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Post-Traumatic Stress Disorders: HELP
Articles by Derrick M. Silove
Based on 89 articles published since 2010
(Why 89 articles?)
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Between 2010 and 2020, D. Silove wrote the following 89 articles about Stress Disorders, Post-Traumatic.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial Do conflict-affected societies need psychiatrists? 2012

Silove, Derrick. · ·Br J Psychiatry · Pubmed #23028081.

ABSTRACT: Symptoms of post-traumatic stress disorder (PTSD), anxiety and depression are prevalent among post-conflict populations worldwide but controversy about the cultural meaning of these symptoms, particularly in relation to PTSD, adds to the challenge for psychiatry in mounting appropriate intervention programmes. Accumulating scientific evidence assists in guiding the focus and scope of emergency mental health programmes, initiatives that can become the vanguard of mental health development and reform for countries recovering from conflict.

2 Review From pioneers to scientists: challenges in establishing evidence-gathering models in torture and trauma mental health services for refugees. 2014

Carlsson, Jessica / Sonne, Charlotte / Silove, Derrick. ·*Competence Centre for Transcultural Psychiatry, Psychiatric Centre Ballerup, the Mental Health Services of the Capital Region of Denmark, Ballerup; †Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; and ‡Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia. ·J Nerv Ment Dis · Pubmed #25167130.

ABSTRACT: Outcome studies on treatment of trauma-affected refugees have been published but are limited in design and quality. In this article, we discuss possible impediments to pursuing research aimed at gathering evidence to support the efficacy of treatments in the field and the challenges in carrying out such inquiries. We then present a working model that demonstrates the feasibility of integrating outcome research into clinical settings. The aim of this model is to involve all personnel in generating research of high quality with minimal additional costs and time commitment. We conclude that although challenges remain in carrying out treatment outcome studies, they can be overcome by careful consultation and negotiation in a setting with an established ethos of commitment to the scientific endeavor. Ultimately, identifying the most effective interventions will provide better treatment and quality of life for the large number of traumatized refugees seeking assistance for mental health problems.

3 Review Predicting the impact of the 2011 conflict in Libya on population mental health: PTSD and depression prevalence and mental health service requirements. 2012

Charlson, Fiona J / Steel, Zachary / Degenhardt, Louisa / Chey, Tien / Silove, Derrick / Marnane, Claire / Whiteford, Harvey A. ·School of Population Health, University of Queensland, Herston, Queensland, Australia. ·PLoS One · Pubmed #22808201.

ABSTRACT: BACKGROUND: Mental disorders are likely to be elevated in the Libyan population during the post-conflict period. We estimated cases of severe PTSD and depression and related health service requirements using modelling from existing epidemiological data and current recommended mental health service targets in low and middle income countries (LMIC's). METHODS: Post-conflict prevalence estimates were derived from models based on a previously conducted systematic review and meta-regression analysis of mental health among populations living in conflict. Political terror ratings and intensity of exposure to traumatic events were used in predictive models. Prevalence of severe cases was applied to chosen populations along with uncertainty ranges. Six populations deemed to be affected by the conflict were chosen for modelling: Misrata (population of 444,812), Benghazi (pop. 674,094), Zintan (pop. 40,000), displaced people within Tripoli/Zlitan (pop. 49,000), displaced people within Misrata (pop. 25,000) and Ras Jdir camps (pop. 3,700). Proposed targets for service coverage, resource utilisation and full-time equivalent staffing for management of severe cases of major depression and post-traumatic stress disorder (PTSD) are based on a published model for LMIC's. FINDINGS: Severe PTSD prevalence in populations exposed to a high level of political terror and traumatic events was estimated at 12.4% (95%CI 8.5-16.7) and was 19.8% (95%CI 14.0-26.3) for severe depression. Across all six populations (total population 1,236,600), the conflict could be associated with 123,200 (71,600-182,400) cases of severe PTSD and 228,100 (134,000-344,200) cases of severe depression; 50% of PTSD cases were estimated to co-occur with severe depression. Based upon service coverage targets, approximately 154 full-time equivalent staff would be required to respond to these cases sufficiently which is substantially below the current level of resource estimates for these regions. DISCUSSION: This is the first attempt to predict the mental health burden and consequent service response needs of such a conflict, and is crucially timed for Libya.

4 Review A critical review of psychological treatments of posttraumatic stress disorder in refugees. 2011

Nickerson, Angela / Bryant, Richard A / Silove, Derrick / Steel, Zachary. ·School of Psychology, University of New South Wales, NSW 2052, Australia. ·Clin Psychol Rev · Pubmed #21112681.

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.

5 Article International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci. 2019

Nievergelt, Caroline M / Maihofer, Adam X / Klengel, Torsten / Atkinson, Elizabeth G / Chen, Chia-Yen / Choi, Karmel W / Coleman, Jonathan R I / Dalvie, Shareefa / Duncan, Laramie E / Gelernter, Joel / Levey, Daniel F / Logue, Mark W / Polimanti, Renato / Provost, Allison C / Ratanatharathorn, Andrew / Stein, Murray B / Torres, Katy / Aiello, Allison E / Almli, Lynn M / Amstadter, Ananda B / Andersen, Søren B / Andreassen, Ole A / Arbisi, Paul A / Ashley-Koch, Allison E / Austin, S Bryn / Avdibegovic, Esmina / Babić, Dragan / Bækvad-Hansen, Marie / Baker, Dewleen G / Beckham, Jean C / Bierut, Laura J / Bisson, Jonathan I / Boks, Marco P / Bolger, Elizabeth A / Børglum, Anders D / Bradley, Bekh / Brashear, Megan / Breen, Gerome / Bryant, Richard A / Bustamante, Angela C / Bybjerg-Grauholm, Jonas / Calabrese, Joseph R / Caldas-de-Almeida, José M / Dale, Anders M / Daly, Mark J / Daskalakis, Nikolaos P / Deckert, Jürgen / Delahanty, Douglas L / Dennis, Michelle F / Disner, Seth G / Domschke, Katharina / Dzubur-Kulenovic, Alma / Erbes, Christopher R / Evans, Alexandra / Farrer, Lindsay A / Feeny, Norah C / Flory, Janine D / Forbes, David / Franz, Carol E / Galea, Sandro / Garrett, Melanie E / Gelaye, Bizu / Geuze, Elbert / Gillespie, Charles / Uka, Aferdita Goci / Gordon, Scott D / Guffanti, Guia / Hammamieh, Rasha / Harnal, Supriya / Hauser, Michael A / Heath, Andrew C / Hemmings, Sian M J / Hougaard, David Michael / Jakovljevic, Miro / Jett, Marti / Johnson, Eric Otto / Jones, Ian / Jovanovic, Tanja / Qin, Xue-Jun / Junglen, Angela G / Karstoft, Karen-Inge / Kaufman, Milissa L / Kessler, Ronald C / Khan, Alaptagin / Kimbrel, Nathan A / King, Anthony P / Koen, Nastassja / Kranzler, Henry R / Kremen, William S / Lawford, Bruce R / Lebois, Lauren A M / Lewis, Catrin E / Linnstaedt, Sarah D / Lori, Adriana / Lugonja, Bozo / Luykx, Jurjen J / Lyons, Michael J / Maples-Keller, Jessica / Marmar, Charles / Martin, Alicia R / Martin, Nicholas G / Maurer, Douglas / Mavissakalian, Matig R / McFarlane, Alexander / McGlinchey, Regina E / McLaughlin, Katie A / McLean, Samuel A / McLeay, Sarah / Mehta, Divya / Milberg, William P / Miller, Mark W / Morey, Rajendra A / Morris, Charles Phillip / Mors, Ole / Mortensen, Preben B / Neale, Benjamin M / Nelson, Elliot C / Nordentoft, Merete / Norman, Sonya B / O'Donnell, Meaghan / Orcutt, Holly K / Panizzon, Matthew S / Peters, Edward S / Peterson, Alan L / Peverill, Matthew / Pietrzak, Robert H / Polusny, Melissa A / Rice, John P / Ripke, Stephan / Risbrough, Victoria B / Roberts, Andrea L / Rothbaum, Alex O / Rothbaum, Barbara O / Roy-Byrne, Peter / Ruggiero, Ken / Rung, Ariane / Rutten, Bart P F / Saccone, Nancy L / Sanchez, Sixto E / Schijven, Dick / Seedat, Soraya / Seligowski, Antonia V / Seng, Julia S / Sheerin, Christina M / Silove, Derrick / Smith, Alicia K / Smoller, Jordan W / Sponheim, Scott R / Stein, Dan J / Stevens, Jennifer S / Sumner, Jennifer A / Teicher, Martin H / Thompson, Wesley K / Trapido, Edward / Uddin, Monica / Ursano, Robert J / van den Heuvel, Leigh Luella / Van Hooff, Miranda / Vermetten, Eric / Vinkers, Christiaan H / Voisey, Joanne / Wang, Yunpeng / Wang, Zhewu / Werge, Thomas / Williams, Michelle A / Williamson, Douglas E / Winternitz, Sherry / Wolf, Christiane / Wolf, Erika J / Wolff, Jonathan D / Yehuda, Rachel / Young, Ross McD / Young, Keith A / Zhao, Hongyu / Zoellner, Lori A / Liberzon, Israel / Ressler, Kerry J / Haas, Magali / Koenen, Karestan C. ·University of California San Diego, Department of Psychiatry, La Jolla, CA, USA. cnievergelt@ucsd.edu. · Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA. cnievergelt@ucsd.edu. · Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA. cnievergelt@ucsd.edu. · University of California San Diego, Department of Psychiatry, La Jolla, CA, USA. · Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA. · Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA. · Harvard Medical School, Department of Psychiatry, Boston, MA, USA. · McLean Hospital, Belmont, MA, USA. · University Medical Center Goettingen, Department of Psychiatry, Göttingen, DE, Germany. · Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA, USA. · Massachusetts General Hospital, Analytic and Translational Genetics Unit, Boston, MA, USA. · Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA, USA. · Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA. · Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA. · King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, GB, USA. · King's College London, NIHR BRC at the Maudsley, London, GB, USA. · University of Cape Town, SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Cape Town, Western Cape, ZA, USA. · Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA. · US Department of Veterans Affairs, Department of Psychiatry, West Haven, CT, USA. · Yale University School of Medicine, Department of Genetics and Neuroscience, New Haven, CT, USA. · VA Connecticut Healthcare Center, West Haven, CT, USA. · Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA. · VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA. · Cohen Veterans Bioscience, Cambridge, MA, USA. · Veterans Affairs San Diego Healthcare System, Million Veteran Program, San Diego, CA, USA. · Veterans Affairs San Diego Healthcare System, Psychiatry Service, San Diego, CA, USA. · Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA. · Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA. · Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Richmond, VA, USA. · The Danish Veteran Centre, Research and Knowledge Centre, Ringsted, Sjaelland, Denmark. · University of Oslo, Institute of Clinical Medicine, Oslo, NO, Norway. · Minneapolis VA Health Care System, Mental Health Service Line, Minneapolis, MN, USA. · Duke University, Duke Molecular Physiology Institute, Durham, NC, USA. · Boston Children's Hospital, Division of Adolescent and Young Adult Medicine, Boston, MA, USA. · Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA, USA. · Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA. · University Clinical Center of Tuzla, Department of Psychiatry, Tuzla, BA, Bosnia and Herzegovina. · University Clinical Center of Mostar, Department of Psychiatry, Mostar, BA, Bosnia and Herzegovina. · Statens Serum Institut, Department for Congenital Disorders, Copenhagen, DK, Denmark. · The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, DK, Denmark. · Durham VA Medical Center, Research, Durham, NC, USA. · Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA. · VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, USA. · Washington University in Saint Louis School of Medicine, Department of Psychiatry, Saint Louis, MO, USA. · Cardiff University, National Centre for Mental Health, MRC Centre for Psychiatric Genetics and Genomics, Cardiff, UK. · UMC Utrecht Brain Center Rudolf Magnus, Department of Translational Neuroscience, Utrecht, Utrecht, NL, Netherlands. · Aarhus University, Centre for Integrative Sequencing, iSEQ, Aarhus, DK, Denmark. · Aarhus University, Department of Biomedicine - Human Genetics, Aarhus, DK, Denmark. · Atlanta VA Health Care System, Mental Health Service Line, Decatur, GA, USA. · Louisiana State University Health Sciences Center, School of Public Health and Department of Epidemiology, New Orleans, LA, USA. · University of New South Wales, Department of Psychology, Sydney, NSW, Australia. · University of Michigan Medical School, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI, USA. · University Hospitals, Department of Psychiatry, Cleveland, OH, USA. · CEDOC -Chronic Diseases Research Centre, Lisbon Institute of Global Mental Health, Lisbon, PT, Portugal. · University of California San Diego, Department of Radiology, Department of Neurosciences, La Jolla, CA, USA. · Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA. · University Hospital of Würzburg, Center of Mental Health, Psychiatry, Psychosomatics and Psychotherapy, Würzburg, DE, Germany. · Kent State University, Department of Psychological Sciences, Kent, OH, USA. · Kent State University, Research and Sponsored Programs, Kent, OH, USA. · Minneapolis VA Health Care System, Research Service Line, Minneapolis, MN, USA. · Medical Center-University of Freiburg, Faculty of Medicine, Department of Psychiatry and Psychotherapy, Freiburg, DE, Germany. · University of Freiburg, Faculty of Medicine, Centre for Basics in Neuromodulation, Freiburg, DE, Germany. · University Clinical Center of Sarajevo, Department of Psychiatry, Sarajevo, BA, Bosnia and Herzegovina. · University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA. · Minneapolis VA Health Care System, Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis, MN, USA. · Cardiff University, National Centre for Mental Health, MRC Centre for Psychiatric Genetics and Genomics, Cardiff, South Glamorgan, GB, USA. · Boston University School of Medicine, Department of Medicine, Boston, MA, USA. · Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA. · University of Melbourne, Department of Psychiatry, Melbourne, VIC, AU, USA. · Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA. · Netherlands Ministry of Defence, Brain Research and Innovation Centre, Utrecht, Utrecht, NL, Netherlands. · UMC Utrecht Brain Center Rudolf Magnus, Department of Psychiatry, Utrecht, Utrecht, NL, Netherlands. · University Clinical Centre of Kosovo, Department of Psychiatry, Prishtina, Kosovo, XK, USA. · QIMR Berghofer Medical Research Institute, Department of Genetics and Computational Biology, Brisbane, Queensland, Australia. · US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, MD, USA. · Washington University in Saint Louis School of Medicine, Department of Genetics, Saint Louis, MO, USA. · Stellenbosch University Faculty of Medicine and Health Sciences, Department of Psychiatry, Cape Town, Western Cape, ZA, South Africa. · University Hospital Center of Zagreb, Department of Psychiatry, Zagreb, HR, USA. · RTI International, Behavioral Health and Criminal Justice Division, Research Triangle Park, NC, USA. · University of Copenhagen, Department of Psychology, Copenhagen, DK, Denmark. · Harvard Medical School, Department of Health Care Policy, Boston, MA, USA. · University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA. · University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA. · Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA, USA. · Queensland University of Technology, Institute of Health and Biomedical Innovation, Kelvin Grove, QLD, AU, Australia. · Queensland University of Technology, School of Biomedical Sciences, Kelvin Grove, QLD, AU, Australia. · UNC Institute for Trauma Recovery, Department of Anesthesiology, Chapel Hill, NC, USA. · Emory University, Department of Gynecology and Obstetrics, Atlanta, GA, USA. · Boston University, Dean's Office, Boston, MA, USA. · New York University School of Medicine, Department of Psychiatry, New York, NY, USA. · United States Army, Command, Fort Sill, OK, USA. · University of Adelaide, Department of Psychiatry, Adelaide, South Australia, AU, Australia. · VA Boston Health Care System, GRECC/TRACTS, Boston, MA, USA. · Harvard University, Department of Psychology, Boston, MA, USA. · UNC Institute for Trauma Recovery, Department of Emergency Medicine, Chapel Hill, NC, USA. · Gallipoli Medical Research Institute, PTSD Initiative, Greenslopes, Queensland, AU, Australia. · Queensland University of Technology, School of Psychology and Counseling, Faculty of Health, Kelvin Grove, QLD, AU, Australia. · Aarhus University Hospital, Psychosis Research Unit, Risskov, DK, Denmark. · Aarhus University, Centre for Integrated Register-based Research, Aarhus, DK, Denmark. · Aarhus University, National Centre for Register-Based Research, Aarhus, DK, Denmark. · University of Copenhagen, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, DK, Denmark. · Veterans Affairs San Diego Healthcare System, Department of Research and Psychiatry, San Diego, CA, USA. · National Center for Post Traumatic Stress Disorder, Executive Division, White River Junction, San Diego, VT, USA. · Northern Illinois University, Department of Psychology, DeKalb, IL, USA. · University of Texas Health Science Center at San Antonio, Department of Psychiatry, San Antonio, TX, USA. · University of Washington, Department of Psychology, Seattle, WA, USA. · U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, USA. · Minneapolis VA Health Care System, Department of Mental Health, Minneapolis, MN, USA. · Minneapolis VA Health Care System, Department of Psychology, Minneapolis, MN, USA. · Charité - Universitätsmedizin, Department of Psychiatry and Psychotherapy, Berlin, GE, Germany. · Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, USA. · Medical University of South Carolina, Department of Nursing and Department of Psychiatry, Charleston, SC, USA. · Maastricht Universitair Medisch Centrum, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, Limburg, NL, Netherlands. · Universidad Peruana de Ciencias Aplicadas Facultad de Ciencias de la Salud, Department of Medicine, Lima, Lima, PE, USA. · University of Michigan, School of Nursing, Ann Arbor, MI, USA. · University of New South Wales, Department of Psychiatry, Sydney, NSW, AU, USA. · Columbia University Medical Center, Department of Medicine, New York, NY, USA. · Mental Health Centre Sct. Hans, Institute of Biological Psychiatry, Roskilde, DK, Denmark. · Oslo University Hospital, KG Jebsen Centre for Psychosis Research, Norway Division of Mental Health and Addiction, Oslo, NO, USA. · University of South Florida College of Public Health, Genomics Program, Tampa, FL, USA. · Uniformed Services University, Department of Psychiatry, Bethesda, Maryland, USA. · Arq, Psychotrauma Reseach Expert Group, Diemen, NH, Netherlands. · Leiden University Medical Center, Department of Psychiatry, Leiden, ZH, NL, Netherlands. · Netherlands Defense Department, Research Center, Utrecht, UT, Netherlands. · Amsterdam UMC (location VUmc), Department of Anatomy and Neurosciences, Amsterdam, Holland, NL, Netherlands. · Amsterdam UMC (location VUmc), Department of Psychiatry, Amsterdam, Holland, NL, Netherlands. · Ralph H Johnson VA Medical Center, Department of Mental Health, Charleston, SC, USA. · Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA. · University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark. · James J Peters VA Medical Center, Department of Mental Health, Bronx, NY, USA. · Baylor Scott and White Central Texas, Department of Psychiatry, Temple, TX, USA. · CTVHCS, COE for Research on Returning War Veterans, Waco, TX, USA. · Yale University, Department of Biostatistics, New Haven, CT, USA. · University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA. · Harvard School of Public Health, Department of Epidemiology, Boston, MA, USA. ·Nat Commun · Pubmed #31594949.

ABSTRACT: The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5-20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson's disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations.

6 Article Functional impairment as a proxy measure indicating high rates of trauma exposure, post-migration living difficulties, common mental disorders, and poor health amongst Rohingya refugees in Malaysia. 2019

Tay, Alvin Kuowei / Rees, Susan / Miah, Mohammed Abdul Awal / Khan, Sanjida / Badrudduza, Mohammad / Morgan, Karen / Fadil Azim, Darlina / Balasundaram, Susheela / Silove, Derrick. ·Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia. alvin.tay@unsw.edu.au. · Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia. · Department of Psychology, Jagannath University, Dhaka, Bangladesh. · School of Medicine, Perdana University-Royal College of Surgeons in Ireland (PU-RCSI), Selangor, Malaysia. · Health Unit, United Nations High Commissioner for Refugees (UNHCR), Kuala Lumpur, Malaysia. ·Transl Psychiatry · Pubmed #31477686.

ABSTRACT: A major challenge in the refugee field is to ensure that scarce mental health resources are directed to those in greatest need. Based on data from an epidemiological survey of 959 adult Rohingya refugees in Malaysia (response rate: 83%), we examine whether a brief screening instrument of functional impairment, the WHO Disability Assessment Schedule (WHODAS), prove useful as a proxy measure to identify refugees who typically attend community mental health services. Based on estimates of mental disorder requiring interventions from analyses of epidemiological studies conducted worldwide, we selected a WHODAS cutoff that identified the top one-fifth of refugees according to severity of functional impairment, the remainder being distributed to moderate and lower impairment groupings, respectively. Compared to the lower impairment grouping, the severe impairment category comprised more boat arrivals (AOR: 5.96 [95% CI 1.34-26.43); stateless persons (A20·11 [95% CI 7.14-10); those with high exposure to pre-migration traumas (AOR: 4.76 [95% CI 1.64-13.73), peri-migration stressors (AOR: 1.26 [95% CI 1.14-1.39]) and postmigration living difficulties (AOR: 1.43 [95% CI 1.32-1.55); persons with single (AOR: 7.48 [95% CI 4.25-13.17]) and comorbid (AOR: 13.54 [95% CI 6.22-29.45]) common mental disorders; and those reporting poorer general health (AOR: 2.23 [95% CI 1-5.02]). In addition, half of the severe impairment grouping (50.6%) expressed suicidal ideas compared to one in six (16.2 percent) of the lower impairment grouping (OR: 2.39 [95% CI 1.94-2.93]). Differences between the severe and moderate impairment groups were similar but less extreme. In settings where large-scale epidemiological studies are not feasible, the WHODAS may serve as readily administered and brief public health screening tool that assists in stratifying the population according to urgency of mental health needs.

7 Article Theoretical background, first stage development and adaptation of a novel Integrative Adapt Therapy (IAT) for refugees. 2019

Tay, A K / Miah, M A A / Khan, S / Badrudduza, M / Morgan, K / Balasundaram, S / Silove, D. ·School of Psychiatry, University of New South Wales Sydney, Australia. · Perdana University-Royal College of Surgeons in Ireland (PU-RCSI) School of Medicine, Selangor, Malaysia. · Department of Psychology, Jagannath University, Dhaka, Bangladesh. · Health Unit, United Nations High Commissioner for Refugees (UNHCR), Kuala Lumpur, Malaysia. ·Epidemiol Psychiatr Sci · Pubmed #31441397.

ABSTRACT: AIMS: Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar. METHODS: A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia. RESULTS: The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia. CONCLUSIONS: IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.

8 Article Identifying distinctive psychological symptom profiles among a nationally representative sample of refugees resettled in Australia. 2019

Nickerson, Angela / Hadzi-Pavlovic, Dusan / Edwards, Ben / O'Donnell, Meaghan / Creamer, Mark / Felmingham, Kim L / Forbes, David / McFarlane, Alexander C / Silove, Derrick / Steel, Zachary / van Hoof, Miranda / Bryant, Richard A. ·1 School of Psychology, University of New South Wales, Sydney, NSW, Australia. · 2 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. · 3 Centre for Social Research & Methods, The Australian National University, Canberra, ACT, Australia. · 4 Phoenix Australia, University of Melbourne, Melbourne, VIC, Australia. · 5 School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia. · 6 Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia. · 7 St John of God Health Care, Richmond Hospital, North Richmond, NSW, Australia. ·Aust N Z J Psychiatry · Pubmed #31032626.

ABSTRACT: OBJECTIVE: The number of refugees worldwide is unprecedented in recent history. Little is known, however, about profiles of psychological symptoms following persecution and displacement. METHODS: This study reports on a latent class analysis that identified profiles of posttraumatic stress disorder (PTSD), depression and anxiety symptoms in a nationally representative sample of 1625 refugees in Australia. The association between specific symptom profiles, exposure to potentially traumatic events and post-migration stressors, and overall health and help-seeking was examined. RESULTS: Latent class analysis yielded an optimal five-class solution. These classes comprised the Pervasive Symptom class (19.2%), the High PTSD Symptom class (17.1%), the High Depression/Anxiety Symptom class (16.4%), the Moderate PTSD Symptom class (16.2%) and the Low Symptom class (31.1%). Participants in the symptomatic classes were more likely to be female, older and report greater post-migration stressors than those in the Low Symptom class. In addition, individuals in classes characterized by PTSD symptoms had been exposed to more types of potentially traumatic events. Membership in symptomatic classes was associated with poorer overall heath and greater help-seeking. CONCLUSION: Qualitatively distinct symptom profiles were observed in a nationally representative sample of refugees. In addition to a group of people who reported high symptoms across psychological disorders and may warrant clinical intervention, we identified two subclinical classes who may be missed by existing diagnostic classification systems. Post-migration stressors play an important role in influencing refugee symptom profiles over and above exposure to potentially traumatic events. Clinicians should consider specific symptom profiles and contextual factors when planning interventions with refugees.

9 Article The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review. 2019

Tay, A K / Riley, A / Islam, R / Welton-Mitchell, C / Duchesne, B / Waters, V / Varner, A / Moussa, B / Mahmudul Alam, A N M / Elshazly, M A / Silove, D / Ventevogel, P. ·School of Psychiatry, University of New South Wales, Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, Sydney, Australia. · Independent consultant. · Institute of Behavioural Science, University of Colorado, Boulder, USA. · Environmental and Occupational Health, Public Health Preparedness and Disaster Response, Colorado School of Public Health, Aurora, CO, USA. · Danish Refugee Council, Cox's Bazar, Bangladesh. · World Concern, Seattle, WA, USA. · Mental Health & Psychosocial Support Team, Public Health & Nutrition Unit, United Nations High Commissioner for Refugees, Cox's Bazar, Bangladesh. · Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland. ·Epidemiol Psychiatr Sci · Pubmed #31006421.

ABSTRACT: AIMS: Despite the magnitude and protracted nature of the Rohingya refugee situation, there is limited information on the culture, mental health and psychosocial wellbeing of this group. This paper, drawing on a report commissioned by the United Nations High Commissioner for Refugees (UNHCR), aims to provide a comprehensive synthesis of the literature on mental health and psychosocial wellbeing of Rohingya refugees, including an examination of associated cultural factors. The ultimate objective is to assist humanitarian actors and agencies in providing culturally relevant Mental Health and Psychosocial Support (MHPSS) for Rohingya refugees displaced to Bangladesh and other neighbouring countries. METHODS: We conducted a systematic search across multiple sources of information with reference to the contextual, social, economic, cultural, mental health and health-related factors amongst Rohingya refugees living in the Asia-Pacific and other regions. The search covered online databases of diverse disciplines (e.g. medicine, psychology, anthropology), grey literature, as well as unpublished reports from non-profit organisations and United Nations agencies published until 2018. RESULTS: The legacy of prolonged exposure to conflict and persecution compounded by protracted conditions of deprivations and displacement is likely to increase the refugees' vulnerability to wide array of mental health problems including posttraumatic stress disorder, anxiety, depression and suicidal ideation. High rates of sexual and gender-based violence, lack of privacy and safe spaces and limited access to integrated psychosocial and mental health support remain issues of concern within the emergency operation in Bangladesh. Another challenge is the limited understanding amongst the MHPSS personnel in Bangladesh and elsewhere of the language, culture and help-seeking behaviour of Rohingya refugees. While the Rohingya language has a considerable vocabulary for emotional and behavioural problems, there is limited correspondence between these Rohingya terms and western concepts of mental disorders. This hampers the provision of culturally sensitive and contextually relevant MHPSS services to these refugees. CONCLUSIONS: The knowledge about the culture, context, migration history, idioms of distress, help-seeking behaviour and traditional healing methods, obtained from diverse sources can be applied in the design and delivery of culturally appropriate interventions. Attention to past exposure to traumatic events and losses need to be paired with attention for ongoing stressors and issues related to worries about the future. It is important to design MHPSS interventions in ways that mobilise the individual and collective strengths of Rohingya refugees and build on their resilience.

10 Article Longitudinal association between trust, psychological symptoms and community engagement in resettled refugees. 2019

Nickerson, Angela / Liddell, Belinda J / Keegan, David / Edwards, Ben / Felmingham, Kim L / Forbes, David / Hadzi-Pavlovic, Dusan / McFarlane, Alexander C / O'Donnell, Meaghan / Silove, Derrick / Steel, Zachary / van Hooff, Miranda / Bryant, Richard A. ·School of Psychology,University of New South Wales,Sydney,Australia. · HOST International,Sydney,Australia. · Centre for Social Research, The Australian National University,Canberra,Australia. · School of Psychological Sciences, University of Melbourne,Melbourne,Victoria,Australia. · Department of Psychiatry,University of Melbourne,Parkville,Victoria,Australia. · The Centre for Traumatic Stress, University of Adelaide,Adelaide,SouthAustralia,Australia. · School of Psychiatry,University of New South Wales,Sydney,Australia. ·Psychol Med · Pubmed #30160232.

ABSTRACT: BACKGROUND: The mental health and social functioning of millions of forcibly displaced individuals worldwide represents a key public health priority for host governments. This is the first longitudinal study with a representative sample to examine the impact of interpersonal trust and psychological symptoms on community engagement in refugees. METHODS: Participants were 1894 resettled refugees, assessed within 6 months of receiving a permanent visa in Australia, and again 2-3 years later. Variables measured included post-traumatic stress disorder symptoms, depression/anxiety symptoms, interpersonal trust and engagement with refugees' own and other communities. RESULTS: A multilevel path analysis was conducted, with the final model evidencing good fit (Comparative Fit Index = 0.97, Tucker-Lewis Index = 0.89, Root Mean Square Error of Approximation = 0.05, Standardized Root-Mean-Square-Residual = 0.05). Findings revealed that high levels of depression symptoms were associated with lower subsequent engagement with refugees' own communities. In contrast, low levels of interpersonal trust were associated with lower engagement with the host community over the same timeframe. CONCLUSIONS: Findings point to differential pathways to social engagement in the medium-term post-resettlement. Results indicate that depression symptoms are linked to reduced engagement with one's own community, while interpersonal trust is implicated in engagement with the broader community in the host country. These findings have potentially important implications for policy and clinical practice, suggesting that clinical and support services should target psychological symptoms and interpersonal processes when fostering positive adaptation in resettled refugees.

11 Article Defining a combined constellation of complicated bereavement and PTSD and the psychosocial correlates associated with the pattern amongst refugees from West Papua. 2019

Tay, Alvin Kuowei / Rees, Susan / Tam, Natalino / Kareth, Moses / Silove, Derrick. ·Centre for Population Mental Health Research, Liverpool Hospital, Psychiatry, Research and Teaching Unit, School of Psychiatry, University of New South Wales,Cnr Forbes and Campbell Streets, Liverpool NSW 2170, Sydney,Australia. ·Psychol Med · Pubmed #30149819.

ABSTRACT: BACKGROUND: Refugees are at risk of experiencing a combined constellation of complicated bereavement and posttraumatic stress disorder (PTSD) symptoms following exposure to complex traumas associated with personal threat and loss. Features of identity confusion are central to both complicated bereavement and PTSD and these characteristics may be particularly prominent amongst refugees from traditional cultures displaced from their homelands, families, and kinship groups. We investigate whether a combined pattern of complicated bereavement and PTSD can be identified amongst West Papuan refugees participating in an epidemiological survey (n = 486, response rate: 85.8%) in a remote town in Papua New Guinea. METHODS: Latent class analysis was applied to derive subpopulations of refugees based on symptoms of complicated bereavement and PTSD. Associations were examined between classes and traumatic loss events, post-migration living difficulties (PMLDs), and psychosocial support systems. RESULTS: The four classes identified comprised a complicated bereavement class (11%), a combined posttraumatic bereavement class (10%), a PTSD class (11%), and a low symptom class (67%). Symptoms of identity confusion were prominent in the posttraumatic bereavement class. Compared with the low symptom class, the combined posttraumatic bereavement class reported greater exposure to traumatic loss events (OR 2.43, 95% CI 1.11-5.34), PMLDs (OR 2.24, 95% CI 1.01-4.6), disruptions to interpersonal bonds and networks (OR 3.3, 95% CI 1.47-7.38), and erosion of roles and identities (OR 2.18, 95% CI 1.11-4.27). CONCLUSIONS: Refugees appear to manifest a combined pattern of complicated bereavement and PTSD symptoms in which identity confusion is a prominent feature. This response appears to reflect the combined impact of high levels of exposure to traumatic losses, PMLDs, and disruption of relevant psychosocial systems.

12 Article The impact of post-traumatic stress disorder symptomatology on quality of life: The sentinel experience of anger, hypervigilance and restricted affect. 2019

Forbes, David / Nickerson, Angela / Bryant, Richard A / Creamer, Mark / Silove, Derrick / McFarlane, Alexander C / Van Hooff, Miranda / Phelps, Andrea / Felmingham, Kim L / Malhi, Gin S / Steel, Zachary / Fredrickson, Julia / Alkemade, Nathan / O'Donnell, Meaghan. ·1 Phoenix Australia Centre for Posttraumatic Mental Health and Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia. · 2 School of Psychology, University of New South Wales, Sydney, NSW, Australia. · 3 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. · 4 Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia. · 5 Division of Psychology, School of Medicine, University of Tasmania, Hobart, TAS, Australia. · 6 Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. ·Aust N Z J Psychiatry · Pubmed #29726277.

ABSTRACT: BACKGROUND: It is unclear which specific symptoms of post-traumatic stress disorder are related to poor perceived quality of life. OBJECTIVE: To investigate the influence of post-traumatic stress disorder symptomatology on quality of life in traumatic injury survivors. METHOD: Traumatic injury survivors completed questionnaires on post-traumatic stress disorder symptomatology and quality of life at 3 months ( n = 987), 12 months ( n = 862), 24 months ( n = 830) and 6 years ( n = 613) post trauma. RESULTS: Low quality of life was reported by 14.5% of injury survivors at 3 months and 8% at 6 years post event. The post-traumatic stress disorder symptom clusters that contributed most to poor perceived quality of life were numbing and arousal, the individual symptoms that contributed most were anger, hypervigilance and restricted affect. CONCLUSIONS: There was variability in the quality of life of traumatic injury survivors in the 6 years following trauma and a consistent proportion reported low quality of life. Early intervention to reduce anger, hypervigilance and restricted affect symptoms may provide a means to improving the quality of life of traumatic injury survivors.

13 Article Factor structures of Complex Posttraumatic Stress Disorder and PTSD in a community sample of refugees from West Papua. 2018

Tay, Alvin Kuowei / Mohsin, Mohammed / Rees, Susan / Tam, Natalino / Kareth, Moses / Silove, Derrick. ·Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia. Electronic address: alvin.tay@unsw.edu.au. · Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia. ·Compr Psychiatry · Pubmed #29936226.

ABSTRACT: OBJECTIVES: The intention to include a category of Complex Posttraumatic Stress Disorder (CPTSD) in ICD-11 has renewed interest in this construct. Although growing evidence from high income countries supports the construct validity of CPTSD, little parallel research has been undertaken across cultures. We tested theoretically supported CPTSD structures (a one-factor, six-factor, one-factor higher-order, and two-factor higher order structure) in a community sample of West Papuan refugees living in a remote town, Kiunga, in Papua New Guinea (PNG). PROCEDURES: A community-wide survey was conducted (2016-2017; response rate 85.5%) amongst 486 West Papuans. Culturally adapted measures were applied to assess cumulative traumatic exposure, postmigration living difficulties (PMLDs), CPTSD symptoms, and functional impairment. FINDINGS: A six factor structure for CPTSD provided the best fit to the data, consistent with our past study amongst West Papuans. CONCLUSIONS: The cross-cultural validity of our findings is supported by the isolation of West Papuan participants from services treating traumatic stress. To further support the universal applicability of CPTSD, our findings need to be confirmed amongst other refugee groups from diverse cultural backgrounds.

14 Article The role of site and severity of injury as predictors of mental health outcomes following traumatic injury. 2018

Baecher, Katharine / Kangas, Maria / Taylor, Alan / O'Donnell, Meaghan L / Bryant, Richard A / Silove, Derrick / McFarlane, Alexander C / Wade, Darryl. ·Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia. · Department of Psychology, Macquarie University, Sydney, NSW, Australia. · Phoenix Australia: Centre for Posttraumatic Mental Health, Carlton, VIC, Australia. · Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia. · School of Psychology, University of New South Wales, Sydney, NSW, Australia. · Mental Health Centre, Liverpool, NSW, Australia. · School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. · Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia. ·Stress Health · Pubmed #29856110.

ABSTRACT: The aim of this study was to investigate the influence of injury site and severity as predictors of mental health outcomes in the initial 12 months following traumatic injury. Using a multisite, longitudinal study, participants with a traumatic physical injury (N = 1,098) were assessed during hospital admission and followed up at 3 months (N = 932, 86%) and at 12 months (N = 715, 71%). Injury site was measured using the Abbreviated Injury Scale 90, and objective injury severity was measured using the Injury Severity Score. Participants also completed the Hospital Anxiety and Depression Scale and the Clinician Administered Post-traumatic Stress Disorder (PTSD) Scale. A random intercept mixed modelling analysis was conducted to evaluate the effects of site and severity of injury in relation to anxiety, PTSD, and depressive symptoms. Injury severity, as well as head and facial injuries, was predictive of elevated PTSD symptoms, and external injuries were associated with both PTSD and depression severity. In contrast, lower extremity injuries were associated with depressive and anxiety symptoms. The findings suggest that visible injuries are predictive of reduced mental health, particularly PTSD following traumatic injury. This has clinical implications for further advancing the screening for vulnerable injured trauma survivors at risk of chronic psychopathology.

15 Article The effect of post-traumatic stress disorder on refugees' parenting and their children's mental health: a cohort study. 2018

Bryant, Richard A / Edwards, Ben / Creamer, Mark / O'Donnell, Meaghan / Forbes, David / Felmingham, Kim L / Silove, Derrick / Steel, Zachary / Nickerson, Angela / McFarlane, Alexander C / Van Hooff, Miranda / Hadzi-Pavlovic, Dusan. ·School of Psychology, University of New South Wales, Sydney, NSW, Australia; Westmead Institute for Medical Research, Sydney, NSW, Australia. Electronic address: r.bryant@unsw.edu.au. · Centre for Social Research and Methods, Australian National University, Canberra, Australian Capital Territory, Australia. · Phoenix Australia, University of Melbourne, Melbourne, VIC, Australia. · School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia. · School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. · School of Psychology, University of New South Wales, Sydney, NSW, Australia. · Centre for Traumatic Stress Studies, University of Adelaide, Adelaide, SA, Australia. ·Lancet Public Health · Pubmed #29731158.

ABSTRACT: BACKGROUND: Children and adolescents, who account for most of the world's refugees, have an increased prevalence of psychological disorders. The mental health of refugee children is often associated with the severity of post-traumatic stress disorder (PTSD) in their caregivers. Despite the potential for refugee caregivers' PTSD to affect child mental health, little evidence exists concerning the underlying mechanisms of this association. This study tested the effect of refugee caregivers' previous trauma and levels of ongoing stressors on current PTSD, and in turn how this influences parenting behaviour and consequent child psychological health. METHODS: This cohort study recruited participants from the Building a New Life in Australia study, a population-based prospective cohort study of refugees admitted to 11 sites in Australia between October, 2013, and February, 2014. Eligible participants were aged 18 years or older and the principal or secondary applicant (ie, the refugee applicant within a migrating family unit) for a humanitarian visa awarded between May, 2013, and December, 2013. Primary caregiver PTSD and postmigration difficulties were assessed at Wave 1 (in 2013), and caregiver PTSD was reassessed at Wave 2 (in 2014). At Wave 3, between October, 2015, and February, 2016, primary caregivers repeated measures of trauma history, postmigration difficulties, probable PTSD, and harsh and warm parenting style, and completed the Strengths and Difficulties Questionnaire for their child. We used path analysis to investigate temporal patterns in PTSD, trauma history, postmigration stressors, parenting style, and children's psychological difficulties. FINDINGS: The current data comprised 411 primary caregivers who provided responses in relation to at least one child (660 children). 394 primary caregivers with 639 children had data on independent variables and were included in the final model. Path analyses revealed that caregivers' trauma history and postmigration difficulties were associated with greater subsequent PTSD, which in turn was associated with greater harsh parenting and in turn, higher levels of child conduct problems (β=0·049, p=0·0214), hyperactivity (β=0·044, p=0·0241), emotional symptoms (β=0·041, p=0·0218), and peer problems (β=0·007, p=0·047). There was also a direct path from primary caregiver PTSD to children's emotional problems (β=0·144, p=0·0001). INTERPRETATION: PTSD in refugees is associated with harsh parenting styles, leading to adverse effects on their children's mental health. Programmes to enhance refugee children's mental health should account for PTSD in parents and caregivers, and the parenting behaviours that these children are exposed to. FUNDING: National Health and Medical Research Council.

16 Article Cohort Profile: Maternal mental health and child development in situations of past violent conflict and ongoing adversity: the DILI birth cohort study. 2018

Tol, W A / Rees, S J / Tay, A K / Tam, N / da Costa Saldanha Segurado, A / da Costa, Z M / da Costa Soares, E S / da Costa Alves, A / Martins, N / Silove, D M. ·Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · Psychiatry Research and Teaching Unit, University of New South Wales, and Academic Mental Health Unit, Sydney South West Local Health District, Sydney, NSW, Australia. · Alola Foundation, Dili, Timor-Leste. · Dili District Health Services, Dili, Timor-Leste. · Faculty of Medicine & Health Science, Universidade Nacional Timor Lorosa'e, Dili, Timor-Leste. ·Int J Epidemiol · Pubmed #29471471.

ABSTRACT: -- No abstract --

17 Article A wait-list controlled study of a trauma-focused cognitive behavioral treatment for intermittent explosive disorder in Timor-Leste. 2018

Hewage, Kalhari / Steel, Zachary / Mohsin, Mohammed / Tay, Alvin Kuowei / De Oliveira, Jose Carlos / Da Piedade, Marcio / Tam, Natalino / Silove, Derrick. ·Therapy Program for Intermittent Explosive Disorder, Dili, Timor-Leste, affiliated with the Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales. · Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales. ·Am J Orthopsychiatry · Pubmed #28749158.

ABSTRACT: We tested a trauma-focused, cognitive-behavior therapy treatment (TF-CBT-anger) for intermittent explosive disorder (IED) and related dimensions of anger adapted to the local culture in postconflict Timor-Leste. The intention-to-treat sample (n = 78) comprised Timorese nationals (women = 49; men = 29), ages 18 years and older, meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for IED, with equal numbers (n = 39 each) being randomized to the treatment group (TG) and wait-list (WL). Assessments were made at 1 week prior to therapy, immediately at posttreatment, and at 1 month follow-up. Primary measures included an IED diagnosis made according to the East Timor explosive anger measure and the directionality of expression and control of anger assessed by 4 dimensions of the State-Trait Anger Expression Inventory (STAXI-2). Secondary measures included psychological distress assessed using the Kessler scale and an index of posttraumatic stress disorder (PTSD) assessed using the Harvard Trauma Questionnaire. In the TG, there was a decline in IED from 100% to zero at follow-up. In the WL, more than 70% (of the 100% at baseline) showed persisting IED at second and third assessments. The TG alone showed significant (p < .05) improvements on all STAXI-2 scales, the effect sizes for the intervention being uniformly large (>0.80). Psychological distress and PTSD showed substantial reductions in the TG but not the WL group. Although based on a modest-sized sample, our findings provide the first evidence in support of the efficacy of TF-CBT-anger for IED in a culturally diverse, postconflict setting. (PsycINFO Database Record

18 Article A controlled trial of trauma-focused therapy versus problem-solving in Islamic children affected by civil conflict and disaster in Aceh, Indonesia. 2018

Dawson, Katie / Joscelyne, Amy / Meijer, Catherine / Steel, Zachary / Silove, Derrick / Bryant, Richard A. ·1 School of Psychology, University of New South Wales, Sydney, NSW, Australia. · 2 Centre Mulia Hati, Meulaboh, Indonesia. · 3 Psychiatry Research & Teaching Unit, Liverpool Hospital, Liverpool, NSW, Australia. ·Aust N Z J Psychiatry · Pubmed #28606000.

ABSTRACT: OBJECTIVE: To evaluate the relative efficacies of trauma-focused cognitive behavior therapy and problem-solving therapy in treating post-traumatic stress disorder in children affected by civil conflict in Aceh, Indonesia. METHOD: A controlled trial of children with post-traumatic stress disorder ( N = 64) randomized children to either five individual weekly sessions of trauma-focused cognitive behavior therapy or problem-solving therapy provided by lay-counselors who were provided with brief training. Children were assessed by blind independent assessors at pretreatment, posttreatment and 3-month follow-up on post-traumatic stress disorder, depression and anger, as well as caregiver ratings of the child's post-traumatic stress disorder levels. RESULTS: Intent-to-treat analyses indicated no significant linear time × treatment condition interaction effects for post-traumatic stress disorder at follow-up ( t(129.05) = -0.55, p = 0.58), indicating the two conditions did not differ. Across both conditions, there were significant reductions in post-traumatic stress disorder on self-reported ( t(131.26) = -9.26, p < 0.001) and caregiver-reported ( t(170.65) = 3.53, p = 0.001) measures and anger ( t(127.66) = -7.14, p < 0.001). Across both conditions, there was a large effect size for self-reported post-traumatic stress disorder (cognitive behavior therapy: 3.73, 95% confidence interval = [2.75, 3.97]; problem-solving: 2.68, 95% confidence interval = [2.07, 3.29]). CONCLUSIONS: These findings suggest that trauma-focused cognitive behavior therapy and problem-solving approaches are comparably successful in reducing post-traumatic stress disorder and anger in treating mental health in children in a post-conflict setting. This pattern may reflect the benefits of non-specific therapy effects or gains associated with trauma-focused or problem-solving approaches.

19 Article Six-year longitudinal study of pathways leading to explosive anger involving the traumas of recurrent conflict and the cumulative sense of injustice in Timor-Leste. 2017

Silove, Derrick / Mohsin, Mohammed / Tay, Alvin Kuowei / Steel, Zachary / Tam, Natalino / Savio, Elisa / Da Costa, Zelia Maria / Rees, Susan. ·Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia. d.silove@unsw.edu.au. · Academic Mental Health Unit, Level 2 Mental Health Centre, The Liverpool Hospital, Sydney, Australia. d.silove@unsw.edu.au. · Psychiatry Research and Teaching Unit, University of New South Wales, Sydney, Australia. · Academic Mental Health Unit, Level 2 Mental Health Centre, The Liverpool Hospital, Sydney, Australia. · School of Psychiatry, St Johns of God, Richmond Hospital, The Black Dog Institute, University of New South Wales, St. John of God, Australia. · Alola Foundation, Dili, Timor-Leste. ·Soc Psychiatry Psychiatr Epidemiol · Pubmed #28825139.

ABSTRACT: PURPOSE: Cumulative evidence suggests that explosive anger may be a common reaction among survivors of mass conflict. However, little is known about the course of explosive anger in the years following mass conflict, or the psychosocial factors that influence the trajectory of that reaction pattern. We examined these issues in a 6-year longitudinal study (2004-2010) conducted among adult residents of a rural and an urban village in Timor-Leste (n = 1022). METHODS: We derived a brief, context-specific index of explosive anger using qualitative methods. Widely used measures of post-traumatic stress disorder (PTSD) and severe psychological distress were calibrated to the Timor context. We developed an index of the cumulative sense of injustice related to consecutive historical periods associated with conflict in Timor-Leste. We applied partial structural equation modeling (SEM) to examine pathways from baseline explosive anger, socio-demographic factors, recurrent trauma, mental health indices (PTSD, severe psychological distress) and the sense of injustice, to explosive anger. RESULTS: Half of the sample with explosive anger at baseline continued to report that reaction pattern after 6 years; and a third of those who did not report explosive anger at baseline developed the response by follow-up. A symmetrical pattern of younger age, female gender and the trauma count for the preceding historical period predicted explosive anger at each assessment point. The sense of injustice was related to explosive anger at follow-up. Explosive anger was associated with impairment in functioning and conflict with the intimate partner and wider family. CONCLUSIONS: Sampling constraints caution against generalizing our findings to other populations. Nevertheless, our data suggest that explosive anger may persist for a prolonged period of time following mass conflict and that the response pattern is initiated and maintained by recurrent trauma exposure associated with a sense of injustice. Averting recurrence of mass violence and addressing persisting feelings of injustice may assist in reducing anger in conflict-affected societies. Whether explosive anger at the individual level increases risk of collective violence under conditions of social and political instability requires further inquiry.

20 Article The Relationship of Complex Post-traumatic Stress Disorder and Post-traumatic Stress Disorder in a Culturally Distinct, Conflict-Affected Population: A Study among West Papuan Refugees Displaced to Papua New Guinea. 2017

Silove, Derrick / Tay, Alvin Kuowei / Kareth, Moses / Rees, Susan. ·Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. ·Front Psychiatry · Pubmed #28620322.

ABSTRACT: BACKGROUND: Controversy continues about the validity of the construct of complex post-traumatic stress disorder (C-PTSD). In particular, questions remain whether C-PTSD can be differentiated from post-traumatic stress disorder (PTSD) and, secondarily, other common mental disorders. The examination of these issues needs to be expanded to populations of diverse cultural backgrounds exposed to prolonged persecution. We undertake such an inquiry among a community sample of West Papuan refugees exposed to extensive persecution and trauma. METHODS: We interviewed over 300 West Papuan refugees using the Refugee-Mental Health Assessment Package to record symptoms of PTSD, C-PTSD, major depressive disorder (MDD), and complex grief (CG). We used first- and second-order confirmatory factor analysis (CFA) to test aspects of the convergent and discriminant validity of C-PTSD. RESULTS: The CFA analysis supported both a one-factor and two-factor model of PTSD and C-PTSD. Nested model comparison tests provide support for the parsimonious one-factor model solution. A second-order CFA model of PTSD and C-PTSD produced a poor fit. The modified three-factor multi-disorder solution combining a traumatic stress (TS) factor (amalgamating PTSD and C-PTSD), MDD, and CG yielded a good fit only after removing three CG domains (estrangement, yearning, and behavioral change), a model that produced large standardized residuals (>0.20). CONCLUSION: The most parsimonious model yielded a single TS factor combining symptom domains of C-PTSD and PTSD in this culturally distinct community exposed to extensive persecution and conflict-related trauma. There may be grounds for expanding the scope of psychological treatments for refugees to encompass this wider TS response. Our findings are consistent with theoretical frameworks focusing on the wider TS reaction of refugees exposed to human rights-related traumas of mass conflict, persecution, and displacement.

21 Article Separation from parents during childhood trauma predicts adult attachment security and post-traumatic stress disorder. 2017

Bryant, R A / Creamer, M / O'Donnell, M / Forbes, D / Felmingham, K L / Silove, D / Malhi, G / van Hoof, M / McFarlane, A C / Nickerson, A. ·School of Psychology,University of New South Wales,Sydney,NSW 2052,Australia. · Phoenix Institute,University of Melbourne,161 Barry Street,Carlton,VIC 3053,Australia. · Department of Psychology,University of Tasmania,Hobart,TAS 7000,Australia. · Department of Psychiatry,University of Sydney,St Leonards,NSW 2065,Australia. · Department of Psychiatry,University of Adelaide,Adelaide,SA 5000,Australia. ·Psychol Med · Pubmed #28535839.

ABSTRACT: BACKGROUND: Prolonged separation from parental support is a risk factor for psychopathology. This study assessed the impact of brief separation from parents during childhood trauma on adult attachment tendencies and post-traumatic stress. METHOD: Children (n = 806) exposed to a major Australian bushfire disaster in 1983 and matched controls (n = 725) were assessed in the aftermath of the fires (mean age 7-8 years) via parent reports of trauma exposure and separation from parents during the fires. Participants (n = 500) were subsequently assessed 28 years after initial assessment on the Experiences in Close Relationships scale to assess attachment security, and post-traumatic stress disorder (PTSD) was assessed using the PTSD checklist. RESULTS: Being separated from parents was significantly related to having an avoidant attachment style as an adult (B = -3.69, s.e. = 1.48, β = -0.23, p = 0.013). Avoidant attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.31, p = 0.045), avoidance (B = 0.03, s.e. = 0.01, β = 0.30, p = 0.001) and numbing (B = 0.03, s.e. = 0.01, β = 0.30, p < 0.001) symptoms. Anxious attachment was associated with re-experiencing (B = 0.03, s.e. = 0.01, β = 0.18, p = 0.001), numbing (B = 0.03, β = 0.30, s.e. = 0.01, p < 0.001) and arousal (B = 0.04, s.e. = 0.01, β = 0.43, p < 0.001) symptoms. CONCLUSIONS: These findings demonstrate that brief separation from attachments during childhood trauma can have long-lasting effects on one's attachment security, and that this can be associated with adult post-traumatic psychopathology.

22 Article The factor structures and correlates of PTSD in post-conflict Timor-Leste: an analysis of the Harvard Trauma Questionnaire. 2017

Tay, Alvin Kuowei / Mohsin, Mohammed / Rees, Susan / Steel, Zachary / Tam, Natalino / Soares, Zelia / Baker, Jessica / Silove, Derrick. ·Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia. alvin.tay@unsw.edu.au. · Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW, 2170, Australia. · The Black Dog Institute, Sydney, Australia. · St John of God, Richmond Hospital, Richmond, NSW, Australia. ·BMC Psychiatry · Pubmed #28532449.

ABSTRACT: BACKGROUND: Post-traumatic stress disorder (PTSD) is the most widely assessed form of mental distress in cross-cultural studies conducted amongst populations exposed to mass conflict and displacement. Nevertheless, there have been longstanding concerns about the universality of PTSD as a diagnostic category when applied across cultures. One approach to examining this question is to assess whether the same factor structure can be identified in culturally diverse populations as has been described in populations of western societies. We examine this issue based on an analysis of the Harvard Trauma Questionnaire (HTQ) completed by a large community sample in conflict-affected Timor-Leste. METHOD: Culturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), ongoing adversities, symptoms of PTSD and psychological distress, and functional impairment amongst a large population sample (n = 2964, response rate: 82.4%) in post-conflict Timor-Leste. RESULTS: Confirmatory factor analyses of the ICD-10, ICD-11, DSM-IV, four-factor Emotional Numbing and five-factor Dysphoric-Arousal PTSD structures, found considerable support for all these models. Based on these classifications, concurrent validity was indicated by logistic regression analyses which showed that being a woman, trauma exposure, ongoing adversity, severe distress, and functional impairment were all associated with PTSD. CONCLUSIONS: Although symptom prevalence estimates varied widely based on different classifications, our study found a general agreement in PTSD assignments across contemporary diagnostic systems in a large conflict-affected population in Timor-Leste. Further studies are needed, however, to establish the construct and concurrent validity of PTSD in other cultures.

23 Article The contemporary refugee crisis: an overview of mental health challenges. 2017

Silove, Derrick / Ventevogel, Peter / Rees, Susan. ·School of Psychiatry, University of New South Wales, and Psychiatry Research and Teaching Unit, Academic Mental Health Centre, Southwestern Sydney Local Health District, Sydney, Australia. · Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland. ·World Psychiatry · Pubmed #28498581.

ABSTRACT: There has been an unprecedented upsurge in the number of refugees worldwide, the majority being located in low-income countries with limited resources in mental health care. This paper considers contemporary issues in the refugee mental health field, including developments in research, conceptual models, social and psychological interventions, and policy. Prevalence data yielded by cross-sectional epidemiological studies do not allow a clear distinction to be made between situational forms of distress and frank mental disorder, a shortcoming that may be addressed by longitudinal studies. An evolving ecological model of research focuses on the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the background disruptions of core psychosocial systems, the scope extending beyond the individual to the conjugal couple and the family. Although brief, structured psychotherapies administered by lay counsellors have been shown to be effective in the short term for a range of traumatic stress responses, questions remain whether these interventions can be sustained in low-resource settings and whether they meet the needs of complex cases. In the ideal circumstance, a comprehensive array of programs should be provided, including social and psychotherapeutic interventions, generic mental health services, rehabilitation, and special programs for vulnerable groups. Sustainability of services, ensuring best practice, evidence-based approaches, and promoting equity of access must remain the goals of future developments, a daunting challenge given that most refugees reside in settings where skills and resources in mental health care are in shortest supply.

24 Article Identifying a combined construct of grief and explosive anger as a response to injustice amongst survivors of mass conflict: A latent class analysis of data from Timor-Leste. 2017

Rees, Susan J / Tay, Alvin Kuowei / Savio, Elisa / Maria Da Costa, Zelia / Silove, Derrick. ·Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2 Mental Health Centre, The Liverpool Hospital, Sydney, Australia. · Alola Foundation, Dili, Timor-Leste. ·PLoS One · Pubmed #28430793.

ABSTRACT: Previous studies have identified high rates of explosive anger amongst post-conflict populations including Timor-Leste. We sought to test whether explosive anger was integrally associated with symptoms of grief amongst the Timorese, a society that has experienced extensive conflict-related losses. In 2010 and 2011 we recruited adults (n = 2964), 18-years and older, living in an urban and a rural village in Timor-Leste. We applied latent class analysis to identify subpopulations based on symptoms of explosive anger and grief. The best fitting model comprised three classes: grief (24%), grief-anger (25%), and a low symptom group (51%). There were more women and urban dwellers in the grief and grief-anger classes compared to the reference class. Persons in the grief and grief-anger classes experienced higher rates of witnessing murder and atrocities and traumatic losses, ongoing poverty, and preoccupations with injustice for the two historical periods of conflict (the Indonesian occupation and the later internal conflict). Compared to the reference class, only the grief-anger class reported greater exposure to extreme deprivations during the conflict, ongoing family conflict, and preoccupations with injustice for contemporary times; and compared to the grief class, greater exposure to traumatic losses, poverty, family conflict and preoccupations with injustice for both the internal conflict and contemporary times. A substantial number of adults in this post-conflict country experienced a combined constellation of grief and explosive anger associated with extensive traumatic losses, deprivations, and preoccupations with injustice. Importantly, grief-anger may be linked to family conflict in this post-conflict environment.

25 Article Assessing the factorial structure and measurement invariance of PTSD by gender and ethnic groups in Sri Lanka: An analysis of the modified Harvard Trauma Questionnaire (HTQ). 2017

Tay, Alvin Kuowei / Jayasuriya, Rohan / Jayasuriya, Dinuk / Silove, Derrick. ·Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Sydney NSW, Australia. Electronic address: alvin.tay@unsw.edu.au. · School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. · Australian National University, Canberra, Australian Capital Territory (ACT), Australia. · Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Sydney NSW, Australia. ·J Anxiety Disord · Pubmed #28254549.

ABSTRACT: The Harvard Trauma Questionnaire (HTQ) remains the most widely used screening measure for post-traumatic stress disorder (PTSD) in the refugee and post-conflict field. The present study is the first to test the factorial structure and measurement invariance of the HTQ according to DSM-5 criteria across gender and ethnic groups in the ethnically diverse society of post-conflict Sri Lanka. The survey sample included 5136 participants (86% response rate) followed up 12 months after a baseline nationally representative survey undertaken in Sri Lanka in 2014. Exposure to conflict-related traumatic experiences (TEs) generating a trauma count (TC), and symptoms of PTSD were assessed using a modified version of the HTQ adapted to the local context. The final analytic sample included 4260 participants after excluding records with missing data on key variables. We conducted Multigroup Confirmatory Factor Analysis (MG-CFA) to test the four-factor (DSM-5 consistent) and three-factor (DSM-IV-TR) models of PTSD, then assessing measurement invariance of the four factor model by gender and ethnic groups. The three-factor and four-factor DSM-5 model each produced a good fit across the sample as a whole. In addition, there was configural, metric, and scalar invariance for the four-factor model both by gender and ethnicity. The trauma count was directly associated with each of the symptom domains of the four factor model. Our findings provide support for the capacity of the modified HTQ to measure the DSM5 construct of PTSD across gender and key ethnic groupings in Sri Lanka. Confirmation of our findings in other cultures will be important.

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