A JAMA THEME ISSUE
Edited by Annette Flanagin, RN, MA, and Thomas B. Cole, MD, MPH
The Wuhu region of Anhui province, People’s Republic of China,
was seriously affected during the Chinese famine of 1959-1961. St Clair and
colleaguesArticle examined medical records for patients
evaluated at the single psychiatric hospital serving the region and found
a 2-fold increased risk of schizophrenia among persons born during the famine
years compared with persons born in the years before or after. In an editorial,
NeugebauerArticle discusses past and present famines
and a potential link between nutritional folate deficiency and schizophrenia.
Suicide and homicide prevention are the focus of 2 articles in this
issue of JAMA. First, Brown and colleaguesArticle found
that a cognitive therapy program was more effective than usual care in preventing
repeat suicide attempts in adults. In a second article, Cook and colleaguesArticle calculated the proportion of homicides that might
be eliminated by a hypothetical intervention targeted at individuals with
a prior criminal record. They concluded that this strategy would reduce the
homicide rate by 31%. In an editorial, Cole and GlassArticle discuss
public health strategies to reduce violent deaths.
War refugees have a high risk of acute psychiatric distress, but whether
this risk persists years later and after resettlement in a resource-rich country
is not known. Marshall and colleaguesArticle interviewed
refugees who had lived in Cambodia during the Khmer Rouge reign and immigrated
to the United States prior to 1993, on average 22 years ago. Nearly all surveyed
persons had experienced serious trauma before immigration, and 70% reported
exposure to violence after settlement in the United States. The authors found
high rates of past-year posttraumatic stress disorder (62%) and major depression
(51%) in this population.
From a survey of survivors of war in the former Yugoslavia who had experienced
at least 1 war-related trauma, Başoğlu and colleaguesArticle assessed
whether redress for trauma and beliefs about justice, safety, sense of control,
and other factors were related to the risk of posttraumatic stress disorder
(PTSD) and depression in these persons. They found that concerns about personal
safety and a feeling of loss of control over life but not a sense of injustice
arising from a perceived lack of redress for the trauma experienced were associated
with PTSD and depression.
Severe malnutrition has a high mortality rate among hospitalized children
in sub-Saharan Africa, but appropriate assessment of malnutrition is not always
feasible. In a cohort study of severely malnourished children aged 1 to 5
years who were hospitalized in rural Kenya, Berkley and colleaguesArticle evaluated
middle upper arm circumference (MUAC) and visible severe wasting as predictors
of inpatient mortality and compared these with the weight-for-height z score (WHZ) and determined that the MUAC is a practical
assessment tool that performs at least as well as WHZ.
Violence and other human rights abuses take many forms, from modern-day
slavery in the United States and elsewhere to the widespread use of rape as
a weapon of terror in Darfur, Sudan.
Clinical ReviewThe mental health of
refugees is influenced by exposure to certain social and political factors
before and after displacement.
Rwandan women and the Women’s Equity in Access to Care and Treatment
(WE-ACTx) have created a counseling and care system after the 1994 genocide
to help surviving women who were raped and are infected with the human immunodeficiency
Strategies for preventing binge drinking, an avoidable cause of violent
Collaborative efforts between researchers studying child maltreatment
and others studying intimate partner violence could lead to a greater understanding
of the risks and consequences of both categories of family violence.
For your patients: Information about refugee mental health.
This Week in JAMA . JAMA. 2005;294(5):523. doi:10.1001/jama.294.5.523