MGH LogoAccording to a study from the Harvard Program in Refugee Trauma (HPRT), based in the Massachusetts General Hospital (MGH) Department of Psychiatry, depression and other emotional symptoms in survivors of torture and other traumatic experiences could possibly be worsened by the effects of head injuries.

The study authors reported to have found structural changes in the brains of former South Vietnamese political detainees who had suffered head injuries. In addition, the authors clearly seem to have linked those changes to psychiatric symptoms frequently seen in survivors of torture.

Lead author of the study, Richard Mollica, MD, director of the HPRT and a professor of Psychiatry at Harvard Medical School said that, “This is the first study since the 1950s to demonstrate brain changes in survivors of extreme violence. That work looked at Holocaust survivors, and now we are the first to connect similar brain damage with mental health issues in survivors of political torture.”

“We believe, although it has not yet been proven, that these physical effects may help explain why survivors of both torture and traumatic head injury often don’t do well with standard therapies for depression and anxiety,” continues Mollica.

Studies by Mollica’s team and others are believed to have recognized the fact that head injures are a common form of torture among prisoners of war and political detainees. However, no earlier work seems to have examined whether the neurologic effects of head injuries were related to the chronic psychiatric disorders often reported in torture survivors.

The latest study was noted to have analyzed information from 42 Vietnamese immigrants, now resettled in the U.S., who had been detained in so-called ‘re-education camps’ and 15 Vietnamese immigrants of similar ages who had not been detained. During the study, all study participants seem to have completed questionnaires regarding any history of head injuries and on their exposure to torture or other traumatic experiences. Subsequently, the study authors interviewed them in order to evaluate existing symptoms of depression and post-traumatic stress disorder.

Complete magnetic resonance imaging studies appear to have measured the size and thickness of brain structures that earlier reports have associated with depression, anxiety and post-traumatic stress disorder (PTSD). In addition, they have suggested that it may perhaps be affected by traumatic head injuries.

The authors found that among the previous detainees, 16 reported having experienced head injuries at sometime whereas 26 did not. The imaging studies showed that detainees with a history of head injury appear to be more likely to report symptoms of depression as compared to those without it. Moreover, it was seen that they had considerable reductions in the thickness of the frontal and temporal lobes of the cerebral cortex, reductions in contrast to those with non-head-injured detainees.

Furthermore, participants whose head injuries were more severe seem to have even greater structural changes and more devastating depression symptoms. These head-injury-associated effects were noted to be independent of the effects of other forms of torture or trauma participants had experienced. Whereas head-injured ex-detainees may perhaps have not been at a greater risk of being diagnosed with PTSD, their PTSD symptoms were more severe.

“It’s well known in neuropsychology that the frontal and temporal lobes affect executive function – which includes planning, learning, self-monitoring, and flexibility in social interactions,” elucidates Mollica.

It could be that torture survivors who are unable to perform well with standard therapies appear to have head-injury-based cognitive deficits that interfere with standard approaches like behavioral or exposure therapy. Additionally, it could possibly be very uncommon for patients to relate subsequent health problems to a head injury or to recognize that a head injury is affecting their emotions.

“Most primary care physicians are not prepared to identify mild traumatic head injury either in patients who may have experienced trauma or torture – including veterans or refugees – or in survivors of assaults or even auto accidents,” he adds.

In some societies, patients and families are assisted in learning that emotional problems are related to a physical injury and may become more committed to working with programs particularly designed to treat head injury patients. Mollica anticipates that their documenting physical effects of brain damage in a group of torture survivors will perhaps provide evidence leading to improved diagnostic and treatment approaches.

The subsequent steps may possibly be clinical trials comparing the results of head-injury-specific treatment programs with more traditional therapies for emotional disorders in patients with a history of both trauma and head injury. He also notes that the need to improve training for the physicians most likely to treat such patients in the community.

The findings of the study have been published in the Archives of General Psychiatry.