Patients from abroad becoming patients in everyday practice: torture survivors in primary care

Since 1975, over 3.5 million refugees have resettled in the United States, many of whom have experienced some form of torture, and little data exists on their primary care needs. This is retrospective chart-review of sixty-one torture survivors in Denver, Colorado. The patients were predominantly from Africa, 88% experienced physical torture, 21% sexual torture. Medical conditions included: major depression (45%), PTSD (48%), anxiety (31%), insomnia (50%), hypertension (29%), dyslipidemia (6%), HIV (6%) and tuberculosis class 2-4 (32%). Physical torture increased rates of PTSD (OR 7.29; CI 1.81, 29.45) and insomnia (OR 5.08; CI 1.41, 18.34). Sexual torture increased rates of major depression (OR 5.44; CI 1.29, 22.99), PTSD (OR 8.24; CI 1.61, 42.18), and insomnia (OR 6.84; CI 1.34, 34.90). Somatic complaints were more frequent in those who had experienced sexual torture (P = 0.041). Torture survivors have complex primary care needs, requiring multidisciplinary treatment.