Practice 10-Minute Consultation

Identifying post-traumatic stress disorder in forced migrants

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1608 (Published 10 May 2018) Cite this as: BMJ 2018;361:k1608
  1. Manpreet Bains, general practitioner1,
  2. Clare Shortall, refugee health lead2,
  3. Tabitha Manzuangani, patient advocate3,
  4. Cornelius Katona, medical director4,
  5. Katherine Russell, consultant epidemiologist5
  1. 1Imperial College Health Partners, London, UK
  2. 2Doctors of the World UK, London, UK
  3. 3Queen Mary University of London, London, UK
  4. 4Helen Bamber Foundation, London, UK
  5. 5Travel and Migrant Health Section, Public Health England, London, UK
  1. Correspondence to M Bains Manpreet.Bains{at}imperialcollegehealthpartners.com

What you need to know

  • Post-traumatic stress disorder (PTSD) commonly coexists with other mental health problems

  • Consider PTSD if there are risk factors and symptoms of re-experiencing, avoidance, hyperarousal, or a heightened sense of current threat, and difficulties with daily functioning for longer than one month

  • Consider whether family members are affected by the same trauma

A 35 year old man, who was recently forced to migrate because of conflict, presents with headaches. Tension headache is diagnosed and review is arranged. On return he reports that the headaches are relieved by the analgesics he was prescribed, but his sleep is poor and he has frequent nightmares, from which he wakes feeling anxious and sweating.

People who have had to undergo forced migration are more likely to have experienced the sort of trauma that would predispose them to post-traumatic stress disorder (PTSD), and are therefore at higher risk of PTSD than the general population in their new country of settlement.1 However, identifying PTSD is often difficult because vulnerable patients can be reluctant to discuss the details of these traumas without having already established trusting relationships with their doctors.

What you should cover

Establish whether there are risk factors for PTSD

If a forced migrant describes specific symptoms of PTSD or symptoms of depression, anxiety, anger, drug misuse, or alcohol misuse, ask sensitive questions about their experience and the events leading up to their forced migration to establish if there is …

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