Dix-Peek Dominique, Dix-Peek Dominique, Werbeloff Merle
Centre for the Study of Violence and Reconciliation (CSVR), South Africa. Correspondence to:
Torture. 2018;28(1):34-57.
To address the consequences of past torture experiences as well as current traumas and daily stressors, the Centre for the Study of Violence and Reconciliation (CSVR) developed a contextually appropriate psychosocial framework for the rehabilitation of individuals who have been affected by torture.
To test the efficacy of this framework, a quasiexperimental study was conducted with torture survivor clients of the CSVR who met the 1985 United Nations Convention Against Torture (UNCAT) definition. A comparison group of clients (n=38) was initially included on a waiting list and thereafter received treatment, whilst the treatment group of clients (n=44) entered straight into treatment.
Baseline t-test comparisons conducted on 13 outcome indicators revealed significantly better initial psychological health and functioning of clients in the treatment group than those in the comparison group, with moderately large differences on PTSD, trauma and anxiety, and strong difference in depression scores. Three-month follow-up comparisons using the conservative Wilcoxon test revealed significantly greater improvement on the functioning and anxiety indicators of the treatment group relative to the waiting-list comparison group (odds ratios = 2.49 and 2.61 respectively). After a further three months, when treatment was based on the CSVR framework for both groups, fewer than half the respondents remained in the study (n=20 in the treatment group; n=16 in the comparison group), and the Wilcoxon repeated measures test results on changes since baseline were counter-intuitive: for these remaining clients, there were now more significant outcome improvements for the comparison group than for the treatment group. However, the relative odds ratios for the groups were not significant for these indicators. Furthermore, the clients who dropped out from the treatment group had shown overall improvement in their psychological health and functioning in the initial three months of the study, whereas those who dropped out from the comparison group had shown improvements on fewer indicators. Thus, the research findings on the efficacy of the framework are inconclusive.
We suggest that this inconclusiveness can be explained by the severe challenges and ethical complexities of psychosocial research on vulnerable groups. The study highlights the serious problem of attrition of participants in the treatment programme which affected the overall study, and which may explain findings that at first appear counter-intuitive.
为应对过去酷刑经历以及当前创伤和日常压力源的后果，暴力与和解研究中心（CSVR）为受酷刑影响的个人康复制定了一个符合具体情况的社会心理框架。
为测试该框架的效果，对符合1985年《联合国禁止酷刑公约》（UNCAT）定义的CSVR酷刑幸存者客户进行了一项准实验研究。一组对照客户（n = 38）最初被列入等候名单，之后接受治疗，而治疗组客户（n = 44）直接进入治疗。
对13项结果指标进行的基线t检验比较显示，治疗组客户的初始心理健康和功能明显优于对照组，在创伤后应激障碍、创伤和焦虑方面存在中度较大差异，抑郁得分存在显著差异。使用保守的威尔科克森检验进行的三个月随访比较显示，治疗组在功能和焦虑指标方面相对于等候名单对照组有显著更大的改善（优势比分别为2.49和2.61）。再过三个月，当两组都基于CSVR框架进行治疗时，不到一半的受访者仍留在研究中（治疗组n = 20；对照组n = 16），威尔科克森重复测量检验关于自基线以来变化的结果与直觉相反：对于这些剩余客户，现在对照组的结果改善比治疗组更显著。然而，这些指标的组间相对优势比并不显著。此外，退出治疗组的客户在研究的最初三个月中心理健康和功能总体上有所改善，而退出对照组 的客户在较少指标上有改善。因此，关于该框架效果的研究结果尚无定论。
我们认为，这种不确定性可以通过对弱势群体进行社会心理研究的严峻挑战和伦理复杂性来解释。该研究突出了治疗项目中参与者流失这一严重问题，这影响了整个研究，并可能解释了最初看似与直觉相反的结果。
