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Meta-Analysis
. 2014 Nov 11;2014(11):CD009317.
doi: 10.1002/14651858.CD009317.pub2.

Psychological, social and welfare interventions for psychological health and well-being of torture survivors

Nimisha Patel  1 , Blerina Kellezi, Amanda C de C Williams
Affiliations
Meta-Analysis

Psychological, social and welfare interventions for psychological health and well-being of torture survivors

Nimisha Patel et al. Cochrane Database Syst Rev. .

Abstract

Background: Torture is widespread, with potentially broad and long-lasting impact across physical, psychological, social and other areas of life. Its complex and diverse effects interact with ethnicity, gender, and refugee experience. Health and welfare agencies offer varied rehabilitation services, from conventional mental health treatment to eclectic or needs-based interventions. This review is needed because relatively little outcome research has been done in this field, and no previous systematic review has been conducted. Resources are scarce, and the challenges of providing services can be considerable.

Objectives: To assess beneficial and adverse effects of psychological, social and welfare interventions for torture survivors, and to compare these effects with those reported by active and inactive controls.

Search methods: Randomised controlled trials (RCTs) were identified through a search of PsycINFO, MEDLINE, EMBASE, Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Specialised Register (CCDANCTR), the Latin American and Caribbean Health Science Information Database (LILACS), the Open System for Information on Grey Literature in Europe (OpenSIGLE), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and Published International Literature On Traumatic Stress (PILOTS) all years to 11 April 2013; searches of Cochrane resources, international trial registries and the main biomedical databases were updated on 20 June 2014. We also searched the Online Library of Dignity (Danish Institute against Torture), reference lists of reviews and included studies and the most frequently cited journals, up to April 2013 but not repeated for 2014. Investigators were contacted to provide updates or details as necessary.

Selection criteria: Full publications of RCTs or quasi-RCTs of psychological, social or welfare interventions for survivors of torture against any active or inactive comparison condition.

Data collection and analysis: We included all major sources of grey literature in our search and used standard methodological procedures as expected by The Cochrane Collaboration for collecting data, evaluating risk of bias and using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods to assess the quality of evidence.

Main results: Nine RCTs were included in this review. All were of psychological interventions; none provided social or welfare interventions. The nine trials provided data for 507 adults; none involved children or adolescents. Eight of the nine studies described individual treatment, and one discussed group treatment. Six trials were conducted in Europe, and three in different African countries. Most people were refugees in their thirties and forties; most met the criteria for post-traumatic stress disorder (PTSD) at the outset. Four trials used narrative exposure therapy (NET), one cognitive-behavioural therapy (CBT) and the other four used mixed methods for trauma symptoms, one of which included reconciliation methods. Five interventions were compared with active controls, such as psychoeducation; four used treatment as usual or waiting list/no treatment; we analysed all control conditions together. Duration of therapy varied from one hour to longer than 20 hours with a median of around 12 to 15 hours. All trials reported effects on distress and on PTSD, and two reported on quality of life. Five studies followed up participants for at least six months.No immediate benefits of psychological therapy were noted in comparison with controls in terms of our primary outcome of distress (usually depression), nor for PTSD symptoms, PTSD caseness, or quality of life. At six-month follow-up, three NET and one CBT study (86 participants) showed moderate effect sizes for intervention over control in reduction of distress (standardised mean difference (SMD) -0.63, 95% confidence interval (CI) -1.07 to -0.19) and of PTSD symptoms (SMD -0.52, 95% CI -0.97 to -0.07). However, the quality of evidence was very low, and risk of bias resulted from researcher/therapist allegiance to treatment methods, effects of uncertain asylum status of some people and real-time non-standardised translation of assessment measures. No measures of adverse events were described, nor of participation, social functioning, quantity of social or family relationships, proxy measures by third parties or satisfaction with treatment. Too few studies were identified for review authors to attempt sensitivity analyses.

Authors' conclusions: Very low-quality evidence suggests no differences between psychological therapies and controls in terms of immediate effects on post-traumatic symptoms, distress or quality of life; however, NET and CBT were found to confer moderate benefits in reducing distress and PTSD symptoms over the medium term (six months after treatment). Evidence was of very low quality, mainly because non-standardised assessment methods using interpreters were applied, and sample sizes were very small. Most eligible trials also revealed medium to high risk of bias. Further, attention to the cultural appropriateness of interventions or to their psychometric qualities was inadequate, and assessment measures used were unsuitable. As such, these findings should be interpreted with caution.No data were available on whether symptom reduction enabled improvements in quality of life, participation in community life, or in social and family relationships in the medium term. Details of adverse events and treatment satisfaction were not available immediately after treatment nor in the medium term. Future research should aim to address these gaps in the evidence and should include larger sample sizes when possible. Problems of torture survivors need to be defined far more broadly than by PTSD symptoms, and recognition given to the contextual influences of being a torture survivor, including as an asylum seeker or refugee, on psychological and social health.

PubMed Disclaimer

Conflict of interest statement

NP and AW are clinical practitioners as well as academics; both have extensive clinical and research experience with torture survivors; AW has conducted a treatment trial in another field of mental health.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Psychological intervention versus control, Outcome 1 Distress.
1.2
1.2. Analysis
Comparison 1 Psychological intervention versus control, Outcome 2 Post‐traumatic stress symptoms.
1.3
1.3. Analysis
Comparison 1 Psychological intervention versus control, Outcome 3 Post‐traumatic stress caseness.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD009317

References

References to studies included in this review

Bichescu 2007 {published data only}
    1. Bichescu D, Neuner F, Schauer M, Elbert T. Narrative exposure therapy for political imprisonment‐related chronic posttraumatic stress disorder and depression. Behaviour Research and Therapy 2007;45(9):2212‐20. - PubMed
Hensel‐Dittmann 2011 {published data only}
    1. Hensel‐Dittmann D, Schauer M, Ruf M, Catani C, Odenwald M, Elbert T, et al. Treatment of traumatized victims of war and torture: a randomized controlled comparison of narrative exposure therapy and stress inoculation training. Psychotherapy and Psychosomatics 2011;80(6):345‐52. - PubMed
Igreja 2004 {published data only}
    1. Igreja V, Kleijn WC, Schreuder BJ, Dijk JA, Verschuur M. Testimony method to ameliorate post‐traumatic stress symptoms. Community‐based intervention study with Mozambican civil war survivors. British Journal of Psychiatry 2004;184:251‐7. - PubMed
Neuner 2010 {published data only}
    1. Neuner F, Kurreck S, Ruf M, Odenwald M, Elbert T, Schauer M. Can asylum‐seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cognitive Behaviour Therapy 2010;39(3):81‐91. - PubMed
Paunovic 2001 {published data only}
    1. Paunovic N, Ost LG. Cognitive‐behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behaviour Research and Therapy 2001;39(10):1183‐97. - PubMed
Pokhariyal 2012 {published data only}
    1. Pokhariyal GP, Rono R, Munywoki S. Analysis of treatment methods for victims of torture in Kenya and East Africa region. Traumatology 2013;19(2):107‐17.
Schauer 2006 {published data only}
    1. Schauer M, Elbert T, Gotthardt S, Rockstroh B, Odenwald M, Neuner F. Imaginary reliving in psychotherapy modifies mind and brain [Wiedererfahrung durch Psychotherapie modifiziert Geistund Gehirn*]. Verhaltenstherapie 2006;16(2):96‐103.
ter Heide 2011 {published data only}
    1. ter Heide JJ, Mooren TM, Kleijn W, Jongh A, Kleber RJ. EMDR versus stabilisation in traumatised asylum seekers and refugees: results of a pilot study. European Journal of Psychotraumatology 2011;2:5881. - PMC - PubMed
Yeomans 2010 {published data only}
    1. Yeomans PD, Forman EM, Herbert JD, Yuen E. A randomized trial of a reconciliation workshop with and without PTSD psychoeducation in Burundian sample. Journal of Traumatic Stress 2010;23(3):305‐12. - PubMed

References to studies excluded from this review

Adenauer 2011 {published data only}
    1. Adenauer H, Catani C, Gola H, Keil J, Ruf M, Schauer M, et al. Narrative exposure therapy for PTSD increases top‐down processing of aversive stimuli—evidence from a randomized controlled treatment trial. BMC Neuroscience 2011;12(127):1‐13. - PMC - PubMed
    1. Catani C, Neuner F. Change of Neural Network Indicators Through Narrative Treatment of PTSD in Torture Victims. NCT00563888 2007 (accessed 20 June 2014).
Akhtar 1994 {published data only}
    1. Akhtar P. Project report: therapeutic effects of music on torture survivors and refugees. Torture 1994;4:121‐3.
Bass 2013 {published data only}
    1. Bass JK, Annan J, McIvor Murray S, Kaysen D, Griffiths S, Ketinoglu T, et al. Controlled trial of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine 2013;368:2182‐91. - PubMed
Carr 2011 {published data only}
    1. Carr C, d'Ardenne P, Sloboda A, Scott C, Wang D, Priebe S. Group music therapy for patients with persistent post‐traumatic stress disorder: an exploratory randomized controlled trial with mixed methods evaluation. Psychology and Psychotherapy: Theory, Research and Practice 2011;10:1‐24. - PubMed
Dybdhal 2001 {published data only}
    1. Dybdahl R. Children and mothers in war: an outcome study of a psychosocial intervention program. Child Development 2001;72(4):1214‐30. - PubMed
Hijazi 2014 {published data only}
    1. Hijazi AM, Lumley MA, Ziadni MS, Rapport LJ, Arnetz BB. Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: a preliminary randomized clinical trial. Journal of Traumatic Stress 2014;27:314‐22. - PMC - PubMed
Kalantari 2012 {published data only}
    1. Kalantari M, Yule W, Dyregrov A, Neshatdoost A, Ahmadi SJ. Efficacy of writing for recovery on traumatic grief symptoms of Afghani refugee bereaved adolescents: a randomized control trial. Omega 2012;65:139‐50. - PubMed
Liedl 2011 {published data only}
    1. Liedl A, Muller J, Morina N, Karl A, Denke C, Knaevelsrud C. Physical activity within a CBT intervention improves coping with pain in traumatized refugees: results of a randomized controlled design. Pain 2011;12(2):234‐45. - PubMed
Meffert 2011 {published data only}
    1. Meffert SM, Abdo AO, Abd Alla OA, Almaki YOM, Omer AA, Yousif S, et al. A pilot randomized controlled trial of interpersonal psychotherapy for Sudanese refugees in Cairo, Egypt. Psychological Trauma: Theory, Research, Practice, and Policy 2011:doi: 10.1037/a0023540.
Mills 2012 {published data only}
    1. Mills LK, Teesson M, Back SE, Brady KT, Baker AL, Hopwood S, et al. Integrated exposure‐based therapy for co‐occurring posttraumatic stress disorder and substance dependence: a randomized controlled trial. Journal of the American Medical Association 2012;308(7):690‐9. - PubMed
Morath 2014 {published data only}
    1. Morath J, Gola H, Sommershof A, Hamuni G, Kolassa S, Catani C, et al. The effect of trauma‐focused therapy on the altered T cell distribution in individuals with PTSD: evidence from a randomized controlled trial. Journal of Psychiatric Research 2014;54:1‐10. - PubMed
Neuner 2004 {published data only}
    1. Neuner F, Schauer M, Klaschik C, Karunakara U, Elbert T. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology 2004;72(4):579‐87. - PubMed
Rees 2013 {published data only}
    1. Rees B, Travis F, Shapiro D, Chant R. Reduction in posttraumatic stress symptoms in Congolese refugees practicing transcendental meditation. Journal of Traumatic Stress 2013;26:295‐8. - PubMed
Schaal 2009 {published data only}
    1. Schaal S, Elbert T, Neuner F. Narrative exposure therapy versus interpersonal psychotherapy: a pilot randomized controlled trial with Rwandan genocide orphans. Psychotherapy and Psychosomatics 2009;78(5):298‐306. - PubMed
Sonne 2013 {published data only}
    1. Sonne C, Carlsson J, Elklit A, Mortensen EL, Ekstrøm M. Treatment of traumatized refugees with sertraline versus venlafaxine in combination with psychotherapy—study protocol for a randomized clinical trial. Trials 2013;14:137. - PMC - PubMed
Stenmark 2013 {published data only}
    1. Halvorsen JØ, Stenmark H, Neuner F, Nordahl HM. Does dissociation moderate treatment outcomes of narrative exposure treatment for PTSD? A secondary analysis from a randomized controlled clinical trial. Behaviour Research and Therapy 2014;57:21‐8. - PubMed
    1. Stenmark H, Catani C, Neuner F, Elbert T, Holen A. Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study. Behaviour Research and Therapy 2013;51:641‐7. - PubMed
Talbot 2013 {published data only}
    1. Talbot A, Uwihoreye C, Kamen C, Grant P, McGlynn L, Mugabe I, et al. Treating psychological trauma among Rwandan orphans is associated with a reduction in HIV risk‐taking behaviors: a pilot study. AIDS Education and Prevention 2013;25:468‐79. - PubMed
Walstrom 2013 {published data only}
    1. Walstrom P, Operario D, Zlotnick C, Mutimura E, Benekigeri C, Cohen MH. 'I think my future will be better than my past': examining support group influence on the mental health of HIV‐infected Rwandan women. Global Public Health 2013;8:90‐105. - PMC - PubMed

References to studies awaiting assessment

Bolton 2011 {published data only}
    1. Bolton P. A Controlled Trial of Mental Health Interventions for Torture Survivors in Kurdistan Scientific title: A Controlled Trial of Mental Health Interventions for Common Mental Health Problems Experienced by Torture Survivors Living in Kurdistan, Iraq. http://clinicaltrials.gov/ct2/show/NCT00925262 2011 (accessed 20 June 2014).
Cavka 2005 {published data only}
    1. Cavka M, Joksimovic L, Schmitz N, Kruse J. Psychotherapeutic treatment of traumatised refugees with PTSD disorders: a randomised controlled trial. Journal of Psychosomatic Research 2005;58(6):S86.
Kolassa 2012 {published data only}
    1. Kolassa IT. Immunological changes through narrative treatment of post‐traumatic stress disorder (PTSD) in torture victims. http://clinicaltrials.gov/ct2/show/NCT01206790 2010 (accessed 20 June 2014).
Robinson 2014 {published data only}
    1. Robinson C. Effectiveness of mental health interventions on the Thailand‐Burma border. http://clinicaltrials.gov/ct2/show/NCT01459068 2011 (accessed 20 June 2014).
Stenmark 2008 {published and unpublished data}
    1. Stenmark H, Catani C, Elbert T, Gøtestam KG. Narrative exposure therapy compared to treatment as usual for refugees with PTSD—preliminary results from a randomized controlled trial. European Psychiatry [abstracts of the 20th European Congress of Psychiatry, EPA 2012 Mar 3‐6; Prague Czech Republic]. 2008; Vol. 23 (Suppl 2):S90.
Weiss 2012 {published data only}
    1. Weiss WM. Study of Effectiveness of Mental Health Interventions Among Torture Survivors in Southern Iraq. http://clinicaltrials.gov/ct2/show/NCT01177072 2012 (accessed 20 June 2014).

References to ongoing studies

Knaevelsrud 2011 {published data only}
    1. Knaevelsrud C. Effects of Exposure for Posttraumatic Stress Disorder With and Without Cognitive Restructuring in an Internet‐based Intervention. http://clinicaltrials.gov/ct2/show/NCT01508377 2011 (accessed 20 June 2014).

Additional references

AI 2013
    1. Amnesty International. Amnesty International Report: The State of the World's Human Rights. http://files.amnesty.org/air13/AmnestyInternational_AnnualReport2013_com... (accessed 25 September 2013).
Basoglu 2001
    1. Basoglu M, Jaranson JM, Mollica R, Kastrup M. Torture and mental health: a research overview. In: Gerrity E, Keane TM, Tuma F editor(s). Mental Health Consequences of Torture. NY: Kluwer Academic/Plenum Publishers, Inc, 2001.
Bisson 2009
    1. Bisson J, Andrew M. Psychological treatment of post‐traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD003388.pub3] - DOI
Bogner 2010
    1. Bögner D, Brewin C, Herlihy J. Refugees’ experiences of Home Office interviews: a qualitative study on the disclosure of sensitive personal information. J Ethnic Migration Studies 2010;36(3):519‐35.
Boyle 1999
    1. Boyle M. Diagnosis. In: Newnes C, Holmes G, Dunn C editor(s). This Is Madness: A Critical Look at Psychiatry and the Future of Mental Health Services. Ross‐on‐Wye: PCCS, 1999.
Boyle 2002
    1. Boyle M. Schizophrenia: A Scientific Delusion?. Second Edition. London: Routledge, 2002.
Boynton 2004
    1. Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ 2004;328:1312‐5. - PMC - PubMed
Bracken 1995
    1. Bracken P, Giller J, Summerfield D. Psychological responses of war and atrocity: limitations of current concepts. Social Science and Medicine 1995;40(8):1073‐82. - PubMed
Bracken 1998
    1. Bracken PJ, Celia P. Rethinking the trauma of war. London: Save the Children with Free Association Books, 1998.
Burck 2004
    1. Burck C. Living in several languages: implications for therapy. Journal of Family Therapy 2004;26:314‐39.
Burnett 2001
    1. Burnett A, Peel M. The health of survivors of torture and organised violence. BMJ 2001;322:606‐9. - PMC - PubMed
Campbell 2007
    1. Campbell T. Psychological assessment, diagnosis, and treatment of torture survivors: a review. Clinical Psychology Review 2007;27:628‐41. - PubMed
CAPS
    1. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician‐administered PTSD scale. Journal of Trauma and Stress 1995;8:75–90. - PubMed
Crumlish 2010
    1. Crumlish N, O’Rourke K. A systematic review of treatments for post‐traumatic stress disorder among refugees and asylum seekers. The Journal of Nervous and Mental Disease 2010;198:237‐51. - PubMed
Elsass 2009
    1. Elsass P, Carlsson J, Jespersen K, Phuntsok K. Questioning Western assessment of trauma among Tibetan torture survivors. A quantitative assessment study with comments from Buddhist Lamas. Torture 2009;19(3):194‐203. - PubMed
Fernando 2003
    1. Fernando S. Cultural Diversity, Mental Health and Psychiatry. Hove: Brunner‐Routledge, 2003.
Gorst‐Unsworth 1998
    1. Gorst‐Unsworth C, Goldenberg E. Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma‐related factors compared with social factors in exile. The British Journal of Psychiatry 1998;172:90‐4. - PubMed
Goswami 2013
    1. Goswami S, Rodriguez‐Sierra O, Cascardi M, Pare D. Animal models of post‐traumatic stress disorder: face validity. Frontiers in Neuroscience 2013;7:89. - PMC - PubMed
Gurr 2001
    1. Gurr R, Quiroga J. Approaches to torture rehabilitation. Torture 2001;11:5‐35.
Haenel 1997
    1. Haenel F. Aspects and problems associated with the use of interpreters in psychotherapy of victims of torture. Torture 1997;7(3):68‐71.
Halvorsen 2014
    1. Halvorsen JØ, Stenmark H, Neuner F, Nordahl HM. Does dissociation moderate treatment outcomes of narrative exposure treatment for PTSD? A secondary analysis from a randomized controlled clinical trial. Behaviour Research and Therapy 2014;57:21‐8. - PubMed
Hamilton 1960
    1. Hamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 1960;23:56‐62. - PMC - PubMed
Heine 2002
    1. Heine SJ, Lehman DR, Peng K, Greenholtz J. What’s wrong with cross‐cultural comparisons of subjective Likert scales? The reference‐group effect. Journal of Personality and Social Psychology 2002;82:903‐18. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DA. Measuring inconsistency in meta‐analyses. British Medical Journal 2003;327:557‐60. - PMC - PubMed
Higgins 2008a
    1. Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2008. www.cochrane‐handbook.org, 2008.
Higgins 2008b
    1. Higgins JPT, Deeks JJ, Altman DG (editors). Chapter 16.5: Special topics in statistics. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2008. www.cochrane‐handbook.org, 2008.
Hollifield 2002a
    1. Hollifield M. Accurate measurement in cultural psychiatry: will we pay the costs?. Transcultural Psychiatry 2002;39:419‐21.
Hollifield 2002b
    1. Hollifield M, Warner T, Lian N, Krakow B, Jenkins JH, Kesler J, et al. Measuring trauma and health status in a refugees: a critical review. Journal of the American Medical Association 2002;288:611‐21. - PubMed
IRCT 2010
    1. International Rehabilitation Council for Torture Victims. 26 June ‐ International Day against Torture. The fight against torture: a key priority for the EU. http://europa.eu/rapid/pressReleasesAction.do?reference=MEMO/07/254. Accessed 25 February 2010.
Jacobs 2001
    1. Jacobs U, Iacopino V. Torture and its consequences: a challenge to clinical neuropsychology. Professional Psychology—Research and Practice 2001;32(5):458‐64.
Jaranson 1995
    1. Jaranson JM. Government‐sanctioned torture: status of the rehabilitation movement. Transcultural Psychiatric Research Review 1995;32:253‐86.
Jaranson 2011
    1. Jaranson JM, Quiroga J. Evaluating the services of torture rehabilitation programmes: history and recommendations. Torture 2011;21:98‐140. - PubMed
Johnson 2006
    1. Johnson TP. Methods and frameworks for cross‐cultural measurement. Medical Care 2006;44:S17‐S20. - PubMed
Johnson 2008
    1. Johnson H, Thompson A. The development and maintenance of post‐traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clinical Psychology Review 2008;28(1):36‐47. - PubMed
Kutchins 1997
    1. Kutchins H, Kirk S. Making Us Crazy: DSM, The Psychiatric Bible and the Creation of Mental Disorders. New York: Free Press, 1997.
Laban 2004
    1. Laban CJ, Gernaat HB, Komproe IH, Schreuders BA, Jong JT. Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands. The Journal of Nervous and Mental Disease 2004;192(12):843‐51. - PubMed
Laungani 2004
    1. Laungani P. Asian Perspectives in Counselling and Psychotherapy. Hove: Brunner‐Routledge, 2004.
Lee 2007
    1. Lee DT, Kleinman J. Kleinman A. Rethinking depression: an ethnographic study of the experiences of depression among Chinese. Harvard Review of Psychiatry 2007;15(1):1‐8. - PubMed
Lund 2008
    1. Lund M, Sørensen JH, Christensen JB, Ølholm A. MTV om behandling og rehabilitering af PTSD—herunder traumatiserede flygtninge. Vejle: Udgivet af Region Syddanmark [Published by Center for Quality, South Denmark], 2008. [ISBN 978‐87‐92217‐03‐5]
Mahtani 2003
    1. Mahtani A. The right to appropriate psychological services. International Journal of Human Rights 2003;7:40‐57.
McFarlane 2012
    1. McFarlane C, Kaplan I. Evidence‐based psychological interventions for adult survivors of torture and trauma: a 30‐year review. Transcult Psychiatry 2012;49:539‐67. - PubMed
McHorney 2006
    1. McHorney CA, Fleishman JA. Assessing and understanding measurement equivalence in health outcome measures. Medical Care 2006;44:S205‐S210. - PubMed
McIvor 1995
    1. McIvor RJ. Turner SW. Assessmnet and treatment approaches for survivors of torture. British Journal of Psychiatry 1995;166:705‐11. - PubMed
Miranda 2005
    1. Miranda J, Bernal G, Lau A, Kohn L, Hwang W, Framboise T. State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology 2005;1:113‐42. - PMC - PubMed
Mollica 2004
    1. Mollica R, McDonald L, Massagli M, Silove D. Measuring Trauma, Measuring Torture: Instructions and Guidance on the Utilization of the Harvard Program in Refugee Trauma’s Versions of the Hopkins Symptom Checklist‐25 (HSCL‐25) and the Harvard Trauma Questionnaire (HTQ). Cambridge, MA: Harvard Program in Refugee Trauma, 2004.
Montgomery 2011
    1. Montgomery E, Patel N. Torture rehabilitation: reflections on treatment outcome studies. Torture 2011;21:141‐5. - PubMed
Moreno 2002
    1. Moreno A, Grodin MA. Torture and its neurological sequelae. Spinal Cord 2002;40(5):213‐23. - PubMed
Newlands 2004
    1. Newlands J, Patel N. Working with diversity: professional practice and ethical considerations. In: Tribe R, Morrissey J editor(s). The Handbook of Professional and Ethical Practice for Psychologists, Counsellors and Psychotherapists. East Sussex: Brunner‐Routledge, 2004:233‐46.
NICE 2005
    1. Post Traumatic Stress Disorder (PTSD). The management of PTSD in adults and children in primary and secondary care. National Clinical Practice Guideline 26 2005.
NICE 2010
    1. Depression. The treatment and management of depression in adults (updated version). National Clinical Practice Guideline 90 2010.
Nicholl 2004
    1. Nicholl C, Thompson AR. The psychological treatment of PTSD in adult refugees: a review of the current state of psychological therapies. Journal of Mental Health 2004;13:351‐62.
Nickerson 2011
    1. Nickerson A, Bryant RA, Silove D, Steel Z. A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review 2011;31:399‐417. - PubMed
Norredam 2005
    1. Norredam M, Crosby S, Munarriz R, Piwowarczyk L, Grodin M. Urologic complications of sexual trauma among male survivors of torture. Urology 2005;65(1):28‐32. - PubMed
Nuesch 2009
    1. Nuesch E, Trelle S, Reichenbach S, Rutjes AW, Burgi E, Scherer M, et al. The effects of excluding patients from the analysis in randomised controlled trials: meta‐epidemiological study. British Medical Journal 2009;339:b3244. - PMC - PubMed
Patel 2000
    1. Patel N, Bennett E, Dennis M, Dosanjh N, Miller A, Mahtani A, et al. Clinical Psychology, 'Race' and Culture: A Resource Pack for Trainers. Leicester: BPS Books, 2000.
Patel 2003a
    1. Patel N. Clinical psychology: reinforcing inequalities or facilitating empowerment?. The International Journal of Human Rights 2003;7(1):16‐39.
Patel 2003b
    1. Patel N. Speaking with the silent: addressing issues of disempowerment when working with refugee people. In: Tribe R, Raval H editor(s). Working with interpreters in Mental Health. Hove: Brunner‐Routledge, 2003:218‐37.
Patel 2004
    1. Patel N, Mahtani A. Psychological approach to rape as torture. In: Peel M editor(s). Rape as Torture. London: Medical Foundation Publications, 2004.
Patel 2007
    1. Patel N. Torture, psychology and the 'war on terror': a human rights framework. In: Roberts R editor(s). Just War: Psychology Terrorism. Ross‐on‐Wye, UK: PCCS Books, 2007.
Patel 2010
    1. Patel N, Granville‐Chapman C. Health Assessments with Survivors of Torture: Good Practice Clinical Guidelines. Health Assessments with Survivors of Torture: Good Clinical Practice Guidelines. London: Medical Foundation with the Department of Health (UK), 2010.
Patel 2011
    1. Patel N. The psychologisation of torture. In: Rapley M, Moncrieff J, Dillon J editor(s). De‐Medicalising Misery: Psychiatry, Psychology and the Human Condition. London: Palgrave Macmillan, 2011.
Pilgrim 1999
    1. Pilgrim D, Bentall R. The medicalisation of misery: a critical realist analysis of the concept of depression. Journal of Mental Health 1999;8:261‐74.
Porter 2005
    1. Porter M, Haslam M. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta‐analysis. Journal of the American Medical Association 2005;294(5):602‐12. - PubMed
Quiroga 2005
    1. Quiroga J, Jaranson JM. Politically‐motivated torture and its survivors: a desk study review of the literature. Torture: Journal on Rehabilitation of Torture Victims and Prevention of Torture 2005;15(2‐3, Thematic issue):1‐111.
Rapley 2011
    1. Rapley M, Moncrieff J, Dillon J. De‐medicalizing Misery: Psychiatry, Psychology and the Human Condition. Houndsmills, Basingstoke Hampshire, England: Palgrave Macmillan, 2011.
Rasmussen 1990
    1. Rasmussen OV. Medical aspects of torture. Danish Medical Bulletin 1990;37(Suppl 1):1‐88. - PubMed
Raval 2003a
    1. Raval H. Applying theoretical frameworks to the work with interpreters. In: Tribe R, Raval H editor(s). Working with Interpreters in Mental Health. Hove: Brunner‐Routledge, 2003:122‐34.
Raval 2003b
    1. Raval H, Smith J. Therapists' experiences of working with language interpreters. International Journal of Mental Health 2003;32(2):6‐31.
Silove 1999
    1. Silove D. The psychosocial effects of torture, mass human rights violations, and refugee trauma: toward an integrated conceptual framework. Journal of Nervous and Mental Disease 1999;187(4):200‐7. - PubMed
Sousa 2011
    1. Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross‐cultural health care research: a clear and user‐friendly guideline. Journal of Evaluation in Clinical Practice 2011;17:268‐74. - PubMed
Steel 2009
    1. Steel Z, Chey T, Silove D, Marnane C, Bryant R, Ommeren M. 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. Journal of the Medical Academy 2009;302(5):537‐49. - PubMed
Summerfield 2001
    1. Summerfield D. The invention of post traumatic stress disorder and the social usefulness of a psychiatric category. British Medical Journal 2001;322:95‐8. - PMC - PubMed
Temple 1997
    1. Temple B. Watch your tongue: issues in translation and cross‐cultural research. Sociology 1997;31(3):607‐18.
Temple 2002
    1. Temple B, Edwards R. Interpreters/translators and cross‐language research: reflexivity and border crossings. International Journal of Qualitative Methods 2002;1(2):1‐12.
Thakker 1999
    1. Thakker J, Ward T, Strongman KT. Mental disorder and cross‐cultural psychology: a constructivist perspective. Clinical Psychology Review 1999;19(7):843‐74. - PubMed
UN 1984
    1. UN General Assembly. Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Available online: http://www2.ohchr.org/english/law/pdf/cat.pdf). Vol. 1465, Geneva: United Nations, Treaty Series, 1984 (10 December):85.
Van Ommeren 2001
    1. Ommeren M, Jong JT, Sharma B, Komproe I, Thapa SB, Cardena E. Psychiatric disorders among tortured Bhutanese refugees in Nepal. Archives of General Psychiatry 2001;58(5):475‐82. - PubMed
Vara 2012
    1. Vara R, Patel N. Working with interpreters in qualitative psychological research: methodological and ethical issues. Qualitative Research in Psychology. 2012; Vol. 9, issue 1:75‐87.
Wenk‐Ansohn 2007
    1. Wenk‐Ansohn M. Treatment of torture survivors—influences of the exile situation on the course of traumatic process and therapeutic possibilities. Torture 2007;17(2):88‐95. - PubMed
Williams 2011
    1. Williams ME, Thompson SC. The use of community‐based interventions in reducing morbidity from the psychological impact of conflict‐related trauma among refugee populations: a systematic review of the literature. Journal of Immigrant and Minority Health 2011;13:780‐94. - PubMed
Williams 2013
    1. Williams ACdeC, Merwe J. The psychological impact of torture. British Journal of Pain 2013;7:101‐6. - PMC - PubMed
Yates 2005
    1. Yates SL, Morley S, Eccleston C, Williams ACD. A scale for rating the quality of psychological trials for pain. Pain 2005;117(3):314‐25. - PubMed

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