Post-traumatic stress disorder in refugee communities: The importance of culturally sensitive screening, diagnosis, and treatment

In the past several decades, millions of refugees fleeing conflicts across the globe have been resettled in other countries, including industrialized Western nations such as the United States, Canada, Australia, and Sweden. Many of these refugees have been exposed to severe-and often repeated-trauma in conflict zones, including combat, torture, sexual violence, and destruction of property. Sadly, countries receiving refugees are often unprepared for the magnitude of mental health problems these refugees bring with them. Post-traumatic stress disorder (PTSD), perhaps not surprisingly, seems to be a particularly prevalent condition among these refugees. Research on repeated waves of refugees from Southeast Asia, the former republics of Yugoslavia, as well as Africa, Southwest Asia, and the Middle East confirms that refugees experience PTSD symptomatology to an alarming degree. In this chapter, we discuss how PTSD manifests itself, sometimes differentially, in refugees, and present some best practices on how to screen for and diagnose it, as well as treat it in a culturally sensitive fashion. We present some standardized assessment inventories, such as the Harvard Trauma Questionnaire, that were deliberately created for use with refugees, and summarize some steps that refugee researchers can use to create their own culturally sensitive screening and diagnostic tools. Then, we introduce some empirically supported treatments used to alleviate PTSD symptomatology in refugees, including Cognitive Behavior Therapy (CBT), Narrative Exposure Therapy (NET), and testimony therapy. Ultimately, we argue that Western mental health practitioners can, through timely triage and provision of mental health services, dramatically improve the quality of refugees' lives and decrease the disease burden incurred by untreated mental health problems in their host countries.