Hierarchical elaboration in the conceptual structures of vietnam combat veterans

Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway

Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.

Schematic integration of traumatic events

Across multiple disciplines of psychology, one commonly used heuristic device, the schema, has often been called upon to illustrate the integration of an event. This paper is a critical examination of the literature on schemas and traumatic events. Three perspectives are identified: process-focused models, content-focused models, and construct-focused models. Process-focused models most clearly elucidate the change mechanisms and provide specific treatment implications in terms of exposure-based interventions. Content-focused models provide clinicians and researchers with hypothesized thematic conflicts that may need to be addressed in treatment. Construct-focused models and methodologies may provide a means by which researchers can represent and quantify the degree of conceptual integration of a traumatic event. The concepts of schema formation, activation, and modification are explored from each perspective. Implications for assessment and clinical interventions are also discussed.