Faculty Bibliography

The lack of transparency in immigration detention in the United States has contributed to serious concerns about the fate of immigrants who are detained in the United States and require medical care. In particular, deficiencies in initial screening, chromic disease management (including referral to outside care), and pain management of detainees have been identified by numerous governmental and nongovernmental groups. We have identified a number of detainee deaths and poor medical outcomes that are related to substandard medical care and suggest system-wide problems in US Immigration and Customs Enforcement (ICE) health care. This article provides an overview of the current ICE health care system, presents four cases of detainee deaths and independent reporting of similar systemic problems, and recommends several specific changes to the ICE health care system.

Each year thousands of Tibetans escape Chinese-controlled Tibet. The authors present findings on the experiences, coping strategies, and psychological distress (depression, anxiety, somatization, and posttraumatic stress disorder) of 769 Tibetan refugees arriving in Dharamsala, India (2003-2004). Distress increased significantly with greater trauma exposure. However, despite a high prevalence of potentially traumatizing events, levels of psychological distress were extremely low. Coping activity (primarily religious) and subjective appraisals of trauma severity appeared to mediate the psychological effects of trauma exposure. The potential impact of other variables, including culturally determined attitudes about trauma and timing of assessment, are discussed

Medical educators strive to promote the development of a sound professional identity in learners, yet it is challenging to design, implement, and sustain fair and meaningful assessments of professionalism to accomplish this goal. The authors developed and implemented a program built around a Web-based Professional Development Portfolio (PDP) to assess and document professional development in medical students at New York University School of Medicine. This program requires students to regularly document their professional development through written reflections on curricular activities spanning preclinical and clinical years. Students post reflections, along with other documents that chronicle their professional growth, to their online PDP. Students meet annually with a faculty mentor to review their portfolios, assess their professional development based on predetermined criteria, and establish goals for the coming year. In this article, the authors describe the development of the PDP and share four years of experience with its implementation. We describe the experiences and attitudes of the first students to participate in this program as reported in an annual student survey. Students' experiences of and satisfaction with the PDP was varied. The PDP has been a catalyst for honest and lively debate concerning the meaning and behavioral manifestations of professionalism. A Web-based PDP promoted self-regulation on an individual level because it facilitated narrative reflection, self-assessment, and goal setting, and it structured mentorship. Therefore, the PDP may prepare students for the self-regulation of the medical profession--a privilege and obligation under the physician's social contract with society

Torture survivors often report chronic debilitating physical and psychological distress. Prior research on the relationship between physical and psychological trauma suggests that the 2 are not independent. Injury sustained during torture may increase the likelihood of subsequent distress as either a moderator or mediator. For long-term psychopathology in a sample of Punjabi Sikh survivors of human rights violations (N = 116), chronic injuries mediated the path between torture and posttraumatic stress disorder, specifically the severity of numbing symptoms. Although injuries were associated with major depression, torture was not, and injuries did not moderate the relationship between major depression and torture. Chronic injuries may represent trauma severity or persistent traumatic cues. These findings emphasize connections between physical and psychological trauma and the importance of an interdisciplinary approach to torture treatment

This study sought to translate and validate the Hopkins Symptom Checklist-25 (HSCL) and the Harvard Trauma Questionnaire (HTQ) in a Tibetan population. Translated questionnaires were administered to 57 Tibetan survivors of torture/human rights abuses living in the United States and receiving services in a torture treatment program. Participants were evaluated to determine if they met criteria for major depressive episode, generalized anxiety disorder, or posttraumatic stress disorder (PTSD). Coefficient alpha for the HSCL Anxiety subscale (.89), Depression subscale (.92), and the HTQ (.89) were high. Diagnostic accuracy using receiver operating characteristic curve analysis generated good classification accuracy for anxiety (.89), depression (.92), and PTSD (.83). However, although sensitivity and specificity for HSCL subscales were quite high, the HTQ generated low sensitivity (.33), partly because of a low rate of PTSD. Results support the reliability and validity of the HSCL but suggest further study of the HTQ with this population is required

Although trauma is widespread in Africa, Africans are unrepresented in the literature on posttraumatic stress disorder (PTSD). The authors used confirmatory factor analysis of responses to the Harvard Trauma Questionnaire to model PTSD symptom structure in a sample of African refugees presenting at a U.S. torture treatment clinic. They tested four models that are proposed in the literature and one based on their clinical experience in which some symptoms of hyperarousal were integrated into intrusion. Their findings support a preference for a 4-factor aroused intrusion model. Discussion focuses on interpretation of models, the role of numbing and avoidance, and the limitations of Euro American symptoms in non-Euro American populations.

Although a subjective component of trauma is commonly recognized in diagnosing posttraumatic stress disorder (PTSD), there are few studies that specifically address Criterion A2, and none addressing this issue among undocumented immigrants. We assessed 212 arriving undocumented immigrants with diverse trauma histories to investigate concordance between objective and subjective factors of trauma (Criteria A1 and A2) and across different types of trauma and PTSD. Concordance between Criteria A1 and A2 varied, with highest rates found for political violence. Interpersonal violence in general was associated with higher rates of PTSD. We identified a dose-response effect for PTSD, but this was not dependent on other events (i.e., other doses) meeting Criterion A2. Discussion focuses on Criterion A within the phenomenology of PTSD and the need to gauge subjective interpretations of trauma events among this population

Few research studies have systematically categorized the types of torture experienced around the world. The purpose of this study is to categorize the diverse traumatic events that are defined as torture, and determine how these torture types relate to demographics and symptom presentation. Data for 325 individuals were obtained through a retrospective review of records from the Bellevue/NYU for Survivors of Torture. A factor analysis generated a model with five factors corresponding to witnessing torture of others, torture of family members, physical beating, rape/sexual assault, and deprivation/passive torture. These factors were significantly correlated with a number of demographic variables (sex, education, and region of origin). Post Traumatic Stress Disorder, anxiety, and depression symptoms were significantly correlated with the rape factor but no other factors were uniquely associated with psychological distress. The results offer insight into the nature of torture and differences in responses