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Despite the frequency that refugees suffer bereavement, there is a dearth of research into the prevalence and predictors of problematic grief reactions in refugees. To address this gap, this study reports a nationally representative population-based study of refugees to determine the prevalence of probable prolonged grief disorder (PGD) and its associated problems.
This study recruited participants from the Building a New Life in Australia (BNLA) prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015–2016, and comprised 1767 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, probable PGD, post-traumatic stress disorder (PTSD) and mental illness. Children were administered the Strengths and Difficulties Questionnaire.
In this cohort, 38.1% of refugees reported bereavement, of whom 15.8% reported probable PGD; this represents 6.0% of the entire cohort. Probable PGD was associated with a greater likelihood of mental illness, probable PTSD, severe mental illness, currently unemployed and reported disability. Children of refugees with probable PGD reported more psychological difficulties than those whose parents did not have probable PGD. Probable PGD was also associated with the history of imprisonment, torture and separation from family. Only 56.3% of refugees with probable PGD had received psychological assistance.
Bereavement and probable PGD appear highly prevalent in refugees, and PGD seems to be associated with disability in the refugees and psychological problems in their children. The low rate of access to mental health assistance for these refugees highlights that there is a need to address this issue in refugee populations.
Refugees report elevated rates of posttraumatic stress disorder (PTSD), but are relatively unlikely to seek help for their symptoms. Mental health stigma is a key barrier to help-seeking amongst refugees. We evaluated the efficacy of an online intervention in reducing self-stigma and increasing help-seeking in refugee men.
Participants were 103 refugee men with PTSD symptoms from Arabic, Farsi or Tamil-speaking backgrounds who were randomly assigned to either receive an 11-module online stigma reduction intervention specifically designed for refugees (‘Tell Your Story’, TYS) or to a wait-list control (WLC) group. Participants completed online assessments of self-stigma for PTSD and help-seeking, and help-seeking intentions and behaviors at baseline, post-intervention, and at a 1 month follow-up.
Intent-to-treat analyses indicated that, compared to the WLC, TYS resulted in significantly smaller increases in self-stigma for seeking help from post-treatment to follow-up (d = 0.42, p = 0.008). Further, participants in the TYS conditions showed greater help-seeking behavior from new sources at follow-up (B = 0.69, 95% CI 0.19–1.18, p = 0.007) than those in the WLC. The WLC showed significantly greater increases in help-seeking intentions from post-intervention to follow-up (d = 0.27, p = 0.027), relative to the TYS group.
This is the first investigation of a mental health stigma reduction program specifically designed for refugees. Findings suggest that evidence-based stigma reduction strategies are beneficial in targeting self-stigma related to help-seeking and increasing help-seeking amongst refugees. These results indicate that online interventions focusing on social contact may be a promising avenue for removing barriers to accessing help for mental health symptoms in traumatized refugees.
We estimate Moody’s preference for accurate versus biased ratings using hand-collected data on the internal labor market outcomes of its analysts. We find that accurate analysts are more likely to be promoted and less likely to depart. The opposite is true for analysts who downgrade more frequently, who assign ratings below those predicted by a ratings model, and whose downgrades are associated with large negative market reactions. Downgraded firms are also more likely to be assigned a new analyst. These patterns are consistent with Moody’s balancing its desire for accuracy against its corporate clients’ desire for higher ratings.
This study investigated the longitudinal associations among prenatal substance use, socioeconomic adversity, parenting (maternal warmth, sensitivity, and harshness), children's self-regulation (internalization of rules and conscience), and conduct problems from infancy to middle childhood (Grade 2). Three competing conceptual models including cascade (indirect or mediated), additive (cumulative), and transactional (bidirectional) effects were tested and compared. The sample consisted of 216 low-income families (primary caretaker and children; 51% girls; 74% African American). Using a repeated-measures, multimethod, multi-informant design, a series of full panel models were specified. Findings primarily supported a developmental cascade model, and there was some support for additive effects. More specifically, maternal prenatal substance use and socioeconomic adversity in infancy were prospectively associated with lower levels of maternal sensitivity. Subsequently, lower maternal sensitivity was associated with decreases in children's conscience in early childhood, and in turn, lower conscience predicted increases in teacher-reported conduct problems in middle childhood. There was also a second pathway from sustained maternal depression (in infancy and toddlerhood) to early childhood conduct problems. These findings demonstrated how processes of risk and resilience collectively contributed to children's early onset conduct problems.
The mental health and social functioning of millions of forcibly displaced individuals worldwide represents a key public health priority for host governments. This is the first longitudinal study with a representative sample to examine the impact of interpersonal trust and psychological symptoms on community engagement in refugees.
Participants were 1894 resettled refugees, assessed within 6 months of receiving a permanent visa in Australia, and again 2–3 years later. Variables measured included post-traumatic stress disorder symptoms, depression/anxiety symptoms, interpersonal trust and engagement with refugees’ own and other communities.
A multilevel path analysis was conducted, with the final model evidencing good fit (Comparative Fit Index = 0.97, Tucker–Lewis Index = 0.89, Root Mean Square Error of Approximation = 0.05, Standardized Root-Mean-Square-Residual = 0.05). Findings revealed that high levels of depression symptoms were associated with lower subsequent engagement with refugees’ own communities. In contrast, low levels of interpersonal trust were associated with lower engagement with the host community over the same timeframe.
Findings point to differential pathways to social engagement in the medium-term post-resettlement. Results indicate that depression symptoms are linked to reduced engagement with one's own community, while interpersonal trust is implicated in engagement with the broader community in the host country. These findings have potentially important implications for policy and clinical practice, suggesting that clinical and support services should target psychological symptoms and interpersonal processes when fostering positive adaptation in resettled refugees.
Although emergency service personnel experience markedly elevated the rates of post-traumatic stress disorder (PTSD), there are no rigorously conducted trials for PTSD in this population. This study assessed the efficacy of cognitive behaviour therapy (CBT) for PTSD in emergency service personnel, and examined if brief exposure (CBT-B) to trauma memories is no less efficacious as prolonged exposure (CBT-L).
One hundred emergency service personnel with PTSD were randomised to either immediate CBT-L, CBT-B or wait-list (WL). Following post-treatment assessment, WL participants were randomised to an active treatment. Participants randomised to CBT-L or CBT-B were assessed at baseline, post-treatment and at 6-month follow-up. Both CBT conditions involved 12 weekly individual sessions comprising education, CBT skills building, imaginal exposure, in vivo exposure, cognitive restructuring and relapse prevention. Imaginal exposure occurred for 40 min per session in CBT-L and for 10 min in CBT-B.
At post-treatment, participants in WL had smaller reductions in PTSD severity (Clinician Administered PTSD Scale), depression, maladaptive appraisals about oneself and the world, and smaller improvements on psychological and social quality of life than CBT-L and CBT-B. There were no differences between CBT-L and CBT-B at follow-up on primary or secondary outcome measures but both CBT-L and CBT-B had large baseline to follow-up effect sizes for reduction of PTSD symptoms.
This study highlights that CBT, which can include either long or brief imaginal exposure, is efficacious in reducing PTSD in emergency service personnel.
We have previously shown that the minor alleles of vascular endothelial growth factor A (VEGFA) single-nucleotide polymorphism rs833069 and superoxide dismutase 2 (SOD2) single-nucleotide polymorphism rs2758331 are both associated with improved transplant-free survival after surgery for CHD in infants, but the underlying mechanisms are unknown. We hypothesised that one or both of these minor alleles are associated with better systemic ventricular function, resulting in improved survival.
This study is a follow-up analysis of 422 non-syndromic CHD patients who underwent neonatal cardiac surgery with cardiopulmonary bypass. Echocardiographic reports were reviewed. Systemic ventricular function was subjectively categorised as normal, or as mildly, moderately, or severely depressed. The change in function was calculated as the change from the preoperative study to the last available study. Stepwise linear regression, adjusting for covariates, was performed for the outcome of change in ventricular function. Model comparison was performed using Akaike’s information criterion. Only variables that improved the model prediction of change in systemic ventricular function were retained in the final model.
Genetic and echocardiographic data were available for 335/422 subjects (79%). Of them, 33 (9.9%) developed worse systemic ventricular function during a mean follow-up period of 13.5 years. After covariate adjustment, the presence of the VEGFA minor allele was associated with preserved ventricular function (p=0.011).
These data support the hypothesis that the mechanism by which the VEGFA single-nucleotide polymorphism rs833069 minor allele improves survival may be the preservation of ventricular function. Further studies are needed to validate this genotype–phenotype association and to determine whether this mechanism is related to increased vascular endothelial growth factor production.
Prolonged separation from parental support is a risk factor for psychopathology. This study assessed the impact of brief separation from parents during childhood trauma on adult attachment tendencies and post-traumatic stress.
Children (n = 806) exposed to a major Australian bushfire disaster in 1983 and matched controls (n = 725) were assessed in the aftermath of the fires (mean age 7–8 years) via parent reports of trauma exposure and separation from parents during the fires. Participants (n = 500) were subsequently assessed 28 years after initial assessment on the Experiences in Close Relationships scale to assess attachment security, and post-traumatic stress disorder (PTSD) was assessed using the PTSD checklist.
Being separated from parents was significantly related to having an avoidant attachment style as an adult (B = −3.69, s.e. = 1.48, β = −0.23, p = 0.013). Avoidant attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.31, p = 0.045), avoidance (B = 0.03, s.e. = 0.01, β = 0.30, p = 0.001) and numbing (B = 0.03, s.e. = 0.01, β = 0.30, p < 0.001) symptoms. Anxious attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.18, p = 0.001), numbing (B = 0.03, β = 0.30, s.e. = 0.01, p < 0.001) and arousal (B = 0.04, s.e. = 0.01, β = 0.43, p < 0.001) symptoms.
These findings demonstrate that brief separation from attachments during childhood trauma can have long-lasting effects on one's attachment security, and that this can be associated with adult post-traumatic psychopathology.
The majority of survivors of mass violence live in low- and middle-income countries (LMICs).
To synthesise empirical findings for psychological interventions for children and adolescents with post-traumatic stress disorder (PTSD) and/or depression in LMICs affected by mass violence.
Randomised controlled trials with children and adolescents with symptoms of PTSD and/or depression in LMICs were identified. Overall, 21812 records were found through July 2016 in the Medline, PsycINFO and PILOTS databases; 21 met the inclusion criteria and were reviewed according to recommended guidelines.
Twenty-one studies were included. Active treatments for PTSD yielded large pre-treatment to post-treatment changes (g = 1.15) and a medium controlled effect size (g = 0.57). Effect sizes were similar at follow-up. Active treatments for depression produced small to medium effect sizes. Finally, after adjustment for publication bias, the imputed uncontrolled and controlled effect sizes for PTSD were medium and small respectively.
Psychological interventions may be effective in treating paediatric PTSD in LMICs. It appears that more targeted approaches are needed for depressive responses.
In order to encouragee broad participation in deliberative forums, it is important to understand how people from politically less powerful groups perceive the deliberative experience and how discussion group composition affects their experiences. Using data from 27 deliberative polls from 2004, we examine how four individual characteristics (sex, age, race, and education) and randomly assigned small group composition predict participants’ attitudes about the deliberative experience. We find evidence that women, young people, non-whites, and those without college degree generally evaluate the experience positively, but find no evidence for the argument that including more people from these groups would lead to more positive deliberation experience for participants from the groups. That is, there is no interaction between minority status and group composition in predicting participants’ evaluation of the deliberation process.
Experiments conducted in the field allay concerns over external validity but are subject to the pitfalls of fieldwork. This article proves that scalable protocols conserve statistical efficiency in the face of problems implementing the treatment regime. Three designs are considered: randomly ordering the application of the treatment; matching subjects into groups prior to assignment; and placebo-controlled experiments. Three examples taken from voter mobilization field experiments demonstrate the utility of the design principles discussed.
If the publication decisions of journals are a function of the statistical significance of research findings, the published literature may suffer from “publication bias.” This paper describes a method for detecting publication bias. We point out that to achieve statistical significance, the effect size must be larger in small samples. If publications tend to be biased against statistically insignificant results, we should observe that the effect size diminishes as sample sizes increase. This proposition is tested and confirmed using the experimental literature on voter mobilization.
Political scientists often analyze data in which the observational units are clustered into politically or socially meaningful groups with an interest in estimating the effects that group-level factors have on individual-level behavior. Even in the presence of low levels of intracluster correlation, it is well known among statisticians that ignoring the clustered nature of such data overstates the precision estimates for group-level effects. Although a number of methods that account for clustering are available, their precision estimates are poorly understood, making it difficult for researchers to choose among approaches. In this paper, we explicate and compare commonly used methods (clustered robust standard errors (SEs), random effects, hierarchical linear model, and aggregated ordinary least squares) of estimating the SEs for group-level effects. We demonstrate analytically and with the help of empirical examples that under ideal conditions there is no meaningful difference in the SEs generated by these methods. We conclude with advice on the ways in which analysts can increase the efficiency of clustered designs.
College students are young, have little or no history of voting, and are residentially mobile, which makes them a population in great need of registering to vote. Universities have a civic, pedagogical, and legal obligation to register their students to vote. In 2006, we conducted a controlled experiment across 16 college campuses to test the efficacy of classroom presentations to increase voter registration. The 25,256 students across more than 1,026 classrooms were randomly assigned to one of three conditions: (1) a control group receiving no presentation; (2) a presentation by a professor; and (3) a presentation by a student volunteer. Verifying registration and voter turnout from a national voter database, we found that both types of presentations increased overall registration by 6 percentage points and turnout rates by approximately 2.6 percentage points. These results demonstrated that universities can take simple steps to engage their students in politics.
Although perceived social support is thought to be a strong predictor of psychological outcomes following trauma exposure, the temporal relationship between perceived positive and negative social support and post-traumatic stress disorder (PTSD) symptoms has not been empirically established. This study investigated the temporal sequencing of perceived positive social support, perceived negative social support, and PTSD symptoms in the 6 years following trauma exposure among survivors of traumatic injury.
Participants were 1132 trauma survivors initially assessed upon admission to one of four Level 1 trauma hospitals in Australia after experiencing a traumatic injury. Participants were followed up at 3 months, 12 months, 24 months, and 6 years after the traumatic event.
Latent difference score analyses revealed that greater severity of PTSD symptoms predicted subsequent increases in perceived negative social support at each time-point. Greater severity of PTSD symptoms predicted subsequent decreases in perceived positive social support between 3 and 12 months. High levels of perceived positive or negative social support did not predict subsequent changes in PTSD symptoms at any time-point.
Results highlight the impact of PTSD symptoms on subsequent perceived social support, regardless of the type of support provided. The finding that perceived social support does not influence subsequent PTSD symptoms is novel, and indicates that the relationship between PTSD and perceived social support may be unidirectional.
Grief symptoms and a sense of injustice may be interrelated responses amongst persons exposed to mass conflict and both reactions may contribute to post-traumatic stress disorder (PTSD) symptoms. As yet, however, there is a dearth of data examining these relationships. Our study examined the contributions of grief and a sense of injustice to a model of PTSD symptoms that included the established determinants of trauma events, ongoing adversity and severe psychological distress. The study involved a large population sample (n = 2964, response rate: 82.4%) surveyed in post-conflict Timor-Leste.
The survey sites included an urban administrative area (suco) in Dili, the capital of Timor-Leste and a rural village located an hour's drive away. Culturally adapted measures were applied to assess conflict related traumatic events (TEs), ongoing adversity, persisting preoccupations with injustice, symptoms of grief, psychological distress (including depressive symptoms) and PTSD symptoms.
We tested a series of structural equation models, the final comprehensive model, which included indices of grief symptoms and injustice, producing a good fit. Locating grief symptoms as the endpoint of the model produced a non-converging model. In the final model, strong associations were evident between grief and injustice (β = 0.34, s.e. = 0.02, p < 0.01) and grief and PTSD symptoms (β = 0.14, s.e. = 0.02, p < 0.01). The sense of injustice exerted a considerable effect on PTSD symptoms (β = 0.13, s.e. = 0.03, p < 0.01). In addition, multiple indirect paths were evident, most involving grief and a sense of injustice, attesting to the complex inter-relationship of these factors in contributing to PTSD symptoms.
Our findings support an expanded model of PTSD symptoms relevant to post-conflict populations, in which grief symptoms and a sense of injustice play pivotal roles. The model supports the importance of a focus on loss, grief and a sense of injustice in conducting trauma-focused psychotherapies for PTSD amongst populations exposed to mass conflict and violence. Further research is needed to identify the precise mechanisms whereby grief symptoms and the sense of injustice impact on PTSD symptoms.
This study reports data from teachers in regular classrooms about their experiences of inclusion for 143 young children with disabilities. Children were recruited from early intervention programs and their experiences were tracked across 3 years, from a Preparatory year to Year 2 of school. Children's teachers rated the appropriateness of the child's placement in their classroom as high to very high. However, most teachers rated the resources and supports available to support inclusion as only adequate. Teachers perceived a range of benefits for the child, peers, and themselves from inclusion but also identified significant challenges, including time pressures and increased responsibilities, as well as various behavioural and developmental concerns that had an impact on all children's learning. Challenges identified deserve continued attention for successful inclusive practice.
Radiocarbon is an exceptionally useful tool for studying soil-respired CO2, providing information about soil carbon turnover rates, depths of production, and the biological sources of production through partitioning. Unfortunately, little work has been done to thoroughly investigate the possibility of inherent biases present in current measurement techniques, like those present in δ13CO2 methodologies, caused by disturbances to the soil's natural diffusive regime. This study investigates the degree of bias present in four 14C sampling chamber methods using a three-dimensional numerical soil-atmosphere CO2 diffusion model. The four chambers were tested in an idealized, surrogate reality by assessing measurement bias with varying Δ14C and δ13C signatures of production, collar lengths, soil biological productivity rates, and soil diffusivities. The static and Iso-FD chambers showed almost no isotopic measurement bias, significantly outperforming dynamic chambers, which demonstrated biases up to 200‰ in some modeled scenarios. The study also showed that 13C and 14C diffusive fractionation are not a constant multiple of one another, but that the δ13C correction still works in diffusive scenarios because the change in fractionation is not large enough to impact measured Δ14C values during chamber equilibration.