عوارض بهداشت روانی پس از سانحه ضربه به سر در بازداشت شدگان سابق سیاسی ویتنام جنوبی که از شکنجه جان سالم به در برده اند

Little is known about the relationship between traumatic head injury (THI) and psychiatric morbidity in torture survivors. We examine the relationship between THI and depression, PTSD, post-concussive syndrome (PCS), disability and poor health status in Vietnamese ex-political detainees who survived incarceration in Vietnamese re-education camps. A community sample of ex-political detainees (n = 337) and a non-THI, non-ex-detainee comparison group (n = 82) were surveyed. Seventy-eight percent of the ex-political detainees had experienced THI; 90.6% of the ex-political detainees and 3.6% of the comparison group had experienced 7 or more trauma events. Depression and PTSD were greater in ex-detainees than in the comparison group (40.9% vs 23.2% and 13.4% vs 0%). Dose–effect relationships for THI and trauma/torture in the ex-political detainee group were significant. Logistic regression in the pooled sample of ex-detainees and the comparison group confirmed the independent impact of THI from trauma/torture on psychiatric morbidity (OR for PTSD = 22.4; 95% CI: 3.0–165.8). These results demonstrate important effects of THI on depression and PTSD in Vietnamese ex-detainees who have survived torture.

Traumatic head injury (THI) is a common form of torture and human degradation that occurs during war and other forms of mass violence. Thygesen et al. [1] demonstrated significant neurological and psychiatric morbidity in concentration camp survivors associated with the most commonly reported torture, blows and kicks to the head. Clinical studies have documented chronic neuropsychiatric findings in torture survivors including cerebral atrophy [2]. Rasmussen [3] found that 64% (N = 200) of torture survivors revealed neurological impairments (2/3 with head injury). Other studies of torture survivors and survivors of mass violence have linked psychiatric symptoms, neurological impairment, and traumatic brain injury (TBI) [4], [5], [6], [7] and [8].

For the first time since the original work of Eitinger [55] and [56] immediately after World War II, THI and presumptive TBI (objectively presented in our neuroimaging study [22]) have been demonstrated to be strongly related to psychiatric morbidity, disability, and poor health status in survivors of extreme violence. THI events such as “beatings to the head” are unfortunately common instruments of human cruelty. The brain is an extremely sensitive organ that can be readily damaged without obvious indications of a penetrating wound or major neurological deficit [63]. These invisible wounds, however, can have major emotional, social, and health consequences over time. Screening for and the treatment of THI health and mental health sequelae must become standard operating practice in the care of those individuals affected by mass violence and torture.