Impact of torture on refugees displaced within the developing world - Symptomatology among Bhutanese refugees in Nepal

Context. - Most of the world's refugees are displaced within the developing world. The impact of torture on such refugees is unknown. Objective. - To examine the impact of torture on Bhutanese refugees in Nepal. Design. - Case-control survey. Interviews were conducted by local physicians and included demographics, questions related to the torture experienced, a checklist of 40 medical complaints, and measures of posttraumatic stress disorder (PTSD), anxiety, and depression. Setting. - Bhutanese refugee community in the United Nations refugee camps in the Terai in eastern Nepal. Participants. - A random sample of 526 tortured refugees and a control group of 526 nontortured refugees matched for age and sex. Main Outcome Measures. - The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for PTSD and the Hopkins Symptom Checklist-25 (HSCL-25) for depression and anxiety. Results. - The 2 groups were similar on most demographic variables. The tortured refugees, as a group, suffered more on 15 of 17 DSM-III-R PTSD symptoms (P < .005) acid had higher HSCL-25 anxiety and depression scores (P < .001) than nontortured refugees. Logistic regression analysis showed that history of torture predicted PTSD symptoms (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.7-8.0), depression symptoms (OR, 1.9; 95% CI, 1.4-2,6), and anxiety symptoms (OR, 1.5; 95% CI, 1.1-1.9). Torture survivors who were Buddhist were less likely to be depressed (OR, 0.5; 95% CI, 0.3-0.9) or anxious (OR, 0.7; 95% CI, 0.4-1.0). Those who were male were less likely to experience anxiety (OR, 0.66; 95% CI, 0.44-1.00). Tortured refugees also presented more musculoskeletal system - and respiratory system-related complaints (P<.001 for both). Conclusion. - Torture plays a significant role in the development of PTSD, depression, and anxiety symptoms among refugees from Bhutan living in the developing world.