (OR 2.74, 95% CI 1.30-5.76, p = 0.008). Severe insomnia was significantly associated with the use of CAMs (OR 3.90, 95% CI 2.04-5.61, p < 0.001). PTSD symptoms were associated with the use of CAMs (β = 8.99, p = 0.001) and NSAIDs (β = 10.39, p < 0.001). Improper analgesics are associated with poor fibromyalgia and mental health outcomes, prompt awareness efforts are required to address this challenge for the refugees and health care providers.
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Affiliation(s)
- Omar Gammoh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, PO BOX 566, Irbid, 21163, Jordan.
| | - Alaa A A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, PO BOX 566, Irbid 21163, Jordan
| | - Murtaza M Tambuwala
- Lincoln Medical School, University of Lincoln, Brayford Pool Campus, Lincoln, LN6 7TS, UK.
- College of Pharmacy, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, UAE.
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Im H, George N, Swan LET. Gendered Health Outcome Among Somali Refugee Youth in Displacement: A Role of Social Support and Religious Belief. J Immigr Minor Health 2024; 26:341-350. [PMID: 37733168 DOI: 10.1007/s10903-023-01546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
This study examines the factors influencing physical health status, specifically focusing on the gender differences in risk and promotive factors affecting health outcomes among Somali refugee youth displaced in Nairobi, Kenya (n = 227). A survey was used to assess participants' physical health along with psychosocial factors, somatic symptoms, and demographic characteristics. The study shows that religious belief and somatic symptoms among the total sample were significant predictors in influencing the outcome of physical health. A moderated mediation analysis and logistic regression analyses also revealed gender differences in associated factors as well as health status; female participants reported higher somatic symptoms, associated with a decline in physical health, whereas the protective effect of social support and religious belief promote was found only among male counterparts. Future studies and interventions would be benefited from a gender-specific approach to health promotion and coping mechanisms in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, USA.
| | - Nicole George
- Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, USA
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, USA
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Tsetseri MN, Keene DJ, Silman AJ, Dakin SG. Exploring the burden, prevalence and associated factors of chronic musculoskeletal pain in migrants from North Africa and Middle East living in Europe: a scoping review. BMC Public Health 2024; 24:769. [PMID: 38475746 PMCID: PMC10935970 DOI: 10.1186/s12889-023-17542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/19/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Immigrants are exposed to numerous risk factors that may contribute to the development of chronic musculoskeletal pain. Recent political and environmental crises in North Africa and the Middle East have led to an increase in immigration to Europe that has challenged the healthcare system and especially the management of chronic conditions. OBJECTIVE The aims of this scoping review are to investigate the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants from North Africa and the Middle East in Europe during the last decade. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research. DESIGN Online databases Medline, Embase, PubMed and Web of Science were used to identify epidemiological studies published from2012-2022 examining chronic pain in populations from North Africa and the Middle East with a migration background residing in Europe. RESULTS In total eleven studies were identified conducted in Norway (n = 3), Denmark (n = 3), Germany (n = 1), Austria (n = 1), Sweden (n = 1), and Switzerland (n = 1). Among the identified studies, eight studies were cross-sectional (n = 8), two were prospective cohort studies (n = 2) and one was a retrospective cohort study (n = 1). Data suggested that chronic pain is more prevalent, more widespread, and more severe in people with than without a migration background. Furthermore, immigrants who have resided in the destination country for a longer period experience a higher prevalence of chronic pain compared to those in the early phases of migration. The following factors were found to be associated with chronic pain in this population: female gender, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, immigration status, anxiety, depression, and post-traumatic stress disorder. CONCLUSION Several gaps in the literature were identified. Research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors. Prospective cohort studies with long follow-ups would aid in improving prevention and management of chronic pain in populations with a migration background. In particular, they should reflect actual immigration trajectories, account for immigration factors, and have valid comparison groups in the countries of origin, transit and destination.
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Affiliation(s)
- Maria-Nefeli Tsetseri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK.
| | - David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Alan J Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
| | - Stephanie G Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
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Alfvén G, Andersson E. Stress and recurrent abdominal pain. Acta Paediatr 2023; 112:2312-2316. [PMID: 37565357 DOI: 10.1111/apa.16946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Abstract
We discuss the aetiology of recurrent abdominal pain of non-organic origin, according to the Rome Criteria for Functional Gastrointestinal Disorders and a psychogenic hypothesis. Stress activates the brain-gut axis, which is important for local gut symptoms, such as abdominal pain, but it also causes pain in other areas, including the head, back and chest. Our research has indicated that the startle reflex plays a dominant role in this stress-induced pain pattern, which is manifested in the whole body. Localised abdominal pain can be part of a general negative stress reaction that causes multiple pains in other areas of the body.
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Affiliation(s)
- Gösta Alfvén
- Clintec, Karolinska Institute, Stockholm, Sweden
| | - Eva Andersson
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
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Westergaard ML, Jensen RH, Carlsson J. Headache comorbidity in refugees and migrants with post-traumatic stress disorder. Cephalalgia 2023; 43:3331024221147502. [PMID: 36786299 DOI: 10.1177/03331024221147502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Headache is often comorbid with post-traumatic stress disorder yet overlooked in health assessments of refugees. OBJECTIVES To describe prevalence of severe headache among refugees with post-traumatic stress disorder and compare severity of post-traumatic stress disorder symptoms and treatment outcomes among those with and without severe headache. METHODS This follow-up study used data from the Danish Database on Refugees with Trauma. Participants were recruited from 2009 to 2015 at a specialized psychiatric clinic. Prevalence of severe headache was computed by age, sex, and history of head injury or torture. Severe headache was defined as maximum headache scores on the Hopkins Symptom Checklist, Symptom Checklist-90 or the Visual Analogue Scale. Groups with and without severe headache were described according to validated questionnaires before and after 12-18 months of multidisciplinary treatment for post-traumatic stress disorder. Regression analyses were used to analyze associations between headache at start of treatment and symptom burden post-treatment, controlled for pre-treatment scores and possible confounders. RESULTS Among 403 female and 489 male participants, nearly all (97.5%) complained of headaches. Severe headache prevalence was 31.4% to 50.0% (depending on which questionnaire was used) and was significantly more common among females and those aged 30-49 years. There was no clear relationship between headache and head injury or torture. Participants with severe headache had heavier symptom burdens compared to those without severe headache. Post-treatment, headache prevalence by age and sex did not change significantly. Those without severe headache showed a tendency toward improvement in outcome measures; this was not seen among those with severe headache. Pre-treatment headache scores were correlated with all outcome measures. Regression analyses controlled for pre-treatment scores of the outcome variables showed associations between pre-treatment headache scores (Hopkins Symptom Checklist or Symptom Checklist-90) and post-treatment scores for intrusion, numbing, hyperarousal, anxiety, disability, and quality of life (all p < 0.02). CONCLUSION Headache is a prevalent comorbid condition among refugees with post-traumatic stress disorder. Measures of pre-treatment headache severity appear to predict post-traumatic stress disorder treatment outcomes. Severe headache adversely affects post-traumatic stress disorder prognosis. Assessment and treatment options should be studied further.
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Affiliation(s)
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Jessica Carlsson
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup.,Mental Health Services in the Capital Region of Denmark, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nordbrandt MS, Vindbjerg E, Mortensen EL, Carlsson J. Chronicity of posttraumatic stress disorder and comorbid pain as predictors of treatment response for trauma-affected refugees. J Trauma Stress 2022; 35:1393-1404. [PMID: 35446986 DOI: 10.1002/jts.22839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022]
Abstract
Predictors of treatment outcomes have received limited attention in the field of trauma-affected refugees. Symptom chronicity is potentially a particularly relevant predictor, as it would instruct earlier interventions for a population less familiar with psychiatric treatment options, and its identification may also reduce or delay the onset of comorbidities, such as chronic pain. Accordingly, this study examined the impacts of posttraumatic stress disorder (PTSD) chronicity and baseline comorbid pain on treatment response in trauma-affected refugees. Multiple regression was used to analyze data from a randomized controlled trial of 318 trauma-affected refugees with PTSD that was conducted at a specialized psychiatric clinic in Denmark. Treatment response was measured by changes in symptoms of PTSD (Harvard Trauma Questionnaire) and depression (Hopkins Symptom Checklist-25). Duration of functional impairment was found to be a significant predictor of PTSD outcomes, p = .003, ΔR2 = .02, f2 = .03; it was not predictive of outcomes for depression. Baseline pain severity was a significant predictor of outcomes for both PTSD, p = .009, ΔR2 = .02, f2 = .02, and depression, p = .041, ΔR2 = .01, f2 = .01. These findings suggest that trauma-affected refugees with long-lasting functional impairment and a high pain score are likely to show less improvement from treatments for PTSD and depression. This points to a need for early intervention to prevent chronic functional impairment and suggests comorbid pain is an important therapeutic target.
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Affiliation(s)
- Maja Sticker Nordbrandt
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Erik Vindbjerg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Hasha W, Igland J, Fadnes LT, Kumar BN, Heltne UM, Diaz E. Effect of a self-help group intervention using Teaching Recovery Techniques to improve mental health among Syrian refugees in Norway: a randomized controlled trial. Int J Ment Health Syst 2022; 16:47. [PMID: 36068576 PMCID: PMC9450394 DOI: 10.1186/s13033-022-00557-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mental health symptoms among refugees are common, often related to chronic pain disorders, and their management is usually challenging. Studies evaluating the effect of group therapies among adult refugees to improve mental health symptoms are scarce. Aims To assess the effect of Teaching Recovery Techniques (TRT) on mental health and to reduce pain disorder among adult Syrian refugees. Method A randomized controlled trial was designed to study the effect of a self-help group intervention using TRT. The outcomes, mental health symptoms measured by Impact of Event Scale-Revised (IES-R) and General Health Questionnaire (GHQ-12) and chronic pain measured by Brief Pain Inventory (BPI), were reported as regression coefficients (B) with 95% confidence intervals. Results Seventy-six adults participated: 38 in the intervention and 38 in the control groups. Intention-to-treat analyses showed a significant effect on general mental health as measured by GHQ-12 with B (95% CI) of -3.8 (-7.2, -0.4). There was no effect of TRT on mental health when assessed by IES-R (-1.3 (-8.7, 6.2)) or on pain levels assessed by BPI (-0.04 (-4.0, 3.9)). Conclusions This self-help group intervention significantly improved general mental health symptoms among adult refugees but had no effect on trauma symptoms or chronic pain. Higher participation rates might be necessary to achieve the full potential of TRT. Trial registration: The trial was registered with Clinical Trials.gov at https://clinicaltrials.gov/ct2/show/NCT03951909. To include user participation in the design of the interventions, the study was retrospectively registered on 19 February 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00557-4.
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Affiliation(s)
- Wegdan Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009, Bergen, Norway.
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009, Bergen, Norway
| | - Lars T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Bernadette N Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, 222 Skøyen, 0213, Oslo, Norway
| | - Unni M Heltne
- Centre for Crisis Psychology, Møllendalsbakken 9, 5020, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009, Bergen, Norway.,Unit for Migration and Health, Norwegian Institute of Public Health, 222 Skøyen, 0213, Oslo, Norway
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Nissen A, Hynek KA, Scales D, Hilden PK, Straiton M. Chronic pain, mental health and functional impairment in adult refugees from Syria resettled in Norway: a cross-sectional study. BMC Psychiatry 2022; 22:571. [PMID: 36002823 PMCID: PMC9404590 DOI: 10.1186/s12888-022-04200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Limited research exists on pain and especially the co-occurrence of pain and mental ill health in general refugee populations. The present study aimed to approximate the prevalence of chronic pain (CP) among adult refugees from Syria resettled in Norway; investigate the association between CP and mental ill health; and explore how CP and mental ill health associate with both perceived general health and functional impairment. Gender as potential effect modifier in these associations was also examined. METHODS Cross-sectional, postal survey questionnaire. INCLUSION CRITERIA ≥ 18 years old; refugee from Syria; and arrived in Norway between 2015 and 2017. Study sample was randomly drawn from full population registries, and n = 902 participated (participation rate ≈10%). CP was measured with 10 items on pain lasting for ≥ 3 consecutive months last year. Symptoms of anxiety, depression and PTSD were measured with the HSCL and HTQ scales, respectively. Ordered and binomial logistic regressions were used in analyses. Gender was tested as effect modifier with Wald test for interaction. RESULTS In the sample overall, the proportion of participants who reported severe CP was 43.1%. There was strong evidence that anxiety, depression and PTSD were associated with higher levels of CP. In fully adjusted regression models, including both CP and mental health variables, CP was strongly associated with poor perceived general health whereas mental health showed much weaker associations. The association between mental health (anxiety and PTSD) and functional impairment was highly gender specific, with strong associations in men but not in women. CP was strongly associated with functional impairment with no difference across gender. CONCLUSION The study shows a high burden of CP in a general population of adult refugees from Syria with likely substantial adverse consequences for daily functioning. The strong association between CP and mental ill health suggests personnel working with refugees' health should be attuned to their co-occurrence as both problems may need to be addressed for either to be effectively mitigated. A clear mismatch exists between the burden on health caused by pain in general refugee populations and the amount of available evidence to guide mitigating strategies. TRIAL REGISTRATION NCT03742128.
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Affiliation(s)
- Alexander Nissen
- Section for Trauma, Catastrophes and Forced Migration - Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, 0484, Oslo, Norway.
| | - Kamila Angelika Hynek
- grid.418193.60000 0001 1541 4204Division for Mental and Physical Health, Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213 Oslo, Norway
| | - David Scales
- grid.5386.8000000041936877XSection of Hospital Medicine, Division of General Internal Medicine, Department of Internal Medicine, Weill Cornell Medicine, 525 E 68th Street, Box 331, New York, NY 10065 USA
| | - Per Kristian Hilden
- grid.504188.00000 0004 0460 5461Section for Trauma, Catastrophes and Forced Migration - Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway
| | - Melanie Straiton
- grid.418193.60000 0001 1541 4204Division for Mental and Physical Health, Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213 Oslo, Norway
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Self-rated health and quality of life among Syrian refugees in Ireland - data from a cross-sectional study. BMC Public Health 2022; 22:1202. [PMID: 35705914 PMCID: PMC9202096 DOI: 10.1186/s12889-022-13610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION As a response to the humanitarian crisis in Syria, the Irish government agreed to accept up to 4000 refugees for resettlement in Ireland in 2016. Prior to their arrival in Ireland, health screening was carried out by the International Organisation for Migration. However, no population-level measurement of the health status or needs takes place in Ireland to inform policy or health services requirements. METHODS Cross-sectional data from a self-completed questionnaire among 194 Syrian Refugees aged 16 years and older resident in reception centres in Ireland in 2017/2018 is reported upon. The questionnaire measured self-reported health including quality of life and all study material were available in English and Arabic. The data was examined applying descriptive statistics and regression analysis. RESULTS Syrian Refugees in Ireland consist of a relatively young cohort; in this study the majority of participants were younger than 35 years (69.5%). Two-thirds of the respondents reported their overall health status to be good or very good. The most common health condition was found to be headache and the most common medications used were painkillers. Chronic pain was experienced by one quarter of respondents; 27.5% were considered as suffering from anxiety and 10.0% had symptoms compatible with post-traumatic stress disorder (PTSD). A significant relationship was observed between chronic pain and self-rated health, as well as between chronic pain and anxiety. Quality of life (QoL) scores were lowest for the QoL environment domain. CONCLUSIONS Chronic pain is relatively widespread among these young and otherwise healthy refugees. Psychological distress and trauma are important factors in respondents' quality of life scores. Chronic pain is associated with one's mental health. Our findings and the literature suggests that the diagnosis and treatment of pain and providing care in a culturally sensitive manner should be a priority and included in the preparation and training of the relevant care providers. Additionally, the impact of living conditions on quality of life should not be underestimated.
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Altun A, Soh SE, Brown H, Russell G. The association between chronic pain and pre-and-post migration experiences in resettled humanitarian refugee women residing in Australia. BMC Public Health 2022; 22:911. [PMID: 35525945 PMCID: PMC9080158 DOI: 10.1186/s12889-022-13226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background Refugee women are potentially at increased risk for chronic pain due to circumstances both in the pre-migration and post-settlement setting. However, this relationship between refugee-related challenges introduced along their migration trajectories and chronic pain remains unclear. This study will therefore examine the association between pre- and post-migration factors and chronic pain in refugee women five years into resettlement in Australia. Methods The first five waves of data from the ‘Building a New Life in Australia’ longitudinal study of humanitarian refugees living in Australia was analysed using logistic regression models to investigate the association between predictor variables and chronic pain. The study outcome was chronic pain and predictors were migration process and resettlement factors in both the pre-and post-settlement setting. Results Chronic pain was reported in 45% (n = 139) of women, and among these a further 66% (n = 120) also reported having a long-term disability or health condition that had lasted 12 months. Pre- migration factors such as increasing age (OR 1.08; 95% CI 1.05, 1.11) and women who migrated under the Women at Risk Visa category (OR 2.40; 95% CI 1.26, 4.56) had greater odds of experiencing chronic pain. Interestingly, post migration factors such as women with better general health (OR 0.04; 95% CI 0.01, 0.11) or those who settled within metropolitan cities (OR 0.29; 95% CI 0.13, 0.68) had lower odds of experiencing chronic pain, and those who experience discrimination (OR 11.23; 95% CI 1.76, 71.51) had greater odds of experiencing chronic pain. Conclusion Our results show that there is a high prevalence of chronic pain in refugee women across the initial years of resettlement in Australia. This may be in part due to pre-migration factors such as age and migration pathway, but more significantly the post migration context that these women settle into such as rurality of settlement, poorer general health and perceived discriminatory experiences. These findings suggest that there may be many unmet health needs which are compounded by the challenges of resettlement in a new society, highlighting the need for increased clinical awareness to help inform refugee health care and settlement service providers managing chronic pain. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13226-5.
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Affiliation(s)
- Areni Altun
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Department of General Practice, Monash University, Melbourne, Australia.
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Brown
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Grant Russell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of General Practice, Monash University, Melbourne, Australia
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13
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Altun A, Brown H, Sturgiss L, Russell G. Evaluating chronic pain interventions in recent refugees and immigrant populations: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:1152-1169. [PMID: 34483005 DOI: 10.1016/j.pec.2021.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/09/2021] [Accepted: 08/22/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Many studies investigating the management of chronic pain often exclude participation of people from refugee and immigrant backgrounds. This review seeks to understand and evaluate the effectiveness of interventions for chronic pain management when applied in the context of refugee and immigrant populations. METHODS A systematic review was undertaken using six databases and the PICO search strategy. Included studies were published in English, comprised of patients over 18 years of age and excluded cancer-related chronic pain. RESULTS Twenty-one papers met the inclusion criteria: 13 cohort studies and eight randomised control trials. The majority of interventions involved multidisciplinary or psychological interventions, with the remaining studies based on education, exercise therapy or culturally adapted information. Studies integrating multidisciplinary care to manage chronic pain showed more consistent improvements in pain intensity and function than other unimodal interventions. CONCLUSIONS Multidisciplinary interventions reduce pain intensity, improve functional impairment, and alleviate other psychosocial symptoms exhibited chronic pain patients from refugee or immigrant backgrounds. Additional well-designed, large-scale studies are needed to decisively estimate the effectiveness of culturally adapted, multidisciplinary intervention programs over time. PRACTICE IMPLICATIONS Clinical practice may benefit from adapting interventions to better support the management of chronic pain in refugee and immigrant populations.
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Affiliation(s)
- Areni Altun
- Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Helen Brown
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Liz Sturgiss
- Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
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14
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Tsur N. Chronic Pain Personification Following Child Abuse: The Imprinted Experience of Child Abuse in Later Chronic Pain. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2516-NP2537. [PMID: 32713232 DOI: 10.1177/0886260520944529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Child abuse has been shown to increase the risk for chronic pain. The illness personification theory implies that individuals tend to ascribe humanlike characteristics to chronic pain, and that this personification is embedded in the way they cope with their chronic condition. Recent findings demonstrate that individuals who experienced interpersonal violence tend to personify chronic pain in a way that resonates with past abusive experience. Although findings prevail to the link between trauma and the experience of the body, the personification of chronic pain among individuals who experienced child abuse has not been examined before. This article includes two studies that tested whether child abuse is implicated in abusive chronic pain personification in a young adult female sample (Study 1) and among females who experienced child abuse (Study 2). In both studies, self-report measures of child abuse, posttraumatic stress (PTS) symptoms, complex posttraumatic symptoms (disturbances of self-organization [DSO]), and abusive chronic pain personification were administered. Structural equation modeling was utilized to assess the hypotheses. The findings of the two studies showed a significant association between child abuse and pain personification. Whereas PTS symptoms did not mediate this link (Study 1), DSO symptoms mediated this association (Study 2). The findings of these studies support the understanding that the experience of interpersonal violence is engraved in the experience of the body, as reflected in abusive chronic pain personification. Disturbances in self-organization seem to underlie this process, thus pertaining to the link between the experience of the body, self, and interpersonal trauma.
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15
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Greene M, Nasir SL. Care of the Refugee. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Jung H, Lee D, Lee D. Longitudinal transitions in patterns of post-traumatic stress disorder symptoms and psychological distress among South Korean adults with traumatic experiences. Stress Health 2021; 37:871-886. [PMID: 33740290 DOI: 10.1002/smi.3046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/07/2022]
Abstract
This study aimed to investigate transitions in patterns of post-traumatic stress disorder (PTSD) symptoms and psychological distress among South Koreans with traumatic experiences. This study consists of two parts: In Part 1 the time since trauma ranged between 0 and 41 years, while in Part 2 participants experienced at least one traumatic event within the previous three years. We identified subgroups and transitions between classes over a one-year period using latent profile analysis and latent transition analysis. First, in Part 1, four classes were identified at T1 and T2. Second, we explored whether age, sex, time since trauma, and time perspective (TP) predicted class membership at T1. Age, past-negative (PN), present-fatalistic, and future TPs were significant predictors of class membership at T1. Finally, sex, PN, and future TPs were identified as significant predictors of class transition over time. The same analysis was conducted in Part 2 with individuals chosen from the Part 1 participants. Differential effects of TP on class membership and transitions in PTSD symptoms and psychological distress indicated the need for intervention programs that consider the TP profiles of individuals with traumatic experiences.
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Affiliation(s)
- Hayoung Jung
- Department of Education, College of Education, Sungkyunkwan University, South Korea
| | - DongHun Lee
- Department of Education, College of Education, Sungkyunkwan University, South Korea
| | - Deokhee Lee
- Department of Education, College of Education, Sungkyunkwan University, South Korea
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17
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[Improving the assessment and treatment of pain in torture survivors : German version]. Schmerz 2021; 36:6-12. [PMID: 34825980 DOI: 10.1007/s00482-021-00606-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
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18
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Strømme EM, Igland J, Haj-Younes J, Kumar BN, Fadnes LT, Hasha W, Diaz E. Chronic pain and mental health problems among Syrian refugees: associations, predictors and use of medication over time: a prospective cohort study. BMJ Open 2021; 11:e046454. [PMID: 34548344 PMCID: PMC8458374 DOI: 10.1136/bmjopen-2020-046454] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study aims to examine associations, predictors and pharmacological treatment of chronic pain and mental health problems among Syrian refugees in a longitudinal perspective. DESIGN Prospective cohort study. SETTING We collected survey data among Syrian refugees in Lebanon granted resettlement to Norway (self-administered questionnaires) and at follow-up 1 year after arrival in Norway (structured telephone interviews). PARTICIPANTS Adult Syrian refugees attending mandatory pretravel courses in Lebanon in 2017-2018 were invited to participate. In total, 353 individuals participated at both time points. PRIMARY AND SECONDARY OUTCOMES We examined the cross-sectional associations between pain, mental health and migration-related exposures at baseline and follow-up and assessed whether associations changed significantly with time. Furthermore, we investigated the longitudinal association between mental health at baseline and pain at follow-up. We also evaluated temporal changes in use of analgesics and psychotropic drugs. RESULTS While most refugees reported improved health from the transit phase in Lebanon to the early resettlement phase in Norway, a few had persisting and intertwined health problems. Most migration-related stressors were more closely associated with chronic pain and mental health problems after resettlement as compared with the transit phase. In parallel, poor mental health was associated with chronic pain in the follow-up (adjusted risk ratio (ARR) 1.5 (1.0, 2.2)), but not at baseline (ARR 1.1 (0.8, 1.5)). Poor mental health at baseline was a statistically significant predictor of chronic pain at follow-up among those not reporting chronic pain at baseline. At both timepoints, one in four of those with chronic pain used analgesics regularly. None with mental health problems used antidepressants daily. CONCLUSIONS Providers of healthcare services to refugees should be attentive to the adverse effect of postmigration stressors and acknowledge the interrelations between pain and mental health. Possible gaps in pharmacological treatment of pain and mental health problems need further clarification.
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Affiliation(s)
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jasmin Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Lars T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Wegdan Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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19
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Borho A, Morawa E, Schmitt GM, Erim Y. Somatic distress among Syrian refugees with residence permission in Germany: analysis of a cross-sectional register-based study. BMC Public Health 2021; 21:896. [PMID: 33975567 PMCID: PMC8114491 DOI: 10.1186/s12889-021-10731-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have already proven high rates of common mental disorders in Syrian refugees. Nevertheless, little is known about the patterns of somatic distress among this refugee population. For this reason, we aimed to examine the prevalence, co-occurrence, and risk factors of somatic distress among Syrian refugees in Germany. METHODS This study analyzes the second measurement point (N = 116) of a prospective register-based survey among 200 adult Syrian refugees with residence permission in Germany. The survey consisted of information on sociodemographic and migration-specific characteristics, health care utilization, traumatic life events, acculturative stress (Barcelona Immigration Stress Scale (BISS); subscales: perceived discrimination, intercultural contact stress, homesickness, and general psychosocial stress), and self-reported outcomes of somatic distress (Patient Health Questionnaire (PHQ-15)), depression (PHQ-9), generalized anxiety disorder (GAD-7), and post-traumatic symptoms (Essen Trauma Inventory (ETI)). RESULTS Almost half of the respondents (49.1%) were identified as being at risk of somatic distress (PHQ-15 score ≥ 6), and even 24.1% being bothered by moderate-to-severe levels of somatic distress (PHQ-15 score ≥ 10). The most robust associations with somatic distress were found for female gender, the amount of health care utilization, multiple trauma exposures, general psychosocial stress, and self-reported depression and anxiety symptoms. High comorbidities with somatic distress were shown for all of the common mental disorders studied. CONCLUSIONS The presented study reveals a significant risk of somatic distress among this displaced population and highlights implications for policy and health care providers.
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Affiliation(s)
- Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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20
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Care of the Refugee. Fam Med 2021. [DOI: 10.1007/978-1-4939-0779-3_137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Opaas M, Wentzel-Larsen T, Varvin S. The 10-year course of mental health, quality of life, and exile life functioning in traumatized refugees from treatment start. PLoS One 2020; 15:e0244730. [PMID: 33382807 PMCID: PMC7775068 DOI: 10.1371/journal.pone.0244730] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/15/2020] [Indexed: 11/19/2022] Open
Abstract
Refugee patients with severe traumatic experiences may need mental health treatment, but treatment results vary, and there is scarcity of studies demonstrating refugees' long-term health and well-being after treatment. In a 10-year naturalistic and longitudinal study, 54 multi-origin traumatized adult refugee patients, with a background of war and persecution, and with a mean stay in Norway of 10.5 years, were recruited as they entered psychological treatment in mental health specialist services. The participants were interviewed face-to-face with multiple methods at admittance, and at varying points in time during and after psychotherapy. The aim was to study the participants' trajectories of symptoms of post-traumatic stress, anxiety and depression, four aspects of quality of life, and two aspects of exile life functioning. Linear mixed effects analyses included all symptoms and quality of life measures obtained at different times and intervals for the participants. Changes in exile life functioning was investigated by exact McNemar tests. Participants responded to the quantitative assessments up to eight times. Length of therapy varied, with a mean of 61.3 sessions (SD = 74.5). The participants improved significantly in symptoms, quality of life, and exile life functioning. Improvement in symptoms of posttraumatic stress, anxiety, and depression yielded small effect sizes (r = .05 to .13), while improvement in quality of psychological and physical health yielded medium effect sizes (r = .38 and .32). Thus, long-time improvement after psychological therapy in these severely traumatized and mostly chronified refugee patients, was more notable in quality of life and exile life functioning than in symptom reduction. The results imply that major symptom reduction may not be attainable, and may not be the most important indication of long-term improvement among refugees with long-standing trauma-related suffering. Other indications of beneficial effects should be applied as well.
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Affiliation(s)
- Marianne Opaas
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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22
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The Effect of Physiotherapy Group Intervention in Reducing Pain Disorders and Mental Health Symptoms among Syrian Refugees: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249468. [PMID: 33348794 PMCID: PMC7767069 DOI: 10.3390/ijerph17249468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
Chronic pain is common among refugees, and often related to mental health problems. Its management, however, is often challenging. A randomized waitlist-controlled trial was designed to study the effect of group physiotherapy activity and awareness intervention (PAAI) on reducing pain disorders, and secondarily improving mental health, among Syrian refugees. A total of 101 adult Syrian refugees suffering from chronic pain were randomized to either the intervention group or the control group, which thereafter also received PAAI after a waiting period. Pain intensity measured by the Brief Pain Inventory (BPI) was the primary outcome. Scores from the Impact of Events Scale-Revised (IES-R 22) and the General Health Questionnaire (GHQ-12) were secondary outcomes. Intention-to-treat analyses (ITT) showed no effect of the intervention on either pain levels (regression coefficient [B {95% CI} of 0.03 {-0.91, 0.96}], IESR scores [4.8 {-3.7, 13.4}] or GHQ-12 scores [-0.4 {-3.1, 2.3}]). Yet, participants highly appreciated the intervention. Despite the negative findings, our study contributes to the evidence base necessary to plan targeted and effective health care services for refugees suffering from chronic pain and highlights the challenge of evaluating complex interventions adapted to a specific group.
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23
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Board D, Childs S, Boulton R. Torture-survivors' experiences of healthcare services for pain: a qualitative study. Br J Pain 2020; 15:291-301. [PMID: 34377457 PMCID: PMC8339948 DOI: 10.1177/2049463720952495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Increasing numbers of torture-survivors are presenting to UK healthcare
services with persistent pain. However, there is a paucity of evidence
surrounding the management of persistent pain among torture-survivors and
their experience of healthcare services for pain is currently unknown. This
qualitative study explores their experiences of services for managing pain,
to inform clinical practice and service provision. Methods: Thirteen participants were recruited from a specialist pain clinic for
torture-survivors in the United Kingdom. Utilising an ethnographic approach,
data were collected via clinic appointment observations, interviews and
medical records and analysed using inductive thematic analysis. Results: Three themes emerged in relation to torture-survivors’ experiences of
healthcare services for pain: the patient–clinician
relationship; multiplicity of diagnoses and
treatments; lack of service integration.
Participants described limited engagement in decision-making processes
regarding their care. Lack of recognition of torture experience when
diagnosing and treating pain, alongside multiple unsuccessful treatments,
led to confusion, frustration and hopelessness. These issues were
exacerbated by the disconnect between physical and mental health
services. Conclusion: This study provides new insight into the challenges faced by
torture-survivors when accessing healthcare services for pain. Our findings
suggest current service provision is not meeting their complex needs.
Clinical implications include the need for integrated care systems and
better recognition of the influence of torture experience on persistent
pain. Strategies to engage and empower torture-survivors in the management
of their pain are suggested.
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Affiliation(s)
- Daniel Board
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Faculty of Health, Social Care and Education, St George's, University of London and Kingston University, London, UK
| | - Susan Childs
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Richard Boulton
- Faculty of Health, Social Care and Education, St George's, University of London and Kingston University, London, UK
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24
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Søegaard EGI, Kan Z, Koirala R, Hauff E, Thapa SB. Variations in psychiatric morbidity between traumatized Norwegian, refugees and other immigrant patients in Oslo. Nord J Psychiatry 2020; 74:390-399. [PMID: 31961250 DOI: 10.1080/08039488.2020.1714724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: There is a lack of clinical studies that focus on different psychiatric disorders after trauma and the relationship with migration status.Purpose: To examine differences in psychiatric morbidity in traumatized patients referred to psychiatric treatment in Southern Oslo.Materials and methods: Hundred and ten patients with trauma background attending an outpatient clinic in Southern Oslo were studied. Forty-four of the participants (40%) were ethnic Norwegians, 25 (22.7%) had refugee background and 41 (37.3%) were first- or second-generation immigrants without refugee background. Thorough diagnostic assessment was done by experienced psychiatrists through several structured clinical interviews and self-report questionnaires.Results: Ninety-eight patients (89%) were diagnosed with at least one Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) disorder. There was a clear difference in the presentation of certain psychiatric disorders between the groups. Ethnic Norwegian patients were more likely to have anxiety disorders: agoraphobia, social phobia and panic disorder than non-refugee immigrant patients. They also had higher rates of alcohol abuse/dependence. Somatoform pain disorder was more common in both the refugee and other-immigrant groups than among the ethnic Norwegian patients. The refugee patients had significantly more major depressive disorder, post-traumatic stress disorder (PTSD) and both co-occurring.Conclusion: Trauma is frequently associated with depression, anxiety disorders, somatoform pain disorder and PTSD in a clinical population. The clinical presentation and comorbidity of these disorders seem to vary significantly between traumatized patients with Norwegian, refugee and non-refugee immigrant backgrounds. After a major trauma, refugees may be at greater risk for both PTSD and depression than other immigrants and the native population.
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Affiliation(s)
- Erik Ganesh Iyer Søegaard
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zhanna Kan
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Rishav Koirala
- Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Brain and Neuroscience Center, Kathmandu, Nepal
| | - Edvard Hauff
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Suraj Bahadur Thapa
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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25
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Ayub S, Marsh V, Reed S. An Exploration of Chronic Disease Perception, Management, and Barriers to Care in Liberian Refugees Resettled in Charlottesville, Virginia. J Natl Med Assoc 2020; 112:654-667. [PMID: 32693979 DOI: 10.1016/j.jnma.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/29/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
Charlottesville is a resettlement site for Liberian refugees. Many receive care at the International Family Medicine Clinic (IFMC). IFMC physicians note reduced adherence to chronic disease medications among refugee patients. This study aims to understand the Liberian refugee populations' model of chronic disease. In 2014, twelve one-on-one interviews were conducted. Topics included concept of disease, health care access, disease burden, acculturation, and socioeconomic factors. Transcripts were analyzed according to the explanatory model of disease and Krueger's framework analysis. This study can assist providers in tailoring their practices to meet the needs of refugee patients and inform future public health interventions.
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Affiliation(s)
- Suniah Ayub
- University of Florida, College of Medicine, Department of Surgery, Gainesville, FL, USA.
| | - Vickie Marsh
- University of Virginia, School of Medicine, Department of Family Medicine, Charlottesville, VA, USA
| | - Sean Reed
- University of Virginia, School of Medicine, Department of Family Medicine, Charlottesville, VA, USA
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26
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de C Williams AC, Hughes J. Improving the assessment and treatment of pain in torture survivors. BJA Educ 2020; 20:133-138. [PMID: 33456942 DOI: 10.1016/j.bjae.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - J Hughes
- The James Cook University Hospital, Middlesbrough, UK
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27
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Craig KD, Holmes C, Hudspith M, Moor G, Moosa-Mitha M, Varcoe C, Wallace B. Pain in persons who are marginalized by social conditions. Pain 2020; 161:261-265. [PMID: 31651578 PMCID: PMC6970566 DOI: 10.1097/j.pain.0000000000001719] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/31/2019] [Accepted: 10/03/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Kenneth D. Craig
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Cindy Holmes
- School of Social Work, University of Victoria, Victoria, BC, Canada
| | | | | | | | - Colleen Varcoe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Bruce Wallace
- School of Social Work, University of Victoria, Victoria, BC, Canada
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28
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Hasha W, Fadnes LT, Igland J, Vårdal R, Giusti LM, Strømme EM, Haj-Younes J, Heltne U, Kumar BN, Diaz E. Two interventions to treat pain disorders and post-traumatic symptoms among Syrian refugees: protocol for a randomized controlled trial. Trials 2019; 20:784. [PMID: 31881990 PMCID: PMC6935096 DOI: 10.1186/s13063-019-3919-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/18/2019] [Indexed: 01/18/2023] Open
Abstract
Background There is a high prevalence of pain and post-traumatic symptoms among refugees and feasible interventions to manage these are needed. However, knowledge about the effect of physiotherapy and psychological group interventions among refugees is scarce. Our aim is to determine whether two different interventions, the Physiotherapy Activity and Awareness Intervention (PAAI) and Teaching Recovery Techniques (TRT), reduce pain and post-traumatic symptoms among refugees from Syria living in Norway. Methods/design Syrian adults with either pain disorders or post-traumatic symptoms, or both, will be recruited to this randomized control trial. The trial will include two separate interventions: participants with dominating pain symptoms will be assigned to the PAAI; and those with a predominance of post-traumatic symptoms will be assigned to the TRT intervention. Participants will be randomized to either the immediate intervention group or the delayed intervention group, for each of the interventions (PAAI and TRT). A minimum of 68 participants will be recruited for the PAAI and 78 participants for TRT, in order to detect clinically and statistically significant symptom improvement, assuming 25–30% attrition after recruitment. The main outcomes for the analyses will be pain intensity measured by the Brief Pain Inventory questionnaire and the scores of the Impact of Events Scale — Revised. The effect will be evaluated at the end of interventions lasting 8 weeks (PAAI) and 6 weeks (TRT) using the same instruments after the end of the intervention, and again 4–6 weeks later. Additionally, a qualitative evaluation will be conducted through an embedded process evaluation and personal interviews with participants after each of the interventions is finished. Discussion Our study will determine the feasibility of the implementation of two different interventions and the effect of these interventions among refugees from Syria with pain disorders and/or post-traumatic symptoms. Trial registration Clinical Trials.gov, NCT03951909. Retrospectively registered on 19 February 2019.
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Affiliation(s)
- Wegdan Hasha
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Lars T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | | | - Jasmin Haj-Younes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Unni Heltne
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Bernadette N Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
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Alfven G, Grillner S, Andersson E. Review of childhood pain highlights the role of negative stress. Acta Paediatr 2019; 108:2148-2156. [PMID: 31162723 PMCID: PMC6899754 DOI: 10.1111/apa.14884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/14/2019] [Accepted: 06/03/2019] [Indexed: 12/19/2022]
Abstract
Aim Recurrent pain of unknown origin is a major problem in children. The aim of the present review was to examine the hypothesis of negative stress as an aetiology of recurrent pain from different aspects. Methods and Results Epidemiological studies, clinical experience and hormonal data give support for such a hypothesis. Negative stress as a tentative aetiology for recurrent pain is reviewed. Stress, muscular tension, the startle reaction and its tentative relation to pain is illuminated. Deviations of hormonal secretion supporting a stress aetiology are mentioned. The role of central sensitisation for recurrent pain is discussed. Possible aetiological implications of recurrent pain as a local symptom or a general disorder are presented. Brain changes due to stress are shortly reviewed. Stress and pain in the clinic are highlighted. The importance of biological, psychological and social factors, as well as genetic elements, is discussed. Conclusion Stress elicits neurobiological mechanisms. They may lead to many neurophysiological deviances. Increase of muscle tension and neuromuscular excitability and enhanced startle reaction may be of importance for recurring pain. The identification of stress as a primary cause of recurrent pain can have huge implications for understanding signs and treatment in clinical practice.
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Affiliation(s)
- G Alfven
- Clintec Karolinska Institute Stockholm Sweden
| | - S Grillner
- Department of Neuroscience Karolinska institute Stockholm Sweden
| | - E Andersson
- Department of Neuroscience Karolinska institute Stockholm Sweden
- Swedish School of Sport and Health Sciences Stockholm Sweden
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Long-term mental health in unaccompanied refugee minors: pre- and post-flight predictors. Eur Child Adolesc Psychiatry 2019; 28:1671-1682. [PMID: 31004294 DOI: 10.1007/s00787-019-01340-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
Unaccompanied refugee minors are a particularly vulnerable group. The aim of this study is to increase our knowledge about possible pathways to well-being and integration for unaccompanied refugee minors as they strive to establish new lives in a host county. The present study followed a group of youth who fled to Norway without their caregivers at three time points; 6 months (n = 95; M age = 13.8, 80% boys), 2 years (n = 78; M age = 16.5, 83% boys), and 5 years (n = 47; M age 20.0, 83% boys) after arrival. Linear mixed effects models were used to assess whether age, gender, and trauma exposure prior to arrival were associated with levels and changes in symptoms of posttraumatic stress (PTS), depression, anxiety, and externalizing symptoms over time. Regression analyses were conducted to examine whether daily hassles, perceived social support, and new trauma experiences predict PTS, internalization, externalization, and somatization. The mean levels of depression had decreased significantly at 5 years, but mean levels of anxiety, PTS, and externalizing symptoms did not. Females and severely trauma exposed had higher levels of symptoms. Higher age was associated with less change in symptoms of depression and posttraumatic stress over time. Five years after arrival, many still experienced clinical levels of mental health problems, and level of daily hassles was an important predictor. Support may be needed not only at arrival to handle mental health problems in general and posttraumatic stress in particular, but also after resettlement. Help to manage daily hassles may be especially important to ensure well-being and integration.
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31
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Pain from torture: assessment and management. Pain Rep 2019; 4:e794. [PMID: 31984299 PMCID: PMC6903341 DOI: 10.1097/pr9.0000000000000794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/26/2019] [Accepted: 09/17/2019] [Indexed: 01/06/2023] Open
Abstract
Introduction: Survivors of torture are for many reasons at particularly high risk for inadequate assessment and management of pain. Among the many health problems associated with torture, persistent pain is frequent, particularly pain in the musculoskeletal system. The pathophysiology underlying post-torture pain is largely unknown, but pain inflicted in torture may have profound effects on neurophysiology and pain processing. Methods: A narrative review of assessment and treatment studies, informed by clinical experience, was undertaken. Results: The clinical presentation in survivors of torture shares characteristics with other chronic primary pain syndromes, including chronic widespread pain. Unfortunately, such pain is often misunderstood and dismissed as a manifestation of psychological distress, both in specialist psychosocially oriented torture services and in mainstream health care. This means that pain is at risk of not being recognized, assessed, or managed as a problem in its own right. Conclusions: The available research literature on rehabilitation for torture survivors is predominantly targeted at mental health problems, and studies of effectiveness of pain management in torture survivors are lacking. Rehabilitation is identified as a right in the UN Convention on Torture, aiming to restore as far as possible torture survivors' health and capacity for full participation in society. It is therefore important that pain and its consequences are adequately addressed in rehabilitative efforts. This article summarizes the current status on assessment and management of pain problems in the torture survivor.
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Nordin L, Perrin S. Pain and posttraumatic stress disorder in refugees who survived torture: The role of pain catastrophizing and trauma-related beliefs. Eur J Pain 2019; 23:1497-1506. [PMID: 31095807 DOI: 10.1002/ejp.1415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Traumatized refugees with comorbid pain report more severe posttraumatic stress disorder (PTSD), respond less well to PTSD-focused treatments and exhibit greater disability. A mutually maintaining relationship may exist between pain and PTSD, that may be partly accounted for by depression, but no prior studies have tested this assumption in traumatized refugees. METHOD Self-report measures of pain, PTSD, depression, disability, pain catastrophizing (PC) and trauma-related beliefs (TRBs) were administered to 197 refugees referred to the Danish Institute Against Torture (DIGNITY) prior to treatment. The contribution of pain, depression, PC, and TRBs to the overall variance in PTSD severity was examined. We also examined whether the relationship between pain and PTSD was mediated by PC and TRBs, after controlling for depression. RESULTS Depression, pain severity, PC and TRBs together accounted for 66% of the overall variance in PTSD, with depression being the primary contributor (57%). In univariate tests, both PC and TRBs significantly mediated the relationship between pain interference/severity and PTSD. However, after controlling for depression only PC mediated this relationship. CONCLUSIONS Negative beliefs about pain and the trauma made small, but additive contributions to the relationship between pain and PTSD severity, after controlling for depression. Longitudinal studies with refugees, involving tests of more complex mutual maintenance models, are warranted. SIGNIFICANCE After controlling for symptoms of depression, pain catastrophizing and negative trauma-related beliefs partly mediated the relationship between pain and PTSD in tortured refugees. The results suggest that all three variables are important in a mutual mediation model of pain and PTSD, and as targets for treatment, in traumatized refugees.
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Affiliation(s)
- Linda Nordin
- DIGNITY: Danish Institute Against Torture, Copenhagen, Denmark.,Department of Psychology, Lund University, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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Golchert J, Roehr S, Berg F, Grochtdreis T, Hoffmann R, Jung F, Nagl M, Plexnies A, Renner A, König HH, Kersting A, Riedel-Heller SG. HELP@APP: development and evaluation of a self-help app for traumatized Syrian refugees in Germany - a study protocol of a randomized controlled trial. BMC Psychiatry 2019; 19:131. [PMID: 31039786 PMCID: PMC6492415 DOI: 10.1186/s12888-019-2110-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Syrians represent the largest group among refugees in Germany. Many of them were exposed to sequential traumatizing events including war, escape and post-migration stressors, which significantly increase the risk to develop symptoms of posttraumatic stress and other mental disorders. However, there is a lack of adequate treatment options for traumatized refugees in Germany. Moreover, their access to psychosocial care is often restricted due to legal regulation, language barriers, and unclear cost coverage. We therefore aim to develop a low-threshold supportive self-help app for Syrian refugees with posttraumatic stress symptoms. By conducting a randomized controlled trial, we further aim to evaluate the apps' efficacy, usability, acceptance, and economic health benefit/cost-effectiveness. METHODS We will develop a modular, interactive self-help app in Arabic, which will be grounded on cognitive-behavioral models for the treatment of posttraumatic stress. Subsequently, screened positive (i.e., Syrian refugees, 18-65 years old, mild to moderate posttraumatic stress symptomatology as quantified by the Posttraumatic Stress Diagnostic Scale for DSM-5/PDS-5) participants (ideally up to n = 234) will be randomly allocated to an intervention (IG) and control group (CG), respectively. Participants in the IG will gain access to the self-help app for one month, while participants in the CG will receive psychoeducational reading material in form of a comprehensive brochure on traumatization and posttraumatic stress. Measurements are scheduled before the intervention (T0), directly after the intervention (T1, one month later) and three months after the intervention (T2). Using linear mixed effect models, we will investigate change in posttraumatic symptomatology. We will also test for changes in secondary outcomes such as depression, anxiety, and quality of life. Moreover, we will inspect the usability and user acceptance of the app. To evaluate the app in terms of its economic health benefit, the incremental cost-effectiveness ratio will be calculated. DISCUSSION We plan to make the app freely available to the general public after evaluation. Thus, the app can help to add-on to routine care, which currently lacks sufficient and appropriate treatment options for Syrian refugees. TRIAL REGISTRATION German Clinical Trials Register/Deutsches Register Klinischer Studien (DRKS). Registration ID: DRKS00013782 . Registered: 06th of July 2018.
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Affiliation(s)
- Johannes Golchert
- 0000 0001 2230 9752grid.9647.cInstitute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
| | - Franziska Berg
- 0000 0001 2230 9752grid.9647.cInstitute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Thomas Grochtdreis
- 0000 0001 2180 3484grid.13648.38Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rahel Hoffmann
- 0000 0000 8517 9062grid.411339.dDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - Franziska Jung
- 0000 0001 2230 9752grid.9647.cInstitute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Michaela Nagl
- 0000 0000 8517 9062grid.411339.dDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - Anna Plexnies
- 0000 0000 8517 9062grid.411339.dDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - Anna Renner
- 0000 0000 8517 9062grid.411339.dDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- 0000 0001 2180 3484grid.13648.38Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anette Kersting
- 0000 0000 8517 9062grid.411339.dDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - Steffi G. Riedel-Heller
- 0000 0001 2230 9752grid.9647.cInstitute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
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Lies J, Jones L, Ho R. The management of post-traumatic stress disorder and associated pain and sleep disturbance in refugees. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
SUMMARYMore than 68 million people worldwide have been forcibly displaced and one-third of these are refugees. This article offers an overview of the current literature and reviews the epidemiology and evidence-based psychological and pharmacological management of post-traumatic stress disorder (PTSD), sleep disturbance and pain in refugees and asylum seekers. It also considers the relationship between sleep disturbance and PTSD and explores concepts of pain in relation to physical and psychological trauma and distress. During diagnosis, clinicians must be aware of ethnic variation in the somatic expression of distress. Treatments for PTSD, pain and sleep disturbance among refugees and asylum seekers are essentially the same as those used in the general population, but treatment strategies must allow for cultural and contextual factors, including language barriers, loss of freedom and threat of repatriation.LEARNING OBJECTIVESAfter reading this article you will be able to:
•recognise the challenges faced by the large number of refugees worldwide•understand the relationship between PTSD, sleep disturbance and pain in refugees•broadly understand the evidence for psychological and pharmacological therapy for treating PTSD, sleep disturbance and pain in refugees.DECLARATION OF INTERESTNone.
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Noh JW, Lee Y, Park H, Lee SH. Medical Expenses of North Korean Defectors with Post-Traumatic Stress Disorder. Psychiatry Investig 2019; 16:154-158. [PMID: 30808122 PMCID: PMC6393748 DOI: 10.30773/pi.2018.12.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/12/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to establish the prevalence of PTSD among North Korean defectors who visited the National Medical Center, Seoul, South Korea over a period of approximately 10 years by examining their medical records and to examine differences in the medical service usage patterns of patients with and without PTSD. METHODS Data from North Korean defectors who used outpatient services at the National Medical Center during a period of 10 years and 3 months (January 1 2006 to February 28, 2016) were analyzed. The general characteristics of the defectors were analyzed by frequency analyses, and descriptive statistics were generated. Additionally, independent t-tests and chi square analyses were performed to examine differences between PTSD patients and those without PTSD. Linear regression analysis was performed to examine factors affecting the mental health of North Korean defectors suffering from PTSD. RESULTS This study assessed the correlations between PTSD, the average number of outpatient visits, and the total revenue. The regression analysis showed a relationship between PTSD and the average number of outpatient visits. There was also a correlation between PTSD and total revenue. The average number of outpatient visits was 41.8 for PTSD patients, whereas it was 33.2 for those without PTSD. The total revenue visit was 953.6 USD for PTSD sufferers and 231.1 USD for those without PTSD. CONCLUSION This study found that the majority of North Korean defectors visit psychiatry departments, and that PTSD patients use outpatient services more frequently and have higher total revenue than those without PTSD. Additionally, patients with PTSD used a greater variety of medical services. Considering the high medical care expenses of North Korean defectors residing in South Korea, future investigations should examine the medical service usage patterns of such patients, especially those diagnosed with PTSD, in greater detail.
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Affiliation(s)
- Jin-Won Noh
- Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea.,Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherland
| | - Yejin Lee
- Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea
| | - Hyunchun Park
- Gyeonggi Public Health Policy Institute, Seongnam, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
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Morina N, Kuenburg A, Schnyder U, Bryant RA, Nickerson A, Schick M. The Association of Post-traumatic and Postmigration Stress with Pain and Other Somatic Symptoms: An Explorative Analysis in Traumatized Refugees and Asylum Seekers. PAIN MEDICINE 2019; 19:50-59. [PMID: 28340069 DOI: 10.1093/pm/pnx005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective Post-traumatic stress disorder (PTSD) and somatic symptoms, such as pain, are frequently seen in refugees. Their relationship is poorly understood, and the treatment of these comorbid conditions can be very challenging. The current cross-sectional study examined pain and other somatic symptoms and their relationship with trauma history, PTSD symptom clusters, and current living difficulties among treatment-seeking refugees. Methods One hundred thirty-four treatment-seeking traumatized refugees (78% male, mean age = 42 years) were assessed regarding lifetime traumatic experiences, symptoms of post-traumatic stress, overall pain and somatic symptoms, and postmigration living difficulties. Results An exploratory factor analysis of the 12 somatic symptoms revealed two distinct factors: somatic symptoms related to bodily dysfunction ("weakness") and somatic symptoms related to increased sympathetic activity ("arousal"). DSM-5 PTSD Criteria D "alterations in cognitions and mood" and E "alterations in arousal and reactivity" were primarily related to "weakness," while PTSD Criterion E "alterations in arousal and reactivity" and postmigration living difficulties were associated with "arousal." Overall pain was associated primarily with living difficulties and PTSD Criterion D and Criterion E. Conclusions Results indicate that somatic symptoms are of considerable concern among traumatized refugees and that different patterns of somatic symptoms are associated with different clusters of PTSD symptoms. The findings contribute to the better understanding of the symptom presentation of traumatized people who are experiencing somatization and potentially inform treatment directions and highlight the importance of screening for PTSD in refugees presenting with pain and somatic symptoms.
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Affiliation(s)
- Naser Morina
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexa Kuenburg
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Post-migration treatment targets associated with reductions in depression and PTSD among survivors of torture seeking asylum in the USA. Psychiatry Res 2019; 271:565-572. [PMID: 30554104 DOI: 10.1016/j.psychres.2018.12.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 12/20/2022]
Abstract
Mental health research among asylum seekers and refugees has largely focused on effects of pre-migration trauma on post-migration wellbeing. While emerging literature highlights the importance of post-migration factors, we do not yet understand how addressing these factors may influence change in psychological distress. This study uses archival clinical data to identify post-migration correlates of reductions in distress among torture survivors, after accounting for pre-migration trauma. Depression (Patient Health Questionnaire-9) and Post Traumatic Stress Disorder (PTSD; Harvard Trauma Questionnaire) were measured among torture survivors following 6 months of interdisciplinary treatment (N = 323). Relationships between pre-, post-migration factors, and changes in symptom levels from intake to six months follow-up, were evaluated using regression analyses. Average levels of depression and PTSD significantly reduced after six months of treatment. Higher exposure to pre-migration trauma, female gender, and change to a more secure visa status were associated with reduced distress. Accessing more social services and not reporting chronic pain were associated with reduced PTSD. Stable housing and employment significantly moderated the relationship between lower chronic pain and reduced PTSD. Although effect sizes were small, results emphasize the importance of post-migration factors on wellbeing among torture survivors and are a first step towards identifying key treatment targets.
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Morina N, Schnyder U, Klaghofer R, Müller J, Martin-Soelch C. Trauma exposure and the mediating role of posttraumatic stress on somatic symptoms in civilian war victims. BMC Psychiatry 2018; 18:92. [PMID: 29631551 PMCID: PMC5891991 DOI: 10.1186/s12888-018-1680-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 03/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It has been well documented that the exposure to war has a negative effect on the psychological health of civilian. However, little is known on the impact of war exposure on the physical health of the civilian population. In addition, the link between trauma exposure and somatic symptoms remain poorly understood. This cross-sectional study examined levels of somatic symptoms in the aftermath of war, and the mediating role of posttraumatic stress symptoms in the relationship between trauma exposure and somatic symptoms. METHODS Civilian war survivors (N = 142) from Kosovo were assessed for potentially traumatic events, posttraumatic stress symptoms, and somatic symptoms. Data were analyzed using mediation analyses. Posttraumatic stress disorder (PTSD) symptoms were categorized based on King's four factor model (Psychol Assessment. 10: 90-96, 1998). RESULTS Participants reported on average more than 5 types of traumatic exposure. The cut-off indicative for PTSD was exceeded by 26.1% of participants. Symptom levels of PTSD were associated with somatic symptoms. The relationship between trauma exposure and somatic symptoms was partly mediated by the active avoidance and hyperarousal symptom clusters of PTSD. CONCLUSION Active avoidance and hyperarousal symptoms seem to play a key role in traumatized people suffering from somatic symptoms.
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Affiliation(s)
- Naser Morina
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland.
| | - Ulrich Schnyder
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Culmannstrasse 8, 8091 Zurich, Switzerland
| | - Richard Klaghofer
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Culmannstrasse 8, 8091 Zurich, Switzerland
| | - Julia Müller
- Psychiatric Services Thurgau, 8596 Münsterlingen, Switzerland ,0000 0004 0523 5263grid.21604.31Paracelsus Medical University, Salzburg, Austria
| | - Chantal Martin-Soelch
- 0000 0004 0478 1713grid.8534.aDivision of Clinical and Health Psychology, Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
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Negron A. Supporting asylum seekers and refugees who suffer chronic pain: an experience. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2017. [DOI: 10.1108/ijmhsc-02-2016-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Refugees and asylum seekers often present complex health needs, including chronic pain, related to traumatic experiences. To help them manage their pain, the Wellbeing and Self-Care Service provides health advice, pain education, soft tissue manual therapies and training in self-help techniques. The paper aims to discuss these issues.
Design/methodology/approach
A 0-10 pain scale (0= no pain, 10= very severe pain) is used to record reported intensity of pain before and after treatment. Change is analysed by comparing the position of a tick on the scale before and after therapy. In follow-up appointments, attendees were asked whether they were practicing self-help techniques; if they experienced improvement, and if so, how long it lasted; and whether they had reduced the use of painkillers.
Findings
From April 2014 to March 2015, 192 people were seen in 524 therapeutic encounters (63 per cent females, 37 per cent males). In total, 173 (90 per cent) were asylum seekers and refugees. Of the refugees and asylum seekers, 40 per cent were torture survivors. After treatment, 53 per cent of the 192 people treated showed a major reduction of pain, and 39 per cent a moderate reduction. In follow-up encounters, 87 per cent reported improvement (⩾2 weeks, 46 per cent), 70 per cent reported a reduction in the use of painkillers and 83 per cent reported that they practiced self-help techniques to different degrees.
Originality/value
Soft tissue manual therapies combined with education and training that emphasise communication and active patient participation in the healing process are non-invasive therapeutic approaches that can confer temporary relief to refugees and asylum seekers suffering chronic pain.
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Müller J, Ganeshamoorthy S, Myers J. Risk factors associated with posttraumatic stress disorder in US veterans: A cohort study. PLoS One 2017; 12:e0181647. [PMID: 28742837 PMCID: PMC5526531 DOI: 10.1371/journal.pone.0181647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/05/2017] [Indexed: 12/16/2022] Open
Abstract
Objective To assess the association between clinical and exercise test factors and the development of posttraumatic stress disorder (PTSD) in US Veterans. Patients and methods Exercise capacity, demographics and clinical variables were assessed in 5826 veterans (mean age 59.4 ± 11.5 years) from the Veterans Affairs Healthcare System in Palo Alto, CA. The study participants underwent routine clinical exercise testing between the years 1987 and 2011. The study end point was the development of PTSD. Results A total of 723 (12.9%) veterans were diagnosed with PTSD after a mean follow-up of 9.6 ± 5.6 years. Drug abuse (HR: 1.98, CI: 1.33–2.92, p = .001), current smoking (HR: 1.57, CI: 1.35–2.24, p <.001), alcohol abuse (HR: 1.58, CI: 1.12–2.24, p = .009), history of chest pain (HR: 1.48, CI: 1.25–1.75, p <.001) and higher exercise capacity (HR: 1.03, CI: 1.01–1.05, p = .003) were strong independent risk factors for PTSD in a univariate model. Physical activity pattern was not associated with PTSD in either the univariate or multivariate models. In the final multivariate model, current smoking (HR: 1.30, CI: 1.10–1.53, p = .002) history of chest pain (HR: 1.37, CI: 1.15–1.63, p <.001) and younger age (HR: 0.97, CI: 0.97–0.98, p <.001) were significantly associated to PTSD. Conclusions Onset of PTSD is significantly associated with current smoking, history of chest pain and younger age. Screening veterans with multiple risk factors for symptoms of PTSD should therefore be taken into account.
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Affiliation(s)
- Jan Müller
- Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
- * E-mail:
| | - Sarmila Ganeshamoorthy
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
- Stanford University School of Medicine, Stanford, California, United States of America
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
- Stanford University School of Medicine, Stanford, California, United States of America
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Nyboe L, Bentholm A, Gyllensten AL. Bodily symptoms in patients with post traumatic stress disorder: A comparative study of traumatized refugees, Danish war veterans, and healthy controls. J Bodyw Mov Ther 2017; 21:523-527. [DOI: 10.1016/j.jbmt.2016.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/12/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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Willen SS, Knipper M, Abadía-Barrero CE, Davidovitch N. Syndemic vulnerability and the right to health. Lancet 2017; 389:964-977. [PMID: 28271847 DOI: 10.1016/s0140-6736(17)30261-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/09/2016] [Accepted: 11/30/2016] [Indexed: 01/10/2023]
Abstract
Investigators working both in syndemics, a field of applied health research with roots in medical anthropology, and in the field of health and human rights recognise that upstream social, political, and structural determinants contribute more to health inequities than do biological factors or personal choices. Syndemics investigates synergistic, often deleterious interactions among comorbid health conditions, especially under circumstances of structural and political adversity. Health and human rights research draws on international law to argue that all people deserve access not only to health care, but also to the underlying determinants of good health. Taking the urgent matter of migrant health as an empirical focus, we juxtapose the fields of syndemics and health and human rights, identify their complementarities, and advocate for a combined approach. By melding insights from these fields, the combined syndemics/health and human rights approach advanced here can provide clinicians and other key stakeholders with concrete insights, tools, and strategies to tackle the health inequities that affect migrants and other vulnerable groups by: (1) mapping the effect of social, political, and structural determinants on health; (2) identifying opportunities for upstream intervention; and (3) working collaboratively to tackle the structures, institutions, and processes that cause and exacerbate health inequities. Undergirding this approach is an egalitarian interpretation of the right to health that differs from narrow legalistic and individual interpretations by insisting that all people are equal in worth and, as a result, equally deserving of protection from syndemic vulnerability.
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Affiliation(s)
- Sarah S Willen
- Department of Anthropology, University of Connecticut, Storrs, CT, USA.
| | - Michael Knipper
- Institute for the History of Medicine, Justus Liebig University Giessen, Giessen, Germany
| | | | - Nadav Davidovitch
- Department of Health Systems Management, Ben Gurion University of the Negev, Beersheva, Israel
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Are multidisciplinary interventions multicultural? A topical review of the pain literature as it relates to culturally diverse patient groups. Pain 2016; 157:321-328. [PMID: 26588691 DOI: 10.1097/j.pain.0000000000000412] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sequenzielle Traumatisierungen, Traumafolgestörungen und psychotherapeutische Behandlungsansätze bei kriegstraumatisierten erwachsenen Flüchtlingen in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:621-6. [DOI: 10.1007/s00103-016-2337-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sonne C, Carlsson J, Bech P, Vindbjerg E, Mortensen EL, Elklit A. Psychosocial predictors of treatment outcome for trauma-affected refugees. Eur J Psychotraumatol 2016; 7:30907. [PMID: 27251179 PMCID: PMC4889772 DOI: 10.3402/ejpt.v7.30907] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/19/2016] [Accepted: 05/05/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. OBJECTIVE The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. METHOD The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients' past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. RESULTS Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. CONCLUSIONS The total score of the CTP Predictor Index correlated significantly with outcomes on most of the rating scales, but correlations were modest in size, possibly due to the number of different factors influencing treatment outcome.
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Affiliation(s)
- Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, University of Southern Denmark, Ballerup, Denmark;
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, University of Copenhagen, Copenhagen, Denmark
| | - Per Bech
- Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - Erik Vindbjerg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, University of Southern Denmark, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Institute of Public Health, Centre for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Co-occurrence between mental distress and poly-drug use: a ten year prospective study of patients from substance abuse treatment. Addict Behav 2015; 48:71-8. [PMID: 26004857 DOI: 10.1016/j.addbeh.2015.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 04/23/2015] [Accepted: 05/03/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Longitudinal research investigating psychiatric trajectories among patients with poly-drug use patterns remains relatively scant, even though this specific population is at elevated risk for multiple negative outcomes. The present study examined temporal associations between poly-drug use (i.e. heroin, cannabis, tranquilizers, and amphetamines) and mental distress over a 10-year period. METHODS A clinical cohort of 481 patients was recruited from substance use treatment facilities in Norway, and prospectively interviewed 1, 2, 7 and 10years after the initial data collection at treatment admission. At each assessment participants completed a questionnaire addressing their substance use and mental distress. Longitudinal growth models were used to examine whether, and if so, how, levels of drug use were associated with the level and rate of change in mental distress over time. RESULTS Results from the longitudinal growth models showed a co-occurrence between active poly-drug use and mental distress, such that there was a dose-response effect where mental distress increased both in magnitude and over time with the number of drugs used. Reduction in mental distress during the 10-year study period was evident only in the no-drug use condition. Use of multiple drugs and mental distress appear strongly co-related over time. CONCLUSIONS Pre-treatment assessment should carefully identify individuals manifesting poly-drug use and mental disorders. Treatment and follow-up services should be tailored to their specific needs.
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