Brain structural abnormalities and mental health sequelae in south Vietnamese ex-political detainees who survived traumatic head injury and torture

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.