Immigrants Suffer Legacy of Violence

More than half of Latino immigrants who visit health clinics in Los Angeles were exposed to political violence or torture before immigrating to the United States, and significant numbers suffer undiagnosed long-term effects, such as depression and post-traumatic stress disorder, UCLA researchers report today.

Most do not receive treatment for their mental problems because they do not report their experiences to physicians and the physicians don’t ask about them, said the study’s lead author, Dr. David Eisenman of the UCLA Medical Center.

The findings suggest that a much larger and more aggressive local mental health care system is necessary to address these problems, which can damage quality of life much as chronic diseases such as asthma do.

“There is very little knowledge among professional health-care providers about the problems of torture and violence,” said Michael Nutkiewicz of the Program for Torture Victims in Los Angeles. “The wounded among us are a larger problem than we might think.”

Eisenman’s results, reported today in the Journal of the American Medical Assn., “are troubling for mental health professionals who care about refugees and immigrants, because they say that, not only is there a lot of suffering among these persons, but also that the systems of care are not addressing it,” said Dr. Stevan Weine of the University of Illinois at Chicago.

“I’m not surprised by the prevalence of exposure to political violence, and I am not surprised by the prevalence of depression and post-traumatic stress disorder,” added Weine, who is also director of the International Center on Human Responses to Social Catastrophes. “I think what is really startling is that only 3% of the patients told a physician about it and that none of the physicians asked about it.”

Eisenman and his colleagues studied 638 Latino immigrants attending three unidentified Los Angeles clinics for help with general health issues, such as diabetes, lower back pain and bone breaks.

Each patient was interviewed for about 45 minutes while waiting to see a physician. Most were from Mexico and Central America.

The team found that 54% of those interviewed had experienced political violence in their home countries. Among those interviewed:

* 8% had been tortured.

* 15% had witnessed violence against their families.

* 27% reported the forced disappearance of family members.

* 26% had witnessed mass violence.

* 32% reported having their lives threatened by attacks with bombs or heavy weapons.

* 5% had witnessed torture or executions.

* 3% had been raped.

That exposure had significant long-term consequences, according to the survey. Of those exposed to political violence, 36% reported symptoms of depression, compared with 20% of those who had not been exposed. Similarly, 18% reported symptoms of post-traumatic stress disorder, compared with 8% of those not exposed.

Eisenman noted that the results were similar to what researchers had previously learned about victims of child and domestic abuse -- that large numbers of people were suffering from aftereffects, but that physicians were not identifying them.

He said he believes that political violence is just as significant a problem.

Nutkiewicz said he was not surprised that most victims hadn’t reported their experiences. “There is too much shame; they are embarrassed; they think their symptoms are unique,” he said.

Most identify their problems as political issues, Weine added.

“They say, ‘I am a survivor,’ not ‘I need help,’ ” he said.

Others need more creative solutions. For Bosnian refugees in Chicago, physicians devised a culturally acceptable form of group therapy.

“That’s a very non-stigmatizing setting,” Weine said. “That’s the kind of thing we need for these groups as well.”