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Refugees typically spend years in a state of protracted displacement prior to permanent resettlement. Little is known about how various prior displacement contexts influence long-term mental health in resettled refugees. In this study, we aimed to determine whether having lived in refugee camps v. community settings prior to resettlement impacted the course of refugees' psychological distress over the 4 years following arrival in Australia.
Participants were 1887 refugees who had taken part in the Building a New Life in Australia study, which comprised of five annual face-to-face or telephone surveys from the year of first arrival in Australia.
Latent growth curve modelling revealed that refugees who had lived in camps showed greater initial psychological distress (as indexed by the K6) and faster decreases in psychological distress in the 4 years after resettling in Australia, compared to those who had lived in community settings. Investigation of refugee camp characteristics revealed that poorer access to services in camps was associated with greater initial distress after resettlement, and greater ability to meet one's basic needs in camps was associated with faster decreases in psychological distress over time.
These findings highlight the importance of the displacement context in influencing the course of post-resettlement mental health. Increasing available services and meeting basic needs in the displacement environment may promote better mental health outcomes in resettled refugees.
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.
The mental health outcomes of military personnel deployed on peacekeeping
missions have been relatively neglected in the military mental health
To assess the mental health impacts of peacekeeping deployments.
In total, 1025 Australian peacekeepers were assessed for current and
lifetime psychiatric diagnoses, service history and exposure to
potentially traumatic events (PTEs). A matched Australian community
sample was used as a comparator. Univariate and regression analyses were
conducted to explore predictors of psychiatric diagnosis.
Peacekeepers had significantly higher 12-month prevalence of
post-traumatic stress disorder (16.8%), major depressive episode (7%),
generalised anxiety disorder (4.7%), alcohol misuse (12%), alcohol
dependence (11.3%) and suicidal ideation (10.7%) when compared with the
civilian comparator. The presence of these psychiatric disorders was most
strongly and consistently associated with exposure to PTEs.
Veteran peacekeepers had significant levels of psychiatric morbidity.
Their needs, alongside those of combat veterans, should be recognised
within military mental health initiatives.
Traumatic injuries affect millions of patients each year, and resulting post-traumatic stress disorder (PTSD) significantly contributes to subsequent impairment.
To map the distinctive long-term trajectories of PTSD responses over 6 years by using latent growth mixture modelling.
Randomly selected injury patients (n = 1084) admitted to four hospitals around Australia were assessed in hospital, and at 3, 12, 24 and 72 months. Lifetime psychiatric history and current PTSD severity and functioning were assessed.
Five trajectories of PTSD response were noted across the 6 years: (a) chronic (4%), (b) recovery (6%), (c) worsening/recovery (8%), (d) worsening (10%) and (e) resilient (73%). A poorer trajectory was predicted by female gender, recent life stressors, presence of mild traumatic brain injury and admission to intensive care unit.
These findings demonstrate the long-term PTSD effects that can occur following traumatic injury. The different trajectories highlight that monitoring a subset of patients over time is probably a more accurate means of identifying PTSD rather than relying on factors that can be assessed during hospital admission.
The latent structure of the proposed ICD-11 post-traumatic stress
disorder (PTSD) symptoms has not been explored.
To investigate the latent structure of the proposed ICD-11 PTSD
Confirmatory factor analyses using data from structured clinical
interviews administered to injury patients (n = 613) 6
years post-trauma. Measures of disability and psychological quality of
life (QoL) were also administered.
Although the three-factor model implied by the ICD-11 diagnostic criteria
fit the data well, a two-factor model provided equivalent, if not
superior, fit. Whereas diagnostic criteria based on this two-factor model
resulted in an increase in PTSD point prevalence (5.1%
v. 3.4%; z = 2.32,
P<0.05), they identified individuals with similar
levels of disability (P = 0.933) and QoL
(P = 0.591) to those identified by the ICD-11
Consistent with theorised reciprocal relationships between
re-experiencing and avoidance in PTSD, these findings support an
alternative diagnostic algorithm requiring at least two of any of the
four re-experiencing/avoidance symptoms and at least one of the two
There have been changes to the criteria for diagnosing post-traumatic
stress disorder (PTSD) in DSM-5 and changes are proposed for ICD-11.
To investigate the impact of the changes to diagnostic criteria for PTSD
in DSM-5 and the proposed changes in ICD-11 using a large multisite
trauma-exposed sample and structured clinical interviews.
Randomly selected injury patients admitted to four hospitals were
assessed 72 months post trauma (n = 510). Structured
clinical interviews for PTSD and major depressive episode, as well as
self-report measures of disability and quality of life were
Current prevalence of PTSD under DSM-5 scoring was not significantly
different from DSM-IV (6.7% v. 5.9%, z
= 0.53, P = 0.59). However, the ICD-11 prevalence was
significantly lower than ICD-10 (3.3% v. 9.0%,
z =–3.8, P<0.001). The PTSD
current prevalence was significantly higher for DSM-5 than ICD-11 (6.7%
v. 3.3%, z = 2.5, P
= 0.01). Using ICD-11 tended to show lower rates of comorbidity with
depression and a slightly lower association with disability.
The diagnostic systems performed in different ways in terms of current
prevalence rates and levels of comorbidity with depression, but on other
broad key indicators they were relatively similar. There was overlap
between those with PTSD diagnosed by ICD-11 and DSM-5 but a substantial
portion met one but not the other set of criteria. This represents a
challenge for research because the phenotype that is studied may be
markedly different according to the diagnostic system used.
The prevalence and nature of post-traumatic stress disorder (PTSD) following mild traumatic brain injury (MTBI) is controversial because of the apparent paradox of suffering PTSD with impaired memory for the traumatic event. In this study, 1167 survivors of traumatic injury (MTBI: 459, No TBI: 708) were assessed for PTSD symptoms and post-traumatic amnesia during hospitalization, and were subsequently assessed for PTSD 3 months later (N = 920). At the follow-up assessment, 90 (9.4%) patients met criteria for PTSD (MTBI: 50, 11.8%; No-TBI: 40, 7.5%); MTBI patients were more likely to develop PTSD than no-TBI patients, after controlling for injury severity (adjusted odds ratio: 1.86; 95% confidence interval, 1.78–2.94). Longer post-traumatic amnesia was associated with less severe intrusive memories at the acute assessment. These findings indicate that PTSD may be more likely following MTBI, however, longer post-traumatic amnesia appears to be protective against selected re-experiencing symptoms. (JINS, 2009, 15, 862–867.)
Studies examining the impact of childhood disaster exposure on the
development of adult psychopathology report increased rates of
post-traumatic stress disorder (PTSD) and other psychopathology.
To examine the rates of PTSD and other lifetime DSM–IV disorders in
adults exposed to an Australian bushfire disaster as children in 1983
using a matched control sample recruited at the time of the original
A total of 1011 adults recruited from an original sample of 1531 were
assessed 20 years following the fires using the Composite International
Diagnostic Interview (CIDI–2.1).
Results showed only a small direct impact of the fires on adult
psychiatric morbidity. A higher proportion of bushfire survivors met
criteria for ‘any DSM–IV disorder’ and ‘any anxiety’.
Findings suggest that the long-term impact of a prominent trauma in
childhood should be assessed in the context of other lifetime trauma in
order to provide a more accurate account of PTSD prevalence rates.
This chapter focuses on the prevalence and etiology of anxiety disorders, including posttraumatic stress disorder (PTSD), following disasters. Recently a number of large national mental health surveys have estimated the prevalence of psychiatric disorders. The anxiety disorders that have been associated with disasters are generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), social phobia, and specific phobia. The discussion of these matters is influenced by the fact that the conventions for recording patterns of comorbidity have changed between Diagnostic and Statistical Manual (DSM)-III and DSM-IV. The relationship between PTSD and the associated comorbidities with other anxiety and depressive disorders is important in determining the chronicity of morbidity following disasters. Anxiety disorders other than PTSD have been looked at in more detail in children, in part because of the potential developmental impact of disorders such as separation anxiety.
Questions remain about the long-term health impacts of the 1991 Gulf War on its veterans.
To measure psychological disorders in Australian Gulf War veterans and a military comparison group and to explore any association with exposure to Gulf War-related psychological stressors.
Prevalences of DSM–IV psychological disorders were measured using the Composite International Diagnostic Interview. Gulf War-related psychological stressors were measured using a service experience questionnaire.
A total of 31% of male Gulf War veterans and 21% of the comparison group met criteria for a DSM–IVdisorder first present in the post-Gulf War period. The veterans were at greater risk of developing post-Gulf War anxiety disorders including post-traumatic stress disorder, affective disorders and substance use disorders. The prevalence of such disorders remained elevated a decade after deployment. The findings can be explained partly as a ‘war-deployment effect‘. There was a strong dose–response relationship between psychological disorders and number of reported Gulf War-related psychological stressors.
Service in the 1991 Gulf War is associated with increased risk of psychological disorders and these are related to stressful experiences.
A group of 469 firefighters were studied 4, 11 and 29 months after having an extreme exposure to a bushfire disaster. The relative importance of the impact of the disaster, personality and ways of coping were investigated as determinants of post-traumatic morbidity. Neuroticism and a past history of treatment for a psychological disorder were better predictors of post-traumatic morbidity than the degree of exposure to the disaster or the losses sustained. These results raise doubts about the postulated central aetiological role a traumatic event plays in the onset of morbidity.
Examining the impact of natural disasters on psychological health provides an opportunity to study the role played by extreme adversity in the onset of psychiatric disorder. Four hundred and sixty-nine fire-fighters who had been intensely exposed to an Australian bushfire disaster completed a detailed inventory of their experiences four months later. They also completed a brief life events schedule and the 12-item General Health Questionnaire. Only 9% of the GHQ score variance could be accounted for by the disaster and other life events; the effects of the disaster appeared to be separate and additive. This is similar to the relationship between life events and psychiatric illness found in other settings. It is suggested that vulnerability is a more important factor in breakdown than the degree of stress experienced.
This longitudinal study examined the psychological impact of a bushfire disaster on a group of 808 children aged from 5 to 12. Contrary to prediction, the prevalence of behaviour and emotional problems 2 months after the fire was less than the prevalence in a carefully selected comparison group. Rather than decrease with time, the prevalence of psychological morbidity increased significantly, being as great 26 months after the disaster as at 8 months.
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