HPRT’s major research contributions over the past two decades, which helped to pioneer the field of refugee mental health and the mental health sequelae of mass violence, were summarized in the June 2000 issue of Scientific American1.
In the 1980s, HPRT’s phenomenological descriptions2 of the mental health conditions of refugee patients described for the first time the extent of trauma associated with psychiatric illness in these patients. Along with Kinzie and his group in Oregon, HPRT’s staff were the first to associate torture and traumatic life experiences with depression and posttraumatic stress disorder (PTSD) in refugee patients.
In 1988, “Community of Confinement,3” Mollica and Jalbert’s mental health needs assessment in the Thai-Cambodian refugee camps, was the first study to reveal the high prevalence of mental health disorders and associated violence in a refugee community. This initial impression was confirmed by the first-ever epidemiological study of a refugee population4, (i.e., the almost half-million Cambodian refugees living on the Thai border) conducted by Mollica and his colleagues in 1990 and published in the Journal of the American Medical Association in 1993. This landmark study set the standard for the field and stimulated the epidemiological studies to follow in Kosovo and other post-conflict societies.
In 1999, HPRT replicated its earlier findings in Cambodian refugees in a Bosnian refugee population, and linked trauma and psychiatric co-morbidity to functional disability. This study5, published in the Journal of the American Medical Association in 1999, was the first major study to link trauma and psychiatric co-morbidity to functioning and socio-economic disability in refugee populations. A longitudinal study of this Bosnian refugee community6 revealed the chronicity of depression in traumatized refugee populations, the association of depression with chronic disability, and the impact of depression on the premature death of elderly refugees. These findings, published in the Journal of the American Medical Association in 2001, have established chronic, disabling depression linked to early mortality as a reality in refugee and civilian populations traumatized by war and other forms of mass violence.
These scientific results have had enormous impact on international policy makers and donors who, until this research was performed, had either denied or ignored the mental health impact of mass violence.
HPRT has also adapted and developed the major research tools necessary to conduct these large scale epidemiological and clinical studies. For example, the Harvard Trauma Questionnaire (HTQ) was the first culturally validated instrument to measure trauma, torture events, and PTSD. The HTQ is now the gold standard instrument in the field, having been subjected to numerous studies evaluating its psychometric properties. HPRT’s screening instruments, including the HTQ, exist in 35 languages and have been used in countless studies by researchers throughout the world.
HPRT’s seminal scientific work has had enormous impact on research activities (as seen in The Science of Refugee Mental Health), clinical care, and policy aimed at the recovery of refugee and civilian survivors of mass violence and torture, worldwide.
Click here for a complete list of HPRT’s publications.
1Mollica, RF. Invisible Wounds: Waging a New Kind of War. Scientific American. June 2000; 282 (6): 54-57.
2Mollica RF, Wyshak G, Lavelle J. The Psychosocial Impact of War Trauma and Torture on Southeast Asian Refugees. American Journal of Psychiatry. 1987; 144: 1567-1572.
Mollica RF, Wyshak G, Lavelle J, Truong T, Tor S, Yang T. Assessing Symptom Change in Southeast Asian Refugee Survivors of Mass Violence and Torture. American Journal of Psychiatry. 1990; 147: 83-88.
3Mollica RF, Jalbert RR. Community of Confinement: The Mental Health Crisis in Site Two (Displaced Persons Camps on the Thai-Kampuchean Border). World Federation for Mental Health, February 1989.
4Mollica RF, Donelan K, Tor S, Lavelle J, Elias C, Frankel M, Bennett D, Blendon RJ, Bass R. The Effect of Trauma and Confinement on Functional Health and Mental Health Status of Cambodians Living in Thai-Cambodia Border Camps. Journal of the American Medical Association. 1993; 270: 581-586.
5Mollica RF, McInnes K, Sarajlic N, Lavelle J, Sarajlic I, Massagli MP. Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. Journal of the American Medical Association. 1999; 282: 433-439.
6Mollica RF, Sarajlic N, Chernoff M, Lavelle J, Sarajlic Vukovic I, Massagli MP. Longitudinal Study of Psychiatric Symptoms, Disability, Mortality and Emigration Among Bosnian Refugees. Journal of the American Medical Association. August 2001; 286(5):546-554.
