CVT Journal Articles | Center for Victims of Torture

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.


Validation of a brief mental health screener for Karen refugees in primary care

Karen refugees from Burma are one of the largest refugee groups currently resettling in the USA. Karen people have endured decades of civil war and human rights violations, leaving them more likely to develop serious mental health disorders. There is a noted lack of brief, culturally validated tools present in primary care settings for detecting posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in Karen refugees. CVT Research Associate, Patricia J. Shannon, and former CVT staff member Gregory A. Vinson are among the authors.

Sharing Circles: learning from a community based psychosocial intervention model implemented with vulnerable populations in Myanmar

This study investigated an eight-session psychotherapy group called Sharing Circles. Trained local staff implemented a group intervention in Yangon, Myanmar with 57 Burmese participants from Yangon identified as belonging to one of three vulnerable groups. Preliminary findings suggest the Sharing Circles may be an effective psychosocial technique for improving psychological symptoms and providing psychosocial support. CVT Research Associate, Maria Vukovich, and former CVT staff member Gwen Vogel Mitchell are authors.

Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians

This report aims to provide information on the sociocultural background of the Syrian population as well as cultural aspects of mental health and psychosocial wellbeing relevant to care and support. It is based on an extensive review of the available literature on mental health and psychosocial support (MHPSS), within the context of the current armed conflict in Syria. The document is primarily meant to inform mental health and psychosocial support (MHPSS) staff, such as: psychologists, psychosocial counsellors, social workers, psychiatrists, psychiatric nurses, and others who are involved providing individual or group counselling, psychotherapy and/or psychiatric treatment for Syrians. Other humanitarian professionals, such as general health providers working with Syrians or staff involved in public health, community-based protection, community mobilisation, child protection, sexual and gender based violence (SGBV), may find this document useful, although it is not primarily written for them.

This document was commissioned by the United Nations High Commissioner for Refugees and posted on the UNHCR website. Several CVT staff members were contributors to or reviewers of the paper.

War trauma and torture experiences reported during public health screening of newly resettled Karen refugees: a qualitative study

Karen refugees have suffered traumatic experiences that affect their physical and mental health in resettlement. The United States Centers for Disease Control and Prevention recommends assessing traumatic histories and mental health symptoms during initial public health screening. This article reports the traumatic experiences that Karen refugees were able to describe during a short screening and contributes knowledge to existing human rights documentation systems. CVT Research Associate, Patricia J. Shannon, and former CVT staff member Gregory A. Vinson are among the authors.

Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees

In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal components analysis yielded categories of successful referrals that included: active care coordination, establishing trust, proactive resolution of barriers, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, refusal to see refugees, and system and language barriers. Recommendations for training and policy are discussed. CVT Research Associate, Patricia Shannon, and former CVT staff members Gregory A. Vinson and Evelyn Lennon are authors.

Exploring Mental Health Screening Feasibility and Training of Refugee Health Coordinators

Forty-four refugee health coordinators responded to a subset of questions from a 28-item, national survey exploring the mental health training of refugee health coordinators and the feasibility of refugee mental health screening. Most participants reported that it would be possible to administer a brief mental health screen; however, only half had received any mental health training. A minority of participants identified symptoms of posttraumatic stress disorder or major depression as their top concerns related to refugee mental health. The majority requested training on the mental health needs of arriving refugees. Training participation was associated with screening and positive referral outcomes. CVT Research Associate Patricia Shannon is one of the authors.



Does Integrated Care Affect Healthcare Utilization in Multi-problem Refugees?

A history of trauma is common in refugee populations and appropriate treatment is frequently avoided. Using a convenience sample of 64 patients in a Somali primary care clinic, a culture and trauma specific intervention was developed to address retention into appropriate treatment. One goal of the intervention was to improve the rate of engagement in psychotherapy after a mental health referral and to test the effect of psychotherapy on health care utilization using a staged primary care clinical tool. Forty-eight percent of patients given a mental health referral engaged in psychotherapy. Patients engaging in psychotherapy had higher baseline utilization and over 12 months trended towards less emergency room use and more primary care. The researchers’ findings suggest that the intervention improved referral and retention in mental health therapy for East African refugee women. Former CVT staff member Carol White is one of the authors.

Complicated grief in help-seeking torture survivors in sub-Saharan African contexts

Many help-seeking torture survivors in sub-Saharan Africa report sudden or violent bereavements, as well as risk factors associated with complicated grief. This mixed-methods article reviews 85 therapeutic client files from torture treatment centers in 3 countries in sub-Saharan Africa. Thirty-nine clients had lost loved ones and were at greater risk for depression (effect size 0.65) and thoughts of suicide (OR = 4.99). Qualitative analysis of case histories and interviews with clients elaborate the links between torture and complicated grief. Recommendations are offered for the treatment of complicated grief in sub-Saharan torture survivors, and implications for assessment, timing, and treatment duration are discussed. CVT researcher Craig Higson-Smith is the author.

Torture, War Trauma and Mental Health Symptoms of Newly Arrived Karen Refugees

The authors document the frequency of torture, war trauma and associations with mental health distress reported by Karen refugees during their initial public health screening in the United States. 179 Karen refugees completed a demographic questionnaire and 25- item mental health screening tool scored on a 4 point Likert scale. Primary and secondary torture was 27.4% and 51.4%, respectively. War trauma was reported by 86%. Torture, older age, and female gender were significantly associated with increased Total Distress, Posttraumatic Stress, Depression and Somatic complaints. Recommendations are reviewed for discussing mental health symptoms with Karen refugees.       

Exploring the Mental Health Effects of Political Trauma With Newly Arrived Refugees

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 Mental Health of Syrian Refugee Children and Adolescents

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.

Beyond Stigma: Barriers to Discussing Mental Health in Refugee Populations

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.

Refugees' Advice to Physicians: How to Ask about Mental Health (PDF)

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.




Mental Health Care for Survivors of Torture and Conflict

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.

Mental Health: Global Humanitarian Priority

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).

Community Intervention During Ongoing Political Violence: What is Possible? What Works?

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.

Counseling Torture Survivors in Contexts of Ongoing Threat: Narratives from Sub-Saharan Africa

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.

Assessment and Management of Conditions Specifically Related to Stress: mhGAP Intervention Guide Module (PDF)

Clinical Advisor Ann Wilhoite reviewed this document for the World Health Organization and UNHCR. Introduction. This Mental Health Gap Action Programme (mhGAP) Intervention Guide module contains assessment and management advice related to acute stress, post-traumatic stress and grief in non-specialized health settings. It is an annex to the mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-specialized Health Settings.



Screening for War Trauma, Torture, and Mental Health Symptoms Among Newly Arrived Refugees

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).

Evaluating the Mental Health Training Needs of Community-based Organizations Serving Refugees

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.

Refugee’s Perspectives on Barriers to Communication about Trauma Histories in Primary Care

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.

Torture Survivors: What to ask, how to document (PDF)

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.


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