title: Disability associated with psychiatric symptoms among torture survivors in rural Nepal.
abstract: Our objective was to explore the relationships between psychiatric symptom categories (posttraumatic stress disorder (PTSD), anxiety, and depression) and disability among torture survivors. We conducted a cross-sectional study of help-seeking torture survivors in highly affected conflict areas in rural mid-Western Nepal, using rating scales to assess symptomatology and disability. Validated screening instruments for the Nepali setting revealed that a high amount of psychopathology was present. Exploration of the relationships between psychiatric symptomatology and disability showed a central role for PTSD and anxiety complaints, but not for depressive complaints. A recursive model in which PTSD has (a) a direct relationship with disability and (b) an indirect relationship with disability mediated by anxiety and depression best fits the data. Findings are consistent with research on tortured refugees, suggesting the importance of a PTSD-anxiety mechanism. Implications for refugees in Western settings are discussed. Complexity of the mental status of torture survivors indicates multidisciplinary treatment.
authors.affiliation: HealthNet TPO, Department of Public Health and Research, Tolstraat 127, Amsterdam, the Netherlands. wtol@healthnettpo.org
authors.forename: Wietse A
authors.initials: WA
authors.lastname: Tol
authors.forename: Ivan H
authors.initials: IH
authors.lastname: Komproe
authors.forename: Suraj B
authors.initials: SB
authors.lastname: Thapa
authors.forename: Mark J D
authors.initials: MJ
authors.lastname: Jordans
authors.forename: Bhogendra
authors.initials: B
authors.lastname: Sharma
authors.forename: Joop T V M
authors.initials: JT
authors.lastname: De Jong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D008952:Mobile Health Units; D009390:Nepal / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014104:Torture / Q000523:psychology* / Q000706:statistics & numerical data