Research questions examined whether survivors receiving medical, psychological and case management services show improvement in psychological health, self-perceived health and functional status, and report increased rates of employment, education, and/or community involvement at follow-up compared to at screening.
Methods: Participants were 39 of 77 adult survivors enrolled in services at the Program for Torture Victims (PTV) in Los Angeles, California. Multidisciplinary services included medical and psychiatric care, psychotherapy, case management, forensic evaluations, and testimony. We employed a within-subjects repeated measures design, with clients as their own control. All new clients who had no immediate asylum court date, and were screened to not be at high risk of psychological or medical crises were invited to participate. IRB approval and informed consent procedures were followed. Data was collected at 3 time points: screening; intake (approximately 1 month post-screening and waitlisted); and follow-up (9-12 months post-intake).
Participant data collected at each time point included demographics, anxiety and depression (HSCL-25), PTSD (PCL-C), physical and mental health assessments, and self-assessment of functioning. Case management assessment and a trauma history covering torture and non-torture events across the lifespan were also collected at intake. Anonymous client satisfaction surveys were conducted at follow-up. Analysis included descriptive statistics and repeated measures using the GLM.
Results: Participants were 56% male, (mean = 37; range 20-58). Half came from Africa, one third from Asia, 13% the Former Soviet Union, 5% Middle East, 2% from Latin America. They had been in the U.S. from 3 days to 12 years prior to receiving PTV services. All experienced psychological torture, 94% physical torture, and 47% sexual torture in their home countries. They experienced clinically and statistically significant (p=.000) improvement in mean level of PTSD (90% to 42%), anxiety (90% to 46%) and depression (95% to 58%) by follow-up; functioning and self-sufficiency also improved. All were seeking asylum at the time of screening and intake; 25% had obtained asylum at follow-up with the rest still awaiting adjudication.
Conclusions and Implications: Results support our hypothesis that within a year of receiving services clients will experience reduced PTSD, depression and anxiety and improved functioning. While most clients receive asylum, it often takes several years during which time family in the home country are often targeted for harassment, torture or death while awaiting reunification. Findings provide practice insights and support policy change to reduce administrative delays to adjudicating cases. Further research is needed to more deeply understand the factors that contribute to positive changes in torture survivors.
