Nervenheilkunde 2017; 36(08): 599-607
DOI: 10.1055/s-0039-3401519
Kulturelle Kompetenz
© Georg Thieme Verlag KG Stuttgart · New York

Challenges in the early assessment and protection of refugee survivors of torture and extreme violence

Besondere Fragestellungen in der Begutachtung und im Schutz von Folteropfern
T. Wenzel
1   WPA Section Sequels to Persecution and Torture and Dep. Psychiatry and Psychotherapy. Medical University of Vienna, Austria
,
H. Graf von Reventlow
2   NEXUS-Klinik, Baden-Baden
,
M. Kletecka-Pulker
3   Institute Law and Ethics in Medicine, University of Vienna and Medical University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

09 January 2017

Publication Date:
02 December 2019 (online)

Zusammenfassung

Die medizinische und psychiatrische Betreuung von Flüchtlingen ist zu einer globalen Herausforderung geworden. Spezielle Behandlung, Unterstützung und Schutz sind aufgrund der Gewalterfahrungen und den daraus resultierenden psychischen Folgen bei vielen Betroffenengruppen erforderlich. Folterüberlebende sind dabei aufgrund der oft schweren psychologischen Traumatisierung als besondere Gruppe zu berücksichtigen. Ihnen steht nach internationalen ethischen und Menschenrechtsstandards besonderer Schutz zu. Hierbei ist es nötig, Betroffene früh wäh-rend des Aufnahmeprozesses zu identifizieren, und diesen besonderen Schutz sowie weitere spezielle Hilfe zu gewähren. Dies erfordert einen interdisziplinären Ansatz unter Berücksichtigung besonderer rechtlicher und menschenrechtlicher Rahmenbedingungen. Bei der Begutachtung sind bezüglich Überlebenden von Folter besondere Aspekte zu berücksichtigen, die im „Istanbul Protokolls“ der Vereinten Nationen festgelegt sind.

Abstract

Refugees have become a global challenge and require special health care, support and protection. Survivors of torture are an especially important group due to their frequently high levels of physical and psychological sequels to the violence encountered. Early recognition and special protection steps are required both by international and by medical standards and may not be neglected out of any considerations. They require an interdisciplinary approach and awareness of legal and human rights standards, transcultural factors, and special formats of documentation and reporting, including the UN “Istanbul Protocol”. In assessment, special factors common in torture survivors must be considered.

 
  • Reference

  • 1 Lee BX, Donnelly PD, Cohen L, Garg S. Violence, health, and the 2030 agenda: Merging evidence and implementation. J Public Health Policy 2016; 37 (Suppl. 01) 1-12
  • 2 Zion D. Extending the clinical contract: advocacy as a part of ethical health care for asylum seekers. Am J Bioeth 2013; 13 (07) 19-21
  • 3 Stotz SJ, Elbert T, Muller V, Schauer M. The relationship between trauma, shame, and guilt: findings from a community-based study of refugee minors in Germany. Eur J Psychotraumatol 2015; 6: 25863
  • 4 Eide K, Hjern A. Unaccompanied refugee children – vulnerability and agency. Acta Paediatr 2013; 102 (07) 666-8
  • 5 Carta MG, Moro MF, Preti A, Lindert J, Bhugra D, Angermeyer M. et al Human rights of asylum seekers with psychosocial disabilities in Europe. Clin Pract Epidemiol Ment Health 2016; 12: 64-6
  • 6 Hopkinson RA, Keatley E, Glaeser E, Erickson-Schroth L, Fattal O, Nicholson SM. Persecution experiences and mental health of LGBT asylum seekers. J Homosex 2016; 10: 1-17
  • 7 Steel Z, Frommer N, Silove D. Part I – the mental health impacts of migration: the law and its effects failing to understand: refugee determination and the traumatized applicant. Int J Law Psychiatry 2004; 27 (06) 511-28
  • 8 Sukale T, Hertel C, Mohler E, Joas J, Muller M, Banaschewski T. et al [Diagnostics and initial estimation of refugee minors]. Nervenarzt 2016: 16 e-pub
  • 9 Sharma M, Fine SL, Brennan RT, Betancourt TS. Coping and mental health outcomes among Sierra Leonean war-affected youth: Results from a longitudinal study. Dev Psychopathol 2016; 21: 1-13
  • 10 Ba I, Bhopal RS. Physical, mental and social consequences in civilians who have experienced war-related sexual violence: a systematic review 1981–2014. Public Health 2016 Sep 10; e-pub
  • 11 Halevi G, Djalovski A, Vengrober A, Feldman R. Risk and resilience trajectories in war-exposed children across the first decade of life. J Child Psychol Psychiatry 2016; 57 (10) 1183-93
  • 12 Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights 2015; 15: 29
  • 13 Mugisha J, Muyinda H, Malamba S, Kinyanda E. Major depressive disorder seven years after the conflict in northern Uganda: burden, risk factors and impact on outcomes (The Wayo-Nero Study). BMC Psychiatry 2015; 15: 48
  • 14 Drozdek B, Kamperman AM, Tol WA, Knipscheer JW, Kleber RJ. Seven-year follow-up study of symptoms in asylum seekers and refugees with PTSD treated with trauma-focused groups. J Clin Psychol 2014; 70 (04) 376-87
  • 15 Buhmann C, Mortensen EL, Nordentoft M, Ryberg J, Ekstrom M. Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees. Torture 2015; 25 (01) 1-16
  • 16 Carlsson JM, Mortensen EL, Kastrup M. A follow-up study of mental health and health-related quality of life in tortured refugees in multidiscipli-nary treatment. J Nerv Ment Dis 2005; 193 (10) 651-7
  • 17 McFarlane CA, Kaplan I. Evidence-based psychological interventions for adult survivors of torture and trauma: a 30-year review. Transcult Psychiatry 2012; 49 3–4 539-67
  • 18 Wenzel T, Kienzler H, Wollmann A. Facing violence – a global challenge. Psychiatr Clin North Am 2015; 38 (03) 529-42
  • 19 Crosby SS. Primary care management of non-English-speaking refugees who have experienced trauma: a clinical review. JAMA 2013; 310 (05) 519-28
  • 20 Heinz A, Schneider F. [Psychiatric and psychotherapeutic care of refugees : Challenges and perspectives]. Nervenarzt 2016 Dec 19, e-pub
  • 21 Bohus M, Missmahl I. [Implementation of alternative treatment models for refugees in Germany : What can and what should we learn from Afghanistan?]. Nervenarzt 2016 Dec 19; e-pub
  • 22 Elbert T, Wilker S, Schauer M, Neuner F. [Dissemination of psychotherapy modules for traumatized refugees : Experience gained from trauma work in crisis and conflict regions]. Nervenarzt 2016 Nov 16, e-pub
  • 23 Fischer CJ, Struwe J, Lemke MR. [Long-term effects of traumatic experiences on somatic and psychic complaints of German World War Two refugees]. Nervenarzt 2006; 77 (01) 58-63
  • 24 Eisenman DP, Gelberg L, Liu H, Shapiro MF. Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA 2003; 290 (05) 627-34
  • 25 Eisenman DP, Keller AS, Kim G. Survivors of torture in a general medical setting: how often have patients been tortured, and how often is it missed?. West J Med 2000; 172 (05) 301-4
  • 26 Sigvardsdotter E, Vaez M, Rydholm Hedman AM, Saboonchi F. Prevalence of torture and other war-related traumatic events in forced migrants: A systematic review. Torture 2016; 26 (02) 41-73
  • 27 Patel N, de C, Kellezi B. Reviewing outcomes of psychological interventions with torture survivors: Conceptual, methodological and ethical Issues. Torture 2016; 26 (01) 2-16
  • 28 Williams AC, Amris K. Treatment of persistent pain from torture: review and commentary. Med Confl Surviv 2016; 1: 22
  • 29 Nickerson A, Garber B, Ahmed O, Asnaani A, Cheung J, Hofmann SG. et al Emotional suppression in torture survivors: Relationship to posttraumatic stress symptoms and trauma-related negative affect. Psychiatry Res 2016; 242: 233-9
  • 30 Choi H, Lee HJ, Lee HY. The effects of torture-related stressors on long-term complex post-traumatic symptoms in South Korean torture survivors. Int J Psychol 2016 May 5, e-pub
  • 31 Basoglu M, Paker M, Ozmen E, Tasdemir O, Sahin D. Factors related to long-term traumatic stress responses in survivors of torture in Turkey. JAMA 1994; 272 (05) 357-63
  • 32 Grunberg K, Markert F. A psychoanalytic grave walk – Scenic memory of the Shoah. On the transgenerational transmission of extreme trauma in Germany. Am J Psychoanal 2012; 72 (03) 207-22
  • 33 Rosenheck R. Impact of posttraumatic stress disorder of World War II on the next generation. J Nerv Ment Dis 1986; 174 (06) 319-27
  • 34 Summerfield D. The psychological legacy of war and atrocity: the question of long-term and transgenerational effects and the need for a broad view. J Nerv Ment Dis 1996; 184 (06) 375-7
  • 35 Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van OM. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 2009; 302 (05) 537-49
  • 36 Thompson M, McGorry P. Psychological sequelae of torture and trauma in Chilean and Salvadorean migrants: a pilot study. Aust N Z J Psychiatry 1995; 29 (01) 84-95
  • 37 Beynon J. „Not waving, drowning“. Asphyxia and torture: the myth of simulated drowning and other forms of torture. Torture 2012; 22 (Suppl. 01) 25-9
  • 38 Wenzel T. Torture. Curr Opin Psychiatry 2007; 20 (05) 491-6
  • 39 Akar FA, Arbel R, Benninga Z, Dia MA, Steiner-Birmanns B. The Istanbul protocol (manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment): implementation and education in Israel. Isr Med Assoc J 2014; 16 (03) 137-41
  • 40 Furtmayr H, Frewer A. Documentation of torture and the Istanbul Protocol: applied medical ethics. Med Health Care Philos 2010; 13 (03) 279-86
  • 41 Ucpinar H, Baykal T. An important step for prevention of torture. The Istanbul protocol and challenges. Torture 2006; 16 (03) 252-67
  • 42 Rasmussen OV. The medical aspects of the UN Convention against Torture. Torture 2006; 16 (01) 58-64
  • 43 Gomez JM, Smith CP, Gobin RL, Tang SS, Freyd JJ. Collusion, torture, and inequality: Understanding the actions of the American Psychological Association as institutional betrayal. J Trauma Dissociation 2016; 17 (05) 527-44
  • 44 Bohannon J. Scientific societies. Torture report prompts APA apology. Science 2015; 349 6245 221-2
  • 45 Caenazzo L, Tozzo P, Rodriguez D. Hospitalized hunger-striking prisoners: the role of ethics consultations. Med Health Care Philos 2016; 19 (04) 623-8
  • 46 Kenny MA, Silove DM, Steel Z. Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike. Med J Aust 2004; 180 (05) 237-40
  • 47 Woodhead M. Australian doctor challenges government over child detention „torture“. BMJ 2016; 352: i550
  • 48 Rogalla B. Nursing behind razor wire: a question of ethics. Aust Nurs J 200 8 (09) 21
  • 49 Coffey GJ, Kaplan I, Sampson RC, Tucci MM. The meaning and mental health consequences of long-term immigration detention for people seeking asylum. Soc Sci Med 2010; 70 (12) 2070-9
  • 50 Koopowitz LF, Abhary S. Psychiatric aspects of detention: illustrative case studies. Aust N Z J Psychiatry 2004; 38 (07) 495-500
  • 51 Sinnerbrink I, Silove D, Field A, Steel Z, Manicavasagar V. Compounding of premigration trauma and postmigration stress in asylum seekers. J Psychol 1997; 131 (05) 463-70
  • 52 Busch J, Hansen SH, Hougen HP. Geographical distribution of torture: An epidemiological study of torture reported by asylum applicants examined at the Department of Forensic Medicine, University of Copenhagen. Torture 2015; 25 (02) 12-21
  • 53 Alempijevic D, Beriashvili R, Beynon J, Duque M, Duterte P, Fernando R. et al Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel, inhuman or degrading treatment or punishment. J Forensic Leg Med 2013; 20 (03) 158-63
  • 54 den Otter JJ, Smit Y, dela Cruz LB, Ozkalipci O, Oral R. Documentation of torture and cruel, inhuman or degrading treatment of children: A review of existing guidelines and tools. Forensic Sci Int 2013; 224 1–3 27-32
  • 55 Park R, Oomen J. Context, evidence and attitude: the case for photography in medical examinations of asylum seekers in the Netherlands. Soc Sci Med 2010; 71 (02) 228-35
  • 56 Haagensen JO. The role of the Istanbul-Protocol in the uphill battle for torture survivors being granted asylum in Europe and ensuring the perpetrators pay. Torture 2007; 17 (03) 236-9
  • 57 Arnold FW. Detained asylum seekers may be being re-traumatised. BMJ 2007; 334 7600 916-7
  • 58 Keller AS, Ford D, Sachs E, Rosenfeld B, TrinhShevrin C, Meserve C. et al The impact of detention on the health of asylum seekers. J Ambul Care Manage 2003; 26 (04) 383-5
  • 59 Storm T, Engberg M. The impact of immigration detention on the mental health of torture survivors is poorly documented – a systematic review. Dan Med J 2013; 60 (11) A4728
  • 60 Iacopino V, Ozkalipci O, Schlar C. The Istanbul Protocol: international standards for the effective investigation and documentation of torture and ill treatment. Lancet 1999; 354 9184 1117
  • 61 Moreno A, Crosby S, Xenakis S, Iacopino V. Implementing Istanbul Protocol standards for forensic evidence of torture in Kyrgyzstan. J Forensic Leg Med 2015; 30: 39-42
  • 62 Moreno A, Iacopino V. Forensic investigations of torture and ill-treatment in Mexico. A follow-up study after the implementation of the Istanbul Protocol. J Leg Med 2008; 29 (04) 443-78
  • 63 Keten A, Akcan R, Karacaoglu E, Odabasi AB, Tumer AR. Medical forensic examination of detained immigrants: is the Istanbul Protocol followed?. Med Sci Law 2013; 53 (01) 40-4
  • 64 Wenzel T, Frewer A, Mirzaei S. The DSM 5 and the Istanbul Protocol: Diagnosis of psychological sequels of torture. Torture 2015; 25 (01) 51-61
  • 65 Wenzel T, Frewer A, Mirzaei S. The DSM 5 and the Istanbul Protocol: Diagnosis of psychological sequels of torture. Torture 2015; 25 (01) 51-61
  • 66 Schnyder U, Muller J, Morina N, Schick M, Bryant RA, Nickerson A. A comparison of DSM-5 and DSM-IV diagnostic criteria for posttraumatic stress disorder in traumatized refugees. J Trauma Stress 2015; 28 (04) 267-74
  • 67 Stojakovic MB. Forensic psychiatric expertise: posttraumatic stress disorder. Srp Arh Celok Lek 2011; 139 (Suppl. 01) 46-51
  • 68 Beltran RO, Silove D, Llewellyn GM. Comparison of ICD-10 diagnostic guidelines and research criteria for enduring personality change after catastrophic experience. Psychopathology 2009; 42 (02) 113-8
  • 69 Beltran RO, Silove D. Expert opinions about the ICD-10 category of enduring personality change after catastrophic experience. Compr Psychiatry 1999; 40 (05) 396-403
  • 70 Wenzel T, Griengl H, Stompe T, Mirzaei S, Kieffer W. Psychological disorders in survivors of torture: exhaustion, impairment and depression. Psycho-pathology 2000; 33 (06) 292-6
  • 71 Wenzel T, Rushiti F, Aghani F, Diaconu G, Maxhuni B, Zitterl W. Suicidal ideation, post-traumatic stress and suicide statistics in Kosovo. An analysis five years after the war. Suicidal ideation in Kosovo. Torture 2009; 19 (03) 238-47
  • 72 Amris K, Williams AC. Managing chronic pain in survivors of torture. Pain Manag 2015; 5 (01) 5-12
  • 73 Bin ZA, Hubbard ME, Dammavalam VM, Balser DY, Pierre G, Kim A. et al Assessment of acute head injury in an emergency department population using sport concussion assessment tool – 3rd edition. Appl Neuropsychol Adult 2016; 1: 10
  • 74 Tator CH, Davis HS, Dufort PA, Tartaglia MC, Davis KD, Ebraheem A. et al Postconcussion syndrome: demographics and predictors in 221 patients. J Neurosurg 2016; 125 (05) 1206-16
  • 75 Keatley E, d‘Alfonso A, Abeare C, Keller A, Bertelsen NS. Health outcomes of traumatic brain injury among refugee survivors of torture. J Head Trauma Rehabil 2015; 30 (06) E1-E8
  • 76 Keatley E, Ashman T, Im B, Rasmussen A. Self-reported head injury among refugee survivors of torture. J Head Trauma Rehabil 2013; 28 (06) E8-E13
  • 77 Weinstein CS, Fucetola R, Mollica R. Neuropsychological issues in the assessment of refugees and victims of mass violence. Neuropsychol Rev 2001; 11 (03) 131-41
  • 78 Koerte IK, Lin AP, Willems A, Muehlmann M, Hufschmidt J, Coleman MJ. et al A review of neuroimaging findings in repetitive brain trauma. Brain Pathol 2015; 25 (03) 318-49
  • 79 Larres DT, Carr W, Gonzales EG, Hawley JS. The natural history of acute recovery of blast-induced mild traumatic brain injury: A case series during war. Mil Med 2016; 181 (Suppl. 05) 23-7
  • 80 Manners JL, Forsten RD, Kotwal RS, Elbin RJ, Collins MW, Kontos AP. Role of pre-morbid factors and exposure to blast mild traumatic brain injury on post-traumatic stress in United States military personnel. J Neurotrauma 2016; 33 (19) 1796-801
  • 81 Warrett M, Tam R, Hernandez-Torres E, Martin N, Perera W, Zhao Y. et al A prospective pilot Investigation of brain volume, white matter hyperintensities, and hemorrhagic lesions after mild traumatic brain injury. Front Neurol 2016; 7: 11
  • 82 Orrison WW, Hanson EH, Alamo T, Watson D, Sharma M, Perkins TG. et al Traumatic brain injury: a review and high-field MRI findings in 100 unarmed combatants using a literature-based checklist approach. J Neurotrauma 2009; 26 (05) 689-701
  • 83 Diamond DM, Zoladz PR. Dysfunctional or hyperfunctional? The amygdala in posttraumatic stress disorder is the bull in the evolutionary China shop. J Neurosci Res 2016; 94 (06) 437-44
  • 84 Sipahi L, Uddin M, Hou ZC, Aiello AE, Koenen KC, Galea S. et al Ancient evolutionary origins of epigenetic regulation associated with posttraumatic stress disorder. Front Hum Neurosci 2014; 8: 284
  • 85 Baldwin DV. Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders. Neurosci Biobehav Rev 2013; 37 (08) 1549-66
  • 86 Jacob KS. DSM-5 and culture: the need to move towards a shared model of care within a more equal patient-physician partnership. Asian J Psychiatr 2014; 7 (01) 89-91
  • 87 Chang EC, Kwon P. Special issue on psychopathology in Asians and the DSM-5: culture matters. Asian J Psychiatr 2014; 7 (01) 66-7
  • 88 Lewis-Fernandez R, Aggarwal NK. Culture and psychiatric diagnosis. Adv Psychosom Med 2013; 33: 15-30
  • 89 Warren BJ. How culture is assessed in the DSM-5. J Psychosoc Nurs Ment Health Serv 2013; 51 (04) 40-5
  • 90 Wenzel T, Frewer A, Mirzaei S. The DSM 5 and the Istanbul Protocol: Diagnosis of psychological sequels of torture. Torture 2015; 25 (01) 51-61
  • 91 Kotov R, Perlman G, Gamez W, Watson D. The structure and short-term stability of the emotional disorders: a dimensional approach. Psychol Med 2015; 45 (08) 1687-98
  • 92 Berna G, Vaiva G, Ducrocq F, Duhem S, Nandrino JL. Categorical and dimensional study of the predictive factors of the development of a psychotrauma in victims of car accidents. J Anxiety Disord 2012; 26 (01) 239-45
  • 93 Diaz E, Anez LM, Silva M, Paris M, Davidson L. Using the cultural formulation interview to build culturally sensitive services. Psychiatr Serv 2016 appips201600440
  • 94 Mills S, Wolitzky-Taylor K, Xiao AQ, Bourque MC, Rojas SM, Bhattacharya D. et al Training on the DSM-5 cultural formulation interview improves cultural competence in general psychiatry residents: A multi-site study. Acad Psychiatry 2016; 40 (05) 829-34
  • 95 Craig SR, Chase L, Lama TN. Taking the MINI to Mustang, Nepal: methodological and epistemological translations of an illness narrative interview tool. Anthropol Med 2010; 17 (01) 1-26
  • 96 Cederbaum JA, Wilcox SL, Sullivan K, Lucas C, Schuyler A. The influence of social support on dyadic functioning and mental health among military personnel during postdeployment reintegration. Public Health Rep 2017; 132 (01) 85-92
  • 97 Cox DW, Owen JJ, Ogrodniczuk JS. Group psychotherapeutic factors and perceived social support among veterans with PTSD symptoms. J Nerv Ment Dis 2016 Dec 1; e-pub
  • 98 Rosner R. Prolonged grief: setting the research agenda. Eur J Psychotraumatol 2015; 6: 27303
  • 99 Wakefield JC. DSM-5, psychiatric epidemiology and the false positives problem. Epidemiol Psychiatr Sci 2015; 24 (03) 188-96
  • 100 Basu H. Listening to disembodied voices: anthropological and psychiatric challenges. Anthropol Med 2014; 21 (03) 325-42
  • 101 van DM, Kleijn W, de JJ. Are symptoms of spirit possessed patients covered by the DSM-IV or DSM-5 criteria for possession trance disorder? A mixed-method explorative study in Uganda. Soc Psychiatry Psychiatr Epidemiol 2013; 48 (09) 1417-30
  • 102 van DM, Cardena E, De Jong JT. The validity of DSM-IV dissociative disorders categories in south-west Uganda. Transcult Psychiatry 2005; 42 (02) 219-41
  • 103 Adler SR. Refugee stress and folk belief: Hmong sudden deaths. Soc Sci Med 1995; 40 (12) 1623-9
  • 104 Tobin JJ, Friedman J. Spirits, shamans, and nightmare death: survivor stress in a Hmong refugee. Am J Orthopsychiatry 1983; 53 (03) 439-48
  • 105 van DM, Kleijn W, de JJ. Unravelling the spirits‘ message: a study of help-seeking steps and explanatory models among patients suffering from spirit possession in Uganda. Int J Ment Health Syst 2014; 8: 24
  • 106 Elmore JL. Dissociative spectrum disorders in the primary care setting. Prim Care Companion J Clin Psychiatry 2000; 2 (02) 37-41
  • 107 Kaiser BN, Haroz EE, Kohrt BA, Bolton PA, Bass JK, Hinton DE. „Thinking too much“: A systematic review of a common idiom of distress. Soc Sci Med 2015; 147: 170-83
  • 108 Kohrt BA, Luitel NP, Acharya P, Jordans MJ. Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal. BMC Psychiatry 2016; 16: 58
  • 109 Wenzel T, Kienzler H, Wollmann A. Facing violence – a global challenge. Psychiatr Clin North Am 2015; 38 (03) 529-42
  • 110 Shannon PJ, Wieling E, McCleary JS, Becher E. Exploring the mental health effects of political trauma with newly arrived refugees. Qual Health Res 2015; 25 (04) 443-57
  • 111 Alemi Q, Weller SC, Montgomery S, James S. Afghan refugee explanatory models of depression: Exploring core cultural beliefs and gender variations. Med Anthropol Q 2016 Apr 26, e-pub
  • 112 Hecker T, Braitmayer L, van DM. Global mental health and trauma exposure: the current evidence for the relationship between traumatic experiences and spirit possession. Eur J Psychotraumatol 2015; 6: 29126
  • 113 Molsa M, Punamaki RL, Saarni SI, Tiilikainen M, Kuittinen S, Honkasalo ML. Mental and somatic health and pre- and post-migration factors among older Somali refugees in Finland. Trans-cult Psychiatry 2014; 51 (04) 499-525
  • 114 Jordans MJ, Semrau M, Thornicroft G, van OM. Role of current perceived needs in explaining the association between past trauma exposure and distress in humanitarian settings in Jordan and Nepal. Br J Psychiatry 2012; 201 (04) 276-81
  • 115 Vindbjerg E, Carlsson J, Mortensen EL, Elklit A, Makransky G. The latent structure of post-traumatic stress disorder among Arabic-speaking refugees receiving psychiatric treatment in Denmark. BMC Psychiatry 2016; 16 (01) 309
  • 116 Hollifield M, Toolson EC, Verbillis-Kolp S, Farmer B, Yamazaki J, Woldehaimanot T. et al Effective screening for emotional distress in refugees: The Refugee Health Screener. J Nerv Ment Dis 2016; 204 (04) 247-53
  • 117 Hollifield M, Verbillis-Kolp S, Farmer B, Toolson EC, Woldehaimanot T, Yamazaki J. et al The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees. Gen Hosp Psychiatry 2013; 35 (02) 202-9
  • 118 Polcher K, Calloway S. Addressing the need for mental health screening of newly resettled refugees: A pilot project. J Prim Care Community Health 2016; 7 (03) 199-203
  • 119 Johnson-Agbakwu CE, Allen J, Nizigiyimana JF, Ramirez G, Hollifield M. Mental health screening among newly arrived refugees seeking routine obstetric and gynecologic care. Psychol Serv 2014; 11 (04) 470-6
  • 120 Rasmussen A, Ventevogel P, Sancilio A, Eggerman M, Panter-Brick C. Comparing the validity of the self reporting questionnaire and the Afghan symptom checklist: dysphoria, aggression, and gender in transcultural assessment of mental health. BMC Psychiatry 2014; 14: 206
  • 121 Miller KE, Omidian P, Quraishy AS, Quraishy N, Nasiry MN, Nasiry S. et al The Afghan symptom checklist: a culturally grounded approach to mental health assessment in a conflict zone. Am J Orthopsychiatry 2006; 76 (04) 423-33
  • 122 Britton PN, Isaacs D. What‘s in the frame: the ethics of asylum seeker health care. Am J Bioeth 2013; 13 (07) 21-2
  • 123 McAdam J. Part III – rights and remedies: the convention against torture alternative asylum mechanisms: the convention against torture and other cruel, inhuman or degrading treatment or punishment. Int J Law Psychiatry 2004; 27 (06) 627-43