Intolerance of uncertainty, posttraumatic stress, depression, and fears for the future among displaced refugees

Bidirectional relationships between intolerance of uncertainty and generalized anxiety among adolescents: insights from cross-lagged panel network analysis

BACKGROUND

Intolerance of uncertainty (IU) has received increasing attention for its role in the development and maintenance of generalized anxiety. However, little is known about the temporal and causal relationships between IU and generalized anxiety, particularly in adolescents. Furthermore, much of the existing literature treats IU and generalized anxiety as unidimensional constructs, limiting a detailed understanding of their internal elements and specific symptom interactions. To address the gaps, this study employed a cross-lagged panel network (CLPN) approach to examine the temporal interactions and predictive relationships between IU elements and generalized anxiety symptoms.

METHODS

A sample of 7,434 nonclinical adolescents (mean age = 15.33 years, range = 11-19 years, 50.6% girls) completed the Intolerance of Uncertainty Scale (Short Form) for Children (IUSC-12) and the Generalized Anxiety Disorder Scale (GAD-7) across two waves, six months apart. Data was analyzed using the CLPN approach.

RESULTS

Bidirectional predictive relationships were found between IU elements and generalized anxiety symptoms, with generalized anxiety symptoms more frequently predicting IU elements. The generalized anxiety symptom named "nervousness" was the strongest predictor of increases in both IU elements and other generalized anxiety symptoms over time, while the IU elements named "frustration" and "work with hindrance" were the strongest predictors of future generalized anxiety symptoms.

CONCLUSIONS

This study provides new insights into the reciprocal relationships between IU and generalized anxiety among adolescents, highlighting the complex interplay between vulnerability and mental health problems. By identifying key IU elements and generalized anxiety symptoms that drive these relationships, the findings contribute to a more nuanced understanding of adolescent psychopathology and inform targeted interventions.

Perceived Social Support, Intolerance of Uncertainty, and War-Related Stress: Unraveling the Nexus with Treatment Burden in Adult-Child Caregivers During War

Adult-child caregivers encounter various challenges due to their array of roles and tasks, often leading to a substantial sense of treatment burden. While previous research has explored factors contributing to treatment burden, much of it has centered on routine periods, leaving a gap in the understanding of this issue during crisis situations characterized by heightened stress and uncertainty. Therefore, this study aims to address this gap by investigating the mediating role of intolerance of uncertainty and war-related stress in the relationship between perceived social support and treatment burden among adult-child caregivers during the Israel-Hamas war. The study involved Israeli adult-child caregivers who completed a structured questionnaire distributed online. The findings showed that perceived social support was negatively associated with intolerance of uncertainty, which, in turn, was positively associated with war-related stress. Consequently, a positive correlation was observed between war-related stress and treatment burden. Perceived social support was found to be negatively associated with war-related stress. These findings underscore the significance of social support in reducing treatment burden, particularly during periods of heightened stress such as wartime. Understanding the interplay between these factors can inform the development of effective interventions aimed at alleviating the burden experienced by adult-child caregivers.

Acute Stress Disorder in Israeli Civilians in Reaction to the 7 October War

To assess levels of acute stress symptoms (ASS) and prevalence of acute stress disorder (ASD) in an Israeli civilian sample and examine sociodemographic and war exposure predictors of ASS and ASD. A telephone survey was conducted in the fourth week of the 7 October war with a random sample of 199 Jewish and 194 Arab adult residents from areas of lower Galilee and Acre, Herzliya, and Eilat. ASS and ASD were measured by the Acute Stress Disorder Interview. War exposure and sociodemographic data were collected. 60% of participants met the criteria for ASD. Levels of ASS were relatively high. 21% of the variance in total ASS score was explained by sociodemographic (sex, age, education, ethnicity) and war exposure variables (acquaintance injured, killed, or kidnapped; subjective sense of danger to self or relatives; property or income damage). The present study revealed significant although mild associations of ASS with war exposure variables (acquaintance injured, killed, or kidnapped; subjective sense of danger to self or relatives; property or home damage; and employment or income damage). Logistic regression indicated that women were 1.55 times more likely to have ASD than men. Arabs were 2.02 times more likely to have ASD than Jews. The present study stresses the need to construct an acute stress screening procedure to identify individuals with severe acute stress reactions. We call attention to the need to build interventions to reduce these symptoms immediately during warfare to prevent them from developing into chronic posttraumatic stress disorder. Strengthening community resilience may reduce the rate of ASS upon exposure to war.

The Relationship Between Intolerance of Uncertainty and Alcohol Use in First Responders: A Cross-Sectional Study of the Direct, Mediating and Moderating Role of Generalized Resistance Resources

Intolerance of uncertainty (IU) refers to the disproportionate propensity to react negatively to uncertain events, and it has been associated with negative psychological outcomes such as depression and anxiety. The current study examined the role of resilience, hardiness, self-efficacy and self-compassion in the relationship between IU and alcohol use in a sample of South African first responders. These variables are examples of what is referred to as generalized resistance resources, which enable individuals to deal with the challenges of life. A sample of 429 first responders completed the Intolerance of Uncertainty Scale-12, the Connor-Davidson Resilience Scale-10, the Self-Compassion Scale-Short Form, the General Self-Efficacy Scale, the Short Hardiness Scale and the Alcohol Use Disorders Identification Test. The results of PROCESS analyses found direct and mediating effects for resilience and self-efficacy, no effects for hardiness and moderating effects for self-compassion. In this regard, a graph of the interaction between intolerance of uncertainty and self-compassion showed that at low levels of self-compassion, the relationship between intolerance of uncertainty and alcohol use was strong and significant, while at high levels of self-compassion the relationship was non-significant. In addition, the Johnson-Neyman plot showed that the exact value of self-compassion at which point the relationship between intolerance and uncertainty ceased to be significant was 36.37. These obtained results confirm the important role of generalized resistance resources in wellbeing and provide a basis for tailored interventions.

The longitudinal relationship between psychological symptoms and social functioning in displaced refugees

BACKGROUND

Refugee experiences of trauma and displacement can significantly disrupt established social networks. While social functioning has been routinely associated with mental health, to our knowledge, no study has tested the direction of influence between social and psychological functioning within displaced refugee communities. This study investigated the temporal association between psychological symptoms (PTSD, depression, anger) and multiple facets of social functioning (including community connectedness, perceived social responsibility, positive social support and negative social support).

METHOD

A culturally diverse sample of refugees (N = 1,235) displaced in Indonesia completed an online survey at four time-points, six months apart. Longitudinal structural equation modelling was used to investigate the temporal ordering between psychological symptoms and social functioning.

RESULTS

Findings revealed that greater psychological symptoms were associated with a subsequent deterioration in social functioning (decreased positive social support and community connectedness and increased negative social support and perceived social responsibility). Greater perceived social responsibility was also associated with subsequent increases in psychological symptoms, while positive social support and community connectedness were bi-directionally associated over-time.

CONCLUSIONS

These findings highlight the potential utility of mental health interventions for displaced refugees as a means to improve social functioning and inclusion with host communities. Findings have important implications in guiding the development of interventions and allocation of resources to support refugee engagement and wellbeing in displacement contexts.

High rates of probable PTSD among Ukrainian war refugees: the role of intolerance of uncertainty, loss of control and subsequent discrimination

Background: Intolerance of uncertainty is a well-known predictor of post-traumatic stress symptoms following a traumatic event. At the same time, it is relatively unknown whether intolerance of uncertainty amplifies the effects of other adverse life events on PTSD symptoms among traumatized individuals.Objective: This article addresses this problem in a study of Ukrainian war refugees' experiences with post-migration discrimination and powerlessness (loss of control).Method: 4972 forced immigrants from Ukraine took part in the study (90.2% women, Mage = 40.4, SD = 12.5) completing the PTSD-8 scale, measures of post-migration discrimination and loss of control experiences, and intolerance of uncertainty.Results: Almost half of respondents (47.5%) have probable PTSD. Regression analysis confirmed that war-related experiences, as well as intolerance of uncertainty, post-migration loss of control and experiences of discrimination were significant predictors of self-reported PTSD symptoms. Also, intolerance of uncertainty weakly moderated the effects of experienced discrimination and control deprivation on self-reported PTSD symptoms, so that the effects of adverse post-migration experiences were more pronounced among individuals high in intolerance of uncertainty.Conclusions: Understanding the effect of post-migration experiences on war refugees' mental health is crucial for developing improved acculturation policies and fostering a supportive environment for forced migrants.

Housing and health for people from refugee and asylum-seeking backgrounds: findings from an Australian qualitative longitudinal study

BACKGROUND

For people from asylum-seeking and refugee backgrounds, housing and the re-establishment of home are key social determinants of health. Research highlights the inequities faced by asylum seekers and refugees in the housing markets of high-income resettlement countries, resulting in their overrepresentation in precarious housing. There is also emerging evidence of the relationship between housing and health for this population relating to lack of affordability, insecurity of tenure, and poor suitability (physical and social). The mechanisms by which housing impacts health for this group within these housing contexts, is however, understudied - especially overtime. This qualitative longitudinal study aimed to address this gap.

METHODS

Semi-structured interviews were conducted with 25 people from asylum-seeking and refugee backgrounds in South Australia, recruited through a community survey. Thematic analysis of interview data across three time points over three years identified four material and psychosocial mechanisms through which housing contributed to health outcomes via psychological and physical stressors - physical environment; stability; safety; and social connections, support and services. The study also identified additional health promoting resources, particularly elements of ontological security. The dynamics of these indirect and direct mechanisms were further illuminated by considering the impact of international, national and local contexts and a range of intersecting social factors including gender, country/culture of origin, family circumstances, immigration status, language skills, income, and health status.

CONCLUSIONS

Rebuilding a sense of home and ontological security is a key resettlement priority and crucial for wellbeing. More comprehensive strategies to facilitate this for refugees and asylum seekers are required.