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Disability Associated With Psychiatric Symptoms Among Torture Survivors in Rural Nepal

Tol, Wietse A. MA*; Komproe, Ivan H. PhD*; Thapa, Suraj B. MD, PhD; Jordans, Mark J.D. MA*; Sharma, Bhogendra MBBS, MPH; De Jong, Joop T.V.M. MD, PhD*

The Journal of Nervous and Mental Disease: June 2007 - Volume 195 - Issue 6 - p 463-469
doi: 10.1097/NMD.0b013e31802f5dac
Original Article

Our objective was to explore the relationships between psychiatric symptom categories (posttraumatic stress disorder (PTSD), anxiety, and depression) and disability among torture survivors. We conducted a cross-sectional study of help-seeking torture survivors in highly affected conflict areas in rural mid-Western Nepal, using rating scales to assess symptomatology and disability.

Validated screening instruments for the Nepali setting revealed that a high amount of psychopathology was present. Exploration of the relationships between psychiatric symptomatology and disability showed a central role for PTSD and anxiety complaints, but not for depressive complaints. A recursive model in which PTSD has (a) a direct relationship with disability and (b) an indirect relationship with disability mediated by anxiety and depression best fits the data. Findings are consistent with research on tortured refugees, suggesting the importance of a PTSD–anxiety mechanism. Implications for refugees in Western settings are discussed. Complexity of the mental status of torture survivors indicates multidisciplinary treatment.

*HealthNet TPO, Department of Public Health and Research, Tolstraat 127, Amsterdam, the Netherlands; †Institute of Psychiatry, University of Oslo, Norway; and ‡Centre for Victims of Torture, Nepal (CVICT), Bansbari, Kathmandu, Nepal.

Send reprint requests to Wietse A. Tol, HealthNet TPO, Department of Public Health and Research, Tolstraat 127, 1074 VJ, Amsterdam, the Netherlands. E-mail: wtol@healthnettpo.org.

© 2007 Lippincott Williams & Wilkins, Inc.