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Metin Baolu, MD, PhD; Murat Paker, MD, MA; Erdogan Özmen, MD; Özgün Tademir, MD, MA; Dogan ahin, MD

JAMA. 1994;272(5):357-363.

Abstract
Objective.
—To examine factors related to long-term psychological functioning in political ex-prisoners who had been subjected to systematic torture.

Design.
—The psychological status of 55 tortured political activists, 55 nontortured political activists, and 55 subjects with no history of torture or political activism was assessed using Structured Clinical Interview for DSM-III for psychiatric assessment, Semi-structured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD). Correlational and multiple regression analyses were used to assess the independent effects of precaptivity, captivity, and postcaptivity variables as predictors of long-term psychological status among the torture survivors.

Setting.
—Istanbul, Turkey.

Main Outcome Measures.
—Number of lifetime and current PTSD symptoms, and scores on the Beck Depression Inventory, Hamilton Depression Rating, Hamilton Anxiety Scale, and State-Trait Anxiety Inventory.

Results.
—Effect of captivity experience on various life areas (eg, family and social, economic, and employment status) and other postcaptivity psychosocial stressors were associated with PTSD symptoms, anxiety, and depression. Perceived severity of torture was related to PTSD symptoms but not to anxiety or depression. Lack of social support predicted anxiety and depression but not PTSD. Family history of psychiatric illness correlated with higher scores on most measures. Impact of captivity experience on family was the strongest predictor of PTSD symptoms.

Conclusions.
—These findings point to three types of stressors related to different aspects of psychopathology in survivors of torture: perceived severity of torture, secondary effects of captivity experience on various life areas, and general psychosocial stressors following captivity. Different interventions may be needed for three components of survivors' traumatic experience: cognitive and behavioral strategies for treatment of PTSD symptoms, marital or family strategies for minimizing the impact of the trauma on the family, and strategies for enhancing social support to minimize postcaptivity depression and anxiety.

(JAMA. 1994;272:357-363)

Author Affiliations
From the Institute of Psychiatry, University of London (England) (Dr Baolu); the New School for Social Research, New York, NY (Drs Paker and Tasdemir); Tademir); Kirköy Psychiatric Hospital, Istanbul, Turkey (Dr Özmen); and the Department of Psychiatry, University of Istanbul (Turkey) (Dr ahin).

Footnotes
Reprint requests to the Institute of Psychiatry, 99 Denmark Hill, London SE5 8AF, England (Dr Baolu).

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