Is legal status impacting outcomes of group therapy for posttraumatic stress disorder with male asylum seekers and refugees from Iran and Afghanistan?

BMC Psychiatry

Rolf J Kleber¹  Jeroen W Knipscheer¹  Wietse A Tol³  Astrid M Kamperman⁴  Boris Drožđek² 

[1] Department of Clinical and Health Psychology, Utrecht University, Utrecht/Arq Foundation, Diemen, The Netherlands;Psychotrauma Centrum Zuid Nederland/Reinier van Arkel groep, Den Bosch, The Netherlands;Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands

关键词: Afghanistan;    Iran;    Resettlement stress;    Group therapy;    Refugees;    Asylum seekers;    Post-traumatic stress disorder;   

Others  :  1124045
DOI  :  10.1186/1471-244X-13-148

 received in 2013-01-26, accepted in 2013-05-21,  发布年份 2013

【 摘 要 】

Background

Legal status and other resettlement stressors are known to impact mental health of asylum seekers and refugees. However, the ways in which they interact with treatment of posttraumatic stress disorder (PTSD) with these populations is still poorly understood. The aim of this study was to examine whether legal status and other resettlement stressors influence outcomes of a trauma-focused group PTSD treatment within a day-treatment setting with asylum seekers and refugees.

Methods

Sixty six male Iranian and Afghan patients with PTSD residing in the Netherlands were assessed with self-rated symptom checklists for PTSD, anxiety and depression, and a demographic questionnaire one week before and two weeks after the treatment. Multivariate linear regression analysis was used to examine the impact of legal status and living arrangements on the treatment outcomes per symptom domain.

Results

The results suggest that both asylum seekers and refugees can be helped with their mental health complaints with a trauma-focused group therapy for PTSD regardless of their legal status. Obtaining a refugee status in a course of the treatment appears to improve the treatment outcomes.

Conclusions

Legal status is impacting outcomes of group therapy for PTSD with male asylum seekers and refugees. Asylum seekers may benefit from group treatment regardless of unstable living conditions.

【 授权许可】

   
2013 Drozdek et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]The United Nations High Commissioner for Refugees: Statistical yearbook 2009: trends in displacement, protection and solutions. Geneva, Switzerland: The United Nations High Commissioner for Refugees; 2009.
• [2]Porter M, Haslam N: Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons. JAMA 2005, 294:602-612.
• [3]Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M: Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement. JAMA 2009, 302:537-549.
• [4]Ryan DA, Kelly FE, Kelly BD: Mental health among persons awaiting an asylum outcome in Western countries. Int J Ment Health 2009, 38:88-111.
• [5]Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z: Anxiety depression and PTSD in asylum-seekers: Associations with pre-migration trauma and post-migration stressors. Br J Psychiat 1997, 170:351-357.
• [6]Laban CJ, Gernaat HBPE, Komproe IH, Schreuders BA, de Jong JTVM: Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 2004, 192:843-851.
• [7]Mueller J, Schmidt M, Staeheli A, Maier T: Mental health of failed asylum seekers as compared with pending and temporarily accepted asylum seekers. Eur J Public Health 2010, 21:184-189.
• [8]Silove D, Steel Z, Watters C: Policies of deterrence and the mental health of asylum seekers in western countries. JAMA 2000, 284:604-611.
• [9]Silove D, Steel Z, Susljik I, Frommer N, Loneragan C, Chey T, Brooks R, Le Touze D, Coello M, Smith M: The Impact of the refugee decision on the trajectory of PTSD, anxiety, and depressive symptoms among asylum seekers: a longitudinal study. Am J Disaster Med 2007, 2:321-329.
• [10]Laban CJ, Gernaat HBPE, Komproe IH, van der Tweel I, de Jong JTVM: Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 2005, 193:825-832.
• [11]Brewin CR, Andrews B, Valentine JD: Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000, 68:748-766.
• [12]Ozer EJ, Best SR, Lipsey TL, Weiss DS: Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003, 129:52-73.
• [13]Carswell K, Blackburn P, Barker C: The relationship between trauma, post-migration problems and the psychological well-being of refugees and asylum seekers. Int J Soc Psychiatr 2011, 57:107-119.
• [14]Kaniasty K, Norris FH: Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. J Trauma Stress 2008, 21:274-281.
• [15]Lindencrona F, Ekblad S, Hauff E: Mental health of recently resettled refugees from the Middle East in Sweden: the impact of pre-resettlement trauma, resettlement stress and capacity to handle stress. Soc Psych Psych Epid 2008, 43:121-131.
• [16]Crumlish N, O’Rourke K: A systematic review of treatments for post-traumatic stress disorder among refugees and asylum-seekers. J Nerv Ment Dis 2010, 198:237-251.
• [17]Nickerson A, Bryant RA, Silove D, Steel Z: A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clin Psychol Rev 2011, 31:399-417.
• [18]Layne CM, Saltzman WR, Poppleton L, Burlingame GM, Pasalic A, Durakovic E, Music M, Campara N, Dapo N, Arslanagic B, Steinberg AM, Pynoos RS: Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2008, 47:1048-1062.
• [19]Drožđek B, Bolwerk N: Evaluation of group therapy with traumatized asylum seekers and refugees - The Den Bosch model. Traumatology 2010, 16:117-127.
• [20]Drožđek B, Kamperman AM, Bolwerk N, Tol WA, Kleber RJ: Group therapy with male asylum seekers and refugees with PTSD: A controlled comparison cohort study of three day-treatment programs. J Nerv Ment Dis 2012, 200:758-765.
• [21]Drožđek B, Bolwerk N: Group therapy with traumatized asylum seekers and refugees: For whom it works and for whom it does not? Traumatology 2010, 16:160-167.
• [22]Drožđek B, Wilson JP: Uncovering: Trauma-focused treatment techniques with asylum seekers. In Broken spirits: The treatment of traumatized asylum seekers, refugees, war and torture victims. Edited by Wilson JP, Drožđek B. New York: Brunner-Routledge; 2004:243-276.
• [23]APA: Diagnostic and statistical manual of mental health disorders. 4th edition. Washington, DC: American Psychiatric Association; 1994.
• [24]Murray KE, Davidson GR, Schweitzer RD: Review of refugee mental health interventions following resettlement: Best practices and recommendations. Am J Orthopsychiat 2010, 80:576-585.
• [25]Resick PA, Bovin MJ, Calloway AL, Dick AM, King MW, Mitchell KS, Suvak MK, Wells SY, Wiltsey Stirman S, Wolf EJ: A critical evaluation of the complex PTSD literature: Implications for DSM-5. J Trauma Stress 2012, 25:241-251.
• [26]Kleijn WC, Hovens JE, Rodenburg JJ: Posttraumatic stress symptoms in refugees: assessment with the Harvard trauma questionnaire and the Hopkins symptom checklist-25 in different languages. Psychol Rep 2001, 88:527-532.
• [27]Mollica RF, Caspi-Yavin Y, Bollini P, Truong T: The Harvard trauma questionnaire: validating a cross-cultural instrument for measuring torture, trauma and post-traumatic stress disorder in Indochinese refugees. J Nerv Ment Dis 1992, 180:111-116.
• [28]Mollica RF, Caspi-Yavin Y, Lavelle J, Tor S, Yang T, Chan S, Pham T, Ryan A, de Marneffe D: Harvard trauma questionnaire (HTQ): manual for Cambodian, Laotian and Vietnamese versions. Torture 1996, 6(Suppl 1):19-33.
• [29]American Psychiatric Association: Diagnostic and statistical manual of mental health disorders (3rd ed rev). Washington, DC: American Psychiatric Association; 1987.
• [30]Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J: Indochinese versions of the Hopkins symptom checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry 1987, 144:497-500.
• [31]Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J: Hopkins symptom checklist (HSCL-25): manual for Cambodian, Laotian and Vietnamese versions. Torture 1996, 6(Suppl. 1):35-42.
• [32]Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J: Measuring trauma and health status in refugees: a critical review. JAMA 2002, 288:611-621.
• [33]Cohen J: Statistical Power Analysis for the Behavioral Sciences. 2nd edition. Mahwah: Lawrence Erlbaum Associates; 1988.
• [34]SPSS Inc: PASW Statistics for Windows.Version 17.0. Chicago: SPSS Inc; 2008.
• [35]Aurora RN, Zak RS, Auerbach SH, Casey KR, Chowdhuri S, Karipott A, Maganti RK, Ramar K, Kristo DA, Bista SR, Lamm CI, Morgenthaler TI: Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med 2010, 6:389-401.
• [36]Stein DJ, Ipser J, McAnda N: Pharmacotherapy of posttraumatic stress disorder: A review of meta-analyses and treatment guidelines. CNS Spectr 2009, 14(Suppl 1):25-31.
• [37]Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA: Mental health of Cambodian refugees two decades after resettlement in the United States. JAMA 2005, 294:571-579.
• [38]Mollica RF, McInnes K, Poole C, Tor S: Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. Br J Psychiat 1998, 173:482-488.
• [39]Mollica RF, McInnes K, Sarajlic N, Lavelle J, Sarajlic I, Massagli MP: Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA 1999, 282:433-439.
• [40]Ryan D, Benson C, Dooley B: Psychological distress and the asylum process: a longitudinal study of forced migrants in Ireland. J Nerv Ment Dis 2008, 196:37-45.
• [41]Momartin S, Steel Z, Coello M, Aroche J, Silove DM, Brooks R: A comparison of the mental health of refugees with temporary versus permanent protection visas. Med J Aust 2006, 185:357-361.
• [42]Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, Suslijk I: Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry 2006, 188:58-64.
• [43]Dermot RA, Benson CA, Dooley BA: Psychological distress and the asylum process: a longitudinal study of forced migrants in Ireland. J Nerv Ment Dis 2008, 196:37-45.
• [44]Basoglu M, Livanou M, Crnobaric C, Franciskovic T, Suljic E, Duric D, Vranesic M: Psychiatric and cognitive effects of war in former Yugoslavia: association of lack of redress for trauma and posttraumatic stress reaction. JAMA 2005, 294:580-590.
• [45]Birman D, Tran N: Psychological distress and adjustment of Vietnamese refugees in the United States: Association with pre- and postmigration factors. Am J Orthopsychiat 2008, 78:109-120.
• [46]Darvishpour M: Immigrant women challenge the role of men: how the changing power relationship within Iranian families in Sweden intensifies family conflicts. J Comp Fam Stud 2002, 33:271-296.
• [47]Laffaye C, Cavella S, Drescher K, Rosen C: Relationships among PTSD symptoms, social support, and support source in veterans with chronic PTSD. J Trauma Stress 2008, 21:394-401.
• [48]Emmelkamp J, Komproe IH, van Ommeren M, Schagen S: The relation between coping, social support and psychological and somatic symptoms among torture survivors in Nepal. Psychol Med 2002, 32:1465-1470.
• [49]Schweitzer R, Melville F, Steel Z, Lacherez P: Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Aust NZ J Psychiat 2006, 40:179-187.
• [50]Gifford SM, Bakopanos C, Kaplan I, Correa-Velez I: Meaning or Measurement? Researching the social contexts of health and settlement among newly-arrived refugee youth in Melbourne, Australia. J Refug Stud 2007, 20:414-440.