Assessment of torture survivors who suffer from co-morbid persistent pain : a descriptive literature review of used assessment tools and key themes to consider

Abstract

Torture is a heinous crime impacting not only the individual but also the community and society. Torture can result in physical and mental health problems, decreased functioning in all aspects, and decreased quality of life. It is not uncommon that torture rips the self-esteem and dignity of the victim. It is not only the traumatic act of torture itself that causes distress to the individual. There is more stress related to the environment where the acts occur, as well as post-migration stress if the person can relocate to another country.

Pain is one of the most common symptoms that Survivors of Torture (SoT) describe, in addition to mental health symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety. Pain is not only about nociception, but there are additional factors at play—individual aspects, such as environment, beliefs, and co-morbidities, also impact it. An increased symptom load has been observed among SoT individuals, resulting in a decreased quality of life and loss of overall functioning. Treatment and rehabilitation success often focus on the intensity of pain before and after, which is assessed using various tools.

This thesis aims to describe the assessment methods used with SoTs suffering from co-morbid paid and to determine the role of quality of life or health-related quality of life in the current literature. The purpose was to study the assessment tools, aims, and methods and build reassemble themes to determine the approach intentions behind the chosen assessment. The background organization for the thesis process was the Helsinki Deaconess Foundation, Center for Psychotraumatology. It is a psychiatric clinic that assesses, treats, and rehabilitates torture victims and their family members. Additionally, they provide education and consultation. The purpose is also to ensure that the medicolegal rights of the SoT are actualized.

The thesis is a descriptive literature review, and thematic analysis has been used. The literature was retrieved from PubMed and CINAHL Ultimate as well from an additional review article by Dee et al. 2020. The final analysis included 14 sources. In the thematization process, seven themes were constructed: Symptom Management and Coping Strategies, Symptom Interference and Daily Functioning, Understanding Individual’s Background and Trauma History, Social Participation and Integration, Diagnostic Properties and Symptom Characteristics, Physiological Measures and Functional Assessment, and The Role of Quality of Life.

The results showed that the assessment processes of survivors of torture are mainly focused on the interference of the symptoms, diagnostic features, and collecting personal information about the person. What was in the minority was the assessment focused on symptom management. This means that the person's coping and self-efficacy were not the focus point. Furthermore, the included literature showed that the quality of life for this patient group is low; however, none of the assessment tools or methods specifically focused on evaluating this factor.

Further studies should focus on the quality of life and health-related quality of life of survivors. Additionally, the assessment process should incorporate more patient-centered coping strategies rather than focusing solely on the illness and clinicians' perspectives.