title: Trauma and loss as determinants of medically unexplained epidemic illness in a Bhutanese refugee camp.
abstract: BACKGROUND
  We sought to identify personal factors that placed people at risk during an epidemic of medically unexplained illness in a Bhutanese refugee camp in southeastern Nepal.
  
  
  METHODS
  We conducted a case-control study, involving 68 cases and 66 controls. Caseness was defined as experiencing at least one attack of medically unexplained fainting or dizziness during the time of the epidemic. We performed hierarchical logistic regression analysis to identify significant predictors of case status.
  
  
  RESULTS
  In terms of Western psychiatric constructs, the illness involved somatoform symptoms of both acute anxiety and dissociation. Sixty per cent reported visual and 28% reported auditory hallucinatory experiences. Cases and controls were similar on all demographic variables, school performance, number of attacks witnessed and psychopathology before the onset of the epidemic. Recent loss, early loss, childhood trauma and pulse-rate were predictors of case status.
  
  
  CONCLUSIONS
  We identified trauma, early loss and, especially, recent loss as predictors of attacks during medically unexplained epidemic illness in a Bhutanese refugee community.
authors.affiliation: Transcultural Psychosocial Organization, Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Van Ommeren
authors.forename: B
authors.initials: B
authors.lastname: Sharma
authors.lastname: Komproe
authors.forename: B N
authors.initials: BN
authors.lastname: Poudyal
authors.forename: G K
authors.initials: GK
authors.lastname: Sharma
authors.forename: E
authors.initials: E
authors.lastname: Cardeña
authors.forename: J T
authors.initials: JT
authors.lastname: De Jong
mesh_terms: D000293:Adolescent; D000328:Adult; D001631:Bhutan / Q000208:ethnology; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D009390:Nepal / Q000453:epidemiology; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000208:ethnology* / Q000523:psychology*; D011795:Surveys and Questionnaires