High Percentage of Latino Immigrants Exposed to Political Violence in Their Homeland

Newswise — According to UCLA researchers, the impact of torture and related violence in a U.S.-based Latino immigrant population shows over half of patients surveyed have been exposed to political violence, including torture, in their homeland. However, very few patients inform their primary care physician about their experiences. The combination of exposure to violence and non-disclosure to the doctors affects the patient's overall health, diagnosis and treatment.

The study reported in the Aug. 6, 2003, issue of the Journal of the American Medical Association looked at whether exposure to different types of political violence and ability to discuss these issues with their doctor, was a key predictor of a patient's current mental health status and health-related quality of life. The results indicate primary care clinicians should ask their immigrant and refugee patients about past exposure to war and political violence.

According to Dr. David Eisenman, clinical instructor of medicine specializing in health services research at UCLA Medical Center, a researcher at RAND, and the study's lead author, "Torture, forced disappearances of family members, and witnessing massacres are just some of the traumas that still affect our patients."

The Latino population is the fastest growing minority group in the United States, comprising 12.5 percent of the population. More than 4.2 million Latino people live in Los Angeles County alone, representing 44.6 percent of its population.

"This population is very significant," Eisenman continued. "Many doctors treat patients who are Latino immigrants. This problem is right under our noses."

Previous studies focused on asylum seekers, refugees living in refugee camps in developing countries, or people in specialty clinic settings looking mainly at post-traumatic stress disorder (PTSD) and depression. These studies have limited relevance to U.S.-based populations of immigrants and refugees and to primary care clinicians practicing in the United States.

This current study used a trauma survey and mental health and health-related quality of life surveys to look at the primary care of the Latino immigrant population in a major American city, Los Angeles.

Adult patients from three community-based, primary care clinics in Los Angeles were randomly chosen to participate in the study. All three sites are free standing community clinics offering medical, pediatric and obstetric-gynecologic services to a mainly uninsured Latino population and serve approximately 24,000 adult patients per year. Latino patients in the study came mostly from Central America and Mexico. None of the sites had special programs targeted to particular populations such as new immigrants, refugees or migrant workers.

Of the 638 patients who participated in the trauma survey, 54 percent had been exposed to political violence. Participants were considered exposed to political violence if they answered "yes" to ever directly experiencing one of the political violence events at any time in their life while living in their native country.

Political violence was broken down as follows: 8 percent reported torture, 15 percent witnessed violence against their family, 27 percent reported forced disappearance of family members, 26 percent witnessed mass violence, and 32 percent reported their lives having been endangered by attacks with bombs or heavy weapons. Five percent reported witnessing torture or an execution and 3 percent reported being raped.

The results show patients exposed to political violence were two to five times more likely than those not exposed to have symptoms consistent with a diagnosis of PTSD, depression, panic disorder and any mental health disorder. In addition, the impairment of health related quality of life was more severe than researchers anticipated. Patients reporting political violence exposure had greater chronic pain, impaired physical functioning and diminished health related quality of life. The magnitude of the effect seen in the health related quality of life scores is comparable to, or greater than, differences seen comparing groups with or without such chronic diseases as mild asthma.

Although more than half of the study participants had some form of exposure to political violence, only three percent of the participants had reported their experiences to a physician after immigration to the United States.

Eisenman stated the significance of the study on primary care physicians, "Doctors should ask patients who are immigrants about war, torture and political violence experiences, especially if there are psychological or chronic pain problems so that these patients can receive proper diagnosis, treatment and referrals."

To improve comparability and quantification of the effects of specific events and to avoid the difficulties presented by the possibly varying meanings of political violence among cultures, an event specific checklist, or trauma survey, was developed as opposed to letting the patients self-define political violence.

The study was co-authored by UCLA Researchers Lillian Gelberg, M.D., M.S.P.H., Honghu Liu, Ph.D., and Martin F. Shapiro, M.D., Ph.D. Drs. Eisenman, Liu and Shapiro are affiliated with UCLA's Division of General Internal Medicine and Health Services Research, and Dr. Gelman is associated with UCLA's Department of Family Medicine. The study was funded by a grant from the Health Resources & Services Administration, and Mary and Irving Lazar Program in Health Services Research.