The Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and the Self-reporting Questionnaire-24 were used to evaluate distress among 22 Dinka and Nuer refugees to the US before and after complete restoration of four to six lower front teeth that had been extracted during childhood in Sudan. Participants reported significant improvement in levels of distress following full restoration of missing teeth, including symptoms of PTSD. These results illustrate the value of incorporating community perspectives into the selection of health treatment options for newly arriving populations. But they also emphasize the unique situation faced by each refugee population as they embark on a wholly new cultural learning process.
Aron, A., & Aron, E.N. ( 2003). Statistics for psychology. Upper Saddle River, NJ: Prentice Hall.
2.
Berry, J.W. ( 1992). Acculturation and adaptation in a new society . International Migration, 30, 69-85.
3.
Berry, J.W., Kim, U., Power, S., Young, M., & Bujaki, M. ( 1987). Comparative studies of acculturative stress. International Migration Review, 21, 491-511.
4.
Berry, J.W., & Sam, D. ( 1997). Acculturation and adaptation. In J.W. Berry, M.H. Segall, & C. Kagitcibasi (Eds.), Handbook of cross-cultural psychology, volume 3: Social behavior and applications (pp. 291-326). Needham Heights, MA: Allyn & Bacon .
5.
Briedenham, S.J. ( 1987). Kaokoland and its people. Journal of the Dental Association of South Africa, 42, 457-460.
6.
Briedenham, S.J., & Van Reenen, J.F. (1978). Tooth mutilating practices amongst the Ovambo and the West Caprivi Bushmen of South West Africa (Namibia) . Journal of the Dental Association of South Africa, 33, 665-671.
7.
Cardoza, B., Vergara, A., Agani, F., & Gotway, C. ( 2000). Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo. Journal of the American Medical Association, 284, 569-577.
8.
Chindia, M.L. ( 1995). Traditional dental practices. East African Medical Journal, 72, 205-206.
9.
Cohen, J., (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum .
10.
Conover, W.J., & Iman, R.L. ( 1981). Rank transformations as a bridge between parametric and nonparametric statistics. The American Statistician, 35(3), 124-129.
11.
Cortes, M.I.S., Marcenes, W., & Sheiham, A. ( 2002). Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children . Community Dentistry and Oral Epidemiology, 30, 193-198.
12.
Crescenzi, A., Ketzer, E., Van Ommeren, M., Phuntsok, K., Komproe, I., & de Jong, J.T.V.M. (2002). Effect of political imprisonment and trauma history on recent Tibetan refugees in India. Journal of Traumatic Stress, 15, 369-375.
13.
Currington, M. ( 2006). Tribal Secrets: The Dinka. Documentary film. National Geographic (USA), Original air date: 22 June 2007.
14.
Davis, D.M., Fiske, J., Scott, B., & Radford, D.R. ( 2000). The emotional effects of tooth loss; A preliminary quantitative study. British Dental Journal, 188, 503-506.
15.
de Jong, J.T.V.M., Komproe, I.H., Van Ommeren, M., Al Masri, M., Araya, M., Khaled, N., van de Put, W., & Somasundaram, D. (2001). Lifetime events and posttraumatic stress disorder in postconflict settings. Journal of the American Medical Association, 286, 555-562.
16.
Deng, F.M. ( 1972). The Dinka of the Sudan. Prospect Heights, IL: Waveland Press.
17.
Domville-Fife, C.W. ( 1927). Savage life in the Black Sudan. Philadelphia , PA: J. B. Lippincott Company.
18.
Doná, G. ( 1993). Acculturation, coping and mental health of Guatemalan refugees living in settlements in Mexico. Unpublished doctoral dissertation, Psychology Department, Queen’s University, Canada .
19.
Doná, G., & Berry, J.W. ( 1994). Acculturation attitudes and acculturative stress of CentralAmerican refugees. International Journal of Psychology , 29, 57-70.
20.
Eisenbruch, M. ( 1984a). Cross-cultural aspects of bereavement: I. A conceptual framework for comparative analysis. Culture, Medicine and Psychiatry, 8, 283-309.
21.
Eisenbruch, M. ( 1984b). Cross-cultural aspects of bereavement: II. Ethnic and cultural variations in the development of bereavement practices. Culture, Medicine and Psychiatry, 8, 315-347.
22.
Eisenbruch, M. ( 1990). The cultural bereavement interview: A new clinical research approach or refugees. Psychiatric Clinics of North America , 13(4), 715-735.
23.
Eisenbruch, M. ( 1991). From post-traumatic stress disorder to cultural bereavement: Diagnosis of Souheast Asian refugees. Social Science and Medicine , 33(6), 673-680.
24.
Eisenbruch, M. ( 1992). Toward a culturally sensitive DSM: Cultural bereavement in Cambodian refugees and the traditional healer as taxonomist. Journal of Nervous and Mental Disease, 180(1), 8-10.
25.
Eisenbruch, M. ( 1997). The cry for the lost placenta: Cultural bereavement and cultural survival among Cambodians who resettled, were repatriated, or stayed at home. In M. van Tilburg & A. Vingerhoets (Eds.), Home is where the heart is: The psychological aspects of permanent and temporary geographical moves (pp. 119-142). Tilburg: Tilburg University Press.
26.
Eli, I., Bar-Tat, Y., & Kostovetzki, I. (2001). At first glance: Social meanings of dental appearance. Journal of Public Health Dentistry , 61, 150-154.
27.
Evans-Pritchard, E.E. ( 1940). The Nuer: A description of the modes of livelihood and political institutions of a Nilotic people. Oxford : Oxford University Press.
28.
Fox, S. ( 2003). The Mandinka nosological system in the context of post trauma syndromes. Transcultural Psychiatry, 40, 488-506.
29.
Fox, S., & Tang, S. ( 2000). The Sierra Leonean refugee experience: Traumatic events and psychiatric sequelae. Journal of Nervous and Mental Disease , 188, 490-495.
30.
Fox, S. H., & Willis, M.S. (in press). Initiatory mental health assessments for Dinka and Nuer refugees from Sudan. Journal of Immigrant and Refugee Studies.
31.
Gettleman, J. ( 2007, September 13). Poolcooch Journal: In Southern Sudan, peace alters a way of life. The New York Times.
32.
Goodkind, J.R. ( 2006). Promoting Hmong Refugees’ well-being through mutual learning; valuing knowledge, culture and experience. American Journal of Community Psychology, 37, 77-93.
33.
Goose, D.H. ( 1963). Tooth-Mutilation in West Africans. Man , 63, 91-93.
34.
Gordon, M.M. ( 1964). Assimilation in American life: The role of race, religion, and national origins. New York: Oxford University Press.
35.
Halestrap, D.J. ( 1971). Indigenous dental practice in Uganda. British Dental Journal, 131, 463-466.
36.
Harding, T.W., De Arango, M.V., Baltazar, J., Climent, C.E., Ibrahim, H.H.A., Ladrido-Ignacio, L., Srinivasa Murthy, R., & Wig, N.N. ( 1980). Mental disorders in primary health care: A study of their frequency and diagnosis in four developing countries. Psychological Medicine, 10, 231-241.
37.
Harrell-Bond, B.E., & Voutira, E. ( 1992). Anthropology and the study of refugees. Anthropology Today, 8, 6-10.
38.
Hassanali, J., & Amwayi, P. ( 1988). Report on two aspects of Maasai dentition. East African Medical Journal, 65, 798-803.
39.
Hinde, S.L., & Hinde H.B. ( 1901). The last of the Masai. London : Heinemann.
40.
Hollifield, M., Warner, T., Lian, N., Krakow, B., Jenkins, J., Kesler, J., Stevenson, J., & Westermeyer, J. (2002). Measuring trauma and health status in refugees. Journal of the American Medical Association , 288, 611-621.
41.
Hollis A.C. ( 1909). The Nandi: Their language and folklore. Oxford: The Clarendon Press.
42.
Hollister, M.C., & Weintraub, J.A. (1993). The association of oral status with systemic health, quality of life, and economic productivity. Journal of Dental Education, 57, 901-912.
43.
Humphreys, C.E. ( 1954). Dental operations practiced in primitive communities . Proceedings of the Royal Society of Medicine, 47, 313-316.
44.
Hutchinson, S.E. ( 1996). Nuer Dilemmas: Coping with money, war, and the state . Los Angeles: University of California Press.
45.
Jenny, J., & Proshek, J. ( 1986). Visibility and prestige of occupations and the importance of dental appearance. Journal of the Canadian Dental Association , 12, 987-989.
46.
Khawaja, N.G., White, K.M., Schweitzer, R., & Greenslade, J. (2008). Difficulties and coping strategies of Sudanese refugees: A qualitative approach. Transcultural Psychiatry, 45(3), 489-512.
47.
Marshall, G.N., Schell, T.L., Elliott, M.N., Berthold, S.M., & Chun, C. ( 2005). Mental health of Cambodian refugees 2 decades after resettlement in the United States. Journal of the American Medical Association , 294, 571-579.
48.
Mollica, R.F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. ( 1992). The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indo-chinese refugees. Journal of Nervous and Mental Disease , 180, 111-116.
49.
Mollica, R.F., Donelan, K., Tor, S., Lavelle, J., Elias, C., Frankel, M., & Blenden, R.J. ( 1993). The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia border camps. Journal of the American Medical Association , 270, 581-586.
50.
Mollica, R.F., McInnes, K., Pham, T., Smith-Fawzi, M.C., Murphy, E., & Lin, L. ( 1998). The dose-response relationship between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group. Journal of Nervous and Mental Disease, 186, 543-553.
51.
Mollica, R.F., McInnes, K., Poole, C., & Tor, S. ( 1998). Dose-effect relationships of trauma to symptoms of depression and posttraumatic stress disorder among Cambodian survivors of mass violence . British Journal of Psychiatry, 173, 482-488.
52.
Mollica, R.F., McInnes, K., Sarajlic, N., Lavelle, J., Sarajlic, I., & Massagli, M.P. (1999). Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia . Journal of the American Medical Association , 282, 433-439.
53.
Mollica, R.F., Wyshak, G., & Lavelle, J. ( 1987). The psychosocial impact of war trauma and torture on Southeast Asian refugees. American Journal of Psychiatry , 144, 1567-1572.
54.
Mollica, R.F., Wyshak, G., Marneffe, D., Khuon, F., & Lavelle, J. ( 1987). Indo-chinese versions of the Hopkins Symptom Checklist - 25: A screening instrument for the psychiatric care of refugees. American Journal of Psychiatry, 144, 497-500.
55.
Morris, A.G. ( 1993). Human remains from the early Iron Age sites of Nanda and KwaGandaganda, Mngeni Valley, Natal, South Africa. Natal Museum Journal of Humanities, 5, 83-98.
56.
Mosha, H.J. ( 1983). Dental mutilation and associated abnormalities in Tanzania . Odontostomatologia Tropica, 4, 215-219.
57.
Nagasawa, R., Qian, Z., & Wong, P. ( 2001). Theory of segmented assimilation and the adoption of marijuana use and delinquent behavior by Asian Pacific youth. The Sociological Quarterly, 42(3), 351-372.
58.
Neuner, F., Schauer, M., Karunakara, U., Klaschik, C., Robert, C., & Elbert, T. ( 2004). Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry, 4. Retrieved October 7, 2005, from http://www.biomedcentral.com/1471-244X-4-34 .
59.
Paardekooper, B., de Jong, J.T., & Hermanns, J.M. (1999). The psychological impact of war and the refugee situation on South Sudanese children in refugee camps in Northern Uganda: an exploratory study. Journal of Child Psychology and Psychiatry, 40(4), 529-536.
60.
Palinkas, L.A., Pickwell, S.M., Brandstein, K., Clark, T.J., Hill, L.L., Moser, R.J., & Osman, A. ( 2003). The journey to wellness: Stages of refugee health promotion and disease prevention. Journal of Immigrant Health , 5(1), 19-28.
61.
Parloff, M.B., Kelman, H.C., & Frank, J.D. ( 1954). Comfort, effectiveness, and self-awareness as criteria of improvement in psychotherapy. American Journal of Psychiatry , 111, 343-352.
62.
Peltzer, K. ( 1999). Trauma and mental health problems of Sudanese refugees in Uganda. Central African Journal of Medicine, 45, 110-113.
63.
Portes, A., Fernádez-Kelly, P., & Haller, W. ( 2005). Segmented assimilation on the ground: The new second generation in early adulthood. Ethnic and Racial Studies , 28(6), 1000-1040.
64.
Portes, A., & Zhou, M. ( 1993). The new second generation: Segmented assimilation and its variants. Annals of the American Academy of Political and Social Science, 530, 74-96.
65.
Schweitzer, R., Melville, F., Steel, Z., & Lacherez, P. ( 2006). Trauma, post-migration difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees . Australian and New Zealand Journal of Psychiatry, 40, 179-187.
66.
Seligman, C.G., & Seligman, B.Z. (1932). Pagan tribes of the Nilotic Sudan. London: George Routledge .
67.
Shaw, W. ( 1981). The influence of children’s dentofacial appearance on their social attractiveness as judged by peers and lay adults . American Journal of Orthodontics, 79, 399-413.
68.
Shaw, W., Rees, G., Dawe, M., & Charles, C. ( 1985). The influence of dentofacial appearances on the social attractiveness of young adults. American Journal of Orthodontics , 87, 21-26.
69.
Shipler, D. ( 2004, January 18) A poor cousin of the middle class. The New York Times Magazine. Late Edition - Final, Section6, p. 22.
70.
Simich, L., Hamilton, H., & Baya, K. ( 2006). Mental distress, economic hardship and expectations of life in Canada among Sudanese newcomers. Transcultural Psychiatry , 43(3), 418-444.
71.
Singer, R. ( 1953, December). Artificial deformation of teeth: A preliminary report. South African Journal of Science, 116-121.
72.
Steel, Z., Silove, D., Phan, T., & Bauman, A. ( 2002). Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study . The Lancet, 360, 1056-1062.
73.
Tang, S., & Fox, S. ( 2001). Traumatic experiences and the mental health of Senegalese refugees. Journal of Nervous and Mental Disease , 189, 507-512.
74.
Townend, B.R. ( 1963). The non-therapeutic extraction of teeth and its relation to the ritual disposal of shed deciduous teeth. British Dental Journal, 115, 354-357.
75.
United Nations High Commissioner for Refugees. ( 2007). 2006 global trends: Refugees, asylum seekers, returnees, internally displaced and stateless persons. Retrieved March 16, 2008, from http://www.unhcr.org/statistics/STATIS-TICS/4676a71d4.pdf .
76.
United States Department of State. Bureau of Population, Refugees and Migration. (2008, February 14). Fact Sheet, Bureau of Population, Refugees, and Migration, Washington, D.C., Refugee Admissions Program for Africa. Retrieved June 26, 2008, from http://www.state.gov/g/prm/refadm/rls/fs/2008/100944.htm.
77.
Van Ommeren, M., Sharma, B., Sharma, G.K., Komproe, I., Cardena, E., & de Jong, J.T.V.M. (2002). The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: Examination of comorbidity with anxiety and depression. Journal of Traumatic Stress, 15, 415-421.
78.
Van Reenen, J.F. ( 1978). Tooth mutilation amongst the peoples of Kavango and Bushmanland, South West Africa (Namibia). Journal of the Dental Association of South Africa, 33, 205-218.
79.
Van Reenen, J.F., & Briedenhahn, S.J. (1985). Tooth mutilating practices amongst the Damara of South West Africa (Namibia). Journal of the Dental Association of South Africa, 40, 537-539.
80.
Van Rippen, B. ( 1918). Practices and customs of the African natives involving dental procedures. Journal of the Allied Dental Society, 13, 1-22.
81.
Willis, M.S., Esqueda, C.W., & Schacht, R.N. ( 2008). Social perceptions of individuals missing upper front teeth. Perceptual and Motor Skills, 106, 423-435.
82.
Willis, M.S., Harris, L.E., & Hergenrader, P.J. (2008). On traditional dental extraction: Case reports from Dinka and Nuer en route to restoration. British Dental Journal, 204, 121-124.
83.
Willis, M.S., & Nkwocha, O. ( 2002). Sudanese refugee focus groups: Preliminary results and resulting research. Unpublished report, Lincoln: Nebraska Department of Health and Human Services.
84.
Willis, M.S., & Nkwocha, O. ( 2006). Health and related factors for Sudanese refugees in Nebraska . Journal of Immigrant and Minority Health, 8, 19-33.
85.
Willis, M.S., Schacht, R.N., & Toothaker, R. ( 2005). Anterior dental extractions among Dinka and Nuer refugees to the United States: A case series. Special Care in Dentistry , 25, 193-196.
86.
Willis, M.S., Swindler, D.R., & Toothaker, R.W. (2005). A description of Nuer and Dinka anterior tooth extractions, practices and a preliminary odontometric analysis of the remaining permanent dentition. In E. ZadZinska (Ed.), Current trends in dental morphology research (pp. 177-189). Lodz: University of Lodz Press.
87.
Wolfart, S., Brunzel, S., Freitag, S., & Kern, M. ( 2004). Assessment of dental appearance following changes in incisor angulation. International Journal of Prosthodontics , 17, 150-154.
88.
World Health Organization (WHO). (1994). A user’s guide to the self-reporting questionnaire (SRQ). Geneva: WHO.
