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International Journal of Social Psychiatry
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Brief Multi-Disciplinary Treatment for Torture Survivors in Nepal: a Naturalistic Comparative Study

Wietse A. Tol

HealthNet TPO, Department of Public Health and Research, Amsterdam, the Netherlands, and Vrije University Medical Center, Amsterdam, the Netherlands, wtol{at}healthnettpo.org

Ivan H. Komproe

HealthNet TPO, Department of Public Health and Research, Amsterdam, the Netherlands

Mark J.D. Jordans

HealthNet TPO, Department of Public Health and Research, Amsterdam, the Netherlands, and Vrije University Medical Center, Amsterdam, the Netherlands

Suraj B. Thapa

Institute of Psychiatry, University of Oslo, Norway

Bhogendra Sharma

Centre for Victims of Torture, Nepal, Kathmandu, Nepal

Joop T.V.M. De Jong

Vrije University Medical Center, Amsterdam, the Netherlands, GGD Amsterdam, the Netherlands, and Boston University, School of Medicine, United States of America

Background: Little is known about the effectiveness of treatment for torture survivors in low-income settings. Multi-disciplinary treatment is an often used approach for this target group.

Aims: This study was aimed at examining the effectiveness of brief multi-disciplinary treatment for torture survivors in Nepal.

Methods: A naturalistic comparative design with help-seeking torture survivors and internally displaced persons assigned to a treatment and a comparison group respectively ( n = 192; treatment group n = 111, comparison group n = 81), with baseline measurements on psychiatric symptomatology, disability, and functioning and a five-month follow-up (n = 107; treatment group n = 62; comparison group n = 45), was employed. Intervention consisted of brief psychosocial services, minimal medical services and/or legal assistance.

Results: Study groups were generally comparable and non-completers did not significantly differ from completers. The treatment group improved more than the comparison group on somatic symptoms, subjective well-being, disability and functioning, with mostly moderate effect sizes.

Conclusion: Treatment was moderately effective, with regards to reducing the nonspecific mental health consequences of torture, but disability scores remained high. For clients presenting with more severe mental health problems, other treatments that are realistic in the resource-poor Nepali context need to be sought.

Key Words: effectiveness • Nepal • psychosocial • torture • treatment

International Journal of Social Psychiatry, Vol. 55, No. 1, 39-56 (2009)
DOI: 10.1177/0020764008091525
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