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Clinical Crossroads
August 7, 2013

Primary Care Management of Non–English-Speaking Refugees Who Have Experienced TraumaA Clinical Review

Author Affiliations
  • 1Associate Professor, Boston University School of Public Health, Boston, Massachusetts
  • 2Associate Professor of Medicine, Boston University School of Medicine, Boston, Massachusetts
JAMA. 2013;310(5):519-528. doi:10.1001/jama.2013.8788
Abstract

Importance  Refugees are a vulnerable class of immigrants who have fled their countries, typically following war, violence, or natural disaster, and who have frequently experienced trauma. In primary care, engaging refugees to develop a positive therapeutic relationship is challenging. Relative to care of other primary care patients, there are important differences in symptom evaluation and developing treatment plans.

Objectives  To discuss the importance of and methods for obtaining refugee trauma histories, to recognize the psychological and physical manifestations of trauma characteristic of refugees, and to explore how cultural differences and limited English proficiency affect the refugee patient–clinician relationship and how to best use interpreters.

Evidence Review  MEDLINE and the Cochrane Library were searched from 1984 to 2012. Additional citations were obtained from lists of references from select research and review articles on this topic.

Findings  Engagement with a refugee patient who has experienced trauma requires an understanding of the trauma history and the trauma-related symptoms. Mental health symptoms and chronic pain are commonly experienced by refugee patients. Successful treatment requires a multidisciplinary approach that is culturally acceptable to the refugee.

Conclusions and Relevance  Refugee patients frequently have experienced trauma requiring a directed history and physical examination, facilitated by an interpreter if necessary. Intervention should be sensitive to the refugee’s cultural mores.

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