Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice

BACKGROUND: The prevalence of torture among foreign-born patients presenting to urban medical clinics is not well documented. OBJECTIVE: To determine the prevalence of torture among foreign-born patients presenting to an urban primary care practice. DESIGN: A survey of foreign-born patients. PATIENTS: Foreign-born patients, age ! 18, presenting to the Primary Care Clinic at Boston Medical Center. MEASUREMENTS: Self-reported history of torture as defined by the UN, and history of prior disclosure of torture. RESULTS: Of the 308 eligible patients, 88 (29%) declined participation, and 78 (25%) were not included owing to lack of a translator. Participants had a mean age of 47 years (range 19 to 76), were mostly female (82/142, 58%), had been in the United States for an average of 14 years (range 1 month to 53 years), and came from 35 countries. Fully, 11% (16/142, 95 percent confidence interval 7% to 18%) of participants reported a history of torture that was consistent with the UN definition of torture. Thirty-nine percent (9/23) of patients reported that their health care provider asked them about torture. While most patients (15/23, 67%) reported discussing their experience of torture with someone in the United States, 8 of 23 (33%) reported that this survey was their first disclosure to anyone in the United States. CONCLUSION. Among foreign-born patients presenting to an urban primary care center, approximately 1 in 9 met the definition established by the UN Convention Against Torture. As survivors of torture may have significant psychological and physical sequelae, these data underscore the necessity for primary care physicians to screen for a torture history among foreign-born patients.