Iranian and Iraqi torture survivors in Finland and Sweden: findings from two population-based studies.

BACKGROUND: Most refugees and other forced migrants have experienced potentially traumatic events (PTEs). Torture and other traumatic experiences, as well as various daily stressors, impact the mental health and psychosocial well-being of war-affected populations. METHODS: The study includes two population-based samples of Iranian and Iraqi men living in Finland and Sweden. The Finnish Migrant Health and Well-being Study (Maamu) was conducted in 2010-2012. The Linköping study was conducted in Sweden in 2005. In both samples, health and well-being measures, social and economic outcomes as well as health service utilization were reported. RESULTS: The final sample for analysis consisted of two groups of males of Iranian or Iraqi origin: 278 residents in Finland and 267 residents in Sweden. Both groups were subdivided according to the reported PTEs: Torture survivors; Other PTEs; No PTEs. Migrants that reported PTEs, torture survivors in particular, had significantly poorer social and health outcomes. Torture survivors also reported lower trust and confidence in authorities and public service providers, as well as more loneliness, social isolation and experiences of discrimination. CONCLUSIONS: Torture and other PTEs prevalent in refugee and migrant populations create a wide-ranging and long-term impact in terms of increased risk of various types of adverse social and health conditions. Early identification through systematic and effective screening should be the first step in guiding migrants and refugees suffering from experiences of torture and other PTEs to flexible, multidisciplinary services.

Development and implementation of a group based mental health intervention for unaccompanied minors.

Unaccompanied refugee minors (UMs) are at significant risk to experience severe mental health symptoms (Derluyn, Broekaert & Schuyten). Trauma-focused treatments have been found to be effective for traumatized refugees (Slobodin & de Jong). However, trauma-focused mental health services are seldom available, and treatment fails when UMs lack trust in service providers (Majumder, O'Reilly, Karim & Vostanis). In order to address this gap, a 10-session group based mental health intervention for UMs was developed and then pilot tested in 3 accommodation units for UMs in Finland. The implementation and effectiveness of the intervention was studied by qualitative and quantitative methods. The process was completed by 18 UMs. Symptom measures showed no statistically significant changes on the mental health variables studied. However, staff members and UMs reported increased trust and communication, and participating staff members felt empowered to facilitate groups independently. The group model promoted social interaction and built trust in the accommodation units. Further studies are required to UMs.

Narrative exposure therapy for immigrant children traumatized by war: study protocol for a randomized controlled trial of effectiveness and mechanisms of change.

BACKGROUND: Millions of children worldwide suffer from posttraumatic stress disorder (PTSD) symptoms and other mental health problems due to repeated exposure to war or organized violence. Forms of cognitive-behavioral therapy (CBT) are the most commonly used treatment for PTSD and appear to be effective for children as well, but little is known about the mechanisms of change through which they achieve their effectiveness. Here we present the study protocol of a randomized controlled trial (RCT) studying the effectiveness and mechanisms of change of Narrative Exposure Therapy (NET), a CBT-based, manualized, short-term intervention for PTSD symptoms resulting from repeated traumatization, in immigrant children traumatized by war. METHODS/DESIGN: We are conducting a multicentre, pragmatic RCT in a usual care setting. Up to 80 9-17-year-old immigrant children who have experienced war and suffer from PTSD symptoms will be randomized into intervention (NET) and control (treatment as usual, TAU) groups of equal sizes. The effectiveness of NET treatment will be compared to both a waiting list and the parallel TAU positive control group, on the primary outcomes of PTSD and depressive symptoms, psychological distress, resilience, and level of cognitive performance. The effects of the intervention on traumatic memories and posttraumatic cognitions will be studied as potential mechanisms of change mediating overall treatment effectiveness. The possible moderating effects of peritraumatic dissociation, level of cognitive performance, and gender on treatment effectiveness will also be considered. We hypothesize that NET will be more effective than a waitlist condition or TAU in reducing PTSD and other symptoms and improving resilience, and that these effects will be mediated by changes in traumatic memories and posttraumatic cognitions. DISCUSSION: The results of this trial will provide evidence for the effectiveness of NET in treating trauma-related symptoms in immigrant children affected by war. The trial will also generate insights into the complex relationships between PTSD, memory functions, posttraumatic cognitions and cognitive performance in children, and help guide the future development and implementation of therapeutic interventions for PTSD in children. TRIAL REGISTRATION: ClinicalTrials.gov NCT02425280 . Registered 15 April 2015.

A network analysis of posttraumatic stress symptoms among help-seeking refugees in Kenya.

We analyzed the network structure of DSM-IV PTSD symptoms among 2792 help-seeking Central and East African refugees in Kenya exposed to multiple, severe traumatic events and on-going stressors. To some extent, our results reproduced structures identified among clinical populations in Europe, including strong links within traditional symptom clusters, such as between avoidance of thoughts and situations, and hypervigilance and startling. However, we found substantial differences in most central symptoms, with detachment and disinterest far less and emotional numbing and concentration problems more central in our analyses. Our networks did not reproduce the common finding of particularly low centrality of amnesia. We further noted substantive similarities in network structure, but also differences, between refugees living in an urban environment and in refugee camps. Concentration problems were most central among mainly Somali refugees at a refugee camp, and associated with amnesia and sense of foreshortened future, while emotional numbing was the most central symptom among majority Congolese refugees in Nairobi. Our findings highlight the importance of contextual and cultural factors for PTSD symptomatology, and are informative for assessment and treatment among help-seeking refugees.

Mental Health and Traumatization of Newly Arrived Asylum Seeker Adults in Finland: A Population-Based Study.

Asylum seekers frequently experience potentially traumatic events (PTEs), but the type and frequency vary depending on the country of origin. The cumulative effect of multiple PTEs and other stressors expose asylum seekers to a significant risk of mental ill health. The aim of the study was to examine the prevalence of PTEs, depression and anxiety symptoms, risk for psychological trauma, psychotropic medication use and previous mental health diagnoses among adult asylum seekers in the Asylum Seekers Health and Wellbeing (TERTTU) Survey (n = 784 respondents, participation rate 78.6%). A substantial majority (88.7%, 95% CI 86.9-90.3) of asylum seekers reported one or more PTEs before arriving to Finland. PTEs during the asylum-seeking journey were reported at 12.0% (95% CI 10.7-13.4), however, when examined by region of origin, the proportion was 34.5% (95% CI 29.5-39.8) for asylum seekers from Africa (excluding North Africa). Significant symptoms of depression were reported by 41.7% (95% CI 39.6-43.9) of asylum seekers and symptoms of anxiety by 34.2% (95% CI 32.1-36.2). Half of the asylum seekers were assessed as having at least a medium-risk for psychological trauma. Prevalence rates were higher among females and asylum seekers from Africa. This study highlights the importance of using screening tools to identify asylum seekers with severe mental health problems that may need referral to further assessment and treatment. Asylum seekers from Africa (excluding North Africa) should be given additional attention in initial health screenings and examinations.