The British Journal of Psychiatry (2010)
196, 122–125. doi: 10.1192/bjp.bp.108.059139
Long-term mental health of Vietnamese refugees
in the aftermath of trauma
Aina Basilier Vaage, Per Hove Thomsen, Derrick Silove, Tore Wentzel-Larsen, Thong Van Ta
and Edvard Hauff
Background
There is no long-term prospective study (420 years) of the
mental health of any refugee group.
Aims
To investigate the long-term course and predictors of
psychological distress among Vietnamese refugees in
Norway.
significantly from T1 to T3 (2005–6), but there was no
significant change in the percentage reaching threshold
scores (GSI =1.00). Trauma-related mental disorder on arrival
and the trajectory of symptoms over the first 3 years of
resettlement predicted mental health after 23 years.
Method
Eighty Vietnamese refugees, 57% of the original cohort
previously interviewed in 1982 (T1) and 1985 (T2), completed
a self-report questionnaire prior to a semi-structured
interview. Mental health was measured using the Symptom
Checklist–90–Revised (SCL–90–R).
Conclusions
Although the self-reported psychological distress decreased
significantly over time, a substantial higher proportion of the
refugee group still remained reaching threshold scores after
23 years of resettlement compared with the Norwegian
population. The data suggest that refugees reaching
threshold scores on measures such as the SCL–90–R soon
after arrival warrant comprehensive clinical assessment.
Results
The SCL–90–R mean Global Severity Index (GSI) decreased
Declaration of interest
None.
To our knowledge no prospective longitudinal study has followed
an adult refugee cohort for more than 10 years. We report findings
from the third interview phase of a longitudinal prospective
community cohort study of Vietnamese refugees settled in
Norway. They were included in the study upon their arrival in
Norway in 1982 (T1) and followed up in 1985 (T2).1 The earlier
findings, of stable and high levels of mental health problems after
3 years in exile,2 are consistent with other subsequent short-term
follow-up studies among refugees.3–5 The aims of the study
reported here were to investigate the long-term course and
outcome of these individuals’ mental status, and to identify which
early resettlement factors were relevant to predicting levels of
psychological distress over 20 years later.
relatively unselected sample from this wave of Vietnamese ‘boat
people’. In the current study (T3; 2005–6) we sought to interview
all surviving members of the cohort remaining in Norway. We
were able to collect data from 80 respondents; 24 others had died
or moved to another country (Fig. 1). Hence the T3 sample
represented 57% of the original cohort and 74% of those eligible
for inclusion.
The Norwegian normative sample, used for comparison of
the Symptom Checklist–90–Revised (SCL–90–R) results, consisted
of 466 men and 507 women over 19 years old who were
representative of the adult population in Norway.6
Assessments
Sociodemographic variables
Method
Design and procedures
The design of the study was similar to that of the two earlier
studies of this cohort.1 An interview administered in the
respondents’ home (by A.B.G. and A.B.V.) included a self-report
questionnaire available in Vietnamese and Norwegian, and a
structured face-to-face interview in Vietnamese. The study was
approved by the regional committee for medical research ethics
and the Norwegian Social Science Data Services. Written
information about the study was provided in Vietnamese and
Norwegian.
Sample
All Vietnamese refugees aged 15 years or older who arrived in
south-east Norway from transit camps in south-east Asia during
an 8-month period in 1982 were invited to take part in the first
study (T1). Norwegian merchant vessels had rescued the refugees
by chance from the South China Sea, and these people were
offered resettlement in Norway. Thus the original cohort was a
122
Included in the self-report questionnaire at T3 were marital status,
family reunion, presence of family in Norway, social network
including Vietnamese and Norwegian friends, religious affiliation,
level of education, current work status and economic support.
Symptoms
Psychological distress was rated with the same measure used in 1982
and 1985: the SCL–90–R.7 This instrument is considered valid and
reliable, and has been used in several studies of refugee mental
health, both in its original form,8,9 and as the shorter 25-item
Hopkins Symptom Checklist (HSCL–25).10,11 The Global Severity
Index (GSI) represents the mean score of all 90 items of the
SCL–90–R, with a score of 1 or more used to identify a probable
psychiatric ‘case’.6 As self-report measures may be oversensitive in
identifying true cases,12 we refer to those scoring at least 1 as
reaching threshold score.
Trauma exposure
The analyses reported here included information gathered at T1
and T2. An additive index combining the factors of having been
Mental health of Vietnamese refugees
comprehensive model predicting GSI at T3, we included some
pre-specified baseline variables from T1 and T2 together with
two indices of mental health status prior to T3, namely the GSI
score at T1 and a change measure (GSI at T2 minus GSI at T1, with
a positive value indicating worsening of symptoms from T1 to T2).
The significance level was set at 0.05. When adjusting for multiple
comparisons the Benjamini–Hochberg procedure was used.14 All
analyses used SPSS version 15 for Windows and R (see above).
T1
Respondent group
n = 145 (100%)
Attrition group
n = 14
(1 dead, 13 did not consent)
T2
Respondent group
n = 131 (90%)
Attrition group
n = 24
(4 dead, 9 emigrated,
10 living abroad
1 untraceable)
Results
Sociodemographic variables
The sample at T3 consisted of 12 women and 68 men, with a mean
age of 47.5 years (s.d. = 6.8, range 38–70), the respondent group
being younger and comprising more men than women compared
with the attrition group (further details are given in online Table
DS1).
Eligible for inclusion
n = 108
(includes 1 additional
participant who
consented at T2)
Refused consent
n = 28
Psychological distress
T3
Respondent group
n = 80 (57%)
Fig. 1
Flow diagram of inclusion and attrition.
wounded in the war, having been incarcerated in prison or a
concentration camp for a year or more, and having been in great
danger before the escape represented the variable ‘extreme
traumatic stress’ before the escape (minimum score 0, maximum 3).
Statistical analysis
Univariate analyses included chi-squared tests, Mann–Whitney
tests, t-tests and Pearson correlations. Changes in SCL–90–R
scores over time were assessed by linear mixed effects models
(R version 2.9.7 for Windows, R package ‘nlme’, R Foundation
for Statistical Computing, see www.r-project.org),13 adjusting for
relevant T1 variables. The relationships between SCL–90–R scores
at T3 and baseline (T1/T2) variables were investigated by two types
of multiple linear regression analyses. First, we generated a model
identical to the one published for T2 data,2 except that the
outcome was the SCL–90–R GSI score at T3 (independent
variables measured at T1 – or, if not assessed at T1, at T2 – were
age, gender, years of education in Vietnam, an additive score
of extreme traumatic stress, close confidante upon arrival, highimpact negative life events during the first 2 years in Norway,
and separation from close family at T2). Second, for a more
All but one of the 80 respondents completed the SCL–90–R at T3
(the exception was a person with psychosis). There was no significant gender difference in mean GSI scores at T3 (women 0.48 v.
men 0.49). The mean GSI decreased significantly from 0.81 at
T1 to 0.49 at T3 (difference: s.d. = 0.55, 95% CI 0.29–0.44,
P50.001).
Table 1 shows the GSI mean scores at the three time points
compared with the Norwegian normative sample (for subscale
scores see online Table DS2). From arrival to follow-up at T3 there
were significant decreases in both the GSI and the means for all
subscales of the SCL–90–R (online Table DS3), with the
exception of somatisation and anger/hostility. Eighteen per cent
of respondents (n = 14) reached threshold scores at T3
(GSI = 1.00), more than twice the percentage of Norwegians
(7.2%). For the Vietnamese cohort there was no significant
difference between GSI rates at T3 and those recorded at T2
(25%, n = 20) and T1 (26%, n = 20).
Prediction of psychological distress at T3
In the first regression analysis using T1/T2 predictors and GSI at
T3, the model being similar to the one published earlier,2 the
included predictors explained 13% of the variance of GSI but
no single predictor was associated significantly with the index of
distress at T3. In the second regression, a greater GSI score at T1
and the change score (the difference in GSI scores between T2
and T1) were both significant predictors of a higher GSI at T3
(Table 2).
Table 1 Global Severity Index scores for the study cohort ( n = 79) at the three assessment points compared with the Norwegian
normative sample
SCL–90–R GSI score: mean (s.d.)
Vietnamesea,b
1982
1985
Norwegianc
2005–6
Total
0.81 (0.45)
0.75 (0.55)
0.49 (0.49)
Male
0.76 (0.41)
0.73 (0.53)
0.49 (0.49)
0.32 (0.36)d
Female
1.04 (0.60)
0.90 (0.64)
0.48 (0.49)
0.41 (0.43)
Respondents scoring 41 at T3, %
Vietnamese
Norwegian
18
7.2
SCL–90–R GSI, Symptom Checklist–90–Revised Global Severity Index.
a. All respondents included at all three time intervals. One respondent was unable to fill in the questionnaire because of psychosis.
b. Male n = 67, female n = 12.
c. Male n = 466, female n = 507.
d. Significant difference between the refugee cohort (at T3) and the Norwegian sample: P = 0.007 (one-sample t-test).
123
Vaage et al
Table 2
Multiple regression analysis for Global Severity Index scores at T 3 ( n = 79)
Variables from T1/T2
Age at inclusion
Regression coefficient
P
95% CI
R2
70.001
0.86
70.02 to 0.01
0.008
Gendera
0.11
0.44
70.18 to 0.40
0.009
Vietnamese contactb
0.14
0.19
70.07 to 0.34
0.049
Norwegian contactc
0.09
0.54
70.20 to 0.37
0.062
70.003
0.98
70.23 to 0.22
0.10
GSI score at T1
0.48
50.001
0.23 to 0.73
0.16
GSI difference (T2 – T1)e
0.41
0.001
0.19 to 0.63
0.31
Healthd
GSI, Global Severity Index; T1, 1982; T2, 1985; T3, 2005–6.
a. Gender: female 1, male 2 (reference category ‘female’).
b. Extent of Vietnamese contact at T2: adequate 0, inadequate 1 (reference category ‘adequate contact’).
c. Extent of Norwegian social contact at T2: adequate 0, inadequate 1 (reference category ‘adequate contact’).
d. Present self-reported health at T2: good health 1, other 2 (reference category ‘good health’).
e. Difference in GSI score between T2 and T1.
Discussion
Our results suggest a complex picture. The mental health of the
cohort as a whole had improved significantly since the refugees’
arrival in Norway, but the mean scores on the SCL–90–R
remained higher than for native Norwegians. Almost a fifth of
the cohort, more than twice the percentage of Norwegians had
psychological distress scores above threshold on the SCL–90–R,
suggesting that the Vietnamese remained a vulnerable group.
These findings are broadly consistent with those of Steel et al
in suggesting that the majority of Vietnamese had achieved
reductions in most symptom domains over time, but a minority
remained highly symptomatic.15
Implications for the treatment of refugees
Our findings may help to clarify the trajectory of symptoms
among refugees over a prolonged period of resettlement. In stable
resettlement environments, refugee populations tend to manifest
high levels of distress over the earlier years, as indicated by the
results for T1 and T2. This is consistent with other studies,4 and
supports the notion that a combination of recent trauma and
resettlement/acculturation challenges continue to act as stressors
during this time. Nevertheless, the T3 data indicate that at a
population level, and in the context of a stable resettlement
environment,16,17 most refugees have the capacity for symptom
improvement over the longer term, although levels of distress
may remain higher than among the host population. Symptom
improvement during the first 3 years, signified in this study by a
reduction in GSI between T1 and T2, may therefore represent an
important predictor of a positive long-term prognosis, in this
instance after 23 years.
Prediction of outcomes: implications for early
assessment and intervention
A minority of study participants remained psychologically
impaired over many years. Trauma might have been a factor
initiating some of these reactions, but in the longer term, as
indicated, a key predictive index appeared to be the level and
trajectory of psychological symptoms during the period of early
resettlement. This supports the potential value of serial screening
programmes for refugees, a procedure that could be followed by
comprehensive assessment of the identified at-risk group to detect
those with clinical disorders in need of treatment. Hence, early
intervention may be relevant not only to overcome immediate
distress but also to avert risk of psychological difficulties in later
years. Still, the predictive capacity of the regression analysis was
modest, suggesting that other unmeasured post-migration
124
experiences and/or personal vulnerabilities might have a role in
perpetuating psychological symptoms over time,18 or in initiating
new disorders during the ensuing two decades.
Limitations
Despite of the strengths of the study, in particular its prospective
longitudinal design, important limitations need consideration.
Attrition is evident in most refugee studies,4 and compared with
the attrition group, included respondents were younger and more
often male than female. This, together with the small original
sample and the special characteristics of Norwegian society, may
limit the generalisability of the findings to other refugee
populations. In addition, gender-specific comparisons could not
be undertaken because the relevant information was not available
for the Norwegian normative data-set.
The follow-up study did not include a clinical diagnostic
interview, which limits comparisons with other studies of
refugees.19,20 Although a study among Vietnamese refugees has
shown reasonable concordance between a clinical interview (the
Structured Clinical Interview for DSM–IV Axis I disorders) and
the HSCL–25,21 a comparable study among Cambodians indicated
that a clinical interview yielded a more conservative prevalence
rate.12 A recent meta-analysis of the entire refugee mental health
field showed a regular pattern in which questionnaires (often
derived from the Symptom Checklist) on average returned a
10–13% higher prevalence than interviews when other methodological factors (sample size, approach to sampling) were taken
into account.22 These observations caution against inferring that
all Vietnamese who scored above threshold in our study could
definitely be assigned to the ‘cases’ group. Further examination
would be needed (and warranted) to specify accurately those in
need of treatment.
We acknowledge the risk of reduced semantic equivalence
arising from the use of an early version of the Vietnamese
translation of the SCL–90–R,23 but we considered it important
to use the same translation for longitudinal comparisons. Other
studies among Vietnamese have used a culturally specific measure
of mental health, the Phan Vietnamese Psychiatric Scale (PVPS),
in conjunction with an international instrument.24 This approach
increased the overall rates of detected mental health disorders,
suggesting the possibility that cases may be overlooked when
Western-derived instruments such as the SCL–90–R are used
alone.
Clinical implications
Although self-reported psychological distress among Vietnamese
refugees decreased significantly over time, even after 23 years of
Mental health of Vietnamese refugees
resettlement a greater proportion of this cohort reached threshold
SCL–90–R scores compared with the native Norwegian group.
Therefore, this population should still be considered to be at
increased risk of mental health problems, justifying special
attention from psychiatric services. The longitudinal data support
the importance of screening refugees in the early years of
resettlement, since elevated levels of psychiatric symptoms during
that period appear to indicate long-term risk.
Aina Basilier Vaage, MD, Centre for Child and Adolescent Mental Health, University
of Bergen, and Department of Child and Adolescent Psychiatry, Stavanger University
Hospital, Stavanger, Norway; Per Hove Thomsen, MD, PhD, Centre for Child and
Adolescent Psychiatry, University of Aarhus, Denmark, and Centre for Child and
Adolescent Mental Health, University of Bergen, Norway; Derrick Silove, FRANZCP,
MD, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New
South Wales, and Centre for Population Mental Health Research, Sydney South West
Area Health Service, Sydney, New South Wales, Australia; Tore Wentzel-Larsen,
MSc, Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway;
Thong Van Ta, International House Foundation, Stavanger, Norway; Edvard Hauff,
MD, PhD, Institute of Psychiatry, University of Oslo, and Oslo University Hospital,
Ullevål Department of Psychiatry, Oslo, Norway
Correspondence: Dr Aina Basilier Vaage, BUPA, SUS, Box 8100, 4068 Stavanger,
Norway. Email: [email protected]
First received 14 Oct 2008, final revision 1 Sep 2009, accepted 25 Sep 2009
7 Derogatis LR. SCL–90–R Administration, Scoring and Procedures Manual–I for
the (Revised) Version. Johns Hopkins School of Medicine, 1977.
8 Ghazinour M, Richter J, Eisemann M. Quality of life among Iranian refugees
resettled in Sweden. J Immigr Health 2004; 6: 71–81.
9 Araya M, Chotai J, Komproe IH, de Jong JTVM. Effect of trauma on quality of
life as mediated by mental distress and moderated by coping and social
support among postconflict displaced Ethiopians. Qual Life Res 2007; 16:
915–27.
10 Thapa SB, Hauff E. Psychological distress among displaced persons during an
armed conflict in Nepal. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 672–9.
11 Hermansson AC. The mental health of war-wounded refugees: an 8-year
follow-up. J Nerv Ment Dis 2002; 190: 374–80.
12 Silove D, Manicavasagar V, Mollica R, Thai M, Khiek D, Lavelle J, et al.
Screening for depression and PTSD in a Cambodian population unaffected by
war: comparing the Hopkins Symptom Checklist and Harvard Trauma
Questionnaire with the structured clinical interview. J Nerv Ment Dis 2007;
195: 152–7.
13 Pinheiro JC, Bates DM. Mixed Effects Models in S and S-plus. Springer, 2000.
14 Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and
powerful approach to multiple testing. J R Stat Soc Ser B 1995; 57:
289–330.
15 Steel Z, Silove D, Phan T, Bauman A. Long-term effect of psychological
trauma on the mental health of Vietnamese refugees resettled in Australia: a
population-based study. Lancet 2002; 360: 1056–62.
16 Schweitzer R, Melville F, Steel Z, Lacherez P. Trauma, post-migration living
difficulties, and social support as predictors of psychological adjustment in
resettled Sudanese refugees. Aust N Z J Psychiatry 2006; 40: 179–87.
Funding
The study was supported by grants from the Western Norway Regional Health Authority,
the Centre for Child and Adolescent Mental Health, University of Bergen, the Legacy of
Sommer, Lundbeck Pharma AS, the Meltzers Høyskolefond, Stavanger University Hospital
and Oslo University Hospital, Ullevål Department of Psychiatry.
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Lie B. A 3-year follow-up study of psychosocial functioning and general
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24 Phan T, Steel Z, Silove D. An ethnographically derived measure of anxiety,
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20 Hinton D, Chau H, Nguyen L, Nguyen M, Pham T, Quinn S, et al. Panic
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125
The British Journal of Psychiatry (2010)
196, 122–125. doi: 10.1192/bjp.bp.108.059139
Data supplement
Table DS1
Sociodemographic variables in the cohort included at T 1 / T 2 and T 3 , n = 80
T1 1982
Marital status
Married
Separated/divorced
Single
T2 1985
%
n
31.3
0
68.8
3.8
96.2
%
T3 2005/6
n
%
n
25
0
55
80
11.3
8.8
64
9
7
3
76
28.8
71.2
19
47
50.001b
Family/relatives in Norway
More than 10
10 or fewer
50.001
Vietnamese friends in Norway
More than 10
10 or fewer
36.4
63.6
28
49
51.5
48.5
34
32
Norwegian friends in Norway
More than 10
10 or fewer
6.5
93.5
5
72
25.8
74.2
17
49
ns
56.7
31.3
12.0
38
21
8
12.61
4.4
50.001c
0.001
nsb
Religious affiliation
Catholic
Buddhist
Other/none
51.3
30.0
18.7
Mean number of years of education
s.d.
10
3.4
Type of education
University or college
High school
Other
Pa
41
24
15
nsc
20.3
27.8
51.9
16
22
41
29.0
17.7
53.3
18
11
33
50.001b
Employment
Permanent or temporary work
Old age pension
35.4
0
Supported incomed
Rehabilitation allowance
Disability pension
Social assistance
Public financial refugee support
0
0
36.4
36.5
28
28
27
66.7
5.8
52
4
7.2
14.1
4.3
0
5
10
3
0
0.063
0.002
50.001
–e
ns, not significant.
a. Exact McNemar tests except when otherwise indicated.
b. Stuart-Maxwell’s marginal homogeneity test for nominal data (using Stata).
c. Exact paired samples Wilcoxon test.
d. Some overlap in categories, separate exact McNemar tests for each category (using StatXact, Cytel Inc, Cambridge, Massachusetts, USA).
e. No test, this income support was for recent refugees only.
1
Table DS2 Scores on the Symptom Checklist–90–Revised (SCL–90–R) Global Severity Index (GSI) and subscales at T 1 , T 2 and T 3
for the Vietnamese (Viet) cohort and the Norwegian normative population (Norm), total and categorised by gender, together with
percentages scoring above 1 on the GSI in both groups at T 3
T1 (1982): mean (s.d.)
T2 (1985): mean (s.d.)
Viet.
Viet.
Viet.
T3 (2005/6): mean (s.d.)
Viet.
Viet.
Norm
Viet.
% 41
Norm
Total
M
F
Total
M
F
Total
M
M
F
F
(n = 79) (n = 67) (n = 12) (n = 79) (n = 67) (n = 12) (n = 79) (n = 67) (n = 466) (n = 12) (n = 507)
Norm
total
total
GSI
0.81
(0.45)
0.76
(0.41)
1.04
(0.60)
0.75
(0.55)
0.73
(0.53)
0.90
(0.64)
0.49
(0.49)
0.49
(0.49)
0.32
(0.36)
0.48
(0.49)
0.41
(0.43)
17.7
7.2
Somatisation
0.56
(0.48)
0.51
(0.44)
0.86
(0.59)
0.50
(0.50)
0.47
(0.46)
0.71
(0.66)
0.53
(0.50)
0.52
(0.52)
0.36
(0.45)
0.58
(0.43)
0.47
(0.51)
17.7
9.7
Obsessive–compulsive
1.16
(0.67)
1.13
(0.65)
1.33
(0.75)
1.07
(0.81)
1.06
(0.81)
1.13
(0.84)
0.72
(0.76)
0.74
(0.78)
0.47
(0.52)
0.62
(0.66)
0.56
(0.58)
31.4
14.5
Interpersonal sensitivity
0.92
(0.61)
0.87
(0.57)
1.20
(0.73)
0.88
(0.71)
0.84
(0.70)
1.08
(0.77)
0.46
(0.54)
0.46
(0.56)
0.38
(0.49)
0.50
(0.48)
0.48
(0.59)
15.2
10.9
Depression
1.11
(0.57)
1.09
(0.54)
1.25
(0.73)
1.04
(0.76)
1.00
(0.71)
1.28
(0.98)
0.56
(0.65)
0.57
(0.66)
0.35
(0.45)
0.50
(0.64)
0.51
(0.58)
22.8
10.9
Anxiety
0.66
(0.54)
0.61
(0.49)
0.93
(0.71)
0.58
(0.65)
0.55
(0.64)
0.74
(0.74)
0.35
(0.46)
0.36
(0.46)
0.25
(0.41)
0.32
(0.47)
0.34
(0.50)
10.1
7.4
Hostility
0.46
(0.45)
0.43
(0.41)
0.64
(0.64)
0.58
(0.66)
0.57
(0.69)
0.63
(0.46)
0.40
(0.47)
0.41
(0.49)
0.29
(0.44)
0.36
(0.31)
0.32
(0.44)
10.1
5.4
Phobic anxiety
0.50
(0.51)
0.43
(0.41)
0.89
(0.80)
0.39
(0.42)
0.36
(0.40)
0.55
(0.50)
0.19
(0.32)
0.19
(0.33)
0.11
(0.26)
0.19
(0.29)
0.18
(0.36)
3.8
2.8
Paranoid ideation
0.93
(0.68)
0.85
(0.56)
1.38
(1.08)
0.89
(0.65)
0.84
(0.57)
1.14
(1.01)
0.55
(0.64)
0.55
(0.62)
0.35
(0.50)
0.57
(0.74)
0.36
(0.55)
22.8
8.9
Psychoticism
0.63
(0.50)
0.61
(0.48)
0.75
(0.63)
0.58
(0.55)
0.58
(0.55)
0.63
(0.55)
0.35
(0.52)
0.34
(0.46)
0.16
(0.27)
0.41
(0.78)
0.18
(0.33)
12.7
2.6
M, male; F, female.
2
Viet.
Table DS3 Differences in Symptom Checklist–90–Revised Global Severity Index (GSI) and subscale scores across the three time a
points ( n = 79)
GSI/subscales
GSI
Somatisation
Time difference
Estimated difference
CI
P
T1–T2
T1–T3
T2–T3
70.05
70.31
70.27
70.16 to 0.07
70.43 to 70.20
70.38 to 70.15
0.53
50.001
50.001
No significant time difference
Obsessive/compulsive
T1–T2
T1–T3
T2–T3
70.08
70.44
70.36
70.25 to 0.09
70.61 to 70.27
70.53 to 70.19
0.52
50.001
50.001
Interpersonal sensitivity
T1–T2
T1–T3
T2–T3
70.04
70.46
70.42
70.20 to 0.12
70.62 to 70.30
70.57 to 70.26
0.66
50.001
50.001
Depression
T1–T2
T1–T3
T2–T3
70.07
70.55
70.48
70.23 to 0.09
70.71 to 70.39
70.64 to 70.32
0.52
50.001
50.001
Anxiety
T1–T2
T1–T3
T2–T3
70.08
70.30
70.22
70.22 to 0.07
70.44 to 70.16
70.36 to 70.08
0.43
50.001
0.005
Hostility
No significant time difference
Phobic anxiety
T1–T2
T1–T3
T2–T3
70.11
70.30
70.19
70.23 to 0.004
70.42 to 70.19
70.31 to 70.08
0.10
50.001
0.002
Paranoid ideation
T1–T2
T1–T3
T2–T3
70.04
70.38
70.34
70.21 to 0.13
70.54 to 70.21
70.50 to 70.17
0.67
50.001
50.001
Psychoticism
T1–T2
T1–T3
T2–T3
70.04
70.28
70.23
70.17 to 0.09
70.41 to 70.15
70.36 to 70.11
0.59
50.001
50.001
a. Applying linear mixed effects models, showing P values adjusted for multiple testing by the Benjamini–Hochberg procedure.
3
Long-term mental health of Vietnamese refugees in the aftermath
of trauma
Aina Basilier Vaage, Per Hove Thomsen, Derrick Silove, Tore Wentzel-Larsen, Thong Van Ta and Edvard
Hauff
BJP 2010, 196:122-125.
Access the most recent version at DOI: 10.1192/bjp.bp.108.059139
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