Disengagement in a torture treatment program.
Disengagement in a torture treatment program.
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脱离酷刑治疗计划。
DOI：
10.1176/appi.ps.201300223
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Paz,Claudia
中科院分区：
文献类型：
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作者：
Rasmussen,Andrew;Keatley,Eva;Paz,Claudia
致编辑：酷刑幸存者的治疗计划通常会在不指定出院时间表的情况下提供护理——这是测试服务参与度的自然条件。尽管这一群体的需求持续存在 (1)，但迁移前和迁移后压力源的差异 (2) 表明需求并非都是长期存在的。我们对 2008 年 4 月至 2013 年 10 月在纽约的一个项目中收集的数据进行生存分析来预测脱离接触，假设创伤后应激障碍 (PTSD) 和相关特征将预测稍后脱离接触，而容纳移民的做法将预测早期脱离接触。 665 名连续样本大部分为男性（N5397，60%）。平均 6SD 年龄为 33.9369。 65 人中，509 人 (77%) 接受过正规教育（模式 12 年），249 人 (37%) 讲功能英语。代表来自非洲（N5343，52%）、亚洲（N5210，32%）、欧洲（N583，13%）和美洲（N524，4%）的 75 个国家。入院时，515 名患者 (77%) 的移民身份不稳定（无证或庇护申请人）。共有 555 人（83%）符合《联合国反酷刑公约》的标准，48 人（7%）仅符合世界医学协会标准，62 人（9%）符合其他标准。哈佛创伤问卷 (HTQ)(3) 的平均 PTSD 得分为 2.596。摄入时为 62，2.146。六个月评估时为 57（N5414，62%），表明症状有所改善。共有305名患者（46%）接受了法语或藏语双语工作人员的服务；其他人以英语（N5227，34%）或通过电话口译员（N562，9%）获得服务。共有 556 人（84%）使用了社会服务，529 人（80%）使用了精神保健（个人和团体治疗以及精神药理学），503 人（76%）接受了法律援助。脱离被定义为六个月内不使用服务。平均脱离接触天数为 816.746 ± 25.85；四分之一（27%）没有脱离。接受社会服务的平均天数为 756.04628。 16；心理保健，616.76626。 61；和法律援助，604.79626。早期脱离的预测因素是年龄＃25（风险比[HR] 5.62；95%置信区间[CI] 5.49–.79）、正规教育（HR5.68、CI5.49–.79）、欧洲原籍国（HR5.61、CI5.46–.82）、功能英语（HR5.58、CI5.00）。 48–.72)，不使用 双语工作人员（HR5.54、CI5.44–.66）和稳定的移民身份（HR5.56、CI5.39–.80）。性别、迫害类型的数量、拘留、性侵犯、头部受伤以及入院时和六个月的 HTQ 分数不能预测脱离接触。预测早期脱离的最简约的 Cox 回归模型包括不使用双语工作人员 (HR5.55, CI5.44–.69) 和稳定的移民身份 (HR5.55, CI5.39–.80)。研究结果表明，一半的酷刑幸存者的需求可以在两年内降至最低水平。大约四分之一的人可能有长期需求。脱离接触预测因素与研究一致，研究表明教育和英语能力与移民的多种积极结果相关 (4)。使用双语工作人员可以预测稍后的脱离，这反驳了一个假设，并表明患者对讲自己语言的从业人员提供的服务的偏好 (5) 延长了他们的护理时间。零创伤发现可能看起来与临床常识不一致，但反映的研究表明，被迫移民的许多需求更多是由于流离失所，而不是创伤严重程度 (2)。计划应强调获得稳定的移民身份并加倍英语教育努力。
To the Editor: Treatment programs for torture survivors often provide care without specifying discharge timelines—natural conditions in which to test service engagement. Although needs persist in this group (1), variance in pre-and postmigration stressors (2) suggests that needs are not uniformly chronic. We used survival analysis of data gathered from April 2008 to October 2013 at a New York program to predict disengagement, hypothesizing that posttraumatic stress disorder (PTSD) and associated characteristics would predict later disengagement and that practices accommodating immigrants would predict earlier disengagement. The consecutive sample of 665 was mostly male (N5397, 60%). The mean6SD age was 33.9369. 65, 509 (77%) reported formal education (mode 12 years), and 249 (37%) spoke functional English. Represented were 75 countries across Africa (N5343, 52%), Asia (N5210, 32%), Europe (N583, 13%), and the Americas (N524, 4%). At intake, 515 patients (77%) had unstable immigration status (undocumented or asylum applicant). A total of 555 (83%) met criteria for the UN Convention Against Torture, 48 (7%) met World Medical Association criteria only, and 62 (9%) met other criteria. Mean PTSD scores on the Harvard Trauma Questionnaire (HTQ)(3) were 2.596. 62 at intake, and 2.146. 57 at six-month assessment (N5414, 62%), indicating improved symptoms. A total of 305 patients (46%) received services from French-or Tibetanspeaking bilingual staff; others received services in English (N5227, 34%) or through telephonic interpreters (N562, 9%). A total of 556 (84%) used social services, 529 (80%) used mental health care (individual and group therapy and psychopharmacology), and 503 (76%) received legal assistance. Disengagement was defined as no use of services for six months. Mean days to disengagement was 816.746 25.85; a quarter (27%) did not disengage. Mean days for receipt of social services was 756.04628. 16; mental health care, 616.76626. 61; and legal assistance, 604.79626. 00. Predictors of earlier disengagement were age# 25 (hazard ratio [HR] 5.62; 95% confidence interval [CI] 5.49–. 79), formal education (HR5. 68, CI5. 49–. 79), European country of origin (HR5. 61, CI5. 46–. 82), functional English (HR5. 58, CI5. 48–. 72), not using bilingual staff (HR5. 54, CI5. 44–. 66), and stable immigration status (HR5. 56, CI5. 39–. 80). Notpredictingdisengagement were gender, number of persecution types, detention, sexual assault, head injury, and HTQ scores at intake and six months. The most parsimonious Cox regression model predicting earlier disengagement comprised not using bilingual staff (HR5. 55, CI5. 44–. 69) and stable immigration status (HR5. 55, CI5. 39–. 80). Findings suggest that the needs of half of torture survivors can be reduced to a minimal level within two years. About a quarter may have chronic needs. Disengagement predictors are consistent with research showing education and English ability to be associated with multiple positive outcomes among immigrants (4). Use of bilingual staff predicted later disengagement, countering a hypothesis and suggesting that patients’ preference for services delivered by practitioners who speak their languages (5) prolongs their care. Null trauma findings may seem inconsistent with clinical common sense but reflect research suggesting that many needs of forced migrants are due more to displacement than to trauma severity (2). Programs should emphasize obtaining stable immigration status and redouble English education efforts.