Tol Wietse A, Komproe Ivan H, Thapa Suraj B, Jordans Mark J D, Sharma Bhogendra, De Jong Joop T V M
HealthNet TPO, Department of Public Health and Research, Tolstraat 127, Amsterdam, the Netherlands.
J Nerv Ment Dis. 2007 Jun;195(6):463-9. doi: 10.1097/NMD.0b013e31802f5dac.
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.
我们的目标是探究酷刑幸存者的精神症状类别（创伤后应激障碍（PTSD）、焦虑和抑郁）与残疾之间的关系。我们在尼泊尔中西部农村受影响严重的冲突地区，对寻求帮助的酷刑幸存者进行了一项横断面研究，使用评定量表评估症状和残疾情况。针对尼泊尔情况的有效筛查工具显示存在大量精神病理学问题。对精神症状与残疾之间关系的探究表明，PTSD和焦虑症状起着核心作用，而抑郁症状并非如此。一个递归模型最能拟合数据，在该模型中，PTSD（a）与残疾有直接关系，（b）与由焦虑和抑郁介导的残疾有间接关系。研究结果与对受折磨难民的研究一致，表明PTSD - 焦虑机制的重要性。讨论了对西方环境中难民的影响。酷刑幸存者精神状态的复杂性表明需要多学科治疗。
