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Mordeno IG, Gallemit IMJS, Dinding DLL. To Leave is to Die a Little: Assessing the Symptom Structure of Separation Anxiety Disorder in Left-Behind Emerging Adults. Psychiatr Q 2023:10.1007/s11126-023-10024-z. [PMID: 37058269 DOI: 10.1007/s11126-023-10024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
The literature on separation anxiety disorder (SAD) presented two contentious issues relating to its assessment. First, studies are scarce in assessing the symptom structure of DSM-5 SAD among the adult population. Second, the accuracy in assessing the severity of SAD through measuring the intensity of disturbance and the frequency of occurrence of symptoms is yet to be studied. To address these limitations, the present study aimed to: (1) examine the latent factor structure of the newly developed separation anxiety disorder symptom severity inventory (SADSSI); (2) evaluate the necessity of using frequency or intensity formats through comparison of differences in the latent level; and (3) investigate SAD latent class analysis. Utilizing 425 left-behind emerging adults (LBA), the findings showed that a general factor with two dimensions (i.e., response formats) measuring frequency and intensity symptom severity separately has excellent fit and good reliability. Finally, the latent class analysis yielded a three-class solution best fitting to the data. Overall, the data provided evidence for the psychometric soundness of SADSSI as an assessment tool for separation anxiety symptoms among LBA.
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Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, Mindanao State University, Iligan Institute of Technology, Iligan City, Philippines.
- Department of Professional Education, College of Education, MSU-Iligan Institute of Technology, Andres Bonifacio Ave, Tibanga, Iligan City, 9200, Philippines.
| | - I Marie Joy S Gallemit
- School of Graduate Studies, College of Education, Mindanao State University, Iligan Institute of Technology, Iligan City, Philippines
| | - Dame Lent L Dinding
- Department of Psychology, Mindanao State University, Marawi City, Philippines
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Ali-Naqvi O, Alburak TA, Selvan K, Abdelmeguid H, Malvankar-Mehta MS. Exploring the Impact of Family Separation on Refugee Mental Health: A Systematic Review and Meta-narrative Analysis. Psychiatr Q 2023; 94:61-77. [PMID: 36690848 DOI: 10.1007/s11126-022-10013-8] [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] [Accepted: 12/26/2022] [Indexed: 01/25/2023]
Abstract
The refugee crisis is spreading rapidly, with the number of global refugees this decade doubling in comparison to the last, leading to further concern regarding asylum policies and their psychological impacts. The aim of this systematic review is to further emphasize the correlation between familial separation and the risk of mental health disorders in refugees. This particular review uses quantitative and qualitative data sourced from a variety of countries to comparatively view the mental health status of approximately 8,737 refugees ages 15 and older. This was done to determine if familial separation could potentially impact their overall quality of life. As a result, separation from one's family was found to be correlated with symptoms of posttraumatic stress disorder, depression, anxiety, adult separation anxiety disorder, intermittent explosive disorder, and more. Studies reported a high variance in the prevalence of mental health disorders when models were adjusted for family separation. Methods to improve asylum procedure and mental health services for refugees is taken into consideration.
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Affiliation(s)
- Ozaay Ali-Naqvi
- Department of Human Health and Nutritional Sciences, The University of Guelph, Guelph, ON, Canada.,RefuHope, London, Canada
| | - Tariq A Alburak
- RefuHope, London, Canada.,Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Kavin Selvan
- RefuHope, London, Canada.,Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hana Abdelmeguid
- RefuHope, London, Canada.,Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Monali S Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada. .,Ivey Eye Institute, St. Joseph's Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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Waiting for family reunification and the risk of mental disorders among refugee fathers: a 24-year longitudinal cohort study from Denmark. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1061-1072. [PMID: 34482426 PMCID: PMC9042990 DOI: 10.1007/s00127-021-02170-1] [Citation(s) in RCA: 10] [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: 01/19/2021] [Accepted: 08/30/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine whether family separation caused by prolonged waiting for family reunification is associated with the risk of mental disorders among refugee fathers. METHOD Based on full-population Danish registry data covering 1995-2015, we mapped arrival patterns among nuclear refugee family members resettled in Denmark (n = 76,776) and established a cohort of refugee fathers (n = 6176) who all arrived alone and later obtained family reunification with their wife and children. The fathers were followed for up to 24 years, from the day their residence permit was issued until their first psychiatric diagnosis, emigration, death, or study end, whichever came first. Using Cox proportional hazard regression, we estimated hazard ratios (HRs) of being diagnosed with a mental disorder (i) for the period while the fathers were still separated from their family and (ii) across varying lengths of family separation. RESULTS The HR of any mental disorder was 2.10 (95% confidence interval (CI): 1.57-2.81) for fathers still separated from their family compared with those who had obtained family reunification. The HR increased with longer family separation. Compared with fathers separated for < 9 months, the HR of any mental disorder was 1.43 (95% CI 1.08-1.89) for 9-11 months' separation, increasing to 2.02 (95% CI 1.52-2.68) for 18-23 months' separation. Results were driven by post-traumatic stress disorder. CONCLUSION Fathers waiting for their wives and children face an increased risk of mental disorders. Countries receiving refugees should be aware that delaying family reunification can lead to adverse mental health effects.
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Hartonen VR, Väisänen P, Karlsson L, Pöllänen S. A stage of limbo: A meta‐synthesis of refugees' liminality. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 2021. [DOI: 10.1111/apps.12349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Ville R. Hartonen
- School of Applied Educational Science and Teacher Education University of Eastern Finland Joensuu Finland
| | - Pertti Väisänen
- School of Applied Educational Science and Teacher Education University of Eastern Finland Joensuu Finland
| | - Liisa Karlsson
- Faculty of Educational Sciences, Department of Education University of Helsinki Helsinki Finland
| | - Sinikka Pöllänen
- School of Applied Educational Science and Teacher Education University of Eastern Finland Joensuu Finland
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Bettinsoli ML, Di Riso D, Napier JL, Moretti L, Bettinsoli P, Delmedico M, Piazzolla A, Moretti B. Mental Health Conditions of Italian Healthcare Professionals during the COVID-19 Disease Outbreak. Appl Psychol Health Well Being 2020. [PMID: 33016564 DOI: 10.1111/aphw.v12.410.1111/aphw.12239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND The COVID-19 pandemic in Italy represents a unique threat in terms of psychological distress. This cross-sectional study aims to investigate the psychological health of Italian healthcare professionals during the COVID-19 outbreak. We assessed participants' current psychological distress and coping strategies in the midst of the COVID outbreak (March-April 2020), and also asked them to retrospectively report how they remember feeling before the COVID-19 outbreak (December 2019). We examined associations between psychological distress and coping strategies with mental health and infection perceptions. METHODS Self-administered questionnaires were distributed online to healthcare professionals (N = 580) residing in different Italian regions from 26 March to 9 April 2020. The questionnaire measured changes in psychological states, coping strategies, and demographic variables testing variations in mental health and infection risk perception among Italian healthcare workers. RESULTS Overall, approximately 33.5 per cent of healthcare professionals in our sample meet the threshold for psychiatric morbidity. Participants perceive their current psychological health to be worse during the COVID-19 emergency outbreak as compared to before the outbreak, and this was especially true among women. CONCLUSIONS Both immediate and long-term monitoring psychological assistance services for healthcare workers should be implemented by national institutions to re-establish the psychological well-being and enhance the self-confidence and resilience of hospital personnel.
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Affiliation(s)
| | | | | | - Lorenzo Moretti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Italy
| | | | | | - Andrea Piazzolla
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Italy
| | - Biagio Moretti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Italy
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Bettinsoli ML, Di Riso D, Napier JL, Moretti L, Bettinsoli P, Delmedico M, Piazzolla A, Moretti B. Mental Health Conditions of Italian Healthcare Professionals during the COVID-19 Disease Outbreak. Appl Psychol Health Well Being 2020; 12:1054-1073. [PMID: 33016564 PMCID: PMC7675316 DOI: 10.1111/aphw.12239] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The COVID‐19 pandemic in Italy represents a unique threat in terms of psychological distress. This cross‐sectional study aims to investigate the psychological health of Italian healthcare professionals during the COVID‐19 outbreak. We assessed participants’ current psychological distress and coping strategies in the midst of the COVID outbreak (March–April 2020), and also asked them to retrospectively report how they remember feeling before the COVID‐19 outbreak (December 2019). We examined associations between psychological distress and coping strategies with mental health and infection perceptions. Methods Self‐administered questionnaires were distributed online to healthcare professionals (N = 580) residing in different Italian regions from 26 March to 9 April 2020. The questionnaire measured changes in psychological states, coping strategies, and demographic variables testing variations in mental health and infection risk perception among Italian healthcare workers. Results Overall, approximately 33.5 per cent of healthcare professionals in our sample meet the threshold for psychiatric morbidity. Participants perceive their current psychological health to be worse during the COVID‐19 emergency outbreak as compared to before the outbreak, and this was especially true among women. Conclusions Both immediate and long‐term monitoring psychological assistance services for healthcare workers should be implemented by national institutions to re‐establish the psychological well‐being and enhance the self‐confidence and resilience of hospital personnel.
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Affiliation(s)
| | | | | | - Lorenzo Moretti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Italy
| | | | | | - Andrea Piazzolla
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Italy
| | - Biagio Moretti
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Italy
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Theoretical background, first stage development and adaptation of a novel Integrative Adapt Therapy (IAT) for refugees. Epidemiol Psychiatr Sci 2019; 29:e47. [PMID: 31441397 PMCID: PMC8061213 DOI: 10.1017/s2045796019000416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIMS Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar. METHODS A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia. RESULTS The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia. CONCLUSIONS IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.
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Miah MA, Mahmuda M, Elshazly M, Khan S, Tay A, Ventevogel P. Contextual adaptation and piloting of Group Integrative Adapt Therapy (IAT-G) amongst Rohingya refugees living in Bangladesh. INTERVENTION-INTERNATIONAL JOURNAL OF MENTAL HEALTH PSYCHOSOCIAL WORK AND COUNSELLING IN AREAS OF ARMED CONFLICT 2019. [DOI: 10.4103/intv.intv_48_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Killikelly C, Bauer S, Maercker A. The Assessment of Grief in Refugees and Post-conflict Survivors: A Narrative Review of Etic and Emic Research. Front Psychol 2018; 9:1957. [PMID: 30405474 PMCID: PMC6204364 DOI: 10.3389/fpsyg.2018.01957] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Prolonged grief disorder (PGD) is a new mental health disorder that will be recognized by the World Health Organization’s disorder classification, the ICD-11, in 2018. Current assessment measures of PGD are largely based on North American and European conceptualizations of grief (etic i.e., from the perspective of the observer). However, research is emerging from communities outside of the Global North, in particular, conflict-exposed communities, exploring local models (emic i.e., from within the cultural group), assessment measures and symptoms of grief. Several reviews have found that refugees have higher rates of mental illness, defined by etic standards as depression, post-traumatic stress disorder (PTSD), anxiety disorders and psychotic symptoms. Yet, presently there are no reviews documenting the assessment of PGD in refugees and post conflict survivors. Method: This narrative review will provide an overview of studies that assess grief in refugees to (1) identify current assessment measures of grief in refugees (i.e., type and frequency of questionnaires used, whether Global North-based, etic, or locally developed, emic, and the level of cultural adaptation) and (2) to document the variety and rate of grief symptoms identified with Global North standard measures and/or local measures (i.e., the endorsement of standard symptom items and the identification of culturally specific symptoms of grief). Results: This review revealed 24 studies that assessed disordered grief in refugee or post conflict samples. Studies were heterogeneous in their assessment methods; the majority (n = 17) used an etic approach, four used a combined etic/emic approach, and three used a predominantly emic approach. The rate of disordered grief was high depending on cultural adaptation approach (31–76%) and when standard etic measures were used the disordered grief rate was 32%. Conclusion: These findings will help to guide future studies to provide accurate assessment of grief in refugee and post conflict populations and has implications for improving cultural knowledge in clinical practice.
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Affiliation(s)
- Clare Killikelly
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Susanna Bauer
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Andreas Maercker
- Division Psychopathology and Clinical Intervention, Department of Psychology, University of Zürich, Zürich, Switzerland
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Morina N, Schnyder U, Schick M, Nickerson A, Bryant RA. Attachment style and interpersonal trauma in refugees. Aust N Z J Psychiatry 2016; 50:1161-1168. [PMID: 26883572 DOI: 10.1177/0004867416631432] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Refugees can suffer many experiences that threaten their trust in others. Although models of refugee mental health have postulated that attachment securities may be damaged by refugee experiences, this has yet to be empirically tested. This study aimed to understand the relationship between the nature of traumatic experiences sustained by refugees and attachment styles. METHOD In a cross-sectional study, treatment-seeking refugees (N = 134) were assessed for traumatic exposure using the Harvard Trauma Questionnaire and Posttraumatic Diagnostic Scale. Attachment style was assessed using the Experiences in Close Relationship Scale. RESULTS Whereas gender and severity of interpersonal traumatic events predicted avoidant attachment style (accounting for 11% of the variance), neither these factors nor non-interpersonal trauma predicted anxious attachment. CONCLUSIONS Exposure to interpersonal traumatic events, including torture, is associated with enduring avoidant attachment tendencies in refugees. This finding accords with attachment theories that prior adverse interpersonal experiences can undermine secure attachment systems, and may promote avoidance of attachment seeking. This finding may point to an important process maintaining poor psychological health in refugees affected by interpersonal trauma.
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Affiliation(s)
- Naser Morina
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Taime T. 'Forgotten': a personal comment and communiqué on West Papuan refugees. Australas Psychiatry 2015; 23:59-60. [PMID: 26634674 DOI: 10.1177/1039856215612979] [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: 11/16/2022]
Abstract
OBJECTIVE To raise awareness of the ongoing human rights violations of the Indigenous residents of West Papua and their mental health consequences. METHOD The author, herself a refugee from West Papua, provides a summary comment from a presentation to the Leadership in Mental Health: Island Nations course, based on personal experience in West Papua and Papua New Guinea, and a telephone survey of West Papuan refugees resident in Australia. RESULT A communiqué in solidarity from all course delegates was produced and is included. CONCLUSION Human rights violations continue in West Papua, and the plight of its indigenous residents and West Papuan refugees in Papua New Guinea and Australia are dire and should not be 'forgotten'.
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Affiliation(s)
- Trix Taime
- Case Worker, St John's Community Care, Innisfail, QLD and; Master of Public Health student, Torrens University, Adelaide, SA, Australia
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