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Previous Trauma Can Still Affect Refugees A Decade Later

A small minority of refugees who experience prior severe trauma remain at risk a decade or more later for severe mental illness.

Because of the risks of chronic psychiatric disability, specialist services for refugees should be developed, contends Dr Derrick Silove and colleagues at the School of Psychiatry, University of New South Wales, Sydney, and the University of Adelaide, Adelaide, Australia.

A cohort of 1,413 adult Vietnamese who resettled in Australia was investigated in this study.

Little is known about the long-term adverse effects of mass trauma on the psychological well being of refugees and other war-affected populations, the clinicians point out. Most previous research has focused on the short-to-medium term and suggests that posttraumatic stress reactions tend to persist.

An estimated 1.5 million Vietnamese have been displaced since the 1970's. At present, the researchers said, deleterious effect on mental function is a critical issue in public health with war, conflict, and terrorism affecting more than 100 countries world-wide.

The researchers studied adult Vietnamese men and women who all lived in Sydney. Assessment using the international classification of disease, version 10, included previous exposure to trauma, history of mental illness in the preceding year, psychiatric assessment, frequency of disability and use of medical services, and social/cultural factors.

The Vietnamese had lived in Australia for a mean of 11.2 years, and mean time since the most severe traumatic event was 14.8 years. Overall, 75 of the Vietnamese (7 percent) had mental disorders. Although their risk of mental illness fell consistently across time, those who had been exposed to more than three trauma events (199) had heightened risk of mental illness (23) after 10 years compared with people with no trauma exposure.

The clinicians said their findings show that most refugees are not at risk of long-term mental illness. "Nevertheless, there was a close association between incremental levels of trauma and risk of mental illness, associated psychosocial dysfunction, and tendency to use both western and traditional health services."

Exposure to trauma seemed to remain relevant for a small subgroup of people exposed to high levels of trauma, who, even after 10 years or more, were at increased risk of mental illness and associated psychosocial disability. "The study findings highlight the need for specialized services for this high-risk group," they conclude.
http://image.thelancet.com/extras/01art9374web.pdf

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