1. Torture survivors’ symptom load compared to chronic pain and psychiatric in-patients
Uwe Harlacher*
Peter Polatin**
*) Nunca Mas & Medicines Sans Frontiers (currently Iraq)
**) George Washington University, Harvard Program in
Refugee Trauma, Boston, MA, USA

2. Background and Introduction
Pre treatment assessment data collected at the Danish Rehabilitation and Research Center for Torture Survivors (RCT) are compared with other patient groups
A Danish comparison between refugee patients with psychiatric in-patients has been re-analyzed in order to correct for a bias due to exclusion of refugee clients with substance abuse and hallucinations

3. Pain rehab without work ambition Pain rehab with work ambition
Disability Rating Index (DRI) Scores (mean of 12 items) for Torture Survivors (RCT prior to rehabilitation) compared to mixed Chronic Pain Patients (assessment only & prior to participation in rehabilitation programs with and without ambition to increase working capability) documented in the Swedish annual report 2008 of the Swedish National Register for Pain Rehabilitation (NRS)
Torture
RCT
n = 197
Pain
assessment
n = 1470
Pain rehab without work ambition
n = 186
Pain rehab with work ambition
n = 818
Mean 57 54 50 53
Sd = 22 21 20 18
t =
1.92
3.35
2.48
p =
.056
.001
.014
Cohen's d =
.15
.34
.22

4. Neck/Shoulder & Low Back Pain
Median for Disability Rating Index (DRI) Scores for Torture Survivors prior to rehabilitation at RCT compared to scores from the DRI evaluation study (arthritis knee/hip = patients waiting for implant surgery, multiple sclerosis = wheel chair bound patients); chi² comparison of the proportion of RCT-subjects above the median of the comparison group
Torture
RCT
Neck/
Shoulder
Neck/Shoulder & Low Back Pain
Arthritis
Knee
Hip
Multiple
Sclerosis
n =
197
127 39 24 23 16
Median 62 27 50 65 85
chi²=
58.96
15.39
2.22
0.85
33.53 p:
<.01
= .14
= .36

5. Hospital Anxiety and Depression Scale (HADS) sum-scores for anxiety and depression for RCT Torture survivors and pain patients documented in the annual report 2013 of the Swedish National Register for Pain Rehabilitation (NRS)
Torture / RCT
Chronic Pain / NRS 2013
Anxiety
n = 147
Depression
n = 1994
n = 1996
Median 18 16 9 8
Mean
16.5
15.5
8.9
8.3 Sd
4.29
4.15
4.86
4.46 t
20.48
20.19
p <
.000
Cohen's d
1.57
1.62

6. Mean d without substance item .40 .57 .71 .61 .44 .08
Health of Nation Outcome Scales (HoNos) sum score (12 items) for refugee patients at intake at the Clinic for PTSD and Transcultural Psychiatry, Aarhus University Hospital (CPTP)* and psychiatric in-patients at intake at the Psychiatric Center North Zealand*. Group wise mean effect sizes (d) of differences between the refugee and all other groups for all items and for the substance abuse and hallucination items and both excluded; the effect sizes are computed based on the item-wise effect sizes provided by Palic et al. (2014). *Denmark
CPTP
Refugees
n=448
Schizo-phrenia
n=3175
Affective
disorders
n=3081
Anxiety disord.
n=1781
Person.
disord.
n=1030
Addic-
tion
n=950
Demen-
tia
Sum all items
15.7
12.2
9.9
9.0
10.2
13.3
15.6
Mean d all items
.32
.49
.62
.51
.17
.05
Mean d without substance item
.40
.57
.71
.61
.44
.08
Mean d without hallucination item
.46
.52
.67
.55
.20
.11
Mean d without both critical items
.56
.77
.50
.15

7. Conclusions
Pain related dysfunction of TOV is higher than that of pain patients receiving about 120 h multidisciplinary pain rehabilitation without ambition to improve/restore working ability
The dysfunction is comparable to about 70 year old patients receiving artificial knees and hips
The degree of anxiety and depression is much higher than that of pain patients
Refugees (including ca. 30% TOV) have more general symptoms than psychiatric in-patients and are most similar to Dementia patients and most dissimilar to Anxiety Disorder patients

8. Discussion and comments
The findings contradict:
Danish political propaganda like “all immigrants have to (implicitly are able to) work”
The assumption that all symptoms of TOV are secondary to PTSD or depression
That minimal treatment, e.g. 5 h (taking translation into account) psychotherapy as applied in a Danish state based treatment program, could have a noteworthy beneficial effect
That the right of rehabilitation for TOV makes sense as far as the given amount of treatment lacks way behind that offered to other patient groups with comparable symptom load
That Danish state-financed organizations declaring to work in the interest of TOV engage in adequate advocacy