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The Dose-Effect Relationships between Torture and Psychiatric Symptoms in Vietnamese Ex-Political Detainees and a Comparison Group

MOLLICA, RICHARD F. M.D., M.A.R.1,2; MCINNES, KEITH M.S.1; PHAM, THANG L.I.C.S.W.1,2; SMITH FAWZI, MARY CATHERINE Sc.D.1; MURPHY, ELIZABETH M.D.1,2; LIN, LIEN1,2

The Journal of Nervous & Mental Disease: September 1998 - Volume 186 - Issue 9 - p 543-553
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The purpose of this study was to determine in Vietnamese ex-political detainees newly arrived into the United States a) the prevalence of torture and psychiatric symptoms and b) the dose-effect relationships between cumulative torture experience and the psychiatric symptoms of posttraumatic stress disorder (PTSD) and major depression. The study population included Vietnamese ex-political detainees (N = 51) and a comparison group (N = 22). All respondents received culturally validated instruments with known psychometric properties including Vietnamese versions of the Hopkins Symptom Checklist-25 and the Harvard Trauma Questionnaire. The ex-political detainees, in contrast to the comparison group, had experienced more torture events (12.2 SD = 4.2 vs. 2.6 SD = 3.1) and had higher rates of PTSD (90% vs. 79%) and depression (49% vs. 15%). Dose-effect relationships between cumulative torture experience and psychiatric symptoms were positive with the PTSD subcategory of "increased arousal" revealing the strongest association. These findings provide evidence that torture is associated with psychiatric morbidity in Vietnamese refugees. The demonstration of significant dose-effect responses supports the hypothesis that torture is a major risk factor in the etiology of major depression and PTSD. The generalizability of these results to other torture survivor groups is unknown. The interaction between torture and other pre- and post-migration risk factors over time in different cultural settings still needs to be examined.

1 Harvard Program in Refugee Trauma, Harvard School of Public Health, 8 Story Street, Third Floor, Cambridge, Massachusetts 02138. Send reprint requests to Dr. Mollica.

2 Indochinese Psychiatry Clinic, Beth Israel Deaconess Medical Center, Harvard Medical School.

Supported by the Bank of Boston and the Mackintosh Foundation. The authors acknowledge the assistance of the Vietnamese-American Civic Association (VACA) in Boston, Massachusetts, and the statistical advice of Dr. Charles Poole, Harvard Program in Refugee Trauma and Boston University School of Public Health.

© Williams & Wilkins 1998. All Rights Reserved.