Psychological distress in torture survivors: pre- and post-migration risk factors in a US sample

  • Suzan J. Song
  • Charles Kaplan
  • Wietse A. Tol
  • Andrew Subica
  • Joop de Jong
Original Paper



To investigate the relationships between sociodemographic, pre- and post-migration variables with prevalence of psychological distress and global functioning in a heterogeneous sample of torture survivors.


Clients referred from resettlement agencies via the Office of Refugee Resettlement (ORR) to a community clinic in the United States (N = 278) were interviewed with structured, translated questionnaires. Univariate and multivariate logistic regression analyses determined the associations of sociodemographic, pre-, and post-migration risk factors with posttraumatic stress disorder (PTSD), depression, anxiety, and global functioning.


Regression data indicate that length of time between arrival in US and clinical services was significantly associated with PTSD and depression; participants receiving services after 1 year of resettlement were more likely to experience PTSD (adjusted OR = 3.29) and depression (adjusted OR = 4.50) than participants receiving services within 1 year. Anxiety was predicted by female gender (adjusted OR = 3.43), age over 40 years (adjusted OR = 3.12), Muslim religion (adjusted OR = 2.64), and receiving medical services (AOR 3.1). Severely impaired global functioning was associated with female gender (adjusted OR = 2.75) and unstable housing status (adjusted OR = 2.21).


Findings highlight the importance of examining post-migration variables such as length of time in country prior to receiving services in addition to pre-migration torture history upon relocated torture survivors. Clinicians and policy-makers should be aware of the importance of early mental health screening and intervention on reducing the psychiatric burden associated with torture and forced relocation.


Refugee Mental health Health services Asylum Trauma 



This project was supported by a grant from the Stanford Office of Community Health. We also wish to express our appreciation to James Livingston, PhD, Sarita Kohli, LMFT and Armina Husic for their support, and to the clinicians of the Center for Survivors of Torture who are dedicated to serving this community. We also thank all of the participants who made this research possible.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Suzan J. Song
    • 1
    • 5
  • Charles Kaplan
    • 2
  • Wietse A. Tol
    • 3
  • Andrew Subica
    • 4
  • Joop de Jong
    • 5
    • 6
    • 7
  1. 1.Center for Survivors of TortureAsian Americans for Community InvolvementSan JoseUSA
  2. 2.Research Professor and Associate Dean of ResearchUniversity of Southern California, School of Social Work, Hamovitch Center for Science in the Human ServicesLos AngelesUSA
  3. 3.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Psychology Applied Research CenterLoyola Marymount UniversityLos AngelesUSA
  5. 5.Amsterdam Institute for Social Science Research (AISSR)University of AmsterdamAmsterdamThe Netherlands
  6. 6.Adjunct Professor of PsychiatryBoston University School of MedicineBostonUSA
  7. 7.Emeritus Prof of Cultural and International Psychiatry VU University Medical CenterAmsterdamThe Netherlands

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