title: Patients from abroad becoming patients in everyday practice: torture survivors in primary care.
abstract: Since 1975, over 3.5 million refugees have resettled in the United States, many of whom have experienced some form of torture, and little data exists on their primary care needs. This is retrospective chart-review of sixty-one torture survivors in Denver, Colorado. The patients were predominantly from Africa, 88% experienced physical torture, 21% sexual torture. Medical conditions included: major depression (45%), PTSD (48%), anxiety (31%), insomnia (50%), hypertension (29%), dyslipidemia (6%), HIV (6%) and tuberculosis class 2-4 (32%). Physical torture increased rates of PTSD (OR 7.29; CI 1.81, 29.45) and insomnia (OR 5.08; CI 1.41, 18.34). Sexual torture increased rates of major depression (OR 5.44; CI 1.29, 22.99), PTSD (OR 8.24; CI 1.61, 42.18), and insomnia (OR 6.84; CI 1.34, 34.90). Somatic complaints were more frequent in those who had experienced sexual torture (P = 0.041). Torture survivors have complex primary care needs, requiring multidisciplinary treatment.
authors.affiliation: Department of Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, CO 80218, USA. jennifer.tamblyn@ucdenver.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Tamblyn
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Calderon
authors.forename: Sarah
authors.initials: S
authors.lastname: Combs
authors.forename: Maureen M
authors.initials: MM
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000175:diagnosis / Q000208:ethnology; D044383:Black People / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care / Q000379:methods*; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000208:ethnology; D018709:Statistics, Nonparametric; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000208:ethnology*; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D014104:Torture / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult; D001741:Black or African American