ORCID Profile
0000-0002-5048-2920
Current Organisations
Kunming University of Science and Technology
,
University of New South Wales
,
St John of God Health Care Inc
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Publications
Dimensions of trauma associated with posttraumatic stress disorder (PTSD) caseness, severity and functional impairment: A study of Bosnian refugees resettled in Australia
Publisher: Elsevier BV
Date: 09-2003
DOI: 10.1016/S0277-9536(02)00452-5
Abstract: Refugee survivors of inter-ethnic warfare vary greatly in the extent and range of their trauma experiences. Discerning which experiences are most salient to generating and perpetuating disorders such as posttraumatic stress disorder (PTSD) is critical to the mounting rational strategies for targeted psychosocial interventions. In a s le of Bosnian Muslim refugees (n=126) drawn from a community centre and supplemented by a snowball s ling method, PTSD status and associated disability were measured using the clinician-administered PTSD Scale (CAPS) for DSM-IV. A principal components analysis (PCA) based on a pool of trauma items yielded four coherent trauma dimensions: Human Rights Violations, Threat to Life, Traumatic Loss and Dispossession and Eviction. A cluster analysis identified three subgroupings according to extent of trauma exposure. There were no differences in PTSD risk for the group most exposed to human rights violations (internment in concentration c s, torture) compared to the general war-exposed group. Logistic regression analysis using the dimensions derived from the PCA indicated that Threat to Life alone of the four trauma factors predicted PTSD status, a finding that supports the DSM-IV definition of a trauma. Both Threat to Life and Traumatic Loss contributed to symptom severity and disability associated with PTSD. It may be that human rights violations pose a more general threat to the survivor's future psychosocial adaptation in areas of functioning that extend beyond the confines of PTSD.
Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders—A pilot group randomized trial
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.JANXDIS.2007.09.010
Abstract: A group randomized trial of adding a home-based walking program to a standard group cognitive behavioral therapy (GCBT+EX) was compared with groups receiving GCBT and educational sessions (GCBT+ED). The study was implemented in an outpatient clinic providing GCBT for clients diagnosed with panic disorder, generalized anxiety disorder or social phobia. Pre- and post-treatment measures included the self-report depression, anxiety, and stress scale (DASS-21) and measures of physical activity. From January 2004 to May 2005, six groups were allocated to GCBT+EX (n=38) and five to GCBT+ED (n=36). Analysis of covariance for completed cases (GCBT+EX, n=21 GCBT+ED, n=20), adjusting for the group design, baseline DASS-21 scores, and anxiety diagnosis showed significant effect for GCBT+EX on depression, anxiety, and stress (regression coefficients=-6.21, -3.41, and -5.14, respectively, p<0.05) compared to the GCBT+ED. The potential of exercise interventions as adjunct to GCBT for anxiety disorder needs to be further explored.
A Mental Health–Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study
Publisher: JMIR Publications Inc.
Date: 22-04-2021
DOI: 10.2196/23432
Abstract: First responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions. This study aims to examine the feasibility and acceptability of delivering a mental health–informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels. We co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention. In total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life (P=.001 Cohen d=0.60) total depression, anxiety, and stress scores (P=.047 Cohen d=0.35) and minutes of walking (P=.04 Cohen d=0.55). Changes in perceived social support from family (P=.07 Cohen d=0.37), friends (P=.10 Cohen d=0.38), and sleep quality (P=.28 Cohen d=0.19) were not significant. The results provide preliminary support for the use of social media and a multiple time series design to deliver mental health–informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required. Australian New Zealand Clinical Trials Registry (ACTRN): 12618001267246 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001267246.
The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013
Publisher: Oxford University Press (OUP)
Date: 19-03-2014
DOI: 10.1093/IJE/DYU038
Adult separation anxiety disorder among war‐affected Bosnian refugees: Comorbidity with PTSD and associations with dimensions of trauma
Publisher: Wiley
Date: 02-2010
DOI: 10.1002/JTS.20490
Abstract: Although separation anxiety disorder appears to be common among children exposed to disasters, there are no data focusing on the impact of trauma on adult separation anxiety disorder. The present exploratory study examined the relationship of adult separation anxiety disorder with other psychological reactions (posttraumatic stress disorder [PTSD], complicated grief, depression) and dimensions of trauma among 126 war-affected Bosnian refugees resettled in Australia. Adult separation anxiety disorder was associated with PTSD, but not with complicated grief or depression. Although adult separation anxiety disorder was weakly linked with traumatic losses, this association was nonspecific. Further research is needed to clarify the pathogenic pathways leading to the comorbid PTSD-adult separation anxiety disorder pattern and its clinical implications.
Six-year trajectories of post-traumatic stress and severe psychological distress symptoms and associations with timing of trauma exposure, ongoing adversity and sense of injustice: a latent transition
Publisher: BMJ
Date: 02-2016
The longitudinal relationship between post-traumatic stress disorder and perceived social support in survivors of traumatic injury
Publisher: Cambridge University Press (CUP)
Date: 27-09-2016
DOI: 10.1017/S0033291716002361
Abstract: 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.
The psychosocial correlates of quality of life in the dialysis population: a systematic review and meta-regression analysis
Publisher: Springer Science and Business Media LLC
Date: 31-07-2012
DOI: 10.1007/S11136-011-9973-9
Abstract: The psychosocial correlates of quality-of-life (QoL) research in end-stage renal disease (ESRD) are important in identifying risk and protective factors that may account for the QoL variability. Thus, the present study provides a meta-analysis of these research results. Published studies reporting associations between any psychosocial factors and QoL were retrieved from Medline, Embase, and PsycINFO. Mean effect sizes were calculated for the associations across psychosocial constructs (affect, stress, cognitive appraisal, social support, personality attributes, and coping process). Multiple hierarchical meta-regressions were applied to moderator analyses. Eighty-one studies covering a combined s le of 13,240 participants were identified resulting in 377 effect sizes of the association between psychosocial factors and QoL. The overall effect size of the association was medium (0.38). Stress, affect, and cognitive appraisal had the largest effect sizes. Location of study, dialysis type, gender, age and QoL domains measured (general well-being, subjective QoL, and health-related QoL) were significant substantive moderators for the associations. The present study shows that there is a moderate association between psychosocial variables and QoL in patients with ESRD, consistent across different QoL domains. The psychosocial constructs that have the strongest association with QoL are stress, affect, and cognitive appraisal.
Psychosocial concerns reported by Syrian refugees living in Jordan: Systematic review of unpublished needs assessments
Publisher: Royal College of Psychiatrists
Date: 08-2016
DOI: 10.1192/BJP.BP.115.165084
Abstract: Humanitarian organisations supporting Syrian refugees in Jordan have conducted needs assessments to direct resources appropriately. To present a model of psychosocial concerns reported by Syrian refugees and a peer review of research practices. Academic and grey literature databases, the United Nations Syria Regional Response website, key humanitarian organisation websites and Google were searched for needs assessments with Syrian refugees in Jordan between February 2011 and June 2015. Information directly reporting the views of Syrian refugees regarding psychosocial needs was extracted and a qualitative synthesis was conducted. Respondents reported that psychological distress was exacerbated by both environmental (financial, housing, employment) and psychosocial outcomes (loss of role and social support, inactivity), which are themselves stressors. Need for improvement in research methodology, participatory engagement and ethical reporting was evident. Participatory engagement strategies might help to address identified psychosocial outcomes. More rigorous qualitative methods are required to ensure accuracy of findings.
The role of grief symptoms and a sense of injustice in the pathways to post-traumatic stress symptoms in post-conflict Timor-Leste
Publisher: Cambridge University Press (CUP)
Date: 30-08-2016
DOI: 10.1017/S2045796016000317
Abstract: 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 s le ( 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.
A Mental Health–Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 12-08-2020
Abstract: irst responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions. his study aims to examine the feasibility and acceptability of delivering a mental health–informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels. e co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention. n total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life ( i P /i =.001 Cohen i d /i =0.60) total depression, anxiety, and stress scores ( i P /i =.047 Cohen i d /i =0.35) and minutes of walking ( i P /i =.04 Cohen i d /i =0.55). Changes in perceived social support from family ( i P /i =.07 Cohen i d /i =0.37), friends ( i P /i =.10 Cohen i d /i =0.38), and sleep quality ( i P /i =.28 Cohen i d /i =0.19) were not significant. he results provide preliminary support for the use of social media and a multiple time series design to deliver mental health–informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required. ustralian New Zealand Clinical Trials Registry (ACTRN): 12618001267246 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001267246.
Home-based imaginal desensitisation in pathological gambling: Short-term outcomes
Publisher: Cambridge University Press (CUP)
Date: 03-2005
DOI: 10.1375/BECH.22.1.13.66782
Abstract: Randomised controlled outcome studies have demonstrated the efficacy of imaginal desensitisation in inpatient settings. The purpose of this study was to evaluate the effects of a prerecorded audiocassette version of the imaginal desensitisation procedure that was designed for home-based use in reducing gambling urges and behaviours on a s le of diagnosed pathological gamblers who sought treatment at a university teaching hospital at 2-month follow-up. Pretreatment to 2-month follow-up repeated measures revealed a significant reduction in visual analogue scale ratings of urge, preoccupation and perceived self-control over gambling indices of actual gambling behaviour and psychometric measures of anxiety, depression and impulsivity. A prerecorded audiocassette version of imaginal desensitisation for home use represents a cost-effective approach in the management of pathological gambling.
Problems Tamil asylum seekers encounter in accessing health and welfare services in Australia
Publisher: Elsevier BV
Date: 10-1999
DOI: 10.1016/S0277-9536(99)00188-4
Abstract: Over the last decade, western countries have reduced their intake of refugees, even though a substantial number of persons continue to be displaced by war and persecution. At the same time, there has been a substantial increase in the number of asylum seekers who apply for refugee status after entering western countries without resettlement documents. Evidence is accruing that asylum seekers are at high risk to trauma-related psychiatric and physical disorders. Increasing concerns have been raised, therefore, about the difficulties that asylum seekers face in accessing health and welfare services. The present Australian-based volunteer study compared Tamil asylum seekers (n = 62) from Sri Lanka with compatriots (30 refugees 62 immigrants) on a number of indices relating to difficulties accessing medical, counselling and welfare services. The majority of asylum seekers (>60%) reported serious difficulties accessing medical and dental services and a sizeable minority reported problems obtaining assistance with welfare (40%), counselling (34%), and charity (23%). Difficulties accessing medical and dental services consistently exceeded those reported by refugees and immigrants. In spite of the inevitable s ling limitations, the data support past research as well as clinical impressions in suggesting that asylum seekers are particularly disadvantaged in accessing health care services.
Children and young people in immigration detention
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
The impact of torture on post-traumatic stress symptoms in war-affected Tamil refugees and immigrants
Publisher: Elsevier BV
Date: 2002
Abstract: The present study examines the effect of torture in generating post-traumatic stress disorder (PTSD) symptoms by comparing its impact with that of other traumas suffered by a war-affected s le of Tamils living in Australia. Traumatic predictors of PTSD were examined among a subs le of 107 Tamils (refugees, asylum seekers, and voluntary immigrants) who had endorsed at least one trauma category on the Harvard Trauma Questionnaire. Principal components analysis (PCA) yielded five trauma factors that were applied to predicting PTSD scores. Tamils exposed to torture returned statistically higher PTSD scores than other war trauma survivors after controlling for overall levels of trauma exposure. The torture factor identified by the PCA was found to be the main predictor of PTSD in a multiple regression analysis. Although limited by s ling constraints and retrospective measurement, the present study provides support for the identification of torture as a particularly traumatic event, even when the impact of other war-related trauma is taken into account.
Trauma, PTSD and the longer-term mental health burden amongst Vietnamese refugees
Publisher: Springer Science and Business Media LLC
Date: 21-04-2007
DOI: 10.1007/S00127-007-0194-Z
Abstract: Uncertainty persists about the impact of trauma on the long-term mental health of resettled refugees. The present study aimed to assess the contributions of trauma and PTSD to overall mental disorder and related need for services amongst Vietnamese refugees resettled for over a decade in Australia. The data were compared with a survey of the host population. The study involved a probabilistic s le of Vietnamese refugees (n = 1,161) resettled in Australia for 11 years. The Australian-born s le (n = 7,961) was drawn from a national survey using the same diagnostic measure, the Composite International Diagnostic Interview (CIDI). The PTSD prevalence for both groups was 3.5% and the diagnosis was present in 50% of Vietnamese and 19% of Australians with any mental disorder(s). Trauma made the largest contribution to mental disorder in the Vietnamese (odds ratio >8), whereas amongst Australians, younger age (odds ratio >3) and trauma (odds ratio >4) each played a role. PTSD was equally disabling in both populations but Vietnamese with the disorder reported more physical, and Australians more mental disability. Approximately one in three Australians and one in 10 Vietnamese with PTSD sought help from mental health professionals. Trauma and PTSD continue to affect the mental health of Vietnamese refugees even after a decade of resettlement in Australia. The tendency of Vietnamese with PTSD to report symptoms of physical disability may create obstacles to their obtaining appropriate mental health care.
Can structured interviews for posttraumatic stress disorder assist clinical decision-making after motor vehicle accidents? An exploratory analysis
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.COMPPSYCH.2005.08.004
Abstract: Motor vehicle accidents (MVAs) represent one of the most common causes of posttraumatic stress disorder (PTSD) worldwide. Predicting those MVA survivors who are likely to experience PTSD in the longer-term has attracted substantial research attention, but most investigators have concluded that early traumatic stress symptoms have only moderate predictive power. The present study focuses on a decision-tree approach that might be useful to clinicians attempting to identify subgroups of MVA survivors with graduated degrees of risk. Eighty-three consecutive MVA admissions (response rate, 65%) were assessed by structured clinical interview within 2 weeks of the accident and at 18 months follow-up. Meeting full criteria for PTSD (other than the time criterion) at baseline achieved a positive predictive power of 0.92 in identifying those who had PTSD over the following 18 months. For the remainder, the PTSD "arousal" domain achieved a positive predictive power of 0.81 for predicting those with either subthreshold PTSD or full PTSD over the 18-month follow-up period. The implications for further research into a stepped approach to intervention and monitoring are discussed.
Trauma exposure, PTSD and psychotic-like symptoms in post-conflict Timor Leste: an epidemiological survey
Publisher: Springer Science and Business Media LLC
Date: 12-2012
How noisy does a noisy miner have to be? Amplitude adjustments of alarm calls in an avian urban 'adapter'
Publisher: Public Library of Science (PLoS)
Date: 04-01-2012
An issue of access: Delivering equitable health care for newly arrived refugee children in Australia
Publisher: Wiley
Date: 09-2004
DOI: 10.1111/J.1440-1754.2004.00466.X
Abstract: Abstract: Newly arrived refugees and asylum seekers are faced with many difficulties in accessing effective health care when settling in Australia. Cultural, language and financial constraints, lack of awareness of available services, and lack of health provider understanding of the complex health concerns of refugees can all contribute to limiting access to health care. Understanding the complexities of a new health care system under these circumstances and finding a regular health provider may be difficult. In some cases there may be a fundamental distrust of government services. The different levels of health entitlements by visa category and (for some) detention on arrival in Australia may further complicate the provision and use of health services for providers and patients. Children are particularly at risk of suboptimal health care due to the impact of these factors combined with the effect of resettlement stresses on parents’ ability to care for their children. Unaccompanied and separated children, and those in detention experience additional challenges in accessing care. This article aims to increase awareness among health professionals caring for refugee children of the challenges faced by this group in accessing and receiving effective health care in Australia. Particular consideration is given to the issues of equity, rights of asylum seekers, communication and cultural sensitivities in health care provision, and addressing barriers to health care. The aim of the paper is to alert practitioners to the complex issues surrounding the delivery of health care to refugee children and provide realistic recommendations to guide practice.
Heart rate variability and the relationship between trauma exposure age, and psychopathology in a post-conflict setting
Publisher: Springer Science and Business Media LLC
Date: 10-05-2016
Range and dimensions of trauma experienced by Bosnian refugees resettled in Australia
Publisher: Informa UK Limited
Date: 2002
The Child Asylum Seeker: Psychological and Developmental Impact of Immigration Detention
Publisher: Elsevier BV
Date: 07-2008
DOI: 10.1016/J.CHC.2008.02.009
Abstract: Asylum-seeking children are one of the most vulnerable groups of displaced persons. The experience of being a detainee, with limited ways of communicating one's plight, shapes the expression of distress. Clinicians need to see the distress and symptoms of mental disorder as emerging in the context of the detention environment rather than within a traditional medical model. The use of diagnostic labels without elaboration does not provide an adequate account of the child's difficulties. The clinician has an important role in bearing witness to the harm done to detainees as well as trying to prevent harm in whatever way possible.
Part I - The mental health impacts of migration: The law and its effects: Failing to understand: Refugee determination and the traumatized applicant
Publisher: Elsevier BV
Date: 11-2004
An ethnographically derived measure of anxiety, depression and somatization: The Phan Vietnamese psychiatric scale
Publisher: SAGE Publications
Date: 06-2004
Abstract: This article describes the development and validation of the Phan Vietnamese Psychiatric Scale (PVPS). The PVPS was derived from Vietnamese idioms and cultural understandings of psychiatric and emotional distress identified from the Vietnamese literature and using ethnographic methods. The PVPS consists of a 26-item depression subscale, a 13-item anxiety subscale and a 14-item somatization subscale. Estimates of internal consistency for the three subscales ranged from .87 to .95, with 4-day interval test–retest reliability ranging from .81 to .89. Confirmatory factor analysis supported the subscale structure, with the depression subscale comprising two components ‘general mood disturbance’ and ‘psychovegetative symptoms.’ Multitrait–multimeasure analysis supported the construct validity of the scale. The PVPS demonstrated good criterion validity against case assignments by psychiatrists, naturalist healers, and structured diagnostic measures. The PVPS was rated as superior in clinical sensitivity and acceptability in comparison to other related measures.
Intercultural willingness to communicate within health services: Investigating anxiety, uncertainty, ethnocentrism and help seeking behaviour
Publisher: Elsevier BV
Date: 09-2016
Investigating the Effect of Anxiety, Uncertainty and Ethnocentrism on Willingness to Interact in an Intercultural Communication
Publisher: SAGE Publications
Date: 19-10-2015
Abstract: The current research aims to explore the effect of low or high perceived predictability and anxiety on willingness to interact with a person from another cultural group. How differences in anxiety, both in idual (trait anxiety) and intergroup (anxiety specifically related to an interaction), influence willingness to engage within an intercultural communication is investigated. In addition, the contribution of ethnocentrism to willingness to interact is explored. Anxiety, uncertainty, and ethnocentrism are all important factors that negatively affect willingness to interact in an intercultural communication. Yet to date, anxiety and uncertainty have been examined separately to ethnocentrism in the literature. The current study found that an anxiety-provoking intercultural interaction has a negative impact on willingness to interact with an intercultural interaction partner. Perceived predictability alone was not found to affect willingness to interact, contrary to previous research, with results suggesting that intergroup anxiety may be a better predictor of willingness to interact than perceived predictability and trait anxiety. Overall results indicate that anxiety and uncertainty are separate but related constructs in support of current theoretical models. Ethnocentrism was shown to uniquely contribute to willingness to interact. This novel finding indicates the importance of cultural factors on willingness to engage in intercultural communication and points to the need for further research to explore the impact of cultural values on these relationships.
Among Inpatients, Posttraumatic Stress Disorder Symptom Severity Is Negatively Associated With Time Spent Walking
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Online physical activity interventions for mental disorders: A systematic review
Publisher: Elsevier BV
Date: 05-2015
Factor structure and interpretation of the K10.
Publisher: American Psychological Association (APA)
Date: 03-2006
DOI: 10.1037/1040-3590.18.1.62
Abstract: The Kessler 10 Psychological Distress Scale (K10) is a brief 10-item questionnaire designed to measure the level of distress and severity associated with psychological symptoms in population surveys. It is being used widely, including in the World Health Organization World Mental Health Survey, and as a clinical outcome measure, although little information is available about the structure of the measure. The factorial composition of the K10 was examined in a prospective community survey and cross-validated in a separate large community survey. The K10 was found to consist of 4 factors and a 2-factor second-order factor structure. This was stable across the 2 waves of the prospective study and the Australian National Survey of Mental Health and Well-Being. The 4 factors, labeled Nervous, Negative Affect, Fatigue, and Agitation, were consistent with the original scales from which the items were taken. The 2 second-order factors represent Depression and Anxiety.
Mental health service use and ethnicity: An analysis of service use and time to access treatment by South East Asian-, Middle Eastern-, and Australian-born patients within Sydney, Australia
Publisher: Informa UK Limited
Date: 03-2017
DOI: 10.1111/AJPY.12113
Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste
Publisher: Cambridge University Press (CUP)
Date: 29-09-2016
DOI: 10.1017/S0033291716002233
Abstract: Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries. We studied 677 spouse dyads ( n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief. Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%) class 2, including men with higher TEs, women with lower TEs (23%) and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1). Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.
Feasibility of an adjunctive cognitive task in the treatment of posttraumatic stress disorder
Publisher: Springer Science and Business Media LLC
Date: 12-2021
DOI: 10.1007/S44202-021-00011-5
Abstract: Visuospatial cognitive tasks that influence memory reconsolidation may be of benefit in reducing intrusive memories for traumatic events when used as an adjunct to trauma-focused psychotherapy. We conducted a feasibility assessment of a protocol that involved the use of a visuospatial cognitive task, the Tetris intervention, alongside routine exposure-based treatment for posttraumatic stress disorder (PTSD). Participants were inpatients attending for PTSD treatment at a psychiatric hospital. The Tetris intervention was administered on three occasions when imaginal exposure had formed part of the treatment session. Using a phone app, participants also monitored intrusive memories over a 3-week period. Feasibility outcomes were fully met for the demand, implementation, practicality and adaptability criteria. Only a single criterion was not met for each of the acceptability and implementation criteria. Limited-efficacy testing outcomes are also discussed. Overall, the findings from our feasibility study indicated viability of the protocol, which involved implementation of the Tetris intervention alongside routine exposure-based treatment for PTSD, in a clinical inpatient setting.
Training the clinical psychologist: Profile of a university-based clinic
Publisher: Informa UK Limited
Date: 2002
Mental health, service use and social capital among Indian-Australians: findings of a wellbeing survey
Publisher: SAGE Publications
Date: 27-09-2012
Abstract: Indian-Australians represent a distinct immigrant group both demographically and culturally. Yet, despite an expanding body of research on transcultural mental health in Australia, there is a paucity of studies regarding mental health of Indian-Australians. This paper explores the extent of psychological morbidity and related service use in a representative s le of Indian-Australians. It further examines the association of mental health with social participation and networking in this ethnic community. Measures to assess current levels of psychological distress, functional disability, service use, and social capital were administered in a random s le of 71 Indian-Australian family groups living in Sydney. Amongst participants, 15% reported high to very high levels of psychological distress. Psychological distress was associated with increased days of functional disability and higher levels of functional impairment, and an increased likelihood of a GP consultation. However, 91% of participants with identifiable mental health needs did not seek any mental health consultation. Social capital was not found to be a significant predictor of psychological health or service use in this s le. Psychological morbidity in the Indian-Australian community is associated with high levels of functional disability, both in number of days and extent of severity, but only a small proportion seeks mental health help.
A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.SOCSCIMED.2013.08.029
Abstract: The levels of exposure to conflict-related trauma and the high rates of mental health impairment amongst asylum seekers pose specific challenges for refugee decision makers who lack mental health training. We examined the use of psychological evidence amongst asylum decision makers in New South Wales, Australia, drawing on the archives of a representative cohort of 52 asylum seekers. A mixed-method approach was used to examine key mental health issues presented in psychological reports accompanying each asylum application, including key documents submitted for consideration of asylum at the primary and review levels. The findings indicated that the majority of decision makers at both levels did not refer to psychological evidence in their decision records. Those who did, particularly in the context of negative decisions, challenged the expert findings and rejected the value of such evidence. Asylum seekers exhibiting traumatic stress symptoms such as intrusive thoughts and avoidance, as well as memory impairment, experienced a lower acceptance rate than those who did not across the primary and review levels. The findings raise concern that trauma-affected asylum seekers may be consistently disadvantaged in the refugee decision-making process and underscore the need to improve the understanding and use of mental health evidence in the refugee decision-making setting. The study findings have been used to develop a set of guidelines to assist refugee decision makers, mental health professionals and legal advisers in improving the quality and use of psychological evidence within the refugee decision-making context.
Mental disorders, disability and health service use amongst Vietnamese refugees and the host Australian population
Publisher: Wiley
Date: 03-2005
DOI: 10.1111/J.1600-0447.2004.00458.X
Abstract: To compare the prevalence of common mental disorders, disability and health service utilization amongst Vietnamese refugees resettled in Australia for 11 years, with data obtained from a national survey of the host population. A stratified multistage probability household survey of 1611 Vietnamese undertaken in the state of New South Wales was compared with data from 7961 Australian-born respondents. Measures included the CIDI 2.1 and the MOS SF-12. The 12-month prevalence of anxiety, depression and drug and alcohol dependence amongst Vietnamese was 6.1% compared with 16.7% amongst Australians. Vietnamese with a mental illness reported higher disability but exhibited similar levels of mental health consultation. The overall service burden of mental disorders was lower for the Vietnamese. The findings suggest that refugee groups resettled for some time in Western countries may show sound mental health adaptation and do not necessarily impose a burden on general or mental health services.
Type 2 Diabetes Among People With Posttraumatic Stress Disorder
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
Impulsivity in pathological gambling: The antisocial impulsivist
Publisher: Wiley
Date: 1997
Repetitive Transcranial Magnetic Stimulation: Influence on Stress and Early Responsiveness Outcomes for Depression, Anxiety, and Stress
Publisher: Springer Science and Business Media LLC
Date: 04-10-2021
DOI: 10.1007/S11126-021-09953-4
Abstract: The present study investigated whether rTMS treatment for depression reduced stress and whether early responsiveness of rTMS predicted outcomes for depression, anxiety, and stress at the conclusion of treatment. Participants (n = 109) were inpatients at a psychiatric hospital referred for rTMS for depression. Linear mixed models were used to analyse data across time and regression analyses were used to assess early responsiveness. Effect sizes, and clinically significant and reliable change were also analysed. Decreases in scores for depression, anxiety, and stress were evident from pre- to mid-treatment, and from mid- to post-treatment. Large effect sizes were reported from pre- to post-treatment for depression and stress. Changes in depression from pre- to mid-treatment predicted post-treatment depression and stress scores. Clinically significant change was most common for stress and reliable change was most common for depression. Standard rTMS treatment for depression appears to have non-specific benefits in that participant anxiety and stress ratings also improve significantly. Early improvements in depressive symptoms may be indicative of later depression and stress outcomes, suggesting clinical benefit in assessing outcomes during rTMS treatment.
Comorbidity of PTSD and depression: Associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia
Publisher: Elsevier BV
Date: 06-2004
Change in visa status amongst Mandaean refugees: Relationship to psychological symptoms and living difficulties
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.PSYCHRES.2010.12.015
Abstract: Policies of deterrence, including the use of detention and temporary visas, have been widely implemented to dissuade asylum seekers from seeking protection in Western countries. The present study examined the impact of visa status change on the mental health of 97 Mandaean refugees resettled in Australia. At the time of the first survey (2004), 68 (70%) participants held temporary protection visas (TPVs) and 29 (30%) held permanent residency (PR) status, whereas by the second survey (2007), 97 (100%) participants held PR status. We tested a meditational model to determine whether the relationship between change in visa status and change in psychological symptoms was mediated by change in living difficulties associated with the visa categories. The conversion of visa status from TPV to PR status was associated with significant improvements in PTSD and depression symptoms, and increases in mental health-related quality of life (MHR-QOL). The relationship between change in visa status and reduced PTSD and depression symptoms was mediated by reductions in living difficulties. In contrast, the relationship between change in visa status and increased MHR-QOL was not mediated by changes in living difficulties. These results suggest that restriction of rights and access to services related to visa status negatively affect the mental health of refugees. Implications for government policies regarding refugees are discussed.
Achieving convergence between a community-based measure of explosive anger and a clinical interview for intermittent explosive disorder in Timor-Leste
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.JAD.2013.06.006
Abstract: There is growing research interest in understanding and analyzing explosive forms of anger. General epidemiological studies have focused on the DSM-IV category of Intermittent Explosive Disorder (IED), while refugee and post-conflict research have used culturally-based indices of explosive anger. The aim of this study was to test the convergence of a culturally-sensitive community measure of explosive anger with a structured clinical interview diagnosis of IED in Timor-Leste, a country with a history of significant mass violence and displacement. A double-blind clinical concordance study was conducted amongst a stratified community s le in post-conflict Timor-Leste (n=85) to compare a community measure of anger against the Structured Clinical Interview (SCID) module for IED. Clinical concordance between the two measures was high: the area under the curve (AUC) index was 0.90 (95% CI: 0.83-0.98) sensitivity and specificity were 93.3% and 87.5% respectively. Response rates were modest due to the participant's time commitments. It is possible to achieve convergence between culturally-sensitive measures of explosive anger and the DSM-IV construct of IED, allowing comparison of findings across settings and populations.
The familial influence of loss and trauma on refugee mental health: A multilevel path analysis
Publisher: Wiley
Date: 25-01-2011
DOI: 10.1002/JTS.20608
Abstract: Although the impact of human rights violations on the mental health of refugees has been well documented, little is known about these effects at a family level. In this study the authors examined the relationships among loss, trauma, and mental health at the in idual and family levels in resettled Mandaean refugees (N = 315). Trauma, loss, posttraumatic stress disorder, depression, complicated grief, and mental health-related quality of life were assessed. A multilevel path analysis revealed that loss and trauma significantly impacted on psychological outcomes at both the in idual and family levels. Effect sizes ranged from .21 to .68 at the in idual level, and .38 to .99 at the family level, highlighting the importance of the family when considering the psychological impact of refugee-related trauma.
Authors' reply
Publisher: Royal College of Psychiatrists
Date: 08-2009
A critical review of psychological treatments of posttraumatic stress disorder in refugees
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.CPR.2010.10.004
Abstract: Despite much research evidence that refugees suffer from elevated rates of posttraumatic stress disorder (PTSD), relatively few studies have examined the effectiveness of psychological treatments for PTSD in refugees. The field of refugee mental health intervention is dominated by two contrasting approaches, namely trauma-focused therapy and multimodal interventions. This article firstly defines these two approaches, then provides a critical review of 19 research studies that have been undertaken to investigate the efficacy of these treatments. Preliminary research evidence suggests that trauma-focused approaches may have some efficacy in treating PTSD in refugees, but limitations in the methodologies of studies caution against drawing definitive inferences. It is clear that research assessing the treatment of PTSD in refugees is lagging behind that available for other traumatized populations. The review examines important considerations in the treatment of refugees. A theoretical framework is offered that outlines contextual issues, maintaining factors, change mechanisms and the distinctive challenges to traditional trauma-focused treatments posed by the needs of refugees with PTSD.
Trauma and Mental Health Awareness in Emergency Service Workers: A Qualitative Evaluation of the Behind the Seen Education Workshops
Publisher: MDPI AG
Date: 21-04-2021
Abstract: Emergency service workers (ESWs) are at high risk of experiencing poor mental health, including posttraumatic stress disorder (PTSD). Programs led by ex-service organizations may play an unrecognized but critical role in mental health prevention and promotion. Behind the Seen (BTS) is an Australian ex-service organization that runs workshops to raise awareness and facilitate conversations around the mental health of ESWs. The purpose of the study is to conduct a qualitative evaluation of workshop participants’ experiences, to understand the acceptability and perceived usefulness over the immediate- (within 1 month), intermediate- (6 months) and longer-terms (12 months). Participants (n = 59 ESWs) were recruited using purposive s ling across five fire and rescue services in metropolitan, regional, and rural locations. Focus groups methodology was used for data collection and data were analyzed using iterative categorization techniques. Participants reported (i) a high perceived need for education about PTSD, (ii) highly salient aspects of the presentation that made for a positive learning experience, including the importance of the lived experiences of the facilitators in the learning process, (iii) key features of changes to intentions, attitudes, and behavior, and (iv) major aspects of the organizational context that affected the understanding and uptake of the program’s key messages. BTS was perceived as an acceptable means of delivering mental health, PTSD, and help-seeking information to ESWs. The program is a promising candidate for scaling-up and further translation.
Onset of common mental disorders and suicidal behavior following women's first exposure to gender based violence: a retrospective, population-based study
Publisher: Springer Science and Business Media LLC
Date: 18-11-2014
Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study
Publisher: Elsevier BV
Date: 05-2014
Human rights and the trauma model: Genuine partners or uneasy allies?
Publisher: Wiley
Date: 10-2009
DOI: 10.1002/JTS.20449
Abstract: Since World War II, a comprehensive body of international law has developed to protect and promote human rights. Three generations of rights can be delineated: civil and political economic, social and cultural and collective rights. The convergence of a medical rights-based c aign in the late 1970s with the emergence of the new trauma model resulted in mental health professionals playing a prominent role in documenting and protecting civil and political rights. Economic, social, and cultural rights also emerged as being pivotal, particularly in the Australian context as mental health professionals began to work with excluded populations such as asylum seekers. Consideration of third-generation rights raises important questions about the responsibilities facing mental health professionals applying the trauma model to non-Western settings.
Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss
Publisher: Springer Science and Business Media LLC
Date: 09-04-2014
Fear of Cultural Extinction and Psychopathology Among Mandaean Refugees: An Exploratory Path Analysis
Publisher: Wiley
Date: 07-08-2009
An online mental health informed physical activity intervention for emergency service workers and their families: A stepped-wedge trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 07-12-2021
Abstract: mergency service workers are at an increased risk of experiencing poor mental health due to prolonged, repeated exposure to potentially traumatic events. Promoting healthy lifestyle behaviours including physical activity and diet may help to mitigate some the consequences of emergency service work. his study aimed to evaluate the impact of an online physical activity and diet intervention on levels of psychological distress among emergency service workers and their nominated support partner e.g., spouse, family member close friend. e delivered a 10-week physical activity program via a private Facebook group. The Facebook group was co-facilitated by exercise physiologists, a dietitian and peer-facilitators. Weekly modules on overcoming barriers to exercise, self-monitoring of activity and nutrition were delivered. Participants could also join weekly group telehealth calls and were provided with a physical activity tracking device. A stepped-wedge design was applied to compare levels of psychological distress (Kessler-6) during baseline, to intervention by comparing slopes of change. Visual inspection of the data was used to identify the location for a knot point. Then separate slopes were modelled for a) baseline b) intervention slope 1 c) intervention slope 2 d) change in level of knot points. Secondary outcomes included a pre-post assessment of mental health symptoms, physical activity levels, quality of life, social support to exercise, sleep quality and suicidal ideation. n total, N=90 participants (n=47 emergency service workers and n=43 support partners) were recruited in 4 separate cohorts (mean age 42.3(SD=11.5) years, 51% male). Levels of psychological distress did not change significantly during the baseline (control) slope, while during the first 6 weeks of intervention (intervention slope 1) levels reduced significantly. The interaction between baseline and intervention slopes were significant, b=-0.351, p = 0.003, (i.e., the trajectories of change were significantly different) and improvements plateaued until the 4-week follow up (intervention slope 2). Participation was associated with improvements in mental health symptoms, weekly minutes of physical activity, sedentary time and quality of life. Retention in the intervention was high (92%). 10-week physical activity intervention delivered via social media is feasible and effective in improving psychological distress among emergency service workers and their support partners. Future research should consider investigating the factors mediating changes in health behaviours and outcomes. ustralian New Zealand Clinical Trials Registry (ACTRN): 12619000877189. R2-10.1136/bmjopen-2019-030668
Complicated grief in Bosnian refugees: Associations with posttraumatic stress disorder and depression
Publisher: Elsevier BV
Date: 11-2004
DOI: 10.1016/J.COMPPSYCH.2004.07.013
Abstract: Complicated grief is likely to be common among refugee populations exposed to war trauma. However, there have been few studies investigating the traumatic antecedents and correlates of complicated grief in refugees, and the relationship of that symptom pattern with other common disorders such as posttraumatic stress disorder (PTSD) and depression. We studied Bosnian refugees recruited from a community center in Sydney, Australia, with the s le being supplemented by a snowball method (N = 126 response rate, 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS), the depression module of the Structured Clinical Interview (SCID), and the Core Bereavement Items (CBI). A dimension of traumatic loss derived from the trauma inventory was a specific predictor of complicated grief, with exposure to human rights violations being associated with images of the traumatic events surrounding the lost person. There was no link between PTSD and grief other than for a low-order association with the PTSD intrusion dimension. In contrast, depression was strongly associated with grief and its subscales. Only the subgroup with comorbid grief and depression reported higher levels of traumatic loss. The results suggest that complicated grief in refugees can become persistent and associated with depression. While PTSD and grief share common symptoms of intrusion, the two symptom domains are sufficiently distinct to warrant independent assessment of grief in refugee populations.
Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study
Publisher: Elsevier BV
Date: 10-2002
Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.SOCSCIMED.2011.02.007
Abstract: Australia has been at the forefront of implementing immigration policies that aim to limit the flow of asylum seekers over recent decades. Two controversial polices have been the use of immigration detention for unauthorized arrivals and the issuing of temporary protection visas (TPVs) for refugees who arrived without valid visas. We conducted a longitudinal survey over 2 years commencing in 2003 of 104 consecutive refugees from Iran and Afghanistan attending a state-wide early intervention program in New South Wales. The s le included those released from immigration detention on TPVs (n = 47) and others granted permanent protection visas prior to entering Australia (PPVs, n = 57). Psychological symptoms were assessed at baseline and follow-up by the Harvard Trauma Questionnaire (HTQ), the Hopkins symptom checklist-25 (HSCL), the GHQ-30 and the Penn State Worry Questionnaires (PSWQ). English language competency, daily living difficulties and coping-related activities were also assessed. The results indicated that TPVs had higher baseline scores than PPVs on the HTQ PTSD scale, the HSCL scales, and the GHQ. ANCOVA models adjusting for baseline symptom scores indicated an increase in anxiety, depression and overall distress for TPVs whereas PPVs showed improvement over time. PTSD remained high at follow-up for TPVs and low amongst PPVs with no significant change over time. The TPVs showed a significant increase in worry at follow-up. TPVs showed no improvement in their English language skills and became increasingly socially withdrawn whereas PPVs exhibited substantial language improvements and became more socially engaged. TPV holders also reported persistently higher levels of distress in relation to a wide range of post-migration living difficulties whereas PPVs reported few problems in meeting these resettlement challenges. The data suggest a pattern of growing mental distress, ongoing resettlement difficulties, social isolation, and difficulty in the acculturation process amongst refugees subject to restrictive immigration policies.
The impact of fear for family on mental health in a resettled Iraqi refugee community
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.JPSYCHIRES.2009.08.006
Abstract: The current study aimed to evaluate the impact of fear for family remaining in the country of origin and under potential threat on the mental health of refugees. Adult Mandaean refugees (N=315) from Iraq, living in Sydney, Australia, were interviewed regarding fear for family in Iraq, fear of genocide, pre-migration trauma, post-migration living difficulties and psychological outcomes. Participants with immediate family in Iraq reported higher levels of symptoms of PTSD and depression, and greater mental health-related disability than those without family in Iraq. Intrusive fears about family independently predicted risk of PTSD, depression and disability after controlling for trauma exposure and current living difficulties. Threat to family members living in a context of ongoing threat predicted psychopathology and disability in Mandaean refugees. The effect of ongoing threat to family still living in conflict-ridden countries on the mental health of refugees should be further considered in the context of healthcare.
Asylum, Detention, and Mental Health in Australia
Publisher: Oxford University Press (OUP)
Date: 2008
DOI: 10.1093/RSQ/HDN034
Intermittent Explosive Disorder amongst Women in Conflict Affected Timor-Leste: Associations with Human Rights Trauma, Ongoing Violence, Poverty, and Injustice
Publisher: Public Library of Science (PLoS)
Date: 07-08-2013
Explosive anger in postconflict Timor Leste: Interaction of socio-economic disadvantage and past human rights-related trauma
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.JAD.2010.12.020
Abstract: Countries emerging from major conflict commonly experience recurrent periods of communal instability. A psychosocial theory, Adaptation and Development after Persecution and Trauma (ADAPT), suggests that experiences of past human rights abuses interact with socio-economic disadvantage in the postconflict period to generate or maintain explosive forms of anger. Previous research has supported a link between trauma exposure and anger but the role of ongoing socio-economic disadvantage requires further clarification. The present study examined a structural equation model based on cross-sectional epidemiological data (n = 1245) collected in post-conflict Timor Leste in 2004. The model included four trauma dimensions derived from a prior factor analysis a latent variable of post-conflict distress symptoms (derived from measures of PTSD and depression/anxiety) an index of socio-economic distress and an indigenously-based measure of explosive anger. The final model yielded a good fit (chi-square = 26.59 df = 20 p = 0.15 CFI = 0.99 TLI = 0.99 RMSEA = 0.016). Postconflict distress symptoms mediated the associations of trauma dimensions and socio-economic disadvantage with anger. Trauma dimensions associated with human rights violations and witnessing murder were partly mediated by ongoing socio-economic disadvantage in the path to postconflict distress and anger. Longitudinal studies will be needed to confirm the chronological sequencing of these relationships. The study offers empirical support for a link between past trauma related to human rights violations and ongoing socio-economic disadvantage in the path to distress and anger.
Posttraumatic stress disorder (PTSD) symptom profiles among people who have experienced abuse: Findings from the NESARC-III study.
Publisher: American Psychological Association (APA)
Date: 13-01-2022
DOI: 10.1037/TRA0001193
Abstract: Greater recognition of ersity in psychological responses to traumatic events has led to increased exploration of posttrauma symptom typologies and risk factors for more "complex" presentations. We sought to identify unique PTSD symptom profiles associated with the experience of physical and sexual abuse and to determine whether exposure in childhood, type of abuse, frequency of abuse and familial support were associated with profiles indicating increased symptom complexity. We analyzed data from 6,769 American adults ( Five classes were educed: High All (19.6%), Threat (14.4%), Dysphoric (13.7%), Moderate Threat (29.4%) and Low Symptom (22.9%). Contrary to our hypotheses, trauma exposure in childhood did not predict class membership while type of abuse did. The High All and Dysphoric classes had greater frequency of childhood abuse, lower support in childhood, and a history of sexual abuse when compared to their less complex, predominantly fear-based counterparts (Threat and Moderate Threat classes, respectively). These constellations of DSM-5 PTSD symptoms may be a proxy for increased "complexity" and may indicate a need for alternative or additional therapeutic interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
The Prevalence of Depression Among Men Living With HIV Infection in Vietnam
Publisher: American Public Health Association
Date: 10-2009
Abstract: Objectives. We assessed the prevalence of depression among men living with HIV infection in Vietnam and compared the findings with those from a general population survey of Vietnamese men. Methods. Between November 2007 and April 2008, 584 participants completed a structured questionnaire in Vietnamese that measured self-reported depression. We used the χ 2 test to detect differences in prevalence rates within HIV populations and between our respondents and a general Vietnamese male population. Results. Respondents had a depression rate of 18.7% over a 1-month period, which was substantially higher than that reported in the Vietnamese male population (0.9%). Rates were highest among men reporting higher levels of stress and more HIV symptoms. Men diagnosed with depression experienced significantly more difficulty than others in accessing medical care. Conclusions. Our results provide the first empirical evidence of depression among men living with HIV in Vietnam and underscore the need to include mental health services in the response to HIV.
Comprehensive health assessment for newly arrived refugee children in Australia
Publisher: Wiley
Date: 09-2004
DOI: 10.1111/J.1440-1754.2004.00465.X
Abstract: Abstract: Providing appropriate and responsive care to refugees from erse backgrounds and with unique health needs is challenging. Refugee children may present with a wide range of conditions, which may be unfamiliar to health professionals in developed countries. Additionally, refugees may experience unfamiliarity with the Australian health system and distrust of authority figures and/or medical practitioners. This article provides an overview of the priority areas in health and health management for paediatric refugee patients for paediatricians as well as other relevant health care providers caring for this group. Specific issues covered include general health assessment, infectious diseases, immunization, growth and nutrition, oral health, development and disability, mental health and child protection. Comprehensive health assessment can assist in identifying children at risk of poor health and to provide them with timely and effective care, advocacy and appropriate referral.
In protest [6] (multiple letters)
Publisher: SAGE Publications
Date: 11-2004
Impact of immigration detention and temporary protection on the mental health of refugees
Publisher: Royal College of Psychiatrists
Date: 2006
DOI: 10.1192/BJP.BP.104.007864
Abstract: Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum. To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees. Lists of names provided by community leaders were supplemented by snowball s ling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed posttraumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to pasttrauma, detention and temporary protection. A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release. Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.
International and indigenous diagnoses of mental disorder among Vietnamese living in Vietnam and Australia
Publisher: Royal College of Psychiatrists
Date: 04-2009
DOI: 10.1192/BJP.BP.108.050906
Abstract: Whether the prevalence rates of common mental disorders can be compared across countries depends on the cultural validity of the diagnostic measures used. To investigate the prevalence of Western and indigenously defined mental disorders among Vietnamese living in Vietnam and in Australia, comparing the data with an Australian-born s le. Comparative analysis of three multistage population surveys, including s les drawn from a community living in the Mekong Delta region of Vietnam ( n =3039), Vietnamese immigrants residing in New South Wales, Australia ( n =1161), and an Australian-born population ( n =7961). Western-defined mental disorders were assessed by the Composite International Diagnostic Interview (CIDI) 2.0 and included DSM–IV anxiety, mood and substance use disorders as well as the ICD–10 category of neurasthenia. The Vietnamese surveys also applied the indigenously based Phan Vietnamese Psychiatric Scale (PVPS). Functional impairment and service use were assessed. The prevalence of CIDI mental disorders for Mekong Delta Vietnamese was 1.8% compared with 6.1% for Australian Vietnamese and 16.7% for Australians. Inclusion of PVPS mental disorders increased the prevalence rates to 8.8% for Mekong Delta Vietnamese and 11.7% for Australian Vietnamese. Concordance was moderate to good between the CIDI and the PVPS for Australian Vietnamese (area under the curve (AUC)=0.77) but low for Mekong Vietnamese (AUC=0.59). PVPS- and CIDI-defined mental disorders were associated with similar levels of functional impairment. Cultural factors in the expression of mental distress may influence the prevalence rates of mental disorders reported across countries. The findings have implications for assessing mental health needs at an international level.
Patterns of risk for anxiety-depression amongst Vietnamese-immigrants: A comparison with source and host populations
Publisher: Springer Science and Business Media LLC
Date: 12-2013
No Refuge from Terror: The Impact of Detention on the Mental Health of Trauma-affected Refugees Seeking Asylum in Australia
Publisher: SAGE Publications
Date: 09-2007
Abstract: The final decades of the twentieth century were accompanied by an upsurge in the number of persons fleeing persecution and regional wars. To stem the flow of asylum seekers, several countries in the west introduced policies of deterrence, including detention. Although many countries detain asylum seekers, Australia has been unique in establishing a policy of mandatory, indefinite detention. The impact of prolonged detention on the mental health of asylum seekers drew commentary from mental health professionals soon after the policy was introduced, but administrators and politicians disputed the assertion that detention was a factor in causing or exacerbating mental disorder. This overview examines the impact of mandatory, indefinite detention on the mental health of asylum seekers by drawing on evidence gathered during Commissions of Inquiry, from observations of health and mental health professionals who have worked in detention centres, and from the small body of systematic research undertaken among immigration detainees. The data from all sources converge in demonstrating that prolonged detention has adverse mental health and psychosocial impacts on adults, families and children. Recent studies suggest that the mental health effects may be prolonged, extending well beyond the point of release into the community. The Australian experience offers general lessons to health professionals worldwide about the importance of remaining vigilant in protecting the rights of vulnerable groups, and more specifically, to ensure that the traumas that cause mental suffering in refugees are not compounded as a consequence of immigration policy decisions in recipient countries. Documentation and research can be vital in achieving policy change in these settings.
Corrigendum to “A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia” [Soc Sci Med 98 (2013) 106–115]
Publisher: Elsevier BV
Date: 08-2015
A New Methodology for Open Pit Slope Design in Karst-Prone Ground Conditions Based on Integrated Stochastic-Limit Equilibrium Analysis
Publisher: Springer Science and Business Media LLC
Date: 16-02-2016
Corrigendum to “Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies” [Soc. Sci. Med. 72 (2011) 1149–1156]
Publisher: Elsevier BV
Date: 08-2015
Global protection and the health impact of migration interception
Publisher: Public Library of Science (PLoS)
Date: 14-06-2011
Pathways from war trauma to posttraumatic stress symptoms among Tamil asylum seekers, refugees, and immigrants
Publisher: Wiley
Date: 07-1999
Psychology and Forced Migrants
Publisher: Wiley
Date: 04-2011
Families of returned defence force personnel: A changing landscape of challenges
Publisher: SAGE Publications
Date: 08-2015
Abstract: This paper aims to identify the key challenges experienced by the families of defence force personnel following deployment. We undertook a selective review of four post-deployment challenges to the families of defence force personnel: (1) changes to relationships (2) changes to family member roles and responsibilities (3) adjustment of children and parenting challenges and (4) anger, family conflict and violence. Emerging issues in the area of post-deployment adjustment are also discussed. Empirical studies of post-deployment family adjustment are lacking. Each of the reviewed challenges can contribute to psychological difficulties and precipitate contact with mental health services. The challenges faced by defence force personnel when returning from deployment arise within a family context. Clinicians should thoroughly assess these factors in families following deployment, but also recognise family strengths and resilience to these challenges.
Physical activity in the treatment of Post-traumatic stress disorder: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.PSYCHRES.2015.10.017
Abstract: People with PTSD experience high levels of cardiovascular disease and comorbid mental health problems. Physical activity (PA) is an effective intervention in the general population. We conducted the first systematic review and meta-analysis to determine the effect of PA on PTSD. We searched major electronic databases from inception till 03/2015 for RCTs of PA interventions among people with PTSD. A random effects meta-analysis calculating hedges g was conducted. From a potential of 812 hits, four unique RCTs met the inclusion criteria (n=200, mean age of participants 34-52 years). The methodological quality of included trials was satisfactory, and no major adverse events were reported. PA was significantly more effective compared to control conditions at decreasing PTSD and depressive symptoms among people with PTSD. There was insufficient data to investigate the effect on anthropometric or cardiometabolic outcomes. Results suggest that PA may be a useful adjunct to usual care to improve the health of people with PTSD. Although there is a relative paucity of data, there is reason to be optimistic for including PA as an intervention for people with PTSD, particularly given the overwhelming evidence of the benefits of PA in the general population. Robust effectiveness and implementation studies are required.
Physical activity and psychological distress amongst Vietnamese living in the Mekong Delta
Publisher: SAGE Publications
Date: 04-09-2012
Abstract: Regular physical activity may be an important contributor to psychological well-being. This link has not been explored in ethnically distinct, low- and middle-income countries (LMIC), especially in countries affected by war. This study aimed to examine the relationship between physical activity and levels of psychological distress in an epidemiological cross-representative s le of Vietnamese living in the Mekong Delta region of Vietnam. The s le was drawn from an urban (Cần Thơ City) and a rural (Hậ u Giang) region, using a multi-stage probabilistic cluster s ling frame. The measures applied included the Composite International Diagnostic Interview (CIDI 2.0) yielding 12-month prevalence rates of common mental disorders, including anxiety, mood and substance use disorders the Phan Vietnamese Psychiatric Scale (PVPS), a culturally specific self-report measure and the Harvard Trauma Questionnaire. The Global Physical Activity Questionnaire (GPAQ version 1) was used to measure activity. Analyses were conducted using SAS software v.9.1.3. The population was assigned to three (high, moderate and low) physical activity levels. Analyses included chi-square tests and univariable and multivariable logistic models. Physical activity was greater in males, the middle-aged group (30–54 years), those who were married, the rural population, less educated in iduals and those who were employed. High physical activity was significantly associated with low levels of psychological distress (indexed by a combination of CIDI and PVPS cases identified) when controlling for socio-demographic factors and number of medical conditions). Membership of the lowest of the three physical activity groups was associated with a psychological distress odds ratio of 2.19 (95% CI 1.28–3.75). The results remained consistent when analyses were undertaken separately for males and females. Low levels of physical activity appear to be associated with greater psychological distress in the Mekong Delta of Vietnam. The association remained after adjusting for the influence of socio-demographic characteristics, exposure to past trauma, urban–rural residency and the presence of self-reported physical disorders. These data provide a foundation for exploring the role of physical activity as an adjunct to conventional interventions for common mental disorders in resource-poor LMIC countries.
Psychosocial risk and protective factors for depression in the dialysis population: A systematic review and meta-regression analysis
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.JPSYCHORES.2011.05.002
Abstract: Research into the association between psychosocial factors and depression in End-Stage Renal Disease (ESRD) has expanded considerably in recent years identifying a range of factors that may act as important risk and protective factors of depression for this population. The present study provides the first systematic review and meta-analysis of this body of research. Published studies reporting associations between any psychosocial factor and depression were identified and retrieved from Medline, Embase, and PsycINFO, by applying optimised search strategies. Mean effect sizes were calculated for the associations across five psychosocial constructs (social support, personality attributes, cognitive appraisal, coping process, stress/stressor). Multiple hierarchical meta-regression analysis was applied to examine the moderating effects of methodological and substantive factors on the strength of the observed associations. 57 studies covering 58 independent s les with 5956 participants were identified, resulting in 246 effect sizes of the association between a range of psychosocial factors and depression. The overall mean effect size (Pearsons correlation coefficient) of the association between psychosocial factor and depression was 0.36. The effect sizes between the five psychosocial constructs and depression ranged from medium (0.27) to large levels (0.46) with personality attributes (0.46) and cognitive appraisal (0.46) having the largest effect sizes. In the meta-regression analyses, identified demographic (gender, age, location of study) and treatment (type of dialysis) characteristics moderated the strength of the associations with depression. The current analysis documents a moderate to large association between the presence of psychosocial risk factors and depression in ESRD.
Disability and health service utilization associated with psychological distress: The influence of ethnicity
Publisher: Springer Science and Business Media LLC
Date: 09-2005
DOI: 10.1007/S11020-005-5785-2
Abstract: This study examined levels of disability and use of health services, as a result of psychological distress, across various ethnic groups after taking into account selected sociodemographic factors such as age, gender, education, and employment. We have analyzed data from the 1997-1998 New South Wales Health Survey, Australia. A telephone interview of 35,025 adults aged 16 years and over selected from each of the 17 Health Service Areas in the state. While people from non-English speaking backgrounds were more likely to suffer high levels of disability as a result of psychological distress, they were less likely to utilize health services compared to those from English speaking backgrounds. This was particularly true for those born in Southern and South-East Asia as well as the Middle East and Africa. Further research into the reasons underlying these findings for each ethnic group is warranted.
Prevalence and treatment implications of ICD-11 complex PTSD in Australian treatment-seeking current and ex-serving military members
Publisher: Informa UK Limited
Date: 2021
The temporal relationship between posttraumatic stress disorder and problem alcohol use following traumatic injury.
Publisher: American Psychological Association (APA)
Date: 11-2014
DOI: 10.1037/A0037920
Abstract: Chronic alcohol abuse is a major public health concern following trauma exposure however, little is known about the temporal association between posttraumatic stress disorder (PTSD) symptoms and problem alcohol use. The current study examined the temporal relationship between PTSD symptom clusters (re-experiencing, effortful avoidance, emotional numbing, and hyperarousal) and problem alcohol use following trauma exposure. This study was a longitudinal survey of randomly selected traumatic injury patients interviewed at baseline, 3 months, 12 months, and 24 months following injury. Participants were 1,139 injury patients recruited upon admission from 4 Level 1 trauma centers across Australia. Participants were assessed using the Clinician Administered PTSD Scale and Alcohol Use Disorders Identification Test. Results indicated that high levels of re-experiencing, effortful avoidance, and hyperarousal symptoms at 12 months were associated with greater increases (or smaller decreases) in problem alcohol use between 12 and 24 months. Findings also suggested that high levels of problem alcohol use at 12 months were associated with greater increases (or smaller decreases) in emotional numbing symptoms between 12 and 24 months. These findings highlight the critical importance of the chronic period following trauma exposure in the relationship between PTSD symptoms and problem alcohol use.
Predicting the Impact of the 2011 Conflict in Libya on Population Mental Health: PTSD and Depression Prevalence and Mental Health Service Requirements
Publisher: Public Library of Science (PLoS)
Date: 13-07-2012
The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.METABOL.2015.04.009
Abstract: People with posttraumatic stress disorder (PTSD) have a higher mortality than the general population, mainly due to cardiovascular diseases (CVD). Metabolic syndrome (MetS) and its components are highly predictive of CVD. The aim of this meta-analysis was to describe pooled frequencies of MetS and its components in people with PTSD and to compare MetS prevalence in PTSD versus the general population. Medline, PsycARTICLES, Embase and CINAHL were searched until 02/2015 for cross-sectional and baseline data of longitudinal studies in adults with PTSD. Two independent reviewers conducted the searches and extracted data. Random effects meta-analysis with a relative risk, subgroups and meta-regression analyses were employed. Overall, 9 studies met the inclusion criteria including 9,673 in iduals in midlife with PTSD and 6852 general population controls. The pooled MetS prevalence was 38.7% (95% CI = 32.1%-45.6% Q = 52.1, p < 0.001 N = 9 n = 9,673 age range = 44-61 years). Abdominal obesity was observed in 49.3% (95% CI = 29.7%-69.0%), hyperglycemia in 36.1% (95% CI = 18.8%-55.6%), hypertriglyceridemia in 45.9% (95% CI = 12.2%-81.9%), low high density-lipoprotein-cholesterol in 46.4% (95% CI = 26.4%-67.0%) and hypertension in 76.9% (95% CI = 67.9%-84.8%). The MetS prevalence was consistently high across geographical regions, settings or populations (war veterans or not). Compared with matched general population controls, people with PTSD had an almost double increased risk for MetS (RR = 1.82 95% CI = 1.72-1.92 p < 0.001). Most analyses were not statistically heterogeneous. MetS is highly prevalent in people with PTSD. Routine screening and multidisciplinary management of medical and behavioral conditions is needed. Future research should focus on how cardio-metabolic outcomes are moderated by clinical and treatment characteristics and genetic factors.
Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement
Publisher: American Medical Association (AMA)
Date: 05-08-2009
Abstract: Uncertainties continue about the roles that methodological factors and key risk factors, particularly torture and other potentially traumatic events (PTEs), play in the variation of reported prevalence rates of posttraumatic stress disorder (PTSD) and depression across epidemiologic surveys among postconflict populations worldwide. To undertake a systematic review and meta-regression of the prevalence rates of PTSD and depression in the refugee and postconflict mental health field. An initial pool of 5904 articles, identified through MEDLINE, PsycINFO and PILOTS, of surveys involving refugee, conflict-affected populations, or both, published in English-language journals between 1980 and May 2009. Surveys were limited to those of adult populations (n > or = 50) reporting PTSD prevalence, depression prevalence, or both. Excluded surveys comprised patients, war veterans, and civilian populations (nonrefugees/asylum seekers) from high-income countries exposed to terrorist attacks or involved in distal conflicts (> or = 25 years). Methodological factors (response rate, s le size and design, diagnostic method) and substantive factors (sociodemographics, place of survey, torture and other PTEs, Political Terror Scale score, residency status, time since conflict). A total of 161 articles reporting results of 181 surveys comprising 81,866 refugees and other conflict-affected persons from 40 countries were identified. Rates of reported PTSD and depression showed large intersurvey variability (0%-99% and 3%-85.5%, respectively). The unadjusted weighted prevalence rate reported across all surveys for PTSD was 30.6% (95% CI, 26.3%-35.2%) and for depression was 30.8% (95% CI, 26.3%-35.6%). Methodological factors accounted for 12.9% and 27.7% PTSD and depression, respectively. Nonrandom s ling, small s le sizes, and self-report questionnaires were associated with higher rates of mental disorder. Adjusting for methodological factors, reported torture (Delta total R(2) between base methodological model and base model + substantive factor [DeltaR(2)] = 23.6% OR, 2.01 95% CI, 1.52-2.65) emerged as the strongest factor associated with PTSD, followed by cumulative exposure to PTEs (DeltaR(2) = 10.8% OR, 1.52 95% CI, 1.21-1.91), time since conflict (DeltaR(2) = 10% OR, 0.77 95% CI, 0.66-0.91), and assessed level of political terror (DeltaR(2) = 3.5% OR, 1.60 95% CI, 1.03-2.50). For depression, significant factors were number of PTEs (DeltaR(2) = 22.0% OR, 1.64 95% CI, 1.39-1.93), time since conflict (DeltaR(2) = 21.9% OR, 0.80 95% CI, 0.69-0.93), reported torture (DeltaR(2) = 11.4% OR, 1.48 95% CI, 1.07-2.04), and residency status (DeltaR(2) = 5.0% OR, 1.30 95% CI, 1.07-1.57). Methodological factors and substantive population risk factors, such as exposure to torture and other PTEs, after adjusting for methodological factors account for higher rates of reported prevalence of PTSD and depression.
Lifetime Prevalence of Gender-Based Violence in Women and the Relationship With Mental Disorders and Psychosocial Function
Publisher: American Medical Association (AMA)
Date: 03-08-2011
Abstract: Intimate partner physical violence, rape, sexual assault, and stalking are pervasive and co-occurring forms of gender-based violence (GBV). An association between these forms of abuse and lifetime mental disorder and psychosocial disability among women needs to be examined. To assess the association of GBV and mental disorder, its severity and comorbidity, and psychosocial functioning among women. A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007, of 4451 women (65% response rate) aged 16 to 85 years. The Composite International Diagnostic Interview version 3.0 of the World Health Organization's World Mental Health Survey Initiative was used to assess lifetime prevalence of any mental disorder, anxiety, mood disorder, substance use disorder, and posttraumatic stress disorder (PTSD). Also included were indices of lifetime trauma exposure, including GBV, sociodemographic characteristics, economic status, family history of mental disorder, social supports, general mental and physical functioning, quality of life, and overall disability. A total of 1218 women (27.4%) reported experiencing at least 1 type of GBV. For women exposed to 3 or 4 types of GBV (n = 139), the rates of mental disorders were 77.3% (odds ratio [OR], 10.06 95% confidence interval [CI], 5.85-17.30) for anxiety disorders, 52.5% (OR, 3.59 95% CI, 2.31-5.60) for mood disorder, 47.1% (OR, 5.61 95% CI, 3.46-9.10) for substance use disorder, 56.2% (OR, 15.90 95% CI, 8.32-30.20) for PTSD, 89.4% (OR, 11.00 95% CI, 5.46-22.17) for any mental disorder, and 34.7% (OR, 14.80 95% CI, 6.89-31.60) for suicide attempts. Gender-based violence was associated with more severe current mental disorder (OR, 4.60 95% CI, 2.93-7.22), higher rates of 3 or more lifetime disorders (OR, 7.79 95% CI, 6.10-9.95), physical disability (OR, 4.00 95% CI, 1.82-8.82), mental disability (OR, 7.14 95% CI, 2.87-17.75), impaired quality of life (OR, 2.96 95% CI, 1.60-5.47), an increase in disability days (OR, 3.14 95% CI, 2.43-4.05), and overall disability (OR, 2.73 95% CI, 1.99-3.75). Among a nationally representative s le of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.
Modeling the Progressive Failure of Jointed Rock Slope Using Fracture Mechanics and the Strength Reduction Method
Publisher: Springer Science and Business Media LLC
Date: 21-05-2014
Clustering of symptoms of mental disorder in the medium-term following conflict: An epidemiological study in Timor-Leste
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.PSYCHRES.2014.05.043
Abstract: It is important to define subpopulations with mental health and psychosocial reactions in the medium-term following conflict to ensure that an appropriate array of services are provided to meet the ersity of needs. We conducted a latent class analysis (LCA) on epidemiological data drawn from an urban and rural s le of 1221 adults (581 men and 640 women, response 82%) in post-conflict Timor Leste 4 years after the cessation of violence. The prevalence of PTSD was 4.9% severe distress 4.8% anger attacks 38.3% and paranoid-like symptoms 10.9%. The best fitting LCA yielded three classes comprising those with no or minimal symptoms (86%), a class with anger-paranoia (13%) and a comorbid mental disorder class (1.5%) characterized by PTSD (100%) and severe distress (98%). The comorbid mental disorder class had an over-representation of men, the unemployed, residents in the urban area and persons with the greatest exposure to human rights trauma, murder and health stress. The anger-paranoia class experienced moderate levels of trauma and had an over-representation of urban dwellers, women, and those with higher levels of education. The analysis assists in clarifying the populations with mental disorder and adverse psychosocial reactions in need of intervention in the medium-term following conflict.
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