Post-Traumatic Stress Disorder - Evidence-Based Preventive Care Checklist for New Immigrants and Refugees

Overview of Post-Traumatic Stress Disorder (PTSD)

45% of Canadian immigrants and refugees from countries involved in war or with significant social unrest have been exposed to traumatic events before migration. Most individuals (estimated 80%) who experience traumatic events heal without intervention after reaching safety:

Key Recommendations:

Do not conduct routine screening for exposure to traumatic events, because pushing for disclosure of traumatic events in well-functioning individuals may result in more harm than good
Be alert for signs and symptoms of PTSD, especially in the context of unexplained somatic symptoms, sleep disorders or mental health disorders such as depression or panic disorder, and perform clinical assessment as needed to address functional impairment

Quality of Evidence: LOW

Balance of benefits and harms	Values and preferences
Many persons who have been exposed to trauma do fine once they find safety and social supports. Brief screening instruments overestimate the rate of disease because they focus on symptoms and do not measure functional impairment. Detailed inquiry and pushing for disclosure without indications of distress or disorder could be harmful. There are no clinical trials demonstrating the benefits of routine screening for PTSD.	The committee: Determined that PTSD was best dealt with through primary care practitioners remaining alert for signs and symptoms of this condition and performing clinical assessment to address functional impairment Attributed more value to: Preventing potential harms from routine screening in the absence of clear evidence of benefits

Balance of benefits and harms

Values and preferences

Many persons who have been exposed to trauma do fine once they find safety and social supports.
Brief screening instruments overestimate the rate of disease because they focus on symptoms and do not measure functional impairment.
Detailed inquiry and pushing for disclosure without indications of distress or disorder could be harmful.
There are no clinical trials demonstrating the benefits of routine screening for PTSD.

The committee:

Determined that PTSD was best dealt with through primary care practitioners remaining alert for signs and symptoms of this condition and performing clinical assessment to address functional impairment

Attributed more value to:

Preventing potential harms from routine screening in the absence of clear evidence of benefits

Links to Other Learning Resources

The Cochrane Collaboration Common Mental Health Problems Case-Based Podcast: http://www.cochrane.org/podcasts/immigrant-health/common-mental-health-problems
Immigrant and Refugee Evidence-Based Clinical Guideline:
http://www.cmaj.ca/content/183/12/E824.full#sec-160
Evidence-Based Migrant Health Network:
http://www.ccirhken.ca/

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer L, Ueffing E, MacDonald N, Hassan G, McNally M, Kahn K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P and co-authors of the Canadian Collaboration for Immigrant and Refugee Health. Overview: Evidence-based clinical guidelines for immigrants and refugees. CMAJ 2011; 183(12):E824-E925.

Design and Production: Centre for e-Learning, Teaching and Learning Support Service (TLSS), University of Ottawa

Evidence-Based Preventative Care Checklist
For New Immigrants and Refugees

Choose a region checklist:

Overview of Post-Traumatic Stress Disorder (PTSD)

Key Recommendations:

Quality of Evidence: LOW

The committee:

Attributed more value to:

Links to Other Learning Resources

Evidence-Based Preventative Care ChecklistFor New Immigrants and Refugees

Choose a region checklist:

Overview of Post-Traumatic Stress Disorder (PTSD)

Key Recommendations:

Quality of Evidence: LOW

The committee:

Attributed more value to:

Links to Other Learning Resources

Evidence-Based Preventative Care Checklist
For New Immigrants and Refugees