Prevalence of mental disorders and torture among Tibetan refugees: a systematic review.
BACKGROUND
Many Tibetan refugees flee Tibet in order to escape physical and mental hardships, and to access the freedoms to practice their culture and religion. We aimed to determine the prevalence of mental illnesses within the refugee population and determine the prevalence of previous torture reported within this population.


METHODS
We performed a systematic literature search of 10 electronic databases from inception to May 2005. In addition, we searched the internet, contacted all authors of located studies, and contacted the Tibetan Government-in-exile, to locate unpublished studies. We included any study reporting on prevalence of mental illness within the Tibetan refugee populations. We determined study quality according to validation, translation, and interview administration. We calculated proportions with exact confidence intervals.


RESULTS
Five studies that met our inclusion criteria (total n = 410). All studies were conducted in North India and 4 were specifically in adult populations. Four studies provided details on the prevalence of torture and previous imprisonment within the populations. The prevalence of post-traumatic stress disorder ranged from 11-23%, anxiety ranged from 25-77%, and major depression ranged from 11.5-57%.


CONCLUSIONS
Our review indicates that the prevalence of serious mental health disorders within this population is elevated. The reported incidence of torture and imprisonment is a possible contributor to the illnesses. Non-government organizations and international communities should be aware of the human rights abuses being levied upon this vulnerable population and the mental health outcomes that may be associated with it.
Mills
Edward J
EJ
Dept. of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada. millsej@mcmaster.ca
Singh
Sonal
S
Holtz
Timothy H
TH
Chase
Robert M
RM
Dolma
Sonam
S
Santa-Barbara
Joanna
J
Orbinski
James J
JJ