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Kirsch J, Kitchens K, Kerr K, Sivakumaran S. Group-Based Intervention Models in Treating Refugee Mental Health in High-Income Countries: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241270039. [PMID: 39143917 DOI: 10.1177/15248380241270039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Refugees within the post-migration context experience higher rates of mental health symptoms due to a variety of pre- and post-migration factors. However, there is a lack of research in understanding best practices in culturally grounded interventions aimed at improving well-being outcomes. Recent research shows group interventions are a potential pathway to mental health treatment for refugees. This systematic review aimed to (1) assess best practices among group-based interventions within the refugee context, (2) provide literature-informed guidance on best practices within group-based interventions for this population, and (3) examine the impact of group-based interventions on the mental health outcomes of adult refugees in the post-migration context in high-income countries. A systematic literature search was conducted using Academic Search Complete, Social Work Abstracts, and PsycINFO. A total of 2,243 studies were identified, with 19 meeting the inclusion criteria to be from a peer-reviewed journal article; be published from 2003 to 2023; be written in English; have a study population of refugees in the post-resettlement context in a high-income country; include a group-based intervention model; and be quantitative or mixed methods. Results demonstrated that group-based interventions improve mental health symptoms, including post-traumatic stress disorder, depression, and anxiety. Studies varied on their use of culturally grounded mechanisms in developing and implementing interventions. Future research is needed to understand the longitudinal impacts of group-based interventions on mental health and better support current practices to facilitate access to intervention implementation.
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Affiliation(s)
- Jaclyn Kirsch
- School of Social Work, University of Texas at Arlington, USA
| | | | - Kristen Kerr
- School of Social Work, University of Texas at Arlington, USA
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Kaufman CC, Rosmarin DH. Spiritually Integrated Group Psychotherapy for First Responders: Forgiveness, Trauma, and Alcohol Use. Int J Group Psychother 2024; 74:217-243. [PMID: 38502106 PMCID: PMC11062829 DOI: 10.1080/00207284.2024.2322500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
First responders (e.g. firefighters, law enforcement, paramedics, corrections officers) experience high rates of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Despite the relevance of both spirituality and forgiveness to PTSD and AUD among first responders, spiritually integrated group interventions for this population are rare. This article discusses a forgiveness session of a spiritually integrated group psychotherapy protocol for first responders (SPIRIT-FR) in acute psychiatric care. This brief group psychotherapy intervention includes (a) psychoeducation about the intersection of PTSD, AUD, and forgiveness (b) discussion of the relevance of forgiveness to PTSD and AUD, and (c) the integration of spiritual beliefs and behaviors to move toward forgiveness. We discuss relevant clinical theory as well as the potential clinical application of this protocol.
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Affiliation(s)
- Caroline. C. Kaufman
- Spirituality and Mental Health Program, McLean Hospital
- Department of Psychiatry, Harvard Medical School
| | - David H. Rosmarin
- Spirituality and Mental Health Program, McLean Hospital
- Department of Psychiatry, Harvard Medical School
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Kang H, Fischer IC, Dickinson S, Na PJ, Tsai J, Tedeschi RG, Pietrzak RH. Posttraumatic Growth in U.S. Military Veterans: Results from the National Health and Resilience in Veterans Study. Psychiatr Q 2024; 95:17-32. [PMID: 37938492 DOI: 10.1007/s11126-023-10061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 11/09/2023]
Abstract
Despite increasing recognition that positive psychological changes or posttraumatic growth (PTG) may develop after highly stressful or traumatic events, contemporary population-based data on the epidemiology of PTG in high-risk samples such as U.S. military veterans are lacking. Additionally, in light of emerging evidence suggesting an 8-factor model of posttraumatic stress disorder (PTSD) symptoms, an up-to-date characterization of how these symptom clusters relate to PTG can help inform efforts to help promote PTG. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative sample of 3,847 trauma-exposed U.S. veterans. Participants completed assessments of potentially traumatic events, PTSD symptoms, and PTG, as well as a broad range of sociodemographic, military, trauma, health, personality, and psychosocial characteristics. Results revealed that 63.2% of trauma-exposed veterans and 86.4% of veterans who screened positive for PTSD endorsed moderate-or-greater PTG; these prevalences are higher than those reported in an independent U.S. veteran sample in 2011 (50.1% and 72.0%, respectively). An inverted U-shaped association was observed between PTSD symptom severity and PTG levels, with scores of 31 to 51 on the PTSD Checklist for DSM-5 associated with the highest likelihood of PTG. Intrinsic religiosity and internally- and externally-generated intrusive symptoms of PTSD were identified as the strongest correlates of PTG. Results suggest that prevention and treatment efforts to mitigate severe PTSD symptoms, and help promote intrinsic religiosity, and more deliberate and organized rumination about traumatic experiences may help foster PTG in veterans.
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Affiliation(s)
- Hun Kang
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Ian C Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Samuel Dickinson
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jack Tsai
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Homeless Programs Office, Department of Veterans Affairs Central Office, National Center on Homelessness among Veterans, Washington, DC, USA
| | | | - Robert H Pietrzak
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA.
- Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Ave 151E, 06516, West Haven, CT, US.
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Exploration of Trauma-Oriented Retreats: Quantitative Changes in Mental Health Measures for Canadian Military Members, Veterans and Royal Canadian Mounted Police with Posttraumatic Stress Disorder and Moral Injury. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Military members, veterans, and public safety personnel have been noted to have a higher risk of exposure to potentially traumatic events and potentially morally injurious events resulting in operational stress injuries (OSI) such as posttraumatic stress disorder (PTSD) and moral injury (MI). Treatments that can quickly and effectively address these conditions are desperately needed. The purpose of this research was to identify the impact of participation in a non-evidence-based trauma-oriented retreat for the above populations experiencing PTSD and MI. Methods: This study was an embedded mixed-methods longitudinal study with parallel repeated quantitative measures designed to evaluate outcomes at 1, 3, 6, and 12 months after completion of the retreat. Results: Analysis showed a statistically significant reduction in self-reported symptoms of PTSD, anxiety, stress, depression, MI, anger, and emotional dysregulation pre/post-retreat, and an increase in resilience. Self-reported longitudinal results did not see a change in symptom scores, with participants continuing to maintain their clinical diagnoses post-retreat. Conclusions: The results from this study illustrate that trauma-oriented retreats may be a complementary treatment modality for OSI-related conditions but should not be seen as a first-line treatment option. Program evaluation, determination of the evidence-based nature of retreats, and standardization are yet needed.
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St. Cyr K, Liu JJW, Cramm H, Nazarov A, Hunt R, Forchuk C, Deda E, Richardson JD. "You can't un-ring the bell": a mixed methods approach to understanding veteran and family perspectives of recovery from military-related posttraumatic stress disorder. BMC Psychiatry 2022; 22:37. [PMID: 35031020 PMCID: PMC8759247 DOI: 10.1186/s12888-021-03622-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Military-related posttraumatic stress disorder (PTSD) is a complex diagnosis with non-linear trajectories of coping and recovery. Current approaches to the evaluation of PTSD and treatment discontinuation often rely on biomedical models that dichotomize recovery based on symptom thresholds. This approach may not sufficiently capture the complex lived experiences of Veterans and their families. To explore conceptualizations of recovery, we sought perspectives from Veterans and their partners in a pilot study to understand: 1) how Veterans nearing completion of treatment for military-related PTSD and their partners view recovery; and 2) the experience of progressing through treatment towards recovery. METHODS We employed a concurrent mixed methods design. Nine Veterans nearing the end of their treatment at a specialized outpatient mental health clinic completed quantitative self-report tools assessing PTSD and depressive symptom severity, and an individual, semi-structured interview assessing views on their treatment and recovery processes. Veterans' partners participated in a separate interview to capture views of their partners' treatment and recovery processes. Descriptive analyses of self-report symptom severity data were interpreted alongside emergent themes arising from inductive content analysis of qualitative interviews. RESULTS While over half of Veterans were considered "recovered" based on quantitative assessments of symptoms, individual reflections of "recovery" were not always aligned with these quantitative assessments. A persistent narrative highlighted by participants was that recovery from military-related PTSD was not viewed as a binary outcome (i.e., recovered vs. not recovered); rather, recovery was seen as a dynamic, non-linear process. Key components of the recovery process identified by participants included a positive therapeutic relationship, social support networks, and a toolkit of adaptive strategies to address PTSD symptoms. CONCLUSIONS For participants in our study, recovery was seen as the ability to navigate ongoing issues of symptom management, re-engagement with meaningful roles and social networks, and a readiness for discontinuing intensive, specialized mental health treatment. The findings of this study highlight important considerations in balancing the practical utility of symptom severity assessments with a better understanding of the treatment discontinuation-related needs of Veterans with military-related PTSD and their families, which align with a contemporary biopsychosocial approach to recovery.
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Affiliation(s)
- Kate St. Cyr
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jenny J. W. Liu
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Western University, London, ON Canada
| | - Heidi Cramm
- grid.410356.50000 0004 1936 8331School of Rehabilitation Therapy, Queen’s University, Kingston, ON Canada
| | - Anthony Nazarov
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Western University, London, ON Canada
| | - Renee Hunt
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Callista Forchuk
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Erisa Deda
- St. Joseph’s Operational Stress Injury Clinic, London, ON Canada
| | - J. Don Richardson
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Western University, London, ON Canada
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Nichols J, Cox SM, Cook C, Lea GW, Belliveau G. Research-based Theatre about veterans transitioning home: A mixed-methods evaluation of audience impacts. Soc Sci Med 2021; 292:114578. [PMID: 34864601 DOI: 10.1016/j.socscimed.2021.114578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 12/01/2022]
Abstract
RATIONALE Contact!Unload, a research-based theatre production, portrays veterans experiencing mental health challenges and overcoming them through therapeutic enactment. It was performed eight times by veteran performers in 2017 for audiences in two Canadian cities comprised of civilians and military-connected personnel and their families (n = 525). METHODS Drawing upon qualitative and quantitative data sources, this paper evaluates the immediate and longer-term impacts of Contact!Unload as a knowledge translation intervention for audience members. RESULTS Our findings suggest that the performance: 1) improved knowledge of mental health concerns and symptoms that some veterans experience when transitioning to civilian life, 2) increased knowledge of the need for mental health supports and care for veterans, 3) sustained impacts on awareness and knowledge six months after the play and 4) sparked dialogue and actions after the show for some audience members. Moreover, theatre was seen as a powerful medium to engage audience members both cognitively and affectively in the topic. CONCLUSIONS Research-based theatre has significant potential as a knowledge translation intervention for mental health topics. The work also points to the untapped potential of using RbT to engage audience members in a mental health literacy intervention. Future work is needed to study how to effectively combine research-based theatre with intervention design frameworks and other mental health literacy interventions.
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Affiliation(s)
- Jennica Nichols
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, The University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z, Canada
| | - Susan M Cox
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, The University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z, Canada.
| | - Christina Cook
- Language & Literacy Education, Faculty of Education, The University of British Columbia, 6445 University Boulevard, Vancouver, BC, V6T 1Z2,, Canada
| | - Graham W Lea
- Faculty of Education, The University of Manitoba, 71 Curry Place, Winnipeg, Manitoba, R3T2N2, Canada
| | - George Belliveau
- Language & Literacy Education, Faculty of Education, The University of British Columbia, 6445 University Boulevard, Vancouver, BC, V6T 1Z2,, Canada
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O’Loughlin JI, Cox DW, Castro CA, Ogrodniczuk JS. Disentangling the Individual and Group Effects of Masculinity Ideology on PTSD Treatment. COUNSELLING PSYCHOLOGY QUARTERLY 2021. [DOI: 10.1080/09515070.2021.1922359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Julia I. O’Loughlin
- Department of Educational & Counselling Psychology, and Special Education, University of British Columbia, Counselling Psychology Program, Vancouver, BC, Canada
| | - Daniel W. Cox
- Department of Educational & Counselling Psychology, and Special Education, University of British Columbia, Counselling Psychology Program, Vancouver, BC, Canada
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, School of Social Work, Los Angeles, California, USA
| | - John S. Ogrodniczuk
- University of British Columbia, Department of Psychiatry, Vancouver, BC Canada
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Cox DW, Baugh LM, McCloskey KD, Iyar M. Social causation or social erosion? Evaluating the association between social support and PTSD among Veterans in a transition program. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2017-0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Social support’s association with posttraumatic stress disorder (PTSD) in Veterans is well established. One explanation for this link is social causation – support inhibits PTSD. Inversely, within the social erosion model, PTSD erodes support. The aim of the present study was to examine if the social causation or social erosion model better explained the association between support and PTSD within a psychosocial intervention context. Methods: Veterans ( N = 218) participating in a multimodal transition program were assessed pre-program, post-program, and at 3-month follow-up on their perceived social support and PTSD symptoms. We used path analysis to conduct a three-wave cross-lagged panel model to compare the social erosion and social causation models. Results: PTSD symptoms were associated with attenuated improvements in social support, while social support was not associated with increased reductions in PTSD symptoms. This association was observed from pre- to post-program and from post-program to follow-up. Discussion: These findings support the social erosion model over the social causation model. Clinical implications of PTSD inhibiting interpersonal gains are discussed.
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Affiliation(s)
- Daniel W. Cox
- Counselling Psychology Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leah M. Baugh
- Counselling Psychology Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine D. McCloskey
- Counselling Psychology Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Megumi Iyar
- Counselling Psychology Program, University of British Columbia, Vancouver, British Columbia, Canada
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Belliveau G, Cook C, McLean B, Lea GW. Thawing out: Therapy through theatre with Canadian military veterans. ARTS IN PSYCHOTHERAPY 2019. [DOI: 10.1016/j.aip.2018.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rose S, VanDenKerkhof E, Schaub M. Determinants of successful transition literature review. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.4313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Steve Rose
- Eastern Michigan University, Ypsilanti, Michigan, USA
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Seidler ZE, Rice SM, River J, Oliffe JL, Dhillon HM. Men’s Mental Health Services: The Case for a Masculinities Model. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1060826517729406] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Simon M. Rice
- The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Jo River
- The University of Sydney, New South Wales, Australia
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