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Refugee Trauma versus Torture Trauma: A Retrospective Controlled Cohort Study of Tibetan Refugees


The Journal of Nervous & Mental Disease: January 1998 - Volume 186 - Issue 1 - p 24-34

A retrospective cohort study of 35 refugee Tibetan nuns and lay students who were arrested and tortured in Tibet matched with 35 controls who were not arrested or tortured was carried out in India. Subjects were administered the Hopkins Checklist-25, evaluating anxiety symptoms, affective disturbances, somatic complaints, and social impairment. The prevalence of symptom scores in the clinical range for both cohorts was 41.4% for anxiety symptoms and 14.3% for depressive symptoms. The torture survivors had a statistically significant higher proportion of elevated anxiety scores than did the nontortured cohort(54.3% vs. 28.6%, p =.05). This was not true for elevated depressive scores. The results suggest that torture has long-term consequences on mental health over and above the effects of being uprooted, fleeing one's country, and living in exile as a refugee, though the additional effects were small. Political commitment, social support in exile, and prior knowledge of and preparedness for confinement and torture in the imprisoned cohort served to foster resilience against psychological sequelae. The contribution of Buddhist spirituality plays an active role in the development of protective coping mechanisms among Tibetan refugees.

1 Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts.

Send requests for reprints to Dr. Holtz, Neponset Health Center, 398 Neponset Ave., Dorchester, Massachusetts 02122.

The author gratefully acknowledges assistance from Doma Tsomo, Ugyen Damdul, Dr. Betsy Napper, Philippa Russell, Dr. Tsetan Dorjee, Kalsang Yugial, Desang Tsering, and Elizabeth Fabel. Thanks are also extended to Dr. Donna Speigelman for her contributions toward data analysis. Special appreciation is expressed to the Tibetan nun and student refugees who participated in this survey. The author was an Aaron Diamond and Emily Davie and Joseph S. Kornfeld Fellow in Human Rights and Medicine at the Center for the Study of Society and Medicine of the College of Physicians and Surgeons of Columbia University during the design and conduct of this study.

© Williams & Wilkins 1998. All Rights Reserved.