Impact of torture on refugees displaced within the developing world: symptomatology among Bhutanese refugees in Nepal.
BACKGROUND
Most of the world's refugees are displaced within the developing world. The impact of torture on such refugees is unknown.


OBJECTIVE
To examine the impact of torture on Bhutanese refugees in Nepal.


METHODS
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.


METHODS
Bhutanese refugee community in the United Nations refugee camps in the Terai in eastern Nepal.


METHODS
A random sample of 526 tortured refugees and a control group of 526 nontortured refugees matched for age and sex.


METHODS
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.


RESULTS
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).


CONCLUSIONS
Torture plays a significant role in the development of PTSD, depression, and anxiety symptoms among refugees from Bhutan living in the developing world.
Center for Victims of Torture, Kathmandu, Nepal.
N M
NM
Shrestha
B
B
Sharma
M
M
Van Ommeren
S
S
Regmi
R
R
Makaju
I
I
Komproe
G B
GB
Shrestha
J T
JT
de Jong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D001631:Bhutan / Q000208:ethnology; D016022:Case-Control Studies; D003863:Depression / Q000209:etiology; D003906:Developing Countries; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D012036:Refugees; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D017741:Survivors / Q000523:psychology; D014104:Torture / Q000523:psychology / Q000706:statistics & numerical data*