Brain Structural Abnormalities and Mental Health Sequelae in South Vietnamese Ex–Political Detainees Who Survived Traumatic Head Injury and Torture Traumatic Head Injury and Torture

Mollica RF, Lyoo I, Chernoff MC, et al. — Sun, 01 Nov 2009 00:00:00 GMT

Context

A pilot study of South Vietnamese ex–political detainees who had been incarcerated in Vietnamese reeducation camps and resettled in the United States disclosed significant mental health problems associated with torture and traumatic head injury (THI).

Objectives

To identify structural brain alterations associated with THI and to investigate whether these deficits are associated with posttraumatic stress disorder and depression.

Design

Cross-sectional neuroimaging study.

Setting

Massachusetts General Hospital and McLean Hospital.

Participants

A subsample of Vietnamese ex–political detainees (n = 42) and comparison subjects (n = 16) selected from a community study of 337 ex–political detainees and 82 comparison subjects.

Main Outcome Measures

Scores on the Vietnamese versions of the Hopkins Symptom Checklist–25 (HSCL) and Harvard Trauma Questionnaire for depression and posttraumatic stress disorder, respectively; cerebral regional cortical thickness; and manual volumetric morphometry of the amygdala, hippocampus, and thalamus.

Results

Ex–political detainees exposed to THI (n = 16) showed a higher rate of depression (odds ratio, 10.2; 95% confidence interval, 1.2-90.0) than those without THI exposure (n = 26). Ex–political detainees with THI had thinner prefrontotemporal cortices than those without THI exposure (P < .001 by the statistical difference brain map) in the left dorsolateral prefrontal and bilateral superior temporal cortices, controlling for age, handedness, and number of trauma/torture events (left superior frontal cortex [SFC], P = .006; left middle frontal cortex, P = .01; left superior temporal cortex [STC], P = .007; right STC, P = .01). Trauma/torture events were associated with bilateral amygdala volume loss (left, P = .045; right, P = .003). Cortical thinning associated with THI in the left SFC and bilateral STC was related to HSCL depression scores in THI-exposed (vs non–THI-exposed) ex–political detainees (left SFC, P for interaction = .007; left STC, P for interaction = .03; right STC, P for interaction = .02).

Conclusions

Structural deficits in prefrontotemporal brain regions are linked to THI exposures. These brain lesions are associated with the symptom severity of depression in Vietnamese ex–political detainees.

JAMA Psychiatry: Torture Topic Collection

Brain Structural Abnormalities and Mental Health Sequelae in South Vietnamese Ex–Political Detainees Who Survived Traumatic Head Injury and Torture Traumatic Head Injury and Torture