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Brain Structural Abnormalities and Mental Health Sequelae in South Vietnamese Ex–Political Detainees Who Survived Traumatic Head Injury and Torture
Richard F. Mollica, MD;
In Kyoon Lyoo, MD, PhD, MMS;
Miriam C. Chernoff, PhD;
Hoan X. Bui;
James Lavelle, LICSW;
Sujung J. Yoon, MD, PhD;
Jieun E. Kim, MD;
Perry F. Renshaw, MD, PhD
Arch Gen Psychiatry. 2009;66(11):1221-1232.
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.
Author Affiliations: Harvard Program in Refugee Trauma, Department of Psychiatry, Massachusetts General Hospital, Cambridge, Massachusetts (Dr Mollica and Mr Lavelle); Departments of Psychiatry (Drs Lyoo and Kim) and Neuroscience (Dr Lyoo), Seoul National University, Seoul, South Korea; McLean Hospital Brain Imaging Center and Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts (Dr Lyoo); Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts (Dr Chernoff); Vietnamese-American Civic Association, Dorchester, Massachusetts (Mr Bui); Department of Psychiatry, Catholic University Medical College, Seoul (Dr Yoon); Department of Psychiatry and The Brain Institute, University of Utah, and Department of Veterans Affairs VISN 19 Mental Illness Research, Education, and Clinical Center, Salt Lake City (Dr Renshaw).
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