Impact of organized violence on illness experience of Turkish/Kurdish and Bosnian migrant patients in primary care.
BACKGROUND
Migration, particularly when associated with exposure to organized violence, can seriously affect mental and physical health in ways that are not obvious. This study considers the clinical impact of organized violence on emotional and somatic problems encountered in the course of primary health care.


METHODS
Migrant patients from Bosnia (n=36) and Turkey (n=62) in primary care were recruited into the study and divided into two groups: male and female migrants of both countries who reported experience of organized violence and those who did not. Symptom profiles and patterns of distress were compared between those with and without experience of organized violence.


RESULTS
Somatic and emotional problems, such as diffuse pain, numbness in arms and legs, stress, flashbacks, disturbed sleep and nightmares were reported significantly more often by violence survivors than by the control group. Also associated with experience of organized violence were higher frequencies of reported emotional problems, such as feeling out of balance in the previous months, extreme sadness and difficulties settling in Switzerland. Among the men, more than 62% of the violence survivors reported thoughts of self-harm compared with 11% of the control group whereas thoughts of self-harm among the women were more associated with the uncertain legal status in Switzerland than with violence experience.


CONCLUSIONS
Exposure to organized violence contributed to increased health problems of these migrant patients who were presenting in primary care. A useful feature of this research should also be incorporated into clinical practice. Consideration of relevant aspects of patients' social experience, including victimization by violence, requires attention not only to spontaneous accounts in the course of history taking but also focused queries to clarify such questions.
Gilgen
Denise
D
Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland.
Gross
Corina Salis
CS
Maeusezahl
Daniel
D
Frey
Conrad
C
Tanner
Marcel
M
Weiss
Mitchell G
MG
Hatz
Christoph
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D017522:Bosnia and Herzegovina; D004641:Emigration and Immigration; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013557:Switzerland; D014421:Turkey; D014754:Violence