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Underlying trauma - that goes unheeded - is common amongst psychiatric patients

October 27, 2003

Traumatic experiences are very common amongst psychiatric patients in Sweden, especially those of non-Swedish origins. Yet this often goes ignored during diagnosis and therapy.

All patients who visited an outpatient psychiatric clinic in a multi-ethnic residential area for an entire year were examined. They were broken down into eight groups according to country of birth to see how clinical diagnoses differed according to ethnicity. The diagnoses they received were highly correlated with their ethnic origins; for example, a diagnosis of psychosis was six times more common amongst Africans, somatoform syndrome nine times more common amongst Greeks, and personality disorders twice as common amongst Swedes as other patients. None of the patients had been diagnosed with post traumatic stress syndrome (PTSD) during the year. Bearing in mind that some of the patients could be assumed to have been exposed to traumatic experiences and to the consequences of such experiences, an additional examination was conducted for trauma and PTSD. Four patient groups were selected: Arabs and Iranians with an assumed high risk of PTSD owing to their background in distressful areas; also Turks, mainly immigrant labour, and Swedes, both of whom were assumed to be in a lower risk category.

The results, which have been presented by psychologist Suad Al-Saffar's in a thesis published by KI, show high incidences of trauma in all patient groups. The prevalence of PTSD was 29% amongst Swedes, 53% amongst Turks, 59% amongst Arabs, and 69% amongst Iranians. The development of PTSD was seldom related to an isolated trauma, but often to a series of traumas. Trauma amongst relatives was of equal significance to the development of PTSD as the patient's own trauma. No gender differences were detected in the development of PTSD.

The long-term results for patients with PTSD were different to those of other psychiatric patients. Those who satisfied the criteria for PTSD had poorer self-rated health, a less active social life and participated less in their work, despite there being no difference between the groups' educational backgrounds.

Patients with several different traumas and those with non-Swedish backgrounds said that their traumas had been more ignored. Those who felt that their traumas had been satisfactorily taken into account in their therapy had better self-rated health and fewer symptoms. They also had greater confidence in those treating them.

The thesis shows that experiences of previous trauma are more the rule than the exception amongst psychiatric patients. There are severe shortcomings in how trauma and PTSD are noted and taken into account, particularly in the treatment of ethnic minorities. Focusing on trauma, both that of the patient and the relatives, can help to greatly improve long-term therapeutic results for psychiatric patients. It would also boost their confidence in those treating them. PTSD is an important diagnosis as it has a prolonged effect on a person's health and social life.

Karolinska Institutet

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