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      Rehabilitation of torture survivors in five countries: common themes and challenges

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          Abstract

          Background

          Torture continues to be a global problem and there is a need for prevention and rehabilitation efforts. There is little available data on torture survivors from studies designed and conducted by health professionals in low income countries. This study is a collaboration between five centres from Gaza, Egypt, Mexico, Honduras and South Africa who provide health, social and legal services to torture survivors, advocate for the prevention of torture and are part of the network of the International Rehabilitation Council for Torture Victims (IRCT).

          Methods

          Socio-demographic, clinical and torture exposure data was collected on the torture survivors attending the five centres at presentation and then at three and six month follow-up periods. This sample of torture survivors is presented using a range of descriptive statistics. Change over time is demonstrated with repeated measures analysis of variance.

          Results

          Of the 306 torture survivors, 23% were asylum seekers or refugees, 24% were socially isolated, 11% in prison. A high level of traumatic events was experienced. 64% had suffered head injury whilst tortured and 24% had ongoing torture injury problems. There was high prevalence of symptoms of anxiety, depression, post traumatic stress as well as medically unexplained somatic symptoms. The analysis demonstrates a modest drop in symptoms over the six months of the study.

          Conclusions

          Data showed that the torture survivors seen in these five centres had high levels of exposure to torture events and high rates of clinical symptoms. In order to provide effective services to torture survivors, health professionals at torture rehabilitation centres in low income countries need to be supported to collect relevant data to document the needs of torture survivors and to evaluate the centres' interventions.

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          Most cited references8

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          Mental health and health-related quality of life: a 10-year follow-up of tortured refugees.

          The aim of the study was to identify predictors of mental symptoms (posttraumatic stress disorder, depression, and anxiety), and of health-related quality of life in refugees 10 years after referral to the Rehabilitation and Research Centre for Torture Victims, and to study changes in mental health over time. The study sample comprises 139 tortured refugees admitted to a pretreatment assessment in 1991 to 1994. Data on background and trauma, and in a subsample on mental symptoms, were collected at baseline. In 2002 and 2003, data on mental symptoms, health-related quality of life, and the participants' social situation were collected. The level of emotional distress was high at follow-up. Social relations and unemployment at follow-up were important predictors of mental health symptoms and low health-related quality of life. A significant decrease in mental symptoms was observed in the subsample. Social relations and unemployment should be taken into account when developing health-related and social interventions.
            • Record: found
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            Intimate partner violence among Afghan women living in refugee camps in Pakistan.

            The purpose of this paper is to explore events and factors that lead to conflict in the home in the Afghan refugee setting, and the current status of the health sector's ability to respond to evidence of conflict. Qualitative interviews were conducted with 20 women of reproductive age and 20 health workers serving these women in an Afghan refugee camp near Peshawar, Pakistan, during the summer of 2004. In particular, this paper analyses women's explanations of how various marriage traditions may be linked to conflict in the home and how the interactions of different family members may be related to conflict. The relationships of women with their parents-in-law and husbands are highlighted in particular, and a model developed to explore the choreography of their relationships and the ways in which these dynamics may encourage or inhibit violence. The perspectives of health workers on the ways in which the health system responds to family conflict and violence are also presented. Finally, this paper provides information that helps to frame the issues of family violence and conflict in long-term refugee populations for intervention designers and those who are working to craft a health sector response to this problem.
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              Brief multi-disciplinary treatment for torture survivors in Nepal: a naturalistic comparative study.

              Little is known about the effectiveness of treatment for torture survivors in low-income settings. Multi-disciplinary treatment is an often used approach for this target group. This study was aimed at examining the effectiveness of brief multi-disciplinary treatment for torture survivors in Nepal. A naturalistic comparative design with help-seeking torture survivors and internally displaced persons assigned to a treatment and a comparison group respectively ( n = 192; treatment group n = 111, comparison group n = 81), with baseline measurements on psychiatric symptomatology, disability, and functioning and a five-month follow-up (n = 107; treatment group n = 62; comparison group n = 45), was employed. Intervention consisted of brief psychosocial services, minimal medical services and/or legal assistance. Study groups were generally comparable and non-completers did not significantly differ from completers. The treatment group improved more than the comparison group on somatic symptoms, subjective well-being, disability and functioning, with mostly moderate effect sizes. Treatment was moderately effective, with regards to reducing the nonspecific mental health consequences of torture, but disability scores remained high. For clients presenting with more severe mental health problems, other treatments that are realistic in the resource-poor Nepali context need to be sought.

                Author and article information

                Journal
                Int J Ment Health Syst
                International Journal of Mental Health Systems
                BioMed Central
                1752-4458
                2010
                18 June 2010
                : 4
                : 16
                Affiliations
                [1 ]International Rehabilitation Council for Torture Victims, Borgergade 13, P.O. Box 9049, 1022 Copenhagen K., Denmark
                [2 ]South African Institute for Traumatic Stress, 302 Ideal Village, 30 Hannaben Street, Johannesburg 2198, South Africa
                [3 ]El Nadim Centre for the Management and Rehabilitation of Victims of Violence, 3A Soliman El Halabi Street from Rasmis Street, Cairo, Egypt
                [4 ]Trauma Centre of Survivors of Violence and Torture, Cowley House, 126 Chapel Street, Woodstock 7925, Cape Town, South Africa
                [5 ]Collective Against Torture and Impunity, Pitágoras 1210, 16 Col. Del Valle, 03100 Mexico DF, Mexico
                [6 ]Centre for Prevention, Treatment and Rehabilitation of Victims of Torture and their Relatives, Col. La Reforma, Calle Principal 109, Contiguo a Centro IDEAL, Tegucigalpa M.D.C., Honduras
                [7 ]Gaza Community Mental Health Programme, Sheikh Ejleen-El Rasheed Street, P.O. Box 1049, Gaza City, Gaza Strip, Palestinian Occupied Territories
                Article
                1752-4458-4-16
                10.1186/1752-4458-4-16
                2904711
                20565852
                18edbf68-73e6-454c-8144-f62d5d8f524a
                Copyright ©2010 McColl et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 February 2010
                : 18 June 2010
                Categories
                Research

                Neurology
                Neurology

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