CVT Journal Articles
Below is a collection of peer-reviewed journal articles by CVT staff. Whenever possible, we include a PDF of the article with the permission of the journal. If you use the article, please cite the publication.
The authors explored the mental health effects of war trauma and torture as described by 111 refugees newly arrived in the United States. Contrary to the belief that stigma prevents refugees from discussing mental health distress, participants readily described complex conceptualizations of degrees of mental health distress informed by political context, observation of symptoms, cultural idioms, and functional impairment. Recommendations for health care providers include assessment processes that inquire about symptoms in their political context, the degree of distress as it is culturally conceptualized, and its effect on functioning. Findings confirm the cross-cultural recognition of symptoms associated with posttraumatic stress disorder; however, refugees described significant cultural variation in expressions of distress, indicating the need for more research on culture-bound disorders and idioms of distress.
The authors of the 20 articles in Forced Migration Review issue 47 offer observations that could be of value in increasing the level of protection for displaced Syrians and in shaping assistance to both the displaced and the countries and communities that are ‘hosting’ them. CVT staff write on the mental health of Syrian refugee children and adolescents.
Mental health stigma remains one of the most commonly cited reason for why refugees fail to access mental health services. This study looks beyond stigma to explore refugees’ perspectives on why it is difficult to discuss mental health. Ethno-cultural methodologies informed 13 focus groups with 111 refugees from Burma, Bhutan, Somali and Ethiopia. Findings describing reasons why it is difficult to discuss mental health include a history of political repression, fear, the belief that talking does not help, lack of knowledge about mental health, avoidance of symptoms, shame, and culture. Recommendations for empowering and educating refugees are discussed.
About 45.2 million people were displaced from their homes in 2012 due to persecution, political conflict and human rights violations. Refugees who endure violence are at increased risk of developing chronic psychiatric disorders such as posttraumatic stress disorder and major depression. The primary care visit may be the first opportunity to detect the devastating psychological effects of trauma. This article by Patricia J. Shannon, PhD and published in Family Practice (2014), shares refugees recommendations that physicians take the time to make refugees comfortable and initiate conversations about mental health.
For the Minority Rights Group International's flagship report, State of the World's Minorities and Indigenous Peoples 2013, CVT Clinical Advisor David Gangsei, PhD; Clinical Advisor Erin Morgan, MS, LMFT; Clinical Advisor Paul Orieny; Clinical Advisor Ann Willhoite; and Communications Director Holly Ziemer, MA, write about CVT’s work providing mental health care to refugee survivors of torture and war trauma and the need to integrate mental health care in support of refugees and during post-conflict rebuilding. This report provides a global picture of the health inequalities experienced by minorities and indigenous communities. The Minority Rights Group International is a human rights organization working to secure the rights of ethnic, religious, and linguistic minorities and indigenous peoples. It works with more than 150 partners in over 50 countries.
Jennifer J. Esala, Ph.D., a CVT Monitoring and Evaluation Advisor, discusses the importance of integrating mental health care in humanitarian responses post-conflict. She writes that mental health is integral to helping individuals and their families rebuild their lives, and it is integral to restoring societies torn apart by violence. Highlighting the vital role the United Nations Voluntary Fund for Victims of Torture plays in supporting torture survivor rehabilitation worldwide, Jennifer also calls upon the international community to generously increase contributions to the Fund. The article was published in the June-Aug. 2013 edition of TORTURE: Asian and Global Perspectives.
Continuous Traumatic Stress: Conceptual Conversations in Contexts of Global Conflict, Violence and Trauma
This article discusses the political and mental health limitations associated with the concept of posttraumatic stress in the context of continuous traumatic stress. The authors call for more nuanced and complex understandings of such complex psychosocial conditions and their effects. They conclude by emphasizing the importance of understanding such contexts of ongoing exposure to dangers as both political and psychological, the need to develop socially relevant clinical and conceptual models that can meaningfully account for the varied impacts and responses to conditions of ongoing threat, and the need to extend or psychological interventions to include culturally and contextually appropriate strategies that are both clinical and psychosocial in orientation. CVT researcher Craig Higson-Smith was one of the authors along with coauthors from the University of the Witwatersrand and the University of Cape Town. The article was published in a special issue Continuous Traumatic Stress in Peace and Conflict: The Journal of Peace Psychology (Vol. 19, No. 2, May 2013).
The authors of this study are from The Tree of Life, a Zimbabwean civil society organization with many years’ experience in community-based healing, in collaboration with CVT researchers Craig Higson-Smith and Dr. Greg Vinson. The article was published in a special issue Continuous Traumatic Stress in Peace and Conflict: The Journal of Peace Psychology (Vol. 19, No. 2, May 2013). The study looked at two approaches to improving the emotional health and community connectedness of 139 torture survivors living in situations of continuous traumatic stress. The article concluded that it is possible to provide healing under conditions of ongoing political violence. Such interventions do contribute to healthier people and communities, and may facilitate lasting peace and security.
CVT researcher Craig Higson-Smith contributed this article to the special issue Continuous Traumatic Stress in Peace and Conflict: The Journal of Peace Psychology (Vol. 19, No. 2, May 2013). In his paper, Craig presents a narrative analysis of interviews with torture survivors from Sub-Saharan Africa and their counselors. He discusses the impact of continuous threat and repeated victimization on torture survivors’ recovery and discusses the implications for counseling when violence is ongoing.
The first national survey of refugee mental health screening practices found that while refugee trauma survivors are at increased risk of developing posttraumatic stress disorder and major depression, most states do not provide mental health screenings. Of the 25 states that provide mental health screening, 17 use informal conversation rather than standardized measures. Co-author Patricia Shannon, MSW, PhD is a research associate at CVT and assistant professor at the University of Minnesota. The article was published in the Journal of Immigrant and Refugee Studies (paid access only).
This article published in Advances in Social Work (Vol 13, No 2) in 2012 looked at the mental health knowledge and training needs of refugee-serving community based organizations, and makes policy recommendations for improving the services offered to refugees. The authors are Jennifer Ann Simmelink, a Doctoral Candidate, and Patricia Shannon, PhD, LP, an Assistant Professor, both in the School of Social Work at the University of Minnesota. Dr. Shannon is also a research associate with CVT’s Healing in Partnership project.
CVT is grateful to the St. Paul Foundation whose financial support made this work possible.
This article published in Mental Health in Family Medicine (vol 9 pp 47-55) found that many refugees fleeing political conflict and violence are affected by their experiences, but have not spoken to their doctors about them. Most refugees surveyed said they would talk to their doctors to receive help for the health, and many showed an interest in learning how stress and trauma affect their health. The authors are Patrician Shannon, PhD, LP, research associate with CVT’s Healing in Partnership project, Erin Mehta, RN, PHN, CVT nurse and clinic manager, and Maureen O’Dougherty with the University of Minnesota. The study is based on data collected as part of CVT’s New Neighbors/Hidden Scars project.
PTSD Symptom Structure Among West African War Trauma Survivors Living in African Refugee Camps: A Factor-Analytic Investigation
In this article published by the Journal of Traumatic Stress, CVT researchers Gregory Vinson, Ph.D. and Zoua Chang, Ph.D., L.P. found that, for West African refugees, posttraumatic stress disorder symptoms clustered in four symptom areas. This is in keeping with other recent research with trauma victims but in contrast with the diagnostic manual used to diagnose PTSD. Most research on PTSD comes from studies on veterans in the West. This study is among the first to examine PTSD symptoms with non-Western, civilian, war-affected populations remaining in their region-of-origin.
This article in the Journal of Family Practice (April 2012) provides practical information for primary care providers to help them better identify survivors of torture, assess and document consequent morbidities and refer them to appropriate treatment programs. The article was written by Steven H. Miles, M.D., CVT board member, and Rosa E. Garcia-Peltoniemi, PhD, LP, senior consulting clinician at CVT.