Conceptual model of traumatic outcomes

Research on refugees has revealed the persistence of negative health and social outcomes decades after their initial experience of violence and dislocation. Emergence of standardized criteria for psychiatric diagnoses and disability and the demonstrated ability to elicit trauma events through simple screening instruments in culturally diverse populations have allowed evidence to accumulate suggesting a model of traumatic outcomes associated with the refugee experience. This model is primarily based upon the classic epidemiological triad which describes the interaction between host (i.e. the refugee), agent (i.e. traumatic life experiences), and environment (e.g. refugee camp) in the pathogenesis of psychiatric disorders. (5,6) This model, illustrated in Fig 1, allows equal attention to be given to all aspects of the refugee experience.

Fig. 1 Conceptual model of refugee risk factors and traumatic outcomes.

The model in Fig 1 has three major elements. First, it suggests that the major medical outcomes associated with the refugee experience are medical illness, psychiatric disorders, and disability. Second, trauma and the personal and environmental characteristics of the refugee describe the major risk factors associated with violent outcomes. Third, the direction of the causal arrows in the model do not imply a lack of reciprocal relationships where none is indicated; instead they indicate what most investigations consider to be the most dominant causal relationship. Despite its limitations, this simple conceptual model can provide the psychiatric professional with a scheme for approaching the refugee patient from either a clinical or public health perspective. The importance of the sociocultural and political context unique to each refugee situation and its impact on each of the model's pathways cannot be overstated, since refugees come from diverse cultural groups and political experiences.

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