Voice hearing in refugees survivors of traumatic events

Introduction: Voice hearing (VH) is commonly associated with psychosis but it has also been reported in PTSD. The aim of this cross-sectional study was to identify the prevalence of VH in a sample of 110 treatment-seeking trauma-affected refugees, and to examine the relative role of certain interpersonal traumatic events (i.e., torture, inprisonment, sexual assault, non-sexual assault), PTSD severity as well as a range of socio-demographic variables in the emergence of VH. Methods: VH was operationalised in accordance with item 27 of Dissociative Experiences Scale-II. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). The relationship between potential predictor variables and VH was analyzed using binary logistic regression. Results: The VH prevalence rate in our sample was 29.1%. Among traumatic events only torture significantly predicted the emergence of VH. Also PTSD severity and a higher degree of education were significantly associated with VH. Discussion: Our study confirms that the experience of VH is relatively frequent in refugee population surviving traumatic events. Moreover, this study suggests the construct validity of severe PTSD with VH related to specific interpersonal traumatic events such as torture. These findings have important diagnostic and therapeutic implications, as increased awareness by clinicians that VH is not uncommon in trauma-affected refugees can potentially reduce misdiagnosis, e.g., by preventing cases of PTSD from being misidentified as psychosis. It is crucial to provide health care professionals with adequate knowledge on the diagnosis and treatment of these particularly complex patterns of post-traumatic disorders in refugees, as they are increasingly present in daily clinical practice in both developing and high-income countries.