Mental Disorders Following War in the Balkans

Symptoms of posttraumatic stress, anxiety, and depression, along with their associated factors, among Eritrean refugees in Dabat town, northwest Ethiopia, 2023

BACKGROUND

Refugee populations are forcibly displaced from their homes as a consequence of natural disasters and armed conflicts. Eritreans, initially displaced to the Maiayni camp within the Tigray region, have faced further relocation to Dabat town due to the conflict between the Tigray People Liberation Front (TPLF) and Ethiopian government forces. Subsequently, another conflict has arisen between the Amhara Popular Force (Fano) and Ethiopian government forces in Dabat town, disrupting its stability. These collective challenges in the new environment may contribute to the development of symptoms such as posttraumatic stress disorder (PTSD), anxiety, and depression. Currently, there is a lack of available data on these symptoms and their associated variables in Dabat Town. Thus, the objective of this study was to assess the prevalence of PTSD, anxiety, and depression symptoms, along with associated factors, among Eritrean refugees in Dabat town, northwest Ethiopia. This will provide significant evidence for developing and implementing mental health intervention strategies that specifically address the particular difficulties faced by refugees.

METHOD

A community-based cross-sectional study was carried out from July 25 to September 30, 2023, in the Eritrean refugee camp in Dabat town. A systematic random sampling method was employed to select a total of 399 Eritrean refugees with 100 response rate. Data were collected using the standard validated Depression, Anxiety, and Stress Scale (DASS-21) questionnaire, which included socio-demographic characteristics. Summary statistics such as frequency and proportion were utilized to present the data in tables and figures. Binary logistic regression was employed to identify associated factors, and variables with a p-value (p ≤ 0.05) were considered statistically significant factors.

RESULT

The findings of this study indicated that 45% (95% CI: 35.6-48.23), 33.6% (95% CI: 31.66-37.45), and 37.3% (95% CI: 35.56-40.34) of the participants had symptoms of depression, anxiety, and PTSD, respectively. Sex, age, employment status, lack of food or water, experience of torture or beating, and imprisonment emerged as statistically significant predictors of depression. Employment status, murder of family or friends, rape or sexual abuse, torture or beating, and lack of housing or shelter were statistically significantly associated with anxiety. PTSD was found to be significantly associated with sex, length of stay at the refugee camp, lack of housing, shelter, food, or water, experience of rape or sexual abuse, abduction, employment status, and murder of family or friends.

CONCLUSIONS AND RECOMMENDATION

The results of this study revealed that more than one-third of Eritreans living in the refugee camp in Dabat town had symptoms of PTSD, anxiety, and depression. This prevalence is higher than the previously reported studies. Various factors, including age, gender, monthly income, unemployment, experiences of rape or sexual abuse, witnessing the murder of family or friends, being torched or beaten, imprisonment, and deprivation of basic needs such as food, shelter, and water, were identified as contributors to the development of depression, anxiety, and PTSD. This research underscores the need for both governmental and non-governmental organizations to secure the provision of essential necessities such as food, clean water, shelter, clothing, and education. This study also suggested that Eritrean refugees be legally protected from rape, sexual abuse, arson, detention without cause, and kidnapping. Moreover, the study calls for health service providers to develop a mental health intervention plan and implement strategies to deliver mental health services at healthcare facilities for Eritrean refugees in the Dabat town Eritrean refugee camp.

Comparison of subjective quality of life domains in schizophrenia, mood, and anxiety disorders; an individual patient data meta-analysis

This study sought to compare satisfaction with different subjective quality of life domains across individuals with three different mental health disorders. Samples from four separate studies were combined to conduct a one-step individual patient data meta-analysis. 5329 individuals with either a schizophrenia (n = 1839), mood (n = 1650), or anxiety disorder (n = 1840) were included. Mean satisfaction ratings for each life domain were compared across disorders. Associations between satisfaction ratings and personal characteristics were investigated using multivariable mixed effect models. Results showed that individuals with an anxiety disorder had the widest range of scores and reported lower satisfaction in most domains compared to those with a schizophrenia or mood disorder. Individuals with a schizophrenia disorder rated domains to do with 'others', such as relationships with family and sex life, as lower than individuals with a mood or anxiety disorder. Satisfaction ratings were often more impacted by personal characteristics, such as employment status, than by diagnostic category. These results demonstrate that specific life areas are impacted differently in the three mental health disorders studied. However, further research needs to consider the impact of personal characteristics across disorders, and the subjective quality of life in individuals with anxiety disorders in particular warrants further investigation.

Associations of night eating with depressive symptoms among health sciences students living in a postconflict region

Populations affected by war may experience food insecurity, which could predispose them to eating disorders. A cross-sectional study was conducted among health sciences students in Northern Kosovo from November 2018 to March 2019. Data were collected using the sociodemographic Night Eating Questionnaire (NEQ), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The study sample comprised 534 students. The prevalence of students who had at least mild depression (BDI ≥ 10) was 20.6%. More frequent night eating was consistently associated with a higher EDI score in the total sample as well as in the subgroup of students whose EDI score was ≥ 10. In addition, having poorer sleep quality and having more anxiety symptoms were associated with having stronger depressive symptoms. In a population of health sciences students who live in a post-conflict region, night eating is associated with having stronger depressive symptoms.

How much schizophrenia do famines cause?

Since the 1970s, famines have been widely invoked as natural experiments in research into the long-term impact of foetal exposure to nutritional shocks. That research has produced compelling evidence for a robust link between foetal exposure and the odds of developing schizophrenia. However, the implications of that research for the human cost of famines in the longer run have not been investigated. We address the connection between foetal origins and schizophrenia with that question in mind. The impact turns out to be very modest-much less than one per cent of the associated famine death tolls-across a selection of case studies.

The relationship between socio-demographic factors and depression: a cross sectional study among civilian participants in hostilities in Ukraine

There is still a gap in scientific knowledge in relation to civilian participants in hostilities. This is despite the fact that there is an extensive body of literature on major depressive disorder (MDD) in individuals who have experienced armed conflict. The purpose of this article is to identify socio-demographic factors which are related to levels of depression among civilian participants in the war in Ukraine, based on a cross-sectional study that was conducted in 2019 from a convenience sample of 314 Ukrainian adults (235 males). Depression was assessed via the Beck Depression Inventory. Multiple regression analyses were conducted to identify possible predictors of depression. Significant predictors were: loss of a loved one, place of residence, age, health insurance, financial situation, and marital status (F (6, 224) = 10.515, p < 0.001, R2 = 0.21; Adjusted R2 = 0.19). They also show that symptoms of depression resulting from the loss of a loved one due to war can be reduced through participation in an educational system. Having children is associated with a risk of more severe depression. Specialists are encouraged to engage in face-to-face interviews and to maintain a supportive and safe environment for participants in hostilities, e.g., in the area of education.

Depression, anxiety, and quality of life as predictors of rehospitalization in patients with chronic heart failure

BACKGROUND

Chronic heart failure (CHF) is a severe condition, often co-occurring with depression and anxiety, that strongly affects the quality of life (QoL) in some patients. Conversely, depressive and anxiety symptoms are associated with a 2-3 fold increase in mortality risk and were shown to act independently of typical risk factors in CHF progression. The aim of this study was to examine the impact of depression, anxiety, and QoL on the occurrence of rehospitalization within one year after discharge in CHF patients.

METHODS

148 CHF patients were enrolled in a 10-center, prospective, observational study. All patients completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Questionnaire Short Form Health Survey 36 (SF-36) at discharge timepoint.

RESULTS

It was found that demographic and clinical characteristics are not associated with rehospitalization. Still, the levels of depression correlated with gender (p ≤ 0.027) and marital status (p ≤ 0.001), while the anxiety values ​​were dependent on the occurrence of chronic obstructive pulmonary disease (COPD). However, levels of depression (HADS-Depression) and anxiety (HADS-Anxiety) did not correlate with the risk of rehospitalization. Univariate logistic regression analysis results showed that rehospitalized patients had significantly lower levels of Bodily pain (BP, p = 0.014), Vitality (VT, p = 0.005), Social Functioning (SF, p = 0.007), and General Health (GH, p = 0.002). In the multivariate model, poor GH (OR 0.966, p = 0.005) remained a significant risk factor for rehospitalization, and poor General Health is singled out as the most reliable prognostic parameter for rehospitalization (AUC = 0.665, P = 0.002).

CONCLUSION

Taken together, our results suggest that QoL assessment complements clinical prognostic markers to identify CHF patients at high risk for adverse events.

CLINICAL TRIAL REGISTRATION

The study is registered under http://clinicaltrials.gov (NCT01501981, first posted on 30/12/2011), sponsored by Charité - Universitätsmedizin Berlin.

Resilience After Trauma in Kosovo and Southeastern Europe: A Scoping Review

Most people who experience trauma want to thrive and often find paths to well-being and healthy functioning. This scoping review explores the existing evidence on adversity and resilience in southeastern European countries, focusing on Kosovo. There is a lack of research on trauma and resilience in cultures outside the US and Western Europe. The paper provides a brief cultural and historical overview of this region and the collectivist cultures found there. We draw from a range of interdisciplinary literatures to identify key strengths that have the potential to improve health outcomes for trauma victims in this region. Overall, 42 papers from PsycInfo and PubMed were identified, using keywords such as "resilience" or "health" and "Kosovo," "Balkans," and "Southeastern Europe." Findings from this scoping review show that different cultural values, norms, and societal ecologies impact resilience within these societies. Some strengths, such as social support and sense of purpose, echoed similar research in the US and Western Europe. There was also evidence that factors such as dignity, family solidarity, social activism, and nationwide meaning-making are strengths associated with resilience for these collectivist societies of southeastern Europe. We also consider the implications of the results for other post-conflict societies. Finally, findings from this review call for culturally sensitive strength-based perspectives in promoting health and well-being after the high dosages of trauma common in this region.

Which life domains are people with major depression satisfied or dissatisfied with? An individual patient data meta-analysis

BACKGROUND

People with depression tend to score low on measures of subjective quality of life (SQoL) which has been suggested to reflect a general negative bias of perception. However, studies do not tend to investigate specific life domains. This study investigated satisfaction with life domains in people with major depression and explored influential factors.

METHODS

A one-step individual patient data meta-analysis combined data of 1710 people with major depression from four studies. In all studies, SQoL was measured on the Manchester Short Assessment of Quality of Life, which provides satisfaction ratings with 12 life domains. Associations between individual characteristics and satisfaction ratings were investigated using univariable and multivariable models.

RESULTS

Mean satisfaction ratings varied across life domains. Participants expressed dissatisfaction with several domains but expressed satisfaction with others, mainly for domains associated with close relationships. Some of the investigated characteristics were consistently associated with satisfaction ratings across the domains.

LIMITATIONS

The primary limitation of this study was in the analysis of individual characteristics, which were chosen based on identification in existing literature and availability in our datasets, and of which several were dichotomised to have sufficiently large numbers which may have resulted in lost nuance in the results.

CONCLUSIONS

People with major depression distinguish between their satisfaction with different life domains and are particularly satisfied with their close relationships. This challenges the notion of a general negative appraisal of life in this group, and highlights the need to evaluate satisfaction with different life domains separately.

Posttraumatic stress disorder in a war-affected area of Northeast Ethiopia: a cross-sectional study

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) is a chronic condition that affects a significant proportion of war survivors following war and conflict. If PTSD is not managed, it can lead to decreased quality of life and impairments in daily functioning and lead to death. This study aimed to assess the prevalence of post-traumatic stress disorder and its associated factors among residents in a war-affected area, Dessie Town, Northeast Ethiopia.

METHODS

A community-based cross-sectional study was conducted among adult residents in the war-affected area, Dessie Town. A total of 615 individuals were selected by a systematic random sampling method. PTSD was assessed using the Post-Traumatic Stress Disorder Checklist, Civilian Version. Multivariable logistic regressions were used to measure the associated factors. Associations between variables were described using odds ratios, 95% confidence intervals, and a p-value less than 0.05.

RESULTS

The prevalence of PTSD was 34.5% (95% CI: 31-38). Female sex (AOR: 1.82; CI: 1.18-2.82), divorced or widowed (AOR: 2.12, CI: 1.23-3.66), having only primary schooling (AOR: 2.17; CI: 1.25-3.78), depression (AOR: 2.03; CI: 1.34-3.08), experienced ill health without medical care during the wartime (AOR: 2.97; CI: 1.43-6.16), forced separation from family (AOR: 1.90; CI: 1.16-3.12), and experienced stressful life events (AOR: 1.60; CI: 1.06-2.42) were significantly associated with PTSD.

CONCLUSION

A significant rate of PTSD was found among residents of the war-affected area, Dessie Town. One in three people was experiencing PTSD. As a result, post-war mental health early screening and intervention is a priority, particularly for females, those who are separated or divorced, and those who have experienced stressful life events due to the war.

Intergenerational trauma and war-induced PTSD in Kosovo: insights from the Albanian ethnic group

Introduction

War has profound and deep-rooted ramifications for individuals and societies. War-induced post-traumatic stress disorder (PTSD) is highly prevalent in Kosovo. This study aimed to obtain insights into the prevalence of perceived PTSD symptoms and their relation to the traumatic experiences of two generations: parents (survivors of the Kosovo War) and youth (children born after the Kosovo War), with an emphasis on the Albanian ethnic group. These experiences were then compared to understand intergenerational trauma. The study also aimed to identify the factors affecting PTSD prevalence, the role of social support, and the participants' experience with mental health services.

Method

A total of 237 Kosovar Albanians (121 parents, 116 youth) from all seven districts of Kosovo were included in this study. Study variables were measured using the PTSD Checklist, the Life Events Checklist, Criterion A, and the Multidimensional Scale of Perceived Social Support.

Results

The results revealed that the youth had significantly higher levels of perceived PTSD symptoms and lower levels of perceived support than their parents. Youth whose parents had PTSD were more prone to experiencing PTSD symptoms than those whose parents did not have PTSD. These youth also experienced significantly more traumatic situations, such as exposure to sudden violent death or accidental death, assault with a weapon, sexual assault, and captivity. Participants with perceived PTSD and lower perceived social support needed mental health interventions significantly more than those without PTSD symptoms.

Discussion

The findings emphasize the importance of addressing the intergenerational nature of PTSD and identifying factors affecting its prevalence, including social support and access to mental health services. The study underscores the need for a comprehensive approach to examine the complex and diverse nature of PTSD and its impact on individuals, families, and communities, especially in conflict-prone or conflict-affected societies.

The Role of COVID-19-Associated Fear, Stress and Level of Social Support in Development of Suicidality in Patients Diagnosed with Affective and Stress-Induced Psychiatric Disorders during the COVID-19 Pandemic-A Comparative Analysis

Only a few studies seem to address suicidality as an effect of the COVID-19 pandemic in persons previously affected by psychiatric disorders. The relationship between fear and stress caused by the COVID-19 pandemic and the level of social support and suicidality in patients diagnosed with affective and stress-induced psychiatric disorders prior to the onset of the COVID-19 pandemic were investigated. This study was observational and involved 100 participants. The examined period was from April 2020 to April 2022. The Fear of COVID-19 Scale (FCV-19S), the Oslo Social Support Scale 3 (OSSS-3) and general psychiatric interviews were used to obtain data. A statistically significant relationship between the impact of COVID-19-related distress on the occurrence of suicidality and the year of the pandemic χ²(2, N = 100) = 8.347, p = 0.015 was observed. No statistically significant correlation was found between suicidal behavior, stress intensity, fear and the score on the social support scale (p > 0.05). Fear related to the COVID-19 pandemic can only be seen as a contributor to suicidality. Overall, social support does not always act protectively. Previously stressful experiences such as wars, poverty and natural disasters seem to play a significant role in the resilience to each new public health crisis.

The effects of prevalence of inequalities in mental disorders between groups using Blinder- Oaxaca decomposition

BACKGROUND

The prevalence of inequalities in sociodemographic factors in some mental disorders (MDs) has been shown in previous reports. The aim of this study was to assess the main contributors that affected prevalence of inequalities in MDs between groups.

MATERIALS AND METHODS

This was a cross-sectional study that was conducted on adults in 10 cities from Ilam province. We selected participants using cluster sampling; clusters were cities (n₁ = 10), geographical area (n₂ = 153), and households (n₃ = 382). Screening tools and clinical interview were applied through standardized and validated questionnaires, namely, GHQ-28 and DSM-IV-TR, respectively. Participants were divided into socioeconomic groups via principal composition analysis (PCA). Blinder-Oaxaca approach was applied to distinguish the gap in inequalities between groups.

RESULTS

The prevalence of MDs in the advantage group was 22.6% and, in disadvantages was 35.6%. The concentration index (CI) of the MD prevalence rate was -0.013 (95% CI: -0.022, -0.004) which indicated that MDs were more common in the disadvantaged groups. The odds of MDs in advantaged people was 81% more compared to the disadvantaged group (OR: 1.81; 95% CI: 1.28, 2.57), also in females compared to males (1.60; 95% CI: 1.21, 2.24). Analysis of gap inequality between groups showed that the gap in prevalence rates of MDs between groups was 12%.

CONCLUSION

This study revealed a socioeconomic inequality in MD rates in the adult population. Therefore, results of this study provide contributors in MDs inequality in order to control and reduce the prevalence of MDs in the community.

Mental health status of internally displaced persons in the Garmian region of Kurdistan, Iraq: a cross-sectional survey

There are an estimated 4 million internally displaced persons (IDPs) in Iraq, mainly settled in the Kurdistan Region of Iraq, and yet few studies have documented the mental health of IDPs in the region. The aims of this study were (1) to assess the prevalence of mental health disorders and trauma experiences amongst IDPs and (2) to explore associations between prior displacement and years living in the camp and mental health disorders. A cross-sectional survey was conducted with adults (N = 100) from March - July 2018. Structured surveys were used to collect sociodemographic information, and adapted measures included the Harvard Trauma Questionnaire (HTQ), Post-traumatic Stress Disorder Inventory (PTSD-8), Hopkins Symptoms Checklist-25 (HSCL-25) and the Post-Migration Living Difficulties Checklist (PMLD). The average number of traumatic events experienced was 4.43 (SD = 2.63). The most commonly reported traumatic events included oppression due to ethnicity, religion or sect (92%) and exposure to combat situations (83%). Nearly half of the participants had experienced ill health without access to medical care, 44% lack of shelter and 43% lack of food or clean water. Thirty-two percent of respondents witnessed someone being murdered. There is a critical need for quality mental health services for IDPs in KR.

Media Religiosity and War Coping Strategies of Young People in Ukraine

The war in Ukraine, in addition to significant human and financial losses, affected the mental health of Ukrainians. This study was carried out within the framework of the population psychological support program in the first month of the war. The objective of the research was to empirically study the interrelationship between media religiosity level and psychological coping given the effects of war. In order to accomplish the research objective, we used the Questionnaire for Media Religious Individual (QMRI: Kostruba, 2021), which involved writing a narrative: "What helps me to cope with negative emotions caused by war?" The survey was conducted during the first month of the war in Ukraine (March 2022) within the framework of the online psychosocial support program for the population. The sample consisted of 66 young volunteers, with the average age of 18.85 years (SD = 1.94), including 8 males and 58 females. The study was conducted using standardized questionnaires and writing a narrative. For statistical analysis, we used Statistica 12 and Linguistic Inquiry and Word Count (LIWC-2015) software. The results demonstrate a tendency for media religious people to use more positive content markers [less emphasis on anger, painful feelings, less focus on the past and thoughts about death, more focus on religious coping (prayer, faith, etc.)].

Echoes of the past: prevalence and correlates of PTSD among formerly abducted youths in northern Uganda: findings from the WAYS study

Background

Post-traumatic stress disorder (PTSD) has considerable and persistent effects on survivors of war, particularly in postconflict areas. Yet, evidence on what keeps survivors on the path of PTSD remains scarce.

Aims

The current study aimed to assess the prevalence and correlates of PTSD symptoms among the war-affected population in northern Uganda.

Methods

Data from 476 war-affected youths (aged 20–27 years) who had participated in a longitudinal cohort study were analysed to describe the enduring associations of background and postwar environmental risk factors with PTSD symptoms. The Impact of Event Scale-Revised was used to evaluate symptoms of PTSD. Descriptive statistics were used to compute background and postwar environmental correlates. Binary logistic regression analyses were fitted to assess the magnitude of the effects of the correlates on PTSD symptoms.

Results

Background and postwar environmental factors (eg, sexual abuse and injury in captivity) were significantly associated with PTSD symptoms. Postwar environmental factors associated with PTSD symptoms included postwar hardships, stigma/discrimination, chronic illness, community relations, family acceptance and general functioning, among others. The odds ratios (ORs) for post-war hardships were 2.41 (95% confidence interval (CI): 1.63 to 3.56) and 2.90 (95% CI: 2.03 to 4.14) for high and severe PTSD, respectively. For stigma/discrimination, compared with higher scores, the ORs were 3.38 (95% CI: 2.22 to 5.17) and 4.12 (95% CI: 2.69 to 6.30) for high and severe PTSD symptoms, respectively.

Conclusions

Background and postwar environmental stressors exacerbate the severity of PTSD symptoms in survivors of war and should form the basis for interventions to alleviate the toxic effects of war on survivors.

Elastic shape analysis of brain structures for predictive modeling of PTSD

It is well-known that morphological features in the brain undergo changes due to traumatic events and associated disorders such as post-traumatic stress disorder (PTSD). However, existing approaches typically offer group-level comparisons, and there are limited predictive approaches for modeling behavioral outcomes based on brain shape features that can account for heterogeneity in PTSD, which is of paramount interest. We propose a comprehensive shape analysis framework representing brain sub-structures, such as the hippocampus, amygdala, and putamen, as parameterized surfaces and quantifying their shape differences using an elastic shape metric. Under this metric, we compute shape summaries (mean, covariance, PCA) of brain sub-structures and represent individual brain shapes by their principal scores under a shape-PCA basis. These representations are rich enough to allow visualizations of full 3D structures and help understand localized changes. In order to validate the elastic shape analysis, we use the principal components (PCs) to reconstruct the brain structures and perform further evaluation by performing a regression analysis to model PTSD and trauma severity using the brain shapes represented via PCs and in conjunction with auxiliary exposure variables. We apply our method to data from the Grady Trauma Project (GTP), where the goal is to predict clinical measures of PTSD. The framework seamlessly integrates accurate morphological features and other clinical covariates to yield superior predictive performance when modeling PTSD outcomes. Compared to vertex-wise analysis and other widely applied shape analysis methods, the elastic shape analysis approach results in considerably higher reconstruction accuracy for the brain shape and reveals significantly greater predictive power. It also helps identify local deformations in brain shapes associated with PTSD severity.

Association of polygenic risk scores, traumatic life events and coping strategies with war-related PTSD diagnosis and symptom severity in the South Eastern Europe (SEE)-PTSD cohort

OBJECTIVES

Posttraumatic stress disorder (PTSD) is triggered by extremely stressful environmental events and characterized by high emotional distress, re-experiencing of trauma, avoidance and hypervigilance. The present study uses polygenic risk scores (PRS) derived from the UK Biobank (UKBB) mega-cohort analysis as part of the PGC PTSD GWAS effort to determine the heritable basis of PTSD in the South Eastern Europe (SEE)-PTSD cohort. We further analyzed the relation between PRS and additional disease-related variables, such as number and intensity of life events, coping, sex and age at war on PTSD and CAPS as outcome variables.

METHODS

Association of PRS, number and intensity of life events, coping, sex and age on PTSD were calculated using logistic regression in a total of 321 subjects with current and remitted PTSD and 337 controls previously subjected to traumatic events but not having PTSD. In addition, PRS and other disease-related variables were tested for association with PTSD symptom severity, measured by the Clinician Administrated PTSD Scale (CAPS) by liner regression. To assess the relationship between the main outcomes PTSD diagnosis and symptom severity, each of the examined variables was adjusted for all other PTSD related variables.

RESULTS

The categorical analysis showed significant polygenic risk in patients with remitted PTSD and the total sample, whereas no effects were found on symptom severity. Intensity of life events as well as the individual coping style were significantly associated with PTSD diagnosis in both current and remitted cases. The dimensional analyses showed as association of war-related frequency of trauma with symptom severity, whereas the intensity of trauma yielded significant results independently of trauma timing in current PTSD.

CONCLUSIONS

The present PRS application in the SEE-PTSD cohort confirms modest but significant polygenic risk for PTSD diagnosis. Environmental factors, mainly the intensity of traumatic life events and negative coping strategies, yielded associations with PTSD both categorically and dimensionally with more significant p-values. This suggests that, at least in the present cohort of war-related trauma, the association of environmental factors and current individual coping strategies with PTSD psychopathology was stronger than the polygenic risk.

The longitudinal course of posttraumatic stress disorder symptoms in war survivors: Insights from cross-lagged panel network analyses

Many war survivors suffer from chronic posttraumatic stress disorder (PTSD). Unraveling the complexities of PTSD symptoms over time is crucial for understanding this condition. Going beyond a common pathogenic pathway perspective, we applied the network approach to psychopathology to analyze longitudinal data from war survivors with PTSD in five Balkan countries approximately 8 years after war in the region and a follow-up assessment 1 year later (N = 698). PTSD diagnosis was established using the Mini-International Neuropsychiatric Interview, and PTSD symptoms were assessed using the Impact of Events Scale-Revised. Undirected cross-sectional networks for baseline and follow-up revealed no differences in the overall connectivity between these two networks. The intrusion symptom "I had waves of strong feelings about it" had the strongest expected influence centrality. Directed cross-lagged panel network models indicated that hyperarousal symptoms predicted other PTSD symptoms from baseline to follow-up, whereas several avoidance symptoms were predicted by other PTSD symptoms. The findings underscore the importance of emotional reactions and further suggest that hyperarousal symptoms may influence other PTSD symptoms. Future research should investigate causality and associations between between-person and within-person networks.

Covid-19-related stressors, mental disorders, depressive and anxiety symptoms: a cross-sectional, nationally-representative, face-to-face survey in Serbia

AIM

The Covid-19 pandemic may be associated with an increase in mental disorders and mental distress. However, there are no representative studies testing the impact of stressors directly related to Covid-19. We aimed to determine whether Covid-19-related stressors were associated with mental disorders, depressive and anxiety symptoms in the second year of the pandemic.

METHOD

This cross-sectional observational epidemiological survey was conducted from June to October 2021. We interviewed a representative sample of the adult population in Serbia (18-65 years) in the second year of the pandemic, at a time when large parts of the population had been affected by the pandemic in different ways. A multistage probabilistic household sampling of the adult population in 60 municipalities was used. Mental disorders were assessed by in-person interviews using the Mini International Neuropsychiatric Interview. Depressive and anxiety symptoms were measured by PHQ-9 and GAD-7 scales. Covid-19-related stressors (Sars-CoV-2 infection, the infection of a close relative, self-isolation and lack of protective equipment at work), as well as other stressors during the pandemic (not directly related to the risk of the infection), were measured. The associations with mental disorders, depressive and anxiety symptoms were explored through univariable and multivariable regression analyses.

RESULTS

In total, 1203 individuals (mean age 43.7 ± 13.6 years, 48.7% male) were interviewed. Most respondents (67.8%) of the sample had already experienced Covid-19-related stressors (20.1% had Sars-CoV-2 infection; 43.2% had a close relative member who had Covid-19; 28.2% reported lack of appropriate protection; 27.5% had been quarantined) and about 50% had already been vaccinated. The prevalence of any mental disorder was 15.2% (95% CI 13.2-17.2): mood disorders 4.6%, anxiety disorders 4.3% and substance use disorders 8.0%. Mean PHQ-9 was 3.2 ± 3.8 and GAD-7 was 2.1 ± 3.1. In this study, one Covid-19 stressor, i.e. lack of protective equipment, was weakly associated with a greater frequency of anxiety disorders (p = 0.023), while the other stressors had significant associations with several groups of mental disorders and symptom levels.

CONCLUSIONS

Our study did not provide any evidence that the prevalence of mental disorders exceeds the range of pre-pandemic data reported in the literature. Covid-related stressors, although frequently reported, did not dramatically influence the prevalence of mental disorders. The provision of the appropriate equipment at workplaces might lead to the reduction of anxiety disorders.

Relationship between Socio-Demographic Factors and Posttraumatic Stress Disorder: A Cross Sectional Study among Civilian Participants' Hostilities in Ukraine

Background: Even though there is an extensive body of literature on posttraumatic stress disorder (PTSD) in individuals who have experienced armed conflict, there are still many grey areas, especially in relation to civilian participants in hostilities. This article evaluates how socio-demographic factors and the interactions between them have influenced PTSD among civilians involved in the recent war in Ukraine. Methods: This cross-sectional study included a convenience sample of 314 adults, 74 women, and 235 men. The mean age was 34.08 years. We used the Posttraumatic Stress Disorder (PTSD) Checklist–Civilian Version (PCL-C). Results: Our findings show that predictors of posttraumatic stress are loss of a loved one, place of residence, gender, continuation of education, and health insurance. We demonstrated that PTSD produced by the loss of a loved one as a result of war is determined by participation in the education system, whatever the level of education. The literature emphasises the importance of social support, e.g., from the family. We demonstrated that having children is associated with a risk of more severe PTSD, causing serious mental strain among participants of hostilities. We discovered that material security lowers PTSD, but only among people who have no children. Conclusions: PTSD is the result of not only the violence and damage caused by war but also of other stressful circumstances associated with the social and financial conditions of life. Further research needs to focus on identifying modifiable risk factors and protective factors that could be embraced by intervention strategies. Our findings can inform the goals behind therapeutic support for civilian participants of hostilities, and implications for social work. Social work professionals are encouraged to engage in direct questioning and to maintain a supportive and safe environment for participants in hostilities, e.g., in the area of education. Trauma-affected people need to be given opportunities to build up their strengths and increase their psychological resources towards well-being. Social security (health insurance, savings, material security) should be taken into account when working with people affected by PTSD.

Post-traumatic stress disorder among Syrian refugees in Greece

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) is a psychiatric entity developed by those who have been through a traumatic experience. The civil wars in Syria and neighboring countries during the past few years might trigger such experiences, and the same could be argued for the difficult journey from the actual war zones to Europe.

PURPOSE

To determine the level of PTSD among Arabic-speaking refugees in a Greek refugee camp, who originate primarily from Syria.

METHODS

This study involves (N = 73) Syrian refugees, all located in Greek camp. Data were gathered using the civilian version of PTSD CheckList (PCL-C). The Arabic version of the PCL-C was used. Individual scores were evaluated via use of DSM-IV criteria.

RESULTS

PTSD was found in 58 participants, afflicting both genders (72% of men and 45% of women). In addition, the severity score was recorded to be significantly elevated for the majority of the participants. Finally, the most vulnerable age group was the same for both genders, featuring those between the ages of 35 and 44 years.

CONCLUSIONS

The findings of this study demonstrated that the traumatic experiences, suffered by these refugees either before and/or on their journey to Greece, had a severe mental impact. It is imperative that all refugees suffering from this disorder be diagnosed in time and receive appropriate support.

Training of psychotherapists in post-conflict regions: A Community case study in the Kurdistan Region of Iraq

The number of wars in the world is on the rise. A number of studies have documented the devastating impact on the public and especially public mental health. Health care systems in low- and lower-middle income countries that are frequently already challenged by the existing mental health services gap cannot provide the necessary care for those displaced by war with existing services. This is especially the case in the Kurdistan Region of Iraq (KRI) after the invasion of the terror organization ISIS in 2014. Most projects in post-conflict areas focus on short term basic psychological services and do not contribute to sustainable long-term capacity building of mental health services. An "Institute for Psychotherapy and Psychotraumatology" was therefore founded in order to train local specialists on a professional level with evidence-based methods adapted to culture and create sustainable long-term structures for psychotherapeutic treatment in the KRI. To achieve this, a number of measures were implemented, including the creation of a "Master of Advanced Studies of Psychotherapy and Psychotraumatology" in collaboration with local communities and the regional University. Two cohorts of students have successfully finished the master's program and a third cohort are expected to graduate in 2023. Improving the capacity of local health care services to provide low-barrier, professional psychotherapeutic care in post-conflict regions supported by the innovative model presented in this article can be expected to improve the burden of psychological problems and contribute to peacebuilding.

Stress research during the COVID-19 pandemic and beyond

The COVID-19 pandemic confronts stress researchers in psychology and neuroscience with unique challenges. Widely used experimental paradigms such as the Trier Social Stress Test feature physical social encounters to induce stress by means of social-evaluative threat. As lockdowns and contact restrictions currently prevent in-person meetings, established stress induction paradigms are often difficult to use. Despite these challenges, stress research is of pivotal importance as the pandemic will likely increase the prevalence of stress-related mental disorders. Therefore, we review recent research trends like virtual reality, pre-recordings and online adaptations regarding their usefulness for established stress induction paradigms. Such approaches are not only crucial for stress research during COVID-19 but will likely stimulate the field far beyond the pandemic. They may facilitate research in new contexts and in homebound or movement-restricted participant groups. Moreover, they allow for new experimental variations that may advance procedures as well as the conceptualization of stress itself. While posing challenges for stress researchers undeniably, the COVID-19 pandemic may evolve into a driving force for progress eventually.

Effectiveness of a structured intervention to make routine clinical meetings therapeutically effective (DIALOG+) for patients with depressive and anxiety disorders in Bosnia and Herzegovina: A cluster randomised controlled trial

Background

DIALOG+ is a patient-centred, solution-focused intervention, which aims to make routine patient-clinician meetings therapeutically effective. Existing evidence suggests that it is effective for patients with psychotic disorders in high-income countries. We tested the effectiveness of DIALOG ​+ ​for patients with depressive and anxiety disorders in Bosnia and Herzegovina, a middle-income country.

Methods

We conducted a parallel-group, cluster randomised controlled trial of DIALOG+ in an outpatient clinic in Sarajevo. Patients inclusion criteria were: 18 years and older, a diagnosis of depressive or anxiety disorders, and low quality of life. Clinicians and their patients were randomly allocated to either the DIALOG ​+ ​intervention or routine care in a 1:1 ratio. The primary outcome, quality of life, and secondary outcomes, psychiatric symptoms and objective social outcomes, were measured at 6- and 12-months by blinded assessors.

Results

Fifteen clinicians and 72 patients were randomised. Loss to follow-up was 12% at 6-months and 19% at 12-months. Quality of life did not significantly differ between intervention and control group after six months, but patients receiving DIALOG ​+ ​had significantly better quality of life after 12 months, with a medium effect size (Cohen's d ​= ​0.632, p ​= ​0.007). General symptoms as well as specifically anxiety and depression symptoms were significantly lower after six and 12 months, and the objective social situation showed a statistical trend after 12 months, all in favour of the intervention group. No adverse events were reported.

Limitations

Delivery of the intervention was variable and COVID-19 affected 12-month follow-up assessments in both groups.

Conclusion

The findings suggest DIALOG ​+ ​could be an effective treatment option for improving quality of life and reducing psychiatric symptoms in patients with depressive and anxiety disorders in a low-resource setting.

•

As DIALOG+ is used within routine clinical meeting, no additional staff or resources are required for implementation.

•

DIALOG+ utilises existing patient resources, is not difficult to implement and is inexpensive.

•

Eighty patients met our inclusion criteria and 72 agreed to participate and completed a baseline assessment.

•

At 12 months, the intervention group showed a significantly better quality of life.

•

Patients in the intervention group had significantly lower levels of symptoms time with medium to large effect sizes.

•

The objective social situation did not differ significantly between the two groups after six months.

•

The objective social situation showed a statistical trend towards a more positive outcome in the intervention group.

•

Findings suggest DIALOG + could be an effective treatment for improving quality of life and reducing psychiatric symptoms.

Mental health in the second year of the COVID-19 pandemic: protocol for a nationally representative multilevel survey in Serbia

INTRODUCTION

The COVID-19 pandemic is likely to have a prolonged impact on mental health (MH); however, the long-term MH effects of the COVID-19 pandemic remain unknown. The Serbian national survey-CoV2Soul.RS-was launched to document the MH status of the Serbian population following the COVID-19 pandemic and to contribute to an international evidence base about MH prevalence rates during different phases of the pandemic.

METHODS AND ANALYSIS

This cross-sectional study was designed to collect a nationally representative sample (N=1200; age 18-65 years; estimated start/end-June/November 2021) using multistage probabilistic household sampling. Trained staff will conduct in-person diagnostic interviews. A battery of self-report instruments will be administered to assess the quality of life (QoL), general distress and associated protective and harmful psychological and societal factors. Analyses will be conducted to delineate the prevalence rates of MH disorders, how MH conditions and QoL vary with respect to sociodemographic variables, personality, health status and traumatic events during the COVID-19 pandemic, and to test how these relations depend on geographical region. Moreover, this study was designed to explore mechanisms linking personality and the perception of pandemic consequences and associated distress. Prevalence rates of MH disorders will be calculated using descriptive statistics. For additional analyses, we will use correlations, analysis of variance and regression analyses. The hierarchical structure of the data will be explored using multilevel random coefficient modelling. Structural equation modelling will be used to investigate the indirect effects of personality on distress through relevant variables.

ETHICS AND DISSEMINATION

Ethical Committees of the Faculty of Medicine (1322-VII/31) and Faculty of Philosophy in Belgrade (02-33/273) and Faculty of Philosophy in Novi Sad (05-27, br.893/1) approved the protocol. Only respondents able to provide informed consent will participate in the study. Research reports will be submitted to peer-reviewed journals and the results will be placed on the website www.cov2soul.rs to be available to funders, researchers, policy-makers and interested laypeople, and will be advertised through social media.

TRIAL REGISTRATION NUMBER

NCT04896983.

Psychological outcomes amongst family medicine healthcare professionals during COVID-19 outbreak: A cross-sectional study in Croatia

Background

Healthcare professionals (HCPs) in family medicine (FM) in Croatia work in a demanding environment caused by the SARS-CoV-2 pandemic. Besides particular circumstances in healthcare, an unknown virus, social distancing, and homeschooling, the capital was hit with the earthquake during the lockdown.

Objectives

To assess the prevalence of stress, anxiety, depression, posttraumatic stress disorder (PTSD) and the influence of demographic characteristics, professional differences, medical history, and specific stressors on the psychological outcomes.

Methods

A cross-sectional study with the online questionnaire containing the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R) was conducted from 1st to 15 May 2020 in FM.

Results

HCPs (534, 35% response rate), predominantly female (84.5%), participated in the research. High prevalence of stress (30.9%), anxiety (33.1%), depression (30.7%), and PTSD (33.0%) were found. Female participants had higher results in the anxiety subscale of DASS-21 and IES-R scores. Pre-existing conditions were associated with higher levels of stress, anxiety, depression, and PTSD. The IES-R score for PTSD showed borderline correlation (p = 0.053) with working in regions with the highest incidence of COVID-19. Having schoolchildren made a difference on a stress subscale in DASS-21 (p < 0.043), but the earthquake did not have an impact.

Conclusion

Family physicians and nurses in FM in Croatia are under a great mental load during the COVID-19 outbreak. Results suggest that HCPs of the female sex, with pre-existing chronic conditions, work in regions with a high incidence of SARS-CoV-2 or have schoolchildren at greater risk of the poor psychological outcome.

Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis

Objective

Extensive research has demonstrated high prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) in war-surviving populations. However, absolute estimates are lacking, which may additionally inform policy making, research and healthcare. We aimed at estimating the absolute global prevalence and disease burden of adult survivors of recent wars (1989–2019) affected by PTSD and/or MD.

Methods

We conducted a systematic literature search and meta-analysis of interview-based epidemiological surveys assessing the prevalence of PTSD and/or MD in representative samples from countries with a recent war history (1989–2019). Drawing on the war definition and geo-referenced data of the Uppsala Conflict Database Programme and population estimates of the United Nations for 2019, we extrapolated the meta-analytic results to absolute global numbers of affected people. Drawing on disability-adjusted life years (DALYs) data of the Global Burden of Diseases Study 2019, we further calculated the PTSD-associated and MD-associated DALYs.

Results

Twenty-two surveys (N=15 420) for PTSD, 13 surveys for MD (N=9836) and six surveys on the comorbidity of PTSD and MD (N=1131) were included. Random effects meta-analyses yielded point prevalences of 26.51% for PTSD and 23.31% for MD. Of those affected by PTSD, 55.26% presented with comorbid MD. Prevalence rates were not significantly associated with war intensity and length, time since war, response rate or survey quality. The extrapolation yielded 316 million adult war-survivors globally who suffered from PTSD and/or MD in 2019. War-survivors were almost exclusively living in low/middle-income countries (LMICs) and carried a burden of 3 105 387 and 4 083 950 DALYs associated with PTSD and MD, respectively.

Conclusions

Since LMICs lack sufficient funding and qualified professionals to provide evidence-based psychological treatments for such large numbers of affected people, alternative and scalable strategies using existing resources in primary care and communities are required. Research is required to assist upscaling.

Unraveling specifics of mental health symptoms in war survivors who fled versus stayed in the area of conflict using network analysis

BACKGROUND

War survivors often report symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and somatization. Hence, understanding symptom constellations among different populations of war survivors is critical.

METHODS

Using the network approach to psychopathology, we examined symptom centrality for these conditions in war survivors from Balkan countries who had stayed in the area of former conflict compared to those individuals from Balkan countries who had fled to Western European countries (N = 4,167) with the Impact of Events Scale-Revised and the Brief Symptom Inventory. We further compared networks for war survivors who met criteria for PTSD-diagnosis (assessed with the MINI-International Neuropsychiatric Interview) to those without PTSD-diagnosis.

RESULTS

Globally, networks were similar across the groups, whereas specific differences emerged in symptom centrality. More consistencies were found between PTSD and Western country networks, which may be partially explained by a higher prevalence of PTSD in those who had fled to Western European than in those who had stayed in the Balkan countries.

LIMITATIONS

Given the cross-sectional nature of our data, the directionality of edges in our networks remains unclear. Further, higher levels of trauma exposure and symptom severity in Western country participants may have confounded results.

CONCLUSIONS

The PTSD findings are in line with previous research on PTSD symptoms. They further provide novel insights into depressive, anxiety, and somatization symptoms in survivors of war. These findings need to be substantiated and call for future intervention studies that test the effects of targeting central symptoms we identified in our study.

Crisis-based psychiatry curriculum update: A cross-sectional study and an expert reflection from Syria

Throughout human history, humanitarian catastrophes had a profound impact on the health and wellbeing of the local populations where they took place. The Syrian war was no different, rather it was the worst humanitarian crisis since World War II. Syrians' wellbeing was severely affected during this past decade, as had Syria's healthcare and mental health facilities. Syrian doctors have faced unprecedented difficulties and challenges across clinical disciplines and services, particularly in psychiatry. Medical students may play a central role in attenuating the burden of psychiatric diseases on their local community. However, a modification of the psychiatry curriculum to meet the current needs is an urgent necessity. Most of the published reports in psychiatry about Syrians were done on refugee populations in neighboring countries and worldwide. In contrast, this study captured the opinions of professors of psychiatry, specialists practicing psychiatrists, psychiatry residents, and a sample of senior medical students around Syria regarding the impact of war on different psychiatric diseases, and their suggestions to increase/reduce the teaching hours allocated to each of them. The votes were weighted then tested against crisis-related published psychiatry reports. The results suggested significant adjustments to the allocated training hours in the curriculum of psychiatry in Syrian medical schools. Increasing the focus of the curriculum of psychiatry on the prevalent disorders and conditions such as post-traumatic stress disorder, acute stress disorder, anxiety, and depression would empower fresh graduates to manage the basic cases of psychiatry, thus alleviating the consequences of the large shortage of psychiatrists inside Syria.

The Impact of COVID-19 Pandemic on Psychiatric Emergency Department Visits - A Descriptive Study

The coronavirus disease 2019 pandemic (COVID-19) has an important direct and indirect impact on both physical and mental health. We aim to describe the impact of an emergency state period due to COVID-19 on psychiatric emergency department (ED) visits. We conducted a retrospective observational study analysing all emergency visits occurring at a metropolitan psychiatric ED between March 19th and May 2nd 2019 and 2020 (the beginning/end date of the emergency state which Portugal was under due to COVID-19). Data regarding age, sex, diagnoses, admission date, discharge destiny and status were collected. Diagnoses were classified using the International Classification of Diseases version 9, Clinical Modification (ICD-9-CM). There was a 52·2% decrease on the number of psychiatric emergency visits during the emergency state period (n₂₀₂₀ = 780 vs n₂₀₁₉ = 1633 episodes). The decrease on psychiatric ED visits was greater in the female sex and in the younger age groups. Episodes with a primary diagnosis of Mood disorders lead the decrease on psychiatric ED visits with 68·3% less episodes. Schizophrenia and other psychotic disorders was the diagnosis group with the smaller decline (9·8% decrease). COVID-19 emergency state period had an important impact on the number and characteristics of psychiatric ED visits, reinforcing the great indirect effects of COVID-19 on mental health.

Coronavirus Disease 2019 (COVID-19) Epidemic and Mental Health Status in the General Adult Population of Serbia: A Cross-Sectional Study

Since its outbreak, coronavirus disease 2019 (COVID-19) has rapidly spread throughout the world. The Serbian government declared a state of emergency on 15 March 2020, implementing some of Europe's strictest measures to combat the pandemic. The aim of this study was to determine the impact of the COVID-19 epidemic on the mental health of the general adult Serbian population and to identify associated factors during the state of emergency and lockdown. Data were collected with a snowball sampling method between 23 March and 25 April 2020, by using an online questionnaire. Multiple ordinal regression was performed to establish the associations between socio-demographic characteristics, self-estimated health status, and depression, anxiety, and stress. Out of 1057 participants included in the study, 28.9%, 36.9%, and 38.1% reported moderate to severe depression, anxiety, and stress symptoms. Uneasiness related to COVID-19 news, the feeling of helplessness, likeliness of impending death, and presence of COVID-19 symptoms were associated with higher depression, anxiety, and stress scores. Current smoking status was associated with a higher risk of depression and stress. Students had a significantly higher level of depression and stress, while older age was protective against anxiety and stress. Higher socioeconomic status was significantly associated with lower levels of depression, anxiety, and stress.

War-related trauma and post-traumatic stress disorder prevalence among Syrian university students

BACKGROUND

Posttraumatic stress disorder (PTSD) is one of the most prevalent mental disorders in war-affected regions. Syria has endured 9 years of war and yet little is known about the impact of the conflict on the well-being of Syrians who remain. In this study, we investigated trauma and estimated PTSD prevalence among university students in Deir-ez-Zor, a Syrian governorate that was under the siege by ISIS for over 3 years.

METHODS

A descriptive cross-sectional study design was used on a sample of Al-Furat university students in Deir-ez-Zor. We collected data on socio-demographics, trauma exposure, and stress levels. PTSD Checklist for DSM-5 was used to provide prevalence rate estimates, and determine the symptom severity among Syrian university students. Binary logistic regression was used to identify factors associated with the development of PTSD symptoms.

RESULTS

A total of 833 students were recruited into the study, 86.4% of the participants were exposed to at least one traumatic event. The estimated PTSD prevalence was 28.2%, and the highest PTSD rates were found among students who were forced into sexual act (46.3%). A significant association was found between PTSD and internal displacement (p = .032), academic year (p = .002), and social economic status (p = .000). Binary logistic regression indicated that PTSD symptoms were predicted by smoking and third-year university students.

CONCLUSIONS

The results presented in this research revealed a high prevalence of trauma exposure and PTSD symptoms among a sample of university students in Deir-ez-Zor. These findings call for immediate actions to help the affected population in restoring their mental health, so they can be prepared to face the challenges and demands of the post-conflict period.

The Curvilinear Association Between Posttraumatic Distress and Posttraumatic Growth Among Pellet Gun Victims: The Moderating Roles of Time Since Trauma and Age

Since 2010, the use of pellet guns in Indian-administered Kashmir has led to serious physical and psychological consequences among a growing number of victims. However, no research to date has examined the association between posttraumatic distress and posttraumatic growth (PTG) within this population. Previous research conducted on other types of trauma exposure has yielded inconsistent findings regarding the nature and directionality of this association; namely, whether it is linear or curvilinear. Moreover, this inconsistency may also be due to the effects of other variables, such as time since trauma and age. In the present study, we investigated whether the association between posttraumatic distress and PTG among pellet gun victims is best explained as linear or curvilinear and tested whether this association was moderated by time since trauma and/or age. Using purposive sampling, 120 pellet gun victims were recruited from Indian-administered Kashmir. The results of quadratic hierarchical regression suggested that an inverted U-shaped curvilinear association, sr² = 0.07 (medium effect), was a better fit over and above a linear term, sr² = 0.06 - 0.08 (medium effect). The moderation test further revealed that this effect was present across time but became apparent, as an inverted U-shape, 18 to 24 months posttrauma, sr² = 0.04 (small effect); age, however, was not found to influence this association. These findings held even after controlling for the effects of confounding variables. The present findings suggest that across time, moderate levels of posttraumatic distress are associated with the highest levels of PTG.

Evaluating the Relationship Between Post Traumatic Stress Disorder Symptoms and Psychological Resilience in a Sample of Turkoman Refugees in Turkey

Turkey has witnessed an increase in migration of people belonging to neighboring countries due to civil war. Traumatic life events experienced by refugees bring along mental problems. Their psychological resilience enables them to cope with these difficulties. In this study, 101 Iraqi Turkoman refugees who migrated to Turkey following the increasing civil war events in their country were evaluated psychologically. Sociodemographic data form Resilience Scale for Adults (RSA) and Clinician-Administered Post-Traumatic Stress Disorder Scale (CAPS) were used for psychological evaluation. The prevalence of lifetime post-traumatic stress disorder (PTSD) among the refugees was 25.7%. There was no significant difference between the psychological resilience of the patients who developed PTSD and those who did not (p = 0.709). As the severity of trauma decreased, psychological resilience increased in the people who developed PTSD (p = 0.001, r = -0.622). Considering the psychological resilience of refugees, the area with the highest resilience is access to social resources, while the area with the lowest is the planned future. It was observed that the basic needs of refugees after migration could not be met clearly compared to the ones before migration. It was noteworthy that in cases diagnosed with PTSD, CAPS scores increased (p = 0.011, r: 0.251) and resilience decreased (p < 0.001, r: -0.376) as the inability to reach basic needs increased. Our study is very important in terms of defining how refugees are mentally affected after settling in another country and what determines their psychological resilience.

Searching for glycomic biomarkers for predicting resilience and vulnerability in a rat model of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is triggered by traumatic events in 10-20% of exposed subjects. N-linked glycosylation, by modifying protein functions, may provide an important environmental link predicting vulnerability. Our goals were (1) to find alterations in plasma N-glycome predicting stress-vulnerability; (2) to investigate how trauma affects N-glycome in the plasma (PGP) and in three PTSD-related brain regions (prefrontal cortex, hippocampus and amygdala; BGP), hence, uncover specific targets for PTSD treatment. We examined male (1) controls, (2) traumatized vulnerable and (3) traumatized resilient rats both before and several weeks after electric footshock. Vulnerable and resilient groups were separated by z-score analysis of behavior. Higher freezing behavior and decreased social interest were detected in vulnerable groups compared to control and resilient rats. Innate anxiety did not predict vulnerability, but pretrauma levels of PGP10(FA1G1Ga1), PGP11(FA2G2), and PGP15(FA3G2) correlated positively with it, the last one being the most sensitive. Traumatic stress induced a shift from large, elaborate N-glycans toward simpler neutral structures in the plasma of all traumatized animals and specifically in the prefrontal cortex of vulnerable rats. In plasma trauma increased PGP17(A2G2S) level in vulnerable animals. In all three brain regions, BGP11(F(6)A2B) was more abundant in vulnerable rats, while most behavioral correlations occurred in the prefrontal cortex. In conclusion, we found N-glycans (especially PGP15(FA3G2)) in plasma as possible biomarkers of vulnerability to trauma that warrants further investigation. Posttrauma PGP17(A2G2S1) increase showed overlap with human results highlighting the utility and relevance of this animal model. Prefrontal cortex is a key site of trauma-induced glycosylation changes that could modulate the behavioral outcome.

Alcohol use among conflict-affected persons in Ukraine: risk factors, coping and access to mental health services

BACKGROUND

There are approximately 1.5 million internally displaced persons (IDPs) in Ukraine as a result of the conflict in eastern Ukraine. Exposure to violence, forced displacement and increased mental disorders are potential risk-factors for alcohol use disorder (AUD). The aim of this study was to estimate the prevalence of and risk factors for AUD among Ukrainian IDPs and investigate the relationship between AUD, mental health service utilization and coping behaviours.

METHODS

A nation-wide cross-sectional survey of 2203 IDPs was conducted. Data were collected on AUD [using alcohol use disorder identification test (AUDIT)], mental health disorders, utilization of health services and coping behaviours. Multivariable logistic regression was used to identify risk factors for AUD, and to estimate the odds ratios for the association between alcohol use and utilization of health services and coping behaviours.

RESULTS

Of 2203 IDPs surveyed, 8.4% of men and 0.7% of women screened positive for AUD (AUDIT >7). Among current drinkers, AUD was present in 14.9% of men and 1.8% of women. Age, cumulative trauma exposure and anxiety were significantly associated with AUD in multivariable analysis. Alcohol users were 43% less likely to access health services for mental health compared with non-users. AUD was associated with more negative coping behaviours.

CONCLUSIONS

AUD is present within the male Ukrainian IDP population. Alcohol use was significantly associated with lower utilization of mental health services and more negative coping behaviours. AUD screening and low-intensity treatment services should be expanded for IDPs in Ukraine, particularly if integrated into mental health and psychosocial support programmes.

Perceived stress and depression in 45 low- and middle-income countries

BACKGROUND

There is limited research examining the association between perceived stress and depression using large population-based datasets, particularly from low- and middle-income countries (LMICs). Thus, the aim of the study was to assess the association between perceived stress and depression in 45 LMICs.

METHODS

We analyzed cross-sectional, predominantly nationally representative data from the World Health Survey. A perceived stress score [range 2 (lowest stress) -10 (highest stress)] was computed based on two questions from the Perceived Stress Scale. DSM-IV depression was based on past 12-month symptoms. Multivariable logistic regression analysis (adjusting for sex and age) and meta-analysis were used to examine the associations.

RESULTS

Data on 232,243 adults aged ≥18 years were analyzed. The overall mean (SD) perceived stress score was 4.8 (2.2), while the prevalence of depression was 6.2% (95%CI=5.9%-6.5%). Overall, there was a linear increase in the prevalence of depression with increasing perceived stress scores [i.e., score 2 (1.9%) to score 10 (22.0%)]. Country-wise analysis showed that higher perceived stress levels were significantly associated with increased odds for depression in all countries with the exception of Georgia and Vietnam. The results of the meta-analysis showed that a one-unit increase in the perceived stress score was associated with a 1.40 (95%CI=1.35-1.44) times higher odds for depression.

LIMITATIONS

The cross-sectional nature of the study limits interpretations about causation.

CONCLUSION

Perceived stress is positively associated with depression across the globe. Future longitudinal and intervention studies from LMICs are warranted to elucidate the potential impact of addressing stress on depression in this setting.

Affective and Psychotic Disorders in War-Torn Eastern Part of the Democratic Republic of the Congo: A Cross-Sectional Study

BACKGROUND

There is lack of information about prevalence of affective and psychotic disorders triggered by traumatic events among people living in war-affected regions. This study is aimed at determining the prevalence rate of affective and psychotic disorders and the associated factors in a war-torn eastern part of Democratic Republic of the Congo.

METHODS

This epidemiological cross-sectional descriptive study was carried out from 1^st January 2019 to 31^st December 2019 at Cepima and Muyisa health centers. This study enrolled 344 patients that had experienced traumatic events in Eastern Democratic Republic of the Congo from the 1119 participants, of whom 229 had positive bipolar affective disorder and 115 patients had psychotic disorders.

RESULTS

The results revealed that bipolar affective disorders were two times more than psychotic disorders. Sexual abuse, sudden death of a relative, kidnapping, the physical torture, and childhood trauma were the psychological factors correlated to the occurrence of bipolar affective and psychotic disorders.

CONCLUSIONS

It was concluded that the traumatic experiences were precursors for the occurrence of bipolar affective and psychotic spectrum disorders.

Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist's view

BACKGROUND

More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care.

METHODS

An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data.

RESULTS

Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers.

CONCLUSIONS

Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study

BACKGROUND AND AIMS

The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds.

DESIGN

Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language.

SETTING

Population-based data were collected from six cities in Finland during 2010-12.

PARTICIPANTS

The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%).

MEASUREMENTS

The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for.

FINDINGS

Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18).

CONCLUSIONS

In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

Psychological symptoms and quality of life after repeated exposure to earthquake: A cohort study in Italy

In 2005, a random sample of 200 people were assessed in Camerino, Italy, eight years after an earthquake. Psychological symptom levels were low and only one person had current Post-Traumatic Stress Disorder (PTSD). In 2016 a new earthquake occurred in Camerino. The study aims to assess the impact of the second exposure in the same cohort. A longitudinal study was conducted, 130 participants were re-interviewed between July and December 2017. Psychological symptoms were self-rated on the Brief Symptom Inventory (BSI) and the Global Severity Index (GSI) was analysed. Post-traumatic stress symptoms were self-rated on the Impact of Event Scale-Revised (IES-R). Subjective quality of life (SQOL) was assessed on the Manchester Short Assessment of Quality of Life (MANSA). Mean scores of GSI and IES-R were significantly higher than in 2005 (p<0.01 and p<0.001), whilst SQOL remained almost unchanged (p = 0.163). In 2017, 16.9% of the sample had reached the PTSD threshold whilst in 2005 only the 0.5% had reached it. Despite low symptom levels several years after an earthquake, people can show psychological distress after a new exposure, whilst average quality of life levels are not affected.

Trauma and suicidality in war affected communities

Purpose

The aim was to assess whether experiences of war trauma remain directly associated with suicidality in war affected communities when other risk factors are considered.

Materials and methods

In the main sample 3313 participants from former Yugoslavia who experienced war trauma were recruited using a random sampling in five Balkan countries. In the second sample 854 refugees from former Yugoslavia recruited through registers and networking in three Western European countries. Sociodemographic and data on trauma exposure, psychiatric diagnoses and level of suicidality were assessed.

Results

In the main sample 113 participants (3.4%) had high suicidality, which was associated with number of potentially traumatic war experiences (odds ratio 1.1) and war related imprisonment (odds ratio 3) once all measured risk factors were considered. These associations were confirmed in the refugee sample with a higher suicidality rate (10.2%).

Discussion and conclusions

Number of potentially traumatic war experiences, in particular imprisonment, may be considered as a relevant risk factor for suicidality in people affected by war.

Identifying distinctive psychological symptom profiles among a nationally representative sample of refugees resettled in Australia

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.

Quality of life in elderly Portuguese war veterans with post-traumatic stress symptoms

Background

Studies show that post-traumatic stress symptoms among Portuguese veterans who participated in Colonial War (1961-75) are high, even though 43 years have gone by since the end of the war.

Aims

This study analyzed the role of family type, personality traits, and social support as predictors of post-traumatic stress symptoms and quality of life in war veterans, and whether satisfaction with social support was a mediator between neuroticism/post-traumatic stress symptoms and quality of life.

Method

A cross-sectional study was conducted including 230 war veterans with a mean age of 60 years (SD=3.82).

Results

Results indicated a high prevalence of post-traumatic stress symptoms as well as high neuroticism, 16.5 (SD=4.41); 81% of veterans presented high psychological distress, suggesting emotional disturbance and 71% belonged to extreme families (families with cohesion and adaptability problems). Results showed that age (β=-0.166, p<0.05), social support (β=-0.184, p<0.01), and neuroticism (β=0.325, p<0.001) predicted post-traumatic stress symptoms. Age, professional status, social support, post-traumatic stress symptoms, family type, neuroticism, and extroversion predicted different dimensions of quality of life. Finally, a path analysis showed that satisfaction with social support was a mediator in the relationship between neuroticism and quality of life (β=-0.066; p<0.01) and between post-traumatic stress symptoms and quality of life (β=-0.108; p<0.01).

Conclusion

Four decades after the Colonial War have passed, there is still a high prevalence of post-traumatic stress symptoms. Screening elderly veterans who present post-traumatic stress symptoms, for the presence of neuroticism traits, and assessing family type and social support, should be a standard practice in health care services, especially in the oldest and those who are retired. Social support should be promoted in order to enhance quality of life in this population.

Supporting community-based care and deinstitutionalisation of mental health services in Eastern Europe: good practices from Bosnia and Herzegovina

In Eastern Europe, the Swiss Agency for Development and Cooperation is supporting various post-communist states in reforming their mental health systems to ensure equal access to high-quality services in community-based settings. The approach and new care models introduced have proven successful in most of these countries, one of which is Bosnia and Herzegovina.

Mental health needs and services for migrants: an overview for primary care providers

BACKGROUND

The objective of this article is to present an overview of the burden, spectrum of diseases and risk factors for mental illness among subgroups of migrants, namely, immigrants, refugees and individuals with precarious legal status. This expert review summarises some of the implications for primary care services in migrant receiving countries in the global North.

METHODS

A broad literature review was conducted on the epidemiology of mental health disorders in migrants and the available evidence on mental health services for this population focusing on key issues for primary care practitioners in high-income countries.

RESULTS

Although most migrants are resilient, migration is associated with an over-representation of mental disorder in specific subpopulations. There is a general consensus that stress-related disorders are more prevalent among refugee populations of all ages compared to the general population. Relative to refugees, migrants with precarious legal status may be at even higher risk of depression and anxiety disorders. Persistence and severity of psychiatric disorders among migrant populations can be attributed to a combination of factors including severity of trauma exposures during the migration process. Exposure to stressors after resettlement, such as poverty and limited social support, also impacts mental illness. Services for migrants are affected by restricted accessibility and should address cultural and linguistic barriers to and issues in the larger social environment that impact psychosocial functioning.

CONCLUSION

There is substantial burden of mental illness among some migrant populations. Primary care providers seeking to assist individuals need to be cognizant of language barriers to and challenges of working with interpreters as well as sensitive to cultural and social contexts within the diagnosis and service delivery process. In addition, best practices in screening migrants and providing intervention services for mental disorders need to be sensitive to where individuals and families are in the resettlement trajectory.