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					Videnscenter for Transkulturel Psykiatri
                                                                           Helle Rasmussen, Informationskoordinator

                                                      Skriv til os :   transkulturel-psykiatri@rh.hosp.dk

Information om Transkulturel Psykiatri, maj 2005
GENERELT

Det är en patientgrupp som måste synliggöras
– En gömd som behöver sjukvård tas emot som vilken annan patient på vårdcentralen som helst. Det handlar
om en grupp människor som måste lyftas fram och synliggöras för att inte riskera att hamna i en parallell
sjukvårdsstruktur till den offentliga.
Det säger Johanna Eriksson, ST-läkare i allmänmedicin vid Kista vårdcentral strax norr om Stockholm. Hon ingår
i det nätverk som Läkare utan gränser byggt upp i Stockholmsregionen och som erbjuder hjälp till gömda
flyktingar.
Läkartidningen 102 (20), 1508ff, 2005
http://www2.lakartidningen.se/store/articlepdf/1/1173/1508.pdf

Flygtninge henvises til at bo i gymnastiksal
Politikens netavis 6. maj / af Sike Bock

Presset på Vestre Fængsel er så voldsomt, at fanger er flyttet ind i Sandholm-lejren. Det tvinger asylsøgere til at
bo under forhold, som Røde Kors kalder 'rystende'
læs artiklen her: http://politiken.dk/visartikel.iasp?pageid=377015

Gömda vågar inte söka vård
Mattias Ohlson projektansvarig för sjukvårdsförmedlingen, Läkare utan gränser, Stockholm

Gömda flyktingar saknar tillgång till offentlig sjukvård, mest på grund av deras egen rädsla för att bli anmälda till
någon myndighet. Höga kostnader, restriktiva lagar, okunskap och avvisande attityder på vårdinrättningarna är
skälen till att Läkare utan gränser startat ett nätverk av idellt arbetande läkare mfl för att skapa tillgång till vård
även för gömda flyktingar.
Läkartidningen 102(2), 1551ff, 2005,
http://www2.lakartidningen.se/store/articlepdf/1/1129/1551_1552.pdf

Kultur og sykdom
NAKMIs hjemmeside 11. maj / av Roald Iversen

Det er nødvendig å se grundigere på de forhold i vårt samfunn som bidrar til å skape sykdom hos
mennesker med immigrantbakgrunn, særlig blant asylsøkere og flyktninger.
Immigrantpasienters møte med nordisk helsevesen oppleves noen ganger som en kulturkollisjon. Ikke minst
gjelder det i psykiatrien. En sydeuropeisk pasient som flyktet til Danmark gav uttrykk for sin forvirring over det
nye kulturmøtet ved å si at hun «følte... det som pludselig at være havnet i et system av uforståelige tegn».

Vi vet at det er for få plasser i psykiatrien og at det er kamp om plassene. Minoritetsgrupper blir i en slik situasjon
lett gjort til syndebukker for sosial misnøye, og rasefordommer øker. Dette er et allment fenomen som man kan
studere på flere arenaer, ikke minst på det europeiske arbeidsmarkedet. Særlig i Tyskland, som har mange
immigranter fra Øst-Europa og Sørøst-Asia. Ingen bør derfor bli overrasket over at noen nå løper til media og
sier at pasienter med immigrantbakgrunn tar opp psykiatriplasser som nordmenn skulle hatt.
læs artiklen her : http://www.nakmi.no/nyheter/artikkel.asp?NyhetID=395&SpraakID=1&SeksjonID=2

Tyrkiske indvandrerkvinder 20 år efter
af Kurt Balle Jensen

Ny undersøgelse, »Stress and Distress in Migration« sætter fokus på en gruppe tyrkiske indvandrerkvinder og
deres fysiske og psykiske tilstand. Den samme gruppe blev interviewet for 20 år siden, og dermed fortæller
undersøgelsen også om, hvordan kvinderne er blevet integreret i det danske sundhedssystem

Omkring 1980 kom der en del tyrkiske indvandrerkvinder til Danmark. Hvordan har de det psykisk og fysisk i dag,
set i forhold til den gang de kom til deres nye land? Og hvordan har de det med deres praktiserende læge? Det
fortæller en større interviewundersøgelse, gennemført af research professor dr. phil. Gretty M. Mirdal,
Psykologisk Institut ved Københavns Universitet, mange interessante ting om. Hun stod også i spidsen for en
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lignende undersøgelse for 20 år siden, og da det er de samme kvinder, der er blevet interviewet, er der rig
lejlighed til at konstatere, hvilke udviklingstendenser der har været undervejs
Ugeskrift for læger, nr. 21, 2005
læs artiklen her : http://www.dadlnet.dk/ufl/2005/2105/LS-html/LS47341.htm

Vi behandles efter vores hudfarve
Af Grethe Kjærgaard, journalist

Diskrimination. Lige så snart man har en anden hudfarve, sker der noget med omgivelsernes reaktioner.
Så får man ikke samme behandling som flertallet, siger Özlem Cekic, som har taget initiativ til
Mangfoldighedsnetværket for etniske sygeplejersker.

Den unge kvindelige patient fra Mellemøsten bad 20-30 gange om dagen og læste flere timer hver dag i
koranen. Men ingen greb ind af respekt for patientens religionsudøvelse. I virkeligheden var der tale om
tvangshandlinger. Patienten led af anoreksi, og ved at bede alle disse mange gange om dagen fik hun brændt
rigtig mange kalorier af.
Sygeplejersken nr. 10, 2005
læs artiklen her : http://www.sygeplejersken.dk/sygeplejersken/default.asp?intArticleID=12761&menu=195009

OM TRANSKULTUREL PSYKIATRI

Apatiska flyktingbarn problem också i Finland
Hufvudstadsbladet 25. maj 2005

I Sverige finns det fyrahundra djupt apatiska flyktingbarn. Det har fått myndigheterna att ordna med
förtur för deras asylansökningar. I Finland finns sex apatiska flyktingbarn.

Också i Finland
Det verkar som om problemet är ett svenskt fenomen, men samtidigt kom vidden av problemet fram först efter en
kartläggning då de sjukaste barnen redan var intagna på sjukhus.
I Finland har också en kartläggning gjorts då det svenska fenomenet blev känt.
- Vi har hittat sex fall av apatiska och djupt deprimerade barn i fem olika familjer, säger Taina Martiskainen från
Centralförbundet för barnskydd.
Av familjerna har en beviljats asyl, en har fått avslag på sin asylansökan och överklagat, en familj har fått beslut
om utvisning från landet, och två sänds tillbaka till Sverige där de först sökt asyl.
læs artiklen her: http://www.hbl.fi/cgi-
bin/mediaweb?Newsp=hbl&Date=050525&Depa=inrikes&Story=07458888.txt&Model=juttu.html

Asylbørn skal undersøges
Kristeligt Dagblad 4. maj / Ritzau
Dansk Røde Kors' asylafdeling vil undersøge forekomsten af apatiske flygtningebørn på organisationens
asylcentre. Det oplyser cheflæge i asylafdelingen Ebbe Munk-Andersen. Undersøgelsen vil finde sted i løbet af
sommeren. Baggrunden er bl.a., at Sverige i sidste uge offentliggjorde en rapport om, at der på de svenske
asylcentre findes 410 tilfælde af såkaldt apatiske flygtningebørn.

Explosionsartad ökning av apatiska flyktingbarn
Dagens nyheter 27. april / av Nader Ahmadi og Marie Hessle

Största antalet fall i Stockholm visar regeringens utredare i sin första rapport . Antalet kända fall av så kallade
apatiska flyktingbarn har ökat dramatiskt till 410 fall. Dessa barn finns över så gott som hela landet, men flertalet
i Stockholmsområdet. Så många som 87,5 procent av barnen kommer från forna Sovjetunionen eller forna
Jugoslavien, 61,5 procent respektive 26 procent. Det visar den första kartläggningen av barn med
uppgivenhetssymtom som nu presenteras av regeringens nationella samordnare Marie Hessle och docent Nader
Ahmadi vid Stockholms universitet och högskolan i Gävle.
læs artiklen her: http://www.dn.se/DNet/jsp/polopoly.jsp?d=572&a=407976&previousRenderType=6


LITTERATUR

BØGER / RAPPORTER

Asylsökande barn med uppgivenhetssymtom – kunskapsöversikt och
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kartläggning
Rapport från den nationella samordnaren för barn i asylprocessen med uppgivenhetssymton 2005:1
Statens offentliga utredningar

læs rapporten her: http://www.regeringen.se/content/1/c6/04/34/53/821d2464.pdf



The mental health of refugees: ecological approaches to healing and
adaptation.
Edited by Kenneth E. Miller and Lisa M. Rasco. Mahwah, New Jersey: Lawrence Erlbaum Associates, 2004. xv +
429 pp. $99.95, ISBN 0 8058 4172 5 hb; $49.95, ISBN 0 8058 4173 3 pb.

In recent years, research on the psychological effects of forced migration has resulted in a substantial body of
literature documenting a range of symptoms such as depression, extreme anxiety, uncontrollable fear and post
traumatic stress disorder. Mental health professionals (psychologists, psychiatrists, and social workers) have
responded by offering clinic-based and, in a few instances, psychosocial services to refugees in camps and in
countries of resettlement. However, this emphasis on trauma and Western treatment interventions has sparked a
heated debate in mental health circles and the authors of this book weigh in on the discussion by offering a
broader approach—ecological theory that emphasizes community as well as individual interventions.
Several critical factors are addressed. Mental health services to refugees are scarce and when available are
often inaccessible. Many countries and cultures do not have a tradition of mental health care and may depend
more on traditional measures offered by the village doctor or medicine man or woman. Another factor is the
relevance and appropriateness of Western mental health approaches that may be culturally foreign to most
refugees. A key question is whether there are universal emotional responses to forced migration and conflict, or
whether these are shaped and influenced by local cultures. The authors argue that clinical approaches are not
sufficient to address the plethora of displacement issues that refugees face on a daily basis. This points to the
need for a new and much broader approach to mental health care of refugees, namely ‘ecological approaches to
healing and adaptation’.
In their model of ecological treatment, Miller and Rasco focus on political violence and displacement issues such
as separation, discrimination, hunger, lack of shelter and medical care, the loss of family and social support, etc.,
and their effects on individual, family, and community well-being. While these effects include trauma, grief,
depression and anxiety in individuals and families, they also alter the supportive fabric of the community,
dissolving institutions and destroying ties and supports that bind people together.
In order to highlight this expanded notion of mental health of refugees, the editors invited noted researchers and
practitioners to discuss the ecological model in the light of their own experiences in providing mental health care
and the challenges they faced. The reader is presented with a number of case studies broken in two parts—
programmes in Africa and Asia and programmes in South and North America—that illustrate not only clinical
interventions for refugees but also interventions to strengthen and rebuild community. These chapters present
strategies for a child-focused, community-based intervention programme, mental health services to reduce the
effects of violence, an approach for empowering war widows, family interventions, and community-based
advocacy and learning intervention.
The authors conclude with two chapters that deal with ‘critical issues’. The first chapter in this section addresses
methods for measuring the effectiveness of ecological interventions with the goal of exploring both process and
outcome evaluations in conflict and non-conflict situations. The use of both qualitative and quantitative measures
is recommended. The last chapter deals with challenges and critical issues in the utilization of ecological
approaches to mental health. A series of useful principles are cited that deal with community involvement and
participation in assessing refugee need, designing interventions, and implementing services as well as building
community capacity, respecting local values and interventions, and emphasizing prevention. Each reflects a
belief that psychological problems are often caused by the mismatch of one's community structure and the
demands placed upon it.
Mental health professionals who work in refugee settings will find this book informative and useful. They are
offered a comprehensive range of suggestions for psychosocial interventions. Programme administrators who
wish to provide mental health services to refugees will have a number of valuable programmes from which to
model new services. Lastly, students of forced migration will gain a solid understanding of the psychological
concomitants of war, violence and migration and become aware of the range of ecological strategies to assist
individuals, families, and communities with these mental health issues.
Frederick L. Ahearn, Jr., Center for International Social Development, The Catholic University of
America, Washington, DC
Journal of refugee studies 18(2), 238-239, 2005

ARTIKLER

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The association between negative self-descriptions and depressive
symptomology: does culture make a difference?
Denise Saint Arnault, Shinji Sakamoto and Aiko Moriwaki

Abstract
Research findings that depressed Americans endorse more negative self-related adjectives than controls may be
related to a shared self-enhancement cultural frame. This study examines the relationship between negative core
self-descriptors and depressive symptoms in 79 Japanese and 50 American women. Americans had more
positive self-descriptions and core self-descriptors; however, there were no cultural group differences in number
of negative self-descriptors or core self-descriptors. There was a significant correlation between negative core
self-descriptor and Beck Depression Inventory (BDI) for Americans only, explaining 10.6% of the BDI variance.
Analysis of variance revealed that there was significant BDI group differences for American negative core self-
descriptor only. Theoretical possibilities are discussed.
Archives of psychiatric nursing 19(2), 93-100, 2005

Behavior problems and mental health referrals of international adoptes: a
meta-analysis
Femmie Juffer, PhD; Marinus H. van IJzendoorn, PhD

Abstract
Context International adoption involves more than 40 000 children a year moving among more than 100
countries. Before adoption, international adoptees often experience insufficient medical care, malnutrition,
maternal separation, and neglect and abuse in orphanages.
Objective To estimate the effects of international adoption on behavioral problems and mental health referrals.
Data Sources We searched MEDLINE, PsychLit, and ERIC from 1950 to January 2005 using the terms adopt*
combined with (behavior) problem, disorder, (mal)adjustment, (behavioral) development, clinical or psychiatric
(referral), or mental health; conducted a manual search of the references of articles, books, book chapters, and
reports; and consulted experts for relevant studies. The search was not limited to English-language publications.
Study Selection Studies that provided sufficient data to compute differences between adoptees (in all age
ranges) and nonadopted controls were selected, resulting in 34 articles on mental health referrals and 64 articles
on behavior problems.
Data Extraction Data on international adoption, preadoption adversity, and other moderators were extracted
from each study and inserted in the program Comprehensive Meta-analysis (CMA). Effect sizes (d) for the overall
differences between adoptees and controls regarding internalizing, externalizing, total behavior problems, and
use of mental health services were computed. Homogeneity across studies was tested with the Q statistic.
Data Synthesis Among 25 281 cases and 80 260 controls, adoptees (both within and between countries)
presented more behavior problems, but effect sizes were small (d, 0.16-0.24). Adoptees (5092 cases) were
overrepresented in mental health services and this effect size was large (d, 0.72). Among 15790 cases and
30450 controls, international adoptees showed more behavior problems than nonadopted controls, but effect
sizes were small (d, 0.07-0.11). International adoptees showed fewer total, externalizing and internalizing
behavior problems than domestic adoptees. Also, international adoptees were less often referred to mental
health services (d, 0.37) than domestic adoptees (d, 0.81). International adoptees with preadoption adversity
showed more total problems and externalizing problems than international adoptees without evidence of extreme
deprivation.
Conclusions Most international adoptees are well-adjusted although they are referred to mental health services
more often than nonadopted controls. However, international adoptees present fewer behavior problems and are
less often referred to mental health services than domestic adoptees.
Journal of the Amerian Medical Association 293(20), 2501-2515, 2005

Caring for the seriously mentally ill in Thailand: buddhist family caregiving
Hunsa Sethabouppha, Catherine Kane

Abstract
The purpose of this study was to explore the lived experiences from Thai Buddhist family caregivers of seriously
mentally ill relatives to understand their perspectives about Buddhist caregiving. A phenomenological study of 15
Thai Buddhist family caregivers was conducted following Cohen et al.'s process for analysis. Analysis of the
interviews revealed five major themes: caregiving is Buddhist belief, caregiving is compassion, caregiving is
management, caregiving is acceptance, and caregiving is suffering. Although suffering from the problems posed
by mental illness permeated their lives, Thai Buddhist caregivers were able to continue to maintain compassion,
management, and acceptance in caregiving to their seriously mentally ill relatives. A model of Thai Buddhist
caregiving, constructed from the five major themes, is presented.
Archives of psychiatric nursing 19(2), 44-57, 2005


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Cultural diversity: what do we fear?
Wilson, Deborah W.

Abstract:
Issues surrounding cultural diversity have taken on a new priority for nursing in the 21st century, engendering
considerable anxiety and reluctance to openly confront many of the factors that affect the profession: the
provision of culturally competent care, educating nurses to be culturally competent, and accepting nurses from
culturally diverse backgrounds. Despite claiming to value diversity, the profession has been either unable or
unwilling to fully embrace it and respond to the challenges that it presents to nursing and to healthcare. If the
profession is to move forward, it must confront these issues and the challenges that they present. This article
addresses the fears related to acknowledging cultural differences, power and control, confronting complex racial
issues, cul-tural competency, and acknowledging biases in research
Keywords: CULTURAL COMPETENCY; CULTURAL DIFFERENCES; CULTURAL DIVERSITY; POWER AND
CONTROL; RACISM; RESEARCH BIAS
Diversity in health and social care 1(2) 145-150, 2004

Exposure to suicide and suicidal behaviors among Hong Kong adolescents
Joy P.S. Wong, Sunita M. Stewart, S.Y. Ho, Uma Rao and T.H. Lam

Abstract
Suicidal behaviors (deliberate self-injury with the intent to hurt or kill oneself) have been little examined outside
the West. The aims of this study were to (a) determine the correlates of suicidal behaviors, and (b) examine
whether depression and suicide ideation moderated the effects of exposure to completed and attempted suicide
on suicidal behaviors among a community sample of Hong Kong youth ages 12–17. Adolescents responded to
questions regarding self-injurious behaviors, and also indicated presence of intention to hurt or kill themselves in
the past 12 months. Based on their responses, two groups of interest were formed: 96 youths reported both self-
injurious behaviors and the intent to hurt or kill themselves, and formed the “suicidal behaviors” group; and, 1213
adolescents reported neither self-injurious behaviors nor intent to hurt self or die, and formed the control group.
The participants also responded to questions about depressive symptoms, anxiety, suicidal ideation and attempt,
alcohol/drug use, stressful life events, and family relationships. They indicated whether anyone they knew had
attempted or completed suicide in the previous 12 months. Logistic regression indicated that depressive
symptoms, stressful life events, suicidal ideation and exposure to suicide attempt (but not completed suicide)
contributed unique variance to the presence of suicidal behaviors, after controlling for demographic variables.
Depression (and at trend levels, suicidal ideation) moderated the effect of exposure to suicide attempt by others
on suicidal behaviors. Our results indicate that completed suicide in the social network increases risk for suicidal
behaviors, but not when other risk factors are controlled. By contrast, a suicide attempt independently increases
risk for suicidal behaviors. Furthermore, those youths who experience depressive symptoms or suicidal ideation
are at particularly high risk for engaging in suicidal behaviors when an exposure to suicide attempt occurs.
Keywords: Suicidal behaviors; Adolescents; Suicide exposure; Hong Kong
Social science and medicine 61(3), 591-599, 2005

Factors that influence Asian communities' access to mental health care
Dianne Wynaden, Rose Chapman, Angelica Orb, Sunita McGowan, Zenith Zeeman and SiewHo Yeak

ABSTRACT:This paper presents the findings of a qualitative study to identify factors that influence Asian
communities' access to mental health care and how mental health care is delivered to them. Semistructured
interviews were completed with Asian community members/leaders and health-care professionals. Content
analysis identified major themes. Participants also completed a demographic data sheet. The research aimed to
provide health professionals with an increased understanding of the values and beliefs held by people from
Asian communities regarding the cause and treatment of mental illness. Data analysis identified six main themes
that influenced Asian communities' access to mental health care and how mental health care is delivered to
them. They were: shame and stigma; causes of mental illness; family reputation; hiding up; seeking help; and
lack of collaboration. The findings highlighted that people from Asian communities are unwilling to access help
from mainstream services because of their beliefs, and that stigma and shame are key factors that influence this
reluctance. The findings also highlight that the mental health needs of refugee women are significant, and that
they comprise a vulnerable group within Australian society.
International Journal of Mental Health Nursing 14(2), 88-95, 2005

International adoption, behavior, and mental health
Laurie C. Miller, MD

Fra starten af artiklen
Adoption has been a part of human culture since earliest recorded times: Moses is perhaps the most famous
adopted person in history. Fascination with adoption pervades literature (from fairy tales and myths to modern
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novels), psychology, and medicine. Researchers have long studied adoption in attempts to isolate the effects of
"nature" and "nurture" on behavioral outcomes and mental health. Genetic factors, separation from birth parents,
environmental exposures (both prenatal and postnatal), and aspects of the adoptive home environment have all
been cited as possible contributors to adverse behavioral and mental health outcomes among adoptees.
Journal of the Amerian Medical Association 293(20), 2533-2535, 2005

Najar or Bhut—Evil eye or ghost affliction: Gujarati views about illness
causation
Alison M. Spiro

Abstract:
This paper examines the supernatural beliefs of najar (evil eye) and bhut (ghost) and their roles in illness
causation in Gujarati families in Britain today. The data arose unexpectedly in an ethnography of child rearing
patterns carried out in Harrow, North West London and a short period of observation in Ahmedabad, India. I used
anthropological methods of participant observation and unstructured interviews, which were transcribed using
pseudonyms. The study group involved 70 Hindu and Jain Gujarati households with children and the fieldwork
was conducted over a period of four years. Many of the individuals studied had migrated from India to East Africa
before coming to the UK in the 1970s, but maintain links with both countries through kinship ties, marriage and
rituals. I set out to study the continuity of women's roles in the transmission of religious and moral values, the
rituals of childhood, views about infant feeding, and parenting relationships within joint families. The beliefs of
najar and bhut in poor, rural settings in India have been described, but these Gujarati beliefs in Britain have not
been well documented. This study indicates that najar and bhut continue to be a concern of women in most
Gujarati families in Britain today and across all socio-economic groups, not confined to those on the ‘bread-line’,
as have been previously suggested. These beliefs align themselves with Hindu ideas of the soul and
reincarnation: powerful forces residing outside the body. An understanding of these beliefs could be informative
to health professionals working with Gujarati communities in the UK.
Anthropology and medicine 12(1), 61-73, 2005

Posttraumatic Stress Disorder and memory problems after female genital
mutilation
Alice Behrendt, Dipl.-Psych., and Steffen Moritz, Ph.D.

Abstract
OBJECTIVE: This pilot study investigated the mental health status of women after genital mutilation. Although
experts have assumed that circumcised women are more prone to developing psychiatric illnesses than the
general population, there has been little research to confirm this claim. It was predicted that female genital
mutilation is associated with a high rate of posttraumatic stress disorder (PTSD).
METHOD: The psychological impact of female genital mutilation was assessed in 23 circumcised Senegalese
women in Dakar. Twenty-four uncircumcised Senegalese women served as comparison subjects. A
neuropsychiatric interview and further questionnaires were used to assess traumatization and psychiatric
illnesses.
RESULTS: The circumcised women showed a significantly higher prevalence of PTSD (30.4%) and other
psychiatric syndromes (47.9%) than the uncircumcised women. PTSD was accompanied by memory problems.
CONCLUSIONS: Within the circumcised group, a mental health problem exists that may furnish the first
evidence of the severe psychological consequences of female genital mutilation.
American journal of psychiatry 162(5), 1000-1002, 2005

Posttraumatic stress disorder and psychiatric co-morbidity: symptoms in a
random sample of female Bosnian refugees
Kristina Sundquist, Leena-Maria Johansson, Valeri DeMarinis, Sven-Erik Johansson and Jan Sundquist

Abstract
Objectives. – This study investigated psychological symptoms in Bosnian women 3–4 years after their arrival in
Sweden.
Subjects and methods. – A simple random sample of 163 Bosnian women aged 19–59 was drawn from the
Swedish populations register in 1996. The control group consisted of 392 Swedish-born women. Data were
collected in face-to-face interviews. The Hopkins Symptom Checklist 25 (HSCL-25) and the Posttraumatic
Symptom Scale (PTSS-10) were used to measure psychological symptoms of depression, anxiety, psychological
distress, and posttraumatic stress disorder (PTSD). Unconditional logistic regression was used to estimate odds
ratios (OR) for psychological symptoms after adjustment for age, country of birth, education, marital status,
economic difficulties, social network, and feeling secure.
Results. – The prevalence of symptoms of PTSD was 28.3% among the Bosnian women. Bosnian women had
significantly higher risks of symptoms of depression, anxiety, and psychological distress than Swedish-born
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women. For depression the odds ratio was 9.50 among Bosnian women.
Conclusion. – Psychiatric community interventions need to target Bosnian refugee women. Awareness among
health-care workers who encounter these women in a clinical setting should be improved.
Keywords: Bosnian refugees; PTSD; Mental health; Random sample
European Psychiatry 20(2), 158-164, 2005

Prevalence of serious mental disorder in 7000 refugees resettled in western
countries: a systematic review
DrMina Fazel MRCPsych, Jeremy Wheeler MSc and ProfJohn Danesh Dphil

Summary
Background
About 13 million people are classified as refugees worldwide, and many more former refugees have been
granted citizenship in their new countries. However, the prevalence of post-traumatic stress disorder, major
depression, or psychotic illnesses in these individuals is not known. We did a systematic review of surveys about
these disorders in general refugee populations in western countries.
Methods
We searched for psychiatric surveys that were based on interviews of unselected refugee populations and that
included current diagnoses of post-traumatic stress disorder, major depression, psychotic illnesses, or
generalised anxiety disorder. We did computer-assisted searches, scanned reference lists, searched journals,
and corresponded with authors to determine prevalence rates of these mental disorders and to explore potential
sources of heterogeneity, such as diagnostic criteria, sampling methods, and other characteristics.
Findings
20 eligible surveys provided results for 6743 adult refugees from seven countries, with substantial variation in
assessment and sampling methods. In the larger studies, 9% (99% CI 8–10%) were diagnosed with post-
traumatic stress disorder and 5% (4–6%) with major depression, with evidence of much psychiatric comorbidity.
Five surveys of 260 refugee children from three countries yielded a prevalence of 11% (7–17%) for post-
traumatic stress disorder. Larger and more rigorous surveys reported lower prevalence rates than did studies
with less optimum designs, but heterogeneity persisted even in findings from the larger studies.
Interpretation
Refugees resettled in western countries could be about ten times more likely to have post-traumatic stress
disorder than age-matched general populations in those countries. Worldwide, tens of thousands of refugees and
former refugees resettled in western countries probably have post-traumatic stress disorder.
Lancet 365(9467), 1309-1314, 2005

Psychiatric disorders in an African refugee camp
Michael Kamau, Derrick Silove, Zachary Steel, Ronald Catanzaro, Catherine Bateman, & Solvig Ekblad

Abstract
This article describes a study of the prevalence of psychiatric disorders among the clients of a community mental
health service in the Kakuma refugee camp in Kenya. It is based on the case logbook maintained by the nurse-
manager over a period of three years. Post-traumatic stress disorder was the most common diagnosis. Findings
suggest that it is feasible to establish a low-cost community mental health service in refugee camps in low-
income countries such as Kenya. Such a service is likely to attract an immediate and growing demand for
assistance.
Intervention 2 (2),84 – 89, 2004
Artiklen kan læses her: http://www.psykosocialmedicin.se/P2451_SE.pdf

Psychological treatment of post-traumatic stress disorder (PTSD) (Cochrane
Review)
Bisson J and Andrew M.

ABSTRACT
A substantive amendment to this systematic review was last made on 25 February 2005. Cochrane reviews are
regularly checked and updated if necessary.
Background: Psychological interventions are widely used in the treatment of post-traumatic stress disorder
(PTSD).
Objectives: To perform a systematic review of randomised controlled trials of all psychological treatments
except eye movement desensitisation and reprocessing following the guidelines of the Cochrane Collaboration.
Search strategy: Systematic searches of computerised databases, hand search of the Journal of Traumatic
Stress, searches of reference lists, known websites and discussion fora, and personal communication with key
workers.
Selection criteria: Types of studies - Any randomised controlled trial of a psychological treatment.Types of
participants - Adults suffering from traumatic stress symptoms for three months or more.Types of interventions
                                                                                                                 7
- Trauma-focused cognitive behavioural therapy/exposure therapy (TFCBT); stress management (SM); other
therapies (supportive therapy, non-directive counselling, psychodynamic therapy and hypnotherapy); group
cognitive behavioural therapy (group CBT). Types of outcomes - Severity of clinician rated traumatic stress
symptoms. Secondary measures included self-reported traumatic stress symptoms, depressive symptoms,
anxiety symptoms, adverse effects and dropouts.
Data collection and analysis: Data was entered using the Review Management software. Quality assessments
were performed. The data were analysed for summary effects using the RevMan 4.2 programme.
Main results: Twenty-nine studies were included in the review. With regards to reduction of clinician assessed
PTSD symptoms TFCBT did significantly better than waitlist/usual care (standardised mean difference (SMD) = -
1.36; 95% CI, -1.88 to -0.84; 13 studies; n = 609). There was no significant difference between TFCBT and SM
(SMD = -0.27; 95% CI, -0.71 to 0.16; 6 studies; n = 239). TFCBT did significantly better than other therapies
(SMD = -0.81; 95% CI, -1.19 to -0.42; 3 studies; n = 120). Stress management did significantly better than
waitlist/usual care (SMD = -1.14; 95% CI, -1.62 to -0.67; 3 studies; n = 86) and than other therapies (SMD = -
1.22; 95% CI, -2.09 to -0.35; 1 study; n = 25). There was no significant difference between other therapies and
waitlist/usual care control (SMD = -0.43; 95% CI, -0.90 to 0.04; 2 studies; n = 72). Group TFCBT was
significantly better than waitlist/usual care (SMD = -0.72; 95% CI, -1.14 to -0.31).
Authors' conclusions: There was evidence that individual TFCBT, stress management and group TFCBT are
effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD
symptoms as significantly. There was some evidence that individual TFCBT is superior to stress management in
the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT was also more
effective than other therapies. There was insufficient evidence to determine whether psychological treatment is
harmful. There was some evidence of greater drop-out in active treatment groups.
The Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003388.pub2. DOI:
10.1002/14651858.CD003388.pub2.
artiklen (67 s.) kan læses her
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003388/pdf_fs.html

Toward an understanding of risk factors for binge-eating disorder in black and
white women: a community-based case-control study
Ruth H. Striegel-Moore, Christopher G. Fairburn, Denise E. Wilfley, Kathleen M. Pike, Faith-Anne Dohm and
Helena C. Kraemer

Abstract
Background. This study sought to identify in white women risk factors specific to binge-eating disorder (BED)
and for psychiatric disorders in general, and to compare black and white women on risk factors for BED.
Method. A case-control design was used. Participants were recruited from the community and included 162
women who met DSM-IV criteria for BED and two comparison groups of women with no history of clinically
significant eating disorder symptoms. The comparison women were matched to BED women on age, education
and ethnicity and divided into a healthy comparison (HC) group, who had no current psychiatric disorder, and a
psychiatric comparison (PC) group, who had a diagnosis of a DSM-IV Axis I psychiatric disorder. The study
sample size was determined by the group with the least members (PC), including 107 women with BED and 214
matched comparison women. A broad range of risk factors was assessed with a Risk Factor Interview and the
Parental Bonding Instrument.
Results. No significant effects for ethnicity by diagnostic group were found. BED women reported higher
exposure to childhood obesity, family overeating or binge-eating, family discord, and high parental demands than
PC women. The combined BED and PC group scored significantly higher than the HC group on measures of
negative affect, parental mood and substance disorders, perfectionism, separation from parents, and maternal
problems with parenting.
Conclusions. These findings indicate that childhood obesity and familial eating problems are reliable specific
risk factors for BED. Ethnicity does not appear to moderate risk for BED.
Psychological medicine , 35(6), 907-917, 2005




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