1
|
Than V, Doroud N, O’Brien L. Mental health service utilization and help seeking behaviours of adult Cambodians living in Western countries: A systematic scoping review. Int J Soc Psychiatry 2024; 70:778-791. [PMID: 38420918 PMCID: PMC11144358 DOI: 10.1177/00207640241230848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Health disparity and under-utilization of health services is prevalent among Asian refugees and migrants in Western countries and can profoundly impact health outcomes. Cambodians who survived extreme physical and emotional trauma during the genocides enacted by the Khmer Rouge regime in the 1970's are particularly vulnerable to poor mental health outcomes decades later. Understanding the experiences of help-seeking and service use by displaced Cambodians in Western countries may help to design more effective and culturally safe healthcare services. AIMS To identify characteristics or factors associated with help seeking behaviours and service utilization of displaced Cambodians with mental health issues living in Western countries. METHODS This review followed the Arksey & O'Malley methodological framework for scoping reviews. Articles for review were identified through searches of nine electronic databases and manual searches. Relevant articles were selected, and data was extracted and synthesized into key themes. RESULTS This review included 15 articles. Most of the studies were conducted in the USA (n = 13) with one each conducted in Canada and New Zealand. Seven studies used qualitative interviews, five used a cross-sectional survey approach, two used a mixed-methods approach and one was a narrative review and case series. Key findings highlighted the impact of Cambodian cultural beliefs about mental health (guilt, shame and help-seeking stigma) on service utilization and the disconnect between Western models of service provision and preferred Cambodian ways of receiving support. CONCLUSION Mental health services in Western countries are likely to be under-utilized by Cambodians due to a mismatch between health beliefs and Western models of care. Further investigation of the association between health beliefs and barriers to service utilization among adult Cambodian refugees is warranted.
Collapse
Affiliation(s)
- Vannaral Than
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Nastaran Doroud
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Lisa O’Brien
- Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
2
|
Lahtinen O, Kangaslampi S, Aalto S, Soosalu J, Peltonen K. Cognitive, social, and mental health functions of refugee children - screening and supportive actions at school: a study protocol. BMC Psychol 2024; 12:251. [PMID: 38715097 PMCID: PMC11077695 DOI: 10.1186/s40359-024-01752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite a world-leading educational system, an achievement gap in educational outcomes exists between children of refugee background and native-born peers in Finland. To offer targeted support for children at schools, we need to be able to reliably assess and understand the interplay of the aspects of children's cognitive, social, and mental health functions that may explain the underachievement of refugee children. This study tests a novel research-based, universally applicable screening battery for evaluating cognitive, social, and mental health functioning of children at schools and planning supportive actions. It aims to answer research questions about a) the cognitive, social, and mental health functioning of refugee children compared with non-refugee immigrant and native-born children, b) the interplay of these different functions among refugee and other children, c) whether implementing a screening battery can inform schools in planning supportive actions for (refugee) children, and d) whether such supportive actions result in improvements in cognitive, social, and mental health functioning. METHODS Four hundred fifty children aged 10-12 will be recruited from primary schools, including 150 children of refugee background, 150 of non-refugee immigrant background, and 150 native-born Finnish children. A screening battery including tasks and questionnaires on different aspects of cognitive, social, and mental health functioning will be used to assess the children in their classrooms at the start and end of a school year. Supporting information will also be collected from parents and teachers. The information gathered will be collated into class-level feedback reports for teachers and, with parental permission, individualized reports for multiprofessional student welfare bodies, for informing supportive actions. Correlational and latent profile analyses, ANOVAs, and linear regression will be used to answer the research questions. DISCUSSION This study will help clarify how the interplay of cognitive, social, and mental health factors may explain underachievement at school among refugee children. It will provide evidence about the extent to which a standardized screening battery could be helpful in informing and planning supportive actions for children at schools, and whether such supportive actions can lead to positive cognitive, social, or mental health outcomes. TRIAL REGISTRATION The study will be preregistered on the Open Science Framework.
Collapse
Affiliation(s)
- Oskari Lahtinen
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland
| | - Samuli Kangaslampi
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland.
- Faculty of Social Sciences / Psychology, Tampere University, Tampere, Finland.
| | - Sanni Aalto
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland
| | - Joosu Soosalu
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland
| | - Kirsi Peltonen
- INVEST Research Flagship Centre, University of Turku, Turku, FI-20014, Finland
| |
Collapse
|
3
|
Chapadia B, Ghimire S, Karmacharya I, Subedi J, Adhikari SB. Role of Social Support on Mental Health Among Resettled Bhutanese Refugees in Ohio. J Immigr Minor Health 2024; 26:316-324. [PMID: 37863865 DOI: 10.1007/s10903-023-01549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/22/2023]
Abstract
More than 80% of Bhutanese refugees have resettled in the United States. Social support can lead to better resilience against poor mental health outcomes among this population. This study assessed the role of social support on mental health among the resettled Bhutanese adults in Central Ohio. This study used data collected by the Ohio Department of Mental Health and Addiction Services on 200 Bhutanese adults in Columbus. Social support was measured using a 12-item perceived social support scale. The 25-item Hopkins Symptoms Checklist was used to quantify depression and anxiety experienced in the past month. One-in-three participants reported mental health problems. Compared to participants with high social support, those with medium (OR 5.28, 95% CI 2.09-13.37) and low social support (OR 10.94, 95% CI 2.53-47.33) had more than 5- and 10-fold increased odds of mental health problems respectively. Future studies could further explore the role of social support on mental health during relocation, resettlement, and acculturation processes.
Collapse
Affiliation(s)
- Bunsi Chapadia
- Department of Microbiology, Miami University, Oxford, OH, USA
| | - Saruna Ghimire
- Department of Sociology and Gerontology, Miami University, 375 Upham Hall, 100 Bishop Circle, Oxford, OH, 45056, USA.
- Scripps Gerontology Center, Miami University, Oxford, OH, USA.
| | - Isha Karmacharya
- Department of Sociology and Gerontology, Miami University, 375 Upham Hall, 100 Bishop Circle, Oxford, OH, 45056, USA
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Janardan Subedi
- Department of Sociology and Gerontology, Miami University, 375 Upham Hall, 100 Bishop Circle, Oxford, OH, 45056, USA
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Surendra Bir Adhikari
- Quality Planning and Research, Ohio Department of Mental Health & Addiction Services, 30 E. Broad Street, Columbus, OH, 43215, USA
| |
Collapse
|
4
|
Stein J, Vöhringer M, Wagner B, Stammel N, Böttche M, Knaevelsrud C. Patterns of posttraumatic stress symptoms, their predictors, and comorbid mental health symptoms in traumatized Arabic-speaking people: A latent class analysis. PLoS One 2023; 18:e0295999. [PMID: 38134211 PMCID: PMC10745222 DOI: 10.1371/journal.pone.0295999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Many people from the Middle East and North Africa (MENA) have experienced traumatic events due to human rights abuses, violence, and conflict in the region, with potential psychological consequences including symptoms of posttraumatic stress and comorbid mental health problems. Yet, little is known about how different posttraumatic stress symptoms unfold in Arabic-speaking people who have experienced diverse traumatic events. This study examined latent classes based on posttraumatic stress symptoms, differences across classes concerning comorbid mental health symptoms and quality of life, and several predictors, including sociodemographic characteristics, social support, and trauma-related characteristics. Participants were 5,140 traumatized Arabic-speaking individuals who had registered for an online intervention. Latent class analysis was conducted to identify distinct classes based on DSM-5 posttraumatic stress symptoms. Multinomial logistic regression was used to analyze predictors of class membership. Differences between classes in severity of posttraumatic stress, depressive, anxiety, and somatoform symptoms, as well as quality of life were examined. Five different latent classes were identified: a general high posttraumatic stress symptom class (43.8%), a high posttraumatic stress symptom-low avoidance class (12.8%), a mixed posttraumatic stress symptom class (20.9%), a high dysphoric-low reexperiencing/avoidance class (14%), and a general low posttraumatic stress symptom class (8.4%). The classes differed in severity of posttraumatic stress, depressive, anxiety and somatoform symptoms, and quality of life. Consistent significant predictors of class membership were gender, social support, cumulative trauma exposure, sexual violence and direct exposure during the most distressing trauma, as well as time since the most distressing trauma. Distinct symptom classes with quantitative and qualitative differences can emerge following exposure to trauma among help-seeking Arabic-speaking people from the MENA region, with gender, social support, and trauma-related characteristics predicting symptom presentation. The results have implications for identifying distressed people and enhancing interventions based on an individual's symptom presentation.
Collapse
Affiliation(s)
- Jana Stein
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Max Vöhringer
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
5
|
Somasundaram D, Jayasuriya R, Perera R, Thamotharampillai U, Wickremasinghe R, Tay AK. Effect of daily stressors and collective efficacy on post-traumatic stress symptoms among internally displaced persons in post-war northern Sri Lanka. BJPsych Open 2023; 9:e180. [PMID: 37818719 PMCID: PMC10594160 DOI: 10.1192/bjo.2023.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Daily stressors have been shown to mediate the relationship of war trauma and trauma-related distress among refugees and internally displaced persons exposed to war and conflict. AIMS To examine the extent to which the relationship between war-related trauma and mental distress was mediated by daily stressors and collective efficacy among internally displaced communities a decade after exposure to war. METHOD In a cross-sectional study, we recruited a random sample of residents in villages severely affected by conflict in five districts in the Northern Province of Sri Lanka. Measures of war trauma, daily stressors, collective efficacy and post-traumatic stress symptoms (PTSS) were examined. Statistical analyses of the mediating and moderating effects of daily stressors were conducted using regression based methods. RESULTS Daily stressors mediated the association of war trauma and PTSS, as both paths of the indirect effect, war trauma to daily stressors and daily stressors to PTSS, were significant. The predictive effect of war trauma on PTSS was positive and significant at moderate and high levels of daily stressors but not at low levels. Higher levels of neighbourhood informal social control, a component of collective efficacy, function as a protective factor to reduce effects of war trauma and daily stressors on mental distress in this population. CONCLUSIONS Daily stressors are an important mediator in the well-established relationship between war exposure and traumatic stress among internally displaced persons, even a decade after the conflict. Mental health and psychosocial support programmes that aim to address mental distress among war-affected communities could reduce daily stressors and enhance collective efficacy in this context.
Collapse
Affiliation(s)
| | - Rohan Jayasuriya
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ruwanthi Perera
- Department of Rogavijnana, Faculty of Indigenous Medicine, Gampaha Wickramarachchi University of Indigenous Medicine, Yakkala, Sri Lanka
| | | | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Alvin Kuowei Tay
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
6
|
Rahimi MP, Wafa MH, Stanikzai MH, Rahimi BA. Post-traumatic stress disorder (PTSD) probability among parents who live in Kandahar, Afghanistan and lost at least a child to armed conflict. Sci Rep 2023; 13:3994. [PMID: 36899175 PMCID: PMC10006089 DOI: 10.1038/s41598-023-31228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
The last 4 decades of conflict in Afghanistan resulted in incalculable deaths, injuries, and millions of displacements. Although there are routine reports on casualties of the warfare, the information on its long-term psycho-social sequelae is somehow discounted. This study aimed to assess post-traumatic stress disorder (PTSD) probability and its associated factors among parents who live in Kandahar, the southern province of Afghanistan, and lost at least one child to armed conflict. We conducted a health-facility-based cross-sectional study involving 474 bereaved parents in Kandahar province from November/2020 to January/2021. The questionnaire was composed of sections on socio-demographic characteristics and mental and medical histories of the parent, features of the traumatic event and the time elapsed since then, age and gender of the lost child, and PCL-5. We performed multivariable logistic analysis to determine factors associated with PTSD probability in such parents. A staggering number of the parents (430; 90.72%) scored > 33 on PCL-5 denoting presence of probable PTSD. We noticed that several attributes of the bereaved parents (rural residence [AOR = 3.71 (95% CI 1.37-9.97)], older age [AOR = 2.41 (95% CI 1.03-5.57)], experiencing more than one traumatic event [AOR = 2.91 (95% CI 1.05-7.94)], pre-existing medical condition [AOR = 3.5 (95% CI 1.55-8.05)], and losing a < 5-years-old child [AOR = 2.38 (95% CI 1.16-4.70)] were significantly associated with PTSD probability. We assert that a very high number of bereaved parents are susceptible to probable PTSD. This finding signifies the eminent necessity of mental health services in such settings and provides implicit insights to relevant humanitarian assistance providers.
Collapse
Affiliation(s)
- Mohammad Paiman Rahimi
- Master of Public Health Program, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Hashim Wafa
- Master of Public Health Program, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.,Neuropsychiatric and Behavioral Science Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Muhammad Haroon Stanikzai
- Master of Public Health Program, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan. .,Public Health Department, Faculty of Medicine, Kandahar University, Near Ayno Mena, 10th District, Kandahar, Afghanistan.
| | - Bilal Ahmad Rahimi
- Master of Public Health Program, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.,Pediatrics Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| |
Collapse
|
7
|
Zylberstajn C, Messina Coimbra B, Oliveira-Watanabe TT, Rangel Maciel M, Calsavara VF, Olff M, Feijo Mello M, Feijo Mello A. The Relationship between Lifetime Exposure to Potentially Traumatic Events, Peritraumatic Dissociation, and PTSD in a Sample of Sexually Assaulted Women in Sao Paulo, Brazil. J Trauma Dissociation 2023; 24:252-267. [PMID: 36271690 DOI: 10.1080/15299732.2022.2136326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sexually assaulted women represent a particularly high-risk group for developing post-traumatic stress disorder (PTSD). Potentially traumatic events (PTEs) and peritraumatic dissociation (PD) are known risk factors for PTSD. However, little is known about how previous trauma affects PD and how this relationship affects PTSD. We aimed to investigate whether PD acts as a mediator between PTEs and PTSD severity in a sample of recently sexually assaulted women in Sao Paulo, Brazil. Seventy-four sexually assaulted women aged 18-44 completed questionnaires and structured interviews on PTSD, PD, and PTEs. We examined direct and indirect effects of variables using causal mediation analysis. Lifetime exposure to PTEs was a risk factor for PD, but PD was not a risk factor for PTSD symptom severity. Also, PD was not a mediator between PTEs and PTSD severity. We provided recommendations on how to further explore the relationship between lifetime traumatic exposure, PTSD, and peritraumatic dissociation.
Collapse
Affiliation(s)
- Cecilia Zylberstajn
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Bruno Messina Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Thauana T Oliveira-Watanabe
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mariana Rangel Maciel
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Vinicius F Calsavara
- Cedars‑Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Miranda Olff
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Marcelo Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
8
|
Johnson RJ, Antonaccio O, Botchkovar E, Hobfoll SE. War trauma and PTSD in Ukraine's civilian population: comparing urban-dwelling to internally displaced persons. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1807-1816. [PMID: 34596712 DOI: 10.1007/s00127-021-02176-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION War in Ukraine started in March 2014 when Russia annexed Crimea and continues today in the Donbass region of Eastern Ukraine. Over 1.5 million people in these regions have been displaced from their homes. We conducted this study 36 months after the conflict began and interviewed civilians residing in Ukraine. PURPOSE This study examines the prevalence of exposure to war trauma, rates of PTSD by symptom clusters, and whether socio-demographic factors are associated with positive scores for PTSD among civilian urban-dwelling and internally displaced persons in Ukraine during the ongoing conflict in its Donbass region. METHODS Face-to-face interviews were conducted using a multi-stage random sample of the general population in two large cities (Kharkiv and Lviv) in Ukraine (n = 1247) and a purposive sample of internally displaced persons (n = 300), half living in each city. Exposure to trauma, symptom clusters for Posttraumatic Stress Disorder (PTSD), and overall PTSD were assessed. RESULTS We found widespread direct exposure to conflict-related traumatic events (65%) among internally displaced people (IDPs) compared to a sizable minority (23%) of urban-dwelling people (UDPs). We found elevated prevalence of PTSD symptoms that were also uniformly spread within several socio-demographic factors. There were, however, significant differences in PTSD between (1) IDPs compared to UDPs and (2) those UDPs with Ukrainian compared to Russian ethnic identity, the former of each pair showing increased likelihoods of positive PTSD scores. CONCLUSIONS Ukraine's adult civilians, enduring the prolonged engagement in war with Russia and Russian separatists, have elevated rates of PTSD. Moreover, those who have been displaced by the ongoing conflict (IDPs) have significantly higher levels of PTSD compared to UDPs.
Collapse
Affiliation(s)
| | | | | | - Stevan E Hobfoll
- STAR-Stress, Anxiety, and Resilience Consultants, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Figge CJ, Martinez-Torteya C, Taing S, Chhim S, Hinton DE. Local clinician perspectives on cause, impact, and treatment of key expressions of distress in Cambodian children. Transcult Psychiatry 2022; 59:506-521. [PMID: 32116154 DOI: 10.1177/1363461520905995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Child trauma and posttraumatic stress in Cambodia is highly prevalent, perpetuated within a postwar sociocultural context. The examination of locally meaningful expressions of distress is needed to provide culturally sensitive assessment and treatment of trauma-affected Cambodian children. The acceptable, feasible, and sustainable incorporation of expressions of distress into assessment and intervention development relies on key mental health professionals operating in Cambodia, who can provide invaluable perspectives on child trauma experiences in this particular sociocultural context. In this study, qualitative interviews were conducted with 15 Cambodian mental health professionals (MHPs) who work directly with trauma-affected Cambodian children. MHPs were presented with seven key posttraumatic problems derived from previous qualitative interviews with Cambodian children and caregivers, and discussed 1) the causes of these problems, 2) the impact of the problem on the child or those around them, 3) the current treatment for the problem in Cambodia, and 4) recommended treatment. MHPs provided unique insights and perspectives of trauma-affected children in the Cambodian context regarding key target problems, including palpitations, difficulties in school, headache, and thinking too much, and highlighted future directions for assessment and intervention. Recommendations are discussed in regard to programming design and organizational training development to promote culturally salient, feasible, and sustainable mental health service provision in Cambodia.
Collapse
Affiliation(s)
| | | | - Sopheap Taing
- Transcultural Psychosocial Organization (TPO) Cambodia
| | | | | |
Collapse
|
10
|
van Dongen DHE, Havermans D, Deckers K, Olff M, Verhey F, Sobczak S. A first insight into the clinical manifestation of posttraumatic stress disorder in dementia: a systematic literature review. Psychogeriatrics 2022; 22:509-520. [PMID: 35474626 DOI: 10.1111/psyg.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 12/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent disorder worldwide and often co-occurs in dementia. Both have a major impact on disease burden and quality of life. PTSD may be difficult to recognize in dementia and a structured diagnostic method is lacking. In order to get insight into the clinical diagnostics of PTSD in dementia, this systematic literature review evaluates the clinical presentation of PTSD and other relevant symptoms in people with dementia. PubMed, PsycINFO, Embase, and CINAHL were searched for all publications through 30 December 2021. Articles were included which met the following criteria: (i) description of at least one case with a current diagnosis of dementia and co-morbid PTSD; (ii) clinical presentation of symptoms being adequately described; (iii) no difference being made between chronic PTSD, PTSD with re-activation, and delayed onset PTSD. Of the 947 identified abstracts, 13 papers met the inclusion criteria and were included (describing 30 cases). Based on our rating, only one case completely fulfilled the DSM-5 criteria of PTSD. Avoidance was only described in three cases. Most commonly described symptoms were irritability and anger (E1, 9%), persistent negative emotional state (D4, 9%), and sleep disturbances (E6, 8%). In 93% of the case reports, other symptoms were also described, i.e. memory problems (58%), screaming (33.3%), and wandering (22.2%). People with dementia who have experienced a traumatic event seem to present, based on our rating method, with insufficient symptoms to meet all criteria for a PTSD DSM-5 diagnosis. The DSM-5 core symptom of avoidance was absent in most of the cases. Clinical presentation consists mainly of symptoms of irritability, anger, persistent negative emotional state, and sleep disturbances, often accompanied by other symptoms. These findings suggest that older people with dementia may have other symptom presentations than people without dementia.
Collapse
Affiliation(s)
- Dorien H E van Dongen
- Department of clinical geriatrics, Zuyderland Medical Hospital, Sittard-Heerlen, The Netherlands
| | - Demi Havermans
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands.,Department of psychotrauma, ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Centrum Limburg, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sjacko Sobczak
- Department of Old Age Psychiatry, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
11
|
Rasmussen A, Leon M, Elklit A. Cross-Cultural Measurement Invariance of the Harvard Trauma Questionnaire Across Nine Adolescent Samples. Assessment 2022:10731911221101912. [PMID: 35699448 DOI: 10.1177/10731911221101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma researchers often make claims about the severity of posttraumatic stress disorder (PTSD) across populations, and yet cross-cultural measurement invariance (MI) is rarely assessed. Nine youth samples with Harvard Trauma Questionnaire (HTQ) responses were grouped based on sampling strategy used into two sets: representative (Denmark, the Faroe Islands, Iceland, and Lithuania, n = 1,457), and convenience (Greenland, India, Kenya, Malaysia, and Uganda, n = 2,036). Confirmatory factor analysis (CFA) was used to gauge whether configural, metric, scalar, and residual invariance of different models held between national samples within the two sets. Configural invariance held for most PTSD models in convenience samples, not in representative samples. Metric invariance was less common, and scalar and residual in general did not hold. Cultural similarity between samples seemed to be associated with invariance. Findings suggest that although PTSD symptoms may cluster similarly across culturally distal groups, comparisons of the severity of symptoms using the HTQ across adolescent samples are not likely valid.
Collapse
Affiliation(s)
| | | | - Ask Elklit
- University of Southern Denmark, Odense, Denmark
| |
Collapse
|
12
|
Tay AK, Mohsin M, Hau KM, Badrudduza M, Balasundaram S, Morgan K, Parthiban N, Silove D. Variations in prevalence and risk profiles for Common Mental Disorders amongst Rohingya, Chin and Kachin refugees from Myanmar. Psychol Med 2022; 52:1306-1320. [PMID: 32914737 DOI: 10.1017/s0033291720003104] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Large variations in prevalence rates of common mental disorder (CMD) amongst refugees and forcibly displaced populations have raised questions about the accuracy and value of epidemiological surveys in these cross-cultural settings. We examined the associations of sociodemographic indices, premigration traumatic events (TEs), postmigration living difficulties (PMLDs), and psychosocial disruptions based on the Adaptive Stress Index (ASI) in relation to CMD prevalence amongst the Rohingya, Chin and Kachin refugees originating from Myanmar and relocated to Malaysia. METHODS Parallel epidemiological studies were conducted in areas where the three groups were concentrated in and around Malaysia (response rates: 80-83%). RESULTS TE exposure, PMLDs and ASI were significantly associated with CMD prevalence in each group but the Rohingya recorded the highest exposure to all three of these former indices relative to Chin and Kachin (TE: mean = 11.1 v. 8.2 v. 11; PMLD: mean = 13.5 v. 7.4 v. 8.7; ASI: mean = 128.9 v. 32.1 v. 35.5). Multiple logistic regression analyses based on the pooled sample (n = 2058) controlling for gender and age, found that ethnic group membership, premigration TEs (16 or more TEs: OR, 2.00; 95% CI, 1.39-2.88; p < 0.001), PMLDs (10-15 PMLDs: OR, 4.19; 95% CI, 3.17-5.54; 16 or more PMLDs: OR, 7.23; 95% CI, 5.24-9.98; p < 0.001) and ASI score (ASI score 100 or greater: OR, 2.19; 95% CI, 1.46-3.30; p < 0.001) contributed to CMD. CONCLUSIONS Factors specific to each ethnic group and differences in the quantum of exposure to TEs, PMLDs and psychosocial disruptions appeared to account in large part for differences in prevalence rates of CMDs observed across these three groups.
Collapse
Affiliation(s)
- Alvin Kuowei Tay
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
- Perdana University-Centre for Global Health and Social Change (PU-GHSC), Kuala Lumpur, Malaysia
| | - Mohammed Mohsin
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
- Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Khat Mung Hau
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
| | - Mohammad Badrudduza
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
| | | | - Karen Morgan
- Perdana University-Centre for Global Health and Social Change (PU-GHSC), Kuala Lumpur, Malaysia
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia
| | - Nirmalatiban Parthiban
- Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia
| | - Derrick Silove
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Australia
| |
Collapse
|
13
|
Mannell J, Minckas N, Burgess R, Chirwa ED, Jewkes R, Gibbs A. Does experiencing a traumatic life event increase the risk of intimate partner violence for young women? A cross-sectional analysis and structural equation model of data from the Stepping Stones and Creating Futures intervention in South Africa. BMJ Open 2022; 12:e051969. [PMID: 35487735 PMCID: PMC9058688 DOI: 10.1136/bmjopen-2021-051969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/14/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To investigate associations and potential pathways between women's lifetime exposure to traumatic events and their recent experiences of intimate partner violence (IPV). SETTING South African informal settlements near Durban. PARTICIPANTS 677 women, living in informal settlements, aged 18-30 years, currently out of school or formal employment. PRIMARY AND SECONDARY OUTCOME MEASURES Self-reported experiences of IPV in the past 12 months and exposure to traumatic neighbourhood events (including witnessing murder, being robbed or kidnapped, witnessing and experiencing rape). RESULTS Exposure to traumatic events was common among the 677 women surveyed. Over 70% had experienced at least one in their lifetime; one quarter (24%) had experienced 3 or more different events. Women exposed to any traumatic event had a 43% increase in the odds of experiencing IPV in comparison to those with no exposure (aOR 1.43, p≤0.000). Exposure to non-partner rape is more strongly associated with IPV than any other traumatic experience. Pathways from exposure to traumatic events and non-partner rape to recent IPV experience are mediated by a latent variable of poor mental health. Food insecurity is associated with all forms of traumatic experience, and is also indirectly associated with IPV through views by women that are unsupportive of gender equality. CONCLUSIONS Women living in South African informal settlements who witness or experience traumatic events were likely to experience IPV, and this increases when women were exposed to multiple types of events. Our model suggests that experiencing traumatic events, and non-partner rape in particular, has negative effects on women's mental health in ways that may increase their vulnerability to IPV. IPV prevention interventions should consider the broader impacts of women's exposure to neighbourhood violence and severe poverty on IPV risk in settings where these are endemic. TRIAL REGISTRATION NUMBER NCT03022370; post-results.
Collapse
Affiliation(s)
| | | | | | - Esnat D Chirwa
- Gender and Health Division, South African Medical Research Council, Pretoria, South Africa
| | - Rachel Jewkes
- Gender and Health Division, South African Medical Research Council, Pretoria, South Africa
| | - Andrew Gibbs
- Gender and Health Division, South African Medical Research Council, Pretoria, South Africa
| |
Collapse
|
14
|
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent and disabling disorder. Evidence that PTSD is characterised by specific psychobiological dysfunctions has contributed to a growing interest in the use of medication in its treatment. OBJECTIVES To assess the effects of medication for reducing PTSD symptoms in adults with PTSD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 11, November 2020); MEDLINE (1946-), Embase (1974-), PsycINFO (1967-) and PTSDPubs (all available years) either directly or via the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR). We also searched international trial registers. The date of the latest search was 13 November 2020. SELECTION CRITERIA All randomised controlled trials (RCTs) of pharmacotherapy for adults with PTSD. DATA COLLECTION AND ANALYSIS Three review authors (TW, JI, and NP) independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. We contacted investigators to obtain missing data. We stratified summary statistics by medication class, and by medication agent for all medications. We calculated dichotomous and continuous measures using a random-effects model, and assessed heterogeneity. MAIN RESULTS We include 66 RCTs in the review (range: 13 days to 28 weeks; 7442 participants; age range 18 to 85 years) and 54 in the meta-analysis. For the primary outcome of treatment response, we found evidence of beneficial effect for selective serotonin reuptake inhibitors (SSRIs) compared with placebo (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.59 to 0.74; 8 studies, 1078 participants), which improved PTSD symptoms in 58% of SSRI participants compared with 35% of placebo participants, based on moderate-certainty evidence. For this outcome we also found evidence of beneficial effect for the noradrenergic and specific serotonergic antidepressant (NaSSA) mirtazapine: (RR 0.45, 95% CI 0.22 to 0.94; 1 study, 26 participants) in 65% of people on mirtazapine compared with 22% of placebo participants, and for the tricyclic antidepressant (TCA) amitriptyline (RR 0.60, 95% CI 0.38 to 0.96; 1 study, 40 participants) in 50% of amitriptyline participants compared with 17% of placebo participants, which improved PTSD symptoms. These outcomes are based on low-certainty evidence. There was however no evidence of beneficial effect for the number of participants who improved with the antipsychotics (RR 0.51, 95% CI 0.16 to 1.67; 2 studies, 43 participants) compared to placebo, based on very low-certainty evidence. For the outcome of treatment withdrawal, we found evidence of a harm for the individual SSRI agents compared with placebo (RR 1.41, 95% CI 1.07 to 1.87; 14 studies, 2399 participants). Withdrawals were also higher for the separate SSRI paroxetine group compared to the placebo group (RR 1.55, 95% CI 1.05 to 2.29; 5 studies, 1101 participants). Nonetheless, the absolute proportion of individuals dropping out from treatment due to adverse events in the SSRI groups was low (9%), based on moderate-certainty evidence. For the rest of the medications compared to placebo, we did not find evidence of harm for individuals dropping out from treatment due to adverse events. AUTHORS' CONCLUSIONS The findings of this review support the conclusion that SSRIs improve PTSD symptoms; they are first-line agents for the pharmacotherapy of PTSD, based on moderate-certainty evidence. The NaSSA mirtazapine and the TCA amitriptyline may also improve PTSD symptoms, but this is based on low-certainty evidence. In addition, we found no evidence of benefit for the number of participants who improved following treatment with the antipsychotic group compared to placebo, based on very low-certainty evidence. There remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD.
Collapse
Affiliation(s)
- Taryn Williams
- The Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nicole J Phillips
- The Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- The Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jonathan C Ipser
- The Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
15
|
Drugs age-of-onset as a signal of later post-traumatic stress disorder: Bayesian analysis of a census protocol. Addict Behav 2022; 125:107131. [PMID: 34763301 DOI: 10.1016/j.addbeh.2021.107131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/24/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022]
Abstract
Individuals with PTSD have an increased risk of drug use disorders. Conversely, we aim to evaluate how early onset of alcohol, tobacco and psychoactive drugs use are associated with PTSD later in life. 2,193 brazilian young adults completed modularized assessments: The Trauma History Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C, transformed to PCL-5 through a crosswalk procedure), the Barratt Impulsivity Scale; and a survey on drug use with self-report questions about first use, current use, frequency, quantity, and interpersonal consequences. Bayesian inference and multivariate regression models were used to examine the effects on the risk of PTSD, considering different assumptions of information flow. Raw and unbiased (multivariate) estimates consistently revealed that earlier age of onset of alcohol and tobacco use increased risk for PTSD (Odds-ratios between 2.39 and 3.19 (Alcohol) and 1.82 to 2.05 (Tobacco). Among those who had PTSD (310), 10.3% (32) were very precocious at the onset age (12 to 18 years) of alcohol consumption (No-PTSD: 89 out 1883, 4.7%). Data supports a model in which age of onset effects are partially mediated by the number of trauma exposures. Early intoxication might suggest vulnerability for qualifying trauma events, or it may increase chances of exposure. Also, PTSD may be more likely to occur among trauma-exposed individuals with early intoxicating experiences due to alcohol or drug self-administration. The last possibility resonates with the idea that early intoxication might disrupt adolescent brain development, with a subsequent reduction in resilience when qualifying trauma events occur.
Collapse
|
16
|
Yoon MS, Zhang N, Feyissa IF. Cultural Bereavement and Mental Distress: Examination of the Cultural Bereavement Framework through the Case of Ethiopian Refugees Living in South Korea. Healthcare (Basel) 2022; 10:healthcare10020201. [PMID: 35206816 PMCID: PMC8872198 DOI: 10.3390/healthcare10020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/27/2021] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
In South Korea, a mono-ethnic nation, refugees and asylum seekers from culturally distant countries are exposed to cultural bereavement, cultural identity shock, and cultural inconsistency for themselves and their children. Along with biological, psychological, and social factors, this phenomenon is hypothesized as playing a major role in an increased rate of distress among refugees. This study explored the experiences of 11 Ethiopian refugees living in South Korea, and their relevance to cultural bereavement while affirming and suggesting an update for the cultural bereavement framework. The analysis showed the refugees experiencing a slight continuation of dwelling in the past; a sense of guilt due to the fading of one’s culture; different types of anger; and anxiety with relation to the cultural identity of themselves and of their young children. Strong religious beliefs, a continuation of religious practice, informal gatherings within the Ethiopian diaspora, and organized community activities provided an antidote for cultural bereavement. The implication of the result hopes to assist and direct practitioners to identify complex manifestations of mental distress that often get wrongfully labeled as to their causation as well as methods and sources of diagnosis. Any update on the cultural bereavement framework also needs to consult the setting and peculiar circumstances of the displaced people in question.
Collapse
Affiliation(s)
- Myeong Sook Yoon
- Department of Social Welfare, Jeonbuk National University, Jeonju 54896, Korea; (M.S.Y.); (N.Z.)
| | - Nan Zhang
- Department of Social Welfare, Jeonbuk National University, Jeonju 54896, Korea; (M.S.Y.); (N.Z.)
| | | |
Collapse
|
17
|
McEwen C, Alisic E, Jobson L. Moderating role of moral injury in the mental health of adolescent refugees. J Clin Psychol 2022; 78:1478-1490. [PMID: 34993952 DOI: 10.1002/jclp.23306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/02/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigated whether moral injury appraisals moderated the relationships between trauma, postmigration living difficulties, resilience, and mental health outcomes in adolescent refugees. METHOD Eighty-five adolescent refugees from a community sample completed an online survey. RESULTS A significant interaction was found between moral injury and discrimination for externalizing and posttraumatic stress disorder (PTSD) symptoms; adolescents whom had experienced high levels of discrimination combined with high levels of moral injury had poorer mental health. A significant interaction was found between moral injury and resilience for internalizing symptoms: high levels of resilience appeared to buffer the association between moral injury and internalizing symptoms. Contrary to predictions, stressful life experiences and postmigration living difficulties did not interact significantly with moral injury to predict mental health. CONCLUSIONS Discrimination may contribute to perpetuating poor mental health in adolescent refugees with high levels of moral injury. Resilience may buffer some of the negative effects of moral injury.
Collapse
Affiliation(s)
- Cassandra McEwen
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Eva Alisic
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Laura Jobson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
18
|
Friedman MJ, Harris WW. Toward a National PTSD Brain Bank. Psychiatry 2022; 85:146-152. [PMID: 35588484 DOI: 10.1080/00332747.2022.2068919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
19
|
Ali D, Azale T, Wondie M, Tadesse J. About Six in Ten Survivors of the November 2020 Maikadra Massacre Suffer from Posttraumatic Stress Disorder, Northwest Ethiopia. Psychol Res Behav Manag 2022; 15:251-260. [PMID: 35177942 PMCID: PMC8845114 DOI: 10.2147/prbm.s338823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is characterized by recurrent, involuntary, and intrusive distressing memories of a traumatic event and dissociative reactions. Little is known about post-traumatic stress disorder in low and middle income countries such as Ethiopia where armed conflict, human rights violations, and ethnic-based violence are becoming everyday occurrences. OBJECTIVE This study aimed to assess the prevalence of post-traumatic stress disorder and associated factors among residents of Maikadra, North West Ethiopia. METHODS A community-based cross-sectional study was employed in April 2021. A multi-stage cluster sampling technique was employed to select the study participants. A post-traumatic stress disorder checklist (PCL-5) was used to assess post-traumatic stress disorder through a face-to-face interview. Bivariate and multi-variable binary logistic regression analyses were carried out to examine the association between posttraumatic stress disorder and several demographic and psychosocial variables. Statistical significance was declared at a P-value <0.05. RESULTS A total of 610 participants were interviewed with a response rate of 98.8%. The prevalence of PTSD in this study was 59.8% with a 95% CI of 55.7-63.9. Female sex (AOR=1.93, 95% CI=1.64-3.24), having a close family member killed or seriously injured (AOR=1.96, 95% CI=1.1-3.48), having moderate (AOR=3.35, 95% CI=1.98-5.68) and high perceived threat to life (AOR=3.66, 95% CI=1.85-6.95), having depression (AOR=1.67, 95% CI=1.13-2.47) and anxiety disorder (AOR=1.85, 95% CI=1.21-2.83), and being directly exposed to the event (AOR=3.27, 95% CI=1.09-9.83) were significantly associated with post-traumatic stress disorder. CONCLUSION The majority of the residents of Maikadra town where the November 2020 massacre took place experienced posttraumatic stress disorder. Female sex, having a family member or a friend murdered or seriously injured, having depression and anxiety disorders and being directly exposed to the trauma were found to be significant predictors of post-traumatic stress disorder. People who have been exposed to such an intense traumatic event need psychosocial support to help them recover from the horrible experiences.
Collapse
Affiliation(s)
- Dawed Ali
- University of Gondar, College of Medicine and Health Sciences, Department of Psychiatry, Gondar, Ethiopia
| | - Telake Azale
- University of Gondar, College of Medicine and Health Sciences, Department Health Education and Behavioral Sciences, Gondar, Ethiopia
- Correspondence: Telake Azale, University of Gondar, College of Medicine and Health Sciences, Department of Health Education and Behavioral Sciences, PO Box 196, Gondar, Ethiopia, Tel +251 918771951, Email
| | - Melese Wondie
- University of Gondar, College of Medicine and Health Sciences, Department of Psychiatry, Gondar, Ethiopia
| | - Jinenus Tadesse
- University of Gondar, College of Medicine and Health Sciences, Department of Psychiatry, Gondar, Ethiopia
| |
Collapse
|
20
|
Pandi-Perumal SR, Kumar VM, Pandian NG, de Jong JT, Andiappan S, Corlateanu A, Mahalaksmi AM, Chidambaram SB, Kumar RR, Ramasubramanian C, Sivasubramaniam S, Bjørkum AA, Cutajar J, Berk M, Trakht I, Vrdoljak A, Meira e Cruz M, Eyre HA, Grønli J, Cardinali DP, Maercker A, van de Put WACM, Guzder J, Bjorvatn B, Tol WA, Acuña-Castroviejo D, Meudec M, Morin CM, Partinen M, Barbui C, Jordans MJD, Braakman MH, Knaevelsrud C, Pallesen S, Sijbrandij M, Golombek DA, Espie CA, Cuijpers P, Agudelo HAM, van der Velden K, van der Kolk BA, Hobfoll SE, Devillé WLJM, Gradisar M, Riemann D, Axelsson J, Benítez-King G, Macy RD, Poberezhets V, Hoole SRH, Murthy RS, Hegemann T, Heinz A, Salvage J, McFarlane AC, Keukens R, de Silva H, Oestereich C, Wilhelm J, von Cranach M, Hoffmann K, Klosinski M, Bhugra D, Seeman MV. Scientists Against War: A Plea to World Leaders for Better Governance. SLEEP AND VIGILANCE 2022; 6:1-6. [PMID: 35317215 PMCID: PMC8930284 DOI: 10.1007/s41782-022-00198-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Seithikurippu R. Pandi-Perumal
- Somnogen Canada Inc., College Street, Toronto, Canada
- grid.412431.10000 0004 0444 045XSaveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | | | - Namasivayam Ganesh Pandian
- grid.258799.80000 0004 0372 2033Institute for Integrated Cell-Material Sciences (WPI-iCeMS), A210, Kyoto University Institute for Advanced Study, Yoshida Ushinomiya-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| | - Joop T. de Jong
- grid.509540.d0000 0004 6880 3010Department of Cultural Psychiatry and Global Mental Health, Amsterdam UMC, Amsterdam, The Netherlands
- grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, USA
| | - Sudalaikannu Andiappan
- grid.10214.360000 0001 2186 7912Department of Gandhian Studies and Ramalingar Philosophy, School of Religions, Philosophy and Humanist Thought, Madurai Kamaraj University, Madurai, Tamil Nadu India
| | - Alexandru Corlateanu
- grid.28224.3e0000 0004 0401 2738Department of Respiratory Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Arehally Marappa Mahalaksmi
- grid.411962.90000 0004 1761 157XDepartment of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, 570015 India
| | - Saravana Babu Chidambaram
- grid.411962.90000 0004 1761 157XDepartment of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, 570015 India
| | - Ramasamy Rajesh Kumar
- Global Community Educational Foundation (NGCEF), 7 Peterlee Pl, Hebersham, NSW 2770 Australia
| | | | - Sudhakar Sivasubramaniam
- grid.411780.b0000 0001 0683 3327Department of Biotechnology, Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu 627012 India
| | - Alvhild Alette Bjørkum
- grid.477239.c0000 0004 1754 9964Department of Safety, Chemistry and Biomedical Laboratory Sciences, Faculty of Engineering and Science, Western Norway University of Applied Sciences, Kronstad, Bergen, Norway
| | - JosAnn Cutajar
- grid.4462.40000 0001 2176 9482Department of Gender and Sexualities, Faculty for Social Wellbeing, University of Malta, Room # 114, Guze Cassar Pullicino Building, Msida, 2080 MSD Malta
| | - Michael Berk
- grid.414257.10000 0004 0540 0062Deakin University, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Geelong, Australia
| | - Ilya Trakht
- grid.21729.3f0000000419368729Department of Medicine, Columbia University, New York, NY USA
| | - Anton Vrdoljak
- grid.413034.10000 0001 0741 1142Faculty of Civil Engineering, Architecture and Geodesy, University of Mostar, Kampus Sveučilišta, Maticehrvatskeb. b, 88000 Mostar, Bosnia and Herzegovina
| | - Miguel Meira e Cruz
- grid.9983.b0000 0001 2181 4263Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Av. Prof. Egas Moniz, 1649–028 Lisboa, Portugal
| | - Harris A. Eyre
- grid.414257.10000 0004 0540 0062Deakin University, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Geelong, Australia
- grid.266102.10000 0001 2297 6811Global Brain Health Institute at University of California, San Francisco (UCSF), San Francisco, CA USA
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, Dublin, Ireland
- grid.39382.330000 0001 2160 926XDepartment of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
- grid.36193.3e0000000121590079Neuroscience-Inspired Policy Initiative, Organisation for Economic Co-operation and Development (OECD) and the PRODEO Institute and Meadows Mental Health Policy Institute, Paris, France
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at Houston, Houston, TX USA
| | - Janne Grønli
- grid.7914.b0000 0004 1936 7443Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Dainiel P. Cardinali
- grid.412525.50000 0001 2097 3932Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Andreas Maercker
- grid.7400.30000 0004 1937 0650Psychopathology and Clinical Intervention, University of Zurich, Binzmuhlestr. 14/17, 8044 Zurich, Switzerland
| | - Willem A. C. M. van de Put
- grid.11505.300000 0001 2153 5088Section of International Health Policy, Institute for Tropical Medicine Antwerp, Antwerp, Belgium
- grid.256023.0000000008755302XInstitute of International Humanitarian Affairs (IIHA), Fordham University, Bronx, NY USA
| | - Jaswant Guzder
- Division of Social and Transcultural Psychiatry, 1033 Pine Ave, Montreal, Canada
- grid.414980.00000 0000 9401 2774Trauma and Global Health Program, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis, Jewish General Hospital, Montreal, QC Canada
| | - Bjørn Bjorvatn
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- grid.412008.f0000 0000 9753 1393Norway and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Wietse A. Tol
- grid.5254.60000 0001 0674 042XSection of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- grid.12380.380000 0004 1754 9227Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- AArq International, Amsterdam, The Netherlands
| | - Darío Acuña-Castroviejo
- grid.4489.10000000121678994Centro de Investigación Biomédica, Departamento de Fisiología, Facultad de Medicina, Instituto de Biotecnología, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, 18016 Granada, Spain
| | - Marie Meudec
- grid.11505.300000 0001 2153 5088Outbreak Research Team and Department of Public Health, Institute of Tropical Medicine (ITM), Antwerpen, Belgium
| | - Charles M. Morin
- grid.23856.3a0000 0004 1936 8390École de Psychologie, Centre d’étude des troubles du sommeil, Centrede recherche CERVO/Brain Research Center, Université Laval, Québec, Canada
| | - Markku Partinen
- Helsinki Sleep Clinic, Terveystalo Healthcare, Valimotie 21, 00380 Helsinki, Finland
- grid.7737.40000 0004 0410 2071Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Corrado Barbui
- grid.5611.30000 0004 1763 1124WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
- grid.5611.30000 0004 1763 1124Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mark J. D. Jordans
- grid.487424.90000 0004 0414 0756Research and Development Department, War Child Holland, Amsterdam, The Netherlands
- grid.7177.60000000084992262Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario H. Braakman
- grid.12295.3d0000 0001 0943 3265Department of Transcultural Forensic Psychiatry, Tilburg University, Tilburg, The Netherlands
| | - Christine Knaevelsrud
- grid.14095.390000 0000 9116 4836Psychologische Psychotherapeutin, Klinisch-Psychologische Intervention, Freie Universität Berlin, Fachbereich Erziehungswissenschaftund Psychologie, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Ståle Pallesen
- grid.7914.b0000 0004 1936 7443Department of Psychosocial Science, University of Bergen, Christiesgt.12, 5015 Bergen, Norway
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Clinical Psychology, World Health Organization (WHO) Collaborating Center, Van der Boechorststraat 7, 1081BT Amsterdam, Netherlands
| | - Diego Andrés Golombek
- grid.11560.330000 0001 1087 5626Universidad Nacional de Quilmes/CONICET, R.S. Peña 352, 1876 Bernal, Buenos Aires, Argentina
| | - Colin A. Espie
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
- grid.4991.50000 0004 1936 8948Sir Jules Thorn Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, Oxford, OX1 3QU UK
| | - Pim Cuijpers
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- grid.12380.380000 0004 1754 9227WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- grid.1374.10000 0001 2097 1371Faculty of Medicine, University of Turku, Turku, Finland
| | | | - Koos van der Velden
- grid.10417.330000 0004 0444 9382Department of Public Health, Radboudumc, Nijmegen, The Netherlands
| | - Bessel A. van der Kolk
- grid.189504.10000 0004 1936 7558Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | | | - Walter L. J. M. Devillé
- National Knowledge and Advisory Center on Migrants, Refugees and Health (Pharos), Utrecht, The Netherlands
- grid.7177.60000000084992262Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Dieter Riemann
- grid.7708.80000 0000 9428 7911Leiter der Abteilung für Klinische Psychologie and Psychophysiologie, Zentrum für Psychische Erkrankungen, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
| | - John Axelsson
- grid.10548.380000 0004 1936 9377Stress Research Institute, Stockholm University, 106 91 Stockholm, Sweden
- grid.4714.60000 0004 1937 0626Department Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Gloria Benítez-King
- grid.419154.c0000 0004 1776 9908Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Calzada México-Xochimilco No 101, Colonia San Lorenzo, Huipulco, 14370 Mexico City, CDMX México
| | - Robert D. Macy
- International Trauma Center, Beverly Farms, Beverly, MA 01915 USA
- grid.38142.3c000000041936754XHarvard Medical School-McLean Hospital Developmental Trauma, Boston, MA USA
- Boston Children’s Foundation, 850 Summer St, South Boston, MA 02127 USA
| | - Vitalii Poberezhets
- grid.446037.2Department of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | | | - Rangaswamy Srinivasa Murthy
- grid.416861.c0000 0001 1516 2246Formally of Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka India
| | - Thomas Hegemann
- Bayerisches Zentrumfür Transkulturelle Medizin, Landshuter Allee 21, 80637 München, Germany
| | - Andreas Heinz
- grid.6363.00000 0001 2218 4662Department Psychiatry and Neurosciences CCM, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jane Salvage
- grid.3575.40000000121633745Midwifery Leadership Consultant, World Health Organization, Geneva, Switzerland
- grid.15538.3a0000 0001 0536 3773Kingston University, London, UK
| | - Alexander C. McFarlane
- grid.1010.00000 0004 1936 7304Department of Psychiatry, The University of Adelaide, Adelaide, 5000 Australia
| | - Rob Keukens
- GGZ Ecademy Coöperatie UA, Keltenstraat 14, 5037 KD, Tilburg, The Netherlands
- Federation Global Initiative on Psychiatry (FGIP), P.O. Box 1956, 1200 BZ Hilversum, The Netherlands
- grid.3575.40000000121633745Supervisor Capacity Building Community Mental Health Ukraine World Health Organization, Geneva, Switzerland
| | - Harendra de Silva
- grid.8065.b0000000121828067Formally of Department of Paediatrics, University of Colombo, Colombo, Sri Lanka
| | - Cornelia Oestereich
- Institut für systemische Therapie und Beratung, Leisewitzstraße 26, 30175 Hannover, Germany
| | - Jochen Wilhelm
- grid.8664.c0000 0001 2165 8627DeutschesZentrum für Lungenforschung (DZL), Justus-Liebig-Universität Gießen (JLU), Gießen, Germany
| | - Michael von Cranach
- grid.434949.70000 0001 1408 3925Hochschule München, Eggenthal, Grub 4, 87653 München, Germany
| | - Klaus Hoffmann
- Forensic Psychiatry and Psychotherapy, Feursteinstr. 55, 78479 Reichenau, Germany
- grid.9811.10000 0001 0658 7699Zentrum für Psychiatrie Reichenau, Akademisches Lehrkrankenhaus der Universität Konstanz, Rechtsfähige Anstalt des öffentlichen Rechts, Reichenau, Germany
| | - Matthias Klosinski
- grid.6936.a0000000123222966Facharzt für Kinder- und Jugendpsychiatrie und -psychotherapie Systemischer Berater (SG), Systemischer Therapeut (SG), TU München, Klinikum rechts der Isar, München, Germany
| | - Dinesh Bhugra
- grid.13097.3c0000 0001 2322 6764Professor Emeritus, Mental Health and Cultural Diversity, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, SE5 8AF UK
| | - Mary V. Seeman
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| |
Collapse
|
21
|
Patterns of conflict-related trauma exposure and their relation to psychopathology: A person-centered analysis in a population-based sample from eastern DRC. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
22
|
Gender and Place of Settlement as Predictors of Perceived Social Support, PTSD, and Insomnia among Internally Displaced Adolescents in North-East Nigeria. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10110428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous research has shown that gender affects social support and post-traumatic stress disorders (PTSD). The present study explores the main and interaction effects of gender and place of settlement on social support, PTSD symptoms, and insomnia in internally displaced adolescents (IDAs) in North-east of Nigeria. A stratified sampling method was used to select 109 participants from IDAs living in the camp, while 27 additional IDAs were purposively recruited from those living in the host community. Participants completed measures of Harvard Trauma Questionnaire Part-II, Insomnia Severity Index, and Crisis Support. No significant effects of gender on perceived social support, PTSDs, and insomnia were observed. Place of settlement had a significant effect on social support, with IDAs living in the camp having a higher mean score, while place of settlement had no significant effects on PTSD and insomnia. A significant interaction effect of gender and place of settlements on insomnia was found, with males living in the community having a higher mean score than their female counterparts, as well as both males and females in the camp. In conclusion, there is a need to understand male IDAs who reside in non-camp settings better, including the nature of their challenges, the outcomes they desire, and the limitations they experienced.
Collapse
|
23
|
Stein J, Niemeyer H, Meyer C, Wirz C, Eiling A, Gruzman R, Heeke C, Stammel N, Knaevelsrud C. Posttraumatic stress in adult civilians exposed to violent conflict, war and associated human rights abuses in the Eastern Mediterranean Region: A systematic review and meta-analysis. J Affect Disord 2021; 294:605-627. [PMID: 34332362 DOI: 10.1016/j.jad.2021.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/07/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Eastern Mediterranean Region (EMR) is the stage of the world's most violent conflicts and the origin of the largest refugee population worldwide. These conflicts can result in symptoms of posttraumatic stress (PTS). To date, no comprehensive meta-analysis on proportions of PTS in civilians from the EMR has been conducted. Sample characteristics, methodological, conflict-related and displacement-related factors might affect rates of PTS. METHODS A systematic literature search for studies investigating PTS in adult civilians from the EMR was conducted until March 2020 and resulted in 118 individual study samples that were suitable for inclusion. A quality assessment was conducted. A random effects meta-analysis on proportions and sensitivity analyses were performed, and a 95% prediction interval was calculated. Subgroup analyses to identify moderators (e.g. diagnostic instruments, displacement) were conducted. RESULTS The quality of the included study samples varied. The pooled estimate of proportions from all 118 study samples was 0.31 (95% CI: 0.27 - 0.35). Heterogeneity was considerable (Q = 10151.58, p < .0001; I2 = 98.64%). The prediction interval was 0.01 to 0.76. The results remained unchanged after excluding nine outlier study samples. Heterogeneity remained high in all subgroups (range of I2: 87.91 to 99.62). LIMITATIONS Due to heterogeneity the pooled estimate cannot be interpreted. Moderators contributing to heterogeneity could not be detected. CONCLUSIONS The proportion of symptoms of PTS in civilians from the EMR varies considerably. The prediction interval indicates that the true rate falls between 1% and 76%. Future studies need to identify variables that affect heterogeneity.
Collapse
Affiliation(s)
- Jana Stein
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany.
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Caroline Meyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christina Wirz
- Division of Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Rebecca Gruzman
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nadine Stammel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Center ÜBERLEBEN, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
24
|
Campbell A, Egan J, Murphy P, Blair C. Getting our act together: a qualitative evaluation of the impact of a play on issues relating to women, sex work and substance use. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16644.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The arts have always sought to explore significant social issues through literature, performing arts and visual art. However, more recently there has been an increase in the use of theatre as a means of gauging audiences’ perception and understanding of key social issues. The primary aim of the current evaluation was to seek the views of audience members, service users of addiction services and expert commentators as regards their perception of a number of key issues related to the content of a play entitled Madame Geneva. Methods: The evaluation used an exploratory qualitative design incorporating a dualistic approach to the research process: including post show discussion with panellists and members of the audience and a focus group comprising service users who had also viewed a live performance of the play. Results: The topics elucidated by the performance of the play included women and sex work, women and substance use, and impact on policy and practice. The discussion of the issues raised reiterated that women still experience high levels of oppression and discrimination in areas of substance use, sex work and welfare ‘reform’ which are often couched within male dominated political discourses and structures in contemporary society. Conclusions: The arts and specifically dramaturgical representations of substance use and related issues is an effective method of initiating important pragmatic and policy discussion of issues, which affect women
Collapse
|
25
|
Hoppen TH, Priebe S, Vetter I, Morina N. Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-006303. [PMID: 34321235 PMCID: PMC8319986 DOI: 10.1136/bmjgh-2021-006303] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/20/2021] [Indexed: 11/06/2022] Open
Abstract
Objective Extensive research has demonstrated high prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) in war-surviving populations. However, absolute estimates are lacking, which may additionally inform policy making, research and healthcare. We aimed at estimating the absolute global prevalence and disease burden of adult survivors of recent wars (1989–2019) affected by PTSD and/or MD. Methods We conducted a systematic literature search and meta-analysis of interview-based epidemiological surveys assessing the prevalence of PTSD and/or MD in representative samples from countries with a recent war history (1989–2019). Drawing on the war definition and geo-referenced data of the Uppsala Conflict Database Programme and population estimates of the United Nations for 2019, we extrapolated the meta-analytic results to absolute global numbers of affected people. Drawing on disability-adjusted life years (DALYs) data of the Global Burden of Diseases Study 2019, we further calculated the PTSD-associated and MD-associated DALYs. Results Twenty-two surveys (N=15 420) for PTSD, 13 surveys for MD (N=9836) and six surveys on the comorbidity of PTSD and MD (N=1131) were included. Random effects meta-analyses yielded point prevalences of 26.51% for PTSD and 23.31% for MD. Of those affected by PTSD, 55.26% presented with comorbid MD. Prevalence rates were not significantly associated with war intensity and length, time since war, response rate or survey quality. The extrapolation yielded 316 million adult war-survivors globally who suffered from PTSD and/or MD in 2019. War-survivors were almost exclusively living in low/middle-income countries (LMICs) and carried a burden of 3 105 387 and 4 083 950 DALYs associated with PTSD and MD, respectively. Conclusions Since LMICs lack sufficient funding and qualified professionals to provide evidence-based psychological treatments for such large numbers of affected people, alternative and scalable strategies using existing resources in primary care and communities are required. Research is required to assist upscaling.
Collapse
Affiliation(s)
- Thole H Hoppen
- Institute of Psychology, University of Münster, Münster, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Inja Vetter
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| |
Collapse
|
26
|
El-Khoury J, Haidar R, Barkil-Oteo A. Psychological torture: Characteristics and impact on mental health. Int J Soc Psychiatry 2021; 67:500-506. [PMID: 32985299 DOI: 10.1177/0020764020961800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Torture has been illegal in most of Europe and the United States for over a century but persisted in other parts of the world. The changing geopolitical landscape has led to its resurgence in recent years. The public rejection of traditional forms of torture that rely on the infliction of physical pain has paradoxically increased the reliance on psychological methods of torture. This critical commentary aims to define and characterize psychological torture (PT) while exploring practical, legal, ethical and therapeutic implications relevant to clinicians and policymakers. Psychological torture comes in a range of forms. It is being increasingly justified and adopted by legitimate authorities in the name of national security. The emphasis on the avoidance of physical pain leads to the assumption that PT does not produce the levels of suffering and harm that are associated with physically violent forms of torture. This same assumption has allowed for the implication of mental health professionals in theorizing and providing legitimacy for the actions of perpetrators. Psychological torture is still poorly defined with limited understanding of its long-term psychiatric impact on those who are subjected to it. The role of mental health professionals in preventing or addressing psychological torture remains ambiguous and needs to be reinforced.
Collapse
Affiliation(s)
- Joseph El-Khoury
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Riwa Haidar
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Andres Barkil-Oteo
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
27
|
den Hertog TN, Maassen E, de Jong JTVM, Reis R. Contextualized understanding of depression: A vignette study among the !Xun and Khwe of South Africa. Transcult Psychiatry 2021; 58:532-545. [PMID: 32281484 DOI: 10.1177/1363461520901888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Colonial misconceptions about the absence of depression and the lack of a psychologization of distress among Africans have long been refuted. However, cultural variation in depression in terms of symptomatic expression, conceptualization, explanatory models, and social responses is widely acknowledged. Insight into the cultural variation of depression is useful for providing appropriate care; however, few studies have explored cultural understandings of depression in African settings. In a depression vignette study of two displaced and marginalized San communities in South Africa, we conducted 20 semistructured interviews to explore causal interpretations and strategies for coping. Causal interpretations consisted of several dimensions, including life struggles and physical, psychological, and spiritual interpretations. Respondents primarily focused on life struggles in terms of socioeconomic and interpersonal problems. They described coping strategies as primarily addressing negative emotional and psychological affect through social support for relief, comfort, distraction, or advice on coping with the situation and emotions. In addition, religious coping and professional support from a social worker, psychologist, support group, or medications were mentioned. Findings illustrate that depression should be understood beyond individual suffering and be situated in its immediate social environment and larger sociopolitical setting. Interventions for depression therefore may benefit from a multilevel approach that addresses socioeconomic conditions, strengthens local resources, and fosters collaboration among locally appropriate informal and formal support structures.
Collapse
Affiliation(s)
- Thijs N den Hertog
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Eva Maassen
- Altrecht Institute for Mental Health Care, Utrecht, the Netherlands
| | - Joop T V M de Jong
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Ria Reis
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
- The Children's Institute, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
28
|
Zimmer Z, Fraser K, Korinek K, Akbulut-Yuksel M, Young YM, Toan TK. War across the life course: examining the impact of exposure to conflict on a comprehensive inventory of health measures in an aging Vietnamese population. Int J Epidemiol 2021; 50:866-879. [PMID: 33395485 DOI: 10.1093/ije/dyaa247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The majority of evidence indicates that exposure to war and other traumatic events continue to have negative impacts on health across the life course. However, existing research on health effects of war exposure primarily concentrates on short-term impacts among veterans in high-income countries sent elsewhere to battle. Yet, most wars situate in lower- and middle-income countries, where many are now or will soon be entering old age. Consequently, the current burden of exposure to war has ignored an important global population. METHODS The Vietnam Health and Aging Study (VHAS) is a longitudinal study designed to examine historical exposure to highly stressful events during the American War. Two modes of data collection, involving a sample of 2447 individuals aged 60+ years in northern Vietnam, took place between May and August 2018. Using this first wave of data, we generate indexed measures of war exposure and analyze their associations with a set of 12 health outcomes, accounting for confounding variables. RESULTS Results indicate that greater exposure to three types of war exposure (death and injury, stressful living conditions, and fearing death and/or injury) in earlier life is associated with worse health in later-life across a large number of health outcomes, such as number of diagnosed health conditions, mental distress, somatic symptoms, physical functioning, post-traumatic stress symptoms and chronic pain. CONCLUSIONS Findings support a life course theory of health and point to long-term effects of war on health that require detailed attention.
Collapse
Affiliation(s)
- Zachary Zimmer
- Global Aging and Community Initiative, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Kathryn Fraser
- Global Aging and Community Initiative, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Kim Korinek
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Tran Khanh Toan
- Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| |
Collapse
|
29
|
Zuberi A, Waqas A, Naveed S, Hossain MM, Rahman A, Saeed K, Fuhr DC. Prevalence of Mental Disorders in the WHO Eastern Mediterranean Region: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:665019. [PMID: 34335323 PMCID: PMC8316754 DOI: 10.3389/fpsyt.2021.665019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/31/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives: To synthesize the prevalence of mental and substance use disorders in countries of the Eastern Mediterranean Region (EMR) of the World Health Organization. Methods: The literature search was conducted across several databases in two phases. First, we searched for systematic reviews and/or meta-analyses published before 2014, reporting prevalence estimates for mental disorders in the EMR. Then, we identified new primary cross-sectional or longitudinal studies published between 2014 and 2020. Studies were included if they had a sample size of ≥ 450 and were conducted among the general adult population. Current, period and lifetime prevalence estimates for each disorder were pooled using random-effects meta-analyses, and subgroup analyses and meta-regressions were conducted. Findings: Prevalence estimates were extracted from 54 cross-sectional studies across 15 countries within the EMR. Pooled analyses of current, period and lifetime prevalence showed the highest prevalence for depression (14.8%, 95% confidence interval, CI: 10.7-20.1%), followed by generalized anxiety disorder (GAD) (10.4%, 95% CI: 7.1-14.7%), post-traumatic stress disorder (7.2%, 95% CI: 2.9-16.6%), substance use (4.0%, 95% CI: 3.1-5.2%), obsessive compulsive disorder (2.8%, 95% CI: 1.6-4.9%), phobic disorders (1.8%, 95% CI: 1.1-2.8%), panic disorders (1.1%, 95% CI: 0.6-2.2%), bipolar disorders (0.7%, 95% CI: 0.3-1.6%), and psychosis (0.5%, 95% CI: 0.3-0.9%). Populations exposed to adverse events had higher prevalence of mental disorders than the general population. Period and lifetime prevalence showed little difference across mental disorders. More pronounced differences in prevalence were seen for depression and GAD, specifically between current and lifetime prevalence (depression: current prevalence 20.5% (95% CI: 14.9-27.4%), vs. lifetime prevalence: 4.2% (95%CI: 1.8-9.6%); GAD: current prevalence 10.3% (95% CI: 6.1-17.0), vs. lifetime prevalence: 4.5% (95% CI: 2.4-8.3%). Differences between current and lifetime prevalence of mental disorders may be due to the use of different screening instruments and thresholds being applied. Conclusion: The prevalence of mental and substance use disorders in the EMR is high. Despite substantial inter-survey heterogeneity, our estimates align with previous global and regional data on mental disorders. Our meta-review provides new evidence on the burden of mental health problems in the EMR. Systematic Review Registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187388.
Collapse
Affiliation(s)
- Alina Zuberi
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ahmed Waqas
- Department of Primary Care and Mental Health, Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sadiq Naveed
- Department of Child Psychiatry, Institute of Living, Hartford, CT, United States
| | - Md Mahbub Hossain
- School of Public Health, Texas A&M University, College Station, TX, United States
| | - Atif Rahman
- Department of Primary Care and Mental Health, Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Khalid Saeed
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Daniela C. Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
30
|
Abstract
The coronavirus disease 2019 pandemic (COVID-19) has an important direct and indirect impact on both physical and mental health. We aim to describe the impact of an emergency state period due to COVID-19 on psychiatric emergency department (ED) visits. We conducted a retrospective observational study analysing all emergency visits occurring at a metropolitan psychiatric ED between March 19th and May 2nd 2019 and 2020 (the beginning/end date of the emergency state which Portugal was under due to COVID-19). Data regarding age, sex, diagnoses, admission date, discharge destiny and status were collected. Diagnoses were classified using the International Classification of Diseases version 9, Clinical Modification (ICD-9-CM). There was a 52·2% decrease on the number of psychiatric emergency visits during the emergency state period (n2020 = 780 vs n2019 = 1633 episodes). The decrease on psychiatric ED visits was greater in the female sex and in the younger age groups. Episodes with a primary diagnosis of Mood disorders lead the decrease on psychiatric ED visits with 68·3% less episodes. Schizophrenia and other psychotic disorders was the diagnosis group with the smaller decline (9·8% decrease). COVID-19 emergency state period had an important impact on the number and characteristics of psychiatric ED visits, reinforcing the great indirect effects of COVID-19 on mental health.
Collapse
|
31
|
Fasfous AF, Pérez-Marfil MN, Cruz-Quintana F, Pérez-García M, Al-Yamani HR, Fernández-Alcántara M. Differences in Neuropsychological Performance between Refugee and Non-Refugee Children in Palestine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115750. [PMID: 34071910 PMCID: PMC8198945 DOI: 10.3390/ijerph18115750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
Neuropsychological studies on refugee children are scarce, but there are even less in the case of Palestinian children. This work aims to study the neuropsychological performance of Palestinian refugee children in Palestine compared to other Palestinian children living outside refugee camps. A comprehensive Neuropsychological battery was administrated to 584 Palestinian school children (464 refugees and 120 non-refugees) aged 6, 7, and 8 years old. Results showed that non-refugee children outperformed refugee children in sustained attention, verbal comprehension, verbal memory, and visual memory. This study is the first to have performed a comprehensive neuropsychological assessment, based on a standardized and validated battery with the Palestinian refugee children. It supports professionals in their evaluation of neurodevelopment and neuropsychological alterations in refugee and non-refugee children in Palestine.
Collapse
Affiliation(s)
- Ahmed F. Fasfous
- Social Sciences Department, Bethlehem University, Bethlehem 92248, Palestine;
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18010 Granada, Spain; (F.C.-Q.); (M.P.-G.)
| | - María Nieves Pérez-Marfil
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18010 Granada, Spain; (F.C.-Q.); (M.P.-G.)
- Faculty of Psychology, University of Granada, 18010 Granada, Spain
- Correspondence: ; Tel.: +34-958242332
| | - Francisco Cruz-Quintana
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18010 Granada, Spain; (F.C.-Q.); (M.P.-G.)
- Faculty of Psychology, University of Granada, 18010 Granada, Spain
| | - Miguel Pérez-García
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18010 Granada, Spain; (F.C.-Q.); (M.P.-G.)
- Faculty of Psychology, University of Granada, 18010 Granada, Spain
| | - Hala R. Al-Yamani
- Faculty of Education, Bethlehem University, Bethlehem 92248, Palestine;
| | | |
Collapse
|
32
|
Abstract
Refugee populations are at high risk of experiencing trauma and developing negative mental health outcomes. The resilience of Syrian refugee children is not well established as far as modifying the association between trauma and mental illness. A total of 339 Syrian refugee children aged 10 to 17 were surveyed to assess resilience, depression and history of trauma. All children reported exposure to at least one traumatic event, 48.6% reported exposure to highly salient traumatic events such as being held hostage, kidnapping or imprisonment. High rates of suicidal ideation and depression symptomatology were found. Resilience was strongly inversely related to depression. Relational support was found to be the most protective resilience factor and was the most highly correlated with less depressive symptomatology. Empowering children and families to build resilience through social support may be a viable prevention and management approach to other unaffordable or unavailable treatments for mental illnesses.
Collapse
|
33
|
Combat stress in a small-scale society suggests divergent evolutionary roots for posttraumatic stress disorder symptoms. Proc Natl Acad Sci U S A 2021; 118:2020430118. [PMID: 33876754 PMCID: PMC8054015 DOI: 10.1073/pnas.2020430118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Did PTSD and combat stress evolve as a universal human response to danger? Or are they culturally specific? We addressed this question by interviewing 218 warriors from the Turkana, a non-Western small-scale society, who engage in high-risk lethal cattle raids. We found that symptoms that may have evolved to protect against danger, like flashbacks and startle response, were high in the Turkana and best predicted by combat exposure. However, symptoms that are similar to depression were lower in the Turkana compared to American service members and were better predicted by moral violations. These findings suggest different evolutionary roots for different symptoms which may lead to better diagnosis and treatment. Military personnel in industrialized societies often develop posttraumatic stress disorder (PTSD) during combat. It is unclear whether combat-related PTSD is a universal evolutionary response to danger or a culture-specific syndrome of industrialized societies. We interviewed 218 Turkana pastoralist warriors in Kenya, who engage in lethal cattle raids, about their combat experiences and PTSD symptoms. Turkana in our sample had a high prevalence of PTSD symptoms, but Turkana with high symptom severity had lower prevalence of depression-like symptoms than American service members with high symptom severity. Symptoms that facilitate responding to danger were better predicted by combat exposure, whereas depressive symptoms were better predicted by exposure to combat-related moral violations. The findings suggest that some PTSD symptoms stem from an evolved response to danger, while depressive PTSD symptoms may be caused by culturally specific moral norm violations.
Collapse
|
34
|
Yuval K, Aizik-Reebs A, Lurie I, Demoz D, Bernstein A. A Functional Network Perspective on Posttraumatic Stress in Refugees: Implications for Theory, Classification, Assessment, and Intervention. Transcult Psychiatry 2021; 58:268-282. [PMID: 33292082 DOI: 10.1177/1363461520965436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is an important, long-standing debate regarding the universality vs. specificity of trauma-related mental health symptoms in socio-culturally and linguistically diverse population groups, such as refugees and asylum seekers. Network theory, an emerging development in the field of psychological science, provides a novel data analytic methodology to evaluate and empirically examine long-standing questions about the structure and function of posttraumatic stress symptoms. We sought to empirically model the functional network of posttraumatic stress symptoms among East African refugees who survived multiple potentially traumatic events. A sample of 148 Sudanese and Eritrean male asylum seekers (M(SD)age = 32.60(7.13) were recruited from the community in Israel. The nature and function(s) of posttraumatic symptoms (Harvard Trauma Questionnaire) were modeled using regularized partial correlation models to derive a network of symptoms. Spinglass and exploratory graph analysis walktrap algorithms were then used to identify functional "circuits of symptoms" or clusters of nodes within the network. Analyses revealed a functional symptom circuitry that shares features with the predominant western model of posttraumatic stress disorder; as well as unique functional clusters of symptoms inconsistent with nosology and symptomatology observed in studies of Western populations. Findings may have important implications for theory, classification, assessment, candidate mechanisms that may drive and maintain posttraumatic stress, and in turn may inform prevention or treatment for socio-culturally diverse forcibly displaced population groups.
Collapse
Affiliation(s)
| | | | - Ido Lurie
- Shalvata Mental Health Center, Hod HaSharon, Israel and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University
| | | | | |
Collapse
|
35
|
Young Y, Korinek K, Zimmer Z, Toan TK. Assessing exposure to war-related traumatic events in older Vietnamese war survivors. Confl Health 2021; 15:14. [PMID: 33676519 PMCID: PMC7936433 DOI: 10.1186/s13031-021-00343-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Though studies measuring war-related stressors and resultant trauma among U.S. military veterans are abundant, few studies address how wartime stressors affect military veterans native to warzones. Even fewer assess the stress exposure and resulting trauma experienced by Vietnamese civilians. This study aimed to construct a scale to quantify wartime stress exposure that is relevant for civilians and military veterans who survived the American War in Vietnam. Methods The study analyzed data from a novel source, the Vietnam Health and Aging Study, which surveyed older men and women residing in central and northern Vietnam. We used a combination of exploratory and confirmatory factor analysis with posthoc tests of reliability and validity to derive measures for assessing exposure to war-related traumatic events. Results We found that a mix of exposure to death, combat, inhospitable living conditions, and forced displacement comprises the traumatic events that potentially contribute to posttraumatic stress disorder and other mental health problems. However, the particular mix of stressful experiences constituting war trauma differs for civilians, veterans of the formal military, and former members of paramilitary organizations. Conclusions These findings suggest the need for distinct but parallel approaches to measuring war-related stressors for populations of veterans and civilians exposed to war in their home countries and the need for greater public attention to the potential lingering trauma of noncombatants. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00343-y.
Collapse
Affiliation(s)
- Yvette Young
- Department of Sociology, University of Utah, Salt Lake City, UT, USA.
| | - Kim Korinek
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Zachary Zimmer
- Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Tran Khanh Toan
- Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| |
Collapse
|
36
|
Hollifield M, Toolson EC, Verbillis-Kolp S, Farmer B, Yamazaki J, Woldehaimanot T, Holland A. Distress and Resilience in Resettled Refugees of War: Implications for Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031238. [PMID: 33573131 PMCID: PMC7908567 DOI: 10.3390/ijerph18031238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about distress (Refugee Health Screener—15 (RHS-15)) and possible predictors of distress were collected at the domestic medical examination (T1) within 90 days of arrival and the civil surgeon examination (T2) 11–16 months after T1 for refugee groups from three countries (COU). Descriptive, correlative, analyses of variance, and regression techniques were used to determine trajectory type and their predictors. A higher percentage (7.3%) were distressed at T2 than at T1. By group, the Bhutanese became more distressed, the Burmese became less distressed, and Iraqi’s continued to have high distress. A regression model showed gender, loss, post-migration stress, and self-efficacy to be significant predictors of trajectory type (R2 = 0.46). When the T1 RHS-15 score was added to the model, observed variance increased (R2 = 0.53) and T1 RHS score accounted for the majority of variance (r = 0.64, p < 0.001), with post-migration stress accounting for markedly less (β = 0.19, p = 0.03). Loss and self-efficacy became less significant. Loss was, however, a strong predictor of delayed and chronic distress trajectory type. These data suggest that screening for distress should occur at least twice during resettlement to detect those with initial distress and those with delayed distress. Screening should be coupled with identifying other social determinants of health and a comprehensive assessment to determine the need for intervention for secondary prevention (i.e., reducing delayed distress) and treatment (reducing chronic distress).
Collapse
Affiliation(s)
- Michael Hollifield
- VA Long Beach Healthcare System, Long Beach, CA 90822, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine, Washington, DC 20052, USA
- War Survivors Institute, 5318 2nd Street, #703, Long Beach, CA, 90803, USA
- Correspondence:
| | - Eric C. Toolson
- Department of Biology, The University of New Mexico, Albuquerque, NM 87131, USA;
| | - Sasha Verbillis-Kolp
- Consultant, 3630 N. Winchell St., Portland, OR 97217, USA;
- Portland State University School of Social Work, Academic Student Recreation Center, Ste. 600, 1800 SW 6th Ave., Portland, OR 97201, USA
| | - Beth Farmer
- International Rescue Committee, 1200 S. 192nd St., SeaTac, WA 98148, USA;
| | - Junko Yamazaki
- Asian Counseling and Referral Service, Seattle, WA 98144, USA; (J.Y.); (T.W.)
| | | | - Annette Holland
- Public Health Seattle & King County, Seattle, WA 98121, USA;
| |
Collapse
|
37
|
Biresaw MS, Gebeyehu ET. Post-traumatic stress disorder and its associated factors among people who experienced traumatic events in east African countries, 2020: a protocol for systematic review and meta-analysis. Ann Gen Psychiatry 2021; 20:4. [PMID: 33422099 PMCID: PMC7797101 DOI: 10.1186/s12991-020-00324-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is the most commonly reported mental health consequence following disasters and traumatic events, either natural or man-made. Nothing is written regarding its pooled prevalence and pooled estimate of factors. Therefore, this study aimed to determine the pooled prevalence of PTSD and estimate the pooled effect of associated factors. METHODS An English version of published articles will be retrieved using the following; PubMed/Medline, Africa-wides, Science Direct, Cochrane Library, Global Health, Google Scholar, EMBASE, and psycINFO. Research reports will be searched from October 10/2020 to November 10/2020. The research reports quality will be assessed using the Newcastle-Ottawa Scale. Relevant information from the searched research reports will be extracted in a Microsoft Excel format. After extraction, the data will be imported to STATA version 14.0 for analysis. An appropriate guideline for a systematic review and meta-analysis report will be used, i.e. the Preferred Reporting Items for Systematic reviews and Meta-Analyses. A random-effects meta-analysis model will be used to estimate the Der Simonian and Laird's pooled prevalence of PTSD and its associated factors. DISCUSSION This study aims to determine the pooled prevalence of PTSD and estimate the pooled effect of associated factors. Several kinds of research have reported the increasing magnitude of PTSD and its determinants in a different population. This might be due to reasons, such as little attention being given to the issue. Therefore, this study will try to fill this gap by giving new evidence-based results to attract policymakers' attention.
Collapse
Affiliation(s)
- Mengesha Srahbzu Biresaw
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Department of Psychiatry, College of Health Sciences, Aksum University, Aksum, Ethiopia.
| | - Enguday Tirfeneh Gebeyehu
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Psychiatry, College of Health Sciences, Aksum University, Aksum, Ethiopia
| |
Collapse
|
38
|
Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Gersons BPR, de Jong J, Layne CM, Maguen S, Neria Y, Norwood AE, Pynoos RS, Reissman D, Ruzek JI, Shalev AY, Solomon Z, Steinberg AM, Ursano RJ. Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry 2021; 84:311-346. [PMID: 35061969 DOI: 10.1080/00332747.2021.2005387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.
Collapse
|
39
|
Klabbers RE, Muwonge TR, Ayikobua E, Izizinga D, Bassett IV, Kambugu A, Tsai AC, Ravicz M, Klabbers G, O'Laughlin KN. Understanding the role of interpersonal violence in assisted partner notification for HIV: a mixed-methods study in refugee settlements in West Nile Uganda. J Glob Health 2020; 10:020440. [PMID: 33312504 PMCID: PMC7719270 DOI: 10.7189/jogh.10.020440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Assisted partner notification (APN) for HIV was introduced in refugee settlements in West Nile Uganda in 2018 to facilitate testing of sexual partners. While APN is an effective strategy recommended by the World Health Organization, its safety has not been evaluated in a refugee settlement context in which participants have high prior exposure to interpersonal violence. The extent to which interpersonal violence influences APN utilization and the frequency with which post-APN interpersonal violence occurs remains unknown. METHODS To explore the relationship between APN and interpersonal violence, a cross-sectional mixed-methods study was conducted at 11 health centers in refugee settlements in West Nile Uganda. Routinely collected index client and sexual partner data were extracted from APN registers and semi-structured interviews were conducted with health workers. RESULTS Through APN, 1126 partners of 882 distinct index clients were identified. For 8% (75/958) of partners, index clients reported a history of intimate partner violence (IPV). For 20% (226/1126) of partners, index clients were screened for post-APN IPV; 8 cases were reported of which 88% (7/8) concerned partners with whom index clients reported prior history of IPV. In qualitative interviews (N = 32), health workers reported HIV disclosure-related physical, sexual and psychological violence and deprivation or neglect. Incidents of disclosure-related violence against health workers and dependents of index clients were also reported. Fear of disclosure-related violence was identified as a major barrier to APN that prevents index clients from listing sexual partners. CONCLUSIONS Incidents of interpersonal violence have been reported following HIV-disclosure and fear of interpersonal violence strongly influences APN participation. Addressing HIV perception and stigma may contribute to APN uptake and program safety. Prospective research on interpersonal violence involving index clients and sexual partners in refugee settlements is needed to facilitate safe engagement in APN for this vulnerable population.
Collapse
Affiliation(s)
- Robin E Klabbers
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Timothy R Muwonge
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Ayikobua
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Diego Izizinga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ingrid V Bassett
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Miranda Ravicz
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gonnie Klabbers
- Department of Health, Ethics and Society, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, Washington, USA
| |
Collapse
|
40
|
Musanabaganwa C, Jansen S, Fatumo S, Rutembesa E, Mutabaruka J, Gishoma D, Uwineza A, Kayiteshonga Y, Alachkar A, Wildman D, Uddin M, Mutesa L. Burden of post-traumatic stress disorder in postgenocide Rwandan population following exposure to 1994 genocide against the Tutsi: A meta-analysis. J Affect Disord 2020; 275:7-13. [PMID: 32658827 PMCID: PMC7395874 DOI: 10.1016/j.jad.2020.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/21/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The 1994 genocide against Tutsi resulted in a massive death toll that reached one million people. Despite the tremendous efforts made to mitigate the adverse effects of the genocide, a substantial burden of mental health disorders still exists including the notably high prevalence of post-traumatic stress disorder (PTSD) among genocide survivors. However, a synthesized model of PTSD vulnerability in this population is currently lacking. METHODS A meta-analysis of 19 original research studies that reported PTSD prevalence (n = 12,610). Medline-PubMed and Science.gov were key search engines. Random-Effects Model (k = 19; tau^2 estimator: DL) was applied. Data extraction, synthesis, and meta-analysis were carried out using R. RESULTS The total of 2957 out of 11,746 individuals suffered from PTSD. The summary proportion is 25% (95% CI=0.16,0.36). The tau^2 is 0.06 (95% CI=0.03,0.14) in the absence of subgroups, and the Q-statistic is 2827.65 (p<0.0001), all of which suggests high heterogeneity in the effect sizes. Year of data collection and Year of publication were significant moderators. PTSD pooled prevalence in the genocide survivor category was estimated at 37% (95% CI=0.21,0.56). CONCLUSION The PTSD prevalence among genocide survivors is considerably higher compared to the general Rwandan population. The burden of PTSD in the general Rwandan population declined significantly over time, likely due to treatment of symptoms through strong national mental health programs, peace building and resolution of symptoms over time. To the best of our knowledge little evidence has reported the burden of PTSD prevalence in African post conflict zones particularly in Rwanda. LIMITATION Limitations of our review include the use of retrospective studies and studies with very small sample sizes, as well as language criterion.
Collapse
Affiliation(s)
- Clarisse Musanabaganwa
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda;,Medical Research Center, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda;,Genomics Program, College of Public Health, University of South Florida, Florida, USA
| | - Stefan Jansen
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda,,Directorate of Research and Innovation, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Segun Fatumo
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, UK;,Uganda Medical Informatics Centre-MRC/UVRI, Entebbe, Uganda;,Genomics Program, College of Public Health, University of South Florida, Florida, USA
| | - Eugene Rutembesa
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | - Jean Mutabaruka
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | - Darius Gishoma
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | - Annette Uwineza
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Yvonne Kayiteshonga
- Division of Mental Health, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Amal Alachkar
- Department of Pharmacology, School of Medicine, University of California Irvine, California, USA
| | - Derek Wildman
- Genomics Program, College of Public Health, University of South Florida, Florida, USA
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Florida, USA
| | - Leon Mutesa
- Centre for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| |
Collapse
|
41
|
Schneider A, Pfeiffer A, Conrad D, Elbert T, Kolassa IT, Wilker S. Does cumulative exposure to traumatic stressors predict treatment outcome of community-implemented exposure-based therapy for PTSD? Eur J Psychotraumatol 2020; 11:1789323. [PMID: 33062203 PMCID: PMC7534285 DOI: 10.1080/20008198.2020.1789323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Posttraumatic Stress Disorder (PTSD) is associated with high levels of functional impairments such as difficulties in academic or occupational performance and in social relationships. With an increasing number of traumatic event types experienced (trauma load), PTSD risk increases in a dose-dependent manner. Accordingly, high rates of PTSD can impair the reconstruction process in post-conflict societies. In order to meet these high needs for mental health services in societies with little access to professional care, task shifting approaches and community-based interventions have been suggested. Narrative Exposure Therapy (NET) has been developed as a short and pragmatic exposure-based PTSD treatment that can be easily trained to lay personnel. Yet, it remains unclear whether NET can be effectively provided by trained lay counsellors even at high levels of trauma load. Objective: To investigate whether trauma load influences the treatment effectiveness of NET provided by trained and supervised local lay counsellors. Method: Linear mixed models were calculated to investigate the influence of trauma load on treatment effectiveness in a sample of N = 323 rebel war survivors from Northern Uganda with PTSD. Results: We found a strong reduction of PTSD symptoms following NET, which was not influenced by trauma load. However, individuals with higher levels of trauma load reported higher PTSD symptoms before therapy as well as 4 and 10 months following treatment completion compared to individuals with lower trauma load. Conclusions: Treatment with NET by lay counsellors is effective independent of trauma load. However, individuals with higher trauma load have a higher probability to show residual symptoms, which might require additional time, sessions or treatment modules.
Collapse
Affiliation(s)
- Anna Schneider
- Clinical & Biological Psychology, Ulm University, Konstanz, Germany
| | - Anett Pfeiffer
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Daniela Conrad
- Clinical & Biological Psychology, Ulm University, Konstanz, Germany.,Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | | | - Sarah Wilker
- Clinical & Biological Psychology, Ulm University, Konstanz, Germany.,Clinical Psychology and Psychotherapy, Bielefeld University, Konstanz, Germany
| |
Collapse
|
42
|
Elucidating Mental Health Disorders among Rohingya Refugees: A Malaysian Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186730. [PMID: 32942770 PMCID: PMC7559711 DOI: 10.3390/ijerph17186730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022]
Abstract
Mental health disorders (MHDs) among refugees has been recognized as a major public health issue. However, to date, there is limited evidence on the prevalence of MHDs among Rohingya refugees in Malaysia. This study aimed to examine the prevalence and associated factors of major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) among Rohingya refugees in Malaysia. A total of 220 refugees were randomly selected to participate in this cross-sectional study, conducted from June 2019 to November 2019. Perceived social support, religious orientation, food security, and sociodemographic characteristics were assessed as independent variables. The dependent variables assessed were MDD, GAD, and PTSD. The prevalence of GAD, PTSD, and MDD was reported at 92 (41.8%), 84 (38.2%), and 71 (32.3%). Several factors were significantly associated with MDD following multivariate analysis such as perceived low to moderate social support (AOR = 2.17; 95% CI 1.13, 4.19) and food insecurity (AOR = 2.77; 95% CI 1.19, 6.47). Exposure to violence (AOR = 38.46; 95% CI 16.27, 90.91) and food insecurity (AOR = 3.74; 95% CI 1.41, 9.91) were significantly associated with PTSD. Addressing these risk factors could be key in improving mental health outcomes among this vulnerable population.
Collapse
|
43
|
Predictors of Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms in Survivors of Torture Living in the United States. J Nerv Ment Dis 2020; 208:593-599. [PMID: 32541397 DOI: 10.1097/nmd.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A constellation of psychosocial factors contributes to the complex trauma symptoms that survivors of torture may experience. We examined the roles of pretrauma, peritrauma, and postmigration factors as predictors of posttraumatic stress disorder, depression, and anxiety in a sample of 101 culturally heterogeneous torture survivors residing in the United States. Predictors included demographic variables (sex, education, marital status), peritrauma torture type variables generated by principal components analysis (PCA), and postmigration variables (employment status, legal immigration status, and family separation). Of the torture factors identified through PCA (torture inflicted on the self and torture inflicted on family members), torture inflicted on the self significantly predicted anxiety. Undocumented legal status and female sex were related to poorer psychological outcomes. Results highlight the importance of considering postmigration factors, specifically legal status, rather than elements of the torture experience itself, in the delivery of trauma-informed psychological interventions and policy development for survivors of torture.
Collapse
|
44
|
Kiselev N, Morina N, Schick M, Watzke B, Schnyder U, Pfaltz MC. Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist's view. BMC Psychiatry 2020; 20:378. [PMID: 32680485 PMCID: PMC7366894 DOI: 10.1186/s12888-020-02783-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. METHODS An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data. RESULTS Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. CONCLUSIONS Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.
Collapse
Affiliation(s)
- Nikolai Kiselev
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Naser Morina
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Matthis Schick
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Birgit Watzke
- grid.7400.30000 0004 1937 0650Department of Clinical Psychology and Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
| |
Collapse
|
45
|
Salama ES, Castaneda AE, Lilja E, Suvisaari J, Rask S, Laatikainen T, Niemelä S. Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study. Addiction 2020; 115:1160-1171. [PMID: 31797477 PMCID: PMC7317749 DOI: 10.1111/add.14904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/01/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds. DESIGN Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language. SETTING Population-based data were collected from six cities in Finland during 2010-12. PARTICIPANTS The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%). MEASUREMENTS The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for. FINDINGS Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18). CONCLUSIONS In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.
Collapse
Affiliation(s)
- Essi S. Salama
- Faculty of MedicineUniversity of TurkuTurkuFinland
- Child PsychiatryTurku University HospitalTurkuFinland
| | - Anu E. Castaneda
- National Institute for Health and Welfare (THL)HelsinkiFinland
- Faculty of Medicine, Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Eero Lilja
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Jaana Suvisaari
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Shadia Rask
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL)HelsinkiFinland
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun sote)JoensuuFinland
| | - Solja Niemelä
- Department of PsychiatryUniversity of TurkuTurkuFinland
- Addiction Psychiatry UnitTurku University HospitalTurkuFinland
| |
Collapse
|
46
|
Veronese G, Sousa C, Cavazzoni F. Survival and Resilience Among Palestinian Women: A Qualitative Analysis Using Individual and Collective Life Events Calendars. Violence Against Women 2020; 27:900-917. [PMID: 32364050 DOI: 10.1177/1077801220914406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Responding to the need for more information concerning the mental health and psychological well-being of women living amid political oppression and war, this study aimed to explore specific factors that contribute to women's individual and collective perceptions about war and the associated traumatic life events that occurred during their lives. Moving from a socioecological and culture-informed perspective, we used narrative timelines elicited from 21 Palestinian women in Gaza, both individually and collectively, as a tool for both data collection and intervention. A deductive, top-down, thematic content analysis procedure was used to categorize data. The main events outlined by the women in their historical accounts, both individual and collective, were linked to political events in and surrounding Palestine. The life events' calendars reflect a constant attempt in balancing and compensating traumatic events with sources of well-being related to social support and family. Individual and collective narrative activities contributed to generate a significant reframing in the attribution of meaning and emotional perceptions of the participants. Women articulated how they build resilience through transgenerational and daily practices of resistance that encompass indigenous strategies of coping and skills of survival.
Collapse
|
47
|
Ng LC, Stevenson A, Kalapurakkel SS, Hanlon C, Seedat S, Harerimana B, Chiliza B, Koenen KC. National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003090. [PMID: 32413027 PMCID: PMC7228043 DOI: 10.1371/journal.pmed.1003090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA. METHODS AND FINDINGS The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional. There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%-32%), while the current prevalence-defined as 1 week to 1 month-was 25% (95% CI 16%-36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%-0%) to 74% (95% CI 72%-76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%-15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%-40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non-peer-reviewed studies. CONCLUSIONS In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.
Collapse
Affiliation(s)
- Lauren C. Ng
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Anne Stevenson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sreeja S. Kalapurakkel
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Centre for Global Mental Health, Health Service and Population Research, Department Institute of Psychiatry, Psychology and Neuroscience King’s College, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Boniface Harerimana
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
48
|
Yaacoub H, Haddad C, Dib T, Zoghbi M, Assaad S, Obeid S, Sacre H, Hallit S, Kazour F. Posttraumatic stress disorders and depression among male inpatient adults involved in the Lebanese war. Perspect Psychiatr Care 2020; 56:263-269. [PMID: 31318076 DOI: 10.1111/ppc.12421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/10/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE to evaluate factors associated with posttraumatic stress disorder (PTSD) and depression in a sample of hospitalized Lebanese adult males who directly or indirectly were involved in armed conflicts. DESIGN Cross-sectional. METHODS Seventy-seven hospitalized males were enrolled between June and December 2016. The Hamilton Anxiety and Depression Scale and the Mini International Neuropsychiatric Interview were used to assess anxiety, depression, and PTSD. RESULTS Participation in war (adjusted odds ratio [ORa] = 6.35) and depression (ORa = 1.08) were associated with higher PTSD, whereas age (ORa = 0.94) and substance use (ORa = 0.19) were associated with lower PTSD. Anxiety (β = .87), substance use (β = 6.27) and PTSD (β = 8.78; P = .008) were associated with higher depression. PRACTICE IMPLICATIONS People who experienced war conflicts (directly or indirectly) are more prone to suffer from mental health disorders.
Collapse
Affiliation(s)
- Hiba Yaacoub
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Chadia Haddad
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Tania Dib
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Marouan Zoghbi
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Shafika Assaad
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Sahar Obeid
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Philosophy and Human Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Faculty of Pedagogy, Lebanese University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Francois Kazour
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Philosophy and Human Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Faculty of Pedagogy, Lebanese University, Beirut, Lebanon.,INSERM U930, équipe 4 "Troubles Affectifs", Université François-Rabelais de Tours, Parc de Grandmont, Tours, France
| |
Collapse
|
49
|
Knipscheer J, Sleijpen M, Frank L, de Graaf R, Kleber R, ten Have M, Dückers M. Prevalence of Potentially Traumatic Events, Other Life Events and Subsequent Reactions Indicative for Posttraumatic Stress Disorder in the Netherlands: A General Population Study Based on the Trauma Screening Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051725. [PMID: 32155752 PMCID: PMC7084195 DOI: 10.3390/ijerph17051725] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
The 12-month and lifetime prevalence of posttraumatic stress disorder (PTSD) in different country populations has been assessed while using clinical interviews. Because this methodology is relatively time-consuming and resource-intensive, disaster health researchers adopted instruments, like the Trauma Screening Questionnaire (TSQ). This study (1) used the TSQ to estimate the lifetime prevalence of potentially traumatic events and other life events (PTE/OLEs) and the one-week prevalence of subsequent reactions indicative for PTSD (based on DSM-IV PTSD criteria) in The Netherlands and (2) investigated risk and protective factors for the development of PTSD to overcome the lack of baseline comparison data on general populations and subgroups. The data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a representative study in the Dutch general population aged 18 to 64 years (N = 6646), using face-to-face interviews. Logistic regression modeling was used to assess PTSD correlates. The lifetime PTE/OLE prevalence was 71.1%. Among exposed subjects, one-week PTSD prevalence was estimated at 2.0%. The correlates of PTSD were female gender, Moroccan, or Turkish ethnicity, and exposure to sexual abuse and exposure time less than four years ago. The results are discussed in relation to earlier 12-month and lifetime general population prevalence of PTSD in the Netherlands and other countries, and TSQ-based disaster studies. General population replications can provide additional TSQ baseline data, and shed light on exposure and PTSD prevalence assessed with different instruments.
Collapse
Affiliation(s)
- Jeroen Knipscheer
- ARQ National Psychotrauma Centre, 1112 XE Diemen, The Netherlands; (M.S.); (L.F.); (R.K.); (M.D.)
- Department of Methodology and Statistics, Utrecht University, 3584 CS Utrecht, the Netherlands
- Correspondence: ; Tel.: +31-206-274-974
| | - Marieke Sleijpen
- ARQ National Psychotrauma Centre, 1112 XE Diemen, The Netherlands; (M.S.); (L.F.); (R.K.); (M.D.)
- Department of Methodology and Statistics, Utrecht University, 3584 CS Utrecht, the Netherlands
| | - Laurence Frank
- ARQ National Psychotrauma Centre, 1112 XE Diemen, The Netherlands; (M.S.); (L.F.); (R.K.); (M.D.)
- Department of Methodology and Statistics, Utrecht University, 3584 CS Utrecht, the Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, 3521 VS Utrecht, The Netherlands; (R.d.G.); (M.t.H.)
| | - Rolf Kleber
- ARQ National Psychotrauma Centre, 1112 XE Diemen, The Netherlands; (M.S.); (L.F.); (R.K.); (M.D.)
- Department of Methodology and Statistics, Utrecht University, 3584 CS Utrecht, the Netherlands
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, 3521 VS Utrecht, The Netherlands; (R.d.G.); (M.t.H.)
| | - Michel Dückers
- ARQ National Psychotrauma Centre, 1112 XE Diemen, The Netherlands; (M.S.); (L.F.); (R.K.); (M.D.)
- Nivel–Netherlands Institute for Health Services Research, 3513 CR Utrecht, The Netherlands
| |
Collapse
|
50
|
Abstract
Individuals with post-traumatic stress disorder avoid trauma-related stimuli and exhibit blunted hypothalamic-pituitary-adrenal axis response at the time of trauma. Our laboratory uses predator odor (i.e. bobcat urine) stress to divide adult Wistar rats into groups that exhibit high (avoiders) or low (nonavoiders) avoidance of a predator odor-paired context, modeling the fact that not all humans exposed to traumatic events develop psychiatric conditions. Male avoiders exhibit lower body weight gain after stress, as well as extinction-resistant avoidance that persists after a second stress exposure. These animals also show attenuated hypothalamic-pituitary-adrenal axis response to predator odor that predicts subsequent avoidance of the odor-paired context. Avoiders exhibit unique brain activation profiles relative to nonavoiders and controls (as measured by Fos immunoreactivity), and higher corticotropin-releasing factor levels in multiple brain regions. Furthermore, avoider rats exhibit escalated and compulsive-like alcohol self-administration after traumatic stress. Here, we review the predator odor avoidance model of post-traumatic stress disorder and its utility for tracking behavior and measuring biological outcomes predicted by avoidance. The major strengths of this model are (i) etiological validity with exposure to a single intense stressor, (ii) established approach distinguishing individual differences in stress reactivity, and (iii) robust behavioral and biological phenotypes during and after trauma.
Collapse
|