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Prevalence of mental disorders and torture among Tibetan refugees: A systematic review

Edward J Mills1*, Sonal Singh2, Timothy H Holtz3, Robert M Chase4, Sonam Dolma5, Joanna Santa-Barbara6 and James J Orbinski7

Author affiliations

1 Dept. of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada

2 Department of Medicine, Wake Forest University, Winston-Salem, USA

3 Rollins School of Public Health, Emory University, Atlanta, USA

4 Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

5 Department of Political Science, York University, Toronto, Canada

6 Department of Psychiatry and Peace Studies, McMaster University, Hamilton, Canada

7 St. Michael's Hospital, University of Toronto, Toronto, Canada

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Citation and License

BMC International Health and Human Rights 2005, 5:7  doi:10.1186/1472-698X-5-7

Published: 9 November 2005



Many Tibetan refugees flee Tibet in order to escape physical and mental hardships, and to access the freedoms to practice their culture and religion. We aimed to determine the prevalence of mental illnesses within the refugee population and determine the prevalence of previous torture reported within this population.


We performed a systematic literature search of 10 electronic databases from inception to May 2005. In addition, we searched the internet, contacted all authors of located studies, and contacted the Tibetan Government-in-exile, to locate unpublished studies. We included any study reporting on prevalence of mental illness within the Tibetan refugee populations. We determined study quality according to validation, translation, and interview administration. We calculated proportions with exact confidence intervals.


Five studies that met our inclusion criteria (total n = 410). All studies were conducted in North India and 4 were specifically in adult populations. Four studies provided details on the prevalence of torture and previous imprisonment within the populations. The prevalence of post-traumatic stress disorder ranged from 11–23%, anxiety ranged from 25–77%, and major depression ranged from 11.5–57%.


Our review indicates that the prevalence of serious mental health disorders within this population is elevated. The reported incidence of torture and imprisonment is a possible contributor to the illnesses. Non-government organizations and international communities should be aware of the human rights abuses being levied upon this vulnerable population and the mental health outcomes that may be associated with it.