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Wazir V, Hanif R, Malik JA. Impact of Trauma Exposure on Psychosocial Functioning of Media Professionals: Sense of Coherence as Moderator. JOURNAL OF LOSS & TRAUMA 2023; 28:715-726. [DOI: 10.1080/15325024.2023.2217039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/21/2023] [Indexed: 08/31/2024]
Affiliation(s)
- Verona Wazir
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Rubina Hanif
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Jamil A. Malik
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
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Duong TV, Nguyen MH, Lai CF, Chen SC, Dadaczynski K, Okan O, Lin CY. COVID-19-related fear, stress and depression in school principals: impacts of symptoms like COVID-19, information confusion, health-related activity limitations, working hours, sense of coherence and health literacy. Ann Med 2022; 54:2064-2077. [PMID: 35876321 PMCID: PMC9318216 DOI: 10.1080/07853890.2022.2101688] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND School principals have been reported to have a higher prevalence of burnout and psychological problems than their colleagues. During the pandemic, extra workload and pressure from unprecedented situations potentially cause fear, stress and depression. Therefore, we aimed to explore associated factors of stress, fear of COVID-19 (F-CoV-19S) and depressive symptoms among school principals. METHODS A cross-sectional online survey was conducted in Taiwan from 23 June to 16 July 2021. Data of 413 school principals were collected, including socio-demographic factors, COVID-19-related factors, work-related information, health status, sense of coherence (SoC), health literacy (HL), F-CoV-19S, stress and depression. Multiple linear and logistic regression models were utilized to explore associations. RESULTS School principals with symptoms like COVID-19 (S-COVID-19-S), or with health-related activity limitations had a higher score of stress (B = 0.92; p = .039) (B = 1.52; p < .001) and a higher depression likelihood (OR = 3.38; p < .001) (OR = 3.06; p < .001), whereas those with a better SoC had a lower stress score (B = -1.39; p < .001) and a lower depression likelihood (OR = 0.76; p = .020). School principals confusing about COVID-19-related information had a higher score of stress (B = 2.47; p < .001) and fear (B = 3.77; p < .001). The longer working time was associated with a higher fear score (B = 1.69; p = .006). Additionally, school principals with a higher HL score had a lower stress score (B = -1.76; p < .001), a lower fear score (B = -1.85; p < .001) and a lower depression likelihood (OR = 0.53; p = .043). CONCLUSIONS Health-related activity limitations, S-COVID-19-S, COVID-19-related information confusion and longer working hours were positively associated with at least one mental health problem (e.g. stress, fear and depression), whereas better SoC and HL showed the benefits to mitigate fear, stress and depressive symptoms in school principals. Our study provides evidence for appropriate strategies to improve principals' mental health during the pandemic.Key messages:School principals with health-related activity limitations or with symptoms like COVID-19 were more likely to be stressed and depressed.Higher levels of stress and fear were observed in school principals who confused about COVID-19-related information, and who had longer working time than before the pandemic.Better sense of coherence and higher health literacy could potentially mitigate the fear, stress and depressive symptoms in school principals.
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Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan.,International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Minh H Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Feng Lai
- Department of Education, National Taichung University of Education, Taichung, Taiwan
| | - Sheng-Chih Chen
- Master's Program of Digital Content and Technologies, College of Communication, National Chengchi University, Taipei, Taiwan
| | - Kevin Dadaczynski
- Public Health Centre Fulda, Fulda University of Applied Sciences, Fulda, Germany.,Center for Applied Health Science, Leuphana University Lueneburg, Lueneburg, Germany
| | - Orkan Okan
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Cheng-Yu Lin
- Department of Radio, Television & Film, Shih Hsin University, Taipei, Taiwan
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An Ethnographic Perspective of Well-Being, Salutogenesis and Meaning Making among Refugees and Asylum Seekers in the Gambia and the United Kingdom. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10090324] [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
Research on refugees and asylum seekers largely focuses on the negative impacts that forced migration has on well-being. Though most individuals do not experience poor long-term mental health because of forced migration, less attention has been given to what factors promote positive well-being. Using an ethnographic approach, I elucidate how the concept of salutogenesis can be applied to African refugees and asylum seekers living in the greater Serrekunda area of the Gambia and in Newcastle-upon-Tyne in the United Kingdom. Specifically, I explore what resources impact on the sense of coherence construct and its three components—comprehensibility, manageability and meaningfulness—and how these are embedded in everyday discussions and understandings. In total, I spent twenty months conducting ethnographic fieldwork between the two sites and conducted forty individual interviews. Amongst my interlocutors, the three most common resources that people spoke positively about, particularly as it relates to meaning making, are work, education and religion. Further research in this area is crucial in order to identify, promote and strengthen those factors facilitating positive well-being amongst those who have been forcibly displaced.
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Wadji DL, Gaillard C, Ketcha Wanda GJM, Wicky C, Morina N, Martin-Soelch C. HPA-axis activity and the moderating effect of self-esteem in the context of intimate partner violence in Cameroon. Eur J Psychotraumatol 2021; 12:1930897. [PMID: 34290846 PMCID: PMC8279150 DOI: 10.1080/20008198.2021.1930897] [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: 10/28/2022] Open
Abstract
BACKGROUND The experience of intimate partner violence (IPV) is stressful. One objective way to monitor it is to assess victims' stress response by measuring the concentration of their salivary cortisol, the major stress hormone released by the hypothalamic-pituitary-adrenal axis. OBJECTIVE We investigated how the IPV experienced by women in Cameroon affects their stress levels and those of their children. METHOD We recruited 50 mother-child dyads exposed to IPV and a control group of 25 mother-child dyads. All mothers completed questionnaires, including the Revised Conflict Tactics Scale to assess IPV, the Sense of Coherence Scale, and the Self-Esteem Scale, to assess their psychological resources. Mothers were asked to collect 3 saliva samples from themselves and 3 from their children on a single weekday: immediately after waking up, 30 minutes after waking up, and 45 minutes after waking up. The total cortisol secretion over the first hour after awakening was determined by calculating the area under the curve with respect to the ground (AUCg). RESULTS Mothers exposed to IPV exhibited higher total post-awakening cortisol concentrations compared with those in the control group. However, no significant difference was found between exposed and non-exposed children. In addition, higher IPV, specifically injuries, was significantly and positively associated with greater AUCg among mothers exhibiting lower self-esteem. When self-esteem was high, however, no significant effect of IPV on AUCg was observed. CONCLUSIONS Of particular clinical significance is that self-esteem can modulate the stress levels of women exposed to IPV, a valuable insight into the development of effective psychosocial interventions to support IPV victims in sub-Saharan Africa.
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Affiliation(s)
- Dany Laure Wadji
- I-Reach Lab, Unit of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Claudie Gaillard
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health (NIMH), Bethesda, MD, USA
| | | | - Chantal Wicky
- Department of Biology, University of Fribourg, Fribourg, Switzerland
| | - Naser Morina
- Department of Consultant-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chantal Martin-Soelch
- I-Reach Lab, Unit of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
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Ren Z, Guo J, Yang C. Loss of homeland: a qualitative study of the changes in perception of relocated Sichuan earthquake survivors with posttraumatic stress disorder. BMC Psychiatry 2020; 20:392. [PMID: 32736652 PMCID: PMC7393814 DOI: 10.1186/s12888-020-02789-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This research aims to explore the life experiences of relocated earthquake survivors with PTSD and develop a conceptual framework for understanding their life experiences. METHOD Interviews were conducted with twenty-three participants. The participant selection, data collection and analysis were based on grounded theory methodology. A theoretical model called "loss of homeland" was developed. RESULTS Loss of homeland was the most important condition that influenced the relocated participants' self-identity, social connections, and meaning system. These aspects were categorized into existential changes, lost connections, and changes in identity. Post-disaster relocation threatens individuals' sense of meaning, integrity of self, and sense of belonging, affects every aspect of everyday life and shatters their inner and outer harmony. CONCLUSIONS Further research guided by this theoretical model is needed to inform post-disaster mental health services and relocation policy. Mental health professionals and policy makers can make more informed decisions in terms of disaster relocation policy and manage post-disaster psychological disturbances by focusing on both places and people.
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Affiliation(s)
- Zhengjia Ren
- Department of Clinical Psychology, Southwest Hospital, The first Hospital affiliated to Army Medical University (Third Military Medical University), Chongqing, China.
| | - Junwei Guo
- The psychological clinic of Chongqing traditional Chinese Medicine Hospital, Chongqing, China
| | - Chunsong Yang
- grid.13291.380000 0001 0807 1581West China Second Hospital, Sichuan University, Chengdu, China
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Mitonga-Monga J, Mayer CH. Sense of Coherence, Burnout, and Work Engagement: The Moderating Effect of Coping in the Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114127. [PMID: 32531877 PMCID: PMC7312054 DOI: 10.3390/ijerph17114127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
Research on coping, sense of coherence, burnout, and work engagement is well documented in western countries. However, a void of studies exists on how coping mechanisms can moderate the relationship among sense of coherence, burnout, and work engagement in a manufacturing company in the Democratic Republic of Congo (DRC). The objective of this research was to examine the moderating effect of coping (COP) in the relationship between sense of coherence (SOC), burnout (BO), and work engagement (WE). The study employed a quantitative research approach, while participants were recruited through convenience sampling. A total of 197 employees (n = 197; females 40%) who are permanently employed in a manufacturing organisation in the DRC participated in the study voluntarily. The results indicate that coping related positively to a sense of coherence. Moreover, the results indicate that sense of coherence and work engagement related negatively to burnout. Furthermore, the results show that coping acted as a moderator in the relationships between variables. The study adds value to the WE theory by suggesting that an employee who has a high level of COP, high SOC, low level of BO, will positively engage, perform, and be productive.
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Snyder JD, Boan D, Aten JD, Davis EB, Van Grinsven L, Liu T, Worthington EL. Resource Loss and Stress Outcomes in a Setting of Chronic Conflict: The Conservation of Resources Theory in the Eastern Congo. J Trauma Stress 2020; 33:227-237. [PMID: 31553500 DOI: 10.1002/jts.22448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/26/2019] [Accepted: 04/29/2019] [Indexed: 11/11/2022]
Abstract
The purpose of this cross-sectional study was to examine conservation of resources (COR) theory in the context of armed conflict in Africa. Specifically, within the setting of ongoing chronic conflict in the eastern Democratic Republic of the Congo (DRC), we tested the COR theory prediction that resource loss contributes to various stress outcomes. A randomly selected sample of 312 adults (125 men, 187 women) from villages in North Kivu, DRC completed orally administered measures of resource loss, daily stressors, and four stress outcomes: depression symptoms, anxiety symptoms, posttraumatic distress, and general distress. Consistent with COR theory, resource loss predicted all four stress outcomes above and beyond the contribution of demographics, relocation experiences, and daily stressors; however, this effect was small, ΔR2 = .02-.06. The most consistent and strongest predictors of stress outcomes were daily stressors, βs = .42-.62; number of relocation experiences, βs = .33-.43; and psychosocial resource loss (e.g., loss of hope, meaning or purpose in life, intimacy with friends and family, physical health of family), βs = .17-.26. Additionally, male sex predicted depression, anxiety, and trauma symptoms, and lower educational status predicted anxiety symptoms and general distress. Our exploratory mediation analysis showed that daily stressors partially mediated all four pairs of associations between psychosocial resource loss and mental health outcomes. We discuss the findings with consideration of research on disasters generally and armed conflicts specifically. We also discuss implications for humanitarian interventions with conflict-affected populations in Africa and beyond.
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Affiliation(s)
- Jordan D Snyder
- School of Psychology, Counseling, and Family Therapy, Wheaton College, Wheaton, Illinois, USA
| | - David Boan
- World Evangelical Alliance, New York, New York, USA
| | - Jamie D Aten
- Humanitarian Disaster Institute, Wheaton College, Wheaton, Illinois, USA
| | - Edward B Davis
- School of Psychology, Counseling, and Family Therapy, Wheaton College, Wheaton, Illinois, USA
| | - Leif Van Grinsven
- Humanitarian Disaster Institute, Wheaton College, Wheaton, Illinois, USA
| | - Tao Liu
- School of Psychology, Counseling, and Family Therapy, Wheaton College, Wheaton, Illinois, USA
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Construct validity and factor structure of sense of coherence (SoC-13) scale as a measure of resilience in Eritrean refugees living in Ethiopia. Confl Health 2019; 13:3. [PMID: 30774708 PMCID: PMC6366046 DOI: 10.1186/s13031-019-0185-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/13/2019] [Indexed: 11/19/2022] Open
Abstract
Background There is a scarcity of adapted measures to study resilience and mental health of people in humanitarian settings in Africa. The aim of this study was to identify the factor structure and other psychometric properties of the Sense of Coherence (SoC-13) scale in Eritrean refugees living in Ethiopia. Methods In a cross-sectional survey, 562 adults were selected randomly from Eritrean refugees living in Mai Aini camp, Ethiopia. The SoC-13, the Center for Epidemiologic Studies Depression scale (CES-D), the Pre and Post-Migration Living Difficulties checklist, the Primary Care Post-Traumatic Stress Disorder screener (PC-PTSD), the Oslo Social Support Scale (OSS-3), the Coping Style scale and the Fast Alcohol Screening Test (FAST) were administered concurrently. Confirmatory Factor Analysis (CFA) was used to investigate the factor structure of the SoC-13 using IBM SPSS Amos, version 21. Result A one factor model of the SoC with twelve items had the best fit to the current data (CFA = 0.982, RMSEA = 0.035 [90%CI = 0.018, 0.050]), with good internal consistency (Cronbach’s Alpha = 0.75). When all 13 items of the Tigrigna version were considered, there was an inverse association of SoC-13 with PC-PTSD(r = − 0.433, p < 0.001), CES-D (r = − 0.597, p < 0.001), Pre and post-migration living difficulties checklist (r = − 0.265, p < .001and r = − 0.249, p < 0.001 respectively), and FAST (r = − 0.105, p < 0.001), providing support for the divergent validity of the scale. The SoC-13 was associated positively with the Oslo Social Support scale (OSS-3)(r = 0.363 p < 0.001) and task-oriented coping (r = 0.089, p < 0.001), demonstrating convergent validity. The four items, specifically item-1, item-2, item-3 and item-12 have shown relatively weaker item loadings (β<0.40); but item-2 demonstrated non-significant loading (β = 0.06, p>0.05) in a one factor model of SoC-13. Conclusions Although the 13-items of the Tigrigna version of the SoC scale loaded significantly onto their respective factors in the three factor model, only 12 items loaded significantly onto the one factor model, which demonstrated superior fit to the current data. Keeping in mind that future research should examine the conceptualizations of the four items demonstrating poor convergent validity in this Eritrean sample, the reduced Tigrigna version of SoC-12 is a reasonable measure of sense of coherence in this community. Electronic supplementary material The online version of this article (10.1186/s13031-019-0185-1) contains supplementary material, which is available to authorized users.
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Zick CD, Buder I, Waitzman NJ, Simonsen S, Digre K. The nexus between health and time use among racially and ethnically diverse women. ETHNICITY & HEALTH 2019; 24:147-167. [PMID: 28406041 DOI: 10.1080/13557858.2017.1315529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 03/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ethnic and racial health disparities have been well-documented in the scholarly literature. In recent years, evidence about time spent in physical (in)activity and its relationship to physical and mental health has also emerged. This study assesses if observed ethnic/racial health differences were associated with differences in time use. DESIGN Our analyses utilized baseline data from 510 Utah women who enrolled in one of two community-based, participatory research intervention studies between 2012 and 2015. The distinct racial/ethnic groups included African immigrants, African Americans, Latinas, Native Hawaiians/Pacific Islanders, American Indians/Alaskan Natives, and rural White, Non-Latina women. In the baseline survey, respondents reported the typical time they spent in paid employment, television/movie viewing, physical activity, food preparation/clean-up, and sleep. Cluster analysis was used to identify seven distinct patterns of time use within these five activities. We related these time use patterns along with race/ethnicity, socio-demographics, and other potentially contributing health-related factors (e.g. smoking status) to two health outcomes: (1) self-reported health status, and (2) depression. RESULTS Our time use clusters revealed heterogeneity by racial/ethnic groups, suggesting that some of the health effects that may have been previously ascribed to group membership should instead be attributed to (un)healthy patterns of time use. In particular, spending too much time in sedentary activities such as watching television/movies and too little time sleeping both linked to poor physical and mental health, independently of racial/ethnic group membership. CONCLUSIONS Researchers and policy makers designing culturally sensitive physical activity health-related interventions should consider patterns of time use that are associated with poor health. Programs designed to improve sleep time and reduce sedentary television-viewing time may be as important as interventions designed to increase physical activity time. These broader patterns of time use mediated the relationships between race/ethnicity and physical and mental health for the women in our study.
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Affiliation(s)
- Cathleen D Zick
- a Department of Family and Consumer Studies , University of Utah , Salt Lake City , USA
| | - Iris Buder
- b Economics Department , Idaho State University
| | | | - Sara Simonsen
- d College of Nursing , University of Utah , Salt Lake City , USA
| | - Kathleen Digre
- e Department of Neurology , University of Utah , Salt Lake City , USA
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Getnet B, Medhin G, Alem A. Symptoms of post-traumatic stress disorder and depression among Eritrean refugees in Ethiopia: identifying direct, meditating and moderating predictors from path analysis. BMJ Open 2019; 9:e021142. [PMID: 30659034 PMCID: PMC6340455 DOI: 10.1136/bmjopen-2017-021142] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study aimed at testing the significance of mediating and moderating roles of sense of coherence, adaptive coping styles and social support in the relationship between exposure to trauma and psychological symptoms in a refugee population in sub-Saharan Africa. METHODS A cross-sectional survey design was employed to collect data. The study was carried out in Mai Aini refugee camp in Ethiopia. A total of 562 adult Eritrean refugees aged 18-74 years were selected randomly to screen for depression and post-traumatic stress disorder (PTSD) symptoms and to examine associated factors. Data were collected using the premigration and postmigration living difficulties checklist, Center for Epidemiologic Studies Depression (CES-D) scale, Primary Care PTSD Screener, coping style scale, Sense of Coherence scale and Oslo Social Support scale. Path modelling was used to test the mediation and moderation effects of prespecified factors. RESULTS Premigration living difficulties were associated directly with symptoms of PTSD (β=0.09, p<0.05), and associated indirectly with PTSD symptoms in paths through duration of stay in the camp, sense of coherence, postmigration living difficulties, task-oriented coping style and depressive symptoms (β=0.26, p<0.01). Premigration and postmigration living difficulties were associated directly with depressive symptoms with standardised estimate of β=0.35(p<0.001) and β=0.23(p<0.05), respectively. Postmigration living difficulties were associated indirectly with PTSD through paths of sense of coherence, task-oriented coping style and depressive symptoms (β=0.13; p<0.01). Social support moderated the effect of postmigration living difficulties on depressive symptoms (p<0.05). Emotion-oriented coping style moderated the effect of premigration threat for abuse on PTSD (β=-0.18, p<0.001) and depressive (β=-0.12, p<0.01) symptoms, as well as moderating threat to life on PTSD symptoms (β=-0.13, p<0.001). CONCLUSIONS Sense of coherence and task-oriented coping style showed a partial mediating effect on the association between exposure to trauma and symptoms of PTSD. An emotion-oriented coping style and social support moderated the effect of premigration and postmigration living difficulties, respectively. Fostering social support, task-oriented and emotion-oriented coping styles may be beneficial for these refugees.
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Affiliation(s)
- Berhanie Getnet
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychology, University of Gondar, Gondar, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Bressler R, Erford BT, Dean S. A Systematic Review of the Posttraumatic Stress Disorder Checklist (PCL). JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rachel Bressler
- Education Specialties Department; Loyola University Maryland
| | - Bradley T. Erford
- Education Specialties Department; Loyola University Maryland
- Now at Department of Human and Organizational Development; Vanderbilt University
| | - Stephanie Dean
- Education Specialties Department; Loyola University Maryland
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12
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Ullmann E, Licinio J, Barthel A, Petrowski K, Stalder T, Bornstein SR, Kirschbaum C. Persistent LHPA Activation in German Individuals Raised in an Overprotective Parental Behavior. Sci Rep 2017; 7:2778. [PMID: 28584276 PMCID: PMC5459846 DOI: 10.1038/s41598-017-01718-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/04/2017] [Indexed: 11/24/2022] Open
Abstract
Parental upbringing may affect their offspring’s mental state across the entire lifespan. Overprotective parental child-rearing style may increase the disease burden in the offspring. Furthermore, this child-rearing style may also play a pathogenetic role by transmitting trauma- and stressor-related disorders (TSRD) across generations. Studies with animals have demonstrated that the mother’s immediate and expansive protection of the newborn decreases the limbic-hypothalamic-pituitary-adrenal (LHPA) axis activity in the offspring. However, few studies have investigated how stress impact humans raised in an overprotective manner. In a cross-sectional study with 40 healthy students recalling their overprotective upbringing, we show an increase in the dehydroepiandrostendione (DHEA) concentration and a reduction in the cortisol/DHEA-ratio in hair. Additionally, this child rearing style was associated with heightened indications of mental burden, depressiveness, and sense of coherence. Our results provide insight into the roots and consequences of psychological trauma across several generations. Further investigations focusing particularly on multigenerational transmission in extremely burdened families will augment our results.
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Affiliation(s)
- E Ullmann
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany. .,Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Leipzig, Germany.
| | - J Licinio
- Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Department of Psychiatry, Flinders University, School of Medicine, Adelaide, Australia.,South Ural State University, Biomedical School, Chelyabinsk, Russian Federation
| | - A Barthel
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany.,Medicover, Bochum, Germany
| | | | - T Stalder
- Department of Psychology, TU Dresden, Dresden, Germany.,Clinical Psychology, University of Siegen, Siegen, Germany
| | - S R Bornstein
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany.,Faculty of Life Sciences & Medicine, Rayne Institute, Endocrinology and Diabetes, Kings College London, London, UK
| | - C Kirschbaum
- Department of Psychology, TU Dresden, Dresden, Germany
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Circumcision does not alter long-term glucocorticoids accumulation or psychological effects associated with trauma- and stressor-related disorders. Transl Psychiatry 2017; 7:e1063. [PMID: 28291263 PMCID: PMC5416669 DOI: 10.1038/tp.2017.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/09/2017] [Accepted: 01/12/2017] [Indexed: 01/17/2023] Open
Abstract
Male infants and boys through early adolescence can undergo circumcision either for the sake of upholding religious traditions or for medical reasons. According to both, Jewish as well as Islamic tenets, circumcision is a religious rite symbolizing the bond with God. The World Health Organization (WHO), the United Nations Council (UNC) as well as the American Academy of Pediatrics (AAP), and the Centers for Disease Control and Prevention (CDC) strongly recommend circumcision to promote hygiene and prevent disease. This procedure has frequently been criticized by various communities claiming that circumcision in infancy and early adolescence were psychologically traumatizing with medical implications up into old age. Due to the lack of evidence concerning an alleged increase in vulnerability, we measured objective and subjective stress and trauma markers, including glucocorticoids from hair samples, in circumcised and non-circumcised males. We found no differences in long-term limbic-hypothalamic-pituitary-adrenal axis activity, subjective stress perception, anxiety, depressiveness, physical complaints, sense of coherence and resilience. Rather, an increase in the glucocorticoid levels indicated a healthy lifestyle and appropriate functioning. Thus, our findings provide evidence that male circumcision does not promote psychological trauma. Moreover, a qualitative approach, the ambivalence construct, was used for the discussion, aiming at a discourse devoid of biases.
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Betancourt TS, Brennan RT, Vinck P, VanderWeele TJ, Spencer-Walters D, Jeong J, Akinsulure-Smith AM, Pham P. Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Post-conflict Sierra Leone. PLoS Med 2016; 13:e1002073. [PMID: 27505186 PMCID: PMC4978463 DOI: 10.1371/journal.pmed.1002073] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/31/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Little attention has been paid to potential relationships between mental health, trauma, and personal exposures to Ebola virus disease (EVD) and health behaviors in post-conflict West Africa. We tested a conceptual model linking mental health and trauma to EVD risk behaviors and EVD prevention behaviors. METHODS AND FINDINGS Using survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines associations between war exposures, post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, and personal EVD exposure (e.g., having family members or friends diagnosed with EVD) and EVD-related health behaviors among 1,008 adults (98% response rate) from 63 census enumeration areas of the Western Rural and Western Urban districts randomly sampled at the height of the EVD epidemic (January-April 2015). Primary outcomes were EVD risk behaviors (14 items, Cronbach's α = 0.84) and EVD prevention behaviors (16 items, Cronbach's α = 0.88). Main predictors comprised war exposures (8 items, Cronbach's α = 0.85), anxiety (10 items, Cronbach's α = 0.93), depression (15 items, Cronbach's α = 0.91), and PTSD symptoms (16 items, Cronbach's α = 0.93). Data were analyzed using two-level, population-weighted hierarchical linear models with 20 multiply imputed datasets. EVD risk behaviors were associated with intensity of depression symptoms (b = 0.05; 95% CI 0.00, 0.10; p = 0.037), PTSD symptoms (b = 0.10; 95% CI 0.03, 0.17; p = 0.008), having a friend diagnosed with EVD (b = -0.04; 95% CI -0.08, -0.00; p = 0.036), and war exposures (b = -0.09; 95% CI -0.17, -0.02; p = 0.013). EVD prevention behaviors were associated with higher anxiety (b = 0.23; 95% CI 0.06, 0.40; p = 0.008), having a friend diagnosed with EVD (b = 0.15; 95% CI 0.04, 0.27; p = 0.011), and higher levels of war exposure (b = 0.45; 95% CI 0.16, 0.74; p = 0.003), independent of mental health. PTSD symptoms were associated with lower levels of EVD prevention behavior (b = -0.24; 95% CI -0.43, -0.06; p = 0.009). CONCLUSIONS In post-conflict settings, past war trauma and mental health problems are associated with health behaviors related to combatting EVD. The associations between war trauma and both EVD risk behaviors and EVD prevention behaviors may be mediated through two key mental health variables: depression and PTSD symptoms. Considering the role of mental health in the prevention of disease transmission may help fight continuing and future Ebola outbreaks in post-conflict Sierra Leone. This sample is specific to Freetown and the Western Area and may not be representative of all of Sierra Leone. In addition, our main outcomes as well as personal EVD exposure, war exposures, and mental health predictors rely on self-report, and therefore raise the possibility of common methods bias. However, the findings of this study may be relevant for understanding dynamics related to EVD and mental health in other major capital cities in the EVD-affected countries of West Africa.
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Affiliation(s)
- Theresa S. Betancourt
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Robert T. Brennan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Patrick Vinck
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Emergency Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Dayo Spencer-Walters
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Phuong Pham
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Emergency Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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15
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Pilot study of adrenal steroid hormones in hair as an indicator of chronic mental and physical stress. Sci Rep 2016; 6:25842. [PMID: 27174654 PMCID: PMC4865856 DOI: 10.1038/srep25842] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 04/20/2016] [Indexed: 11/14/2022] Open
Abstract
Currently, the quantitative analysis of moderators affecting the function of the hypothalamus-pituitary-adrenal (HPA)-axis in health and sickness is still unreliable. This is, in particular, due to physiological factors such as pulsatile ultradian and circadian glucocorticoid secretion as well as to methodological limitations of the current techniques for steroid hormone determination. Based on this background, the determination of long-term hair steroid concentrations is an important methodological improvement allowing for the quantitative analysis of chronic HPA axis-activation. In order to determine the relationship between chronic mental and physical stress and a chronic activation of the HPA axis, we performed a cross-sectional pilot-study with 40 healthy students and examined the relationships between physical activity, mental burden(s), subjective stress perceptions, depressiveness, anxiety, physical complaints, sense of coherence, resilience, and the long-term integrated steroid hormone levels in hair. The results showed that the concentrations of cortisol, cortisone, and dehydroepiandrosterone in hair were significantly correlated to mental (p = 0.034) and physical stress (p = 0.001) as well as to subjective stress perception (p = 0.006). We conclude that steroid concentrations in hair are decisive predictors for an increase in the long-term-HPA axis activity. Moreover, this biomarker is suitable for capturing the stresslevel after burdening events and physical activity.
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16
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Seguin M, Roberts B. Coping strategies among conflict-affected adults in low- and middle-income countries: A systematic literature review. Glob Public Health 2015; 12:811-829. [PMID: 26609735 DOI: 10.1080/17441692.2015.1107117] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mental health is recognised as a key issue for populations affected by conflict. The aim of this systematic literature review is to examine coping strategies among conflict-affected civilians in low- and middle-income countries. The objectives were to examine (1) the types of coping strategies used by conflict-affected civilians; (2) factors influencing coping strategies; (3) relationships between coping strategies and mental health outcomes. A database search was conducted on May 13, 2014. Qualitative and quantitative studies that report on coping strategies used by adult conflict-affected civilians in LMICs were included, yielding 50 articles. Coping strategies were organised into a typology of problem-solving, support seeking, escape-avoidance, distraction, and positive cognitive restructuring domains. Support-seeking, positive cognitive restructuring, and problem-solving domains were the most frequently reported coping domains across the articles. Significant factors influencing coping included gender and exposure to trauma. The relationship between coping and mental health outcomes was nuanced. The diverse findings reported across the studies reflect the variety of contexts from which the samples are drawn, the range of coping typologies, and differing methodological approaches to exploring coping and mental health. Context-specific studies are needed in order to capture the social and cultural influences on coping and mental health.
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Affiliation(s)
- Maureen Seguin
- a Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | - Bayard Roberts
- a Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , UK
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17
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Goodkind JR, Hess JM, Isakson B, LaNoue M, Githinji A, Roche N, Vadnais K, Parker DP. Reducing refugee mental health disparities: a community-based intervention to address postmigration stressors with African adults. Psychol Serv 2014; 11:333-46. [PMID: 24364594 PMCID: PMC4107192 DOI: 10.1037/a0035081] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Refugees resettled in the United States have disproportionately high rates of psychological distress. Research has demonstrated the roles of postmigration stressors, including lack of meaningful social roles, poverty, unemployment, lack of environmental mastery, discrimination, limited English proficiency, and social isolation. We report a multimethod, within-group longitudinal pilot study involving the adaptation for African refugees of a community-based advocacy and learning intervention to address postmigration stressors. We found the intervention to be feasible, acceptable, and appropriate for African refugees. Growth trajectory analysis revealed significant decreases in participants' psychological distress and increases in quality of life, and also provided preliminary evidence of intervention mechanisms of change through the detection of mediating relationships whereby increased quality of life was mediated by increases in enculturation, English proficiency, and social support. Qualitative data helped to support and explain the quantitative data. Results demonstrate the importance of addressing the sociopolitical context of resettlement to promote the mental health of refugees and suggest a culturally appropriate, and replicable model for doing so.
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Affiliation(s)
| | - Julia M Hess
- Department of Pediatrics, University of New Mexico Health Sciences Center
| | - Brian Isakson
- Department of Psychiatry, University of New Mexico Health Sciences Center
| | - Marianna LaNoue
- Department of Family & Community Medicine, Jefferson Medical College, Thomas Jefferson University
| | - Ann Githinji
- Department of Anthropology, University of Virginia
| | - Natalie Roche
- Department of Pediatrics, University of New Mexico Health Sciences Center
| | | | - Danielle P Parker
- Department of Pediatrics, University of New Mexico Health Sciences Center
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18
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Kuittinen S, Punamäki RL, Mölsä M, Saarni SI, Tiilikainen M, Honkasalo ML. Depressive Symptoms and Their Psychosocial Correlates Among Older Somali Refugees and Native Finns. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2014. [DOI: 10.1177/0022022114543519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we analyzed the manifestation of somatic-affective and cognitive depressive symptoms among older Somali refugees and native Finns. Second, we explored how depressive symptoms, alexithymia, and somatization are associated in the two groups. Finally, we analyzed how two psychosocial factors, sense of coherence (SOC) and social support, are connected to depressive symptoms among Somalis and Finns. The participants were examined with the Beck Depression Inventory (BDI) for depressive symptoms, the Symptom Checklist–90–Revised (SCL-90-R) for somatization, Toronto Alexithymia Scale (TAS-20) for alexithymia, and the Sense of Coherence (SOC-13) concept for SOC. Social support was indicated by help received from social networks and marital status. Results showed that Somalis manifested more somatic-affective symptoms of depression than Finns, whereas Finns manifested more cognitive symptoms than Somalis. The association between depressive symptoms and alexithymia was stronger in the Finnish group, whereas the association between depressive symptoms and somatization was stronger in the Somali group. The association between alexithymia and somatization did not differ between the groups. A weak SOC explained depressive symptoms among Somalis and Finns, but poor social support did not explain depression in either group. The results are discussed in relation to Somali and Finnish cultures, mental health beliefs, and immigrant populations.
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Affiliation(s)
| | | | - Mulki Mölsä
- University of Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Samuli I. Saarni
- University of Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
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19
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Tyer-Viola LA, Corless IB, Webel A, Reid P, Sullivan KM, Nichols P. Predictors of medication adherence among HIV-positive women in North America. J Obstet Gynecol Neonatal Nurs 2014; 43:168-78. [PMID: 24502460 PMCID: PMC4409428 DOI: 10.1111/1552-6909.12288] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To explore the relationships among contextual, environmental, and regulatory factors with antiretroviral (ARV) medication adherence to assist care providers in improving care for women living with HIV. DESIGN Descriptive, multicenter study. SETTING Sixteen HIV clinics and service organizations in North America. PARTICIPANTS This convenience sample was drawn from a larger study of 2,182 persons living with HIV recruited from clinics and service from September 2009 to January 2011. We included 383 women living with HIV who were taking ARV medications. METHODS We assessed the relationship of contextual, environmental, and psychological factors specific to women living with HIV in relation to adherence to ARV medication. Descriptive and multivariate statistics were used to examine the effects of these factors on self-reported ARV drug adherence. RESULTS Age, depression symptoms, stigma, engagement with health care provider, and four psychological factors were correlated with self-reported ARV medication adherence (p = .01). Regression analysis indicated that adherence self-efficacy and depression symptoms accounted for 19% for 3-day and 22% for 30-day self-reported medication adherence. CONCLUSIONS Adherence self-efficacy and depression symptoms predict ARV medication adherence in women and should be evaluated by nurses. Future research is needed to identify antecedents to and interventions that support adherence self-efficacy and decrease depression symptoms.
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20
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Phillips JC, Webel A, Rose CD, Corless IB, Sullivan KM, Voss J, Wantland D, Nokes K, Brion J, Chen WT, Iipinge S, Eller LS, Tyer-Viola L, Rivero-Méndez M, Nicholas PK, Johnson MO, Maryland M, Kemppainen J, Portillo CJ, Chaiphibalsarisdi P, Kirksey KM, Sefcik E, Reid P, Cuca Y, Huang E, Holzemer WL. Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America. BMC Public Health 2013; 13:736. [PMID: 23924399 PMCID: PMC3750916 DOI: 10.1186/1471-2458-13-736] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 08/06/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one's life chances and overcome life's challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH. METHODS We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations. RESULTS Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence. CONCLUSIONS Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society's most vulnerable populations.
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Affiliation(s)
- J Craig Phillips
- Faculty of Health Sciences, University of Ottawa School of Nursing, 451 chemin Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Allison Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44122, USA
| | - Carol Dawson Rose
- Department of Community Health Systems, University of California School of Nursing, San Francisco, CA 94143-0608, USA
| | - Inge B Corless
- MGH Institute of Health Professions, CNY 36 1st Avenue, Boston, MA 02116, USA
| | - Kathleen M Sullivan
- University of Hawaii School of Nursing, McCarthy Mall, Webster 439, Honolulu, HI 96822, USA
| | - Joachim Voss
- University of Washington School of Nursing, Box 357266, Seattle, WA 98103, USA
| | - Dean Wantland
- Office of Research & Evaluation, Rutgers College of Nursing, Ackerson Hall, 180 University Avenue, Room 330, Newark, NJ 07102, USA
| | - Kathleen Nokes
- Hunter College, CUNY, Hunter Bellevue SON, 425 East 25 Street, Box 874, New York, NY 10010, USA
| | - John Brion
- Duke University School of Nursing, 20 West Bridlewood Trail, Durham, NC 27713, USA
| | - Wei-Ti Chen
- Yale University School of Nursing, PO Box 27399, West Haven, CT 06516-7399, USA
| | - Scholastika Iipinge
- University of Namibia Main Campus, Mandume Ndemufayo Avenue, Block F, Room 204, 3rd Level, Windhoek, Namibia
| | | | - Lynda Tyer-Viola
- MGH Institute of Health Professions, 3047 Bonnebridge Way, Houston, TX 77082, USA
| | - Marta Rivero-Méndez
- University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067, Puerto Rico
| | - Patrice K Nicholas
- Global Health and Academic Partnerships, Brigham and Women's Hospital and MGH, Institute of Health Professions, 36 1st Avenue, Boston, MA 02129, USA
| | - Mallory O Johnson
- University of California, 50 Beale Street, Suite 1300, San Francisco, CA 94105, USA
| | - Mary Maryland
- Chicago State University College of Health Sciences, Department of Nursing, 420 S. Home Avenue, Oak Park, IL 60302, USA
| | - Jeanne Kemppainen
- University of North Carolina Wilmington, 601 S. College Road, Wilmington, NC 28403, USA
| | - Carmen J Portillo
- University of California, School of Nurisng, 2 Koret Way, San Francisco, CA 94143, USA
| | | | - Kenn M Kirksey
- Nursing Strategic Initiatives, Lyndon B. Johnson Hospital – Executive Administration, Harris Health System, 5656 Kelley Street, Houston, TX 77026, USA
| | - Elizabeth Sefcik
- Texas A&M University-Corpus Christi, 6300 Ocean Dr. Island Hall, Rm 329, Corpus Christi, TX 78404, USA
| | - Paula Reid
- The University of North Carolina at Wilmington, School of Nursing, 601 College Road, Wilmington, NC 28403-5995, USA
| | - Yvette Cuca
- University of California, School of Nurisng, 2 Koret Way, San Francisco, CA 94143, USA
| | - Emily Huang
- University of California, School of Nurisng, 2 Koret Way, San Francisco, CA 94143, USA
| | - William L Holzemer
- Rutgers College of Nursing, Ackerson Hall, 180 University Avenue, Room 302C, Newark, NJ 07102, USA
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21
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Lim AG, Stock L, Shwe Oo EK, Jutte DP. Trauma and mental health of medics in eastern Myanmar's conflict zones: a cross-sectional and mixed methods investigation. Confl Health 2013; 7:15. [PMID: 23899166 PMCID: PMC3750555 DOI: 10.1186/1752-1505-7-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In conflict and disaster settings, medical personnel are exposed to psychological stressors that threaten their wellbeing and increase their risk of developing burnout, depression, anxiety, and PTSD. As lay medics frequently function as the primary health providers in these situations, their mental health is crucial to the delivery of services to afflicted populations. This study examines a population of community health workers in Karen State, eastern Myanmar to explore the manifestations of health providers' psychological distress in a low-resource conflict environment. METHODS Mental health screening surveys were administered to 74 medics, incorporating the 12-item general health questionnaire (GHQ-12) and the posttraumatic checklist for civilians (PCL-C). Semi-structured qualitative interviews were conducted with 30 medics to investigate local idioms of distress, sources of distress, and the support and management of medics' stressors. RESULTS The GHQ-12 mean was 10.7 (SD 5.0, range 0-23) and PCL-C mean was 36.2 (SD 9.7, range 17-69). There was fair internal consistency for the GHQ-12 and PCL-C (Cronbach's alpha coeffecients 0.74 and 0.80, respectively) and significant correlation between the two scales (Pearson's R-correlation 0.47, P<0.001). Qualitative results revealed abundant evidence of stressors, including perceived inadequacy of skills, transportation barriers, lack of medical resources, isolation from family communities, threats of military violence including landmine injury, and early life trauma resulting from conflict and displacement. Medics also discussed mechanisms to manage stressors, including peer support, group-based and individual forms of coping. CONCLUSIONS The results suggest significant sources and manifestations of mental distress among this under-studied population. The discrepancy between qualitative evidence of abundant stressors and the comparatively low symptom scores may suggest marked mental resilience among subjects. The observed symptom score means in contrast with the qualitative evidence of abundant stressors may suggest the development of marked mental resilience among subjects. Alternatively, the discrepancy may reflect the inadequacy of standard screening tools not validated for this population and potential cultural inappropriateness of established diagnostic frameworks. The importance of peer-group support as a protective factor suggests that interventions might best serve healthworkers in conflict areas by emphasizing community- and team-based strategies.
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Affiliation(s)
- Andrew George Lim
- UC Berkeley-UCSF Joint Medical Program at the University of California, Berkeley School of Public Health, 570 University Hall #1190, Berkeley, CA 94720, USA
- University of California, San Francisco School of Medicine, 500 Parnassus Ave., San Francisco, CA 94143, USA
- Present address: 2550 Ninth St., Suite III, Berkeley, CA 94110, USA
| | - Lawrence Stock
- Global Health Access Program, 22/13 Trok Naikao, Mae Sot, Tak 63110, Thailand
- David Geffen School of Medicine at the University of California, Los Angeles, 924 Westwood Blvd., Suite 300, Los Angeles, CA 90024, USA
| | - Eh Kalu Shwe Oo
- Karen Department of Health and Welfare, 9/164 Soi 3 Mae Sot Villa, Intarakiri Rd., Mae Sot, Tak 63110, Thailand
| | - Douglas P Jutte
- UC Berkeley-UCSF Joint Medical Program at the University of California, Berkeley School of Public Health, 570 University Hall #1190, Berkeley, CA 94720, USA
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22
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Corless IB, Guarino AJ, Nicholas PK, Tyer-Viola L, Kirksey K, Brion J, Dawson Rose C, Eller LS, Rivero-Mendez M, Kemppainen J, Nokes K, Sefcik E, Voss J, Wantland D, Johnson MO, Phillips JC, Webel A, Iipinge S, Portillo C, Chen WT, Maryland M, Hamilton MJ, Reid P, Hickey D, Holzemer WL, Sullivan KM. Mediators of antiretroviral adherence: a multisite international study. AIDS Care 2012; 25:364-77. [PMID: 22774796 PMCID: PMC3491166 DOI: 10.1080/09540121.2012.701723] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.
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Affiliation(s)
- I B Corless
- School of Nursing, MGH Institute of Health Professions, Boston, MA, USA.
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Kaźmierczak IE, Strelau J, Zawadzki B. Search for a curvilinear relationship between the sense of coherence and the intensity of PTSD in MVA survivors. ANXIETY STRESS AND COPING 2011; 25:443-55. [PMID: 21992182 DOI: 10.1080/10615806.2011.618224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The relationship between the sense of coherence (SOC) and the intensity of posttraumatic stress disorder (PTSD) was examined in order to determine its nature and to resolve the inconsistencies between (1) a growing body of empirical research that indicates a linear relationship between these variables, and (2) the schema-based theories of PTSD that suggest a curvilinear relationship between cognitions and the intensity of PTSD. In this cross-sectional study an attempt was also made to identify some psychological factors that moderate this relationship. Participants were a sample of 1132 motor vehicle accident (MVA) survivors. The results showed that gender and temperamental predisposition to PTSD constituted moderator variables of the relationship between SOC and the intensity of PTSD. This supported both the empirical evidence on the linear and negative relationship between SOC and the intensity of PTSD and the theories that postulated the curvilinear relationship.
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