Impact of Torture on Refugees Displaced Within the Developing World

TLDR

Most refugees worldwide are displaced within the developing world. The study aimed to assess the impact of torture on Bhutanese refugees in Nepal through a case‑control survey. Researchers conducted physician‑led interviews with 526 tortured and 526 matched nontortured refugees, collecting demographics, torture history, 40 medical complaints, and DSM‑III‑R PTSD and HSCL‑25 anxiety/depression scores. Tortured refugees exhibited significantly more PTSD symptoms, higher anxiety and depression scores, and increased musculoskeletal and respiratory complaints, with torture history predicting PTSD (OR 4.6), depression (OR 1.9), and anxiety (OR 1.5); Buddhist faith and male sex were associated with lower depression and anxiety, respectively.

Abstract

Most of the world's refugees are displaced within the developing world. The impact of torture on such refugees is unknown.To examine the impact of torture on Bhutanese refugees in Nepal.Case-control survey. Interviews were conducted by local physicians and included demographics, questions related to the torture experienced, a checklist of 40 medical complaints, and measures of posttraumatic stress disorder (PTSD), anxiety, and depression.Bhutanese refugee community in the United Nations refugee camps in the Terai in eastern Nepal.A random sample of 526 tortured refugees and a control group of 526 nontortured refugees matched for age and sex.The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for PTSD and the Hopkins Symptom Checklist-25 (HSCL-25) for depression and anxiety.The 2 groups were similar on most demographic variables. The tortured refugees, as a group, suffered more on 15 of 17 DSM-III-RPTSD symptoms (P<.005) and had higher HSCL-25 anxiety and depression scores (P<.001) than nontortured refugees. Logistic regression analysis showed that history of torture predicted PTSD symptoms (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.7-8.0), depression symptoms (OR, 1.9; 95% CI, 1.4-2.6), and anxiety symptoms (OR, 1.5; 95% CI, 1.1-1.9). Torture survivors who were Buddhist were less likely to be depressed (OR, 0.5; 95% CI, 0.3-0.9) or anxious (OR, 0.7; 95% CI, 0.4-1.0). Those who were male were less likely to experience anxiety (OR, 0.66; 95% CI, 0.44-1.00). Tortured refugees also presented more musculoskeletal system- and respiratory system-related complaints (P<.001 for both).Torture plays a significant role in the development of PTSD, depression, and anxiety symptoms among refugees from Bhutan living in the developing world.