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ST. PAUL — Intensive psychotherapy can help restore the mental of health of refugees scarred by the trauma of war and torture.
That’s one of the key findings from a recently released study by the Center for Victims of Torture that followed 214 Karen refugee patients diagnosed with major depression at two St. Paul-based health clinics.
The study — the first scientific study to measure mental health outcomes in refugees — split patients into two groups. One received “care as usual” mental health treatment; the other received intensive psychotherapy, primary care at the clinics and a social worker to help navigate employment, education and other non-health issues.
Patients who got the extra help showed greater improvements in their depression and post-traumatic stress disorder symptoms compared to those who underwent typical treatment, researchers found.
Several patients who received psychotherapy and a social worker “were completely transformed,” Dr. Jim Letts, a family physician with Fairview Health Services, said in a statement. “I saw their depression and PTSD symptoms improve dramatically and very meaningful improvements in their social functioning.”
The results show that “robust recovery is possible” within recently settled refugee communities who’ve experienced trauma “when the right type of care is provided in the right way at the right time,” said Andrea Northwood, director of client services for the Center for Victims of Torture and the study’s lead author.
The center studied Karen arrivals in the Twin Cities because of their large numbers here — they number more than 7,000 in Minnesota with the largest concentration living in St. Paul — and their long history as an ethnic minority persecuted by the government in Myanmar.
In a 2015 study in the medical journal BMC International Health and Human Rights, nearly 200 Karen refugees interviewed reported the torture of family members; more than 25 percent said they’d been tortured or witnessed torture.
The Center for Victims of Torture study found that most of the Karen patietns studied in Minnesota had never received mental health care or help with social services before coming here.
Soe Nyo, one of the patients who participated in the study, said he realized physical pain could be tied to mental pain after sessions with his therapist.
“He told me you take medication, but it’s not going to cure everything,” Nyo explained in a 2018 article from the center published in the International Journal of Migration, Health and Social Care. “Those pains you have, it’s correlated with everything. The stress and also the thought that comes up within you, it’s correlated with everything.”
Htee Shwe, another patient who participated in the study, spoke in the same article about how helpful her social worker was in helping her navigate Medical Assistance, Minnesota’s version of Medicaid, and the federal Supplemental Nutrition Assistance Program, formerly known as food stamps.
“Some people, when they need help with their paperwork or anything, they go to another office,” Shwe said. “But for me, I don’t know where those places are. I just come here and it is beneficial to me.”
Saw Dah Bu, who also spoke in the 2018 article, described how his social worker’s efforts went beyond assisting him with public aid programs.
“She is helping me with finding a normal place to stay,” he explained. “She’s helping me with citizenship. She’s helping me with all these things.”
Part of the reason such a study had never been conducted before came from its high cost — $4 million funded by local foundations and federal grants — and challenges convincing a refugee community to participate, Northwood said.
The Center for Victims of Torture did this by working with two St. Paul clinics — M Health Fairview Clinic-Bethesda and M Health Fairview Clinic-Roselawn — that already had strong ties with the local Karen community. The center also employs Karen workers.
Making such a study ethical is another challenge. Three independent ethical review boards approved the study’s procedures before it began. Among these boards was one from the University of Minnesota.
Researchers conducting the study were comfortable with the approach because both clinics are known for providing quality health care to refugees, Northwood said. “We knew care at these two clinics was pretty good, and it’s what people are getting anyway, whether we do our study or not.”
The researchers hope to use the study to influence the widening public policy debate now over refugees, a debate increasingly short on facts or evidence, Northwood said.
The study also pointed to gains in outcomes beyond mental health improvement. Refugee patients who received care and social support, for example, reported gains in their safety and employment.
The study offers evidence that refugees don’t “just arrive and then wallow at the bottom of the scale,” Northwood said.
She added: “The fact that people do get better and want to become independent and give back to their communities and support their families counters that narrative.”