Crystal Riley

High prevalence rates of diabetes and hypertension among refugee psychiatric patients

There is increasing evidence that immigrants and traumatized individuals have elevated prevalence of medical disease. This study focuses on 459 Vietnamese, Cambodian, Somali, and Bosnian refugee psychiatric patients to determine the prevalence of hypertension and diabetes. The prevalence of hypertension was 42% and of diabetes was 15.5%. This was significantly higher than the US norms, especially in the groups younger than 65. Diabetes and hypertension were higher in the high-trauma versus low-trauma groups. However, in the subsample with body mass index (BMI) measurements subjected to logistic regression, only BMI was related to diabetes, and BMI and age were related to hypertension. Immigrant status, presence of psychiatric disorder, history of psychological trauma, and obesity probably all contributed to the high prevalence rate. With 2.5 million refugees in the country, there is a strong public health concern for cardiovascular disease in this group.

A ten-year treatment outcome study of traumatized Cambodian refugees

The purpose of this study was to assess treatment outcome among 23 severely traumatized Cambodian refugee patients with posttraumatic stress disorder who had been in continuous treatment for 10 or more years. Primary outcome parameters were symptom severity, social and vocational disability, and subjective quality of life. All patients were interviewed using standard assessment tools by a research psychiatrist not connected with the treatment, and charts were reviewed for past and current traumas and for treatment history. There was a wide range of current posttraumatic stress disorder symptom scores, but current depression scores were very low. Thirteen patients were judged to have good outcomes, and 10 had relatively poor outcomes. Reported degree of previous trauma and demographic factors did not distinguish between the two outcome groups. Sixty percent of patients greatly improved. However, even with comprehensive continuous treatment over a period of 10 or more years, a substantial minority was still impaired.

Group therapy with Southeast Asian refugees

This report describes a one-year experience with a new program of group therapy for Southeast Asians who were treated in a psychiatric program for Indochinese refugees. Cultural factors involving communication styles, respect for authority, and traditional social relationships greatly influence the group process. Socialization experiences which encouraged traditional activities and practical information were the most acceptable medium by all the groups. Psychological issues of losses, cultural conflicts, and persistent discussion of somatic symptoms were voiced throughout the activities. Formal group psychotherapy was periodically useful in some groups. Flexibility, meeting concrete needs, keeping a bicultural focus, and maintaining the individual therapy sessions contributed to the acceptance by the patient.

Traumatized Refugee Children: The Case for Individualized Diagnosis and Treatment.

The first 131 traumatized refugee children evaluated and treated in a child specialty clinic indicated a wide variety of trauma including war-related traumas (21%) for areas of recent conflict and domestic violence (28%) predominantly occurring in patients from Mexico and Latin America. Clinical diagnoses indicate PTSD was common (63%) in the war trauma group but was found less (25%) in the domestic violence group. Otherwise, the refugee clinic population showed a wide variety of diagnoses, including 20% having learning or cognitive disability or clear mental retardation. The traumatized refugee children had a similar prevalence of PTSD and depression to a comparable group of American child psychiatry patients. Refugee children have faced a variety of traumas and have a variety of diagnoses. All traumatized refugee children need an individualized evaluation and treatment plan. Trauma focused therapy is not appropriate for all refugee children.