Development of the Arabic versions of the Impact of Events Scale‐Revised and the Posttraumatic Growth Inventory to assess trauma and growth in Middle Eastern refugees in Australia

Influence of post-migration living difficulties on mental health among refugees and asylum seekers: A scoping-review on clinical tools

BACKGROUND

The literature indicates an increasing interest in the mental health of refugees (R) and asylum seekers (AS) - particularly how it could be affected by previous exposure to trauma and violence - but less has been written about the issues they are forced to face during the post-migration period and how these also can affect mental health. Research shows that the mental health of R/AS is highly influenced by their post-migration conditions and may deteriorate due to post-migration social health-related determinants; in addition, a lack of language skills, discrimination, separation from family, poverty, and other stressors can contribute to social isolation. The difficulty in asking for help in case of psychological distress and, consequently, in accessing care, contributes to the worsening of their clinical condition.

AIMS

The primary purpose of this study is to identify and provide a review of the clinical tools used to screen migrants (R/AS) at risk of developing psychological distress, identifying post-migration difficulties.

METHODS

We searched studies in PubMed, Embase, Scopus, Cochrane (Central), and Cinahl (ultimate) with the last search on 14 April 2023, using a combination of keywords and Medical Subject Headings (MeSH).

RESULTS

Our systematic search identified 1,878 records. After removing duplicates, we screened 1,238 records by title and abstract, retaining 97 for full text review. Of these, 68 met full eligibility criteria (1995-2023). A total of 30 social scales have been identified, as well as structured or semi-structured questionnaires and interviews. Translated into multiple languages, the tools can be self-administered or administered by trained professionals. PMLD is known for its effectiveness in evaluating the post-migration period and predicting mental health issues.

CONCLUSIONS

Considering the limited number of studies and, consequently, the limited number of tools found, it can be inferred that not enough attention is given to post-migration in the broader sense.

The impact of an exercise and sport intervention on cognitive function and pain among forcibly displaced individuals at risk for PTSD: a secondary analysis of the SALEEM randomized controlled trial

BACKGROUND

In response to the global scope of forced displacement, international organizations highlight the need of scalable solutions to support individuals' health and integration into host societies. Exposure to high mental and physical stress perceived before, during, and after displacement can impair functional capabilities, essential for adapting to a new environment. This secondary analysis examined the impact of an exercise and sport intervention on cognitive function and pain severity among individuals living in a refugee camp in Greece.

METHODS

We implemented a randomized controlled trial involving n = 142 (52.8% women) forcibly displaced individuals from Southwest Asia and Sub-Saharan Africa. Participants were randomly assigned to a waitlist or a 10-week co-designed exercise and sport intervention with a 1:1 allocation rate between groups and sexes. Assessments at baseline and follow-up included the Flanker task, the Oddball paradigm, pain severity via visual analog scales, and the Åstrand-Rhyming indirect test of maximal oxygen uptake. We analyzed the intervention effects using structural equation modeling.

RESULTS

Our findings did not indicate a direct intervention effect on cognitive function or pain (p ≥ .332). However, the intervention group significantly improved cardiorespiratory fitness, ß = .17, p = .010, which was associated with faster reaction times in cognitive tasks, ß =  - .22, p = .004. Moreover, there was some evidence that adherence might be linked to reduced pain severity, ß =  - .14, p = .065.

CONCLUSIONS

Exercise and sport did not directly impact cognitive function and pain severity among a sociodemographically diverse sample living in a refugee camp, suggesting the need for complementary measures. Nevertheless, our results indicate that improvements in cardiorespiratory fitness benefit aspects of attention.

TRIAL REGISTRATION

The study was approved by the local ethics committee of the University of Thessaly (no. 39) and registered prospectively on February 8, 2021 at the ISRCTN registry (no. 16291983).

Self-Reported Physical Activity and Mental Health Among Asylum Seekers in a Refugee Camp

BACKGROUND

Global forced displacement has been rising steeply since 2015 as a result of wars and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which can cause traumatic experiences and poor mental health. Physical activity has been linked with better mental health, although such evidence is scarce among those populations. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among people residing in a refugee camp in Greece as asylum seekers.

METHODS

Participants were 151 individuals (76 women, 75 men; mean age 28.90 y) displaced from their homes for an average of 32.03 months. Among them, 67% were from Afghanistan and countries from southwest Asia, and 33% from sub-Saharan African countries. Participants completed self-report measures assessing physical activity, fitness, symptoms of post-traumatic stress disorder, depression, anxiety, and well-being.

RESULTS

High prevalence of mental health disorder symptoms and poor well-being were identified, with women and Asians showing poorer mental health. Symptoms of post-traumatic stress disorder, depression, and anxiety were related to perceived fitness, but not to self-reported physical activity. Regression analysis showed that perceived fitness (β: 0.34; 95% CI, 0.43 to 1.52) and low-intensity physical activity (β: 0.24; 95% CI, 0.001 to 0.009) significantly positively predicted well-being, showing small to medium effect.

CONCLUSIONS

The findings provide useful insights regarding the link between physical activity and well-being; nevertheless, further research examining objectively measured physical activity is warranted to complement these data and further explore the associations between physical activity and mental health.

Mental health and conflict: a pilot of an online eye movement desensitisation and reprocessing (EMDR) intervention for forcibly displaced Syrian women

Background

The Syrian conflict has been ongoing since 2011. Practical and scalable solutions are urgently needed to meet an increase in need for specialised psychological support for post-traumatic stress disorder given limited availability of clinicians. Training forcibly displaced Syrians with a mental health background to remotely deliver specialised interventions increases the availability of evidence based psychological support. Little is known about the effectiveness of online therapy for forcibly displaced Syrian women provided by forcibly displaced Syrian women therapists.

Purpose

To pilot an evidence-based trauma therapy, Eye Movement Desensitisation and Reprocessing (EMDR), carried out online by trained forcibly displaced Syrian women therapists for forcibly displaced Syrian women who require treatment for post-traumatic stress disorder (PTSD).

Methods

83 forcibly displaced Syrian women, living in Türkiye or inside Syria, with diagnosable PTSD, were offered up to 12 sessions of online EMDR over a period of 3 months. This was delivered by forcibly displaced Syrian women therapists who were trained in EMDR. Data were gathered, using Arabic versions, on PTSD symptoms using the Impact of Events Scale Revised, depression symptoms using the Patient Health Questionnaire-9 and anxiety symptoms using the Generalised Anxiety Disorder Assessment-7 at baseline, mid-point, and end of therapy.

Results

PTSD scores, depression scores and anxiety scores all significantly reduced over the course of treatment, with lower scores at midpoint than baseline and lower scores at end of treatment than at midpoint. Only one participant (1%) exceeded the cutoff point for PTSD, and 13 (16%) exceeded the cutoff points for anxiety and depression at the end of treatment.

Conclusion

In this pilot study up to 12 sessions of online EMDR were associated with reductions in PTSD, anxiety and depression symptoms in Syrian women affected by the Syrian conflict. The training of forcibly displaced Syrian mental health professionals to deliver online therapy is a relatively low cost, scalable, sustainable solution to ensure that those who are affected by the conflict can access specialised support. Further research is needed using a control group to confirm that the observed effects are due to EMDR treatment, as is research with post-treatment follow-up to ascertain that benefits are maintained.

Prevalence of anxiety, depression, and post-traumatic stress disorder among Omani children and adolescents diagnosed with cancer: a prospective cross-sectional study

BACKGROUND

Children and adolescents diagnosed with cancer often experience psychological distress, encompassing anxiety, depression, and post-traumatic stress disorder (PTSD). This study aimed to evaluate the prevalence of these conditions among Omani children and adolescents diagnosed with cancer, alongside identifying contributing factors.

METHODS

A prospective cross-sectional study was conducted from October 2021 to June 2023 among a cohort of Omani children and adolescents (6-18 years old) diagnosed with cancer at three primary cancer referral centres in Oman. Validated Arabic-language versions of the Screen for Child Anxiety Related Disorders, the Center for Epidemiologic Studies Depression Scale for Children, and the Impact of Event Scale-Revised instruments were used to assess symptoms of anxiety, depression, and PTSD, respectively. An initial assessment (T1) was undertaken within the first 3 months of diagnosis, followed by a second assessment (T2) 3-6 months later.

RESULTS

Of 113 eligible participants, 101 agreed to participate in the study (response rate: 95.6%), with 92 (91.0%) completing both assessments and included in the final analysis. Prevalence rates of anxiety, depression, and PTSD decreased from 43.5%, 56.5%, and 32.6%, respectively, at T1, to 38.0%, 35.9%, and 23.9% at T2. All average scores were below diagnostic cut-off points, except for the depression score at T1. Anxiety and depression scores decreased significantly (p = 0.043 and 0.001, respectively) between T1 and T2, as did the overall prevalence of depression (p = 0.004). At T1, linear regression analysis showed significant correlations between anxiety scores and the child's age and PTSD score (p < 0.05); these variables were also correlated with depression scores (p ≤ 0.001). At T2, significant correlations were observed between anxiety scores and the child's age and PTSD scores (p < 0.001). At both T1 and T2, anxiety, depression, and PTSD scores remained significantly correlated (p < 0.001).

CONCLUSIONS

Omani children and adolescents recently diagnosed with cancer exhibit a high prevalence of anxiety, depression, and PTSD over time. Age-appropriate communication, ongoing support, and mental health services are recommended to help this patient group cope with their diagnosis and manage their emotional wellbeing. There is a need for future research to determine the effectiveness of specific psychological interventions in reducing the frequency of these disorders.

Overcoming the civil wars: the role of attachment styles between the impact of war and psychological symptoms and post-traumatic growth among Libyan citizens

Background: Civil wars in Libya have impacted the mental health of the general population. The ways in which individuals cope with traumatic events are influenced by several psychological variables.Objectives: The present study aimed to investigate how post-traumatic stress symptoms (PTSS) are associated with psychological symptoms and post-traumatic growth (PTG), and to evaluate the role of avoidant and anxious attachment dimensions as mediators in these associations, among Libyan citizens.Method: Three-hundred participants (147 females; age 31.0 ± 8.4 years) completed the Impact of Event Scale - Revised, Experiences in Close Relationships, Patient Health Questionnaire, and Post-traumatic Growth Inventory - Short Form.Results: The structural equation model revealed that insecure attachment dimensions mediated the association between PTSS and psychological symptoms and PTG. PTSS were positively associated with psychological symptoms, PTG, and both insecure attachment dimensions. Insecure attachment dimensions were positively associated with psychological symptoms and negatively with PTG.Conclusion: The present findings contribute to growing empirical research on the roles of insecure attachment dimensions in the association between the impact of war, psychological symptoms, and PTG.

Measures of ability to learn, grow and make decisions among older persons: a systematic review of measurement properties

OBJECTIVE

this study aims to conduct a systematic review on available instruments for measuring older persons' ability to learn, grow and make decisions and to critically review the measurement properties of the identified instruments.

METHODS

we searched six electronic databases, which include PubMed, Embase, PsycINFO, SciELO, ERIC and AgeLine, between January 2000 and April 2022. Reference lists of the included papers were also manually searched. The COSMIN (CONsensus-based Standards for the selection of health Measurement Instruments) guidelines were used to evaluate the measurement properties and the quality of evidence for each instrument.

RESULTS

13 instruments from 29 studies were included for evaluation of their measurement properties. Of the 13 reviewed, 6 were on the ability to learn, 3 were on the ability to grow and 4 were on the ability to make decisions. The review found no single instrument that measured all three constructs in unidimensional or multidimensional scales. Many of the instruments were found to have sufficient overall rating on content validity, structural validity, internal consistency and cross-cultural validity. The quality of evidence was rated as low due to a limited number of related validation studies.

CONCLUSION

a few existing instruments to assess the ability to learn, grow and make decisions of older people can be identified in the literature. Further research is needed in validating them against functional, real-world outcomes.

Psychological well-being, mental distress, metabolic syndrome, and associated factors among people living in a refugee camp in Greece: a cross-sectional study

Background

Forcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO's call for evidence-based public health policies and programs for forcibly displaced people.

Methods

We conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake.

Results

The prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002).

Conclusion

There is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits.

The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87-0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.

Cross-cultural adaptation and psychometric properties of patient-reported outcome measures in Arabic speaking countries: A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly recognized as an indicator of healthcare quality and safety. Over the past decades, there has been a growing interest in using PROMs in Arabic-speaking populations. However, there is a paucity of data regarding the quality of their cross-cultural adaptation (CCA) and measurement properties.

OBJECTIVES

To identify PROMs that have been developed, validated or cross-culturally adapted to Arabic and evaluate methodological qualities of CCA and measurement properties.

METHODS

MEDLINE, EMBASE, CINAHL, PsycINFO, IPA, and ISI Web of Science were searched using search terms 'PROMs', 'Arabic countries', 'CCA', and 'psychometric properties'. Measurement properties were evaluated using COSMIN quality criteria and CCA quality was assessed using the Oliveria rating method.

RESULTS

This review included 260 studies with 317 PROMs, focusing on psychometric testing (83.8%), CCA (75.8%), utilizing PROMs as outcome measures (13.4%), and developing PROMs (2.3%). Out of the 201 cross-culturally adapted PROMs, forward translation was the most frequently reported component of CCA (n = 178), followed by back translation (n = 174). Out of the 235 PROMs that reported measurement properties, internal consistency was the most frequently reported measurement property (n = 214), followed by reliability (n = 160) and hypotheses testing (n = 143). Other measurement properties were less reported, including responsiveness (n = 36), criterion validity (n = 22), measurement error (n = 12), and cross-cultural validity (n = 10). The strongest measurement property was hypotheses testing (n = 143), followed by reliability (n = 132).

CONCLUSION

There are several caveats regarding the quality of CCA and measurement properties of PROMs included in this review. Only 1 out of 317 Arabic PROMs met CCA and psychometric optimal quality criteria. Therefore, there is a need to improve the methodological quality of CCA and measurement properties of PROMs. This review provides valuable information for researchers and clinicians when choosing PROMs for practice and research. There were only 5 treatment-specific PROMs, indicating the necessity for more research focusing on development and CCA of such measures.

"Psychometric properties of the Arabic version of the post-traumatic growth inventory with university students in Jordan

Post-traumatic Growth plays a key role to cope with traumatic incidents. The scale for Post-Traumatic Growth Inventory (PTGI) has been used by several researchers in different languages. This study aims to evaluate the Arabic-translated version of the PTGI scale by focusing on its validity in different languages and contexts. This study introduces an Arabic version of the PTGI-M normed with 417 undergraduate students at a large university in Jordan. The internal consistency (Cronbach's alpha) and test-retest reliability of the instrument were 0.97 and 0.82, respectively. Bivariate correlation was used to approximate the concurrent validity (CV). Significant correlations were found between the PTGI-M and the beck depression inventory (BDI), perceived stress scale (PSS), Taylor's manifest anxiety (TMAS), satisfaction with life (SWL), and the Rosenberg self-esteem scale (RSES). Confirmatory factor analysis (CFA) to assess the convergent and discriminant validity of the translated scale. Convergent and discriminant validity was established for the Arabic version of the PTGI-M by conducting a confirmatory factor analysis (CFA). In conclusion, this study proposes that future investigations should consider analysing the total PTGI-M subtotal scores to comprehend the complexity of the post-traumatic growth experience.

Reliability and factor analysis of Hindi version of IES-R scale: Effect of Rajyoga meditation on perceiving the impact of COVID-19

The purpose of this study is to present the Hindi translation and validation of the Impact of Event Scale-Revised and to evaluate psychometric qualities of this scale in a sample of regular Rajyoga meditators to examine the psychological impact of Coronavirus on them. The convenience sampling method was used to collect the data from 801 Rajyoga meditators through online survey. Data were analysed using SPSS 26.0. The Hindi version of IES-R demonstrated good internal consistency with the value of alpha coefficient being 0.91 for the scale and ranging between 0.81 to 0.83 for the subscales. The correlations between the subscales varied between 0.55 and 0.66. Principal components analysis using Varimax rotation was run with three-factor solution based on eigen value greater than one. This solution explained 54 percent of the total variance. It generated mainly two factors, an intrusion hyperarousal factor and an avoidance factor and third factor with one item only. Only 4.7 percent of the meditators rated the outbreak's psychological impact as moderate or severe. The mean score of IES-R was 10.01 (with an S.D. of 11.107). Significant positive correlations were found among IES-R scores and the presence of COVID symptoms. Thus, in clinical and research contexts, the scale appears to be a valid measure of post-trauma occurrences. The present study was conducted to generate a validated Hindi version of the IES-R that is easier and more compatible for use in the Indian population.

Social Support Is Linked to Post-Traumatic Growth among Tunisian Postoperative Breast Cancer Women

The struggle with breast cancer (BC) is often associated with positive changes after diagnosis and treatment, that are being referred to as posttraumatic growth (PTG). We aimed to examine PTG and its relationship with psychosocial (i.e., psychological distress, spiritual well-being, social support), sociodemographic and cancer-related variables in Tunisian women operated on for breast cancer. This was a cross-sectional study. Seventy-nine (79) postoperative BC women were administered the Post-Traumatic Growth Inventory, the Spiritual Well-being Scale, the Depression, Anxiety and Stress Scales, and the Multidimensional Scale of Perceived Social Support. The changes most frequently reported by participants were discovering that they were stronger than they thought they were (70.0%), having stronger religious faith (65.0%), and being better able to accept the way things work out (63.8%). Multivariate analysis showed that anxiety and social support remained significantly associated with PTG, while no significant relationship has been found for spiritual well-being. Overall, the present study adds to the existing body of research by identifying factors related to women’ s experience of PTG in a previously unexplored Arab Muslim cultural context, Tunisia. We believe that our findings may help inform strategies aiming at promoting positive psychological changes after experiencing BC, at least in our context.

Effect of a self-help group intervention using Teaching Recovery Techniques to improve mental health among Syrian refugees in Norway: a randomized controlled trial

Background

Mental health symptoms among refugees are common, often related to chronic pain disorders, and their management is usually challenging. Studies evaluating the effect of group therapies among adult refugees to improve mental health symptoms are scarce.

Aims

To assess the effect of Teaching Recovery Techniques (TRT) on mental health and to reduce pain disorder among adult Syrian refugees.

Method

A randomized controlled trial was designed to study the effect of a self-help group intervention using TRT. The outcomes, mental health symptoms measured by Impact of Event Scale-Revised (IES-R) and General Health Questionnaire (GHQ-12) and chronic pain measured by Brief Pain Inventory (BPI), were reported as regression coefficients (B) with 95% confidence intervals.

Results

Seventy-six adults participated: 38 in the intervention and 38 in the control groups. Intention-to-treat analyses showed a significant effect on general mental health as measured by GHQ-12 with B (95% CI) of -3.8 (-7.2, -0.4). There was no effect of TRT on mental health when assessed by IES-R (-1.3 (-8.7, 6.2)) or on pain levels assessed by BPI (-0.04 (-4.0, 3.9)).

Conclusions

This self-help group intervention significantly improved general mental health symptoms among adult refugees but had no effect on trauma symptoms or chronic pain. Higher participation rates might be necessary to achieve the full potential of TRT.

Trial registration: The trial was registered with Clinical Trials.gov at https://clinicaltrials.gov/ct2/show/NCT03951909. To include user participation in the design of the interventions, the study was retrospectively registered on 19 February 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13033-022-00557-4.

Psychological effects of, and compliance with, self-isolation among COVID-19 patients in South Batinah Governorate, Oman: a cross-sectional study

Background

Covid-19 pandemic has left deep psychological impacts, especially among infected patients. It is extremely important to understand the extent of those effects, while improving the compliance with isolation measures at the same time.

Objectives

To detect prevalence of stress using two psychological scales and examine the stress associated factors, also to identify self-isolation compliance rates among COVID-19 patients.

Methods

Cross-sectional research was conducted from 15 November to 22 December 2020, involving 379 patient participants selected via systematic random sampling. Kessler 10 Psychological Distress (K10) and the impact of event scale-revised (IES-R) tests were used to ascertain the levels of distress.

Results

K10 measure revealed elevated stress amongst 121 (31.9%) of participants, whereas IES_R indicated the level was 37.7%. Using the K10 indicated the multivariate analysis was significant for females (OR = 2.482, 95% CI: 1.532–4.021), patients with financial problems (OR = 2.332, 95% CI: 1.270–4.282) and patients experiencing shortages of essentials (OR = 4.920, 95% CI: 2.524–9.590). The IES-R scale indicated that only female and patients experiencing shortages scored significantly in multivariate analysis, (OR = 1.895, 95% CI: 1.1223–2.935) and (OR = 2.928, 95% CI: 1.1580–5.424), respectively. Those undergoing shorter isolation periods reported lower levels of stress on both K10, p=0.016 and IES-R, p=0.002. Approximately 90% of patients used their own towels during isolation. Moreover, 80.2% slept in separate rooms and 74% used masks in the presence of other family members. Essential supply shortages were reported by 14.2% of respondents.

Conclusions

Self-compliance rates were not optimal, while psychological distress was more prevalent among some groups. Intervention is imperative to minimize stress and improve self-isolation compliance.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

COVID-19-Related Psychological Trauma and Psychological Distress Among Community-Dwelling Psychiatric Patients: People Struck by Depression and Sleep Disorders Endure the Greatest Burden

COVID-19 has created a general state of worry and distress, especially among vulnerable groups such as those with psychiatric diagnoses. Worldwide, psychiatric care provision has drastically suffered during the pandemic, with many patients unable to access proper care, which may have implications for increased mental health consequences in patients with psychiatric disorders (e.g., relapse and suicide). This cross-sectional study used structural equation modeling to investigate COVID-19-related trauma and distress among Arab psychiatric population during COVID-19 quarantine. Patients with pre-existing psychiatric disorders (N = 168) completed an online survey that comprised the Depression Anxiety Stress Scale 21 (DASS-21), the Impact of Event Scale-Revised (IES-R), and a questionnaire on COVID-19-related attitudes/perceptions, sources of information, used protective measures, and socio-demographic information. Respondents commonly reported feeling down-hearted/blue, trouble concentrating, along with symptoms of avoidance and rumination related to the pandemic. Patients with depression and sleep disorders expressed higher COVID-19-related trauma than patients with other disorders. Perceived physical health mediated the effect of co-morbid chronic physical disorders on COVID-19 trauma, psychological distress, perceived vulnerability to COVID-19, and perceived likelihood of recovery in case of contracting COVID-19. Perceived physical health and perceived vulnerability to COVID-19 were strong direct predictors of COVID-19-related trauma and psychological distress. Staying at home negatively predicted COVID-19 trauma and exerted an indirect negative effect on psychological distress via COVID-19 trauma. COVID-19 trauma, age, and marital status directly predicted psychological distress, with COVID-19 trauma being the strongest predictor. Educational level, income, having family members working in the medical field, keeping up to date with the news on deaths/infected cases or the development of COVID-19 drugs or vaccines, satisfaction with available information on COVID-19, and using different protective measures were not associated with significant differences in COVID-19 trauma and psychological distress scores. Immuno-psychiatric interventions should be designed to target COVID-19-trauma and distress among younger single patients with perceived poor physical health, especially those diagnosed with depression and sleep disorders.

Working memory and emotional interpretation bias in a sample of Syrian refugee adolescents

The number of adolescent refugees around the world has been continuously increasing over the past few years trying to escape war and terror, among other things. Such experience not only increases the risk for mental health problems including anxiety, depression, and post-traumatic stress disorder (PTSD), but also may have implications for socio-cognitive development. This study tested cognitive-affective processing in refugee adolescents who had escaped armed conflict in Syria and now resided in Istanbul, Turkey. Adolescents were split into a high trauma (n = 31, 12 girls, mean age = 11.70 years, SD = 1.15 years) and low trauma (n = 27, 14 girls, mean age = 11.07 years, SD = 1.39 years) symptom group using median split, and performed a working memory task with emotional distraction to assess cognitive control and a surprise faces task to assess emotional interpretation bias. The results indicated that high (vs. low) trauma symptom youth were ~ 20% worse correctly remembering the spatial location of a cue, although both groups performed at very low levels. However, this finding was not modulated by emotion. In addition, although all youths also had a ~ 20% bias toward interpreting ambiguous (surprise) faces as more negative, the high (vs. low) symptom youth were faster when allocating such a face to the positive (vs. negative) emotion category. The findings suggest the impact of war-related trauma on cognitive-affective processes essential to healthy development.

START adolescents: study protocol of a randomised controlled trial to investigate the efficacy of a low-threshold group treatment programme in traumatised adolescent refugees

Introduction

No evaluated therapeutic approaches, that can efficiently be established in routine mental healthcare, are currently available for traumatised adolescent refugees in Germany. This study evaluates the efficacy of the Stress-Traumasymptoms-Arousal-Regulation-Treatment (START) programme to reduce trauma-related symptoms and psychological distress in traumatised adolescent refugees based in Germany.

Methods and analysis

This randomised, waiting-list-controlled, multicentre trial with a 12-week follow-up will include 174 refugee minors with partial or full post-traumatic stress disorder who are fluent in either Arabic, Dari, English, German or Somali. Eligible refugee minors will be randomised to the START or waiting-list control groups. The manualised 8-week START programme is based on techniques of dialectical behaviour therapy (DBT), fosters adaptive coping with emotional distress and traumatic symptoms and comprises eight therapy modules and a booster session. Study assessments are planned at baseline, post-treatment (ie, after programme participation or waiting time), booster session at week 12 or 12-week waiting time, and at the 12-week follow-up. Primary and coprimary outcomes are changes in psychological distress and traumatic symptoms at post-treatment and will be analysed as response variables in linear mixed regression models. Secondary outcomes are changes in further trauma-related and other psychopathological symptoms, emotion regulation and intermediate effects of the programme at follow-up. We will also assess effects of the programme with ecological momentary assessments and on neuroendocrine stress parameters using hair cortisol.

Ethics and dissemination

This study has been approved by the lead ethics committee of Rhineland-Palatinate and the ethics committees of participating sites. The study results will be disseminated through peer-reviewed publications and scientific conferences.

Trial registration number

DRKS00020771.

Effects of an exercise and sport intervention among refugees living in a Greek refugee camp on mental health, physical fitness and cardiovascular risk markers: study protocol for the SALEEM pragmatic randomized controlled trial

BACKGROUND

Due to ongoing political and social conflicts, the number of international refugees has been increasing. Refugees are exposed to severe mental and physical strain, as well as traumatic experiences during their flight. Therefore, the risk of psychiatric disorders is markedly increased among international refugees. International organizations have criticized the lack of early interventions as a key problem, because untreated mental disorders are often difficult to cure at a later stage. Today, exercise and sport have been successfully employed to treat a wide range of psychiatric disorders. With patients with post-traumatic stress disorders (PTSD), very limited empirical evidence exists, and studies carried out with international refugees are nearly non-existent.

METHODS

We intend to implement a pragmatic randomized controlled trial (RCT) with an exercise and sport intervention group (n = 68, 50% women) and a wait-list control group (n = 68, 50% women) in the Koutsochero refugee camp, located close to the city of Larissa (Greece). During the RCT, exercise and sport will be offered five times per week (60 min/session) for 10 weeks. Participants will be asked to participate in at least two sessions per week. The programme is developed according to the participants' needs and preferences and they will be able to choose between a range of activities. PTSD symptoms will serve as primary outcome, and several secondary outcomes will be assessed. Qualitative data collection methods will be used to gain a more in-depth appraisal of the participants' perception of the intervention programme. In the second year of study, the programme will be opened to all camp residents. A strategy will be developed how the programme can be continued after the end of the funding period, and how the programme can be scaled up beyond the borders of the Koutsochero camp.

DISCUSSION

By moving towards the primary prevention of chronic physical conditions and psychiatric disorders, a relevant contribution can be done to enhance the quality and quantity of life of refugee camp residents in Greece. Our findings may also strengthen the evidence for exercise as medicine as a holistic care option in refugee camps, by helping camp residents to adopt and maintain a physically active lifestyle.

TRIAL REGISTRATION

The study was registered prospectively on the 8 February 2021 with ISRCTN https://www.isrctn.com/ISRCTN16291983.

Psychometric Properties of the Syrian Arabic Version of the Impact of Event Scale-Revised in the Context of the Syrian Refugee Crisis

The Impact of Event Scale-Revised (IES-R) is a widely used self-report questionnaire used to assess symptoms of posttraumatic stress disorder (PTSD). Although the IES-R has been translated and validated in multiple languages, no previous version has employed the Arabic dialect commonly spoken in Syria. The present work aimed to assess the psychometric properties of a Syrian Arabic version of the IES-R. Syrian citizens (N = 288) living in refugee camps in Turkey were administered the Syrian Arabic IES-R as part of a humanitarian aid project focused on providing psychological assistance. The data were analyzed with respect to 10 previously published factor solutions. We found that the best-fitting model was a four-factor structure that included factors involving Avoidance-Numbing, Intrusion, Hyperarousal, and Sleep Disturbance. The model showed strong measurement invariance between male and female subsamples, allowing for meaningful comparisons of the factor means. Overall, the present findings support the validity of a new version of the IES-R, which can be used by both researchers and clinicians responding to the urgent need for psychological care for Syrian refugees fleeing war-related violence.

Post-traumatic stress symptoms among an Egyptian sample of post-remission COVID-19 survivors: prevalence and sociodemographic and clinical correlates

Background

Given its global spread, the COVID-19 virus infection itself may be experienced as a traumatic and stressful event among survivors. The post-traumatic stress symptoms (PTSS) among those surviving the disease were under evaluated. This study aimed to identify and compare PTSS and associated correlates among COVID-19 survivors and control subjects. A cross-sectional design with a convenience sampling included a total of 85 adults who survived COVID-19 virus infection and 85 control subjects (matched for age, sex, education, and socioeconomic level) who were recruited from Zagazig University Hospitals, Sharkia Province, Egypt. The participants were interviewed using a semistructured demographic and clinical checklist, Structured Clinical Interview for DSM-5 Axis I Disorders (SCID-5), the Impact of Event Scale-Revised (IES-R), and the Hospital Anxiety Depression Scale (HADS).

Results

Approximately, 72% of COVID-19 survivors experienced moderate-to-severe PTSS (compared to 53% of control subjects). Individuals who survived the COVID-19 virus infection were more likely to have intensified hyperarousal symptoms (OR: 2.7, 95% CI: 1.7–4.4), with higher total IES-R scoring (OR: 1.03, 95% CI: 1.01–1.05). Among COVID-19 survivors, those who reported moderate-to-severe PTSS were likely to experience severe COVID-19 symptoms during their illness (OR: 4.1, 95% CI: 1.4–11.9).

Conclusions

PTSS was prevalent among COVID-19 survivors in Egypt. The hyperarousal symptoms were the most experienced ones. The symptom severity of COVID-19 virus infection predicted PTSS in COVID-19 survivors.

Level of asthma control and mental health of asthma patients during lockdown for COVID-19: a cross-sectional survey

Background

Lockdown has been enforced globally to curb the spread of SARS-CoV-2. Patients with uncontrolled asthma are at risk of severe illness from COVID-19, highlighting the priority of adequate asthma control during the pandemic. Staying indoors exposes asthmatics to indoor asthma triggers, including disinfectants used for limiting the virus spread, in addition to psychological stresses of the pandemic which represent crucial contributors to loss of asthma control. Elective medical care, curtailed by the lockdown procedures, compromises adequate asthma follow up. The current study evaluated the effect of COVID-19 lockdown on the level of asthma control and mental health of bronchial asthma patients. The study included 264 bronchial asthma patients, aged 12 years and older, who responded to an online questionnaire including the asthma control test to evaluate asthma control in the preceding 4 weeks. Anxiety and depression scores and the impact of event scale were also provided.

Results

Seventy percent of asthmatics had uncontrolled asthma, and disinfectant use was associated with perceived increase in asthma symptoms in 77.7%. Anxiety and depression were associated with uncontrolled asthma in 50% of participants, suggesting a possible psychological impact on asthma patients.

Conclusions

During lockdown, asthma patients participating in the study had significantly uncontrolled disease and associated anxiety and depression. Since regular follow-up of asthma patients is cornerstone to adequate asthma control, alternative methods of medical care for asthma patients during lockdown are warranted, and particular need for mental health support ought to be provided as a continuum to adequate asthma control.

Impact of COVID-19 Pandemic and Lockdown Measures on the Mental Health of the General Population in the Gulf Cooperation Council States: A Cross-Sectional Study

Background: In the Gulf Cooperation Council (GCC) countries (Kuwait, Qatar, Saudi Arabia, Bahrain, United Arab Emirates, and Oman), as in the rest of the world, the COVID-19 has been spreading since 2019, and it had a significant impact on various aspects of life. The outbreak and the restrictive measures imposed by countries to stop the spread of the virus could harm the mental health condition of the general population. This cross-sectional study aims to assess the impact of the pandemic on mental health and investigate the potential risk factors. Methods: An online survey was collected from individuals in GCC countries from May to October 2020. The final sample included 14,171 participants, 67.3% females and 60.4% younger than 35 years old. The survey consisted of depression, Anxiety, Insomnia, and post-traumatic stress questionnaires. Crude and adjusted Odds ratios are calculated using simple and multivariable logistic regressions to investigate the association between risk factors and mental health issues. Results: Endorsement rates for depression were 11,352 (80.1%), 9,544 (67.3%) for anxiety, 8,845 (63.9%) for insomnia and 9,046 (65.2%) for post-traumatic stress. Being female and younger age were associated with a higher likelihood of developing depression, anxiety, insomnia, and post-traumatic stress. In addition, participants with underlying psychological problems were three times more likely to develop depressive and post-traumatic stress symptoms. Conclusion: According to the findings, women, youth, singles, divorced individuals, and individuals with pre-existing psychological and medical conditions are subject to a higher risk of mental health problems during the pandemic, which policy-makers should consider when imposing restrictive measures.

Psychological Distress in Quarantine Designated Facility During COVID-19 Pandemic in Saudi Arabia

BACKGROUND

Quarantine is a useful measure for preventing and controlling pandemics; however, it might be stressful for quarantined individuals. Fear and anxiety about a disease can be overwhelming. These emotions were reported for individuals in involuntary quarantine facilities dedicated to quarantine purposes.

METHODS

This cross-sectional study surveyed the individuals in involuntary quarantine institutions (for a planned period of 14 days of quarantine) in two regions of Saudi Arabia. The mental health status of individuals was assessed using the Revised Impact of Event Scale (IES-R) and Depression, Anxiety, and Stress Scale (DASS-21).

RESULTS

The study surveyed 214 quarantined/isolated individuals. The stress, anxiety, and depression rates were 25.7%, 21.5%, and 32.7%, respectively. On the IES-R, 28.0% of the participants met the criteria for psychological distress. Female gender, self-reported history of psychiatric disorder, and average health status were significantly associated with negative psychological impact and depression, anxiety, and stress symptoms (p<0.05). Watching television was found to be a factor in reducing rates on the IES-R and DASS-21 scale while working out lowered rates on the IES-R alone (p<0.05).

CONCLUSION

During an institutional involuntary quarantine, additional attention should be paid to vulnerable groups like females and individuals with a history of psychiatric illness. More than one-fourth of our sample experienced a negative psychological impact; therefore, coping practices like working out should be encouraged. This study contributes to the ongoing discussion about the psychological aspects of being quarantined. Much work remains to be done to identify strategies that prevent and mitigate psychological distress throughout the quarantine experience and to determine whether these impacts will last for an extended period of time.

The Effect of Physiotherapy Group Intervention in Reducing Pain Disorders and Mental Health Symptoms among Syrian Refugees: A Randomized Controlled Trial

Chronic pain is common among refugees, and often related to mental health problems. Its management, however, is often challenging. A randomized waitlist-controlled trial was designed to study the effect of group physiotherapy activity and awareness intervention (PAAI) on reducing pain disorders, and secondarily improving mental health, among Syrian refugees. A total of 101 adult Syrian refugees suffering from chronic pain were randomized to either the intervention group or the control group, which thereafter also received PAAI after a waiting period. Pain intensity measured by the Brief Pain Inventory (BPI) was the primary outcome. Scores from the Impact of Events Scale-Revised (IES-R 22) and the General Health Questionnaire (GHQ-12) were secondary outcomes. Intention-to-treat analyses (ITT) showed no effect of the intervention on either pain levels (regression coefficient [B {95% CI} of 0.03 {-0.91, 0.96}], IESR scores [4.8 {-3.7, 13.4}] or GHQ-12 scores [-0.4 {-3.1, 2.3}]). Yet, participants highly appreciated the intervention. Despite the negative findings, our study contributes to the evidence base necessary to plan targeted and effective health care services for refugees suffering from chronic pain and highlights the challenge of evaluating complex interventions adapted to a specific group.

The psychological impact of COVID-19 pandemic on the general population of Saudi Arabia

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging infection causing a widely spread pandemic of Coronavirus disease 2019 (COVID-19). The current COVID-2019 pandemic is prompting fear of falling sick, dying, helplessness and stigma, urgent and timely understanding of mental health status is needed to help the community. Our investigation designed to survey the general population in Saudi Arabia to assess the degree of psychological impact during the pandemic.

METHODS

During the early stage of the outbreak, we conducted an online-based survey using a snowballing sample technique. The surveys collected data about several aspects of participant sociodemographic, knowledge, concerns, psychological impact, and mental health status. We assessed the psychological impact and mental health status using the Impact of Event Scale-Revised (IES-R), and the Depression, Anxiety, and Stress Scale (DASS-21).

RESULTS

Our survey recruited 1160 respondents of the general public of Saudi Arabia. Of them, 23.6% reported moderate or severe psychological impact of the outbreak, 28.3%,24%, and 22.3% reported moderate to severe depressive, anxiety, and stress symptoms, respectively. Females reported IES-R (B: 5.46, 95% CI: 3.61 to 7.31) and DASS subscales B coefficient ranged from 1.65 to 2.63, along with high-school students, working in the medical field, and poor self-reported health status was significantly associated with a high level of IES-R and DASS scales (p < .05). Experiencing breathing difficulty and dizziness showed a stronger association with higher IES-R and DASS subscales than other somatic symptoms (e.g., headache and fever);(p < .001). Respondents who practiced specific preventative measures (e.g., hand washing, social distancing) demonstrated a protective effect against stress, anxiety, and depression symptoms. Social distancing appeared to be protective on stress and anxiety subscales (B: -1.49, 95% CI: -2.79 to -0.19),(B: -1.53, 95% CI: -2.50 to -0.57),respectively; and hand hygiene on depression subscale (B: -2.43, 95% CI: -4.44 to -0.42).

CONCLUSION

Throughout the early stage of the COVID-19 outbreak in Saudi Arabia, the results showed that nearly one-fourth of the sampled general population experienced moderate to severe psychological impact. Following specific precautionary measures appeared to have a protective effect on the individual's mental health. Our findings can be used to construct psychological interventions directed toward vulnerable populations and to implement public mental health strategies in the early stages of the outbreak.

Distorted Time Perspective in Adolescent Afghan and Syrian Refugees Is Associated With Psychological Distress

Young refugees are a high-risk group for mental disorders, particularly for posttraumatic stress disorder (PTSD). Individuals with PTSD suffer from an altered time perspective with a focus on negative experiences in the past and a disregard for positive life events and the future. This study investigates time perspectives and psychological distress in 30 adolescent refugees from Syria and Afghanistan in Germany. Time perspective was assessed using the Zimbardo Time Perspective Inventory. The refugees exhibited a distorted time perspective that is common for individuals with PTSD: a high orientation toward the negative past and a low orientation toward the positive past and future. A high orientation toward the negative past was associated with high levels of general psychological distress, PTSD symptoms, and depression. A low orientation toward the future was related to high levels of anxiety. Taking time perspective and corresponding beliefs into consideration may be advantageous when treating refugees with trauma-related disorders.

Évaluation des symptômes de stress post-traumatique chez les femmes atteintes d’un cancer du sein nouvellement diagnostiqué

Introduction : Le diagnostic du cancer du sein est un événement potentiellement mortel associé à une détresse importante. La présente étude visait à évaluer la prévalence et la sévérité des symptômes de stress post-traumatique ; et à analyser l’association entre les symptômes de stress posttraumatique et la dépression, les données relatives à la maladie cancéreuse et les données sociodémographiques chez ces femmes.

Méthodes : Soixante et une femmes atteintes d’un cancer du sein nouvellement diagnostiqué ont rempli deux questionnaires : l’Impact of Event Scale révisé (IES-R) et la souséchelle DASS–Dépression des échelles de dépression, de stress et d’anxiété (DASS-21). Les femmes ont été interrogées quatre semaines après l’annonce du diagnostic. Les patientes étaient âgées de 18 à 65 ans et avaient un cancer du sein histologiquement confirmé et sans antécédents d’autres cancers.

Résultats : L’âge moyen des patientes incluses dans cette étude était de 46,5 ans. La majorité d’entre elles vivaient en milieux urbains (82 %) et avaient un niveau socioéconomique moyen (83,6 %). Trente-six pour cent des patientes atteintes d’un cancer du sein ont été diagnostiquées à un stade avancé (III et IV) et ont reçu un traitement chirurgical dans 73,8 % des cas. 57,4 % des patientes atteintes d’un cancer du sein nouvellement diagnostiqué présentaient des symptômes de stress post-traumatique supérieurs au seuil (score IER-S > 33) et 18,0 %des symptômes dépressifs (score DASS-dépression > 9). L’absence de revenu (notamment être sans profession ou étudiante) et la dépression étaient les meilleurs prédicteurs des symptômes du trouble de stress post-traumatique dans notre population.

Conclusion : L’observation de la complexité du vécu des patientes atteintes de cancer du sein renforce l’idée de la nécessité d’un accompagnement spécifique. Une évaluation précoce des besoins psychoémotionnels des patientes atteintes de cancer du sein et une intervention précoce pourraient être particulièrement utiles.

The sampling precision of research in five major areas of psychology

After obtaining a sample of published, peer-reviewed articles from journals with high and low impact factors in social, cognitive, neuro-, developmental, and clinical psychology, we used a priori equations recently derived by Trafimow (Educational and Psychological Measurement, 77, 831-854, 2017; Trafimow & MacDonald in Educational and Psychological Measurement, 77, 204-219, 2017) to compute the articles' median levels of precision. Our findings indicate that developmental research performs best with respect to precision, whereas cognitive research performs the worst; however, none of the psychology subfields excelled. In addition, we found important differences in precision between journals in the upper versus lower echelons with respect to impact factors in cognitive, neuro-, and clinical psychology, whereas the difference was dramatically attenuated for social and developmental psychology. Implications are discussed.

Impact of an 8-Week Exercise and Sport Intervention on Post-Traumatic Stress Disorder Symptoms, Mental Health, and Physical Fitness among Male Refugees Living in a Greek Refugee Camp

Objective: To explore the potential impact of exercise and sport training on symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, quality of life, pain, and fitness in male refugees living in a Greek refugee camp. Methods: This investigation was designed as a one group pre-test/post-test study. A total of 45 refugees (M_age = 25.6) participated in the data assessment. All participants were invited to engage in an 8-week exercise and sport intervention. Data were analysed with hierarchical regression analyses. Results: Baseline scores significantly predicted post-intervention scores across all study variables. Regression analyses showed that a higher participation rate predicted fewer anxiety symptoms, better health-related quality of life, higher self-perceived fitness, higher handgrip strength, and better cardiovascular fitness at post-intervention. A non-significant trend was also found for PTSD and depressive symptoms, showing that a higher participation rate was associated with fewer complaints at post-intervention. Conclusions: Among male refugees living in precarious conditions in a Greek refugee camp, frequency of participation in an 8-week exercise and sport training program seemed to have the potential to positively impact refugees’ health. Due to the pre-experimental study design, our results must be interpreted with caution.

Well-Being and Posttraumatic Growth Among Syrian Refugees in Jordan

The Syrian War has created a mass exodus of Syrian citizens to neighboring countries and exposed them to many atrocities. We explored factors affecting well-being and posttraumatic growth (PTG) of refugees residing in Jordan. Participants (N = 250) were surveyed via nongovernmental organizations (NGOs). Outcome criteria included a global well-being rating and the Posttraumatic Growth Inventory. Trauma exposure assessment included The Harvard Trauma Questionnaire (HTQ) and The War Events Questionnaire. Ordinary least squares regression examined associations between potential contributors to refugee well-being and PTG, including work, age, sex, income, education, posttraumatic stress disorder (PTSD) severity, physical pain, health, NGO assistance, psychotic/affective mental disorder, and length of residence in Jordan. Mean participant score on the PTSD-HTQ scale was 2.37 (SD = 0.63; range: 1 [no symptoms] to 3.88 [extremely severe symptoms]). Additionally, 74.6% of participants received NGO assistance and 92.7% experienced war events. Univariate and multivariate results indicated enhancement of well-being was associated with income, r = .34, β = .26, p < .001; health, r = .35, β = .26, p = .001; and absence of affective disorder, r = -.31, β = -.18, p = .012; and that PTG increased in association with income, r = .28, β = .20, p = .007; NGO assistance, r = .07, β = .14, p = .045; and absence of psychosis, r = -.12, β = -.17, p = .013, and affective disorder, r = -.26; β = -.16, p = .033. Findings suggest sufficient income and humanitarian assistance can contribute to Syrian refugees' mental health.

PTSD and Depression Among Museum Workers After the March 18 Bardo Museum Terrorist Attack

On March 18, 2015, two gunmen attacked the Bardo museum in Tunis, Tunisia, killing 23 foreign tourists. We assessed PTSD and depression symptoms 4-6 weeks after the event among museum workers, in relation to sociodemographic factors and social support, and we analysed the determinants and predictor factors of PTSD and depression symptoms among the participants. Our findings indicated that 68.6% of the respondents had posttraumatic stress symptoms above the cutoff point (IER-S scores >33), and 40.6% reported severe levels of depressive symptoms (DASS-depression scores >20). Male and female participants did not significantly differ in terms of their symptom severities. Low social support was the best predictor of PTSD and depression symptoms. Our results suggest that interventions designed to reinforce ties within social networks may be particularly helpful for victims in the aftermath of a terrorist attack.

The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews

BACKGROUND

First generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population.

METHODS

Scientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed.

RESULTS

One thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8-12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1-2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country.

CONCLUSION

First generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.

Mental health and psychosocial wellbeing of Syrians affected by armed conflict

AIMS

This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.

METHODS

We conducted a systematic literature search designed to capture clinical, social science and general literature examining the mental health of the Syrian population. The main medical, psychological and social sciences databases (e.g. Medline, PubMed, PsycInfo) were searched (until July 2015) in Arabic, English and French language sources. This search was supplemented with web-based searches in Arabic, English and French media, and in assessment reports and evaluations, by nongovernmental organisations, intergovernmental organisations and agencies of the United Nations. This search strategy should not be taken as a comprehensive review of all issues related to MHPSS of Syrians as some unpublished reports and evaluations were not reviewed.

RESULTS

Conflict affected Syrians may experience a wide range of mental health problems including (1) exacerbations of pre-existing mental disorders; (2) new problems caused by conflict related violence, displacement and multiple losses; as well as (3) issues related to adaptation to the post-emergency context, for example living conditions in the countries of refuge. Some populations are particularly vulnerable such as men and women survivors of sexual or gender based violence, children who have experienced violence and exploitation and Syrians who are lesbian, gay, bisexual, transgender or intersex. Several factors influence access to MHPSS services including language barriers, stigma associated with seeking mental health care and the power dynamics of the helping relationship. Trust and collaboration can be maximised by ensuring a culturally safe environment, respectful of diversity and based on mutual respect, in which the perspectives of clients and their families can be carefully explored.

CONCLUSIONS

Sociocultural knowledge and cultural competency can improve the design and delivery of interventions to promote mental health and psychosocial wellbeing of Syrians affected by armed conflict and displacement, both within Syria and in countries hosting refugees from Syria.