The psychiatric sequelae of human rights violations: a challenge for primary health care.
High rates of psychiatric morbidity have been documented in survivors of gross human rights abuses. Nevertheless, there has been relatively little focus on such patients in the context of primary care medicine. A sample of 134 survivors of gross human rights violations was assessed using a structured interview to determine exposure to violations and psychiatric status. In addition, psychiatric treatment history was probed with an open-ended interview. The study found that of the 95 of 134 (72%) participants who were assessed and found to have a current psychiatric diagnosis, only three were receiving treatment for such a disorder. Many subjects had presented to primary care clinics with somatic symptoms and had been prescribed benzodiazepines. Reasons for not reporting trauma or not seeking treatment included issues revolving around fear and mistrust, privacy and confidentiality, re-experiencing the trauma, and lack of awareness. Misdiagnosis and ineffective treatment of survivors of human rights abuses are likely to pose a significant drain on primary care resources. Accurate diagnosis and appropriate treatment are important challenges in primary care settings.
Zungu-Dirwayi
Nompumelelo
N
Medical Research Council Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa.
Kaminer
Debra
D
Mbanga
Irene
I
Stein
Dan J
DJ
D001364:Awareness; D003219:Confidentiality; D005239:Fear; D005260:Female; D045809:Human Rights Abuses / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000331:legislation & jurisprudence*; D011570:Psychiatry / Q000331:legislation & jurisprudence*; D013019:South Africa; D017741:Survivors / Q000523:psychology