Authors' reply

Newly arrived refugees will often see their problems initially in terms of past experience (e.g. war-violence or torture) rather than emotional impact. They share a need for security and safety. However, it would be illogical to conclude that they are thereby free of psychopathology. It is not a case of either one state or the other. Factors operating in different domains frequently interact. This is the situation here.

Interestingly, as many as 11.1% of 522 subjects responded that they had a mental health problem and that they now wanted help (i.e. ‘Western’ treatment). We would expect help-seeking to increase in those with persisting symptoms, in line with experience in treatment services after any major incident.

To assert that significant psychopathology is ‘uncommon’ is wrong. It implies that civil war, rape and torture do not have important psychopathological consequences in significant numbers of people. This flies in the face of the evidence. It is reminiscent of the problems that Eitinger and others had when trying to justify reparation for some concentration camp survivors on the basis of psychological injury. Surely we have moved on since then.

In this instance, we do not assert psychopathology on the basis of self-report measures. This would have been an overestimate as we demonstrated in our report. An Albanian-speaking doctor undertook semi-structured clinical interviews (in Albanian).

Summerfield refers to additional data in our survey. We wish to present a factual analysis of these. We asked an open question about respondents’ main concerns. The responses to this question are in the respondents’ own words but if anxiety, tension, nervousness, stress or trembling are grouped together as likely anxiety symptoms, these were in fact the most frequent of the first priority problems and overall were reported by 21% (of 509 respondents). Sleep disturbance was reported by 16%, depression, hopelessness, sadness, mental problems and (poor) concentration by 8%. Many reported additional somatic complaints or general health problems, probably including a significant additional burden of psychological difficulty. Surprisingly, worries about family and friends were reported by only 17%. Concerns about work/economy (6%) and school/language (3%) were infrequent.

Rather than contradict the responses to the more structured questions, answers to these open questions reinforce our more quantitative findings.