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
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
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DOI：
10.1001/jama.290.5.627
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发表时间：
2003-08-06
影响因子：
120.7
通讯作者：
Shapiro, MF
中科院分区：
文献类型：
--
作者：
Eisenman, DP;Gelberg, L;Shapiro, MF
背景虽然政治暴力继续在中美洲，南美洲和墨西哥的部分地区，很少有人知道它的关系，以健康的拉丁美洲移民生活在美国。和墨西哥及其对精神健康和健康相关的生活质量的影响和（2）披露的政治暴力的频率，以初级保健clinics.Design，设置和参与者两阶段的集群设计调查的系统样本的拉丁美洲移民成年人在3个社区为基础的初级保健诊所在洛杉矶，主要结果测量报告移民美国前在本国接触政治暴力的情况，并与临床医生就政治暴力进行沟通;使用医疗结果研究简表36自我报告的健康相关生活质量测量（MOS SF-36）;使用精神障碍初级保健评估的抑郁、焦虑和酒精障碍症状（PRIME-MD）;结果638例（69%）创伤后应激障碍（PTSD）患者中，有11例（63.3%）有PTSD症状，有1例（6.4%）有PTSD症状。919名合格患者参加了研究。无应答率在年龄、性别、招募地点或门诊次数方面没有差异。在加权分析中，54%的参与者报告了本国的政治暴力经历，其中8%报告了酷刑。在那些暴露于政治暴力的人中，36%有抑郁症状，18%有创伤后应激障碍症状，而在那些没有暴露于政治暴力的人中，分别为20%和8%。在512名参与者（56%）的子样本中控制年龄，性别，国家，在美国居住的时间，文化适应，收入，健康保险状况和招募地点，那些报告政治暴力暴露的人更有可能符合PTSD的症状标准（调整后的比值比[AOR]，3.4; 95%置信区间[CI]，1.4-8.4），并有抑郁症状（AOR，2.8; 95%CI，1.4-5.4）和惊恐障碍症状（AOR，4.8; 95%CI，1.6-14.4）比参与者没有报告政治暴力。那些暴露于政治暴力的人报告说，由于身体问题，以及更差的身体功能和一般健康的看法比那些没有暴露于政治暴力的人更慢性疼痛和作用的限制。只有3%的267例患者经历过政治暴力报告曾经告诉临床医生，它移民后，没有报告他们目前的医生询问政治violence.Conclusion拉丁裔移民在初级保健在洛杉矶有很高的患病率，暴露于政治暴力移民到美国之前，在心理健康和健康相关的生活质量的损害。
Context Although political violence continues in parts of Central America, South America, and Mexico, little is known about its relationship to the health of Latino immigrants living in the United States.Objective To determine (1) rates of exposure to political violence among Latino adult primary care patients who have immigrated to the United States from Central America, South America, and Mexico and its impact on mental health and health-related quality of life and (2) frequency of disclosure of political violence to primary care clinicians.Design, Setting, and Participants Two-stage cluster design survey of a systematic sample of Latino immigrant adults in 3 community-based primary care clinics in Los Angeles, conducted from July 2001 to February 2002.Main Outcome Measures Reports of exposure to political violence in home country before immigrating to the United States and communication with clinicians about political violence; self-reported measures of health-related quality of life using the Medical Outcomes Study Short Form 36 (MOS SF-36); symptoms of depression, anxiety, and alcohol disorders using the Primary Care Evaluation of Mental Disorders (PRIME-MD); and symptoms of posttraumatic stress disorder (PTSD) using the PTSD Checklist-Civilian Version (PCL-C).Results A total of 638 (69%) of 919 eligible patients participated. The nonresponse rates did not differ by age, sex, recruitment sites, or clinic sessions. In weighted analyses, 54% of participants reported political violence experiences in their home countries, including 8% who reported torture. Of those exposed to political violence, 36% had symptoms of depression and 18% had symptoms of PTSD vs 20% and 8%, respectively, among those not exposed to political violence. Controlling for age, sex, country, years lived in the United States, acculturation, income, health insurance status, and recruitment site in a subsample of 512 participants (56%), those who reported political violence exposure were more likely to meet symptom criteria for PTSD (adjusted odds ratio [AOR], 3.4; 95% confidence interval [CI], 1.4-8.4) and to have symptoms of depression (AOR, 2.8; 95% CI, 1.4-5.4) and symptoms of panic disorder (AOR, 4.8; 95% CI, 1.6-14.4) than participants not reporting political violence. Those exposed to political violence reported more chronic pain and role limitations due to physical problems, as well as worse physical functioning and lower perceptions of general health than those who were not exposed to political violence. Only 3% of the 267 patients who had experienced political violence reported ever telling a clinician about it after immigrating; none reported their current physician asking about political violence.Conclusion Latino immigrants in primary care in Los Angeles have a high prevalence of exposure to political violence before immigrating to the United States and associated impairments in mental health and health-related quality of life.